WorldWideScience

Sample records for stroke transition approaches

  1. Autopsy approach to stroke.

    Science.gov (United States)

    Love, Seth

    2011-02-01

    Stroke is a major cause of morbidity and mortality but the brain and other relevant tissues are often examined only cursorily when stroke patients come to autopsy. The pathological findings and clinical implications vary according to the type of stroke and its location and cause. Large ischaemic strokes are usually associated with atherosclerosis of extracranial or major intracranial arteries but can be caused by dissection. Most small cerebral infarcts are caused by arteriosclerosis or, in the elderly, cerebral amyloid angiopathy (CAA). However, vasculitides and coagulopathies can cause a range of different patterns of ischaemic (and, occasionally, haemorrhagic) stroke. Global brain ischaemia, caused by severe hypotension or raised intracranial pressure, produces damage that is accentuated in certain regions and neuronal populations and may be confused with hypoglycaemic injury. The main cause of subarachnoid haemorrhage is a ruptured berry aneurysm but CAA, arteriovenous malformations and infective aneurysms are occasionally responsible. These can also cause parenchymal brain haemorrhage, although this most often complicates hypertensive small vessel disease. Sometimes the haemorrhage arises from a neoplasm. Performing an adequate autopsy in stroke requires proper preparation, awareness of the likely pathological processes, familiarity with intracranial vascular anatomy, careful gross examination and dissection, and appropriate use of histology. © 2010 Blackwell Publishing Limited.

  2. Empirical evidence of bias in the design of experimental stroke studies - A metaepidemiologic approach

    NARCIS (Netherlands)

    Crossley, Nicolas A.; Sena, Emily; Goehler, Jos; Horn, Jannekke; van der Worp, Bart; Bath, Philip M. W.; Macleod, Malcolm; Dirnagl, Ulrich

    2008-01-01

    Background and Purpose - At least part of the failure in the transition from experimental to clinical studies in stroke has been attributed to the imprecision introduced by problems in the design of experimental stroke studies. Using a metaepidemiologic approach, we addressed the effect of

  3. Taste and Temperature in Swallowing Transit Time after Stroke

    Directory of Open Access Journals (Sweden)

    Paula C. Cola

    2012-09-01

    Full Text Available Background: Oropharyngeal dysphagia is common in individuals after stroke. Taste and temperature are used in dysphagia rehabilitation. The influence of stimuli, such as taste and temperature, on swallowing biomechanics has been investigated in both healthy individuals and in individuals with neurological disease. However, some questions still remain unanswered, such as how the sequence of offered stimuli influences the pharyngeal response. The goal of the present study was to determine the influence of the sequence of stimuli, sour taste and cold temperature, on pharyngeal transit time during deglutition in individuals after stroke. Methods: The study included 60 individuals with unilateral ischemic stroke, 29 males and 31 females, aged 41–88 years (mean age: 66.2 years examined 0–50 days after ictus (median: 6 days, with mild to moderate oropharyngeal dysphagia. Exclusion criteria were hemorrhagic stroke patients, patients with decreased level of consciousness, and clinically unstable patients, as confirmed by medical evaluation. The individuals were divided into two groups of 30 individuals each. Group 1 received a nonrandomized sequence of stimuli (i.e. natural, cold, sour, and sour-cold and group 2 received a randomized sequence of stimuli. A videofluoroscopic swallowing study was performed to analyze the pharyngeal transit time. Four different stimuli (natural, cold, sour, and sour-cold were offered. The images were digitalized and specific software was used to measure the pharyngeal transit time. Since the values did not present regular distribution and uniform variances, nonparametric tests were performed. Results: Individuals in group 1 presented a significantly shorter pharyngeal transit time with the sour-cold stimulus than with the other stimuli. Individuals in group 2 did not show a significant difference in pharyngeal transit time between stimuli. Conclusions: The results showed that the sequence of offered stimuli influences

  4. Racial Differences by Ischemic Stroke Subtype: A Comprehensive Diagnostic Approach

    Directory of Open Access Journals (Sweden)

    Sarah Song

    2012-01-01

    Full Text Available Background. Previous studies have suggested that black populations have more small-vessel and fewer cardioembolic strokes. We sought to analyze racial differences in ischemic stroke subtype employing a comprehensive diagnostic workup with magnetic resonance-imaging-(MRI- based evaluation including diffusion-weighted imaging (DWI. Methods. 350 acute ischemic stroke patients admitted to an urban hospital with standardized comprehensive diagnostic evaluations were retrospectively analyzed. Ischemic stroke subtype was determined by three Trial of Org 10172 in Acute Stroke Treatment (TOAST classification systems. Results. We found similar proportions of cardioembolic and lacunar strokes in the black and white cohort. The only subtype category with a significant difference by race was “stroke of other etiology,” more common in whites. Black stroke patients were more likely to have an incomplete evaluation, but this did not reach significance. Conclusions. We found similar proportions by race of cardioembolic and lacunar strokes when employing a full diagnostic evaluation including DWI MRI. The relatively high rate of cardioembolism may have been underappreciated in black stroke patients when employing a CT approach to stroke subtype diagnosis. Further research is required to better understand the racial differences in frequency of “stroke of other etiology” and explore disparities in the extent of diagnostic evaluations.

  5. Transit time homogenization in ischemic stroke - A novel biomarker of penumbral microvascular failure?

    DEFF Research Database (Denmark)

    Engedal, Thorbjørn S; Hjort, Niels; Hougaard, Kristina D

    2017-01-01

    Cerebral ischemia causes widespread capillary no-flow in animal studies. The extent of microvascular impairment in human stroke, however, is unclear. We examined how acute intra-voxel transit time characteristics and subsequent recanalization affect tissue outcome on follow-up MRI in a historic...... cohort of 126 acute ischemic stroke patients. Based on perfusion-weighted MRI data, we characterized voxel-wise transit times in terms of their mean transit time (MTT), standard deviation (capillary transit time heterogeneity - CTH), and the CTH:MTT ratio (relative transit time heterogeneity), which...... tissue, prolonged mean transit time (>5 seconds) and very low cerebral blood flow (≤6 mL/100 mL/min) was associated with high risk of infarction, largely independent of recanalization status. In the remaining mismatch region, low relative transit time heterogeneity predicted subsequent infarction...

  6. Diagnostic approach and management strategy of childhood stroke

    International Nuclear Information System (INIS)

    Salih, Mustafa A.; Abdel-Gader, Abdel-Galil M.

    2006-01-01

    Prompt recognition and early intervention, with pertinent management and medication, may reduce subsequent neurologic deficits in stroke, which constitutes a devastating event in children. This is due to the tasking and demanding consequences including death or residual neurological deficits, which may last for many decades, in over 60% of survivors. Evidence based treatment for children with stroke is still lacking, reflecting scarcity in base line epidemiological data on pediatric stroke, the multitude of underlying risk factors, and ethical and practical challenges incurred in conducting clinical trials. Based on the experience we gained from a combined a combined prospective and retrospective study on childhood stroke (covering 10 years and 7 months and involving a cohort of 104 Saudi children), a diagnostic algorithm, which outlines the approach to a child with suspected stroke/cerebovascular lesion was designed. This algorithm might also be of use for managing other children with stroke from the Arabian Peninsula and Middle East Region with similar demographic, socioeconomic, and ethnic backgrounds. Underlying risk factors which need special attention, include thrombophilia and hypercoagulable states and sickle cell diseases (SCD), which contrary to previous studies from Saudi Arabia, were found to constitute a common risk factor with severe manifestations. Other risk factors include infections (especially neurobrucellosis), cardiac diseases, and hypernatremic dehydration. Recognition of an identifiable syndrome or inherited metabolic cause may unravel an underlying cerebovascular disease. This is particularly important in this region, given the large pool of autosomal recessive diseases and the high rate of consanguinity. In the evaluation of a suspected case of stroke, important imaging modalities include cranial CT, MRI (including diffusion-weighted images), magnetic resonance angiography (MRA), magnetic resonance venography (MRV) and conventional

  7. An Approach to Coordinate Efforts to Reduce the Public Health Burden of Stroke: The Delta States Stroke Consortium

    OpenAIRE

    Virginia J. Howard; Joe Acker; Camilo R. Gomez; Ada H. Griffies; Wanda Magers; Max Michael III; Sean R. Orr; Martha Phillips; James M. Raczynski; John E. Searcy; Richard M. Zweifler; George Howard

    2004-01-01

    Stroke is the third leading cause of death and a leading cause of disability in the United States, with a particularly high burden on the residents of the southeastern states, a region dubbed the Stroke Belt. These five states Alabama, Arkansas, Louisiana, Mississippi, and Tennessee have formed the Delta States Stroke Consortium to direct efforts to reduce this burden. The consortium is proposing an approach to identify domains where interventions may be instituted and an array of activitie...

  8. Stroke

    Science.gov (United States)

    ... doctor Preventing falls Stroke - discharge Swallowing problems Images Brain Carotid stenosis, x-ray of the left artery Carotid stenosis, x-ray of the right artery Stroke Brainstem function Cerebellum - function Circle of Willis Left cerebral hemisphere - ...

  9. Cell approach to glass transition

    International Nuclear Information System (INIS)

    Aste, Tomaso; Coniglio, Antonio

    2003-01-01

    We present a novel theoretical approach to understanding the complex dynamics of glass-forming liquids, granular packings and amorphous solids. This theory, which is an elaboration of the free volume and inherent structure approaches, allows one to retrieve the thermodynamical properties of these systems from studies of geometrical and topological properties of local, static configurations alone. When applied to hard-sphere systems, the present theory reproduces with a good quantitative agreement the equation of state for the crystalline and the disordered glassy phases. Moreover, we find that, as the density approaches a critical value close to the random close-packing density, the configurational entropy approaches zero and the large relaxation time diverges according to the Vogel-Fulcher behaviour, following also the Adam-Gibbs relation

  10. Current approaches to antithrombotic therapy in patients with cardioembolic stroke

    Directory of Open Access Journals (Sweden)

    Oleg Ivanovich Vinogradov

    2013-01-01

    Full Text Available The rate of cardiogenic embolism among all ischemic strokes is as high as 38%. Cardioembolic strokes are characterized by the higher magnitude of neurological deficit, the high risk of recurrent acute stroke, and a lethal outcome. This review deals with the etiopathogenesis of thrombus formation in the heart chambers, with current criteria for the verification of cardioembolic strokes, with the results of trials of new oral anticoagulants, and latest guidelines for antithrombotic therapy to prevent stroke. Special focus is given to secondary stroke prevention in patients with nonvalvular atrial fibrillation since it is atrial fibrillation that is the most common cause of cardioembolic stroke.

  11. Lesions Responsible for Delayed Oral Transit Time in Post-stroke Dysphagia.

    Science.gov (United States)

    Moon, Hyun Im; Yoon, Seo Yeon; Yi, Tae Im; Jeong, Yoon Jeong; Cho, Tae Hwan

    2017-10-11

    Some stroke patients show oral phase dysphagia, characterized by a markedly prolonged oral transit time that hinders oral feeding. The aim of this study was to clarify the clinical characteristics and lesions responsible for delayed swallowing. We reviewed 90 patients with stroke. The oral processing time plus the postfaucial aggregation time required to swallow semisolid food was assessed. The patients were divided into two groups according to oral transit time, and we analyzed the differences in characteristics such as demographic factors, lesion factors, and cognitive function. Logistic regression analyses were performed to examine the predictors of delayed oral transit time. Lesion location and volume were measured on brain magnetic resonance images. We generated statistic maps of lesions related to delayed oral phase in swallowing using voxel-based lesion symptom mapping (VLSM). The group of patients who showed delayed oral transit time had significantly low cognitive function. Also, in a regression model, delayed oral phase was predicted with low K-MMSE (Korean version of the Mini Mental Status Exam). Using VLSM, we found the lesion location to be associated with delayed oral phase after adjusting for K-MMSE score. Although these results did not reach statistical significance, they showed the lesion pattern with predominant distribution in the left frontal lobe. Delayed oral phase in post-stroke patients was not negligible clinically. Patients' cognitive impairments affect the oral transit time. When adjusting it, we found a trend that the lesion responsible for delayed oral phase was located in the left frontal lobe, though the association did not reach significance. The delay might be related to praxis function.

  12. An Institutional Approach to Understanding Energy Transitions

    Science.gov (United States)

    Koster, Auriane Magdalena

    Energy is a central concern of sustainability because how we produce and consume energy affects society, economy, and the environment. Sustainability scientists are interested in energy transitions away from fossil fuels because they are nonrenewable, increasingly expensive, have adverse health effects, and may be the main driver of climate change. They see an opportunity for developing countries to avoid the negative consequences fossil-fuel-based energy systems, and also to increase resilience, by leap-frogging-over the centralized energy grid systems that dominate the developed world. Energy transitions pose both challenges and opportunities. Obstacles to transitions include 1) an existing, centralized, complex energy-grid system, whose function is invisible to most users, 2) coordination and collective-action problems that are path dependent, and 3) difficulty in scaling up RE technologies. Because energy transitions rely on technological and social innovations, I am interested in how institutional factors can be leveraged to surmount these obstacles. The overarching question that underlies my research is: What constellation of institutional, biophysical, and social factors are essential for an energy transition? My objective is to derive a set of "design principles," that I term institutional drivers, for energy transitions analogous to Ostrom's institutional design principles. My dissertation research will analyze energy transitions using two approaches: applying the Institutional Analysis and Development Framework and a comparative case study analysis comprised of both primary and secondary sources. This dissertation includes: 1) an analysis of the world's energy portfolio; 2) a case study analysis of five countries; 3) a description of the institutional factors likely to promote a transition to renewable-energy use; and 4) an in-depth case study of Thailand's progress in replacing nonrenewable energy sources with renewable energy sources. My research will

  13. Rehabilitation of stroke patients needs a family-centred approach

    NARCIS (Netherlands)

    Visser-Meily, Anne; Post, Marcel; Gorter, Jan Willem; Berlekom, Steven Berdenis V.; van den Bos, Trudi; Lindeman, Eline

    2006-01-01

    To highlight the importance of the spouse in stroke rehabilitation. Stroke not only affects the patients, but also their families, but rehabilitation practice is still primarily focused on the patient only. Analysis of the position of the spouse and possible consequences of stroke for the spouse,

  14. Actual diagnostic approach to the acute stroke patient

    International Nuclear Information System (INIS)

    Loevblad, Karl-Olof; Baird, Alison E.

    2006-01-01

    Since acute stroke is now considered a potentially treatable medical emergency, a rapid and correct diagnosis must be made. The first step is to exclude hemorrhage, then to visualize any early ischemic changes, demonstrate the presence of hypoperfusion and locate the presence of a vascular underlying pathology as well as elucidate the presence of a potential penumbra (tissue at risk). Thanks to improvements and advances in both MR and CT technology, this can now be done in a number of ways. At the moment, CT is the most widely available and fast method for obtaining imaging of the brain and neck vessels of patients presenting with acute stroke. MRI can provide more precise information, although it remains slightly more time-consuming, but is, however, the method of choice for follow-up imaging. The main point is to take the one-stop-shopping approach where imaging of the vessels and brain is done from the aortic arch to the circle of Willis in one single session in order to have all the necessary information in the acute phase. (orig.)

  15. Impact of light rail transit on traffic-related pollution and stroke mortality.

    Science.gov (United States)

    Park, Eun Sug; Sener, Ipek Nese

    2017-09-01

    This paper evaluates the changes in vehicle exhaust and stroke mortality for the general public residing in the surrounding area of the light rail transit (LRT) in Houston, Texas, after its opening. The number of daily deaths due to stroke for 2002-2005 from the surrounding area of the original LRT line (exposure group) and the control groups was analyzed using an interrupted time-series analysis. Ambient concentrations of acetylene before and after the opening of LRT were also compared. A statistically significant reduction in the average concentration of acetylene was observed for the exposure sites whereas the reduction was negligible at the control site. Poisson regression models applied to the stroke mortality data indicated a significant reduction in daily stroke mortality after the opening of LRT for the exposure group, while there was either an increase or a considerably smaller reduction for the control groups. The findings support the idea that LRT systems provide health benefits for the general public and that the reduction in motor-vehicle-related air pollution may have contributed to these health benefits.

  16. Use of outcome measures in stroke rehabilitation in the transition from hospital to home-based rehabilitation

    DEFF Research Database (Denmark)

    Maribo, Thomas; Nielsen, Claus Vinther

    Relevance: Stroke is one of the major chronic diseases leading to long-term disability. Stroke treatment has improved and in-hospital stays have been reduced, leading to increasing emphasis on home-based rehabilitation. The transition from hospital to home-based rehabilitation is critical, as vital...... are vague. Purpose: The purpose was to examine the use of outcome measures used in clinical practice in the transition from hospital to home-based rehabilitation. Methods/Analysis: A questionnaire were sent to the heads of 26 hospitals discharging patients with stroke and 52 municipalities' health services...... rehabilitation, especially in the transition between hospital and home-based rehabilitation. A nationwide, interprofessional and intersectional group is currently discussing recommendations for the use of outcome measures in stroke rehabilitation. Results from this group will be presented at the conference...

  17. Robotic approaches for rehabilitation of hand function after stroke.

    Science.gov (United States)

    Lum, Peter S; Godfrey, Sasha B; Brokaw, Elizabeth B; Holley, Rahsaan J; Nichols, Diane

    2012-11-01

    The goal of this review was to discuss the impairments in hand function after stroke and present previous work on robot-assisted approaches to movement neurorehabilitation. Robotic devices offer a unique training environment that may enhance outcomes beyond what is possible with conventional means. Robots apply forces to the hand, allowing completion of movements while preventing inappropriate movement patterns. Evidence from the literature is emerging that certain characteristics of the human-robot interaction are preferable. In light of this evidence, the robotic hand devices that have undergone clinical testing are reviewed, highlighting the authors' work in this area. Finally, suggestions for future work are offered. The ability to deliver therapy doses far higher than what has been previously tested is a potentially key advantage of robotic devices that needs further exploration. In particular, more efforts are needed to develop highly motivating home-based devices, which can increase access to high doses of assisted movement therapy.

  18. Simplified Approach to Predicting Rough Surface Transition

    Science.gov (United States)

    Boyle, Robert J.; Stripf, Matthias

    2009-01-01

    Turbine vane heat transfer predictions are given for smooth and rough vanes where the experimental data show transition moving forward on the vane as the surface roughness physical height increases. Consiste nt with smooth vane heat transfer, the transition moves forward for a fixed roughness height as the Reynolds number increases. Comparison s are presented with published experimental data. Some of the data ar e for a regular roughness geometry with a range of roughness heights, Reynolds numbers, and inlet turbulence intensities. The approach ta ken in this analysis is to treat the roughness in a statistical sense , consistent with what would be obtained from blades measured after e xposure to actual engine environments. An approach is given to determ ine the equivalent sand grain roughness from the statistics of the re gular geometry. This approach is guided by the experimental data. A roughness transition criterion is developed, and comparisons are made with experimental data over the entire range of experimental test co nditions. Additional comparisons are made with experimental heat tran sfer data, where the roughness geometries are both regular as well a s statistical. Using the developed analysis, heat transfer calculatio ns are presented for the second stage vane of a high pressure turbine at hypothetical engine conditions.

  19. The organisational context of nursing care in stroke units: a case study approach.

    Science.gov (United States)

    Burton, Christopher R; Fisher, Andrea; Green, Theresa L

    2009-01-01

    Internationally the stroke unit is recognised as the evidence-based model for patient management, although clarity about the effective components of stroke units is lacking. Whilst skilled nursing care has been proposed as one component, the theoretical and empirical basis for stroke nursing is limited. We attempted to explore the organisational context of stroke unit nursing, to determine those features that staff perceived to be important in facilitating high quality care. A case study approach was used, that included interviews with nurses and members of the multidisciplinary teams in two Canadian acute stroke units. A total of 20 interviews were completed, transcribed and analysed thematically using the Framework Approach. Trustworthiness was established through the review of themes and their interpretation by members of the stroke units. Nine themes that comprised an organisational context that supported the delivery of high quality nursing care in acute stroke units were identified, and provide a framework for organisational development. The study highlighted the importance of an overarching service model to guide the organisation of care and the development of specialist and advanced nursing roles. Whilst multidisciplinary working appears to be a key component of stroke unit nursing, various organisational challenges to its successful implementation were highlighted. In particular the consequence of differences in the therapeutic approach of nurses and therapy staff needs to be explored in greater depth. Successful teamwork appears to depend on opportunities for the development of relationships between team members as much as the use of formal communication systems and structures. A co-ordinated approach to education and training, clinical leadership, a commitment to research, and opportunities for role and practice development also appear to be key organisational features of stroke unit nursing. Recommendations for the development of stroke nursing

  20. The association between neurological deficit in acute ischemic stroke and mean transit time. Comparison of four different perfusion MRI algorithms

    International Nuclear Information System (INIS)

    Schellinger, Peter D.; Latour, Lawrence L.; Chalela, Julio A.; Warach, Steven; Wu, Chen-Sen

    2006-01-01

    The purpose of our study was to identify the perfusion MRI (pMRI) algorithm which yields a volume of hypoperfused tissue that best correlates with the acute clinical deficit as quantified by the NIH Stroke Scale (NIHSS) and therefore reflects critically hypoperfused tissue. A group of 20 patients with a first acute stroke and stroke MRI within 24 h of symptom onset were retrospectively analyzed. Perfusion maps were derived using four different algorithms to estimate relative mean transit time (rMTT): (1) cerebral blood flow (CBF) arterial input function (AIF)/singular voxel decomposition (SVD); (2) area peak; (3) time to peak (TTP); and (4) first moment method. Lesion volumes based on five different MTT thresholds relative to contralateral brain were compared with each other and correlated with NIHSS score. The first moment method had the highest correlation with NIHSS (r=0.79, P<0.001) followed by the AIF/SVD method, both of which did not differ significantly from each other with regard to lesion volumes. TTP and area peak derived both volumes, which correlated poorly or only moderately with NIHSS scores. Data from our pilot study suggest that the first moment and the AIF/SVD method have advantages over the other algorithms in identifying the pMRI lesion volume that best reflects clinical severity. At present there seems to be no need for extensive postprocessing and arbitrarily defined delay thresholds in pMRI as the simple qualitative approach with a first moment algorithm is equally accurate. Larger sample sizes which allow comparison between imaging and clinical outcomes are needed to refine the choice of best perfusion parameter in pMRI. (orig.)

  1. Creating a Novel Video Vignette Stroke Preparedness Outcome Measure Using a Community-Based Participatory Approach.

    Science.gov (United States)

    Skolarus, Lesli E; Murphy, Jillian B; Dome, Mackenzie; Zimmerman, Marc A; Bailey, Sarah; Fowlkes, Sophronia; Morgenstern, Lewis B

    2015-07-01

    Evaluating the efficacy of behavioral interventions for rare outcomes is a challenge. One such topic is stroke preparedness, defined as inteventions to increase stroke symptom recognition and behavioral intent to call 911. Current stroke preparedness intermediate outcome measures are centered on written vignettes or open-ended questions and have been shown to poorly reflect actual behavior. Given that stroke identification and action requires aural and visual processing, video vignettes may improve on current measures. This article discusses an approach for creating a novel stroke preparedness video vignette intermediate outcome measure within a community-based participatory research partnership. A total of 20 video vignettes were filmed of which 13 were unambiguous (stroke or not stroke) as determined by stroke experts and had test discrimination among community participants. Acceptable reliability, high satisfaction, and cultural relevance were found among the 14 community respondents. A community-based participatory approach was effective in creating a video vignette intermediate outcome. Future projects should consider obtaining expert and community feedback prior to filming all the video vignettes to improve the proportion of vignettes that are usable. While content validity and preliminary reliability were established, future studies are needed to confirm the reliability and establish construct validity. © 2014 Society for Public Health Education.

  2. Bobath and traditional approaches in post-stroke gait rehabilitation in adults

    Directory of Open Access Journals (Sweden)

    Mikołajewska Emilia

    2017-02-01

    Full Text Available Study aim: The aim of this study was to compare the outcomes of a study of post-stroke gait reeducation using the Bobath neuro‑developmental treatment (NDT-Bobath method and the traditional approach.

  3. Bobath and traditional approaches in post-stroke gait rehabilitation in adults

    OpenAIRE

    Mikołajewska Emilia

    2017-01-01

    Study aim: The aim of this study was to compare the outcomes of a study of post-stroke gait reeducation using the Bobath neuro‑developmental treatment (NDT-Bobath) method and the traditional approach.

  4. Contemporary approach to stroke prevention in atrial fibrillation: Risks, benefits, and new options.

    Science.gov (United States)

    Stock, Jonathan; Malm, Brian J

    2018-04-04

    Atrial fibrillation is a common diagnosis affecting nearly 3 million adults in the United States. Morbidity and mortality in these patients is driven largely by the associated increased risk of thromboembolic complications, especially stroke. Atrial fibrillation is a stronger risk factor than hypertension, coronary disease, or heart failure and is associated with an approximately five-fold increased risk. Mitigating stroke risk can be challenging and requires accurate assessment of stroke risk factors and careful selection of appropriate therapy. Anticoagulation, including the more recently introduced direct oral anticoagulants, is the standard of care for most patients. In addition, emerging non-pharmacologic mechanical interventions are playing an expanding role in reducing stroke risk in select patients. In this review we highlight the current approach to stroke risk stratification in atrial fibrillation and discuss in detail the mechanism, risks, and benefits of current and evolving therapies. Copyright © 2018 Elsevier Inc. All rights reserved.

  5. Multimodal approach to the international transit transport

    Directory of Open Access Journals (Sweden)

    D. Bazaras

    2003-12-01

    Full Text Available In the article not only the problems of multi-modal and inter-modal conveyances in Lithuania and the concept of transit and the transit system stimulating factors are analysed, but also the modelling of transit transport and the flows of the loads are given. The main part of the article comes to the analysis of resent situation of Lithuania. In this part the place of transport sector in the market of transit services is analysed and the transit profit for Lithuanian economy is evaluated. The conclusions and proposals are given at the end of the article.

  6. Stroke prevention-surgical and interventional approaches to carotid stenosis

    Directory of Open Access Journals (Sweden)

    Kumar Rajamani

    2013-01-01

    Full Text Available Extra cranial carotid artery stenosis is an important cause of stroke, which often needs treatment with carotid revascularization. To prevent stroke recurrence, carotid endarterectomy (CEA has been well-established for several decades for symptomatic high and moderate grade stenosis. Carotid stenting is a less invasive alternative to CEA and several recent trials have compared the efficacy of the 2 procedures in patients with carotid stenosis. Carotid artery stenting has emerged as a potential mode of therapy for high surgical risk patients with symptomatic high-grade stenosis. This review focuses on the current data available that will enable the clinician to decide optimal treatment strategies for patients with carotid stenosis.

  7. Renormalization group approach to QCD phase transitions

    International Nuclear Information System (INIS)

    Midorikawa, S.; Yoshimoto, S.; So, H.

    1987-01-01

    Effective scalar theories for QCD are proposed to investigate the deconfining and chiral phase transitions. The orders of the phase transitions are determined by infrared stabilities of the fixed points. It is found that the transitions in SU(3) gauge theories are of 1st order for any number of massless flavors. The cases of SU(2) and SU(4) gauge theories are also discussed. (orig.)

  8. A stepwise approach to stroke surveillance in Brazil: the EMMA (Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral) study.

    Science.gov (United States)

    Goulart, Alessandra C; Bustos, Iara R; Abe, Ivana M; Pereira, Alexandre C; Fedeli, Ligia M; Benseñor, Isabela M; Lotufo, Paulo A

    2010-08-01

    Stroke mortality rates in Brazil are the highest in the Americas. Deaths from cerebrovascular disease surpass coronary heart disease. To verify stroke mortality rates and morbidity in an area of São Paulo, Brazil, using the World Health Organization Stepwise Approach to Stroke Surveillance. We used the World Health Organization Stepwise Approach to Stroke Surveillance structure of stroke surveillance. The hospital-based data comprised fatal and nonfatal stroke (Step 1). We gathered stroke-related mortality data in the community using World Health Organization questionnaires (Step 2). The questionnaire determining stroke prevalence was activated door to door in a family-health-programme neighbourhood (Step 3). A total of 682 patients 18 years and above, including 472 incident cases, presented with cerebrovascular disease and were enrolled in Step 1 during April-May 2009. Cerebral infarction (84.3%) and first-ever stroke (85.2%) were the most frequent. In Step 2, 256 deaths from stroke were identified during 2006-2007. Forty-four per cent of deaths were classified as unspecified stroke, 1/3 as ischaemic stroke, and 1/4 due to haemorrhagic subtype. In Step 3, 577 subjects over 35 years old were evaluated at home, and 244 cases of stroke survival were diagnosed via a questionnaire, validated by a board-certified neurologist. The population demographic characteristics were similar in the three steps, except in terms of age and gender. By including data from all settings, World Health Organization stroke surveillance can provide data to help plan future resources that meet the needs of the public-health system.

  9. Computational and mathematical approaches to societal transitions

    NARCIS (Netherlands)

    J.S. Timmermans (Jos); F. Squazzoni (Flaminio); J. de Haan (Hans)

    2008-01-01

    textabstractAfter an introduction of the theoretical framework and concepts of transition studies, this article gives an overview of how structural change in social systems has been studied from various disciplinary perspectives. This overview first leads to the conclusion that computational and

  10. The Multidisciplinary Swallowing Team Approach Decreases Pneumonia Onset in Acute Stroke Patients.

    Directory of Open Access Journals (Sweden)

    Shiro Aoki

    Full Text Available Dysphagia occurs in acute stroke patients at high rates, and many of them develop aspiration pneumonia. Team approaches with the cooperation of various professionals have the power to improve the quality of medical care, utilizing the specialized knowledge and skills of each professional. In our hospital, a multidisciplinary participatory swallowing team was organized. The aim of this study was to clarify the influence of a team approach on dysphagia by comparing the rates of pneumonia in acute stroke patients prior to and post team organization. All consecutive acute stroke patients who were admitted to our hospital between April 2009 and March 2014 were registered. We analyzed the difference in the rate of pneumonia onset between the periods before team organization (prior period and after team organization (post period. Univariate and multivariate analyses were performed using a Cox proportional hazards model to determine the predictors of pneumonia. We recruited 132 acute stroke patients from the prior period and 173 patients from the post period. Pneumonia onset was less frequent in the post period compared with the prior period (6.9% vs. 15.9%, respectively; p = 0.01. Based on a multivariate analysis using a Cox proportional hazards model, it was determined that a swallowing team approach was related to pneumonia onset independent from the National Institutes of Health Stroke Scale score on admission (adjusted hazard ratio 0.41, 95% confidence interval 0.19-0.84, p = 0.02. The multidisciplinary participatory swallowing team effectively decreased the pneumonia onset in acute stroke patients.

  11. The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke

    Directory of Open Access Journals (Sweden)

    Paula Cristina Cola

    2010-03-01

    Full Text Available CONTEXT: The effect of sour taste and food temperature variations in dysphagic patients has not been entirely clarified. OBJECTIVE: To determine the effect of sour and cold food in the pharyngeal transit times of patients with stroke. METHODS: Patients participating in this study were 30 right-handed adults, 16 of which were male and 14 were female, aged 41 to 88 (average age 62.3 years with ictus varying from 1 to 30 days (median of 6 days. To analyze the pharyngeal transit time a videofluoroscopy swallow test was performed. Each patient was observed during swallow of a 5 mL paste bolus given by spoon, totaling four different stimuli (natural, cold, sour and cold sour, one at a time, room temperature (22ºC and cold (8ºC were used. Later, the tests were analyzed using specific software to measure bolus transit time during the pharyngeal phase. RESULTS: The results showed that the pharyngeal transit time was significantly shorter during swallow of cold sour bolus when compared with other stimuli. Conclusion - Sour taste stimuli associated to cold temperature cause significant change in swallowing patterns, by shortening the pharyngeal transit time, which may lead to positive effects in patients with oropharyngeal dysphagia.CONTEXTO: O efeito do sabor azedo e as variações da temperatura dos alimentos em indivíduos disfágicos, ainda não foi totalmente esclarecidos. OBJETIVO: Verificar o efeito do sabor azedo e da temperatura fria no tempo de trânsito faríngeo da deglutição em indivíduos após acidente vascular encefálico hemisférico isquêmico. MÉTODOS: Participaram deste estudo 30 indivíduos adultos, sendo 16 do gênero masculino e 14 do feminino, destros, com faixa etária variando de 41 a 88 anos (média de 62,3 anos e ictus que variou de 1 a 30 dias (mediana de 6 dias. Para analisar o tempo de trânsito faríngeo da deglutição foi realizado o exame de videofluoroscopia da deglutição. Cada indivíduo foi observado durante a

  12. High mortality among children with sickle cell anemia and overt stroke who discontinue blood transfusion after transition to an adult program.

    Science.gov (United States)

    McLaughlin, Joseph F; Ballas, Samir K

    2016-05-01

    Chronic blood transfusion is the standard of care in the management of overt stroke due to sickle cell anemia (SS) to prevent recurrence of stroke. The problem arises when children are transitioned to adult care where blood transfusion may be discontinued. The purpose of this study was to report the outcome of 22 patients with SS and overt stroke who were transitioned to our adult program between 1993 and 2009. Transitioned patients were kept on chronic blood transfusion they had as children. Blood bank data were performed and computerized according to FDA and AABB regulations. Records were kept prospectively. Blood counts and percent hemoglobin (Hb)S were obtained before and after transfusion. HbS was kept below 30% after transfusion. Metabolic profiles were obtained every 6 months or more often if needed. Statistical analysis was by the two-tailed t-test. Patients who were compliant with blood transfusion were rarely hospitalized for painful crises. Alloimmunization and iron overload were the major complications of blood transfusion. Eight patients who refused to be maintained on chronic blood transfusion or who were noncompliant died within 1 to 5 years after transition. Causes of death included stroke in two, sudden in three, and multiorgan failure in three. The overall rate of death after transition was 36% and the major cause was discontinuation of blood transfusion. Efforts must be made to maintain adequate chronic simple or exchange blood transfusion for children with SS and stroke after transition to adult care. © 2015 AABB.

  13. Early versus delayed rehabilitation treatment in hemiplegic patients with ischemic stroke: proprioceptive or cognitive approach?

    Science.gov (United States)

    Morreale, Manuela; Marchione, Pasquale; Pili, Antonio; Lauta, Antonella; Castiglia, Stefano F; Spallone, Aldo; Pierelli, Francesco; Giacomini, Patrizia

    2016-02-01

    Early/intensive mobilization may improve functional recovery after stroke but it is not clear which kind of "mobilization" is more effective. Proprioceptive neuromuscular facilitation (PNF) and cognitive therapeutic exercise (CTE) are widespread applied in post-stroke rehabilitation but their efficacy and safety have not been systematically investigated. To compare PNF and CTE methods in a two different time setting (early versus standard approach) in order to evaluate different role of time and techniques in functional recovery after acute ischemic stroke. We designed a prospectical multicenter blinded interventional study of early versus standard approach with two different methods by means of both PNF and CTE. A discrete stroke-dedicated area for out-of-thrombolysis patients, connected with two different comprehensive stroke centres in two different catchment areas. Three hundred and forty consecutive stroke patient with first ever sub-cortical ischemic stroke in the mean cerebral artery (MCA) territory and contralateral hemiplegia admitted within 6 and 24 hours from symptoms onset. All patients were randomly assigned by means of a computer generated randomization sequence in blocks of 4 to one to the 4 interventional groups: early versus delayed rehabilitation programs with Kabat's schemes or Perfetti's technique. Patients in both delayed group underwent to a standard protocol in the acute phase. disability at 3-12 months. Disability measures: modified Rankin Score and Barthel Index. Safety outcome: immobility-related adverse events. Six-Minute Walking Test, Motricity Index, Mini-Mental State Examination, Beck Depression Inventory. Disability was not different between groups at 3 months but Barthel Index significantly changed between early versus delayed groups at 12 months (P=0.01). Six-Minute Walking Test (P=0.01) and Motricity Index in both upper (P=0.01) and lower limbs (P=0.001) increased in early versus delayed groups regardless rehabilitation schedule. A

  14. Transition of care for acute stroke and myocardial infarction patients: from hospitalization to rehabilitation, recovery, and secondary prevention.

    Science.gov (United States)

    Olson, DaiWai M; Bettger, Janet Prvu; Alexander, Karen P; Kendrick, Amy S; Irvine, Julian R; Wing, Liz; Coeytaux, Remy R; Dolor, Rowena J; Duncan, Pamela W; Graffagnino, Carmelo

    2011-01-01

    OBJECTIVES To review the available published literature to assess whether evidence supports a beneficial role for coordinated transition of care services for the postacute care of patients hospitalized with first or recurrent stroke or myocardial infarction (MI). This review was framed around five areas of investigation: (1) key components of transition of care services, (2) evidence for improvement in functional outcomes, morbidity, mortality, and quality of life, (3) associated risks or potential harms, (4) evidence for improvement in systems of care, and (5) evidence that benefits and harms vary by patient-based or system-based characteristics. DATA SOURCES MEDLINE(®), CINAHL(®), Cochrane Database of Systematic Reviews, and Embase(®). REVIEW METHODS We included studies published in English from 2000 to 2011 that specified postacute hospitalization transition of care services as well as prevention of recurrent stroke or MI. RESULTS A total of 62 articles representing 44 studies were included for data abstraction. Transition of care interventions were grouped into four categories: (1) hospital -initiated support for discharge was the initial stage in the transition of care process, (2) patient and family education interventions were started during hospitalization but were continued at the community level, (3) community-based models of support followed hospital discharge, and (4) chronic disease management models of care assumed the responsibility for long-term care. Early supported discharge after stroke was associated with reduced total hospital length of stay without adverse effects on functional recovery, and specialty care after MI was associated with reduced mortality. Because of several methodological shortcomings, most studies did not consistently demonstrate that any specific intervention resulted in improved patient-or system -based outcomes. Some studies included more than one intervention, which made it difficult to determine the effect of individual

  15. Transition of care for acute stroke and myocardial infarction patients: from hospitalization to rehabilitation, recovery, and secondary prevention.

    Science.gov (United States)

    Olson, DaiWai M; Bettger, Janet Prvu; Alexander, Karen P; Kendrick, Amy S; Irvine, Julian R; Wing, Liz; Coeytaux, Remy R; Dolor, Rowena J; Duncan, Pamela W; Graffagnino, Carmelo

    2011-10-01

    To review the available published literature to assess whether evidence supports a beneficial role for coordinated transition of care services for the postacute care of patients hospitalized with first or recurrent stroke or myocardial infarction (MI). This review was framed around five areas of investigation: (1) key components of transition of care services, (2) evidence for improvement in functional outcomes, morbidity, mortality, and quality of life, (3) associated risks or potential harms, (4) evidence for improvement in systems of care, and (5) evidence that benefits and harms vary by patient-based or system-based characteristics. MEDLINE(®), CINAHL(®), Cochrane Database of Systematic Reviews, and Embase(®). We included studies published in English from 2000 to 2011 that specified postacute hospitalization transition of care services as well as prevention of recurrent stroke or MI. A total of 62 articles representing 44 studies were included for data abstraction. Transition of care interventions were grouped into four categories: (1) hospital -initiated support for discharge was the initial stage in the transition of care process, (2) patient and family education interventions were started during hospitalization but were continued at the community level, (3) community-based models of support followed hospital discharge, and (4) chronic disease management models of care assumed the responsibility for long-term care. Early supported discharge after stroke was associated with reduced total hospital length of stay without adverse effects on functional recovery, and specialty care after MI was associated with reduced mortality. Because of several methodological shortcomings, most studies did not consistently demonstrate that any specific intervention resulted in improved patient-or system -based outcomes. Some studies included more than one intervention, which made it difficult to determine the effect of individual components on clinical outcomes. There was

  16. Collective fluctuations in magnetized plasma: Transition probability approach

    International Nuclear Information System (INIS)

    Sosenko, P.P.

    1997-01-01

    Statistical plasma electrodynamics is elaborated with special emphasis on the transition probability approach and quasi-particles, and on modern applications to magnetized plasmas. Fluctuation spectra in the magnetized plasma are calculated in the range of low frequencies (with respect to the cyclotron one), and the conditions for the transition from incoherent to collective fluctuations are established. The role of finite-Larmor-radius effects and particle polarization drift in such a transition is explained. The ion collective features in fluctuation spectra are studied. 63 refs., 30 figs

  17. Understanding electron magnetic circular dichroism in a transition potential approach

    Science.gov (United States)

    Barthel, J.; Mayer, J.; Rusz, J.; Ho, P.-L.; Zhong, X. Y.; Lentzen, M.; Dunin-Borkowski, R. E.; Urban, K. W.; Brown, H. G.; Findlay, S. D.; Allen, L. J.

    2018-04-01

    This paper introduces an approach based on transition potentials for inelastic scattering to understand the underlying physics of electron magnetic circular dichroism (EMCD). The transition potentials are sufficiently localized to permit atomic-scale EMCD. Two-beam and three-beam systematic row cases are discussed in detail in terms of transition potentials for conventional transmission electron microscopy, and the basic symmetries which arise in the three-beam case are confirmed experimentally. Atomic-scale EMCD in scanning transmission electron microscopy (STEM), using both a standard STEM probe and vortex beams, is discussed.

  18. Nonperturbative approach to quantum field theories: phase transitions and confinement

    International Nuclear Information System (INIS)

    Yankielowicz, S.

    1976-08-01

    Lectures are given on a nonperturbative approach to quantum field theories. Phenomena are discussed for which the usual weak coupling perturbative approach in terms of Feynman diagrams is of no assistance. Properties associated with large distance behavior, i.e., phase transitions, low lying spectra, coherent excitations which are presumably built out of the long wave structure of the theory are described. These methods are important for the study of strong coupling field theories and the question of quarks confinement. 25 references

  19. Assessing Transition Service for Handicapped Youth: A Cooperative Interagency Approach.

    Science.gov (United States)

    Stodden, Robert A.; Boone, Rosalie

    1987-01-01

    The article presents a cooperative interagency approach for assessing effectiveness of programs and services to facilitate the transition of handicapped students from school to adult community living. Features of the model include cooperative planning at the policy level, implementation level, and direct service level; and collaboration by state…

  20. Music Upper Limb Therapy – Integrated: an Enriched Collaborative Approach for Stroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Preeti Raghavan

    2016-10-01

    spontaneous movement, and enhanced emotional engagement. The results suggest that the MULT-I intervention may help stroke survivors re-create their sense of self by integrating sensorimotor, emotional and interoceptive information, and facilitate long-term recovery across multiple domains of disability, even in the chronic stage post-stroke. Randomized controlled trials are warranted to confirm the efficacy of this approach. Clinical Trial Registration: National Institutes of Health, clinicaltrials.gov, NCT01586221.

  1. Tailor-made rehabilitation approach using multiple types of hybrid assistive limb robots for acute stroke patients: A pilot study.

    Science.gov (United States)

    Fukuda, Hiroyuki; Morishita, Takashi; Ogata, Toshiyasu; Saita, Kazuya; Hyakutake, Koichi; Watanabe, Junko; Shiota, Etsuji; Inoue, Tooru

    2016-01-01

    This article investigated the feasibility of a tailor-made neurorehabilitation approach using multiple types of hybrid assistive limb (HAL) robots for acute stroke patients. We investigated the clinical outcomes of patients who underwent rehabilitation using the HAL robots. The Brunnstrom stage, Barthel index (BI), and functional independence measure (FIM) were evaluated at baseline and when patients were transferred to a rehabilitation facility. Scores were compared between the multiple-robot rehabilitation and single-robot rehabilitation groups. Nine hemiplegic acute stroke patients (five men and four women; mean age 59.4 ± 12.5 years; four hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using multiple types of HAL robots for 19.4 ± 12.5 days, and 14 patients (six men and eight women; mean age 63.2 ± 13.9 years; nine hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using a single type of HAL robot for 14.9 ± 8.9 days. The multiple-robot rehabilitation group showed significantly better outcomes in the Brunnstrom stage of the upper extremity, BI, and FIM scores. To the best of the authors' knowledge, this is the first pilot study demonstrating the feasibility of rehabilitation using multiple exoskeleton robots. The tailor-made rehabilitation approach may be useful for the treatment of acute stroke.

  2. Bridging analytical approaches for low-carbon transitions

    Science.gov (United States)

    Geels, Frank W.; Berkhout, Frans; van Vuuren, Detlef P.

    2016-06-01

    Low-carbon transitions are long-term multi-faceted processes. Although integrated assessment models have many strengths for analysing such transitions, their mathematical representation requires a simplification of the causes, dynamics and scope of such societal transformations. We suggest that integrated assessment model-based analysis should be complemented with insights from socio-technical transition analysis and practice-based action research. We discuss the underlying assumptions, strengths and weaknesses of these three analytical approaches. We argue that full integration of these approaches is not feasible, because of foundational differences in philosophies of science and ontological assumptions. Instead, we suggest that bridging, based on sequential and interactive articulation of different approaches, may generate a more comprehensive and useful chain of assessments to support policy formation and action. We also show how these approaches address knowledge needs of different policymakers (international, national and local), relate to different dimensions of policy processes and speak to different policy-relevant criteria such as cost-effectiveness, socio-political feasibility, social acceptance and legitimacy, and flexibility. A more differentiated set of analytical approaches thus enables a more differentiated approach to climate policy making.

  3. Regulation of Neurological Devices and Neurointerventional Endovascular Approaches for Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Christopher M. Loftus

    2018-06-01

    s regulatory landscape for neurological devices and neurointerventional endovascular approaches for acute ischemic stroke; this is essential information for those seeking to successfully translate medical device neurotechnologies for patient and consumer use.

  4. Relationship Between Collateral Status, Contrast Transit, and Contrast Density in Acute Ischemic Stroke.

    Science.gov (United States)

    Kawano, Hiroyuki; Bivard, Andrew; Lin, Longting; Spratt, Neil J; Miteff, Ferdinand; Parsons, Mark W; Levi, Christopher R

    2016-03-01

    Collateral circulation is recognized to influence the life expectancy of the ischemic penumbra in acute ischemic stroke. The best method to quantify collateral status on acute imaging is uncertain. We aimed to determine the relationship between visual collateral status, quantitative collateral assessments, baseline computed tomographic perfusion measures, and tissue outcomes on follow-up imaging. Sixty-six consecutive patients with acute ischemic stroke clinically eligible for recanalization therapy and with M1 or M2 middle cerebral artery occlusion were evaluated. We compared the visual collateral scoring with measures of contrast peak time delay and contrast peak density. We also compared these measures for their ability to predict perfusion lesion and infarct core volumes, final infarct, and infarct growth. Shorter contrast peak time delay (P=0.041) and higher contrast peak density (P=0.002) were associated with good collateral status. Shorter contrast peak time delay correlated with higher contrast peak density (β=-4.413; P=0.037). In logistic regression analysis after adjustment for age, sex, onset-computed tomographic time, and occlusion site, higher contrast peak density was independently associated with good collateral status (P=0.009). Multiple regression analysis showed that higher contrast peak density was an independent predictor of smaller perfusion lesion volume (P=0.029), smaller ischemic core volume (P=0.044), smaller follow-up infarct volume (P=0.005), and smaller infarct growth volume (P=0.010). Visual collateral status, contrast peak density, and contrast peak time delay were inter-related, and good collateral status was strongly associated with contrast peak density. Contrast peak density in collateral vessel may be an important factor in tissue fate in acute ischemic stroke. © 2016 American Heart Association, Inc.

  5. Optimising MR perfusion imaging: comparison of different software-based approaches in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Schaafs, Lars-Arne [Charite-Universitaetsmedizin, Department of Radiology, Berlin (Germany); Charite-Universitaetsmedizin, Academic Neuroradiology, Department of Neurology and Center for Stroke Research, Berlin (Germany); Porter, David [Fraunhofer Institute for Medical Image Computing MEVIS, Bremen (Germany); Audebert, Heinrich J. [Charite-Universitaetsmedizin, Department of Neurology with Experimental Neurology, Berlin (Germany); Fiebach, Jochen B.; Villringer, Kersten [Charite-Universitaetsmedizin, Academic Neuroradiology, Department of Neurology and Center for Stroke Research, Berlin (Germany)

    2016-11-15

    Perfusion imaging (PI) is susceptible to confounding factors such as motion artefacts as well as delay and dispersion (D/D). We evaluate the influence of different post-processing algorithms on hypoperfusion assessment in PI analysis software packages to improve the clinical accuracy of stroke PI. Fifty patients with acute ischaemic stroke underwent MRI imaging in the first 24 h after onset. Diverging approaches to motion and D/D correction were applied. The calculated MTT and CBF perfusion maps were assessed by volumetry of lesions and tested for agreement with a standard approach and with the final lesion volume (FLV) on day 6 in patients with persisting vessel occlusion. MTT map lesion volumes were significantly smaller throughout the software packages with correction of motion and D/D when compared to the commonly used approach with no correction (p = 0.001-0.022). Volumes on CBF maps did not differ significantly (p = 0.207-0.925). All packages with advanced post-processing algorithms showed a high level of agreement with FLV (ICC = 0.704-0.879). Correction of D/D had a significant influence on estimated lesion volumes and leads to significantly smaller lesion volumes on MTT maps. This may improve patient selection. (orig.)

  6. Optimising MR perfusion imaging: comparison of different software-based approaches in acute ischaemic stroke

    International Nuclear Information System (INIS)

    Schaafs, Lars-Arne; Porter, David; Audebert, Heinrich J.; Fiebach, Jochen B.; Villringer, Kersten

    2016-01-01

    Perfusion imaging (PI) is susceptible to confounding factors such as motion artefacts as well as delay and dispersion (D/D). We evaluate the influence of different post-processing algorithms on hypoperfusion assessment in PI analysis software packages to improve the clinical accuracy of stroke PI. Fifty patients with acute ischaemic stroke underwent MRI imaging in the first 24 h after onset. Diverging approaches to motion and D/D correction were applied. The calculated MTT and CBF perfusion maps were assessed by volumetry of lesions and tested for agreement with a standard approach and with the final lesion volume (FLV) on day 6 in patients with persisting vessel occlusion. MTT map lesion volumes were significantly smaller throughout the software packages with correction of motion and D/D when compared to the commonly used approach with no correction (p = 0.001-0.022). Volumes on CBF maps did not differ significantly (p = 0.207-0.925). All packages with advanced post-processing algorithms showed a high level of agreement with FLV (ICC = 0.704-0.879). Correction of D/D had a significant influence on estimated lesion volumes and leads to significantly smaller lesion volumes on MTT maps. This may improve patient selection. (orig.)

  7. Stroke Rehabilitation.

    Science.gov (United States)

    Belagaje, Samir R

    2017-02-01

    Rehabilitation is an important aspect of the continuum of care in stroke. With advances in the acute treatment of stroke, more patients will survive stroke with varying degrees of disability. Research in the past decade has expanded our understanding of the mechanisms underlying stroke recovery and has led to the development of new treatment modalities. This article reviews and summarizes the key concepts related to poststroke recovery. Good data now exist by which one can predict recovery, especially motor recovery, very soon after stroke onset. Recent trials have not demonstrated a clear benefit associated with very early initiation of rehabilitative therapy after stroke in terms of improvement in poststroke outcomes. However, growing evidence suggests that shorter and more frequent sessions of therapy can be safely started in the first 24 to 48 hours after a stroke. The optimal amount or dose of therapy for stroke remains undetermined, as more intensive treatments have not been associated with better outcomes compared to standard intensities of therapy. Poststroke depression adversely affects recovery across a variety of measures and is an important target for therapy. Additionally, the use of selective serotonin reuptake inhibitors (SSRIs) appears to benefit motor recovery through pleiotropic mechanisms beyond their antidepressant effect. Other pharmacologic approaches also appear to have a benefit in stroke rehabilitation. A comprehensive rehabilitation program is essential to optimize poststroke outcomes. Rehabilitation is a process that uses three major principles of recovery: adaptation, restitution, and neuroplasticity. Based on these principles, multiple different approaches, both pharmacologic and nonpharmacologic, exist to enhance rehabilitation. In addition to neurologists, a variety of health care professionals are involved in stroke rehabilitation. Successful rehabilitation involves understanding the natural history of stroke recovery and a

  8. A Nonlinear Dynamic Approach Reveals a Long-Term Stroke Effect on Cerebral Blood Flow Regulation at Multiple Time Scales

    Science.gov (United States)

    Hu, Kun; Lo, Men-Tzung; Peng, Chung-Kang; Liu, Yanhui; Novak, Vera

    2012-01-01

    Cerebral autoregulation (CA) is an important vascular control mechanism responsible for relatively stable cerebral blood flow despite changes of systemic blood pressure (BP). Impaired CA may leave brain tissue unprotected against potentially harmful effects of BP fluctuations. It is generally accepted that CA is less effective or even inactive at frequencies >∼0.1 Hz. Without any physiological foundation, this concept is based on studies that quantified the coupling between BP and cerebral blood flow velocity (BFV) using transfer function analysis. This traditional analysis assumes stationary oscillations with constant amplitude and period, and may be unreliable or even invalid for analysis of nonstationary BP and BFV signals. In this study we propose a novel computational tool for CA assessment that is based on nonlinear dynamic theory without the assumption of stationary signals. Using this method, we studied BP and BFV recordings collected from 39 patients with chronic ischemic infarctions and 40 age-matched non-stroke subjects during baseline resting conditions. The active CA function in non-stroke subjects was associated with an advanced phase in BFV oscillations compared to BP oscillations at frequencies from ∼0.02 to 0.38 Hz. The phase shift was reduced in stroke patients even at > = 6 months after stroke, and the reduction was consistent at all tested frequencies and in both stroke and non-stroke hemispheres. These results provide strong evidence that CA may be active in a much wider frequency region than previously believed and that the altered multiscale CA in different vascular territories following stroke may have important clinical implications for post-stroke recovery. Moreover, the stroke effects on multiscale cerebral blood flow regulation could not be detected by transfer function analysis, suggesting that nonlinear approaches without the assumption of stationarity are more sensitive for the assessment of the coupling of nonstationary

  9. Giant monopole transition densities within the local scale ATDHF approach

    International Nuclear Information System (INIS)

    Dimitrova, S.S.; Petkov, I.Zh.; Stoitsov, M.V.

    1986-01-01

    Transition densities for 12 C, 16 O, 28 Si, 32 S, 40 Ca, 48 Ca, 56 Ni, 90 Zr, 208 Pb even-even nuclei corresponding to nuclear glant monopole resonances obtained within a local-scale adiabatic time-dependent Hartree-Fook approach in terms of effective Skyrme-type forces SkM and S3. The approach, the particular form and all necessary coefficients of these transition densities are reported. They are of a simple analytical form and may be directly used for example in analyses of particle inelastic scattering on nuclei by distorted wave method and a such a way allowing a test of the theoretical interpretation of giant monopole resonances

  10. Early sitting, standing, and walking in conjunction with contemporary Bobath approach for stroke patients with severe motor deficit.

    Science.gov (United States)

    Tang, Qingping; Tan, Lihong; Li, Baojun; Huang, Xiaosong; Ouyang, Chunhong; Zhan, Hailan; Pu, Qinqin; Wu, Lixiang

    2014-01-01

    The commonly used therapeutic approach, the contemporary Bobath approach (CBA), is not sufficient to restore independent locomotion for individuals with severe motor deficit (SMD) after stroke. Therefore, we propose that the early sitting, standing, and walking in conjunction with the CBA (ECBA) be used to treat individuals with SMD after stroke. To investigate whether ECBA may enhance mobility and balance in subjects with SMD after stroke. Thirty-three men and 15 women, aged 60 to 74 years, with SMD after stroke were recruited for the study. CBA or ECBA was performed with the subjects 5 times per week in 50-minute sessions for 8 weeks. The Stroke Rehabilitation Assessment of Movement (STREAM) and the Berg Balance Scale were implemented before treatment and at 4 and 8 weeks after treatment, respectively. The STREAM scores indicated that ECBA was more efficient than the CBA intervention for lower extremity mobility, F(1, 46) = 24.0, P < .001, and basic mobility, F(1, 46) = 102.6, P < .001. Overall STREAM scores were higher in the ECBA group, F(1, 46) =24.1, P < .001, after 8 weeks of therapy. Balance scores of the ECBA subjects were higher than those of the CBA subjects after 8 weeks of therapy, F(1, 46) = 73.1, P < .001. However, there was no difference in upper extremity mobility between the 2 groups. ECBA is a valuable intervention to improve lower extremity mobility, basic mobility, and balance ability for individuals with SMD after stroke.

  11. Severe COPD and the transition to a palliative approach

    Directory of Open Access Journals (Sweden)

    Amanda Landers

    2017-12-01

    A specific transition point is difficult to identify in severe COPD. Tools are available that may assist the physician in identifying those at risk of dying. It is essential that the patient voice is heard, patients can describe specific events that may be used as a “trigger” for a palliative approach. Specialist palliative care services may only be required for a subgroup of patients whose needs cannot be managed by the primary care team.

  12. Comparing a diffusion tensor and non-tensor approach to white matter fiber tractography in chronic stroke.

    Science.gov (United States)

    Auriat, A M; Borich, M R; Snow, N J; Wadden, K P; Boyd, L A

    2015-01-01

    Diffusion tensor imaging (DTI)-based tractography has been used to demonstrate functionally relevant differences in white matter pathway status after stroke. However, it is now known that the tensor model is insensitive to the complex fiber architectures found in the vast majority of voxels in the human brain. The inability to resolve intra-voxel fiber orientations may have important implications for the utility of standard DTI-based tract reconstruction methods. Intra-voxel fiber orientations can now be identified using novel, tensor-free approaches. Constrained spherical deconvolution (CSD) is one approach to characterize intra-voxel diffusion behavior. In the current study, we performed DTI- and CSD-based tract reconstruction of the corticospinal tract (CST) and corpus callosum (CC) to test the hypothesis that characterization of complex fiber orientations may improve the robustness of fiber tract reconstruction and increase the sensitivity to identify functionally relevant white matter abnormalities in individuals with chronic stroke. Diffusion weighted magnetic resonance imaging was performed in 27 chronic post-stroke participants and 12 healthy controls. Transcallosal pathways and the CST bilaterally were reconstructed using DTI- and CSD-based tractography. Mean fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD) were calculated across the tracts of interest. The total number and volume of reconstructed tracts was also determined. Diffusion measures were compared between groups (Stroke, Control) and methods (CSD, DTI). The relationship between post-stroke motor behavior and diffusion measures was evaluated. Overall, CSD methods identified more tracts than the DTI-based approach for both CC and CST pathways. Mean FA, ADC, and RD differed between DTI and CSD for CC-mediated tracts. In these tracts, we discovered a difference in FA for the CC between stroke and healthy control groups using CSD but

  13. Comparing a diffusion tensor and non-tensor approach to white matter fiber tractography in chronic stroke

    Directory of Open Access Journals (Sweden)

    A.M. Auriat

    2015-01-01

    Full Text Available Diffusion tensor imaging (DTI-based tractography has been used to demonstrate functionally relevant differences in white matter pathway status after stroke. However, it is now known that the tensor model is insensitive to the complex fiber architectures found in the vast majority of voxels in the human brain. The inability to resolve intra-voxel fiber orientations may have important implications for the utility of standard DTI-based tract reconstruction methods. Intra-voxel fiber orientations can now be identified using novel, tensor-free approaches. Constrained spherical deconvolution (CSD is one approach to characterize intra-voxel diffusion behavior. In the current study, we performed DTI- and CSD-based tract reconstruction of the corticospinal tract (CST and corpus callosum (CC to test the hypothesis that characterization of complex fiber orientations may improve the robustness of fiber tract reconstruction and increase the sensitivity to identify functionally relevant white matter abnormalities in individuals with chronic stroke. Diffusion weighted magnetic resonance imaging was performed in 27 chronic post-stroke participants and 12 healthy controls. Transcallosal pathways and the CST bilaterally were reconstructed using DTI- and CSD-based tractography. Mean fractional anisotropy (FA, apparent diffusion coefficient (ADC, axial diffusivity (AD, and radial diffusivity (RD were calculated across the tracts of interest. The total number and volume of reconstructed tracts was also determined. Diffusion measures were compared between groups (Stroke, Control and methods (CSD, DTI. The relationship between post-stroke motor behavior and diffusion measures was evaluated. Overall, CSD methods identified more tracts than the DTI-based approach for both CC and CST pathways. Mean FA, ADC, and RD differed between DTI and CSD for CC-mediated tracts. In these tracts, we discovered a difference in FA for the CC between stroke and healthy control groups

  14. Rehabilitation of gait after stroke: a review towards a top-down approach

    Science.gov (United States)

    2011-01-01

    This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity. The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches), functional electrical stimulation (FES), robotic devices, and brain-computer interfaces (BCI). From the analysis of these approaches, we can draw the following conclusions. Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than over-ground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait. Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy. Functional near infrared spectroscopy (fNIRS) enables researchers to detect signals from specific regions of the cortex during performance of motor activities for the development of future BCIs. Future research would make possible to analyze the impact of rehabilitation on brain plasticity, in order to adapt treatment resources to meet the needs of each patient and to optimize the recovery process. PMID:22165907

  15. Rehabilitation of gait after stroke: a review towards a top-down approach

    Directory of Open Access Journals (Sweden)

    Belda-Lois Juan-Manuel

    2011-12-01

    Full Text Available Abstract This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity. The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches, functional electrical stimulation (FES, robotic devices, and brain-computer interfaces (BCI. From the analysis of these approaches, we can draw the following conclusions. Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than over-ground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait. Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy. Functional near infrared spectroscopy (fNIRS enables researchers to detect signals from specific regions of the cortex during performance of motor activities for the development of future BCIs. Future research would make possible to analyze the impact of rehabilitation on brain plasticity, in order to adapt treatment resources to meet the needs of each patient and to optimize the recovery process.

  16. The Dilemma of Incumbents in Sustainability Transitions: A Narrative Approach

    Directory of Open Access Journals (Sweden)

    Karoline Augenstein

    2015-12-01

    Full Text Available In the context of the larger sustainability discourse, “sufficiency” is beginning to emerge as a new value throughout Western societies, and the question asked in this article is: Can we observe and conceptually identify opportunities to link successful business strategies of incumbents to principles of sufficiency? Thus, how feasible is sustainable entrepreneurship for incumbents? In this paper, a conceptual approach is developed combining insights from sociology, transition research, management and sustainable entrepreneurship research with a focus on narratives as a translation mechanism in situations where tensions emerge between corporate narratives and unexpected societal trends, e.g., the emergence of sufficient lifestyles. It will be shown that even though these are still a niche phenomenon, a focus on corporate narratives is an important element in understanding the role of incumbents in transitions to sustainability.

  17. Wetting transitions: A functional renormalization-group approach

    International Nuclear Information System (INIS)

    Fisher, D.S.; Huse, D.A.

    1985-01-01

    A linear functional renormalization group is introduced as a framework in which to treat various wetting transitions of films on substrates. A unified treatment of the wetting transition in three dimensions with short-range interactions is given. The results of Brezin, Halperin, and Leibler in their three different regimes are reproduced along with new results on the multicritical behavior connecting the various regimes. In addition, the critical behavior as the coexistence curve is approached at complete wetting is analyzed. Wetting in the presence of long-range substrate-film interactions that fall off as power laws is also studied. The possible effects of the nonlinear terms in the renormalization group are examined briefly and it appears that they do not alter the critical behavior found using the truncated linear renormalization group

  18. QCD phase transition at real chemical potential with canonical approach

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Atsushi [RCNP, Osaka University,Osaka, 567-0047 (Japan); Nishina Center, RIKEN,Wako, Saitama 351-0198 (Japan); School of Biomedicine, Far Eastern Federal University,Vladivostok, 690950 (Russian Federation); Oka, Shotaro [Institute of Theoretical Physics, Department of Physics, Rikkyo University,Toshima-ku, Tokyo 171-8501 (Japan); Taniguchi, Yusuke [Graduate School of Pure and Applied Sciences, University of Tsukuba,Tsukuba, Ibaraki 305-8571 (Japan)

    2016-02-08

    We study the finite density phase transition in the lattice QCD at real chemical potential. We adopt a canonical approach and the canonical partition function is constructed for N{sub f}=2 QCD. After derivation of the canonical partition function we calculate observables like the pressure, the quark number density, its second cumulant and the chiral condensate as a function of the real chemical potential. We covered a wide range of temperature region starting from the confining low to the deconfining high temperature; 0.65T{sub c}≤T≤3.62T{sub c}. We observe a possible signal of the deconfinement and the chiral restoration phase transition at real chemical potential below T{sub c} starting from the confining phase. We give also the convergence range of the fugacity expansion.

  19. Bilateral robotic priming before task-oriented approach in subacute stroke rehabilitation: a pilot randomized controlled trial.

    Science.gov (United States)

    Hsieh, Yu-Wei; Wu, Ching-Yi; Wang, Wei-En; Lin, Keh-Chung; Chang, Ku-Chou; Chen, Chih-Chi; Liu, Chien-Ting

    2017-02-01

    To investigate the treatment effects of bilateral robotic priming combined with the task-oriented approach on motor impairment, disability, daily function, and quality of life in patients with subacute stroke. A randomized controlled trial. Occupational therapy clinics in medical centers. Thirty-one subacute stroke patients were recruited. Participants were randomly assigned to receive bilateral priming combined with the task-oriented approach (i.e., primed group) or to the task-oriented approach alone (i.e., unprimed group) for 90 minutes/day, 5 days/week for 4 weeks. The primed group began with the bilateral priming technique by using a bimanual robot-aided device. Motor impairments were assessed by the Fugal-Meyer Assessment, grip strength, and the Box and Block Test. Disability and daily function were measured by the modified Rankin Scale, the Functional Independence Measure, and actigraphy. Quality of life was examined by the Stroke Impact Scale. The primed and unprimed groups improved significantly on most outcomes over time. The primed group demonstrated significantly better improvement on the Stroke Impact Scale strength subscale ( p = 0.012) and a trend for greater improvement on the modified Rankin Scale ( p = 0.065) than the unprimed group. Bilateral priming combined with the task-oriented approach elicited more improvements in self-reported strength and disability degrees than the task-oriented approach by itself. Further large-scale research with at least 31 participants in each intervention group is suggested to confirm the study findings.

  20. Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges

    Directory of Open Access Journals (Sweden)

    Stefano Mazzoleni

    2017-01-01

    Full Text Available A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill relearning, that is, intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function. Other studies have begun to investigate the benefits of combined approaches that target muscle function (functional electrical stimulation and botulinum toxin injections, modulate neural activity (noninvasive brain stimulation, and enhance motivation (virtual reality in an attempt to potentialize the benefits of robot-mediated training. The aim of this paper is to overview the current status of such combined treatments and to analyze the rationale behind them.

  1. Comparison of ductile-to-brittle transition curve fitting approaches

    International Nuclear Information System (INIS)

    Cao, L.W.; Wu, S.J.; Flewitt, P.E.J.

    2012-01-01

    Ductile-to-brittle transition (DBT) curve fitting approaches are compared over the transition temperature range for reactor pressure vessel steels with different kinds of data, including Charpy-V notch impact energy data and fracture toughness data. Three DBT curve fitting methods have been frequently used in the past, including the Burr S-Weibull and tanh distributions. In general there is greater scatter associated with test data obtained within the transition region. Therefore these methods give results with different accuracies, especially when fitting to small quantities of data. The comparison shows that the Burr distribution and tanh distribution can almost equally fit well distributed and large data sets extending across the test temperature range to include the upper and lower shelves. The S-Weibull distribution fit is poor for the lower shelf of the DBT curve. Overall for both large and small quantities of measured data the Burr distribution provides the best description. - Highlights: ► Burr distribution offers a better fit than that of a S-Weibull and tanh fit. ► Burr and tanh methods show similar fitting ability for a large data set. ► Burr method can fit sparse data well distributed across the test temperature. ► S-Weibull method cannot fit the lower shelf well and show poor fitting quality.

  2. Pediatric Stroke

    Science.gov (United States)

    ... and Patient Resources Home » Patients & Families » About Stroke » Pediatric Stroke » Introduction Introduction What is a Stroke? Ischemic Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Pediatric Stroke Introduction Types of Stroke Diagnosis and Treatment ...

  3. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  4. New approach to detect and classify stroke in skull CT images via analysis of brain tissue densities.

    Science.gov (United States)

    Rebouças Filho, Pedro P; Sarmento, Róger Moura; Holanda, Gabriel Bandeira; de Alencar Lima, Daniel

    2017-09-01

    Cerebral vascular accident (CVA), also known as stroke, is an important health problem worldwide and it affects 16 million people worldwide every year. About 30% of those that have a stroke die and 40% remain with serious physical limitations. However, recovery in the damaged region is possible if treatment is performed immediately. In the case of a stroke, Computed Tomography (CT) is the most appropriate technique to confirm the occurrence and to investigate its extent and severity. Stroke is an emergency problem for which early identification and measures are difficult; however, computer-aided diagnoses (CAD) can play an important role in obtaining information imperceptible to the human eye. Thus, this work proposes a new method for extracting features based on radiological density patterns of the brain, called Analysis of Brain Tissue Density (ABTD). The proposed method is a specific approach applied to CT images to identify and classify the occurrence of stroke diseases. The evaluation of the results of the ABTD extractor proposed in this paper were compared with extractors already established in the literature, such as features from Gray-Level Co-Occurrence Matrix (GLCM), Local binary patterns (LBP), Central Moments (CM), Statistical Moments (SM), Hu's Moment (HM) and Zernike's Moments (ZM). Using a database of 420 CT images of the skull, each extractor was applied with the classifiers such as MLP, SVM, kNN, OPF and Bayesian to classify if a CT image represented a healthy brain or one with an ischemic or hemorrhagic stroke. ABTD had the shortest extraction time and the highest average accuracy (99.30%) when combined with OPF using the Euclidean distance. Also, the average accuracy values for all classifiers were higher than 95%. The relevance of the results demonstrated that the ABTD method is a useful algorithm to extract features that can potentially be integrated with CAD systems to assist in stroke diagnosis. Copyright © 2017 Elsevier B.V. All rights

  5. Tailored approaches to stroke health education (TASHE): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Ravenell, Joseph; Leighton-Herrmann, Ellyn; Abel-Bey, Amparo; DeSorbo, Alexandra; Teresi, Jeanne; Valdez, Lenfis; Gordillo, Madeleine; Gerin, William; Hecht, Michael; Ramirez, Mildred; Noble, James; Cohn, Elizabeth; Jean-Louis, Giardin; Spruill, Tanya; Waddy, Salina; Ogedegbe, Gbenga; Williams, Olajide

    2015-04-19

    Stroke is a leading cause of adult disability and mortality. Intravenous thrombolysis can minimize disability when patients present to the emergency department for treatment within the 3 - 4½ h of symptom onset. Blacks and Hispanics are more likely to die and suffer disability from stroke than whites, due in part to delayed hospital arrival and ineligibility for intravenous thrombolysis for acute stroke. Low stroke literacy (poor knowledge of stroke symptoms and when to call 911) among Blacks and Hispanics compared to whites may contribute to disparities in acute stroke treatment and outcomes. Improving stroke literacy may be a critical step along the pathway to reducing stroke disparities. The aim of the current study is to test a novel intervention to increase stroke literacy in minority populations in New York City. In a two-arm cluster randomized trial, we will evaluate the effectiveness of two culturally tailored stroke education films - one in English and one in Spanish - on changing behavioral intent to call 911 for suspected stroke, compared to usual care. These films will target knowledge of stroke symptoms, the range of severity of symptoms and the therapeutic benefit of calling 911, as well as address barriers to timely presentation to the hospital. Given the success of previous church-based programs targeting behavior change in minority populations, this trial will be conducted with 250 congregants across 14 churches (125 intervention; 125 control). Our proposed outcomes are (1) recognition of stroke symptoms and (2) behavioral intent to call 911 for suspected stroke, measured using the Stroke Action Test at the 6-month and 1-year follow-up. This is the first randomized trial of a church-placed narrative intervention to improve stroke outcomes in urban Black and Hispanic populations. A film intervention has the potential to make a significant public health impact, as film is a highly scalable and disseminable medium. Since there is at least one

  6. A New Approach for Determining Onset of Transition

    Science.gov (United States)

    Hassan, H. A.; Warren, E. S.

    1997-01-01

    The final report consists of three papers which outline and demonstrate the new method for determining transition onset. The procedure developed under this grant requires specification of the instability mechanism, i.e., Tollmien-Schlichting or crossflow, that leads to transition. The attached papers are entitled: 'An Alternative to the e(sup n) Method for Determining Onset of Transition', 'Transition Model for Swept Wing Flows', and 'A Transition Closure Model for Predicting Transition Onset'.

  7. Effective assessments of electroencephalography during stroke recovery: contemporary approaches and considerations.

    Science.gov (United States)

    Iyer, Kartik K

    2017-11-01

    Stroke is one of the leading causes of permanent disability worldwide, relying conventionally on extended periods of physiotherapy to recover functional ability. While neuroimaging techniques and emerging neurorehabilitation paradigms have advanced our understanding of pathophysiological mechanisms underlying stroke, recent evidence has renewed focus on quantifying features of cortical activity present in electroencephalography recordings to greatly enhance our understanding of stroke treatment and recovery. This Neuro Forum article reviews these key advances and discusses the importance of quantifying electroencephalography in future assessments of stroke survivors. Copyright © 2017 the American Physiological Society.

  8. Multiphoton transitions in semiconductors in the non-perturbative approach

    International Nuclear Information System (INIS)

    Iqbal, M.Z.; Hassan, A.R.

    1987-09-01

    Transition rates for multiphoton absorption via direct band-to-band excitation have been calculated using a non-perturbative approach due to Jones and Reiss, based on the Volkov type final state wave functions. Both cases of parabolic and non-parabolic energy bands have been included in our calculations. Absorption coefficients have been obtained for the cases of plane polarized and circularly polarized light. In particular, two-photon absorption coefficients are derived for the two cases of polarization for the parabolic band approximation as well as for non-parabolic bands and compared with the results based on perturbation theory. Numerical estimates of the two photon absorption coefficients resulting from our calculations are also provided. (author). 10 refs, 1 tab

  9. An outcomes approach to stroke care: the importance of teamwork and evidence-based nursing care.

    Science.gov (United States)

    Middleton, Sandy

    2012-04-01

    The Quality in Acute Stroke Care (QASC) was a cluster randomised control trial (CRCT) which evaluated the effectiveness of evidence-based clinical treatment protocols for the management of fever, hyperglycaemia and swallowing, in conjunction with multidisciplinary team building workshops, and a standardised interactive staff education program (collectively known as the Fever, Sugar, Swallowing (FeSS) intervention) to improve patient outcomes 90-days. We found that patients cared for in stroke units who received our intervention were 15·7% more likely to be alive and independent 90 days following their stroke. They also had significantly: fewer episodes of fever, lower mean temperatures, lower mean blood glucose levels, and better screening for swallowing difficulties. © 2012 The Author. International Journal of Stroke © 2012 World Stroke Organization.

  10. Effect of foot placements during sit to stand transition on timed up and go test in stroke subjects: A cross sectional study.

    Science.gov (United States)

    Joshua, Abraham M; Karnad, Shreekanth D; Nayak, Akshatha; Suresh, B V; Mithra, Prasanna; Unnikrishnan, B

    2017-01-01

    Timed up and go (TUG) test is been used as a screening tool for the assessment of risk of falling in individuals following stroke. Though TUG test is a quick test, it has fair sensitivity compared to other tests. This study was carried out to obtain and compare test scores for different types of foot placements during sit to stand transition in stroke subjects. A Cross-sectional study with purposive sampling included 28 post stroke subjects who were able to walk 6 meter with or without assistance. Timed Up and Go test was carried out with four different types of foot placements and scores were recorded. The data were compared using Kruskal-Wallis One way analysis of variance and Wilcoxon signed ranks test. There were comparable differences between asymmetric 1 test strategy which involved affected extremity to be placed behind the unaffected and other test strategies (Z = -4.457,-3.848,-4.458; p = 0.000). The initial foot placements during sit to stand transition influenced the time taken to complete the test which was significantly higher in asymmetric 1 strategy, Incorporation of the initial foot placement mainly asymmetric 1 strategy into conventional TUG test would help in identifying accurately the subject's functional mobility and postural stability.

  11. Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach

    Directory of Open Access Journals (Sweden)

    Dirks Maaike

    2010-11-01

    Full Text Available Abstract Background Economic evaluation of stroke services indicates that such services may lead to improved quality of life at affordable cost. The present study assesses lifetime health impact and cost consequences of stroke in an integrated service setting. Methods The EDISSE study is a prospective non-randomized controlled cluster trial that compared stroke services (n = 151 patients to usual care (n = 187 patients. Health status and cost trial-data were entered in multi-dimensional stroke life-tables. The tables distinguish four levels of disability which are defined by the modified Rankin scale. Quality-of-life scores (EuroQoL-5D, transition and survival probabilities are based on concurrent Dutch follow-up studies. Outcomes are quality-adjusted life years lived and lifetime medical cost by disability category. An economic analysis compares outcomes from a successful stroke service to usual care, by bootstrapping individual costs and effects data from patients in each arm. Results Lifetime costs and QALYs after stroke depend on age-of-onset of first-ever stroke. Lifetime QALYs after stroke are 2.42 (90% CI - 0.49 - 2.75 for male patients in usual care and 2.75 (-0.61; 6.26 for females. Lifetime costs for men in the usual care setting are €39,335 (15,951; 79,837 and €42,944 (14,081; 95,944 for women. A comparison with the stroke service results in an ICER of €11,685 saved per QALY gained (€14,211 and €7,745 for men and women respectively. This stroke service is with 90% certainty cost-effective. Conclusions Our analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings.

  12. Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS: A practical and evidence-based framework for clinical rehabilitation management

    Directory of Open Access Journals (Sweden)

    Johan A. Franck

    2015-10-01

    Full Text Available The volume of information on new treatment techniques supporting the restoration of arm-hand function (AHF and arm-hand skill performance (ASHP in stroke survivors overwhelms therapists in everyday clinical practice when choosing the appropriate therapy. The Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS is designed for paramedical staff to structure and implement training of AHF and AHSP in stroke survivors. The CARAS is based on four constructs: (a stratification according to the severity of arm–hand impairment (using the Utrecht Arm/Hand -Test [UAT], (b the individual’s rehabilitation goals and concomitant potential rehabilitation outcomes, (c principles of self-efficacy, and (d possibilities to systematically incorporate (new technology and new evidence-based training elements swiftly. The framework encompasses three programs aimed at treating either the severely (UAT 0-1, moderately (UAT 2-3, or mildly (UAT 4-7 impaired arm-hand. Program themes are: taking care of the limb and prevention of complications (Program 1, task-oriented gross motor grip performance (Program 2, and functional AHSP training (Program 3. Each program is preceded and followed by an assessment. Training modularity facilitates rapid interchange/adaptation of sub-elements. Proof-of-principle in clinical rehabilitation has been established. The CARAS facilitates rapid structured design and provision of state-of-the-art AHF and ASHP treatment in stroke patients.

  13. An assistive control approach for a lower-limb exoskeleton to facilitate recovery of walking following stroke.

    Science.gov (United States)

    Murray, Spencer A; Ha, Kevin H; Hartigan, Clare; Goldfarb, Michael

    2015-05-01

    This paper presents a control approach for a lower-limb exoskeleton intended to facilitate recovery of walking in individuals with lower-extremity hemiparesis after stroke. The authors hypothesize that such recovery is facilitated by allowing the patient rather than the exoskeleton to provide movement coordination. As such, an assistive controller that provides walking assistance without dictating the spatiotemporal nature of joint movement is described here. Following a description of the control laws and finite state structure of the controller, the authors present the results of an experimental implementation and preliminary validation of the control approach, in which the control architecture was implemented on a lower limb exoskeleton, and the exoskeleton implemented in an experimental protocol on three subjects with hemiparesis following stroke. In a series of sessions in which each patient used the exoskeleton, all patients showed substantial single-session improvements in all measured gait outcomes, presumably as a result of using the assistive controller and exoskeleton.

  14. Current approaches to diagnosis, treatment, support and rehabilitation of patients after a stroke

    Directory of Open Access Journals (Sweden)

    K. V. Aymedov

    2016-03-01

    Full Text Available The authors focus their attention on the relevance and prevalence of cardiovascular diseases among whom a significant percentage is occupied by strokes. For every 100 million people there are about 500 thousand strokes and cerebral vascular crises per year. The urgency of this problem causes a high percentage of disability patients (15-30%. Primary diagnosis and early intervention play an important role in the further rehabilitation of stroke patients. The authors note the urgent need to revise the methods of early diagnosis and the use of modern technologies in diagnosis. Synthesis and analysis of scientific and theoretical achievements and the results of experimental studies was aimed at examining modern research methods with the aim of choosing an adequate diagnostic method and isolating the main neurosurgical markers in individuals who had suffered a stroke.

  15. Acute ischemic stroke imaging: a practical approach for diagnosis and triage.

    Science.gov (United States)

    Young, Joseph Yeen; Schaefer, Pamela Whitney

    2016-01-01

    Ischemic stroke is a prevalent disease with significant associated morbidity and healthcare costs. There are currently effective intravenous and endovascular therapies that have the potential to improve functional outcome when used in the appropriate patient population. The utilization of various imaging modalities has been shown to be crucial in identifying which patients may benefit from these therapies. Therefore, a thorough understanding of the role that imaging plays in guiding therapeutic decisions in acute ischemic stroke patients is important.

  16. A Systems Biology Approach to Heat Stress, Heat Injury and Heat Stroke

    Science.gov (United States)

    2015-01-01

    stroke [3, 11, 12], leading to severe encephalopathy , rhabdomyolysis, acute renal failure, acute respiratory distress syndrome, myocardial injury...heart, kidney, and liver failure are increased by 40% in Service members with a history of heat stroke [5, 6]. Indeed, there is an urgent need for...other organs at high risk for injury, such as liver and kidney [24, 25]. 2.1 Utility of the computational model Molecular indicators of heat

  17. Planning for School Transition: An Ecological-Developmental Approach.

    Science.gov (United States)

    Diamond, Karen E.; And Others

    1988-01-01

    The paper describes an ecological-developmental model for planning a child's transition from a preschool special education program to a public school classroom. The model stresses interactions between the various environments in which the child functions. A description of a preschool transition program based on the model is also included.…

  18. Clinical Approach to the Standardization of Oriental Medical Diagnostic Pattern Identification in Stroke Patients

    Directory of Open Access Journals (Sweden)

    Han Jung Kim

    2011-01-01

    Full Text Available In Korea, many stroke patients receive oriental medical care, in which pattern-identification plays a major role. Pattern-identification is Oriental Medicine's unique diagnostic system. This study attempted to standardize oriental medical pattern-identification for stroke patients. This was a community-based multicenter study that enrolled stroke patients within 30 days after their ictus. We assessed the patients' general characteristics and symptoms related to pattern-identification. Each patient's pattern was determined when two doctors had the same opinion. To determine which variables affect the pattern-identification, binary logistic regression analysis was used with the backward method. A total of 806 stroke patients were enrolled. Among 480 patients who were identified as having a certain pattern, 100 patients exhibited the Fire Heat Pattern, 210 patients the Phlegm Dampness Pattern, nine patients the Blood Stasis Pattern, 110 patients the Qi Deficiency Pattern, and 51 patients the Yin Deficiency Pattern. After the regression analysis, the predictive logistic equations for the Fire Heat, Phlegm Dampness, Qi Deficiency, and Yin Deficiency patterns were determined. The Blood Stasis Pattern was omitted because the sample size was too small. Predictive logistic equations were suggested for four of the patterns. These criteria would be useful in determining each stroke patient's pattern in clinics. However, further studies with large samples are necessary to validate and confirm these criteria.

  19. Shared decision-making in stroke: an evolving approach to improved patient care.

    Science.gov (United States)

    Armstrong, Melissa J

    2017-06-01

    Shared decision-making (SDM) occurs when patients, families and clinicians consider patients' values and preferences alongside the best medical evidence and partner to make the best decision for a given patient in a specific scenario. SDM is increasingly promoted within Western contexts and is also being explored outside such settings, including in China. SDM and tools to promote SDM can improve patients' knowledge/understanding, participation in the decision-making process, satisfaction and trust in the healthcare team. SDM has also proposed long-term benefits to patients, clinicians, organisations and healthcare systems. To successfully perform SDM, clinicians must know their patients' values and goals and the evidence underlying different diagnostic and treatment options. This is relevant for decisions throughout stroke care, from thrombolysis to goals of care, diagnostic assessments, rehabilitation strategies, and secondary stroke prevention. Various physician, patient, family, cultural and system barriers to SDM exist. Strategies to overcome these barriers and facilitate SDM include clinician motivation, patient participation, adequate time and tools to support the process, such as decision aids. Although research about SDM in stroke care is lacking, decision aids are available for select decisions, such as anticoagulation for stroke prevention in atrial fibrillation. Future research is needed regarding both cultural aspects of successful SDM and application of SDM to stroke-specific contexts.

  20. A programme management approach for supporting a transition to integrated flood management in the Netherlands

    NARCIS (Netherlands)

    Rijke, J.S.; Van Herk, S.; Zevenbergen, C.; Ashley, R.

    2012-01-01

    In the Netherlands and many other developed countries, flood management is transitioning from sectoral engineering approaches to more integrated approaches. The 2.3 billion Euro Room for the River programme plays an important role in this transition, because it is the first large scale

  1. Stroke Treatments

    Science.gov (United States)

    ... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... works by dissolving the clot and improving blood flow to the part of the brain being deprived ...

  2. Current developments in cell- and biomaterial-based approaches for stroke repair

    Czech Academy of Sciences Publication Activity Database

    Jendelová, Pavla; Kubinová, Šárka; Sandvig, I.; Erceg, Slaven; Sandvig, A.; Syková, Eva

    2016-01-01

    Roč. 16, č. 1 (2016), s. 43-56 ISSN 1471-2598 R&D Projects: GA MŠk(CZ) 7F14057 Institutional support: RVO:68378041 Keywords : clinical trials * ischemic lesion * mesenchymal stem cells * neural progenitors * neurogenesis * noninvasive imaging * stem cells * stroke * translation Subject RIV: FH - Neurology Impact factor: 3.684, year: 2016

  3. Diversity of approaches in assessment of executive functions in stroke: Limited evidence?

    Directory of Open Access Journals (Sweden)

    Juliana Conti

    2015-03-01

    There is a paucity of tools to reliably measure executive dysfunction after stroke, despite the fact that executive dysfunction is frequent. Identification of the best tools for executive dysfunction assessment is necessary to address important gaps in research and in clinical practice.

  4. Nystagmus-based approach to vertebrobasilar stroke presenting as vertigo without initial neurologic signs.

    Science.gov (United States)

    Kim, Min-Beom; Boo, Sung Hyun; Ban, Jae Ho

    2013-01-01

    We aimed to investigate the clinical courses and common nystagmus of isolated vertigo patients with vertebrobasilar stroke. The patients who presented with isolated acute spontaneous vertigo with spontaneous nystagmus (acute vestibular syndrome) at the Emergency Department were retrospectively analyzed. They were referred to the Otolaryngology Department due to the absence of neurologic signs or even of imaging abnormalities after the initial examination at the Emergency Department. Various clinical features, including presenting symptoms, delayed neurologic signs, the site of infarction, and videonystagmographic (VNG) findings were analyzed. Of the 468 cases of acute vestibular syndrome, 23 (4.9%) cases of radiologically proven vertebrobasilar stroke were identified. Of the 23 patients, 17 (74%) showed aggravation of vertigo or delayed neurologic signs during the admission. In the analysis of VNG, 11 (48%) cases of direction-changing gaze-evoked nystagmus, 7 (30%) cases of fixation failure in the caloric test, 6 (27%) cases of periodic alternating nystagmus, and 4 (17%) cases of atypical head-shaking nystagmus were presented. Stroke occurred in the cerebellum (n=18, 78%), medulla (n=4, 17%), and pons (n=1, 4%). In the early stage of vertebrobasilar stroke, an accurate diagnosis was difficult in the Emergency Department even though a radiologic study was performed, but various VNG abnormalities and delayed neurologic signs could help to diagnose whether the origin is central or not. Copyright © 2013 S. Karger AG, Basel.

  5. Dependence of synchronization transitions on mean field approach in two-way coupled neural system

    Science.gov (United States)

    Shi, J. C.; Luo, M.; Huang, C. S.

    2018-03-01

    This work investigates the synchronization transitions in two-way coupled neural system by mean field approach. Results show that, there exists a critical noise intensity for the synchronization transitions, i.e., above (or below) the critical noise intensity, the synchronization transitions are decreased (or hardly change) with increasing the noise intensity. Meanwhile, the heterogeneity effect plays a negative role for the synchronization transitions, and above critical coupling strength, the heterogeneity effect on synchronization transitions can be negligible. Furthermore, when an external signal is introduced into the coupled system, the novel frequency-induced and amplitude-induced synchronization transitions are found, and there exist an optimal frequency and an optimal amplitude of external signal which makes the system to display the best synchronization transitions. In particular, it is observed that the synchronization transitions can not be further affected above critical frequency of external signal.

  6. A multi-faceted knowledge translation approach to support persons with stroke and cognitive impairment: evaluation protocol.

    Science.gov (United States)

    McEwen, Sara E; Donald, Michelle; Dawson, Deirdre; Egan, Mary Y; Hunt, Anne; Quant, Sylvia; Runions, Sharron; Linkewich, Elizabeth

    2015-11-05

    Patients with cognitive impairments following a stroke are often denied access to inpatient rehabilitation. The few patients with cognitive impairment admitted to rehabilitation generally receive services based on outdated impairment-reduction models, rather than recommended function-based approaches. Both reduced access to rehabilitation and the knowledge-to-practice gap stem from a reported lack of skills and knowledge regarding cognitive rehabilitation on the part of inpatient rehabilitation team members. To address these issues, a multi-faceted knowledge translation (KT) initiative will be implemented and evaluated. It will be targeted specifically at the inter-professional application of the cognitive orientation to daily occupational performance (CO-OP). CO-OP training combined with KT support is called CO-OP KT. The long-term objective of CO-OP KT is to optimize functional outcomes for individuals with stroke and cognitive impairments. Three research questions are posed: 1. Is the implementation of CO-OP KT associated with a change in the proportion of patients with cognitive impairment following a stroke accepted to inpatient rehabilitation? 2. Is the implementation of CO-OP KT associated with a change in rehabilitation clinicians' practice, knowledge, and self-efficacy related to implementing the CO-OP approach, immediately following and 1 year later? 3. Is CO-OP KT associated with changes in activity, participation, and self-efficacy to perform daily activities in patients with cognitive impairment following stroke at discharge from inpatient rehabilitation and at 1-, 3-, and 6-month follow-ups? Three interrelated studies will be conducted. Study 1 will be a quasi-experimental, interrupted time series design measuring monthly summaries of stroke unit level data. Study 2, which relates to changes in health care professional practice and self-efficacy, will be a single group pre-post evaluation design incorporating chart audits and a self-report survey

  7. [The complex approach to the rehabilitation of post-stroke patients with movement disorders in the early rehabilitation period].

    Science.gov (United States)

    Khabirov, F A; Khaĭbullin, T I; Grigor'eva, O V

    2011-01-01

    We studied 110 patients, aged 34-71 years, in the early rehabilitation period after stroke who were admitted to a rehabilitation neurologic department of Kazan. The rehabilitation approach was based on the combination of several methods: kinesitherapy, transcranial magnetic stimulation and cerebrolysin treatment. This complex reanimation allowed to achieve the marked functional restoration of movement abilities in many cases that was correlated with the normalization of brain bioelectric activity (the increase of alpha-rhythm spectral power, the decrease of slow-wave EEG components). The combined use of these three methods was more effective than a combination of any two of them.

  8. The case for an integrated approach to transition programmes at ...

    African Journals Online (AJOL)

    The case for developing intentional and vertically integrated transition programmes is tied to: the need to understand the desired behaviours and learning outcomes at each stage of a student's experience; an appreciation of the cognitive, psychosocial and identity development at different years of study; and a recognition of ...

  9. Transition to Sustainable Fertilisation in Agriculture, A Practices Approach

    NARCIS (Netherlands)

    Huttunen, Suvi; Oosterveer, Peter

    2017-01-01

    It is argued that sustainability transition in agriculture requires a shift from a regime oriented towards increasing agricultural productivity to a regime in which the environmental and social effects of production are regarded as central. Practice theories represent an emerging perspective on

  10. Global Natural Disaster Risk Hotspots: Transition to a Regional Approach

    Science.gov (United States)

    Lerner-Lam, A.; Chen, R.; Dilley, M.

    2005-12-01

    economic losses, are also limited. On one hand the data are adequate for general identification of areas of the globe that are at relatively higher single- or multiple-hazard risk than other areas. On the other hand they are inadequate for understanding the absolute levels of risk posed by any specific hazard or combination of hazards. Nevertheless it is possible to assess in general terms the exposure and potential magnitude of losses to people and their assets in these areas. Such information, although not ideal, can still be very useful for informing a range of disaster prevention and preparedness measures, including prioritization of resources, targeting of more localized and detailed risk assessments, implementation of risk-based disaster management and emergency response strategies, and development of long-term plans for poverty reduction and economic development. In addition to summarizing the results of the Hotspots Project, we discuss data collection issues and suggest methodological approaches for making the transition to more detailed regional and national studies. Preliminary results for several regional case studies will be presented.

  11. Watsu approach for improving spasticity and ambulatory function in hemiparetic patients with stroke.

    Science.gov (United States)

    Chon, Seung Chul; Oh, Duck Won; Shim, Jae Hun

    2009-06-01

    This study reports the effect of Watsu as rehabilitation method for hemiparetic patients with stroke. Watsu consisted of 40 treatment sessions for 8 weeks, delivered underwater or at water surface level, it applied in three patients. Outcome measures included tools for assessing spasticity and ambulatory function. All patients showed decreased scores in the TAS and RVGA after Watsu application. Watsu was helpful in controlling spasticity and improving ambulatory function of the patients with hemiparesis.

  12. Coherent state approach for the Φ6-lattice model and phase transitions

    International Nuclear Information System (INIS)

    Aguero-Granados, M.A.; Makhan'kov, V.G.

    1991-01-01

    Phase transitions in the lattice version of the Φ 6 -field theory are studied. The generalized coherent states approach to is used. In such a way the roles of kinks and bubbles in phase transitions have been reexamined. It is shown via a numerical analysis that first and second order phase transitions appear due to the behaviour of kinks and bubbles excitations. 12 refs.; 10 figs

  13. TOPSIS Multi-Criteria Decision Modeling Approach for Biolubricant Selection for Two-Stroke Petrol Engines

    Directory of Open Access Journals (Sweden)

    Masoud Dehghani Soufi

    2015-12-01

    Full Text Available Exhaust pollutants from two-stroke petrol engines are a problem for the environment. Biolubricants are a new generation of renewable and eco-friendly vegetable-based lubricants, which have attracted a lot of attention in recent years. In this paper, the applicability of the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS method to support the process of building the scoring system for selecting an appropriate two-stroke lubricant has been analyzed. For this purpose, biolubricants (TMP-triesters based on castor oil, palm oil, and waste cooking oil were produced and then utilized in a 200 cc two-stroke gasoline engine to investigate their effects on its performance and exhaust emissions. The results obtained from the use of the entropy technique in the TOPSIS algorithm showed that palm oil-based lubricant took up the greatest distance from the Negative Ideal Solution (NIS and was selected as the most optimal lubricant for these types of engines.

  14. Network Analysis Approach to Stroke Care and Assistance Provision: An Empirical Study

    Directory of Open Access Journals (Sweden)

    Szczygiel Nina

    2017-06-01

    Full Text Available To model and analyse stroke care and assistance provision in the Portuguese context from the network perspective. We used the network theory as a theoretical foundation for the study. The model proposed by Frey et al. (2006 was used to elicit and comprehend possible interactions and relations between organisations expected to be involved in the provision of care and assistance to stroke patients in their pathway to rehabilitation. Providers were identified and contacted to evaluate the nature and intensity of relationships. Network analysis was performed with the NodeXL software package. Analysis of 509 entities based on about 260 000 entries indicates that stroke care provision in the evaluated context is best captured in the coalition-collaboration setting, which appears to best demonstrate the character of the network. Information from analysis of the collaboration stage was not sufficient to determine the network dynamics. Application of the network theory to understand interorganisational dynamics of the complex health care context. Empirical validation of the model proposed by Frey et al. (2006 in terms of its operationalisation and the way it actually reflects the practical context. Examination and analysis of interorganisational relationships and its contribution to management of compound health care context involving actors from various sectors.

  15. Sonification of Arm Movements in Stroke Rehabilitation – A Novel Approach in Neurologic Music Therapy

    Science.gov (United States)

    Scholz, Daniel S.; Rohde, Sönke; Nikmaram, Nikou; Brückner, Hans-Peter; Großbach, Michael; Rollnik, Jens D.; Altenmüller, Eckart O.

    2016-01-01

    Gross motor impairments are common after stroke, but efficient and motivating therapies for these impairments are scarce. We present an innovative musical sonification therapy, especially designed to retrain patients’ gross motor functions. Sonification should motivate patients and provide additional sensory input informing about relative limb position. Twenty-five stroke patients were included in a clinical pre–post study and took part in the sonification training. The patients’ upper extremity functions, their psychological states, and their arm movement smoothness were assessed pre and post training. Patients were randomly assigned to either of two groups. Both groups received an average of 10 days (M = 9.88; SD = 2.03; 30 min/day) of musical sonification therapy [music group (MG)] or a sham sonification movement training [control group (CG)], respectively. The only difference between the two protocols was that in the CG no sound was played back during training. In the beginning, patients explored the acoustic effects of their arm movements in space. At the end of the training, the patients played simple melodies by coordinated arm movements. The 15 patients in the MG showed significantly reduced joint pain (F = 19.96, p therapy. Taken together, musical sonification may be a promising therapy for motor impairments after stroke, but further research is required since estimated effect sizes point to moderate treatment outcomes. PMID:27445970

  16. Sonification of Arm Movements in Stroke Rehabilitation - A Novel Approach in Neurologic Music Therapy.

    Science.gov (United States)

    Scholz, Daniel S; Rohde, Sönke; Nikmaram, Nikou; Brückner, Hans-Peter; Großbach, Michael; Rollnik, Jens D; Altenmüller, Eckart O

    2016-01-01

    Gross motor impairments are common after stroke, but efficient and motivating therapies for these impairments are scarce. We present an innovative musical sonification therapy, especially designed to retrain patients' gross motor functions. Sonification should motivate patients and provide additional sensory input informing about relative limb position. Twenty-five stroke patients were included in a clinical pre-post study and took part in the sonification training. The patients' upper extremity functions, their psychological states, and their arm movement smoothness were assessed pre and post training. Patients were randomly assigned to either of two groups. Both groups received an average of 10 days (M = 9.88; SD = 2.03; 30 min/day) of musical sonification therapy [music group (MG)] or a sham sonification movement training [control group (CG)], respectively. The only difference between the two protocols was that in the CG no sound was played back during training. In the beginning, patients explored the acoustic effects of their arm movements in space. At the end of the training, the patients played simple melodies by coordinated arm movements. The 15 patients in the MG showed significantly reduced joint pain (F = 19.96, p musical sonification may be a promising therapy for motor impairments after stroke, but further research is required since estimated effect sizes point to moderate treatment outcomes.

  17. Modelling conditional correlations of asset returns: A smooth transition approach

    DEFF Research Database (Denmark)

    Silvennoinen, Annastiina; Teräsvirta, Timo

    In this paper we propose a new multivariate GARCH model with time-varying conditional correlation structure. The time-varying conditional correlations change smoothly between two extreme states of constant correlations according to a predetermined or exogenous transition variable. An LM-test is d......In this paper we propose a new multivariate GARCH model with time-varying conditional correlation structure. The time-varying conditional correlations change smoothly between two extreme states of constant correlations according to a predetermined or exogenous transition variable. An LM......-test is derived to test the constancy of correlations and LM- and Wald tests to test the hypothesis of partially constant correlations. Analytical expressions for the test statistics and the required derivatives are provided to make computations feasible. An empirical example based on daily return series of ve...

  18. Invariant molecular-dynamics approach to structural phase transitions

    International Nuclear Information System (INIS)

    Wentzcovitch, R.M.

    1991-01-01

    Two fictitious Lagrangians to be used in molecular-dynamics simulations with variable cell shape and suitable to study problems like structural phase transitions are introduced. Because they are invariant with respect to the choice of the simulation cell edges and eliminate symmetry breaking associated with the fictitious part of the dynamics, they improve the physical content of numerical simulations that up to now have been done by using Parrinello-Rahman dynamics

  19. Electromagnetic transitions between giant resonances within a continuum-RPA approach

    NARCIS (Netherlands)

    Rodin, VA; Dieperink, AEL

    2002-01-01

    A general continuum-RPA approach is developed to describe electromagnetic transitions between giant resonances. Using a diagrammatic representation for the three-point Green's function, an expression for the transition amplitude is derived which allows one to incorporate effects of mixing of single

  20. The Digital Learning Transition MOOC for Educators: Exploring a Scalable Approach to Professional Development

    Science.gov (United States)

    Kleiman, Glenn M.; Wolf, Mary Ann; Frye, David

    2013-01-01

    In conjunction with the relaunch of the Digital Learning Transition (DLT) Massive Open Online Course for Educatos (MOOC-Ed) in September 2013, the Alliance and the Friday Institute released "The Digital Learning Transition MOOC for Educators: Exploring a Scalable Approach to Professional Development", a new paper that describes the…

  1. Work Transitions as Told: A Narrative Approach to Biographical Learning

    Science.gov (United States)

    Hallqvist, Anders; Hyden, Lars-Christer

    2013-01-01

    In this article, we introduce a narrative approach to biographical learning; that is, an approach that considers autobiographical storytelling as a practice through which claims about life history are performed and negotiated. Using insights from narrative theory, we highlight evaluations in those narratives and suggest their crucial role in…

  2. The 'valuation milieu': Toward a territorial approach to sustainability transitions

    International Nuclear Information System (INIS)

    Huguenin, Ariane

    2017-01-01

    During the last decade research in Transition Studies has highlighted the complex and multidimensional dynamics involved in the transformation towards new socio-technical regimes of sustainable development. However, existing analysis have often neglected the territorial dimension of such transformations. To deal more explicitly with this dimension, this article proposes the concept of 'milieu valuateur'. Through a case analysis in the field of energy in the Swiss municipality of Neuchatel, this article illustrates how the reterritorialization of productive capacities at a city scale enables to reconstruct a higher value through demonstration

  3. Labor transitions of Spanish workers: a flexicurity approach

    Directory of Open Access Journals (Sweden)

    Ángel Alonso Domínguez

    2013-04-01

    Full Text Available This paper uses data from the Continuous Sample of Working Lives (MCVL to assess whether flexicurity can contribute to solving endemic problems in the Spanish labor market. Two different periods are considered: 2005–2007, in which the unprecedented expansion of the Spanish economy came to an end, and 2008–2010, which clearly shows how the economic crisis has affected the employment rate. The results obtained bear out the preliminary hypotheses. More specifically, a labor market transitions have come to a halt, and b contractual arrangements which may act as gateways to more stable employment are being misused.

  4. [Modern approach to gait restoration in patients in the acute period of cerebral stroke].

    Science.gov (United States)

    Skvortsova, V I; Ivanova, G E; Rumiantseva, N A; Staritsyn, A N; Kovrazhkina, E A; Suvorov, A Iu

    2010-01-01

    An objective of the study was to work out a complex program of gait restoration in patients with stroke using robot-driven mechanized gait trainers. The study included patients in the acute period of stroke (the mean age 59+/-10,4 years) who were not able to walk without assistance; 53 patients of the main group and 25 patients of the control group. The mean interval from the disease onset to the beginning of gait retraining sessions with mechanized gait trainers was 14+/-1,6 days depending on the adequacy of functional probes. The restoration program included everyday 30 minute sessions of exercise therapy. Patients of the main group received 20 min sessions using mechanized gait trainers Motomed Viva 2 and Gait Trainer 1 (GT1) with continuous monitoring of blood pressure and cardiac beat frequency. The number of sessions with GT1 was from 5 to 12, mean 7+/-1 sessions. After the complex restoration treatment, significant positive changes on scales of standing balance, functional categories of gait, Berg, Barthel (p< or =0.01) were observed in patients of the main group compared to controls. All patients of the main group became able to walk with a support or independently. The significant decrease (p< or =0.05) of a number of patients with disorders of proprioceptive sensitivity (from 37,7 to 9,4%) and with ataxia of the low extremities (from 37 to 11,3%) was observed in the main group, while no changes were seen in the control group. It has been concluded that the complex use of reflex kinesitherapy and robot-driven mechanotherapy in patients in the acute period of stroke allows to increase the functional activity and the level of self-service already prior to the discharge from hospital.

  5. Topological transitions at finite temperatures: A real-time numerical approach

    International Nuclear Information System (INIS)

    Grigoriev, D.Yu.; Rubakov, V.A.; Shaposhnikov, M.E.

    1989-01-01

    We study topological transitions at finite temperatures within the (1+1)-dimensional abelian Higgs model by a numerical simulation in real time. Basic ideas of the real-time approach are presented and some peculiarities of the Metropolis technique are discussed. It is argued that the processes leading to topological transitions are of classical origin; the transitions can be observed by solving the classical field equations in real time. We show that the topological transitions actually pass via the sphaleron configuration. The transition rate as a function of temperature is found to be in good agreement with the analytical predictions. No extra suppression of the rate is observed. The conditions of applicability of our approach are discussed. The temperature interval where the low-temperature broken phase persists is estimated. (orig.)

  6. Pharmacologic approaches to cerebral aging and neuroplasticity: insights from the stroke model.

    Science.gov (United States)

    Chollet, François

    2013-03-01

    Brain plasticity is an intrinsic characteristic of the nervous system that allows continuous remodeling of brain functions in pathophysiological conditions. Although normal aging is associated with morphological modifications and decline of cerebral functions, brain plasticity is at least partially preserved in elderly individuals. A growing body of evidence supports the notion that cognitive enrichment and aerobic training induce a dynamic reorganization of higher cerebral functions, thereby helping to maintain operational skills in the elderly and reducing the incidence of dementia. The stroke model clearly shows that spontaneous brain plasticity exists after a lesion, even in old patients, and that it can be modulated through external factors like rehabilitation and drugs. Whether drugs can be used with the aim of modulating the effects of physical training or cognitive stimulation in healthy aged people has not been addressed until now. The risk:benefit ratio will be the key question with regard to the ethical aspect of this challenge. We review in this article the main aspects of human brain plasticity as shown in patients with stroke, the drug modulation of brain plasticity and its consequences on recovery, and finally we address the question of the influence of aging on brain plasticity.

  7. Risk assessment of transitional economies by multivariate and multicriteria approaches

    Directory of Open Access Journals (Sweden)

    Tomić-Plazibat Neli

    2010-01-01

    Full Text Available This article assesses country-risk of sixteen Central, Baltic and South-East European transition countries, for 2005 and 2007, using multivariate cluster analysis. It was aided by the appropriate ANOVA (analysis of variance testing and the multicriteria PROMETHEE method. The combination of methods makes for more accurate and efficient country-risk assessment. Country risk classifications and ratings involve evaluating the performance of countries while considering their economic and socio-political characteristics. The purpose of the article is to classify, and then find the comparative position of each individual country in the group of analyzed countries, in order to find out to which extent development of market economy and democratic society has been achieved.

  8. The Neurorehabilitation Training Toolkit (NTT: A Novel Worldwide Accessible Motor Training Approach for At-Home Rehabilitation after Stroke

    Directory of Open Access Journals (Sweden)

    Sergi Bermúdez i Badia

    2012-01-01

    Full Text Available After stroke, enduring rehabilitation is required for maximum recovery, and ideally throughout life to prevent functional deterioration. Hence we developed a new concept for at-home low-cost motor rehabilitation, the NTT, an Internet-based interactive system for upper-limb rehabilitation. In this paper we present the NTT design concepts, its implementation and a proof of concept study with 10 healthy participants. The NTT brings together concepts of optimal learning, engagement, and storytelling to deliver a personalized training to its users. In this study we evaluate the feasibility of NTT as a tool capable of automatically assessing and adapting to its user. This is achieved by means of a psychometric study where we show that the NTT is able to assess movement kinematics—movement smoothness, range of motion, arm displacement and arm coordination—in healthy users. Subsequently, a modeling approach is presented to understand how the measured movement kinematics relate to training parameters, and how these can be modified to adapt the training to meet the needs of patients. Finally, an adaptive algorithm for the personalization of training considering motivational and performance aspects is proposed. In the next phase we will deploy and evaluate the NTT with stroke patients at their homes.

  9. Strategic Niche Management and Transition Management: different but complementary approaches

    NARCIS (Netherlands)

    D.A. Loorbach (Derk); R. van Raak (Ronald)

    2006-01-01

    textabstractThis discussion paper sets out to compare two different, yet related, approaches to achieve sustainable development and (technological) innovation. Strategic Niche Management (SNM) (Kemp, Schot et al. 1998; Weber 1999) emerged as a novel concept by the end of the 1990’s and is presented

  10. Microscopic mean-field boson approach to the shape transition in Sm isotopes

    International Nuclear Information System (INIS)

    Kuchta, R.

    1988-01-01

    The phase transition from spherical to deformed shape in Sm 146-156 nuclei is analyzed within the mean-field approximation applied to the Dyson image of the shell-model Hamiltonian. No quasiparticle transformation is involved in the present approach and the Pauli principle in the physical boson subspace is properly taken into account. The low-lying spectra, B(E2; O 1 + →2 + ) probabilities and the corresponding densities of electromagnetic transitions are calculated. The results provide a reasonable explanation of the phase transition in the Sm isotopes. The role of bosons with different multipolarity is investigated and it is found that g-bosons (J=4) cannot be neglected in the transition region. Comparison of the present results with those of other approaches is given as well

  11. Exploring the bases for a mixed reality stroke rehabilitation system, Part I: A unified approach for representing action, quantitative evaluation, and interactive feedback

    Science.gov (United States)

    2011-01-01

    Background Although principles based in motor learning, rehabilitation, and human-computer interfaces can guide the design of effective interactive systems for rehabilitation, a unified approach that connects these key principles into an integrated design, and can form a methodology that can be generalized to interactive stroke rehabilitation, is presently unavailable. Results This paper integrates phenomenological approaches to interaction and embodied knowledge with rehabilitation practices and theories to achieve the basis for a methodology that can support effective adaptive, interactive rehabilitation. Our resulting methodology provides guidelines for the development of an action representation, quantification of action, and the design of interactive feedback. As Part I of a two-part series, this paper presents key principles of the unified approach. Part II then describes the application of this approach within the implementation of the Adaptive Mixed Reality Rehabilitation (AMRR) system for stroke rehabilitation. Conclusions The accompanying principles for composing novel mixed reality environments for stroke rehabilitation can advance the design and implementation of effective mixed reality systems for the clinical setting, and ultimately be adapted for home-based application. They furthermore can be applied to other rehabilitation needs beyond stroke. PMID:21875441

  12. TRANSIT

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. TRANSIT. SYSTEM: DETERMINE 2D-POSITION GLOBALLY BUT INTERMITTENT (POST-FACTO). IMPROVED ACCURACY. PRINCIPLE: POLAR SATELLITES WITH INNOVATIONS OF: GRAVITY-GRADIENT ATTITUDE CONTROL; DRAG COMPENSATION. WORKS ...

  13. Study of the coefficients of internal conversion for transition energies approaching the threshold

    International Nuclear Information System (INIS)

    Farani Coursol, Nelcy.

    1979-01-01

    Internal conversion coefficients were determined experimentally with great accuracy for areas of transition energies, which constitute tests for the theories (energies at the most ten kEv above the threshold of K shell), then the results obtained were compared with the values calculated (or to be calculated) from theoretical models. Owing to the difficulties raised by the precise determination of the internal conversion coefficients (ICC), in the first stage we selected radionuclides with a relatively simple decay pattern, the transitions: 30 keV of sup(93m)Nb, 35 keV of sup(125m)Te, 14 keV of 57 Fe and 39 keV of sup(129m)Xe. It was observed that 'problems' exist with respect to the ICC's of the great multipolarity transitions, so the transitions of this kind were examined in a systematic manner. The possibility of penetration effects occurring for the transitions studied experimentally was examined. The considerations are presented which 'authorized' us to disregard the dynamic part of the ICC for the transitions approaching the threshold (L selection rules and life of nuclear levels in relation to Weisskopf-Moszkowski estimations). The Kurie straight line was determined experimentally for the β - transition and the Qsub(β) was evaluated with an important accuracy gain compared with the values available at present. Finally, a certain number of ICC's of transitions already determined with good precision were recalculated, in order to extend our analysis and detect any possible systematic errors [fr

  14. The application of SHERPA (Systematic Human Error Reduction and Prediction Approach) in the development of compensatory cognitive rehabilitation strategies for stroke patients with left and right brain damage.

    Science.gov (United States)

    Hughes, Charmayne M L; Baber, Chris; Bienkiewicz, Marta; Worthington, Andrew; Hazell, Alexa; Hermsdörfer, Joachim

    2015-01-01

    Approximately 33% of stroke patients have difficulty performing activities of daily living, often committing errors during the planning and execution of such activities. The objective of this study was to evaluate the ability of the human error identification (HEI) technique SHERPA (Systematic Human Error Reduction and Prediction Approach) to predict errors during the performance of daily activities in stroke patients with left and right hemisphere lesions. Using SHERPA we successfully predicted 36 of the 38 observed errors, with analysis indicating that the proportion of predicted and observed errors was similar for all sub-tasks and severity levels. HEI results were used to develop compensatory cognitive strategies that clinicians could employ to reduce or prevent errors from occurring. This study provides evidence for the reliability and validity of SHERPA in the design of cognitive rehabilitation strategies in stroke populations.

  15. Serum metabolites and risk of myocardial infarction and ischemic stroke: a targeted metabolomic approach in two German prospective cohorts.

    Science.gov (United States)

    Floegel, Anna; Kühn, Tilman; Sookthai, Disorn; Johnson, Theron; Prehn, Cornelia; Rolle-Kampczyk, Ulrike; Otto, Wolfgang; Weikert, Cornelia; Illig, Thomas; von Bergen, Martin; Adamski, Jerzy; Boeing, Heiner; Kaaks, Rudolf; Pischon, Tobias

    2018-01-01

    Metabolomic approaches in prospective cohorts may offer a unique snapshot into early metabolic perturbations that are associated with a higher risk of cardiovascular diseases (CVD) in healthy people. We investigated the association of 105 serum metabolites, including acylcarnitines, amino acids, phospholipids and hexose, with risk of myocardial infarction (MI) and ischemic stroke in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam (27,548 adults) and Heidelberg (25,540 adults) cohorts. Using case-cohort designs, we measured metabolites among individuals who were free of CVD and diabetes at blood draw but developed MI (n = 204 and n = 228) or stroke (n = 147 and n = 121) during follow-up (mean, 7.8 and 7.3 years) and among randomly drawn subcohorts (n = 2214 and n = 770). We used Cox regression analysis and combined results using meta-analysis. Independent of classical CVD risk factors, ten metabolites were associated with risk of MI in both cohorts, including sphingomyelins, diacyl-phosphatidylcholines and acyl-alkyl-phosphatidylcholines with pooled relative risks in the range of 1.21-1.40 per one standard deviation increase in metabolite concentrations. The metabolites showed positive correlations with total- and LDL-cholesterol (r ranged from 0.13 to 0.57). When additionally adjusting for total-, LDL- and HDL-cholesterol, triglycerides and C-reactive protein, acyl-alkyl-phosphatidylcholine C36:3 and diacyl-phosphatidylcholines C38:3 and C40:4 remained associated with risk of MI. When added to classical CVD risk models these metabolites further improved CVD prediction (c-statistics increased from 0.8365 to 0.8384 in EPIC-Potsdam and from 0.8344 to 0.8378 in EPIC-Heidelberg). None of the metabolites was consistently associated with stroke risk. Alterations in sphingomyelin and phosphatidylcholine metabolism, and particularly metabolites of the arachidonic acid pathway are independently associated with risk of MI in

  16. The effect of Bobath approach on the excitability of the spinal alpha motor neurones in stroke patients with muscle spasticity.

    Science.gov (United States)

    Ansari, N N; Naghdi, S

    2007-01-01

    A clinical study was performed to evaluate the efficacy of the Bobath approach on the excitability of the spinal alpha motor neurones in patients with poststroke spasticity. Ten subjects ranging in age from 37 through 76 years (average 60 years) with ankle plantarflexor spasticity secondary to a stroke were recruited and completed the trial. They had physiotherapy according to Bobath concept for ten treatment sessions, three days per week. Two repeated measures, one before and another after treatment, were taken to quantify clinical efficacy. The effect of this type of therapy on the excitability of alpha motor neurones (aMN) was assessed by measuring the latency of the Hoffmann reflex (H-reflex) and the Hmax/Mmax ratio. The original Ashworth scale and ankle range of motion were also measured. The mean HmaxlMmax ratio on the affected side at baseline was high in the study patients. However, there were no statistically significant differences in the HmaxlMmax ratio or in the H-reflex latency between the baseline values and those recorded after therapy intervention. Before treatment, the HmaxlMmax ratio was significantly higher in the affected side than in the unaffected side. However, it was similar at both sides after treatment. Following treatment, the significant reduction in spasticity was clinically detected as measured with the original Ashworth scale. The ankle joint active and passive range of motion was significantly increased. In conclusion, Bobath therapy had a statistically significant effect on the excitability of the aMN in the affected side compared to the unaffected side in stroke patients with muscle spasticity.

  17. The effects of key parameters on the transition from SI combustion to HCCI combustion in a two-stroke free piston linear engine

    International Nuclear Information System (INIS)

    Hung, Nguyen Ba; Lim, Ocktaeck; Iida, Norimasa

    2015-01-01

    Highlights: • A free piston engine is modeled and simulated by three mathematical models. • The models include dynamic model, linear alternator model and thermodynamic model. • The SI-HCCI transition is successful if the key parameters are adjusted suitably. • Spring stiffness has a strong influence on reducing peak temperature in HCCI mode. • Adjusting spark timing helps the SI-HCCI transition to be more convenient. - Abstract: An investigation was conducted to examine the effects of key parameters such as intake temperature, equivalence ratio, engine load, intake pressure, spark timing and spring stiffness on the transition from SI combustion to HCCI combustion in a two-stroke free piston linear engine. Operation of the free piston engine was simulated based on the combination of three mathematical models including a dynamic model, a linear alternator model and a thermodynamic model. These mathematical models were combined and solved by a program written in Fortran. To validate the mathematical models, the simulation results were compared with experimental data in the SI mode. For the transition from SI combustion to HCCI combustion, the simulation results show that if the equivalence ratio is decreased, the intake temperature and engine load should be increased to get a successful SI-HCCI transition. However, the simulation results also show that the in-cylinder pressure is decreased, while the peak in-cylinder temperature in HCCI mode is increased significantly if the intake temperature is increased so much. Beside the successful SI-HCCI transition, the increase of intake pressure from P in = 1.1 bar to P in = 1.6 bar is one of solutions to reduce peak in-cylinder temperature in HCCI mode. However, the simulation results also indicate that if the intake pressure is increased so much (P in = 1.6 bar), the engine knocking problem is occurred. Adjusting spring stiffness from k = 2.9 N/mm to k = 14.7 N/mm is also considered one of useful solutions for

  18. An analysis of clinical transition stresses experienced by dental students: A qualitative methods approach.

    Science.gov (United States)

    Botelho, M; Gao, X; Bhuyan, S Y

    2018-04-17

    Stress in dental students is well established with potential psychological distress, emotional exhaustion and burnout-related symptoms. Little attention has been given to the problems encountered by dental students during the transition from theoretical or paraclinical training to the clinical environment. The aim of this study was to adopt a qualitative research methods approach to understand the perceived stressors during students' clinical transition and provide insights for curriculum planners to enhance learning. This study analysed four groups of 2nd- and 3rd-year BDS students' experiences in focus group interviews relating to their pre-clinical and clinical transitions. The interviews were recorded and transcribed verbatim, and a thematic analysis was performed using an inductive qualitative approach. Key overlapping domains identified were the transition gap and stresses. The transition gap was subclassified into knowledge and skill (hard and soft), and stresses was subcategorised into internal and external stresses. On first coming to clinics, students experienced knowledge gaps of unfamiliar clinical treatments with mismatches between knowledge acquisition and clinical exposure. Students felt incompetent owing to the stresses attributable to curriculum design, staff and the patient. This negatively affected their confidence and clinical performance. A range of challenges have been identified that will allow curriculum designer's to plan a more supportive learning experience to help students during their transition to clinical practice giving them timely knowledge, confidence and clinical performance to better prepare them for entering clinics. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Passenger flow analysis of Beijing urban rail transit network using fractal approach

    Science.gov (United States)

    Li, Xiaohong; Chen, Peiwen; Chen, Feng; Wang, Zijia

    2018-04-01

    To quantify the spatiotemporal distribution of passenger flow and the characteristics of an urban rail transit network, we introduce four radius fractal dimensions and two branch fractal dimensions by combining a fractal approach with passenger flow assignment model. These fractal dimensions can numerically describe the complexity of passenger flow in the urban rail transit network and its change characteristics. Based on it, we establish a fractal quantification method to measure the fractal characteristics of passenger follow in the rail transit network. Finally, we validate the reasonability of our proposed method by using the actual data of Beijing subway network. It has been shown that our proposed method can effectively measure the scale-free range of the urban rail transit network, network development and the fractal characteristics of time-varying passenger flow, which further provides a reference for network planning and analysis of passenger flow.

  20. Quantum scaling in many-body systems an approach to quantum phase transitions

    CERN Document Server

    Continentino, Mucio

    2017-01-01

    Quantum phase transitions are strongly relevant in a number of fields, ranging from condensed matter to cold atom physics and quantum field theory. This book, now in its second edition, approaches the problem of quantum phase transitions from a new and unifying perspective. Topics addressed include the concepts of scale and time invariance and their significance for quantum criticality, as well as brand new chapters on superfluid and superconductor quantum critical points, and quantum first order transitions. The renormalisation group in real and momentum space is also established as the proper language to describe the behaviour of systems close to a quantum phase transition. These phenomena introduce a number of theoretical challenges which are of major importance for driving new experiments. Being strongly motivated and oriented towards understanding experimental results, this is an excellent text for graduates, as well as theorists, experimentalists and those with an interest in quantum criticality.

  1. A crystal chemical approach to superconductivity. I. A bond-valence sum analysis of inorganic compounds

    International Nuclear Information System (INIS)

    Liebau, Friedrich; Klein, Hans-Joachim; Wang, Xiqu

    2011-01-01

    A crystal-chemical approach to superconductivity is described that is intended to complement the corresponding physical approach. The former approach takes into account the distinction between the stoichiometric valence ( stoich V) and the structural valence ( struct V) which is represented by the bond-valence sums (BVS). Through calculations of BVS values from crystal-structure data determined at ambient temperature and pressure it has been found that in chalcogenides und pnictides of the transition metals Fe, Co, Ni, Mn, Hf, and Zr the atoms of the potential superconducting units yield values of vertical stroke BVS vertical stroke = vertical stroke struct V vertical stroke ≥ 1.11 x vertical stroke stoich V vertical stroke, whereas the atoms of the charge reservoirs have in general values of vertical stroke struct V vertical stroke stoich V vertical stroke. In corresponding compounds which contain the same elements but are not becoming superconducting, nearly all atoms are found to have vertical stroke struct V vertical stroke stoich V vertical stroke. For atoms of oxocuprates that are not becoming superconducting and for atoms of the charge reservoirs of oxocuprates that become superconducting, the relation vertical stroke struct V vertical stroke stoich V vertical stroke seems also to be fulfilled, with the exception of Ba. However, in several oxocuprates the relation vertical stroke struct V vertical stroke = 1.11 x vertical stroke stoich V vertical stroke for the atoms that become superconducting units is violated. These violations seem to indicate that in oxocuprates it is the local bond-valence distribution rather than the bond-valence sums that is essential for superconductivity. The present analysis can possibly be used to predict, by a simple consideration of ambient-T, P structures, whether a compound can become an unconventional superconductor at low T, under high P and/or by doping, or not. (orig.)

  2. A modular RANS approach for modelling laminar–turbulent transition in turbomachinery flows

    International Nuclear Information System (INIS)

    Liang Wang; Song Fu; Carnarius, Angelo; Mockett, Charles; Thiele, Frank

    2012-01-01

    Highlights: ► We propose a laminar–turbulent transition model for turbomachinery applications. ► The model considers the effects of the various instability modes. ► The pressure–diffusion process is represented by an elliptic formulation. ► The mixed-mode transition scenario benefits from our modular prediction approach. - Abstract: In this study we propose a laminar–turbulent transition model, which considers the effects of the various instability modes that exist in turbomachinery flows. This model is based on a K–ω–γ three-equation eddy-viscosity concept with K representing the fluctuating kinetic energy, ω the specific dissipation rate and γ the intermittency factor. As usual, the local mechanics by which the freestream disturbances penetrate into the laminar boundary layer, namely convection and viscous diffusion, are described by the transport equations. However, as a novel feature, the non-local effects due to pressure diffusion are additionally represented by an elliptic formulation. Such an approach allows the present model to respond accurately to freestream turbulence intensity properly and to predict both long and short bubble lengths well. The success in its application to a 3-D cascade indicates that the mixed-mode transition scenario indeed benefits from such a modular prediction approach, which embodies current conceptual understanding of the transition process.

  3. From dictatorship to a reluctant democracy: stroke therapists talking about self-management.

    Science.gov (United States)

    Norris, Meriel; Kilbride, Cherry

    2014-01-01

    Self-management is being increasingly promoted within chronic conditions including stroke. Concerns have been raised regarding professional ownership of some programmes, yet little is known of the professional's experience. This paper aims to present the views of trained therapists about the utility of a specific self-management approach in stroke rehabilitation. Eleven stroke therapists trained in the self-management approach participated in semi-structured interviews. These were audio recorded, transcribed verbatim and analysed thematically. Two overriding themes emerged. The first was the sense that in normal practice therapists act as "benign dictators", committed to help their patients, but most comfortable when they, the professional, are in control. Following the adoption of the self-management approach therapists challenged themselves to empower stroke survivors to take control of their own recovery. However, therapists had to confront many internal and external challenges in this transition of power resulting in the promotion of a somewhat "reluctant democracy". This study illustrates that stroke therapists desire a more participatory approach to rehabilitation. However, obstacles challenged the successful delivery of this goal. If self-management is an appropriate model to develop in post stroke pathways, then serious consideration must be given to how and if these obstacles can be overcome. Stroke therapists perceive that self-management is appropriate for encouraging ownership of rehabilitation post stroke. Numerous obstacles were identified as challenging the implementation of self-management post stroke. These included: professional models, practices and expectations; institutional demands and perceived wishes of stroke survivors. For self-management to be effectively implemented by stroke therapists, these obstacles must be considered and overcome. This should be as part of an integrated therapy service, rather than as an add-on.

  4. Quantum Geometry: Relativistic energy approach to cooperative electron-nucleary-transition spectrum

    Directory of Open Access Journals (Sweden)

    Ольга Юрьевна Хецелиус

    2014-11-01

    Full Text Available An advanced relativistic energy approach is presented and applied to calculating parameters of electron-nuclear 7-transition spectra of nucleus in the atom. The intensities of the spectral satellites are defined in the relativistic version of the energy approach (S-matrix formalism, and gauge-invariant quantum-electrodynamical perturbation theory with the Dirac-Kohn-Sham density-functional zeroth approximation.

  5. An inverse-scattering approach to the physics of transition metals ...

    African Journals Online (AJOL)

    A method is developed for the deduction of a transition metal ion potential from a knowledge of the phase-shift. The method used is based the distorted plane – wave scattering approximation for the deduction of non singular potentials from scattering phase shifts in an inverse scattering approach. The resulting electron ...

  6. Stroke Unit: General principles and standards

    Directory of Open Access Journals (Sweden)

    Mehmet Akif Topçuoğlu

    2015-04-01

    Full Text Available Evidence-based medicinal methods have convincingly shown that stroke unit approach reduces mortality and disability rates, improves the quality of life and economic burden resulting from acute ischemic and hemorrhagic stroke. Any contemporary stroke system of care cannot be successful without putting the stroke unit concept in the center of its organization. Stroke units are the main elements of primary and comprehensive stroke centers. As a modernization process, this article focuses on practical issues and suggestions related to integration of the stroke unit approach to a regionally organized stroke system of care for perusal by not only national health authorities and service providers, but also neurologists. Stroke unit quality metrics revisited herein are of critical importance for hospitals establishing or renovating primary and comprehensive stroke centers.

  7. Child-Mediated Stroke Communication: findings from Hip Hop Stroke.

    Science.gov (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William

    2012-01-01

    Low thrombolysis rates for acute ischemic stroke are linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether "Child-Mediated Stroke Communication" could improve stroke literacy of parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke. Parents of children aged 9 to 12 years from 2 public schools in Harlem, New York City, were recruited to participate in stroke literacy questionnaires before and after their child's participation in Hip Hop Stroke, a novel Child-Mediated Stroke Communication intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week after the intervention. Fifth and sixth grade students (n=182) were enrolled into Hip Hop Stroke. One hundred two parents were approached in person to participate; 75 opted to participate and 71 completed both the pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program; before the program, 3 parents of 75 (3.9%) were able to identify the 5 cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911) compared with 21 of 71 parents (29.6%) postintervention (P<0.001). The FAST mnemonic was known by 2 (2.7%) of participants before the program versus 29 (41%) after program completion (P<0.001). Knowledge of stroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that school children aged 9 to 12 years may be effective conduits of critical stroke knowledge to their parents.

  8. GIS-based Approaches to Catchment Area Analyses of Mass Transit

    DEFF Research Database (Denmark)

    Andersen, Jonas Lohmann Elkjær; Landex, Alex

    2009-01-01

    Catchment area analyses of stops or stations are used to investigate potential number of travelers to public transportation. These analyses are considered a strong decision tool in the planning process of mass transit especially railroads. Catchment area analyses are GIS-based buffer and overlay...... analyses with different approaches depending on the desired level of detail. A simple but straightforward approach to implement is the Circular Buffer Approach where catchment areas are circular. A more detailed approach is the Service Area Approach where catchment areas are determined by a street network...... search to simulate the actual walking distances. A refinement of the Service Area Approach is to implement additional time resistance in the network search to simulate obstacles in the walking environment. This paper reviews and compares the different GIS-based catchment area approaches, their level...

  9. Ischemic Stroke

    Science.gov (United States)

    ... Workplace Giving Fundraise Planned Giving Corporate Giving Cause Marketing Join your team, your way! The Stroke Challenge ... Your Technology Guide High Blood Pressure and Stroke Importance of Physical Activity See More Multimedia Las minorías ...

  10. Paediatric stroke

    African Journals Online (AJOL)

    2011-04-02

    Apr 2, 2011 ... Organization definition of stroke is 'a clinical syndrome of rapidly developing focal or global ..... In the case of sickle cell disease primary and secondary prevention is by ... stroke and must involve caregivers. Prognosis7,10,17.

  11. A systems approach framework for the transition to sustainable development: Potential value based on coastal experiments

    DEFF Research Database (Denmark)

    Hopkins, Tom S.; Bailly, Denis; Elmgren, Ragnar

    2012-01-01

    This article explores the value of the Systems Approach Framework (SAF) as a tool for the transition to sustainable development in coastal zone systems, based on 18 study sites in Europe, where the SAF was developed and tested. The knowledge gained from these experiments concerns the practical......-dependent and system-independent problems, and the inclusion of non-market evaluations. It also develops a real partnership among research, management, and stakeholders to establish a quantitative basis for collaborative decision making. Furthermore, the article argues that the transition to sustainable development...

  12. Relativistic many-body theory of atomic transitions: the relativistic equation-of-motion approach

    International Nuclear Information System (INIS)

    Huang, K.N.

    1981-01-01

    An equation-of-motion approach is used to develop the relativistic many-body theory of atomic transitions. The relativistic equations of motion for transition matrices are formulated using techniques of quantum field theory. To reduce the equation of motion to a tractable form which is appropriate for numerical calculations, a graphical method is employed to resolve the complication arising from the antisymmetrization and angular momentum coupling. The relativistic equation-of-motion method allows an ab initio treatment of correlation and relativistic effects in both closed- and open-shell many-body systems. A special case of the present formulation reduces to the relativistic random-phase approximation

  13. Transition to Coherence in Populations of Coupled Chaotic Oscillators: A Linear Response Approach

    International Nuclear Information System (INIS)

    Topaj, Dmitri; Kye, Won-Ho; Pikovsky, Arkady

    2001-01-01

    We consider the collective dynamics in an ensemble of globally coupled chaotic maps. The transition to the coherent state with a macroscopic mean field is analyzed in the framework of the linear response theory. The linear response function for the chaotic system is obtained using the perturbation approach to the Frobenius-Perron operator. The transition point is defined from this function by virtue of the self-excitation condition for the feedback loop. Analytical results for the coupled Bernoulli maps are confirmed by the numerics

  14. Clinical neurogenetics: stroke.

    Science.gov (United States)

    Rost, Natalia S

    2013-11-01

    Understanding the genetic architecture of cerebrovascular disease holds promise of novel stroke prevention strategies and therapeutics that are both safe and effective. Apart from a few single-gene disorders associated with cerebral ischemia or intracerebral hemorrhage, stroke is a complex genetic phenotype that requires careful ascertainment and robust association testing for discovery and validation analyses. The recently uncovered shared genetic contribution between clinically manifest stroke syndromes and closely related intermediate cerebrovascular phenotypes offers effective and efficient approaches to complex trait analysis. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Transition state theory approach to polymer escape from a one dimensional potential well.

    Science.gov (United States)

    Mökkönen, Harri; Ikonen, Timo; Ala-Nissila, Tapio; Jónsson, Hannes

    2015-06-14

    The rate of escape of an ideal bead-spring polymer in a symmetric double-well potential is calculated using transition state theory (TST) and the results compared with direct dynamical simulations. The minimum energy path of the transitions becomes flat and the dynamics diffusive for long polymers making the Kramers-Langer estimate poor. However, TST with dynamical corrections based on short time trajectories started at the transition state gives rate constant estimates that agree within a factor of two with the molecular dynamics simulations over a wide range of bead coupling constants and polymer lengths. The computational effort required by the TST approach does not depend on the escape rate and is much smaller than that required by molecular dynamics simulations.

  16. Gravitational wave generation from bubble collisions in first-order phase transitions: An analytic approach

    International Nuclear Information System (INIS)

    Caprini, Chiara; Durrer, Ruth; Servant, Geraldine

    2008-01-01

    Gravitational wave production from bubble collisions was calculated in the early 1990s using numerical simulations. In this paper, we present an alternative analytic estimate, relying on a different treatment of stochasticity. In our approach, we provide a model for the bubble velocity power spectrum, suitable for both detonations and deflagrations. From this, we derive the anisotropic stress and analytically solve the gravitational wave equation. We provide analytical formulas for the peak frequency and the shape of the spectrum which we compare with numerical estimates. In contrast to the previous analysis, we do not work in the envelope approximation. This paper focuses on a particular source of gravitational waves from phase transitions. In a companion article, we will add together the different sources of gravitational wave signals from phase transitions: bubble collisions, turbulence and magnetic fields and discuss the prospects for probing the electroweak phase transition at LISA

  17. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

    Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

  18. Deconfinement phase transition in the Hamiltonian approach to Yang–Mills theory in Coulomb gauge

    Directory of Open Access Journals (Sweden)

    Reinhardt H.

    2014-04-01

    Full Text Available Recent results obtained for the deconfinement phase transition within the Hamiltonian approach to Yang–Mills theory are reviewed. Assuming a quasiparticle picture for the grand canonical gluon ensemble the thermal equilibrium state is found by minimizing the free energy with respect to the quasi-gluon energy. The deconfinement phase transition is accompanied by a drastic change of the infrared exponents of the ghost and gluon propagators. Above the phase transition the ghost form factor remains infrared divergent but its infrared exponent is approximately halved. The gluon energy being infrared divergent in the confined phase becomes infrared finite in the deconfined phase. Furthermore, the effective potential of the order parameter for confinement is calculated for SU(N Yang–Mills theory in the Hamiltonian approach by compactifying one spatial dimension and using a background gauge fixing. In the simplest truncation, neglecting the ghost and using the ultraviolet form of the gluon energy, we recover the Weiss potential. From the full non-perturbative potential (with the ghost included we extract a critical temperature of the deconfinement phase transition of 269 MeV for the gauge group SU(2 and 283 MeV for SU(3.

  19. Comparison of methodological approaches to identify economic activity regularities in transition economy

    Directory of Open Access Journals (Sweden)

    Jitka Poměnková

    2011-01-01

    Full Text Available Presented paper focuses on consideration and evaluation of methodical approaches to analyze cyclical structure character of economic activity in transition economy. As a starting point, work in time domain is applied, which is followed in frequency domain approach. Both approaches are viewed from methodical as well as application point of view and their advantage and disadvantage are discussed. Consequently, time-frequency domain approach is added and applied on real data. On the basis of obtained results recommendation is formulated. All discussed methodical approaches are also considered from the perspective of capability to evaluate behaving of business cycle in time of global economic crisis before/after year 2008. The empirical part of the paper deals with data of gross domestic product in the Czech Republic in 1996/Q1–2010/Q2.

  20. Multimodal Approaches for Regenerative Stroke Therapies: Combination of Granulocyte Colony-Stimulating Factor with Bone Marrow Mesenchymal Stem Cells is Not Superior to G-CSF Alone

    Directory of Open Access Journals (Sweden)

    Adrian Tudor Balseanu

    2014-06-01

    Full Text Available Attractive therapeutic strategies to enhance post-stroke recovery of aged brains include methods of cellular therapy that can enhance the endogenous restorative mechanisms of the injured brain. Since stroke afflicts mostly the elderly, it is highly desirable to test the efficacy of cell therapy in the microenvironment of aged brains that is generally refractory to regeneration. In particular, stem cells from the bone marrow allow an autologous transplantation approach that can be translated in the near future to the clinical practice. Such a bone marrow-derived therapy includes the grafting of stem cells as well as the delayed induction of endogenous stem cell mobilization and homing by the stem cell mobilizer granulocyte colony-stimulating factor (G-CSF. We tested the hypothesis that grafting of bone marrow-derived pre-differentiated mesenchymal cells (BM-MSCs in G-CSF-treated animals improves the long-term functional outcome in aged rodents. To this end, G-CSF alone (50 μg/kg or in combination with a single dose (106 cells of rat BM MSCs was administered intravenously to Sprague-Dawley rats at 6 h after transient occlusion (90 min of the middle cerebral artery. Infarct volume was measured by magnetic resonance imaging at 3 and 48 days post-stroke and additionally by immunhistochemistry at day 56. Functional recovery was tested during the entire post-stroke survival period of 56 days. Daily treatment for post-stroke aged rats with G-CSF led to a robust and consistent improvement of neurological function after 28 days. The combination therapy also led to robust angiogenesis in the formerly infarct core and beyond in the “islet of regeneration.” However, G-CSF + BM MSCs may not impact at all on the spatial reference-memory task or infarct volume and therefore did not further improve the post-stroke recovery. We suggest that in a real clinical practice involving older post-stroke patients, successful regenerative therapies

  1. A team leadership approach to managing the transition from construction to operations for an environmental project

    International Nuclear Information System (INIS)

    Kelly, J.W.

    1994-06-01

    This presentation describes a team approach, at the totalproject level that focused team members with common objectives, for the transition to start-up and operation of the project. The Integrated Management Team (IMT) approach has been successful for this US Department of Energy (DOE) environmental restoration project at the Hanford Site in Richland, Washington. The $53.8-million project will collect, treat, and dispose of low-level mixed waste water discharges from the Hanford Site. Construction is scheduled for completion in September 1994 and facility start-up in June 1995. The project challenge is for leadership that is committed to the transition from construction to operation of the environmental restoration project

  2. A THEORETICAL APPROACH TO THE TRANSITION FROM A RESOURCE BASED TO A KNOWLEDGE-ECONOMY

    Directory of Open Access Journals (Sweden)

    Diana GIOACASI

    2015-09-01

    Full Text Available Economic development and the emergence of new technologies have changed the optics on the factors that are generating added value. The transition from a resource-dependent economy to one focused on tangible non-financial factors has progressed in a gradual manner and took place under the influence of globalization and of the internet boom. The aim of this article is to provide a theoretical approach to this phenomenon from the perspective of the temporal evolution of enterprise resources.

  3. Different Strokes for Different Folks? Contrasting Approaches to Cultural Adaptation of Parenting Interventions.

    Science.gov (United States)

    Mejia, Anilena; Leijten, Patty; Lachman, Jamie M; Parra-Cardona, José Ruben

    2017-08-01

    Relevant achievements have been accomplished in prevention science with regard to disseminating efficacious parenting interventions among underserved populations. However, widespread disparities in availability of parenting services continue to negatively impact diverse populations in high-income countries (e.g., the USA) and low- and middle-income countries. As a result, a scholarly debate on cultural adaptation has evolved over the years. Specifically, some scholars have argued that in diverse cultural contexts, existing evidence-based parenting interventions should be delivered with strict fidelity to ensure effectiveness. Others have emphasized the need for cultural adaptations of interventions when disseminated among diverse populations. In this paper, we propose that discussions on cultural adaptation should be conceptualized as a "both-and," rather than an "either-or" process. To justify this stance, we describe three distinct parenting intervention projects to illustrate how cultural adaptation and efficacy of evidence-based interventions can be achieved using contrasting approaches and frameworks, depending on cultural preferences and available resources of local contexts. Further, we suggest the need to develop guidelines for consistent reporting of cultural adaptation procedures as a critical component of future investigations. This discussion is relevant for the broader public health field and prevention science.

  4. Effective and accurate approach for modeling of commensurate-incommensurate transition in krypton monolayer on graphite.

    Science.gov (United States)

    Ustinov, E A

    2014-10-07

    Commensurate-incommensurate (C-IC) transition of krypton molecular layer on graphite received much attention in recent decades in theoretical and experimental researches. However, there still exists a possibility of generalization of the phenomenon from thermodynamic viewpoint on the basis of accurate molecular simulation. Recently, a new technique was developed for analysis of two-dimensional (2D) phase transitions in systems involving a crystalline phase, which is based on accounting for the effect of temperature and the chemical potential on the lattice constant of the 2D layer using the Gibbs-Duhem equation [E. A. Ustinov, J. Chem. Phys. 140, 074706 (2014)]. The technique has allowed for determination of phase diagrams of 2D argon layers on the uniform surface and in slit pores. This paper extends the developed methodology on systems accounting for the periodic modulation of the substrate potential. The main advantage of the developed approach is that it provides highly accurate evaluation of the chemical potential of crystalline layers, which allows reliable determination of temperature and other parameters of various 2D phase transitions. Applicability of the methodology is demonstrated on the krypton-graphite system. Analysis of phase diagram of the krypton molecular layer, thermodynamic functions of coexisting phases, and a method of prediction of adsorption isotherms is considered accounting for a compression of the graphite due to the krypton-carbon interaction. The temperature and heat of C-IC transition has been reliably determined for the gas-solid and solid-solid system.

  5. Effective and accurate approach for modeling of commensurate–incommensurate transition in krypton monolayer on graphite

    International Nuclear Information System (INIS)

    Ustinov, E. A.

    2014-01-01

    Commensurate–incommensurate (C-IC) transition of krypton molecular layer on graphite received much attention in recent decades in theoretical and experimental researches. However, there still exists a possibility of generalization of the phenomenon from thermodynamic viewpoint on the basis of accurate molecular simulation. Recently, a new technique was developed for analysis of two-dimensional (2D) phase transitions in systems involving a crystalline phase, which is based on accounting for the effect of temperature and the chemical potential on the lattice constant of the 2D layer using the Gibbs–Duhem equation [E. A. Ustinov, J. Chem. Phys. 140, 074706 (2014)]. The technique has allowed for determination of phase diagrams of 2D argon layers on the uniform surface and in slit pores. This paper extends the developed methodology on systems accounting for the periodic modulation of the substrate potential. The main advantage of the developed approach is that it provides highly accurate evaluation of the chemical potential of crystalline layers, which allows reliable determination of temperature and other parameters of various 2D phase transitions. Applicability of the methodology is demonstrated on the krypton–graphite system. Analysis of phase diagram of the krypton molecular layer, thermodynamic functions of coexisting phases, and a method of prediction of adsorption isotherms is considered accounting for a compression of the graphite due to the krypton–carbon interaction. The temperature and heat of C-IC transition has been reliably determined for the gas–solid and solid–solid system

  6. How is the patient’s nutrition after a stroke?

    Science.gov (United States)

    Ballesteros Pomar, María D; Palazuelo Amez, Laura

    2017-05-08

    Neurological conditions usually cause altered levels of consciousness or swallowing mechanisms which make artificial nutritional support necessary. International guidelines recommend nutritional screening to detect malnutrition in patients with neurological diseases. Dysphagia is a common problem after a stroke, however, it is a treatable pathology, and swallowing rehabilitation allows for improving patients’ nutritional status. Awareness of this problem is required among healthcare professionals both for its diagnosis and for the implementation of nutritional intervention measures. Patients should be tested for dysphagia within the first 24 hours of the stroke onset; this swallowing assessment as well as malnutrition screening should never be delayed by more than 72 hours. The present study addresses diagnostic and therapeutic approaches, the indications of the different nutritional treatments available and the transition to oral feeding in patients who have had a stroke episode.

  7. Stroke treatment outcomes in hospitals with and without Stroke Units.

    Science.gov (United States)

    Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M

    2017-10-23

    Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. How to finance energy transition? Elements of analysis for a strategic approach

    International Nuclear Information System (INIS)

    Ruedinger, Andreas

    2015-01-01

    If regulatory and economic signals are the first determining factors for the launching of energy transition projects, financing tools are a major stake. But financing these projects is also facing two complementary challenges: the mobilisation of additional capital resources to face the needs, and the re-orientation of a part of this financing towards more efficient projects. In order to asses the consistency of financing tools, this study identifies three determining financing stakes: an inter-mediation with capital markets to mobilise capitals at low cost, a calibration of project financing mechanisms to meet the needs of the different actors and sectors and to limit transaction costs, and a better articulation between financial tools and regulatory tools. The authors thus propose an integrated approach to the stakes of transition financing

  9. Relativistic many-body theory of atomic transitions. The relativistic equation-of-motion approach

    International Nuclear Information System (INIS)

    Huang, K.

    1982-01-01

    An equation-of-motion approach is used to develop the relativistic many-body theory of atomic transitions. The relativistic equations of motion for transition matrices are formulated with the use of techniques of quantum-field theory. To reduce the equations of motion to a tractable form which is appropriate for numerical calculations, a graphical method to resolve the complication arising from the antisymmetrization and angular-momentum coupling is employed. The relativistic equation-of-motion method allows an ab initio treatment of correlation and relativistic effects in both closed- and open-shell many-body systems. A special case of the present formulation reduces to the relativistic random-phase approximation

  10. Computed Tomography Perfusion Alberta Stroke Program Early Computed Tomography Score Is Associated with Hemorrhagic Transformation after Acute Cardioembolic Stroke

    Directory of Open Access Journals (Sweden)

    Lan Liu

    2017-11-01

    Full Text Available Alberta Stroke Program Early Computed Tomography (CT score (ASPECTS has been applied to CT perfusion (CTP with good interrater agreement to predict early ischemic stroke, and it can be useful in decision making in acute ischemic stroke. The aim of the present study was to assess the predictive value of CTP ASPECTS of hemorrhagic transformation (HT in acute cardioembolic stroke. This is a single-enter, retrospective study. All patients hospitalized with acute cardioembolic stroke from January 2008 to September 2013 were included. ASPECTS of baseline non-contrast CT, CTP maps of cerebral blood volume (CBV, cerebral blood flow, and mean transit time were collected from 52 consecutive patients with less than 12-h anterior circulation ischemic stroke. MRI scan was performed within 72 h of symptom onset after index stroke including T2*-weighted gradient echo to identify HT. For bleeding risk assessment, CTP and diffusion-weighted imaging ASPECTS were categorized into 0–7 or 8–10. Baseline characteristics, ASPCETS scores and HT were compared. Eighteen (34.6% patients had HT and four (7.7% developed symptomatic HT. On univariate analysis, the proportion of patients with CBV-ASPECTS 0–7 was significantly higher in HT patients as compared to patients without HT (44 versus 9%, P = 0.005. CBV ASPECTS 0–7 remained independent prognostic factors for HT after adjustment for clinical baseline variables. CBV ASPECTS could be of value to predict HT risk after acute cardioembolic stroke and may be a quick risk assessment approach before reperfusion therapy.

  11. Effects of an aquatic therapy approach (Halliwick-Therapy) on functional mobility in subacute stroke patients: a randomized controlled trial.

    Science.gov (United States)

    Tripp, Florian; Krakow, Karsten

    2014-05-01

    To evaluate the effects of an aquatic physiotherapy method (Halliwick-Therapy) upon mobility in the post-acute phase of stroke rehabilitation. Randomized controlled trial. Hospital for neurological rehabilitation. Adult patients after first-ever stroke in post-acute inpatient rehabilitation at least two weeks after the onset of stroke (n = 30). In the Halliwick-Therapy group (n = 14) the treatment over a period of two weeks included 45 minutes of aquatic therapy three times per week and a conventional physiotherapeutic treatment twice a week. Subjects in the control group (n = 16) received conventional physiotherapeutic treatment over a period of two weeks five times per week. The primary outcome variable was postural stability (Berg Balance Scale). Secondary outcome variables were functional reach, functional gait ability and basic functional mobility. Compared to the control group, significantly more subjects in the Halliwick-Therapy group (83.3% versus 46.7%) attained significant improvement of the Berg Balance Scale (P stroke patients in post-acute rehabilitation and has positive effects upon some aspects of mobility.

  12. Nostalgia, Transition and the School: An Innovative Approach of Using Photographic Images as a Visual Method in Educational Research

    Science.gov (United States)

    Shohel, M. Mahruf C.

    2012-01-01

    The context of the study reported in this paper is the difficulties of transition from nonformal primary schools to formal secondary schools in Bangladesh. The difficulties affecting a smooth school transition relate not only to the making of new relationships and adapting to new norms in a new environment, but also to a very different approach to…

  13. Towards a comprehensive approach for managing transitions of older workers with hearing loss.

    Science.gov (United States)

    Fok, Daniel; Shaw, Lynn; Jennings, Mary Beth; Cheesman, Margaret

    2009-01-01

    Demographic and legislative trends suggest that many older workers may remain at work past the traditional retirement age. This extended work trajectory poses new challenges and opportunities for workers with acquired hearing loss as they age. Workplaces require a new approach to enable transitions of older workers with hearing loss to remain safe and productive. A review of the literature on older workers, those with hearing loss, and strategies used to accommodate them suggests that individualized and piecemeal approaches are predominant. While universal design represents a fresh ideology that may help create more accessible and usable products and environments, its application to improve workplaces for older workers with hearing loss is limited. This paper proposes that occupational science be integrated with knowledge in hearing sciences, accessibility, and usability to assist with the transitions faced by older workers with hearing loss. A more comprehensive approach including the following three key components will be posited to examine the nexus of aging, hearing loss and work: (1) the use of an occupational perspective, along with concepts in hearing sciences to examine hearing demands and improve hearing access; (2) the use of contextual processes to promote physical and social change, and (3) the inclusion of Universal Design for Hearing (UDH) considerations as stakeholders develop more hearing friendly workplaces.

  14. Using a State-and-Transition Approach to Manage Endangered Eucalyptus albens (White Box) Woodlands

    Science.gov (United States)

    Spooner, Peter G.; Allcock, Kimberly G.

    2006-11-01

    Eucalyptus albens (White Box) woodlands are among the most poorly conserved and threatened communities in Australia. Remnants are under further threat from stock grazing, deteriorating soil conditions, weed invasion, and salinity. There is an urgent need to restore degraded White Box and other woodland ecosystems to improve landscape function. However, there is still a poor understanding of the ecology of degraded woodland ecosystems in fragmented agricultural landscapes, and consequently a lack of precise scientific guidelines to manage these ecosystems in a conservation context. State and Transition Models (STMs) have received a great deal of attention, mainly in rangeland applications, as a suitable framework for understanding the ecology of complex ecosystems and to guide management. We have developed a STM for endangered White Box woodlands and discuss the merits of using this approach for land managers of other endangered ecosystems. An STM approach provides a greater understanding of the range of states, transitions, and thresholds possible in an ecosystem, and provides a summary of processes driving the system. Importantly, our proposed STM could be used to clarify the level of “intactness” of degraded White Box woodland sites, and provide the impetus to manage different states in complementary ways, rather than attempting to restore ecosystems to one pristine stable state. We suggest that this approach has considerable potential to integrate researcher and land manager knowledge, focus future experimental studies, and ultimately serve as a decision support tool in setting realistic and achievable conservation and restoration goals.

  15. Simulation and evaluation of urban rail transit network based on multi-agent approach

    Directory of Open Access Journals (Sweden)

    Xiangming Yao

    2013-03-01

    Full Text Available Purpose: Urban rail transit is a complex and dynamic system, which is difficult to be described in a global mathematical model for its scale and interaction. In order to analyze the spatial and temporal characteristics of passenger flow distribution and evaluate the effectiveness of transportation strategies, a new and comprehensive method depicted such dynamic system should be given. This study therefore aims at using simulation approach to solve this problem for subway network. Design/methodology/approach: In this thesis a simulation model based on multi-agent approach has been proposed, which is a well suited method to design complex systems. The model includes the specificities of passengers’ travelling behaviors and takes into account of interactions between travelers and trains. Findings: Research limitations/implications: We developed an urban rail transit simulation tool for verification of the validity and accuracy of this model, using real passenger flow data of Beijing subway network to take a case study, results show that our simulation tool can be used to analyze the characteristic of passenger flow distribution and evaluate operation strategies well. Practical implications: The main implications of this work are to provide decision support for traffic management, making train operation plan and dispatching measures in emergency. Originality/value: A new and comprehensive method to analyze and evaluate subway network is presented, accuracy and computational efficiency of the model has been confirmed and meet with the actual needs for large-scale network.

  16. Dynamics of a lightning corona sheath—A constant field approach using the generalized traveling current source return stroke model

    Science.gov (United States)

    Cvetic, Jovan; Heidler, Fridolin; Markovic, Slavoljub; Radosavljevic, Radovan; Osmokrovic, Predrag

    2012-11-01

    A generalized lightning traveling current source return stroke model has been used to examine the characteristics of the lightning channel corona sheath surrounding a thin channel core. A model of the lightning channel consisting of a charged corona sheath and a narrow, highly conducting central core that conducts the main current flow is assumed. Strong electric field, with a predominant radial direction, has been created during the return stroke between the channel core and the outer channel sheath containing the negative charge. The return stroke process is modeled with the positive charge coming from the channel core discharging the negative leader charge in the corona sheath. The corona sheath model that predicts the charge motion in the sheath is used to derive the expressions of the sheath radius vs. time during the return stroke. According to the corona sheath model proposed earlier by Maslowski and Rakov (2006) and Maslowski et al. (2009), it consists of three zones, zone 1 (surrounding channel core with net positive charge), zone 2 (surrounding zone 1 with negative charge) and zone 3 (outer zone representing the virgin air without charges). We adopted the assumption of a constant electric field inside zone 1 of the corona sheath observed in the experimental research of corona discharges in a coaxial geometry by Cooray (2000). This assumption seems to be more realistic than the assumption of a uniform corona space charge density used previously in the study of Maslowski and Rakov (2006), Marjanovic and Cvetic (2009), and Tausanovic et al. (2010). Applying the Gauss' law on the infinitesimally small cylindrical section of the channel the expressions for time-dependence of the radii of zones 1 and 2 during the return stroke are derived. The calculations have shown that the overall channel dynamics concerning electrical discharge is roughly 50% slower and the maximum radius of zone 1 is about 33% smaller compared to the corresponding values calculated in the

  17. The Stroke RiskometerTM App: Validation of a data collection tool and stroke risk predictor

    NARCIS (Netherlands)

    P. Parmar (Priya); R. Krishnamurthi (Rita); M.A. Ikram (Arfan); A. Hofman (Albert); S.S. Mirza (Saira); Y. Varakin (Yury); M. Kravchenko (Michael); M. Piradov (Michael); A.G. Thrift (Amanda G.); B. Norrving (Bo); W. Wang (Wenzhi); D.K. Mandal (Dipes Kumar); S. Barker-Collo (Suzanne); R. Sahathevan (Ramesh); S.M. Davis (Stephen); G. Saposnik (Gustavo); M. Kivipelto (Miia); S. Sindi (Shireen); S.R. Bornstein (Stefan); M. Giroud (Maurice); Y. Béjot (Yannick); M. Brainin (Michael); R. Poulton (Richie); K.M.V. Narayan (K. M. Venkat); M. Correia (Manuel); A. Freire (António); Y. Kokubo (Yoshihiro); D. Wiebers (David); F.K.F. Mensah (Fane ); N.F. Bindhim (Nasser); P.A. Barber (P. Alan); N.G. Pandian (Natesa); G.J. Hankey (Graeme); M.M. Mehndiratta (Man Mohan); S. Azhagammal (Shobhana); N.M. Ibrahim (Norlinah Mohd); M. Abbott (Max); E. Rush (Elaine); P. Hume (Patria); T. Hussein (Tasleem); R. Bhattacharjee (Rohit); M. Purohit (Mitali); V.L. Feigin (V.)

    2015-01-01

    textabstractBackground: The greatest potential to reduce the burden of stroke is by primary prevention of first-ever stroke, which constitutes three quarters of all stroke. In addition to population-wide prevention strategies (the 'mass' approach), the 'high risk' approach aims to identify

  18. Beyond agricultural innovation systems? Exploring an agricultural innovation ecosystems approach for niche design and development in sustainability transitions

    NARCIS (Netherlands)

    Pigford, Ashlee Ann E.; Hickey, Gordon M.; Klerkx, Laurens

    2018-01-01

    Well-designed and supported innovation niches may facilitate transitions towards sustainable agricultural futures, which may follow different approaches and paradigms such as agroecology, local place-based food systems, vertical farming, bioeconomy, urban agriculture, and smart farming or digital

  19. Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations-Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke.

    Science.gov (United States)

    Cohen, José E; Leker, Ronen R; Gomori, J Moshe; Eichel, Roni; Rajz, Gustavo; Moscovici, Samuel; Itshayek, Eyal

    2016-12-01

    Patients suffering from acute atherothrombotic occlusion of the proximal vertebral artery (VA) and concomitant basilar artery (BA) occlusion present a grim prognosis. We describe our experience in the endovascular recanalization of tandem vertebrobasilar occlusions using endovascular techniques. The BA was accessed through the normal VA (clean-road) or the occluded, thrombotic VA (dirty-road), and stentriever-based thrombectomy was performed using antegrade or reverse revascularization variants. Seven patients underwent successful stentriever-assisted mechanical thrombectomy of the BA and five sustained concomitant VA revascularization. Stroke onset to endovascular intervention initiation (time-to-treatment) ranged from 4.5-13hours (mean 8.6). In two of seven patients, the BA occlusion was approached with a 'clean-road' approach via the contralateral VA; in five of seven patients, a 'dirty-road' approach via the occluded VA was used. Mean time-to-recanalization was 66minutes (range 55-82). There were no perforations, iatrogenic vessel dissections, or other technical complications. Four patients presented mild-to-moderate disability (modified Rankin Scale [mRS] 0-3) at 3months, one remained with moderate-to-severe disability (mRS 4), and two patients died on days 9 and 23 after their strokes. Follow-up ranged from 6-45months (mean 24months). In selected patients with acute VA-BA occlusion, stentriever-based thrombectomy performed through either the patent or the occluded VA, may be feasible, effective, and safe. Clinical outcomes in these patients seem to equipoise the neurological outcome of patients with successful revascularization for isolated BA occlusion. This unique pair of occlusions confirms the role of VA ostium stenosis as a cause of vertebrobasilar stroke. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Detecting Transitions in Manual Tasks from Wearables: An Unsupervised Labeling Approach

    Directory of Open Access Journals (Sweden)

    Sebastian Böttcher

    2018-03-01

    Full Text Available Authoring protocols for manual tasks such as following recipes, manufacturing processes or laboratory experiments requires significant effort. This paper presents a system that estimates individual procedure transitions from the user’s physical movement and gestures recorded with inertial motion sensors. Combined with egocentric or external video recordings, this facilitates efficient review and annotation of video databases. We investigate different clustering algorithms on wearable inertial sensor data recorded on par with video data, to automatically create transition marks between task steps. The goal is to match these marks to the transitions given in a description of the workflow, thus creating navigation cues to browse video repositories of manual work. To evaluate the performance of unsupervised algorithms, the automatically-generated marks are compared to human expert-created labels on two publicly-available datasets. Additionally, we tested the approach on a novel dataset in a manufacturing lab environment, describing an existing sequential manufacturing process. The results from selected clustering methods are also compared to some supervised methods.

  1. Improving the iterative Linear Interaction Energy approach using automated recognition of configurational transitions.

    Science.gov (United States)

    Vosmeer, C Ruben; Kooi, Derk P; Capoferri, Luigi; Terpstra, Margreet M; Vermeulen, Nico P E; Geerke, Daan P

    2016-01-01

    Recently an iterative method was proposed to enhance the accuracy and efficiency of ligand-protein binding affinity prediction through linear interaction energy (LIE) theory. For ligand binding to flexible Cytochrome P450s (CYPs), this method was shown to decrease the root-mean-square error and standard deviation of error prediction by combining interaction energies of simulations starting from different conformations. Thereby, different parts of protein-ligand conformational space are sampled in parallel simulations. The iterative LIE framework relies on the assumption that separate simulations explore different local parts of phase space, and do not show transitions to other parts of configurational space that are already covered in parallel simulations. In this work, a method is proposed to (automatically) detect such transitions during the simulations that are performed to construct LIE models and to predict binding affinities. Using noise-canceling techniques and splines to fit time series of the raw data for the interaction energies, transitions during simulation between different parts of phase space are identified. Boolean selection criteria are then applied to determine which parts of the interaction energy trajectories are to be used as input for the LIE calculations. Here we show that this filtering approach benefits the predictive quality of our previous CYP 2D6-aryloxypropanolamine LIE model. In addition, an analysis is performed of the gain in computational efficiency that can be obtained from monitoring simulations using the proposed filtering method and by prematurely terminating simulations accordingly.

  2. TU-C-BRE-10: A Streamlined Approach to EPID Transit Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Morris, B; Fontenot, J [Louisiana State University, Baton Rouge, LA (United States); Mary Bird Perkins Cancer Center, Baton Rouge, LA (United States)

    2014-06-15

    Purpose: To investigate the feasibility of a simple and efficient transit dosimetry method using the electronic portal imaging device (EPID) for dose delivery error detection and prevention. Methods: In the proposed method, 2D reference transit images are generated for comparison with online images acquired during treatment. Reference transit images are generated by convolving through-air EPID measurements of each field with pixel-specific kernels selected from a library of pre-calculated Monte Carlo pencil kernels of varying radiological thickness. The kernel used for each pixel is selected based on the calculated radiological thickness of the patient along a line joining the pixel and the virtual source. The accuracy of the technique was evaluated in flat homogeneous and heterogeneous plastic water phantoms, a heterogeneous cylindrical phantom, and an anthropomorphic head phantom. Gamma criteria of 3%/3 mm was used to quantify the accuracy of the technique for the various cases. Results: An average of 99.9% and 99.7% of the points in the comparison between the measured and predicted images passed a 3%/3mm gamma for the homogeneous and heterogeneous plastic water phantoms, respectively. 97.1% of the points passed for the analysis of the heterogeneous cylindrical phantom. For the anthropomorphic head phantom, an average of 97.8% of points passed the 3%/3mm gamma criteria for all field sizes. Failures were observed primarily in areas of drastic thickness or material changes and at the edges of the fields. Conclusion: The data suggest that the proposed transit dosimetry method is a feasible approach to in vivo dose monitoring. Future research efforts could include implementation for more complex fields and sensitivity testing of the method to setup errors and changes in anatomy. Oncology Data Systems provided partial funding support but did not participate in the collection or analysis of data.

  3. Dynamic conductivity from audio to optical frequencies of semiconducting manganites approaching the metal-insulator transition

    Science.gov (United States)

    Lunkenheimer, P.; Mayr, F.; Loidl, A.

    2006-07-01

    We report the frequency-dependent conductivity of the manganite system La1-xSrxMnO3 (x0.2) when approaching the metal-insulator transition from the insulating side. Results from low-frequency dielectric measurements are combined with spectra in the infrared region. For low doping levels the behavior is dominated by hopping transport of localized charge carriers at low frequencies and by phononic and electronic excitations in the infrared region. For the higher Sr contents the approach of the metallic state is accompanied by the successive suppression of the hopping contribution at low frequencies and by the development of polaronic excitations in the infrared region, which finally become superimposed by a strong Drude contribution in the fully metallic state.

  4. Dynamic conductivity from audio to optical frequencies of semiconducting manganites approaching the metal-insulator transition

    International Nuclear Information System (INIS)

    Lunkenheimer, P.; Mayr, F.; Loidl, A.

    2006-01-01

    We report the frequency-dependent conductivity of the manganite system La 1-x Sr x MnO 3 (x≤0.2) when approaching the metal-insulator transition from the insulating side. Results from low-frequency dielectric measurements are combined with spectra in the infrared region. For low doping levels the behavior is dominated by hopping transport of localized charge carriers at low frequencies and by phononic and electronic excitations in the infrared region. For the higher Sr contents the approach of the metallic state is accompanied by the successive suppression of the hopping contribution at low frequencies and by the development of polaronic excitations in the infrared region, which finally become superimposed by a strong Drude contribution in the fully metallic state. (Abstract Copyright [2006], Wiley Periodicals, Inc.)

  5. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

    Langhorne, P.; Bernhardt, J.; Kwakkel, G.

    2011-01-01

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially

  6. An integral approach to corporate environmentalism and its application to a country in transition

    Directory of Open Access Journals (Sweden)

    Domen Bajde

    2012-06-01

    Full Text Available In this paper we propose and implement an integral approach to corporate environmentalism. Our integral model accounts not only for corporate environmentalism motivation and conception but also for corporate environmentalism mode and speed of implementation. A broad range of identified corporate environmentalism dimensions helps characterize fi ve basic groups of companies we propose to name “non-compliers,” “legalistic incrementalists,” “greenwashers,” “incremental innovators,” and “radical innovators.” We then seek to empirically verify the soundness of the proposed integral typology by surveying a large sample of Slovenian manufacturing companies. Maximum likelihood probit estimation, exploratory factor analysis, cluster analysis andbinary logistic modeling are used in the empirical analysis. Our main conclusions are twofold: (1 The integral approach to corporate environmentalism works: in the framework of a small open transitional economy, the model differentiates wellamong different groups of companies. (2 There are no radical innovators among Slovenian companies, and less than one third of the companies are actively thinking and acting in line of environment-friendly processes and products. This fi nding can be partially explained by the fact that Slovenian economy still has some transitional characteristics.

  7. Meeting the Late-Career Needs of Faculty Transitioning Through Retirement: One Institution's Approach.

    Science.gov (United States)

    Cain, Joanna M; Felice, Marianne E; Ockene, Judith K; Milner, Robert J; Congdon, John L; Tosi, Stephen; Thorndyke, Luanne E

    2018-03-01

    Medical school faculty are aging, but few academic health centers are adequately prepared with policies, programs, and resources (PPR) to assist late-career faculty. The authors sought to examine cultural barriers to successful retirement and create alignment between individual and institutional needs and tasks through PPR that embrace the contributions of senior faculty while enabling retirement transitions at the University of Massachusetts Medical School, 2013-2017. Faculty 50 or older were surveyed, programs at other institutions and from the literature (multiple fields) were reviewed, and senior faculty and leaders, including retired faculty, were engaged to develop and implement PPR. Cultural barriers were found to be significant, and a multipronged, multiyear strategy to address these barriers, which sequentially added PPR to support faculty, was put in place. A comprehensive framework of sequenced PPR was developed to address the needs and tasks of late-career transitions within three distinct phases: pre-retirement, retirement, and post-retirement. This sequential introduction approach has led to important outcomes for all three of the retirement phases, including reduction of cultural barriers, a policy that has been useful in assessing viability of proposed phased retirement plans, transparent and realistic discussions about financial issues, and consideration of roles that retired faculty can provide. The authors are tracking the issues mentioned in consultations and efficacy of succession planning, and will be resurveying faculty to further refine their work. This framework approach could serve as a template for other academic health centers to address late-career faculty development.

  8. Training symmetry of weight distribution after stroke: a randomized controlled pilot study comparing task-related reach, Bobath and feedback training approaches.

    Science.gov (United States)

    Mudie, M H; Winzeler-Mercay, U; Radwan, S; Lee, L

    2002-09-01

    To determine (1) the most effective of three treatment approaches to retrain seated weight distribution long-term after stroke and (2) whether improvements could be generalized to weight distribution in standing. Inpatient rehabilitation unit. Forty asymmetrical acute stroke subjects were randomly allocated to one of four groups in this pilot study. Changes in weight distribution were compared between the 10 subjects of each of three treatment groups (task-specific reach, Bobath, or Balance Performance Monitor [BPM] feedback training) and a no specific treatment control group. One week of measurement only was followed by two weeks of daily training sessions with the treatment to which the subject was randomly allocated. Measurements were performed using the BPM daily before treatment sessions, two weeks after cessation of treatment and 12 weeks post study. Weight distribution was calculated in terms of mean balance (percentage of total body weight) or the mean of 300 balance points over a 30-s data run. In the short term, the Bobath approach was the most effective treatment for retraining sitting symmetry after stroke (p = 0.004). Training with the BPM and no training were also significant (p = 0.038 and p = 0.035 respectively) and task-specific reach training failed to reach significance (p = 0.26). At 12 weeks post study 83% of the BPM training group, 38% of the task-specific reach group, 29% of the Bobath group and 0% of the untrained group were found to be distributing their weight to both sides. Some generalization of symmetry training in sitting to standing was noted in the BPM training group which appeared to persist long term. Results should be treated with caution due to the small group sizes. However, these preliminary findings suggest that it might be possible to restore postural symmetry in sitting in the early stages of rehabilitation with therapy that focuses on creating an awareness of body position.

  9. Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study.

    Science.gov (United States)

    Langhammer, B; Stanghelle, J K

    2000-08-01

    To examine whether two different physiotherapy regimes caused any differences in outcome in rehabilitation after acute stroke. A double-blind study of patients with acute first-ever stroke. Sixty-one patients were consecutively included, block randomized into two groups, and stratified according to gender and hemiplegic site. Group 1 (33 patients) and group 2 (28 patients) had physiotherapy according to Motor Relearning Programme (MRP) and Bobath, respectively. The supplemental treatment did not differ in the two groups. The Motor Assessment Scale (MAS), the Sødring Motor Evaluation Scale (SMES), the Barthel ADL Index and the Nottingham Health Profile (NHP) were used. The following parameters were also registered: length of stay in the hospital, use of assistive devices for mobility, and the patient's accommodation after discharge from the hospital. Patients treated according to MRP stayed fewer days in hospital than those treated according to Bobath (mean 21 days versus 34 days, p = 0.008). Both groups improved in MAS and SMES, but the improvement in motor function was significantly better in the MRP group. The two groups improved in Barthel ADL Index without significant differences between the groups. However, women treated by MRP improved more in ADL than women treated by Bobath. There were no differences between the groups in the life quality test (NHP), use of assistive devices or accommodation after discharge from the hospital. The present study indicates that physiotherapy treatment using the MRP is preferable to that using the Bobath programme in the acute rehabilitation of stroke patients.

  10. Exploring multifunctional agriculture. A review of conceptual approaches and prospects for an integrative transitional framework.

    Science.gov (United States)

    Renting, H; Rossing, W A H; Groot, J C J; Van der Ploeg, J D; Laurent, C; Perraud, D; Stobbelaar, D J; Van Ittersum, M K

    2009-05-01

    In the last decade the multifunctional agriculture (MFA) concept has emerged as a key notion in scientific and policy debates on the future of agriculture and rural development. Broadly speaking, MFA refers to the fact that agricultural activity beyond its role of producing food and fibre may also have several other functions such as renewable natural resources management, landscape and biodiversity conservation and contribution to the socio-economic viability of rural areas. The use of the concept can be traced to a number of wider societal and political transformation processes, which have influenced scientific and policy approaches in different ways amongst countries and disciplines. This paper critically discusses various existing research approaches to MFA, both from natural and social sciences. To this aim different strands of literature are classified according to their focus on specific governance mechanisms and levels of analysis into four main categories of research approaches (market regulation, land-use approaches, actor-oriented and public regulation approaches). For each category an overview of the state-of-the-art of research is given and an assessment is made of its strengths and weaknesses. The review demonstrates that the multifunctionality concept has attracted a wealth of scientific contributions, which have considerably improved our understanding of key aspects of MFA. At the same time approaches in the four categories have remained fragmented and each has limitations to understand MFA in all its complexity due to inherent constraints of applied conceptualizations and associated disciplinary backgrounds. To go beyond these limitations, we contend, new meta-level frameworks of analysis are to be developed that enable a more integrated approach. The paper concludes by presenting the main lines of an integrative, transitional framework for the study of MFA, which analyses multifunctional agriculture against the background of wider societal change

  11. Time dependent transition of the levels of protein-conjugated acrolein (PC-Acro), IL-6 and CRP in plasma during stroke.

    Science.gov (United States)

    Yoshida, Madoka; Kato, Naoki; Uemura, Takeshi; Mizoi, Mutsumi; Nakamura, Mizuho; Saiki, Ryotaro; Hatano, Keisuke; Sato, Kunitomo; Kakizaki, Shota; Nakamura, Aya; Ishii, Takuya; Terao, Tohru; Murayama, Yuichi; Kashiwagi, Keiko; Igarashi, Kazuei

    2017-06-01

    Measurement of plasma levels of protein-conjugated acrolein (PC-Acro) together with IL-6 and CRP can be used to identify silent brain infarction (SBI) with high sensitivity and specificity. The aim of this study was to determine how these biomarkers vary during stroke. Levels of PC-Acro, IL-6 and CRP in plasma were measured on day 0, 2, 7 and 14 after the onset of ischemic or hemorrhagic stroke. After the onset of stroke, the level of PC-Acro in plasma was elevated corresponding to the size of stroke. It returned to near control levels by day 2, and remained similar through day 14. The degree of the decrease in PC-Acro on day 2 was greater when the size of brain infarction or hemorrhage was larger. An increase in IL-6 and CRP occurred after the increase in PC-Acro, and it was well correlated with the size of the injury following infarction or hemorrhage. The results suggest that acrolein becomes a trigger for the production of IL-6 and CRP, as previously observed in a mouse model of stroke and in cell culture systems. The increase in IL-6 and CRP was also correlated with poor outcome judging from mRS. The results indicate that the degree of the decrease in PC-Acro and the increase in IL-6 and CRP from day 0 to day 2 was correlated with the size of brain infarction, and the increase in IL-6 and CRP with poor outcome at discharge.

  12. Problematising risk in stroke rehabilitation.

    Science.gov (United States)

    Egan, Mary Y; Kessler, Dorothy; Ceci, Christine; Laliberté-Rudman, Debbie; McGrath, Colleen; Sikora, Lindsey; Gardner, Paula

    2016-11-01

    Following stroke, re-engagement in personally valued activities requires some experience of risk. Risk, therefore, must be seen as having positive as well as negative aspects in rehabilitation. Our aim was to identify the dominant understanding of risk in stroke rehabilitation and the assumptions underpinning these understandings, determine how these understandings affect research and practise, and if necessary, propose alternate ways to conceptualise risk in research and practise. Alvesson and Sandberg's method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives. Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation. Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation. Implications for rehabilitation Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation. The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke. The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or

  13. Vibrational transitions in hydrogen bonded bimolecular complexes – A local mode perturbation theory approach to transition frequencies and intensities

    DEFF Research Database (Denmark)

    Mackeprang, Kasper; Kjærgaard, Henrik Grum

    2017-01-01

    The local mode perturbation theory (LMPT) model was developed to improve the description of hydrogen bonded XH-stretching transitions, where X is typically O or N. We present a modified version of the LMPT model to extend its application from hydrated bimolecular complexes to hydrogen bonded...

  14. Recovery of Dysphagia in Lateral Medullary Stroke

    Directory of Open Access Journals (Sweden)

    Hitesh Gupta

    2014-01-01

    Full Text Available Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

  15. Recovery of Dysphagia in lateral medullary stroke.

    Science.gov (United States)

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

  16. Recovery of Dysphagia in Lateral Medullary Stroke

    Science.gov (United States)

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function. PMID:25045555

  17. Preventing stroke

    Science.gov (United States)

    ... with which you were born Changes to your lifestyle You can change some risk factors for stroke, ... sodium (salt). Read labels and stay away from unhealthy fats. Avoid foods with: Saturated fat Partially-hydrogenated ...

  18. Stroke Rehabilitation

    Science.gov (United States)

    ... of the effects of a stroke Trouble swallowing (dysphagia) Problems with bowel or bladder control Fatigue Difficulty ... NINDS Focus on Disorders Alzheimer's & Related Dementias Epilepsy Parkinson's Disease Spinal Cord Injury Traumatic Brain Injury Focus ...

  19. An Ecological Approach to Seeking and Utilising the Views of Young People with Intellectual Disabilities in Transition Planning

    Science.gov (United States)

    Small, Neil; Raghavan, Raghu; Pawson, Nicole

    2013-01-01

    Transition planning using a person-centred approach has, in the main, failed to shape service provision. We offer an alternative based on an ecological understanding of human development linked to public health approaches that prioritise whole system planning. A total of 43 young people with intellectual disabilities, in Bradford, England, who…

  20. Breaking Through the Glass Ceiling: Recent Experimental Approaches to Probe the Properties of Supercooled Liquids near the Glass Transition.

    Science.gov (United States)

    Smith, R Scott; Kay, Bruce D

    2012-03-15

    Experimental measurements of the properties of supercooled liquids at temperatures near their glass transition temperatures, Tg, are requisite for understanding the behavior of glasses and amorphous solids. Unfortunately, many supercooled molecular liquids rapidly crystallize at temperatures far above their Tg, making such measurements difficult to nearly impossible. In this Perspective, we discuss some recent alternative approaches to obtain experimental data in the temperature regime near Tg. These new approaches may yield the additional experimental data necessary to test current theoretical models of the dynamical slowdown that occurs in supercooled liquids approaching the glass transition.

  1. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.

    2008-01-01

    Stroke in childhood has gained increasingly more attention and is accepted as an important disease in childhood. The reasons for this severe event and the consequences for the rest of the life are totally different than for adults. This is also true for the diagnosis and therapy. This paper gives a comprehensive overview on the characteristics of pediatric stroke to assist radiologists in making a rapid and safe diagnosis in order to identify the underlying disease. (orig.) [de

  2. Phase transition approach to bursting in neuronal cultures: quorum percolation models

    Science.gov (United States)

    Monceau, P.; Renault, R.; Métens, S.; Bottani, S.; Fardet, T.

    2017-10-01

    The Quorum Percolation model has been designed in the context of neurobiology to describe bursts of activity occurring in neuronal cultures from the point of view of statistical physics rather than from a dynamical synchronization approach. It is based upon information propagation on a directed graph with a threshold activation rule; this leads to a phase diagram which exhibits a giant percolation cluster below some critical value mC of the excitability. We describe the main characteristics of the original model and derive extensions according to additional relevant biological features. Firstly, we investigate the effects of an excitability variability on the phase diagram and show that the percolation transition can be destroyed by a sufficient amount of such a disorder; we stress the weakly averaging character of the order parameter and show that connectivity and excitability can be seen as two overlapping aspects of the same reality. Secondly, we elaborate a discrete time stochastic model taking into account the decay originating from ionic leakage through the membrane of neurons and synaptic depression; we give evidence that the decay softens and shifts the transition, and conjecture than decay destroys the transition in the thermodynamical limit. We were able to develop mean-field theories associated with each of the two effects; we discuss the framework of their agreement with Monte Carlo simulations. It turns out that the the critical point mC from which information on the connectivity of the network can be inferred is affected by each of these additional effects. Lastly, we show how dynamical simulations of bursts with an adaptive exponential integrateand- fire model can be interpreted in terms of Quorum Percolation. Moreover, the usefulness of the percolation model including the set of sophistication we investigated can be extended to many scientific fields involving information propagation, such as the spread of rumors in sociology, ethology, ecology.

  3. A Systems Approach Framework for the Transition to Sustainable Development: Potential Value Based on Coastal Experiments

    Directory of Open Access Journals (Sweden)

    Tom S. Hopkins

    2012-09-01

    Full Text Available This article explores the value of the Systems Approach Framework (SAF as a tool for the transition to sustainable development in coastal zone systems, based on 18 study sites in Europe, where the SAF was developed and tested. The knowledge gained from these experiments concerns the practical aspects of (a governance in terms of policy effectiveness, (b sustainability science in terms of applying transdisciplinary science to social-ecological problems, and (c simulation analysis in terms of quantifying dysfunctions in complex systems. This new knowledge can help broaden our perspectives on how research can be changed to better serve society. The infusion of systems thinking into research and policy making leads to a preference for multi-issue instead of single-issue studies, an expansion from static to dynamic indicators, an understanding of the boundaries between system-dependent and system-independent problems, and the inclusion of non-market evaluations. It also develops a real partnership among research, management, and stakeholders to establish a quantitative basis for collaborative decision making. Furthermore, the article argues that the transition to sustainable development for coastal systems requires consideration of the scale interdependency from individual to global and recognition of the probable global reorganizational emergence of scale-free networks that could cooperate to maximize the integrated sustainability among them.

  4. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara; Rockwood, Alyn; Ghanem, Bernard

    2015-01-01

    Are simple strokes unique to the artist or designer who renders them? If so, can this idea be used to identify authorship or to classify artistic drawings? Also, could training methods be devised to develop particular styles? To answer these questions, we propose the Stroke Authorship Recognition (SAR) approach, a novel method that distinguishes the authorship of 2D digitized drawings. SAR converts a drawing into a histogram of stroke attributes that is discriminative of authorship. We provide extensive classification experiments on a large variety of data sets, which validate SAR's ability to distinguish unique authorship of artists and designers. We also demonstrate the usefulness of SAR in several applications including the detection of fraudulent sketches, the training and monitoring of artists in learning a particular new style and the first quantitative way to measure the quality of automatic sketch synthesis tools. © 2015 The Eurographics Association and John Wiley & Sons Ltd.

  5. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara

    2015-10-15

    Are simple strokes unique to the artist or designer who renders them? If so, can this idea be used to identify authorship or to classify artistic drawings? Also, could training methods be devised to develop particular styles? To answer these questions, we propose the Stroke Authorship Recognition (SAR) approach, a novel method that distinguishes the authorship of 2D digitized drawings. SAR converts a drawing into a histogram of stroke attributes that is discriminative of authorship. We provide extensive classification experiments on a large variety of data sets, which validate SAR\\'s ability to distinguish unique authorship of artists and designers. We also demonstrate the usefulness of SAR in several applications including the detection of fraudulent sketches, the training and monitoring of artists in learning a particular new style and the first quantitative way to measure the quality of automatic sketch synthesis tools. © 2015 The Eurographics Association and John Wiley & Sons Ltd.

  6. A Fourier Collocation Approach for Transit-Time Ultrasonic Flowmeter Under Multi-Phase Flow Conditions

    DEFF Research Database (Denmark)

    Simurda, Matej; Lassen, Benny; Duggen, Lars

    2017-01-01

    A numerical model for a clamp-on transit-time ultrasonic flowmeter (TTUF) under multi-phase flow conditions is presented. The method solves equations of linear elasticity for isotropic heterogeneous materials with background flow where acoustic media are modeled by setting shear modulus to zero....... Spatial derivatives are calculated by a Fourier collocation method allowing the use of the fast Fourier transform (FFT) and time derivatives are approximated by a finite difference (FD) scheme. This approach is sometimes referred to as a pseudospectral time-domain method. Perfectly matched layers (PML......) are used to avoid wave-wrapping and staggered grids are implemented to improve stability and efficiency. The method is verified against exact analytical solutions and the effect of the time-staggering and associated lowest number of points per minimum wavelengths value is discussed. The method...

  7. The transition of childbirth practices among tribal women in Gujarat, India - a grounded theory approach

    Science.gov (United States)

    2013-01-01

    Background Under the National Rural Health Mission, the current emphasis is on achieving universal institutional births through incentive schemes as part of reforms related to childbirth in India. There has been rapid progress in achieving this goal. To understand the choices made as well as practices and perceptions related to childbirth amongst tribal women in Gujarat and how these have been influenced by modernity in general and modernity brought in through maternal health policies. Method A model depicting the transition in childbirth practices amongst tribal women was constructed using the grounded theory approach with; 8 focus groups of women, 5 in depth interviews with traditional birth attendants, women, and service providers and field notes on informal discussions and observations. Results A transition in childbirth practices across generations was noted, i.e. a shift from home births attended by Traditional Birth Attendants (TBAs) to hospital births. The women and their families both adapted to and shaped this transition through a constant ’trade-off between desirable and essential’- the desirable being a traditional homebirth in secure surroundings and the essential being the survival of mother and baby by going to hospital. This transition was shaped by complex multiple factors: 1) Overall economic growth and access to modern medical care influencing women’s choices, 2) External context in terms of the international maternal health discourses and national policies, especially incentive schemes for promoting institutional deliveries, 3) Socialisation into medical childbirth practices, through exposure to many years of free outreach services for maternal and child health, 4) Loss of self reliance in the community as a consequence of role redefinition and deskilling of the TBAs and 5) Cultural belief that intervention is necessary during childbirth aiding easy acceptance of medical interventions. Conclusion In resource poor settings where choices are

  8. Health status transitions in community-living elderly with complex care needs: a latent class approach.

    Science.gov (United States)

    Lafortune, Louise; Béland, François; Bergman, Howard; Ankri, Joël

    2009-02-03

    For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164), we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles) based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability) Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical information for the planning of longitudinal studies of aging

  9. Health status transitions in community-living elderly with complex care needs: a latent class approach

    Directory of Open Access Journals (Sweden)

    Béland François

    2009-02-01

    Full Text Available Abstract Background For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Methods Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164, we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. Results We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Conclusion Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical

  10. Stroke: advances in medical therapy and acute stroke intervention.

    Science.gov (United States)

    Barrett, Kevin M; Lal, Brajesh K; Meschia, James F

    2015-10-01

    Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythmia. Some accepted ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic therapy, and surgical techniques. Intra-arterial therapy, particularly with stent retrievers after intravenous tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in ischemic stroke management and prevention where equipoise remains.

  11. Technical Approach and Plan for Transitioning Spent Nuclear Fuel (SNF) Project Facilities to the Environmental Restoration Program

    International Nuclear Information System (INIS)

    SKELLY, W.A.

    1999-01-01

    This document describes the approach and process in which the 100-K Area Facilities are to be deactivated and transitioned over to the Environmental Restoration Program after spent nuclear fuel has been removed from the K Basins. It describes the Transition Project's scope and objectives, work breakdown structure, activity planning, estimated cost, and schedule. This report will be utilized as a planning document for project management and control and to communicate details of project content and integration

  12. Systems Biology Approach and Mathematical Modeling for Analyzing Phase-Space Switch During Epithelial-Mesenchymal Transition.

    Science.gov (United States)

    Simeoni, Chiara; Dinicola, Simona; Cucina, Alessandra; Mascia, Corrado; Bizzarri, Mariano

    2018-01-01

    In this report, we aim at presenting a viable strategy for the study of Epithelial-Mesenchymal Transition (EMT) and its opposite Mesenchymal-Epithelial Transition (MET) by means of a Systems Biology approach combined with a suitable Mathematical Modeling analysis. Precisely, it is shown how the presence of a metastable state, that is identified at a mesoscopic level of description, is crucial for making possible the appearance of a phase transition mechanism in the framework of fast-slow dynamics for Ordinary Differential Equations (ODEs).

  13. Atherosclerosis and Stroke

    Science.gov (United States)

    ... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... endothelium significantly. The artery’s diameter shrinks and blood flow decreases, reducing oxygen supply. How atherosclerotic plaque causes ...

  14. Arm rehabilitation in post stroke subjects: A randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach.

    Science.gov (United States)

    Jonsdottir, Johanna; Thorsen, Rune; Aprile, Irene; Galeri, Silvia; Spannocchi, Giovanna; Beghi, Ettore; Bianchi, Elisa; Montesano, Angelo; Ferrarin, Maurizio

    2017-01-01

    Motor recovery of persons after stroke may be enhanced by a novel approach where residual muscle activity is facilitated by patient-controlled electrical muscle activation. Myoelectric activity from hemiparetic muscles is then used for continuous control of functional electrical stimulation (MeCFES) of same or synergic muscles to promote restoration of movements during task-oriented therapy (TOT). Use of MeCFES during TOT may help to obtain a larger functional and neurological recovery than otherwise possible. Multicenter randomized controlled trial. Eighty two acute and chronic stroke victims were recruited through the collaborating facilities and after signing an informed consent were randomized to receive either the experimental (MeCFES assisted TOT (M-TOT) or conventional rehabilitation care including TOT (C-TOT). Both groups received 45 minutes of rehabilitation over 25 sessions. Outcomes were Action Research Arm Test (ARAT), Upper Extremity Fugl-Meyer Assessment (FMA-UE) scores and Disability of the Arm Shoulder and Hand questionnaire. Sixty eight subjects completed the protocol (Mean age 66.2, range 36.5-88.7, onset months 12.7, range 0.8-19.1) of which 45 were seen at follow up 5 weeks later. There were significant improvements in both groups on ARAT (median improvement: MeCFES TOT group 3.0; C-TOT group 2.0) and FMA-UE (median improvement: M-TOT 4.5; C-TOT 3.5). Considering subacute subjects (time since stroke rehabilitation (57.9%) than in the C-TOT group (33.2%) (difference in proportion improved 24.7%; 95% CI -4.0; 48.6), though the study did not meet the planned sample size. This is the first large multicentre RCT to compare MeCFES assisted TOT with conventional care TOT for the upper extremity. No adverse events or negative outcomes were encountered, thus we conclude that MeCFES can be a safe adjunct to rehabilitation that could promote recovery of upper limb function in persons after stroke, particularly when applied in the subacute phase.

  15. An Approach to the Prototyping of an Optimized Limited Stroke Actuator to Drive a Low Pressure Exhaust Gas Recirculation Valve.

    Science.gov (United States)

    Gutfrind, Christophe; Dufour, Laurent; Liebart, Vincent; Vannier, Jean-Claude; Vidal, Pierre

    2016-05-20

    The purpose of this article is to describe the design of a limited stroke actuator and the corresponding prototype to drive a Low Pressure (LP) Exhaust Gas Recirculation (EGR) valve for use in Internal Combustion Engines (ICEs). The direct drive actuator topology is an axial flux machine with two air gaps in order to minimize the rotor inertia and a bipolar surface-mounted permanent magnet in order to respect an 80° angular stroke. Firstly, the actuator will be described and optimized under constraints of a 150 ms time response, a 0.363 N·m minimal torque on an angular range from 0° to 80° and prototyping constraints. Secondly, the finite element method (FEM) using the FLUX-3D(®) software (CEDRAT, Meylan, France) will be used to check the actuator performances with consideration of the nonlinear effect of the iron material. Thirdly, a prototype will be made and characterized to compare its measurement results with the analytical model and the FEM model results. With these electromechanical behavior measurements, a numerical model is created with Simulink(®) in order to simulate an EGR system with this direct drive actuator under all operating conditions. Last but not least, the energy consumption of this machine will be estimated to evaluate the efficiency of the proposed EGR electromechanical system.

  16. An Approach to the Prototyping of an Optimized Limited Stroke Actuator to Drive a Low Pressure Exhaust Gas Recirculation Valve

    Science.gov (United States)

    Gutfrind, Christophe; Dufour, Laurent; Liebart, Vincent; Vannier, Jean-Claude; Vidal, Pierre

    2016-01-01

    The purpose of this article is to describe the design of a limited stroke actuator and the corresponding prototype to drive a Low Pressure (LP) Exhaust Gas Recirculation (EGR) valve for use in Internal Combustion Engines (ICEs). The direct drive actuator topology is an axial flux machine with two air gaps in order to minimize the rotor inertia and a bipolar surface-mounted permanent magnet in order to respect an 80° angular stroke. Firstly, the actuator will be described and optimized under constraints of a 150 ms time response, a 0.363 N·m minimal torque on an angular range from 0° to 80° and prototyping constraints. Secondly, the finite element method (FEM) using the FLUX-3D® software (CEDRAT, Meylan, France) will be used to check the actuator performances with consideration of the nonlinear effect of the iron material. Thirdly, a prototype will be made and characterized to compare its measurement results with the analytical model and the FEM model results. With these electromechanical behavior measurements, a numerical model is created with Simulink® in order to simulate an EGR system with this direct drive actuator under all operating conditions. Last but not least, the energy consumption of this machine will be estimated to evaluate the efficiency of the proposed EGR electromechanical system. PMID:27213398

  17. Know Your Client and Know Your Team: A Complexity Inspired Approach to Understanding Safe Transitions in Care

    Directory of Open Access Journals (Sweden)

    Deborah Tregunno

    2013-01-01

    Full Text Available Background. Transitions in care are one of the most important and challenging client safety issues in healthcare. This project was undertaken to gain insight into the practice setting realities for nurses and other health care providers as they manage increasingly complex care transitions across multiple settings. Methods. The Appreciative Inquiry approach was used to guide interviews with sixty-six healthcare providers from a variety of practice settings. Data was collected on participants’ experience of exceptional care transitions and opportunities for improving care transitions. Results. Nurses and other healthcare providers need to know three things to ensure safe care transitions: (1 know your client; (2 know your team on both sides of the transfer; and (3 know the resources your client needs and how to get them. Three themes describe successful care transitions, including flexible structures; independence and teamwork; and client and provider focus. Conclusion. Nurses often operate at the margins of acceptable performance, and flexibility with regulation and standards is often required in complex sociotechnical work like care transitions. Priority needs to be given to creating conditions where nurses and other healthcare providers are free to creatively engage and respond in ways that will optimize safe care transitions.

  18. Post-stroke Movement Disorders: Clinical Manifestations and Pharmacological Management.

    Science.gov (United States)

    Siniscalchi, Antonio; Gallelli, Luca; Labate, Angelo; Malferrari, Giovanni; Palleria, Caterina; Sarro, Giovambattista De

    2012-09-01

    Involuntary abnormal movements have been reported after ischaemic and haemorrhagic stroke. Post stroke movement disorders can appear as acute or delayed sequel. At the moment, for many of these disorders the knowledge of pharmacological treatment is still inadequate. Dopaminergic and GABAergic systems may be mainly involved in post-stroke movement disorders. This article provides a review on drugs commonly used in post-stroke movement disorders, given that some post-stroke movement disorders have shown a partial benefit with pharmacological approach.

  19. Analysis of transitions at two-fold redundant sites in mammalian genomes. Transition redundant approach-to-equilibrium (TREx distance metrics

    Directory of Open Access Journals (Sweden)

    Liberles David A

    2006-03-01

    Full Text Available Abstract Background The exchange of nucleotides at synonymous sites in a gene encoding a protein is believed to have little impact on the fitness of a host organism. This should be especially true for synonymous transitions, where a pyrimidine nucleotide is replaced by another pyrimidine, or a purine is replaced by another purine. This suggests that transition redundant exchange (TREx processes at the third position of conserved two-fold codon systems might offer the best approximation for a neutral molecular clock, serving to examine, within coding regions, theories that require neutrality, determine whether transition rate constants differ within genes in a single lineage, and correlate dates of events recorded in genomes with dates in the geological and paleontological records. To date, TREx analysis of the yeast genome has recognized correlated duplications that established a new metabolic strategies in fungi, and supported analyses of functional change in aromatases in pigs. TREx dating has limitations, however. Multiple transitions at synonymous sites may cause equilibration and loss of information. Further, to be useful to correlate events in the genomic record, different genes within a genome must suffer transitions at similar rates. Results A formalism to analyze divergence at two fold redundant codon systems is presented. This formalism exploits two-state approach-to-equilibrium kinetics from chemistry. This formalism captures, in a single equation, the possibility of multiple substitutions at individual sites, avoiding any need to "correct" for these. The formalism also connects specific rate constants for transitions to specific approximations in an underlying evolutionary model, including assumptions that transition rate constants are invariant at different sites, in different genes, in different lineages, and at different times. Therefore, the formalism supports analyses that evaluate these approximations. Transitions at synonymous

  20. [In-hospital mortality due to stroke].

    Science.gov (United States)

    Rodríguez Lucci, Federico; Pujol Lereis, Virginia; Ameriso, Sebastián; Povedano, Guillermo; Díaz, María F; Hlavnicka, Alejandro; Wainsztein, Néstor A; Ameriso, Sebastián F

    2013-01-01

    Overall mortality due to stroke has decreased in the last three decades probable due to a better control of vascular risk factors. In-hospital mortality of stroke patients has been estimated to be between 6 and 14% in most of the series reported. However, data from recent clinical trials suggest that these figures may be substantially lower. Data from FLENI Stroke Data Bank and institutional mortality records between 2000 and 2010 were reviewed. Ischemic stroke subtypes were classified according to TOAST criteria and hemorrhagic stroke subtypes were classified as intraparenchymal hematoma, aneurismatic subarachnoid hemorrhage, arterio-venous malformation, and other intraparenchymal hematomas. A total of 1514 patients were studied. Of these, 1079 (71%) were ischemic strokes,39% large vessels, 27% cardioembolic, 9% lacunar, 14% unknown etiology, and 11% others etiologies. There were 435 (29%) hemorrhagic strokes, 27% intraparenchymal hematomas, 30% aneurismatic subarachnoid hemorrhage, 25% arterio-venous malformation, and 18% other intraparenchymal hematomas. Moreover, 38 in-hospital deaths were recorded (17 ischemic strokes and 21 hemorrhagic strokes), accounting for 2.5% overall mortality (1.7% in ischemic strokes and 4.8% in hemorrhagic strokes). No deaths occurred associated with the use of intravenous fibrinolytics occurred. In our Centre in-hospital mortality in patients with stroke was low. Management of these patients in a Centre dedicated to neurological diseases along with a multidisciplinary approach from medical and non-medical staff trained in the care of cerebrovascular diseases could, at least in part, account for these results.

  1. Heat Stroke

    DEFF Research Database (Denmark)

    Mørch, Sofie Søndergaard; Andersen, Johnny Dohn Holmgren; Bestle, Morten Heiberg

    2017-01-01

    not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat......Heat stroke is an acute, life-threatening emergency characterized clinically by elevated body temperature and central nervous system dysfunction. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications are essential to reduce morbidity...... and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were...

  2. Status and future transition of rapid urbanizing landscape in central Western Ghats - CA based approach

    Science.gov (United States)

    Bharath, S..; Rajan, K. S.; Ramachandra, T. V.

    2014-11-01

    The land use changes in forested landscape are highly complex and dynamic, affected by the natural, socio-economic, cultural, political and other factors. The remote sensing (RS) and geographical information system (GIS) techniques coupled with multi-criteria evaluation functions such as Markov-cellular automata (CA-Markov) model helps in analysing intensity, extent and future forecasting of human activities affecting the terrestrial biosphere. Karwar taluk of Central Western Ghats in Karnataka state, India has seen rapid transitions in its forest cover due to various anthropogenic activities, primarily driven by major industrial activities. A study based on Landsat and IRS derived data along with CA-Markov method has helped in characterizing the patterns and trends of land use changes over a period of 2004-2013, expected transitions was predicted for a set of scenarios through 2013-2022. The analysis reveals the loss of pristine forest cover from 75.51% to 67.36% (1973 to 2013) and increase in agriculture land as well as built-up area of 8.65% (2013), causing impact on local flora and fauna. The other factors driving these changes are the aggregated level of demand for land, local and regional effects of land use activities such as deforestation, improper practices in expansion of agriculture and infrastructure development, deteriorating natural resources availability. The spatio temporal models helped in visualizing on-going changes apart from prediction of likely changes. The CA-Markov based analysis provides us insights into the localized changes impacting these regions and can be useful in developing appropriate mitigation management approaches based on the modelled future impacts. This necessitates immediate measures for minimizing the future impacts.

  3. Transition to turbulence in pulsatile flow through heart valves--a modified stability approach.

    Science.gov (United States)

    Bluestein, D; Einav, S

    1994-11-01

    The presence of turbulence in the cardiovascular system is generally an indication of some type of abnormality. Most cardiologists agree that turbulence near a valve indicates either valvular stenosis or regurgitation, depending on the phase of its occurrence during the cardiac cycle. As no satisfying analytical solutions of the stability of turbulent pulsatile flow exist, accurate, unbiased flow stability criteria are needed for the identification of turbulence initiation. The traditional approach uses a stability diagram based upon the stability of a plane Stokes layer where alpha (the Womersley parameter) is defined by the fundamental heart rate. We suggest a modified approach that involves the decomposition of alpha into its frequency components, where alpha is derived from the preferred modes induced on the flow by interaction between flow pulsation and the valve. Transition to turbulence in pulsatile flow through heart values was investigated in a pulse duplicator system using three polymer aortic valve models representing a normal aortic valve, a 65 percent stenosed valve and a 90 percent severely stenosed valve, and two mitral valve models representing a normal mitral valve and a 65 percent stenosed valve. Valve characteristics were closely simulated as to mimic the conditions that alter flow stability and initiate turbulent flow conditions. Valvular velocity waveforms were measured by laser Doppler anemometry (LDA). Spectral analysis was performed on velocity signals at selected spatial and temporal points to produce the power density spectra, in which the preferred frequency modes were identified. The spectra obtained during the rapid closure stage of the valves were found to be governed by the stenosis geometry. A shift toward higher dominant frequencies was correlated with the severity of the stenosis. According to the modified approach, stability of the flow is represented by a cluster of points, each corresponding to a specific dominant mode apparent

  4. A Preisach approach to modeling partial phase transitions in the first order magnetocaloric material MnFe(P,As)

    Energy Technology Data Exchange (ETDEWEB)

    Moos, L. von, E-mail: lmoo@dtu.dk [Department of Energy Conversion and Storage, Technical University of Denmark, 4000 Roskilde (Denmark); Bahl, C.R.H.; Nielsen, K.K.; Engelbrecht, K. [Department of Energy Conversion and Storage, Technical University of Denmark, 4000 Roskilde (Denmark); Küpferling, M.; Basso, V. [Istituto Nazionale di Ricerca Metrologica, 10135 Torino (Italy)

    2014-02-15

    Magnetic refrigeration is an emerging technology that could provide energy efficient and environmentally friendly cooling. Magnetocaloric materials in which a structural phase transition is found concurrently with the magnetic phase transition are often termed first order magnetocaloric materials. Such materials are potential candidates for application in magnetic refrigeration devices. However, the first order materials often have adverse properties such as hysteresis, making actual performance troublesome to quantify, a subject not thoroughly studied within this field. Here we investigate the behavior of MnFe(P,As) under partial phase transitions, which is similar to what materials experience in actual magnetic refrigeration devices. Partial phase transition curves, in the absence of a magnetic field, are measured using calorimetry and the experimental results are compared to simulations of a Preisach-type model. We show that this approach is applicable and discuss what experimental data is required to obtain a satisfactory material model.

  5. Genetic View To Stroke Occurrence

    Directory of Open Access Journals (Sweden)

    Sadegh Yoosefee

    2017-02-01

    Full Text Available Stroke is the third leading cause of death. The role of genetics in the etiology and development of this disease is undeniable. As a result of inadequate previous research, more and more studies in the field of genetics are necessary to identify pathways involved in the pathogenesis of stroke, which in turn, may lead to new therapeutic approaches. However, due to the multifactorial nature of stroke and the few studies conducted in this field, genetic diversity is able to predict only a small fraction of the risk of disease. On the other hand, studies have shown genetically different architecture for different types of stroke, and finally pharmacogenomics as an important part of personalized medicine approach, is influenced by genetic studies, all of which confirm the need of addressing the topic by researchers.

  6. Evaluating the functional outcomes of ultrasound-guided botulinum toxin type A injections using the Euro-musculus approach for upper limb spasticity treatment in post-stroke patients; an observational study.

    Science.gov (United States)

    Buyukavci, Raikan; Akturk, Semra; Ersoy, Yüksel

    2018-02-07

    Ultrasound-guided botulinum toxin type A injection is an effective treatment for spasticity. Euro-musculus spasticity approach is a new method for administering injections to the correct point of the correct muscle. The clinical outcomes of this practical approach is not yet available in the literature. The purpose of this study was to evaluate the effects on spasticity and the functional outcomes of ultrasound guided botulinum toxin type A injections via the Euro-musculus spasticity approach to treat upper limb spasticity in post-stroke patients. An observational study. Inpatient post-stroke patients. Twenty five post-stroke patients with post-stroke upper limb spasticity were recruited. The ultrasound-guided botulinum toxin type A injections were administered into the spastic target muscles using the Euro-musculus spasticity approach, and all of the patients were enrolled in rehabilitation programmes after the injections. This research included the innervation zone and injection site figures and ultrasound images of each muscle in the upper limb. The degree of spasticity was assessed via the Modified Ashworth Scale and the upper limb motor function via the Fugl Meyer Upper Extremity Scale at the baseline and 4 and 12 weeks after the botulinum toxin type A injection. Significant decreases in the Modified Ashworth Scale scores of the upper limb flexor muscle tone measured 4 and 12 weeks after the botulinum toxin type A injection were found when compared to the baseline scores (pbotulinum toxin type A injection via the Euro- musculus spasticity approach is a practical and effective method for administering injections to the correct point of the correct muscle. Ultrasound-guided botulinum toxin type A injections combined with rehabilitation programmes decrease spasticity and improve the upper extremity motor functions in stroke patients. This new approach for ultrasound- guided botulinum toxin type A injection is very practical and effective method for upper

  7. Biotherapies in stroke.

    Science.gov (United States)

    Detante, O; Jaillard, A; Moisan, A; Barbieux, M; Favre, I M; Garambois, K; Hommel, M; Remy, C

    2014-12-01

    characterization, delivery route and in vivo biodistribution. Bone marrow-derived cell populations such as mesenchymal stromal/stem cells (MSC) or mononuclear cells (MNC), umbilical cord stem cells and NSC are most investigated notably in clinical trials. Finally, we discuss perspectives concerning potential novel biotherapies such as combinatorial approaches (growth factor combined with cell therapy, in vitro optimization of cell products, or co-transplantation) and the development of biomaterials, which could be used as injectable hydrogel scaffold matrices that could protect a cell graft or selectively deliver drugs and growth factors into the post-stroke cavity at chronic stages. Considering the remaining questions about the best procedure and the safety cautions, we can hope that future translational research about biotherapies will bring more efficient treatments that will decrease post-stroke disability for many patients. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  8. An ecological approach to seeking and utilising the views of young people with intellectual disabilities in transition planning.

    Science.gov (United States)

    Small, Neil; Raghavan, Raghu; Pawson, Nicole

    2013-12-01

    Transition planning using a person-centred approach has, in the main, failed to shape service provision. We offer an alternative based on an ecological understanding of human development linked to public health approaches that prioritise whole system planning. A total of 43 young people with intellectual disabilities, in Bradford, England, who were approaching transition from school or college were recruited to a qualitative study. Their ethnic breakdown was as follows: 16 white British, 24 Pakistani, 2 Bangladeshi and 1 Black African. Each young person was interviewed twice, at recruitment and a year later, to observe any changes in their social networks during transition. Interviews were undertaken with a semi-structured interview schedule and with the pictorial approach of Talking Mats. Both the networks the young people live within, and their sense of what the future might hold for them, are described and linked to Bronfenbrenner's ecological model of human development. The importance of the family and school is emphasised, as is the absence of engagement in leisure activities and work. Transition planning needs to start with mapping the systems individuals live within, areas of strength should be supported and parts of the system, which are not fit for purpose for these young people, should be prioritised for interventions.

  9. A Strategic Enrollment Management Approach to Studying High School Student Transition to a Two-Year College

    Science.gov (United States)

    Wang, Yan; Ye, Feifei; Pilarzyk, Tom

    2014-01-01

    This study used a strategic enrollment management (SEM) approach to studying high school students' transition to a two-year college and their initial college success. Path analyses suggested two important findings: (a) clear career choices among students, family influence, academic preparedness, and college recruitment efforts predicted earlier…

  10. A novel approach to gait synchronization and transition for reconfigurable walking platforms

    Directory of Open Access Journals (Sweden)

    Shunsuke Nansai

    2015-04-01

    Full Text Available Legged robots based on one degree-of-freedom reconfigurable planar leg mechanisms, that are capable of generating multiple useful gaits, are highly desired due to the possibility of handling environments and tasks of high complexity while maintaining simple control schemes. An essential consideration in these reconfigurable legged robots is to attain stability in motion, at rest as well as while transforming from one configuration to another with the minimum number of legs as long as the full range of their walking patterns, resulting from the different gait cycles of their legs, is achieved. To this end, in this paper, we present a method for the generation of input joint trajectories to properly synchronize the movement of quadruped robots with reconfigurable legs. The approach is exemplified in a four-legged robot with reconfigurable Jansen legs capable of generating up to six useful different gait cycles. The proposed technique is validated through simulated results that show the platform׳s stability across its six feasible walking patterns and during gait transition phases, thus considerably extending the capabilities of the non-reconfigurable design.

  11. A state-and-transition simulation modeling approach for estimating the historical range of variability

    Directory of Open Access Journals (Sweden)

    Kori Blankenship

    2015-04-01

    Full Text Available Reference ecological conditions offer important context for land managers as they assess the condition of their landscapes and provide benchmarks for desired future conditions. State-and-transition simulation models (STSMs are commonly used to estimate reference conditions that can be used to evaluate current ecosystem conditions and to guide land management decisions and activities. The LANDFIRE program created more than 1,000 STSMs and used them to assess departure from a mean reference value for ecosystems in the United States. While the mean provides a useful benchmark, land managers and researchers are often interested in the range of variability around the mean. This range, frequently referred to as the historical range of variability (HRV, offers model users improved understanding of ecosystem function, more information with which to evaluate ecosystem change and potentially greater flexibility in management options. We developed a method for using LANDFIRE STSMs to estimate the HRV around the mean reference condition for each model state in ecosystems by varying the fire probabilities. The approach is flexible and can be adapted for use in a variety of ecosystems. HRV analysis can be combined with other information to help guide complex land management decisions.

  12. Using the Life Satisfaction Approach to Value Daylight Savings Time Transitions: Evidence from Britain and Germany

    OpenAIRE

    Daniel Kuehnle; Christoph Wunder

    2015-01-01

    Daylight savings time (DST) represents a public good with costs and benefits. We provide the first comprehensive examination of the welfare effects of the spring and autumn transitions for the UK and Germany. Using individual-level data and a regression discontinuity design, we estimate the effect of the transitions on life satisfaction. Our results show that individuals in both the UK and Germany experience deteriorations in life satisfaction in the first week after the spring transition. We...

  13. Rehabilitation following hemorrhagic stroke: building the case for stroke-subtype specific recovery therapies [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Tomoko Kitago

    2017-11-01

    Full Text Available Intracerebral hemorrhage (ICH, a form of brain bleeding and minor subtype of stroke, leads to significant mortality and long-term disability. There are currently no validated approaches to promote functional recovery after ICH. Research in stroke recovery and rehabilitation has largely focused on ischemic stroke, but given the stark differences in the pathophysiology between ischemic and hemorrhagic stroke, it is possible that strategies to rehabilitate the brain in distinct stroke subtypes will be different. Here, we review our current understanding of recovery after primary intracerebral hemorrhage with the intent to provide a framework to promote novel, stroke-subtype specific approaches.

  14. Do post-stroke patients benefit from robotic verticalization? A pilot-study focusing on a novel neurophysiological approach.

    Science.gov (United States)

    Calabrò, Rocco Salvatore; Naro, Antonino; Russo, Margherita; Leo, Antonino; Balletta, Tina; Saccá, Ileana; De Luca, Rosaria; Bramanti, Placido

    2015-01-01

    Tilt-table equipped with the dynamic foot-support (ERIGO) and the functional electric stimulation could be a safe and suitable device for stabilization of vital signs, increasing patient's motivation for further recovery, decreasing the duration of hospitalization, and accelerating the adaptation to vertical posture in bedridden patients with brain-injury. Moreover, it is conceivable that verticalization may improve cognitive functions, and induce plastic changes at sensory motor and vestibular system level that may in turn facilitate motor functional recovery. To test the safety and effectiveness of ERIGO treatment on motor and cognitive functions, cortical plasticity within vestibular and sensory-motor systems in a bedridden post-stroke sample. 20 patients were randomly divided in two groups that performed ERIGO training (30 sessions) (G1) or physiotherapist-assisted verticalization training (same duration) (G2), beyond conventional neurorehabilitation treatment. Motor and cognitive functions as well as sensory-motor and vestibular system plasticity were investigated either before (T0) or after (T1) the rehabilitative protocols. Both the verticalization treatments were well-tolerated. Notably, the G1 patients had a significant improvement in cognitive function (p = 0.03), global motor function (p = 0.006), sensory-motor (p vertical position with a better global function improvement, as also suggested by the sensory-motor and vestibular system plasticity induction.

  15. Elastic Model Transitions: a Hybrid Approach Utilizing Quadratic Inequality Constrained Least Squares (LSQI) and Direct Shape Mapping (DSM)

    Science.gov (United States)

    Jurenko, Robert J.; Bush, T. Jason; Ottander, John A.

    2014-01-01

    A method for transitioning linear time invariant (LTI) models in time varying simulation is proposed that utilizes both quadratically constrained least squares (LSQI) and Direct Shape Mapping (DSM) algorithms to determine physical displacements. This approach is applicable to the simulation of the elastic behavior of launch vehicles and other structures that utilize multiple LTI finite element model (FEM) derived mode sets that are propagated throughout time. The time invariant nature of the elastic data for discrete segments of the launch vehicle trajectory presents a problem of how to properly transition between models while preserving motion across the transition. In addition, energy may vary between flex models when using a truncated mode set. The LSQI-DSM algorithm can accommodate significant changes in energy between FEM models and carries elastic motion across FEM model transitions. Compared with previous approaches, the LSQI-DSM algorithm shows improvements ranging from a significant reduction to a complete removal of transients across FEM model transitions as well as maintaining elastic motion from the prior state.

  16. Backup_of_23. THE SOCIO-ECONOMIC IMPACT OF STROKE ON

    African Journals Online (AJOL)

    Esem

    problems. The study aimed at assessing the socio- economic impact of stroke in households in Livingstone district. A total ... economic challenges after stroke with a few of them were ..... 20 Trainer T, The transition; Getting to a sustainable and.

  17. Building Bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke.

    Science.gov (United States)

    Jones, Fiona; Pöstges, Heide; Brimicombe, Lucinda

    2016-10-14

    Programmes providing self-management support for patients and families are gaining attention and have shown promising outcomes with regards to reducing long-term unmet needs post stroke. However, notions of what good self-management support looks like can differ depending on professional opinion, individual preferences, skills and experiences of patients and their families as well as on how care and rehabilitation is organised in a particular healthcare setting. This resonates with the perspective of patient-centred care, according to which the meaning of good care is not universal, but rather jointly shaped between healthcare professionals and patients in everyday interactions. While self-management support is continuously co-produced in care and rehabilitation practices, most self-management programmes are typically provided as an 'add-on' to existing statutory care. This paper aims to deepen the understanding of how self-management support can be made an integral part of everyday care and rehabilitation using Bridges methodology. The authors provide a self-reflective account on 'Bridges' an integrated approach to self-management support, which is used by healthcare professionals within acute and community stroke rehabilitation across the UK, and in some parts of New Zealand and Australia. Bridges is based on self-efficacy principles, but has a central aim of professionals sharing decision-making and expertise with patients and families in every healthcare interaction. Methodologically, the co-production of a Bridges support package with local healthcare professionals and patients is critical. The authors present the values articulated by the support package and how it engages professionals, patients and Bridges training facilitators in a continuous process of adjusting and re-adjusting situated self-management support practices. Our reflections reveal the need to consider development and implementation of self-management support as one and the same on

  18. Incorporating unreliability of transit in transport demand models: theoretical and practical approach

    NARCIS (Netherlands)

    van Oort, N.; Brands, Ties; de Romph, E.; Aceves Flores, J.

    2014-01-01

    Nowadays, transport demand models do not explicitly evaluate the impacts of service reliability of transit. Service reliability of transit systems is adversely experienced by users, as it causes additional travel time and unsecure arrival times. Because of this, travelers are likely to perceive a

  19. Genetics of ischaemic stroke in young adults

    OpenAIRE

    Terni, Eva; Giannini, Nicola; Brondi, Marco; Montano, Vincenzo; Bonuccelli, Ubaldo; Mancuso, Michelangelo

    2015-01-01

    Background: Stroke may be a clinical expression of several inherited disorders in humans. Recognition of the underlined genetic disorders causing stroke is important for a correct diagnosis, for genetic counselling and, even if rarely, for a correct therapeutic management. Moreover, the genetics of complex diseases such the stroke, in which multiple genes interact with environmental risk factors to increase risk, has been revolutionized by the Genome-Wide Association Study (GWAS) approach. ...

  20. Content validation of the international classification of functioning, disability and health core set for stroke from gender perspective using a qualitative approach.

    Science.gov (United States)

    Glässel, A; Coenen, M; Kollerits, B; Cieza, A

    2014-06-01

    The extended ICF Core Set for stroke is an application of the International Classification of Functioning, Disability and Health (ICF) of the World Health Organisation (WHO) with the purpose to represent the typical spectrum of functioning of persons with stroke. The objective of the study is to add evidence to the content validity of the extended ICF Core Set for stroke from persons after stroke taking into account gender perspective. A qualitative study design was conducted by using individual interviews with women and men after stroke in an in- and outpatient rehabilitation setting. The sampling followed the maximum variation strategy. Sample size was determined by saturation. Concepts from qualitative data analysis were linked to ICF categories and compared to the extended ICF Core Set for stroke. Twelve women and 12 men participated in 24 individual interviews. In total, 143 out of 166 ICF categories included in the extended ICF Core Set for stroke were confirmed (women: N.=13; men: N.=17; both genders: N.=113). Thirty-eight additional categories that are not yet included in the extended ICF Core Set for stroke were raised by women and men. This study confirms that the experience of functioning and disability after stroke shows communalities and differences for women and men. The validity of the extended ICF Core Set for stroke could be mostly confirmed, since it does not only include those areas of functioning and disability relevant to both genders but also those exclusively relevant to either women or men. Further research is needed on ICF categories not yet included in the extended ICF Core Set for stroke.

  1. Stroke rehabilitation.

    Science.gov (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

    2011-05-14

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. Financial Distress Prediction Using Discrete-time Hazard Model and Rating Transition Matrix Approach

    Science.gov (United States)

    Tsai, Bi-Huei; Chang, Chih-Huei

    2009-08-01

    Previous studies used constant cut-off indicator to distinguish distressed firms from non-distressed ones in the one-stage prediction models. However, distressed cut-off indicator must shift according to economic prosperity, rather than remains fixed all the time. This study focuses on Taiwanese listed firms and develops financial distress prediction models based upon the two-stage method. First, this study employs the firm-specific financial ratio and market factors to measure the probability of financial distress based on the discrete-time hazard models. Second, this paper further focuses on macroeconomic factors and applies rating transition matrix approach to determine the distressed cut-off indicator. The prediction models are developed by using the training sample from 1987 to 2004, and their levels of accuracy are compared with the test sample from 2005 to 2007. As for the one-stage prediction model, the model in incorporation with macroeconomic factors does not perform better than that without macroeconomic factors. This suggests that the accuracy is not improved for one-stage models which pool the firm-specific and macroeconomic factors together. In regards to the two stage models, the negative credit cycle index implies the worse economic status during the test period, so the distressed cut-off point is adjusted to increase based on such negative credit cycle index. After the two-stage models employ such adjusted cut-off point to discriminate the distressed firms from non-distressed ones, their error of misclassification becomes lower than that of one-stage ones. The two-stage models presented in this paper have incremental usefulness in predicting financial distress.

  3. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha

    2008-12-01

    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  4. A GIS-based approach for the screening assessment of noise and vibration impacts from transit projects.

    Science.gov (United States)

    Hamed, Maged; Effat, Waleed

    2007-08-01

    Urban transportation projects are essential in increasing the efficiency of moving people and goods within a city, and between cities. Environmental impacts from such projects must be evaluated and mitigated, as applicable. Spatial modeling is a valuable tool for quantifying the potential level of environmental consequences within the context of an environmental impact assessment (EIA) study. This paper presents a GIS-based tool for the assessment of airborne-noise and ground-borne vibration from public transit systems, and its application to an actual project. The tool is based on the US Federal Transit Administration's (FTA) approach, and incorporates spatial information, satellite imaging, geostatistical modeling, and software programming. The tool is applied on a case study of initial environmental evaluation of a light rail transit project in an urban city in the Middle East, to evaluate alternative layouts. The tool readily allowed the alternative evaluation and the results were used as input to a multi-criteria analytic framework.

  5. ANALYSIS OF BUSINESS ENVIRONMENT USING THE MULTI-CRITERIA APPROACH – CASE OF BALKAN’S TRANSITION ECONOMIES

    Directory of Open Access Journals (Sweden)

    Saša Obradović

    2012-02-01

    Full Text Available Due to the lack of their own financial resources, attracting the foreign direct investment (FDI isthe main prerequisite for transitional economies in order to increase production and employment, sothat they can ensure the long term sustainable economic growth. In addition, the foreign directinvestment is an important instrument for the economy restructuring, based on market principles.However, achieving this goal is not simple at all. In order to attract foreign investors, it is necessaryto create a favorable business environment in transition countries, which requires a number ofeconomic, institutional, political and other reforms. The aim of this paper is to point out the mainfactors attracting foreign direct investment and, by using the multi-criteria approach, to rank theBalkan’s transition economies depending on the preferences of investors taking into account certaincomponents of the business environment.

  6. Reconciling Marriage and Care after Stroke.

    Science.gov (United States)

    Anderson, Sharon; Keating, Norah; Wilson, Donna

    2017-09-01

    Most research on stroke's impact on couples has focused on the transition to caregiving/receiving. Despite considerable evidence that marriage is the primary source of support in the face of chronic conditions, little is known about what happens to marriage in the context of care after stroke. To address this gap, we undertook a qualitative grounded-theory study of 18 couples in which one partner had experienced a stroke. Findings revealed two interrelated themes of the couple processes: working out care, which involved discovering and addressing disruptions in day-to-day activities; and rethinking marriage, which involved determining the meaning of their relationship within the new context of care and disability. Three distinct types of marriages evolved from these processes: reconfirmed around their pre-stroke marriage; recalibrated around care; and a parallel relationship, "his" and "her" marriage. Our findings highlight the need to consider relationship dynamics in addition to knowledge about stroke and care.

  7. Designing a Summer Transition Program for Incoming and Current College Students on the Autism Spectrum: A Participatory Approach

    Directory of Open Access Journals (Sweden)

    Emily Hotez

    2018-02-01

    Full Text Available Students with Autism Spectrum Disorder (ASD face unique challenges transitioning from high school to college and receive insufficient support to help them navigate this transition. Through a participatory collaboration with incoming and current autistic college students, we developed, implemented, and evaluated two intensive week-long summer programs to help autistic students transition into and succeed in college. This process included: (1 developing an initial summer transition program curriculum guided by recommendations from autistic college students in our ongoing mentorship program, (2 conducting an initial feasibility assessment of the curriculum [Summer Transition Program 1 (STP1], (3 revising our initial curriculum, guided by feedback from autistic students, to develop a curriculum manual, and (4 pilot-testing the manualized curriculum through a quasi-experimental pre-test/post-test assessment of a second summer program [Summer Transition Program 2 (STP2]. In STP2, two autistic college students assumed a leadership role and acted as “mentors” and ten incoming and current autistic college students participated in the program as “mentees.” Results from the STP2 pilot-test suggested benefits of participatory transition programming for fostering self-advocacy and social skills among mentees. Autistic and non-autistic mentors (but not mentees described practicing advanced forms of self-advocacy, specifically leadership, through their mentorship roles. Autistic and non-autistic mentors also described shared (e.g., empathy and unique (an intuitive understanding of autism vs. an intuitive understanding of social interaction skills that they contributed to the program. This research provides preliminary support for the feasibility and utility of a participatory approach in which autistic college students are integral to the development and implementation of programming to help less experienced autistic students develop the self

  8. Project Management Approach to Transition of the Miamisburg Closure Project From Environmental Cleanup to Post-Closure Operations

    International Nuclear Information System (INIS)

    Carpenter, C.P.; Marks, M.L.; Smiley, S.L.; Gallaher, D.M.; Williams, K.D.

    2006-01-01

    The U.S. Department of Energy (DOE) used a project management approach to transition the Miamisburg Closure Project from cleanup by the Office of Environmental Management (EM) to post-closure operations by the Office of Legacy Management (LM). Two primary DOE orders were used to guide the site transition: DOE Order 430.1B, Real Property Asset Management, for assessment and disposition of real property assets and DOE Order 413.3, Program and Project Management for Acquisition of Capital Assets, for project closeout of environmental cleanup activities and project transition of post-closure activities. To effectively manage these multiple policy requirements, DOE chose to manage the Miamisburg Closure Project as a project under a cross-member transitional team using representatives from four principal organizations: DOE-LM, the LM contractor S.M. Stoller Corporation, DOE-EM, and the EM contractor CH2M Hill Mound Inc. The mission of LM is to manage the Department's post-transition responsibilities and long-term care of legacy liabilities and to ensure the future protection of human health and the environment for cleanup sites after the EM has completed its cleanup activities. (authors)

  9. Impulsive synchronization of Markovian jumping randomly coupled neural networks with partly unknown transition probabilities via multiple integral approach.

    Science.gov (United States)

    Chandrasekar, A; Rakkiyappan, R; Cao, Jinde

    2015-10-01

    This paper studies the impulsive synchronization of Markovian jumping randomly coupled neural networks with partly unknown transition probabilities via multiple integral approach. The array of neural networks are coupled in a random fashion which is governed by Bernoulli random variable. The aim of this paper is to obtain the synchronization criteria, which is suitable for both exactly known and partly unknown transition probabilities such that the coupled neural network is synchronized with mixed time-delay. The considered impulsive effects can be synchronized at partly unknown transition probabilities. Besides, a multiple integral approach is also proposed to strengthen the Markovian jumping randomly coupled neural networks with partly unknown transition probabilities. By making use of Kronecker product and some useful integral inequalities, a novel Lyapunov-Krasovskii functional was designed for handling the coupled neural network with mixed delay and then impulsive synchronization criteria are solvable in a set of linear matrix inequalities. Finally, numerical examples are presented to illustrate the effectiveness and advantages of the theoretical results. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. The use of biomarkers as integrative tools for transitional water bodies monitoring in the Water Framework Directive context - A holistic approach in Minho river transitional waters.

    Science.gov (United States)

    Capela, R; Raimundo, J; Santos, M M; Caetano, M; Micaelo, C; Vale, C; Guimarães, L; Reis-Henriques, M A

    2016-01-01

    The Water Framework Directive (WFD) provides an important legislative opportunity to promote and implement an integrated approach for the protection of inland surface waters, transitional waters, coastal waters and groundwaters. The transitional waters constitute a central piece as they are usually under high environmental pressure and by their inherent characteristics present monitoring challenges. Integrating water quality monitoring with biological monitoring can increase the cost-effectiveness of monitoring efforts. One way of doing this is with biomarkers, which effectively integrate physical-chemical status and biological quality elements, dealing holistically with adverse consequences on the health of water bodies. The new Marine Strategy Framework Directive (MSFD) already incorporates the biomarker approach. Given the recent activities of OSPAR and HELCOM to harmonize existing monitoring guidelines between MSFD and WFD the use of similar methodologies should be fostered. To illustrate the potential of the biomarker approach, juveniles of flounder (Platichthys flesus) were used to evaluate the quality of the Minho river-estuary water bodies. The use of juveniles instead of adults eliminates several confounding factors such changes on the biological responses associated with reproduction. Here, a panel of well-established biomarkers, EROD, AChE, SOD, CAT, GST, LPO, ENA and FACs (1-Hydroxyrene) were selected and measured along with a gradient of different physical conditions, and integrated with trace elements characterization on both biota and sediments. In general, a clear profile along the water bodies was found, with low seasonal and spatial variation, consistent with a low impacted area. Overall, the results support the use of both the battery of biomarkers and the use of juvenile flounders in the monitoring of the water quality status within the WFD. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Theory of the multiphoton cascade transitions with two photon links: comparison of quantum electrodynamical and quantum mechanical approaches

    International Nuclear Information System (INIS)

    Zalialiutdinov, T; Baukina, Yu; Solovyev, D; Labzowsky, L

    2014-01-01

    The theory of multiphoton cascade transitions with two-photon links is considered within two different approaches: quantum electrodynamical (QED) and phenomenological quantum mechanical (QM). A problem of regularization of the cascade contributions is investigated in detail. It is argued that the correct regularization should include both initial and intermediate level widths in the singular energy denominators. This result follows both from the QED and from the QM approach. Particular transitions nl → 1s + 2γ with nl = 3s, 4s, 3d, 4d and nl → 1s + 3γ with nl = 3p, 4p are considered as examples. The importance of the proper cascade regularization is also demonstrated. (paper)

  12. Cooperative effect of random and time-periodic coupling strength on synchronization transitions in one-way coupled neural system: mean field approach.

    Science.gov (United States)

    Jiancheng, Shi; Min, Luo; Chusheng, Huang

    2017-08-01

    The cooperative effect of random coupling strength and time-periodic coupling strengh on synchronization transitions in one-way coupled neural system has been investigated by mean field approach. Results show that cooperative coupling strength (CCS) plays an active role for the enhancement of synchronization transitions. There exist an optimal frequency of CCS which makes the system display the best CCS-induced synchronization transitions, a critical frequency of CCS which can not further affect the CCS-induced synchronization transitions, and a critical amplitude of CCS which can not occur the CCS-induced synchronization transitions. Meanwhile, noise intensity plays a negative role for the CCS-induced synchronization transitions. Furthermore, it is found that the novel CCS amplitude-induced synchronization transitions and CCS frequency-induced synchronization transitions are found.

  13. Development of generalized boiling transition model applicable for wide variety of fuel bundle geometries. Basic strategy and numerical approaches

    International Nuclear Information System (INIS)

    Ninokata, Hisashi; Sadatomi, Michio; Okawa, Tomio

    2003-01-01

    In order to establish a key technology to realize advanced BWR fuel designs, a three-year project of the advanced subchannel analysis code development had been started since 2002. The five dominant factors involved in the boiling transitional process in the fuel bundles were focused. They are, (1) inter-subchannel exchanges, (2) influences of obstacles (3) dryout of liquid film, (4) transition of two-phase flow regimes and (5) deposition of droplets. It has been recognized that present physical models or constitutive equations in subchannel formulations need to be improved so that they include geometrical effects in the fuel bundle design more mechanistically and universally. Through reviewing literatures and existent experimental results, underlying elementary processes and geometrical factors that are indispensable for improving subchannel codes were identified. The basic strategy that combines numerical and experimental approaches was proposed aiming at establishment of mechanistic models for the five dominant factors. In this paper, the present status of methodologies for detailed two-phase flow studies has been summarized. According to spatial scales of focused elementary processes, proper numerical approaches were selected. For some promising numerical approaches, preliminary calcitonins were performed for assessing their applicability to investigation of elementary processes involved in the boiling transition. (author)

  14. Teaching a Systematic Approach for Transitioning Patients to College: An Interactive Continuing Medical Education Program.

    Science.gov (United States)

    Martel, Adele; Derenne, Jennifer; Chan, Vivien

    2015-10-01

    The purpose of this article is to determine the effectiveness of a hands-on continuing education program for practicing child and adolescent psychiatrists (CAPs) with a focus on best practices in transitioning psychiatric patients to college. The plan was to build on the unique knowledge and skill set of CAPs, use audience and facilitator feedback from prior programs to inform program content, structure, and format, and incorporate findings from the evolving literature. A 3-h interactive workshop was designed with an emphasis on audience participation. The workshop was divided into three main segments: didactics, whole group discussion/brainstorming, and small group discussion of illustrative case vignettes. Improvements and changes in knowledge, skills, and attitudes related to transition planning were identified by program participants. Quantitative feedback in the form of course evaluations, pre- and posttests, and a 6-month follow-up questionnaire indicate that the use of interactive teaching techniques is a productive learning experience for practicing CAPs. Qualitative feedback was that the discussion of the case vignettes was the most helpful. The use of a workshop format is an effective strategy to engage practicing CAPs in learning about and implementing best practices to support the transition of their patients to college and into young adulthood. Comprehensive and proactive transition planning, facilitated by clinicians, should promote the wellness of college-bound patients and help to reduce the potential risks in the setting of an upcoming transition.

  15. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  16. Interprofessional stroke rehabilitation for stroke survivors using home care.

    Science.gov (United States)

    Markle-Reid, Maureen; Orridge, Camille; Weir, Robin; Browne, Gina; Gafni, Amiram; Lewis, Mary; Walsh, Marian; Levy, Charissa; Daub, Stacey; Brien, Heather; Roberts, Jacqueline; Thabane, Lehana

    2011-03-01

    To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services. Randomized controlled trial of 101 community-living stroke survivors (stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months. A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p=0.76). A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229.

  17. A purely nonlinear route to transition approaching the edge of chaos in a boundary layer

    International Nuclear Information System (INIS)

    Cherubini, S; De Palma, P; Robinet, J-Ch; Bottaro, A

    2012-01-01

    The understanding of transition in shear flows has recently progressed along new paradigms based on the central role of coherent flow structures and their nonlinear interactions. We follow such paradigms to identify, by means of a nonlinear optimization of the energy growth at short time, the initial perturbation which most easily induces transition in a boundary layer. Moreover, a bisection procedure has been used to identify localized flow structures living on the edge of chaos, found to be populated by hairpin vortices and streaks. Such an edge structure appears to act as a relative attractor for the trajectory of the laminar base state perturbed by the initial finite-amplitude disturbances, mediating the route to turbulence of the flow, via the triggering of a regeneration cycle of Λ and hairpin structures at different space and time scales. These findings introduce a new, purely nonlinear scenario of transition in a boundary-layer flow. (paper)

  18. Achieving a holistic perspective in stroke rehabilitation

    DEFF Research Database (Denmark)

    Kristensen, Hanne Kaae; Lund, Hans; Jones, Dorrie

    2015-01-01

    Background/Aims: Holistic, multidisciplinary rehabilitation is often the most appropriate for stroke patients. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) provides a comprehensive conceptual framework and systematic terminology used...... to a holistic approach in stroke rehabilitation, including an understanding of functioning and the ability to participate in everyday life. Using this approach to rehabilitation, disability is not only perceived as a consequence of stroke but also in the context of the individual person, where interactions...... the holistic approach....

  19. How oncology fellows discuss transitions in goals of care: a snapshot of approaches used prior to training.

    Science.gov (United States)

    Back, Anthony L; Michaelsen, Kate; Alexander, Stewart; Hopley, Elizabeth; Edwards, Kelly; Arnold, Robert M

    2010-04-01

    The moment when a physician raises the possibility of discontinuing palliative chemotherapy at the end of life is a critical moment in the illness, and a difficult conversation. Expert recommendations cite the importance of giving bad news in these situations but there is limited research addressing how physicians should discuss transitions in goals of care from disease-modifying therapy to end-of-life care. While existing research includes survey data and observational studies of oncologist outpatient visits with patient who have advanced cancer, there are no studies that characterize actual physician communication behaviors when the physician tried to initiate a transitions conversation with a patient who has advanced cancer. In this study, we examined the communication approaches used by oncology fellows discussing transitions with a standardized patient using audiorecordings collected prior to an intensive communication skills workshop. In this preworkshop encounter, each oncology fellow had the task of discussing a transition in goals of care with a patient who was experiencing cancer progression despite treatment with existing evidence-based therapies. We used qualitative methodology to characterize the approaches used by oncology fellows in 20 of these pre-workshop conversations. We identified two themes in the approaches that fellows used: (1) the limitations of biomedical disease-modifying treatments and (2) the possibility of a new direction for medical care when disease-modifying treatments have been exhausted. We found that for each theme, fellows tended to emphasize a logical frame or an experiential frame. Understanding these frames could be useful in designing future communication skills training interventions.

  20. METHODOLOGICAL APPROACHES TO FORMATION OF CONDITIONS OF TRANSITION TO STEADY DEVELOPMENT OF THE CREDIT ORGANIZATIONS OF REGION

    Directory of Open Access Journals (Sweden)

    O.I. Pechonik

    2006-03-01

    Full Text Available Formation of conditions of transition to steady development of the credit organizations assumes presence of scientific toolkit which should have methodological character and represent a set of scientific receptions, methods and principles of research to which definition given clause is devoted. The executed research has shown, that the logic and the scheme of the scientific analysis of processes of maintenance with bank service of economic system of region and formation of conditions of steady development of regional bank system should: to be based on statistical methods with use of system of national accounts in addition with the SWOT-analysis of bank system; formation of conditions of transition to steady development to be spent in a complex and comprehensively; management of process of transition to steady development of bank system should be carried out at active state participation within the limits of creation socially focused according to plan-market economy. At the given approach formation of conditions of transition of regional bank system on steady development, in our opinion, becomes possible.

  1. A Review of the Approaches Investigating the Post-16 Transition of Young Adults with Learning Difficulties

    Science.gov (United States)

    Carroll, Catherine

    2015-01-01

    Investigations into the lives and transition from compulsory schooling of young adults with a disability, including a learning difficulty (LD), are increasing. The emerging consensus is one which points to this group of young people experiencing greater difficulties and poorer outcomes compared to the general population. How these investigations…

  2. Improving Collaborative School-Agency Transition Planning: A Statewide DBMS Approach.

    Science.gov (United States)

    Peterson, Randolph L.; Roessler, Richard T.

    1997-01-01

    Describes the development and components of a referral database management system developed by the Arkansas Transition Project. The system enables individualized-education-plan team members to refer students with disabilities directly to adult agencies and to receive a monitoring report describing the agency response to the referral. The system is…

  3. Determination of the glass-transition temperature of proteins from a viscometric approach.

    Science.gov (United States)

    Monkos, Karol

    2015-03-01

    All fully hydrated proteins undergo a distinct change in their dynamical properties at glass-transition temperature Tg. To determine indirectly this temperature for dry albumins, the viscosity measurements of aqueous solutions of human, equine, ovine, porcine and rabbit serum albumin have been conducted at a wide range of concentrations and at temperatures ranging from 278 K to 318 K. Viscosity-temperature dependence of the solutions is discussed on the basis of the three parameters equation resulting from Avramov's model. One of the parameter in the Avramov's equation is the glass-transition temperature. For all studied albumins, Tg of a solution monotonically increases with increasing concentration. The glass-transition temperature of a solution depends both on Tg for a dissolved dry protein Tg,p and water Tg,w. To obtain Tg,p for each studied albumin the modified Gordon-Taylor equation was applied. This equation describes the dependence of Tg of a solution on concentration, and Tg,p and a parameter depending on the strength of the protein-solvent interaction are the fitting parameters. Thus determined the glass-transition temperature for the studied dry albumins is in the range (215.4-245.5)K. Copyright © 2014 Elsevier B.V. All rights reserved.

  4. North American oriented strand board markets, arbitrage activity, and market price dynamics: A smooth transition approach

    Science.gov (United States)

    Barry Goodwin; Matthew Holt; Jeffrey P. Prestemon

    2011-01-01

    Price dynamics for North American oriented strand board markets are examined. The role of transactions costs are explored vis-à-vis the law of one price. Nonlinearities induced by unobservable transactions costs are modeled by estimating time-varying smooth transition autoregressions (TV-STARs). Results indicate that nonlinearity and structural change are important...

  5. An integrated approach to climate adaptation at the Chicago Transit Authority.

    Science.gov (United States)

    2013-08-01

    CTA was selected as one of seven pilots funded by FTA to advance the state of practice for adapting transit systems to the impacts of : climate change. This effort is in keeping with broader long-term goals to address state-of-good-repair needs and t...

  6. Approaches to incorporating climate change effects in state and transition simulation models of vegetation

    Science.gov (United States)

    Becky K. Kerns; Miles A. Hemstrom; David Conklin; Gabriel I. Yospin; Bart Johnson; Dominique Bachelet; Scott Bridgham

    2012-01-01

    Understanding landscape vegetation dynamics often involves the use of scientifically-based modeling tools that are capable of testing alternative management scenarios given complex ecological, management, and social conditions. State-and-transition simulation model (STSM) frameworks and software such as PATH and VDDT are commonly used tools that simulate how landscapes...

  7. Transition to Collisionless Ion-Temperature-Gradient-Driven Plasma Turbulence: A Dynamical Systems Approach

    International Nuclear Information System (INIS)

    Kolesnikov, R.A.; Krommes, J.A.

    2005-01-01

    The transition to collisionless ion-temperature-gradient-driven plasma turbulence is considered by applying dynamical systems theory to a model with 10 degrees of freedom. The study of a four-dimensional center manifold predicts a 'Dimits shift' of the threshold for turbulence due to the excitation of zonal flows and establishes (for the model) the exact value of that shift

  8. Distorted wave approach to calculate Auger transition rates of ions in metals

    Energy Technology Data Exchange (ETDEWEB)

    Deutscher, Stefan A. E-mail: sad@utk.edu; Diez Muino, R.; Arnau, A.; Salin, A.; Zaremba, E

    2001-08-01

    We evaluate the role of target distortion in the determination of Auger transition rates for multicharged ions in metals. The required two electron matrix elements are calculated using numerical solutions of the Kohn-Sham equations for both the bound and continuum states. Comparisons with calculations performed using plane waves and hydrogenic orbitals are presented.

  9. Strong, weak and branching bisimulation for transition systems and Markov reward chains: A unifying matrix approach

    NARCIS (Netherlands)

    Trcka, N.; Andova, S.; McIver, A.; D'Argenio, P.; Cuijpers, P.J.L.; Markovski, J.; Morgan, C.; Núñez, M.

    2009-01-01

    We first study labeled transition systems with explicit successful termination. We establish the notions of strong, weak, and branching bisimulation in terms of boolean matrix theory, introducing thus a novel and powerful algebraic apparatus. Next we consider Markov reward chains which are

  10. An integral approach to corporate environmentalism and its application to a country in transition

    DEFF Research Database (Denmark)

    Prašnikar, J.; Ograjenšek, I.; Pahor, M.

    2012-01-01

    : in the framework of a small open transitional economy, the model differentiates well among different groups of companies. (2) There are no radical innovators among Slovenian companies, and less than one third of the companies are actively thinking and acting in line of environment-friendly processes and products...

  11. Ecological Approaches to Transition Planning for Students with Autism and Asperger's Syndrome

    Science.gov (United States)

    Dente, Claire L.; Parkinson Coles, Kallie

    2012-01-01

    This article presents a compelling case for the increased role of social workers in work with individuals with autism and Asperger's syndrome in secondary school settings, specifically in transition planning for postsecondary educational pursuits. Social work education prepares social workers to address micro, mezzo, and macro levels of practice…

  12. Sustainable Energy United in Diversity: Challenges and Approaches in Energy Transition in the EU

    NARCIS (Netherlands)

    Squintani, Lorenzo; Vedder, Hans; Vanheusden, Bernard; Reese, Moritz

    2014-01-01

    This book focuses on the relationship between environmental protection and the production, distribution and consumption of energy and the regulatory and policy challenges that are felt in the transition to a sustainable energy system and more generally a low carbon economy. Today, an increasingly

  13. How Graduates Make the School-To-Work Transition : A Person-in-Context Approach

    NARCIS (Netherlands)

    Baay, P.E.

    2015-01-01

    After finishing school, some graduates quickly and easily find a suitable job, while others face periods of un(der)employment. The current dissertation investigated such individual differences in school-to-work transition success. Our focus was on Vocational Education and Training graduates (VET –

  14. Driving After a Stroke

    Science.gov (United States)

    ... 23,2015 Can I drive after a stroke? Driving is often a major concern after someone has a stroke. It’s not unusual for stroke survivors to want to drive. Being able to get around after a stroke is important. Safety behind the wheel is even more important after ...

  15. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  16. Nursing application of Bobath principles in stroke care.

    Science.gov (United States)

    Passarella, P M; Lewis, N

    1987-04-01

    The nursing approach in the care of stroke patients has a direct impact on functional outcome. Nursing application of Bobath principles in stroke care offers a nursing focus on involvement of the affected side; facilitation of normal tone, posture, and movement; and development of more normal function. A research study evaluating the functional gains of stroke patients demonstrated a significant level of functional improvement in those treated with Bobath principles over stroke patients treated with the traditional nursing approach. Practical methods for applying Bobath principles in patient care activities are described. These therapeutic methods provide nurses with the means to maximize stroke patients' potential and further influence their functional recovery.

  17. Transition pedagogy: A third generation approach to FYE - A case study of policy and practice for the higher education sector

    Directory of Open Access Journals (Sweden)

    Sally Kift

    2010-07-01

    Full Text Available Current research and practice related to the first year experience (FYE of commencing higher education students are still mainly piecemeal rather than institution-wide with institutions struggling to achieve cross-institutional integration, coordination and coherence of FYE policy and practice. Drawing on a decade of FYE-related research including an ALTC Senior Fellowship and evidence at a large Australian metropolitan university, this paper explores how one institution has addressed that issue by tracing the evolution and maturation of strategies that ultimately conceptualize FYE as “everybody's business.” It is argued that, when first generation co-curricular and second generation curricular approaches are integrated and implemented through an intentionally designed curriculum by seamless partnerships of academic and professional staff in a whole-of-institution transformation, we have a third generation approach labelled here as transition pedagogy. It is suggested that transition pedagogy provides the optimal vehicle for dealing with the increasingly diverse commencing student cohorts by facilitating a sense of engagement, support and belonging. What is presented here is an example of transition pedagogy in action.

  18. Stroke: Working toward a Prioritized World Agenda

    Science.gov (United States)

    Hachinski, Vladimir; Donnan, Geoffrey A.; Gorelick, Philip B.; Hacke, Werner; Cramer, Steven C.; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M.; Lo, Eng H.; Skolnick, Brett E.; Furie, Karen L.; Hankey, Graeme J.; Kivipelto, Miia; Morris, John; Rothwell, Peter M.; Sacco, Ralph L.; Smith, Jr., Sidney C.; Wang, Yulun; Bryer, Alan; Ford, Gary A.; Iadecola, Costantino; Martins, Sheila C.O.; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M.; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A.; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P.; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H.; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K.; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M.; Davis, Stephen M.; Goldstein, Larry B.; Leys, Didier; Tuomilehto, Jaakko

    2010-01-01

    Background and Purpose The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent ‘silo’ mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (e.g., social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build

  19. Stroke: working toward a prioritized world agenda.

    Science.gov (United States)

    Hachinski, Vladimir; Donnan, Geoffrey A; Gorelick, Philip B; Hacke, Werner; Cramer, Steven C; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M; Lo, Eng H; Skolnick, Brett E; Furie, Karen L; Hankey, Graeme J; Kivipelto, Miia; Morris, John; Rothwell, Peter M; Sacco, Ralph L; Smith, Sidney C; Wang, Yulun; Bryer, Alan; Ford, Gary A; Iadecola, Costantino; Martins, Sheila C O; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M; Davis, Stephen M; Goldstein, Larry B; Leys, Didier; Tuomilehto, Jaakko

    2010-01-01

    The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent 'silo' mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (e.g., social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and

  20. Stroke: working toward a prioritized world agenda.

    Science.gov (United States)

    Hachinski, Vladimir; Donnan, Geoffrey A; Gorelick, Philip B; Hacke, Werner; Cramer, Steven C; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M; Lo, Eng H; Skolnick, Brett E; Furie, Karen L; Hankey, Graeme J; Kivipelto, Miia; Morris, John; Rothwell, Peter M; Sacco, Ralph L; Smith, Sidney C; Wang, Yulun; Bryer, Alan; Ford, Gary A; Iadecola, Costantino; Martins, Sheila C O; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M; Davis, Stephen M; Goldstein, Larry B; Leys, Didier; Tuomilehto, Jaakko

    2010-08-01

    The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Preliminary work was performed by seven working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent 'silo' mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and

  1. A training approach for the transition of repeatable collaboration processes to practitioners

    NARCIS (Netherlands)

    Kolfschoten, G.L.; De Vreede, G.J.; Pietron, L.R.

    2011-01-01

    This paper presents a training approach to support the deployment of collaboration process support according to the Collaboration Engineering approach. In Collaboration Engineering, practitioners in an organization are trained to facilitate a specific collaborative work practice on a recurring

  2. Greater stroke severity predominates over all other factors for the worse outcome of cardioembolic stroke.

    Science.gov (United States)

    Hong, Keun-Sik; Lee, Juneyoung; Bae, Hee-Joon; Lee, Ji Sung; Kang, Dong-Wha; Yu, Kyung-Ho; Han, Moon-Ku; Cho, Yong-Jin; Song, Pamela; Park, Jong-Moo; Oh, Mi-Sun; Koo, Jaseong; Lee, Byung-Chul

    2013-11-01

    Cardioembolic (CE) strokes are more disabling and more fatal than non-CE strokes. Multiple prognostic factors have been recognized, but the magnitude of their relative contributions has not been well explored. Using a prospective stroke outcome database, we compared the 3-month outcomes of CE and non-CE strokes. We assessed the relative contribution of each prognostic factor of initial stroke severity, poststroke complications, and baseline characteristics with multivariable analyses and model fitness improvement using -2 log-likelihood and Nagelkerke R2. This study included 1233 patients with acute ischemic stroke: 193 CE strokes and 1040 non-CE strokes. Compared with the non-CE group, CE group had less modified Rankin Scale (mRS) 0-2 outcomes (47.2% versus 68.5%; odds ratio [95% confidence interval], .41 [.30-.56]), less mRS 0-1 outcomes (33.7% versus 53.5%; .44 [.32-.61]), more mRS 5-6 outcomes (32.1% versus 10.9%; 3.88 [2.71-5.56]), and higher mortality (19.2% versus 5.2%; 4.33 [2.76-6.80]) at 3 months. When adjusting either baseline characteristics or poststroke complications, the outcome differences between the 2 groups remained significant. However, adjusting initial National Institute of Health Stroke Scale (NIHSS) score alone abolished all outcome differences except for mortality. For mRS 0-2 outcomes, the decrement of -2 log-likelihood and the Nagelkerke R2 of the model adjusting initial NIHSS score alone approached 70.2% and 76.7% of the fully adjusting model. Greater stroke severity predominates over all other factors for the worse outcome of CE stroke. Primary prevention and more efficient acute therapy for stroke victims should be given top priorities to reduce the burden of CE strokes. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Dry Electrodes for ECG and Pulse Transit Time for Blood Pressure: A Wearable Sensor and Smartphone Communication Approach

    Science.gov (United States)

    Shyamkumar, Prashanth

    Cardiovascular Diseases (CVDs) have been a major cause for deaths in both men and women in United States. Cerebrovascular Diseases like Strokes are known to have origins in CVDs as well. Moreover, nearly 18 Million Americans have a history of myocardial infarction and are currently undergoing cardiac rehabilitation. Consequently, CVDs are the highest costing disease groups and cost more than all types of cancer combined. However, significant cost reduction is possible through the effective use of the vast advances in embedded and pervasive electronic devices for healthcare. These devices can automate and move a significant portion of disease management to the patient's home through cyber connectivity, a concept known as point-of-care (POC) diagnostics and healthcare services. POC can minimize hospital visits and potentially avoid admission altogether with prognostic tools that give advanced notice of any abnormalities or chronic illnesses so that the treatment can be planned in advance. The POC concept requires continuous remote health monitoring. Therefore, the various sensors needed for comprehensive monitoring need to be worn daily and throughout the day. Moreover, true "roaming" capability is necessary so that it does not restrict the user's travel or his/her quotidian activities. Two biomedical signals namely, Electrocardiogram (ECG) and Blood Pressure are important diagnostic tests in assessing the cardiac health of a person. To that end, the research presented in this thesis: First , describes the development of a remote monitoring solution based on Bluetooth(TM), smartphones and cyber infrastructure for cardiac care called e-nanoflex. Second, Sensors for ECG that are compatible with everyday life style namely, (a) dry, gel-less vertically aligned gold nanowire electrodes, (b) dry textile-based conductive sensor electrodes to address the need for this technology to monitor cardiovascular diseases in women are tested with e-nanoflex and discussed. Third, non

  4. Minimally invasive soft tissue release of foot and ankle contracture secondary to stroke.

    Science.gov (United States)

    Boffeli, Troy J; Collier, Rachel C

    2014-01-01

    Lower extremity contracture associated with stroke commonly results in a nonreducible, spastic equinovarus deformity of the foot and ankle. Rigid contracture deformity leads to gait instability, pain, bracing difficulties, and ulcerations. The classic surgical approach for stroke-related contracture of the foot and ankle has been combinations of tendon lengthening, tendon transfer, osteotomy, and joint fusion procedures. Recovery after traditional foot and ankle reconstructive surgery requires a period of non-weightbearing that is not typically practical for these patients. Little focus has been given in published studies on minimally invasive soft tissue release of contracture. We present the case of a 61-year-old female with an equinovarus foot contracture deformity secondary to stroke. The patient underwent Achilles tendon lengthening, posterior tibial tendon Z lengthening, and digital flexor tenotomy of each toe with immediate weightbearing in a walking boot, followed by transition to an ankle-foot orthosis. The surgical principles and technique tips are presented to demonstrate our minimally invasive approach to release of foot and ankle contracture secondary to stroke. The main goal of this approach is to improve foot and ankle alignment for ease of bracing, which, in turn, will improve gait, reduce the risk of falls, decrease pain, and avoid the development of pressure sores. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Mott-Hubbard transition and Anderson localization: A generalized dynamical mean-field theory approach

    International Nuclear Information System (INIS)

    Kuchinskii, E. Z.; Nekrasov, I. A.; Sadovskii, M. V.

    2008-01-01

    The DOS, the dynamic (optical) conductivity, and the phase diagram of a strongly correlated and strongly disordered paramagnetic Anderson-Hubbard model are analyzed within the generalized dynamical mean field theory (DMFT + Σ approximation). Strong correlations are taken into account by the DMFT, and disorder is taken into account via an appropriate generalization of the self-consistent theory of localization. The DMFT effective single-impurity problem is solved by a numerical renormalization group (NRG); we consider the three-dimensional system with a semielliptic DOS. The correlated metal, Mott insulator, and correlated Anderson insulator phases are identified via the evolution of the DOS and dynamic conductivity, demonstrating both the Mott-Hubbard and Anderson metal-insulator transition and allowing the construction of the complete zero-temperature phase diagram of the Anderson-Hubbard model. Rather unusual is the possibility of a disorder-induced Mott insulator-to-metal transition

  6. The Nordic welfare model providing energy transition? A political geography approach to the EU RES directive

    International Nuclear Information System (INIS)

    Westholm, Erik; Beland Lindahl, Karin

    2012-01-01

    The EU Renewable Energy Strategy (RES) Directive requires that each member state obtain 20% of its energy supply from renewable sources by 2020. If fully implemented, this implies major changes in institutions, infrastructure, land use, and natural resource flows. This study applies a political geography perspective to explore the transition to renewable energy use in the heating and cooling segment of the Swedish energy system, 1980–2010. The Nordic welfare model, which developed mainly after the Second World War, required relatively uniform, standardized local and regional authorities functioning as implementation agents for national politics. Since 1980, the welfare orientation has gradually been complemented by competition politics promoting technological change, innovation, and entrepreneurship. This combination of welfare state organization and competition politics provided the dynamics necessary for energy transition, which occurred in a semi-public sphere of actors at various geographical scales. However, our analysis, suggest that this was partly an unintended policy outcome, since it was based on a welfare model with no significant energy aims. Our case study suggests that state organization plays a significant role, and that the EU RES Directive implementation will be uneven across Europe, reflecting various welfare models with different institutional pre-requisites for energy transition. - Highlights: ► We explore the energy transition in the heating/cooling sector in Sweden 1980–2000. ► The role of the state is studied from a political geography perspective. ► The changing welfare model offered the necessary institutional framework. ► Institutional arrangements stand out as central to explain the relative success. ► The use of renewables in EU member states will continue to vary significantly.

  7. Trip time prediction in mass transit companies. A machine learning approach

    OpenAIRE

    João M. Moreira; Alípio Jorge; Jorge Freire de Sousa; Carlos Soares

    2005-01-01

    In this paper we discuss how trip time prediction can be useful foroperational optimization in mass transit companies and which machine learningtechniques can be used to improve results. Firstly, we analyze which departmentsneed trip time prediction and when. Secondly, we review related work and thirdlywe present the analysis of trip time over a particular path. We proceed by presentingexperimental results conducted on real data with the forecasting techniques wefound most adequate, and concl...

  8. North American Oriented Strand Board Markets, Arbitrage Activity, and Market Price Dynamics: A Smooth Transition Approach

    OpenAIRE

    Goodwin, Barry K.; Holt, Matthew T.; Prestemon, Jeffery P.

    2008-01-01

    Price dynamics for North American oriented strand board (OSB) markets are examined. The role of transactions costs are explored vis-a-vis the law of one price. Weekly data, February 3rd, 1995 through October 9th, 2009, are used in the analysis. Nonlinearities induced by unobservable transactions costs are modeled by estimating Time-Varying Smooth Transition Autoregressions (TV-STARs). Results indicate that nonlinearity and structural change are important features of these markets; price...

  9. The Transition to Collisionless Ion-temperature-gradient-driven Plasma Turbulence: A Dynamical Systems Approach

    International Nuclear Information System (INIS)

    Kolesnikov, R.A.; Krommes, J.A.

    2004-01-01

    The transition to collisionless ion-temperature-gradient-driven plasma turbulence is considered by applying dynamical systems theory to a model with ten degrees of freedom. Study of a four-dimensional center manifold predicts a ''Dimits shift'' of the threshold for turbulence due to the excitation of zonal flows and establishes the exact value of that shift in terms of physical parameters. For insight into fundamental physical mechanisms, the method provides a viable alternative to large simulations

  10. Approach to Multifunctional Device Platform with Epitaxial Graphene on Transition Metal Oxide (Postprint)

    Science.gov (United States)

    2015-09-23

    layers, respectively. 15. SUBJECT TERMS Heterostructures, two-dimensional materials, van der Waals interaction , 2D graphene, metal oxide (TiO2...sample holder with a 10.6 μ m CO2 IR laser . The laser output power was adjusted until the target temperature was reached. The temperature of the sample... Laser Deposited Transition- Metal Carbides for Field-Emission Cathode Coatings. ACS Appl. Mater. Interfaces 5, 9241–9246 (2013). 13. Swift, G. A

  11. Intersegment interactions and helix-coil transition within the generalized model of polypeptide chains approach

    Science.gov (United States)

    Badasyan, A. V.; Hayrapetyan, G. N.; Tonoyan, Sh. A.; Mamasakhlisov, Y. Sh.; Benight, A. S.; Morozov, V. F.

    2009-09-01

    The generalized model of polypeptide chains is extended to describe the helix-coil transition in a system comprised of two chains interacting side-by-side. The Hamiltonian of the model takes into account four possible types of interactions between repeated units of the two chains, i.e., helix-helix, helix-coil, coil-helix, and coil-coil. Analysis reveals when the energy Ihh+Icc of (h-h, c-c) interactions overwhelms the energy Ihc+Ich of mixed (h-c, c-h) interactions, the correlation length rises substantially, resulting in narrowing of the transition interval. In the opposite case, when Ihh+Icctransition point. Conceptual links are established with experimentally oriented theories of Ghosh and Dill [J. Am. Chem. Soc. 131, 2306 (2009)] and Skolnick and Holtzer [Biochemistry 25, 6192 (1986)], providing a potential explanation for both favorable helix formation and disfavored intersegment interactions from the same theoretical perspective.

  12. Business models for Serious Games developers - transition from a product centric to a service centric approach.

    Directory of Open Access Journals (Sweden)

    Jannicke Baalsrud Hauge

    2014-02-01

    Full Text Available In the context of the serious games industry, up to now the most commonly used BM among developers representing SMEs consists in offering an individual product to the customer, based on tailored one-of a kind production. Such production has high costs and low re-usability and leads to a long time-to-market. For an industry dealing with products highly dependent on technological advances, this implies high risks for failure and thus being put out of business. Consequently, an increasing number of Serious Games developers are struggling to survive. These trends are not specific for the SG development sector, but can actually be observed in several others, like software industry as well as the manufacturing industry, where a transition to less product-oriented BM can be observed. This article is based on an analysis of cases studies to outline how such a transition might be possible also within serious game industry, but also to discuss the threats and opportunities of the transition, both based on case studies as well as on comparison with experiences in other industries

  13. Thermodynamics and kinetics of the glass transition: A generic geometric approach

    International Nuclear Information System (INIS)

    Gutzow, I.; Ilieva, D.; Babalievski, F.; Yamakov, V.

    2000-01-01

    A generic phenomenological theory of the glass transition is developed in the framework of a quasilinear formulation of the thermodynamics of irreversible processes. Starting from one of the basic principles of this science in its approximate form given by de Donder's equation, after a change of variables the temperature dependence of the structural parameter ξ(T), the thermodynamic potentials ΔG(tilde sign)(T), the thermodynamic functions and the time of molecular relaxation τ of vitrifying systems is constructed. In doing so, a new effect in the ΔG(tilde sign)(T) course is observed. The analysis of the higher derivatives of the thermodynamic potential, and especially the nullification of the second derivative of the configurational specific heats ΔC(tilde sign) p (T) of the vitrifying liquid defines glass transition temperature T(tilde sign) g and leads directly to the basic dependence of glass transition kinetics: the Frenkel-Kobeko-Reiner equation. The conditions guaranteeing the fulfillment of this equation specify the temperature dependence of the activation energy U(T,ξ(tilde sign)) for viscous flow and give a natural differentiation of glass formers into fragile and strong liquids. The effect of thermal prehistory on the temperature dependence of both thermodynamic functions and kinetic coefficients is established by an appropriate separation of de Donder's equation. (c) 2000 American Institute of Physics

  14. Strategies for stroke rehabilitation.

    Science.gov (United States)

    Dobkin, Bruce H

    2004-09-01

    Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realised any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multijoint movements on tasks that increase independence and enrich daily activity. Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.

  15. Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa - A survey based approach.

    Science.gov (United States)

    Lin, Chen; Vakani, Ravi; Kussin, Peter; Guhwe, Mary; Farjat, Alfredo E; Choudhury, Kingshuk; Renner, David; Oduor, Chrispine; Graffagnino, Carmelo

    2017-08-01

    There is no published literature regarding sub-Saharan health-care providers' understanding of stroke management patterns. Understanding current stroke management knowledge is important in formulating future education opportunities for providers to optimize patient outcomes. A cross-sectional survey of acute stroke diagnosis, hospital management, and secondary prevention questions was administered to health-care providers working in one large Kenyan acute referral hospital. Due to the prevalence of medical students (61.8%), an experienced-focused analysis contrasted students with more experienced providers. Providers (n=199) anonymously responded to the surveys. Among the acute diagnosis most respondents stated that stroke scales should always used (58.3% of respondents), 3h was the time period for alteplase (t-PA) (53.8% of respondents), and CT scan should be always be obtained prior to administration of anticoagulant therapy (61.3% of respondents). Neither VTE prophylaxis nor dysphagia/swallowing screening were considered to be done a majority of time. Secondary prevention results were variable. The respondent's level of clinical experience made the most difference in correctly answering the most appropriate IV Fluid to use in stroke patients (adjusted p=0.003) and the ideal initiation time for antithrombotic therapy (adjusted p=0.0017). Healthcare providers demonstrated a wide variability in their responses. Future efforts to improve stroke care in sub-Saharan Africa should include education and process improvement initiatives to focus on more specific aspects of stroke management based on the results from this survey. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Principles of precision medicine in stroke.

    Science.gov (United States)

    Hinman, Jason D; Rost, Natalia S; Leung, Thomas W; Montaner, Joan; Muir, Keith W; Brown, Scott; Arenillas, Juan F; Feldmann, Edward; Liebeskind, David S

    2017-01-01

    The era of precision medicine has arrived and conveys tremendous potential, particularly for stroke neurology. The diagnosis of stroke, its underlying aetiology, theranostic strategies, recurrence risk and path to recovery are populated by a series of highly individualised questions. Moreover, the phenotypic complexity of a clinical diagnosis of stroke makes a simple genetic risk assessment only partially informative on an individual basis. The guiding principles of precision medicine in stroke underscore the need to identify, value, organise and analyse the multitude of variables obtained from each individual to generate a precise approach to optimise cerebrovascular health. Existing data may be leveraged with novel technologies, informatics and practical clinical paradigms to apply these principles in stroke and realise the promise of precision medicine. Importantly, precision medicine in stroke will only be realised once efforts to collect, value and synthesise the wealth of data collected in clinical trials and routine care starts. Stroke theranostics, the ultimate vision of synchronising tailored therapeutic strategies based on specific diagnostic data, demand cerebrovascular expertise on big data approaches to clinically relevant paradigms. This review considers such challenges and delineates the principles on a roadmap for rational application of precision medicine to stroke and cerebrovascular health. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Making the ecosystem approach operational-Can regime shifts in ecological- and governance systems facilitate the transition?

    DEFF Research Database (Denmark)

    Österblom, H.; Gårdmark, A.; Bergström, L.

    2010-01-01

    Effectively reducing cumulative impacts on marine ecosystems requires co-evolution between science, policy and practice. Here, long-term social–ecological changes in the Baltic Sea are described, illustrating how the process of making the ecosystem approach operational in a large marine ecosystem...... stimulating innovations and re-organizing governance structures at drainage basin level to the Baltic Sea catchment as a whole. Experimentation and innovation at local to the regional levels is critical for a transition to ecosystem-based management. Establishing science-based learning platforms at sub...

  18. The art of 'doing' sustainable agricultural innovation: approaches and attitudes to facilitating transitional projects

    NARCIS (Netherlands)

    Loeber, A.; Vermeulen, T.; Barbier, M.; Elzen, B.

    2012-01-01

    The management of projects for sustainable innovation is characterised by a variety of intricacies. Facilitators play a central role in dealing with these challenges. Adopting an empirical approach, this chapter discusses the practical approaches and attitudes that facilitators develop to deal with

  19. Assessments in Australian stroke rehabilitation units: a systematic review of the post-stroke validity of the most frequently used.

    Science.gov (United States)

    Kitsos, Gemma; Harris, Dawn; Pollack, Michael; Hubbard, Isobel J

    2011-01-01

    In Australia, stroke is the leading cause of adult disability. For most stroke survivors, the recovery process is challenging, and in the first few weeks their recovery is supported with stroke rehabilitation services. Stroke clinicians are expected to apply an evidence-based approach to stroke rehabilitation and, in turn, use standardised and validated assessments to monitor stroke recovery. In 2008, the National Stroke Foundation conducted the first national audit of Australia's post acute stroke rehabilitation services and findings identified a vast array of assessments being used by clinicians. This study undertook a sub-analysis of the audit's assessment tools data with the aim of making clinically relevant recommendations concerning the validity of the most frequently selected assessments. Data reduction ranked the most frequently selected assessments across a series of sub-categories. A serial systematic review of relevant literature using Medline and the Cumulative Index to Nursing and Allied Health Literature identified post-stroke validity ranking. The study found that standardised and non-standardised assessments are currently in use in stroke rehabilitation. It recommends further research in the sub-categories of strength, visual acuity, dysphagia, continence and nutrition and found strengths in the sub-categories of balance and mobility, upper limb function and mood. This is the first study to map national usage of post-stroke assessments and review that usage against the evidence. It generates new knowledge concerning what assessments we currently use post stroke, what we should be using and makes some practical post stroke clinical recommendations.

  20. Business models for Serious Games developers - transition from a product centric to a service centric approach

    DEFF Research Database (Denmark)

    Hauge, Jannicke Baalsrud; Wiesner, Stefan; Sanchez, Rosa Garcia

    2014-01-01

    In the context of the serious games industry, up to now the most commonly used business models (BM) among developers representing small and medium enterprises (SMEs) consists in offering an individual product to the customer, based on tailored one-of a kind production. Such production has high...... application fields of SG, before it presents two examples of a successful transition towards a service oriented BM within the same fields Based on this, it finally discusses the opportunities and the threats of using such BMs for SG developers....

  1. Strong, Weak and Branching Bisimulation for Transition Systems and Markov Reward Chains: A Unifying Matrix Approach

    Directory of Open Access Journals (Sweden)

    Nikola Trčka

    2009-12-01

    Full Text Available We first study labeled transition systems with explicit successful termination. We establish the notions of strong, weak, and branching bisimulation in terms of boolean matrix theory, introducing thus a novel and powerful algebraic apparatus. Next we consider Markov reward chains which are standardly presented in real matrix theory. By interpreting the obtained matrix conditions for bisimulations in this setting, we automatically obtain the definitions of strong, weak, and branching bisimulation for Markov reward chains. The obtained strong and weak bisimulations are shown to coincide with some existing notions, while the obtained branching bisimulation is new, but its usefulness is questionable.

  2. Airplane stroke syndrome.

    Science.gov (United States)

    Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

    2016-07-01

    Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. A cautionary approach in transitioning to 'green' energy technologies and practices is required.

    Science.gov (United States)

    Matatiele, Puleng; Gulumian, Mary

    2016-06-01

    Renewable energy technologies (wind turbines, solar cells, biofuels, etc.) are often referred to as 'clean' or 'green' energy sources, while jobs linked to the field of environmental protection and energy efficiency are referred to as 'green' jobs. The energy efficiency of clean technologies, which is likely to reduce and/or eliminate reliance on fossil fuels, is acknowledged. However, the potential contribution of green technologies and associated practices to ill health and environmental pollution resulting from consumption of energy and raw materials, generation of waste, and the negative impacts related to some life cycle phases of these technologies are discussed. Similarly, a point is made that the green jobs theme is mistakenly oversold because the employment opportunities generated by transitioning to green technologies are not necessarily safe and healthy jobs. Emphasis is put on identifying the hazards associated with these green designs, assessing the risks to the environment and worker health and safety, and either eliminating the hazards or minimizing the risks as essential elements to the design, construction, operation, and maintenance of green technologies. The perception that it is not always economically possible to consider all risk factors associated with renewable energy technologies at the beginning without hampering their implementation, especially in the poor developing countries, is dismissed. Instead, poor countries are encouraged to start implementing environmentally sound practices while transitioning to green technologies in line with their technological development and overall economic growth.

  4. A new approach to define surface/sub-surface transition in gravel beds

    Science.gov (United States)

    Haynes, Heather; Ockelford, Anne-Marie; Vignaga, Elisa; Holmes, William

    2012-12-01

    The vertical structure of river beds varies temporally and spatially in response to hydraulic regime, sediment mobility, grain size distribution and faunal interaction. Implicit are changes to the active layer depth and bed porosity, both critical in describing processes such as armour layer development, surface-subsurface exchange processes and siltation/ sealing. Whilst measurements of the bed surface are increasingly informed by quantitative and spatial measurement techniques (e.g., laser displacement scanning), material opacity has precluded the full 3D bed structure analysis required to accurately define the surface-subsurface transition. To overcome this problem, this paper provides magnetic resonance imaging (MRI) data of vertical bed porosity profiles. Uniform and bimodal (σ g = 2.1) sand-gravel beds are considered following restructuring under sub-threshold flow durations of 60 and 960 minutes. MRI data are compared to traditional 2.5D laser displacement scans and six robust definitions of the surface-subsurface transition are provided; these form the focus of discussion.

  5. [Ecological misunderstanding, integrative approach, and potential industries in circular economy transition].

    Science.gov (United States)

    Wang, Rusong

    2005-12-01

    Based on the Social-Economic-Natural Complex Ecosystem theory, this paper questioned 8 kinds of misunderstandings in current planning, incubation, development, and management of circular economy, which had led to either ultra-right or ultra-left actions in ecological and economic development. Rather than concentrated only on the 3-r micro-principles of "reduce-reuse-recycle", thise paper suggested 3-R macro-principles of "Rethinking-Reform-Refunction" for circular economy development. Nine kinds of eco-integrative strategies in industrial transition were put forward, i.e., food web-based horizontal/parallel coupling, life cycle-oriented vertical/serial coupling, functional service rather than products-oriented production, flexible and adaptive structure, ecosystem-based regional coupling, social integrity, comprehensive capacity building, employment enhancement, and respecting human dignity. Ten promising potential eco-industries in China's near-future circular economy development were proposed, such as the transition of traditional chemical fertilizer and pesticide industry to a new kind of industrial complex for agro-ecosystem management.

  6. Level dynamics: An approach to the study of avoided level crossings and transition to chaos

    International Nuclear Information System (INIS)

    Wang, S.; Chu, S.Y.

    1993-01-01

    The Dyson-Pechukas level dynamics has been reformulated and made suitable for studying avoided level crossings and transition to chaos. The N-level dynamics is converted into a many-body problem of one-dimensional Coulomb gas with N-constituent particles having intrinsic excitations. It is shown that local fluctuation of the level distribution is generated by a large number of avoided level crossings. The role played by avoided level crossings in generating chaoticity in level dynamics is similar to the role played by short-range collisions in causing thermalization in many-body dynamics. Furthermore, the effect of level changing rates in producing avoided level crossings is the same as particle velocities in causing particle-particle collisions. A one-dimensional su(2) Hamiltonian has been constructed as an illustration of the level dynamics, showing how the avoided level crossings cause the transition from a regular distribution to the chaotic Gaussian orthogonal ensemble (GOE) distribution of the levels. The existence of the one-dimensional su(2) Hamiltonian which can show both GOE and Poisson level statistics is remarkable and deserves further investigation

  7. Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?

    Science.gov (United States)

    Nistor, Dan-Viorel; Caterev, Sergiu; Bolboacă, Sorana-Daniela; Cosma, Dan; Lucaciu, Dan Osvald Gheorghe; Todor, Adrian

    2017-11-01

    We conducted this study to establish if the transition from a lateral approach (LA) to the direct anterior approach (DAA) for a low volume hip arthroplasty surgeon during the steep learning curve can be performed maintaining the muscle sparing approach of the DAA without increasing the complication rates. In this controlled, prospective, randomized clinical study we investigated 70 patients (35 DAA, 35 LA) with similar demographics that underwent a total hip arthroplasty. Assessment of the two approaches consisted of determining the invasiveness through serum markers for muscle damage (i.e. myoglobin, creatine kinase and lactate dehydrogenase), the operative parameters such as post-operative pain and rescue medication consumption, the component positioning and complication rates. Post-operative myoglobin levels were higher (p < 0.001) in the LA group (326.42 ± 84.91 ng/mL) as compared to the DAA group (242.80 ± 71.03 ng/mL), but with no differences regarding other biomarkers for muscle damage. Pain levels were overall lower in the DAA group, with a statistical and clinical difference during surgery day (p < 0.001) associated with lower (p < 0.001) rescue medication consumption (median 1 (1; 3) mg morphine vs. 3 (2; 4) mg morphine). Most patients in the LA group reported chronic post-operative pain throughout all three evaluated months, while the majority of patients in the DAA group reported no pain after week six. Component positioning did not differ significantly between groups and neither did complication rates. The DAA can be transitioned from the LA safely, without higher complication rates while maintaining its muscle spearing advantages when performed by a low volume hip arthroplasty surgeon.

  8. Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study.

    Science.gov (United States)

    Wang, Ray-Yau; Chen, Hsiu-I; Chen, Chen-Yin; Yang, Yea-Ru

    2005-03-01

    To investigate the effectiveness of Bobath on stroke patients at different motor stages by comparing their treatment with orthopaedic treatment. A single-blind study, with random assignment to Bobath or orthopaedic group. Physical therapy department of a medical centre. Twenty-one patients with stroke with spasticity and 23 patients with stroke at relative recovery stages participated. Twenty sessions of Bobath programme or orthopaedic treatment programme given in four weeks. Stroke Impairment Assessment Set (SIAS), Motor Assessment Scale (MAS), Berg Balance Scale (BBS) and Stroke Impact Scale (SIS) for impairment and functional limitation level. Participants with spasticity showed greater improvement in tone control (change score: 1.20 +/- 1.03 versus 0.08 +/- 0.67, p = 0.006), MAS (change score: 7.64 +/- 4.03 versus 4.00 +/- 1.95, p = 0.011), and SIS (change score: 7.30 +/- 6.24 versus 1.25 +/- 5.33, p = 0.023) after 20 sessions of Bobath treatment than with orthopaedic treatment. Participants with relative recovery receiving Bobath treatment showed greater improvement in MAS (change score: 6.14 +/- 5.55 versus 2.77 +/- 9.89, p = 0.007), BBS (change score: 19.18 +/- 15.94 versus 6.85 +/- 5.23, p = 0.015), and SIS scores (change score: 8.50 +/- 3.41 versus 3.62 +/- 4.07, p = 0.006) than those with orthopaedic treatment. Bobath or orthopaedic treatment paired with spontaneous recovery resulted in improvements in impairment and functional levels for patient with stroke. Patients benefit more from the Bobath treatment in MAS and SIS scores than from the orthopaedic treatment programme regardless of their motor recovery stages.

  9. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Stroke Heroes Among Us Difficulty Swallowing After Stroke (Dysphagia) Updated:Nov 15,2016 Excerpted and adapted from "Swallowing Disorders After a Stroke," Stroke Connection Magazine July/August ...

  10. Stroke genetics: prospects for personalized medicine

    Directory of Open Access Journals (Sweden)

    Markus Hugh S

    2012-09-01

    Full Text Available Abstract Epidemiologic evidence supports a genetic predisposition to stroke. Recent advances, primarily using the genome-wide association study approach, are transforming what we know about the genetics of multifactorial stroke, and are identifying novel stroke genes. The current findings are consistent with different stroke subtypes having different genetic architecture. These discoveries may identify novel pathways involved in stroke pathogenesis, and suggest new treatment approaches. However, the already identified genetic variants explain only a small proportion of overall stroke risk, and therefore are not currently useful in predicting risk for the individual patient. Such risk prediction may become a reality as identification of a greater number of stroke risk variants that explain the majority of genetic risk proceeds, and perhaps when information on rare variants, identified by whole-genome sequencing, is also incorporated into risk algorithms. Pharmacogenomics may offer the potential for earlier implementation of 'personalized genetic' medicine. Genetic variants affecting clopidogrel and warfarin metabolism may identify non-responders and reduce side-effects, but these approaches have not yet been widely adopted in clinical practice.

  11. The art of 'doing' sustainable agricultural innovation: approaches and attitudes to facilitating transitional projects

    OpenAIRE

    Loeber, A.; Vermeulen, T.; Barbier, M.; Elzen, B.

    2012-01-01

    The management of projects for sustainable innovation is characterised by a variety of intricacies. Facilitators play a central role in dealing with these challenges. Adopting an empirical approach, this chapter discusses the practical approaches and attitudes that facilitators develop to deal with such challenges in the domain of agricultural innovation. To that end, the paper presents a list of four intricacies inherent in running projects that seek to enhance sustainable development, based...

  12. The Challenges of Afghanistan and Iraq Veterans' Transition from Military to Civilian Life and Approaches to Reconnection.

    Directory of Open Access Journals (Sweden)

    Jennifer Ahern

    Full Text Available Afghanistan and Iraq veterans experienced traumas during deployment, and disrupted connections with friends and family. In this context, it is critical to understand the nature of veterans' transition to civilian life, the challenges navigated, and approaches to reconnection. We investigated these issues in a qualitative study, framed by homecoming theory, that comprised in-depth interviews with 24 veterans. Using an inductive thematic analysis approach, we developed three overarching themes. Military as family explored how many veterans experienced the military environment as a "family" that took care of them and provided structure. Normal is alien encompassed many veterans experiences of disconnection from people at home, lack of support from institutions, lack of structure, and loss of purpose upon return to civilian life. Searching for a new normal included strategies and supports veterans found to reconnect in the face of these challenges. A veteran who had successfully transitioned and provided support and advice as a peer navigator was frequently discussed as a key resource. A minority of respondents-those who were mistreated by the military system, women veterans, and veterans recovering from substance abuse problems-were less able to access peer support. Other reconnection strategies included becoming an ambassador to the military experience, and knowing transition challenges would ease with time. Results were consistent with and are discussed in the context of homecoming theory and social climate theory. Social support is known to be protective for veterans, but our findings add the nuance of substantial obstacles veterans face in locating and accessing support, due to disconnection and unsupportive institutions. Larger scale work is needed to better understand how to foster peer connection, build reconnection with family, and engage the broader community to understand and support veterans; interventions to support reconnection for

  13. The Challenges of Afghanistan and Iraq Veterans' Transition from Military to Civilian Life and Approaches to Reconnection.

    Science.gov (United States)

    Ahern, Jennifer; Worthen, Miranda; Masters, Jackson; Lippman, Sheri A; Ozer, Emily J; Moos, Rudolf

    2015-01-01

    Afghanistan and Iraq veterans experienced traumas during deployment, and disrupted connections with friends and family. In this context, it is critical to understand the nature of veterans' transition to civilian life, the challenges navigated, and approaches to reconnection. We investigated these issues in a qualitative study, framed by homecoming theory, that comprised in-depth interviews with 24 veterans. Using an inductive thematic analysis approach, we developed three overarching themes. Military as family explored how many veterans experienced the military environment as a "family" that took care of them and provided structure. Normal is alien encompassed many veterans experiences of disconnection from people at home, lack of support from institutions, lack of structure, and loss of purpose upon return to civilian life. Searching for a new normal included strategies and supports veterans found to reconnect in the face of these challenges. A veteran who had successfully transitioned and provided support and advice as a peer navigator was frequently discussed as a key resource. A minority of respondents-those who were mistreated by the military system, women veterans, and veterans recovering from substance abuse problems-were less able to access peer support. Other reconnection strategies included becoming an ambassador to the military experience, and knowing transition challenges would ease with time. Results were consistent with and are discussed in the context of homecoming theory and social climate theory. Social support is known to be protective for veterans, but our findings add the nuance of substantial obstacles veterans face in locating and accessing support, due to disconnection and unsupportive institutions. Larger scale work is needed to better understand how to foster peer connection, build reconnection with family, and engage the broader community to understand and support veterans; interventions to support reconnection for veterans should be

  14. Co-Producing a Vision and Approach for the Transition towards a Circular Economy: Perspectives from Government Partners

    Directory of Open Access Journals (Sweden)

    Anne P. M. Velenturf

    2018-05-01

    Full Text Available The United Kingdom’s (UK economy is overly reliant on unsustainable production and consumption practices that deplete finite resources at rates that will increase production costs, business risk, and economic instability; it also produces emissions and waste that cause climate change and environmental degradation, impacting on well-being in the UK and beyond. The Resource Recovery from Waste programme (RRfW promotes a transition towards waste and resource management in a circular economy that restores the environment, creates societal benefits, and promotes clean growth by engaging relevant actors in academia, government, and industry to co-produce a shared vision and approach that will realise such a transition. Sharing the RRfW’s government engagement results, this article presents a positive outlook for changing the UK economy and society through waste and resource management practices that maximise the values of materials by circulating them in the economy for as long as possible. Key themes, regulatory instruments, a stable policy framework, and an approach for effective academic–government collaboration are proposed. Comparing the results to government plans in four UK nations shows great differences in progress towards realising a circular economy. The article concludes with recommendations to capitalise on opportunities for growth, innovation, and resilient infrastructure whilst contributing to quality jobs and welfare throughout the UK.

  15. The role of the Courts sustaining democracy: An approach from transitional regimes

    Directory of Open Access Journals (Sweden)

    Vicente F. Benítez R.

    2016-06-01

    Full Text Available This article explores the political factors that enable or prevent the consolidation of an effective judicial review in transitional democracies such as the Colombian and the Venezuelan ones. These democracies, in turn, are likely to be victims of abusive constitutionalism attempts by powerful executives, which is a phenomenon typical of young democracies. This paper analyzes key cases of successful and unsuccessful experiences in Central Europe, Asia and Latin America in order to identify what kind of factors allow or hinder a Tribunal’s effective judicial review in new democracies. I argue that factors as judicial independence, separation of powers, Courts’ reputation, and judicial deference to other branches, are key elements to determine whether a Tribunal will be a successful institution.

  16. An Information-theoretic Approach to Optimize JWST Observations and Retrievals of Transiting Exoplanet Atmospheres

    Science.gov (United States)

    Howe, Alex R.; Burrows, Adam; Deming, Drake

    2017-01-01

    We provide an example of an analysis to explore the optimization of observations of transiting hot Jupiters with the James Webb Space Telescope (JWST) to characterize their atmospheres based on a simple three-parameter forward model. We construct expansive forward model sets for 11 hot Jupiters, 10 of which are relatively well characterized, exploring a range of parameters such as equilibrium temperature and metallicity, as well as considering host stars over a wide range in brightness. We compute posterior distributions of our model parameters for each planet with all of the available JWST spectroscopic modes and several programs of combined observations and compute their effectiveness using the metric of estimated mutual information per degree of freedom. From these simulations, clear trends emerge that provide guidelines for designing a JWST observing program. We demonstrate that these guidelines apply over a wide range of planet parameters and target brightnesses for our simple forward model.

  17. Forbidden transitions in excitation by electron impact in Co3+: an R-matrix approach

    International Nuclear Information System (INIS)

    Stancalie, V

    2011-01-01

    Collision strengths for the electron-impact excitation of forbidden transitions between 136 terms arising from 3d 6 , 3d 5 4s and 3d 5 4p configurations of Co 3+ have been calculated using the R-matrix method. The accuracy of a series of models for the target terms was considered, which form the basis for R-matrix collision calculations. The importance of including configuration interaction wave functions both in the target-state expansion and in the (N+1)-electron quadratically integrable function expansion is discussed. Collision strengths were calculated for incident electron energies up to 6 Ryd. These results are believed to be the first such values for this system and will be important for plasma modelling.

  18. Transition Metal Catalyzed Reactions of Carbohydrates: a Nonoxidative Approach to Oxygenated Organics

    Energy Technology Data Exchange (ETDEWEB)

    Andrews, Mark

    1997-01-08

    There is a critical need for new environmentally friendly processes in the United States chemical industry as legislative and economic pressures push the industry to zero-waste and cradle-to-grave responsibility for the products they produce. Carbohydrates represent a plentiful, renewable resource, which for some processes might economically replace fossil feedstocks. While the conversion of biomass to fuels, is still not generally economical, the selective synthesis of a commodity or fine chemical, however, could compete effectively if appropriate catalytic conversion systems can be found. Oxygenated organics, found in a variety of products such as nylon and polyester, are particularly attractive targets. We believe that with concerted research efforts, homogeneous transition metal catalyzed reactions could play a significant role in bringing about this future green chemistry technology.

  19. Implementation of Bus Rapid Transit in Copenhagen: A Mesoscopic Model Approach

    DEFF Research Database (Denmark)

    Ingvardson, Jesper Bláfoss; Kornerup Jensen, Jonas

    2012-01-01

    Bus Rapid Transit(BRT) has shown to be an efficient and cost-effective mode of public transport, and has gained popularity in many cities around the world.To optimise the operations and infrastructure it is advantageous to deploy transportmodels. However, microscopic models are very inefficient...... upgrades (busways and enhanced stations) ensure a reduction to traveltime whereas no improvements to reliability occur. Upgrades to technology and serviceplanning (pre-paid fare collection, boarding and alighting from all doors, special BRT vehicles, ITS, and active bus control) ensure an increase...... in service reliability whereas only small reductions to travel time are observed. By combining all BRT elements it is possible to obtain synergies where the improved reliability due to planning and technology elements makes it possible to utilise the infrastructure optimally. Hence, it is possible...

  20. AN INFORMATION-THEORETIC APPROACH TO OPTIMIZE JWST OBSERVATIONS AND RETRIEVALS OF TRANSITING EXOPLANET ATMOSPHERES

    Energy Technology Data Exchange (ETDEWEB)

    Howe, Alex R.; Burrows, Adam [Department of Astronomy, University of Michigan, 1085 S. University, Ann Arbor, MI 48109 (United States); Deming, Drake, E-mail: arhowe@umich.edu, E-mail: burrows@astro.princeton.edu, E-mail: ddeming@astro.umd.edu [Department of Astronomy, University of Maryland College Park, MD 20742 (United States)

    2017-01-20

    We provide an example of an analysis to explore the optimization of observations of transiting hot Jupiters with the James Webb Space Telescope ( JWST ) to characterize their atmospheres based on a simple three-parameter forward model. We construct expansive forward model sets for 11 hot Jupiters, 10 of which are relatively well characterized, exploring a range of parameters such as equilibrium temperature and metallicity, as well as considering host stars over a wide range in brightness. We compute posterior distributions of our model parameters for each planet with all of the available JWST spectroscopic modes and several programs of combined observations and compute their effectiveness using the metric of estimated mutual information per degree of freedom. From these simulations, clear trends emerge that provide guidelines for designing a JWST observing program. We demonstrate that these guidelines apply over a wide range of planet parameters and target brightnesses for our simple forward model.

  1. Youth residential situation in the transition to adulthood: The case of Serbia (an exploratory approach

    Directory of Open Access Journals (Sweden)

    Milić Jelena

    2015-01-01

    Full Text Available Research undertaken on housing and youth to date primarily focus on those at the very bottom of the social ladder. Nonetheless, a large percentage of youth population around the world is facing a crisis in terms of achieving residential autonomy. This paper attempts to illustrate the possibilities and obstacles that prevent youth from achieving residential independence in Serbia. The data collected in this exploratory study conducted in 2014, on a sample of 312 respondents, is used to analyze some of the most important structural factors (job market, education, financial situation and access to the housing market in order to assess both current situation and the possible prospects of the youth housing issue in the country. Serbia, as most Southern European countries, has a 'Mediterranean' model of transition to adulthood, which is characterized by great reliance on the family of origin. It has been observed by respondents to this study that the most represented living arrangement was living with parents and that even older cohorts (30 to 35 years old in most cases continued living with their family of origin to date. As our findings indicate, youth from the sample perceived this residential arrangement more as a consequence of poor financial situation and lack of cheap housing, rather than a desirable choice. It is difficult to predict if there will be significant improvements in the housing affordability or job market situation for youth, therefore the prospect of achieving residential independency for generations to come will remain tremendously challenging. Investigating existing and defining new strategies, in both the family and broader society contexts, is an important task for future research on accessibility of housing and youth residential situation advancement given the importance of this factor in the transition to adulthood.

  2. [Ischemic stroke in the young adult].

    Science.gov (United States)

    Calvet, D

    2016-01-01

    Ischemic stroke is not rare in young adults since one in ten stroke patients are less than 50 years old. This incidence increased over the past last years, mainly due to the rise in the prevalence of traditional vascular risk factors in this sub-group of age but also of illegal drug use. Even though both survival and functional outcome of young stroke patients are better than those observed in older patients, socio-economic and quality of life consequences make this disease a main objective in terms of primary and secondary prevention. Identifying the cause of ischemic stroke in young adults is of major importance to prevent stroke recurrence. However, given the wide variety of potential underlying causes, the etiologic work-up of stroke in young adults requires a different approach from that in the elderly. In this context, a sequential diagnostic work-up is needed in order to optimize the yield of diagnostic tests, to reduce their cost and risks for the patient. Arterial dissection is the most frequent cause of stroke in young adults but other less frequent causes are numerous. Despite a comprehensive work-up, about one third of cases remains unexplained leading to the diagnosis of cryptogenic ischemic stroke. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  3. Acute stroke: automatic perfusion lesion outlining using level sets.

    Science.gov (United States)

    Mouridsen, Kim; Nagenthiraja, Kartheeban; Jónsdóttir, Kristjana Ýr; Ribe, Lars R; Neumann, Anders B; Hjort, Niels; Østergaard, Leif

    2013-11-01

    To develop a user-independent algorithm for the delineation of hypoperfused tissue on perfusion-weighted images and evaluate its performance relative to a standard threshold method in simulated data, as well as in acute stroke patients. The study was approved by the local ethics committee, and patients gave written informed consent prior to their inclusion in the study. The algorithm identifies hypoperfused tissue in mean transit time maps by simultaneously minimizing the mean square error between individual and mean perfusion values inside and outside a smooth boundary. In 14 acute stroke patients, volumetric agreement between automated outlines and manual outlines determined in consensus among four neuroradiologists was assessed with Bland-Altman analysis, while spatial agreement was quantified by using lesion overlap relative to mean lesion volume (Dice coefficient). Performance improvement relative to a standard threshold approach was tested with the Wilcoxon signed rank test. The mean difference in lesion volume between automated outlines and manual outlines was -9.0 mL ± 44.5 (standard deviation). The lowest mean volume difference for the threshold approach was -25.8 mL ± 88.2. A significantly higher Dice coefficient was observed with the algorithm (0.71; interquartile range [IQR], 0.42-0.75) compared with the threshold approach (0.50; IQR, 0.27- 0.57; P , .001). The corresponding agreement among experts was 0.79 (IQR, 0.69-0.83). The perfusion lesions outlined by the automated algorithm agreed well with those defined manually in consensus by four experts and were superior to those obtained by using the standard threshold approach. This user-independent algorithm may improve the assessment of perfusion images as part of acute stroke treatment. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121622/-/DC1. RSNA, 2013

  4. The European Stroke Organisation Guidelines: a standard operating procedure.

    Science.gov (United States)

    Ntaios, George; Bornstein, Natan M; Caso, Valeria; Christensen, Hanne; De Keyser, Jacques; Diener, Hans-Christoph; Diez-Tejedor, Exuperio; Ferro, Jose M; Ford, Gary A; Grau, Armin; Keller, Emanuella; Leys, Didier; Russell, David; Toni, Danilo; Turc, Guillaume; Van der Worp, Bart; Wahlgren, Nils; Steiner, Thorsten

    2015-10-01

    In 2008, the recently founded European Stroke Organisation published its guidelines for the management of ischemic stroke and transient ischemic attack. This highly cited document was translated in several languages and was updated in 2009. Since then, the European Stroke Organisation has published guidelines for the management of intracranial aneurysms and subarachnoidal hemorrhage, for the establishment of stroke units and stroke centers, and recently for the management of intracerebral hemorrhage. In recent years, the methodology for the development of guidelines has evolved significantly. To keep pace with this progress and driven by the strong determination of the European Stroke Organisation to further promote stroke management, education, and research, the European Stroke Organisation decided to delineate a detailed standard operating procedure for its guidelines. There are two important cornerstones in this standard operating procedure: The first is the implementation of the Grading of Recommendations Assessment, Development, and Evaluation methodology for the development of its Guideline Documents. The second one is the decision of the European Stroke Organisation to move from the classical model of a single Guideline Document about a major topic (e.g. management of ischemic stroke) to focused modules (i.e. subdivisions of a major topic). This will enable the European Stroke Organisation to react faster when new developments in a specific stroke field occur and update its recommendations on the related module rather swiftly; with the previous approach of a single large Guideline Document, its entire revision had to be completed before an updated publication, delaying the production of up-to-date guidelines. After discussion within the European Stroke Organisation Guidelines Committee and significant input from European Stroke Organisation members as well as methodologists and analysts, this document presents the official standard operating procedure for

  5. Brain Basics: Preventing Stroke

    Science.gov (United States)

    ... NINDS) are committed to reducing that burden through biomedical research. What is a Stroke? A stroke, or "brain ... Testimony Legislative Updates Impact NINDS Contributions to Approved Therapies ... Director, Division of Intramural Research

  6. Stroke Warning Signs

    Science.gov (United States)

    ... person to repeat a simple sentence, like "The sky is blue." Is the person able to correctly ... to Your Doctor to Create a Plan The Life After Stroke Journey Every stroke recovery is different. ...

  7. The Net Black Advantage in Educational Transitions: An Education Careers Approach

    Science.gov (United States)

    Merolla, David M.

    2013-01-01

    Recent studies have found a net Black advantage in educational attainment. This pattern indicates that after controlling for socioeconomic and academic characteristics, Black students are more likely to continue education than are their White counterparts. Using an educational careers approach, this study examines selection and student…

  8. Developmental Transition of Motherhood: Treating Postpartum Depression Using a Feminist Approach

    Science.gov (United States)

    Davis-Gage, Darcie; Kettmann, Julie Jenks; Moel, Joy

    2010-01-01

    During the developmental lifeline for women, some individuals are affected by postpartum depression. This article describes the treatment of a Latina woman experiencing postpartum depression. The authors illustrate the feminist approach using counseling interventions that incorporate the client's developmental level, cultural background, and…

  9. A level set approach for shock-induced α-γ phase transition of RDX

    Science.gov (United States)

    Josyula, Kartik; Rahul; De, Suvranu

    2018-02-01

    We present a thermodynamically consistent level sets approach based on regularization energy functional which can be directly incorporated into a Galerkin finite element framework to model interface motion. The regularization energy leads to a diffusive form of flux that is embedded within the level sets evolution equation which maintains the signed distance property of the level set function. The scheme is shown to compare well with the velocity extension method in capturing the interface position. The proposed level sets approach is employed to study the α-γphase transformation in RDX single crystal shocked along the (100) plane. Example problems in one and three dimensions are presented. We observe smooth evolution of the phase interface along the shock direction in both models. There is no diffusion of the interface during the zero level set evolution in the three dimensional model. The level sets approach is shown to capture the characteristics of the shock-induced α-γ phase transformation such as stress relaxation behind the phase interface and the finite time required for the phase transformation to complete. The regularization energy based level sets approach is efficient, robust, and easy to implement.

  10. [Genetics of ischemic stroke].

    Science.gov (United States)

    Gschwendtner, A; Dichgans, M

    2013-02-01

    Stroke is one of the most widespread causes of mortality und disability worldwide. Around 80 % of strokes are ischemic and different forms of intracranial bleeding account for the remaining cases. Monogenic stroke disorders are rare but the diagnosis may lead to specific therapeutic consequences for the affected patients who are predominantly young. In common sporadic stroke, genetic factors play a role in the form of susceptibility genes. Their discovery may give rise to new therapeutic options in the future.

  11. Environmental changes during Frasnian-Famennian transition in south China: A multiproxy approach

    Science.gov (United States)

    Xu, Bing; Gu, Zhaoyan; Han, Jingtai; Wang, Chengyuan

    2008-12-01

    This study presents high-resolution multiproxy analyses on two Late Devonian sequences for characterizing the environmental changes during the Frasnian-Famennian (F-F) transition in south China. Carbon isotope signatures of the carbonate and organic matter consistently show two positive excursions in the late rhenana zone and around the F-F boundary, implying two increased organic carbon burial events. These observations are consistent with the records from other continents, providing further support for the documented perturbations of the global carbon cycle. Redox indices, mainly of the Cu/Al and U/Al ratios, and hydrothermal-volcanic proxies, Al/(Al + Fe) and Zr/Al, indicate reducing conditions and increased hydrothermal-volcanic activities during these carbon isotope excursions. High-resolution investigations revealed that the reducing conditions predate the onset of the carbon isotope excursions, suggesting that the two positive carbon isotope shifts are likely caused by the expansion of anoxic conditions. The low Al/(Al + Fe) ratio around the F-F boundary leads the U/Al and Cu/Al anomalies in timing, implying that this anoxic event might have resulted from a long-term cumulative effect of intense hydrothermal-volcanic activities. In the late rhenana zone, enhanced hydrothermal activity also seems responsible for the reducing conditions.

  12. On the dynamics of liquids in their viscous regime approaching the glass transition.

    Science.gov (United States)

    Chen, Z; Angell, C A; Richert, R

    2012-07-01

    Recently, Mallamace et al. (Eur. Phys. J. E 34, 94 (2011)) proposed a crossover temperature, T(×), and claimed that the dynamics of many supercooled liquids follow an Arrhenius-type temperature dependence between T(×) and the glass transition temperature T(g). The opposite, namely super-Arrhenius behavior in this viscous regime, has been demonstrated repeatedly for molecular glass-former, for polymers, and for the majority of the exhaustively studied inorganic glasses of technological interest. Therefore, we subject the molecular systems of the Mallamace et al. study to a "residuals" analysis and include not only viscosity data but also the more precise data available from dielectric relaxation experiments over the same temperature range. Although many viscosity data sets are inconclusive due to their noise level, we find that Arrhenius behavior is not a general feature of viscosity in the T(g) to T(×) range. Moreover, the residuals of dielectric relaxation times with respect to an Arrhenius law clearly reveal systematic curvature consistent with super-Arrhenius behavior being an endemic feature of transport properties in this viscous regime. We also observe a common pattern of how dielectric relaxation times decouple slightly from viscosity.

  13. A molecular dynamics approach for predicting the glass transition temperature and plasticization effect in amorphous pharmaceuticals.

    Science.gov (United States)

    Gupta, Jasmine; Nunes, Cletus; Jonnalagadda, Sriramakamal

    2013-11-04

    The objectives of this study were as follows: (i) To develop an in silico technique, based on molecular dynamics (MD) simulations, to predict glass transition temperatures (Tg) of amorphous pharmaceuticals. (ii) To computationally study the effect of plasticizer on Tg. (iii) To investigate the intermolecular interactions using radial distribution function (RDF). Amorphous sucrose and water were selected as the model compound and plasticizer, respectively. MD simulations were performed using COMPASS force field and isothermal-isobaric ensembles. The specific volumes of amorphous cells were computed in the temperature range of 440-265 K. The characteristic "kink" observed in volume-temperature curves, in conjunction with regression analysis, defined the Tg. The MD computed Tg values were 367 K, 352 K and 343 K for amorphous sucrose containing 0%, 3% and 5% w/w water, respectively. The MD technique thus effectively simulated the plasticization effect of water; and the corresponding Tg values were in reasonable agreement with theoretical models and literature reports. The RDF measurements revealed strong hydrogen bond interactions between sucrose hydroxyl oxygens and water oxygen. Steric effects led to weak interactions between sucrose acetal oxygens and water oxygen. MD is thus a powerful predictive tool for probing temperature and water effects on the stability of amorphous systems during drug development.

  14. Transition-state characterization: a new approach combining inhibitor analogues and variation in enzyme structure.

    Science.gov (United States)

    Phillips, M A; Kaplan, A P; Rutter, W J; Bartlett, P A

    1992-02-04

    A new strategy of potentially broad application for probing transition-state (TS) analogy in enzymatic systems is described in this paper. The degree to which a series of phosphonate inhibitors act as TS analogues of rat carboxypeptidase A1 has been determined for the wild-type enzyme, for the R127K, R127M, and R127A mutants, and for the R127A mutant in the presence of 0.5 M guanidine hydrochloride. The impact that the mutations have on the inverse second-order rate constants (Km/kcat) for substrate hydrolysis is mirrored by the effect on the inhibition constants (Ki) for the corresponding phosphonate inhibitors. These results demonstrate that the phosphonate moiety mimics some of the electronic as well as the geometric characteristics of the TS. A similar but distinctly separate correlation is observed for tripeptide analogues in comparison to analogues of the dipeptide Cbz-Gly-Phe, reflecting an anomalous mode of binding for the latter system. The selective rate increases and corresponding enhancement in inhibitor binding observed on addition of 0.5 M guanidine hydrochloride to the R127A mutant indicate that the exogenous cation can assume the role played by Arg-127 in stabilizing the TS and in providing substrate selectivity at the P2 position.

  15. Influence of network communities and transition to web 3.0 on change of approaches

    Directory of Open Access Journals (Sweden)

    Ринат Гинаятович Рамазанов

    2018-12-01

    Full Text Available The article presents the genesis of network communities, the transformation of the interaction of participants in the evolution of this form of communication. The main characteristics and stages inherent in changing the formats of network interaction are described. The concept of networked communities is multifaceted and includes various processes of socialization: from the behaviour of people in interest groups to the formation of large international online communities. The evolution of such communities includes the transition from guest books and forums to more complex systems with many additional tools for networking. The introduction of modern technologies in all spheres of life leads to the formation of a qualitatively new distinctive model of education. In such conditions, the roles of participants in the educational process are changing, more attention is paid to self-education and development at the expense of the internal need for learning, the organizational and methodological component of the educational process is being reconstructed, and new conditions are created for the development of distance learning technologies. All this allows us to develop a more competitive system of interaction, make management processes transparent and create conditions for the independent development of each participant in the network space. Online network communities are a powerful tool that must be used in the education system in various interpretations, and as an additional resource that allows the principle of “lifelong learning” to be introduced into the teacher’s self-education system.

  16. Variational local moment approach: From Kondo effect to Mott transition in correlated electron systems

    International Nuclear Information System (INIS)

    Kauch, Anna; Byczuk, Krzysztof

    2012-01-01

    The variational local moment approach (VLMA) solution of the single impurity Anderson model is presented. It generalizes the local moment approach of Logan et al. by invoking the variational principle to determine the lengths of local moments and orbital occupancies. We show that VLMA is a comprehensive, conserving and thermodynamically consistent approximation and treats both Fermi and non-Fermi liquid regimes as well as local moment phases on equal footing. We tested VLMA on selected problems. We solved the single- and multi-orbital impurity Anderson model in various regions of parameters, where different types of Kondo effects occur. The application of VLMA as an impurity solver of the dynamical mean-field theory, used to solve the multi-orbital Hubbard model, is also addressed.

  17. A herd health approach to dairy cow nutrition and production diseases of the transition cow.

    Science.gov (United States)

    Mulligan, F J; O'Grady, L; Rice, D A; Doherty, M L

    2006-12-01

    This paper presents a practical, on-farm approach for the monitoring and prevention of production disease in dairy cattle. This integrated approach, should be used in an interdisciplinary way by farmers, veterinarians, nutrition advisors and other relevant professionals for the improvement of animal health and welfare and producer profitability. The key areas that form the basis for this approach are body condition score management, negative energy balance, hypocalcaemia, rumen health and trace element status. Monitoring criteria are described for each of these key areas, which when considered collectively, will facilitate the assessment of dairy cow health with regard to clinical and subclinical disease. The criteria, which are informed by published scientific literature, are based on farm management and environmental factors, clinical data, milk production records, dietary analysis, and assessment of blood and liver concentrations of various metabolites or trace elements. The aim is to review the efficacy of production disease control measures currently in place, and if necessary to modify them or formulate new ones.

  18. New approaches to obtaining scientific innovation in morphological studies of bladder transitional epithelium

    Directory of Open Access Journals (Sweden)

    O Popadynets

    2017-06-01

    Full Text Available Objective: To demonstrate the capabilities of cluster analysis in receiving scientific innovation results in morphological studies of cells of the bladder urothelium. Materials and methods.10 Wistar rats were used. Histological sections were stained with hematoxylin and eosin; electron microscope studies were  conducted; morphometry was performed in ImageJ and statistics – in studio-R using nonparametric methods and multivariate statistics. Results. A brief description of the main stages of cluster analysis shows way to determine the most important features of uroteliocytes and to reveal their heterogeneity, algorithms of Euclidean metrics and methods of clustering were described, the features of the application of the analysis in morphological studies were presented, an example of using these methods in searching for new results was presented, the models of morphological substantiation of clustering results were showed.  Conclusion: 1 cluster analysis provides a scientific novelty in studies of transitional epithelium of the bladder; 2 it is used in case of heterogeneity of cellular composition of urothelium that is detected with a help of coefficient of variation; 3 the most significant features of uroteliocytes are their cell area and their nuclei area; 4 new results on the number of clusters were obtained by method of Ward, and new data on their indicators – by k-means; 5 Euclidean metric is the best to use; 6 to assess the adequacy of the results pairwise comparisons between multiple clusters were carried out according to their indicators; 7 results are presented in dimentional projection and they characterize cellular composition of the urothelium as structural system and detect systemic effects.

  19. Walking at speeds close to the preferred transition speed as an approach to obesity treatment

    Directory of Open Access Journals (Sweden)

    Ilić Duško

    2012-01-01

    Full Text Available Introduction. Increasing energy expenditure through certain exercise is an important component of effective interventions to enhance initial weight loss and prevent weight regain. Objective. The purpose of this study was to determine the effect of a 16-week weight loss exercise programme on morpho-functional changes in female adults and to examine the programme effects on two subpopulations with different levels of obesity. Methods. Fifty-six middle-aged women were divided into 2 groups according to their body mass index (BMI: 25-29.9 kg/m2 - overweight (OW and ≥30 kg/m2 - obese (OB. The exercise protocol included a walking technique based on hip rotation at horizontal plane at speeds close to the preferred transition speed (PTS. At the initiation of the study and after 16 weeks of the programme, anthropometric, morphological and cardiovascular parameters of all subjects were assessed. The main effects of Group (OW and OB and Time and the interaction effect of Group by Time were tested by time repeated measures General Linear Model (mixed between-within subjects ANOVA. Results. Mean weight loss during the programme was 10.3 kg and 20.1 kg in OW and OB, respectively. The average fat mass (FM loss was 9.4 kg in OW and 16.9 kg in OB. The Mixed ANOVA revealed a significant Group by Time interaction effects for waist circumference, body weight, body water, fat free mass, FM, %FM and BMI (p<0.05. Conclusion. The applied exercise protocol has proved as beneficial in the treatment of obesity, since it resulted in a significant weight loss and body composition changes. The reduction in body weight was achieved mainly on account of the loss of fat mass.

  20. Comparison of groundwater transit velocity estimates from flux theory and water table recession based approaches for solute transport.

    Science.gov (United States)

    Rasiah, Velu; Armour, John David

    2013-02-15

    Reliable information in transit time (TT) derived from transit velocity (TV) for rain or irrigation water to mix with groundwater (GW) and the subsequent discharge to surface water bodies (SWB) is essential to address the issues associated with the transport of nutrients, particularly nitrate, from GW to SWB. The objectives of this study are to (i) compare the TV estimates obtained using flux theory-based (FT) approach with the water table rise/recession (WT) rate approach and (ii) explore the impact of the differences on solute transport from GW to SWB. The results from a study conducted during two rainy seasons in the northeast humid tropics of Queensland, Australia, showed the TV varied in space and over time and the variations depended on the estimation procedures. The lateral TV computed using the WT approach ranged from 1.00 × 10(-3) to 2.82 × 10(-1) m/d with a mean of 6.18 × 10(-2) m/d compared with 2.90 × 10(-4) to 5.15 × 10(-2) m/d for FT with a mean of 2.63 × 10(-2) m/d. The vertical TV ranged from 2.00 × 10(-3) to 6.02 × 10(-1) m/d with a mean of 1.28 × 10(-1) m/d for the WT compared with 6.76 × 10(-3)-1.78 m/d for the FT with a mean of 2.73 × 10(-1) m/d. These differences are attributed to the role played by different flow pathways. The bypass flow pathway played a role only in WT but not in FT. Approximately 86-95% of the variability in lateral solute transport was accounted for by the lateral TV and the total recession between two consecutive major rainfall events. A comparison of TT from FT and WT approaches indicated the laterally transported nitrate from the GW to the nearby creek was relatively 'new', implying the opportunity for accumulation and to undergo biochemical reactions in GW was low. The results indicated the WT approach produced more reliable TT estimates than FT in the presence of bypass flow pathways. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Early Rehabilitation After Stroke: a Narrative Review.

    Science.gov (United States)

    Coleman, Elisheva R; Moudgal, Rohitha; Lang, Kathryn; Hyacinth, Hyacinth I; Awosika, Oluwole O; Kissela, Brett M; Feng, Wuwei

    2017-11-07

    Despite current rehabilitative strategies, stroke remains a leading cause of disability in the USA. There is a window of enhanced neuroplasticity early after stroke, during which the brain's dynamic response to injury is heightened and rehabilitation might be particularly effective. This review summarizes the evidence of the existence of this plastic window, and the evidence regarding safety and efficacy of early rehabilitative strategies for several stroke domain-specific deficits. Overall, trials of rehabilitation in the first 2 weeks after stroke are scarce. In the realm of very early mobilization, one large and one small trial found potential harm from mobilizing patients within the first 24 h after stroke, and only one small trial found benefit in doing so. For the upper extremity, constraint-induced movement therapy appears to have benefit when started within 2 weeks of stroke. Evidence for non-invasive brain stimulation in the acute period remains scant and inconclusive. For aphasia, the evidence is mixed, but intensive early therapy might be of benefit for patients with severe aphasia. Mirror therapy begun early after stroke shows promise for the alleviation of neglect. Novel approaches to treating dysphagia early after stroke appear promising, but the high rate of spontaneous improvement makes their benefit difficult to gauge. The optimal time to begin rehabilitation after a stroke remains unsettled, though the evidence is mounting that for at least some deficits, initiation of rehabilitative strategies within the first 2 weeks of stroke is beneficial. Commencing intensive therapy in the first 24 h may be harmful.

  2. Multi-layer Lanczos iteration approach to calculations of vibrational energies and dipole transition intensities for polyatomic molecules

    International Nuclear Information System (INIS)

    Yu, Hua-Gen

    2015-01-01

    We report a rigorous full dimensional quantum dynamics algorithm, the multi-layer Lanczos method, for computing vibrational energies and dipole transition intensities of polyatomic molecules without any dynamics approximation. The multi-layer Lanczos method is developed by using a few advanced techniques including the guided spectral transform Lanczos method, multi-layer Lanczos iteration approach, recursive residue generation method, and dipole-wavefunction contraction. The quantum molecular Hamiltonian at the total angular momentum J = 0 is represented in a set of orthogonal polyspherical coordinates so that the large amplitude motions of vibrations are naturally described. In particular, the algorithm is general and problem-independent. An application is illustrated by calculating the infrared vibrational dipole transition spectrum of CH based on the ab initio T8 potential energy surface of Schwenke and Partridge and the low-order truncated ab initio dipole moment surfaces of Yurchenko and co-workers. A comparison with experiments is made. The algorithm is also applicable for Raman polarizability active spectra

  3. Unilateral versus bilateral upper limb training after stroke: the ULTRA-Stroke clinical trial

    NARCIS (Netherlands)

    van Delden, A.E.Q.; Peper, C.E.; Nienhuys, K.; Zijp, N.I.; Beek, P.J.; Kwakkel, G.

    2013-01-01

    Background and Purpose - Unilateral and bilateral training protocols for upper limb rehabilitation after stroke represent conceptually contrasting approaches with the same ultimate goal. In a randomized controlled trial, we compared the merits of modified constraint-induced movement therapy,

  4. Spontaneous spin-polarization and phase transition in the relativistic approach

    International Nuclear Information System (INIS)

    Maruyama, Tomoyuki; Tatsumi, Toshitaka

    2001-01-01

    We study the spin-polarization mechanism in the highly dense nuclear matter with the relativistic mean-field approach. In the relativistic Hartree-Fock framework we find that there are two kinds of spin-spin interaction channels, which are the axial-vector and tensor exchange ones. If each interaction is strong and different sign, the system loses the spherical symmetry and holds the spin-polarization in the high-density region. When the axial-vector interaction is negative enough, the system holds ferromagnetism. (author)

  5. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death.......5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women...

  6. Recovery of dressing ability after stroke

    OpenAIRE

    Fletcher-Smith, Joanna C.

    2011-01-01

    The research programme was designed to coincide with a separate phase II randomised controlled trial (RCT) of a Neuropsychological approach to dressing rehabilitation after stroke entitled ‘Dressing Rehabilitation Evaluation Stroke Study’ (DRESS). This research programme incorporated the cohort of participants from the DRESS study. It was an original piece of work that involved three separate but related research studies. The first project involved an inter-rater reliability study of ...

  7. Seizure development after stroke.

    Science.gov (United States)

    Misirli, H; Ozge, A; Somay, G; Erdoğan, N; Erkal, H; Erenoğlu, N Y

    2006-12-01

    Although there have been many studies on seizures following stroke, there is still much we do not know about them. In this study, we evaluated the characteristics of seizures in stroke patients. There were 2267 patients with a first-ever stroke, and after excluding 387 patients, 1880 were available for analysis. Of these 1880 patients, we evaluated 200 patients with seizures and 400 patients without seizures. We investigated the seizures according to age, gender, stroke type, the aetiology of ischaemic stroke and the localisation of the lesion. The seizures were classified as early onset and late onset and the seizure type as partial, generalised or secondarily generalised. Seizures occurred in 200 (10.6%) of 1880 strokes. The number of patients with seizures were 138 (10.6%) in ischaemic stroke group and 62 (10.7%) in haemorrhagic stroke group. Patients with ischaemic strokes had 41 embolic (29.7%) and 97 thrombotic (70.3%) origin, and these were not statistically significant in comparison with controls. Cortical involvement for the development of seizures was the most important risk factor (odds ratios = 4.25, p < 0.01). It was concluded that embolic strokes, being younger than 65 years old, and cortical localisation of stroke were important risks for developing seizures.

  8. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

  9. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich

    2014-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  10. Organization of prehospital medical care for patients with cerebral stroke

    Directory of Open Access Journals (Sweden)

    Nikolai Anatolyevich Shamalov

    2013-01-01

    Full Text Available The main tasks of prehospital medical care are to make a correct diagnosis of stroke and to minimize patient transportation delays. Stroke is a medical emergency so all patients with suspected stroke must be admitted by a first arrived ambulance team to a specialized neurology unit for stroke patients. Most rapidly transporting the patient to hospital, as well as reducing the time of examination to verify the pattern of stroke are a guarantee of successful thrombolytic therapy that is the most effective treatment for ischemic stroke. Substantially reducing the time of in-hospital transfers (the so-called door-to-needle time allows stroke patients to be directly admitted to the around the clock computed tomography room, without being sent to the admission unit. Prehospital stroke treatment policy (basic therapy is to correct the body’s vital functions and to maintain respiration, hemodynamics, and water-electrolyte balance and it can be performed without neuroimaging verification of the pattern of stroke. The application of current organizational, methodical, and educational approaches is useful in improving the quality of medical care for stroke patients, in enhancing the continuity between prehospital and hospital cares, and in promoting new effective technologies in stroke therapy.

  11. Rehabilitation of a patient with stroke

    Directory of Open Access Journals (Sweden)

    Apurba Barman

    2013-01-01

    Full Text Available Stroke is a significant cause of long-term disability world-wide. The post-stroke disabilities are due to loss of locomotion, activity of daily living, cognition and communication skills. Rehabilitation is an integral part of medical management and continues longitudinally through acute care, post-acute care and community reintegration. The objectives of stroke rehabilitation are to maximize the functional independence, minimize the disabilities, reintegrate back into the home and community and improve the self-esteem of patient. A comprehensive stroke rehabilitation service should provide early assessment of impairments and disabilities, management and prevention of complications and well-organized rehabilitation program in both in-patient and out-patient settings. A multidisciplinary or interdisciplinary team approach is necessary to reduce the post-stroke disabilities. It has many members, including physicians, physical therapists, occupational therapists, speech and language pathologists, orthotist, psychotherapists, social workers, vocational rehabilitation therapists, rehabilitation nurse, patients, families and other caregivers. Physicians caring for patients with stroke during rehabilitation must be aware of potential medical complications, as well as a number of special problems that may complicate recovery, including cognitive deficits, aphasia, dysphagia, urinary incontinence, shoulder pain, spasticity, falls and depression. Involvement of patient and caregivers in the rehabilitation process is essential. This article outlines the salient features of the early comprehensive rehabilitation after stroke.

  12. Geostatistical Approach to Find ‘Hotspots’ Where Biodiversity is at Risk in a Transition Country

    Directory of Open Access Journals (Sweden)

    Petrişor Alexandru-Ionuţ

    2014-10-01

    Full Text Available Global change‟ is a relatively recent concept, related to the energy - land use - climate change nexus, and designated to include all changes produced by the human species and the consequences of its activities over natural ecological complexes and biodiversity. The joint effects of these drivers of change are particularly relevant to understanding the changes of biodiversity. This study overlaps results of previous studies developed in Romania to find, explain and predict potential threats on biodiversity, including the effects of very high temperatures and low precipitations, urban sprawl and deforestation in order to identify „hotspots‟ of high risk for the loss of biodiversity using geostatistical tools. The results found two hotspots, one in the center and the other one in the south, and show that the area affected by three factors simultaneously represents 0.2% of the national territory, while paired effects cover 4% of it. The methodological advantage of this approach is its capacity to pinpoint hotspots with practical relevance. Nevertheless, its generalizing character impairs its use at the local scale..

  13. Successes of trade reorientation and expansion in post-communist transition: an enterprise-level approach

    Directory of Open Access Journals (Sweden)

    Jan Winiecki

    2000-06-01

    Full Text Available The article offers an approach to the westward reorientation of foreign trade by the post-communist economies of East-Central Europe at the micro--i.e. enterprise--level. Having presented the dynamics of reorientation and its theoretical/historical underpinnings, the writer then goes on to underline the surprisingly large number of microeconomic determinants behind the strong westbound export surge. The article starts with the most often cited factor, namely the distressed sale argument, and then shifts the focus to determinants that have received far less attention: an unusual extension of the "distressed sale" argument and another, more important one, namely the legacy of the oversized industrial sector and resultant availability of firms ready (or forced to test their mettle on the world markets. The following section extends the list of determinants to foreign direct investment and the growing export activity of domestic de novo firms. The linkages between the determinants are also pointed out. The final section sums up the observations.

  14. Effects of stroke education of junior high school students on stroke knowledge of their parents: Tochigi project.

    Science.gov (United States)

    Matsuzono, Kosuke; Yokota, Chiaki; Takekawa, Hidehiro; Okamura, Tomonori; Miyamatsu, Naomi; Nakayama, Hirofumi; Nishimura, Kunihiro; Ohyama, Satoshi; Ishigami, Akiko; Okumura, Kosuke; Toyoda, Kazunori; Miyamoto, Yoshihiro; Minematsu, Kazuo

    2015-02-01

    Educating the youth about stroke is a promising approach for spreading stroke knowledge. The aim of this study was to verify communication of stroke knowledge to parents by educating junior high school students about stroke. We enrolled 1127 junior high school students (age, 13-15 years) and their parents in the Tochigi prefecture, Japan. All students received a stroke lesson, watched an animated cartoon, and read the related Manga comic as educational aids. The students took back home the Manga and discussed what they learned with their parents. Questionnaires on stroke knowledge were given to all at baseline and immediately after the lesson. A total of 1125 students and 915 parents answered the questionnaires. In the students, the frequency of correct answers increased significantly for all questions on stroke symptoms except for headache, and for all questions on risk factors after the lesson. In the parents, the correct answer rates increased for stroke symptoms except for headache and numbness in one side of the body, and for all questions on risk factors except for hypertension. Ninety-one percent of students and 92.7% of parents correctly understood the Face, Arm, Speech, and Time (FAST) mnemonic after the lesson. Improvement of stroke knowledge immediately after the stroke lesson was observed in parents as well as their children, which indicated that our teaching materials using the Manga was effective in delivering the stroke knowledge to parents through their children. © 2014 American Heart Association, Inc.

  15. Teaching Animal Physiology: a 12-year experience transitioning from a classical to interactive approach with continual assessment and computer alternatives.

    Science.gov (United States)

    Kaisarevic, Sonja N; Andric, Silvana A; Kostic, Tatjana S

    2017-09-01

    In response to the Bologna Declaration and contemporary trends in Animal Physiology education, the Animal Physiology course at the Faculty of Sciences, University of Novi Sad, Serbia, has evolved over a 12-yr period (2001-2012): from a classical two-semester course toward a one-semester course utilizing computer simulations of animal experiments, continual assessment, lectures, and an optional oral exam. This paper presents an overview of student achievement, the impact of reforms on learning outcomes, and lessons that we as educators learned during this process. The reforms had a positive impact on the percentage of students who completed the course within the same academic year. In addition, the percentage of students who completed the practical exam increased from 54% to >95% following the transition to a Bologna-based approach. However, average final grades declined from 8.0 to 6.8 over the same period. Students also appear reluctant to take the optional oral exam, and 82-91% of students were satisfied with the lower final grade obtained from only assessments and tests administered during the semester. In our endeavor to achieve learning outcomes set during the pre-Bologna period, while adopting contemporary teaching approaches, we sought to increase students' motivation to strive toward better performance, while ensuring that the increased quantity of students who complete the course is coupled with increased quality of education and a more in-depth understanding of animal physiology. Copyright © 2017 the American Physiological Society.

  16. Transition from failing dentition to complete-arch implant rehabilitation with a staged approach: a 3-year clinical report.

    Science.gov (United States)

    Papaspyridakos, Panos; Chronopoulos, Vasilios

    2014-09-01

    The transition of patients from failing dentition to complete-arch implant rehabilitation often means that the patient is rendered edentulous and has to wear a removable complete denture for a time. Many patients find this objectionable. A staged treatment approach provides a fixed interim prosthesis for use throughout the rehabilitation process, allowing patient comfort and prosthodontic control. This clinical report describes a staged approach protocol with a new type of interim prosthesis. The prosthesis is supported by hopeless teeth and the soft tissues of the maxillary tuberosities and mandibular retromolar pads for the complete-arch implant rehabilitation of a patient with failing dentition. This protocol allows for a fixed interim prosthesis with combined tooth and mucosa or implant support during the entire rehabilitation process, thus avoiding the use of complete dentures. The implants and prostheses were functioning successfully after 3 years of clinical service. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  17. Stroke And Substance Abuse

    Directory of Open Access Journals (Sweden)

    A Chitsaz

    2017-02-01

    Full Text Available Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes. Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism. AMPHETAMINE AND other psychostimulants: In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two. Decongestants and diet pills: Phenylpropanolamine (PPA, an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA with amphetamine like can

  18. Stroke in Commercial Flights.

    Science.gov (United States)

    Álvarez-Velasco, Rodrigo; Masjuan, Jaime; DeFelipe, Alicia; Corral, Iñigo; Estévez-Fraga, Carlos; Crespo, Leticia; Alonso-Cánovas, Araceli

    2016-04-01

    Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis. © 2016 American Heart Association, Inc.

  19. Social Work Intervention Focused on Transitions

    Science.gov (United States)

    2016-12-19

    Study Focus: 30-day Rehospitalizations Among At-risk Older Adults Randomized to a Social Work-driven Care Transitions Intervention; Heart Disease; Diabetes; Hypertension; Cancer; Depression; Asthma; Chronic Heart Failure; Chronic Obstructive Pulmonary Disease; Stroke

  20. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener

    2005-03-01

    Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

  1. Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

    OpenAIRE

    Grace Vincent-Onabajo; Taritei Moses

    2016-01-01

    Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke?whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors. Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk fac...

  2. Transcranial magnetic stimulation in mild to severe hemiparesis early after stroke: a proof of principle and novel approach to improve motor function

    Science.gov (United States)

    Anjos, Sarah M.; Saposnik, Gustavo; Mello, Eduardo A.; Nagaya, Erina M.; Santos, Waldyr; Ferreiro, Karina N.; Melo, Eduardo S.; Reis, Felipe I.; Scaff, Milberto; Cohen, Leonardo G.

    2016-01-01

    Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the unaffected hemisphere can enhance function of the paretic hand in patients with mild motor impairment. Effects of low-frequency rTMS to the contralesional motor cortex at an early stage of mild to severe hemiparesis after stroke are unknown. In this pilot, randomized, double-blind clinical trial we compared the effects of low-frequency rTMS or sham rTMS as add-on therapies to outpatient customary rehabilitation, in 30 patients within 5–45 days after ischemic stroke, and mild to severe hand paresis. The primary feasibility outcome was compliance with the interventions. The primary safety outcome was the proportion of intervention-related adverse events. Performance of the paretic hand in the Jebsen–Taylor test and pinch strength were secondary outcomes. Outcomes were assessed at baseline, after ten sessions of treatment administered over 2 weeks and at 1 month after end of treatment. Baseline clinical features were comparable across groups. For the primary feasibility outcome, compliance with treatment was 100% in the active group and 94% in the sham group. There were no serious intervention-related adverse events. There were significant improvements in performance in the Jebsen–Taylor test (mean, 12.3% 1 month after treatment) and pinch force (mean, 0.5 Newtons) in the active group, but not in the sham group. Low-frequency rTMS to the contralesional motor cortex early after stroke is feasible, safe and potentially effective to improve function of the paretic hand, in patients with mild to severe hemiparesis. These promising results will be valuable to design larger randomized clinical trials. PMID:22173953

  3. Adopting a Patient-Centered Approach to Primary Outcome Analysis of Acute Stroke Trials by Use of a Utility-Weighted Modified Rankin Scale

    Science.gov (United States)

    Chaisinanunkul, Napasri; Adeoye, Opeolu; Lewis, Roger J.; Grotta, James C.; Broderick, Joseph; Jovin, Tudor G.; Nogueira, Raul G.; Elm, Jordan; Graves, Todd; Berry, Scott; Lees, Kennedy R.; Barreto, Andrew D.; Saver, Jeffrey L.

    2015-01-01

    Background and Purpose Although the modified Rankin Scale (mRS) is the most commonly employed primary endpoint in acute stroke trials, its power is limited when analyzed in dichotomized fashion and its indication of effect size challenging to interpret when analyzed ordinally. Weighting the seven Rankin levels by utilities may improve scale interpretability while preserving statistical power. Methods A utility weighted mRS (UW-mRS) was derived by averaging values from time-tradeoff (patient centered) and person-tradeoff (clinician centered) studies. The UW-mRS, standard ordinal mRS, and dichotomized mRS were applied to 11 trials or meta-analyses of acute stroke treatments, including lytic, endovascular reperfusion, blood pressure moderation, and hemicraniectomy interventions. Results Utility values were: mRS 0–1.0; mRS 1 - 0.91; mRS 2 - 0.76; mRS 3 - 0.65; mRS 4 - 0.33; mRS 5 & 6 - 0. For trials with unidirectional treatment effects, the UW-mRS paralleled the ordinal mRS and outperformed dichotomous mRS analyses. Both the UW-mRS and the ordinal mRS were statistically significant in six of eight unidirectional effect trials, while dichotomous analyses were statistically significant in two to four of eight. In bidirectional effect trials, both the UW-mRS and ordinal tests captured the divergent treatment effects by showing neutral results whereas some dichotomized analyses showed positive results. Mean utility differences in trials with statistically significant positive results ranged from 0.026 to 0.249. Conclusion A utility-weighted mRS performs similarly to the standard ordinal mRS in detecting treatment effects in actual stroke trials and ensures the quantitative outcome is a valid reflection of patient-centered benefits. PMID:26138130

  4. Stroke And Substance Abuse

    OpenAIRE

    A Chitsaz

    2017-01-01

    Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injec...

  5. Stroke Prevention & Treatment: Diet & Nutrition

    Science.gov (United States)

    ... Prevention & Treatment: Diet & Nutrition Stroke Prevention & Treatment: Diet & Nutrition A healthy diet can reduce your risk for ... Treatment How does a stroke affect eating and nutrition? Stroke can devastate a person's nutritional health because ...

  6. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke

  7. Risks for Heart Disease & Stroke

    Science.gov (United States)

    ... Prevent Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and ... can’t change some of your risks for heart disease and stroke, but you can manage many of ...

  8. A prospective cohort study of stroke characteristics, care, and mortality in a hospital stroke registry in Vietnam

    Directory of Open Access Journals (Sweden)

    Tirschwell David L

    2012-12-01

    Full Text Available Abstract Background As low and middle-income countries such as Vietnam experience the health transition from infectious to chronic diseases, the morbidity and mortality from stroke will rise. In line with the recommendation of the Institute of Medicine’s report on “Promoting Cardiovascular Health in the Developing World” to “improve local data”, we sought to investigate patient characteristics and clinical predictors of mortality among stroke inpatients at Da Nang Hospital in Vietnam. Methods A stroke registry was developed and implemented at Da Nang Hospital utilizing the World Health Organization’s Stroke STEPS instrument for data collection. Results 754 patients were hospitalized for stroke from March 2010 through February 2011 and admitted to either the intensive care unit or cardiology ward. Mean age was 65 years, and 39% were female. Nearly 50% of strokes were hemorrhagic. At 28-day follow-up, 51.0% of patients with hemorrhagic stroke died whereas 20.3% of patients with ischemic stroke died. A number of factors were independently associated with 28-day mortality; the two strongest independent predictors were depressed level of consciousness on presentation and hemorrhagic stroke type. While virtually all patients completed a CT during the admission, evidence-based processes of care such as anti-thrombotic therapy and carotid ultrasound for ischemic stroke patients were underutilized. Conclusions This cohort study highlights the high mortality due in part to the large proportion of hemorrhagic strokes in Vietnam. Lack of hypertension awareness and standards of care exacerbated clinical outcomes. Numerous opportunities for simple, inexpensive interventions to improve outcomes or reduce recurrent stroke have been identified.

  9. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2013-01-01

    Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....

  10. Growing up in an Intact Vs. Non-Intact Family and the Transition from School to Permanent Work: A Gender Approach for Spain in 2000

    Science.gov (United States)

    Canada-Vicinay, J.A.

    2005-01-01

    This paper explores the influence of marital disruption and family environment on three major events that mark the transition from adolescence to young adulthood for children between the ages of 16 and 25, these being leaving school, entering the labor market and obtaining permanent employment. This is a gender approach, given that the two sexes…

  11. Ischemic Stroke: MedlinePlus Health Topic

    Science.gov (United States)

    ... Spanish Thrombolytic therapy (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Ischemic Stroke updates ... cardiogenic embolism Stroke - slideshow Thrombolytic therapy Related Health Topics Hemorrhagic Stroke Stroke Stroke Rehabilitation National Institutes of ...

  12. Uncertain long-run emissions targets, CO{sub 2} price and global energy transition: A general equilibrium approach

    Energy Technology Data Exchange (ETDEWEB)

    Durand-Lasserve, Olivier, E-mail: olivier.durand@uclouvain.b [Universite Catholique de Louvain (UCL), CORE, Voie du Roman Pays 34, B-1348 Louvain-la-Neuve (Belgium); Pierru, Axel, E-mail: axel.pierru@ifp.f [IFP, Economics Department, 232 Avenue Napoleon Bonaparte, 92852 Rueil-Malmaison (France); Smeers, Yves, E-mail: yves.smeers@uclouvain.ac.b [Universite Catholique de Louvain (UCL), CORE, Voie du Roman Pays 34, B-1348 Louvain-la-Neuve (Belgium)

    2010-09-15

    The persistent uncertainty about mid-century CO{sub 2} emissions targets is likely to affect not only the technological choices that energy-producing firms will make in the future but also their current investment decisions. We illustrate this effect on CO{sub 2} price and global energy transition within a MERGE-type general-equilibrium model framework, by considering simple stochastic CO{sub 2} policy scenarios. In these scenarios, economic agents know that credible long-run CO{sub 2} emissions targets will be set in 2020, with two possible outcomes: either a 'hard cap' or a 'soft cap'. Each scenario is characterized by the relative probabilities of both possible caps. We derive consistent stochastic trajectories-with two branches after 2020-for prices and quantities of energy commodities and CO{sub 2} emissions permits. The impact of uncertain long-run CO{sub 2} emissions targets on prices and technological trajectories is discussed. In addition, a simple marginal approach allows us to analyze the Hotelling rule with risk premia observed for certain scenarios.

  13. Uncertain long-run emissions targets, CO{sub 2} price and global energy transition. A general equilibrium approach

    Energy Technology Data Exchange (ETDEWEB)

    Durand-Lasserve, Olivier; Smeers, Yves [Universite Catholique de Louvain (UCL), CORE, Voie du Roman Pays 34, B-1348 Louvain-la-Neuve (Belgium); Pierru, Axel [IFP, Economics Department, 232 Avenue Napoleon Bonaparte, 92852 Rueil-Malmaison (France)

    2010-09-15

    The persistent uncertainty about mid-century CO{sub 2} emissions targets is likely to affect not only the technological choices that energy-producing firms will make in the future but also their current investment decisions. We illustrate this effect on CO{sub 2} price and global energy transition within a MERGE-type general-equilibrium model framework, by considering simple stochastic CO{sub 2} policy scenarios. In these scenarios, economic agents know that credible long-run CO{sub 2} emissions targets will be set in 2020, with two possible outcomes: either a hard cap or a soft cap. Each scenario is characterized by the relative probabilities of both possible caps. We derive consistent stochastic trajectories - with two branches after 2020 - for prices and quantities of energy commodities and CO{sub 2} emissions permits. The impact of uncertain long-run CO{sub 2} emissions targets on prices and technological trajectories is discussed. In addition, a simple marginal approach allows us to analyze the Hotelling rule with risk premia observed for certain scenarios. (author)

  14. Uncertain long-run emissions targets, CO2 price and global energy transition. A general equilibrium approach

    International Nuclear Information System (INIS)

    Durand-Lasserve, Olivier; Smeers, Yves; Pierru, Axel

    2010-01-01

    The persistent uncertainty about mid-century CO 2 emissions targets is likely to affect not only the technological choices that energy-producing firms will make in the future but also their current investment decisions. We illustrate this effect on CO 2 price and global energy transition within a MERGE-type general-equilibrium model framework, by considering simple stochastic CO 2 policy scenarios. In these scenarios, economic agents know that credible long-run CO 2 emissions targets will be set in 2020, with two possible outcomes: either a hard cap or a soft cap. Each scenario is characterized by the relative probabilities of both possible caps. We derive consistent stochastic trajectories - with two branches after 2020 - for prices and quantities of energy commodities and CO 2 emissions permits. The impact of uncertain long-run CO 2 emissions targets on prices and technological trajectories is discussed. In addition, a simple marginal approach allows us to analyze the Hotelling rule with risk premia observed for certain scenarios. (author)

  15. Dysphagia Post Subcortical and Supratentorial Stroke.

    Science.gov (United States)

    Wan, Ping; Chen, Xuhui; Zhu, Lequn; Xu, Shuangjin; Huang, Li; Li, Xiangcui; Ye, Qing; Ding, Ruiying

    2016-01-01

    Studies have recognized that the damage in the subcortical and supratentorial regions may affect voluntary and involuntary aspects of the swallowing function. The current study attempted to explore the dysphagia characteristics in patients with subcortical and supratentorial stroke. Twelve post first or second subcortical and supratentorial stroke patients were included in the study. The location of the stroke was ascertained by computed tomography and magnetic resonance imaging. The characteristics of swallowing disorder were assessed by video fluoroscopic swallowing assessment/fiberoptic endoscopic evaluation of swallowing. The following main parameters were analyzed: oral transit time, pharyngeal delay time, presence of cricopharyngeal muscle achalasia (CMA), distance of laryngeal elevation, the amounts of vallecular residue and pyriform sinus residue (PSR), and the extent of pharyngeal contraction. Eighty-three percent of the 12 patients were found suffering from pharyngeal dysphagia, with 50% having 50%-100% PSRs, 50% having pharyngeal delay, and 41.6% cases demonstrating CMA. Simple regression analysis showed PSRs were most strongly associated with CMA. Pharyngeal delay in the study can be caused by infarcts of basal ganglia/thalamus, infarcts of sensory tract, infarcts of swallowing motor pathways in the centrum semiovale, or a combination of the three. Subcortical and supratentorial stroke may result in pharyngeal dysphagia such as PSR and pharyngeal delay. PSR was mainly caused by CMA. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Examining a participation-focused stroke self-management intervention in a day rehabilitation setting: a quasi-experimental pilot study.

    Science.gov (United States)

    Lee, Danbi; Fischer, Heidi; Zera, Sarah; Robertson, Rosetta; Hammel, Joy

    2017-12-01

    Background People with stroke often find discharge from rehabilitation distressing because they do not feel prepared to participate in life roles as they want. A self-management approach can facilitate improvement in confidence and ability to manage post-stroke community living and participation after transitioning into the community. Objective To evaluate the feasibility and effectiveness of the Improving Participation After Stroke Self-management program - Rehab version (IPASS-R) in a day rehabilitation setting. Methods We used a mixed-method non-randomized quasi-experimental design. The IPASS-R program is a six-session group-based intervention led by a trained occupational therapist and lay person with stroke. The program uses an efficacy building approach to support aging adults to maintain active participation in home and community activities post-stroke. Primary outcome measures were the Reintegration to Normal Living Index (RNLI), Stroke Impact Scale (SIS), and Participation Strategies Self-Efficacy Scale. Qualitative feedback was collected post-treatment. Results Seventeen participants with stroke (intervention n = 9; control n = 8) were enrolled across two sites. Non-parametric effect sizes calculated using the Wilcoxon Signed-Rank test revealed larger effects on RNLI and SIS outcomes in the intervention group. The Mann-Whitney U test showed significant differences between the two groups' changes in scores on perceived recovery and strength. Conclusions The result shows that IPASS-R has the potential to be integrated into a day rehabilitation setting with a positive impact on community integration and perceived recovery outcomes. Future study is needed to investigate the IPASS-R with a larger sample size and more rigorous study design.

  17. Dysphagia following stroke: evaluation with digital radiography

    International Nuclear Information System (INIS)

    Chu, Sung Nam; Kang, Heoung Keun; Joo, Jung Hyun; Kim, Chang Il; Park, Soo Min; Jeong, Yong Yeon; Seo, Jeong Jin; Chung, Tae Woong

    1997-01-01

    The purpose of this study is to evaluate the usefulness of digital radiography in the assessment of dysphagia following stroke. Eighteen stroke patients (8 men, 10 women) referred for dysphagia and ten controls without known pharyngeal swallowing difficulty underwent digital radiography using a 1:1 mixture of barium and water. We evaluated oropharyngeal transit time and the location and severity of dysphagia; transit time was defined as the time from the first movement of the bolus to the return of the epiglottis to its original position. We sought to observe specific patterns of oropharyngeal dysfunction; dysphagia was classified as mild, moderate, or severe. The dynamic image of the pharynx, as seen on a digital radiograph, may be diagnostically useful for defining the location and severity of dysphagia; in order to make feeding recommendations, this information is essential. (author). 17 refs., 5 figs

  18. Dysphagia following stroke: evaluation with digital radiography

    Energy Technology Data Exchange (ETDEWEB)

    Chu, Sung Nam; Kang, Heoung Keun; Joo, Jung Hyun; Kim, Chang Il; Park, Soo Min; Jeong, Yong Yeon; Seo, Jeong Jin; Chung, Tae Woong [Chonnam Univ., Kwanju (Korea, Republic of). Medical School

    1997-12-01

    The purpose of this study is to evaluate the usefulness of digital radiography in the assessment of dysphagia following stroke. Eighteen stroke patients (8 men, 10 women) referred for dysphagia and ten controls without known pharyngeal swallowing difficulty underwent digital radiography using a 1:1 mixture of barium and water. We evaluated oropharyngeal transit time and the location and severity of dysphagia; transit time was defined as the time from the first movement of the bolus to the return of the epiglottis to its original position. We sought to observe specific patterns of oropharyngeal dysfunction; dysphagia was classified as mild, moderate, or severe. The dynamic image of the pharynx, as seen on a digital radiograph, may be diagnostically useful for defining the location and severity of dysphagia; in order to make feeding recommendations, this information is essential. (author). 17 refs., 5 figs.

  19. Diagnostic neuroimaging in stroke

    International Nuclear Information System (INIS)

    Jarenwattananon, A.; Khandji, A.; Brust, J.C.M.

    1988-01-01

    Since the development of cerebral angiography 60 years ago, there has been a proliferation of increasingly sophisticated, expensive, and, fortunately, safe imaging techniques for patients with cerebrovascular disease. In addition, occlusive and hemorrhagic stroke are now recognized as having a wide variety of possible causes. This chapter addresses the different imaging options available for particular kinds of stroke

  20. Relational Processing Following Stroke

    Science.gov (United States)

    Andrews, Glenda; Halford, Graeme S.; Shum, David; Maujean, Annick; Chappell, Mark; Birney, Damian

    2013-01-01

    The research examined relational processing following stroke. Stroke patients (14 with frontal, 30 with non-frontal lesions) and 41 matched controls completed four relational processing tasks: sentence comprehension, Latin square matrix completion, modified Dimensional Change Card Sorting, and n-back. Each task included items at two or three…

  1. Stroke (For Kids)

    Science.gov (United States)

    ... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body Works ... for Educators Search English Español Stroke KidsHealth / For Kids / Stroke What's in this article? What Happens During ...

  2. Stroke treatment in Stroke Unit: from scientific evidences to clinical practice

    Directory of Open Access Journals (Sweden)

    Michele Stornello

    2013-04-01

    Full Text Available Background: In themanagement of stroke disease, evidences fromthe literature demonstrate that the introduction of stroke units, hospital wards with dedicated beds providing intensive care within 48 hours of symptoms’ onset, produced a real improvement in the outcome, reducing in-hospital fatality cases and increasing the proportion of patients independently living in long term follow-up. Discussion: The article focuses on stroke disease-management, suggesting a stroke integrated approach for the admission of patients on dedicated beds, in order to extend the ‘‘stroke care’’ approach outcomes to as many hospitals as possible in Italy. This approach implies the set up of a stroke network for an effective patients’ stratification according to the severity of the illness at debut; the set up of an integrated team of specialists in hospital management of the acute phase (first 48 hours and a timely rehabilitation treatment. Ultimately the hospital should be organized according to department’s semi-intensive areas in order to assure to the patients, in the early stage of the disease, a timely high intensity care aimed to improve the long term outcome.

  3. Burden of stroke in Bangladesh.

    Science.gov (United States)

    Islam, Md Nazmul; Moniruzzaman, Mohammed; Khalil, Md Ibrahim; Basri, Rehana; Alam, Mohammad Khursheed; Loo, Keat Wei; Gan, Siew Hua

    2013-04-01

    Stroke is the third leading cause of death in Bangladesh. The World Health Organization ranks Bangladesh's mortality rate due to stroke as number 84 in the world. The reported prevalence of stroke in Bangladesh is 0.3%, although no data on stroke incidence have been recorded. Hospital-based studies conducted in past decades have indicated that hypertension is the main cause of ischaemic and haemorrhagic stroke in Bangladesh. The high number of disability-adjusted life-years lost due to stroke (485 per 10,000 people) show that stroke severely impacts Bangladesh's economy. Although two non-governmental organizations, BRAC and the Centre for the Rehabilitation of the Paralysed, are actively involved in primary stroke prevention strategies, the Bangladeshi government needs to emphasize healthcare development to cope with the increasing population density and to reduce stroke occurrence. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  4. The Relationship between Positive Development and Psychopathology during the Transition to Adulthood: A Person-Centred Approach

    Science.gov (United States)

    O'Connor, Meredith; Sanson, Ann; Hawkins, Mary T.; Olsson, Craig; Frydenberg, Erica; Toumbourou, John W.; Letcher, Primrose

    2012-01-01

    The transition to adulthood is characterised by potential for both positive development and problem outcomes such as psychopathology, yet little is known about relationships between the two. Given the diversity of pathways observed during this transition period, there is likely to be significant heterogeneity in young people's experiences of these…

  5. Post-stroke depression among stroke survivors attending two ...

    African Journals Online (AJOL)

    Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a ...

  6. Stroke mimic diagnoses presenting to a hyperacute stroke unit.

    Science.gov (United States)

    Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J

    2016-10-01

    Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

  7. Setting stroke research priorities: The consumer perspective.

    Science.gov (United States)

    Sangvatanakul, Pukkaporn; Hillege, Sharon; Lalor, Erin; Levi, Christopher; Hill, Kelvin; Middleton, Sandy

    2010-12-01

    To test a method of engaging consumers in research priority-setting using a quantitative approach and to determine consumer views on stroke research priorities for clinical practice recommendations with lower levels of evidence (Level III and Level IV) and expert consensus opinion as published in the Australian stroke clinical practice guidelines. Survey Urban community Eighteen stroke survivors (n = 12) and carers (n = 6) who were members of the "Working Aged Group - Stroke" (WAGS) consumer support group. Phase I: Participants were asked whether recommendations were "worth" researching ("yes" or "no"); and, if researched, what potential impact they likely would have on patient outcomes. Phase II: Participants were asked to rank recommendations rated by more than 75% of participants in Phase I as "worth" researching and "highly likely" or "likely" to generate research with a significant effect on patient outcomes (n = 13) in order of priority for future stroke research. All recommendations were rated by at least half (n = 9, 50%) of participants as "worth" researching. The majority (67% to 100%) rated all recommendations as "highly likely" or "likely" that research would have a significant effect on patient outcomes. Thirteen out of 20 recommendations were ranked for their research priorities. Recommendations under the topic heading Getting to hospital were ranked highest and Organization of care and Living with stroke were ranked as a lower priority for research. This study provided an example of how to involve consumers in research priority setting successfully using a quantitative approach. Stroke research priorities from the consumer perspective were different from those of health professionals, as published in the literature; thus, consumer opinion should be considered when setting research priorities. Copyright © 2010 Society for Vascular Nursing, Inc. Published by Mosby, Inc. All rights reserved.

  8. Communication disorders after stroke in Aboriginal Australians.

    Science.gov (United States)

    Armstrong, Elizabeth; Hersh, Deborah; Hayward, Colleen; Fraser, Joan

    2015-01-01

    Limited research exists on acquired communication disorders (ACD) in Aboriginal Australians despite their high rates of stroke. Their uptake of rehabilitation services is low, and little information is available on functional consequences for this population. This pilot study explored consequences of ACD for Aboriginal Australians after stroke, including their experiences of services received. Semi-structured interviews were collected with 13 Aboriginal people with ACD, and family members, in Perth. Ages ranged from 30 to 78 years and time post stroke from 0.5 to 29 years. A qualitative, thematic analysis of interview transcripts was undertaken. The key themes which emerged were "getting on with life", coping with change, independence/interdependence, the importance of communication for maintaining family and community connection, role and identity issues and viewing the stroke consequences within the broader context of co-morbidities. While similar life disruptions were found to those previously reported in the general stroke population, this study highlighted differences, which reflect the particular context of ACD for Aboriginal people and which need to be considered when planning future services. While implications are limited due to small numbers, the findings emphasise the importance of a holistic approach, and integration of communication treatments into community-led social activities. Implications for Rehabilitation Aboriginal Australians frequently experience a range of concurrent and complex co-morbidities and demanding social or family circumstances at the same time as coping with communication disorders post-stroke. A holistic approach to post stroke rehabilitation may be appropriate with services that accommodate communication disorders, delivered in collaboration with Aboriginal organisations, emphasising positive attitudes and reintegration into community as fully as possible. Communication and yarning are important for maintaining family and

  9. Cognitive impairment and stroke in elderly patients

    Directory of Open Access Journals (Sweden)

    Lo Coco D

    2016-03-01

    Full Text Available Daniele Lo Coco,1 Gianluca Lopez,1 Salvatore Corrao,2,31Neurology and Stroke Unit, 2Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, 3Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M., Di.Bi.M.I.S., University of Palermo, Palermo, Italy Abstract: We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the

  10. Coordination of IVI and transit signal priority on transit evacuations.

    Science.gov (United States)

    2011-02-01

    During an emergency evacuation, execution time is always critical to the evacuees who are : transit dependent. Transit Signal Priority (TSP) can speed up the transit services by prioritizing : the approaching bus at a signalized intersection. With th...

  11. Stroke Risk Factors and Symptoms

    Science.gov (United States)

    ... » [ pdf, 433 kb ] Order Materials » Stroke Risk Factors and Symptoms Risk Factors for a Stroke Stroke prevention is still ... it. Treatment can delay complications that increase the risk of stroke. Transient ischemic attacks (TIAs). Seek help. ...

  12. Geology of the Terra Cimmeria-Utopia Planitia Highland Lowland Transitional Zone: Final Technical Approach and Scientific Results

    Science.gov (United States)

    Skinner, J. A., Jr.; Tanaka, K. L.

    2010-01-01

    The southern Utopia highland-lowland transitional zone extends from northern Terra Cimmeria to southern Utopia Planitia and contains broad, bench-like platforms with depressions, pitted cones, tholi, and lobate flows. The locally occurring geologic units and landforms contrast other transitional regions and record a spatially partitioned geologic history. We systematically delineated and described the geologic units and landforms of the southern Utopia-Cimmeria highland-lowland transitional zone for the production of a 1:1,000,000-scale geologic map (MTMs 10237, 15237, 20237, 10242, 15242, 20242, 10247, 15247, and 20247). Herein, we present technical and scientific results of this mapping project.

  13. Dizziness in stroke

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad

    2015-01-01

    Full Text Available Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness. The treatment of patients with stroke-induced dizziness involves a wide range of medications for the reduction of the degree of dizziness and unsteadiness and for the secondary prevention of stroke. Vestibular rehabilitation is an important component of treatment. The paper describes an observation of a patient with poorly controlled hypertension, who developed new-onset acute systemic dizziness. Vestibular neuronitis might be presumed to be a peripheral cause of vestibular disorders, by taking into account the absence of additional obvious neurological symptoms (such as pareses, defective sensation, diplopia, etc. and the nature of nystagmus. However, intention tremor in fingernose and heel-knee tests on the left side, a negative Halmagyi test, and results of Romberg’s test could suggest that stroke was a cause ofdizziness.

  14. Stroke in tuberculous meningitis.

    Science.gov (United States)

    Misra, Usha Kant; Kalita, Jayantee; Maurya, Pradeep Kumar

    2011-04-15

    Stroke in tuberculous meningitis (TBM) occurs in 15-57% of patients especially in advance stage and severe illness. The majority of strokes may be asymptomatic because of being in a silent area, deep coma or associated pathology such as spinal arachnoiditis or tuberculoma. Methods of evaluation also influence the frequency of stroke. MRI is more sensitive in detecting acute (DWI) and chronic (T2, FLAIR) stroke. Most of the strokes in TBM are multiple, bilateral and located in the basal ganglia especially the 'tubercular zone' which comprises of the caudate, anterior thalamus, anterior limb and genu of the internal capsule. These are attributed to the involvement of medial striate, thalamotuberal and thalamostriate arteries which are embedded in exudates and likely to be stretched by a coexistent hydrocephalus. Cortical stroke can also occur due to the involvement of proximal portion of the middle, anterior and posterior cerebral arteries as well as the supraclinoid portion of the internal carotid and basilar arteries which are documented in MRI, angiography and autopsy studies. Arteritis is more common than infarction in autopsy study. The role of cytokines especially tumor necrosis factor (TNFα), vascular endothelial growth factor (VEGF) and matrix metaloproteineases (MMPs) in damaging the blood brain barrier, attracting leucocytes and release of vasoactive autocoids have been suggested. The prothrombotic state may also contribute to stroke in TBM. Corticosteroids with antitubercular therapy were thought to reduce mortality and morbidity but their role in reducing strokes has not been proven. Aspirin also reduces mortality and its role in reducing stroke in TBM needs further studies. Copyright © 2010 Elsevier B.V. All rights reserved.

  15. Hyponatremia in stroke

    Directory of Open Access Journals (Sweden)

    Sheikh Saleem

    2014-01-01

    Full Text Available Introduction: Hyponatremia is a common electrolyte disorder encountered in patients of neurological disorders which is usually either due to inappropriate secretion of Antidiuretic hormone (SIADH or cerebral salt wasting syndrome (CSWS. We conducted this study in a tertiary care hospital to determine the incidence and etiology of hyponatremia in patients of stroke admitted in the hospital. Materials and Methods: It was a prospective study done over a period of two years that included established cases of stroke diagnosed on the basis of clinical history, examination and neuroimaging. 1000 stoke patients were evaluated for hyponatremia (serum sodium <130 meq/l. The data was analysed using Chi-square test using SPSS (Statistical package for social science software. Results: Out of 1000 patients, 353 patients had hyponatremia. Out of this 353 patients, 238 (67% had SIADH and 115 (33% had CSWS. SIADH was seen in 83 patients who had ischemic stroke and 155 patients of hemorrhagic stroke. CSWS was found in 38 patients with ischemic stroke and 77 patients with hemorrhagic stroke. Statistical analysis revealed that hyponatremia significantly affects the outcome of stroke especially when it is due to CSWS rather than SIADH. Conclusion: Incidence of hyponatremia in our study population was 35%. In patients of hyponatremia 67% were having SIADH and 33% were having CSWS. Overall hyponatremia affected the outcome of stroke especially when caused by CSWS. Therefore close monitoring of serum sodium must be done in all patients who are admitted with stroke and efforts must be made to determine the cause of hyponatremia, in order to properly manage such patients thereby decreasing the mortality rate.

  16. A Preisach approach to modeling partial phase transitions in the first order magnetocaloric material MnFe(P,As)

    DEFF Research Database (Denmark)

    von Moos, Lars; Bahl, C.R.H.; Nielsen, Kaspar Kirstein

    2014-01-01

    of MnFe(P,As) under partial phase transitions, which is similar to what materials experience in actual magnetic refrigeration devices. Partial phase transition curves, in the absence of a magnetic field, are measured using calorimetry and the experimental results are compared to simulations......Magnetic refrigeration is an emerging technology that could provide energy efficient and environmentally friendly cooling. Magnetocaloric materials in which a structural phase transition is found concurrently with the magnetic phase transition are often termed first order magnetocaloric materials....... Such materials are potential candidates for application in magnetic refrigeration devices. However, the first order materials often have adverse properties such as hysteresis, making actual performance troublesome to quantify, a subject not thoroughly studied within this field.Here we investigate the behavior...

  17. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke

    2015-01-01

    . The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...

  18. Determinan Penyakit Stroke

    Directory of Open Access Journals (Sweden)

    Woro Riyadina

    2013-02-01

    Full Text Available Penyakit stroke merupakan penyebab kematian dan kecacatan kronik yang paling tinggi pada kelompok umur diatas usia 45 tahun terbanyak di Indonesia. Tujuan penelitian ini untuk mengidentifikasi determinan utama yang berhubungan dengan penyakit stroke pada masyarakat di kelurahan Kebon Kalapa Bogor. Analisis lanjut terhadap 1.912 responden subset baseline data penelitian “Studi Kohort Faktor Risiko Penyakit Tidak Menular” Data dikumpulkan dengan metode wawancara pada penduduk tetap di kelurahan Kebon Kalapa, Kecamatan Bogor Tengah, Bogor tahun 2012. Diagnosis stroke berdasarkan anamnesis dan pemeriksaan dokter spesialis syaraf. Variabel independen meliputi karakteristik sosiodemografi, status kesehatan dan perilaku berisiko. Data dianalisis dengan uji regresi logistik ganda. Penyakit stroke ditemukan pada 49 (2,6% orang. Determinan utama stroke meliputi hipertensi (OR = 4,20; IK 95% = 2,20 – 8,03, penyakit jantung koroner (OR = 2,74; IK 95% = 1,51 – 4,99, diabetes melitus (OR = 2,89; IK 95% = 1,47 – 5,64, dan status ekonomi miskin (OR = 1,83 ; IK 95% = 1,03 – 3,33. Pencegahan penyakit stroke dilakukan dengan peningkatan edukasi (kampanye/penyuluhan melalui pengendalian faktor risiko utama yaitu hipertensi dan pencegahan terjadinya penyakit degeneratif lain yaitu penyakit jantung koroner dan diabetes melitus. Stroke disease is the leading cause of death and chronic disabi lity in most over the age of 45 years in Indonesia. The aim of study was to identify the major determinants of stroke disease in Kebon Kalapa community in Bogor. A deep analyze was conducted in 1.912 respondents based on the subset of baseline data “Risk Factors Cohort Study of Non Communicable Diseases.” Data was collected by interviews on Kebon Kalapa community, Bogor in 2012. Stroke diagnosis was determined by anamnesis and neu-rological examination with specialist. Independent variables were sociodemographic characteristics, health status and risk behavior

  19. Hypertension and experimental stroke therapies

    OpenAIRE

    O'Collins, Victoria E; Donnan, Geoffrey A; Macleod, Malcolm R; Howells, David W

    2013-01-01

    Hypertension is an established target for long-term stroke prevention but procedures for management of hypertension in acute stroke are less certain. Here, we analyze basic science data to examine the impact of hypertension on candidate stroke therapies and of anti-hypertensive treatments on stroke outcome. Methods: Data were pooled from 3,288 acute ischemic stroke experiments (47,899 animals) testing the effect of therapies on infarct size (published 1978–2010). Data were combined using meta...

  20. Do post-stroke patients benefit from robotic verticalization? A pilot-study focusing on a novel neurophysiological approach

    Science.gov (United States)

    Calabrò, Rocco Salvatore; Naro, Antonino; Russo, Margherita; Leo, Antonino; Balletta, Tina; Saccá, Ileana; De Luca, Rosaria; Bramanti, Placido

    2015-01-01

    Abstract Background: Tilt-table equipped with the dynamic foot-support (ERIGO) and the functional electric stimulation could be a safe and suitable device for stabilization of vital signs, increasing patient’s motivation for further recovery, decreasing the duration of hospitalization, and accelerating the adaptation to vertical posture in bedridden patients with brain-injury. Moreover, it is conceivable that verticalization may improve cognitive functions, and induce plastic changes at sensory motor and vestibular system level that may in turn facilitate motor functional recovery. Objective: To test the safety and effectiveness of ERIGO treatment on motor and cognitive functions, cortical plasticity within vestibular and sensory-motor systems in a bedridden post-stroke sample. Methods: 20 patients were randomly divided in two groups that performed ERIGO training (30 sessions) (G1) or physiotherapist-assisted verticalization training (same duration) (G2), beyond conventional neurorehabilitation treatment. Motor and cognitive functions as well as sensory-motor and vestibular system plasticity were investigated either before (T0) or after (T1) the rehabilitative protocols. Results: Both the verticalization treatments were well-tolerated. Notably, the G1 patients had a significant improvement in cognitive function (p = 0.03), global motor function (p = 0.006), sensory-motor (p vertical position with a better global function improvement, as also suggested by the sensory-motor and vestibular system plasticity induction. PMID:26410207

  1. Clinical and diagnostic approach to patients with hypopituitarism due to traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and ischemic stroke (IS).

    Science.gov (United States)

    Karamouzis, Ioannis; Pagano, Loredana; Prodam, Flavia; Mele, Chiara; Zavattaro, Marco; Busti, Arianna; Marzullo, Paolo; Aimaretti, Gianluca

    2016-06-01

    The hypothalamic-pituitary dysfunction attributable to traumatic brain injury (TBI), aneurysmal subarachnoid hemorrhage (SAH), and ischemic stroke (IS) has been lately highlighted. The diagnosis of TBI-induced-hypopituitarism, defined as a deficient secretion of one or more pituitary hormones, is made similarly to the diagnosis of classical hypopituitarism because of hypothalamic/pituitary diseases. Hypopituitarism is believed to contribute to TBI-associated morbidity and to functional and cognitive final outcome, and quality-of-life impairment. Each pituitary hormone must be tested separately, since there is a variable pattern of hormone deficiency among patients with TBI-induced-hypopituitarism. Similarly, the SAH and IS may lead to pituitary dysfunction although the literature in this field is limited. The drive to diagnose hypopituitarism is the suspect that the secretion of one/more pituitary hormone may be subnormal. This suspicion can be based upon the knowledge that the patient has an appropriate clinical context in which hypopituitarism can be present, or a symptom known as caused by hypopituitarism. Hypopituitarism should be diagnosed as a combination of low peripheral and inappropriately normal/low pituitary hormones although their basal evaluation may be not distinctive due to pulsatile, circadian, or situational secretion of some hormones. Evaluation of the somatotroph and corticotroph axes require dynamic stimulation test (ITT for both axes, GHRH + arginine test for somatotroph axis) in order to clearly separate normal from deficient responses.

  2. Improving Community Stroke Preparedness in the HHS (Hip-Hop Stroke) Randomized Clinical Trial.

    Science.gov (United States)

    Williams, Olajide; Leighton-Herrmann Quinn, Ellyn; Teresi, Jeanne; Eimicke, Joseph P; Kong, Jian; Ogedegbe, Gbenga; Noble, James

    2018-04-01

    Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among economically disadvantaged minorities. We evaluated the effectiveness of a stroke preparedness intervention delivered to preadolescent urban public school children on the stroke knowledge/preparedness of their parents. We recruited 3070 fourth through sixth graders and 1144 parents from 22 schools into a cluster randomized trial with schools randomized to the HHS (Hip-Hop Stroke) intervention or attentional control (nutrition classes). HHS is a 3-hour culturally tailored, theory-based, multimedia stroke literacy intervention targeting school children, which systematically empowers children to share stroke information with parents. Our main outcome measures were stroke knowledge/preparedness of children and parents using validated surrogates. Among children, it was estimated that 1% (95% confidence interval [CI], 0%-1%) of controls and 2% (95% CI, 1%-4%; P =0.09) of the intervention group demonstrated optimal stroke preparedness (perfect scores on the knowledge/preparedness test) at baseline, increasing to 57% (95% CI, 44%-69%) immediately after the program in the intervention group compared with 1% (95% CI, 0%-1%; P <0.001) among controls. At 3-month follow-up, 24% (95% CI, 15%-33%) of the intervention group retained optimal preparedness, compared with 2% (95% CI, 0%-3%; P <0.001) of controls. Only 3% (95% CI, 2%-4%) of parents in the intervention group could identify all 4 letters of the stroke FAST (Facial droop, Arm weakness, Speech disturbance, Time to call 911) acronym at baseline, increasing to 20% at immediate post-test (95% CI, 16%-24%) and 17% at 3-month delayed post-test (95% CI, 13%-21%; P =0.0062), with no significant changes (3% identification) among controls. Four children, all in the intervention group, called 911 for real-life stroke symptoms, in 1 case overruling a parent's wait-and-see approach. HHS is an effective, intergenerational model for

  3. Continuous solid-state phase transitions in energy storage materials with orientational disorder – Computational and experimental approach

    International Nuclear Information System (INIS)

    Singh, Harpreet; Talekar, Anjali; Chien, Wen-Ming; Shi, Renhai; Chandra, Dhanesh; Mishra, Amrita; Tirumala, Muralidhar; Nelson, Daryl J.

    2015-01-01

    We report on TES (thermal energy storage) in new CT (continuous phase transitions) in multicomponent tetrahederally configured (orientationally disordered) crystals of NPG-neopentylglycol-C 5 H 12 O 2 , PG-pentaglycerine-C 5 H 12 O 3 , and PE-pentaerythritol-C 5 H 12 O 4 . This discovery is applicable in thermal energy storage in many systems which do not require conventional isothermal first-order phase transition energy storage. The above compounds exhibit polymorphs of orientationally disordered phases in which O–H…O bond rotation around the C–C bond stores significant amount of energy; for example, in PE 41.26 kJ/mol are absorbed isothermally during solid–solid transitions. In this paper we show, anisothermal continuous phase transitions (CT), due to compositional changes with changes in temperature, associated with a measurable amount of energy, not reported earlier. The correlation of phase stability regions in pseudo-binaries, calculated from ternary NPG–PG–PE phase diagrams, is validated by experimental ternary DSC (differential scanning calorimetry) and in-situ x-ray diffraction data. We established equations for determining the CT in a temperature range, and their respective enthalpies of transitions for any composition of the ternaries. Thermodynamic calculations of the Gibbs energies of the solution phases are modeled as substitutional solid solutions, in which the excess Gibbs energies are expressed by the Redlich–Kister–Muggianu polynomial. There is excellent agreement between the experimental and CALPHAD calculated data. - Highlights: • Continuous phase transition (CT) thermal energy storage in organic ternary system. • Anisothermal temperature ramping leads to CT transitions as per lever rule. • Orientationally disordered phases store energy in O–H…O bond rotation/oscillation. • Validated calculated data with measured thermodynamic properties in ternary system. • Used CALPHAD methodology to calculate Gibbs energies of

  4. Methods guiding stakeholder engagement in planning a pragmatic study on changing stroke systems of care.

    Science.gov (United States)

    Gesell, Sabina B; Klein, Karen Potvin; Halladay, Jacqueline; Bettger, Janet Prvu; Freburger, Janet; Cummings, Doyle M; Lutz, Barbara J; Coleman, Sylvia; Bushnell, Cheryl; Rosamond, Wayne; Duncan, Pamela W

    2017-04-01

    The Comprehensive Post-Acute Stroke Services (COMPASS) Study is one of the first large pragmatic randomized-controlled clinical trials using comparative effectiveness research methods, funded by the Patient-Centered Outcomes Research Institute. In the COMPASS Study, we compare the effectiveness of a patient-centered, transitional care intervention versus usual care for stroke patients discharged home from acute care. Outcomes include stroke patient post-discharge functional status and caregiver strain 90 days after discharge, and hospital readmissions. A central tenet of Patient-Centered Outcomes Research Institute-funded research is stakeholder engagement throughout the research process. However, evidence on how to successfully implement a pragmatic trial that changes systems of care in combination with robust stakeholder engagement is limited. This combination is not without challenges. We present our approach for broad-based stakeholder engagement in the context of a pragmatic trial with the participation of patients, caregivers, community stakeholders, including the North Carolina Stroke Care Collaborative hospital network, and policy makers. To maximize stakeholder engagement throughout the COMPASS Study, we employed a conceptual model with the following components: (1) Patient and Other Stakeholder Identification and Selection; (2) Patient and Other Stakeholder Involvement Across the Spectrum of Research Activities; (3) Dedicated Resources for Patient and Other Stakeholder Involvement; (4) Support for Patient and Other Stakeholder Engagement Through Organizational Processes; (5) Communication with Patients and Other Stakeholders; (6) Transparent Involvement Processes; (7) Tracking of Engagement; and (8) Evaluation of Engagement. In this paper, we describe how each component of the model is being implemented and how this approach addresses existing gaps in the literature on strategies for engaging stakeholders in meaningful and useful ways when conducting

  5. Stroke: Hope through Research

    Science.gov (United States)

    ... in a compromised state for several hours. With timely treatment these cells can be saved. The ischemic ... this research is the use of transcranial magnetic stimulation (TMS) in stroke rehabilitation. Some evidence suggests that ...

  6. Healthy Living after Stroke

    Science.gov (United States)

    ... Nutrition Cooking for Health Food for Thought: Heart-healthy Diet is Also Good For Your Brain Physical Activity Get Moving and Boost Your Brain Power Understanding Risky Conditions Converging Risk Factors for Stroke ...

  7. The "Know Stroke" Campaign

    Science.gov (United States)

    ... Issue Past Issues Special Section The "Know Stroke" Campaign Past Issues / Summer 2007 Table of Contents For ... Javascript on. NINDS is conducting a public awareness campaign across the United States to educate people about ...

  8. Recovering after stroke

    Science.gov (United States)

    ... urine from their body. To prevent skin or pressure sores: Clean up after incontinence Change position often and ... artery surgery - discharge Daily bowel care program Preventing pressure ulcers Stroke - discharge References Dobkin BH. Neurological rehabilitation In: ...

  9. National Stroke Association

    Science.gov (United States)

    ... partnership will offer free access to the RapidSOS Haven app for one year, providing individuals with enhanced ... of care to thrive after stroke. Make your tax-deductible donation today to support the growing needs ...

  10. Strokes (For Parents)

    Science.gov (United States)

    ... paralysis or weakness on one side of the body language or speech delays or changes, such as slurring ... uses many different types of therapy to help children recover from stroke. Outlook At this time, no ...

  11. Stroke - risk factors

    Science.gov (United States)

    ... oxygen. Brain cells can die, causing lasting damage. Risk factors are things that increase your chance of ... a disease or condition. This article discusses the risk factors for stroke and things you can do ...

  12. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O

    1987-01-01

    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...... with other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex...... was not involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  13. Smoking and the risk of a stroke

    International Nuclear Information System (INIS)

    Bell, B.A.; Ambrose, J.

    1982-01-01

    A retrospective study has been undertaken of 236 men and women with a stroke investigated by computed tomography and, where indicated, cerebral angiography. An excess of cigarette smokers has been found where the stroke was the result of ischaemia. Results indicate that continued smoking increases the risk of sustaining cerebral infarction by a factor of 1.9 for men and 2.4 for women. Smoking does not appear to be a risk factor in primary intracerebral haemorrhage, unlike subarachnoid haemorrhage where smokers carry a relative risk approaching four times that of non-smokers. (Author)

  14. Chemical approach to neutral-ionic valence instability, quantum phase transition, and relaxor ferroelectricity in organic charge-transfer complexes

    International Nuclear Information System (INIS)

    Horiuchi, Sachio; Kumai, Reiji; Okimoto, Yoichi; Tokura, Yoshinori

    2006-01-01

    Neutral-ionic (NI) phase transition is a reversible switching of organic charge-transfer complexes between distinct valence states by external stimuli. This phase transformation in the low-dimensional system is demonstrated to provide a variety of novel dielectric, structural, and electronic properties. Importantly, ionization of the electron donor-acceptor pairs is usually accompanied by a ferroelectric or antiferroelectric order of the molecular lattice, leading to huge dielectric response near the transition point. Although these characteristics are potentially useful for future electronic and optical applications, the thermally accessible NI transition (TINIT) is still an extremely rare case. The TINIT compounds including some new materials are overviewed in order to provide convenient guides to their design and experimental identifications. The phase transition and dielectric properties can be closely controlled in various ways depending on chemical and physical modifications of the crystals. Among them, a quantum phase transition and relaxor ferroelectricity, both of which are currently attracting subjects from both scientific and practical perspectives, are highlighted as the first achievements in organic charge-transfer complexes

  15. An effective Hamiltonian approach for Donor-Bridge-Acceptor electronic transitions: Exploring the role of bath memory

    Directory of Open Access Journals (Sweden)

    E.R. Bittner

    2016-03-01

    Full Text Available We present here a formally exact model for electronic transitions between an initial (donor and final (acceptor states linked by an intermediate (bridge state. Our model incorporates a common set of vibrational modes that are coupled to the donor, bridge, and acceptor states and serves as a dissipative bath that destroys quantum coherence between the donor and acceptor. Taking the memory time of the bath as a free parameter, we calculate transition rates for a heuristic 3-state/2 mode Hamiltonian system parameterized to represent the energetics and couplings in a typical organic photovoltaic system. Our results indicate that if the memory time of the bath is of the order of 10-100 fs, a two-state kinetic (i.e., incoherent hopping model will grossly underestimate overall transition rate.

  16. Small-scale spatial variability of phenoxy acid mineralization potentials in transition zones with a multidisciplinary approach

    DEFF Research Database (Denmark)

    Pazarbasi, Meric Batioglu

    The phenoxy acid group of herbicides is widely used to control broadleaf weeds, and it contaminates groundwater and surface water by leaching from agricultural soil or landfills. Due to the distinct vertical and horizontal gradients in nutrients and hydrologic exchange in transition zones...... in two transition zones, (1) the interfaces of unsaturated and saturated zones and (2) groundwater and surface water. Small-scale spatial variability of phenoxy acids was previously shown in topsoil; however, such small-scale studies are scarce in subsurface environments. We therefore studied the factors...... classes in the different mineralization potentials of discharge zones. Understanding of the natural attenuation potential of groundwater-surface water transition zones is important for stream water protection. In landfill-impacted groundwater-surface water interface, we further analyzed bacterial...

  17. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin

    2018-01-01

    AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...

  18. Ischemic stroke: carotid and vertebral artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, P.; Goulao, A. [Hospital Garcia de Orta, Servico de Neurorradiologia, Almada (Portugal)

    2005-03-01

    Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. (orig.)

  19. Ischemic stroke: carotid and vertebral artery disease

    International Nuclear Information System (INIS)

    Vilela, P.; Goulao, A.

    2005-01-01

    Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. (orig.)

  20. Poverty and stroke in India: a time to act.

    Science.gov (United States)

    Pandian, Jeyaraj D; Srikanth, Velandai; Read, Stephen J; Thrift, Amanda G

    2007-11-01

    In developed countries, the predominant health problems are those lifestyle-related illnesses associated with increased wealth. In contrast, diseases occurring in developing countries can largely be attributed to poverty, poor healthcare infrastructure, and limited access to care. However, many developing countries such as India have undergone economic and demographic growth in recent years resulting in a transition from diseases caused by poverty toward chronic, noncommunicable, lifestyle-related diseases. Despite this recent rapid economic growth, a large proportion of the Indian population lives in poverty. Although risk factors for stroke in urban Indian populations are similar to developed nations, it is likely that they may be quite different among those afflicted by poverty. Furthermore, treatment options for stroke are fewer in developing countries like India. Well-organized stroke services and emergency transport services are lacking, many treatments are unaffordable, and sociocultural factors may influence access to medical care for many stroke victims. Most stroke centers are currently in the private sector and establishing such centers in the public sector will require enormous capital investment. Given the limited resources available for hospital treatments, it would be logical to place a greater emphasis on effective populationwide interventions to control or reduce exposure to leading stroke risk factors. There also needs to be a concerted effort to ensure access to stroke care programs that are tailored to suit Indian communities and are accessible to the large majority of the population, namely the poor.

  1. Mitochondrial Impairment in Cerebrovascular Endothelial Cells is Involved in the Correlation between Body Temperature and Stroke Severity

    Science.gov (United States)

    Hu, Heng; Doll, Danielle N.; Sun, Jiahong; Lewis, Sara E.; Wimsatt, Jeffrey H.; Kessler, Matthew J.; Simpkins, James W.; Ren, Xuefang

    2016-01-01

    stroke severity in experimental stroke animal models and may have translational significance for clinical stroke patients - targeting endothelial mitochondria may be a clinically useful approach for stroke therapy. PMID:26816660

  2. Stroke risk perception among participants of a stroke awareness campaign

    Science.gov (United States)

    Kraywinkel, Klaus; Heidrich, Jan; Heuschmann, Peter U; Wagner, Markus; Berger, Klaus

    2007-01-01

    Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. Stroke risk factor knowledge, perception of lifetime stroke risk and risk factor status were included in the questionnaire, and the determinants of good risk factor knowledge and high stroke risk perception were identified using logistic regression models. Results Overall stroke risk factor knowledge was good with 67–96% of the participants recognizing established risk factors. The two exceptions were diabetes (recognized by 49%) and myocardial infarction (57%). Knowledge of a specific factor was superior among those affected by it. 13% of all participants considered themselves of having a high stroke risk, 55% indicated a moderate risk. All major risk factors contributed significantly to the perception of being at high stroke risk, but the effects of age, sex and education were non-significant. Poor self-rated health was additionally associated with high individual stroke risk perception. Conclusion Stroke risk factor knowledge was high in this study. The self perception of an increased stroke risk was associated with established risk factors as well as low perception of general health. PMID:17371603

  3. Microwave stability at transition

    International Nuclear Information System (INIS)

    Holt, J.A.; Colestock, P.L.

    1995-05-01

    The question of microwave stability at transition is revisited using a Vlasov approach retaining higher order terms in the particle dynamics near the transition energy. A dispersion relation is derived which can be solved numerically for the complex frequency in terms of the longitudinal impedance and other beam parameters. Stability near transition is examined and compared with simulation results

  4. Asymptomatic acute ischemic stroke after primary percutaneous coronary intervention in patients with acute coronary syndrome might be caused mainly by manipulating catheters or devices in the ascending aorta, regardless of the approach to the coronary artery

    International Nuclear Information System (INIS)

    Murai, Motonobu; Hazui, Hiroshi; Sugie, Akira

    2007-01-01

    Asymptomatic acute ischemic stroke (aAIS) following primary percutaneous coronary intervention (p-PCI) in patients with acute coronary syndrome (ACS) has not been studied in detail. Of 75 patients who underwent p-PCI, 26 (34.7%) developed aAIS as determined by diffusion-weighted magnetic resonance imaging (MRI). Including the approach to the coronary artery (via lower limb or right upper limb), 23 factors were compared between patients with (n=26) and without (n=49) aAIS. Age, hypertension, smoking, plasma glucose levels, Killip grade, right coronary artery (RCA) as culprit vessel, percutaneous coronary intervention (PCI) time, and the frequency of device insertion into the coronary artery differed in a statistically significant manner. However, multivariate analysis showed that the RCA (odds ratio 3.477) and the frequency of device insertion (1.375) were independent factors linked to the incidence of aAIS. Moreover, anterior or posterior location and left or right cerebral circulation of aAIS were equivalent in both approaches. Cranial MRI images following emergency PCI revealed that 34.7% of the patients with ACS had aAIS that might be caused by manipulating the catheter or devices in the ascending aorta, micro-air bubble embolism during injection, or micro-thrombus embolism derived from the ACS lesions during the PCI procedure. (author)

  5. Satisfaction with palliative care after stroke: a prospective cohort study.

    Science.gov (United States)

    Blacquiere, Dylan; Bhimji, Khadija; Meggison, Hilary; Sinclair, John; Sharma, Michael

    2013-09-01

    The determinants of satisfaction for families of acute stroke patients receiving palliative care have not been extensively studied. We surveyed families to determine how they perceived palliative care after stroke. Families of patients palliated after ischemic stroke, intracerebral, or subarachnoid hemorrhage were approached. Four weeks after the patient's death, families were administered the After-Death Bereaved Family Member Interview to determine satisfaction with the care provided. Fifteen families participated. Families were most satisfied with participation in decision making and least satisfied with attention to emotional needs. In stroke-specific domains, families had less satisfaction with artificial feeding, hydration, and communication. Overall satisfaction was high (9.04 out of 10). Families of patients receiving palliative care at our institution showed generally high satisfaction with palliation after stroke; specific domains were identified for improvement. Further study in larger populations is required.

  6. Atlas of the Global Burden of Stroke (1990-2013)

    DEFF Research Database (Denmark)

    Feigin, Valery L; Mensah, George A; Norrving, Bo

    2015-01-01

    for ischemic stroke and hemorrhagic stroke in the world for 1990-2013. METHODOLOGY: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated following the general approach of the Global Burden of Disease (GBD) 2010 with several important improvements in methods. Data were updated for mortality......BACKGROUND: World mapping is an important tool to visualize stroke burden and its trends in various regions and countries. OBJECTIVES: To show geographic patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends...... estimates of global population. All estimates have been computed with 95% uncertainty intervals. RESULTS: Age-standardized incidence, mortality, prevalence and DALYs/YLDs declined over the period from 1990 to 2013. However, the absolute number of people affected by stroke has substantially increased across...

  7. Relearning the Basics: Rehabilitation after a Stroke

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Stroke Rehabilitation Relearning the Basics: Rehabilitation After a Stroke Past ... to help them recover successfully. What is post-stroke rehabilitation? Rehab helps stroke survivors relearn skills lost to ...

  8. Energy transitions in Built Environment of Netherlands : A System Dynamics approach to diffusion of Solar boilers and Insulation

    NARCIS (Netherlands)

    Muhaimin, T.A.; Nikolaos, M.

    2014-01-01

    In context of rising demand for energy amidst limited resources, energy efficiency is one of the major concerns of a modernized world. Gas consumption in the built environment constitutes for more than 30% of the overall energy consumption in the world. Hence, energy transitions and their

  9. Code stroke in Asturias.

    Science.gov (United States)

    Benavente, L; Villanueva, M J; Vega, P; Casado, I; Vidal, J A; Castaño, B; Amorín, M; de la Vega, V; Santos, H; Trigo, A; Gómez, M B; Larrosa, D; Temprano, T; González, M; Murias, E; Calleja, S

    2016-04-01

    Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available. We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient. We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score. Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Treadmill training with partial body weight support after stroke.

    Science.gov (United States)

    Hesse, Stefan; Werner, Cordula; von Frankenberg, Sophie; Bardeleben, Anita

    2003-02-01

    Treadmill therapy with partial BWS is a promising new approach to improve gait ability after stroke. This task-specific approach enables nonambulatory patients the repetitive practice of complex gait cycles instead of single-limb gait-preparatory maneuvers. Patients walk more symmetrically with less spasticity and better cardiovascular efficiency on the treadmill than with floor walking. Several controlled, clinical studies have shown the potential of treadmill training as a therapeutic intervention for nonambulatory patients with chronic stroke-related hemiplegia. Furthermore, controlled trials in acute stroke survivors have shown that treadmill training is as effective as other physiotherapy approaches that stress the repetitive practice of gait. Controlled multicenter trials comparing locomotor training with conventional therapy will be forthcoming. An electromechanical gait trainer that relieves the strenuous effort of the therapists and provides control of the trunk in a phase-dependent manner is a new technical alternative for gait training in severely impaired stroke patients.

  11. Late night activity regarding stroke codes: LuNAR strokes.

    Science.gov (United States)

    Tafreshi, Gilda; Raman, Rema; Ernstrom, Karin; Rapp, Karen; Meyer, Brett C

    2012-08-01

    There is diurnal variation for cardiac arrest and sudden cardiac death. Stroke may show a similar pattern. We assessed whether strokes presenting during a particular time of day or night are more likely of vascular etiology. To compare emergency department stroke codes arriving between 22:00 and 8:00 hours (LuNAR strokes) vs. others (n-LuNAR strokes). The purpose was to determine if late night strokes are more likely to be true strokes or warrant acute tissue plasminogen activator evaluations. We reviewed prospectively collected cases in the University of California, San Diego Stroke Team database gathered over a four-year period. Stroke codes at six emergency departments were classified based on arrival time. Those arriving between 22:00 and 8:00 hours were classified as LuNAR stroke codes, the remainder were classified as 'n-LuNAR'. Patients were further classified as intracerebral hemorrhage, acute ischemic stroke not receiving tissue plasminogen activator, acute ischemic stroke receiving tissue plasminogen activator, transient ischemic attack, and nonstroke. Categorical outcomes were compared using Fisher's Exact test. Continuous outcomes were compared using Wilcoxon's Rank-sum test. A total of 1607 patients were included in our study, of which, 299 (19%) were LuNAR code strokes. The overall median NIHSS was five, higher in the LuNAR group (n-LuNAR 5, LuNAR 7; P=0·022). There was no overall differences in patient diagnoses between LuNAR and n-LuNAR strokes (P=0·169) or diagnosis of acute ischemic stroke receiving tissue plasminogen activator (n-LuNAR 191 (14·6%), LuNAR 42 (14·0%); P=0·86). Mean arrival to computed tomography scan time was longer during LuNAR hours (n-LuNAR 54·9±76·3 min, LuNAR 62·5±87·7 min; P=0·027). There was no significant difference in 90-day mortality (n-LuNAR 15·0%, LuNAR 13·2%; P=0·45). Our stroke center experience showed no difference in diagnosis of acute ischemic stroke between day and night stroke codes. This

  12. Management of arterial hypertension in patients with acute stroke.

    Science.gov (United States)

    Adeoye, Opeolu; Jauch, Edward C

    2006-11-01

    Management of arterial hypertension in the hyperacute period immediately after stroke ictus remains controversial. Extremes of blood pressure (BP) are associated with poor outcomes in all stroke subtypes. Severely hypertensive patients likely benefit from modest BP reductions, but aggressive BP reduction may worsen outcome. Although little evidence is currently available to definitively establish guideline recommendations for optimal BP goals at stroke presentation, recently published research is shedding some light on how to approach management of BP after stroke. Antihypertensive treatment should probably be deferred in ischemic stroke patients except in cases of severe hypertension or when thrombolytic therapy is warranted and the patient's BP is above acceptable levels. Hypertensive hemorrhagic stroke patients may benefit from modest BP reductions. Relative hypotension causing regional hypoperfusion is an increasingly understood concept immediately following ischemic or hemorrhagic stroke, emphasizing the need for careful titration of appropriate medications to minimize fluctuations in BP for treated patients. Ongoing trials will improve our current knowledge regarding BP management after ischemic and hemorrhagic stroke.

  13. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

    Science.gov (United States)

    Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang

    2017-07-01

    Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.

  14. A microscopic approach based on particle-vibration coupling: application to charge-exchange transitions and multiplets in odd nuclei

    Directory of Open Access Journals (Sweden)

    Colò Gianluca

    2016-01-01

    Full Text Available In this contribution, we shall describe a formalism that goes beyond the simple time-dependent mean field and is based on particle-vibration coupling (PVC. Such a formalism has been developed with the idea of being self-consistent. It makes use of Skyrme effective forces, and has been used for several applications. We will focus on charge-exchange transitions, namely we will show that our model describes well both the Gamow-Teller giant resonance width, and the low-lying transitions associated with β-decay. In this latter case, including PVC produces a significant improvement of the half-lives obtained at mean-field level, and leads to a good agreement with experimental data. We will end by discussing particle-phonon multiplets in odd nuclei.

  15. Stability and transitions in mother-infant face-to-face communication during the first 6 months: a microhistorical approach.

    Science.gov (United States)

    Hsu, Hui-Chin; Fogel, Alan

    2003-11-01

    In this study the authors attempted to unravel the relational, dynamical, and historical nature of mother-infant communication during the first 6 months. Thirteen mothers and their infants were videotaped weekly from 4 to 24 weeks during face-to-face interactions. Three distinct patterns of mother-infant communication were identified: symmetrical, asymmetrical, and unilateral. Guided by a dynamic systems perspective, the authors explored the stability of and transitions between these communication patterns. Findings from event history analysis showed that (a) there are regularly recurring dyadic communication patterns in early infancy, (b) these recurring patterns show differential stabilities and likelihoods of transitions, (c) dynamic stability in dyadic communication is shaped not only by individual characteristics (e.g., infant sex and maternal parity) but also by the dyad's communication history, and (d) depending on their recency, communication histories varying in temporal proximity exert differential effects on the self-organization processes of a dyadic system. ((c) 2003 APA, all rights reserved)

  16. Diabetes, Heart Disease, and Stroke

    Science.gov (United States)

    ... Disease, & Other Dental Problems Diabetes, Sexual, & Bladder Problems Diabetes, Heart Disease, and Stroke Having diabetes means that ... help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood ...

  17. Preventable Pediatric Stroke via Vaccination?

    Directory of Open Access Journals (Sweden)

    Craig A. Press

    2015-11-01

    Full Text Available Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS group studied the risk of arterial ischemic stroke (AIS associated with minor infection and routine childhood vaccinations.

  18. Heart Disease and Stroke Statistics

    Science.gov (United States)

    ... Media for Heart.org Heart and Stroke Association Statistics Each year, the American Heart Association, in conjunction ... health and disease in the population. Heart & Stroke Statistics FAQs What is Prevalence? Prevalence is an estimate ...

  19. Multi-Disciplinary Stroke Care in Developing Countries – Lessons from the Wessex-Ghana Stroke Partnership

    Directory of Open Access Journals (Sweden)

    Louise Johnson

    2017-11-01

    Full Text Available Stroke disease in Ghana has been of increasing concern since the mid to late 20th century, in association with the increasing westernisation of diet and lifestyle [1]. Two thirds of world-wide mortality cases from stroke occur in sub-Saharan Africa [2], and in the Ghanaian capital city region of Accra, stroke is now attributed as the second largest cause of death [1]. The burden of stroke in sub-Saharan Africa is significant [3]. Experts recommend a three-prong approach to dealing with the burden of non-communicable disease (NCD: epidemiological surveillance; primary prevention (preventing disease in healthy populations; and secondary prevention (preventing complications and improving quality of life in affected communities [4]. This paper outlines the development of a specialist stroke service in Accra, Ghana. This work therefore broadly relates to the secondary prevention aspect, achieved through the development of a dedicated and specialised stroke service. Whilst this project took place in Ghana, the learning could be applied to the development of a stroke service in any resource poor setting, such as South Sudan. Indeed, because the focus is on establishing the fundamentals of organised stroke care, the principles are also entirely relevant to more developed health care systems.

  20. Pre-melting hcp to bcc Transition in Beryllium: A Study by First-Principles Phonon Quasiparticle Approach

    Science.gov (United States)

    Zhang, D. B., Sr.

    2017-12-01

    Beryllium (Be) is an important material with wide applications ranging from aerospace components to X-ray equipments. Yet a precise understanding of its phase diagram remains elusive. We have investigated the phase stability of Be using a recently developed hybrid free energy computation method that accounts for anharmonic effects by invoking phonon quasiparticles. We find that the hcp to bcc transition occurs near the melting curve at 0

  1. Investigating the relationship between the mantle transition zone and the fate of subducted slabs: an adaptative-mesh numerical approach

    Science.gov (United States)

    Garel, F.; Davies, R.; Goes, S. D.; Davies, J.; Lithgow-Bertelloni, C. R.; Stixrude, L. P.

    2012-12-01

    Seismic observations show a wide range of slab morphologies within the mantle transition zone. This zone is likely to have been critical in Earth's thermal and chemical evolution, acting as a 'valve' that controls material transfer between the upper and lower mantle. However, the interaction between slabs and this complex region remains poorly understood. The complexity arises from non-linear and multi-scale interactions between several aspects of the mantle system, including mineral phase changes and material rheology. In this study, we will utilize new, multi-scale geodynamic models to determine what controls the seismically observed variability in slab behavior within the mantle transition zone and, hence, the down-going branch of the mantle 'valve'. Our models incorporate the newest mineral physics and theoretical constraints on density, phase proportions and rheology. In addition we exploit novel and unique adaptive grid methodologies to provide the resolution necessary to capture rapid changes in material properties in and around the transition zone. Our early results, which will be presented, illustrate the advantages of the new modelling technique for studying subduction including the effects of changes in material properties and mineral phases.

  2. A New Approach for Accurate Prediction of Liquid Loading of Directional Gas Wells in Transition Flow or Turbulent Flow

    Directory of Open Access Journals (Sweden)

    Ruiqing Ming

    2017-01-01

    Full Text Available Current common models for calculating continuous liquid-carrying critical gas velocity are established based on vertical wells and laminar flow without considering the influence of deviation angle and Reynolds number on liquid-carrying. With the increase of the directional well in transition flow or turbulent flow, the current common models cannot accurately predict the critical gas velocity of these wells. So we built a new model to predict continuous liquid-carrying critical gas velocity for directional well in transition flow or turbulent flow. It is shown from sensitivity analysis that the correction coefficient is mainly influenced by Reynolds number and deviation angle. With the increase of Reynolds number, the critical liquid-carrying gas velocity increases first and then decreases. And with the increase of deviation angle, the critical liquid-carrying gas velocity gradually decreases. It is indicated from the case calculation analysis that the calculation error of this new model is less than 10%, where accuracy is much higher than those of current common models. It is demonstrated that the continuous liquid-carrying critical gas velocity of directional well in transition flow or turbulent flow can be predicted accurately by using this new model.

  3. A study of isotropic-nematic transition of quadrupolar Gay-Berne fluid using density-functional theory approach

    Science.gov (United States)

    Singh, Ram Chandra; Ram, Jokhan

    2011-11-01

    The effects of quadrupole moments on the isotropic-nematic (IN) phase transitions are studied using the density-functional theory (DFT) for a Gay-Berne (GB) fluid for a range of length-to-breadth parameters ? in the reduced temperature range ? . The pair-correlation functions of the isotropic phase, which enter into the DFT as input parameters are found by solving the Percus-Yevick integral equation theory. The method used involves an expansion of angle-dependent functions appearing in the integral equations in terms of spherical harmonics and the harmonic coefficients are obtained by an iterative algorithm. All the terms of harmonic coefficients which involve l indices up to less than or equal to 6 are considered. The numerical accuracy of the results depends on the number of spherical harmonic coefficients considered for each orientation-dependent function. As the length-to-breadth ratio of quadrupolar GB molecules is increased, the IN transition is seen to move to lower density (and pressure) at a given temperature. It has been observed that the DFT is good to study the IN transitions in such fluids. The theoretical results have also been compared with the computer simulation results wherever they are available.

  4. Burden of Stroke in Qatar.

    Science.gov (United States)

    Ibrahim, Faisal; Deleu, Dirk; Akhtar, Naveed; Al-Yazeedi, Wafa; Mesraoua, Boulenouar; Kamran, Sadaat; Shuaib, Ashfaq

    2015-12-01

    Qatar is located on the northeastern coast of the Arabian Peninsula. The total population is over 2.1 million with around 15% being Qatari citizens. Hamad General Hospital (HGH) is the only tertiary referral governmental hospital in Qatar which admits acute (thrombolysis-eligible) stroke patients. To provide an overview of the burden of stroke in Qatar. Data from literature databases, online sources and our stroke registry were collated to identify information on the burden of stroke in Qatar. Overall, over 80% of all stroke patients in Qatar are admitted in HGH. In 2010, the age-standardized incidence for first-ever ischemic stroke was 51.88/100,000 person-years. To date our stroke registry reveals that 79% of all stroke patients are male and almost 50% of stroke patients are 50 years or less. Hypertension, diabetes and dyslipidemia are the main predisposing factors for stroke, with ischemic stroke being more common (87%) than hemorrhagic stroke (13%). Despite the lack of a stroke unit, 9% of ischemic stroke patients are being thrombolyzed. However the presence of a stroke ward allows swift turnover of patients with a length of stay of less than 5 days before discharge or, if required, transfer to the fully-equipped hospital-based rehabilitation service. Several community awareness programs are ongoing, in addition to several research programs funded by the Qatar National Research Fund and Hamad Medical Corporation. In a country where over 15% of the population suffers from diabetes there is continuous need for national community-based awareness campaigns, prevention and educational programs particularly targeting patients and health care workers. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Rehabilitation after stroke.

    Science.gov (United States)

    Knecht, Stefan; Hesse, Stefan; Oster, Peter

    2011-09-01

    Stroke is becoming more common in Germany as the population ages. Its long-term sequelae can be alleviated by early reperfusion in stroke units and by complication management and functional restoration in early-rehabilitation and rehabilitation centers. Selective review of the literature. Successful rehabilitation depends on systematic treatment by an interdisciplinary team of experienced specialists. In the area of functional restoration, there has been major progress in our understanding of the physiology of learning, relearning, training, and neuroenhancement. There have also been advances in supportive pharmacotherapy and robot technology. Well-organized acute and intermediate rehabilitation after stroke can provide patients with the best functional results attainable on the basis of our current scientific understanding. Further experimental and clinical studies will be needed to expand our knowledge and improve the efficacy of rehabilitation.

  6. Mortality after hemorrhagic stroke

    DEFF Research Database (Denmark)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann

    2013-01-01

    OBJECTIVE: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database. METHODS: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH...... = 0.03). CONCLUSIONS: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated......, 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend stroke patients...

  7. Post Stroke Llife in Iranian People: Used and Recommended Strategies

    Directory of Open Access Journals (Sweden)

    Asghar Dalvandi

    2009-04-01

    Full Text Available Objectives: Stroke survivors develop their own strategies to combat disabilities, developing strategies to maintain or reestablish a sense of continuity after the disruptive life event that stroke represents, using strategies to foster hope during the process of adjusting to life after stroke and drawing on spiritual practices. The aim of this study is to identify the used and recommended strategies of life after stroke among Iranian people. Methods: A grounded theory approach was recruited using semi-structured interviews with 10 stroke survivors, 12 family caregivers and 6 formal care givers. Results: Five main concepts emerged describing as the used and recommended strategies of the participants including, improving functional performance, re-learning life skills and educational support, accessing to rehabilitative services, socio-economical support and well-suited coping strategies. Discussion: Participants valued better knowledge and skills regarding the adaptive strategies for stroke survivors and their family care givers are essential in accomplishing with activities of daily living and doing social roles for improving life after stroke. Also developing the socio- economic supports is crucial for assuring a more supportive approach to achieve rehabilitation services and design better educational program for them.

  8. Parvovirus B19 Infection in Children With Arterial Ischemic Stroke.

    Science.gov (United States)

    Fullerton, Heather J; Luna, Jorge M; Wintermark, Max; Hills, Nancy K; Tokarz, Rafal; Li, Ying; Glaser, Carol; DeVeber, Gabrielle A; Lipkin, W Ian; Elkind, Mitchell S V

    2017-10-01

    Case-control studies suggest that acute infection transiently increases the risk of childhood arterial ischemic stroke. We hypothesized that an unbiased pathogen discovery approach utilizing MassTag-polymerase chain reaction would identify pathogens in the blood of childhood arterial ischemic stroke cases. The multicenter international VIPS study (Vascular Effects of Infection in Pediatric Stroke) enrolled arterial ischemic stroke cases, and stroke-free controls, aged 29 days through 18 years. Parental interview included questions on recent infections. In this pilot study, we used MassTag-polymerase chain reaction to test the plasma of the first 161 cases and 34 controls enrolled for a panel of 28 common bacterial and viral pathogens. Pathogen DNA was detected in no controls and 14 cases (8.7%): parvovirus B19 (n=10), herpesvirus 6 (n=2), adenovirus (n=1), and rhinovirus 6C (n=1). Parvovirus B19 infection was confirmed by serologies in all 10; infection was subclinical in 8. Four cases with parvovirus B19 had underlying congenital heart disease, whereas another 5 had a distinct arteriopathy involving a long-segment stenosis of the distal internal carotid and proximal middle cerebral arteries. Using MassTag-polymerase chain reaction, we detected parvovirus B19-a virus known to infect erythrocytes and endothelial cells-in some cases of childhood arterial ischemic stroke. This approach can generate new, testable hypotheses about childhood stroke pathogenesis. © 2017 American Heart Association, Inc.

  9. Questions and Answers about Stroke

    Science.gov (United States)

    ... stroke. High blood pressure increases your risk of stroke four to six times. Heart disease, especially a condition ... leading cause of serious, long-term adult disability. Four million Americans are living with the effects of stroke. The length of time to recover from a ...

  10. Stroke and Episodic Memory Disorders

    Science.gov (United States)

    Lim, Chun; Alexander, Michael P.

    2009-01-01

    Memory impairments are common after stroke, and the anatomical basis for impairments may be quite variable. To determine the range of stroke-related memory impairment, we identified all case reports and group studies through the Medline database and the Science Citation Index. There is no hypothesis about memory that is unique to stroke, but there…

  11. Stroke care in Central Eastern Europe: current problems and call for action.

    Science.gov (United States)

    Lenti, Laura; Brainin, Michael; Titianova, Ekaterina; Morovic, Sandra; Demarin, Vida; Kalvach, Pavel; Skoloudik, David; Kobayashi, Adam; Czlonkowska, Anna; Muresanu, Dafin F; Shekhovtsova, Ksenia; Skvortsova, Veronica I; Sternic, Nadezda; Beslac Bumbasirevic, Ljiljana; Svigelj, Viktor; Turcani, Peter; Bereczki, Dániel; Csiba, László

    2013-07-01

    Stroke is a major medical problem and one of the leading causes of mortality and disability all over in Europe. However, there are significant East-West differences in stroke care as well as in stroke mortality and morbidity rates. Central and Eastern European countries that formerly had centralized and socialist health care systems have serious and similar problems in organizing health and stroke care 20 years after the political transition. In Central and Eastern Europe, stroke is more frequent, the mortality rate is higher, and the victims are younger than in Western Europe. High-risk patients live in worse environmental conditions, and the socioeconomic consequences of stroke further weaken the economic development of these countries. To address these issues, a round table conference was organized. The main aim of this conference was to discuss problems to be solved related to acute and chronic stroke care in Central and Eastern European countries, and also, to exchange ideas on possible solutions. In this article, the discussed problems and possible solutions will be summarized, and introduce 'The Budapest Statement of Stroke Experts of Central and Eastern European countries'. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  12. Mridangam stroke dataset

    OpenAIRE

    CompMusic

    2014-01-01

    The audio examples were recorded from a professional Carnatic percussionist in a semi-anechoic studio conditions by Akshay Anantapadmanabhan using SM-58 microphones and an H4n ZOOM recorder. The audio was sampled at 44.1 kHz and stored as 16 bit wav files. The dataset can be used for training models for each Mridangam stroke. /n/nA detailed description of the Mridangam and its strokes can be found in the paper below. A part of the dataset was used in the following paper. /nAkshay Anantapadman...

  13. Stroke and Therapeutic Hypothermia

    Directory of Open Access Journals (Sweden)

    Ozlem Ozkan Kuscu

    2016-09-01

    Full Text Available Stroke is significant cause of morbidity and mortality caused by disruption of blood flow. Neural injury occurs with two stage; while primary neural injury occurs with disruption of blood flow, after days and hours with metabolic processes secondary injury develops in tissues which is non injured in the first stage. Therefore it is important to prevent and treat the secondary injury as much as preventing and treating the primary neural injury. In this article developing pathophysiological changes after stroke, mechanisms of therapeutic hypothermia, application methods, the factors that determine the effectiveness, side effects and complications were reviewed. [Archives Medical Review Journal 2016; 25(3.000: 351-368

  14. Melatonin-Based Therapeutics for Neuroprotection in Stroke

    Directory of Open Access Journals (Sweden)

    Cesar V. Borlongan

    2013-04-01

    Full Text Available The present review paper supports the approach to deliver melatonin and to target melatonin receptors for neuroprotection in stroke. We discuss laboratory evidence demonstrating neuroprotective effects of exogenous melatonin treatment and transplantation of melatonin-secreting cells in stroke. In addition, we describe a novel mechanism of action underlying the therapeutic benefits of stem cell therapy in stroke, implicating the role of melatonin receptors. As we envision the clinical entry of melatonin-based therapeutics, we discuss translational experiments that warrant consideration to reveal an optimal melatonin treatment strategy that is safe and effective for human application.

  15. ANTITHROMBOCYTIC THERAPY IN THE SECONDARY PREVENTION OF ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    Andrey Viktorovich Fonyakin

    2009-01-01

    Full Text Available Approaches to preventing recurrent stroke by antithrombocytic therapy are shown to be as diverse as its causes. The diagnosis of cardioembolic stroke in patients with atrial fibrillation should not limit the choice of an antithrombocytic agent to only oral (indirect anticoagulants (OAC. If OAC cannot be used, antithrombocytic therapy, including combined (clopidogrel + ASA one, may be considered as a reasonable alternative. Approaches to choosing the optimal antithrombocytic drug in noncardioembolic strokes are intricate since atherosclerosis is a systemic vascular disease and the poststroke period is characterized by a higher risk for not only recurrent stroke, but also for coronary catastrophes. It is concluded that an antithrombocytic agent should be chosen, by taking into account the multifocality of atherosclerosis, associated clinical conditions, diabetes mellitus, intravascular interventions and the individual risk of all cardiovascular events.

  16. Effect of water on glass transition in starch/sucrose matrices investigated through positron annihilation lifetime spectroscopy: a new approach.

    Science.gov (United States)

    Sharma, Sandeep Kumar; Zaydouri, Abdelhadi; Roudaut, Gaëlle; Duplâtre, Gilles

    2011-11-21

    Glass transition is studied through positron annihilation lifetime spectroscopy (PALS) in maize starch matrices containing 10 (batch STS10) and 20 (STS20) w/w% sucrose, as a function of temperature (T) and water content (c(w)). To circumvent important losses of water upon heating while recording the PALS spectra, a new method is developed: instead of a series of measurements of τ(3), the triplet positronium lifetime, at different T, the latter is kept constant and the series relates to c(w), which is left to decrease at a constant rate. Similarly to the changes in τ(3) with T, the τ(3)vs. c(w) plots obtained show a smooth linear increase until a break, denoting the occurrence of glass transition, followed by a sharper increase. The gradients appear to be independent of T. The variation of the glass transition temperature, T(g), with c(w) shows a broad sigmoid with a large linear central part; as expected from the plasticising effect of sucrose, the plot for STS20 lies some 10 K below that for STS10. Results from differential scanning calorimetry for STS20 yield T(g) values some 15 K higher than from PALS. On the basis of the general shape of the τ(3)vs. T variations, a general equation is set for τ(3)(T, c(w)), leading one to expect a similar shape for τ(3)vs. c(w), as experimentally observed. This journal is © the Owner Societies 2011

  17. Methodological practices of positive energy territories. To articulate approaches and tools in order to implement energy transition

    International Nuclear Information System (INIS)

    Bailleul, Esther

    2017-01-01

    This publication comments the results of a survey which aimed at understanding how French territories are properly implementing their local energy transition by using a variety of tools designed for the design and follow-up of their climate-energy policies, and other supports (regional programs, experts, local associations, and so on). Different aspects are addressed: the importance of support devices, the uneven level of knowledge or adequacy of tools, the role of external expertise, the way the great number of tools is managed, additional needs, issues related to financing and to mobilisation. In the second part, six examples are presented which correspond to different geographical situations and stakes

  18. Family History in Young Patients With Stroke.

    Science.gov (United States)

    Thijs, Vincent; Grittner, Ulrike; Dichgans, Martin; Enzinger, Christian; Fazekas, Franz; Giese, Anne-Katrin; Kessler, Christof; Kolodny, Edwin; Kropp, Peter; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Rothwell, Peter M; Schmidt, Reinhold; Tanislav, Christian; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt

    2015-07-01

    Family history of stroke is an established risk factor for stroke. We evaluated whether family history of stroke predisposed to certain stroke subtypes and whether it differed by sex in young patients with stroke. We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young patients (aged stroke in whom cardiovascular risk factors and family history of stroke were obtained and detailed stroke subtyping was performed. A family history of stroke was present in 1578 of 4232 transient ischemic attack and ischemic stroke patients (37.3%). Female patients more often had a history of stroke in the maternal lineage (P=0.027) than in the paternal lineage. There was no association with stroke subtype according to Trial of Org 10172 in Acute Stroke Treatment nor with the presence of white matter disease on brain imaging. Patients with dissection less frequently reported a family history of stroke (30.4% versus 36.3%; P=0.018). Patients with a parental history of stroke more commonly had siblings with stroke (3.6% versus 2.6%; P=0.047). Although present in about a third of patients, a family history of stroke is not specifically related to stroke pathogenic subtypes in patients with young stroke. Young women with stroke more often report stroke in the maternal lineage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  19. Equation of motion approach for describing allowed transitions in Ne and Al3+ under classical and quantum plasmas

    Science.gov (United States)

    Chaudhuri, Supriya K.; Mukherjee, Prasanta K.; Chaudhuri, Rajat K.; Chattopadhyay, Sudip

    2018-04-01

    The equation of motion coupled cluster methodology within relativistic framework has been applied to analyze the electron correlation effects on the low lying dipole allowed excited states of Ne and Al3+ under classical and quantum plasma environments. The effect of confinement due to classical plasma has been incorporated through screened Coulomb potential, while that of quantum plasma has been treated by exponential cosine screened Coulomb potential. The confined structural properties investigated are the depression of ionization potential, low lying excitation energies (dipole allowed), oscillator strengths, transition probabilities, and frequency dependent polarizabilities under systematic variation of the plasma-atom coupling strength determined through the screening parameter. Specific atomic systems are chosen for their astrophysical importance and availability of experimental data related to laboratory plasma with special reference to Al3+ ion. Here, we consider 1 s22 s22 p6(1S0)→1 s22 s22 p5 n s /n d (1P1) (n =3 ,4 ) dipole allowed transitions of Ne and Al3+. Results for the free (isolated) atomic systems agree well with those available in the literature. Spectroscopic properties under confinement show systematic and interesting pattern with respect to plasma screening parameter.

  20. UniEdge: A first year transition program and its continued evolution through a reflective approach. A Practice Report

    Directory of Open Access Journals (Sweden)

    Ann Lefroy

    2014-03-01

    Full Text Available Phillipa Sturgess 14.00 800x600 The shift in Australian higher education policy to widen participation and ensure equity across all student cohorts has led to the need for specific, structured transition programs. The First Year Advisor Network at Murdoch University in Perth, Australia has designed and implemented a transition program for commencing students called UniEdge. The aims of the program are: (1 to help foster a sense of community for first year students; (2 to  make new students aware of the support services available; and (3 to improve the confidence and preparedness of new students. The program has received high praise from students, but rates of attendance have been problematic. By reflecting on student and staff feedback, the program has been adapted over multiple semesters, resulting in increased student attendance and therefore a greater impact on the first year experience at Murdoch University. Normal 0 false false false EN-AU X-NONE X-NONE

  1. A novel approach for analyzing glass-transition temperature vs. composition patterns: application to pharmaceutical compound+polymer systems.

    Science.gov (United States)

    Kalogeras, Ioannis M

    2011-04-18

    In medicine, polymer-based materials are commonly used as excipients of poorly water-soluble drugs. The success of the encapsulation, as well as the physicochemical stability of the products, is often reflected on their glass transition temperature (T(g)) vs. composition (w) dependencies. The shape of the T(g)(w) patterns is critically influenced by polymer's molecular mass, drug molecule's shape and molecular volume, the type and degree of shielding of hydrogen-bonding capable functional groups, as well as aspects of the preparation process. By altering mixture's T(g) the amorphous solid form of the active ingredient may be retained at ambient or body temperatures, with concomitant improvements in handling, solubility, dissolution rate and oral bioavailability. Given the importance of the problem, the glass transitions observed in pharmaceutical mixtures have been extensively analyzed, aiming to appraise the state of mixing and intermolecular interactions. Here, accumulated experimental information on related systems is re-evaluated and comparably discussed under the light of a more effective and system-inclusive T(g)(w) equation. The present analysis indicates that free volume modifications and conformational changes of the macromolecular chains dominate, over enthalpic effects of mixing, in determining thermal characteristics and crystallization inhibition/retardation. Moreover, hydrogen-bonding and ion-dipole heterocontacts--although favorable of a higher degree of mixing--appear less significant compared to the steric hindrances and the antiplasticization proffered by the higher viscosity component. Copyright © 2011 Elsevier B.V. All rights reserved.

  2. Stroke Connection Magazine

    Science.gov (United States)

    ... controlling blood pressure over the long term than exercise, diet, not smoking and reducing alcohol consumption. Combo of Smaller Meds May Just Be the Dose to Lower Blood Pressure Combined smaller doses of blood pressure medications may be effective with ... Exercise May Lessen Stroke Severity Being physically active may ...

  3. Neurorehabilitation after Stroke

    Directory of Open Access Journals (Sweden)

    Rüdiger J. Seitz

    2013-08-01

    Full Text Available Recovery from ischaemic stroke is determined in the acute phase by the lesion impact of ischaemia and subsequently, by functional and structural network changes in the spared brain tissue. Neurorehabilitation supports the restitution of function using repetitive, learning-based and, more recently, technology-based training strategies.

  4. Ischemic strokes and migraine

    Energy Technology Data Exchange (ETDEWEB)

    Bousser, M.G.; Baron, J.C.; Chiras, J.

    1985-11-01

    Lasting neurological deficits, though most infrequent, do occur in migrainous subjects and are well documented by clinical angiographic computed tomographic (CT scan) and even pathological studies. However the mechanism of cerebral ischemia in migraine remains widely unknown and the precise role of migraine in the pathogenesis of ischemic strokes is still debated. (orig./MG).

  5. The Optimal Golf Stroke

    DEFF Research Database (Denmark)

    Buchinger, Mikael; Durigen, Susan; Dahl, Johan Rambech

    2006-01-01

    The paper presents a preliminary investigation into aspects of the game of golf. A series of models is proposed for the golf stroke, the momentum transfer between club and ball and the flight of the ball.Numerical and asymptotic solutions are presented reproducing many of the features observed in...

  6. Hypercholesterolemia, Stroke And Statins

    Directory of Open Access Journals (Sweden)

    Prabhakar S

    2005-01-01

    Full Text Available The link between serum cholesterol levels and the incidence of stroke still remain to be established. There are conflicting reports from a series of observational cohort studies. However, clinical trials with HMG CoA reductase inhibitors (also called statins have shown that cholesterol lowering therapy used in the primary and secondary prevention of myocardial infarction significantly reduced cardiovascular events including strokes. Meta analysis of trials with statins have shown a relative risk reduction in stroke of 12 to 48% in patients with coronary heart disease after MI. It has been postulated that the clinical action of statins is the result of pleiotropic / antiatherogenic effects rather than simply a reduction in cholesterol. The putative beneficial effect of statins in stroke involve blocking of macrophage and platelet activation, improvement of endothelial cell vasomotor function, enhancement of endothelial fibrinolytic function, immunosuppressive and anti-inflammatory action, inhibition of smooth muscle cell proliferation and particularly enhancement of endothelial nitric oxide synthase (eNOS.

  7. Stroke? Localized, otogenic meningitis!

    DEFF Research Database (Denmark)

    Ingolfsdottir, Harpa Maria; Thomasen, Per Caye

    2011-01-01

    We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur...

  8. Anxiety After Stroke: The Importance of Subtyping.

    Science.gov (United States)

    Chun, Ho-Yan Yvonne; Whiteley, William N; Dennis, Martin S; Mead, Gillian E; Carson, Alan J

    2018-03-01

    Anxiety after stroke is common and disabling. Stroke trialists have treated anxiety as a homogenous condition, and intervention studies have followed suit, neglecting the different treatment approaches for phobic and generalized anxiety. Using diagnostic psychiatric interviews, we aimed to report the frequency of phobic and generalized anxiety, phobic avoidance, predictors of anxiety, and patient outcomes at 3 months poststroke/transient ischemic attack. We followed prospectively a cohort of new diagnosis of stroke/transient ischemic attack at 3 months with a telephone semistructured psychiatric interview, Fear Questionnaire, modified Rankin Scale, EuroQol-5D5L, and Work and Social Adjustment Scale. Anxiety disorder was common (any anxiety disorder, 38 of 175 [22%]). Phobic disorder was the predominant anxiety subtype: phobic disorder only, 18 of 175 (10%); phobic and generalized anxiety disorder, 13 of 175 (7%); and generalized anxiety disorder only, 7 of 175 (4%). Participants with anxiety disorder reported higher level of phobic avoidance across all situations on the Fear Questionnaire. Younger age (per decade increase in odds ratio, 0.64; 95% confidence interval, 0.45-0.91) and having previous anxiety/depression (odds ratio, 4.38; 95% confidence interval, 1.94-9.89) were predictors for anxiety poststroke/transient ischemic attack. Participants with anxiety disorder were more dependent (modified Rankin Scale score 3-5, [anxiety] 55% versus [no anxiety] 29%; P anxiety] 19.5, 10-27 versus [no anxiety] 0, 0-5; P Anxiety after stroke/transient ischemic attack is predominantly phobic and is associated with poorer patient outcomes. Trials of anxiety intervention in stroke should consider the different treatment approaches needed for phobic and generalized anxiety. © 2018 The Authors.

  9. Virtual reality for stroke rehabilitation.

    Science.gov (United States)

    Laver, Kate E; George, Stacey; Thomas, Susie; Deutsch, Judith E; Crotty, Maria

    2011-09-07

    Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness. To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke. We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to March 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers. Randomised and quasi-randomised trials of virtual reality ('an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion') in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function. Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information. We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. results were statistically significant for arm function (standardised

  10. Effect of Visual Art School-Based Stroke Intervention for Middle School Students.

    Science.gov (United States)

    Johnson, Ashleigh B; Montgomery, Chelsea M; Dillard, Wesley A; Morrill, Kenneth; Hoesli, Coral; Gillette, Wesley M; Johnson, Brandon K; Nathaniel, Thomas I

    2017-08-01

    Community stroke awareness initiatives have traditionally been used to expand knowledge of stroke signs and risk factors to high-risk adult populations. Here, we use a novel unfettered, visual art-based approach for an elementary school initiative to raise stroke awareness. Seventh graders in a middle school art class received stroke awareness training during the course of the 2015 to 2016 school year through their teacher in the visual arts class. In turn, they used this training to develop their own artistic interpretations of key stroke awareness concepts via project-based learning and then present their projects to raise awareness about stroke. We evaluated our predata and postdata to determine whether the visual art school-based stroke intervention was effective in both educating students about stroke and enabling them to effectively disseminate this information to parents and other adults in their community. The pretest evaluation indicates a fair or good knowledge about stroke, and no student indicated an "outstanding" or "excellent" knowledge. The posttest evaluation indicated a higher degree of stroke awareness because students were rated as having an "outstanding," "excellent," or "very good" performance especially in the ability to translate knowledge of stroke awareness lessons learned in their art class into a well-articulated stroke-related project and presentation. Pearson χ test reveals significant difference (P art teacher to lead the educational component in the intervention indicates that expertise in neurology or stroke is not necessary to facilitate understanding of stroke and highlights the importance of creativeness in stroke education for children.

  11. Spatiotemporal PET Imaging of Dynamic Metabolic Changes After Therapeutic Approaches of Induced Pluripotent Stem Cells, Neuronal Stem Cells, and a Chinese Patent Medicine in Stroke.

    Science.gov (United States)

    Zhang, Hong; Song, Fahuan; Xu, Caiyun; Liu, Hao; Wang, Zefeng; Li, Jinhui; Wu, Shuang; YehuaShen; Chen, Yao; Zhu, Yunqi; Du, Ruili; Tian, Mei

    2015-11-01

    This study aimed to use spatiotemporal PET imaging to investigate the dynamic metabolic changes after a combined therapeutic approach of induced pluripotent stem cells (iPSCs), neuronal stem cells (NSCs), and Chinese patent medicine in a rat model of cerebral ischemia-reperfusion injury. Cerebral ischemia was established by the middle cerebral artery occlusion approach. Thirty-six male rats were randomly assigned to 1 of the 6 groups: control phosphate-buffered saline (PBS), Chinese patent medicine (Qing-kai-ling [QKL]), induced pluripotent stem cells (iPSCs), combination of iPSCs and QKL, neuronal stem cells (NSCs), and combination of NSCs and QKL. Serial (18)F-FDG small-animal PET imaging and neurofunctional tests were performed weekly. Autoradiographic imaging and immunohistochemical and immunofluorescent analyses were performed at 4 wk after stem cell transplantation. Compared with the PBS control group, significantly higher (18)F-FDG accumulations in the ipsilateral cerebral infarction were observed in 5 treatment groups from weeks 1-4. Interestingly, the most intensive (18)F-FDG accumulation was found in the NSCs + QKL group at week 1 but in the iPSCs + QKL group at week 4. The neurofunctional scores in the 5 treatment groups were significantly higher than that of the PBS group from week 3 to 4. In addition, there was a significant correlation between the PET imaging findings and neurofunctional recovery (P PET imaging with (18)F-FDG demonstrated dynamic metabolic and functional recovery after iPSCs or NSCs combined with QKL in a rat model of cerebral ischemia-reperfusion injury. iPSCs or NSCs combined with Chinese medicine QKL seemed to be a better therapeutic approach than these stem cells used individually. © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  12. Collaborative Negotiations: A Successful Approach for Negotiation Compliance Milestones for the transition of the PFP Hanford Nuclear Reservation

    International Nuclear Information System (INIS)

    HOPKINS, A.M.

    2003-01-01

    The new approach to negotiations was termed collaborative (win-win) rather than positional (win-lose). Collaborative negotiations were conducted to establish milestones for the decommissioning of the Plutonium Finishing Plant, PFP

  13. Unusual dileptions at RHIC a field theoretic approach based on a non-equilibrium chiral phase transition

    International Nuclear Information System (INIS)

    Cooper, F.

    1997-01-01

    This paper contains viewgraphs on unusual dileptons at Brookhaven RHIC. A field theory approach is used based on a non-equilibrium chiral phase transformation utilizing the schroedinger and Heisenberg picture

  14. Unusual dileptions at RHIC a field theoretic approach based on a non-equilibrium chiral phase transition

    Energy Technology Data Exchange (ETDEWEB)

    Cooper, F. [Los Alamos National Labs., NM (United States)

    1997-09-22

    This paper contains viewgraphs on unusual dileptons at Brookhaven RHIC. A field theory approach is used based on a non-equilibrium chiral phase transformation utilizing the schroedinger and Heisenberg picture.

  15. Stroke trends in an aging population. The Technology Assessment Methods Project Team.

    Science.gov (United States)

    Niessen, L W; Barendregt, J J; Bonneux, L; Koudstaal, P J

    1993-07-01

    Trends in stroke incidence and survival determine changes in stroke morbidity and mortality. This study examines the extent of the incidence decline and survival improvement in the Netherlands from 1979 to 1989. In addition, it projects future changes in stroke morbidity during the period 1985 to 2005, when the country's population will be aging. A state-event transition model is used, which combines Dutch population projections and existing data on stroke epidemiology. Based on the clinical course of stroke, the model describes historical national age- and sex-specific hospital admission and mortality rates for stroke. It extrapolates observed trends and projects future changes in stroke morbidity rates. There is evidence of a continuing incidence decline. The most plausible rate of change is an annual decline of -1.9% (range, -1.7% to -2.1%) for men and -2.4% (range, -2.3% to -2.8%) for women. Projecting a constant mortality decline, the model shows a 35% decrease of the stroke incidence rate for a period of 20 years. Prevalence rates for major stroke will decline among the younger age groups but increase among the oldest because of increased survival in the latter. In absolute numbers this results in an 18% decrease of acute stroke episodes and an 11% increase of major stroke cases. The increase in survival cannot fully explain the observed mortality decline and, therefore, a concomitant incidence decline has to be assumed. Aging of the population partially outweighs the effect of an incidence decline on the total burden of stroke. Increase in cardiovascular survival leads to a further increase in major stroke prevalence among the oldest age groups.

  16. Thrombolysis in Postoperative Stroke.

    Science.gov (United States)

    Voelkel, Nicolas; Hubert, Nikolai Dominik; Backhaus, Roland; Haberl, Roman Ludwig; Hubert, Gordian Jan

    2017-11-01

    Intravenous thrombolysis (IVT) is beneficial in reducing disability in selected patients with acute ischemic stroke. There are numerous contraindications to IVT. One is recent surgery. The aim of this study was to analyze the safety of IVT in patients with postoperative stroke. Data of consecutive IVT patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (February 2003 to October 2014; n=4848) were retrospectively searched for keywords indicating preceding surgery. Patients were included if surgery was performed within the last 90 days before stroke. The primary outcome was defined as surgical site hemorrhage. Subgroups with major/minor surgery and recent/nonrecent surgery (within 10 days before IVT) were analyzed separately. One hundred thirty-four patients underwent surgical intervention before IVT. Surgery had been performed recently (days 1-10) in 49 (37%) and nonrecently (days 11-90) in 85 patients (63%). In 86 patients (64%), surgery was classified as major, and in 48 (36%) as minor. Nine patients (7%) developed surgical site hemorrhage after IVT, of whom 4 (3%) were serious, but none was fatal. One fatal bleeding occurred remotely from surgical area. Rate of surgical site hemorrhage was significantly higher in recent than in nonrecent surgery (14.3% versus 2.4%, respectively, odds ratio adjusted 10.73; 95% confidence interval, 1.88-61.27). Difference between patients with major and minor surgeries was less distinct (8.1% and 4.2%, respectively; odds ratio adjusted 4.03; 95% confidence interval, 0.65-25.04). Overall in-hospital mortality was 8.2%. Intracranial hemorrhage occurred in 9.7% and was asymptomatic in all cases. IVT may be administered safely in postoperative patients as off-label use after appropriate risk-benefit assessment. However, bleeding risk in surgical area should be taken into account particularly in patients who have undergone surgery shortly before stroke onset. © 2017 American Heart Association, Inc.

  17. Rehabilitating the Stroke Collection

    Directory of Open Access Journals (Sweden)

    Mary Grimmond

    2006-06-01

    Full Text Available Objective The aim of this project was to complete an analysis of monograph and audiovisual items held in the Central Coast Health Service (CCHS Libraries and containing information relevant to the treatment of acute stroke. Acute stroke is treated by multidisciplinary teams of clinicians based at two hospitals within the CCHS. The adequacy of the library collection was measured by subject coverage and age. Methods The methodology used consisted of three main steps: a literature review; design, administration, and analysis of a questionnaire to members of the CCHS Acute Stroke Team; and an analysis of the libraries’ collections. The research project utilised project management methodology and an evidence based librarianship framework. Results The questionnaire revealed that electronic resources were by far the most frequently used by participants, followed in order by print journals, books, interlibrary loan articles, and audiovisual items. Collection analysis demonstrated that the monograph and audiovisual collections were adequate in both scope and currency to support the information needs of Acute Stroke Team members, with the exception of resources to support patient education. Conclusion The researchers developed recommendations for future collection development in the area of acute stroke resources. Conducting this project within the evidence based librarianship framework helped to develop library staff members’ confidence in their ability to make future collection development decisions, informed by the target group’s information needs and preferences. The collection analysis methodology was designed to be replicated, and new specialist groups within the client base of the library will be targeted to repeat the collection analysis process.

  18. Imaging of Hemorrhagic Stroke.

    Science.gov (United States)

    Hakimi, Ryan; Garg, Ankur

    2016-10-01

    Hemorrhagic stroke comprises approximately 15% to 20% of all strokes. This article provides readers with an understanding of the indications and significance of various neuroimaging techniques available for patients presenting with hemorrhagic strokes of distinct causes. The most common initial neuroimaging study is a noncontrast head CT, which allows for the identification of hemorrhage. Once an intracranial hemorrhage has been identified, the pattern of blood and the patient's medical history, neurologic examination, and laboratory studies lead the practitioner to pursue further neuroimaging studies to guide the medical, surgical, and interventional management. Given that hemorrhagic stroke constitutes a heterogeneous collection of diagnoses, the subsequent neuroimaging pathway necessary to better evaluate and care for these patients is variable based on the etiology.With an increasing incidence and prevalence of atrial fibrillation associated with the aging population and the introduction of three new direct factor Xa inhibitors and one direct thrombin inhibitor to complement vitamin K antagonists, oral anticoagulant use continues to increase. Patients on oral anticoagulants have a sevenfold to tenfold increased risk for intracerebral hemorrhage (ICH). Furthermore, patients who have an ICH associated with oral anticoagulant use have a higher mortality rate than those with primary ICH. Despite the reduced incidence of hypertension-related ICH over the past decade, it is expected that the incidence of ICH will continue to increase. Neuroimaging studies are integral to the identification of hemorrhagic stroke, determination of the underlying etiology, prevention of hematoma expansion, treatment of acute complications, and treatment of the underlying etiology, if indicated. Neuroimaging is essential for prognostication and thus directly impacts patient care.

  19. A Bayesian approach to infer the radial distribution of temperature and anisotropy in the transition zone from seismic data

    Science.gov (United States)

    Drilleau, M.; Beucler, E.; Mocquet, A.; Verhoeven, O.; Moebs, G.; Burgos, G.; Montagner, J.

    2013-12-01

    Mineralogical transformations and matter transfers within the Earth's mantle make the 350-1000 km depth range (considered here as the mantle transition zone) highly heterogeneous and anisotropic. Most of the 3-D global tomographic models are anchored on small perturbations from 1-D models such as PREM, and are secondly interpreted in terms of temperature and composition distributions. However, the degree of heterogeneity in the transition zone can be strong enough so that the concept of a 1-D reference seismic model may be addressed. To avoid the use of any seismic reference model, we developed a Markov chain Monte Carlo algorithm to directly interpret surface wave dispersion curves in terms of temperature and radial anisotropy distributions, considering a given composition of the mantle. These interpretations are based on laboratory measurements of elastic moduli and Birch-Murnaghan equation of state. An originality of the algorithm is its ability to explore both smoothly varying models and first-order discontinuities, using C1-Bézier curves, which interpolate the randomly chosen values for depth, temperature and radial anisotropy. This parameterization is able to generate a self-adapting parameter space exploration while reducing the computing time. Using a Bayesian exploration, the probability distributions on temperature and anisotropy are governed by uncertainties on the data set. The method was successfully applied to both synthetic data and real dispersion curves. Surface wave measurements along the Vanuatu- California path suggest a strong anisotropy above 400 km depth which decreases below, and a monotonous temperature distribution between 350 and 1000 km depth. On the contrary, a negative shear wave anisotropy of about 2 % is found at the top of the transition zone below Eurasia. Considering compositions ranging from piclogite to pyrolite, the overall temperature profile and temperature gradient are higher for the continental path than for the oceanic

  20. An alternative approach to the determination of scaling law expressions for the L–H transition in Tokamaks utilizing classification tools instead of regression

    International Nuclear Information System (INIS)

    Gaudio, P; Gelfusa, M; Lupelli, I; Murari, A; Vega, J

    2014-01-01

    A new approach to determine the power law expressions for the threshold between the H and L mode of confinement is presented. The method is based on two powerful machine learning tools for classification: neural networks and support vector machines. Using as inputs clear examples of the systems on either side of the transition, the machine learning tools learn the input–output mapping corresponding to the equations of the boundary separating the confinement regimes. Systematic tests with synthetic data show that the machine learning tools provide results competitive with traditional statistical regression and more robust against random noise and systematic errors. The developed tools have then been applied to the multi-machine International Tokamak Physics Activity International Global Threshold Database of validated ITER-like Tokamak discharges. The machine learning tools converge on the same scaling law parameters obtained with non-linear regression. On the other hand, the developed tools allow a reduction of 50% of the uncertainty in the extrapolations to ITER. Therefore the proposed approach can effectively complement traditional regression since its application poses much less stringent requirements on the experimental data, to be used to determine the scaling laws, because they do not require examples exactly at the moment of the transition. (paper)

  1. A new approach of chaos and complex network method to study fluctuation and phase transition in nuclear collision at high energy

    Energy Technology Data Exchange (ETDEWEB)

    Bhaduri, Susmita; Bhaduri, Anirban; Ghosh, Dipak [Deepa Ghosh Research Foundation, Kolkata (India)

    2017-06-15

    In the endeavour to study fluctuation and a signature of phase transition in ultrarelativistic nuclear collision during the process of particle production, an approach based on chaos and complex network is proposed. In this work we have attempted an exhaustive study of pion fluctuation in η space, φ space, their cross-correlation and finally two-dimensional fluctuation in terms of scaling of void probability distribution. The analysis is done on the η values and their corresponding φ values extracted from the {sup 32}S-Ag/Br interaction at an incident energy of 200 GeV per nucleon. The methods used are Multifractal Detrended Cross-Correlation Analysis (MF-DXA) and a chaos-based rigorous complex network method -Visibility Graph. The analysis reveals that the highest degree of cross-correlation between pseudorapidity and azimuthal angles exists in the most central region of the interaction. The analysis further shows that two-dimensional void distribution corresponding to the η-φ space reveals a strong scaling behaviour. Both cross-correlation coefficients of MF-DXA and PSVG (Power of the Scale-freeness in Visibility Graph, which is implicitly connected with the Hurst exponent) can be effectively used for the quantitative assessment of pion fluctuation in a very precise manner and have the capability to assess the tendency of approaching criticality for phase transitions. (orig.)

  2. Ischemic Stroke during Pregnancy and Puerperium

    Directory of Open Access Journals (Sweden)

    Elisabetta Del Zotto

    2011-01-01

    Full Text Available Ischemic stroke during pregnancy and puerperium represents a rare occurrence but it could be a serious and stressful event for mothers, infants, and also families. Whenever it does occur, many concerns arise about the safety of the mother and the fetus in relation to common diagnostic tests and therapies leading to a more conservative approach. The physiological adaptations in the cardiovascular system and in the coagulability that accompany the pregnant state, which are more significant around delivery and in the postpartum period, likely contribute to increasing the risk of an ischemic stroke. Most of the causes of an ischemic stroke in the young may also occur in pregnant patients. Despite this, there are specific conditions related to pregnancy which may be considered when assessing this particular group of patients such as pre-eclampsia-eclampsia, choriocarcinoma, peripartum cardiomiopathy, amniotic fluid embolization, and postpartum cerebral angiopathy. This article will consider several questions related to pregnancy-associated ischemic stroke, dwelling on epidemiological and specific etiological aspects, diagnostic issue concerning the use of neuroimaging, and the related potential risks to the embryo and fetus. Therapeutic issues surrounding the use of anticoagulant and antiplatelets agents will be discussed along with the few available reports regarding the use of thrombolytic therapy during pregnancy.

  3. Recovery of motor function after stroke.

    Science.gov (United States)

    Sharma, Nikhil; Cohen, Leonardo G

    2012-04-01

    The human brain possesses a remarkable ability to adapt in response to changing anatomical (e.g., aging) or environmental modifications. This form of neuroplasticity is important at all stages of life but is critical in neurological disorders such as amblyopia and stroke. This review focuses upon our new understanding of possible mechanisms underlying functional deficits evidenced after adult-onset stroke. We review the functional interactions between different brain regions that may contribute to motor disability after stroke and, based on this information, possible interventional approaches to motor stroke disability. New information now points to the involvement of non-primary motor areas and their interaction with the primary motor cortex as areas of interest. The emergence of this new information is likely to impact new efforts to develop more effective neurorehabilitative interventions using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) that may be relevant to other neurological disorders such as amblyopia. Copyright © 2010 Wiley Periodicals, Inc.

  4. Outcome Determinants of Stroke in a Brazilian Primary Stroke Center

    Directory of Open Access Journals (Sweden)

    Gustavo W. Kuster

    2014-01-01

    Full Text Available Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS, transient ischemic attack (TIA, and intracerebral hemorrhage (ICH admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.

  5. Examining Differences in Patterns of Sensory and Motor Recovery After Stroke With Robotics.

    Science.gov (United States)

    Semrau, Jennifer A; Herter, Troy M; Scott, Stephen H; Dukelow, Sean P

    2015-12-01

    Developing a better understanding of the trajectory and timing of stroke recovery is critical for developing patient-centered rehabilitation approaches. Here, we quantified proprioceptive and motor deficits using robotic technology during the first 6 months post stroke to characterize timing and patterns in recovery. We also make comparisons of robotic assessments to traditional clinical measures. One hundred sixteen subjects with unilateral stroke were studied at 4 time points: 1, 6, 12, and 26 weeks post stroke. Subjects performed robotic assessments of proprioceptive (position sense and kinesthesia) and motor function (unilateral reaching task and bimanual object hit task), as well as several clinical measures (Functional Independence Measure, Purdue Pegboard, and Chedoke-McMaster Stroke Assessment). One week post stroke, many subjects displayed proprioceptive (48% position sense and 68% kinesthesia) and motor impairments (80% unilateral reaching and 85% bilateral movement). Interindividual recovery on robotic measures was highly variable. However, we characterized recovery as early (normal by 6 weeks post stroke), late (normal by 26 weeks post stroke), or incomplete (impaired at 26 weeks post stroke). Proprioceptive and motor recovery often followed different timelines. Across all time points, robotic measures were correlated with clinical measures. These results highlight the need for more sensitive, targeted identification of sensory and motor deficits to optimize rehabilitation after stroke. Furthermore, the trajectory of recovery for some individuals with mild to moderate stroke may be much longer than previously considered. © 2015 American Heart Association, Inc.

  6. An audit of the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital.

    Science.gov (United States)

    Khalil, Viviane; Li, Matthew; Hua, Qiantong Amanda

    2015-02-01

    According to the Australian Bureau of Statistics, stroke is the second leading cause of death in Australia. The clinical Guidelines for stroke management published by the National Stroke Foundation provide a series of evidence based recommendations to assist clinicians in the management of stroke patients. Appropriate management of patients admitted to stroke units reduces death and disability by 20 %. Moreover, a multidisciplinary team approach also improves patient outcomes. To retrospectively review the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital, and to compare adherence with the guidelines for stroke management with the national stroke foundation data with and without pharmacist intervention. A retrospective audit of medical records was undertaken of all patients admitted to a large teaching hospital with the diagnosis of stroke or cerebral infarction from January 2013 to May 2013. A total of 124 patients were included in the study. Most patients were discharged on appropriate pharmacological intervention for the prevention of secondary stroke: antihypertensive agents (71 %), lipid lowering agents (67 %) and antithrombotic (85 %) medications. The majority of the cohort was discharged on the appropriate evidence based medications for the management of secondary stroke. Further improvement may be achieved by pharmacist intervening as part of a multidisciplinary team.

  7. First-order dynamical phase transition in models of glasses: an approach based on ensembles of histories

    International Nuclear Information System (INIS)

    Garrahan, Juan P; Jack, Robert L; Lecomte, Vivien; Duijvendijk, Kristina van; Wijland, Frederic van; Pitard, Estelle

    2009-01-01

    We investigate the dynamics of kinetically constrained models of glass formers by analysing the statistics of trajectories of the dynamics, or histories, using large deviation function methods. We show that, in general, these models exhibit a first-order dynamical transition between active and inactive dynamical phases. We argue that the dynamical heterogeneities displayed by these systems are a manifestation of dynamical first-order phase coexistence. In particular, we calculate dynamical large deviation functions, both analytically and numerically, for the Fredrickson-Andersen model, the East model, and constrained lattice gas models. We also show how large deviation functions can be obtained from a Landau-like theory for dynamical fluctuations. We discuss possibilities for similar dynamical phase-coexistence behaviour in other systems with heterogeneous dynamics

  8. Fourier Collocation Approach With Mesh Refinement Method for Simulating Transit-Time Ultrasonic Flowmeters Under Multiphase Flow Conditions.

    Science.gov (United States)

    Simurda, Matej; Duggen, Lars; Basse, Nils T; Lassen, Benny

    2018-02-01

    A numerical model for transit-time ultrasonic flowmeters operating under multiphase flow conditions previously presented by us is extended by mesh refinement and grid point redistribution. The method solves modified first-order stress-velocity equations of elastodynamics with additional terms to account for the effect of the background flow. Spatial derivatives are calculated by a Fourier collocation scheme allowing the use of the fast Fourier transform, while the time integration is realized by the explicit third-order Runge-Kutta finite-difference scheme. The method is compared against analytical solutions and experimental measurements to verify the benefit of using mapped grids. Additionally, a study of clamp-on and in-line ultrasonic flowmeters operating under multiphase flow conditions is carried out.

  9. Order-disorder transitions in time-discrete mean field systems with memory: a novel approach via nonlinear autoregressive models

    International Nuclear Information System (INIS)

    Frank, T D; Mongkolsakulvong, S

    2015-01-01

    In a previous study strongly nonlinear autoregressive (SNAR) models have been introduced as a generalization of the widely-used time-discrete autoregressive models that are known to apply both to Markov and non-Markovian systems. In contrast to conventional autoregressive models, SNAR models depend on process mean values. So far, only linear dependences have been studied. We consider the case in which process mean values can have a nonlinear impact on the processes under consideration. It is shown that such models describe Markov and non-Markovian many-body systems with mean field forces that exhibit a nonlinear impact on single subsystems. We exemplify that such nonlinear dependences can describe order-disorder phase transitions of time-discrete Markovian and non-Markovian many-body systems. The relevant order parameter equations are derived and issues of stability and stationarity are studied. (paper)

  10. Virtual reality for stroke rehabilitation.

    Science.gov (United States)

    Laver, Kate E; Lange, Belinda; George, Stacey; Deutsch, Judith E; Saposnik, Gustavo; Crotty, Maria

    2017-11-20

    Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large

  11. Symptoms and risk factors for stroke in a community-based observational sample in Viet Nam.

    Science.gov (United States)

    Fitzpatrick, Annette L; Ngo, Quang Van; Ly, Kiet A; Ton, Thanh G N; Longstreth, W T; Vo, Tung T; Heitzinger, Kristen; Pham, Chien H; Tirschwell, David L

    2012-09-01

    Viet Nam is experiencing a health transition from infectious to chronic disease. Data on cardiovascular diseases, including strokes, are limited. Data were randomly collected from six communities in Da Nang, Viet Nam, on participant demographics, medical history, blood pressure, anthropometrics and health behavior using World Health Organization (WHO) guidelines. Stroke symptoms were collected by self-report with the standardized Questionnaire for Verifying Stroke Free Status. Multivariate logistic regression was used to identify factors associated with the presence of stroke symptoms. One thousand six hundred and twenty one adults were examined with a mean age of 52.0 years (± 12.5 years), of which 56.1% were women. 27.3% of the participants were found to have hypertension, 26.2% used tobacco, and 16.1% were overweight. More than two-thirds of the participants with hypertension were unaware of their condition. Almost one fourth of the participants were identified by the questionnaire as previously experiencing at least one stroke symptom. Age, rural residence, and education were associated with the presence of stroke symptoms. Models adjusted for demographics found hypertension, high cholesterol, reported severe chest pain, former smoking, and being overweight to be associated with a higher prevalence of stroke symptoms. The high frequency of stroke symptoms in Da Nang calls for further evaluation and interventions to reduce hypertension and other risk factors for chronic disease in Viet Nam and other health transition countries.

  12. A novel approach to determine the thermal transition of gum powder/hydro-gels using dynamic mechanical analysis

    Science.gov (United States)

    Nagamadhu, M.; Jeyaraj, P.; Kumar, G. C. Mohan

    2018-04-01

    The dynamic characterization of materials plays a major role in the present area. The many researchers are worked on solid materials and its characterization, it can be tested using dynamic mechanical analyzer (DMA), however, no such work on powder a semiliquid samples. The powder and liquid samples can also easily characterization as like solid samples using DMA. These powder samples are analyzed with a material pocket method which can be used to accurately determine very low levels of variation in powder properties, due to the high sensitivity of DMA to glass transitions. No such DMA studies on hydrogel and Gum powders. The gum powders are used in various applications start from food industries, pharmacy, natural gums paste, biomedical applications etc. among all this applications gum Ghatti is one of the powders using for varies applications. Around 50 milligrams of Ghatti powders are placed inside material pocket and analyzed storage modulus (G'), loss modulus (G″) and tan delta (δ). Also, understand the curing and glass transition effect using water, glycerin and superplastic from room temperature to 200°C. The result shows that storage modulus decreases with increase in temperature in pure Ghatti powder. The surprising improvement in storage modulus was found with an increase in temperature with addition of water, glycerin, and superplastic. However, loss modulus and tan delta are also having very significant influence and also shows a clear peak of the tan delta. The loss modulus results were found to be improved by adding solidifying agents, along with this water and superplastic better influence. But glycerine found to be hydrogel in nature and thermodynamic properties are much influenced by frequency.

  13. Coronary heart disease patients transitioning to a normal life: perspectives and stages identified through a grounded theory approach.

    Science.gov (United States)

    Najafi Ghezeljeh, Tahereh; Yadavar Nikravesh, Mansoureh; Emami, Azita

    2014-02-01

    To explore how Iranian patients with coronary heart disease experience their lives. Coronary heart disease is a leading cause of death in Iran and worldwide. Understanding qualitatively how patients experience the acute and postacute stages of this chronic condition is essential knowledge for minimising the negative consequences of coronary heart disease. Qualitative study using grounded theory for the data analysis. Data for this study were collected through individual qualitative interviews with 24 patients with coronary heart disease, conducted between January 2009 and January 2011. Patients with angina pectoris were selected for participation through purposive sampling, and sample size was determined by data saturation. Data analysis began with initial coding and continued with focused coding. Categories were determined, and the core category was subsequently developed and finalised. The main categories of the transition from acute phase to a modified or 'new normal' life were: (1) Loss of normal life. Experiencing emotions and consequences of illness; (2) Coming to terms. Using coping strategies; (3) Recreating normal life. Healthcare providers must correctly recognise the stages of transition patients navigate while coping with coronary heart disease to support and educate them appropriately throughout these stages. Patients with coronary heart disease lose their normal lives and must work towards recreating a revised life using coping strategies that enable them to come to terms with their situations. By understanding Iranian patients' experiences, healthcare providers and especially nurses can use the information to support and educate patients with coronary heart disease on how to more effectively deal with their illness and its consequences. © 2013 John Wiley & Sons Ltd.

  14. Interrelations between EOS parameters and cohesive energy of transition metals: Thermostatistical approach, ab initio calculations and analysis of ;universality; features

    Science.gov (United States)

    Bertoldi, Dalía S.; Ramos, Susana B.; Guillermet, Armando Fernández

    2017-08-01

    We present a theoretical analysis of the equation of state (EOS) of metals using a quasi-harmonic Einstein model with a dimensionless cohesive energy versus distance function (F(z)) involving the Wigner-Seitz radius and a material-dependent scaling length, as suggested in classical works by Rose, Ferrante, Smith and collaborators. Using this model, and "universal" values for the function and its first and second derivatives at the equilibrium distance (z=0), three general interrelations between EOS parameters and the cohesive energy are obtained. The first correlation involves the bulk modulus, and the second, the thermal expansion coefficient. In order to test these results an extensive database is developed, which involves available experimental data, and results of current ab initio density-functional-theory calculations using the VASP code. In particular, the 0 K values for volume, bulk modulus, its pressure derivative, and the cohesive energy of 27 elements belonging to the first (Sc, Ti, V, Cr, Fe, Co, Ni, Cu, Zn), second (Y, Zr, Nb, Mo, Tc, Ru, Rh, Pd, Ag, Cd) and third (Hf, Ta, W, Re, Os, Ir, Pt, Au) transition row of the Periodic Table are calculated ab initio and used to test the present results. The third correlation obtained, allows an evaluation of the third derivative of F(z) at z=0 for the current elements. With this new information, a discussion is presented of the possibility of finding a "universal" F(z) versus z function able to account accurately for the pressure derivative of the bulk modulus of the transition elements.

  15. Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation.

    Science.gov (United States)

    Rice, Danielle; Janzen, Shannon; McIntyre, Amanda; Vermeer, Julianne; Britt, Eileen; Teasell, Robert

    2016-05-01

    Few studies have considered the effectiveness of outpatient rehabilitation programs for stroke patients. The objective of this study was to assess the effectiveness of a hospital-based interdisciplinary outpatient stroke rehabilitation program with respect to physical functioning, mobility, and balance. The Comprehensive Outpatient Rehabilitation Program provides a hospital-based interdisciplinary approach to stroke rehabilitation in Southwestern Ontario. Outcome measures from physiotherapy and occupational therapy sessions were available at intake and discharge from the program. A series of paired sample t-tests were performed to assess patient changes between time points for each outcome measure. A total of 271 patients met the inclusion criteria for analysis (56.1% male; mean age = 62.9 ± 13.9 years). Significant improvements were found between admission and discharge for the Functional Independence Measure, grip strength, Chedoke-McMaster Stroke Assessment, two-minute walk test, maximum walk test, Timed Up and Go, Berg Balance Scale, and one-legged stance (P rehabilitation program was effective at improving the physical functioning, mobility, and balance of individuals after a stroke. A hospital-based, stroke-specific rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Stroke occurring in patients with cognitive impairment or dementia

    Directory of Open Access Journals (Sweden)

    Solène Moulin

    Full Text Available ABSTRACT One in six patients admitted for stroke was previously demented. These patients have less access to appropriate stroke care, although little is known about their optimal management. Objective To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods Literature search. Results (i A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others. Conclusion Patients with cognitive impairment who develop a stroke have worse outcomes, but should be treated like others.

  17. Astrocytes, therapeutic targets for neuroprotection and neurorestoration in ischemic stroke

    Science.gov (United States)

    Liu, Zhongwu; Chopp, Michael

    2015-01-01

    Astrocytes are the most abundant cell type within the central nervous system. They play essential roles in maintaining normal brain function, as they are a critical structural and functional part of the tripartite synapses and the neurovascular unit, and communicate with neurons, oligodendrocytes and endothelial cells. After an ischemic stroke, astrocytes perform multiple functions both detrimental and beneficial, for neuronal survival during the acute phase. Aspects of the astrocytic inflammatory response to stroke may aggravate the ischemic lesion, but astrocytes also provide benefit for neuroprotection, by limiting lesion extension via anti-excitotoxicity effects and releasing neurotrophins. Similarly, during the late recovery phase after stroke, the glial scar may obstruct axonal regeneration and subsequently reduce the functional outcome; however, astrocytes also contribute to angiogenesis, neurogenesis, synaptogenesis, and axonal remodeling, and thereby promote neurological recovery. Thus, the pivotal involvement of astrocytes in normal brain function and responses to an ischemic lesion designates them as excellent therapeutic targets to improve functional outcome following stroke. In this review, we will focus on functions of astrocytes and astrocyte-mediated events during stroke and recovery. We will provide an overview of approaches on how to reduce the detrimental effects and amplify the beneficial effects of astrocytes on neuroprotection and on neurorestoration post stroke, which may lead to novel and clinically relevant therapies for stroke. PMID:26455456

  18. Surgical prophylaxis secundary to cryptogenic stroke or transient ischemic attack in patients with patent foramen ovale Profilaxia cirúrgica secundária do acidente vascular cerebral ou ataque isquêmico transitório de origem indeterminada em pacientes com forame oval persistente

    Directory of Open Access Journals (Sweden)

    Michele E.A. Guffi

    2003-09-01

    avoids recurrent stroke.INTRODUÇÃO: A prevenção do acidente vascular cerebral (AVC ou ataque isquêmico transitório (AIT de origem indeterminada recorrente em adultos com forame oval persistente (FOP representa um desafio terapêutico. O tratamento farmacológico antitrombótico é amplamente usado, mas a sua indicação é limitada, devido principalmente às suas importantes complicações. OBJETIVO: Demonstrar a eficácia da atriosseptorrafia como profilaxia secundária do AVC ou AIT de origem indeterminada em pacientes com FOP. MÉTODO: Foram estudados 47 pacientes, sendo 31 homens e 16 mulheres com eventos isquêmicos cerebrais. Todos foram submetidos a fechamento cirúrgico direto do FOP. A idade media foi de 40 anos. Não foi achada causa concomitante do AVC ou AIT após investigações, as quais incluíram testes de coagulação sanguínea, ecocardiografia transesofágica de contraste (ETE, ultra-sonografia doppler transcraniana e extracraniana (UDT, monitorização eletrocardiográfica de 24 horas, ressonância magnética cerebral (RMC e tomografia axial computadorizada (TAC. Os critérios para indicação cirúrgica foram pelo menos dois dos seguintes eventos: aneurisma do septo interatrial, infartos cerebrais múltiplos, eventos cerebrais múltiplos e história de manobra de Valsalva antes do AVC ou AIT. RESULTADOS: Não ocorreram complicações durante ou após as operações. Quatro pacientes apresentaram arritmia transitória algumas horas após a operação, sem fibrilação atrial, nem instabilidade hemodinâmica ou embolismo. Todos os pacientes sobreviveram em classe I (NYHA e durante seguimento médio de 36 meses nenhum paciente apresentou recorrência do AVC ou AIT. Todos os pacientes foram submetidos prospectivamente a RMC e ETE de contraste com simultânea UDT. Apenas um paciente apresentou desvio residual direita-esquerda, menor do que o desvio pré-operatório, porém sem lesões na RMC. CONCLUSÃO: A atriosseptorrafia em pacientes com suspeita

  19. Development and Pilot Testing of 24/7 In-Ambulance Telemedicine for Acute Stroke : Prehospital Stroke Study at the Universitair Ziekenhuis Brussel-Project

    NARCIS (Netherlands)

    Espinoza, Alexis Valenzuela; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Tellez, Helio Fernandez; Dupont, Alain; Putman, Koen; Brouns, Raf

    2016-01-01

    Background: In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study

  20. Clinical Manifestations, Outcomes, and Etiologies of Perinatal Stroke in Taiwan: Comparisons between Ischemic, and Hemorrhagic Stroke Based on 10-year Experience in A Single Institute

    Directory of Open Access Journals (Sweden)

    Chien-Chung Lee

    2017-06-01

    Conclusion: Perinatal stroke is associated with high mortality and morbidity rates in infants. Clinically, it can be difficult to distinguish PAIS and PHS. One should keep a high level of suspicion, especially for PHS, if infants develop unexplained seizure, cyanosis, conscious change, anemia, and/or thrombocytopenia. A systematic diagnostic approach is helpful in identifying the etiologies of perinatal stroke.

  1. Construction of unitary matrices from observable transition probabilities

    International Nuclear Information System (INIS)

    Peres, A.

    1989-01-01

    An ideal measuring apparatus defines an orthonormal basis vertical strokeu m ) in Hilbert space. Another apparatus defines another basis vertical strokeυ μ ). Both apparatuses together allow to measure the transition probabilities P mμ =vertical stroke(u m vertical strokeυ μ )vertical stroke 2 . The problem is: Given all the elements of a doubly stochastic matrix P mμ , find a unitary matrix U mμ such that P mμ =vertical strokeU mμ vertical stroke 2 . The number of unknown nontrivial phases is equal to the number of independent equations to satisfy. The problem can therefore be solved provided that the values of the P mμ satisfy some inequalities. (orig.)

  2. Cochrane review: virtual reality for stroke rehabilitation.

    Science.gov (United States)

    Laver, K; George, S; Thomas, S; Deutsch, J E; Crotty, M

    2012-09-01

    Virtual reality and interactive video gaming are innovative therapy approaches in the field of stroke rehabilitation. The primary objective of this review was to determine the effectiveness of virtual reality on motor function after stroke. The impact on secondary outcomes including activities of daily living was also assessed. Randomised and quasi-randomised controlled trials that compared virtual reality with an alternative or no intervention were included in the review. The authors searched the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, electronic databases, trial registers, reference lists, Dissertation Abstracts, conference proceedings and contacted key researchers and virtual reality manufacturers. Search results were independently examined by two review authors to identify studies meeting the inclusion criteria. Nineteen studies with a total of 565 participants were included in the review. Variation in intervention approaches and outcome data collected limited the extent to which studies could be compared. Virtual reality was found to be significantly more effective than conventional therapy in improving upper limb function (standardised mean difference, SMD) 0.53, 95% confidence intervals [CI] 0.25 to 0.81)) based on seven studies, and activities of daily living (ADL) function (SMD 0.81, 95% CI 0.39 to 1.22) based on three studies. No statistically significant effects were found for grip strength (based on two studies) or gait speed (based on three studies). Virtual reality appears to be a promising approach however, further studies are required to confirm these findings.

  3. Urinary Retention Associated with Stroke.

    Science.gov (United States)

    Umemura, Takeru; Ohta, Hirotsugu; Yokota, Akira; Yarimizu, Shiroh; Nishizawa, Shigeru

    Patients often exhibit urinary retention following a stroke. Various neuropathological and animal studies have implicated the medulla oblongata, pons, limbic system, frontal lobe as areas responsible for micturition control, although the exact area responsible for urinary retention after stroke is not clear. The purpose of this study was to identify the stroke area responsible for urinary retention by localizing the areas where strokes occur. We assessed 110 patients with cerebral infarction and 27 patients with cerebral hemorrhage (78 men, 59 women; mean age, 73.0 years) who had been admitted to our hospital between October, 2012 and September, 2013. We used computed tomography (CT) and magnetic resonance imaging (MRI) to investigate the stroke location, and evaluated whether post-stroke urinary retention occurred. Twelve (8.8%) of the 137 patients (7 men, 5 women; mean age, 78.8 years) exhibited urinary retention after a stroke. Stroke occurred in the right/left dominant hemisphere in 7 patients; nondominant hemisphere in 1; cerebellum in 3; and brainstem in 1. Strokes in the dominant hemisphere were associated with urinary retention (P = 0.0314), particularly in the area of the insula (P < 0.01). We concluded that stroke affecting the insula of the dominant hemisphere tends to cause urinary retention.

  4. Organizational issues in stroke treatment: The Swiss paradigm - Stroke units

    Directory of Open Access Journals (Sweden)

    Georgios K Matis

    2013-01-01

    Full Text Available Stroke represents the leading cause of acquired disability in adults and poses a tremendous socioeconomic burden both on patients and the society. In this sense, prompt diagnosis and urgent treatment are needed in order to radically reduce the devastating consequences of this disease. Herein the authors present the new guidelines recently adopted by the Swiss Stroke Society concerning the establishment of stroke units. Standardized treatment and allocation protocols along with an acute rehabilitation concept seem to be the core of the Swiss stroke management system. Coordinated multidisciplinary care provided by specialized medical, nursing and therapy staff is of utmost importance for achieving a significant dependency and death reduction. It is believed that the implementation of these guidelines in the stroke care system would be beneficial not only for the stroke patients, but also for the health system.

  5. Proceedings: 1996 EPRI conference on innovative approaches to electricity pricing: Managing the transition to market-based pricing

    International Nuclear Information System (INIS)

    1996-03-01

    This report presents the proceedings from the EPRI conference on innovative approaches to electricity pricing. Topics discussed include: power transmission pricing; retail pricing; price risk management; new pricing paradigms; changes from cost-based to a market-based pricing scheme; ancillary services; retail market strategies; profitability; unbundling; and value added services. This is the leading abstract. Papers are processed separately for the databases

  6. Playing Piano Can Improve Upper Extremity Function after Stroke: Case Studies

    OpenAIRE

    Villeneuve, Myriam; Lamontagne, Anouk

    2013-01-01

    Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken a...

  7. Guidelines for acute ischemic stroke treatment: part II: stroke treatment

    Directory of Open Access Journals (Sweden)

    Sheila Cristina Ouriques Martins

    2012-11-01

    Full Text Available The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br.

  8. [Neuroimaging and Blood Biomarkers in Functional Prognosis after Stroke].

    Science.gov (United States)

    Branco, João Paulo; Costa, Joana Santos; Sargento-Freitas, João; Oliveira, Sandra; Mendes, Bruno; Laíns, Jorge; Pinheiro, João

    2016-11-01

    Stroke remains one of the leading causes of morbidity and mortality around the world and it is associated with an important long-term functional disability. Some neuroimaging resources and certain peripheral blood or cerebrospinal fluid proteins can give important information about etiology, therapeutic approach, follow-up and functional prognosis in acute ischemic stroke patients. However, among the scientific community, there is currently more interest in the stroke vital prognosis over the functional prognosis. Predicting the functional prognosis during acute phase would allow more objective rehabilitation programs and better management of the available resources. The aim of this work is to review the potential role of acute phase neuroimaging and blood biomarkers as functional recovery predictors after ischemic stroke. Review of the literature published between 2005 and 2015, in English, using the terms "ischemic stroke", "neuroimaging" e "blood biomarkers". We included nine studies, based on abstract reading. Computerized tomography, transcranial doppler ultrasound and diffuse magnetic resonance imaging show potential predictive value, based on the blood flow study and the evaluation of stroke's volume and localization, especially when combined with the National Institutes of Health Stroke Scale. Several biomarkers have been studied as diagnostic, risk stratification and prognostic tools, namely the S100 calcium binding protein B, C-reactive protein, matrix metalloproteinases and cerebral natriuretic peptide. Although some biomarkers and neuroimaging techniques have potential predictive value, none of the studies were able to support its use, alone or in association, as a clinically useful functionality predictor model. All the evaluated markers were considered insufficient to predict functional prognosis at three months, when applied in the first hours after stroke. Additional studies are necessary to identify reliable predictive markers for functional

  9. Locomotor circumvention strategies are altered by stroke: I. Obstacle clearance.

    Science.gov (United States)

    Darekar, Anuja; Lamontagne, Anouk; Fung, Joyce

    2017-06-15

    Functional locomotion requires the ability to adapt to environmental challenges such as the presence of stationary or moving obstacles. Difficulties in obstacle circumvention often lead to restricted community ambulation in individuals with stroke. The objective of this study was to contrast obstacle circumvention strategies between post-stroke (n = 12) and healthy individuals (n = 12) performing locomotor and perceptuomotor (joystick navigation) tasks with different obstacle approaches. Participants walked and navigated with a joystick towards a central target, in a virtual environment simulating a large room, while avoiding an obstacle that either remained stationary at the pre-determined point of intersection or moved from head-on or diagonally 30° left/right. The outcome measures included dynamic clearance (DC), instantaneous distance from obstacle at crossing (IDC), number of collisions and preferred side of circumvention. These measures were compared between groups (stroke vs. healthy), obstacle parameter (stationary vs. moving head-on) and direction of approach (left/paretic vs. right/non-paretic). DC was significantly larger when circumventing a moving obstacle that approached head-on as compared to a stationary obstacle for both groups during both tasks, while not significantly different in either diagonal approach in either group. IDC was smaller in the stroke group while walking and larger in both groups during joystick navigation when avoiding moving as compared to stationary obstacle. IDC was significantly larger in the stroke group compared to controls for diagonal approaches during walking, wherein two different strategies emerged amongst individuals with stroke: circumventing to the same (V same n = 6) or opposite (V opp n = 4) side of obstacle approach. This behavior was not seen in the perceptuomotor task, wherein post-stroke participants circumvented to opposite side of the obstacle approach as seen in healthy participants. In the

  10. Mode coupling analysis of coherent quasi-elastic neutron scattering from fluorite-type materials approaching the superionic transition

    International Nuclear Information System (INIS)

    Chaturvedi, D.K.; Tosi, M.P.

    1987-08-01

    Neutron scattering experiments on SrCl 2 , CaF 2 and PbF 2 have shown that intensity and width of the coherent diffuse quasi-elastic spectrum increase rapidly with temperature into the fast-ion conducting phase, the main feature in the integrated quasi-elastic intensity being a peak just beyond the (200) point along the (100) direction in scattering wave vector space. The Zwanzig-Mori memory function formalism is used in this work to analyze the quasi-elastic scattering cross section from charge density fluctuations in terms of anharmonic couplings between the vibrational modes of the crystal. The two- and three-mode channels are examined for compatibility with the quasi-elastic neutron scattering evidence, on the basis of (i) energy and momentum conservation and van Hove singularity arguments and (ii) measured phonon dispersion curves along the main symmetry directions in SrCl 2 , CaF 2 , SrF 2 and BaF 2 . The analysis identifies a specific microscopic role for the Raman-active optic branches. The eigenvectors of the relevant Raman-active and partner modes in the three-mode channel describe relative displacements of the two halogens in the unit cell superposed on relative displacements of the halogen and alkaline earth components. This microscopic picture is thus consistent with the superionic transition being associated with the onset of dynamic disorder in the anionic component of the crystal. (author). 13 refs, 2 tabs

  11. The Delicate Balance to Adjustment: A Qualitative Approach of Student’s Transition to the First Year at University

    Directory of Open Access Journals (Sweden)

    Mikaël De Clercq

    2018-04-01

    Full Text Available First year experience in higher education has been extensively investigated in the literature. However, two limitations can be identified in the literature. The majority of studies have focused on single factor analysis, limiting the multifactorial understanding of the determinants of adjustment. Moreover, the temporal and dynamic nature of the first year at university has mainly been disregarded, so limiting the dynamic framing of the adjustment process. To overcome these limitations, the current study used a longitudinal qualitative design in order to grasp the dynamic complexity of the adjustment process. Semi-structured interviews were conducted in two phases with 17 freshmen from the Science department. The aims were to reveal the constructs at play in the students’ adjustment process and the dynamic interplay between them over time. The analyses were grounded in Nicholson’s theoretical framework of the transition cycle and the material was analyzed through thematic and sequential analysis. Four themes ('readiness, reaching personal drives, fighting an overwhelming program, becoming a self-regulated learner' and four different events ('starting up, click, exhaustion, deficiency accumulation' were identified in the material. These revealed the dynamic nature of the adjustment process. An overall reflection on the findings is offered in the conclusion.

  12. First-Principles Momentum Dependent Local Ansatz Approach to the Momentum Distribution Function in Iron-Group Transition Metals

    Science.gov (United States)

    Kakehashi, Yoshiro; Chandra, Sumal

    2017-03-01

    The momentum distribution function (MDF) bands of iron-group transition metals from Sc to Cu have been investigated on the basis of the first-principles momentum dependent local ansatz wavefunction method. It is found that the MDF for d electrons show a strong momentum dependence and a large deviation from the Fermi-Dirac distribution function along high-symmetry lines of the first Brillouin zone, while the sp electrons behave as independent electrons. In particular, the deviation in bcc Fe (fcc Ni) is shown to be enhanced by the narrow eg (t2g) bands with flat dispersion in the vicinity of the Fermi level. Mass enhancement factors (MEF) calculated from the jump on the Fermi surface are also shown to be momentum dependent. Large mass enhancements of Mn and Fe are found to be caused by spin fluctuations due to d electrons, while that for Ni is mainly caused by charge fluctuations. Calculated MEF are consistent with electronic specific heat data as well as recent angle resolved photoemission spectroscopy data.

  13. Hemichorea after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Sadullah Saglam

    2016-03-01

    Full Text Available The deterioration of the balance between direct and indirect ways in the basal ganglia causes chorea. The lesions of contralateral basal ganglia, thalamus or the connection of them all together are responsible for this. Chorea can be observed during the course of metabolic and vascular diseases, neurodegenerative or hereditary diseases. Hyperkinetic movement disorders after acute ischemic stroke are reported as rare; however, hemichorea is the most frequent developing disorder of hyperkinetic movement as a result of cerebrovascular disease. In this case report, we presented two case who applied us with choreiform movements in his left half of the body after acute thalamic stroke. [Cukurova Med J 2016; 41(0.100: 29-32

  14. Action research in rehabilitation with chronic stroke recovery

    DEFF Research Database (Denmark)

    Pedersen, Malene; Bundgaard, Tina H; Zeeman, Peter

    2016-01-01

    BACKGROUND: Chronic stroke patients are primarily referred to general rehabilitation, rather than to specific neurorehabilitation. Currently, there are no Danish clinical guidelines for chronic stroke, but recent research in neuroplasticity has contributed to possible rehabilitation interventions....... CONCLUSIONS: This report indicates that a specific neuroplastic focus in combination with action research has an impact on the participants with chronic stroke. However, there is still no clarity regarding what type of rehabilitation methods can be considered the most efficacious in promoting neuroplasticity...... for these patients. OBJECTIVE: The purpose of this project is to describe the use of a specialized neuroplastic approach in combination with an already existing training program. METHODS: The project is designed as an action research project concerning four participants with chronic stroke. Through ten intervention...

  15. Khat and stroke

    Directory of Open Access Journals (Sweden)

    Sanjay V Kulkarni

    2012-01-01

    Full Text Available Khat chewing, though a tradition followed majorly in African countries, has of late spread widely across the globe due to faster transport systems and advanced preservation techniques. Many complications such as psychosis, arterial hypertension, angina pectoris, and myocardial infarction have been reported in connection to khat abuse. We present a case of a young man who presented with acute onset left-sided weakness. He was a known khat addict for over three decades. A diagnosis of left hemiplegia due to right middle cerebral artery infarction was established. Detailed evaluation revealed no significant underlying cause for stroke. Since the main central nervous system effects of khat are comparable with those of amphetamines and there are established reports of stroke in amphetamine abuse, the former was assumed to be the etiological factor. The patient was discontinued from taking khat and was managed conservatively. The subject showed significant recovery with no further complications or similar episodes during follow-up. To the best of our knowledge, this is the second case of stroke associated with khat. Since the management is essentially conservative, a vigilant history eliciting of khat abuse in prevalent countries would cut down unnecessary healthcare costs.

  16. Initial Results of Bladder Preserving Approach by Chemo-Radiotherapy in Patients with Muscle Invading Transitional Cell Carcinoma

    International Nuclear Information System (INIS)

    Aboziada, M.A.; Hamza, H.; Abdlrahem, A.M.

    2009-01-01

    This study was conducted to test the efficacy and tolerability of trimodality treatment for invasive bladder cancer and to test the possibility of bladder sparing. Methods: This study had been carried out on 50 patients with transitional cell carcinoma (TCC) stage T2- T3 tumors with adequate performance status and renal function. All patients were subjected to maximum transurethral resection of bladder tumors (TURBT). Patients were then subjected to chemo-radiation that was executed in two treatment phases. Phase I was external radiotherapy in the form of 46 Gy /23 fractions /5 weeks to whole pelvis with concurrent cisplatin 40 mg/m 2 weekly. Phase II was 20 Gy /10 fractions /2 weeks to the bladder tumor with concurrent cisplatin 40 mg/m2 weekly. After phase I, patients who had complete response (CR) or partial response (PR) were subjected to phase II and patients who had stationary disease (SD) were subjected to salvage cystectomy. After the end of treatment, patients who had CR were subjected to bladder preservation. Radiological and cystoscopic reevaluation was done to assess the tumor response after phase I and phase II. After completion of the scheduled treatment, patients were under follow up for clinical examination, radiological, and cystoscopic assessment. Results: The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of treatment. Bladder preservation was achieved in 72% of patients. The actuarial relapse free survival and overall survival at a median follow up 18 months for patients who were candidate for bladder preservation were 81% and 100%; respectively. Invasive recurrence (16%) sal-Jvaged with cystectomy and superficial recurrence (6%) successfully treated with Bacilles bilie de Calmette- Guerin. Conclusions: This study indicates that in spite of a relatively small number of patients and short follow-up period; the trimodality treatment could be an

  17. In silico prediction of nematic transition temperature for liquid crystals using quantitative structure-property relationship approaches.

    Science.gov (United States)

    Fatemi, Mohammad Hossein; Ghorbanzad'e, Mehdi

    2009-11-01

    Quantitative structure-property relationship models for the prediction of the nematic transition temperature (T (N)) were developed by using multilinear regression analysis and a feedforward artificial neural network (ANN). A collection of 42 thermotropic liquid crystals was chosen as the data set. The data set was divided into three sets: for training, and an internal and external test set. Training and internal test sets were used for ANN model development, and the external test set was used for evaluation of the predictive power of the model. In order to build the models, a set of six descriptors were selected by the best multilinear regression procedure of the CODESSA program. These descriptors were: atomic charge weighted partial negatively charged surface area, relative negative charged surface area, polarity parameter/square distance, minimum most negative atomic partial charge, molecular volume, and the A component of moment of inertia, which encode geometrical and electronic characteristics of molecules. These descriptors were used as inputs to ANN. The optimized ANN model had 6:6:1 topology. The standard errors in the calculation of T (N) for the training, internal, and external test sets using the ANN model were 1.012, 4.910, and 4.070, respectively. To further evaluate the ANN model, a crossvalidation test was performed, which produced the statistic Q (2) = 0.9796 and standard deviation of 2.67 based on predicted residual sum of square. Also, the diversity test was performed to ensure the model's stability and prove its predictive capability. The obtained results reveal the suitability of ANN for the prediction of T (N) for liquid crystals using molecular structural descriptors.

  18. Post-stroke cognitive impairments

    Directory of Open Access Journals (Sweden)

    Elena Anatolyevna Katunina

    2013-01-01

    Full Text Available Post-stroke cognitive impairments are common effects of stroke. Vascular cognitive impairments are characterized by the heterogeneity of the neuropsychological profile in relation to the site and pattern of stroke. Their common trait is the presence of dysregulation secondary to frontal dysfunction. The treatment of vascular cognitive impairments should be multimodality and aimed at stimulating neuroplasticity processes, restoring neurotransmitter imbalance, and preventing recurrent vascular episodes.

  19. Rethinking Recovery: Incorporating Holistic Nursing Perspectives in Post-Stroke Care

    Science.gov (United States)

    Peterson-Burch, Frances; Reuter-Rice, Karin; Barr, Taura L.

    2016-01-01

    Stroke is a life changing experience. Current treatments focus on treating the condition, rather than the whole person. The goal of this report is to communicate the benefits of a holistic approach to the treatment and recovery of stroke. Our intent is to begin a conversation to transform our approach to stroke care to focus on the whole person, body, mind and spirit. Wellness approaches are fiscally responsible ways of providing holistic care for patients and their family members to help them achieve optimal individualized recovery. Very few multidimensional programs for wellness exist for stroke and brain injury patients. Given the changes in healthcare and the call to action set forth in the Institute of Medicine's 2010 report, it would behoove us to consider holistic approaches to stroke care and research programs. Nurses are uniquely positioned to implement multidisciplinary, innovative holistic approaches to address solutions for issues in stroke care. Wellness is a critically important area of stroke care and an opportunity for research. As both patient advocates and nurses with personal experiences, we hope this commentary stimulates conversation around developing and testing multi-dimensional holistic programs of wellness for stroke prevention, treatment, and recovery. PMID:27902520

  20. An approach to the determination of physical-chemical limits of energy consumption for the transition to a stationary state

    International Nuclear Information System (INIS)

    Zimen, K.E.

    1975-02-01

    The paper gives a model of energy consumption and a programme for its application. Previous models are mainly criticized on the grounds that new technological developments as well as adjustments due to learning processes of homo sapiens are generally not sufficiently accounted for in these models. The approach of this new model is therefore an attempt at the determination of the physical-chemical limiting values for the capacity of the global HST (homo sapiens - Tellus) system or of individual regions with respect to certain critical factors. These limiting values determined by the physical-chemical system of the earth are independent of human ingenuity and flexibility. (orig./AK) [de