Sample records for stroke transition approaches

  1. Autopsy approach to stroke. (United States)

    Love, Seth


    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. Pediatric Stroke: Clinical Findings and Radiological Approach

    Directory of Open Access Journals (Sweden)

    Giuseppe Lanni


    Full Text Available This paper focuses on radiological approach in pediatric stroke including both ischemic stroke (Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis and hemorrhagic stroke. Etiopathology and main clinical findings are examined as well. Magnetic Resonance Imaging could be considered as the first-choice diagnostic exam, offering a complete diagnostic set of information both in the discrimination between ischemic/hemorrhagic stroke and in the identification of underlying causes. In addition, Magnetic Resonance vascular techniques supply further information about cerebral arterial and venous circulation. Computed Tomography, for its limits and radiation exposure, should be used only when Magnetic Resonance is not available and on unstable patients.

  3. A New Model for Secondary Prevention of Stroke: TRAnsition Coaching for Stroke (TRACS

    Directory of Open Access Journals (Sweden)

    Cheryl eBushnell


    Full Text Available Non-adherence to stroke prevention medications is a risk factor for first-ever and recurrent stroke. As of yet, there are no guidelines for processes to recognize and address medication non-adherence in stroke patients. We developed a new model of post-discharge prevention care that measures and addresses medication-taking (TRAnsition Coaching for Stroke or TRACS. TRACS includes personalized education about risk factors and medications prior to discharge, follow-up telephone calls, and appointments with a stroke nurse practitioner (NP. The stroke NP asks about medication use (persistence and whether doses are missed (adherence, and helps to solve problems with access to medications or side effects. In an analysis of 142 patients enrolled in TRACS from October 2012 to February 2014, medication persistence (use of medications from discharge to the time of measurement was about 80%. Medication persistence at NP visit was higher in those patients with a first-ever stroke (78.9 % vs those with recurrent stroke (60.7 %; p=0.045. Concerted efforts with 2-day RN follow-up calls and earlier NP appointments to improve medication-taking behaviors are underway.

  4. Taste and Temperature in Swallowing Transit Time after Stroke

    Directory of Open Access Journals (Sweden)

    Paula C. Cola


    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

  5. Improving stroke transitions: Development and implementation of a social work case management intervention. (United States)

    Hughes, Anne K; Woodward, Amanda T; Fritz, Michele C; Reeves, Mathew J


    Strokes impact over 800,000 people every year. Stroke care typically begins with inpatient care and then continues across an array of healthcare settings. These transitions are difficult for patients and caregivers, with psychosocial needs going unmet. Our team developed a case management intervention for acute stroke patients and their caregivers aimed at improving stroke transitions. The intervention focusses on four aspects of a successful care transition: support, preparedness, identifying and addressing unmet needs, and stroke education. This paper describes the development and implementation of this program, and is an example of the synergy created between neuroscience and clinical practice.

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

    Directory of Open Access Journals (Sweden)

    Sarah Song


    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.

  7. Management of stroke: a clinical approach. (United States)

    Prasad, Kameshwar; Kumar, Amit


    Stroke is defined as repidly developing symptoms or signs of loss of cerebral function with no apparent cause other than vascular origin. The issues to be addressed when making diagnosis of stroke are : (1) is it a stroke? (2) What pathological type of stroke? (3) Where is the lesion? (4) What caused it? Differential diagnosis of stroke is chronic subdural haematoma, brain tumour, hypoglycaemic, metabolic encephalopathies, postictal neurological deficit and functional. CT or MRI is important investigation while dealing with a stroke patient. In treating acute stroke one has to go through the objectives eg, optimising the patient's chance of survival, minimising the risk and degree of disability and preventing recurrence. One has to think of genera care required in management of stroke. Control of blood pressure and blood sugar is important. Specific treatment includes aspirin, t-PA, low molecular weight heparin, calcium antagonists though some reservation persists over efficacy. Psychological support, cognitive impairment, motor and sensory impairment are to be addressed. Functional rehabilitation interventions, log-term management and secondary prevention are to be cared for.

  8. 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


    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...

  9. Diagnostic approach and management strategy of childhood stroke

    International Nuclear Information System (INIS)

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


    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

  10. Transition Studies: Basic Ideas and Analytical Approaches

    NARCIS (Netherlands)

    Grin, J.; Brauch, H.G.; Oswald Spring, Ú.; Grin, J.; Scheffran, J.


    As a background to later contributions, this chapter provides a concise introduction to different approaches to (i) understanding and (ii) shaping transition dynamics: (1) A sociotechnical approach, with the multilevel perspective as its main concept, and strategic niche management as its governance

  11. Acute anti-inflammatory approaches to ischemic stroke


    del Zoppo, Gregory J.


    In preparation for designing and undertaking trials of strategies that can modulate “innate inflammation” to improve outcomes of ischemic injury, consideration of approaches that have managed cellular inflammation in ischemic stroke are instructive. Robust experimental work has demonstrated the efficacy (and apparent safety) of targeting PMN leukocyte–endothelial cell interactions in the early moments following focal ischemia onset in model systems. Four clinical trial programs were undertake...

  12. Acute anti-inflammatory approaches to ischemic stroke (United States)

    del Zoppo, Gregory J.


    In preparation for designing and undertaking trials of strategies that can modulate “innate inflammation” to improve outcomes of ischemic injury, consideration of approaches that have managed cellular inflammation in ischemic stroke are instructive. Robust experimental work has demonstrated the efficacy (and apparent safety) of targeting PMN leukocyte–endothelial cell interactions in the early moments following focal ischemia onset in model systems. Four clinical trial programs were undertaken to assess the safety and efficacy of inhibitors to PMN leukocyte interactions with the endothelial cell during ischemic stroke. Experiences in those clinical trial programs indicate specific limitations that halted progress in this line of investigation before an adequate hypothesis test could be achieved. Although innate inflammation is a central part of injury evolution following focal ischemia, great care in the translation from experimental studies to Phase I/II clinical safety assessments and to the design and conduct of Phase III trials is needed. PMID:20955437

  13. An Institutional Approach to Understanding Energy Transitions (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

  14. Primary stroke prevention in China ? a new approach


    Feigin, Valery L.; Wang, Wenzhi; Fu, Hua; Liu, Liping; Krishnamurthi, Rita; Bhattacharjee, Rohit; Parmar, Priya; Hussein, Tasleem; Barker-Collo, Suzanne


    The growing burden of stroke in China, along with the increasing cost of health care calls for new, more effective strategies for stroke prevention. These strategies should include increasing awareness of stroke symptoms, awareness of risk factors, and provision of easily available information on means of modifying risk factors. The Stroke Riskometer App is exactly such a tool, available in Mandarin, for adult individuals to calculate their risk of stroke over the next 5 and 10?years, and to ...

  15. Lesions Responsible for Delayed Oral Transit Time in Post-stroke Dysphagia. (United States)

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


    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.

  16. Simplified Approach to Predicting Rough Surface Transition (United States)

    Boyle, Robert J.; Stripf, Matthias


    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.

  17. Stroke (United States)

    ... adjust your treatment as needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, ... may have trouble communicating after a stroke. You may not be able to find the ...

  18. 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...

  19. Impact of light rail transit on traffic-related pollution and stroke mortality. (United States)

    Park, Eun Sug; Sener, Ipek Nese


    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.

  20. 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


    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,

  1. Robotic approaches for rehabilitation of hand function after stroke. (United States)

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


    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.

  2. 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


    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.)

  3. Post-stroke cognitive impairments: diagnosis and therapeutic approaches

    Directory of Open Access Journals (Sweden)

    Natalia Vyacheslavovna Pizova


    Full Text Available Stroke is a leading cause of disability not only due to its impact on motor or sensory functions, but also to post-stroke cognitive impairments (CI. Within the first year after stroke, the rate of CI may be as high as 80-90% and 7-23% of patients develop dementia. The most important risk factors for CI are strokes, their extent, site, and number. Old age, low education level, severe previous pathological changes in the brain parenchyma, diabetes mellitus, atrial fibrillations, and recurrent strokes in particular, are associated with an increased risk of CI. Examining cognitive functions, monitoring the evolution of cognitive deficit, and post-stroke rehabilitation are indicated in patients who have had stroke. The main treatments in patients with CI are secondary stroke prevention, including lifestyle modification and symptomatic therapy. Sermion is one of the promising agents for the prevention and treatment of CI in these patients.

  4. The organisational context of nursing care in stroke units: a case study approach. (United States)

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


    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

  5. Center for stroke disparities solutions community- based care transition interventions: study protocol of a randomized controlled trial. (United States)

    Feldman, Penny H; McDonald, Margaret V; Trachtenberg, Melissa A; Schoenthaler, Antoinette; Coyne, Noreen; Teresi, Jeanne


    Racial and ethnic disparities persist in stroke occurrence, recurrence, morbidity and mortality. Uncontrolled hypertension (HTN) is the most important modifiable risk factor for stroke risk. Home health care organizations care for many patients with uncontrolled HTN and history of stroke; however, recurrent stroke prevention has not been a home care priority. We are conducting a randomized controlled trial (RCT) to compare the effectiveness, relative to usual home care (UHC), of two Community Transitions Interventions (CTIs). The CTIs aim to reduce recurrent stroke risk among post-stroke patients via home-based transitional care focused on better HTN management. This 3-arm trial will randomly assign 495 black and Hispanic post-stroke home care patients with uncontrolled systolic blood pressure (SBP) to one of three arms: UHC, UHC complemented by nurse practitioner-delivered transitional care (UHC + NP) or UHC complemented by an NP plus health coach (UHC + NP + HC). Both intervention arms emphasize: 1) linking patients to continuous, responsive preventive and primary care, 2) increasing patients'/caregivers' ability to manage a culturally and individually tailored BP reduction plan, and 3) facilitating the patient's reintegration into the community after home health care discharge. The primary hypothesis is that both NP-only and NP + HC transitional care will be more effective than UHC alone in achieving a SBP reduction. The primary outcome is change in SPB at 3 and 12 months. The study also will examine cost-effectiveness, quality of life and moderators (for example, race/ethnicity) and mediators (for example, changes in health behaviors) that may affect treatment outcomes. All outcome data are collected by staff blinded to group assignment. This study targets care gaps affecting a particularly vulnerable black/Hispanic population characterized by persistent stroke disparities. It focuses on care transitions, a juncture when patients are

  6. Advances in hemorrhagic stroke therapy: conventional and novel approaches. (United States)

    Lapchak, Paul A; Araujo, Dalia M


    escalating morbidity and mortality rate associated with brain bleeding is slow, perseverance and applied translational drug development will eventually be productive. The urgent need for such therapy becomes more evident in light of concerns related to uncontrolled high blood pressure in the general population, increased use of blood thinners by the elderly (e.g., warfarin) and thrombolytics by acute ischemic stroke patients, respectively. The future of drug development for hemorrhage may require a multifaceted approach, such as combining drugs with diverse mechanisms of action. Because of the substantial benefit of factor VIIa in reducing hemorrhage volume, it should be considered as a prime drug candidate included in combination therapy as an off-label use if the FAST trial proves that the risk of thromboembolic events is not increased with drug administration. Other promising drugs that may be considered in combination include uncompetitive NMDA receptor antagonists (such as memantine), antioxidants, metalloprotease inhibitors, statins and erythropoietin analogs, all of which have been shown to reduce hemorrhage and behavioral deficits in one or more animal models.

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

    Directory of Open Access Journals (Sweden)

    Mikołajewska Emilia


    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.

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

    Directory of Open Access Journals (Sweden)

    Kumar Rajamani


    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.

  9. Computational and mathematical approaches to societal transitions

    NARCIS (Netherlands)

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


    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. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions (United States)

    Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh


    Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices. PMID:27610118

  11. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions. (United States)

    Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh


    Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interventional Laboratory Consensus (SILC) criteria using a 7M management approach for the development and standardization of each stroke interventional laboratory within stroke centers. The SILC criteria include: (1) manpower: personnel including roles of medical and administrative directors, attending physicians, fellows, physician extenders, and all the key stakeholders in the stroke chain of survival; (2) machines: resources needed in terms of physical facilities, and angiography equipment; (3) materials: medical device inventory, medications, and angiography supplies; (4) methods: standardized protocols for stroke workflow optimization; (5) metrics (volume): existing credentialing criteria for facilities and stroke interventionalists; (6) metrics (quality): benchmarks for quality assurance; (7) metrics (safety): radiation and procedural safety practices.

  12. New approaches in organometallic and transition metal assemblies

    Indian Academy of Sciences (India)

    Stannoxanes and phosphonates: New approaches in organometallic and transition metal assemblies. VADAPALLI CHANDRASEKHAR*, KANDASAMY GOPAL,. LOGANATHAN NAGARAJAN, PALANI SASIKUMAR and PAKKIRISAMY THILAGAR. Department of Chemistry, Indian Institute of Technology, Kanpur 208 016.

  13. 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


    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

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

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


    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.

  15. Dietary Approaches to Stop Hypertension Diet and Incidence of Stroke: Results From 2 Prospective Cohorts. (United States)

    Larsson, Susanna C; Wallin, Alice; Wolk, Alicja


    High adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower risk of hypertension, the major risk factor for stroke. We examined whether adherence to the DASH diet is inversely associated with the incidence of stroke. The study population comprised 74 404 men and women (45-83 years of age), without stroke at baseline, from the Cohort of Swedish Men and the Swedish Mammography Cohort. Diet was assessed with a food-frequency questionnaire. A modified DASH diet score was created based on consumption of vegetables, fruits, legumes and nuts, whole grains, low-fat dairy, red meat and processed meat, and sweetened beverages. Stroke cases were identified through linkage to the Swedish National Patient and Cause of Death Registers. Relative risks and 95% confidence intervals were estimated using Cox proportional hazards regression model. During 882 727 person-years (mean, 11.9 years) of follow-up, 3896 ischemic strokes, 560 intracerebral hemorrhages, and 176 subarachnoid hemorrhages were ascertained. The modified DASH diet score was statistically significantly inversely associated with the risk of ischemic stroke (P for trend=0.002), with a multivariable relative risk of 0.86 (95% confidence interval, 0.78-0.94) for the highest versus the lowest quartile of the score. The modified DASH diet score was nonsignificantly inversely associated with intracerebral hemorrhage (corresponding relative risk=0.81; 95% confidence interval, 0.63-1.05) but was not associated with subarachnoid hemorrhage. These findings indicate that high adherence to the DASH diet is associated with a reduced risk of ischemic stroke. URL: Unique identifiers: NCT01127698 and NCT01127711 for the Swedish Mammography Cohort and the Cohort of Swedish Men, respectively. © 2016 American Heart Association, Inc.

  16. Proximal to distal approach in the treatment of tandem occlusions causing an acute stroke. (United States)

    Spiotta, Alejandro M; Lena, Jonathan; Vargas, Jan; Hawk, Harris; Turner, Raymond D; Chaudry, M Imran; Turk, Aquilla S


    A tandem occlusion is a rare presentation of acute stroke that involves an occlusion of the internal carotid artery at the bifurcation with an intracranial middle cerebral artery occlusion. This study describes the experience at our institution in treating tandem occlusions with a proximal to distal approach in the acute stroke setting. A retrospective review of acute strokes caused by tandem occlusions requiring thrombectomy were performed. 16 cases were identified with a mean National Institutes of Health Stroke Scale score at presentation of 13.1 ± 3.9. The proximal occlusion was crossed initially with a microwire in all cases. All carotid occlusions were treated with stenting, and intracranial vessel thrombectomy was performed with a variety of devices. Procedure related complications occurred in two (12.5%) patients. Eight patients (50%) achieved a good outcome (modified Rankin Scale score of 0-2). A tandem occlusion of the carotid artery at the bifurcation with a concomitant intracranial occlusion is a relatively rare and complex presentation of acute stroke. We have found that addressing the proximal lesion first and covering it with a stent prior to performing distal thrombectomy appears to be a safe and effective option in the treatment algorithm. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  17. Collective fluctuations in magnetized plasma: Transition probability approach

    International Nuclear Information System (INIS)

    Sosenko, P.P.


    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

  18. Understanding electron magnetic circular dichroism in a transition potential approach (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.


    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.

  19. High mortality among children with sickle cell anemia and overt stroke who discontinue blood transfusion after transition to an adult program. (United States)

    McLaughlin, Joseph F; Ballas, Samir K


    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.

  20. Early versus delayed rehabilitation treatment in hemiplegic patients with ischemic stroke: proprioceptive or cognitive approach? (United States)

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


    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

  1. Efficacy of Occupational Therapy Task-oriented Approach in Upper Extremity Post-stroke Rehabilitation. (United States)

    Almhdawi, Khader A; Mathiowetz, Virgil G; White, Matthew; delMas, Robert C


    There is a need for more effective rehabilitation methods for individuals post-stroke. Occupational Therapy Task-Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more-affected Upper Extremity (UE) of persons post-stroke. A randomized single-blinded cross-over trial recruited 20 participants post-stroke (mean chronicity = 62 months) who demonstrated at least 10° active more-affected shoulder flexion and abduction and elbow flexion-extension. Participants were randomized into immediate (n = 10) and delayed intervention (n = 10) groups. Immediate group had 6 weeks of 3 hr/week TO intervention followed by 6 weeks of no-intervention control. Delayed intervention group underwent the reversed order. Functional measures included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). Impairment measures included UE Active Range of Motion (AROM) and handheld dynamometry strength. Measurements were obtained at baseline, cross over, and end of the study. TO intervention showed statistically higher functional change scores. COPM performance and satisfaction scores were 2.83 and 3.46 units greater respectively (p post-stroke rehabilitation approach inducing clinically meaningful functional improvements. More studies are needed with larger samples and specific stroke chronicity and severity. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

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

    International Nuclear Information System (INIS)

    Yankielowicz, S.


    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

  3. Theoretical approaches to the glass transition in simple liquids

    Indian Academy of Sciences (India)

    - ature. A connection with the glass transition ..... for which the density is the control parameter). The density functional theory .... approach to studies of such spin glass models is provided by the replica formal- ism [75]. It is, therefore, interesting ...

  4. Bridging analytical approaches for low-carbon transitions (United States)

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


    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.


    Directory of Open Access Journals (Sweden)

    Jurgen Broeren


    Full Text Available This report describes the possibilities of information and communication technology (ICT in stroke care, addressing a person-centered care approach. Attention is paid to user involvement, design, videogames, and communication between health care professionals mutually as well as with patients, and how to share performance data with an electronic health record. This is the first step towards a supportive ICT system that facilitates interoperability, making healthcare information and services available to citizen’s across organizational boundaries.

  6. Active music therapy approach for stroke patients in the post-acute rehabilitation. (United States)

    Raglio, Alfredo; Zaliani, Alberto; Baiardi, Paola; Bossi, Daniela; Sguazzin, Cinzia; Capodaglio, Edda; Imbriani, Chiara; Gontero, Giulia; Imbriani, Marcello


    Guidelines in stroke rehabilitation recommend the use of a multidisciplinary approach. Different approaches and techniques with music are used in the stroke rehabilitation to improve motor and cognitive functions but also psychological outcomes. In this randomized controlled pilot trial, relational active music therapy approaches were tested in the post-acute phase of disease. Thirty-eight hospitalized patients with ischemic and hemorrhagic stroke were recruited and allocated in two groups. The experimental group underwent the standard of care (physiotherapy and occupational therapy daily sessions) and relational active music therapy treatments. The control group underwent the standard of care only. Motor functions and psychological aspects were assessed before and after treatments. Music therapy process was also evaluated using a specific rating scale. All groups showed a positive trend in quality of life, functional and disability levels, and gross mobility. The experimental group showed a decrease of anxiety and, in particular, of depression (p = 0.016). In addition, the strength of non-dominant hand (grip) significantly increased in the experimental group (p = 0.041). Music therapy assessment showed a significant improvement over time of non-verbal and sonorous-music relationships. Future studies, including a greater number of patients and follow-up evaluations, are needed to confirm promising results of this study.

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

    International Nuclear Information System (INIS)

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


    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

  8. Severe COPD and the transition to a palliative approach

    Directory of Open Access Journals (Sweden)

    Amanda Landers


    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.

  9. Effect of different combinations of physiotherapy treatment approaches on functional outcomes in stroke patients: A retrospective analysis

    Directory of Open Access Journals (Sweden)

    Bryan Ping Ho Chung, MSc in Health Care


    Full Text Available This retrospective study compared the functional outcomes among stroke patients who had received rehabilitation based on different physiotherapy treatment approaches. The participants were divided into three groups according to the physiotherapist in charge of their treatment. The primary treatment approaches applied in Group A, Group B, and Group C were the functional approach, the Bobath approach, and the motor learning approach, respectively. For each participant, the Berg's Balance Scale score, the Modified Barthel Index, and the Modified Rivermead Mobility Index were compared among these three groups prior to and after the stroke rehabilitation programme. Within-group analysis showed that Group A, Group B, and Group C participants had a statistically significant improvement in their Modified Barthel Index (p  0.05. In summary, this study showed that different combinations of treatment approaches may induce similar improvement in functional outcomes after stroke rehabilitation.

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

    Directory of Open Access Journals (Sweden)

    Preeti Raghavan


    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,, NCT01586221.

  11. Music Upper Limb Therapy-Integrated: An Enriched Collaborative Approach for Stroke Rehabilitation. (United States)

    Raghavan, Preeti; Geller, Daniel; Guerrero, Nina; Aluru, Viswanath; Eimicke, Joseph P; Teresi, Jeanne A; Ogedegbe, Gbenga; Palumbo, Anna; Turry, Alan


    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. National Institutes of Health,, NCT01586221.

  12. Music Upper Limb Therapy—Integrated: An Enriched Collaborative Approach for Stroke Rehabilitation (United States)

    Raghavan, Preeti; Geller, Daniel; Guerrero, Nina; Aluru, Viswanath; Eimicke, Joseph P.; Teresi, Jeanne A.; Ogedegbe, Gbenga; Palumbo, Anna; Turry, Alan


    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,, NCT01586221. PMID:27774059

  13. Tailor-made rehabilitation approach using multiple types of hybrid assistive limb robots for acute stroke patients: A pilot study. (United States)

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


    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.

  14. A Family Systems Nursing Approach for Families Following a Stroke: Family Health Conversations. (United States)

    Östlund, Ulrika; Bäckström, Britt; Saveman, Britt-Inger; Lindh, Viveca; Sundin, Karin


    Stroke in midlife is a life altering, challenging experience for the whole family thereby necessitating a family approach to intervention. The aim of this study was to describe the experiences of 17 family members living in Sweden, including seven adult stroke patients (six males; one female) under the age of 65 who participated in a series of three nurse-led family conversations that were offered in each family's home. These Family Health Conversations (FamHC) were guided by the conceptual lens of Family System Nursing. Individual, semi-structured, evaluative interviews conducted with each participant one month after the FamHC were analyzed by qualitative content analysis. The FamHC were described by family members as a unique conversation that they had not previously experienced in health care contexts. Family members described possibilities for relational sharing and meaningful conversations as well as changes in family functioning that support the suitability of FamHC for family stroke care. © The Author(s) 2016.

  15. A neurocognitive approach for recovering upper extremity movement following subacute stroke: a randomized controlled pilot study. (United States)

    Sallés, Laia; Martín-Casas, Patricia; Gironès, Xavier; Durà, María José; Lafuente, José Vicente; Perfetti, Carlo


    [Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol. [Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis. [Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic). [Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol's feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness.

  16. Remote Ischemic Conditioning: A Novel Non-Invasive Approach to Prevent Post-Stroke Depression

    Directory of Open Access Journals (Sweden)

    Wenbo Zhao


    Full Text Available Post-stroke depression (PSD is a common neuropsychiatric complication of stroke. However, due to the high expense and side effects of pharmacotherapy and the difficult-to-achieve of psychotherapy, the prevention and treatment of PSD are still far from satisfaction. Inflammation hypothesis is now playing an essential role in the pathophysiological mechanism of PSD, and it may be a new preventive and therapeutic target. Remote ischemic conditioning (RIC is a non-invasive and easy-to-use physical strategy, which has been used to protect brain (including ischemic and hemorrhagic stroke, heart and many other organs in clinical trials. The underlying mechanisms of RIC include anti-inflammation, anti-oxidative stress, immune system regulation and other potential pathways. Our hypothesis is that RIC is a novel approach to prevent PSD. The important implications of this hypothesis are that: (1 RIC could be widely used in clinical practice to prevent PSD if our hypothesis were verified; and (2 RIC would be thoroughly explored to test its effects on other neurobehavioral disorders (e.g., cognitive impairment.

  17. Compelled Body-Weight Shift Approach in Rehabilitation of Individuals with Chronic Stroke (United States)

    Aruin, Alexander S.; Rao, Noel; Sharma, Asha; Chaudhuri, Gouri


    Purpose To evaluate the effectiveness of the Compelled Body Weight Shift (CBWS) therapy approach in the rehabilitation of individuals with chronic stroke. CBWS involves a forced shift of body weight towards a person’s affected side by means of a shoe insert that establishes a lift of the non-affected lower extremity. Method Eighteen individuals with chronic, unilateral stroke (mean age 57.7 ± 11.9 years, with a range of 35–75 years, mean time since stroke 6.7±3.9 years with a range of 1.1–14.1 years) who showed asymmetrical stance were randomly divided into two groups: the experimental group received a six-week physical therapy combined with CBWS therapy and the control group received only physical therapy. Both groups underwent a battery of identical tests (Fugl-Meyer assessment, Berg Balance Scale, weight bearing, and gait velocity) before the start of the rehabilitation intervention, following its completion, and three months after the end of therapy. Results After the intervention, weight bearing on the affected side (measured with the Balance Master®) increased in the experimental group to a larger degree compared to the control group (9.7% vs. 6.4%). Similarly, gait velocity increased 10.5% in the experimental group compared to the control group. Improvements in weight bearing and gait velocity were maintained in the experimental group after the three month retention period. Conclusion The study outcome revealed that a six-week intervention involving CBWS therapy could result in a long-lasting improvement of the symmetry of weight bearing and velocity of gait in individuals with chronic stroke. PMID:23192720

  18. Relationship Between Collateral Status, Contrast Transit, and Contrast Density in Acute Ischemic Stroke. (United States)

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Karoline Augenstein


    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.

  20. 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)


    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.

  1. Connecting perspectives on stroke disability: The measurement and the classification approach


    Geyh, Szilvia


    1. Background Stroke is a frequently occurring condition and a common cause of death and disability. Many stroke survivors are facing long-term disability. The consequences of stroke on patients’ functioning are usually complex and heterogeneous. Precise knowledge of patients’ stroke related disability is necessary in health services provision and research. Clinical stroke management, but also epidemiological and clinical research, depend on the careful detection of functioning problems, ...

  2. 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


    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.)

  3. 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)


    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.)

  4. EMG-based pattern recognition approach in post stroke robot-aided rehabilitation: a feasibility study (United States)


    Background Several studies investigating the use of electromyographic (EMG) signals in robot-based stroke neuro-rehabilitation to enhance functional recovery. Here we explored whether a classical EMG-based patterns recognition approach could be employed to predict patients’ intentions while attempting to generate goal-directed movements in the horizontal plane. Methods Nine right-handed healthy subjects and seven right-handed stroke survivors performed reaching movements in the horizontal plane. EMG signals were recorded and used to identify the intended motion direction of the subjects. To this aim, a standard pattern recognition algorithm (i.e., Support Vector Machine, SVM) was used. Different tests were carried out to understand the role of the inter- and intra-subjects’ variability in affecting classifier accuracy. Abnormal muscular spatial patterns generating misclassification were evaluated by means of an assessment index calculated from the results achieved with the PCA, i.e., the so-called Coefficient of Expressiveness (CoE). Results Processing the EMG signals of the healthy subjects, in most of the cases we were able to build a static functional map of the EMG activation patterns for point-to-point reaching movements on the horizontal plane. On the contrary, when processing the EMG signals of the pathological subjects a good classification was not possible. In particular, patients’ aimed movement direction was not predictable with sufficient accuracy either when using the general map extracted from data of normal subjects and when tuning the classifier on the EMG signals recorded from each patient. Conclusions The experimental findings herein reported show that the use of EMG patterns recognition approach might not be practical to decode movement intention in subjects with neurological injury such as stroke. Rather than estimate motion from EMGs, future scenarios should encourage the utilization of these signals to detect and interpret the normal and

  5. Does spasticity interfere with functional recovery after stroke? A novel approach to understand, measure and treat spasticity after acute stroke

    NARCIS (Netherlands)

    Malhotra, S.; Malhotra, Shweta


    The principal aim of this thesis is on identifying if spasticity on the wrist after an acute stroke interferes with functional recovery of the upper limb.This randomized study demonstrated that sNMES treatment along with standardized upper limb therapy improves muscle strength for wrist extension

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

    International Nuclear Information System (INIS)

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


    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.

  7. Early sitting, standing, and walking in conjunction with contemporary Bobath approach for stroke patients with severe motor deficit. (United States)

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


    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 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.

  8. Azithromycin protects mice against ischemic stroke injury by promoting macrophage transition towards M2 phenotype. (United States)

    Amantea, Diana; Certo, Michelangelo; Petrelli, Francesco; Tassorelli, Cristina; Micieli, Giuseppe; Corasaniti, Maria Tiziana; Puccetti, Paolo; Fallarino, Francesca; Bagetta, Giacinto


    To develop novel and effective treatments for ischemic stroke, we investigated the neuroprotective effects of the macrolide antibiotic azithromycin in a mouse model system of transient middle cerebral artery occlusion. Intraperitoneal administration of azithromycin significantly reduced blood-brain barrier damage and cerebral infiltration of myeloid cells, including neutrophils and inflammatory macrophages. These effects resulted in a dose-dependent reduction of cerebral ischemic damage, and in a remarkable amelioration of neurological deficits up to 7 days after the insult. Neuroprotection was associated with increased arginase activity in peritoneal exudate cells, which was followed by the detection of Ym1- and arginase I-immunopositive M2 macrophages in the ischemic area at 24-48 h of reperfusion. Pharmacological inhibition of peritoneal arginase activity counteracted azithromycin-induced neuroprotection, pointing to a major role for drug-induced polarization of migratory macrophages towards a protective, non-inflammatory M2 phenotype. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Comparing a diffusion tensor and non-tensor approach to white matter fiber tractography in chronic stroke. (United States)

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


    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

  10. 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


    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

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

    Directory of Open Access Journals (Sweden)

    Belda-Lois Juan-Manuel


    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.

  12. Bilateral robotic priming before task-oriented approach in subacute stroke rehabilitation: a pilot randomized controlled trial. (United States)

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


    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.

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

    International Nuclear Information System (INIS)

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


    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

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

    Directory of Open Access Journals (Sweden)

    Stefano Mazzoleni


    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.

  15. New approach to detect and classify stroke in skull CT images via analysis of brain tissue densities. (United States)

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


    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

  16. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

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


    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....

  17. Effectiveness of the Combined Approach for Assessing Social Gradients in Stroke Risk Among Married Women in Japan (United States)

    Honjo, Kaori; Iso, Hiroyasu; Iwata, Masahiko; Cable, Noriko; Inoue, Manami; Sawada, Norie; Tsugane, Shoichiro


    Background Analysis of the effects of social gradients on women’s health requires a suitable means of assessing social standing. Methods We compared social gradients in stroke risk among 9317 married Japanese women from the Japan Public Health Center-based Prospective Study over a 16-year period. Social gradient was estimated by 3 methods of indicating social position: education level derived by using the individual approach (woman’s own educational level), the conventional approach (using her partner’s educational level), and the combined approach (combining the woman’s and her partner’s educational levels). Results As compared with the lowest educational group, stroke risk was similar among women in the highest educational group using the individual approach and lower, but not significantly so, with the conventional approach. With the combined approach, however, the age- and area-adjusted hazard ratio (HR) was significantly lower among the highest education group as compared with the lowest group (HR = 0.52, 95% CI: 0.36, 0.76), and the relative index of inequality was significant (RII = 0.48, 95% CI: 0.32, 0.72). Using the combined approach, the results were similar irrespective of employment status. In the combined highest educational group, stroke risk among unemployed women was significantly reduced by 54%, while stroke risk for employed women was significantly reduced by 46%, as compared with the lowest educational group, with RIIs of 0.42 (95% CI: 0.21, 0.85) and 0.49 (0.30, 0.80), respectively. Conclusions The results suggest that a combined approach better reflects social standing among married women in Japan. PMID:22522151

  18. Effectiveness of the combined approach for assessing social gradients in stroke risk among married women in Japan. (United States)

    Honjo, Kaori; Iso, Hiroyasu; Iwata, Masahiko; Cable, Noriko; Inoue, Manami; Sawada, Norie; Tsugane, Shoichiro


    Analysis of the effects of social gradients on women's health requires a suitable means of assessing social standing. We compared social gradients in stroke risk among 9317 married Japanese women from the Japan Public Health Center-based Prospective Study over a 16-year period. Social gradient was estimated by 3 methods of indicating social position: education level derived by using the individual approach (woman's own educational level), the conventional approach (using her partner's educational level), and the combined approach (combining the woman's and her partner's educational levels). As compared with the lowest educational group, stroke risk was similar among women in the highest educational group using the individual approach and lower, but not significantly so, with the conventional approach. With the combined approach, however, the age- and area-adjusted hazard ratio (HR) was significantly lower among the highest education group as compared with the lowest group (HR = 0.52, 95% CI: 0.36, 0.76), and the relative index of inequality was significant (RII = 0.48, 95% CI: 0.32, 0.72). Using the combined approach, the results were similar irrespective of employment status. In the combined highest educational group, stroke risk among unemployed women was significantly reduced by 54%, while stroke risk for employed women was significantly reduced by 46%, as compared with the lowest educational group, with RIIs of 0.42 (95% CI: 0.21, 0.85) and 0.49 (0.30, 0.80), respectively. The results suggest that a combined approach better reflects social standing among married women in Japan.

  19. Superfluid phase transition with activated velocity fluctuations: Renormalization group approach (United States)

    Dančo, Michal; Hnatič, Michal; Komarova, Marina V.; Lučivjanský, Tomáš; Nalimov, Mikhail Yu.


    A quantum field model that incorporates Bose-condensed systems near their phase transition into a superfluid phase and velocity fluctuations is proposed. The stochastic Navier-Stokes equation is used for a generation of the velocity fluctuations. As such this model generalizes model F of critical dynamics. The field-theoretic action is derived using the Martin-Siggia-Rose formalism and path integral approach. The regime of equilibrium fluctuations is analyzed within the perturbative renormalization group method. The double (ɛ ,δ ) -expansion scheme is employed, where ɛ is a deviation from space dimension 4 and δ describes scaling of velocity fluctuations. The renormalization procedure is performed to the leading order. The main corollary gained from the analysis of the thermal equilibrium regime suggests that one-loop calculations of the presented models are not sufficient to make a definite conclusion about the stability of fixed points. We also show that critical exponents are drastically changed as a result of the turbulent background and critical fluctuations are in fact destroyed by the developed turbulence fluctuations. The scaling exponent of effective viscosity is calculated and agrees with expected value 4 /3 .

  20. Superfluid phase transition with activated velocity fluctuations: Renormalization group approach. (United States)

    Dančo, Michal; Hnatič, Michal; Komarova, Marina V; Lučivjanský, Tomáš; Nalimov, Mikhail Yu


    A quantum field model that incorporates Bose-condensed systems near their phase transition into a superfluid phase and velocity fluctuations is proposed. The stochastic Navier-Stokes equation is used for a generation of the velocity fluctuations. As such this model generalizes model F of critical dynamics. The field-theoretic action is derived using the Martin-Siggia-Rose formalism and path integral approach. The regime of equilibrium fluctuations is analyzed within the perturbative renormalization group method. The double (ε,δ)-expansion scheme is employed, where ε is a deviation from space dimension 4 and δ describes scaling of velocity fluctuations. The renormalization procedure is performed to the leading order. The main corollary gained from the analysis of the thermal equilibrium regime suggests that one-loop calculations of the presented models are not sufficient to make a definite conclusion about the stability of fixed points. We also show that critical exponents are drastically changed as a result of the turbulent background and critical fluctuations are in fact destroyed by the developed turbulence fluctuations. The scaling exponent of effective viscosity is calculated and agrees with expected value 4/3.

  1. Bridging analytical approaches for low-carbon transitions


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


    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, stren...

  2. The shuttle walk test: a new approach to functional walking capacity measurements for patients after stroke?

    NARCIS (Netherlands)

    Bloemendaal, M.; Kokkeler, A.M.; Port, I.G. van de


    OBJECTIVE: To determine the construct validity, test-retest reliability, and measurement error of the shuttle walk test (SWT) for patients after stroke. DESIGN: Clinimetric study. SETTING: Three rehabilitation centers in the Netherlands. PARTICIPANTS: A sample of patients after stroke (N=75; mean

  3. Novel nonpharmacologic approaches for stroke prevention in atrial fibrillation: results from clinical trials. (United States)

    Proietti, Riccardo; Joza, Jacqueline; Arensi, Andrea; Levi, Michael; Russo, Vincenzo; Tzikas, Apostolos; Danna, Paolo; Sagone, Antonio; Viecca, Maurizio; Essebag, Vidal


    Atrial fibrillation (AF), the most common cardiac arrhythmia, confers a 5-fold risk of stroke that increases to 17-fold when associated with mitral stenosis. At this time, the most effective long-term solution to protect patients from stroke and thromboembolism is oral anticoagulation, either with vitamin K antagonists (VKAs) or a novel oral anticoagulant (NOAC). Despite the significant benefits they confer, both VKAs and NOACs are underused because of their increased potential for bleeding, and VKAs are underused because of their narrow therapeutic range, need for regular international normalized ratio checks, and interactions with food or medications. In patients with nonvalvular AF, approximately 90% of strokes originate from the left atrial appendage (LAA); in patients with rheumatic mitral valve disease, many patients (60%) have strokes that originate from the left atrium itself. Surgical LAA amputation or closure, although widely used to reduce stroke risk in association with cardiac surgery, is not currently performed as a stand-alone operation for stroke risk reduction because of its invasiveness. Percutaneous LAA closure, as an alternative to anticoagulation, has been increasingly used during the last decade in an effort to reduce stroke risk in nonvalvular AF. Several devices have been introduced during this time, of which one has demonstrated noninferiority compared with warfarin in a randomized controlled trial. This review describes the available technologies for percutaneous LAA closure, as well as a summary of the published trials concerning their safety and efficacy in reducing stroke risk in AF.

  4. An outcomes approach to stroke care: the importance of teamwork and evidence-based nursing care. (United States)

    Middleton, Sandy


    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.

  5. 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.


    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

  6. Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions


    Shams, Tanzila; Zaidat, Osama; Yavagal, Dileep; Xavier, Andrew; Jovin, Tudor; Janardhan, Vallabh


    Brain attack care is rapidly evolving with cutting-edge stroke interventions similar to the growth of heart attack care with cardiac interventions in the last two decades. As the field of stroke intervention is growing exponentially globally, there is clearly an unmet need to standardize stroke interventional laboratories for safe, effective, and timely stroke care. Towards this goal, the Society of Vascular and Interventional Neurology (SVIN) Writing Committee has developed the Stroke Interv...

  7. An assistive control approach for a lower-limb exoskeleton to facilitate recovery of walking following stroke. (United States)

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


    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.

  8. 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


    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.

  9. Contribution of limbs' actions to the four competitive swimming strokes: a nonlinear approach. (United States)

    Bartolomeu, Raul F; Costa, Mário J; Barbosa, Tiago M


    The aim of our study was to assess the effect of the limbs' actions on the nonlinear properties of the four competitive swimming strokes. Forty-nine swimmers performed all-out sprints at front-crawl, backstroke, breaststroke and butterfly, each one at full stroke (FS), only the arms' stroke (AS), and only leg kicking (LK), in a total of 12 bouts, 6 per day. A speedo-meter cable was attached to the swimmer's hip, to collect the speed-time raw data (f = 50Hz). Velocity, speed fluctuation, sample entropy and fractal dimension were derived from the speed-time series. Significant and moderate-strong effects were noted for both stroke and condition in all variables in the study (p ≤ 0.001; 0,560backstroke and front-crawl.

  10. Dependence of synchronization transitions on mean field approach in two-way coupled neural system (United States)

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


    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.

  11. Acute ischemic stroke imaging: a practical approach for diagnosis and triage. (United States)

    Young, Joseph Yeen; Schaefer, Pamela Whitney


    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.

  12. Stroke Treatments (United States)

    ... Month Infographic Stroke Hero F.A.S.T. Quiz Stroke Treatment Stroke used to rank fourth in leading causes of ... type of treatment depends on the type of stroke. Ischemic stroke happens when a clot blocks a ...

  13. Identifying Unique Neighborhood Characteristics to Guide Health Planning for Stroke and Heart Attack: Fuzzy Cluster and Discriminant Analyses Approaches (United States)

    Pedigo, Ashley; Seaver, William; Odoi, Agricola


    Background Socioeconomic, demographic, and geographic factors are known determinants of stroke and myocardial infarction (MI) risk. Clustering of these factors in neighborhoods needs to be taken into consideration during planning, prioritization and implementation of health programs intended to reduce disparities. Given the complex and multidimensional nature of these factors, multivariate methods are needed to identify neighborhood clusters of these determinants so as to better understand the unique neighborhood profiles. This information is critical for evidence-based health planning and service provision. Therefore, this study used a robust multivariate approach to classify neighborhoods and identify their socio-demographic characteristics so as to provide information for evidence-based neighborhood health planning for stroke and MI. Methods and Findings The study was performed in East Tennessee Appalachia, an area with one of the highest stroke and MI risks in USA. Robust principal component analysis was performed on neighborhood (census tract) socioeconomic and demographic characteristics, obtained from the US Census, to reduce the dimensionality and influence of outliers in the data. Fuzzy cluster analysis was used to classify neighborhoods into Peer Neighborhoods (PNs) based on their socioeconomic and demographic characteristics. Nearest neighbor discriminant analysis and decision trees were used to validate PNs and determine the characteristics important for discrimination. Stroke and MI mortality risks were compared across PNs. Four distinct PNs were identified and their unique characteristics and potential health needs described. The highest risk of stroke and MI mortality tended to occur in less affluent PNs located in urban areas, while the suburban most affluent PNs had the lowest risk. Conclusions Implementation of this multivariate strategy provides health planners useful information to better understand and effectively plan for the unique

  14. The European approach to in-transit melanoma lesions

    NARCIS (Netherlands)

    Hoekstra, H. J.

    The biological behavior of melanoma is unpredictable. Three to five per cent of melanoma patients will develop in-transit lesions and the median time to recurrence ranges between 13-16 months. At the time of recurrence the risk of occult nodal metastasis, with clinically negative regional lymph

  15. 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 ...

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

    NARCIS (Netherlands)

    Huttunen, Suvi; Oosterveer, Peter


    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

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

    Directory of Open Access Journals (Sweden)

    Han Jung Kim


    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.

  18. Shared decision-making in stroke: an evolving approach to improved patient care. (United States)

    Armstrong, Melissa J


    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.

  19. The shuttle walk test: a new approach to functional walking capacity measurements for patients after stroke? (United States)

    van Bloemendaal, Maijke; Kokkeler, Astrid M; van de Port, Ingrid G


    To determine the construct validity, test-retest reliability, and measurement error of the shuttle walk test (SWT) for patients after stroke. Clinimetric study. Three rehabilitation centers in the Netherlands. A sample of patients after stroke (N=75; mean age ± SD, 58.8±9.8y) who are capable of walking without physical assistance. Patients were excluded if they had sustained a subarachnoid hemorrhage or a stroke in the cerebellum or brainstem, or had any other conditions that limited their walking capacity more than the current stroke, or had sensory aphasia. Not applicable. Construct validity (6-minute walk test [6MWT]) and test-retest reliability of the SWT were assessed. Measurement error was determined with the standard error of measurement (SEM), limits of agreement, and smallest detectable differences (SDDs). Construct validity was confirmed by high significant correlations (r(p)≥.65, Pwalking distance in favor of the 6MWT. Test-retest reliability was good (intraclass correlation coefficient model 2,1 [ICC(2,1)]=.961 [.936-.977]). SEM was 6.0%, and the SDDs for individual and group were 302.0m (37%) and 38.7m (5%), respectively. The SWT is a valid and reliable measure and therefore a feasible instrument to determine functional walking capacity of patients after stroke, especially in high-speed walkers. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. Global Natural Disaster Risk Hotspots: Transition to a Regional Approach (United States)

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


    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.

  1. The cost effectiveness of an early transition from hospital to nursing home for stroke patients: design of a comparative study. (United States)

    Heijnen, Ron W H; Evers, Silvia M A A; van der Weijden, Trudy D E M; Limburg, Martien; Schols, Jos M G A


    As the incidence of stroke has increased, its impact on society has increased accordingly, while it continues to have a major impact on the individual. New strategies to further improve the quality, efficiency and logistics of stroke services are necessary. Early discharge from hospital to a nursing home with an adequate rehabilitation programme could help to optimise integrated care for stroke patients.The objective is to describe the design of a non-randomised comparative study evaluating early admission to a nursing home, with multidisciplinary assessment, for stroke patients. The study is comprised of an effect evaluation, an economic evaluation and a process evaluation. The design involves a non-randomised comparative trial for two groups. Participants are followed for 6 months from the time of stroke. The intervention consists of a redesigned care pathway for stroke patients. In this care pathway, patients are discharged from hospital to a nursing home within 5 days, in comparison with 12 days in the usual situation. In the nursing home a structured assessment takes place, aimed at planning adequate rehabilitation. People in the control group receive the usual care. The main outcome measures of the effect evaluation are quality of life and daily functioning. In addition, an economic evaluation will be performed from a societal perspective. A process evaluation will be carried out to evaluate the feasibility of the intervention as well as the experiences and opinions of patients and professionals. The results of this study will provide information about the cost effectiveness of the intervention and its effects on clinical outcomes and quality of life. Relevant strengths and weaknesses of the study are addressed in this article. Current Controlled Trails ISRCTN58135104.

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

    International Nuclear Information System (INIS)

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


    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

  3. Progress in AQP Research and New Developments in Therapeutic Approaches to Ischemic and Hemorrhagic Stroke

    Directory of Open Access Journals (Sweden)

    Lauren E. Previch


    Full Text Available Cerebral edema often manifests after the development of cerebrovascular disease, particularly in the case of stroke, both ischemic and hemorrhagic. Without clinical intervention, the influx of water into brain tissues leads to increased intracranial pressure, cerebral herniation, and ultimately death. Strategies to manage the development of edema constitute a major unmet therapeutic need. However, despite its major clinical significance, the mechanisms underlying cerebral water transport and edema formation remain elusive. Aquaporins (AQPs are a class of water channel proteins which have been implicated in the regulation of water homeostasis and cerebral edema formation, and thus represent a promising target for alleviating stroke-induced cerebral edema. This review examines the significance of relevant AQPs in stroke injury and subsequently explores neuroprotective strategies aimed at modulating AQP expression, with a particular focus on AQP4, the most abundant AQP in the central nervous system.

  4. Progress in AQP Research and New Developments in Therapeutic Approaches to Ischemic and Hemorrhagic Stroke (United States)

    Previch, Lauren E.; Ma, Linlin; Wright, Joshua C.; Singh, Sunpreet; Geng, Xiaokun; Ding, Yuchuan


    Cerebral edema often manifests after the development of cerebrovascular disease, particularly in the case of stroke, both ischemic and hemorrhagic. Without clinical intervention, the influx of water into brain tissues leads to increased intracranial pressure, cerebral herniation, and ultimately death. Strategies to manage the development of edema constitute a major unmet therapeutic need. However, despite its major clinical significance, the mechanisms underlying cerebral water transport and edema formation remain elusive. Aquaporins (AQPs) are a class of water channel proteins which have been implicated in the regulation of water homeostasis and cerebral edema formation, and thus represent a promising target for alleviating stroke-induced cerebral edema. This review examines the significance of relevant AQPs in stroke injury and subsequently explores neuroprotective strategies aimed at modulating AQP expression, with a particular focus on AQP4, the most abundant AQP in the central nervous system. PMID:27438832

  5. 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...

  6. The Digital Learning Transition MOOC for Educators: Exploring a Scalable Approach to Professional Development (United States)

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


    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…

  7. Invariant molecular-dynamics approach to structural phase transitions

    International Nuclear Information System (INIS)

    Wentzcovitch, R.M.


    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

  8. Novel nonpharmacologic approaches for stroke prevention in atrial fibrillation: results from clinical trials

    Directory of Open Access Journals (Sweden)

    Proietti R


    Full Text Available Riccardo Proietti,1,2 Jacqueline Joza,1 Andrea Arensi,2 Michael Levi,1 Vincenzo Russo,3 Apostolos Tzikas,4 Paolo Danna,2 Antonio Sagone,2 Maurizio Viecca,2 Vidal Essebag1,5 1McGill University Health Center, Montreal, QC, Canada; 2Cardiology Department, Luigi Sacco Hospital, Milano, Italy; 3Cardiology Department, Second University of Naples, Monaldi Hospital, Naples, Italy; 4Interbalkan European Medical Centre, Thessaloniki, Greece; 5Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada Abstract: Atrial fibrillation (AF, the most common cardiac arrhythmia, confers a 5-fold risk of stroke that increases to 17-fold when associated with mitral stenosis. At this time, the most effective long-term solution to protect patients from stroke and thromboembolism is oral anticoagulation, either with vitamin K antagonists (VKAs or a novel oral anticoagulant (NOAC. Despite the significant benefits they confer, both VKAs and NOACs are underused because of their increased potential for bleeding, and VKAs are underused because of their narrow therapeutic range, need for regular international normalized ratio checks, and interactions with food or medications. In patients with nonvalvular AF, approximately 90% of strokes originate from the left atrial appendage (LAA; in patients with rheumatic mitral valve disease, many patients (60% have strokes that originate from the left atrium itself. Surgical LAA amputation or closure, although widely used to reduce stroke risk in association with cardiac surgery, is not currently performed as a stand-alone operation for stroke risk reduction because of its invasiveness. Percutaneous LAA closure, as an alternative to anticoagulation, has been increasingly used during the last decade in an effort to reduce stroke risk in nonvalvular AF. Several devices have been introduced during this time, of which one has demonstrated noninferiority compared with warfarin in a randomized controlled trial. This review describes the

  9. Transfer of training between distinct motor tasks after stroke: implications for task-specific approaches to upper-extremity neurorehabilitation. (United States)

    Schaefer, Sydney Y; Patterson, Chavelle B; Lang, Catherine E


    Although task-specific training is emerging as a viable approach for recovering motor function after stroke, there is little evidence for whether the effects of such training transfer to other functional motor tasks not directly practiced in therapy. The purpose of the current study was to test whether training on one motor task in individuals with chronic hemiparesis poststroke would transfer to untrained tasks that were either spatiotemporally similar or different. In all, 11 participants with chronic mild to moderate hemiparesis following stroke completed 5 days of supervised massed practice of a feeding task with their affected side. Performance on the feeding task, along with 2 other untrained functional upper-extremity motor tasks (sorting, dressing) was assessed before and after training. Performance of all 3 tasks improved significantly after training exclusively on 1 motor task. The amount of improvement in the untrained tasks was comparable and was not dependent on the degree of similarity to the trained task. Because the number and type of tasks that can be practiced are often limited within standard stroke rehabilitation, results from this study will be useful for designing task-specific training plans to maximize therapy benefits.

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

    Directory of Open Access Journals (Sweden)

    Juliana Conti


    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.

  11. Nystagmus-based approach to vertebrobasilar stroke presenting as vertigo without initial neurologic signs. (United States)

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


    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.

  12. 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


    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

  13. Labor transitions of Spanish workers: a flexicurity approach

    Directory of Open Access Journals (Sweden)

    Ángel Alonso Domínguez


    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.

  14. Multi-finger coordination in healthy subjects and stroke patients: a mathematical modelling approach

    Directory of Open Access Journals (Sweden)

    Ferrarin Maurizio


    Full Text Available Abstract Background Approximately 60% of stroke survivors experience hand dysfunction limiting execution of daily activities. Several methods have been proposed to objectively quantify fingers' joints range of motion (ROM, while few studies exist about multi-finger coordination during hand movements. The present work analysed this aspect, by providing a complete characterization of spatial and temporal aspects of hand movement, through the mathematical modelling of multi-joint finger motion in healthy subjects and stroke patients. Methods Hand opening and closing movements were examined in 12 healthy volunteers and 14 hemiplegic stroke survivors by means of optoelectronic kinematic analysis. The flexion/extension angles of metacarpophalangeal (MCPJ and proximal interphalangeal joints (IPJ of all fingers were computed and mathematically characterized by a four-parameter hyperbolic tangent function. Accuracy of the selected model was analysed by means of coefficient of determination (R2 and root mean square error (RMSE. Test-retest reliability was quantified by intraclass correlation coefficient (ICC and test-retest errors. Comparison between performances of healthy controls and stroke subjects were performed by analysing possible differences in parameters describing angular and temporal aspects of hand kinematics and inter-joint, inter-digit coordination. Results The angular profiles of hand opening and closing were accurately characterized by the selected model, both in healthy controls and in stroke subjects (R2 > 0.973, RMSE 0.75 and remarking errors comparable to those obtained with other methods. Comparison with healthy controls revealed that hemiparetic hand movement was impaired not only in joints ROM but also in the temporal aspects of motion: peak velocities were significantly decreased, inter-digit coordination was reduced of more than 50% and inter-joint coordination patterns were highly disrupted. In particular, the stereotypical

  15. Multi-finger coordination in healthy subjects and stroke patients: a mathematical modelling approach. (United States)

    Carpinella, Ilaria; Jonsdottir, Johanna; Ferrarin, Maurizio


    Approximately 60% of stroke survivors experience hand dysfunction limiting execution of daily activities. Several methods have been proposed to objectively quantify fingers' joints range of motion (ROM), while few studies exist about multi-finger coordination during hand movements. The present work analysed this aspect, by providing a complete characterization of spatial and temporal aspects of hand movement, through the mathematical modelling of multi-joint finger motion in healthy subjects and stroke patients. Hand opening and closing movements were examined in 12 healthy volunteers and 14 hemiplegic stroke survivors by means of optoelectronic kinematic analysis. The flexion/extension angles of metacarpophalangeal (MCPJ) and proximal interphalangeal joints (IPJ) of all fingers were computed and mathematically characterized by a four-parameter hyperbolic tangent function. Accuracy of the selected model was analysed by means of coefficient of determination (R2) and root mean square error (RMSE). Test-retest reliability was quantified by intraclass correlation coefficient (ICC) and test-retest errors. Comparison between performances of healthy controls and stroke subjects were performed by analysing possible differences in parameters describing angular and temporal aspects of hand kinematics and inter-joint, inter-digit coordination. The angular profiles of hand opening and closing were accurately characterized by the selected model, both in healthy controls and in stroke subjects (R2 > 0.973, RMSE 0.75 and remarking errors comparable to those obtained with other methods. Comparison with healthy controls revealed that hemiparetic hand movement was impaired not only in joints ROM but also in the temporal aspects of motion: peak velocities were significantly decreased, inter-digit coordination was reduced of more than 50% and inter-joint coordination patterns were highly disrupted. In particular, the stereotypical proximal-to-distal opening sequence (reversed during

  16. Watsu approach for improving spasticity and ambulatory function in hemiparetic patients with stroke. (United States)

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


    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.

  17. Sonification of Arm Movements in Stroke Rehabilitation – A Novel Approach in Neurologic Music Therapy (United States)

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


    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 Fugl–Meyer assessment after training. They also reported a trend to have improved hand function in the stroke impact scale as compared to the CG. Movement smoothness at day 1, day 5, and the last day of the intervention was compared in MG patients and found to be significantly better after the 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

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

    NARCIS (Netherlands)

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


    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

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

    Directory of Open Access Journals (Sweden)

    Masoud Dehghani Soufi


    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.

  20. Posturography stability score generation for stroke patient using Kinect: Fuzzy based approach. (United States)

    Mazumder, Oishee; Chakravarty, Kingshuk; Chatterjee, Debatri; Sinha, Aniruddha; Das, Abhijit


    Aim of this paper is to formulate a posturography stability score for stroke patients using fuzzy logic. Postural instability is one of the prominent symptoms of stroke, dementia, parkinsons disease, myopathy, etc. and is the major precursor of fall. Conventional scoring techniques used to assess postural stability require manual intervention and are dependent on live interaction with physiotherapist. We propose a novel scoring technique to calculate static stability of a person using posturography features acquired by Kinect sensor, which do not require any manual intervention or expert guidance, is cost effective and hence are ideal for tele rehabilitation purpose. Stability analysis is done during Single Limb Stance (SLS) exercise. Kinect sensor is used to calculate three features, naming SLS duration, vibration index, calculated from mean vibration of twenty joints and sway area of Centre of Mass (CoM). Based on the variation of these features, a fuzzy rule base is generated which calculates a static stability score. One way analysis of variance (Anova) between a group of stroke population and healthy individuals under study validates the reliability of the proposed scorer. Generated fuzzy score are comparable with standard stability scorer like Berg Balance scale and fall risk assessment tool like Johns Hopkins scale. Stability score, besides providing an index of overall stability can also be used as a fall predictability index.

  1. Top 10 research priorities relating to stroke nursing: a rigorous approach to establish a national nurse-led research agenda. (United States)

    Rowat, Anne; Pollock, Alex; St George, Bridget; Cowey, Eileen; Booth, Joanne; Lawrence, Maggie


    To determine the top 10 research priorities specific to stroke nursing. It is important that stroke nurses build their research capability and capacity. This project built on a previous James Lind Alliance prioritization project, which established the shared stroke research priorities of stroke survivors, carers and health professionals. Research priority setting project using James Lind Alliance methods; a survey for interim prioritization and a consensus meeting for final priority setting. Between September - November 2014, stroke nurses were invited to select their top 10 priorities from a previously established list of 226 unique unanswered questions. These data were used to generate a list of shared research priorities (interim priority setting stage). A purposefully selected group of stroke nurses attended a final consensus meeting (April 2015) to determine the top 10 research priorities. During the interim prioritization stage, 97 stroke nurses identified 28 shared priority treatment uncertainties. At the final consensus meeting, 27 stroke nurses reached agreement on the top 10 stroke nursing research priorities. Five of the top 10 questions relate to stroke-specific impairments and five relate to rehabilitation and long-term consequences of stroke. The research agenda for stroke nursing has now been clearly defined, facilitating nurses to undertake research, which is of importance to stroke survivors and carers and central to supporting optimal recovery and quality of life after stroke. © 2016 John Wiley & Sons Ltd.

  2. Cross-Cultural Approaches to Biographical Interviews: Looking at Career Transitions and Lifelong Learning (United States)

    Barabasch, Antje; Merrill, Barbara


    This article focuses on the methodological approaches used in the European Centre for the Development of Vocational Training (Cedefop) research project "Learning for Career and Labour Market Transitions--individual biographies". In particular, it illuminates how biographical approaches were employed to help the in-depth understanding of…

  3. The HAAPI (Home Arm Assistance Progression Initiative) Trial: - A Novel Robotics Delivery Approach in Stroke Rehabilitation (United States)

    Wolf, Steven L.; Sahu, Komal; Bay, R. Curtis; Buchanan, Sharon; Reiss, Aimee; Linder, Susan; Rosenfeldt, Anson; Alberts, Jay


    Background Geographical location, socioeconomic status and logistics surrounding transportation impede access of post-stroke individuals to comprehensive rehabilitative services. Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing for the remote monitoring and adjusting therapy for underserved populations. The Hand Mentor Pro (HMP), was incorporated within a home exercise program (HEP) to improve upper extremity functional capabilities post-stroke. Objective To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months post-stroke and characterized as underserved. Methods In this prospective, single-blinded, multisite, randomized controlled trial, 99 hemiparetic participants with limited access to upper extremity rehabilitation were randomized to the: 1) experimental group which received combined HEP and HMP for 3 hrs/day x 5 days x 8 weeks; or 2) control group which received HEP only at an identical dosage. Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription. The Action Research Arm Test and Wolf Motor Function Test along with the Fugl Meyer Assessment (upper extremity) were primary and secondary outcome measures respectively, undertaken before and after the interventions. Results Both groups demonstrated improvement across all upper extremity outcomes. Conclusions Robotic+HEP and HEP only were both effectively delivered remotely. There was no difference between groups in change in motor function over time, additional research is necessary to determine appropriate dosage of HMP and HEP. PMID:25782693


    Indian Academy of Sciences (India)


  5. A central pattern generator approach to footstep transition for biped navigation

    Directory of Open Access Journals (Sweden)

    Zeyang Xia


    Full Text Available Existing sampling-based footstep planning method for biped navigation used an intermediate static posture for footstep transition. However, when adopting this approach, the robot is sensitive to modeling error and external environments, and also the transition between different gait patterns is unnatural. This article presents a central pattern generator approach to footstep transition for biped navigation. First, this approach decomposes the biped walking motion into five motion types and designs central pattern generator network for all joints of legs accordingly. Then, the central pattern generator parameters are simplified and the relationship between these parameters and footstep transition is formulated. By modifying the central pattern generator parameters, different walking gaits can be obtained. With sensing feedbacks, self-adaption walking on irregular terrains, such as walking on unknown sloped terrains and flat floor with tiny obstacles, is realized. Experiments were conducted both in simulator and on a physical biped robot. Results have shown that the proposed approach is able to generate gesture transition trajectory for biped robot navigation and realize a self-adaption walking for irregular terrains.

  6. Comparison of two approaches to screen for dysphagia among acute ischemic stroke patients: nursing admission screening tool versus National Institutes of Health stroke scale. (United States)

    Bravata, Dawn M; Daggett, Virginia S; Woodward-Hagg, Heather; Damush, Teresa; Plue, Laurie; Russell, Scott; Allen, George; Williams, Linda S; Harezlak, Jaroslaw; Chumbler, Neale R


    This study assessed the positive and negative predictive values and the sensitivity and specificity of a nursing dysphagia screening tool and the National Institutes of Health Stroke Scale (NIHSS) for the identification of dysphagia for veterans hospitalized with ischemic stroke.A secondary objective of this study was to evaluate the speech-language pathology consult rate before and after the nursing admission dysphagia screening tool. This retrospective cohort study evaluated veterans admitted to one Department of Veterans Affairs medical center with ischemic stroke during the 6 months both before and after the implementation of a nursing dysphagia screening tool, which was part of the admission nursing template. Stroke severity was measured with the use of the retrospective NIHSS. Dysphagia diagnosis was based on speech-language pathology evaluations.Dysphagia was present in 38 of 101 patients (38%) with ischemic stroke. The nursing dysphagia screening tool had a positive predictive value of 50% and a negative predictive value of 68%, with a sensitivity of 29% and specificity of 84%. The use of the NIHSS to identify dysphagia risk had a positive predictive value of 60% and a negative predictive value of 84%.The NIHSS had better test characteristics in predicting dysphagia than the nursing dysphagia screening tool. Future research should evaluate the use of the NIHSS as a screening tool for dysphagia.

  7. The Cognitive Neuroplasticity of Reading Recovery following Chronic Stroke: A Representational Similarity Analysis Approach. (United States)

    Fischer-Baum, Simon; Jang, Ava; Kajander, David


    Damage to certain left hemisphere regions leads to reading impairments, at least acutely, though some individuals eventually recover reading. Previous neuroimaging studies have shown a relationship between reading recovery and increases in contralesional and perilesional activation during word reading tasks, relative to controls. Questions remain about how to interpret these changes in activation. Do these changes reflect functional take-over, a reorganization of functions in the damaged brain? Or do they reveal compensatory masquerade or the use of alternative neural pathways to reading that are available in both patients and controls? We address these questions by studying a single individual, CH, who has made a partial recovery of reading familiar words following stroke. We use an fMRI analysis technique, representational similarity analysis (RSA), which allows us to decode cognitive function from distributed patterns of neural activity. Relative to controls, we find that CH shows a shift from visual to orthographic processing in contralesional regions, with a marginally significant result in perilesional regions as well. This pattern supports a contralesional reorganization of orthographic processing following stroke. More generally, these analyses demonstrate how powerful RSA can be for mapping the neural plasticity of language function.

  8. Sequential endovascular thrombectomy approach (SETA) to acute ischemic stroke: preliminary single-centre results and cost analysis. (United States)

    Comai, Alessio; Haglmüller, Thomas; Ferro, Federica; Dall'Ora, Elisa; Currò Dossi, Roberto; Bonatti, Giampietro


    We report the preliminary results of a single-centre experience in the endovascular treatment (ET) of acute ischemic stroke (AIS) with a sequential endovascular thrombectomy approach (SETA), which comprehends a direct aspiration first-pass technique (ADAPT) eventually followed by stent retriever thrombectomy. We prospectively analyzed data from 16 patients with severe to moderate AIS and CT angiography demonstration of large intracranial vessel occlusion treated with SETA between July 2013 and March 2014. We evaluated recanalization rate, clinical outcome after 90 days as well as differential costs of aspiration and stent-assisted thrombectomy. A group of 16 patients met the eligibility criteria to undergo ET with a baseline NIHSS score of 22 (range 12-39). In 15/16 cases, we obtained target vessel recanalization, 11 cases with ADAPT technique alone. Modified rankin score (mRS) at 90 days follow-up was ≤2 in 9/16 patients (56%). ADAPT technique had a lower device-related cost than stent-assisted thrombectomy leading to an overall saving of -2,747.28 . Our preliminary data suggest that a SETA beginning with direct aspiration could be useful to optimize ET of stroke in terms of invasiveness, safety and cost-effectiveness allowing recanalization with low complication rate.

  9. A nearly full-recovery from AVM hemorrhagic stroke 17 years after insult using a new integrated neurodevelopmental approach: A case report. (United States)

    Friedmann, Alberto J


    With the prevalence of stroke increasing in the USA and the world along with increased survival and longevity due to medical advancements, it has become increasingly necessary to look at the chronic phase of stroke recovery. Previous paradigms of stroke treatment have proven ineffective when looking at 10, 15, or 20 years of survival post insult. The patient, being a young man just out of high school, was concerned with his overall morbidity. He was highly concerned with the quality of life he could expect as a stroke survivor with a life expectancy of 60 years or more. C was diagnosed with a hemorrhagic AVM stroke that impacted several regions of the brain, particularly the right occipital and temporal lobes as well as bilateral motor control. C experienced severe hpertonicity of the musculature and significant vertigo. This study investigated a novel approach to chronic-phase stroke rehabilitation using traditional child motor-learning techniques, play, and proprioceptive-building activities in addition to current stroke rehabilitation techniques. During an initial six-month period, followed by a three-year period, the participant used motor-developmental learning activities as well as traditional strength, gait, and balance training. During the initial phase of treatment, clinically-significant improvements were recorded along with self-reported lifestyle enhancements. These gains continued throughout the three-and-a-half year process. C regained the ability to free-walk in small bouts and went from the use of a walker to canes. He regained use of his hands and removed a large partion of his vertigo. Of specific interest was the participant's ability to progress from using a walker to driving, returning to school, and starting a family. This study lays the groundwork for future studies into this type of therapeutic approach as well as highlighting the ability of chronic-phase stroke patients to recover well into the second decade post stroke. After the initial

  10. Modified Approach to Stroke Rehabilitation (MAStR): feasibility study of a method to apply procedural memory concepts to transfer training. (United States)

    Pavol, Marykay A; Bassile, Clare C; Lehman, Jennifer R; Harmon, Emma; Ferreira, Nancy; Shinn, Brittany; St James, Nancy; Callender, Jacqueline; Stein, Joel


    Training and implementation for a multidisciplinary stroke rehabilitation method emphasizing procedural memory. Current practice in stroke rehabilitation relies on explicit memory, often compromised by stroke, failing to capitalize on better-preserved procedural memory skills. Recruitment of procedural memory requires consistency and practice, characteristics difficulty to promote on inpatient rehabilitation units. We designed a method Modified Approach to Stroke Rehabilitation (MAStR) to maximize consistency and practice for transfer training with stroke patients. Phase I, single-group study. MAStR has two innovations: (1) simplification of instructions to only three words, other direction provided non-verbally; (2) having all rehabilitation staff apply the same approach for transfers. Staff training in MAStR included review of written material describing the rationale for MAStR and demonstration of a transfer using MAStR. Enrolled patients completed each transfer with MAStR in addition to standard rehabilitation therapy. The MAStR method was taught to a large, multidisciplinary rehabilitation staff (n = 31). Training and certification required 15 min per staff member. Five stroke patients were enrolled. No transfers with MAStR resulted in injury, no negative feedback was received from staff or patients. Staff reported satisfaction with the brief MAStR training and reported transfers were easier to complete with the MAStR method. Feasibility was demonstrated for an innovative application of procedural memory concepts to stroke rehabilitation. All rehabilitation disciplines were successfully trained. MAStR was well-tolerated and liked by rehabilitation staff and patients. These results support pursuit of a Phase II pilot study.

  11. Passenger flow analysis of Beijing urban rail transit network using fractal approach (United States)

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


    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.

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

    CERN Document Server

    Continentino, Mucio


    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.

  13. Treatment Effects of Ischemic Stroke by Berberine, Baicalin, and Jasminoidin from Huang-Lian-Jie-Du-Decoction (HLJDD Explored by an Integrated Metabolomics Approach

    Directory of Open Access Journals (Sweden)

    Qian Zhang


    Full Text Available Berberine, baicalin, and jasminoidin were major active ingredients of Huang-Lian-Jie-Du-Decoction (HLJDD, a famous prescription of traditional Chinese medicine (TCM, which has been used for the treatment of ischemic stroke. The aim of the present study was to classify their roles in the treatment effects of ischemic stroke. A rat model of middle cerebral artery occlusion (MCAO was constructed to mimic ischemic stroke and treatment effects of berberine, baicalin, and jasminoidin, and HLJDD was assessed by neurologic deficit scoring, infarct volume, histopathology, immunohistochemistry, biochemistry, quantitative real-time polymerase chain reaction (qRT-PCR, and Western blotting. In addition, the 1H NMR metabolomics approach was used to assess the metabolic profiles, which combined with correlation network analysis successfully revealed metabolic disorders in ischemic stroke concerning the treatment of the three principal compounds from HLJDD for the first time. The combined results suggested that berberine, baicalin, and jasminoidin are responsible for the effectiveness of HLJDD on the treatment of ischemic stroke by amelioration of abnormal metabolism and regulation of oxidative stress, neuron autophagy, and inflammatory response. This integrated metabolomics approach showed its potential in understanding the function of complex formulae and clarifying the role of its components in the overall treatment effects.

  14. Preventing stroke (United States)

    ... A.M. Editorial team. Related MedlinePlus Health Topics Hemorrhagic Stroke Ischemic Stroke Stroke Browse the Encyclopedia A.D. ... any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should ...

  15. Stroke Rehabilitation (United States)

    A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lost because of ... them relearn those skills. The effects of a stroke depend on which area of the brain was ...

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

    Directory of Open Access Journals (Sweden)

    Ольга Юрьевна Хецелиус


    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.

  17. 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 ...

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


    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

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

    DEFF Research Database (Denmark)

    Andersen, Jonas Lohmann Elkjær; Landex, Alex


    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...

  20. World Stroke Organization Global Stroke Services Guidelines and Action Plan


    Lindsay, Patrice; Furie, Karen L.; Davis, Stephen M.; Donnan, Geoffrey A.; Norrving, Bo


    Every two seconds, someone across the globe suffers a symptomatic stroke. 'Silent' cerebrovascular disease insidiously contributes to worldwide disability by causing cognitive impairment in the elderly. The risk of cerebrovascular disease is disproportionately higher in low to middle income countries where there may be barriers to stroke care. The last two decades have seen a major transformation in the stroke field with the emergence of evidence-based approaches to stroke prevention,...

  1. 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


    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

  2. 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. (United States)

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


    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.

  3. The effect of Bobath approach on the excitability of the spinal alpha motor neurones in stroke patients with muscle spasticity. (United States)

    Ansari, N N; Naghdi, S


    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.

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

    CERN Document Server

    Caprini, Chiara; Servant, Géraldine


    Gravitational wave production from bubble collisions was calculated in the early nineties 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 formulae 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.

  5. Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme. (United States)

    Bagot, Kathleen L; Cadilhac, Dominique A; Kim, Joosup; Vu, Michelle; Savage, Mark; Bolitho, Les; Howlett, Glenn; Rabl, Justin; Dewey, Helen M; Hand, Peter J; Denisenko, Sonia; Donnan, Geoffrey A; Bladin, Christopher F


    Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017. The aim of this paper is to summarise the factors that facilitated the state-wide transition of the VST programme. A naturalistic case-study was used and data were obtained from programme documents, e.g. minutes of governance committees, including the steering committee, the management committee and six working groups; operational and evaluation documentation, interviews and research field-notes taken by project staff. Thematic analysis was undertaken, with results presented in narrative form to provide a summary of the lived experience of developing and scaling the VST programme. The main success factors were attaining funding from various sources, identifying a clinical need and evidence-based solution, engaging stakeholders and facilitating co-design, including embedding the programme within policy, iterative evaluation including performing financial sustainability modelling, and conducting dissemination activities of the interim results, including promotion of early successes.

  6. Paediatric stroke

    African Journals Online (AJOL)


    Apr 2, 2011 ... Ischemic Stroke Registry yielded an incidence of 3.3 cases per 100 000 children per year, of ... Neonatal stroke. The newborn period confers the highest risk period for childhood ischaemic stroke. Focal patterns of ischaemic brain injury to the perinatal brain are .... family history of young stroke/ thrombosis.

  7. From dictatorship to a reluctant democracy: stroke therapists talking about self-management. (United States)

    Norris, Meriel; Kilbride, Cherry


    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.

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

    Directory of Open Access Journals (Sweden)

    Reinhardt H.


    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.

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

    International Nuclear Information System (INIS)

    Kelly, J.W.


    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


    Directory of Open Access Journals (Sweden)

    Diana GIOACASI


    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.

  11. An evidence-based practice approach to improving nursing care of acute stroke in an Australian Emergency Department. (United States)

    Considine, Julie; McGillivray, Bree


    The aim of this study was to improve the emergency nursing care of acute stroke by enhancing the use of evidence regarding prevention of early complications. Preventing complications in the first 24-48 hours decreases stroke-related mortality. Many patients spend considerable part of the first 24 hours following stroke in the Emergency Department therefore emergency nurses play a key role in patient outcomes following stroke. A pre-test/post-test design was used and the study intervention was a guideline for Emergency Department nursing management of acute stroke. The following outcomes were measured before and after guideline implementation: triage category, waiting time, Emergency Department length of stay, time to specialist assessment, assessment and monitoring of vital signs, temperature and blood glucose and venous-thromboembolism and pressure injury risk assessment and interventions. There was significant improvement in triage decisions (21.4% increase in triage category 2, p = 0.009; 15.6% decrease in triage category 4, p = 0.048). Frequency of assessments of respiratory rate (p = 0.009), heart rate (p = 0.022), blood pressure (p = 0.032) and oxygen saturation (p = 0.001) increased. In terms of risk management, documentation of pressure area interventions increased by 28.8% (p = 0.006), documentation of nil orally status increased by 13.8% (ns), swallow assessment prior to oral intake increased by 41.3% (p = 0.003), speech pathology assessment in Emergency Department increased by 6.1% (ns) and there was 93.5 minute decrease in time to speech pathology assessment for admitted patients (ns). An evidence-based guideline can improve emergency nursing care of acute stroke and optimise patient outcomes following stroke. As the continuum of stroke care begins in the Emergency Department, detailed recommendations for evidence-based emergency nursing care should be included in all multidisciplinary guidelines for the management of acute stroke.

  12. Child-Mediated Stroke Communication: Findings from Hip Hop Stroke (United States)

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


    Background and Purpose Low thrombolysis rates for acute ischemic stroke is linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether “Child-Mediated Stroke Communication” (CMSC) could improve stroke literacy parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke (HHS). Methods Parents of children aged 9 to 12 years from two public schools in Harlem, NYC, were recruited to participate in stroke literacy questionnaires before and after their child’s participation in HHS, a novel CMSC intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week following the intervention. Results Fifth and Sixth grade students (n =182) were enrolled into HHS. 102 parents were approached in person to participate; 75 opted to participate and 71 completed both 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 five cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911), compared to 21 of 71 parents (29.6%) post-intervention (pstroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that schoolchildren aged 9-12 may be effective conduits of critical stroke knowledge to their Parents. PMID:22033995

  13. Phase transition for cutting-plane approach to vertex-cover problem. (United States)

    Dewenter, Timo; Hartmann, Alexander K


    We study the vertex-cover problem, which is a nondeterministic polynomial-time hard optimization problem and a prototypical model exhibiting phase transitions on random graphs, such as Erdős-Rényi (ER) random graphs. These phase transitions coincide with changes of the solution space structure, e.g., for the ER ensemble at connectivity c=e≈2.7183 from replica symmetric to replica-symmetry broken. For the vertex-cover problem, the typical complexity of exact branch-and-bound algorithms, which proceed by exploring the landscape of feasible configurations, also changes close to this phase transition from "easy" to "hard." In this work, we consider an algorithm which has a completely different strategy: The problem is mapped onto a linear programming problem augmented by a cutting-plane approach; hence the algorithm operates in a space outside the space of feasible configurations until the final step, where a solution is found. Here we show that this type of algorithm also exhibits an easy-hard transition around c=e, which strongly indicates that the typical hardness of a problem is fundamental to the problem and not due to a specific representation of the problem.

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

    International Nuclear Information System (INIS)

    Ustinov, E. A.


    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

  15. Transition of care for young adult survivors of childhood and adolescent cancer: rationale and approaches. (United States)

    Freyer, David R


    Young adult survivors of childhood and adolescent cancer are an ever-growing population of patients, many of whom remain at lifelong risk for potentially serious complications of their cancer therapy. Yet research shows that many of these older survivors have deficient health-related knowledge and are not engaging in recommended health promotion and screening practices that could improve their long-term outcomes. The purpose of this review is to address these disparities by discussing how formal transition of care from pediatric to adult-focused survivorship services may help meet the unique medical, developmental, and psychosocial challenges of these young adults. Literature review and discussion. This article summarizes current research documenting the medical needs of young adult survivors, their suboptimal compliance with recommended follow-up, and the rationale, essential functions, current models, and innovative approaches for transition of follow-up care. Systematic health care transition constitutes the standard of care for young adult survivors of childhood cancer. In developing a transitional care program, it is necessary to consider the scope of services to be provided, available resources, and other local exigencies that help determine the optimal model for use. Additional research is needed to improve health services delivery to this population. Effective advocacy is needed, particularly in the United States, to ensure the availability of uninterrupted health insurance coverage for survivorship services in young adulthood.

  16. Child-Mediated Stroke Communication: findings from Hip Hop Stroke. (United States)

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


    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.

  17. Immune interventions in stroke (United States)

    Fu, Ying; Liu, Qiang; Anrather, Josef


    Inflammatory and immune responses in the brain can shape the clinical presentation and outcome of stroke. Approaches for effective management of acute stroke are sparse and many measures for brain protection fail, but our ability to modulate the immune system and modify the disease progression of multiple sclerosis is increasing. As a result, immune interventions are currently being explored as therapeutic interventions in acute stroke. In this Review, we compare the immunological features of acute stroke with those of multiple sclerosis, identify unique immunological features of stroke, and consider the evidence for immune interventions. In acute stroke, microglia activation and cell death products trigger an inflammatory cascade that damages vessels and the parenchyma within minutes to hours of the ischaemia or haemorrhage. Immune interventions that restrict brain inflammation, vascular permeability and tissue oedema must be administered rapidly to reduce acute immune-mediated destruction and to avoid subsequent immunosuppression. Preliminary results suggest that the use of drugs that modify disease in multiple sclerosis might accomplish these goals in ischaemic and haemorrhagic stroke. Further elucidation of the immune mechanisms involved in stroke is likely to lead to successful immune interventions. PMID:26303850

  18. 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


    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......-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...

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

    International Nuclear Information System (INIS)

    Ruedinger, Andreas


    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

  20. Ischemic Stroke (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 ...

  1. Stroke - slideshow (United States)

    ... this page: // Stroke - series—Part 1 To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Ischemic Stroke A.D.A.M., Inc. is accredited by ...

  2. Nostalgia, Transition and the School: An Innovative Approach of Using Photographic Images as a Visual Method in Educational Research (United States)

    Shohel, M. Mahruf C.


    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…

  3. Clinical neurogenetics: stroke. (United States)

    Rost, Natalia S


    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.

  4. Towards a comprehensive approach for managing transitions of older workers with hearing loss. (United States)

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


    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.

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

    Spooner, Peter G.; Allcock, Kimberly G.


    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.

  6. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia


    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.

  7. 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)


    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.

  8. A Targeted Self-Management Approach for Reducing Stroke Risk Factors in African American Men Who Have Had a Stroke or Transient Ischemic Attack. (United States)

    Sajatovic, Martha; Tatsuoka, Curtis; Welter, Elisabeth; Colon-Zimmermann, Kari; Blixen, Carol; Perzynski, Adam T; Amato, Shelly; Cage, Jamie; Sams, Johnny; Moore, Shirley M; Pundik, Svetlana; Sundararajan, Sophia; Modlin, Charles; Sila, Cathy


    This study compared a novel self-management (TargetEd MAnageMent Intervention [TEAM]) versus treatment as usual (TAU) to reduce stroke risk in African American (AA) men. Six-month prospective randomized controlled trial with outcomes evaluated at baseline, 3 months, and 6 months. Academic health center. Thirty-eight (age 60 were randomly assigned to TEAM (n = 19) or TAU (n = 19). Self-management training, delivered in 1 individual and 4 group sessions (over 3 months). Blood pressure, glycosylated hemoglobin (HbA 1c ), lipids, medication adherence, weight, and standardized measures of health behaviors (diet, exercise, smoking, substances), depression, and quality of life. Qualitative assessments evaluated the perspectives of TEAM participants. T tests for paired differences and nonparametric tests. Thematic content qualitative analysis. Mean age was 52.1 (standard deviation [SD] = 7.4) and mean body mass index was 31.4 (SD = 7.4). Compared to TAU, TEAM participants had significantly lower mean systolic blood pressure by 24 weeks, and there was also improvement in HbA 1c and high-density lipoprotein cholesterol ( P = .03). Other biomarker and health behaviors were similar between groups. Qualitative results suggested improved awareness of risk factors as well as positive effects of group support.

  9. Clinical events after transitioning from apixaban versus warfarin to warfarin at the end of the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. (United States)

    Granger, Christopher B; Lopes, Renato D; Hanna, Michael; Ansell, Jack; Hylek, Elaine M; Alexander, John H; Thomas, Laine; Wang, Junyuan; Bahit, M Cecilia; Verheugt, Freek; Lawrence, Jack; Xavier, Denis; Wallentin, Lars


    We sought to assess the occurrence of events after blinded study drug discontinuation and transition to open-label vitamin K antagonist (VKA) in ARISTOTLE. At the end of ARISTOTLE, blinded study drug was stopped, and open-label VKA was recommended. For patients completing the trial on blinded study drug, a 2-day bridging period with apixaban or apixaban placebo was recommended (while beginning open-label VKA). Outcomes were assessed during the 30 days after stopping blinded study drug. Of the 6,809 patients in the apixaban group and 6,588 in the warfarin group who completed the trial on study drug, there were 21 strokes or systemic emboli (4.02%/year) and 26 major bleeding (4.97%/year) events in the apixaban group (transitioning to VKA) and 5 strokes or systemic emboli (0.99%/year) and 10 major bleeding (1.97%/year) events in the warfarin group (continuing on VKA), with most of the imbalance between groups being after the first week. Similar results were seen in the first 30 days of the trial where warfarin-naive patients starting warfarin had a higher rate of stroke or systemic emboli (5.41%/year) than warfarin-experienced patients (1.42%/year), a pattern not seen when starting apixaban. No similar increase in events with apixaban versus warfarin was seen during temporary or permanent study drug discontinuation during the trial. The excess in thrombotic and bleeding events in the apixaban group after study drug discontinuation appears to be related to an increased risk associated with the initiation of a VKA rather than a direct effect of apixaban. Whether ≥2 days of apixaban bridging improves outcomes during VKA transition is unknown and deserves further evaluation. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Surface science approach to heterogeneous catalysis: CO hydrogenation on transition metals (United States)

    Bonzel, H. P.; Krebs, H. J.


    Modern surface sensitive electron spectroscopies and other surface analytical techniques have in recent years been extensively applied to the study of H 2 and CO adorption on transition metals. This work has now been extended to include the heterogeneous reaction between adsorbed H 2 and CO on these metals. The combination of surface analysis (carried out under ultra-high vacuum conditions) and reaction rate measurements in the range of 100 mbar to 1 bar total pressure is being practiced. This approach yields information on changes of the surface composition of the catalyst as well as data on reaction kinetics and the possible time dependence of the reaction rate. Low surface area samples — either single or polycrystalline - are used for these studies. In the present paper the results obtained by this approach will be reviewed and discussed in the light of the adsorption data. Recent advances in the direction of studying either poisoned or promoted catalytic surfaces will also be mentioned.

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

    DEFF Research Database (Denmark)

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


    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...... sample of Slovenian manufacturing companies. Maximum likelihood probit estimation, exploratory factor analysis, cluster analysis and binary 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 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...

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

    Directory of Open Access Journals (Sweden)

    Domen Bajde


    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.

  13. How is the patient’s nutrition after a stroke? (United States)

    Ballesteros Pomar, María D; Palazuelo Amez, Laura


    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.

  14. Eulearian approach to bounce-transit and drift resonance with magnetic drifts in tokamaks (United States)

    Shaing, Ker Chung; Seol, J.; Chu, M. S.; Sabbagh, S. A.


    Bounce-transit and drift resonance can be important to plasma confinement in tokamaks with broken symmetry, and can have implications on the wave-particle resonance. Usually, the resonance is either treated by integrating along the unperturbed orbits or calculated using an action-angle approach. An Eulerian approach has been developed so that momentum conservation property of the Coulomb collision operator can be taken into account. The parallel flows appear in the thermodynamic forces in the Eulerian approach. However, in the existing theory, only E × B drift is kept; the magnetic drifts are neglected by adopting the large aspect ratio assumption. Here, E is the electric field, and B is the magnetic field. The importance of the magnetic drifts in finite aspect ratio tokamaks is demonstrated in. Here, the Eulerian approach is extended to include the magnetic drifts to calculate neoclassical toroidal plasma viscosity in finite aspect ratio tokamaks. The relation to the nonlinear plasma viscosity in the plateau regime will also be discussed. This work was supported by Taiwan Ministry of Science and Technology under Grant No. 100-2112-M-006-004-MY3, and Republic of Korea MSIP (Ministry of Science, ICT and Future Planning) under KSTAR program.

  15. TTC7B emerges as a novel risk factor for ischemic stroke through the convergence of several genome-wide approaches. (United States)

    Krug, Tiago; Gabriel, João Paulo; Taipa, Ricardo; Fonseca, Benedita V; Domingues-Montanari, Sophie; Fernandez-Cadenas, Israel; Manso, Helena; Gouveia, Liliana O; Sobral, João; Albergaria, Isabel; Gaspar, Gisela; Jiménez-Conde, Jordi; Rabionet, Raquel; Ferro, José M; Montaner, Joan; Vicente, Astrid M; Silva, Mário Rui; Matos, Ilda; Lopes, Gabriela; Oliveira, Sofia A


    We hereby propose a novel approach to the identification of ischemic stroke (IS) susceptibility genes that involves converging data from several unbiased genetic and genomic tools. We tested the association between IS and genes differentially expressed between cases and controls, then determined which data mapped to previously reported linkage peaks and were nominally associated with stroke in published genome-wide association studies. We first performed gene expression profiling in peripheral blood mononuclear cells of 20 IS cases and 20 controls. Sixteen differentially expressed genes mapped to reported whole-genome linkage peaks, including the TTC7B gene, which has been associated with major cardiovascular disease. At the TTC7B locus, 46 tagging polymorphisms were tested for association in 565 Portuguese IS cases and 520 controls. Markers nominally associated in at least one test and defining associated haplotypes were then examined in 570 IS Spanish cases and 390 controls. Several polymorphisms and haplotypes in the intron 5-intron 6 region of TTC7B were also associated with IS risk in the Spanish and combined data sets. Multiple independent lines of evidence therefore support the role of TTC7B in stroke susceptibility, but further work is warranted to identify the exact risk variant and its pathogenic potential.

  16. Ultrasonographic Evaluation of Botulinum Toxin Injection Site for the Medial Approach to Tibialis Posterior Muscle in Chronic Stroke Patients with Spastic Equinovarus Foot: An Observational Study

    Directory of Open Access Journals (Sweden)

    Alessandro Picelli


    Full Text Available The tibialis posterior muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the tibialis posterior muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the tibialis posterior muscle in chronic stroke patients with spastic equinovarus foot. Forty-six patients were evaluated at the affected middle lower leg medial surface with ultrasonography according to the following parameters: tibialis posterior muscle depth, thickness, and echo intensity. As to the spastic tibialis posterior, we found a mean muscle depth of 26.5 mm and a mean muscle thickness of 10.1 mm. Furthermore we observed a median tibialis posterior muscle echo intensity of 3.00 on the Heckmatt scale. The tibialis posterior muscle thickness was found to be inversely associated with its depth (p < 0.001 and echo intensity (p = 0.006. Furthermore, tibialis posterior muscle depth was found to be directly associated with its echo intensity (p = 0.004. Our findings may usefully inform manual needle placement into the tibialis posterior for the botulinum toxin treatment of spastic equinovarus foot in chronic stroke patients.

  17. Stroke treatment outcomes in hospitals with and without Stroke Units. (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


    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.

  18. A rehabilitation device to improve the hand grasp function of stroke patients using a patient-driven approach. (United States)

    Park, Wanjoo; Jeong, Wookjin; Kwon, Gyu-Hyun; Kim, Yun-Hee; Kim, Laehyun


    This paper proposes a robotic hand rehabilitation device for grasp training. The device is designed for stroke patients to train and recover their hand grasp function in order to undertake activities of daily living (ADL). The device consists of a control unit, two small actuators, an infrared (IR) sensor, and pressure sensors in the grasp handle. The advantages of this device are that it is small in size, inexpensive, and available for use at home without specialist's supervision. In addition, a novel patient-driven strategy based on the patient's movement intention detected by the pressure sensors without bio-signals is introduced. Once the system detects a patient's movement intention, it triggers the robotic device to move the patient's hand to form the normal grasping behavior. This strategy may encourage stroke patients to participate in rehabilitation training to recover their hand grasp function and it may also enhance neural plasticity. A user study was conducted in order to investigate the usability, acceptability, satisfaction, and suggestions for improvement of the proposed device. The results of this survey included positive reviews from therapists and a stroke patient. In particular, therapists expected that the proposed patient-driven mode can motivate patients for their rehabilitation training and it can be effective to prevent a compensational strategy in active movements. It is expected that the proposed device will assist stroke patients in restoring their grasp function efficiently.

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

    Tripp, Florian; Krakow, Karsten


    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 Halliwick-Therapy group (mean (SD) 1.25(0.86)) than in the control group (mean (SD) 0.73 (0.70)) (P Halliwick-Therapy is safe and well tolerated in stroke patients in post-acute rehabilitation and has positive effects upon some aspects of mobility.

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

    Smith, R Scott; Kay, Bruce D


    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. Phase transition approach to bursting in neuronal cultures: quorum percolation models (United States)

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


    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.

  2. Fight like a ferret: a novel approach of using art therapy to reduce anxiety in stroke patients undergoing hospital rehabilitation. (United States)

    Ali, Khalid; Gammidge, Tony; Waller, Diane


    The holistic aspect of stroke rehabilitation to include psychological well-being is currently neglected, with more emphasis placed on physical recovery despite anxiety and depression being common poststroke. From the limited amount of current literature, it seems that creative strategies such as art therapy (AT) can be beneficial in reducing isolation and anxiety among stroke patients. Stroke patients (able to consent) in a hospital rehabilitation unit were invited to participate in two weekly AT sessions for 6 weeks, facilitated by an art psychotherapist using paints, crayons, clay, a camera and an iPad. Hospital anxiety and depression scales (HAD) and therapy outcome measures (TOM) were measured at the beginning and end of the study. Six male patients were recruited, average age 69 years (38-85). Group discussions allowed patients to express openly feelings of frustration as well as hope for physical and emotional recovery: 'fight like a ferret', an expression used by a group member. The group produced several art objects and photographic images that were collated using stop-frame animation to produce a 10 min film. Median HAD score for the group was eight points upon entering the study and six points on finishing the study. There is little attention to the emotional needs of stroke patients in rehabilitation. Properly designed research studies exploring the role of AT in addressing anxiety and depression poststroke are needed. Our study showed that AT was a feasible intervention that helped patients explore the sequel of stroke in an open supportive environment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  3. 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. (United States)

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


    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.

  4. 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


    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.

  5. 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 F.); 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.)


    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

  6. Recovering after stroke (United States)

    Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke; Stroke - recovery; CVA - recovery ... LIVE AFTER A STROKE Most people will need stroke rehabilitation (rehab) to help them recover after they leave ...

  7. 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.


    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

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

    Directory of Open Access Journals (Sweden)

    Béland François


    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

  9. Systems Biology Approach and Mathematical Modeling for Analyzing Phase-Space Switch During Epithelial-Mesenchymal Transition. (United States)

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


    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).

  10. 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


    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.

  11. Depressive symptoms following stroke and transient ischemic attack: is it time for a more intensive treatment approach? results from the TABASCO cohort study. (United States)

    Tene, Oren; Shenhar-Tsarfaty, Shani; Korczyn, Amos D; Kliper, Efrat; Hallevi, Hen; Shopin, Ludmila; Auriel, Eitan; Mike, Anat; Bornstein, Natan M; Assayag, Einor Ben


    To examine whether depressive symptoms after a stroke or a transient ischemic attack (TIA) increase the risk of cognitive impairment and functional deterioration at 2-year follow-up. Participants were survivors of first-ever, mild-to-moderate ischemic stroke or TIA from the TABASCO prospective cohort study who underwent 3T magnetic resonance imaging and were examined by a multiprofessional team 6, 12, and 24 months after the event using direct interviews, depression scales, and neurologic, neuropsychological, and functional evaluations. The main outcome was the development of cognitive impairment, either mild cognitive impairment (MCI) or dementia. MCI was diagnosed by a decline on at least 1 cognitive domain (≥ 1.5 SD) of the Montreal Cognitive Assessment score and/or on the computerized neuropsychological battery, as compared with age- and education-matched published norms. Dementia was diagnosed by a consensus forum that included senior neurologists specializing in memory disorders and a neuropsychologist. Data were obtained from 306 consecutive eligible patients (mean age: 67.1 ± 10.0 years) who were admitted to the department of emergency medicine at the Tel Aviv Medical Center from April 1, 2008, to December 1, 2011, within 72 hours from onset of symptoms of TIA or stroke. Of these patients, 51 (16.7%) developed cognitive impairment during a 2-year follow-up. Multivariate regression analysis showed that a Geriatric Depression Scale (GDS) score ≥ 6 at admission and at 6 months after the event was a significant independent marker of cognitive impairment 2 years after the stroke/TIA (OR = 3.62, 95% CI, 1.01-13.00; OR = 3.68, 95% CI, 1.03-13.21, respectively). A higher GDS score at 6 months was also related to a worse functional outcome (P depression screening among stroke and TIA survivors as a tool to identify patients who are prone to have a worse cognitive and functional outcome. These patients may benefit from closer medical surveillance and a more

  12. Stroke prevention: an update. (United States)

    Bousser, Marie-Germaine


    Stroke is a personal, familial, and social disaster. It is the third cause of death worldwide, the first cause of acquired disability, the second cause of dementia, and its cost is astronomic. The burden of stroke is likely to increase given the aging of the population and the growing incidence of many vascular risk factors. Prevention of stroke includes--as for all other diseases--a "mass approach" aiming at decreasing the risk at the society level and an individual approach, aiming at reducing the risk in a given subject. The mass approach is primarily based on the identification and treatment of vascular risk factors and, if possible, in the implementation of protective factors. These measures are the basis of primary prevention but most of them have now been shown to be also effective in secondary prevention. The individual approach combines a vascular risk factor modification and various treatments addressing the specific subtypes of stroke, such as antiplatelet drugs for the prevention of cerebral infarction in large and small artery diseases of the brain, carotid endarterectomy or stenting for tight carotid artery stenosis, and oral anticoagulants for the prevention of cardiac emboli. There is a growing awareness of the huge evidence-to-practice gap that exists in stroke prevention largely due to socio-economic factors. Recent approaches include low cost intervention packages to reduce blood pressure and cheap "polypills" combining in a single tablet aspirin and several drugs to lower blood pressure and cholesterol. Polypill intake should however not lead to abandon the healthy life-style measures which remain the mainstay of stroke prevention.

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

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


    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.

  14. Stroke Rehabilitation (United States)

    ... unique for each person. Although a majority of functional abilities may be restored soon after a stroke, recovery is an ongoing process. Effects of a Stroke Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body that may affect the whole ...

  15. Pediatric Stroke (United States)

    ... of 3 and 10. In those with SCD, ischemic strokes most often occur in children under the age of 15 and adults over the age of 30, while hemorrhagic strokes most often occur in young adults between the ages of 20 and 30. ...

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


    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.

  17. Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. (United States)

    Langhammer, B; Stanghelle, J K


    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.

  18. 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


    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

  19. S-matrix decomposition, natural reaction channels, and the quantum transition state approach to reactive scattering. (United States)

    Manthe, Uwe; Ellerbrock, Roman


    A new approach for the quantum-state resolved analysis of polyatomic reactions is introduced. Based on the singular value decomposition of the S-matrix, energy-dependent natural reaction channels and natural reaction probabilities are defined. It is shown that the natural reaction probabilities are equal to the eigenvalues of the reaction probability operator [U. Manthe and W. H. Miller, J. Chem. Phys. 99, 3411 (1993)]. Consequently, the natural reaction channels can be interpreted as uniquely defined pathways through the transition state of the reaction. The analysis can efficiently be combined with reactive scattering calculations based on the propagation of thermal flux eigenstates. In contrast to a decomposition based straightforwardly on thermal flux eigenstates, it does not depend on the choice of the dividing surface separating reactants from products. The new approach is illustrated studying a prototypical example, the H + CH4 → H2 + CH3 reaction. The natural reaction probabilities and the contributions of the different vibrational states of the methyl product to the natural reaction channels are calculated and discussed. The relation between the thermal flux eigenstates and the natural reaction channels is studied in detail.

  20. Stroke and Cerebrovascular Diseases Registry (United States)


    Stroke; Acute Stroke; Acute Brain Injury; Ischemic Stroke; Hemorrhagic Stroke; Transient Ischemic Attack; Subarachnoid Hemorrhage; Cerebral Ischemia; Cerebral Infarction; Cerebral Stroke; Venous Sinus Thrombosis, Cranial

  1. Status and future transition of rapid urbanizing landscape in central Western Ghats - CA based approach (United States)

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


    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.

  2. Land cover change using an energy transition paradigm in a statistical mechanics approach (United States)

    Zachary, Daniel S.


    This paper explores a statistical mechanics approach as a means to better understand specific land cover changes on a continental scale. Integrated assessment models are used to calculate the impact of anthropogenic emissions via the coupling of technoeconomic and earth/atmospheric system models and they have often overlooked or oversimplified the evolution of land cover change. Different time scales and the uncertainties inherent in long term projections of land cover make their coupling to integrated assessment models difficult. The mainstream approach to land cover modelling is rule-based methodology and this necessarily implies that decision mechanisms are often removed from the physical geospatial realities, therefore a number of questions remain: How much of the predictive power of land cover change can be linked to the physical situation as opposed to social and policy realities? Can land cover change be understood using a statistical approach that includes only economic drivers and the availability of resources? In this paper, we use an energy transition paradigm as a means to predict this change. A cost function is applied to developed land covers for urban and agricultural areas. The counting of area is addressed using specific examples of a Pólya process involving Maxwell-Boltzmann and Bose-Einstein statistics. We apply an iterative counting method and compare the simulated statistics with fractional land cover data with a multi-national database. An energy level paradigm is used as a basis in a flow model for land cover change. The model is compared with tabulated land cover change in Europe for the period 1990-2000. The model post-predicts changes for each nation. When strong extraneous factors are absent, the model shows promise in reproducing data and can provide a means to test hypothesis for the standard rules-based algorithms.

  3. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

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


    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

  4. Problematising risk in stroke rehabilitation. (United States)

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


    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

  5. Estimating the lifetime economic burden of stroke according to the age of onset in South Korea: a cost of illness study

    Directory of Open Access Journals (Sweden)

    Suh Hae Sun


    Full Text Available Abstract Background The recently-observed trend towards younger stroke patients in Korea raises economic concerns, including erosion of the workforce. We compared per-person lifetime costs of stroke according to the age of stroke onset from the Korean societal perspective. Methods A state-transition Markov model consisted of three health states ('post primary stroke event', 'alive post stroke', and 'dead' was developed to simulate the natural history of stroke. The transition probabilities for fatal and non-fatal recurrent stroke by age and gender and for non-stroke causes of death were derived from the national epidemiologic data of the Korean Health Insurance Review and Assessment Services and data from the Danish Monitoring Trends in Cardiovascular Disease study. We used an incidence-based approach to estimate the long-term costs of stroke. The model captured stroke-related costs including costs within the health sector, patients' out-of-pocket costs outside the health sector, and costs resulting from loss of productivity due to morbidity and premature death using a human capital approach. Average insurance-covered costs occurring within the health sector were estimated from the National Health Insurance claims database. Other costs were estimated based on the national epidemiologic data and literature. All costs are presented in 2008 Korean currency values (Korean won = KRW. Results The lifetime costs of stroke were estimated to be: 200.7, 81.9, and 16.4 million Korean won (1,200 KRW is approximately equal to one US dollar for men who suffered a first stroke at age 45, 55 and 65 years, respectively, and 75.7, 39.2, and 19.3 million KRW for women at the same age. While stroke occurring among Koreans aged 45 to 64 years accounted for only 30% of the total disease incidence, this age group incurred 75% of the total national lifetime costs of stroke. Conclusions A higher lifetime burden and increasing incidence of stroke among younger Koreans

  6. Recovery of Dysphagia in Lateral Medullary Stroke

    Directory of Open Access Journals (Sweden)

    Hitesh Gupta


    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.

  7. An ecological approach to seeking and utilising the views of young people with intellectual disabilities in transition planning. (United States)

    Small, Neil; Raghavan, Raghu; Pawson, Nicole


    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.

  8. A Strategic Enrollment Management Approach to Studying High School Student Transition to a Two-Year College (United States)

    Wang, Yan; Ye, Feifei; Pilarzyk, Tom


    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…

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

    Directory of Open Access Journals (Sweden)

    Shunsuke Nansai


    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.

  10. Bioinformatic approaches to augment study of epithelial-to-mesenchymal transition in lung cancer. (United States)

    Beck, Tim N; Chikwem, Adaeze J; Solanki, Nehal R; Golemis, Erica A


    Bioinformatic approaches are intended to provide systems level insight into the complex biological processes that underlie serious diseases such as cancer. In this review we describe current bioinformatic resources, and illustrate how they have been used to study a clinically important example: epithelial-to-mesenchymal transition (EMT) in lung cancer. Lung cancer is the leading cause of cancer-related deaths and is often diagnosed at advanced stages, leading to limited therapeutic success. While EMT is essential during development and wound healing, pathological reactivation of this program by cancer cells contributes to metastasis and drug resistance, both major causes of death from lung cancer. Challenges of studying EMT include its transient nature, its molecular and phenotypic heterogeneity, and the complicated networks of rewired signaling cascades. Given the biology of lung cancer and the role of EMT, it is critical to better align the two in order to advance the impact of precision oncology. This task relies heavily on the application of bioinformatic resources. Besides summarizing recent work in this area, we use four EMT-associated genes, TGF-β (TGFB1), NEDD9/HEF1, β-catenin (CTNNB1) and E-cadherin (CDH1), as exemplars to demonstrate the current capacities and limitations of probing bioinformatic resources to inform hypothesis-driven studies with therapeutic goals. Copyright © 2014 the American Physiological Society.

  11. Inverse modeling of hydraulic tests in fractured crystalline rock based on a transition probability geostatistical approach (United States)

    Blessent, Daniela; Therrien, René; Lemieux, Jean-Michel


    This paper presents numerical simulations of a series of hydraulic interference tests conducted in crystalline bedrock at Olkiluoto (Finland), a potential site for the disposal of the Finnish high-level nuclear waste. The tests are in a block of crystalline bedrock of about 0.03 km3 that contains low-transmissivity fractures. Fracture density, orientation, and fracture transmissivity are estimated from Posiva Flow Log (PFL) measurements in boreholes drilled in the rock block. On the basis of those data, a geostatistical approach relying on a transitional probability and Markov chain models is used to define a conceptual model based on stochastic fractured rock facies. Four facies are defined, from sparsely fractured bedrock to highly fractured bedrock. Using this conceptual model, three-dimensional groundwater flow is then simulated to reproduce interference pumping tests in either open or packed-off boreholes. Hydraulic conductivities of the fracture facies are estimated through automatic calibration using either hydraulic heads or both hydraulic heads and PFL flow rates as targets for calibration. The latter option produces a narrower confidence interval for the calibrated hydraulic conductivities, therefore reducing the associated uncertainty and demonstrating the usefulness of the measured PFL flow rates. Furthermore, the stochastic facies conceptual model is a suitable alternative to discrete fracture network models to simulate fluid flow in fractured geological media.

  12. Optimal precursors triggering the Kuroshio Extension state transition obtained by the Conditional Nonlinear Optimal Perturbation approach (United States)

    Zhang, Xing; Mu, Mu; Wang, Qiang; Pierini, Stefano


    In this study, the initial perturbations that are the easiest to trigger the Kuroshio Extension (KE) transition connecting a basic weak jet state and a strong, fairly stable meandering state, are investigated using a reduced-gravity shallow water ocean model and the CNOP (Conditional Nonlinear Optimal Perturbation) approach. This kind of initial perturbation is called an optimal precursor (OPR). The spatial structures and evolutionary processes of the OPRs are analyzed in detail. The results show that most of the OPRs are in the form of negative sea surface height (SSH) anomalies mainly located in a narrow band region south of the KE jet, in basic agreement with altimetric observations. These negative SSH anomalies reduce the meridional SSH gradient within the KE, thus weakening the strength of the jet. The KE jet then becomes more convoluted, with a high-frequency and large-amplitude variability corresponding to a high eddy kinetic energy level; this gradually strengthens the KE jet through an inverse energy cascade. Eventually, the KE reaches a high-energy state characterized by two well defined and fairly stable anticyclonic meanders. Moreover, sensitivity experiments indicate that the spatial structures of the OPRs are not sensitive to the model parameters and to the optimization times used in the analysis.

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

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Christophe Gutfrind


    Full Text Available 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.

  15. Navigation strategy training using virtual reality in six chronic stroke patients: A novel and explorative approach to the rehabilitation of navigation impairment. (United States)

    Claessen, Michiel H G; van der Ham, Ineke J M; Jagersma, Elbrich; Visser-Meily, Johanna M A


    Recent studies have shown that navigation impairment is a common complaint after brain injury. Effective training programmes aiming to improve navigation ability in neurological patients are, however, scarce. The few reported programmes are merely focused on recalling specific routes rather than encouraging brain-damaged patients to use an alternative navigation strategy, applicable to any route. Our aim was therefore to investigate the feasibility of a (virtual reality) navigation training as a tool to instruct chronic stroke patients to adopt an alternative navigation strategy. Navigation ability was systematically assessed before the training. The training approach was then determined based on the individual pattern of navigation deficits of each patient. The use of virtual reality in the navigation strategy training in six middle-aged stroke patients was found to be highly feasible. Furthermore, five patients learned to (partially) apply an alternative navigation strategy in the virtual environment, suggesting that navigation strategies are mouldable rather than static. In the evaluation of their training experiences, the patients judged the training as valuable and proposed some suggestions for further improvement. The notion that the navigation strategy people use can be influenced after a short training procedure is a novel finding and initiates a direction for future studies.

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

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


    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.

  17. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.


    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

  18. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara


    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.

  19. 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.


    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

  20. Caregiver Perspectives during the Post Inpatient Hospital Transition: A Mixed Methods Approach (United States)

    Blizzard, Angela M.; Weiss, Catherine L.; Wideman, Rukiya; Stephan, Sharon H.


    Background: Knowledge of caregiver perspectives of their psychosocial resources and needs during the post inpatient psychiatric hospitalization is limited. Examining caregivers' perspectives of the transition period may be a critical step in improving the transition success of children with emotional and behavioral disorders. Using quantitative…

  1. Driving After a Stroke (United States)

    ... Stroke Professionals for Stroke Shop for Stroke Support for Stroke Association. ... a wheelchair accessible or modified van, truck or car can provide the assurance you need to feel ...

  2. A comparison of three random effects approaches to analyze repeated bounded outcome scores with an application in a stroke revalidation study. (United States)

    Molas, Marek; Lesaffre, Emmanuel


    Discrete bounded outcome scores (BOS), i.e. discrete measurements that are restricted on a finite interval, often occur in practice. Examples are compliance measures, quality of life measures, etc. In this paper we examine three related random effects approaches to analyze longitudinal studies with a BOS as response: (1) a linear mixed effects (LM) model applied to a logistic transformed modified BOS; (2) a model assuming that the discrete BOS is a coarsened version of a latent random variable, which after a logistic-normal transformation, satisfies an LM model; and (3) a random effects probit model. We consider also the extension whereby the variability of the BOS is allowed to depend on covariates. The methods are contrasted using a simulation study and on a longitudinal project, which documents stroke rehabilitation in four European countries using measures of motor and functional recovery. Copyright 2008 John Wiley & Sons, Ltd.


    Directory of Open Access Journals (Sweden)

    Saša Obradović


    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.

  4. Family life cycle transitions and the onset of eating disorders: a retrospective grounded theory approach. (United States)

    Berge, Jerica M; Loth, Katie; Hanson, Carrie; Croll-Lampert, Jillian; Neumark-Sztainer, Dianne


    The aim of this retrospective qualitative study is to understand how transitions in the family life cycle and responses to these events may relate to the onset of eating disorders in an attempt to generate new theoretical insights and inform future research in the area of eating disorder prevention. Little is known about the contextual factors that occur throughout the family life cycle that may be risk factors for the development of eating disorders. Semi-structured interviews were conducted with 27 individuals of varied ages (age range = 17-64; median = 27; SD 13·7) currently receiving treatment for eating disorders in an outpatient clinic specialising in eating disorder treatment. Data were analysed using grounded theory methods. Six themes were identified as family life cycle transitional events that preceded the onset of participants' eating disorders: (1) school transitions, (2) death of a family member, (3) relationship changes, (4) home and job transitions (5) illness/hospitalisation and (6) abuse, sexual assault, or incest. Results indicated that transitional events in the family life cycle followed by a lack of needed support during these transitions may precipitate the onset of eating disorders. Thus, future research should use these findings to inform the creation of interventions that reduce the intensity of the stress brought about by these transitional periods and increase the adaptability and coping skills of individuals and family members to prevent eating disorders. Relevance to clinical practice.  Nurses and other healthcare professionals should be aware of the importance of transitional events occurring in the family life cycle of adolescents and young adults. Helping parents to be aware and supportive of difficult transitional events may be more important than trying to solve or fix the problem. © 2011 Blackwell Publishing Ltd.

  5. Family Life Cycle Transitions and the Onset of Eating Disorders: A Retrospective Grounded Theory Approach (United States)

    Berge, Jerica M.; Loth, Katie; Hanson, Carrie; Croll, Jillian; Neumark-Sztainer, Dianne


    Aims and Objective The aim of this retrospective qualitative study is to understand how transitions in the family life cycle and responses to these events may relate to the onset of eating disorders in an attempt to generate new theoretical insights and inform future research in the area of eating disorder prevention. Background Little is known about the contextual factors that occur throughout the family life cycle that may be risk factors for the development of eating disorders. Design and Methods Semi-structured interviews were conducted with 27 individuals of varied ages (age range =17–64; Median = 27; SD 13.7) currently receiving treatment for eating disorders in an outpatient clinic specialising in eating disorder treatment. Data were analysed using grounded theory methods. Results Six themes were identified as family life cycle transitional events that preceded the onset of participants’ eating disorders: (a) School Transitions, (b) Death of a Family Member, (c) Relationship Changes, (d) Home and Job Transitions (e) Illness/Hospitalisation and (f) Abuse, Sexual Assault, or Incest. Conclusions Results indicated that transitional events in the family life cycle followed by a lack of needed support during these transitions may precipitate the onset of eating disorders. Thus, future research should use these findings to inform the creation of interventions that reduce the intensity of the stress brought about by these transitional periods and increase the adaptability and coping skills of individuals and family members to prevent eating disorders. Relevance to Clinical Practice Nurses and other healthcare professionals should be aware of the importance of transitional events occurring in the family life cycle of adolescents and young adults. Helping parents to be aware and supportive of difficult transitional events may be more important than trying to solve or fix the problem. PMID:21749510

  6. Designing a Summer Transition Program for Incoming and Current College Students on the Autism Spectrum: A Participatory Approach (United States)

    Hotez, Emily; Shane-Simpson, Christina; Obeid, Rita; DeNigris, Danielle; Siller, Michael; Costikas, Corinna; Pickens, Jonathan; Massa, Anthony; Giannola, Michael; D'Onofrio, Joanne; Gillespie-Lynch, Kristen


    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-advocacy skills

  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


    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.


    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. Affordable Housing in transit-oriented developments : impacts on driving and policy approaches. (United States)


    This paper studies the intersection of policies promoting affordable housing, transit-oriented developments (TODs), and the reduction of vehicle miles traveled (VMT) in metropolitan areas. In particular, this paper focuses on the following questions:...

  10. Impulsive synchronization of Markovian jumping randomly coupled neural networks with partly unknown transition probabilities via multiple integral approach. (United States)

    Chandrasekar, A; Rakkiyappan, R; Cao, Jinde


    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.

  11. 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. (United States)

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


    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.

  12. Genetic View To Stroke Occurrence

    Directory of Open Access Journals (Sweden)

    Sadegh Yoosefee


    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.

  13. Heat Stroke

    DEFF Research Database (Denmark)

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


    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...... 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...

  14. A novel MMP12 locus is associated with large artery atherosclerotic stroke using a genome-wide age-at-onset informed approach.

    Directory of Open Access Journals (Sweden)

    Matthew Traylor


    Full Text Available Genome-wide association studies (GWAS have begun to identify the common genetic component to ischaemic stroke (IS. However, IS has considerable phenotypic heterogeneity. Where clinical covariates explain a large fraction of disease risk, covariate informed designs can increase power to detect associations. As prevalence rates in IS are markedly affected by age, and younger onset cases may have higher genetic predisposition, we investigated whether an age-at-onset informed approach could detect novel associations with IS and its subtypes; cardioembolic (CE, large artery atherosclerosis (LAA and small vessel disease (SVD in 6,778 cases of European ancestry and 12,095 ancestry-matched controls. Regression analysis to identify SNP associations was performed on posterior liabilities after conditioning on age-at-onset and affection status. We sought further evidence of an association with LAA in 1,881 cases and 50,817 controls, and examined mRNA expression levels of the nearby genes in atherosclerotic carotid artery plaques. Secondly, we performed permutation analyses to evaluate the extent to which age-at-onset informed analysis improves significance for novel loci. We identified a novel association with an MMP12 locus in LAA (rs660599; p = 2.5×10⁻⁷, with independent replication in a second population (p = 0.0048, OR(95% CI = 1.18(1.05-1.32; meta-analysis p = 2.6×10⁻⁸. The nearby gene, MMP12, was significantly overexpressed in carotid plaques compared to atherosclerosis-free control arteries (p = 1.2×10⁻¹⁵; fold change = 335.6. Permutation analyses demonstrated improved significance for associations when accounting for age-at-onset in all four stroke phenotypes (p<0.001. Our results show that a covariate-informed design, by adjusting for age-at-onset of stroke, can detect variants not identified by conventional GWAS.

  15. Do post-stroke patients benefit from robotic verticalization? A pilot-study focusing on a novel neurophysiological approach. (United States)

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


    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 < 0.001) and vestibular system plasticity (p = 0.02) as compared to G2. ERIGO training could be a valuable tool for the adaptation to the vertical position with a better global function improvement, as also suggested by the sensory-motor and vestibular system plasticity induction.

  16. A 12-year prospective study of stroke risk in older Medicare beneficiaries

    Directory of Open Access Journals (Sweden)

    Pavlik Claire E


    Full Text Available Abstract Background 5.8 M living Americans have experienced a stroke at some time in their lives, 780K had either their first or a recurrent stroke this year, and 150K died from strokes this year. Stroke costs about $66B annually in the US, and also results in serious, long-term disability. Therefore, it is prudent to identify all possible risk factors and their effects so that appropriate intervention points may be targeted. Methods Baseline (1993–1994 interview data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD were linked to 1993–2005 Medicare claims. Participants were 5,511 self-respondents ≥ 70 years old. Two ICD9-CM case-identification approaches were used. Two approaches to stroke case-identification based on ICD9-CM codes were used, one emphasized sensitivity and the other emphasized specificity. Participants were censored at death or enrollment into managed Medicare. Baseline risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting post-baseline non-stroke hospitalizations was included to reflect health shocks, and sensitivity analyses were conducted to identify its peak effect. Competing risk, proportional hazards regression was used. Results Post-baseline strokes occurred for 545 (9.9%; high sensitivity approach and 374 (6.8%; high specificity approach participants. The greatest static risks involved increased age, being widowed or never married, living in multi-story buildings, reporting a baseline history of diabetes, hypertension, or stroke, and reporting difficulty picking up a dime, refusing to answer the delayed word recall test, or having poor cognition. Risks were similar for both case-identification approaches and for recurrent and first-ever vs. only first-ever strokes. The time-dependent health shock (recent hospitalization marker did

  17. A Novel MMP12 Locus Is Associated with Large Artery Atherosclerotic Stroke Using a Genome-Wide Age-at-Onset Informed Approach (United States)

    Traylor, Matthew; Mäkelä, Kari-Matti; Kilarski, Laura L.; Holliday, Elizabeth G.; Devan, William J.; Nalls, Mike A.; Wiggins, Kerri L.; Zhao, Wei; Cheng, Yu-Ching; Achterberg, Sefanja; Malik, Rainer; Sudlow, Cathie; Bevan, Steve; Raitoharju, Emma; Oksala, Niku; Thijs, Vincent; Lemmens, Robin; Lindgren, Arne; Slowik, Agnieszka; Maguire, Jane M.; Walters, Matthew; Algra, Ale; Sharma, Pankaj; Attia, John R.; Boncoraglio, Giorgio B.; Rothwell, Peter M.; de Bakker, Paul I. W.; Bis, Joshua C.; Saleheen, Danish; Kittner, Steven J.; Mitchell, Braxton D.; Rosand, Jonathan; Meschia, James F.; Levi, Christopher; Dichgans, Martin; Lehtimäki, Terho


    Genome-wide association studies (GWAS) have begun to identify the common genetic component to ischaemic stroke (IS). However, IS has considerable phenotypic heterogeneity. Where clinical covariates explain a large fraction of disease risk, covariate informed designs can increase power to detect associations. As prevalence rates in IS are markedly affected by age, and younger onset cases may have higher genetic predisposition, we investigated whether an age-at-onset informed approach could detect novel associations with IS and its subtypes; cardioembolic (CE), large artery atherosclerosis (LAA) and small vessel disease (SVD) in 6,778 cases of European ancestry and 12,095 ancestry-matched controls. Regression analysis to identify SNP associations was performed on posterior liabilities after conditioning on age-at-onset and affection status. We sought further evidence of an association with LAA in 1,881 cases and 50,817 controls, and examined mRNA expression levels of the nearby genes in atherosclerotic carotid artery plaques. Secondly, we performed permutation analyses to evaluate the extent to which age-at-onset informed analysis improves significance for novel loci. We identified a novel association with an MMP12 locus in LAA (rs660599; p = 2.5×10−7), with independent replication in a second population (p = 0.0048, OR(95% CI) = 1.18(1.05–1.32); meta-analysis p = 2.6×10−8). The nearby gene, MMP12, was significantly overexpressed in carotid plaques compared to atherosclerosis-free control arteries (p = 1.2×10−15; fold change = 335.6). Permutation analyses demonstrated improved significance for associations when accounting for age-at-onset in all four stroke phenotypes (pstroke, can detect variants not identified by conventional GWAS. PMID:25078452

  18. Recovery of somatosensory and motor functions of the paretic upper limb in patients after stroke: Comparison of two therapeutic approaches

    Directory of Open Access Journals (Sweden)

    Kateřina Macháčková


    Full Text Available Background: Frequent and extensive disturbances to the somatosensory and motor hand functions after stroke are common. This study explores a new therapeutic approach that may improve the effectiveness of rehabilitation for these upper limb impairments. Objective: To assess the effect of rehabilitation combining standard therapy and somatosensory stimulation on sensorimotor hand functions. To compare the effect of this method with the standard method of rehabilitation. Methods: Two groups of patients were used to compare the effect of standard therapy (group A, n = 15, age = 59.8 ± 9.4 years, and the effect of therapy with targeted somatosensory stimulation (group B, n = 15, age = 65.5 ± 8.2. The groups consisted of patients after an ischemic stroke in post-acute phase, with hemiparesis, aged from 45 to 75 years, both men and women. The methods used to assess patients comprised a neurological clinical examination, two batteries of tests of somatosensory function (Rivermead Assessment of Somatosensory Performance, Fabric Matching Test, two batteries of tests of motor function (Nine Hole Peg Test, Test of Manipulation Functions, and activities of daily living assessment. Results: The results show that before therapy a deficit of somatosensory function occurred on the paretic upper limb in more than 50% of patients in both groups. Motor functions were impaired more frequently than somatosensory functions. Somatosensory stimulation therapy had an enhanced improvement of somatosensory functions, especially tactile discrimination of the object surface. Conclusions: Major improvement, particularly of tactile discrimination sensation, occurred in group B, where therapy focused on somatosensory deficit was applied. We did not show that such considerable improvement in discrimination sensation in group B was associated with any change in motor function. Clinical improvement in the motor function of the paretic limb occurred in

  19. Teaching a Systematic Approach for Transitioning Patients to College: An Interactive Continuing Medical Education Program. (United States)

    Martel, Adele; Derenne, Jennifer; Chan, Vivien


    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.

  20. Endovascular stroke treatment in a small-volume stroke center. (United States)

    Behzadi, Gry N; Fjetland, Lars; Advani, Rajiv; Kurz, Martin W; Kurz, Kathinka D


    Our purpose was to evaluate the safety and efficacy of endovascular treatment (EVT) of stroke caused by large vessel occlusions (LVO) performed by general interventional radiologists in cooperation with stroke neurologists and neuroradiologists at a center with a limited annual number of procedures. We aimed to compare our results with those previously reported from larger stroke centers. A total of 108 patients with acute stroke due to LVO treated with EVT were included. Outcome was measured using the modified Rankin scale (mRS) at 90 days. Efficacy was classified according to the modified thrombolysis in cerebral infarction (mTICI) scoring system. Safety was evaluated according to the incidence of procedural complications and symptomatic intracranial hemorrhage (sICH). Mean age of the patients was 67.5 years. The median National Institutes of Health Stroke Scale (NIHSS) on hospital admission was 17. Successful revascularization was achieved in 76%. 39.4% experienced a good clinical outcome (mRS<3). Intraprocedural complications were seen in 7.4%. 7.4% suffered a sICH. 21.3% died within 3 months after EVT. The use of general interventional radiologists in EVT of LVO may be a possible approach for improving EVT coverage where availability of specialized neurointerventionalists is challenging. EVT for LVO stroke performed by general interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists can be safe and efficacious despite the low number of annual procedures.

  1. The interplay between language, gesture, and affect during communicative transition: a dynamic systems approach. (United States)

    Parladé, Meaghan V; Iverson, Jana M


    From a dynamic systems perspective, transition points in development are times of increased instability, during which behavioral patterns are susceptible to temporary decoupling. This study investigated the impact of the vocabulary spurt on existing patterns of communicative coordination. Eighteen typically developing infants were videotaped at home 1 month before, at, and after the vocabulary spurt. Infants were identified as spurters if they underwent a discrete phase transition in vocabulary development (marked by an inflection point), and compared with a group of nonspurters whose word-learning rates followed a trajectory of continuous change. Relative to surrounding sessions, there were significant reductions in overall coordination of communicative behaviors and in words produced in coordination at the vocabulary spurt session for infants who experienced more dramatic vocabulary growth. In contrast, nonspurters demonstrated little change across sessions. Findings underscore the importance of transitions as opportunities for observing processes of developmental change. (c) 2011 APA, all rights reserved.

  2. Dynamical transition on the periodic Lorentz gas: Stochastic and deterministic approaches (United States)

    Feliczaki, Rafael Mateus; Vicentini, Eduardo; González-Borrero, Pedro Pablo


    The effect of dynamical properties of the periodic Lorentz gas on the autocorrelation function and diffusion coefficient are investigated in various geometric transitions between billiards without horizon and infinite horizon. Numerical simulations are performed using a double square lattice which permits us to isolate different types of corridors and to describe the individual effects of each corridor. The results are compared with a stochastic model based on a escape-rate formalism which reveals the sensibility of the diffusion coefficient and clarifies the role of the open corridors mechanism on the dynamical transitions


    Directory of Open Access Journals (Sweden)

    O.I. Pechonik


    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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


    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.

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

    DEFF Research Database (Denmark)

    Ingvardson, Jesper Bláfoss; Kornerup Jensen, Jonas


    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...

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

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


    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. Determination of the glass-transition temperature of proteins from a viscometric approach. (United States)

    Monkos, Karol


    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.

  8. A Review of the Approaches Investigating the Post-16 Transition of Young Adults with Learning Difficulties (United States)

    Carroll, Catherine


    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…

  9. North American oriented strand board markets, arbitrage activity, and market price dynamics: A smooth transition approach (United States)

    Barry Goodwin; Matthew Holt; Jeffrey P. Prestemon


    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...

  10. An integrated approach to climate adaptation at the Chicago Transit Authority. (United States)


    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...

  11. Variational local moment approach: from Kondo effect to Mott transition in correlated electron systems

    Czech Academy of Sciences Publication Activity Database

    Kauch, Anna; Byczuk, K.


    Roč. 407, č. 2 (2012), s. 209-217 ISSN 0921-4526 Institutional research plan: CEZ:AV0Z10100520 Keywords : single impurity Anderson model * Kondo effect * dynamical mean-field theory * metal-insulator transition Subject RIV: BM - Solid Matter Physics ; Magnetism Impact factor: 1.327, year: 2012

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

    NARCIS (Netherlands)

    Baay, P.E.


    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 –

  13. Ecological Approaches to Transition Planning for Students with Autism and Asperger's Syndrome (United States)

    Dente, Claire L.; Parkinson Coles, Kallie


    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…

  14. Approaches to Modelling the Human Immune Response in Transition of Candidates from Research to Development

    Directory of Open Access Journals (Sweden)

    Diane Williamson


    Full Text Available This review considers the steps required to evaluate a candidate biodefense vaccine or therapy as it emerges from the research phase, in order to transition it to development. The options for preclinical modelling of efficacy are considered in the context of the FDA’s Animal Rule.

  15. Improving interunit transitions of care between emergency physicians and hospital medicine physicians: a conceptual approach. (United States)

    Beach, Christopher; Cheung, Dickson S; Apker, Julie; Horwitz, Leora I; Howell, Eric E; O'Leary, Kevin J; Patterson, Emily S; Schuur, Jeremiah D; Wears, Robert; Williams, Mark


    Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focusing on the hand-off process between emergency and hospital medicine physicians. Sensitivity to cultural and operational differences and a common set of expectations pertaining to hand-off content will more effectively prepare the next provider to act safely and efficiently when caring for the patient. Through a consensus decision-making process of experienced and published authorities in health care transitions, including physicians in both specialties as well as in communication studies, the authors propose content and style principles clinicians may use to improve transition communication. With representation from both community and academic settings, similarities and differences between emergency medicine and internal medicine are highlighted to heighten appreciation of the values, attitudes, and goals of each specialty, particularly pertaining to communication. The authors also examine different communication media, social and cultural behaviors, and tools that practitioners use to share patient care information. Quality measures are proposed within the structure, process, and outcome framework for institutions seeking to evaluate and monitor improvement strategies in hand-off performance. Validation studies to determine if these suggested improvements in transition communication will result in improved patient outcomes will be necessary. By exploring the dynamics of transition communication between specialties and suggesting best practices, the authors hope to strengthen hand-off skills and contribute to improved continuity of care. © 2012 by the Society for Academic Emergency Medicine.

  16. The Efficacy of the proprioceptive neuromuscular facilitation (PNF) approach in stroke rehabilitation to improve basic activities of daily living and quality of life: a systematic review and meta-analysis protocol. (United States)

    Guiu-Tula, Francesc Xavier; Cabanas-Valdés, Rosa; Sitjà-Rabert, Mercè; Urrútia, Gerard; Gómara-Toldrà, Natàlia


    Proprioceptive neuromuscular facilitation (PNF) is a widely used rehabilitation concept, although its efficacy has not yet been demonstrated in stroke survivors. The aim of this systematic review is to identify, assess and synthesise the potential benefits of using PNF to improve the activities of daily living (ADL) and quality of life (QoL) of individuals with stroke. A systematic electronic search will be conducted in MEDLINE, Embase, CENTRAL and PEDro. We will include randomised or quasi-randomised controlled trials of PNF interventions conducted in stroke survivors up to April 2017. Two review authors will independently select relevant studies and will extract data using the Cochrane handbook for systematic reviews of interventions approach and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The methodological quality will be assessed by using the PEDro scale. Finally, with the permitted numeric data, we will carry out a meta-analysis. Ethical considerations will not be required. Results will be disseminated in a peer-review journal. This systematic review aims to examine the effects of PNF (neurophysiological approach) in order to clarify its efficacy in improving ADL and QoL in the rehabilitation process of stroke survivors. CRD42016039135. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Genetics of ischaemic stroke in young adults


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


    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. ...

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

    NARCIS (Netherlands)

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


    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

  19. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik


    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  20. Embolic stroke of undetermined source: a retrospective analysis from an Italian Stroke Unit

    Directory of Open Access Journals (Sweden)

    Marco Masina


    Full Text Available The new clinical construct of embolic stroke of undetermined source (ESUS suggests that many cryptogenic strokes are related to minor-risk covert embolic cardiac sources or to embolus from non-occlusive plaques in the aortic arch or in the cerebral arteries. The authors analyzed the prevalence of ESUS in a real-life condition in Italy and compared the recurrence rates in cryptogenic strokes, cardioembolic strokes, and ESUS. The authors retrospectively reassessed according to ESUS criteria 391 consecutive admissions in a stroke unit where extensive diagnostic search was routinely performed. Recurrences in each stroke type within a 3-year follow-up period (mean time: 25.44 months - standard deviation: 9.42 were also compared. The prevalence of ESUS in the aforementioned cohort was 10.5%. All ESUS patients received antiplatelet agents. Warfarin was prescribed in 56.9% of cardioembolic strokes. The recurrence rate in ESUS patients was 4.4% per year, slightly higher than in cardioembolic strokes (3.5% and significantly higher than in cryptogenic non-ESUS (1.2% (P<0.0001. This is the first description of a cohort of ESUS patients in an Italian stroke unit. Patients with ESUS have a significantly higher risk of recurrence than in those with non-ESUS cryptogenic strokes, and slightly higher than in those with cardioembolic strokes. Results support the hypothesis of a more extensive diagnostic evaluation in cryptogenic strokes and the feasibility of such approach.

  1. Understanding transitions in care from hospital to homeless shelter: a mixed-methods, community-based participatory approach. (United States)

    Greysen, S Ryan; Allen, Rebecca; Lucas, Georgina I; Wang, Emily A; Rosenthal, Marjorie S


    Coordinated transitions from hospital to shelter for homeless patients may improve outcomes, yet patient-centered data to guide interventions are lacking. To understand patients' experiences of transitions from hospital to a homeless shelter, and determine aspects of these experiences associated with perceived quality of these transitions. Mixed methods with a community-based participatory research approach, in partnership with personnel and clients from a homeless shelter. Ninety-eight homeless individuals at a shelter who reported at least one acute care visit to an area hospital in the last year. Using semi-structured interviews, we collected quantitative and qualitative data about transitions in care from the hospital to the shelter. We analyzed qualitative data using the constant comparative method to determine patients' perspectives on the discharge experience, and we analyzed quantitative data using frequency analysis to determine factors associated with poor outcomes from patients' perspective. Using qualitative analysis, we found homeless participants with a recent acute care visit perceived an overall lack of coordination between the hospital and shelter at the time of discharge. They also described how expectations of suboptimal coordination exacerbate delays in seeking care, and made three recommendations for improvement: 1) Hospital providers should consider housing a health concern; 2) Hospital and shelter providers should communicate during discharge planning; 3) Discharge planning should include safe transportation. In quantitative analysis of recent hospital experiences, 44 % of participants reported that housing status was assessed and 42 % reported that transportation was discussed. Twenty-seven percent reported discharge occurred after dark; 11 % reported staying on the streets with no shelter on the first night after discharge. Homeless patients in our community perceived suboptimal coordination in transitions of care from the hospital to the

  2. Sigmoid transition approach of the central pattern generator-based controller for the snake-like robot

    Directory of Open Access Journals (Sweden)

    Guifang Qiao


    Full Text Available Snake-like robots can perform various types of locomotion in the complex environments. In this article, a novel two-layered central pattern generator-based controller is proposed for controlling snake-like robots. To adapt to rough terrain, snake-like robots can dynamically adjust their locomotion through modulating the control parameters of the central pattern generator-based controller based on the sensory feedback. When the parameters are modulated through the step function, the outputs of the central pattern generator-based controller may be unsmooth or discontinuous during the transition process. This will result in stiff and flexible impulses on the motors and gearboxes. In this article, the curvilinear continuity is used to evaluate the continuity degree of the outputs of the central pattern generator-based controller. In order to avoid the damage to the joint motors, two sigmoid transition approaches are proposed. First, a sigmoid parametric modulation method for the central pattern generator-based controller is proposed to eliminate the abrupt changes in the control signals of the joint motors. Second, a sigmoid start-up method is presented to improve the motion efficiency of the snake-like robot. The simulation results of the snake-like robot show that the outputs of the central pattern generator-based controller transit smoothly with the proposed sigmoid parametric modulation method. The snake-like robot can perform a soft start when the sigmoid start-up method is applied. The results demonstrate that the central pattern generator-based controller and the two proposed sigmoid transition approaches are effective.

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


    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.

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


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


    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...

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


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


    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...

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


    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

  8. Stroke rehabilitation. (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert


    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.

  9. 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


    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

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

    International Nuclear Information System (INIS)

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


    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

  11. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha


    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.

  12. Design and implementation of a targeted approach for pharmacist-mediated medication management at care transitions. (United States)

    Ploenzke, Chris; Kemp, Tessa; Naidl, Todd; Marraffa, Rebecca; Bolduc, Jennifer


    To improve patient care through the development of a clinical risk stratification tool to identify high-risk patients and implementation of pharmacist-mediated medication management after patient care transitions. Minneapolis Veterans Affairs (VA) Health Care System from December 1, 2014, to April 1, 2015. A composite care transition score was developed based on risk factors obtained from a literature review and combined with a national stratification tool unique to the Veterans Health Administration (VHA) primary care population, the Care Assessment Need (CAN) score. High-risk individuals were identified to receive a comprehensive medication therapy management (MTM) encounter within 7 days of a recent transition of care. Pharmacists identified and resolved medication-related problems and drug discrepancies using an independent scope of practice. Pharmacists with an independent scope of practice, using a novel risk-stratification tool, are able have a positive impact on transitions of care for high-risk patients. High-risk patients engaged in comprehensive medication therapy management appointments performed by primary care clinical pharmacists with an independent scope of practice. Medication-related problems, drug discrepancies, and pharmacist mediated interventions were analyzed after completion of MTM encounters in 31 high-risk patients. Patient characteristics and time demands per encounter were also assessed. A total of 31 patients were seen for MTM encounters. A total of 127 medication-related problems were identified, resulting in an average of 4.1 ± 2.9 (range, 0-14) problems per patient. In addition, 137 drug discrepancies were found during medication reconciliation, with an average of 4.4 ± 2.8 (range, 0-13) discrepancies per patient. Pharmacist-mediated interventions were performed in 84% (n = 26) of patients, totaling 121 interventions with an average of 3.9 ±3.8 (range, 0-13) interventions per patient. Stratification of patients and pharmacist

  13. Preventing Stroke Deaths (United States)

    ... die within minutes. Strokes happen more in some populations and geographic areas. Stroke death declines have stalled in 3 out of every 4 states. Blacks have the highest stroke death rates among all ...

  14. Two Kinds of Stroke (United States)

    ... Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table of Contents For ... are often a warning sign for future strokes. Stroke Can Affect Anyone Award-winning actress Julie Harris ...

  15. Healthy Living after Stroke (United States)

    ... Stories Stroke Heroes Among Us Healthy Living After Stroke Nutrition Good nutrition is one way to reduce ... the hospital. Thank goodness, she did. Subscribe to Stroke Connection Get quarterly digital issues plus our monthly ...

  16. [Smoking and stroke]. (United States)

    Hashimoto, Yoichiro


    Cigarette smoking is a risk factor for the brain infarction (lacunar and atherothrombotic brain infarction) and subarachnoid hemorrhage. Not only active smoking but also passive smoking and smokeless tobacco products pose a risk. The risk after smoking cessation for 5-10 years is equal to that faced by a non-smoker. Many patients continue smoking even after an attack of stroke; therefore, support measures to enforce nonsmoking are required in this high-risk population. We offer nonsmoking support using the 5A approach, and assess the nonsmoking stage (precontemplation, contemplation, preparation, action, and maintenance). We also administer medical therapy for smoking cessation when the patients find it difficult to quit smoking on their own accord. Nicotine dependency needs a follow-up like that required for other risk factors in the primary and secondary prevention of the stroke because smoking is a chronic disease that tends to recur.

  17. Guidelines for the Primary Prevention of Stroke (United States)

    Meschia, James F.; Bushnell, Cheryl; Boden-Albala, Bernadette; Braun, Lynne T.; Bravata, Dawn M.; Chaturvedi, Seemant; Creager, Mark A.; Eckel, Robert H.; Elkind, Mitchell S.V.; Fornage, Myriam; Goldstein, Larry B.; Greenberg, Steven M.; Horvath, Susanna E.; Iadecola, Costantino; Jauch, Edward C.; Moore, Wesley S.; Wilson, John A.


    The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale. PMID:25355838

  18. Understanding Life After Stroke


    Hjelmblink, Finn


    Stroke is an acute, neurological dysfunction of vascular origin with sudden occurrence and it influences physical, cognitive and psychological functions. Initial treatment aims at eliminating or reducing the brain damage. Soon, however, the influence of the stroke on the entire life of stroke survivors has to be considered. This thesis explores the meaning of life after stroke to 19 elderly stroke survivors during the first year post stroke. Survivors were interviewed twice and the interviews...

  19. Difficulty Swallowing After Stroke (Dysphagia) (United States)

    ... Simple Techniques Can Help Memory after a Stroke Self-Esteem after Stroke Cognitive Challenges After Stroke Depression Trumps ... spasticity), fatigue and more. Let's Talk About Stroke Fact Sheets Our stroke fact sheets cover treatments, recovery, ...

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

    Directory of Open Access Journals (Sweden)

    Nikola Trčka


    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.

  1. Transitional dialysis care units: A new approach to increase home dialysis modality uptake and patient outcomes. (United States)

    Morfín, José A; Yang, Alex; Wang, Elizabeth; Schiller, Brigitte


    Home hemodialysis (HHD) and peritoneal dialysis (PD) are associated with better clinical outcomes, lower hospitalization rates, and improved quality of life compared with conventional in-center hemodialysis. However, dialysis therapy use HHD or PD in the United States, even though over 90% of nephrologists would choose home-based dialysis modalities for themselves. Inadequate patient education and decision-making support are key barriers to patients choosing home-based therapy. Likewise, there are key challenges for dialysis providers, including development and optimal delivery of education materials, appropriate staffing, and training. The Satellite Healthcare Optimal Transitions (OT) Program was developed to provide education and decision support to patients during the transitional period. OT provides in-depth education in all dialysis modalities at the start of dialysis over a flexible time period (1-4 weeks, adapted for various learning curves) to allow for time to physical stabilization, self-care training, and modality choice based on each patient's individual life motivations, goals, and environments. OT may provide value to patients and providers by providing comprehensive support for dialysis modality selection, resulting in increased patient confidence to execute home dialysis with the potential for improved patient outcomes, and reduced hospitalizations. © 2017 Wiley Periodicals, Inc.

  2. [Ecological misunderstanding, integrative approach, and potential industries in circular economy transition]. (United States)

    Wang, Rusong


    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.

  3. A new approach to define surface/sub-surface transition in gravel beds (United States)

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


    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.

  4. A cautionary approach in transitioning to 'green' energy technologies and practices is required. (United States)

    Matatiele, Puleng; Gulumian, Mary


    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.

  5. 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

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

    DEFF Research Database (Denmark)

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


    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...... sample of Slovenian manufacturing companies. Maximum likelihood probit estimation, exploratory factor analysis, cluster analysis and binary logistic modeling are used in the empirical analysis. Our main conclusions are twofold: (1) The integral approach to corporate environmentalism works...

  7. 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


    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.

  8. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D


    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.

  9. 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. (United States)

    Buyukavci, Raikan; Akturk, Semra; Ersoy, Yüksel


    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 (pFugl Meyer Upper Extremity subgroup scores, the sitting position, wrist and total scores at 4 and 12 weeks were significantly improved (pFugl Meyer Upper Extremity hand scores were significantly improved 12 weeks after the injection (p<0.025). Ultrasound-guided botulinum 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

  10. Education and fertility decline in China during transitional times: A cohort approach. (United States)

    Piotrowski, Martin; Tong, Yuying


    We examine the effect of education on birth outcomes in China during the period of economic transition and large-scale changes in mass education and population control measures. Retrospective micro data from the 2008 Chinese General Social Survey and discrete time event history analysis are used to examine the fertility history of several cohorts of women born between 1945 and 1968. We observed births at different parities, distinguishing the education effect across cohorts and rural/urban sectors. We found differences across cohorts consistent with unique features of the Chinese context, such as the radical egalitarian era of educational expansion, and the Reform Era. We also found that despite the increase in some education levels across cohorts (e.g., junior high school in rural areas), birth chances were more likely to be concentrated among less educated women, suggesting the impact of factors related to returns to education and hence the desire for children. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Vicente F. Benítez R.


    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.


    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:, E-mail:, E-mail: [Department of Astronomy, University of Maryland College Park, MD 20742 (United States)


    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.

  13. A Parallel Processing Approach to Transition Prediction for Laminar Flow Control System Design

    Directory of Open Access Journals (Sweden)

    R. W. Ford


    Full Text Available The performance of transport aircraft can be considerably improved if the process by which the wing boundary layer becomes turbulent can be controlled and extensive areas of laminar flow maintained. In order to design laminar flow control systems, it is necessary to be able to predict the movement of the transition location in response to changes in control variables, e.g., surface suction. At present, the technique which is available to industry requires excessively long computational time – so long that it is not suitable for use in the "design process." Therefore, there is a clear need to produce a system which delivers results in near realtime, i.e., in seconds rather than hours. This article details how parallel computing techniques on a KSR-1 produce these performance improvements.

  14. A structured and qualitative systems approach to analysing hydrogen transitions: Key changes and actor mapping

    Energy Technology Data Exchange (ETDEWEB)

    Hugh, Michael J.; Yetano Roche, Maria [Departamento de Engenharia Mecanica (IDMEC), Pav. De Mecanica 1-2, Av. Rovisco Pais, 1049-001 Lisboa (Portugal); Bennett, Simon J. [Imperial College Centre for Energy Policy and Technology (ICCEPT), Imperial College London, Fourth Floor RSM Building, Prince Consort Road, London SW7 2BP (United Kingdom)


    A number of 'roadmapping' activities are being carried out internationally with the aim of planning and facilitating transitions to hydrogen energy systems. However, there is an evident discrepancy between the treatment of quantitative and qualitative information in the majority of roadmapping efforts. Whilst quantitative information is frequently analysed in numerical and computational models, conversely qualitative information tends to be incorporated on a significantly more ad hoc basis. Previous attempts at incorporating qualitative considerations have not usually been systematised. In this paper we present a methodology aimed at increasing the rigour with which qualitative information is treated in hydrogen roadmapping activities. The key changes and actor mapping (KCAM) methodology was developed as the primary qualitative component of the European Hydrogen Energy Roadmap project 'HyWays'. KCAM, developed from a well known general systems development model, constitutes a means of qualitatively analysing variable hydrogen supply chains that is structured, systematic and flexible. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

    Andrews, Mark


    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.

  16. How is rehabilitation with and without an integrated self-management approach perceived by UK community-dwelling stroke survivors? A qualitative process evaluation to explore implementation and contextual variations. (United States)

    Jones, Fiona; McKevitt, Christopher; Riazi, Afsane; Liston, Matthew


    Self-management programmes could support long-term needs after stroke and using methods integrated into rehabilitation is one option. To explore theoretical assumptions and possible mechanisms of implementation a process evaluation was delivered alongside a cluster trial which has demonstrated feasibility of an integrated self-management programme (Bridges SMP) in community-dwelling stroke survivors. This paper aims to show the extent to which experiences from stroke survivors receiving rehabilitation in control (usual care) and intervention (integrated self-management) sites reflected the differences in rehabilitation received and whether their understandings aligned with the self-management approach employed. Semistructured qualitative interviews carried out as part of a process evaluation analysed thematically. Study was based in South London; all interviews were carried out in participants' home setting. 22 stroke participants recruited; 12 from integrated self-management sites and 10 from usual care sites. All participants revealed shared appreciation of knowledge and support from therapists but subtle differences emerged between sites in respect to perceptions about responsibility, control and how previous experiences were used. Accounts depicted a variance regarding who had structured and planned their rehabilitation, with greater flexibility about content and involvement perceived by participants from the integrated self-management sites. They also provided accounts and experiences which aligned with principles of the intervention, such as self-discovery and problem-solving. The findings reflect our theoretical assumptions and possible mechanisms of implementation that rehabilitation with a focus on supporting self-management is reflected in accounts and understandings of stroke survivors. Taken together with our previous research this justifies evaluating the effectiveness of Bridges SMP in a larger sample to further contribute to an understanding of the

  17. Early rehabilitation after stroke. (United States)

    Bernhardt, Julie; Godecke, Erin; Johnson, Liam; Langhorne, Peter


    Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions. Trials in this early time window are few. Although the seminal AVERT trial suggests that a cautious approach is necessary immediately (stroke, early mobility training and mobilization appear well tolerated, with few reasons to delay initiating some rehabilitation within the first week. The results of large clinical trials of early aphasia therapy are on the horizon, and examples of targeted upper limb treatments with better patient selection are emerging. Early rehabilitation trials are complex, particularly those that intervene across acute and rehabilitation care settings, but these trials are important if we are to optimize recovery potential in the critical window for repair. Concerted efforts to standardize 'early' recruitment, appropriately stratify participants and implement longer term follow-up is needed. Trial standards are improving. New recommendations from a recent Stroke Recovery and Rehabilitation Roundtable will help drive new research.

  18. Nursing application of Bobath principles in stroke care. (United States)

    Passarella, P M; Lewis, N


    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.

  19. A four-phase approach for systematically collecting data and measuring medication discrepancies when patients transition between health care settings (United States)

    Kennelty, Korey A.; Witry, Matthew J.; Gehring, Michael; Dattalo, Melissa; Rogus-Pulia, Nicole


    Background No methodological standards are available for researchers and clinicians to examine medication discrepancies between health care settings. Systematic methods of examining medication discrepancies will allow researchers and clinicians to better understand factors driving medication discrepancies, to better measure effects of medication reconciliation interventions, and to compare findings across studies. Objective This article proposes a four-phase approach for systematically collecting medication data and measuring medication discrepancies between a hospital and community pharmacies. Methodologic considerations related to studying medication discrepancies in health services research are also discussed. Methods A multi-disciplinary study team developed a four-phase systematic approach to improve quality of data and study rigor: 1) operationalization of a medication discrepancy, 2) acquiring medication data, 3) abstraction of medication data and creation of dataset, and 4) measuring and reporting medication discrepancies. Results Using this phase-based approach, the study team successfully identified and reported medication discrepancies between a hospital and community pharmacies at the patient, medication, and community pharmacy units of analyses. Conclusions Systematically measuring medication discrepancies that occur in the care transitions process is a critical step as researchers, clinicians, and other stakeholders work to improve health care quality and patient outcomes. This article detailed how a phase-based approach can be used in research to examine medication discrepancies as well as address the complexity of collecting medication data and analyzing medication discrepancies. Such methods should be considered when developing, conducting, and reporting research on medication discrepancies. PMID:26781670

  20. Stroke: Working toward a Prioritized World Agenda (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


    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

  1. Stroke: working toward a prioritized world agenda. (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


    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

  2. Developmental Transition of Motherhood: Treating Postpartum Depression Using a Feminist Approach (United States)

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


    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…

  3. The Net Black Advantage in Educational Transitions: An Education Careers Approach (United States)

    Merolla, David M.


    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…

  4. Novel approach for studying two-photon transitions in heavy HCI (United States)

    Trotsenko, S.; Kumar, A.; Banaś, D.; Volotka, A. V.; Gumberidze, A.; Kozhuharov, C.; Thorn, D. B.; Beyer, H. F.; Fritzsche, S.; Hagmann, S.; Hess, S.; Jagodziński, P.; Reuschl, R.; Salem, S.; Simon, A.; Spillmann, U.; Trassinelli, M.; Tribedi, L. C.; Weber, G.; Winters, D.; Stöhlker, T.


    In this contribution, we report on an experimental approach which allowed for a background-free measurements of the two-photon spectral shape. A number of advantages over conventional techniques lead to the ability for the first time to experimentally disentangle relativistic and non-relativistic theories with an excellent agreement to the first one.

  5. Transitioning to the Real World through Problem-Based Learning: A Collaborative Approach to Teacher Preparation (United States)

    Barron, Lisa; Wells, Lauren


    Problem-based learning (PBL) creates opportunities for authentic learning in teacher preparation programs. In addition to developing content knowledge and pedagogy, problem-based learning affords students the framework for a holistic, collaborative approach to solving several interconnected problems. As students move through the process of…

  6. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

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


    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...

  7. Stroke: First Aid (United States)

    First aid Stroke: First aid Stroke: First aid By Mayo Clinic Staff A stroke occurs when there's bleeding into your brain or when blood flow to your ... cells start dying. Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is ...

  8. Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa - A survey based approach. (United States)

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


    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.

  9. Adapting the Home After a Stroke (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  10. Search for magnetism in transition metal atoms doped tetragonal graphene: A DFT approach (United States)

    Chowdhury, Suman; Majumdar, Arnab; Jana, Debnarayan


    The discovery of different two-dimensional (2D) materials both theoretically and experimentally, can change the scenario of the current electronic industry because of their intriguing properties. Among the 2D materials, the first one which was discovered experimentally was graphene. In this work we have studied the electronic and magnetic properties of a new allotrope of disordered graphene, which is not hexagonal, rather possesses tetragonal symmetry known as T-graphene (TG). Density functional theory (DFT) has been thoroughly employed to study the relevant electronic properties. In previous works, it has been reported that pristine TG is non-magnetic. It is also known that, introducing transition metal (TM) atoms is a feasible way to control the electronic and magnetic properties. Here we have reported the relevant properties of four TM atoms i.e. Sc, V, Cr and Mn doped TG. From the defect formation energy study, it has been noticed that all the structures are endothermic in nature. For each case, we have found appreciable amount of magnetic moment. With increasing atomic weight of the dopant atom, the magnitude of the magnetic moment also increases. We have tried to explain this magnetic ordering with the help of spin-polarized partial density of states (PDOS). Controlling spin degrees of freedom is important for building spintronic devices. From that point of view, we hope this study will be useful to build TG based spintronic devices.

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

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


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

    Directory of Open Access Journals (Sweden)

    Ринат Гинаятович Рамазанов


    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.

  13. On the dynamics of liquids in their viscous regime approaching the glass transition. (United States)

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


    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.

  14. A molecular dynamics approach for predicting the glass transition temperature and plasticization effect in amorphous pharmaceuticals. (United States)

    Gupta, Jasmine; Nunes, Cletus; Jonnalagadda, Sriramakamal


    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.

  15. The impact of economic conditions on the disablement process: A Markov transition approach using SHARE data. (United States)

    Arrighi, Y; Rapp, T; Sirven, N


    A growing number of studies underline the relationship between socioeconomic status and health at older ages. Following that literature, we explore the impact of economic conditions on changes in functional health overtime. Frailty, a state of physiological instability, has been identified in the public health literature as a candidate for disability prevention but received little attention from health economists. Using SHARE panel data, respondents aged 50 and over from ten European countries were categorised as robust, frail and dependent. The determinants of health states' changes between two interviews were analysed using multinomial Probit models accounting for potential sample attrition. A particular focus was made on initial socioeconomic status, proxied by three alternative measures. Concentration indices were computed for key transition probabilities. Across Europe, poorer and less educated elders were substantially more likely to experience health degradations and also less likely to experience health improvements. The economic gradient for the recovery from frailty was steeper than that of frailty onset, but remained lower than that of dependency onset. The existing social programs in favour of deprived and dependent elders could be widened to those diagnosed as frail to reduce the onset of dependency and economic inequalities in health at older ages. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Mothers' and fathers' attachment and caregiving representations during transition to parenthood: an actor-partner approach. (United States)

    Fonseca, Ana; Nazaré, Bárbara; Canavarro, Maria Cristina


    This study aimed to investigate the effect of one's attachment representations on one's and the partner's caregiving representations. According to attachment theory, individual differences in parenting and caregiving behaviours may be a function of parents' caregiving representations of the self as caregiver, and of others as worthy of care, which are rooted on parents' attachment representations. Furthermore, the care-seeking and caregiving interactions that occur within the couple relationship may also shape individuals' caregiving representations. The sample comprised 286 cohabiting couples who were assessed during pregnancy (attachment representations) and one month post-birth (caregiving representations). Path analyses were used to examine effects among variables. Results showed that for mothers and fathers, their own more insecure attachment representations predicted their less positive caregiving representations of the self as caregiver and of others as worthy of help and more self-focused motivations for caregiving. Moreover, fathers' attachment representations were found to predict mothers' caregiving representations of themselves as caregivers. Secure attachment representations of both members of the couple seem to be an inner resource promoting parents' positive representations of caregiving, and should be assessed and fostered during the transition to parenthood in both members of the couple.

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

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


    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. Comparison of groundwater transit velocity estimates from flux theory and water table recession based approaches for solute transport. (United States)

    Rasiah, Velu; Armour, John David


    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.

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

    Directory of Open Access Journals (Sweden)

    O Popadynets


    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.

  20. Transition from Round to Shaped Implants in Immediate Breast Reconstruction: Our Preferred Approach and Clinical Outcomes. (United States)

    Imahiyerobo, Thomas A; Small, Kevin H; Sackeyfio, Robyn; Hoffman, Hannah; Talmor, Mia


    Smooth, round, silicone implants predominate device-based breast reconstruction in the USA; despite their prevalence, complications can include bottoming out, superior contour deformity, rippling, and/or lateral malposition. This complication profile increases the need for revision surgery and subsequent patient dissatisfaction. With the resurgence of shaped, textured, silicone implants in the USA, we report the senior author's success with these devices and outline a strategy to optimize outcomes in breast reconstruction surgery. A retrospective chart review was conducted on a prospectively collected IRB-approved database of nipple-sparing mastectomies (NSMs) with immediate breast reconstruction with smooth, round, silicone implants (Group A) in 2011 in comparison to textured, shaped, silicone implants (Group B) in 2012. Changes in operative technique were highlighted and extrapolated. Outcomes were reviewed. In Group A, 128 NSMs were performed in 76 patients. In Group B, 109 NSMs were performed in 59 patients. Thirteen percent of patients in Group A had direct to implant reconstruction as compared with 21% in Group B. Patients with textured, shaped implants were more likely to have acellular dermal matrix (61 vs 34%, p implants. Patients who had smooth, round implants were more likely to have postoperative nipple malposition (18 vs 0%, p implants had fewer operative revision reconstructions as compared with those with smooth, round implants (36.71 vs 12.8%, p < 0.0001) Based on these results, our technique has evolved and has eight key technical modifications. With a few adaptations in surgical technique, the transition to textured, shaped, silicone devices for breast reconstruction can be seamless with superior breast contour and reduced complications/revision rates. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the

  1. Principles of precision medicine in stroke. (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


    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

  2. A Comparison of Density Functional Theory with Ab initio Approaches for Systems Involving First Transition Row Metals (United States)

    Ricca, Alessandra; Bauschlicher, Charles W.; Langhoff, Stephen R. (Technical Monitor)


    Density functional theory (DFT) is found to give a better description of the geometries and vibrational frequencies of FeL and FeL(sup +) systems than second order Moller Plesset perturbation theory (MP2). Namely, the DFT correctly predicts the shift in the CO vibrational frequency between free CO and the Sigma(sup -) state of FeCO and yields a good result for the Fe-C distance in the quartet states of FeCH4(+) 4 These are properties where the MP2 results are unsatisfactory. Thus DFT appears to be an excellent approach for optimizing the geometries and computing the zero-point energies of systems containing first transition row atoms. Because the DFT approach is biased in favor of the 3d(exp 7) occupation, whereas the more traditional approaches are biased in favor of the 3d(exp 6) occupation, differences are found in the relative ordering of states. It is shown that if the dissociation is computed to the most appropriate atomic asymptote and corrected to the ground state asymptote using the experimental separations, the DFT results are in good agreement with high levels of theory. The energetics at the DFT level are much superior to the MP2 and in most cases in good agreement with high levels of theory.

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

    International Nuclear Information System (INIS)

    Maruyama, Tomoyuki; Tatsumi, Toshitaka


    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)

  4. Cost of stroke in France. (United States)

    Chevreul, K; Durand-Zaleski, I; Gouépo, A; Fery-Lemonnier, E; Hommel, M; Woimant, F


    A cost of illness study was undertaken on behalf of the French Ministry of Health to estimate the annual cost of stroke in France with the goal of better understanding the current economic burden so that improved strategies for care may be developed. Using primary data from exhaustive national databases and both top-down and bottom-up approaches, the stroke-related costs for healthcare, nursing care and lost productivity were estimated. The total healthcare cost of stroke patients in France in 2007 was €5.3 billion, 92% of which was borne by statutory health insurance. The average cost of incident cases was €16 686 per patient in the first year, while the annual cost of prevalent cases was a little less than half that amount (€8099). Nursing care costs were estimated at €2.4 billion. Lost productivity reached €255.9 million and that income loss for stroke patients was partially compensated by €63.3 million in social benefit payments. With healthcare costs representing 3% of total health expenditure in France, stroke constitutes an ongoing burden for the health system and overall economy. Nursing care added nearly half again the amount spent on healthcare, while productivity losses were more limited because nearly 80% of acute incident strokes were in patients over age 65. The high cost of illness underscores the need for improved prevention and interventions to limit the disabling effects of stroke. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

  5. Transition from an open-plan to a two-cot neonatal intensive care unit: a participatory action research approach. (United States)

    Broom, Margaret; Gardner, Anne; Kecskes, Zsuzsoka; Kildea, Sue


    To facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. In 2012, an Australian regional neonatal intensive care unit transitioned from an open-plan to a two-cot neonatal intensive care unit design. Research has reported single- and small-room neonatal intensive care unit design may negatively impact on the distances nurses walk, reducing the time they spend providing direct neonatal care. Studies have also reported nurses feel isolated and need additional support and education in such neonatal intensive care units. Staff highlighted their concerns regarding the impact of the new design on workflow and clinical practice. A participatory action research approach. A participatory action group titled the Change and Networking Group collaborated with staff over a four-year period (2009-2013) to facilitate the transition. The Change and Networking Group used a collaborative, cyclical process of planning, gathering data, taking action and reviewing the results to plan the next action. Data sources included meeting and workshop minutes, newsletters, feedback boards, subgroup reports and a staff satisfaction survey. The study findings include a description of (1) how the participatory action research cycles were used by the Change and Networking Group: providing examples of projects and strategies undertaken; and (2) evaluations of participatory action research methodology and Group by neonatal intensive care unit staff and Change and Networking members. This study has described the benefits of using participatory action research to facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. Participatory action research methodology enabled the inclusion of staff to find solutions to design and clinical practice questions. Future research is required to assess the long-term effect of neonatal intensive care unit design on staff workload, maintaining and supporting a skilled workforce as well as

  6. Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study. (United States)

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


    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.

  7. Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: a comparative effectiveness before and after model.

    Directory of Open Access Journals (Sweden)

    Rachael Maree Hunter

    Full Text Available BACKGROUND: In July 2010 a new multiple hub-and-spoke model for acute stroke care was implemented across the whole of London, UK, with continuous specialist care during the first 72 hours provided at 8 hyper-acute stroke units (HASUs compared to the previous model of 30 local hospitals receiving acute stroke patients. We investigated differences in clinical outcomes and costs between the new and old models. METHODS: We compared outcomes and costs 'before' (July 2007-July 2008 vs. 'after' (July 2010-June 2011 the introduction of the new model, adjusted for patient characteristics and national time trends in mortality and length of stay. We constructed 90-day and 10-year decision analytic models using data from population based stroke registers, audits and published sources. Mortality and length of stay were modelled using survival analysis. FINDINGS: In a pooled sample of 307 patients 'before' and 3156 patients 'after', survival improved in the 'after' period (age adjusted hazard ratio 0.54; 95% CI 0.41-0.72. The predicted survival rates at 90 days in the deterministic model adjusted for national trends were 87.2% 'before' % (95% CI 86.7%-87.7% and 88.7% 'after' (95% CI 88.6%-88.8%; a relative reduction in deaths of 12% (95% CI 8%-16%. Based on a cohort of 6,438 stroke patients, the model produces a total cost saving of £5.2 million per year at 90 days (95% CI £4.9-£5.5 million; £811 per patient. CONCLUSION: A centralized model for acute stroke care across an entire metropolitan city appears to have reduced mortality for a reduced cost per patient, predominately as a result of reduced hospital length of stay.

  8. Energy and lysine requirements and balances of sows during transition and lactation: A factorial approach

    DEFF Research Database (Denmark)

    Feyera, Takele; Theil, Peter Kappel


    This study aimed to quantify daily requirements for metabolizable energy (ME) and standard ileal digestible (SID) lysine in late gestating and lactating sows using a factorial approach. Metabolizable energy and SID lysine required for fetal and mammary growth, colostrum and milk production, uterine...... components (including uterus wall, placenta and membrane fluids) and maintenance were estimated. It was estimated that maintenance, additional heat loss, colostrum production, fetal growth, mammary growth and uterine components accounted for 66.8%, 19.3%, 7.2%, 5.0%, 1.3% and 0.5% of total ME requirements......, respectively, in the last 12 days of gestation. Oxidation/transamination, fetal growth, mammary growth, colostrum production, maintenance and uterine components were estimated to account for 29.5%, 22.7%, 16.8%, 16.1%, 10.4% and 4.5% of total SID lysine requirements, respectively, in the last 12 days...

  9. Airplane stroke syndrome. (United States)

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


    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.

  10. Acute stroke: automatic perfusion lesion outlining using level sets. (United States)

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


    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. RSNA, 2013

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

    Directory of Open Access Journals (Sweden)

    Petrişor Alexandru-Ionuţ


    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..

  12. Risks for Heart Disease & Stroke (United States)

    ... Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and strokes ... the Centers for Disease Control and Prevention: Heart Disease Stroke High Blood Pressure Cholesterol Salt Video: Know Your ...

  13. Transition from failing dentition to complete-arch implant rehabilitation with a staged approach: a 3-year clinical report. (United States)

    Papaspyridakos, Panos; Chronopoulos, Vasilios


    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.

  14. Teaching Animal Physiology: a 12-year experience transitioning from a classical to interactive approach with continual assessment and computer alternatives. (United States)

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


    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.

  15. [Ischemic stroke in the young adult]. (United States)

    Calvet, D


    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.

  16. Stroke Management: An Emerging Role of Nanotechnology

    Directory of Open Access Journals (Sweden)

    Deepaneeta Sarmah


    Full Text Available Stroke is among the leading causes of mortality and morbidity worldwide. Stroke incidences and associated mortality are expected to rise to 23 million and 7.8 million, respectively, by 2030. Further, the aging population, imbalanced lifestyles, and environmental factors continue to shift the rate of stroke incidence, particularly in developing countries. There is an urgent need to develop new therapeutic approaches for treating stroke. Nanotechnology is a growing field, offering an encouraging future prospect for medical research in the management of strokes. The world market for nanotechnology derived products is expected to rise manyfold in the coming decades. Different types of nanomaterials such as perfluorocarbon nanoparticles, iron oxide nanoparticles, gold nanoparticles, polymeric nanoparticles, quantum dots, nanospheres, etc. have been developed for the diagnosis as well as therapy of strokes. Today, nanotechnology has also been integrated with stem cell therapy for treating stroke. However several obstacles remain to be overcome when using such nanomaterials for treating stroke and other neurological diseases.

  17. The European Stroke Organisation Guidelines: a standard operating procedure. (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


    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

  18. Test Your Stroke Knowledge (United States)

    ... 9-1-1. Which of the following are risk factors for stroke? High blood pressure Heart disease Smoking High cholesterol Diabetes Show Answer All of these are risk factors for stroke. If you smoke - quit. If you have high ...

  19. Heart and Stroke Encyclopedia (United States)

    ... Thromboembolism Aortic Aneurysm More The Heart and Stroke Encyclopedia Click a letter below to get a brief ... of cardiovascular terms from our Heart and Stroke Encyclopedia and get links to in-depth information. A ...

  20. Stroke Connection Magazine (United States)

    ... Resources Submit A Story Edit Module Show Tags Stroke Rehabilitation Two-Part Series Making the Best Decisions at ... first part of a two-part series on stroke rehab, we offer guidance for the decision-making process ...

  1. Stroke (For Kids) (United States)

    ... your friend. Being around friends can help with healing. Preventing Strokes Some strokes can be prevented in ... Why Does Hair Turn Gray? What Are Wrinkles? Alzheimer Disease Your Brain & Nervous System Why Exercise Is ...

  2. Stroke Trials Registry (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...

  3. Renal Function Predicts Outcomes in Patients with Ischaemic Stroke and Haemorrhagic Stroke. (United States)

    Snarska, Katarzyna; Kapica-Topczewska, Katarzyna; Bachórzewska-Gajewska, Hanna; Małyszko, Jolanta


    We evaluated renal function and the impact of renal function on in-hospital outcomes in patients with ischaemic and haemorrhagic stroke. We collected data from 766 patients with stroke; 637 (83.2 %) with ischaemic and 129 with haemorrhagic one. The mean serum creatinine on admission in patients with both types of stroke, who died, was significantly higher than in those who survived. Multivariate analysis showed that independent predictors of mortality in patients with ischaemic stroke were: ischemic heart disease or prior myocardial infarction, diabetes, admission glucose and eGFR on admission. Also, multivariate analysis showed that independent predictors of mortality in patients with haemorrhagic stroke were: age and admission glucose. Patients with haemorrhagic stroke, in particular with acute kidney injury during hospitalisation had significantly worse outcomes than patients with ischaemic stroke. Assessment of kidney function is prerequisite to employ the necessary measures to decrease the risk of in-hospital mortality among patients with acute stroke. Appropriate approach to patients with renal dysfunction (adequate hydration, avoidance of nephrotoxic drugs, drug dose adjustment etc) should be considered as preventive and therapeutic strategies in the management of acute stroke. © 2016 The Author(s) Published by S. Karger AG, Basel.

  4. [Genetics of ischemic stroke]. (United States)

    Gschwendtner, A; Dichgans, M


    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.

  5. Hemorrhagic Stroke in Children


    Jordan M.D., Lori C.; Hillis M.D., Argye E.


    Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research ...

  6. Social Work Intervention Focused on Transitions (United States)


    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

  7. Back Disorder Intervention Strategies for Mass Transit Operators Exposed to Whole-Body VIBRATION—COMPARISON of Two Transit System Approaches and Practices (United States)

    Johanning, E.


    Occupational long-term whole-body vibration (WBV) has been recognized as a major risk factor for low back disorders, one of the most important reasons for medical impairment and early permanent disability among mass transit operators. Although no firm health and safety vibration exposure threshold limits have been established, the available data suggests that rail vehicle operators would probably fall under the proposed WBV “action levels” of the EU directive provisions for protection from physical hazards. This provision calls for technical, administrative and medical controls. This paper examines and compares the current conditions, provisions and plans of two major mass transit systems, the New Yorker MTA and the Munich MVV. The available data, information and publications (English/German) on working conditions, vibration exposure, epidemiology and intervention strategies (primary and secondary prevention) for rail bound mass transit workers were reviewed. Results strongly suggest that the MTA transit system has currently and in the near future no effective and meaningful controls in place to significantly reduce the WBV exposure of subway operators. It appears that the MVV system has more and better control measures in place to reduce harmful effects of WBV. Results of a scientific evaluation of a participatory, collaborative project in the MVV system suggest that the MVV may have developed a successful method of a “condition prevention” (Verhältnisprävention)—and “behavioral prevention” (Verhaltensprävention) intervention strategy, which appears beneficial for WBV exposed workers with existing low back pain. Long-term outcomes and benefits need to be assessed further.

  8. Unscrambling the egg: A muddled path to a holistic, coherent and integrated institution wide approach to first year student transition. A Practice Report

    Directory of Open Access Journals (Sweden)

    Betty Gill


    Full Text Available A Third Generation approach to the first year experience and transition is widely recognised as essential and current best practice. However the significant challenges to institutions in achieving such an approach is broadly acknowledged. This Practice Report outlines the beginning attempts of one institution to recognise such a goal, and is designed to seek input and insight from workshop participants on proven strategies to progress this goal.

  9. 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.


    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,

  10. Aetiological blood biomarkers of ischaemic stroke. (United States)

    Sonderer, Julian; Katan Kahles, Mira


    Each year, over 5 million people die worldwide from stroke, and at least every sixth patient who survives will experience another stroke within five years [1]. We are therefore eager to advance early and rapid diagnosis, prognosis and optimal risk stratification, as well as secondary prevention. In this context, blood biomarkers may improve patient care, as they have already done in other fields in the past, for example, troponin T/I in patients with heart attacks, natriuretic peptides in patients with heart failure or PCT (procalcitonin) [2] in patients with pneumonia. In the setting of acute stroke, a blood biomarker can be any quantifiable entity that reflects the manifestation of a stroke-related process. The most fruitful implementation of stroke biomarkers is in areas where information from traditional clinical sources is limited. There may be markers, for example, to guide risk stratification, reveal stroke aetiology, identify patients who may benefit most from interventions, monitor treatment efficacy, and recognise the risk of short-term complications or unfavourable long-term outcomes. For this review we focus on blood biomarkers that could help distinguish the underlying aetiology of an ischaemic stroke. Stroke tends to be a much more heterogeneous condition than ischaemic heart disease, which is caused by atherosclerosis in the vast majority of cases. Causes of stroke include small and large vessel disease, cardioembolism, dissections, and rare vasculo- and coagulopathies, among others. Because of this heterogeneity among stroke patients, it is clear that a monolithic approach to stroke prevention or secondary prevention is not warranted. Aetiological classification is important specifically because prognosis, risk of recurrence and management options differ greatly between aetiological subtypes. Considering that today up to 30% of stroke patients still cannot be classified into a specific subtype [3], the ability to improve aetiological classification

  11. 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


    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)

  12. Combination treatment of low-frequency rTMS and occupational therapy with levodopa administration: an intensive neurorehabilitative approach for upper limb hemiparesis after stroke. (United States)

    Kakuda, Wataru; Abo, Masahiro; Kobayashi, Kazushige; Momosaki, Ryo; Yokoi, Aki; Fukuda, Akiko; Ito, Hiroshi; Tominaga, Ayumi


    The combination treatment of low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy was applied with concomitant oral administration of levodopa in five post-stroke patients with upper limb hemiparesis (age at treatment: 56-66 years; interval between onset of stroke and treatment: 18-143 months) as a 15-day inpatient protocol. Daily levodopa administration of 100 mg was initiated 1 week before admission and continued until 4 weeks after discharge. Low-frequency rTMS of 1 Hz was applied to the contralesional hemisphere for 40 min daily (two 20-min sessions) combined with intensive occupational therapy consisting of 60-min one-on-one training and 60-min self-exercise. Motor function of the affected upper limb was serially evaluated with the Fugl-Meyer Assessment and the Wolf Motor Function Test. At the end of the treatment, all patients showed improved motor function in the affected upper limbs. In some patients, the improvement was maintained until 4 weeks after discharge. No patient showed any adverse effect from the intervention. Our proposed protocol featuring levodopa administration, low-frequency rTMS, and intensive occupational therapy could provide a safe and feasible intervention for upper limb hemiparesis after stroke.

  13. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

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


    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...

  14. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D


    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.

  15. Registration of acute stroke

    DEFF Research Database (Denmark)

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


    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...

  16. Sleep and Stroke

    Directory of Open Access Journals (Sweden)

    M V Padma Srivastav


    Full Text Available Circadian variations in conjunction with sleep-related heart rhythm changes and sleepdisordered breathing (SDB are contributing risk factors for stroke. Strong scientificevidence now exists indicating that SDB contributes to systemic hypertension, aprominent risk factor for stroke, and compelling circumstantial evidence is presentsuggesting that SDB raises the risk for development of stroke through other circulatorymechanisms as well. Preliminary evidence indicates that post-stroke patients have ahigher prevalence of SDB, which is likely to compromise their rehabilitation outcomes.Since SDB is modifiable with the application of CPAP and other treatment modalities,there is practical value in investigating patients at risk of stroke or post stroke forpresence of SDB. Successful application of CPAP or BiPAP therapy may improve theoutcome in both instances.Key words : Sleep, Stroke, SDB, CPAP

  17. A fourth generation approach to transition in the first year in higher education: First year in higher education community of practice (FYHECoP

    Directory of Open Access Journals (Sweden)

    Sorrel Penn-Edwards


    Full Text Available We  propose that higher education institutions move beyond the third generation approach to transition pedagogy (Kift, Nelson, & Clarke, 2010 to a fourth generation approach. We argue that higher education institutions are, as Abraham Lincoln extols, of the people, by the people, for the people and that all major stakeholders:  educationalists; social groups; and civic bodies should be involved in supporting the transition of the higher education first year student. We suggest that university-community partnerships, specifically, those involving the wider social/civic community, have an integral part to play at each point in the progression of the student through undergraduate studies. Our fourth generation approach extends Kift’s (2008 exhortation that the first year experience is “everybody’s business” by being characterised and driven by a social and civic “community of practice” (Wenger, 1998.

  18. The Relationship between Positive Development and Psychopathology during the Transition to Adulthood: A Person-Centred Approach (United States)

    O'Connor, Meredith; Sanson, Ann; Hawkins, Mary T.; Olsson, Craig; Frydenberg, Erica; Toumbourou, John W.; Letcher, Primrose


    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…

  19. The Academic Spin-Offs as an Engine of Economic Transition in Eastern Europe. A Path-Dependent Approach (United States)

    Tchalakov, Ivan; Mitev, Tihomir; Petrov, Venelin


    The paper questions some of the premises in studying academic spin-offs in developed countries, claiming that when taken as characteristics of "academic spin-offs per se," they are of little help in understanding the phenomenon in the Eastern European countries during the transitional and post-transitional periods after 1989. It argues…

  20. Rehabilitation of a patient with stroke

    Directory of Open Access Journals (Sweden)

    Apurba Barman


    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.

  1. Numerical investigation of the behavior of approach slabs in transition zone of ballasted track to box culvert in high-speed railway lines

    Directory of Open Access Journals (Sweden)

    Morteza Esmaeili


    Full Text Available One of the most important issues in operation of high-speed railway tracks is avoiding to sudden variation of the track stiffness. Culverts and bridges are common areas which this problem is occurred along the railway lines. One of the method for applying the gradual variation of the track stiffness in these areas is using the approach slabs in transition zone. Therefore, in this research it has attempted to study this problem using numerical simulation. In this regard, a typical culvert of Tehran-Qom-Esfahan high-speed railway line with 6.6 m length was simulated. Then for studying the effect of transition zones, an approach slab includes of three parts with 6m length and various thicknesses simulated by FE model. In this model the ballasted track and its components such as railpads, sleepers, ballast and subgrade were modeled as lumped mass-dashpot-spring systems and the rails, approach slabs and culvert were modeled by Euler-Bernoulli beam elements. Then the dynamic behavior of the transition zone investigated under the passing of the moving loads same as the axle loads of the ICE high speed train. In this matter a series of sensitivity analyses were carried out on some parameters such as vehicle speed, approach slab thickness as well as damping and stiffness of track. Consequently, the achieved results show that the increasing of damping and stiffness of the track cause to the ballast forces increased and in other side it causes to the acceleration and settlement of the ballasted track and the approach slabs decreased. These aforementioned effects are more obvious in damping values higher than 200 kN.sec/m and the track stiffness values in the range of 120 MN/m to 180 MN/m. Moreover, it was understood that increasing the approach slabs thickness has remarkable effect on improving the dynamic behavior of the transition zone especially in speeds more than 340 km/hr.

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


    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.

  3. Coordination of IVI and transit signal priority on transit evacuations. (United States)


    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...

  4. Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS: diagnostic criteria, features of epileptic seizures, and treatment approaches by the example of a clinical case

    Directory of Open Access Journals (Sweden)

    M. A. Yamin


    Full Text Available The paper describes a patient with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS. The features of  the course and therapy of epilepsy in MELAS are discussed. The disease  is known for its late diagnosis when years elapse from the onset of the  clinical manifestations to diagnosis. The paper presents clinical criteria  for the diagnosis of MELAS and the specific features of brain neuroimaging changes that allow identification of the disease at an early stage.

  5. Stroke in Commercial Flights. (United States)

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


    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.

  6. Stroke And Substance Abuse

    Directory of Open Access Journals (Sweden)

    A Chitsaz


    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

  7. Geology of the Terra Cimmeria-Utopia Planitia Highland Lowland Transitional Zone: Final Technical Approach and Scientific Results (United States)

    Skinner, J. A., Jr.; Tanaka, K. L.


    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.

  8. Challenges in building interpersonal care in organized hospital stroke units: The perspectives of stroke survivors, family caregivers and the multidisciplinary team. (United States)

    Ryan, Tony; Harrison, Madeleine; Gardiner, Clare; Jones, Amanda


    To explore the organized stroke unit experience from the multiple perspectives of stroke survivor, family carer and the multi-disciplinary team. Organized stroke unit care reduces morbidity, mortality and institutionalization and is promoted globally as the most effective form of acute and postacute provision. Little research has focused on how care is experienced in this setting from the perspectives of those who receive and provide care. This study used a qualitative approach, employing Framework Analysis. This methodology allows for a flexible approach to data collection and a comprehensive and systematic method of analysis. Semi-structured interviews were undertaken during 2011 and 2012 with former stroke unit stroke survivors, family carers and senior stroke physicians. In addition, eight focus groups were conducted with members of the multi-disciplinary team. One hundred and twenty-five participants were recruited. Three key themes were identified across all data sets. First, two important processes are described: responses to the impact of stroke and seeking information and stroke-specific knowledge. These are underpinned by a third theme: the challenge in building relationships in organized stroke unit care. Stroke unit care provides satisfaction for stroke survivors, particularly in relation to highly specialized medical and nursing care and therapy. It is proposed that moves towards organized stroke unit care, particularly with the emphasis on reduction of length of stay and a focus on hyper-acute models, have implications for interpersonal care practices and the sharing of stroke-specific knowledge. © 2017 John Wiley & Sons Ltd.

  9. Sequential strokes in a hyperacute stroke unit. (United States)

    Ganesalingam, Jeban; Buddha, Sandeep; Carlton-Jones, Anoma L; Nicholas, Richard


    Vasculitis is a rare, but treatable condition that can present to hyperacute stroke units. Thrombolysis does not treat the underlying pathology, and a rapidly evolving clinical picture drives clinical decision often before all the investigation results are available.

  10. Perlecan domain V therapy for stroke: a beacon of hope? (United States)

    Bix, Gregory J


    The sad reality is that in the year 2012, people are still dying or suffering from the extreme morbidity of ischemic stroke. This tragedy is only compounded by the graveyard full of once promising new therapies. While it is indeed true that the overall mortality from stroke has declined in the United States, perhaps due to increased awareness of stroke symptoms by both the lay public and physicians, it is clear that better therapies are needed. In this regard, progress has been tremendously slowed by the simple fact that experimental models of stroke and the animals that they typically employ, rats and mice, do not adequately represent human stroke. Furthermore, the neuroprotective therapeutic approach, in which potential treatments are administered with the hope of preventing the spread of dying neurons that accompanies a stroke, typically fail for a number of reasons such as there is simply more brain matter to protect in a human than there is in a rodent! For this reason, there has been somewhat of a shift in stroke research away from neuroprotection and toward a neurorepair approach. This too may be problematic in that agents that might foster brain repair could be acutely deleterious or neurotoxic and vice versa, making the timing of treatment administration after stroke critical. Therefore, in our efforts to discover a new stroke therapy, we decided to focus on identifying brain repair elements that were (1) endogenously and actively generated in response to stroke in both human and experimental animal brains, (2) present acutely and chronically after ischemic stroke, suggesting that they could have a role in acute neuroprotection and chronic neurorepair, and (3) able to be administered peripherally and reach the site of stroke brain injury. In this review, I will discuss the evidence that suggests that perlecan domain V may be just that substance, a potential beacon of hope for stroke patients.

  11. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener


    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.

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


    Grace Vincent-Onabajo; Taritei Moses


    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...

  13. European Stroke Science Workshop (United States)

    Mattle, Heinrich P.; Brainin, Michael; Chamorro, Angel; Diener, Hans Christoph; Hacke, Werner; Leys, Didier; Norrving, Bo; Ward, Nick


    The European Stroke Organisation (ESO) held its first European Stroke Science Workshop in Garmisch-Partenkirchen, Germany (15-17 December 2011). Stroke experts based in Europe were invited to present and discuss their current research. The scope of the workshop was to review the most recent findings of selected topics in stroke, to exchange ideas, to stimulate new research and to enhance collaboration between European stroke research groups. Seven scientific sessions were held, each starting with a keynote lecture to review the state of the art of the given topic, followed by 4 or 5 short presentations by experts. They were asked to limit their presentations to 10 slides containing only recent information. The meeting was organized by the executive committee of the ESO (Heinrich Mattle, chairman, Michael Brainin, Angel Chamorro, Werner Hacke, Didier Leys) and supported by the European Stroke Conference (Michael Hennerici). In this article we summarize the main contents of this successful workshop. PMID:22836350

  14. 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

  15. Dysphagia Post Subcortical and Supratentorial Stroke. (United States)

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


    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. 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.


    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

  17. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj


    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 ...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....

  18. Acupuncture for acute stroke. (United States)

    Xu, Mangmang; Li, Dan; Zhang, Shihong


    Sensory stimulation via acupuncture has been reported to alter activities of numerous neural systems by activating multiple efferent pathways. Acupuncture, one of the main physical therapies in Traditional Chinese Medicine, has been widely used to treat patients with stroke for over hundreds of years. This is the first update of the Cochrane Review originally published in 2005. To assess whether acupuncture could reduce the proportion of people with death or dependency, while improving quality of life, after acute ischemic or hemorrhagic stroke. We searched the Cochrane Stroke Group trials register (last searched on February 2, 2017), the Cochrane Central Register of Controlled Trials Ovid (CENTRAL Ovid; 2017, Issue 2) in the Cochrane Library, MEDLINE Ovid (1946 to February 2017), Embase Ovid (1974 to February 2017), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO (1982 to February 2017), the Allied and Complementary Medicine Database (AMED; 1985 to February 2017), China Academic Journal Network Publishing Database (1998 to February 2017), and the VIP database (VIP Chinese Science Journal Evaluation Reports; 1989 to February 2017). We also identified relevant trials in the Chinese Clinical Trial Registry (last searched on Feburuary 20, 2017), the World Health Organization (WHO) International Clinical Trials Registry Platform (last searched on April 30, 2017), and (last searched on April 30, 2017). In addition, we handsearched the reference lists of systematic reviews and relevant clinical trials. We sought randomized clinical trials (RCTs) of acupuncture started within 30 days from stroke onset compared with placebo or sham acupuncture or open control (no placebo) in people with acute ischemic or hemorrhagic stroke, or both. Needling into the skin was required for acupuncture. Comparisons were made versus (1) all controls (open control or sham acupuncture), and (2) sham acupuncture controls. Two review authors applied

  19. 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


    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

  20. Patients' Experiences of Disruptions Associated with Post-Stroke Dysarthria (United States)

    Dickson, Sylvia; Barbour, Rosaline S.; Brady, Marian; Clark, Alexander M.; Paton, Gillian


    Background: Post-stroke dysarthria rehabilitation should consider social participation for people with dysarthria, but before this approach can be adopted, an understanding of the psychosocial impact of dysarthria is required. Despite the prevalence of dysarthria as a result of stroke, there is a paucity of research into this communication…

  1. Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients (United States)

    Wintermark, Max; Sanelli, Pina C.; Albers, Gregory W.; Bello, Jacqueline A.; Derdeyn, Colin P.; Hetts, Steven W.; Johnson, Michele H.; Kidwell, Chelsea S.; Lev, Michael H.; Liebeskind, David S.; Rowley, Howard A.; Schaefer, Pamela W.; Sunshine, Jeffrey L.; Zaharchuk, Greg; Meltzer, Carolyn C.


    In the article entitled “Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients: A Joint Statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery”, we are proposing a simple, pragmatic approach that will allow the reader to develop an optimal imaging algorithm for stroke patients at their institution. PMID:23948676

  2. 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


    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.

  3. Workup for Perinatal Stroke Does Not Predict Recurrence. (United States)

    Lehman, Laura L; Beaute, Jeanette; Kapur, Kush; Danehy, Amy R; Bernson-Leung, Miya E; Malkin, Hayley; Rivkin, Michael J; Trenor, Cameron C


    Perinatal stroke, including neonatal and presumed perinatal presentation, represents the age in childhood in which stroke occurs most frequently. The roles of thrombophilia, arteriopathy, and cardiac anomalies in perinatal ischemic stroke are currently unclear. We took a uniform approach to perinatal ischemic stroke evaluation to study these risk factors and their association with recurrent stroke. We reviewed records of perinatal stroke patients evaluated from August 2008 to February 2016 at a single referral center. Demographics, echocardiography, arterial imaging, and thrombophilia testing were collected. Statistical analysis was performed using Fisher exact test. Across 215 cases, the median follow-up was 3.17 years (1.49, 6.46). Females comprised 42.8% of cases. Age of presentation was neonatal (110, 51.2%) or presumed perinatal (105, 48.8%). The median age at diagnosis was 2.9 days (interquartile range, 2.0-9.9) for neonatal stroke and 12.9 months (interquartile range, 8.7-32.8) for presumed perinatal stroke. Strokes were classified as arterial (149, 69.3%), venous (60, 27.9%), both (4, 1.9%), or uncertain (2, 0.9%) by consensus imaging review. Of the 215 cases, there were 6 (2.8%) recurrent ischemic cerebrovascular events. Abnormal thrombophilia testing was not associated with recurrent stroke, except for a single patient with combined antithrombin deficiency and protein C deficiency. After excluding venous events, 155 patients were evaluated for arteriopathy and cardioembolic risk factors; neither was associated with recurrent stroke. Positive family history of thrombosis was not predictive of abnormal thrombophilia testing. Thrombophilia, arteriopathy, or cardioembolic risk factors were not predictive of recurrent events after perinatal stroke. Thrombophilia evaluation in perinatal stroke should only rarely be considered. © 2017 American Heart Association, Inc.

  4. Stroke treatment in Stroke Unit: from scientific evidences to clinical practice

    Directory of Open Access Journals (Sweden)

    Michele Stornello


    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.

  5. Phase transitions in Bose-Fermi-Hubbard model in the heavy fermion limit: Hard-core boson approach

    Directory of Open Access Journals (Sweden)

    I.V. Stasyuk


    Full Text Available Phase transitions are investigated in the Bose-Fermi-Hubbard model in the mean field and hard-core boson approximations for the case of infinitely small fermion transfer and repulsive on-site boson-fermion interaction. The behavior of the Bose-Einstein condensate order parameter and grand canonical potential is analyzed as functions of the chemical potential of bosons at zero temperature. The possibility of change of order of the phase transition to the superfluid phase in the regime of fixed values of the chemical potentials of Bose- and Fermi-particles is established. The relevant phase diagrams are built.

  6. Microwave stability at transition

    International Nuclear Information System (INIS)

    Holt, J.A.; Colestock, P.L.


    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

  7. Relational Processing Following Stroke (United States)

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


    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…

  8. National Stroke Association (United States)

    ... Event Join a Stroke Challenge Team Comeback Trail Tell Your Story Community Presentations Faces of Stroke Volunteer With Us ... in a video presentation. Watch Video ... to feel the right side of her body. Kathryn’s friends performed the FAST exam and soon ...

  9. Diagnostic neuroimaging in stroke

    International Nuclear Information System (INIS)

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


    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

  10. The Optimal Golf Stroke

    DEFF Research Database (Denmark)

    Buchinger, Mikael; Durigen, Susan; Dahl, Johan Rambech


    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 the golf stroke of a professional golfer....

  11. Case Study of physioterapy treatment of a patient after hemoragic stroke with left hemiparesis


    Formánková, Dita


    Title: Case study of physioterapy treatment of a patient after hemoragic stroke with left hemiparesis. Objectives: The aim of the thesis is to obtain academic findings about stroke concerning anatomy, pathology, therapetuic approaches and methods which can be utilised in cases of stroke. The specific part focuses on the therapeutic care of a patient after hemorragic stroke which was taken during a month practice at Rehabilitation clinic Malvazinky, Medditera s.r.o. Summary: The theory of the ...

  12. Case study of physioterapy treatment of patient after hemoragic stroke with left hemiparesis


    Waldmann, Tadeáš


    Title: Case study of physioterapy treatment of a patient after hemoragic stroke with left hemiparesis. Objectives: The aim of the thesis is to obtain academic findings about stroke concerning anatomy, pathology, therapetuic approaches and methods which can be utilised in cases of stroke. The specific part focuses on the therapeutic care of a patient after hemorragic stroke which was taken during a month practice at Regional hospital Kladno Spa Summary: The theory of the thesis discusses anato...

  13. Transitional Challenges Faced by Post-Secondary International Students and Approaches for Their Successful Inclusion in Classrooms (United States)

    Xu, Lichan


    As the number of international students in post-secondary education institutions in Canada and the United States continues to increase substantially, much scholarly attention is being paid to the wide variety of transitional challenges that international students face. At the same time frequent controversial conversations are occurring about…

  14. Generalized Sturmian approach to extracting transition amplitudes for two-photon ionization of atoms by electromagnetic pulses

    International Nuclear Information System (INIS)

    Gómez, A I; Gasaneo, G; Mitnik, D M


    In this work we present the application of the Generalized Sturmian basis to the process of photonionization by an electromagnetic pulse in the framework of a perturbation theory. The Generalized Sturmian basis have the proper asymptotic behavior allowing us to extract the transition amplitudes directly from the coefficients of expansion. (paper)

  15. 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.


    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

  16. Acute ischemic stroke update. (United States)

    Baldwin, Kathleen; Orr, Sean; Briand, Mary; Piazza, Carolyn; Veydt, Annita; McCoy, Stacey


    Stroke is the third most common cause of death in the United States and is the number one cause of long-term disability. Legislative mandates, largely the result of the American Heart Association, American Stroke Association, and Brain Attack Coalition working cooperatively, have resulted in nationwide standardization of care for patients who experience a stroke. Transport to a skilled facility that can provide optimal care, including immediate treatment to halt or reverse the damage caused by stroke, must occur swiftly. Admission to a certified stroke center is recommended for improving outcomes. Most strokes are ischemic in nature. Acute ischemic stroke is a heterogeneous group of vascular diseases, which makes targeted treatment challenging. To provide a thorough review of the literature since the 2007 acute ischemic stroke guidelines were developed, we performed a search of the MEDLINE database (January 1, 2004-July 1, 2009) for relevant English-language studies. Results (through July 1, 2009) from clinical trials included in the Internet Stroke Center registry were also accessed. Results from several pivotal studies have contributed to our knowledge of stroke. Additional data support the efficacy and safety of intravenous alteplase, the standard of care for acute ischemic stroke since 1995. Due to these study results, the American Stroke Association changed its recommendation to extend the time window for administration of intravenous alteplase from within 3 hours to 4.5 hours of symptom onset; this recommendation enables many more patients to receive the drug. Other findings included clinically useful biomarkers, the role of inflammation and infection, an expanded role for placement of intracranial stents, a reduced role for urgent carotid endarterectomy, alternative treatments for large-vessel disease, identification of nontraditional risk factors, including risk factors for women, and newly published pediatric stroke guidelines. In addition, new devices for

  17. The Danish Stroke Registry

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager


    AIM OF DATABASE: The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. STUDY POPULATION: All patients with acute stroke (from 2003) or TIA (from 2013) treated...... at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. MAIN VARIABLES: The registry holds prospectively collected data on key processes...... of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients...

  18. Stroke mimic diagnoses presenting to a hyperacute stroke unit. (United States)

    Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J


    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.

  19. 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 ...

  20. Perception of stroke among patients with stroke | Ajayi | Nigerian ...

    African Journals Online (AJOL)

    The perception of patients to stroke is variable. The aim of this study was to determine the perception of stroke among stroke patients. The study was carried out between January 2004 - December 2004 on all the patients presenting with features of stroke at the Federal Medical Center Ido, Nigeria. Data were collected by ...

  1. Cerebrorenal interaction and stroke. (United States)

    Toyoda, Kazunori


    Beyond the original meaning of chronic kidney disease (CKD) as high-risk state for future dialysis, CKD is now known as an established risk factor for cardiovascular diseases. Stroke is a major player of cardiovascular disease and has deep two-way relationships with CKD. CKD is an evident risk factor for stroke. Meta-analyses of cohort studies and trials indicate that proteinuria/albuminuria increases the risk of stroke by 71-92%, and reduced glomerular filtration rate increases the risk by 43%. In addition, CKD has a strong relationship with subclinical brain damage including white matter changes, microbleeds, cognitive impairment, and carotid atherosclerosis. CKD is prevalent in acute stroke patients; patients with estimated glomerular filtration rate stroke patients and 39% of total intracerebral hemorrhage patients in our institute. Acute and chronic management of stroke are influenced by CKD. Therapeutic effects of several antithrombotic and thrombolytic agents, including recently-developed novel oral anticoagulants, are affected by renal function. Moreover, reduced glomerular filtration rate is independently associated with increased 1- and 10-year mortalities in the end. Stroke also has deep relationships with end-stage kidney disease. Stroke occurs much more commonly in dialysis patients than general population or CKD patients without need for dialysis. The triggers of ischemic and hemorrhagic stroke in patients with end-stage kidney disease include special characteristics unique to dialysis, such as drastic hemodynamic change, dialysate and anticoagulants, and vascular calcification. As cohorts of dialysis patients become older, more hypertensive, and more diabetic than before, stroke become more prevalent and more serious events in dialysis clinics. Now, clinicians should have much interest in the association between CKD and cerebrovascular diseases, so-called the cerebro-renal interaction. Copyright © 2013 S. Karger AG, Basel.

  2. Communication disorders after stroke in Aboriginal Australians. (United States)

    Armstrong, Elizabeth; Hersh, Deborah; Hayward, Colleen; Fraser, Joan


    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

  3. Cognitive impairment and stroke in elderly patients

    Directory of Open Access Journals (Sweden)

    Lo Coco D


    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

  4. Effects of magma and conduit conditions on transitions between effusive and explosive activity: a numerical modeling approach (United States)

    Carr, B. B.; De'Michieli Vitturi, M.; Clarke, A. B.; Voight, B.


    Transitions between effusive and explosive eruptions, common at silicic volcanoes, can occur between distinct eruptive episodes or can occur as changes between effusive and explosive phases within a single episode. The precise causes of these transitions are difficult to determine due to the multitude of mechanisms and variables that can influence fragmentation thresholds. Numerical modeling of magma ascent within a volcanic conduit allows the influence of key variables to be extensively tested. We study the effect of different variables on the mass eruption rate at the vent using a conservative, 1-D, two-phase, steady-state model that allows for lateral gas loss at shallow depths. Several fragmentation criteria are also tested. We are able to generate a number of regime diagrams for a variety of magma and conduit conditions that constrain transitions from effusive to explosive episodes. We show that a transition to explosive activity can occur without changes in the bulk chemistry, crystal volume fraction, or gas mass fraction of the magma. Eruptive style can be controlled by the pressure gradient within the conduit caused by either overpressure in the chamber or varying lava dome size at the vent. Specific results are sensitive to both magma temperature and conduit geometry. It is important that these variables are well constrained when applying this model to different volcanic systems. We apply our model to the recent activity at Merapi Volcano in Indonesia. We constrain model input and output parameters using current petrologic, seismic, and geodetic studies of the Merapi system, and vary critical parameters over reasonable ranges as documented in the literature. Our model is able to reproduce eruption rates observed during both the 2006 effusive and 2010 explosive/effusive eruptions. Our modeling suggests that a combination of chamber overpressure, increased volatile content, and decreased crystal content due to the voluminous injection of new magma into the

  5. Medical phenomenology and stroke rehabilitation: an introduction. (United States)

    Goldberg, Gary


    This issue of Topics in Stroke Rehabilitation explores the theme of medical phenomenology and stroke rehabilitation through open peer commentary format. The theme is introduced by a brief summary and overview of phenomenology as a branch of philosophy whose focus is the development of methodology for describing and ordering human experience. The application of this philosophical approach to medicine in general and stroke rehabilitation in particular is then considered. An approach to patients informed by both phenomenology and science provides a more complete, holistic, and humanistic framework than science alone. Phenomenology helps the clinician to understand the importance of narrative, the process of adaptation at the level of the integrated whole person, and the important role of context in determining how recovery unfolds. Embodiment is presented as an organizing principle that links the nature of conscious experience in the lived body and the basic transformation in experience and function associated with an acquired pathology such as stroke. Finally, the nature of open peer commentary is considered and introduced in terms of how it has been specifically implemented in this issue of Topics in Stroke Rehabilitation.

  6. Acute ischemic stroke--from symptom recognition to thrombolysis. (United States)

    Kurz, M W; Kurz, K D; Farbu, E


    The understanding of stroke has changed in the recent years from rehabilitation to an emergency approach. We review existing data from symptom recognition to thrombolysis and identify challenges in the different phases of patient treatment. Implementation of treatment in dedicated stroke units with a multidisciplinary team exclusively treating stroke patients has led to significant reduction of stroke morbidity and mortality. Yet, first the introduction of treatment with intravenous rtPA (IVT) has led to the 'time is brain' concept where stroke is conceived as an emergency. As neuronal death in stroke is time dependent, all effort should be laid on immediate symptom recognition, rapid transport to the nearest hospital with a stroke treatment facility and diagnosis and treatment as soon as possible. The main cause of prehospital delay is that patients do not recognize that they suffered a stroke or out of other reasons do not call the Emergency Medical Services immediately. Educational stroke awareness campaigns may have an impact in increasing the number of patients eligible for rtPA treatment and can decrease the prehospital times if they are directed both to the public and to the medical divisions treating stroke. Stroke transport times can be shortened by the use of helicopter and a stroke mobile--an ambulance equipped with a CT scanner--may be helpful to decrease time from onset to treatment start in the future. Yet, IVT has several limitations such as a narrow time window and a weak effect in ischemic strokes caused by large vessel occlusions. In these cases, interventional procedures and the concept of bridging therapy, a combined approach of IVT and intraarterial thrombolysis or mechanical thrombectomy, might improve recanalization rates and patient outcome. As neuronal death in stroke patients occurs in a time-dependent fashion, all effort should be made to decrease time from symptom onset to treatment start with rtPA: major challenges are stroke

  7. “I prefer to stay in bed all day” : Everyday geographies of stroke patients

    NARCIS (Netherlands)

    Meijering, Louise


    Stroke patients typically undergo a sudden transition from being able to being disabled. A stroke, or cerebrovascular accident (CVA), refers to brain damage because of a temporal shortage of oxygen in the brain. This shortage is due to lack of blood flow caused by blockage or a leakage of blood. A

  8. Third European Stroke Science Workshop

    NARCIS (Netherlands)

    Dichgans, Martin; Planas, Anna M.; Biessels, Geert Jan|info:eu-repo/dai/nl/165576367; van der Worp, Bart|info:eu-repo/dai/nl/189855010; Sudlow, Cathie; Norrving, B.; Lees, Kennedy; Mattle, Heinrich P.


    Lake Eibsee, Garmisch-Partenkirchen, November 19 to 21, 2015: The European Stroke Organization convened >120 stroke experts from 27 countries to discuss latest results and hot topics in clinical, translational, and basic stroke research. Since its inception in 2011, the European Stroke Science

  9. 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


    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.

  10. Stability and transitions in mother-infant face-to-face communication during the first 6 months: a microhistorical approach. (United States)

    Hsu, Hui-Chin; Fogel, Alan


    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)

  11. Transitioning issues in adolescent to young adult hemophilia patients with inhibitors: an approach for a growing population. (United States)

    Young, Guy


    The major adverse effect of factor replacement therapy in patients with hemophilia is the development of neutralizing antibodies termed inhibitors. This complication renders standard factor replacement therapy ineffective resulting in increased morbidity and mortality. Until recently, the population of adults with inhibitors was relatively small due to the death of many of the patients from HIV that they contracted from contaminated factor in the early 1980s. With the advent of factor products with reduced risks for deadly infections in the mid-1980s to early 1990s, a cohort of inhibitor patients is now beginning to enter adulthood thus raising the issues regarding the transition of these patients into adulthood. It is, therefore, expected that adult hematologists will be seeing more inhibitor patients and that pediatric hematologists will be faced with managing this transition process, which may not necessarily include transition to an adult facility or adult hematologist. This review will discuss the various issues ranging from choice of medical provider to a discussion of psychosocial and financial issues facing this specific patient population.

  12. Dizziness in stroke

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad


    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.

  13. Methods guiding stakeholder engagement in planning a pragmatic study on changing stroke systems of care. (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


    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

  14. Neurodevelopmental treatment after stroke : a comparative study

    NARCIS (Netherlands)

    Dr. T.B. Hafsteinsdóttir; A Algra; M.H.F. Grypdonck; L.J. Kappelle


    Background: Neurodevelopmental treatment (NDT) is a rehabilitation approach increasingly used in the care of stroke patients, although no evidence has been provided for its efficacy. Objective: To investigate the effects of NDT on the functional status and quality of life (QoL) of patients

  15. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke


    . 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...

  16. Determinan Penyakit Stroke

    Directory of Open Access Journals (Sweden)

    Woro Riyadina


    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

  17. The Migraine?Stroke Connection


    Lee, Mi Ji; Lee, Chungbin; Chung, Chin-Sang


    Migraine and stroke are common neurovascular disorders which share underlying physiological processes. Increased risks of ischemic stroke, hemorrhagic stroke, and subclinical ischemic lesions have been consistently found in migraineurs. Three possible associations are suggested. One is that underlying pathophysiology of migraine can lead to ischemic stroke. Second, common comorbidities between migraine and stroke can be present. Lastly, some syndromes can manifest with both migraine-like head...

  18. Current clinical practices in stroke rehabilitation: regional pilot survey. (United States)

    Natarajan, Pradeep; Oelschlager, Ashley; Agah, Arvin; Pohl, Patricia S; Ahmad, S Omar; Liu, Wen


    This study was aimed at understanding the current physical and occupational therapy practices in stroke rehabilitation in the Midwest. The insights gained from this pilot study will be used in a future study aimed at understanding stroke rehabilitation practices across the nation. Researchers and clinicians in the field of stroke rehabilitation were interviewed, and past studies in the literature were analyzed. Through these activities, we developed a 37-item questionnaire that was sent to occupational and physical therapists practicing in Kansas and Missouri who focus on the care of people who have had a stroke (n = 320). A total of 107 respondents returned a com pleted questionnaire, which gives a response rate of about 36%. The majority of respondents had more than 12 years of experience treating patients with stroke. Consensus of 70% or more was found for 80% of the items. The preferred approaches for the rehabilitation of people who have had a stroke are the Bobath and Brunnstrom methods, which are being used by 93% and 85% of the physical and occupational therapists, respectively. Even though some variability existed in certain parts of the survey, in general clinicians agreed on different treatment approaches in issues dealing with muscle tone, weakness, and limited range of motion in stroke rehabilitation. Some newer treatment approaches that have been proven to be effective are practiced only by a minority of clinicians. The uncertainty among clinicians in some sections of the survey reveals that more evidence on clinical approaches is needed to ensure efficacious treatments.

  19. The role of neuroimaging in acute stroke

    Directory of Open Access Journals (Sweden)

    Dhamija Rajinder


    its clinical usefulness is being assessed in a number of ongoing trials. Penumbral tissue can be identified by perfusion MRI. CT perfusion (CTP is an emerging alternative, providing similar information about the penumbra and infarct core. A combined approach of NCCT, CT angiography (CTA, and CTP is now being employed at many centers and is known as multimodal CT imaging (MMCT. MMCT provides information about the pathophysiology of acute stroke which is comparable to that provided by MRI, and the technique has the potential to refine patient selection for thrombolysis.

  20. Gene expression profiling of blood for the prediction of ischemic stroke. (United States)

    Stamova, Boryana; Xu, Huichun; Jickling, Glen; Bushnell, Cheryl; Tian, Yingfang; Ander, Bradley P; Zhan, Xinhua; Liu, Dazhi; Turner, Renee; Adamczyk, Peter; Khoury, Jane C; Pancioli, Arthur; Jauch, Edward; Broderick, Joseph P; Sharp, Frank R


    A blood-based biomarker of acute ischemic stroke would be of significant value in clinical practice. This study aimed to (1) replicate in a larger cohort our previous study using gene expression profiling to predict ischemic stroke; and (2) refine prediction of ischemic stroke by including control groups relevant to ischemic stroke. Patients with ischemic stroke (n=70, 199 samples) were compared with control subjects who were healthy (n=38), had vascular risk factors (n=52), and who had myocardial infarction (n=17). Whole blood was drawn ≤3 hours, 5 hours, and 24 hours after stroke onset and from control subjects. RNA was processed on whole genome microarrays. Genes differentially expressed in ischemic stroke were identified and analyzed for predictive ability to discriminate stroke from control subjects. The 29 probe sets previously reported predicted a new set of ischemic strokes with 93.5% sensitivity and 89.5% specificity. Sixty- and 46-probe sets differentiated control groups from 3-hour and 24-hour ischemic stroke samples, respectively. A 97-probe set correctly classified 86% of ischemic strokes (3 hour+24 hour), 84% of healthy subjects, 96% of vascular risk factor subjects, and 75% with myocardial infarction. This study replicated our previously reported gene expression profile in a larger cohort and identified additional genes that discriminate ischemic stroke from relevant control groups. This multigene approach shows potential for a point-of-care test in acute ischemic stroke.

  1. Smoking and the risk of a stroke

    International Nuclear Information System (INIS)

    Bell, B.A.; Ambrose, J.


    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)

  2. Effect of water on glass transition in starch/sucrose matrices investigated through positron annihilation lifetime spectroscopy: a new approach. (United States)

    Sharma, Sandeep Kumar; Zaydouri, Abdelhadi; Roudaut, Gaëlle; Duplâtre, Gilles


    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

  3. π ± ↔ K ± meson-vacuum transitions (oscillations) in diagram approach in the model of dynamical analogy of the Cabibbo-Kobayashi-Maskawa matrices

    International Nuclear Information System (INIS)

    Beshtoev, Kh.M.


    The elements of the theory of vacuum oscillations and the model of dynamical expansion of the theory of weak interactions working at the tree level, i.e. the model of dynamical analogy of Cabibbo-Kobayashi-Maskawa matrices and its further development, are given. It is shown that the quarks and massive vector bosons must be structural and these structural particles (subparticles) must interact to generate quark and vector boson masses. In this case the problem of singularity cancellations does not arise in this model. It is also shown that for self-consistence of the theory the weak decays of K-mesons must go through massive vector boson B but not W-boson. In the framework of this model the probability of π ↔ K transitions (oscillations) in the diagram approach is computed. These transitions (oscillations) can be registered through K-decays after transitions of virtual K-mesons to their own mass shell by using their quasielastic strong interactions

  4. Universal fluctuations: a new approach to the study of ''phase transitions'' in intermediate energy heavy ion collisions

    International Nuclear Information System (INIS)

    Frankland, J.D.; Chbihi, A.; Hudan, S.


    The universal theory of order parameter fluctuations (Δ-scaling laws) is applied to a wide range of intermediate energy heavy-ion collision data obtained with INDRA. This systematic study confirms that the observed fragment production is compatible with aggregation scenarios for in- or out-of-equilibrium continuous phase transitions, while not showing any sign of critical behaviour or phase coexistence. We stress the importance of the methodology employed in order to gain further insight into the mechanism(s) responsible. (authors)

  5. Methodological practices of positive energy territories. To articulate approaches and tools in order to implement energy transition

    International Nuclear Information System (INIS)

    Bailleul, Esther


    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

  6. Effects of the Interest Rate and Reserve Requirement Ratio on Bank Risk in China: A Panel Smooth Transition Regression Approach

    Directory of Open Access Journals (Sweden)

    Zhongyuan Geng


    Full Text Available This paper applies the Panel Smooth Transition Regression (PSTR model to simulate the effects of the interest rate and reserve requirement ratio on bank risk in China. The results reveal the nonlinearity embedded in the interest rate, reserve requirement ratio, and bank risk nexus. Both the interest rate and reserve requirement ratio exert a positive impact on bank risk for the low regime and a negative impact for the high regime. The interest rate performs a significant effect while the reserve requirement ratio shows an insignificant effect on bank risk on a statistical basis for both the high and low regimes.

  7. Stroke - risk factors (United States)

    ... Brain cells can die, causing lasting damage. Risk factors are things that increase your chance of getting ... disease or condition. This article discusses the risk factors for stroke and things you can do to ...

  8. Post-Stroke Rehabilitation (United States)

    ... negotiate the provision of reasonable accommodations in the workplace. When can a stroke patient begin rehabilitation? Rehabilitation ... at home gives people the advantage of practicing skills and developing compensatory strategies in the context of ...

  9. A Stroke of Language (United States)

    Blaisdell, Bob


    The author reflects on foreign-language learning by his EFL students as well as his own foreign-language learning. He concludes by musing on the possible and fantastical devastation on language-ability wrought by strokes.

  10. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O


    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....

  11. The "Know Stroke" Campaign (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 ...

  12. Poverty and stroke in India: a time to act. (United States)

    Pandian, Jeyaraj D; Srikanth, Velandai; Read, Stephen J; Thrift, Amanda G


    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.

  13. 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


    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

  14. 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)


    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.)

  15. Ischemic stroke: carotid and vertebral artery disease

    International Nuclear Information System (INIS)

    Vilela, P.; Goulao, A.


    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.)

  16. Telestroke in stroke survivors. (United States)

    Joubert, Jacques; Joubert, Lynette B; de Bustos, Elizabeth Medeiros; Ware, Dallas; Jackson, David; Harrison, Terrence; Cadilhac, Dominique


    Stroke is a high-frequency disorder placing a significant burden on the health care systems, being the foremost cause of complex chronic disability in adults. Devising systems that can enhance the prevention of stroke recurrence is an important priority and challenge in both the developed and the developing world. The potential for recurrent stroke can be substantially reduced by effective management of vascular risk factors. Telestroke is a tool with potential application to improve risk management of stroke survivors. Lack of acknowledgment of existing practices as well as lack of awareness of potential financial barriers to diffusion of telestroke can lead to limited implementation. Telestroke offers service providers the opportunity to access large numbers of stroke survivors targeting secondary prevention. The ideal 'telestroke model' provides service support, education for the patient and caregiver, as well as integration of specialist and primary care services. Effective use of technological advances, with adequate recognition of the importance of human interaction in the long-term management of a largely elderly population of stroke survivors is challenging but possible. Telestroke should be systems- and not technology-driven. Barriers in the implementation of telestroke have been identified as insufficient planning of IT infrastructure, lack of long-term vision for sustainability, a lack of contextual perspective as well as poor communication across domains. Future telestroke models should provide effective action in an integrated model of care recognizing and involving all existing players and practices. (c) 2009 S. Karger AG, Basel.

  17. Post-stroke dyskinesias

    Directory of Open Access Journals (Sweden)

    Nakawah MO


    Full Text Available Mohammad Obadah Nakawah, Eugene C Lai Stanely H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA Abstract: Strokes, whether ischemic or hemorrhagic, are among the most common causes of secondary movement disorders in elderly patients. Stroke-related (vascular movement disorders, however, are uncommon complications of this relatively common disease. The spectrum of post-stroke movement disorders is broad and includes both hypo- and hyperkinetic syndromes. Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify. Nevertheless, identification of the most relevant motor phenotype, whenever possible, allows for a more specific phenomenological categorization of the dyskinesia and thus helps guide its treatment. Fortunately, post-stroke dyskinesias are usually self-limiting and resolve within 6 to 12 months of onset, but a short-term pharmacotherapy might sometimes be required for symptom control. Functional neurosurgical interventions targeting the motor thalamus or globus pallidus interna might be considered for patients with severe, disabling, and persistent dyskinesias (arbitrarily defined as duration longer than 12 months. Keywords: vascular dyskinesia, stroke, movement disorders

  18. Ligand-Assisted Co-Assembly Approach toward Mesoporous Hybrid Catalysts of Transition-Metal Oxides and Noble Metals: Photochemical Water Splitting. (United States)

    Liu, Ben; Kuo, Chung-Hao; Chen, Jiejie; Luo, Zhu; Thanneeru, Srinivas; Li, Weikun; Song, Wenqiao; Biswas, Sourav; Suib, Steven L; He, Jie


    A bottom-up synthetic approach was developed for the preparation of mesoporous transition-metal-oxide/noble-metal hybrid catalysts through ligand-assisted co-assembly of amphiphilic block-copolymer micelles and polymer-tethered noble-metal nanoparticles (NPs). The synthetic approach offers a general and straightforward method to precisely tune the sizes and loadings of noble-metal NPs in metal oxides. This system thus provides a solid platform to clearly understand the role of noble-metal NPs in photochemical water splitting. The presence of trace amounts of metal NPs (≈0.1 wt %) can enhance the photocatalytic activity for water splitting up to a factor of four. The findings can conceivably be applied to other semiconductors/noble-metal catalysts, which may stand out as a new methodology to build highly efficient solar energy conversion systems. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  19. Mitochondrial Impairment in Cerebrovascular Endothelial Cells is Involved in the Correlation between Body Temperature and Stroke Severity (United States)

    Hu, Heng; Doll, Danielle N.; Sun, Jiahong; Lewis, Sara E.; Wimsatt, Jeffrey H.; Kessler, Matthew J.; Simpkins, James W.; Ren, Xuefang


    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

  20. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin


    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...

  1. Improving public education about stroke. (United States)

    Alberts, Mark J


    Stroke is a common and serious disease. Most studies have shown that basic public knowledge about what a stroke is, symptoms of a stroke, and the proper reaction to a stroke is quite deficient. The fact that a stroke affects cognitive, communicative, and motor functions may partially explain the poor reaction to acute stroke symptoms. Several educational studies, using diverse formats and messaging paradigms, have been shown to positively affect public knowledge of stroke symptoms. Such efforts have often used mass media public education campaigns with an emphasis on recognizing symptoms of an acute stroke. Some have been able to demonstrate an increase in the chance of patients (or by-standers) calling 911 and seeking emergency care. However, many programs were of brief duration, and their long-term benefits are uncertain. Continual educational efforts will be needed to improve stroke knowledge and increase the percentage of patients who seek emergency care. © 2012 New York Academy of Sciences.

  2. Auckland Stroke Outcomes Study. Part 1: Gender, stroke types, ethnicity, and functional outcomes 5 years poststroke. (United States)

    Feigin, V L; Barker-Collo, S; Parag, V; Senior, H; Lawes, C M M; Ratnasabapathy, Y; Glen, E


    Studying long-term stroke outcomes including body functioning (neurologic and neuropsychological impairments) and activity limitations and participation is essential for long-term evidence-based rehabilitation and service planning, resource allocation, and improving health outcomes in stroke. However, reliable data to address these issues is lacking. This study (February 2007-December 2008) sourced its participants from the population-based incidence study conducted in Auckland in 2002-2003. Participants completed structured self-administered questionnaires, and a face-to-face interview including a battery of neuropsychological tests. Logistic regression analysis was used to analyze associations between and within functional outcomes and their potential predictors. Of 418 5-year stroke survivors, two-thirds had good functional outcome in terms of neurologic impairment and disability (defined as modified Rankin Score <3), 22.5% had cognitive impairment indicative of dementia, 20% had experienced a recurrent stroke, almost 15% were institutionalized, and 29.6% had symptoms suggesting depression. Highly significant correlations were found between and within various measurements of body functioning (especially neuropsychological impairments), activity, and participation. Age, dependency, and depression were independently associated with most outcomes analyzed. The strong associations between neuropsychological impairment and other functional outcomes and across various measurements of body functioning, activity, and participation justify utilizing a multidisciplinary approach to studying and managing long-term stroke outcomes. Observed gender and ethnic differences in some important stroke outcomes warrant further investigations.

  3. 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)


    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.

  4. Geometric approach to the Miesowicz coefficients at the region of the crystalline-nematic transition and a universal relation for their ratio (United States)

    Simões, M.; Domiciano, S. M.


    In this work the ratios between the Miesowicz coefficients of rigid calamitic nematic liquid crystals will be studied. It will be shown that the microscopic theory that describes these coefficients, the kinetic theory [M. Doi and S. F. Edwards, The Theory of Polymer Dynamics (Oxford Press, New York, 1986)], suggests that some ratios between the Miesowicz coefficients would have a universal character, that does not depend on the nematic material being examined. A set of experimental data has been collected from the liquid crystal literature and, once these data are rescaled in a common temperature scale, they point to the existence of such a universality. Nevertheless, only in the neighborhoods of the nematic-isotropic transition, do the theoretical calculations of the kinetic theory and the experimental data predict the same profile for this universality; when the region of the crystalline-nematic transition is approached theory and experiment present severe discrepancies. The reason for this disagreement is studied and it is proposed that it results from the fact that the kinetic theory does not take into account the packing properties of the nematic medium. A different approach to the calculation of these ratios is proposed and it is shown that it describes the experimental data for all temperatures.

  5. 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


    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)

  6. 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)


    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.)

  7. Satisfaction with palliative care after stroke: a prospective cohort study. (United States)

    Blacquiere, Dylan; Bhimji, Khadija; Meggison, Hilary; Sinclair, John; Sharma, Michael


    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.

  8. A Bayesian approach to infer the radial distribution of temperature and anisotropy in the transition zone from seismic data (United States)

    Drilleau, M.; Beucler, E.; Mocquet, A.; Verhoeven, O.; Moebs, G.; Burgos, G.; Montagner, J.


    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

  9. Using a complex adaptive system lens to understand family caregiving experiences navigating the stroke rehabilitation system. (United States)

    Ghazzawi, Andrea; Kuziemsky, Craig; O'Sullivan, Tracey


    Family caregivers provide the stroke survivor with social support and continuity during the transition home from a rehabilitation facility. In this exploratory study we examined family caregivers' perceptions and experiences navigating the stroke rehabilitation system. The theories of continuity of care and complex adaptive systems were integrated to examine the transition from a stroke rehabilitation facility to the patient's home. This study provides an understanding of the interacting complexities at the macro and micro levels. A convenient sample of family caregivers (n = 14) who provide care for a stroke survivor were recruited 4-12 weeks following the patient's discharge from a stroke rehabilitation facility in Ontario, Canada. Interviews were conducted with family caregivers to examine their perceptions and experiences navigating the stroke rehabilitation system. Directed and inductive content analysis and the theory of Complex Adaptive Systems were used to interpret the perceptions of family caregivers. Health system policies and procedures at the macro-level determined the types and timing of information being provided to caregivers, and impacted continuity of care and access to supports and services at the micro-level. Supports and services in the community, such as outpatient physiotherapy services, were limited or did not meet the specific needs of the stroke survivors or family caregivers. Relationships with health providers, informational support, and continuity in case management all influence the family caregiving experience and ultimately the quality of care for the stroke survivor, during the transition home from a rehabilitation facility.

  10. 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


    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)

  11. First-order dynamical phase transition in models of glasses: an approach based on ensembles of histories

    Energy Technology Data Exchange (ETDEWEB)

    Garrahan, Juan P [School of Physics and Astronomy, University of Nottingham, Nottingham, NG7 2RD (United Kingdom); Jack, Robert L [Department of Chemistry, University of California, Berkeley, CA 94720-1460 (United States); Lecomte, Vivien; Duijvendijk, Kristina van; Wijland, Frederic van [Laboratoire Matiere et Systemes Complexes (CNRS UMR 7057), Universite Paris Diderot, 10 rue Alice Domon et Leonie Duquet, 75205 Paris Cedex 13 (France); Pitard, Estelle [Laboratoire des Colloides, Verres et Nanomateriaux (CNRS UMR 5587), Universite de Montpellier II, place Eugene Bataillon, 34095 Montpellier Cedex 5 (France)


    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.

  12. Schizophrenia and Psychosis: Diagnosis, Current Research Trends, and Model Treatment Approaches with Implications for Transitional Age Youth. (United States)

    Chan, Vivien


    This article reviews the current state of diagnosis and treatment of schizophrenia, describing the recent proliferation of research in high-risk psychosis spectrum conditions, which are different from childhood-onset and early onset schizophrenia, and findings of psychotic-like experiences in the normal population. Taken from adult and childhood literature, clinical quandaries in accurate diagnosis, and treatment gaps in co-occurring, or sometimes confounding, conditions are discussed. Thoughts on the impact of schizophrenia on an emerging adulthood trajectory are offered. Recent best practices in the treatment of schizophrenia are consistent with a recovery-oriented model of mental health services for transitional age youth. Copyright © 2017 The Author. Published by Elsevier Inc. All rights reserved.

  13. Transcranial Direct Current Stimulation combined with treadmill training in the subacute phase following stroke: case series

    DEFF Research Database (Denmark)

    Figlewski, Krystian; Nielsen, Jørgen Feldbæk; Blicher, Jakob

    anodal tDCS. Aims: to evaluate the feasibility of anodal tDCS with body weight support treadmill training (BWSTT) in the subacute stroke patients. Methods Four subjects (Table 1.) participated in BWSTT coupled with anodal tDCS thrice per week for 4 weeks. Subjects were included within 14 days from stroke......Background Stroke is a common cause of gait impairment and regaining a normal gait is a major target in stroke rehabilitation. To facilitate motor recovery after stroke, a variety of experimental approaches have been tested. Recent developments include non-invasive brain stimulation techniques...

  14. Interrelations between EOS parameters and cohesive energy of transition metals: Thermostatistical approach, ab initio calculations and analysis of ;universality; features (United States)

    Bertoldi, Dalía S.; Ramos, Susana B.; Guillermet, Armando Fernández


    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. Relearning the Basics: Rehabilitation after a Stroke (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 ...

  16. Management of arterial hypertension in patients with acute stroke. (United States)

    Adeoye, Opeolu; Jauch, Edward C


    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.

  17. Deep brain stimulation for stroke: Current uses and future directions. (United States)

    Elias, Gavin J B; Namasivayam, Andrew A; Lozano, Andres M

    Survivors of stroke often experience significant disability and impaired quality of life related to ongoing maladaptive responses and persistent neurologic deficits. Novel therapeutic options are urgently needed to augment current approaches. One way to promote recovery and ameliorate symptoms may be to electrically stimulate the surviving brain. Various forms of brain stimulation have been investigated for use in stroke, including deep brain stimulation (DBS). We conducted a comprehensive literature review in order to 1) review the use of DBS to treat post-stroke maladaptive responses including pain, dystonia, dyskinesias, and tremor and 2) assess the use and potential utility of DBS for enhancing plasticity and recovery from post-stroke neurologic deficits. A large variety of brain structures have been targeted in post-stroke patients, including motor thalamus, sensory thalamus, basal ganglia nuclei, internal capsule, and periventricular/periaqueductal grey. Overall, the reviewed clinical literature suggests a role for DBS in the management of several post-stroke maladaptive responses. More limited evidence was identified regarding DBS for post-stroke motor deficits, although existing work tentatively suggests DBS-particularly DBS targeting the posterior limb of the internal capsule-may improve paresis in certain circumstances. Substantial future work is required both to establish optimal targets and parameters for treatment of maladapative responses and to further investigate the effectiveness of DBS for post-stroke paresis. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Mini-Stroke vs. Regular Stroke: What's the Difference? (United States)

    ... How is a ministroke different from a regular stroke? Answers from Jerry W. Swanson, M.D. When ... brain, spinal cord or retina, which may cause stroke-like symptoms but does not damage brain cells ...

  19. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes. (United States)

    Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang


    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.

  20. Stroke risk perception among participants of a stroke awareness campaign


    Kraywinkel, Klaus; Heidrich, Jan; Heuschmann, Peter U; Wagner, Markus; Berger, Klaus


    Abstract 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. S...

  1. Proceedings: 1996 EPRI conference on innovative approaches to electricity pricing: Managing the transition to market-based pricing

    International Nuclear Information System (INIS)


    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

  2. Multi-Disciplinary Stroke Care in Developing Countries – Lessons from the Wessex-Ghana Stroke Partnership

    Directory of Open Access Journals (Sweden)

    Louise Johnson


    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.

  3. From stroke unit care to stroke care unit

    NARCIS (Netherlands)

    De Keyser, J; Sulter, G.


    In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring

  4. Improving Renewable Energy Transition Acceptance: A Simulation Gaming Approach on a Multi Actor Setting in the Netherlands

    Directory of Open Access Journals (Sweden)

    Aziiz Sutrisno


    Full Text Available The Netherlands have tried very hard to increase their renewable energy sources (RES shares to fulfill the European Union target in 2050. However, RES performance did not show the expected result as the performance declined in 2009 producing even wider gap compare to the target. The Dutch government’s tried to incorporate all interested stakeholders by forming the Dutch energy transition task force. Nevertheless, the task force’s result is also not showing a desirable trend. Key reasons behind the Dutch low RES performance are the lack of shared understanding and positive attitude toward RES development among interested actors. This research uses a role-playing game to increase shared understanding and positive attitude within the actors. The game set players in a competing role as the government, an energy company and the end user. Players were given the ability to make decisions on their respective area. A pilot study was then conducted to measure the effectiveness of the game. The pilot study showed the game increased actor’s individual understanding and shared understanding. Moreover, it also showed that the game increases actor’s positive attitude toward RES development in the Netherlands.

  5. New Approaches to Assessing and Predicting the Hydrologic Impacts of Urban Disturbance Using Isotopes and Transit Time Analysis (United States)

    Soulsby, C.; Geris, J.; Birkel, C.; Tetzlaff, D.


    Urbanization is an abrupt hydrological disturbance that affects large parts of the world. For ameliorative management, an understanding of how flow partitioning and storage dynamics are affected is crucial, yet this remains limited. This reflects the lack of integrated monitoring and modelling frameworks for characterizing these hydrological response dynamics to incremental urban development. Here we use a coupled flow-isotope model to assess the impacts of urbanisation (~20%) on stream water age distributions in an 8 km2 catchment. A conceptual runoff model was used with flux tracking to estimate the time-varying age of stream water at the outlet and both urban and non-urban sub-catchments over a 3 year period. Combined objective functions of both flow and isotope metric constrained model structures, improved calibration and aided model evaluation. Specifically, we explored (1) the age distribution of stream water draining urban and non-urban areas, (2) the integrated effect of these different land uses at larger catchment scales, and (3) how the modelling can predict the impacts on the stream water age of future urbanization proposals. The results showed that stream water draining the most urbanized tributary was youngest with a mean transit time (MTT) of sustainable urban water design in terms of targeted restriction of rapid water fluxes.

  6. Diabetes, Heart Disease, and Stroke (United States)

    ... Disease, & Other Dental Problems Diabetes & Sexual & Urologic 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 ...

  7. The obesity paradox in stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj


    . Data include age, gender, civil status, stroke severity, computed tomography, and cardiovascular risk factors. Patients were followed up to 9·8 years (median 2·6 years). We used Cox regression models to compare risk of death and readmission for recurrent stroke in the four body mass index groups......BACKGROUND: Although associated with excess mortality and morbidity, obesity is associated with lower mortality after stroke. The association between obesity and risk of recurrent stroke is unclear. AIMS: The study aims to investigate the association in stroke patients between body mass index...... and risk of death and readmission for recurrent stroke. METHODS: An administrative Danish quality-control registry designed to collect a predefined dataset on all hospitalized stroke patients in Denmark 2000–2010 includes 45 615 acute first-ever stroke patients with information on body mass index in 29 326...

  8. Preventable Pediatric Stroke via Vaccination?

    Directory of Open Access Journals (Sweden)

    Craig A. Press


    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.

  9. Post Stroke Llife in Iranian People: Used and Recommended Strategies

    Directory of Open Access Journals (Sweden)

    Asghar Dalvandi


    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.

  10. Parvovirus B19 Infection in Children With Arterial Ischemic Stroke. (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


    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.

  11. Modeling the Ductile Brittle Fracture Transition in Reactor Pressure Vessel Steels using a Cohesive Zone Model based approach

    Energy Technology Data Exchange (ETDEWEB)

    Pritam Chakraborty; S. Bulent Biner


    Fracture properties of Reactor Pressure Vessel (RPV) steels show large variations with changes in temperature and irradiation levels. Brittle behavior is observed at lower temperatures and/or higher irradiation levels whereas ductile mode of failure is predominant at higher temperatures and/or lower irradiation levels. In addition to such temperature and radiation dependent fracture behavior, significant scatter in fracture toughness has also been observed. As a consequence of such variability in fracture behavior, accurate estimates of fracture properties of RPV steels are of utmost importance for safe and reliable operation of reactor pressure vessels. A cohesive zone based approach is being pursued in the present study where an attempt is made to obtain a unified law capturing both stable crack growth (ductile fracture) and unstable failure (cleavage fracture). The parameters of the constitutive model are dependent on both temperature and failure probability. The effect of irradiation has not been considered in the present study. The use of such a cohesive zone based approach would allow the modeling of explicit crack growth at both stable and unstable regimes of fracture. Also it would provide the possibility to incorporate more physical lower length scale models to predict DBT. Such a multi-scale approach would significantly improve the predictive capabilities of the model, which is still largely empirical.

  12. Modelling the ductile brittle fracture transition in reactor pressure vessel steels using a cohesive zone model based approach

    International Nuclear Information System (INIS)

    Chakraborty, Pritam; Bulent Biner, S.


    Fracture properties of Reactor Pressure Vessel (RPV) steels show large variations with changes in temperature and irradiation levels. Brittle behaviour is observed at lower temperatures and/or higher irradiation levels whereas ductile mode of failure is predominant at higher temperatures and/or lower irradiation levels. In addition to such temperature and radiation dependent fracture behaviour, significant scatter in fracture toughness has also been observed. As a consequence of such variability in fracture behaviour, accurate estimates of fracture properties of RPV steels are of utmost importance for safe and reliable operation of reactor pressure vessels. A cohesive zone based approach is being pursued in the present study where an attempt is made to obtain a unified law capturing both stable crack growth (ductile fracture) and unstable failure (cleavage fracture). The parameters of the constitutive model are dependent on both temperature and failure probability. The effect of irradiation has not been considered in the present study. The use of such a cohesive zone based approach would allow the modelling of explicit crack growth at both stable and unstable regimes of fracture. Also it would provide the possibility to incorporate more physical lower length scale models to predict DBT. Such a multi-scale approach would significantly improve the predictive capabilities of the model, which is still largely empirical. (authors)



    Sujatha; Ramalingam; Vinodkumar; Vasumathi; Valarmathi; Anu


    BACKGROUND Ischemic strokes account for >80% of total stroke events. Biochemical modalities like serum uric acid, ESR, CRP, Serum Fibrinogen will be a low cost and useful way to predict functional outcome after ischemic stroke. The Barthel ADL index it is an ordinal scale helping us to measure performances in ADL-activities in daily living. The present study aims to study the Biochemical parameters Uric Acid, CRP, ESR and Fibrinogen in Ischemic Stroke patients and to assess fu...

  14. The importance of rehabilitation nursing care of stroke patiens


    Drahošová, Radka


    ANOTATION Author: Marie Kynštová Institution: Ústav sociálního lékařství LF UK v Hradci Králové Oddělení ošetřovatelství Title of thesis: The importance of rehabilitation nursing care of stroke patients Thesis' supervisor: Jaroslava Pečenková Number of pages: 121 Number of attachments: 8 Year of examination: 2012 Abstract: This thesis deals with the importance of rehabilitation nursing care of patients with stroke. Theoretical part approaches the issue of stroke and the importance of early tr...

  15. Enhanced Metal-Insulator Transition Performance in Scalable Vanadium Dioxide Thin Films Prepared Using a Moisture-Assisted Chemical Solution Approach. (United States)

    Liang, Weizheng; Gao, Min; Lu, Chang; Zhang, Zhi; Chan, Cheuk Ho; Zhuge, Lanjian; Dai, Jiyan; Yang, Hao; Chen, Chonglin; Park, Bae Ho; Jia, Quanxi; Lin, Yuan


    Vanadium dioxide (VO 2 ) is a strong-correlated metal-oxide with a sharp metal-insulator transition (MIT) for a range of applications. However, synthesizing epitaxial VO 2 films with desired properties has been a challenge because of the difficulty in controlling the oxygen stoichiometry of VO x , where x can be in the range of 1 < x < 2.5 and V has multiple valence states. Herein, a unique moisture-assisted chemical solution approach has been developed to successfully manipulate the oxygen stoichiometry, to significantly broaden the growth window, and to significantly enhance the MIT performance of VO 2 films. The obvious broadening of the growth window of stoichiometric VO 2 thin films, from 4 to 36 °C, is ascribed to a self-adjusted process for oxygen partial pressure at different temperatures by introducing moisture. A resistance change as large as 4 orders of magnitude has been achieved in VO 2 thin films with a sharp transition width of less than 1 °C. The much enhanced MIT properties can be attributed to the higher and more uniform oxygen stoichiometry. This technique is not only scientifically interesting but also technologically important for fabricating wafer-scaled VO 2 films with uniform properties for practical device applications.

  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.


    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. Personal accounts of stroke experiences

    NARCIS (Netherlands)

    Wachters-Kaufmann, CSM


    As there appeared to be a need for personal accounts of stroke experiences, a book called "Speaking about Stroke" was written for stroke patients and their caregivers. For the past two years, a questionnaire was sent to the people who had ordered the book, to gain an insight into the characteristics

  18. Questions and Answers about Stroke (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 ...

  19. Stroke and Episodic Memory Disorders (United States)

    Lim, Chun; Alexander, Michael P.


    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…

  20. Influence of counter-rotating interaction on quantum phase transition in Dicke-Hubbard lattice: an extended coherent-state approach (United States)

    Lu, Yongchuan; Wang, Chen


    We investigate the ground-state behavior of the Dicke-Hubbard model including counter-rotating terms. By generalizing an extended coherent-state approach within mean-field theory, we self-consistently obtain the ground-state energy and delocalized order parameter. Localization-delocalization quantum phase transition of photons is clearly observed by breaking the parity symmetry. Particularly, Mott lobes are fully suppressed, and the delocalized order parameter shows monotonic enhancement by increasing qubit-cavity coupling strength, in sharp contrast to the Dicke-Hubbard model under rotating-wave approximation. Moreover, the corresponding phase boundaries are stabilized by decreasing photon hopping strength, compared to the Rabi-Hubbard model.

  1. Early-stage roughening of the polymer-polymer interface approaching the glass transition temperature by real-time neutron reflection. (United States)

    Carelli, C; Higgins, A M; Jones, R A L; Sferrazza, M


    The early-stage roughening of the interface between thin deuterated poly(methyl methacrylate) (d-PMMA) layers on thick polystyrene (PS) films was studied as a function of the temperature using real-time specular neutron reflectivity. By measuring the growth of the interface roughness as a precursor of the dewetting, the characteristic time constant of the early stages of the process was studied as a function of the temperature approaching the glass transition temperature (T(g)) of the two polymers from above and compared with the prediction of the growth of the interface by the spinodal process. Both solid and liquid regimes were probed, in which the viscosity of the thin film or the substrate dominates respectively. The characteristic growth time of the process also depends on the upper film thickness to a power of 5 or 6 in the solid or liquid regimes, respectively, as predicted by the theory of spinodal dewetting.

  2. Determination of the solid surface critical exponent β1 from contact-angle variation on approach to a wetting transition: Cyclohexane/aniline/quartz (United States)

    Pallas, Norman R.


    The three-phase contact angle (θ) for the system cyclohexane/aniline/quartz has been measured from drop shapes as a function of temperature on approach to the cyclohexane/aniline upper consolute solution temperature Tc. The experiments employed exacting criteria previously established for thermodynamic-quality measurements at fluid interfaces. A first-order wetting transition from partial wetting to complete wetting was observed at a temperature Tw, 2.12 K below Tc. The contact angle vanishes at Tw, scaling as cos θ ˜ |T - Tc|β1-μ for T contact angle near the critical point for this system. These results are in marked contrast to previous measurements on this system from measurements of capillary rise and meniscus curvature.



    Bushra Rehman; Praveen Rawat; Vaibhav Agarwal; Shiv Kumar Verma


    Objective: To compare the effects of the Bobath Therapy and Constraint-Induced Movement Therapy on arm motor function and hand dexterity function among stroke patients with a high level of function on the affected side. Materials and Methods: Study has conducted at the Outpatient physiotherapy department of a stroke unit. With a total of 30 patients were conveniently recruited and then randomized to Bobath Concept group and constraint-induced movement therapy group. Intervention included ...

  4. 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.


    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

  5. 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.


    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...... of the Baltic Sea sub-basins, and their driving forces, points to a number of challenges. There is however a movement towards a new governance regime. Bottom-up pilot initiatives can lead to a diffusion of innovation within the existing governance framework. Top-down, enabling EU legislation, can help...

  6. Ischemic Stroke and Cancer: Stroke Severely Impacts Cancer Patients, While Cancer Increases the Number of Strokes


    Bang, Oh Young; Seok, Jin Myoung; Kim, Seon Gyeong; Hong, Ji Man; Kim, Hahn Young; Lee, Jun; Chung, Pil-Wook; Park, Kwang-Yeol; Kim, Gyeong-Moon; Chung, Chin-Sang; Lee, Kwang Ho


    Background Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke. Main Contents This revi...

  7. Family History in Young Patients With Stroke. (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


    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: Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  8. Effect of Visual Art School-Based Stroke Intervention for Middle School Students. (United States)

    Johnson, Ashleigh B; Montgomery, Chelsea M; Dillard, Wesley A; Morrill, Kenneth; Hoesli, Coral; Gillette, Wesley M; Johnson, Brandon K; Nathaniel, Thomas I


    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.

  9. A review: Motor rehabilitation after stroke with control based on human intent. (United States)

    Li, Min; Xu, Guanghua; Xie, Jun; Chen, Chaoyang


    Strokes are a leading cause of acquired disability worldwide, and there is a significant need for novel interventions and further research to facilitate functional motor recovery in stroke patients. This article reviews motor rehabilitation methods for stroke survivors with a focus on rehabilitation controlled by human motor intent. The review begins with the neurodevelopmental principles of motor rehabilitation that provide the neuroscientific basis for intuitively controlled rehabilitation, followed by a review of methods allowing human motor intent detection, biofeedback approaches, and quantitative motor rehabilitation assessment. Challenges for future advances in motor rehabilitation after stroke using intuitively controlled approaches are addressed.

  10. Anxiety After Stroke: The Importance of Subtyping. (United States)

    Chun, Ho-Yan Yvonne; Whiteley, William N; Dennis, Martin S; Mead, Gillian E; Carson, Alan J


    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.

  11. University First Year Advisors: A network approach for first year student transition and retention. A Practice Report.

    Directory of Open Access Journals (Sweden)

    Geraldine Box


    Full Text Available Focussing expressly on student support and retention, improving the first year experience has been addressed by Murdoch University through the implementation of a School discipline-specific network of professional First Year Advisors (FYAs. FYA initiatives, both broad-based and varied, have been developed in alignment with the changing needs of students as identified throughout the semesters. A combination of outreach telephone campaigns and face-to-face student support enables FYAs to conduct a "just in time" approach to positively increase student engagement, and ultimately, retention. With a bespoke database, FYAs and academic staff have been able to streamline the process of reporting students in need of support, and gather data relating to student retention. The FYA program is yet to be formally evaluated although initial feedback and student consultation is promising. This paper outlines the program's development, current initiatives and expected outcomes.  

  12. Ageism in stroke rehabilitation studies. (United States)

    Gaynor, Eva Joan; Geoghegan, Sheena Elizabeth; O'Neill, Desmond


    stroke is predominantly a disease of older people. While age bias has been demonstrated in studies of pharmacological therapeutic interventions in stroke, the extent of discrimination by age in stroke rehabilitation studies is unknown. The aim of this study was to systematically review the literature to assess the extent of ageism in stroke rehabilitation studies. all randomised control trials (RCT) on stroke rehabilitation entered in the Cochrane database which reported mean age were included. Patient gender and exclusion criteria were also recorded. of 241 RCT's identified, 182 were eligible for inclusion. The mean age of all patients was 64.3, almost a decade younger than those seen by stroke physicians in daily practice in global terms, and 11-12 years younger than encountered in hospital practice in the British Isles. Almost half (46%) of trials excluded patients with cognitive impairment, almost one-quarter (23%) patients with dysphasia and one-eighth (13%) excluded patients with multiple strokes. we have identified a clear difference in the mean age of those included in stroke rehabilitation studies compared with the international mean age of stroke. In addition, a quarter of trials excluded dysphasic patients which may indicate omission of more severe strokes. This means that the evidence base for stroke rehabilitation is deficient in terms of matching the characteristics of patients encountered in clinical practice, and a more representative sample of older people and those with significant disability must be included in future trials.

  13. Stroke? Localized, otogenic meningitis!

    DEFF Research Database (Denmark)

    Ingolfsdottir, Harpa Maria; Thomasen, Per Caye


    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...

  14. Ischemic strokes and migraine

    International Nuclear Information System (INIS)

    Bousser, M.G.; Baron, J.C.; Chiras, J.


    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)

  15. Stroke while jogging.


    Kelly, W. F.; Roussak, J.


    Jogging is a form of physical exercise that has stimulated the imagination of the public as shown by recent appearance of its own journal (Jogging Magazine, Editor J. Bryant). We wish to report the unusual complication of an acute stroke sustained during jogging.

  16. Stroke while jogging. (United States)

    Kelly, W. F.; Roussak, J.


    Jogging is a form of physical exercise that has stimulated the imagination of the public as shown by recent appearance of its own journal (Jogging Magazine, Editor J. Bryant). We wish to report the unusual complication of an acute stroke sustained during jogging. Images p229-a Fig. 1 PMID:7448490

  17. Sex differences in stroke.

    NARCIS (Netherlands)

    Haast, R.A.M.; Gustafson, D.R.; Kiliaan, A.J.


    Sex differences in stroke are observed across epidemiologic studies, pathophysiology, treatments, and outcomes. These sex differences have profound implications for effective prevention and treatment and are the focus of this review. Epidemiologic studies reveal a clear age-by-sex interaction in

  18. Transitional Justice

    DEFF Research Database (Denmark)

    Gissel, Line Engbo

    This presentation builds on an earlier published article, 'Contemporary Transitional Justice: Normalising a Politics of Exception'. It argues that the field of transitional justice has undergone a shift in conceptualisation and hence practice. Transitional justice is presently understood...... to be the provision of ordinary criminal justice in contexts of exceptional political transition....

  19. Examining Differences in Patterns of Sensory and Motor Recovery After Stroke With Robotics. (United States)

    Semrau, Jennifer A; Herter, Troy M; Scott, Stephen H; Dukelow, Sean P


    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.

  20. Ischemic Stroke during Pregnancy and Puerperium

    Directory of Open Access Journals (Sweden)

    Elisabetta Del Zotto


    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.