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Sample records for stroke unit facilities

  1. Telephone audit for monitoring stroke unit facilities: a post hoc analysis from PROSIT study.

    Science.gov (United States)

    Candelise, Livia; Gattinoni, Monica; Bersano, Anna

    2015-01-01

    Although several valid approaches exist to measure the number and the quality of acute stroke units, only few studies tested their reliability. This study is aimed at establishing whether the telephone administration of the PROject of Stroke unIt ITaly (PROSIT) audit questionnaire is reliable compared with direct face-to-face interview. Forty-three medical leaders in charge of in-hospital stroke services were interviewed twice using the same PROSIT questionnaire with 2 different modalities. First, the interviewers approached the medical leaders by telephone. Thereafter, they went to the hospital site and performed a direct face-to-face interview. Six independent couples of trained researchers conducted the audit interviews. The degree of intermodality agreement was measured with kappa statistic. We found a perfect agreement for stroke units identification between the 2 different audit modalities (K = 1.00; standard error [SE], 1.525). The agreement was also very good for stroke dedicated beds (K = 1.00; SE, 1.525) and dedicated personnel (K = 1.00; SE, 1.525), which are the 2 components of stroke unit definition. The agreement was lower for declared in use process of care and availability of diagnostic investigations. The telephone audit can be used for monitoring stroke unit structures. It is more rapid, less expensive, and can repeatedly be used at appropriate intervals. However, a reliable description of the process of care and diagnostic investigations indicators should be obtained by either local site audit visit or prospective stroke register based on individual patient data. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. Stroke mimic diagnoses presenting to a hyperacute stroke unit.

    Science.gov (United States)

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

    2016-10-01

    Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

  3. Stroke Unit: General principles and standards

    Directory of Open Access Journals (Sweden)

    Mehmet Akif Topçuoğlu

    2015-04-01

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

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

    Science.gov (United States)

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

    2017-10-23

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

  5. Facilities of Early Rehabilitation post Stroke in Poland 2010

    DEFF Research Database (Denmark)

    Opara, Jozef; Langhorne, Peter; Larsen, Torben

    2012-01-01

    Rationale -The aim of this work was to survey the contemporary facilities for early poststroke rehabilitation in Poland. The main research questions were: what is the availability of inpatient rehabilitation for post-stroke patients in neurological departments and in rehabilitation departments......? Aims - Growing costs of health care are encouraging healthcare planners to look for new organizational solutions of services which could enable rehabilitation as early as possible after disease onset. Early post-stroke rehabilitation consists of many elements that provide for early onset rehabilitation...... and its continuation after discharge from stroke unit. Participants - Two questionnaires evaluating neurorehabilitation of people who underwent stroke was designed and distributed: first to 221 neurological wards and second to 154 rehabilitation departments in Poland. Design - We asked about delay before...

  6. Organizational issues in stroke treatment: The Swiss paradigm - Stroke units

    Directory of Open Access Journals (Sweden)

    Georgios K Matis

    2013-01-01

    Full Text Available Stroke represents the leading cause of acquired disability in adults and poses a tremendous socioeconomic burden both on patients and the society. In this sense, prompt diagnosis and urgent treatment are needed in order to radically reduce the devastating consequences of this disease. Herein the authors present the new guidelines recently adopted by the Swiss Stroke Society concerning the establishment of stroke units. Standardized treatment and allocation protocols along with an acute rehabilitation concept seem to be the core of the Swiss stroke management system. Coordinated multidisciplinary care provided by specialized medical, nursing and therapy staff is of utmost importance for achieving a significant dependency and death reduction. It is believed that the implementation of these guidelines in the stroke care system would be beneficial not only for the stroke patients, but also for the health system.

  7. [Training and experience in stroke units].

    Science.gov (United States)

    Arenillas, J F

    2008-01-01

    The social and sanitary benefits provided by stroke units can not be achieved without an adequate training and learning process. This dynamic process consists of the progressive acquisition of: a) a greater degree of expertise in stroke management by the stroke team; b) better coordination between the stroke team, extrahospitalary emergency medical systems, and other in-hospital professionals involved in stroke assistance, and c) more human and technological resources dedicated to improve attention to stroke patients. The higher degree of experience in a stroke unit will have an effect: a) improving (time and quality) the diagnostic process in acute stroke patients; b) increasing the proportion of patients treated with thrombolysis; c) reducing extra and intrahospitalary latencies to stroke treatment, and d) improving stroke outcome in terms of reducing mortality and increasing functional independence. Finally, comprehensive stroke centers will achieve a higher degree of organizational complexity that will permit a global assessment of the most advanced aspects in stroke management, including education and research.

  8. Comprehensive stroke units: a review of comparative evidence and experience.

    Science.gov (United States)

    Chan, Daniel K Y; Cordato, Dennis; O'Rourke, Fintan; Chan, Daniel L; Pollack, Michael; Middleton, Sandy; Levi, Chris

    2013-06-01

    Stroke unit care offers significant benefits in survival and dependency when compared to general medical ward. Most stroke units are either acute or rehabilitation, but comprehensive (combined acute and rehabilitation) model (comprehensive stroke unit) is less common. To examine different levels of evidence of comprehensive stroke unit compared to other organized inpatient stroke care and share local experience of comprehensive stroke units. Cochrane Library and Medline (1980 to December 2010) review of English language articles comparing stroke units to alternative forms of stroke care delivery, different types of stroke unit models, and differences in processes of care within different stroke unit models. Different levels of comparative evidence of comprehensive stroke units to other models of stroke units are collected. There are no randomized controlled trials directly comparing comprehensive stroke units to other stroke unit models (either acute or rehabilitation). Comprehensive stroke units are associated with reduced length of stay and greatest reduction in combined death and dependency in a meta-analysis study when compared to other stroke unit models. Comprehensive stroke units also have better length of stay and functional outcome when compared to acute or rehabilitation stroke unit models in a cross-sectional study, and better length of stay in a 'before-and-after' comparative study. Components of stroke unit care that improve outcome are multifactorial and most probably include early mobilization. A comprehensive stroke unit model has been successfully implemented in metropolitan and rural hospital settings. Comprehensive stroke units are associated with reductions in length of stay and combined death and dependency and improved functional outcomes compared to other stroke unit models. A comprehensive stroke unit model is worth considering as the preferred model of stroke unit care in the planning and delivery of metropolitan and rural stroke services

  9. Facilities of Early Rehabilitation after Stroke in Poland 2010

    Science.gov (United States)

    Opara, Jozef A.; Langhorne, Peter; Larsen, Torben; Mehlich, Krzysztof; Szczygiel, Jaroslaw

    2012-01-01

    The aim of this work was to survey the contemporary facilities for early post-stroke rehabilitation in Poland. The main research questions were as follows: what is the availability of inpatient rehabilitation for post-stroke patients in neurological departments and in rehabilitation departments? The growing costs of healthcare are encouraging…

  10. Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

    LENUS (Irish Health Repository)

    Walsh, T

    2012-01-31

    BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

  11. General Stroke Management In Stroke Unit: Guidelines Of Turkish Society Of Cerebrovascular Diseases – 2015

    Directory of Open Access Journals (Sweden)

    Mehmet Akif Topçuoğlu

    2015-08-01

    Full Text Available In this section, in the light of evidence-based data concerning essentiality that the stoke patients should be treated in A stroke unit and related centers, a brief and current information about general stroke treatment of patients with stroke during acute phase will be offered.

  12. Who benefits from treatment and rehabilitation in a stroke Unit?

    DEFF Research Database (Denmark)

    Jorgensen, H S; Kammersgaard, L P; Houth, J

    2000-01-01

    The beneficial effects of treatment and rehabilitation of patients with acute stroke in a dedicated stroke unit (SU) are well established. We wanted to examine if these effects are limited to certain groups of patients or if they apply to all patients independent of age, sex, comorbidity......, and initial stroke severity....

  13. Acute stroke unit improves stroke management-four years on from INASC.

    Science.gov (United States)

    Shanahan, E; Keenan, R; Cunningham, N; O'Malley, G; O'Connor, M; Lyons, D; Peters, C

    2015-02-01

    The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = Stroke management has significantly improved from 2008, however some deficiencies remain.

  14. Improving Stroke Management through Specialized Stroke Units in ...

    African Journals Online (AJOL)

    Alasia Datonye

    seeking help early enough are also highlighted. Conclusion: The evidence ... Stroke as defined by the World Health Organization. (WHO) is a syndrome of ... parenteral nutrition and prevention of constipation by using stool softeners. The case ...

  15. The Lombardia Stroke Unit Registry: a year experience

    Directory of Open Access Journals (Sweden)

    Giuseppe Micieli

    2010-12-01

    Full Text Available Stroke is the third cause of death and the first long-term disability cause in industrialised countries. It is therefore an important problem, not only from a clinical point of view, but also because of the high costs involved in its management. The results of clinical trials, reviews and meta-analysis highlight the importance of the Stroke Unit in the correct and adequate management of the patient with stroke. This article describes the Lombardia Stroke Unit and the related Stroke Registry. In 2010 this Registry includes 27 Centres and recruits patients with acute stroke or transient ischaemic attacks (TIAs. The Registry aims at measuring performance parameters, identifying guidelines, non-compliance causes, and analysing care processes.

  16. Stroke care: Experiences and clinical research in stroke units in Chennai

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    Gobindram Arjundas

    2006-01-01

    Full Text Available Background: S troke is the second commonest cause of death in India with crude overall prevalence rate of 220 per 100,000. With an increasing aging population at risk, the stroke burden in India can be expected to reach epidemic proportions. Materials and Methods: The first protocol-based prospective studies, funded by private agencies was conducted in Madras Institute of Neurology in 1984-86. The results led to establishment of the first stroke unit in Tamil Nadu state, in the institute. The first all-India hospital-based studies in acute stroke was completed as INDIAN COOPERATIVE ACUTE STROKE STUDIES (ICASS I and ICASS II with WHO STEP ONE by members of the Indian Stroke Association between 2000-2005. This has generated very useful data for our country. Results: Mortality in 1984-86 was 40%. Stroke unit in the institute dropped it to 12%. About 10 years later, ICASS studies showed a further fall of mortality to 8%, which is the current international figure in the west. Morbidity pattern showed about half return to their original activities. But about one third are left totally disabled needing prolonged care, for which fiscal, social and rehab provisions have to be done on a national basis. Conclusions: The progress and success of care of Stroke in the last three decades, from treatment in medical and neurology wards to specialized stroke units is presented. The main risk factors are hypertension, diabetes and ischemic heart disease across the country. Hypertension alone or with the other two diseases was present in 72% of cases. Prevention and treatment of these factors will reduce the stroke burden, mortality and morbidity of strokes. The Stroke-team concept can be extended to the smallest hospitals in our country.

  17. Acute stroke unit improves stroke management-four years on from INASC.

    LENUS (Irish Health Repository)

    Shanahan, E

    2015-02-01

    The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = < 0.001). 100% of ischaemic strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = < 0.02) and SALT (74% vs 26%, p = < 0.02). Stroke management has significantly improved from 2008, however some deficiencies remain.

  18. Large motor units are selectively affected following a stroke.

    Science.gov (United States)

    Lukács, M; Vécsei, L; Beniczky, S

    2008-11-01

    Previous studies have revealed a loss of functioning motor units in stroke patients. However, it remained unclear whether the motor units are affected randomly or in some specific pattern. We assessed whether there is a selective loss of the large (high recruitment threshold) or the small (low recruitment threshold) motor units following a stroke. Forty-five stroke patients and 40 healthy controls participated in the study. Macro-EMG was recorded from the abductor digiti minimi muscle at two levels of force output (low and high). The median macro motor unit potential (macro-MUP) amplitude on the paretic side was compared with those on the unaffected side and in the controls. In the control group and on the unaffected side, the macro-MUPs were significantly larger at the high force output than at the low one. However, on the paretic side the macro-MUPs at the high force output had the same amplitude as those recorded at the low force output. These changes correlated with the severity of the paresis. Following a stroke, there is a selective functional loss of the large, high-threshold motor units. These changes are related to the severity of the symptoms. Our findings furnish further insight into the pathophysiology of the motor deficit following a stroke.

  19. Understanding nursing practice in stroke units: a Q-methodological study.

    OpenAIRE

    Clarke, DJ; Holt, J

    2014-01-01

    Abstract Purpose: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses' involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses' practice in stroke rehabilitation. Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit t...

  20. Telemedicine Can Replace the Neurologist on a Mobile Stroke Unit.

    Science.gov (United States)

    Wu, Tzu-Ching; Parker, Stephanie A; Jagolino, Amanda; Yamal, Jose-Miguel; Bowry, Ritvij; Thomas, Abraham; Yu, Amy; Grotta, James C

    2017-02-01

    The BEST-MSU study (Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit) is a comparative effectiveness trial in patients randomized to mobile stroke unit or standard management. A substudy tested interrater agreement for tissue-type plasminogen activator eligibility between a telemedicine vascular neurologist and onboard vascular neurologist. On scene, both the telemedicine vascular neurologist and onboard vascular neurologist independently evaluated the patient, documenting their tissue-type plasminogen activator treatment decision, National Institutes of Health Stroke Scale score, and computed tomographic interpretation. Agreement was determined using Cohen κ statistic. Telemedicine-related technical failures that impeded remote assessment were recorded. Simultaneous and independent telemedicine vascular neurologist and onboard vascular neurologist assessment was attempted in 174 patients. In 4 patients (2%), the telemedicine vascular neurologist could not make a decision because of technical problems. The telemedicine vascular neurologist agreed with the onboard vascular neurologist on 88% of evaluations (κ=0.73). Remote telemedicine vascular neurologist assessment is reliable and accurate, supporting either telemedicine vascular neurologist or onboard vascular neurologist assessment on our mobile stroke unit. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02190500. © 2017 American Heart Association, Inc.

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

    Directory of Open Access Journals (Sweden)

    Michele Stornello

    2013-04-01

    Full Text Available Background: In themanagement of stroke disease, evidences fromthe literature demonstrate that the introduction of stroke units, hospital wards with dedicated beds providing intensive care within 48 hours of symptoms’ onset, produced a real improvement in the outcome, reducing in-hospital fatality cases and increasing the proportion of patients independently living in long term follow-up. Discussion: The article focuses on stroke disease-management, suggesting a stroke integrated approach for the admission of patients on dedicated beds, in order to extend the ‘‘stroke care’’ approach outcomes to as many hospitals as possible in Italy. This approach implies the set up of a stroke network for an effective patients’ stratification according to the severity of the illness at debut; the set up of an integrated team of specialists in hospital management of the acute phase (first 48 hours and a timely rehabilitation treatment. Ultimately the hospital should be organized according to department’s semi-intensive areas in order to assure to the patients, in the early stage of the disease, a timely high intensity care aimed to improve the long term outcome.

  2. [Medico-economic assessment of the Pontoise Hospital stroke unit].

    Science.gov (United States)

    Yekhlef, F; Decup, D; Niclot, P; Servan, J; Descombes, S; Richecoeur, J; Ollivier, A

    2010-11-01

    Annually, approximately 120,000 people in France have a stroke. Various controlled studies have pointed out the benefits of treatment in a stroke unit (SU). The objective of this study was to evaluate, from a medical point of view, the economic impact of the Pontoise Hospital SU. Based on the national cost study (NCS [étude nationale des coûts: ENC]) we analyzed data of five diagnosis related groups (DRG) which have a principle diagnosis in relation with stroke. This work was limited to strokes and transient ischemic events in adults and excluded sub-arachnoid hemorrhage. Medical and economic parameters were collected over the period from January to October 2006 and compared with those of the same period in 2005, that is to say before the opening of the SU. Three hundred and twenty-three hospital stays occurred between January 1st and October 31st, 2006 and 216 during the same time period before the opening of the SU, an increase of approximately 50% of all stroke-related admissions in our hospital. The number of stays carried out in the neurology unit increased by 29%. There was no significant difference between the two periods regarding age (median 69 versus 70 years) and sex- ratio. Average length of stay (ALS) was the same (9 days). There were no significant differences concerning the death rate (5.6% versus 6.2%) and that of discharge to home (44.6% versus 44.4%). The cost by stay in 2006 was 3534 euros [median; min 664-max 57,542] versus 3541 euros in 2005 [681-35,149] (p=0.57). Analysis by DRG highlighted an increase in the cost for serious strokes, cerebral infarctions and hemorrhages. For transitory ischemic events, the cost and the ALS decreased. After the opening of the SU, there was an increase in the activity without an increase in the total cost. This could be related in part to the limited means allocated to the stroke unit at its opening (in particular medical staff). The NCS can be used to evaluate the activity of a stroke unit. This work could

  3. Toll Facilities in the United States

    Data.gov (United States)

    Department of Transportation — Biennial report containing selected information on toll facilities in the United States that has been provided to FHWA by the States and/or various toll authorities...

  4. Radiation therapy facilities in the United States

    International Nuclear Information System (INIS)

    Ballas, Leslie K.; Elkin, Elena B.; Schrag, Deborah; Minsky, Bruce D.; Bach, Peter B.

    2006-01-01

    Purpose: About half of all cancer patients in the United States receive radiation therapy as a part of their cancer treatment. Little is known, however, about the facilities that currently deliver external beam radiation. Our goal was to construct a comprehensive database of all radiation therapy facilities in the United States that can be used for future health services research in radiation oncology. Methods and Materials: From each state's health department we obtained a list of all facilities that have a linear accelerator or provide radiation therapy. We merged these state lists with information from the American Hospital Association (AHA), as well as 2 organizations that audit the accuracy of radiation machines: the Radiologic Physics Center (RPC) and Radiation Dosimetry Services (RDS). The comprehensive database included all unique facilities listed in 1 or more of the 4 sources. Results: We identified 2,246 radiation therapy facilities operating in the United States as of 2004-2005. Of these, 448 (20%) facilities were identified through state health department records alone and were not listed in any other data source. Conclusions: Determining the location of the 2,246 radiation facilities in the United States is a first step in providing important information to radiation oncologists and policymakers concerned with access to radiation therapy services, the distribution of health care resources, and the quality of cancer care

  5. Stroke Mortality in Intensive Care Unit from Tertiary Care Neurological Center

    Directory of Open Access Journals (Sweden)

    Lekhjung Thapa

    2013-06-01

    Full Text Available Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. About a quarter of stroke patients are dead within a month, about a third by 6 months, and a half by 1 year. Although the most substantial advance in stroke has been the routine management of patients in stroke care units, intensive care unit has remained the choice for stroke patients’ care in developing countries. This study explores the mortality of stroke patients in intensive care unit setting in tertiary care neurological centre in a developing country. Methods: We collected data of stroke patients admitted in our ICU from August 2009 to Aug 2010 and analyzed. Results: Total 44 (10.25% patients were admitted for acute stroke. Age ranged from 17-93 years. Low GCS (Glasgow Coma Scale, uncontrolled hypertension and aspiration pneumonia were common indications for admission in ICU. Total 23 (52.3% patients had hemorrhagic stroke and 21(47.7% patients had ischemic stroke. 13 (29.54% patients of stroke died within 7 days, 9 (69.23% patients of hemorrhagic stroke died within 6 days, and 4 patients (30.76% of ischemic stroke died within 7 days. 6 (13.63% patients left hospital against medical advice. All of these patients had ischemic stroke. Conclusions: Stroke mortality in intensive care unit remains high despite of care in tertiary neurological center in resource poor settings. Stroke care unit, which would also help dissemination of knowledge of stroke management, is an option for improved outcome in developing countries Keywords: intensive care unit; mortality; stroke; stroke care unit.

  6. Updating on Italian stroke units: the "CCM study".

    Science.gov (United States)

    Guidetti, D; Spallazzi, M; Toni, D; Rota, E; Morelli, N; Immovilli, P; Baldereschi, M; Polizzi, B M; Ferro, S; Inzitari, D

    2013-07-01

    The stroke units (SUs) have been demonstrated to be efficient and cost effective for acute stroke care. Nevertheless, the level of stroke unit implementation in Italy does not correspond to expectations yet. This study is a survey, which aims at assessing the current status of in-hospital stroke care in the Italian regions and at updating SUs. The survey was conducted by means of a semi-structured questionnaire, based on 18 stroke care "quality indicators", submitted to all the Italian centres that had taken part in the SITS-MOST study, and to other centres advised by the coordinator of SITS studies and by regional opinion leaders of stroke. SUs were defined as acute wards, with stroke-dedicated beds and dedicated teams that had been formally authorised to administer rt-PA. A statistical analysis was performed by a descriptive statistics and logistic regression model. The study was carried out from November 2009 to September 2010. A total of 168 forms were sent out and 153 replies received. Seven centres, which had not performed any thrombolytic treatment, and 16 which did not fulfil the criteria for the definition of SU were excluded from the study. Most of the centres reported more than 100 stroke patient admissions per year, i.e., 122 (84%) from 100 to 500, 18 (12%) more than 500. The 19% of the centres admitted more than 30% of patients within 3 h from the symptom onset and only 30% admitted more than 30% of patients within 4.5 h. The mean number of thrombolyses performed in the last 6 months was 10 for centres with a doctor on duty 24 h a day, 6 for those that have a doctor on duty from 8 a.m. to 8 p.m. and a doctor on call for night, and 5 for centres with a doctor on call 24 h a day. The territorial distribution of the SUs is remarkably heterogeneous: 87 SUs (67%) are located in the North of Italy, 28 (22%) in the central part of Italy and only 15 (11%) in the South. The last few years have witnessed a rise in both the diffusion of SUs and access to

  7. Estimating the cost-effectiveness of stroke units in France compared with conventional care.

    Science.gov (United States)

    Launois, R; Giroud, M; Mégnigbêto, A C; Le Lay, K; Présenté, G; Mahagne, M H; Durand, I; Gaudin, A F

    2004-03-01

    The incidence of stroke in France is estimated at between 120 000 and 150 000 cases per year. This modeling study assessed the clinical and economic benefits of establishing specialized stroke units compared with conventional care. Data from the Dijon stroke registry were used to determine healthcare trajectories according to the degree of autonomy and organization of patient care. The relative risks of death or institutionalization or death or dependence after passage through a stroke unit were compared with conventional care. These risks were then inserted with the costing data into a Markov model to estimate the cost-effectiveness of stroke units. Patients cared for in a stroke unit survive more trimesters without sequelae in the 5 years after hospitalization than those cared for conventionally (11.6 versus 8.28 trimesters). The mean cost per patient at 5 years was estimated at 30 983 for conventional care and 34 638 in a stroke unit. An incremental cost-effectiveness ratio for stroke units of 1359 per year of life gained without disability was estimated. The cost-effectiveness ratio for stroke units is much lower than the threshold (53 400 ) of acceptability recognized by the international scientific community. This finding justifies organizational changes in the management of stroke patients and the establishment of stroke units in France.

  8. Toll Facilities in the United States - Toll Facilities in the United States

    Data.gov (United States)

    Department of Transportation — Biennial report containing selected information on toll facilities in the United States that has been provided to FHWA by the States and/or various toll authorities...

  9. Systemic risk score evaluation in ischemic stroke patients (SCALA): a prospective cross sectional study in 85 German stroke units.

    Science.gov (United States)

    Weimar, Christian; Goertler, Michael; Röther, Joachim; Ringelstein, E Bernd; Darius, Harald; Nabavi, Darius Günther; Kim, In-Ha; Theobald, Karlheinz; Diener, Han-Christoph

    2007-11-01

    Stratification of patients with transient ischemic attack (TIA) or ischemic stroke (IS) by risk of recurrent stroke can contribute to optimized secondary prevention. We therefore aimed to assess cardiovascular risk factor profiles of consecutive patients hospitalized with TIA/IS to stratify the risk of recurrent stroke according to the Essen Stroke Risk Score (ESRS) and of future cardiovascular events according to the ankle brachial index (ABI) as a marker of generalized atherosclerosis In this cross-sectional observational study, 85 neurological stroke units throughout Germany documented cardiovascular risk factor profiles of 10 consecutive TIA/IS patients on standardized questionnaires. Screening for PAD was done with Doppler ultrasonography to calculate the ABI. A total of 852 patients (57% men) with a mean age of 67+/-12.4 years were included of whom 82.9 % had IS. The median National Institutes of Health stroke sum score was 4 (TIA: 1). Arterial hypertension was reported in 71%, diabetes mellitus in 26%, clinical PAD in 10%, and an ABI or = 3 was observed in 58%, which in two previous retrospective analyses corresponded to a recurrent stroke risk of > or = 4%/year. The correlation between the ESRS and the ABI was low (r = 0.21). A high proportion of patients had asymptomatic atherosclerotic disease and a considerable risk of recurrent stroke according to the ABI and ESRS category. The prognostic accuracy as well as the potential benefit of various risk stratification scores in secondary stroke prevention require validation in a larger prospective study.

  10. Continuous stroke unit electrocardiographic monitoring versus 24-hour Holter electrocardiography for detection of paroxysmal atrial fibrillation after stroke.

    Science.gov (United States)

    Rizos, Timolaos; Güntner, Janina; Jenetzky, Ekkehart; Marquardt, Lars; Reichardt, Christine; Becker, Rüdiger; Reinhardt, Roland; Hepp, Thomas; Kirchhof, Paulus; Aleynichenko, Elena; Ringleb, Peter; Hacke, Werner; Veltkamp, Roland

    2012-10-01

    Cardioembolism in paroxysmal atrial fibrillation (pxAF) is a frequent cause of ischemic stroke. Sensitive detection of pxAF after stroke is crucial for adequate secondary stroke prevention; the optimal diagnostic modality to detect pxAF on stroke units is unknown. We compared 24-hour Holter electrocardiography (ECG) with continuous stroke unit ECG monitoring (CEM) for pxAF detection. Patients with acute ischemic stroke or transient ischemic attack were prospectively enrolled. After a 12-channel ECG on admission, all patients received 24-hour Holter ECG and CEM. Additionally, ECG monitoring data underwent automated analysis using dedicated software to identify pxAF. Patients with a history of atrial fibrillation or with atrial fibrillation on the admission ECG were excluded. Four hundred ninety-six patients (median age, 69 years; 61.5% male) fulfilled all inclusion criteria (ischemic stroke: 80.4%; transient ischemic attack: 19.6%). Median stroke unit stay lasted 88.8 hours (interquartile range, 65.0-122.0). ECG data for automated CEM analysis were available for a median time of 64.0 hours (43.0-89.8). Paroxysmal AF was documented in 41 of 496 patients (8.3%). Of these, Holter detected pxAF in 34.1%; CEM in 65.9%; and automated CEM in 92.7%. CEM and automated CEM detected significantly more patients with pxAF than Holter (Pstroke on stroke units compared with 24-hour Holter ECG. The comparative usefulness of prolonged or repetitive Holter ECG recordings requires further evaluation.

  11. Risk of falling in a stroke unit after acute stroke: The Fall Study of Gothenburg (FallsGOT).

    Science.gov (United States)

    Persson, Carina U; Kjellberg, Sigvar; Lernfelt, Bodil; Westerlind, Ellen; Cruce, Malin; Hansson, Per-Olof

    2018-03-01

    This study aimed to investigate incidence of falls and different baseline variables and their association with falling during hospitalization in a stroke unit among patients with acute stroke. Prospective observational study. A stroke unit at a university hospital. A consecutive sample of stroke patients, out of which 504 were included, while 101 declined participation. The patients were assessed a mean of 1.7 days after admission and 3.8 days after stroke onset. The primary end-point was any fall, from admission to the stroke unit to discharge. Factors associated with falling were analysed using univariable and multivariable Cox hazard regression analyses. Independent variables were related to function, activity and participation, as well as personal and environmental factors. In total, 65 patients (13%) fell at least once. Factors statistically significantly associated with falling in the multivariable analysis were male sex (hazard ratio (HR): 1.88, 95% confidence interval (CI): 1.13-3.14, P = 0.015), use of a walking aid (HR: 2.11, 95% CI: 1.24-3.60, P = 0.006) and postural control as assessed with the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS). No association was found with age, cognition or stroke severity, the HR for low SwePASS scores (⩽24) was 9.33 (95% CI: 2.19-39.78, P = 0.003) and for medium SwePASS scores (25-30) was 6.34 (95% CI: 1.46-27.51, P = 0.014), compared with high SwePASS scores (⩾31). Postural control, male sex and use of a walking aid are associated with falling during hospitalization after acute stroke.

  12. [Efficacy of agreements within the Enchede Stroke Service to refer patients with a stroke from the stroke unit in the hospital to a nursing home for short-term rehabilitation

    NARCIS (Netherlands)

    Nijmeijer, N.M.; Stegge, B.M. aan de; Zuidema, S.U.; Sips, H.J.W.; Brouwers, P.J.

    2005-01-01

    OBJECTIVE: To assess the efficacy of agreements within the Enschede Stroke Service to refer patients with a stroke from the stroke unit in the hospital to a nursing home for short-term rehabilitation. DESIGN: Prospective, partly retrospective. METHOD: All patients who were referred from the stroke

  13. Impact of state Medicaid coverage on utilization of inpatient rehabilitation facilities among patients with stroke.

    Science.gov (United States)

    Skolarus, Lesli E; Burke, James F; Morgenstern, Lewis B; Meurer, William J; Adelman, Eric E; Kerber, Kevin A; Callaghan, Brian C; Lisabeth, Lynda D

    2014-08-01

    Poststroke rehabilitation is associated with improved outcomes. Medicaid coverage of inpatient rehabilitation facility (IRF) admissions varies by state. We explored the role of state Medicaid IRF coverage on IRF utilization among patients with stroke. Working age ischemic stroke patients with Medicaid were identified from the 2010 Nationwide Inpatient Sample. Medicaid coverage of IRFs (yes versus no) was ascertained. Primary outcome was discharge to IRF (versus other discharge destinations). We fit a logistic regression model that included patient demographics, Medicaid coverage, comorbidities, length of stay, tissue-type plasminogen activator use, state Medicaid IRF coverage, and the interaction between patient Medicaid status and state Medicaid IRF coverage while accounting for hospital clustering. Medicaid did not cover IRFs in 4 (TN, TX, SC, WV) of 42 states. The impact of State Medicaid IRF coverage was limited to Medicaid stroke patients (P for interaction stroke patients in states with Medicaid IRF coverage, Medicaid stroke patients hospitalized in states without Medicaid IRF coverage were less likely to be discharged to an IRF of 11.6% (95% confidence interval, 8.5%-14.7%) versus 19.5% (95% confidence interval, 18.3%-20.8%), Pstroke patients with Medicaid. Given the increasing stroke incidence among the working age and Medicaid expansion under the Affordable Care Act, careful attention to state Medicaid policy for poststroke rehabilitation and analysis of its effects on stroke outcome disparities are warranted. © 2014 American Heart Association, Inc.

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

    Science.gov (United States)

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

    2009-01-01

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

  15. Digital tape unit test facility software

    Science.gov (United States)

    Jackson, J. T.

    1971-01-01

    Two computer programs are described which are used for the collection and analysis of data from the digital tape unit test facility (DTUTF). The data are the recorded results of skew tests made on magnetic digital tapes which are used on computers as input/output media. The results of each tape test are keypunched onto an 80 column computer card. The format of the card is checked and the card image is stored on a master summary tape via the DTUTF card checking and tape updating system. The master summary tape containing the results of all the tape tests is then used for analysis as input to the DTUTF histogram generating system which produces a histogram of skew vs. date for selected data, followed by some statistical analysis of the data.

  16. The post-stroke depression and its impact on functioning in young and adult stroke patients of a rehabilitation unit.

    Science.gov (United States)

    Amaricai, Elena; Poenaru, Dan V

    2016-01-01

    Stroke is a leading cause of disability and a major public health problem. To determine frequency and degree of post-stroke depression (PSD) and its impact on functioning in young and adult stroke patients in a rehabilitation unit. The study included 72 stroke patients (aged 29-59 years) who were attending rehabilitation. The patients were assessed for depressive symptoms by Beck Depression Inventory (BDI), and their functioning by using the Stroke Impact Scale (SIS) and the Barthel Index of Activities of Daily Living (ADL). Forty-eight patients had different degrees of depression: borderline clinical depression (13.8%), moderate depression (34.7%), severe depression (15.2%) or extreme depression (2.9%). There were no significant differences of BDI scores in 30-39, 40-49 and 50-59 years groups. Statistically significant correlations were between BDI score and SIS score, between BDI score and ADL index, and between SIS score and ADL index in men, women and total study patients. More than half of the PSD patients had a moderate degree of depression. Significant correlations were noticed between depressive symptoms and functional status evaluated both by an instrument of assessing stroke impact upon general health and an instrument for assessing the everyday activities.

  17. Stroke

    Science.gov (United States)

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

  18. Treatment and rehabilitation on a stroke unit improves 5-year survival. A community-based study

    DEFF Research Database (Denmark)

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

    1999-01-01

    We have previously reported a marked reduction in mortality up to 1 year after treatment and rehabilitation on a stroke unit versus on general neurological and medical wards in unselected stroke patients. In the present study we wanted to test the hypothesis that this mortality-reducing effect...

  19. Variations of Blood Pressure in Stroke Unit Patients May Result from Alternating Body Positions

    NARCIS (Netherlands)

    Aries, M.J.H.; Elting, Jan Willem; Stewart, Roy E.; de Keyser, Jacques; Thien, Theo; Kremer, Berry P.; Vroomen, Patrick C. A. J.

    Background: Blood pressure (BP) is one of the major vital parameters monitored in the stroke unit. The accuracy of indirect BP measurement is strongly influenced by the position of both patient and arm during the measurement. Acute stroke patients are often nursed in lateral decubitus positions. The

  20. Prevalence of physical activity and sedentary behavior among stroke survivors in the United States.

    Science.gov (United States)

    Butler, Eboneé N; Evenson, Kelly R

    2014-01-01

    The risk of stroke is greatest among adults who have experienced a previous stroke, transient ischemic attack, or myocardial infarction. Physical activity may reduce the secondary risk of stroke through mediating effects on blood pressure, vasoconstriction, and circulating lipid concentrations; however, little is known about the prevalence of physical activity and sedentary behavior among stroke survivors in the United States. Using data from the National Health and Nutrition Examination Survey (NHANES), we describe self-reported and objectively measured physical activity and sedentary behavior among adults with a self-reported history of stroke. We also contrast physical activity among stroke survivors with that of adults without stroke (unexposed) to illustrate expected behavior in the absence of disease. Fewer participants with stroke met weekly physical activity guidelines as outlined in the 2008 Physical Activity Guidelines for Americans when compared with unexposed participants (17.9% vs 25.0%) according to self-reported data. In addition, participants with stroke reported less moderate (46.1% vs 54.7%) and vigorous (9.1% vs 19.6%) leisure activity compared with unexposed participants. As measured by accelerometer, time since diagnosis was inversely associated with physical activity engagement, and participants with stroke recorded more daily hours of sedentary behavior compared with unexposed participants (10.1 hours vs 8.9 hours). Findings from this study provide a basis for future work seeking to measure the impact of physical activity on the secondary prevention of stroke by characterizing the prevalence of physical activity and sedentary behavior among stroke survivors in the United States.

  1. Impact of stroke unit in a public hospital on length of hospitalization and rate of early mortality of ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Maria Sheila G. Rocha

    2013-10-01

    Full Text Available We ascertained whether a public health stroke unit reduces the length of hospitalization, the rate of inpatient fatality, and the mortality rate 30 days after the stroke. Methods We compared a cohort of stroke patients managed on a general neurology/medical ward with a similar cohort of stroke patients managed in a str oke unit. The in-patient fatality rates and 30-day mortality rates were analyzed. Results 729 patients were managed in the general ward and 344 were treated at a comprehensive stroke unit. The in-patient fatality rates were 14.7% for the general ward group and 6.9% for the stroke unit group (p<0.001. The overall mortality rate 30 days after stroke was 20.9% for general ward patients and 14.2% for stroke unit patients (p=0.005. Conclusions We observed reduced in-patient fatalities and 30-day mortality rates in patients managed in the stroke unit. There was no impact on the length of hospitalization.

  2. Development of the Stroke-unit Discharge Guideline: choice of assessment instruments for prediction in the subacute phase post-stroke

    NARCIS (Netherlands)

    Meijer, Ronald; van Limbeek, Jacques; de Haan, Rob

    2006-01-01

    The purpose of this paper is to present the design of an evidence-based dataset of assessment instruments for the prognostic factors of the Stroke-unit Discharge Guideline (SDG), a consensus based guideline for the decision of the discharge destination from the hospital stroke unit. In our

  3. Development of the Stroke-unit Discharge Guideline: choice of assessment instruments for prediction in the subacute phase post-stroke.

    NARCIS (Netherlands)

    Meijer, R.; Limbeek, J. van; Haan, R. de

    2006-01-01

    The purpose of this paper is to present the design of an evidence-based dataset of assessment instruments for the prognostic factors of the Stroke-unit Discharge Guideline (SDG), a consensus based guideline for the decision of the discharge destination from the hospital stroke unit. In our

  4. Informal caregiving burden and perceived social support in an acute stroke care facility.

    Science.gov (United States)

    Akosile, Christopher Olusanjo; Banjo, Tosin Olamilekan; Okoye, Emmanuel Chiebuka; Ibikunle, Peter Olanrewaju; Odole, Adesola Christiana

    2018-04-05

    Providing informal caregiving in the acute in-patient and post-hospital discharge phases places enormous burden on the caregivers who often require some form of social support. However, it appears there are few published studies about informal caregiving in the acute in-patient phase of individuals with stroke particularly in poor-resource countries. This study was designed to evaluate the prevalence of caregiving burden and its association with patient and caregiver-related variables and also level of perceived social support in a sample of informal caregivers of stroke survivors at an acute stroke-care facility in Nigeria. Ethical approval was sought and obtained. Fifty-six (21 males, 35 females) consecutively recruited informal caregivers of stroke survivors at the medical ward of a tertiary health facility in South-Southern Nigeria participated in this cross-sectional survey. Participants' level of care-giving strain/burden and perceived social support were assessed using the Caregiver Strain Index and the Multidimensional Scale of Perceived Social Support respectively. Caregivers' and stroke survivors' socio-demographics were also obtained. Data was analysed using frequency count and percentages, independent t-test, analysis of variance (ANOVA) and partial correlation at α =0.05. The prevalence of care-giving burden among caregivers is 96.7% with a high level of strain while 17.9% perceived social support as low. No significant association was found between caregiver burden and any of the caregiver- or survivor-related socio-demographics aside primary level education. Only the family domain of the Multidimensional Scale of Perceived Social Support was significantly correlated with burden (r = - 0.295). Informal care-giving burden was highly prevalent in this acute stroke caregiver sample and about one in every five of these caregivers rated social support low. This is a single center study. Healthcare managers and professionals in acute care facilities

  5. BCI and FES Based Therapy for Stroke Rehabilitation Using VR Facilities

    Directory of Open Access Journals (Sweden)

    Robert Gabriel Lupu

    2018-01-01

    Full Text Available In recent years, the assistive technologies and stroke rehabilitation methods have been empowered by the use of virtual reality environments and the facilities offered by brain computer interface systems and functional electrical stimulators. In this paper, a therapy system for stroke rehabilitation based on these revolutionary techniques is presented. Using a virtual reality Oculus Rift device, the proposed system ushers the patient in a virtual scenario where a virtual therapist coordinates the exercises aimed at restoring brain function. The electrical stimulator helps the patient to perform rehabilitation exercises and the brain computer interface system and an electrooculography device are used to determine if the exercises are executed properly. Laboratory tests on healthy people led to system validation from technical point of view. The clinical tests are in progress, but the preliminary results of the clinical tests have highlighted the good satisfaction degree of patients, the quick accommodation with the proposed therapy, and rapid progress for each user rehabilitation.

  6. Overview of United States synchrotron radiation facilities

    International Nuclear Information System (INIS)

    Watson, R.E.

    1983-01-01

    There has been considerable activity within the past year involving the creation of new and the improvement of existing capabilities for research with synchrotron light. The purpose of this review is to summarize what has happened within the United States. Being a status report, some of the information necessarily has a date attached to it - the date, in this case, being early September 1983

  7. Prehospital and hospital delays after stroke onset--United States, 2005-2006.

    Science.gov (United States)

    2007-05-18

    Each year approximately 700,000 persons in the United States have a new or recurrent stroke; of these persons, 15%-30% become permanently disabled, and 20% require institutionalization during the first 3 months after the stroke. The severity of stroke-related disability can be reduced if timely and appropriate treatment is received. Patients with ischemic stroke may be eligible for treatment with intravenous thrombolytic (i.e., tissue plasminogen activator [t-PA]) therapy within 3 hours of symptom onset. Receipt of this treatment usually requires patients to recognize stroke symptoms and receive prompt transport to a hospital emergency department (ED), where timely evaluation and brain imaging (i.e., computed tomography or magnetic resonance imaging) can take place. For patients eligible for t-PA, evidence suggests that the earlier patients are treated after the onset of symptoms the greater the likelihood of a more favorable outcome. In 2001, Congress established the Paul Coverdell National Acute Stroke Registry to measure and track the quality of care provided to acute stroke patients. To assess prehospital delays from onset of stroke symptoms to ED arrival and hospital delays from ED arrival to receipt of brain imaging, CDC analyzed data from the four states participating in the national stroke registry. The results of that analysis indicated that fewer than half (48.0%) of stroke patients for whom onset data were available arrived at the ED within 2 hours of symptom onset, and prehospital delays were shorter for persons transported to the ED by ambulance (i.e., emergency medical services) than for persons who did not receive ambulance transport. The interval between ED arrival and brain imaging also was significantly reduced for those arriving by ambulance. More extensive public education is needed regarding early recognition of stroke and the urgency of telephoning 9-1-1 to receive ambulance transport. Shortening prehospital and hospital delays will increase

  8. Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation.

    Science.gov (United States)

    Bonaiuti, Donatella; Sioli, Paolo; Fumagalli, Lorenzo; Beghi, Ettore; Agostoni, Elio

    2011-08-01

    Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks.

  9. Can online benchmarking increase rates of thrombolysis? Data from the Austrian stroke unit registry.

    Science.gov (United States)

    Ferrari, Julia; Seyfang, Leonhard; Lang, Wilfried

    2013-09-01

    Despite its widespread availability and known safety and efficacy, a therapy with intravenous thrombolysis is still undergiven. We aimed to identify whether nationwide quality projects--like the stroke registry in Austria--as well as online benchmarking and predefined target values can increase rates of thrombolysis. Therefore, we assessed 6,394 out of 48,462 patients with ischemic stroke from the Austrian stroke registry (study period from March 2003 to December 2011) who had undergone thrombolysis treatment. We defined lower level and target values as quality parameters and evaluated whether or not these parameters could be achieved in the past years. We were able to show that rates of thrombolysis in Austria increased from 4.9% in 2003 to 18.3% in 2011. In a multivariate regression model, the main impact seen was the increase over the years [the OR ranges from 0.47 (95% CI 0.32-0.68) in 2003 to 2.51 (95% CI 2.20-2.87) in 2011). The predefined lower and target levels of thrombolysis were achieved at the majority of participating centers: in 2011 the lower value of 5% was achieved at all stroke units, and the target value of 15% was observed at 21 of 34 stroke units. We conclude that online benchmarking and the concept of defining target values as a tool for nationwide acute stroke care appeared to result in an increase in the rate of thrombolysis over the last few years while the variability between the stroke units has not yet been reduced.

  10. Regulations for radiochemical facilities in the United States

    International Nuclear Information System (INIS)

    Emeigh, Ch; Smith, B.; Williams, T

    1999-01-01

    Material control and accounting is implemented to provide assurance that physical protection measures have been effective, and in case they fail, to provide delayed detection of the loss. Regulations in the United States have been developed that include both performance and compliance requirements to provide a defence in depth approach addressing the unique characteristics of each facility. Regulations address administrative controls, material control and material accounting. Nuclear materials control and accounting plans are negotiated between regulatory agencies and facilities to develop a site-specific approach. An overview of the regulations and their implementation in the United State is provided [ru

  11. The physical environment and patients' activities and care: A comparative case study at three newly built stroke units.

    Science.gov (United States)

    Anåker, Anna; von Koch, Lena; Sjöstrand, Christina; Heylighen, Ann; Elf, Marie

    2018-04-20

    To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units. Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce. This work is a comparative descriptive case study. Patients (N = 55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioural mapping analysed with descriptive statistics and field note taking analysed with deductive content analysis. Data were collected from April 2013 - December 2015. The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single-room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care. Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  12. Exertional heat stroke management strategies in United States high school football.

    Science.gov (United States)

    Kerr, Zachary Y; Marshall, Stephen W; Comstock, R Dawn; Casa, Douglas J

    2014-01-01

    The 5-year period of 2005-2009 saw more exertional heat stroke-related deaths in organized sports than any other 5-year period in the past 35 years. The risk of exertional heat stroke appears highest in football, particularly during the preseason. To estimate the incidence of exertional heat stroke events and assess the utilization of exertional heat stroke management strategies during the 2011 preseason in United States high school football programs. Cross-sectional study; Level of evidence, 3. A self-administered online questionnaire addressing the incidence of exertional heat stroke events and utilization of exertional heat stroke management strategies (eg, removing athlete's football equipment, calling Emergency Medical Services [EMS]) was completed in May to June 2012 by 1142 (18.0%) athletic trainers providing care to high school football athletes during the 2011 preseason. Among all respondents, 20.3% reported treating at least 1 exertional heat stroke event. An average of 0.50 ± 1.37 preseason exertional heat stroke events were treated per program. Athletic trainers responding to exertional heat stroke reported using an average of 6.6 ± 1.8 management strategies. The most common management strategies were low-level therapeutic interventions such as removing the athlete's football equipment (98.2%) and clothing (77.8%) and moving the athlete to a shaded area (91.6%). Few athletic trainers reported active management strategies such as calling EMS (29.3%) or using a rectal thermometer to check core body temperature (0.9%). Athletic trainers in states with mandated preseason heat acclimatization guidelines reported a higher utilization of management strategies such as cooling the athlete through air conditioning (90.1% vs 65.0%, respectively; P football programs. The standard of care is (and should be) to treat proactively; therefore, treatment is not a perfect proxy for incidence. Nevertheless, there is an urgent need for improved education and awareness of

  13. Development and feasibility testing of an oral hygiene intervention for stroke unit care.

    Science.gov (United States)

    Smith, Craig J; Horne, Maria; McCracken, Giles; Young, David; Clements, Ian; Hulme, Sharon; Ardron, Claire; Hamdy, Shaheen; Vail, Andy; Walls, Angus; Tyrrell, Pippa J

    2017-03-01

    To develop an oral hygiene complex intervention and evaluate its feasibility in a single UK stroke centre. Oral hygiene interventions might improve clinical outcomes after stroke but evidence-based practice is lacking. We used a sequential mixed methods approach and developed an oral hygiene complex intervention comprising: (i) web-based education and 'hands-on' practical training for stroke unit nursing staff, (ii) a pragmatic oral hygiene protocol consisting of twice-daily powered (or manual if preferred) brushing with chlorhexidine gel (or non-foaming toothpaste) ± denture care. We evaluated feasibility of (i) the staff education and training and (ii) the oral hygiene protocol in consenting inpatients with confirmed stroke, requiring assistance with at least one aspect of personal care. The staff education and training were feasible, acceptable and raised knowledge and awareness. Several barriers to completing the education and training were identified. The oral hygiene protocol was feasible and well-tolerated. 22% of eligible patients screened declined participation in the study. Twenty-nine patients (median age = 78 year; National Institutes of Health Stroke Scale score = 8.5; 73% dentate) were recruited at a median of 7 days from stroke onset. 97% of participants chose the default chlorhexidine-based protocol; the remainder chose the non-foaming toothpaste-based protocol. The mouth hygiene protocol was administered as prescribed on 95% of occasions, over a median duration of 28 days. There were no adverse events attributed to the oral hygiene protocol. Our oral hygiene complex intervention was feasible in a single UK stroke centre. Further studies to optimise patient selection, model health economics and explore efficacy are now required. © 2016 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  14. Data Glove System Embedded With Inertial Measurement Units for Hand Function Evaluation in Stroke Patients.

    Science.gov (United States)

    Lin, Bor-Shing; Hsiao, Pei-Chi; Yang, Shu-Yu; Su, Che-Shih; Lee, I-Jung

    2017-11-01

    This paper proposes a data glove system integrated with six-axis inertial measurement unit sensors for evaluating the hand function of patients who have suffered a stroke. The modular design of this data glove facilitates its use for stroke patients. The proposed system can use the hand's accelerations, angular velocities, and joint angles as calculated by a quaternion algorithm, to help physicians gain new insights into rehabilitation treatments. A clinical experiment was performed on 15 healthy subjects and 15 stroke patients whose Brunnstrom stages (BSs) ranged from 4 to 6. In this experiment, the participants were subjected to a grip task, thumb task, and card turning task to produce raw data and three features, namely, the average rotation speed, variation of movement completion time, and quality of movement; these features were extracted from the recorded data to form 2-D and 3-D scatter plots. These scatter plots can provide reference information and guidance to physicians who must determine the BSs of stroke patients. The proposed system demonstrated a hit rate of 70.22% on average. Therefore, this system can effectively reduce physicians' load and provide them with detailed information about hand function to help them adjust rehabilitation strategies for stroke patients.

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

    Science.gov (United States)

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

    2011-01-01

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

  16. Exploring the decision-making process in the delivery of physiotherapy in a stroke unit.

    Science.gov (United States)

    McGlinchey, Mark P; Davenport, Sally

    2015-01-01

    The aim of this study was to explore the decision-making process in the delivery of physiotherapy in a stroke unit. A focused ethnographical approach involving semi-structured interviews and observations of clinical practice was used. A purposive sample of seven neurophysiotherapists and four patients participated in semi-structured interviews. From this group, three neurophysiotherapists and four patients were involved in observation of practice. Data from interviews and observations were analysed to generate themes. Three themes were identified: planning the ideal physiotherapy delivery, the reality of physiotherapy delivery and involvement in the decision-making process. Physiotherapists used a variety of clinical reasoning strategies and considered many factors to influence their decision-making in the planning and delivery of physiotherapy post-stroke. These factors included the therapist's clinical experience, patient's presentation and response to therapy, prioritisation, organisational constraints and compliance with organisational practice. All physiotherapists highlighted the importance to involve patients in planning and delivering their physiotherapy. However, there were varying levels of patient involvement observed in this process. The study has generated insight into the reality of decision-making in the planning and delivery of physiotherapy post-stroke. Further research involving other stroke units is required to gain a greater understanding of this aspect of physiotherapy. Implications for Rehabilitation Physiotherapists need to consider multiple patient, therapist and organisational factors when planning and delivering physiotherapy in a stroke unit. Physiotherapists should continually reflect upon how they provide physiotherapy, with respect to the duration, frequency and time of day sessions are delivered, in order to guide current and future physiotherapy delivery. As patients may demonstrate varying levels of participation in deciding and

  17. Recent age- and gender-specific trends in mortality during stroke hospitalization in the United States.

    Science.gov (United States)

    Ovbiagele, Bruce; Markovic, Daniela; Towfighi, Amytis

    2011-10-01

    Advancements in diagnosis and treatment have resulted in better clinical outcomes after stroke; however, the influence of age and gender on recent trends in death during stroke hospitalization has not been specifically investigated. We assessed the impact of age and gender on nationwide patterns of in-hospital mortality after stroke. Data were obtained from all US states that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 1998 (n=1 351 293) and 2005 and 2006 (n=1 202 449), with a discharge diagnosis of stroke (identified by the International Classification of Diseases, Ninth Revision procedure codes), were included. Time trends for in-hospital mortality after stroke were evaluated by gender and age group based on 10-year age increments (84) using multivariable logistic regression. Between 1997 and 2006, in-hospital mortality rates decreased across time in all sub-groups (all P84 years. In unadjusted analysis, men aged >84 years in 1997-1998 had poorer mortality outcomes than similarly aged women (odds ratio 0·93, 95% confidence interval=0·88-0·98). This disparity worsened by 2005-2006 (odds ratio 0·88, 95% confidence interval=0·84-0·93). After adjusting for confounders, compared with similarly aged women, the mortality outcomes among men aged >84 years were poorer in 1997-1998 (odds ratio 0·97, 95% confidence interval=0·92-1·02) and were poorer in 2005-2006 (odds ratio 0·92, 95% confidence interval=0·87-0·96), P=0·04, for gender × time trend. Over the last decade, in-hospital mortality rates after stroke in the United States have declined for every age/gender group, except men aged >84 years. Given the rapidly ageing US population, avenues for boosting in-hospital survival among very elderly men with stroke need to be explored. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

  18. Motor unit properties of biceps brachii in chronic stroke patients assessed with high-density surface EMG

    NARCIS (Netherlands)

    Kallenberg, L.A.C.; Hermens, Hermanus J.

    2009-01-01

    The aim of this study was to investigate motor unit (MU) characteristics of the biceps brachii in post-stroke patients, using high-density surface electromyography (sEMG). Eighteen chronic hemiparetic stroke patients took part. The Fugl-Meyer score for the upper extremity was assessed. Subjects

  19. The impact of stroke unit care on outcome in a Scottish stroke population, taking into account case mix and selection bias.

    Science.gov (United States)

    Turner, Melanie; Barber, Mark; Dodds, Hazel; Dennis, Martin; Langhorne, Peter; Macleod, Mary Joan

    2015-03-01

    Randomised trials indicate that stroke unit care reduces morbidity and mortality after stroke. Similar results have been seen in observational studies but many have not corrected for selection bias or independent predictors of outcome. We evaluated the effect of stroke unit compared with general ward care on outcomes after stroke in Scotland, adjusting for case mix by incorporating the six simple variables (SSV) model, also taking into account selection bias and stroke subtype. We used routine data from National Scottish datasets for acute stroke patients admitted between 2005 and 2011. Patients who died within 3 days of admission were excluded from analysis. The main outcome measures were survival and discharge home. Multivariable logistic regression was used to estimate the OR for survival, and adjustment was made for the effect of the SSV model and for early mortality. Cox proportional hazards model was used to estimate the hazard of death within 365 days. There were 41 692 index stroke events; 79% were admitted to a stroke unit at some point during their hospital stay and 21% were cared for in a general ward. Using the SSV model, we obtained a receiver operated curve of 0.82 (SE 0.002) for mortality at 6 months. The adjusted OR for survival at 7 days was 3.11 (95% CI 2.71 to 3.56) and at 1 year 1.43 (95% CI 1.34 to 1.54) while the adjusted OR for being discharged home was 1.19 (95% CI 1.11 to 1.28) for stroke unit care. In routine practice, stroke unit admission is associated with a greater likelihood of discharge home and with lower mortality up to 1 year, after correcting for known independent predictors of outcome, and excluding early non-modifiable mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Specific features of acute stroke in the Russian Federation and in the People’s Republic of China (according to the data of some big stroke units

    Directory of Open Access Journals (Sweden)

    S. S. Yu

    2016-01-01

    Full Text Available The study focuses on comparison and analysis of the work of big stroke units in the Russian Federation and the People’s Republic of China specialized in the medical care for patients with acute stroke. 522 patients were surveyed in Russia’s and China’s regional stroke units. In the Russian Federation, patients being treated in the «City Hospital No.26» (SaintPetersburg took part in the study. In China patients of the First Affiliated Hospital of the Chongqing Medical University, Central Hospital Jiang jin, Regional People’s Hospital Yubei district, Regional People’s Hospital Bishan (Chongqing Province. The analysis of differences was performed by the following parameters: personality traits, age, gender, level of education, income, health insurance category, profession, employment, professional activities over the last year, place of residence of the patient, features of the stroke, time during the first symptoms of stroke to hospitalization, kinds of medical services, the main risk factors and value of prevention before stroke.

  1. Behavior of medial gastrocnemius motor units during postural reactions to external perturbations after stroke.

    Science.gov (United States)

    Pollock, C L; Ivanova, T D; Hunt, M A; Garland, S J

    2015-10-01

    This study investigated the behavior of medial gastrocnemius (GM) motor units (MU) during external perturbations in standing in people with chronic stroke. GM MUs were recorded in standing while anteriorly-directed perturbations were introduced by applying loads of 1% body mass (BM) at the pelvis every 25-40s until 5% BM was maintained. Joint kinematics, surface electromyography (EMG), and force platform measurements were assessed. Although external loads caused a forward progression of the anterior-posterior centre of pressure (APCOP), people with stroke decreased APCOP velocity and centre of mass (COM) velocity immediately following the highest perturbations, thereby limiting movement velocity in response to perturbations. MU firing rate did not increase with loading but the GM EMG magnitude increased, reflecting MU recruitment. MU inter spike interval (ISI) during the dynamic response was negatively correlated with COM velocity and hip angular velocity. The GM utilized primarily MU recruitment to maintain standing during external perturbations. The lack of MU firing rate modulation occurred with a change in postural central set. However, the relationship of MU firing rate with kinematic variables suggests underlying long-loop responses may be somewhat intact after stroke. People with stroke demonstrate alterations in postural control strategies which may explain MU behavior with external perturbations. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  2. An interdisciplinary visual team in an acute and sub-acute stroke unit: Providing assessment and early rehabilitation.

    Science.gov (United States)

    Norup, Anne; Guldberg, Anne-Mette; Friis, Claus Radmer; Deurell, Eva Maria; Forchhammer, Hysse Birgitte

    2016-07-15

    To describe the work of an interdisciplinary visual team in a stroke unit providing early identification and assessment of patients with visual symptoms, and secondly to investigate frequency, type of visual deficits after stroke and self-evaluated impact on everyday life after stroke. For a period of three months, all stroke patients with visual or visuo-attentional deficits were registered, and data concerning etiology, severity and localization of the stroke and initial visual symptoms were registered. One month after discharge patients were contacted for follow-up. Of 349 acute stroke admissions, 84 (24.1%) had visual or visuo-attentional deficits initially. Of these 84 patients, informed consent was obtained from 22 patients with a mean age of 67.7 years(SD 10.1), and the majority was female (59.1%). Based on the initial neurological examination, 45.4% had some kind of visual field defect, 27.2% had some kind of oculomotor nerve palsy, and about 31.8% had some kind of inattention or visual neglect. The patients were contacted for a phone-based follow-up one month after discharge, where 85.7% reported changes in their vision since their stroke. In this consecutive sample, a quarter of all stroke patients had visual or visuo-attentional deficits initially. This emphasizes how professionals should have increased awareness of the existence of such deficits after stroke in order to provide the necessary interdisciplinary assessment and rehabilitation.

  3. Altered motor unit discharge patterns in paretic muscles of stroke survivors assessed using surface electromyography

    Science.gov (United States)

    Hu, Xiaogang; Suresh, Aneesha K.; Rymer, William Z.; Suresh, Nina L.

    2016-08-01

    Objective. Hemispheric stroke survivors often show impairments in voluntary muscle activation. One potential source of these impairments could come from altered control of muscle, via disrupted motor unit (MU) firing patterns. In this study, we sought to determine whether MU firing patterns are modified on the affected side of stroke survivors, as compared with the analogous contralateral muscle. Approach. Using a novel surface electromyogram (EMG) sensor array, coupled with advanced template recognition software (dEMG) we recorded surface EMG signals over the first dorsal interosseous (FDI) muscle on both paretic and contralateral sides. Recordings were made as stroke survivors produced isometric index finger abductions over a large force range (20%-60% of maximum). Utilizing the dEMG algorithm, MU firing rates, recruitment thresholds, and action potential amplitudes were estimated for concurrently active MUs in each trial. Main results. Our results reveal significant changes in the firing rate patterns in paretic FDI muscle, in that the discharge rates, characterized in relation to recruitment force threshold and to MU size, were less clearly correlated with recruitment force than in contralateral FDI muscles. Firing rates in the affected muscle also did not modulate systematically with the level of voluntary muscle contraction, as would be expected in intact muscles. These disturbances in firing properties also correlated closely with the impairment of muscle force generation. Significance. Our results provide strong evidence of disruptions in MU firing behavior in paretic muscles after a hemispheric stroke, suggesting that modified control of the spinal motoneuron pool could be a contributing factor to muscular weakness in stroke survivors.

  4. Disturbances of motor unit rate modulation are prevalent in muscles of spastic-paretic stroke survivors

    Science.gov (United States)

    Heckman, C. J.; Powers, R. K.; Rymer, W. Z.; Suresh, N. L.

    2014-01-01

    Stroke survivors often exhibit abnormally low motor unit firing rates during voluntary muscle activation. Our purpose was to assess the prevalence of saturation in motor unit firing rates in the spastic-paretic biceps brachii muscle of stroke survivors. To achieve this objective, we recorded the incidence and duration of impaired lower- and higher-threshold motor unit firing rate modulation in spastic-paretic, contralateral, and healthy control muscle during increases in isometric force generated by the elbow flexor muscles. Impaired firing was considered to have occurred when firing rate became constant (i.e., saturated), despite increasing force. The duration of impaired firing rate modulation in the lower-threshold unit was longer for spastic-paretic (3.9 ± 2.2 s) than for contralateral (1.4 ± 0.9 s; P unit was also longer for the spastic-paretic (1.7 ± 1.6 s) than contralateral (0.3 ± 0.3 s; P = 0.007) and control (0.1 ± 0.2 s; P = 0.009) muscles. This impaired firing rate of the lower-threshold unit arose, despite an increase in the overall descending command, as shown by the recruitment of the higher-threshold unit during the time that the lower-threshold unit was saturating, and by the continuous increase in averages of the rectified EMG of the biceps brachii muscle throughout the rising phase of the contraction. These results suggest that impairments in firing rate modulation are prevalent in motor units of spastic-paretic muscle, even when the overall descending command to the muscle is increasing. PMID:24572092

  5. The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Rasmussen, Lars S.; Lohse, Nicolai

    2017-01-01

    Background: Transportation by helicopter may reduce time to hospital admission and improve outcome. We aimed to investigate the effect of transport mode on mortality, disability, and labour market affiliation in patients admitted to the stroke unit. Methods: Prospective, observational study with 5...... patients. Primary outcome was long-term mortality after admission to the stroke unit. Results: Of the 1679 patients admitted to the stroke unit, 1068 were eligible for inclusion. Mortality rates were 9.04 per 100 person-years at risk (PYR) in GEMS patients and 9.71 per 100 PYR in HEMS patients (IRR = 1...... for neurological outcome is probably difficult to detect by considering mortality, but for the secondary analyses we had less statistical power as illustrated by the wide confidence intervals. Conclusion: Helicopter transport of stroke patients was not associated with reduced mortality or disability, nor improved...

  6. WIPP Facility Work Plan for Solid Waste Management Units

    Energy Technology Data Exchange (ETDEWEB)

    Washington TRU Solutions LLC

    2001-02-25

    This 2001 Facility Work Plan (FWP) has been prepared as required by Module VII, Section VII.M.1 of the Waste Isolation Pilot Plant (WIPP) Hazardous Waste Facility Permit, NM4890139088-TSDF (the Permit); (NMED, 1999a), and incorporates comments from the New Mexico Environment Department (NMED) received on December 6, 2000 (NMED, 2000a). This February 2001 FWP describes the programmatic facility-wide approach to future investigations at Solid Waste Management Units (SWMUs) and Areas of Concern (AOCs) specified in the Permit. The permittees are evaluating data from previous investigations of the SWMUs and AOCs against the newest guidance proposed by the NMED. Based on these data, the permittees expect that no further sampling will be required and that a request for No Further Action (NFA) at the SWMUs and AOCs will be submitted to the NMED. This FWP addresses the current Permit requirements. It uses the results of previous investigations performed at WIPP and expands the investigations as required by the Permit. As an alternative to the Resource Conservation and Recovery Act (RCRA) Facility Investigation (RFI) specified in Module VII of the Permit, current NMED guidance identifies an Accelerated Corrective Action Approach (ACAA) that may be used for any SWMU or AOC (NMED, 1998). This accelerated approach is used to replace the standard RFI Work Plan and Report sequence with a more flexible decision-making approach. The ACAA process allows a Facility to exit the schedule of compliance contained in the Facility’s Hazardous and Solid Waste Amendments (HSWA) permit module and proceed on an accelerated time frame. Thus, the ACAA process can be entered either before or after an RFI Work Plan. According to the NMED's guidance, a facility can prepare an RFI Work Plan or Sampling and Analysis Plan (SAP) for any SWMU or AOC (NMED, 1998). Based on this guidance, a SAP constitutes an acceptable alternative to the RFI Work Plan specified in the Permit.

  7. Determinants of Length of Stay in Stroke Patients: A Geriatric Rehabilitation Unit Experience

    Science.gov (United States)

    Atalay, Ayce; Turhan, Nur

    2009-01-01

    The objective was to identify the predictors of length of stay--the impact of age, comorbidity, and stroke subtype--on the outcome of geriatric stroke patients. One hundred and seventy stroke patients (129 first-ever ischemic, 25 hemorrhagic, and 16 ischemic second strokes) were included in the study. The Oxfordshire Community Stroke Project…

  8. WIPP Facility Work Plan for Solid Waste Management Units

    International Nuclear Information System (INIS)

    2000-01-01

    This Facility Work Plan (FWP) has been prepared as required by Module VII,Section VII.M.1 of the Waste Isolation Pilot Plant (WIPP) Hazardous Waste Permit, NM4890139088-TSDF (the Permit); (NMED, 1999a). This work plan describes the programmatic facility-wide approach to future investigations at Solid Waste Management Units (SWMUs) and Areas of Concern (AOCs) specified in the Permit. This FWP addresses the current Permit requirements. It uses the results of previous investigations performed at WIPP and expands the investigations as required by the Permit. As an alternative to the Resource Conservation and Recovery Act (RCRA) Facility Investigation (RFI) specified in Module VII of the Permit, current New Mexico Environment Department (NMED) guidance identifies an Accelerated Corrective Action Approach (ACAA) that may be used for any SWMU or AOC (NMED, 1998). This accelerated approach is used to replace the standard RFI Work Plan and Report sequence with a more flexible decision-making approach. The ACAA process allows a Facility to exit the schedule of compliance contained in the Facility's's Hazardous and Solid Waste Amendments (HSWA) permit module and proceed on an accelerated time frame. Thus, the ACAA process can be entered either before or after an RFI Work Plan. According to NMED's guidance, a facility can prepare an RFI Work Plan or Sampling and Analysis Plan (SAP) for any SWMU or AOC (NMED, 1998). Based on this guidance, a SAP constitutes an acceptable alternative to the RFI Work Plan specified in the Permit. The scope of work for the RFI Work Plan or SAP is being developed by the Permittees. The final content of the RFI Work Plan or SAP will be coordinated with the NMED for submittal on May 24, 2000. Specific project-related planning information will be included in the RFI Work Plan or SAP. The SWMU program at WIPP began in 1994 under U.S. Environmental Protection Agency (EPA) regulatory authority. NMED subsequently received regulatory authority from EPA. A

  9. Assessing altered motor unit recruitment patterns in paretic muscles of stroke survivors using surface electromyography

    Science.gov (United States)

    Hu, Xiaogang; Suresh, Aneesha K.; Rymer, William Z.; Suresh, Nina L.

    2015-12-01

    Objective. The advancement of surface electromyogram (sEMG) recording and signal processing techniques has allowed us to characterize the recruitment properties of a substantial population of motor units (MUs) non-invasively. Here we seek to determine whether MU recruitment properties are modified in paretic muscles of hemispheric stroke survivors. Approach. Using an advanced EMG sensor array, we recorded sEMG during isometric contractions of the first dorsal interosseous muscle over a range of contraction levels, from 20% to 60% of maximum, in both paretic and contralateral muscles of stroke survivors. Using MU decomposition techniques, MU action potential amplitudes and recruitment thresholds were derived for simultaneously activated MUs in each isometric contraction. Main results. Our results show a significant disruption of recruitment organization in paretic muscles, in that the size principle describing recruitment rank order was materially distorted. MUs were recruited over a very narrow force range with increasing force output, generating a strong clustering effect, when referenced to recruitment force magnitude. Such disturbances in MU properties also correlated well with the impairment of voluntary force generation. Significance. Our findings provide direct evidence regarding MU recruitment modifications in paretic muscles of stroke survivors, and suggest that these modifications may contribute to weakness for voluntary contractions.

  10. Relative contribution of different altered motor unit control to muscle weakness in stroke: a simulation study

    Science.gov (United States)

    Shin, Henry; Suresh, Nina L.; Zev Rymer, William; Hu, Xiaogang

    2018-02-01

    Objective. Chronic muscle weakness impacts the majority of individuals after a stroke. The origins of this hemiparesis is multifaceted, and an altered spinal control of the motor unit (MU) pool can lead to muscle weakness. However, the relative contribution of different MU recruitment and discharge organization is not well understood. In this study, we sought to examine these different effects by utilizing a MU simulation with variations set to mimic the changes of MU control in stroke. Approach. Using a well-established model of the MU pool, this study quantified the changes in force output caused by changes in MU recruitment range and recruitment order, as well as MU firing rate organization at the population level. We additionally expanded the original model to include a fatigue component, which variably decreased the output force with increasing length of contraction. Differences in the force output at both the peak and fatigued time points across different excitation levels were quantified and compared across different sets of MU parameters. Main results. Across the different simulation parameters, we found that the main driving factor of the reduced force output was due to the compressed range of MU recruitment. Recruitment compression caused a decrease in total force across all excitation levels. Additionally, a compression of the range of MU firing rates also demonstrated a decrease in the force output mainly at the higher excitation levels. Lastly, changes to the recruitment order of MUs appeared to minimally impact the force output. Significance. We found that altered control of MUs alone, as simulated in this study, can lead to a substantial reduction in muscle force generation in stroke survivors. These findings may provide valuable insight for both clinicians and researchers in prescribing and developing different types of therapies for the rehabilitation and restoration of lost strength after stroke.

  11. The impact of a neuro-intensivist on patients with stroke admitted to a neurosciences intensive care unit.

    Science.gov (United States)

    Varelas, Panayiotis N; Schultz, Lonni; Conti, Mary; Spanaki, Marianna; Genarrelli, Thomas; Hacein-Bey, Lotfi

    2008-01-01

    Stroke Units improve the outcome in patients with mild to moderate severity strokes. We sought to examine the role that a full-time neurointensivist (NI) might play on the outcomes of patients with more severe strokes admitted to a Neurosciences Intensive Care Unit (NICU). Data regarding 433 stroke patients admitted to a 10-bed university hospital NICU were prospectively collected in two 19-month periods, before and after the appointment of a NI. Outcomes and disposition of patients with ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were compared between the two periods, using univariate and multivariate analyses. One hundred and seventy-four patients with strokes were admitted in the period before and 259 in the period after the NI. Observed mortality did not differ between the two periods. More patients were discharged home in the after period (75% vs. 54% in the before period (P = 0.003). After adjusting for covariates, the NICU and hospital LOS were shorter for each type of stroke in the after period (Cox proportional hazard ratios, 95% CI were 2.37, 1.4-4.1 and 1.8, 1.04-3 for IS, 1.98, 1.3-3 and 1.2, 0.8-1.9 for ICH, and 1.6, 1.1-2.3 and 1.4, 1.01-2 for SAH, respectively) or for all strokes (1.92, 1.52-2.43 and 1.7, 1.28-2.25 for the first 12 days of hospital admission). The direct patient care offered and the organizational changes implemented by a NI shortened the NICU and hospital LOS and improved the disposition of patients with strokes admitted to a NICU.

  12. Motor Unit Activity during Fatiguing Isometric Muscle Contraction in Hemispheric Stroke Survivors

    Directory of Open Access Journals (Sweden)

    Lara McManus

    2017-11-01

    Full Text Available Enhanced muscle weakness is commonly experienced following stroke and may be accompanied by increased susceptibility to fatigue. To examine the contributions of central and peripheral factors to isometric muscle fatigue in stroke survivors, this study investigates changes in motor unit (MU mean firing rate, and action potential duration during, and directly following, a sustained submaximal fatiguing contraction at 30% maximum voluntary contraction (MVC. A series of short contractions of the first dorsal interosseous muscle were performed pre- and post-fatigue at 20% MVC, and again following a 10-min recovery period, by 12 chronic stroke survivors. Individual MU firing times were extracted using surface EMG decomposition and used to obtain the spike-triggered average MU action potential waveforms. During the sustained fatiguing contraction, the mean rate of change in firing rate across all detected MUs was greater on the affected side (-0.02 ± 0.03 Hz/s than on the less-affected side (-0.004 ± 0.003 Hz/s, p = 0.045. The change in firing rate immediately post-fatigue was also greater on the affected side than less-affected side (-13.5 ± 20 and 0.1 ± 19%, p = 0.04. Mean MU firing rates increased following the recovery period on the less-affected side when compared to the affected side (19.3 ± 17 and 0.5 ± 20%, respectively, p = 0.03. MU action potential duration increased post-fatigue on both sides (10.3 ± 1.2 to 11.2 ± 1.3 ms on the affected side and 9.9 ± 1.7 to 11.2 ± 1.9 ms on the less-affected side, p = 0.001 and p = 0.02, respectively, and changes in action potential duration tended to be smaller in subjects with greater impairment (p = 0.04. This study presents evidence of both central and peripheral fatigue at the MU level during isometric fatiguing contraction for the first time in stroke survivors. Together, these preliminary observations indicate that the response to an isometric fatiguing contraction differs between the

  13. Results of clinicians using a therapeutic robotic system in an inpatient stroke rehabilitation unit.

    Science.gov (United States)

    Abdullah, Hussein A; Tarry, Cole; Lambert, Cynthia; Barreca, Susan; Allen, Brian O

    2011-08-26

    Physical rehabilitation is an area where robotics could contribute significantly to improved motor return for individuals following a stroke. This paper presents the results of a preliminary randomized controlled trial (RCT) of a robot system used in the rehabilitation of the paretic arm following a stroke. The study's objectives were to explore the efficacy of this new type of robotic therapy as compared to standard physiotherapy treatment in treating the post-stroke arm; to evaluate client satisfaction with the proposed robotic system; and to provide data for sample size calculations for a proposed larger multicenter RCT. Twenty clients admitted to an inpatient stroke rehabilitation unit were randomly allocated to one of two groups, an experimental (robotic arm therapy) group or a control group (conventional therapy). An occupational therapist blinded to patient allocation administered two reliable measures, the Chedoke Arm and Hand Activity Inventory (CAHAI-7) and the Chedoke McMaster Stroke Assessment of the Arm and Hand (CMSA) at admission and discharge. For both groups, at admission, the CMSA motor impairment stage of the affected arm was between 1 and 3. Data were compared to determine the effectiveness of robot-assisted versus conventional therapy treatments. At the functional level, both groups performed well, with improvement in scores on the CAHAI-7 showing clinical and statistical significance. The CAHAI-7 (range7-49) is a measure of motor performance using functional items. Individuals in the robotic therapy group, on average, improved by 62% (95% CI: 26% to 107%) while those in the conventional therapy group changed by 30% (95% CI: 4% to 61%). Although performance on this measure is influenced by hand recovery, our results showed that both groups had similar stages of motor impairment in the hand. Furthermore, the degree of shoulder pain, as measured by the CMSA pain inventory scale, did not worsen for either group over the course of treatment. Our

  14. Evaluation of existing United States' facilities for use as a mixed-oxide (MOX) fuel fabrication facility for plutonium disposition

    International Nuclear Information System (INIS)

    Beard, C.A.; Buksa, J.J.; Chidester, K.; Eaton, S.L.; Motley, F.E.; Siebe, D.A.

    1995-01-01

    A number of existing US facilities were evaluated for use as a mixed-oxide fuel fabrication facility for plutonium disposition. These facilities include the Fuels Material Examination Facility (FMEF) at Hanford, the Washington Power Supply Unit 1 (WNP-1) facility at Hanford, the Barnwell Nuclear Fuel Plant (BNFP) at Barnwell, SC, the Fuel Processing Facility (FPF) at Idaho National Engineering Laboratory (INEL), the Device Assembly Facility (DAF) at the Nevada Test Site (NTS), and the P-reactor at the Savannah River Site (SRS). The study consisted of evaluating each facility in terms of available process space, available building support systems (i.e., HVAC, security systems, existing process equipment, etc.), available regional infrastructure (i.e., emergency response teams, protective force teams, available transportation routes, etc.), and ability to integrate the MOX fabrication process into the facility in an operationally-sound manner that requires a minimum amount of structural modifications

  15. Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: a controlled before-after pilot study.

    Science.gov (United States)

    Rosbergen, Ingrid Cm; Grimley, Rohan S; Hayward, Kathryn S; Walker, Katrina C; Rowley, Donna; Campbell, Alana M; McGufficke, Suzanne; Robertson, Samantha T; Trinder, Janelle; Janssen, Heidi; Brauer, Sandra G

    2017-11-01

    To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. Controlled before-after pilot study. An acute stroke unit in a regional Australian hospital. Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. The enriched environment group ( n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in 'any' activity (71% vs. 58%, P = 0.005) compared to the usual care group ( n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). Embedding an enriched environment in an acute stroke unit increased activity in stroke patients.

  16. WIPP Facility Work Plan for Solid Waste Management Units

    Energy Technology Data Exchange (ETDEWEB)

    Washington TRU Solutions LLC

    2000-02-25

    This Facility Work Plan (FWP) has been prepared as required by Module VII,Section VII.M.1 of the Waste Isolation Pilot Plant (WIPP) Hazardous Waste Permit, NM4890139088-TSDF (the Permit); (NMED, 1999a). This work plan describes the programmatic facility-wide approach to future investigations at Solid Waste Management Units (SWMUs) and Areas of Concern (AOCs) specified in the Permit. This FWP addresses the current Permit requirements. It uses the results of previous investigations performed at WIPP and expands the investigations as required by the Permit. As an alternative to the Resource Conservation and Recovery Act (RCRA) Facility Investigation (RFI) specified in Module VII of the Permit, current New Mexico Environment Department (NMED) guidance identifies an Accelerated Corrective Action Approach (ACAA) that may be used for any SWMU or AOC (NMED, 1998). This accelerated approach is used to replace the standard RFI Work Plan and Report sequence with a more flexible decision-making approach. The ACAA process allows a Facility to exit the schedule of compliance contained in the Facility’s Hazardous and Solid Waste Amendments (HSWA) permit module and proceed on an accelerated time frame. Thus, the ACAA process can be entered either before or after an RFI Work Plan. According to NMED’s guidance, a facility can prepare an RFI Work Plan or Sampling and Analysis Plan (SAP) for any SWMU or AOC (NMED, 1998). Based on this guidance, a SAP constitutes an acceptable alternative to the RFI Work Plan specified in the Permit. The scope of work for the RFI Work Plan or SAP is being developed by the Permittees. The final content of the RFI Work Plan or SAP will be coordinated with the NMED for submittal on May 24, 2000. Specific project-related planning information will be included in the RFI Work Plan or SAP. The SWMU program at WIPP began in 1994 under U.S. Environmental Protection Agency (EPA) regulatory authority. NMED subsequently received regulatory authority from EPA

  17. Clinical Information Systems Integration in New York City's First Mobile Stroke Unit.

    Science.gov (United States)

    Kummer, Benjamin R; Lerario, Michael P; Navi, Babak B; Ganzman, Adam C; Ribaudo, Daniel; Mir, Saad A; Pishanidar, Sammy; Lekic, Tim; Williams, Olajide; Kamel, Hooman; Marshall, Randolph S; Hripcsak, George; Elkind, Mitchell S V; Fink, Matthew E

    2018-01-01

    Mobile stroke units (MSUs) reduce time to thrombolytic therapy in acute ischemic stroke. These units are widely used, but the clinical information systems underlying MSU operations are understudied. The first MSU on the East Coast of the United States was established at New York Presbyterian Hospital (NYP) in October 2016. We describe our program's 7-month pilot, focusing on the integration of our hospital's clinical information systems into our MSU to support patient care and research efforts. NYP's MSU was staffed by two paramedics, one radiology technologist, and a vascular neurologist. The unit was equipped with four laptop computers and networking infrastructure enabling all staff to access the hospital intranet and clinical applications during operating hours. A telephone-based registration procedure registered patients from the field into our admit/discharge/transfer system, which interfaced with the institutional electronic health record (EHR). We developed and implemented a computerized physician order entry set in our EHR with prefilled values to permit quick ordering of medications, imaging, and laboratory testing. We also developed and implemented a structured clinician note to facilitate care documentation and clinical data extraction. Our MSU began operating on October 3, 2016. As of April 27, 2017, the MSU transported 49 patients, of whom 16 received tissue plasminogen activator (t-PA). Zero technical problems impacting patient care were reported around registration, order entry, or intranet access. Two onboard network failures occurred, resulting in computed tomography scanner malfunctions, although no patients became ineligible for time-sensitive treatment as a result. Thirteen (26.5%) clinical notes contained at least one incomplete time field. The main technical challenges encountered during the integration of our hospital's clinical information systems into our MSU were onboard network failures and incomplete clinical documentation. Future

  18. Sanford Underground Research Facility - The United State's Deep Underground Research Facility

    Science.gov (United States)

    Vardiman, D.

    2012-12-01

    The 2.5 km deep Sanford Underground Research Facility (SURF) is managed by the South Dakota Science and Technology Authority (SDSTA) at the former Homestake Mine site in Lead, South Dakota. The US Department of Energy currently supports the development of the facility using a phased approach for underground deployment of experiments as they obtain an advanced design stage. The geology of the Sanford Laboratory site has been studied during the 125 years of operations at the Homestake Mine and more recently as part of the preliminary geotechnical site investigations for the NSF's Deep Underground Science and Engineering Laboratory project. The overall geology at DUSEL is a well-defined stratigraphic sequence of schist and phyllites. The three major Proterozoic units encountered in the underground consist of interbedded schist, metasediments, and amphibolite schist which are crosscut by Tertiary rhyolite dikes. Preliminary geotechnical site investigations included drift mapping, borehole drilling, borehole televiewing, in-situ stress analysis, laboratory analysis of core, mapping and laser scanning of new excavations, modeling and analysis of all geotechnical information. The investigation was focused upon the determination if the proposed site rock mass could support the world's largest (66 meter diameter) deep underground excavation. While the DUSEL project has subsequently been significantly modified, these data are still available to provide a baseline of the ground conditions which may be judiciously extrapolated throughout the entire Proterozoic rock assemblage for future excavations. Recommendations for facility instrumentation and monitoring were included in the preliminary design of the DUSEL project design and include; single and multiple point extensometers, tape extensometers and convergence measurements (pins), load cells and pressure cells, smart cables, inclinometers/Tiltmeters, Piezometers, thermistors, seismographs and accelerometers, scanners (laser

  19. Comparisons of social interaction and activities of daily living between long-term care facility and community-dwelling stroke patients.

    Science.gov (United States)

    Yoon, Jeong-Ae; Park, Se-Gwan; Roh, Hyo-Lyun

    2015-10-01

    [Purpose] This study was conducted to compare the correlation between social interaction and activities of daily living (ADL) between community-dwelling and long-term care facility stroke patients. [Subjects and Methods] The Subjects were 65 chronic stroke patients (32 facility-residing, 33 community-dwelling). The Evaluation Social Interaction (ESI) tool was used to evaluate social interaction and the Assessment of Motor and Process Skills (AMPS) measure was used to evaluate ADL. [Results] Both social interaction and ADL were higher in community-dwelling than facility-residing stroke patients. There was a correlation between ESI and ADL for both motor and process skills among facility-residing patients, while only ADL process skills and ESI correlated among community-dwelling patients. In a partial correlation analysis using ADL motor and process skills as control variables, only process skills correlated with ESI. [Conclusion] For rehabilitation of stroke patients, an extended treatment process that combines ADL and social activities is likely to be required. Furthermore, treatment programs and institutional systems that can improve social interaction and promote health maintenance for community-dwelling and facility-residing chronic stroke patients are needed throughout the rehabilitation process.

  20. Effect of a provincial system of stroke care delivery on stroke care and outcomes

    Science.gov (United States)

    Kapral, Moira K.; Fang, Jiming; Silver, Frank L.; Hall, Ruth; Stamplecoski, Melissa; O’Callaghan, Christina; Tu, Jack V.

    2013-01-01

    Background: Systems of stroke care delivery have been promoted as a means of improving the quality of stroke care, but little is known about their effectiveness. We assessed the effect of the Ontario Stroke System, a province-wide strategy of regionalized stroke care delivery, on stroke care and outcomes in Ontario, Canada. Methods: We used population-based provincial administrative databases to identify all emergency department visits and hospital admissions for acute stroke and transient ischemic attack from Jan. 1, 2001, to Dec. 31, 2010. Using piecewise regression analyses, we assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centres, and on rates of discharge to long-term care facilities and 30-day mortality after stroke. Results: We included 243 287 visits by patients with acute stroke or transient ischemic attack. The full implementation of the Ontario Stroke System in 2005 was associated with an increase in rates of care at stroke centres (before implementation: 40.0%; after implementation: 46.5%), decreased rates of discharge to long-term care facilities (before implementation: 16.9%; after implementation: 14.8%) and decreased 30-day mortality for hemorrhagic (before implementation: 38.3%; after implementation: 34.4%) and ischemic stroke (before implementation: 16.3%; after implementation: 15.7%). The system’s implementation was also associated with marked increases in the proportion of patients who received neuroimaging, thrombolytic therapy, care in a stroke unit and antithrombotic therapy. Interpretation: The implementation of an organized system of stroke care delivery was associated with improved processes of care and outcomes after stroke. PMID:23713072

  1. [A comparison of stroke patients' characteristics between a sub-Saharan Africa population (Abidjan) and a French stroke unit (Amiens): An observational study].

    Science.gov (United States)

    Bugnicourt, J-M; Tchouata-Ngandjouc, L; Beugre, K; Chillon, J-M; Godefroy, O

    2013-03-01

    Stroke characteristics in Sub-Saharan Africa (SSA) differ from developed countries. However, SSA subjects undergo epidemiological and demographic transition and it appears that the prevalence of vascular risk factors (RF) increases in this population. Here we aimed to compare stroke patients' characteristics between a SSA hospital (Cocody University Hospital, Abidjan, Côte d'Ivoire) and a French stroke unit (Amiens University Hospital, Amiens, France). This retrospective study included all consecutive stroke patients admitted between January and May 2008 (Cocody University Hospital, Abidjan, Côte d'Ivoire) and between October and December 2008 (Amiens University Hospital, Amiens, France). We assessed each patient's demographic details, RF, and CT confirmed pathological stroke type. The glomerular filtration rate (GFR) was estimated using the four-component Modification of Diet in Renal Disease (MDRD) equation and CKD was defined as a GFR less than 60ml/min/1.73 m(2). One hundred and ninety five patients were included (Amiens: 92; Abidjan: 103) with a mean age of 63±14 years. Patients in Amiens had more known vascular RF than African patients, whereas African patients had more RF discovered during hospitalisation. Furthermore, CKD was significantly more common in SSA patients (43% vs 24%, P=0.001). More African than European patients had cerebral hemorrhage (34% vs 8%, Pstroke mortality and treatments at hospital discharge were similar between the two hospitals. Finally, a high proportion of patients in Abidjan suffered from cervical atherosclerosis, although it was significantly lower than patients in Amiens (37% vs 67%, Pstroke patients. These findings could partly explain the high prevalence of cervical atherosclerosis found in this population. These results warrant confirmation in prospective studies. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  2. Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke.

    Science.gov (United States)

    Xian, Ying; Thomas, Laine; Liang, Li; Federspiel, Jerome J; Webb, Laura E; Bushnell, Cheryl D; Duncan, Pamela W; Schwamm, Lee H; Stein, Joel; Fonarow, Gregg C; Hoenig, Helen; Montalvo, Cris; George, Mary G; Lutz, Barbara J; Peterson, Eric D; Bettger, Janet Prvu

    2017-10-01

    Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. URL: https://clinicaltrials.gov. Unique identifier: NCT02284165. © 2017 American Heart Association, Inc.

  3. Correctional Facilities, United States, 2015, EPA Region 9

    Data.gov (United States)

    U.S. Environmental Protection Agency — This GIS dataset contains point features that represent correctional facilities associated with a single NAICS code. Establishment-specific information, except...

  4. Improvement of Oil-Vapor Treatment Facility for Wolsong Unit 3,4

    International Nuclear Information System (INIS)

    Kim, Jeong Guk; Kwon, S. W.; Lee, H. S.

    2009-11-01

    With the purpose to minimize an oil-vapor discharge to the atmosphere and to be an environmentally friendly nuclear power plant by an improvement of mist eliminator for turbine lubricant system at Wolsong Nuclear Power Plant Unit 3,4, this project - project name : Improvement of Oil-vapor Treatment Facility for Wolsong Unit 3,4 - was conducted for six months (from Apr. 15, 2009 to Oct. 14, 2009). This Project contains Oil-vapor Source and Environmental Regulation, Analysis on the Present Oil-vapor Treatment Facility, Improvement of Oil-vapor Treatment Facility, Test Facility Design, Fabrication, Installation, Test Operation, Evaluation of the Facility

  5. Full Implementation of Screening for Nutritional Risk and Dysphagia in an Acute Stroke Unit: A Clinical Audit.

    Science.gov (United States)

    Kampman, Margitta T; Eltoft, Agnethe; Karaliute, Migle; Børvik, Margrethe T; Nilssen, Hugo; Rasmussen, Ida; Johnsen, Stein H

    2015-10-01

    In patients with acute stroke, undernutrition and aspiration pneumonia are associated with increased mortality and length of hospital stay. Formal screening for nutritional risk and dysphagia helps to ensure optimal nutritional management in all patients with stroke and to reduce the risk of aspiration in patients with dysphagia. We developed a national guideline for nutritional and dysphagia screening in acute stroke, which was introduced in our stroke unit on June 1, 2012. The primary objective was to audit adherence to the guideline and to achieve full implementation. Second, we assessed the prevalence of nutritional risk and dysphagia. We performed a chart review to assess performance of screening for nutritional risk and dysphagia in all patients with stroke hospitalized for ≥48 hours between June 1, 2012, and May 31, 2013. Next we applied a "clinical microsystems approach" with rapid improvement cycles and audits over a 6-month period to achieve full implementation. The chart review showed that nutritional risk screening was performed in 65% and swallow testing in 91% of eligible patients (n = 185). Proactive implementation resulted in >95% patients screened (n = 79). The overall prevalence of nutritional risk was 29%, and 23% of the patients failed the initial swallow test. Proactive implementation is required to obtain high screening rates for nutritional risk and swallowing difficulties using validated screening tools. The proportion of patients at nutritional risk and the prevalence of dysphagia at initial swallow test were in the lower range of previous reports.

  6. Biomarkers for acute diagnosis and management of stroke in neurointensive care units

    Directory of Open Access Journals (Sweden)

    Olena Y Glushakova

    2016-01-01

    Full Text Available The effectiveness of current management of critically ill stroke patients depends on rapid assessment of the type of stroke, ischemic or hemorrhagic, and on a patient′s general clinical status. Thrombolytic therapy with recombinant tissue plasminogen activator (r-tPA is the only effective treatment for ischemic stroke approved by the Food and Drug Administration (FDA, whereas no treatment has been shown to be effective for hemorrhagic stroke. Furthermore, a narrow therapeutic window and fear of precipitating intracranial hemorrhage by administering r-tPA cause many clinicians to avoid using this treatment. Thus, rapid and objective assessments of stroke type at admission would increase the number of patients with ischemic stroke receiving r-tPA treatment and thereby, improve outcome for many additional stroke patients. Considerable literature suggests that brain-specific protein biomarkers of glial [i.e. S100 calcium-binding protein B (S100B, glial fibrillary acidic protein (GFAP] and neuronal cells [e.g., ubiquitin C-terminal hydrolase-L1 (UCH-L1, neuron-specific enolase (NSE, αII-spectrin breakdown products SBDP120, SBDP145, and SBDP150, myelin basic protein (MBP, neurofilament light chain (NF-L, tau protein, visinin-like protein-1 (VLP 1, NR2 peptide] injury that could be detected in the cerebrospinal fluid (CSF and peripheral blood might provide valuable and timely diagnostic information for stroke necessary to make prompt management and decisions, especially when the time of stroke onset cannot be determined. This information could include injury severity, prognosis of short-term and long-term outcomes, and discrimination of ischemic or hemorrhagic stroke. This chapter reviews the current status of the development of biomarker-based diagnosis of stroke and its potential application to improve stroke care.

  7. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

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

    2011-01-01

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

  8. Coastal Energy Facilities in the United States for 2012.

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — These data depict the location of facilities that generate electricity. The locations are created from the Environmental Protection Agency Emissions & Generation...

  9. Computed tomography scanning and stroke mortality in an urban medical unit in Cameroon

    Directory of Open Access Journals (Sweden)

    Alain Lekoubou

    2016-03-01

    Conclusion: In this resource-limited environment, the absence of brain imaging on admission was associated with high in-hospital death from stroke, which was only partially explained by delayed hospitalization with severe disease. These results stressed the importance of scaling up acute stroke management in low- and middle-income countries.

  10. Woodrow Wilson's hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy.

    Science.gov (United States)

    Menger, Richard P; Storey, Christopher M; Guthikonda, Bharat; Missios, Symeon; Nanda, Anil; Cooper, John M

    2015-07-01

    World War I catapulted the United States from traditional isolationism to international involvement in a major European conflict. Woodrow Wilson envisaged a permanent American imprint on democracy in world affairs through participation in the League of Nations. Amid these defining events, Wilson suffered a major ischemic stroke on October 2, 1919, which left him incapacitated. What was probably his fourth and most devastating stroke was diagnosed and treated by his friend and personal physician, Admiral Cary Grayson. Grayson, who had tremendous personal and professional loyalty to Wilson, kept the severity of the stroke hidden from Congress, the American people, and even the president himself. During a cabinet briefing, Grayson formally refused to sign a document of disability and was reluctant to address the subject of presidential succession. Wilson was essentially incapacitated and hemiplegic, yet he remained an active president and all messages were relayed directly through his wife, Edith. Patient-physician confidentiality superseded national security amid the backdrop of friendship and political power on the eve of a pivotal juncture in the history of American foreign policy. It was in part because of the absence of Woodrow Wilson's vocal and unwavering support that the United States did not join the League of Nations and distanced itself from the international stage. The League of Nations would later prove powerless without American support and was unable to thwart the rise and advance of Adolf Hitler. Only after World War II did the United States assume its global leadership role and realize Wilson's visionary, yet contentious, groundwork for a Pax Americana. The authors describe Woodrow Wilson's stroke, the historical implications of his health decline, and its impact on United States foreign policy.

  11. Decommissioning of nuclear facilities by the United States Department of Energy Oak Ridge Field Office

    International Nuclear Information System (INIS)

    DeLozier, M.F.P.

    1992-01-01

    The Oak Ridge Field Office of the United States Department of Energy is projecting one of the largest decommissioning efforts in the nation during the next ten to twenty years. The nuclear facilities are varied with respect to the types of contaminants and types of structures and equipment involved. The facilities planned for decommissioning include 26 ORNL facilities (e.g., OGR, HRE, MSRE), 70 facilities at Oak Ridge K25 site, and the Y-12 plant at Oak Ridge. Innovative technologies are required to decommission the facilities and dispose of the waste generated. (R.P.)

  12. Predictors of pneumonia in acute stroke in patients in an emergency unit

    Directory of Open Access Journals (Sweden)

    Sara R. M. Almeida

    2015-05-01

    Full Text Available Objective To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results 159 patients (18-90 years were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001, higher National Institute of Health Stroke Scale (NIHSS (p = 0.047 and, lower Glasgow Coma Score (GCS (p < 0.0001. Patients with pneumonia had longer hospitalization (p < 0.0001. Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002. Conclusion Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

  13. Listed waste history at Hanford facility TSD units

    International Nuclear Information System (INIS)

    Miskho, A.G.

    1996-01-01

    This document was prepared to close out an occurrence report that Westinghouse Hanford Company issued on December 29, 1994. Occurrence Report RL-WHC-GENERAL-1994-0020 was issued because knowledge became available that could have impacted start up of a Hanford Site facility. The knowledge pertained to how certain wastes on the Hanford Site were treated, stored, or disposed of. This document consolidates the research performed by Westinghouse Hanford Company regarding listed waste management at onsite laboratories that transfer waste to the Double-Shell Tank System. Liquid and solid (non-liquid) dangerous wastes and mixed wastes at the Hanford Site are generated from various Site operations. These wastes may be sampled and characterized at onsite laboratories to meet waste management requirements. In some cases, the wastes that are generated in the field or in the laboratory from the analysis of samples require further management on the Hanford Site and are aggregated together in centralized tank storage facilities. The process knowledge presented herein documents the basis for designation and management of 242-A Evaporator Process Condensate, a waste stream derived from the treatment of the centralized tank storage facility waste (the Double-Shell Tank System). This document will not be updated as clean up of the Hanford Site progresses

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

    OpenAIRE

    Grace Vincent-Onabajo; Taritei Moses

    2016-01-01

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

  15. 77 FR 74781 - Safety Zones; Columbia Grain and United Grain Corporation Facilities; Columbia and Willamette Rivers

    Science.gov (United States)

    2012-12-18

    ... 45-38'30'' N/122- 46'25'' W. In essence, these boundaries extend from the shoreline of the facility.../122-41'31'' W. In essence, these boundaries extend from the shoreline of the facility 150 yards onto... waters of the United States means those waters defined as such in 33 CFR part 2. (3) Navigation Rules...

  16. Facebook as a Learning Tool: Perception of Stroke Unit Nurses in a Tertiary Care Hospital in Islamabad.

    Science.gov (United States)

    Siddiqui, Maimoona; Bukhari, Ahmed S; Shamael, Ibrahim; Shah, Zubana A; Maken, Neil

    2018-03-22

    Objective To obtain the perception of nurses on the use of Facebook as a learning tool. Materials & methods We conducted a pilot observational study in which data were collected through a detailed course evaluation and feedback survey questionnaire. Twelve stroke care nurses were enrolled in a stroke course specifically designed to provide participants with information and knowledge about stroke unit nursing care. Firstly, a closed Facebook group consisting of the participants and facilitators was created. An activity in accordance with the course content was posted in the group daily. Before the start of the course, a pre-course test was conducted. The four-week course culminated in a graded written examination. Its results were compared with the pre-course test. A detailed feedback questionnaire was given to the participants at the end of the course, which was specifically designed to elicit perceptions of nurses about the use of Facebook as a learning tool. Results Of the 12 enrolled nurses, 10 completed the certification and the post-course feedback evaluation. Facebook was used by all participants as a platform to view and study the course contents. The timing of the course activities was rated "very good" by three and 'good' by six of 10 participants. However, one of the major issues faced by five participants was problematic internet access. The overall rating of the course was "very good" by five participants, "good" by three, and "satisfactory" by two of 10 participants. The post-course test showed that nine of 10 candidates passed with scores >70% compared to only two candidates getting scores >50% in the pre-course test. Conclusion Facebook use enabled participants to study the material when their schedule permitted them. The online teaching and facilitation were ideal for our full-time stroke unit nurses as reflected by their improved post-course test results.

  17. Stroke and death in elderly patients with atrial fibrillation in Japan compared with the United Kingdom.

    Science.gov (United States)

    Senoo, Keitaro; An, Yoshimori; Ogawa, Hisashi; Lane, Deirdre A; Wolff, Andreas; Shantsila, Eduard; Akao, Masaharu; Lip, Gregory Y H

    2016-12-01

    Data on stroke, mortality and associated comorbidities in elderly patients with atrial fibrillation (AF) in Japan may differ from Western countries. There have been few systematic comparisons between stroke risk profiles and outcomes among community-based elderly (aged ≥75 years) patients with AF in Japan and the UK. We compared clinical characteristics, stroke risk and outcomes among elderly patients with AF from the Fushimi AF Registry (Japan; N=1791) and the Darlington AF Registry (UK; N=1338). The Fushimi cohort had a mean age 81.8 (standard deviation (SD) 5.3) years and CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years (double), diabetes mellitus, previous thromboembolism (double), vascular disease, age 65-74 years and female gender) score 4.3 (1.4), whereas the Darlington cohort had a mean age 83.6 (5.7) years and CHA 2 DS 2 -VASc score 4.4 (1.4). Over a 12-month follow-up period, observed stroke and mortality rates in Fushimi were 3.4% (n=61) and 11.5% (n=206), while corresponding event rates in the Darlington cohort were 4.4% (n=59) and 14.1% (n=188), respectively. Appropriate use of oral anticoagulation (OAC, essentially a vitamin K antagonist) was Japan vs UK) was neither associated with the risk of stroke (OR 0.92, 95% CI 0.63 to 1.36; p=0.69) nor death (OR 0.92, 95% CI 0.80 to 1.27; p=0.92). In a subgroup analysis of elderly patients not receiving OAC (n=1489), a history of stroke was associated with the risk of stroke (OR 2.42, 95% CI 1.39 to 4.12; p=0.002), but not ethnicity (OR 0.86, 95% CI 0.50 to 1.47; p=0.58). Elderly (age ≥75 years) patients with AF in both Japan and the UK are at similarly high risk of stroke and death, with OAC still underused in both populations. Ethnicity was not independently associated with the risk of stroke, regardless of OAC use or non-use. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program.

    Science.gov (United States)

    Güngen, Belma Doğan; Tunç, Abdulkadir; Aras, Yeşim Güzey; Gündoğdu, Aslı Aksoy; Güngen, Adil Can; Bal, Serdar

    2017-07-11

    The aim of this study was to investigate the predictors of intensive care unit (ICU) admission and mortality among stroke patients and the effects of a pulmonary rehabilitation program on stroke patients. This prospective study enrolled 181 acute ischemic stroke patients aged between 40 and 90 years. Demographical characteristics, laboratory tests, diffusion-weighed magnetic resonance imaging (DWI-MRI) time, nutritional status, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin scale (MRS) scores were recorded for all patients. One-hundred patients participated in the pulmonary rehabilitation program, 81 of whom served as a control group. Statistically, one- and three-month mortality was associated with NIHSS and MRS scores at admission and three months (pstroke patients. We believe that a pulmonary rehabilitation program, in addition to general stroke rehabilitation programs, can play a critical role in improving survival and functional outcomes. NCT03195907 . Trial registration date: 21.06.2017 'Retrospectively registered'.

  19. Integrating industry nuclear codes and standards into United States Department of Energy facilities

    Energy Technology Data Exchange (ETDEWEB)

    Jacox, J.

    1995-02-01

    Recently the United States Department of Energy (DOE) has mandated facilities under their jurisdiction use various industry Codes and Standards developed for civilian power reactors that operate under U.S. Nuclear Regulatory Commission License. While this is a major step forward in putting all our nuclear facilities under common technical standards there are always problems associated with implementing such advances. This paper will discuss some of the advantages and problems experienced to date. These include the universal challenge of educating new users of any technical documents, repeating errors made by the NRC licensed facilities over the years and some unique problems specific to DOE facilities.

  20. The Text of the Agreement for the Application of Agency Safeguards to United States Reactor Facilities

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1964-08-14

    The text of the Agreement between the Agency and the Government of the United States of America for the application of Agency safeguards to United States reactor facilities, which was signed on 15 June 1964 and entered into force on 1 August 1964, is reproduced in this document for the information of all Members.

  1. An interdisciplinary visual team in an acute and sub-acute stroke unit

    DEFF Research Database (Denmark)

    Norup, Anne; Guldberg, Anne-Mette; Friis, Claus Radmer

    2016-01-01

    . METHODS: For a period of three months, all stroke patients with visual or visuo-attentional deficits were registered, and data concerning etiology, severity and localization of the stroke and initial visual symptoms were registered. One month after discharge patients were contacted for follow-up. RESULTS......: Of 349 acute stroke admissions, 84 (24.1%) had visual or visuo-attentional deficits initially. Of these 84 patients, informed consent was obtained from 22 patients with a mean age of 67.7 years(SD 10.1), and the majority was female (59.1%). Based on the initial neurological examination, 45.4% had some...... kind of visual field defect, 27.2% had some kind of oculomotor nerve palsy, and about 31.8% had some kind of inattention or visual neglect. The patients were contacted for a phone-based follow-up one month after discharge, where 85.7% reported changes in their vision since their stroke. CONCLUSION...

  2. Pediatric Stroke

    Science.gov (United States)

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

  3. Stroke unit Nurse Managers' views of individual and organizational factors liable to influence evidence-based practice: A survey.

    Science.gov (United States)

    Drury, Peta; McInnes, Elizabeth; Hardy, Jennifer; Dale, Simeon; Middleton, Sandy

    2016-04-01

    The uptake of evidence into practice may be impeded or facilitated by individual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence-based practice (EBP) and readiness for change. Overall Nurse Managers reported high-level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff; and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP. © 2015 John Wiley & Sons Australia, Ltd.

  4. United Nuclear Industries, Inc. reactor and fuel production facilities 1975 environmental release report

    International Nuclear Information System (INIS)

    Cucchiara, A.L.

    1976-01-01

    During calendar year 1975, an estimated total of 3,000,000 pounds of waste materials and approximately 150 curies of radionuclides were discharged to the environs in liquid effluent streams emanating from United Nuclear Industries, Inc., operated facilities. During the same period, approximately 1,700,000 pounds of reported waste materials, including 34,000 curies of reported radionuclides, were discharged to the atmosphere from United Nuclear Industries, Inc., operated facilities. Superscript numbers reference explanatory notes contained at the end of the report

  5. Biosecurity and bird movement practices in upland game bird facilities in the United States.

    Science.gov (United States)

    Slota, Katharine E; Hill, Ashley E; Keefe, Thomas J; Bowen, Richard A; Pabilonia, Kristy L

    2011-06-01

    Since 1996, the emergence of Asian-origin highly pathogenic avian influenza subtype H5N1 has spurred great concern for the global poultry industry. In the United States, there is concern over the potential of a foreign avian disease incursion into the country. Noncommercial poultry operations, such as upland game bird facilities in the United States, may serve as a potential source of avian disease introduction to other bird populations including the commercial poultry industry, backyard flocks, or wildlife. In order to evaluate how to prevent disease transmission from these facilities to other populations, we examined biosecurity practices and bird movement within the upland game bird industry in the United States. Persons that held a current permit to keep, breed, or release upland game birds were surveyed for information on biosecurity practices, flock and release environments, and bird movement parameters. Biosecurity practices vary greatly among permit holders. Many facilities allow for interaction between wild birds and pen-reared birds, and there is regular long-distance movement of live adult birds among facilities. Results suggest that upland game bird facilities should be targeted for biosecurity education and disease surveillance efforts.

  6. Independent dose per monitor unit review of eight U.S.A. proton treatment facilities

    International Nuclear Information System (INIS)

    Moyers, M. F.; Ibbott, G. S.; Grant, R. L.; Summers, P. A.; Followill, D. S.

    2014-01-01

    Purpose: Compare the dose per monitor unit at different proton treatment facilities using three different dosimetry methods. Methods: Measurements of dose per monitor unit were performed by a single group at eight facilities using 11 test beams and up to six different clinical portal treatment sites. These measurements were compared to the facility reported dose per monitor unit values. Results: Agreement between the measured and reported doses was similar using any of the three dosimetry methods. Use of the ICRU 59 N D,w based method gave results approximately 3% higher than both the ICRU 59 N X and ICRU 78 (TRS-398) N D,w based methods. Conclusions: Any single dosimetry method could be used for multi-institution trials with similar conformity between facilities. A multi-institutional trial could support facilities using both the ICRU 59 N X based and ICRU 78 (TRS-398) N D,w based methods but use of the ICRU 59 N D,w based method should not be allowed simultaneously with the other two until the difference is resolved

  7. Radiation dose distribution monitoring at neutron radiography facility area, Nuclear Energy Unit, Malaysia

    International Nuclear Information System (INIS)

    Abdul Razak Daud

    1995-01-01

    One experiment was carried out to get the distribution of radiation doses at the neutron radiography facilities, Nuclear Energy Unit, Malaysia. The analysis was done to evaluate the safety level of the area. The analysis was used in neutron radiography work

  8. Evaluation of syngas production unit cost of bio-gasification facility using regression analysis techniques

    Energy Technology Data Exchange (ETDEWEB)

    Deng, Yangyang; Parajuli, Prem B.

    2011-08-10

    Evaluation of economic feasibility of a bio-gasification facility needs understanding of its unit cost under different production capacities. The objective of this study was to evaluate the unit cost of syngas production at capacities from 60 through 1800Nm 3/h using an economic model with three regression analysis techniques (simple regression, reciprocal regression, and log-log regression). The preliminary result of this study showed that reciprocal regression analysis technique had the best fit curve between per unit cost and production capacity, with sum of error squares (SES) lower than 0.001 and coefficient of determination of (R 2) 0.996. The regression analysis techniques determined the minimum unit cost of syngas production for micro-scale bio-gasification facilities of $0.052/Nm 3, under the capacity of 2,880 Nm 3/h. The results of this study suggest that to reduce cost, facilities should run at a high production capacity. In addition, the contribution of this technique could be the new categorical criterion to evaluate micro-scale bio-gasification facility from the perspective of economic analysis.

  9. Design of a Facility to Test the Advanced Stirling Radioisotope Generator Engineering Unit

    Science.gov (United States)

    Lewandowski, Edward J.; Schreiber, Jeffrey G.; Oriti, Salvatore M.; Meer, David W.; Brace, Michael H.; Dugala, Gina

    2009-01-01

    The Advanced Stirling Radioisotope Generator (ASRG) is being considered to power deep space missions. An engineering unit, the ASRG-EU, was designed and fabricated by Lockheed Martin under contract to the Department of Energy. This unit is currently on an extended operation test at NASA Glenn Research Center to generate performance data and validate the life and reliability predictions for the generator and the Stirling convertors. A special test facility was designed and built for testing the ASRG-EU. Details of the test facility design are discussed. The facility can operate the convertors under AC bus control or with the ASRG-EU controller. It can regulate input thermal power in either a fixed temperature or fixed power mode. An enclosure circulates cooled air around the ASRG-EU to remove heat rejected from the ASRG-EU by convection. A custom monitoring and data acquisition system supports the test. Various safety features, which allow 2417 unattended operation, are discussed.

  10. Evaluation of nuclear facility decommissioning projects. Status report. Humboldt Bay Power Plant Unit 3, SAFSTOR decommissioning

    International Nuclear Information System (INIS)

    Baumann, B.L.; Haffner, D.R.; Miller, R.L.; Scotti, K.S.

    1986-06-01

    This document explains the purpose of the US Nuclear Regulatory Commission's (NRC) Evaluation of Nuclear Facility Decommissioning Projects (ENFDP) program and summarizes information concerning the decommissioning of the Humboldt Bay Power Plant (HBPP) Unit 3 facility. Preparations to put this facility into a custodial safe storage (SAFSTOR) mode are currently scheduled for completion by June 30, 1986. This report gives the status of activities as of June 1985. A final summary report will be issued after completion of this SAFSTOR decommissioning activity. Information included in this status report has been collected from the facility decommissioning plan, environmental report, and other sources made available by the licensee. This data has been placed in a computerized data base system which permits data manipulation and summarization. A description of the computer reports that can be generated by the decommissioning data system (DDS) for Humboldt Bay and samples of those reports are included in this document

  11. Overview of new, upgraded, or proposed high energy physics facilities in the United States and Canada

    International Nuclear Information System (INIS)

    Gabriel, T.A.

    1994-01-01

    This article reviews six new, proposed, or upgraded accelerator facilities in the United States and Canada. All of the accelerators that are presented here in one form or fashion challenge the validity of the Standard Model of high energy physics which ''currently explains'' all experimentally know phenomena. These facilities include the Continuous Electron Beam Accelerator Facility (CEBAF) at Newport News, Virginia, the Kaon Factory at TRIUMF in Vancouver, British Columbia, Canada, the Asymmetric B Factory at the Stanford Linear Accelerator Center (SLAC) in Palo Alto, California, the Relativistic Heavy Ion Collider (RHIC) facility at Brookhaven National Laboratory in Upton, New York, the injector upgrade project at the Fermi National Accelerator Laboratory (FNAL) in Batavia, Illinois, and the Superconducting Super Collider Laboratory (SSCL) in Waxachachie, Texas

  12. Risk factors and mortality from hospital acquired pneumonia in the Stroke Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Liudmila Carnesoltas Suarez

    2013-02-01

    Full Text Available Introduction. Stroke is the third leading cause of death. Hospital acquired pneumonia is an ongoing challenge due to the current microbiological spectrum, antimicrobial resistance, high mortality and associated costs. Objetive. To describe risk factors and their relationship to hospital stay and mortality of patients admitted to the Stroke ICU with hospital acquired pneumonia from 2007 to 2009. Methods. Prospective descriptive study. Variables: age, sex, risk factors, time of onset, stay and discharge status. We used chi square (X2 of homogeneity to determine the possible association between variables and the Fisher test probabilities. Results. 61 patients developed hospital acquired pneumonia (34.07%. We found a predominance of 60-80 year-old males. Among the risk factors we found major neurological damage in 21 (34.4%, smoking in 15 (24.5%, heart failure in 11 (18.0%, diabetes mellitus in 6 (9.8%, COPD in 4 (6.5%. Mechanical ventilation was used in 14 (38.4%, endotracheal intubation in 16 (29.2%, prolonged bedridden condition in 11 (18% and nasogastric tube placement in 7 (11.5%. The infection appeared between the third and sixth day in 57.4%; hospital stay was prolonged in 54% and 25 patients died (40.92%. Conclusions. Hospital acquired pneumonia was more common patients with mechanical ventilation, which prolonged stay and increased mortality. The microbiological environment was dominated by Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumanni.

  13. Nurses' and nurse assistants' beliefs, attitudes and actions related to role and function in an inpatient stroke rehabilitation unit-A qualitative study

    DEFF Research Database (Denmark)

    Loft, Mia I; Poulsen, Ingrid; Esbensen, Bente A

    2017-01-01

    AIMS AND OBJECTIVES: To explore nurses' and nurse assistants' beliefs, attitudes and actions related to their function in an inpatient stroke rehabilitation unit. BACKGROUND: Several attempts have been made to describe nurses' roles and functions in inpatient neurorehabilitation. However, current...... understandings of the contributions that nurses and nurse assistants make to neurorehabilitation remain sparse. DESIGN: Descriptive, interpretive qualitative study. METHODS: Participant observations were conducted during 1 month in a stroke rehabilitation unit at a university hospital in the Capital Region...... stroke rehabilitation. We obtained insights into nursing staff's beliefs and attitudes about rehabilitation-as well as their own role and function-and furthermore how the latter affects their actions in daily practice. RELEVANCE TO CLINICAL PRACTICE: The nursing role and function are still not clearly...

  14. Closure of hazardous and mixed radioactive waste management units at DOE facilities

    International Nuclear Information System (INIS)

    1990-06-01

    This is document addresses the Federal regulations governing the closure of hazardous and mixed waste units subject to Resource Conservation and Recovery Act (RCRA) requirements. It provides a brief overview of the RCRA permitting program and the extensive RCRA facility design and operating standards. It provides detailed guidance on the procedural requirements for closure and post-closure care of hazardous and mixed waste management units, including guidance on the preparation of closure and post-closure plans that must be submitted with facility permit applications. This document also provides guidance on technical activities that must be conducted both during and after closure of each of the following hazardous waste management units regulated under RCRA

  15. Outline of construction and facility features of Onagawa nuclear power station Unit No. 2

    International Nuclear Information System (INIS)

    Umimura, Yoshiharu; Tsunoda, Ryohei; Watanabe, Kazunori

    1996-01-01

    Tohoku Electric Power Company promotes development of various power sources to provide a stable supply of electricity in the future, and nuclear power takes a leading part. In August 1989, construction of Onagawa nuclear power plant Unit No. 2 (825MW) was started, following Unit No. 1 (524MW) which went on line in 1984 as Tohoku Electric's first nuclear power plant unit. Unit No. 2 began commercial operation in July 1995 through satisfactory construction work such as RPV hydraulic test in March 1994, fuel loading in October 1994, and various startup tests in each power stage. The design and construction of Unit No. 2 reflect construction and operation experience gained from Unit No. 1, and the latest technology, including that of the LWR Improvement and Standardization Program, was adopted to enhance facility reliability, improve operation and maintenance performance, and reduce worker dosage. Features of the facility, construction techniques, and a description of preoperation of Onagawa nuclear power plant Unit No. 2 are described in this paper. (author)

  16. Bidirectional and Multi-User Telerehabilitation System: Clinical Effect on Balance, Functional Activity, and Satisfaction in Patients with Chronic Stroke Living in Long-Term Care Facilities

    Directory of Open Access Journals (Sweden)

    Kwan-Hwa Lin

    2014-07-01

    Full Text Available Background: The application of internet technology for telerehabilitation in patients with stroke has developed rapidly. Objective: The current study aimed to evaluate the effect of a bidirectional and multi-user telerehabilitation system on balance and satisfaction in patients with chronic stroke living in long-term care facilities (LTCFs. Method: This pilot study used a multi-site, blocked randomization design. Twenty-four participants from three LTCFs were recruited, and the participants were randomly assigned into the telerehabilitation (Tele and conventional therapy (Conv groups within each LTCF. Tele group received telerehabilitation but the Conv group received conventional therapy with two persons in each group for three sessions per week and for four weeks. The outcome measures included Berg Balance Scale (BBS, Barthel Index (BI, and the telerehabilitation satisfaction of the participants. Setting: A telerehabilitation system included “therapist end” in a laboratory, and the “client end” in LTCFs. The conventional therapy was conducted in LTCFs. Results: Training programs conducted for both the Tele and Conv groups showed significant effects within groups on the participant BBS as well as the total and self-care scores of BI. No significant difference between groups could be demonstrated. The satisfaction of participants between the Tele and the Conv groups also did not show significant difference. Conclusions: This pilot study indicated that the multi-user telerehabilitation program is feasible for improving the balance and functional activity similar to conventional therapy in patients with chronic stroke living in LTCFs.

  17. Post-stroke disposition from a geriatric-rehabilitative stroke care area: an Italian experience

    Directory of Open Access Journals (Sweden)

    Marco Masina

    2014-02-01

    Full Text Available A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6, after stroke functional status (mRankin≥3, poor pre-stroke functional level (mRankin≥3 and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ≥3. Disposition to a skilled

  18. Impact of naturalistic lighting on hospitalized stroke patients in a rehabilitation unit

    DEFF Research Database (Denmark)

    West, Anders; Jennum, Poul; Simonsen, Sofie Amalie

    2017-01-01

    Introduction and rationale: Stroke is a major cause of acquired cerebral disability among adults, frequently accompanied by depression, anxiety, cognitive impairment, disrupted sleep and fatigue. New ways of intervention to prevent these complications are therefore needed. The major circadian...... a positive impact on the health of poststroke patients admitted to rehabilitation. We test specifically for improved sleep and less fatigue (questionnaires, polysomnography, Actiwatch), improved well-being (questionnaires), lessen anxiety and depression (questionnaires), improved cognition (tests...... on patients during long-term hospitalization in a real hospital setting. The hypotheses are based on preclinical research, as studies using naturalistic light have never been performed before. Investigating the effects of naturalistic light in a clinical setting is therefore much needed....

  19. Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

    Science.gov (United States)

    Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

    2012-01-01

    The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

  20. Hanford facility dangerous waste permit application, 325 hazardous waste treatment units. Revision 1

    International Nuclear Information System (INIS)

    1997-07-01

    This report contains the Hanford Facility Dangerous Waste Permit Application for the 325 Hazardous Waste Treatment Units (325 HWTUs) which consist of the Shielded Analytical Laboratory, the 325 Building, and the 325 Collection/Loadout Station Tank. The 325 HWTUs receive, store, and treat dangerous waste generated by Hanford Facility programs. Routine dangerous and/or mixed waste treatment that will be conducted in the 325 HWTUs will include pH adjustment, ion exchange, carbon absorption, oxidation, reduction, waste concentration by evaporation, precipitation, filtration, solvent extraction, solids washing, phase separation, catalytic destruction, and solidification/stabilization

  1. Hanford facility dangerous waste permit application, 325 hazardous waste treatment units. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-07-01

    This report contains the Hanford Facility Dangerous Waste Permit Application for the 325 Hazardous Waste Treatment Units (325 HWTUs) which consist of the Shielded Analytical Laboratory, the 325 Building, and the 325 Collection/Loadout Station Tank. The 325 HWTUs receive, store, and treat dangerous waste generated by Hanford Facility programs. Routine dangerous and/or mixed waste treatment that will be conducted in the 325 HWTUs will include pH adjustment, ion exchange, carbon absorption, oxidation, reduction, waste concentration by evaporation, precipitation, filtration, solvent extraction, solids washing, phase separation, catalytic destruction, and solidification/stabilization.

  2. Management Of Patients With Stroke In Critical Care Units, Considering Osmotic Therapy And Hypothermia

    Directory of Open Access Journals (Sweden)

    Ata Mahmoodpoor

    2017-02-01

    Full Text Available Cytotoxic brain edema is an early complication of stroke which increases the possibility of secondary ischemia. Hypertonic solutions, mannitol and recently hypertonic saline (HS has been considered for treatment of increased ICP. HS could decrease ICP especially in hypotensive patients with different mechanisms, direct effect on edema, decreasing inflammation which is mediated by attenuation of TNFa and IL-1b stimulation on Na-K-Cl cotransporter 1 and improvement of microcirculation. Improvement of microcirculation is so important for hypertonic solutions to be effective in ischemia especially focal ischemia. Based on the literature, hypertonic saline is more effective in decreasing cerebral edema than the equal volume of mannitol. The optimal dose and duration of therapy needs more trials. Caution should be performed with patients with moderate size hemispheric infarcts on presentation, race and genetic factors regarding osmotic therapy. Hypothermia has been rated as one of the most active modes of neuroprotection based on the results of different trials. Hypothermia in both ways, surface and intravascular, decreases cerebral metabolic rate of O2 and glucose and reduces brain oxygen consumption, inflammation and oxidative stress. Recent data continue to support consideration of therapeutic hypothermia for cerebral ischemia in larger clinical trials of acute ischemic stroke. By increasing the time window to therapy initiation and decreasing the treatment duration, selective intracarotid cold saline administration brings increased feasibility, potentially better outcomes and perhaps fewer complications compared with the whole body cooling. Hypothermia is now recommended as a targeted temperature management with defined protocol which should be started early; it may be performed pharmacologically in combination with other therapies. Applying hypothermia should be considered regarding its cost, using in awaked patients, re-warming protocol

  3. The association between race/ethnicity and the prevalence of stroke among United States adults in 2015: a secondary analysis study using Behavioural Risk Factor Surveillance System (BRFSS).

    Science.gov (United States)

    Aldayel, Abdulrahman Yousef; Alharbi, Muteb Mousa; Shadid, Asem Mustafa; Zevallos, Juan Carlos

    2017-12-01

    Worldwide, stroke is considered the second leading cause of death, accounting for 11.8% of all deaths in 2013. In the Unites States (US), approximately 795,000 people have a stroke every year. Stroke has many different risk factors that vary by race/ethnicity. There is limited contemporary published literature about the prevalence of stroke among racial/ethnic groups in the US adult population. This study aimed to determine the association between race/ethnicity and the prevalence of stroke among US adults in 2015. This study was an observational, non-concurrent prospective of the Behavioural Risk Factor Surveillance System (BRFSS) in 2015 to assess the association between race/ethnicity and the prevalence of stroke. The final study sample was 432,814 US adults ≥ 18 years old. Variables were excluded from the model if there were missing, refused, or did not know responses to the variables of interest. A binary logistic regression analysis was used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the association between race/ethnicity and stroke. The Chi-square test was used to study bivariate associations between categorical variables. The collinearity was assessed. A p-value of <0.05 was considered statistically significant. Statistical analysis was completed using STATA version 14 (Stata Corp, College Station, TX). The highest proportion of participants (43%) were ≥ 44 years old with a balanced distribution of males and females. The highest proportion of stroke was found among Hispanics (4.2%) and non-Hispanic Blacks (4.1%) as compared to 3.2% among non-Hispanic Whites (p<0.001). Furthermore, Hispanics and Blacks were significantly more likely to develop stroke (OR=1.57, 95% CI=1.28-1.91; and OR=1.30, 95% CI=1.16-1.45, respectively) after adjusting for confounding variables. Hispanics and Blacks had a higher prevalence of stroke in comparison with non-Hispanic Whites. Further studies are needed to verify these findings and to determine which

  4. Heat Stroke

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  5. Installation of a Low Flow Unit at the Abiquiu Hydroelectric Facility

    Energy Technology Data Exchange (ETDEWEB)

    Jack Q. Richardson

    2012-06-28

    Final Technical Report for the Recovery Act Project for the Installation of a Low Flow Unit at the Abiquiu Hydroelectric Facility. The Abiquiu hydroelectric facility existed with two each 6.9 MW vertical flow Francis turbine-generators. This project installed a new 3.1 MW horizontal flow low flow turbine-generator. The total plant flow range to capture energy and generate power increased from between 250 and 1,300 cfs to between 75 and 1,550 cfs. Fifty full time equivalent (FTE) construction jobs were created for this project - 50% (or 25 FTE) were credited to ARRA funding due to the ARRA 50% project cost match. The Abiquiu facility has increased capacity, increased efficiency and provides for an improved aquatic environment owing to installed dissolved oxygen capabilities during traditional low flow periods in the Rio Chama. A new powerhouse addition was constructed to house the new turbine-generator equipment.

  6. RCRA facility investigation report for the 200-PO-1 operable unit. Revision 1

    International Nuclear Information System (INIS)

    1997-05-01

    This Resource Conservation and Recovery Act (RCRA) Facility Investigation (RFI) report is prepared in support of the RFI/corrective measures study process for the 200-PO-1 Groundwater Operable Unit in the 200 East Area of the Hanford Site. This report summarizes existing information on this operable unit presented in the 200 East and PUREX Aggregate Area Management Study Reports, contaminant specific studies, available modeling data, and groundwater monitoring data summary reports. Existing contaminant data are screened against current regulatory limits to determine contaminants of potential concern (COPC). Each identified COPC is evaluated using well-specific and plume trend analyses

  7. Pacific Northwest National Laboratory Facility Radionuclide Emissions Units and Sampling Systems

    Energy Technology Data Exchange (ETDEWEB)

    Barnett, J. Matthew; Brown, Jason H.; Walker, Brian A.

    2012-04-01

    Battelle–Pacific Northwest Division operates numerous research and development (R&D) laboratories in Richland, WA, including those associated with Pacific Northwest National Laboratory (PNNL) on the U.S. Department of Energy (DOE)’s Hanford Site and PNNL Site that have the potential for radionuclide air emissions. The National Emission Standard for Hazardous Air Pollutants (NESHAP 40 CFR 61, Subparts H and I) requires an assessment of all emission units that have the potential for radionuclide air emissions. Potential emissions are assessed annually by PNNL staff members. Sampling, monitoring, and other regulatory compliance requirements are designated based upon the potential-to-emit dose criteria found in the regulations. The purpose of this document is to describe the facility radionuclide air emission sampling program and provide current and historical facility emission unit system performance, operation, and design information. For sampled systems, a description of the buildings, exhaust units, control technologies, and sample extraction details is provided for each registered emission unit. Additionally, applicable stack sampler configuration drawings, figures, and photographs are provided. Deregistered emission unit details are provided as necessary for up to 5 years post closure.

  8. WIPP Facility Work Plan for Solid Waste Management Units and Areas of Concern

    International Nuclear Information System (INIS)

    2001-01-01

    This 2001 Facility Work Plan (FWP) has been prepared as required by Module VII, Section VII.M.1 of the Waste Isolation Pilot Plant (WIPP) Hazardous Waste Facility Permit, NM4890139088-TSDF (the Permit); (NMED, 1999a), and incorporates comments from the New Mexico Environment Department (NMED) received on December 6, 2000 (NMED, 2000a). This February 2001 FWP describes the programmatic facility-wide approach to future investigations at Solid Waste Management Units (SWMUs) and Areas of Concern (AOCs) specified in the Permit. The permittees are evaluating data from previous investigations of the SWMUs and AOCs against the newest guidance proposed by the NMED. Based on these data, the permittees expect that no further sampling will be required and that a request for No Further Action (NFA) at the SWMUs and AOCs will be submitted to the NMED. This FWP addresses the current Permit requirements. It uses the results of previous investigations performed at WIPP and expands the investigations as required by the Permit. As an alternative to the Resource Conservation and Recovery Act (RCRA) Facility Investigation (RFI) specified in Module VII of the Permit, current NMED guidance identifies an Accelerated Corrective Action Approach (ACAA) that may be used for any SWMU or AOC (NMED, 1998). This accelerated approach is used to replace the standard RFI Work Plan and Report sequence with a more flexible decision-making approach. The ACAA process allows a Facility to exit the schedule of compliance contained in the Facility's Hazardous and Solid Waste Amendments (HSWA) permit module and proceed on an accelerated time frame. Thus, the ACAA process can be entered either before or after an RFI Work Plan. According to the NMED's guidance, a facility can prepare an RFI Work Plan or Sampling and Analysis Plan (SAP) for any SWMU or AOC (NMED, 1998). Based on this guidance, a SAP constitutes an acceptable alternative to the RFI Work Plan specified in the Permit.

  9. Examining the Potential for Agricultural Benefits from Pollinator Habitat at Solar Facilities in the United States.

    Science.gov (United States)

    Walston, Leroy; Mishra, Shruti Khadka; Hartmann, Heidi M; Hlohowskyj, Ihor; McCall, James; Macknick, Jordan

    2018-05-28

    Of the many roles insects serve for ecosystem function, pollination is possibly the most important service directly linked to human well-being. However, land use changes have contributed to the decline of pollinators and their habitats. In agricultural landscapes that also support renewable energy developments such as utility-scale solar energy [USSE] facilities, opportunities may exist to conserve insect pollinators and locally restore their ecosystem services through the implementation of vegetation management approaches that aim to provide and maintain pollinator habitat at USSE facilities. As a first step towards understanding the potential agricultural benefits of solar-pollinator habitat, we identified areas of overlap between USSE facilities and surrounding pollinator-dependent crop types in the United States (U.S.). Using spatial data on solar energy developments and crop types across the U.S, and assuming a pollinator foraging distance of 1.5 km, we identified over 3,500 km2 of agricultural land near existing and planned USSE facilities that may benefit from increased pollination services through the creation of pollinator habitat at the USSE facilities. The following five pollinator-dependent crop types accounted for over 90% of the agriculture near USSE facilities, and these could benefit most from the creation of pollinator habitat at existing and planned USSE facilities: soybeans, alfalfa, cotton, almonds, and citrus. We discuss how our results may be used to understand potential agro-economic implications of solar-pollinator habitat. Our results show that ecosystem service restoration through the creation of pollinator habitat could improve the sustainability of large-scale renewable energy developments in agricultural landscapes.

  10. Lowering bronchoaspiration rate in an acute stroke unit by means of a 2 volume/3 texture dysphagia screening test with pulsioximetry.

    Science.gov (United States)

    Cocho, D; Sagales, M; Cobo, M; Homs, I; Serra, J; Pou, M; Perez, G; Pujol, G; Tantinya, S; Bao, P; Aloy, A; Sabater, R; Gendre, J; Otermin, P

    During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. We examined 418 patients with acute stroke (G0=275, G1=143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P=.005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P=.003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P=.4), lower mortality (1.7% in G0 vs. 0.7% in G1, P=.3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P=.05). Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Little change of modifiable risk factors 1 year after stroke: a pilot study

    DEFF Research Database (Denmark)

    Hornnes, Nete; Larsen, Klaus; Boysen, Gudrun

    2010-01-01

    Recurrent stroke accounts for about 25% of admissions for acute stroke. For the prevention of recurrent cerebro and cardiovascular disease, stroke patients are advised to change modifiable stroke risk factors before discharge from stroke units.......Recurrent stroke accounts for about 25% of admissions for acute stroke. For the prevention of recurrent cerebro and cardiovascular disease, stroke patients are advised to change modifiable stroke risk factors before discharge from stroke units....

  12. Corrective action management unit application for the Environmental Restoration Disposal Facility

    Energy Technology Data Exchange (ETDEWEB)

    Evans, G.C.

    1994-06-01

    The Environmental Restoration Disposal Facility (ERDF) is to accept both CERCLA (EPA-regulated) and RCRA (Ecology-regulated) remediation waste. The ERDF is considered part of the overall remediation strategy on the Hanford Site, and as such, determination of ERDF viability has followed both RCRA and CERCLA decision making processes. Typically, determination of the viability of a unit, such as the ERDF, would occur as part of record of decision (ROD) or permit modification for each remediation site before construction of the ERDF. However, because construction of the ERDF may take a significant amount of time, it is necessary to begin design and construction of the ERDF before final RODs/permit modifications for the remediation sites. This will allow movement of waste to occur quickly once the final remediation strategy for the RCRA and CERCLA past-practice units is determined. Construction of the ERDF is a unique situation relative to Hanford Facility cleanup, requiring a Hanford Facility specific process be developed for implementing the ERDF that would satisfy both RCRA and CERCLA requirements. While the ERDF will play a significant role in the remediation process, initiation of the ERDF does not preclude the evaluation of remedial alternatives at each remediation site. To facilitate this, the January 1994 amendment to the Tri-Party Agreement recognizes the necessity for the ERDF, and the Tri-Party Agreement states: ``Ecology, EPA, and DOE agree to proceed with the steps necessary to design, approve, construct, and operate such a ... facility.`` The Tri-Party Agreement requires the DOE-RL to prepare a comprehensive ``package`` for the EPA and Ecology to consider in evaluating the ERDF. The package is to address the criteria listed in 40 CFR 264.552(c) for corrective action management unit (CAMU) designation and a CERCLA ROD. This CAMU application is submitted as part of the Tri-Party Agreement-required information package.

  13. Corrective action management unit application for the Environmental Restoration Disposal Facility

    International Nuclear Information System (INIS)

    Evans, G.C.

    1994-06-01

    The Environmental Restoration Disposal Facility (ERDF) is to accept both CERCLA (EPA-regulated) and RCRA (Ecology-regulated) remediation waste. The ERDF is considered part of the overall remediation strategy on the Hanford Site, and as such, determination of ERDF viability has followed both RCRA and CERCLA decision making processes. Typically, determination of the viability of a unit, such as the ERDF, would occur as part of record of decision (ROD) or permit modification for each remediation site before construction of the ERDF. However, because construction of the ERDF may take a significant amount of time, it is necessary to begin design and construction of the ERDF before final RODs/permit modifications for the remediation sites. This will allow movement of waste to occur quickly once the final remediation strategy for the RCRA and CERCLA past-practice units is determined. Construction of the ERDF is a unique situation relative to Hanford Facility cleanup, requiring a Hanford Facility specific process be developed for implementing the ERDF that would satisfy both RCRA and CERCLA requirements. While the ERDF will play a significant role in the remediation process, initiation of the ERDF does not preclude the evaluation of remedial alternatives at each remediation site. To facilitate this, the January 1994 amendment to the Tri-Party Agreement recognizes the necessity for the ERDF, and the Tri-Party Agreement states: ''Ecology, EPA, and DOE agree to proceed with the steps necessary to design, approve, construct, and operate such a ... facility.'' The Tri-Party Agreement requires the DOE-RL to prepare a comprehensive ''package'' for the EPA and Ecology to consider in evaluating the ERDF. The package is to address the criteria listed in 40 CFR 264.552(c) for corrective action management unit (CAMU) designation and a CERCLA ROD. This CAMU application is submitted as part of the Tri-Party Agreement-required information package

  14. Stroke Treatments

    Science.gov (United States)

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

  15. Combined clinical and home rehabilitation: case report of an integrated knowledge-to-action study in a Dutch rehabilitation stroke unit.

    Science.gov (United States)

    Nanninga, Christa S; Postema, Klaas; Schönherr, Marleen C; van Twillert, Sacha; Lettinga, Ant T

    2015-04-01

    There is growing awareness that the poor uptake of evidence in health care is not a knowledge-transfer problem but rather one of knowledge production. This issue calls for re-examination of the evidence produced and assumptions that underpin existing knowledge-to-action (KTA) activities. Accordingly, it has been advocated that KTA studies should treat research knowledge and local practical knowledge with analytical impartiality. The purpose of this case report is to illustrate the complexities in an evidence-informed improvement process of organized stroke care in a local rehabilitation setting. A participatory action approach was used to co-create knowledge and engage local therapists in a 2-way knowledge translation and multidirectional learning process. Evidence regarding rehabilitation stroke units was applied in a straightforward manner, as the setting met the criteria articulated in stroke unit reviews. Evidence on early supported discharge (ESD) could not be directly applied because of differences in target group and implementation environment between the local and reviewed settings. Early supported discharge was tailored to the needs of patients severely affected by stroke admitted to the local rehabilitation stroke unit by combining clinical and home rehabilitation (CCHR). Local therapists welcomed CCHR because it helped them make their task-specific training truly context specific. Key barriers to implementation were travel time, logistical problems, partitioning walls between financing streams, and legislative procedures. Improving local settings with available evidence is not a straightforward application process but rather a matter of searching, logical reasoning, and creatively working with heterogeneous knowledge sources in partnership with different stakeholders. Multiple organizational levels need to be addressed rather than focusing on therapists as sole site of change. © 2015 American Physical Therapy Association.

  16. The unit cost factors and calculation methods for decommissioning - Cost estimation of nuclear research facilities

    International Nuclear Information System (INIS)

    Kwan-Seong Jeong; Dong-Gyu Lee; Chong-Hun Jung; Kune-Woo Lee

    2007-01-01

    Available in abstract form only. Full text of publication follows: The uncertainties of decommissioning costs increase high due to several conditions. Decommissioning cost estimation depends on the complexity of nuclear installations, its site-specific physical and radiological inventories. Therefore, the decommissioning costs of nuclear research facilities must be estimated in accordance with the detailed sub-tasks and resources by the tasks of decommissioning activities. By selecting the classified activities and resources, costs are calculated by the items and then the total costs of all decommissioning activities are reshuffled to match with its usage and objectives. And the decommissioning cost of nuclear research facilities is calculated by applying a unit cost factor method on which classification of decommissioning works fitted with the features and specifications of decommissioning objects and establishment of composition factors are based. Decommissioning costs of nuclear research facilities are composed of labor cost, equipment and materials cost. Of these three categorical costs, the calculation of labor costs are very important because decommissioning activities mainly depend on labor force. Labor costs in decommissioning activities are calculated on the basis of working time consumed in decommissioning objects and works. The working times are figured out of unit cost factors and work difficulty factors. Finally, labor costs are figured out by using these factors as parameters of calculation. The accuracy of decommissioning cost estimation results is much higher compared to the real decommissioning works. (authors)

  17. Comparison of costs and discharge outcomes for patients hospitalized for ischemic or hemorrhagic stroke with or without atrial fibrillation in the United States.

    Science.gov (United States)

    Pan, Xianying; Simon, Teresa A; Hamilton, Melissa; Kuznik, Andreas

    2015-05-01

    This retrospective analysis investigated the impact of baseline clinical characteristics, including atrial fibrillation (AF), on hospital discharge status (to home or continuing care), mortality, length of hospital stay, and treatment costs in patients hospitalized for stroke. The analysis included adult patients hospitalized with a primary diagnosis of ischemic or hemorrhagic stroke between January 2006 and June 2011 from the premier alliance database, a large nationally representative database of inpatient health records. Patients included in the analysis were categorized as with or without AF, based on the presence or absence of a secondary listed diagnosis of AF. Irrespective of stroke type (ischemic or hemorrhagic), AF was associated with an increased risk of mortality during the index hospitalization event, as well as a higher probability of discharge to a continuing care facility, longer duration of stay, and higher treatment costs. In patients hospitalized for a stroke event, AF appears to be an independent risk factor of in-hospital mortality, discharge to continuing care, length of hospital stay, and increased treatment costs.

  18. Recreational marijuana use and acute ischemic stroke: A population-based analysis of hospitalized patients in the United States.

    Science.gov (United States)

    Rumalla, Kavelin; Reddy, Adithi Y; Mittal, Manoj K

    2016-05-15

    Recreational marijuana use is considered to have few adverse effects. However, recent evidence has suggested that it precipitates cardiovascular and cerebrovascular events. Here, we investigated the relationship between marijuana use and hospitalization for acute ischemic stroke (AIS) using data from the largest inpatient database in the United States. The Nationwide Inpatient Sample was queried from 2004 to 2011 for all patients (age 15-54) with a primary diagnosis of AIS. The incidence of AIS hospitalization in marijuana users and non-marijuana users was determined. We utilized multivariable logistic regression analyses to study the independent association between marijuana use and AIS. Overall, the incidence of AIS was significantly greater among marijuana users compared to non-users (Relative Risk [RR]: 1.13, 95% CI: 1.11-1.15, PMarijuana use was more prevalent among younger patients, males, African Americans, and Medicaid enrollees (PMarijuana users were more likely to use other illicit substances but had less overall medical comorbidity. In multivariable analysis, adjusted for potential confounders, marijuana (Odds Ratio [OR]: 1.17, 95% CI: 1.15-1.20), tobacco (OR: 1.76, 95% CI: 1.74-1.77), cocaine (OR: 1.32, 95% CI: 1.30-1.34), and amphetamine (OR: 2.21, 95% CI: 2.12-2.30) usage were found to increase the likelihood of AIS (all Precreational marijuana use is independently associated with 17% increased likelihood of AIS hospitalization. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

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

  20. Advanced Motor Control Test Facility for NASA GRC Flywheel Energy Storage System Technology Development Unit

    Science.gov (United States)

    Kenny, Barbara H.; Kascak, Peter E.; Hofmann, Heath; Mackin, Michael; Santiago, Walter; Jansen, Ralph

    2001-01-01

    This paper describes the flywheel test facility developed at the NASA Glenn Research Center with particular emphasis on the motor drive components and control. A four-pole permanent magnet synchronous machine, suspended on magnetic bearings, is controlled with a field orientation algorithm. A discussion of the estimation of the rotor position and speed from a "once around signal" is given. The elimination of small dc currents by using a concurrent stationary frame current regulator is discussed and demonstrated. Initial experimental results are presented showing the successful operation and control of the unit at speeds up to 20,000 rpm.

  1. Application of the LR-56 at DOE Facilities in the United States

    International Nuclear Information System (INIS)

    Smith, A.C.

    1998-05-01

    The ability to ship Type B liquid packages will be necessary for the nuclear industry to meet the energy production requirements of the next century. There are no packages licensed in the United States for transportation of large quantities of such liquids at present. Packages designed for transporting liquids must address technical challenges and incorporate features which are not common to packages designed for solid contents. These issues and the methods of addressing them are illustrated by the safety analysis performed for utilization of the LR-56 Liquid Package at US DOE facilities

  2. Nuclear Facility Accident (NFAC) Unit Test Report For HPAC Version 6.3

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ronald W. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Computational Sciences and Engineering Division; Morris, Robert W. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Computational Sciences and Engineering Division; Sulfredge, Charles David [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Computational Sciences and Engineering Division

    2015-12-01

    This is a unit test report for the Nuclear Facility Accident (NFAC) model for the Hazard Prediction and Assessment Capability (HPAC) version 6.3. NFAC’s responsibility as an HPAC component is three-fold. First, it must present an interactive graphical user interface (GUI) by which users can view and edit the definition of an NFAC incident. Second, for each incident defined, NFAC must interact with RTH to create activity table inputs and associate them with pseudo materials to be transported via SCIPUFF. Third, NFAC must create SCIPUFF releases with the associated pseudo materials for transport and dispersion. The goal of NFAC unit testing is to verify that the inputs it produces are correct for the source term or model definition as specified by the user via the GUI.

  3. Nuclear Facility Accident (NFAC) Unit Test Report For HPAC Version 6.3

    International Nuclear Information System (INIS)

    Lee, Ronald W.; Morris, Robert W.; Sulfredge, Charles David

    2015-01-01

    This is a unit test report for the Nuclear Facility Accident (NFAC) model for the Hazard Prediction and Assessment Capability (HPAC) version 6.3. NFAC's responsibility as an HPAC component is three-fold. First, it must present an interactive graphical user interface (GUI) by which users can view and edit the definition of an NFAC incident. Second, for each incident defined, NFAC must interact with RTH to create activity table inputs and associate them with pseudo materials to be transported via SCIPUFF. Third, NFAC must create SCIPUFF releases with the associated pseudo materials for transport and dispersion. The goal of NFAC unit testing is to verify that the inputs it produces are correct for the source term or model definition as specified by the user via the GUI.

  4. WIPP Facility Work Plan for Solid Waste Management Units and Areas of Concern

    International Nuclear Information System (INIS)

    2002-01-01

    This 2002 Facility Work Plan (FWP) has been prepared as required by Module VII, Permit Condition VII.U.3 of the Waste Isolation Pilot Plant (WIPP) Hazardous Waste Facility Permit, NM4890139088-TSDF (the Permit) (New Mexico Environment Department [NMED], 1999a), and incorporates comments from the NMED received on December 6, 2000 (NMED, 2000a). This February 2002 FWP describes the programmatic facility-wide approach to future investigations at Solid Waste Management Units (SWMU) and Areas of Concern (AOC) specified in the Permit. The Permittees are evaluating data from previous investigations of the SWMUs and AOCs against the most recent guidance proposed by the NMED. Based on these data, and completion of the August 2001 sampling requested by the NMED, the Permittees expect that no further sampling will be required and that a request for No Further Action (NFA) at the SWMUs and AOCs will be submitted to the NMED. This FWP addresses the current Permit requirements. It uses the results of previous investigations performed at WIPP and expands the investigations as required by the Permit. As an alternative to the Resource Conservation and Recovery Act (RCRA) Facility Investigation (RFI) specified in Module VII of the Permit, current NMED guidance identifies an Accelerated Corrective Action Approach (ACAA) that may be used for any SWMU or AOC (NMED, 1998). This accelerated approach is used to replace the standard RFI Work Plan and Report sequence with a more flexible decision-making approach. The ACAA process allows a facility to exit the schedule of compliance contained in the facility's Hazardous and Solid Waste Amendments (HSWA) permit module and proceed on an accelerated time frame. Thus, the ACAA processcan be entered either before or after an RFI Work Plan. According to the NMED's guidance, a facility can prepare an RFI Work Plan or Sampling and Analysis Plan (SAP) for any SWMU or AOC (NMED, 1998). Based on this guidance, a SAP constitutes an acceptable

  5. Design and Testing of a Breadboard Electrical Power Control Unit for the Fluid Combustion Facility Experiment

    Science.gov (United States)

    Kimnach, Greg L.; Lebron, Ramon C.

    1999-01-01

    The Fluid Combustion Facility (FCF) Project and the Power Technology Division at the NASA Glenn Research Center (GRC) at Lewis Field in Cleveland, OH along with the Sundstrand Corporation in Rockford, IL are jointly developing an Electrical Power Converter Unit (EPCU) for the Fluid Combustion Facility to be flown on the International Space Station (ISS). The FCF facility experiment contains three racks: A core rack, a combustion rack, and a fluids rack. The EPCU will be used as the power interface to the ISS 120V(sub dc) power distribution system by each FCF experiment rack which requires 28V(sub dc). The EPCU is a modular design which contains three 120V(sub dc)-to-28V(sub dc) full-bridge, power converters rated at 1 kW(sub e) each bus transferring input relays and solid-state, current-limiting input switches, 48 current-limiting, solid-state, output switches; and control and telemetry hardware. The EPCU has all controls required to autonomously share load demand between the power feeds and--if absolutely necessary--shed loads. The EPCU, which maximizes the usage of allocated ISS power and minimizes loss of power to loads, can be paralleled with other EPCUs. This paper overviews the electrical design and operating characteristics of the EPCU and presents test data from the breadboard design.

  6. Status of Cardiovascular Disease and Stroke in Hispanics/Latinos in the United States

    Science.gov (United States)

    Rodriguez, Carlos J.; Allison, Matthew; Daviglus, Martha L.; Isasi, Carmen R.; Keller, Colleen; Leira, Enrique C.; Palaniappan, Latha; Piña, Ileana L.; Ramirez, Sarah M.; Rodriguez, Beatriz; Sims, Mario

    2015-01-01

    Background and Purpose This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA’s 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers. Methods Writing group members were nominated by the AHA’s Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before

  7. Stroke rehabilitation.

    Science.gov (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

    2011-05-14

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

  8. The regulation and licensing of research reactors and associated facilities in the United Kingdom

    International Nuclear Information System (INIS)

    Weightman, M.W.; Willby, C.R.

    1990-01-01

    In the United Kingdom, the Nuclear Installations Inspectorate (NII) licenses nuclear facilities, including research reactors, on behalf of the Health and Safety Executive (HSE). The legislation, the regulatory organizations and the methods of operation that have been developed over the last 30 years result in a largely non-prescriptive form of control that is well suited to research reactors. The most important part of the regulatory system is the license and the attachment of conditions which it permits. These conditions require the licensee to prepare arrangements to control the safety of the facility. In doing so the licensee is encouraged to develop a 'safety culture' within its organization. This is particularly important for research reactors which may have limited staff resources and where the ability, and at times the need, to have access to the core is much greater than for nuclear power plants. Present day issues such as the ageing of nuclear facilities, public access to the rationale behind regulatory decisions, and the emergence of more stringent safety requirements, which include a need for quantified safety criteria, have been addressed by the NII. This paper explores the relevance of such issues to the regulation of research reactors. In particular, it discusses some of the factors associated with research reactors that should be considered in developing criteria for the tolerability of risk from these nuclear facilities. From a consideration of these factors, it is the authors' view that the range of tolerable risk to the public from the operation of new research reactors may be expected to be more stringent than similar criteria for new nuclear power plants, whereas the criteria for tolerable risk for research reactor workers are expected to be about the same as those for power reactor workers

  9. The Text of the Agreement for the Application of Agency Safeguards to Four United States Reactor Facilities

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1962-05-24

    The text of the Agreement between the Agency and the United States of America for the application of Agency safeguards to four United States reactor facilities, which was signed on 30 March 1962 and will enter into force on 1 June 1962, is reproduced in this document for the information of all Members of the Agency.

  10. 78 FR 16705 - Llano Seco Riparian Sanctuary Unit Restoration and Pumping Plant/Fish Screen Facility Protection...

    Science.gov (United States)

    2013-03-18

    ...-FF08RSRC00] Llano Seco Riparian Sanctuary Unit Restoration and Pumping Plant/ Fish Screen Facility Protection... removal and management of invasive plant species would occur at the Riparian Sanctuary. No active... impact statement and environmental impact report (EIS/EIR) for the Llano Seco Riparian Sanctuary Unit...

  11. 77 FR 26569 - Llano Seco Riparian Sanctuary Unit Restoration and Pumping Plant/Fish Screen Facility Protection...

    Science.gov (United States)

    2012-05-04

    ...-FF08RSRC00] Llano Seco Riparian Sanctuary Unit Restoration and Pumping Plant/ Fish Screen Facility Protection... would occur at the Riparian Sanctuary. No active restoration of native plants would occur. Maintenance... statement and environmental impact report (EIS/EIR) for the Llano Seco Riparian Sanctuary Unit Restoration...

  12. Testing of the Engineering Model Electrical Power Control Unit for the Fluids and Combustion Facility

    Science.gov (United States)

    Kimnach, Greg L.; Lebron, Ramon C.; Fox, David A.

    1999-01-01

    The John H. Glenn Research Center at Lewis Field (GRC) in Cleveland, OH and the Sundstrand Corporation in Rockford, IL have designed and developed an Engineering Model (EM) Electrical Power Control Unit (EPCU) for the Fluids Combustion Facility, (FCF) experiments to be flown on the International Space Station (ISS). The EPCU will be used as the power interface to the ISS power distribution system for the FCF's space experiments'test and telemetry hardware. Furthermore. it is proposed to be the common power interface for all experiments. The EPCU is a three kilowatt 12OVdc-to-28Vdc converter utilizing three independent Power Converter Units (PCUs), each rated at 1kWe (36Adc @ 28Vdc) which are paralleled and synchronized. Each converter may be fed from one of two ISS power channels. The 28Vdc loads are connected to the EPCU output via 48 solid-state and current-limiting switches, rated at 4Adc each. These switches may be paralleled to supply any given load up to the 108Adc normal operational limit of the paralleled converters. The EPCU was designed in this manner to maximize allocated-power utilization. to shed loads autonomously, to provide fault tolerance. and to provide a flexible power converter and control module to meet various ISS load demands. Tests of the EPCU in the Power Systems Facility testbed at GRC reveal that the overall converted-power efficiency, is approximately 89% with a nominal-input voltage of 12OVdc and a total load in the range of 4O% to 110% rated 28Vdc load. (The PCUs alone have an efficiency of approximately 94.5%). Furthermore, the EM unit passed all flight-qualification level (and beyond) vibration tests, passed ISS EMI (conducted, radiated. and susceptibility) requirements. successfully operated for extended periods in a thermal/vacuum chamber, was integrated with a proto-flight experiment and passed all stability and functional requirements.

  13. Blood Pressure Guideline Adherence in Patients with Ischemic and Hemorrhagic Stroke in the Neurointensive Care Unit Setting.

    Science.gov (United States)

    Porto, Guilherme B F; Spiotta, Alejandro M; Chalela, Julio A; Kellogg, Ryan T; Jauch, Edward C

    2015-12-01

    Patients with acute brain injuries require strict physiologic control to minimize morbidity and mortality. This study aimed to assess in-hospital compliance to strict physiologic parameters (BP, HR, ICP, SpO2) in these populations. Patients with severe cerebrovascular events were admitted to the neurointensive care unit (NSICU) and were continuously monitored using the BedMasterEX (Excel Medical Electronics Inc, FL) system, which recorded hemodynamic data via an arterial catheter continuously in 5-s intervals. Furthermore, we investigated the impact of healthcare provider shift changes (6-8 a.m./p.m) and of day (6 a.m.-6 p.m.) versus night (6 p.m-6 a.m) shifts in hemodynamic control. Fifty patients admitted to the NSICU, 50 % male, mean age 59.7 ± 13.9 years with subarachnoid hemorrhage (23), ischemic stroke (8), subdural hematoma (4), intracerebral hemorrhage (3), intraventricular hemorrhage (2), and miscellaneous injuries (10) were enrolled. Data represented 2,337 total hours of continuous monitoring. Systolic BPs (SBP) were on average outside of recommended ranges 32.26 ± 30.46 % of the monitoring period. We subdivided adherence to ideal SBP range: optimal (≥99 % of time spent in NSICU within range) was achieved in 12 %, adequate (90 %) in 16 %, suboptimal (80 %) in 20 %, inadequate I (70 %) in 12 %, and inadequate II (<70 %) in 40 % of patients. Comparison of shift change %time and day versus night %time out of parameter yielded no statistically significant differences across SAH patients. Hemodynamic management of patients with cerebrovascular injuries, based on targeted thresholds in the NSICU, yielded optimal control of SBP in only 28 % of our patients (within parameters ≥90 % of time).

  14. RCRA facility investigation/corrective measures study work plan for the 100-HR-1 operable unit, Hanford Site, Richland, Washington

    International Nuclear Information System (INIS)

    1992-09-01

    Four areas of the Hanford Site (the 100, 200, 300, and 1100 Areas) have been included on the US. Environmental Protection Agency's (EPA's) National Priorities List (NPL) under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). Under the Hanford Federal Facility Agreement and Consent Order, signed by the Washington State Department of Ecology (Ecology), EPA, and the US Department of Energy (DOE), more than 1,000 inactive waste disposal and unplanned release sites on the Hanford Site have been grouped into a number of source and groundwater operable units. These operable units contain contamination in the form of hazardous waste, radioactive/hazardous mixed waste, and other CERCLA hazardous substances. This work plan and the attached supporting project plans establish the operable unit setting and the objectives, procedures, tasks, and schedule for conducting the RCRA facility investigation/corrective measures study (RFI/CMS) for the 100-HR-1 source operable unit. Source operable units include facilities and unplanned release sites that are potential sources of contamination. The 100-HR-3 operable unit underlies the D/DR and H Areas, the 600 Area between them, and the six source operable units these areas contain. The 100-HR-3 operable unit includes all contamination found in the aquifer soils and water within its boundary. Separate work plans have been initiated for the 100-HR-3 groundwater operable unit (DOE-RL 1992a) and the 100-DR-1 (DOE-RL 1992b) source operable units

  15. RCRA facility investigation/corrective measures study work plan for the 100-DR-1 operable unit, Hanford Site, Richland, Washington

    International Nuclear Information System (INIS)

    1992-09-01

    Four areas of the Hanford Site (the 100, 200, 300, and 1100 Areas) have been included on the US Environmental Protection Agency's (EPA's) National Priorities List (NPL) under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). Under the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement, Ecology et. al. 1990a), signed by the Washington State Department of Ecology (Ecology), EPA, and the US Department of Energy (DOE), more than 1,000 inactive waste disposal and unplanned release sites on the Hanford Site have been grouped into a number of source and groundwater operable units. These operable units contain contamination in the form of hazardous waste, radioactive/hazardous mixed waste, and other CERCLA hazardous substances. Also included in the Tri-Party Agreement are 55 Resource Conservation and Recovery Act (RCRA) treatment, storage, or disposal (TSD) facilities that will be closed or permitted to operate in accordance with RCRA regulations. Some of the TSD facilities are included in the operable units. This work plan and the attached supporting project plans establish the operable unit setting and the objectives, procedures, tasks, and schedule for conducting the RCRA facility investigation/corrective measures study (RFI/CMS) for the 100-DR-1 source operable unit Source operable units include facilities and unplanned release sites that are potential sources of contamination

  16. Initial closed operation of the CELSS Test Facility Engineering Development Unit

    Science.gov (United States)

    Kliss, M.; Blackwell, C.; Zografos, A.; Drews, M.; MacElroy, R.; McKenna, R.; Heyenga, A. G.

    2003-01-01

    As part of the NASA Advanced Life Support Flight Program, a Controlled Ecological Life Support System (CELSS) Test Facility Engineering Development Unit has been constructed and is undergoing initial operational testing at NASA Ames Research Center. The Engineering Development Unit (EDU) is a tightly closed, stringently controlled, ground-based testbed which provides a broad range of environmental conditions under which a variety of CELSS higher plant crops can be grown. Although the EDU was developed primarily to provide near-term engineering data and a realistic determination of the subsystem and system requirements necessary for the fabrication of a comparable flight unit, the EDU has also provided a means to evaluate plant crop productivity and physiology under controlled conditions. This paper describes the initial closed operational testing of the EDU, with emphasis on the hardware performance capabilities. Measured performance data during a 28-day closed operation period are compared with the specified functional requirements, and an example of inferring crop growth parameters from the test data is presented. Plans for future science and technology testing are also discussed. Published by Elsevier Science Ltd on behalf of COSPAR.

  17. Design of chemical treatment unit for radioactive liquid wastes in Serpong nuclear facilities

    International Nuclear Information System (INIS)

    Salimin, Z.; Walman, E.; Santoso, P.; Purnomo, S.; Sugito; Suwardiyono; Wintono

    1996-01-01

    The chemical treatment unit for radioactive liquid wastes arising from nuclear fuel fabrication, radioisotopes production and radiometallurgy facility has been designed. The design of chemical processing unit is based on the characteristics of liquid wastes containing fluors from uranium fluoride conversion process to ammonium uranyl carbonate on the fuel fabrication. The chemical treatment has the following process steps: coagulation-precipitation of fluoride ion by calcium hydroxide coagulant, separation of supernatant solution from sludge, coagulation of remaining fluoride on the supernatant solution by alum, separation of supernatant from sludge, and than precipitation of fluors on the supernatant by polymer resin WWS 116. The processing unit is composed of 3 storage tanks for raw liquid wastes (capacity 1 m 3 per tank), 5 storage tanks for chemicals (capacity 0.5 m 3 per tank), 2 mixing reactors (capacity 0.5 m 3 per reactor), 1 storage tank for supernatant solution (capacity 1 m 3 ), and 1 storage tank for sludge (capacity 1 m 3 )

  18. RCRA facility investigation/corrective measures study work plan for the 100-HR-3 operable unit, Hanford Site, Richland, Washington

    International Nuclear Information System (INIS)

    1992-09-01

    Four areas of the Hanford Site (the 100, 200, 300, and 1100 Areas) have been included on the US Environmental Protection Agency's (EPA's) National Priorities List (NPL) under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). Under the Hanford Federal Facility Agreement and Consent Order, signed by the Washington State Department of Ecology (Ecology), EPA, and the US Department of Energy (DOE), more than 1000 inactive waste disposal and unplanned release sites on the Hanford Site have been grouped into a number of source and groundwater operable units. These operable units contain contamination in the form of hazardous waste, radioactive/hazardous mixed waste, and other CERCLA hazardous substances. Also included in the Tri-Party Agreement are 55 Resource Conservation and Recovery Act (RCRA) treatment, storage, or disposal (TSD) facilities that will be closed or permitted to operate in accordance with RCRA regulations, under the authority of Chapter 173-303 Washington Administrative Code (WAC). Some of the TSD facilities are included in the operable units. This work plan and the attached supporting project plans establish the operable unit setting and the objectives, procedures, tasks, and schedule for conducting the RCRA facility investigation/corrective measures study (RFI/CMS) for the 100-HR-3 operable unit. The 100-HR-3 operable unit underlies the D/DR and H Areas, the 600 Area between them, and the six source operable units these areas contain. The 100-HR-3 operable unit includes all contamination found in the aquifer soils and water within its boundary. Source operable units include facilities and unplanned release sites that are potential sources of contamination. Separate work plans have been initiated for the 100-DR-1 (DOE-RL 1992a) and 100-HR-1 (DOE-RL 1992b) source operable units

  19. Local control unit for ITER-India gyrotron test facility (IIGTF)

    Energy Technology Data Exchange (ETDEWEB)

    Rathod, Vipal, E-mail: vipal.rathod@iter-india.org; Shah, Ronak; Mandge, Deepak; Parmar, Rajvi; Rao, S.L.

    2016-11-15

    Highlights: • A dedicated full scale ITER prototype Local Control Unit for ITER-India Gyrotron test facility. • National Instruments® make PXIe system for real time control & data acquisition and Siemens® PLC for sequence control function. • Hardwired FPGA based fast protection interlock system. • High speed analog fiber optical transmission link using V/F and F/V technique. • Software framework based on LabVIEW™ platform and ITER CODAC Core System. - Abstract: Electron Cyclotron system on ITER, is one of the important RF ancillary systems based on high power Gyrotron RF sources, that is used for plasma heating and current drive applications. To operate a Gyrotron source, various auxiliary systems and services such as Super Conducting Magnet set, High Voltage Power Supplies, Auxiliary Power Supplies, Waveguide components, Cooling water system and a Local Control Unit (LCU) are required. The LCU plays a very crucial role for the safe and reliable operation of Gyrotron system. A dedicated full scale ITER prototype LCU is being developed for testing and commissioning of an ITER like Test Gyrotron at ITER-India Gyrotron Test facility (IIGTF). The main functions of LCU include Sequence Control, Local Interlock Protection and Real Time Data Acquisition. PLC based slow controller is used for implementing the Sequence Control & Slow Interlock functions. Critical Protection Interlocks are required to have a response time of <10 μs and are implemented using custom built hardware and PXIe based fast controller. Also PXIe system is used for implementing Real Time Data Acquisition function that is required to have slow and fast acquisition with online visualization and off line analysis facility. A Signal Conditioning Unit (SCU) is used to interface and faithfully transmit the field signals to the remote control systems. Necessary controller hardware is procured and several pre-prototype developments have been taken up to establish the critical subsystems such as

  20. Local control unit for ITER-India gyrotron test facility (IIGTF)

    International Nuclear Information System (INIS)

    Rathod, Vipal; Shah, Ronak; Mandge, Deepak; Parmar, Rajvi; Rao, S.L.

    2016-01-01

    Highlights: • A dedicated full scale ITER prototype Local Control Unit for ITER-India Gyrotron test facility. • National Instruments® make PXIe system for real time control & data acquisition and Siemens® PLC for sequence control function. • Hardwired FPGA based fast protection interlock system. • High speed analog fiber optical transmission link using V/F and F/V technique. • Software framework based on LabVIEW™ platform and ITER CODAC Core System. - Abstract: Electron Cyclotron system on ITER, is one of the important RF ancillary systems based on high power Gyrotron RF sources, that is used for plasma heating and current drive applications. To operate a Gyrotron source, various auxiliary systems and services such as Super Conducting Magnet set, High Voltage Power Supplies, Auxiliary Power Supplies, Waveguide components, Cooling water system and a Local Control Unit (LCU) are required. The LCU plays a very crucial role for the safe and reliable operation of Gyrotron system. A dedicated full scale ITER prototype LCU is being developed for testing and commissioning of an ITER like Test Gyrotron at ITER-India Gyrotron Test facility (IIGTF). The main functions of LCU include Sequence Control, Local Interlock Protection and Real Time Data Acquisition. PLC based slow controller is used for implementing the Sequence Control & Slow Interlock functions. Critical Protection Interlocks are required to have a response time of <10 μs and are implemented using custom built hardware and PXIe based fast controller. Also PXIe system is used for implementing Real Time Data Acquisition function that is required to have slow and fast acquisition with online visualization and off line analysis facility. A Signal Conditioning Unit (SCU) is used to interface and faithfully transmit the field signals to the remote control systems. Necessary controller hardware is procured and several pre-prototype developments have been taken up to establish the critical subsystems such as

  1. The "Know Stroke" Campaign

    Science.gov (United States)

    ... Issue Past Issues Special Section The "Know Stroke" Campaign Past Issues / Summer 2007 Table of Contents For ... Javascript on. NINDS is conducting a public awareness campaign across the United States to educate people about ...

  2. Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia.

    Science.gov (United States)

    Pérez, Laura Mónica; Inzitari, Marco; Roqué, Marta; Duarte, Esther; Vallés, Elisabeth; Rodó, Montserrat; Gallofré, Miquel

    2015-10-01

    Recovery after a stroke is determined by a broad range of neurological, functional and psychosocial factors. Evidence regarding these factors is not well established, in particular influence of cognition changes during rehabilitation. We aimed to investigate whether selective characteristics, including cognitive performance and its change over time, modulate functional recovery with home discharge in stroke survivors admitted to post-acute rehabilitation units. We undertook a multicenter cohort study, including all patients discharged from acute wards to any geriatric rehabilitation unit in Catalonia-Spain during 2008. Patients were assessed for demographics, clinical and functional variables using Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris (CMBD-RSS), which adapts the Minimum Data Set tool used in America's nursing homes. Baseline-to-discharge change in cognition was calculated on repeated assessments using the Cognitive Performance Scale (CPS, range 0-6, best-worst cognition). The multivariable effect of these factors was analyzed in relation to the outcome. 879 post-stroke patients were included (mean age 77.48 ± 10.18 years, 52.6% women). A worse initial CPS [OR (95% CI) = 0.851 (0.774-0.935)] and prevalent fecal incontinence [OR (95% CI) = 0.560 (0.454-0.691)] reduced the likelihood of returning home with functional improvement; whereas improvement of CPS, baseline to discharge, [OR (95% CI) = 1.348 (1.144-1.588)], more rehabilitation days within the first 2 weeks [OR (95% CI) = 1.011 (1.006-1.015)] and a longer hospital stay [OR (95% CI) = 1.011 (1.006-1.015)] were associated with the outcome. In our sample, different clinical characteristics, including cognitive function and its improvement over time, are associated with functional improvement in stroke patients undergoing rehabilitation. Our results might provide information to further studies aimed at exploring the influence of cognition changes during rehabilitation.

  3. Security central processing unit applications in the protection of nuclear facilities

    International Nuclear Information System (INIS)

    Goetzke, R.E.

    1987-01-01

    New or upgraded electronic security systems protecting nuclear facilities or complexes will be heavily computer dependent. Proper planning for new systems and the employment of new state-of-the-art 32 bit processors in the processing of subsystem reports are key elements in effective security systems. The processing of subsystem reports represents only a small segment of system overhead. In selecting a security system to meet the current and future needs for nuclear security applications the central processing unit (CPU) applied in the system architecture is the critical element in system performance. New 32 bit technology eliminates the need for program overlays while providing system programmers with well documented program tools to develop effective systems to operate in all phases of nuclear security applications

  4. Safety assessment and licensing issues of low level radioactive waste disposal facilities in the United Kingdom

    Energy Technology Data Exchange (ETDEWEB)

    Fearnley, I. G. [British Nuclear Fuels Ltd., Sellafield (United Kingdom)

    1997-12-31

    More than 90% of radioactive waste generated in the United Kingdom is classified as low level and is disposed of in near surface repositories. BNFL owns and operates the principal facility for the disposal of this material at Drigg in West Cumbria. In order to fully optimise the use of the site and effectively manage this `national` resource a full understanding and assessment of the risks associated with the performance of the repository to safely contain the disposed waste must be achieved to support the application for the site authorization for disposal. This paper describes the approaches adopted by BNFL to reviewing these risks by the use of systematic Safety and Engineering Assessments supported in turn by experimental programmes and computations models. (author). 6 refs., 1 tab., 4 figs.

  5. Safety assessment and licensing issues of low level radioactive waste disposal facilities in the United Kingdom

    International Nuclear Information System (INIS)

    Fearnley, I. G.

    1997-01-01

    More than 90% of radioactive waste generated in the United Kingdom is classified as low level and is disposed of in near surface repositories. BNFL owns and operates the principal facility for the disposal of this material at Drigg in West Cumbria. In order to fully optimise the use of the site and effectively manage this 'national' resource a full understanding and assessment of the risks associated with the performance of the repository to safely contain the disposed waste must be achieved to support the application for the site authorization for disposal. This paper describes the approaches adopted by BNFL to reviewing these risks by the use of systematic Safety and Engineering Assessments supported in turn by experimental programmes and computations models. (author). 6 refs., 1 tab., 4 figs

  6. Research on Dynamic Facility Layout Problem of Manufacturing Unit Considering Human Factors

    Directory of Open Access Journals (Sweden)

    Jinying Li

    2018-01-01

    Full Text Available As many said, industry 4.0 is an epoch-making revolution which brought the manufacturing market much faster changes and severer competitions. As an important part of the manufacturing system, facility layout has direct impact on business benefit; at the same time, despite the intelligent factory, intelligent production has its own characteristics. However, there is one point on which industry and academia have basically formed a consensus: it is not true that industry 4.0 does not need human beings; on the contrary, human initiative plays an unabated role in the development of industry 4.0. This paper will focus on the dynamic facility layout of the manufacturing unit. Based on the system above and the traditional optimization model, a mathematic model is built to find the best solution combining safety, sustainability, high efficiency, and low cost. And penalty function with adaptive penalty factor and advanced artificial bee colony algorithm is used to solve the constrained model. In the end, by studying few cases, the model is proved to be effective in both efficiency improvement and the implementation of safe and comfort human-machine interaction.

  7. Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey.

    Science.gov (United States)

    Scobbie, Lesley; Duncan, Edward A; Brady, Marian C; Wyke, Sally

    2015-01-01

    We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services (n = 358/395) reported setting goals with "all" or "most" stroke survivors. Seventeen percent (n = 65/380) reported that no methods were used to guide goal setting practice; 47% (n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n = 362/369) reported routinely asking patients about goal priorities; 39% (n = 141/360) reported routinely providing patients with a copy of their goals. Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist. Implications for Rehabilitation Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients. Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal. Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

  8. Replacement of the moderator cell unit of JRR-3's cold neutron source facility

    International Nuclear Information System (INIS)

    Hazawa, Tomoya; Nagahori, Kazuhisa; Kusunoki, Tsuyoshi

    2006-10-01

    The moderator cell of the JRR-3's cold neutron source (CNS) facility, converts thermal neutrons into cold neutrons by passing through liquid cold hydrogen. The cold neutrons are used for material and life science research such as the neutron scattering. The CNS has been operated since the start of JRR-3's in 1990. The moderator cell containing liquid hydrogen is made of stainless steel. The material irradiation lifetime is limited to 7 years due to irradiation brittleness. The first replacement was done by using a spare part made in France. This replacement work of 2006 was carried out by using the domestic moderator cell unit. The following technologies were developed for the moderator cell unit production. 1) Technical development of black treatment on moderator cell surface to increase radiation heat. 2) Development of bending technology of concentric triple tubes consisting from inside tube, Outside tube and Vacuum insulation tube. 3) Development of manufacturing technique of the moderator cell with complicated shapes. According to detail planed work procedures, replacement work was carried out. As results, the working days were reduced to 80% of old ones. The radiation dose was also reduced due to reduction of working days. It was verified by measurement of neutrons characteristics that the replaced moderator cell has the same performance as that of the old moderator cell. The domestic manufacturing of the moderator cell was succeeded. As results, the replacement cost was reduced by development of domestic production technology. (author)

  9. Processes of early stroke care and hospital costs.

    Science.gov (United States)

    Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H; Ingeman, Annette; Johnsen, Søren P

    2014-08-01

    The relationship between processes of early stroke care and hospital costs remains unclear. We therefore examined the association in a population based cohort study. We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005 and 2010.The examined recommended processes of care included early admission to a stroke unit, early initiation of antiplatelet or anticoagulant therapy, early computed tomography/magnetic resonance imaging (CT/MRI) scan, early physiotherapy and occupational therapy, early assessment of nutritional risk, constipation risk and of swallowing function, early mobilization,early catheterization, and early thromboembolism prophylaxis.Hospital costs were assessed for each patient based on the number of days spent in different in-hospital facilities using local hospital charges. The mean costs of hospitalization were $23 352 (standard deviation 27 827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose–response relationship. The adjusted costs were $24 566 (95% confidence interval 19 364–29 769) lower for patients who received 75–100% of the relevant processes of care compared with patients receiving 0–24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Early care in agreement with key guidelines recommendations for the management of patients with stroke may be associated with hospital savings.

  10. Economic impacts of oil spills: Spill unit costs for tankers, pipelines, refineries, and offshore facilities

    International Nuclear Information System (INIS)

    1993-01-01

    The impacts of oil spills -- ranging from the large, widely publicized Exxon Valdez tanker incident to smaller pipeline and refinery spills -- have been costly to both the oil industry and the public. For example, the estimated costs to Exxon of the Valdez tanker spill are on the order of $4 billion, including $2.8 billion (in 1993 dollars) for direct cleanup costs and $1.125 billion (in 1992 dollars) for settlement of damages claims caused by the spill. Application of contingent valuation costs and civil lawsuits pending in the State of Alaska could raise these costs appreciably. Even the costs of the much smaller 1991 oil spill at Texaco's refinery near Anacortes, Washington led to costs of $8 to 9 million. As a result, inexpensive waming, response and remediation technologies could lower oil spin costs, helping both the oil industry, the associated marine industries, and the environment. One means for reducing the impact and costs of oil spills is to undertake research and development on key aspects of the oil spill prevention, warming, and response and remediation systems. To target these funds to their best use, it is important to have sound data on the nature and size of spills, their likely occurrence and their unit costs. This information could then allow scarce R ampersand D dollars to be spent on areas and activities having the largest impact. This report is intended to provide the ''unit cost'' portion of this crucial information. The report examines the three key components of the US oil supply system, namely, tankers and barges; pipelines and refineries; and offshore production facilities. The specific purpose of the study was to establish the unit costs of oil spills. By manipulating this key information into a larger matrix that includes the size and frequency of occurrence of oil spills, it will be possible' to estimate the likely future impacts, costs, and sources of oil spills

  11. Recovery of Dysphagia in Lateral Medullary Stroke

    OpenAIRE

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia...

  12. 78 FR 76317 - Llano Seco Riparian Sanctuary Unit Restoration and Pumping Plant/Fish Screen Facility Protection...

    Science.gov (United States)

    2013-12-17

    ...-FF08RSRC00] Llano Seco Riparian Sanctuary Unit Restoration and Pumping Plant/ Fish Screen Facility Protection... and Wildlife (CDFW), announce that the record of decision (ROD) for the Llano Seco Riparian Sanctuary...: www.fws.gov/refuge/sacramento river/ and http://www.riverpartners.org/where-we-work/sanctuary...

  13. Directory of Facilities for Mentally Ill Children in the United States.

    Science.gov (United States)

    National Association for Mental Health, New York, NY.

    Facilities for mentally ill children are listed by states in this directory for parents and professional people. Each entry includes information on diagnostic considerations, capacity, admission criteria, whether the facility is residential or day care, geographic eligibility, and fees. Separate indexes list residential and day care facilities and…

  14. Maternal and newborn morbidity by birth facility among selected United States 2006 low-risk births.

    Science.gov (United States)

    Wax, Joseph R; Pinette, Michael G; Cartin, Angelina; Blackstone, Jacquelyn

    2010-02-01

    We sought to evaluate perinatal morbidity by delivery location (hospital, freestanding birth center, and home). Selected 2006 US birth certificate data were accessed online from the Centers for Disease Control and Prevention. Low-risk maternal and newborn outcomes were tabulated and compared by birth facility. A total of 745,690 deliveries were included, of which 733,143 (97.0%) occurred in hospital, 4661 (0.6%) at birth centers, and 7427 (0.9%) at home. Compared with hospital deliveries, home and birthing center deliveries were associated with more frequent prolonged and precipitous labors. Home births experienced more frequent 5-minute Apgar scores home and birthing center deliveries were associated with less frequent chorioamnionitis, fetal intolerance of labor, meconium staining, assisted ventilation, neonatal intensive care unit admission, and birthweight Home births are associated with a number of less frequent adverse perinatal outcomes at the expense of more frequent abnormal labors and low 5-minute Apgar scores. Copyright 2010 Mosby, Inc. All rights reserved.

  15. Occupational Therapy in the Neonatal Intensive Care Unit for a Neonate with Perinatal Stroke: A Case Report.

    Science.gov (United States)

    Roan, Cecilia; Bell, Alison

    2017-08-01

    This case report describes an occupational therapy intervention based on synactive theory for a neonate born full-term with a diagnosis of perinatal stroke. Occupational therapy was provided 4-5 times a week for 3 weeks. The focus was improving infant state regulation and motor skills to support developmentally appropriate behaviors through environmental modifications, positioning, guided progression of sensory stimulation, and promotion of motor and postural skills. At discharge on day 24, the infant had improved state regulation, behavioral organization, and motor performance. Occupational therapy based on synactive theory was an effective therapeutic approach for improving the behavioral and motor organization of a full term infant diagnosed with perinatal stroke.

  16. Safety analysis report for the mixed waste storage facility and portable storage units at the Idaho National Engineering Laboratory

    International Nuclear Information System (INIS)

    Peatross, R.

    1997-01-01

    The Mixed Waste Storage Facility (MWSF) including the Portable Storage Units (PSUs) is a government-owned contractor-operated facility located at the Idaho National Engineering Laboratory (INEL). Lockheed Martin Idaho Technologies Company (LMITCO) is the current operating contractor and facility Architect/Engineer as of September 1996. The operating contractor is referred to as open-quotes the Companyclose quotes or open-quotes Companyclose quotes throughout this document. Oversight of MWSF is provided by the Department of Energy Idaho Operations Office (DOE-ID). The MWSF is located in the Power Burst Facility (PBF) Waste Reduction Operations Complex (WROC) Area, approximately 10.6 km (6.6 mi) from the southern INEL boundary and 4 km (2.5 mi) from U.S. Highway 20

  17. Resource Conservation and Recovery Act closure plan for the Intermediate-Level Transuranic Storage Facility mixed waste container storage units

    International Nuclear Information System (INIS)

    Nolte, E.P.; Spry, M.J.; Stanisich, S.N.

    1992-11-01

    This document describes the proposed plan for clean closure of the Intermediate-Level Transuranic Storage Facility mixed waste container storage units at the Idaho National Engineering Laboratory in accordance with the Resource Conservation and Recovery Act closure requirements. Descriptions of the location, size, capacity, history, and current status of the units are included. The units will be closed by removing waste containers in storage, and decontamination structures and equipment that may have contacted waste. Sufficient sampling and documentation of all activities will be performed to demonstrate clean closure. A tentative schedule is provided in the form of a milestone chart

  18. Burden of Stroke in Qatar.

    Science.gov (United States)

    Ibrahim, Faisal; Deleu, Dirk; Akhtar, Naveed; Al-Yazeedi, Wafa; Mesraoua, Boulenouar; Kamran, Sadaat; Shuaib, Ashfaq

    2015-12-01

    Qatar is located on the northeastern coast of the Arabian Peninsula. The total population is over 2.1 million with around 15% being Qatari citizens. Hamad General Hospital (HGH) is the only tertiary referral governmental hospital in Qatar which admits acute (thrombolysis-eligible) stroke patients. To provide an overview of the burden of stroke in Qatar. Data from literature databases, online sources and our stroke registry were collated to identify information on the burden of stroke in Qatar. Overall, over 80% of all stroke patients in Qatar are admitted in HGH. In 2010, the age-standardized incidence for first-ever ischemic stroke was 51.88/100,000 person-years. To date our stroke registry reveals that 79% of all stroke patients are male and almost 50% of stroke patients are 50 years or less. Hypertension, diabetes and dyslipidemia are the main predisposing factors for stroke, with ischemic stroke being more common (87%) than hemorrhagic stroke (13%). Despite the lack of a stroke unit, 9% of ischemic stroke patients are being thrombolyzed. However the presence of a stroke ward allows swift turnover of patients with a length of stay of less than 5 days before discharge or, if required, transfer to the fully-equipped hospital-based rehabilitation service. Several community awareness programs are ongoing, in addition to several research programs funded by the Qatar National Research Fund and Hamad Medical Corporation. In a country where over 15% of the population suffers from diabetes there is continuous need for national community-based awareness campaigns, prevention and educational programs particularly targeting patients and health care workers. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Patient education and emotional support practices in abortion care facilities in the United States.

    Science.gov (United States)

    Gould, Heather; Perrucci, Alissa; Barar, Rana; Sinkford, Danielle; Foster, Diana Greene

    2012-01-01

    Little is known about how patient education and emotional support is provided at abortion facilities. This pilot study documents 27 facilities' practices in this aspect of abortion care. We conducted confidential telephone interviews with staff from 27 abortion facilities about their practices. The majority of facilities reported they rely primarily on trained nonclinician staff to educate patients and provide emotional support. As part of their informed consent and counseling processes, facilities reported that staff always provide patients with information about the procedure (96%), assess the certainty of their abortion decisions (92%), assess their feelings and provide emotional support (74%), and provide contraceptive health education (92%). Time spent providing these components of care varied across facilities and patients. When describing their facility's care philosophy, many respondents expressed support for "patient-centered," "supportive," "nonjudgmental" care. Eighty-two percent agreed that it is the facility's role to provide counseling for emotional issues related to abortion. All facilities valued informed consent, patient education, and emotional support. Although the majority of facilities considered counseling for emotional issues to be a part of their role, some did not. Future research should examine patients' preferences regarding abortion care and counseling and how different approaches to care affect women's emotional well-being after having an abortion. This information is important in light of current, widespread legislative efforts that aim to regulate abortion counseling, which are being proposed without an understanding of patient needs or facility practices. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  20. Effects of alteplase for acute stroke according to criteria defining the European Union and United States marketing authorizations: Individual-patient-data meta-analysis of randomized trials.

    Science.gov (United States)

    Hacke, Werner; Lyden, Patrick; Emberson, Jonathan; Baigent, Colin; Blackwell, Lisa; Albers, Gregory; Bluhmki, Erich; Brott, Thomas; Cohen, Geoffrey; Davis, Stephen M; Donnan, Geoffrey A; Grotta, James C; Howard, George; Kaste, Markku; Koga, Masatoshi; von Kummer, Rüdiger; Lansberg, Maarten G; Lindley, Richard I; Olivot, Jean-Marc; Parsons, Mark; Sandercock, Peter Ag; Toni, Danilo; Toyoda, Kazunori; Wahlgren, Nils; Wardlaw, Joanna M; Whiteley, William N; Del Zoppo, Gregory; Lees, Kennedy R

    2018-02-01

    Background The recommended maximum age and time window for intravenous alteplase treatment of acute ischemic stroke differs between the Europe Union and United States. Aims We compared the effects of alteplase in cohorts defined by the current Europe Union or United States marketing approval labels, and by hypothetical revisions of the labels that would remove the Europe Union upper age limit or extend the United States treatment time window to 4.5 h. Methods We assessed outcomes in an individual-patient-data meta-analysis of eight randomized trials of intravenous alteplase (0.9 mg/kg) versus control for acute ischemic stroke. Outcomes included: excellent outcome (modified Rankin score 0-1) at 3-6 months, the distribution of modified Rankin score, symptomatic intracerebral hemorrhage, and 90-day mortality. Results Alteplase increased the odds of modified Rankin score 0-1 among 2449/6136 (40%) patients who met the current European Union label and 3491 (57%) patients who met the age-revised label (odds ratio 1.42, 95% CI 1.21-1.68 and 1.43, 1.23-1.65, respectively), but not in those outside the age-revised label (1.06, 0.90-1.26). By 90 days, there was no increased mortality in the current and age-revised cohorts (hazard ratios 0.98, 95% CI 0.76-1.25 and 1.01, 0.86-1.19, respectively) but mortality remained higher outside the age-revised label (1.19, 0.99-1.42). Similarly, alteplase increased the odds of modified Rankin score 0-1 among 1174/6136 (19%) patients who met the current US approval and 3326 (54%) who met a 4.5-h revised approval (odds ratio 1.55, 1.19-2.01 and 1.37, 1.17-1.59, respectively), but not for those outside the 4.5-h revised approval (1.14, 0.97-1.34). By 90 days, no increased mortality remained for the current and 4.5-h revised label cohorts (hazard ratios 0.99, 0.77-1.26 and 1.02, 0.87-1.20, respectively) but mortality remained higher outside the 4.5-h revised approval (1.17, 0.98-1.41). Conclusions An age-revised European Union label or 4

  1. RCRA Facility Investigation/Remedial Investigation Report for Gunsite 720 Rubble Pit Unit (631-16G) - March 1996

    Energy Technology Data Exchange (ETDEWEB)

    Palmer, E. [Westinghouse Savannah River Company, AIKEN, SC (United States)

    1996-03-01

    Gunsite 720 Rubble Pit Unit is located on the west side of SRS. In the early to mid 1980`s, while work was being performed in this area, nine empty, partially buried drums, labeled `du Pont Freon 11`, were found. As a result, Gunsite 720 became one of the original waste units specified in the SRS RCRA Facility Assessment (RFA). The drums were excavated on July 30, 1987 and placed on a pallet at the unit. Both the drums and pallet were removed and disposed of in October 1989. The area around the drums was screened during the excavation and the liquid (rainwater) that collected in the excavated drums was sampled prior to disposal. No evidence of hazardous materials was found. Based on the review of the analytical data and screening techniques used to evaluate all the chemicals of potential concern at Gunsite 720 Rubble Pit Unit, it is recommended that no further remedial action be performed at this unit.

  2. RCRA Facility Investigation/Remedial Investigation Report for Gunsite 720 Rubble Pit Unit (631-16G) - March 1996

    International Nuclear Information System (INIS)

    Palmer, E.

    1996-03-01

    Gunsite 720 Rubble Pit Unit is located on the west side of SRS. In the early to mid 1980's, while work was being performed in this area, nine empty, partially buried drums, labeled 'du Pont Freon 11', were found. As a result, Gunsite 720 became one of the original waste units specified in the SRS RCRA Facility Assessment (RFA). The drums were excavated on July 30, 1987 and placed on a pallet at the unit. Both the drums and pallet were removed and disposed of in October 1989. The area around the drums was screened during the excavation and the liquid (rainwater) that collected in the excavated drums was sampled prior to disposal. No evidence of hazardous materials was found. Based on the review of the analytical data and screening techniques used to evaluate all the chemicals of potential concern at Gunsite 720 Rubble Pit Unit, it is recommended that no further remedial action be performed at this unit

  3. Title 16 united states code §55 and its implications for management of concession facilities in Yosemite National Park

    Science.gov (United States)

    Lemons, John

    1987-08-01

    Yosemite National Park is one of the nation's most scenic and ecologically/geologically important parks. Unfortunately, the park is subject to extensive development of concession facilities and associated high levels of visitor use. Those concerned with preservation of the park's resources have attempted to limit the types and extent of such facilities to reduce adverse impacts. Strictly speaking, resolution of the preservation versus use controversy must be based on whether the National Park Service is adhering to its legislative mandate to regulate development and use in the parks. The common interpretation of legislative mandates for national parks, including Yosemite, is that they call for a difficult balancing between the conflicting goals of preservation and use. Accordingly, although concession developments cause significant impacts, they usually have been interpreted to be within the legal discretion allowed the secretary of the interior. However, the usual interpretations of the meanings of legislative mandates for Yosemite National Park have not considered Title 16 United States Code §55, which is a very restrictive statute limiting concession facilities. Many of the limitations imposed on concession facilities by the plain language of the statute have been exceeded. If it can be shown that 16 United States Code §55 is a valid statute, the policy implications for park management in Yosemite National Park would be considerable — namely, that significant reductions in concession facilities could be required. This article examines whether the statute can reasonably be thought to be valid and encourages others to conduct further examination of this question.

  4. HRP facility for fabrication of ITER vertical target divertor full scale plasma facing units

    International Nuclear Information System (INIS)

    Visca, Eliseo; Roccella, S.; Candura, D.; Palermo, M.; Rossi, P.; Pizzuto, A.; Sanguinetti, G.P.; Mancini, A.; Verdini, L.; Cacciotti, E.; Cerri, V.; Mugnaini, G.; Reale, A.; Giacomi, G.

    2015-01-01

    Highlights: • R&D activities for the manufacturing of ITER divertor high heat flux plasma-facing components (HHFC). • ENEA and Ansaldo have jointly manufactured several actively cooled monoblock mock-ups and prototypical components. • ENEA and ANSALDO NUCLEARE jointly participate to the European program for the qualification of the manufacturing technology for the ITER divertor IVT. • Successful manufacturing by HRP (Hot Radial Pressing) of first full-scale full-W armored IVT qualification prototype. - Abstract: ENEA and Ansaldo Nucleare S.p.A. (ANN) have being deeply involved in the European development activities for the manufacturing of the ITER Divertor Inner Vertical Target (IVT) plasma-facing components. During normal operation the heat flux deposited on the bottom segment of divertor is 5–10 MW/m 2 but the capability to remove up to 20 MW/m 2 during transient events of 10 s must also be demonstrated. In order to fulfill ITER requirements, ENEA has set up and widely tested a manufacturing process, named Hot Radial Pressing (HRP). The last challenge is now to fabricate full-scale prototypes of the IVT, aimed to be qualified for the next step, i.e. the series production. On the basis of the experience of manufacturing hundreds of small mock-ups, ENEA designed and installed a new suitable HRP facility. The objective of getting a final shaped plasma facing unit (PFU) that satisfies these requirements is an ambitious target because tolerances set by ITER/F4E are very tight. The setting-up of the equipment started with the fabrication of full scale and representative ‘dummies’ in which stainless steel instead of CFC or W was used for monoblocks. The results confirmed that dimensions were compliant with the required tolerances. The paper reports a brief description of the innovative HRP equipment and the dimensional check results after HRP of the first full-scale full-W PFU.

  5. HRP facility for fabrication of ITER vertical target divertor full scale plasma facing units

    Energy Technology Data Exchange (ETDEWEB)

    Visca, Eliseo, E-mail: eliseo.visca@enea.it [Unità Tecnica Fusione, ENEA C. R. Frascati, via E. Fermi 45, IT-00044 Frascati (Roma) (Italy); Roccella, S. [Unità Tecnica Fusione, ENEA C. R. Frascati, via E. Fermi 45, IT-00044 Frascati (Roma) (Italy); Candura, D.; Palermo, M. [Ansaldo Nucleare S.p.A., Corso Perrone 25, IT-16152 Genova (Italy); Rossi, P.; Pizzuto, A. [Unità Tecnica Fusione, ENEA C. R. Frascati, via E. Fermi 45, IT-00044 Frascati (Roma) (Italy); Sanguinetti, G.P. [Ansaldo Nucleare S.p.A., Corso Perrone 25, IT-16152 Genova (Italy); Mancini, A.; Verdini, L.; Cacciotti, E.; Cerri, V.; Mugnaini, G.; Reale, A.; Giacomi, G. [Unità Tecnica Fusione, ENEA C. R. Frascati, via E. Fermi 45, IT-00044 Frascati (Roma) (Italy)

    2015-10-15

    Highlights: • R&D activities for the manufacturing of ITER divertor high heat flux plasma-facing components (HHFC). • ENEA and Ansaldo have jointly manufactured several actively cooled monoblock mock-ups and prototypical components. • ENEA and ANSALDO NUCLEARE jointly participate to the European program for the qualification of the manufacturing technology for the ITER divertor IVT. • Successful manufacturing by HRP (Hot Radial Pressing) of first full-scale full-W armored IVT qualification prototype. - Abstract: ENEA and Ansaldo Nucleare S.p.A. (ANN) have being deeply involved in the European development activities for the manufacturing of the ITER Divertor Inner Vertical Target (IVT) plasma-facing components. During normal operation the heat flux deposited on the bottom segment of divertor is 5–10 MW/m{sup 2} but the capability to remove up to 20 MW/m{sup 2} during transient events of 10 s must also be demonstrated. In order to fulfill ITER requirements, ENEA has set up and widely tested a manufacturing process, named Hot Radial Pressing (HRP). The last challenge is now to fabricate full-scale prototypes of the IVT, aimed to be qualified for the next step, i.e. the series production. On the basis of the experience of manufacturing hundreds of small mock-ups, ENEA designed and installed a new suitable HRP facility. The objective of getting a final shaped plasma facing unit (PFU) that satisfies these requirements is an ambitious target because tolerances set by ITER/F4E are very tight. The setting-up of the equipment started with the fabrication of full scale and representative ‘dummies’ in which stainless steel instead of CFC or W was used for monoblocks. The results confirmed that dimensions were compliant with the required tolerances. The paper reports a brief description of the innovative HRP equipment and the dimensional check results after HRP of the first full-scale full-W PFU.

  6. Design and operational considerations of United States commercial nea-surface low-level radioactive waste disposal facilities

    International Nuclear Information System (INIS)

    Birk, Sandra M.

    1997-01-01

    Low-level radioactive waste disposal standards and techniques in the United States have evolved significantly since the early 1960's. Six commercial LLW disposal facilities(Barnwell, Richland, Ward Valley, Sierra Blanca, Wake County and Boyd County) operated and proposed between 1962 and 1997. This report summarizes each site's design and operational considerations for near-surface disposal of low-level radioactive waste. These new standards and mitigating efforts at closed facilities (Sheffield, Maxey Flats, Beatty and West Valley) have helped to ensure that the public has been safely protected from LLW. 15 refs

  7. Ischemic Stroke

    Science.gov (United States)

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

  8. Paediatric stroke

    African Journals Online (AJOL)

    2011-04-02

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

  9. BSL-3 laboratory practices in the United States: comparison of select agent and non-select agent facilities.

    Science.gov (United States)

    Richards, Stephanie L; Pompei, Victoria C; Anderson, Alice

    2014-01-01

    New construction of biosafety level 3 (BSL-3) laboratories in the United States has increased in the past decade to facilitate research on potential bioterrorism agents. The Centers for Disease Control and Prevention inspect BSL-3 facilities and review commissioning documentation, but no single agency has oversight over all BSL-3 facilities. This article explores the extent to which standard operating procedures in US BSL-3 facilities vary between laboratories with select agent or non-select agent status. Comparisons are made for the following variables: personnel training, decontamination, personal protective equipment (PPE), medical surveillance, security access, laboratory structure and maintenance, funding, and pest management. Facilities working with select agents had more complex training programs and decontamination procedures than non-select agent facilities. Personnel working in select agent laboratories were likely to use powered air purifying respirators, while non-select agent laboratories primarily used N95 respirators. More rigorous medical surveillance was carried out in select agent workers (although not required by the select agent program) and a higher level of restrictive access to laboratories was found. Most select agent and non-select agent laboratories reported adequate structural integrity in facilities; however, differences were observed in personnel perception of funding for repairs. Pest management was carried out by select agent personnel more frequently than non-select agent personnel. Our findings support the need to promote high quality biosafety training and standard operating procedures in both select agent and non-select agent laboratories to improve occupational health and safety.

  10. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

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

  11. What reductions in dependency costs result from treatment in an inpatient neurological rehabilitation unit for people with stroke?

    Science.gov (United States)

    O'Connor, Rory J; Beden, Rushdy; Pilling, Andrew; Chamberlain, M Anne

    2011-02-01

    This paper examines the reductions in care costs that result from inpatient multidisciplinary rehabilitation for younger people with acquired brain injury. Thirty-five consecutive patients admitted following a stroke over one year were recruited to this observational study. Physical ability, dependency and potential community care costs were measured on admission and discharge. Fifty-one community-dwelling patients were transferred to rehabilitation from acute medical wards in a large teaching hospital; 35 met the inclusion criteria. After a median of 59 days of rehabilitation, 29 patients were discharged home and six to nursing homes. Patients made highly significant gains in physical ability (median Barthel index 50 to 64; p rehabilitation costs was 21 weeks. Savings occurred in those with moderate and severe disability and they have the potential to continue to accrue for over 12 years. Similar results will probably be found for rehabilitation in other forms of acquired brain injury.

  12. Factors associated with bat mortality at wind energy facilities in the United States

    Science.gov (United States)

    Thompson, Maureen; Beston, Julie A.; Etterson, Matthew A.; Diffendorfer, James E.; Loss, Scott R.

    2017-01-01

    Hundreds of thousands of bats are killed annually by colliding with wind turbines in the U.S., yet little is known about factors causing variation in mortality across wind energy facilities. We conducted a quantitative synthesis of bat collision mortality with wind turbines by reviewing 218 North American studies representing 100 wind energy facilities. This data set, the largest compiled for bats to date, provides further evidence that collision mortality is greatest for migratory tree-roosting species (Hoary Bat [Lasiurus cinereus], Eastern Red Bat [Lasiurus borealis], Silver-haired Bat [Lasionycteris noctivagans]) and from July to October. Based on 40 U.S. studies meeting inclusion criteria and analyzed under a common statistical framework to account for methodological variation, we found support for an inverse relationship between bat mortality and percent grassland cover surrounding wind energy facilities. At a national scale, grassland cover may best reflect openness of the landscape, a factor generally associated with reduced activity and abundance of tree-roosting species that may also reduce turbine collisions. Further representative sampling of wind energy facilities is required to validate this pattern. Ecologically informed placement of wind energy facilities involves multiple considerations, including not only factors associated with bat mortality, but also factors associated with bird collision mortality, indirect habitat-related impacts to all species, and overall ecosystem impacts.

  13. Regulation of chemical safety at fuel cycle facilities by the United States Nuclear Regulatory Commission

    International Nuclear Information System (INIS)

    Ramsey, Kevin M.

    2013-01-01

    When the U.S. Nuclear Regulatory Commission (NRC) was established in 1975, its regulations were based on radiation dose limits. Chemical hazards rarely influenced NRC regulations. After the Three Mile Island reactor accident in 1979, the NRC staff was directed to address emergency planning at non-reactor facilities. Several fuel cycle facilities were ordered to submit emergency plans consistent with reactor emergency plans because no other guidance was available. NRC published a notice that it was writing regulations to codify the requirements in the Orders and upgrade the emergency plans to address all hazards, including chemical hazards. The legal authority of NRC to regulate chemical safety was questioned. In 1986, an overfilled uranium hexafluoride cylinder ruptured and killed a worker. The NRC staff was directed to address emergency planning for hazardous chemicals in its regulations. The final rule included a requirement for fuel cycle facilities to certify compliance with legislation requiring local authorities to establish emergency plans for hazardous chemicals. As with emergency planning, NRC's authority to regulate chemical safety during routine operations was limited. NRC established memoranda of understanding (MOUs) with other regulatory agencies to encourage exchange of information between the agencies regarding occupational hazards. In 2000, NRC published new, performance-based, regulations for fuel cycle facilities. The new regulations required an integrated safety analysis (ISA) which used quantitative standards to assess chemical exposures. Some unique chemical exposure cases were addressed while implementing the new regulations. In addition, some gaps remain in the regulation of hazardous chemicals at fuel cycle facilities. The status of ongoing efforts to improve regulation of chemical safety at fuel cycle facilities is discussed. (authors)

  14. Simulation based assembly and alignment process ability analysis for line replaceable units of the high power solid state laser facility

    International Nuclear Information System (INIS)

    Wang, Junfeng; Lu, Cong; Li, Shiqi

    2016-01-01

    Highlights: • Discrete event simulation is applied to analyze the assembly and alignment process ability of LRUs in SG-III facility. • The overall assembly and alignment process of LRUs with specific characteristics is described. • An extended-directed graph is proposed to express the assembly and alignment process of LRUs. • Different scenarios have been simulated to evaluate assembling process ability of LRUs and decision making is supported to ensure the construction millstone. - Abstract: Line replaceable units (LRUs) are important components of the very large high power solid state laser facilities. The assembly and alignment process ability of LRUs will impact the construction milestone of facilities. This paper describes the use of discrete event simulation method for assembly and alignment process analysis of LRUs in such facilities. The overall assembly and alignment process for LRUs is presented based on the layout of the optics assembly laboratory and the process characteristics are analyzed. An extended-directed graph is proposed to express the assembly and alignment process of LRUs. Taking the LRUs of disk amplifier system in Shen Guang-III (SG-III) facility as the example, some process simulation models are built based on the Quest simulation platform. The constraints, such as duration, equipment, technician and part supply, are considered in the simulation models. Different simulation scenarios have been carried out to evaluate the assembling process ability of LRUs. The simulation method can provide a valuable decision making and process optimization tool for the optics assembly laboratory layout and the process working out of such facilities.

  15. Simulation based assembly and alignment process ability analysis for line replaceable units of the high power solid state laser facility

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Junfeng; Lu, Cong; Li, Shiqi, E-mail: sqli@hust.edu.cn

    2016-11-15

    Highlights: • Discrete event simulation is applied to analyze the assembly and alignment process ability of LRUs in SG-III facility. • The overall assembly and alignment process of LRUs with specific characteristics is described. • An extended-directed graph is proposed to express the assembly and alignment process of LRUs. • Different scenarios have been simulated to evaluate assembling process ability of LRUs and decision making is supported to ensure the construction millstone. - Abstract: Line replaceable units (LRUs) are important components of the very large high power solid state laser facilities. The assembly and alignment process ability of LRUs will impact the construction milestone of facilities. This paper describes the use of discrete event simulation method for assembly and alignment process analysis of LRUs in such facilities. The overall assembly and alignment process for LRUs is presented based on the layout of the optics assembly laboratory and the process characteristics are analyzed. An extended-directed graph is proposed to express the assembly and alignment process of LRUs. Taking the LRUs of disk amplifier system in Shen Guang-III (SG-III) facility as the example, some process simulation models are built based on the Quest simulation platform. The constraints, such as duration, equipment, technician and part supply, are considered in the simulation models. Different simulation scenarios have been carried out to evaluate the assembling process ability of LRUs. The simulation method can provide a valuable decision making and process optimization tool for the optics assembly laboratory layout and the process working out of such facilities.

  16. Standards and general criteria for the planning and certification of need of megavoltage radiation oncology units in health care facilities

    International Nuclear Information System (INIS)

    1977-01-01

    Minimum standards and guidelines to be applied by State agencies and New Jersey health systems agencies in the examination of certificate-of-need applications and in the development of planning activities for radiation oncology units in health care facilities are presented. Radiation oncology is a medical discipline devoted to education and research in the use of ionizing radiation for the treatment of neoplastic disease. The proper application of radiation can be directed at either curative or palliative intent. It is an important and effective technique for the management of cancer. Radiotherapy equipment in clinical use is divided into four main categories: superficial, orthovoltage, megavoltage, and treatment planning facilities. Particular attention is given to megavoltage equipment which emits or generates rays over 1,000 kilovolts. These high energy rays effect better penetration of human tissue and are skin-sparing in nature, thus allowing for better tumor-to- skin dose ratios. The regionalization of megavoltage therapy services is discussed. Data on hospital megavoltage facilities in New Jersey for 1974, 1975, and 1976 are provided. The standards and guidelines pertain to utilization, personnel, and general criteria. A form for use by megavoltage radiation therapy units is appended

  17. Central and Eastern United States (CEUS) Seismic Source Characterization (SSC) for Nuclear Facilities Project

    Energy Technology Data Exchange (ETDEWEB)

    Kevin J. Coppersmith; Lawrence A. Salomone; Chris W. Fuller; Laura L. Glaser; Kathryn L. Hanson; Ross D. Hartleb; William R. Lettis; Scott C. Lindvall; Stephen M. McDuffie; Robin K. McGuire; Gerry L. Stirewalt; Gabriel R. Toro; Robert R. Youngs; David L. Slayter; Serkan B. Bozkurt; Randolph J. Cumbest; Valentina Montaldo Falero; Roseanne C. Perman' Allison M. Shumway; Frank H. Syms; Martitia (Tish) P. Tuttle

    2012-01-31

    This report describes a new seismic source characterization (SSC) model for the Central and Eastern United States (CEUS). It will replace the Seismic Hazard Methodology for the Central and Eastern United States, EPRI Report NP-4726 (July 1986) and the Seismic Hazard Characterization of 69 Nuclear Plant Sites East of the Rocky Mountains, Lawrence Livermore National Laboratory Model, (Bernreuter et al., 1989). The objective of the CEUS SSC Project is to develop a new seismic source model for the CEUS using a Senior Seismic Hazard Analysis Committee (SSHAC) Level 3 assessment process. The goal of the SSHAC process is to represent the center, body, and range of technically defensible interpretations of the available data, models, and methods. Input to a probabilistic seismic hazard analysis (PSHA) consists of both seismic source characterization and ground motion characterization. These two components are used to calculate probabilistic hazard results (or seismic hazard curves) at a particular site. This report provides a new seismic source model. Results and Findings The product of this report is a regional CEUS SSC model. This model includes consideration of an updated database, full assessment and incorporation of uncertainties, and the range of diverse technical interpretations from the larger technical community. The SSC model will be widely applicable to the entire CEUS, so this project uses a ground motion model that includes generic variations to allow for a range of representative site conditions (deep soil, shallow soil, hard rock). Hazard and sensitivity calculations were conducted at seven test sites representative of different CEUS hazard environments. Challenges and Objectives The regional CEUS SSC model will be of value to readers who are involved in PSHA work, and who wish to use an updated SSC model. This model is based on a comprehensive and traceable process, in accordance with SSHAC guidelines in NUREG/CR-6372, Recommendations for Probabilistic

  18. Central and Eastern United States (CEUS) Seismic Source Characterization (SSC) for Nuclear Facilities

    International Nuclear Information System (INIS)

    Coppersmith, Kevin J.; Salomone, Lawrence A.; Fuller, Chris W.; Glaser, Laura L.; Hanson, Kathryn L.; Hartleb, Ross D.; Lettis, William R.; Lindvall, Scott C.; McDuffie, Stephen M.; McGuire, Robin K.; Stirewalt, Gerry L.; Toro, Gabriel R.; Youngs, Robert R.; Slayter, David L.; Bozkurt, Serkan B.; Cumbest, Randolph J.; Falero, Valentina Montaldo; Perman, Roseanne C.; Shumway, Allison M.; Syms, Frank H.; Tuttle, Martitia P.

    2012-01-01

    This report describes a new seismic source characterization (SSC) model for the Central and Eastern United States (CEUS). It will replace the Seismic Hazard Methodology for the Central and Eastern United States, EPRI Report NP-4726 (July 1986) and the Seismic Hazard Characterization of 69 Nuclear Plant Sites East of the Rocky Mountains, Lawrence Livermore National Laboratory Model, (Bernreuter et al., 1989). The objective of the CEUS SSC Project is to develop a new seismic source model for the CEUS using a Senior Seismic Hazard Analysis Committee (SSHAC) Level 3 assessment process. The goal of the SSHAC process is to represent the center, body, and range of technically defensible interpretations of the available data, models, and methods. Input to a probabilistic seismic hazard analysis (PSHA) consists of both seismic source characterization and ground motion characterization. These two components are used to calculate probabilistic hazard results (or seismic hazard curves) at a particular site. This report provides a new seismic source model. Results and Findings The product of this report is a regional CEUS SSC model. This model includes consideration of an updated database, full assessment and incorporation of uncertainties, and the range of diverse technical interpretations from the larger technical community. The SSC model will be widely applicable to the entire CEUS, so this project uses a ground motion model that includes generic variations to allow for a range of representative site conditions (deep soil, shallow soil, hard rock). Hazard and sensitivity calculations were conducted at seven test sites representative of different CEUS hazard environments. Challenges and Objectives The regional CEUS SSC model will be of value to readers who are involved in PSHA work, and who wish to use an updated SSC model. This model is based on a comprehensive and traceable process, in accordance with SSHAC guidelines in NUREG/CR-6372, Recommendations for Probabilistic

  19. Closure Report for Corrective Action Unit 116: Area 25 Test Cell C Facility, Nevada National Security Site, Nevada

    Energy Technology Data Exchange (ETDEWEB)

    NSTec Environmental Restoration

    2011-09-29

    This Closure Report (CR) presents information supporting closure of Corrective Action Unit (CAU) 116, Area 25 Test Cell C Facility. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; the U.S. Department of Energy (DOE), Environmental Management; the U.S. Department of Defense; and DOE, Legacy Management (FFACO, 1996 [as amended March 2010]). CAU 116 consists of the following two Corrective Action Sites (CASs), located in Area 25 of the Nevada National Security Site: (1) CAS 25-23-20, Nuclear Furnace Piping and (2) CAS 25-41-05, Test Cell C Facility. CAS 25-41-05 consisted of Building 3210 and the attached concrete shield wall. CAS 25-23-20 consisted of the nuclear furnace piping and tanks. Closure activities began in January 2007 and were completed in August 2011. Activities were conducted according to Revision 1 of the Streamlined Approach for Environmental Restoration Plan for CAU 116 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSA/NSO], 2008). This CR provides documentation supporting the completed corrective actions and provides data confirming that closure objectives for CAU 116 were met. Site characterization data and process knowledge indicated that surface areas were radiologically contaminated above release limits and that regulated and/or hazardous wastes were present in the facility.

  20. Factors associated with bat mortality at wind energy facilities in the United States

    Science.gov (United States)

    Hundreds of thousands of bats are killed annually by colliding with wind turbines in the U.S., yet little is known about factors causing variation in mortality across wind energy facilities. We conducted a quantitative synthesis of bat collision mortality with wind turbines by re...

  1. Community Extreme Tonnage User Service (CETUS): A 5000 Ton Open Research Facility in the United States

    Science.gov (United States)

    Danielson, L. R.; Righter, K.; Vander Kaaden, K. E.; Rowland, R. L., II; Draper, D. S.; McCubbin, F. M.

    2017-12-01

    Large sample volume 5000 ton multi-anvil presses have contributed to the exploration of deep Earth and planetary interiors, synthesis of ultra-hard and other novel materials, and serve as a sample complement to pressure and temperature regimes already attainable by diamond anvil cell experiments. However, no such facility exists in the Western Hemisphere. We are establishing an open user facility for the entire research community, with the unique capability of a 5000 ton multi-anvil and deformation press, HERA (High pressure Experimental Research Apparatus), supported by a host of extant co-located experimental and analytical laboratories and research staff. We offer wide range of complementary and/or preparatory experimental options. Any required synthesis of materials or follow up experiments can be carried out controlled atmosphere furnaces, piston cylinders, multi-anvil, or experimental impact apparatus. Additionally, our division houses two machine shops that would facilitate any modification or custom work necessary for development of CETUS, one for general fabrication and one located specifically within our experimental facilities. We also have a general sample preparation laboratory, specifically for experimental samples, that allows users to quickly and easily prepare samples for ebeam analyses and more. Our focus as contract staff is on serving the scientific needs of our users and collaborators. We are seeking community expert input on multiple aspects of this facility, such as experimental assembly design, module modifications, immediate projects, and future innovation initiatives. We've built a cooperative network of 12 (and growing) collaborating institutions, including COMPRES. CETUS is a coordinated effort leveraging HERA with our extant experimental, analytical, and planetary process modelling instrumentation and expertise in order to create a comprehensive model of the origin and evolution of our solar system and beyond. We are looking to engage

  2. Stroke Rehabilitation.

    Science.gov (United States)

    Belagaje, Samir R

    2017-02-01

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

  3. Institutional aspects of siting nuclear waste disposal facilities in the United States

    International Nuclear Information System (INIS)

    Stewart, J.C.; Prichard, W.C.

    1987-01-01

    This paper has dealt with the institutional issues associated with disposal of nuclear waste in the US. The authors believe that these institutional problems must be resolved, no matter how technologically well suited a site may be for disposal, before site selection may take place. The authors have also pointed out that the geography of the US, with its large arid regions of very low population density, contributes to the institutional acceptability of nuclear waste disposal. Economic factors, especially in sparsely populated areas where the uranium mining and milling industry has caused operation, also weigh on the acceptability of nuclear waste to local communities. This acceptability will be highest where there are existing nuclear facilities and/or facilities which are closed - thus creating unemployment especially where alternative economic opportunities are few

  4. Final Status Survey Report for Corrective Action Unit 117 - Pluto Disassembly Facility, Building 2201, Nevada National Security Site, Nevada

    International Nuclear Information System (INIS)

    Gwin, Jeremy; Frenette, Douglas

    2010-01-01

    This document contains the process knowledge, radiological data and subsequent statistical methodology and analysis to support approval for the radiological release of Corrective Action Unit (CAU) 117 - Pluto Disassembly Facility, Building 2201 located in Area 26 of the Nevada National Security Site (NNSS). Preparations for release of the building began in 2009 and followed the methodology described in the Multi-Agency Radiation Survey and Site Investigation Manual (MARSSIM). MARSSIM is the DOE approved process for release of Real Property (buildings and landmasses) to a set of established criteria or authorized limits. The pre-approved authorized limits for surface contamination values and corresponding assumptions were established by DOE O 5400.5. The release criteria coincide with the acceptance criteria of the U10C landfill permit. The U10C landfill is the proposed location to dispose of the radiologically non-impacted, or ''clean,'' building rubble following demolition. However, other disposition options that include the building and/or waste remaining at the NNSS may be considered providing that the same release limits apply. The Final Status Survey was designed following MARSSIM guidance by reviewing historical documentation and radiological survey data. Following this review a formal radiological characterization survey was performed in two phases. The characterization revealed multiple areas of residual radioactivity above the release criteria. These locations were remediated (decontaminated) and then the surface activity was verified to be less than the release criteria. Once remediation efforts had been successfully completed, a Final Status Survey Plan (10-015, ''Final Status Survey Plan for Corrective Action Unit 117 - Pluto Disassembly Facility, Building 2201'') was developed and implemented to complete the final step in the MARSSIM process, the Final Status Survey. The Final Status Survey Plan consisted of categorizing each individual room into one

  5. Environmental Monitoring Report - United States Department of Energy, Oak Ridge Facilities, Calendar Year 1984

    Energy Technology Data Exchange (ETDEWEB)

    Jordan, R.G.

    1999-01-01

    Each year since 1972, a report has been prepared on the environmental monitoring activities for the DOE facilities in oak Ridge, Tennessee, for the previous calendar year. previously, the individual facilities published quarterly and annual progress reports that contained some environmental monitoring data. The environmental monitoring program for 1984 includes sampling and analysis of air, water from surface streams, groundwater, creek sediment, biota, and soil for both radioactive and nonradioactive (including hazardous) materials. Special environmental studies that have been conducted in the Oak Ridge area are included in this report, primarily as abstracts or brief summaries. The annual report for 1984 on environmental monitoring and surveillance of the Oak Ridge community by Oak Ridge Associated Universities (ORAU) is included as an appendix. A brief description of the topography and climate of the Oak Ridge area and a short description of the three DOE facilities are provided below to enhance the reader's understanding of the direction and contents of the environmental monitoring program for Oak Ridge.

  6. STREAMLINED APPROACH FOR ENVIRONMENTAL RESTORATION PLAN FOR CORRECTIVE ACTION UNIT 116: AREA 25 TEST CELL C FACILITY NEVADA TEST SITE, NEVADA

    International Nuclear Information System (INIS)

    2006-01-01

    This Streamlined Approach for Environmental Restoration Plan identifies the activities required for the closure of Corrective Action Unit 116, Area 25 Test Cell C Facility. The Test Cell C Facility is located in Area 25 of the Nevada Test Site approximately 25 miles northwest of Mercury, Nevada

  7. Relationship between the Quality of Educational Facilities, School Climate, and School Safety of High School Tenth Graders in the United States

    Science.gov (United States)

    Bell, Darnell Brushawn

    2011-01-01

    The purpose of the study was to understand the relationships among facility conditions, school climate, and school safety of high school tenth graders in the United States. Previous research on the quality of educational facilities influence on student achievement has varied. Recent research has suggested that the quality of educational facilities…

  8. Burden of stroke in Cambodia.

    Science.gov (United States)

    Loo, Keat Wei; Gan, Siew Hua

    2013-08-01

    In Cambodia, stroke is not ranked among the top 10 leading causes of death, but infectious disease are among the top three leading causes of death. This finding could be attributed to a lack of awareness among Cambodians of the signs and symptoms of stroke or to poor reporting, incomplete data, lack of neurologists and neurosurgeons, or low accessibility to the hospitals. The only study of stroke in Cambodia is the Prevalence of Non-Communicable Disease Risk Factors in Cambodia survey, which identified several stroke-related risk factors in the population. Tobacco chewing or smoking is the main risk factor for stroke in Cambodia. Traditional therapies, such as oyt pleung (moxibustion) and jup (cupping), are widely practiced for stroke rehabilitation. In Cambodia, there are few neurologists and few important equipment, such as magnetic resonance imaging machines and computed tomography scanners. The Cambodian government should cooperate with the World Health Organization and the United Nations Children's Fund to attract foreign expertise and technologies to treat stroke patients. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  9. An Applied Study on the Decontamination and Decommissioning of Hot Cell Facilities in the United States and Comparison with the Studsvik Facility for Solid and Liquid Waste

    International Nuclear Information System (INIS)

    Varley, Geoff; Rusch, Chris

    2006-07-01

    occurred during Phase II. The activities included: a. Dismantlement of the building structure surrounding the hot cells and then finally dismantlement of the hot cell block b. Soil remediation c. Handling and disposal of decommissioning wastes d. Confirmatory surveys 3. Final site release occurred during Phase III. 4. The final activity which occurred substantially after Phases II and III were complete was the shipment of the IFM to a DOE facility. The HCF and HM structures are approximately the same size on a volumetric basis. The volume of the HM hot cells is about 12 percent greater than at HCF but the HCF had 27 percent more surface area due to the existence of three separate cells. Of potential importance is that the contamination levels on the hot cell surfaces were not equal. The HCF facility was highly contaminated from such activities as band-sawing irradiated high temperature gas cooled reactor fuel. On these grounds it might be expected that the HCF actual costs would be higher than HM estimates. However, a factor of almost nine times higher seems to be exceptional. The very large difference in fact stems from a number of special circumstances at HCF that need to be backed-out of a cost comparison in order to make it meaningful. One special requirement was the removal and safe management of irradiated fuel material, including high enriched uranium. Another cost related to maintenance of the building before decommissioning could commence. The costs of waste disposal also vary substantially, in terms of unit costs and the proportion of dismantling waste that needs to be sentenced to a radioactive waste repository. The available information for HM has been evaluated and compared, to the extent possible, with the HCF decommissioning costs and other selected NAC derived decommissioning cost benchmarks. In summary the main conclusions for the HM decommissioning cost estimate are as follows: Theoretical estimates of planning and other support activities can have a

  10. An Applied Study on the Decontamination and Decommissioning of Hot Cell Facilities in the United States and Comparison with the Studsvik Facility for Solid and Liquid Waste

    Energy Technology Data Exchange (ETDEWEB)

    Varley, Geoff; Rusch, Chris [NAC International, Atlanta, GA (United States)

    2006-07-15

    Dismantlement occurred during Phase II. The activities included: a. Dismantlement of the building structure surrounding the hot cells and then finally dismantlement of the hot cell block b. Soil remediation c. Handling and disposal of decommissioning wastes d. Confirmatory surveys 3. Final site release occurred during Phase III. 4. The final activity which occurred substantially after Phases II and III were complete was the shipment of the IFM to a DOE facility. The HCF and HM structures are approximately the same size on a volumetric basis. The volume of the HM hot cells is about 12 percent greater than at HCF but the HCF had 27 percent more surface area due to the existence of three separate cells. Of potential importance is that the contamination levels on the hot cell surfaces were not equal. The HCF facility was highly contaminated from such activities as band-sawing irradiated high temperature gas cooled reactor fuel. On these grounds it might be expected that the HCF actual costs would be higher than HM estimates. However, a factor of almost nine times higher seems to be exceptional. The very large difference in fact stems from a number of special circumstances at HCF that need to be backed-out of a cost comparison in order to make it meaningful. One special requirement was the removal and safe management of irradiated fuel material, including high enriched uranium. Another cost related to maintenance of the building before decommissioning could commence. The costs of waste disposal also vary substantially, in terms of unit costs and the proportion of dismantling waste that needs to be sentenced to a radioactive waste repository. The available information for HM has been evaluated and compared, to the extent possible, with the HCF decommissioning costs and other selected NAC derived decommissioning cost benchmarks. In summary the main conclusions for the HM decommissioning cost estimate are as follows: Theoretical estimates of planning and other support activities can

  11. United States Advanced Ultra-Supercritical Component Test Facility for 760°C Steam Power Plants ComTest Project

    Energy Technology Data Exchange (ETDEWEB)

    Hack, Horst [Electric Power Research Institute (EPRI); Purgert, Robert Michael [Energy Industries of Ohio

    2017-12-13

    Following the successful completion of a 15-year effort to develop and test materials that would allow coal-fired power plants to be operated at advanced ultra-supercritical (A-USC) steam conditions, a United States-based consortium is presently engaged in a project to build an A-USC component test facility (ComTest). A-USC steam cycles have the potential to improve cycle efficiency, reduce fuel costs, and reduce greenhouse gas emissions. Current development and demonstration efforts are focused on enabling the construction of A-USC plants, operating with steam temperatures as high as 1400°F (760°C) and steam pressures up to 5000 psi (35 MPa), which can potentially increase cycle efficiencies to 47% HHV (higher heating value), or approximately 50% LHV (lower heating value), and reduce CO2 emissions by roughly 25%, compared to today’s U.S. fleet. A-USC technology provides a lower-cost method to reduce CO2 emissions, compared to CO2 capture technologies, while retaining a viable coal option for owners of coal generation assets. Among the goals of the ComTest facility are to validate that components made from advanced nickel-based alloys can operate and perform under A-USC conditions, to accelerate the development of a U.S.-based supply chain for the full complement of A-USC components, and to decrease the uncertainty of cost estimates for future A-USC power plants. The configuration of the ComTest facility would include the key A-USC technology components that were identified for expanded operational testing, including a gas-fired superheater, high-temperature steam piping, steam turbine valve, and cycling header component. Membrane walls in the superheater have been designed to operate at the full temperatures expected in a commercial A-USC boiler, but at a lower (intermediate) operating pressure. This superheater has been designed to increase the temperature of the steam supplied by the host utility boiler up to 1400°F (760

  12. Development of field simulator to test and qualify the gyrotron local control unit for ITER-India Gyrotron Test Facility

    International Nuclear Information System (INIS)

    Shah, Ronak; Mandge, Deepak; Rathod, Vipal; Parmar, Rajvi; Dilip, E. Sharan; Yadav, Amit; Sharma, Anjali; Rao, S.L.

    2017-01-01

    High power RF sources such as a Gyrotron system are operated at required output parameter by using various auxiliary power supplies, High voltage power supplies, auxiliary services and a dedicated Local Control Unit (LCU). These sub-systems must be operated in synchronous and safe way to control the gyrotron output parameters. The LCU performs remote, synchronous and safe operation of the all the gyrotron sub-systems. Broadly the LCU functions are operational control, data acquisition, protection and safety of the gyrotron system. At ITER-India gyrotron Test Facility (IIGTF) a local control unit (LCU) is being developed to operate the complete gyrotron system. This paper presents the design, development and various features of the field simulator. It also discuss LCU functionality test cases and results obtained using field simulator

  13. Positioning and early mobilisation in stroke.

    Science.gov (United States)

    Keating, Moira; Penney, Maree; Russell, Petra; Bailey, Emma

    Stroke unit care, providing early rehabilitation, improves long-term outcomes for patients following a stroke. Early mobilisation and good positioning are recognised as key aspects of care in stroke units. Nurses working on stroke units have an important role because they are able to implement positioning and early mobilisation strategies 24 hours a day, reducing the risk of complications and improving functional recovery. Patients benefit if nurses work effectively with the therapy team in positioning and early mobilisation. Nurses also need appropriate training and expertise to make best use of specialist equipment.

  14. Recovery of Dysphagia in Lateral Medullary Stroke

    Directory of Open Access Journals (Sweden)

    Hitesh Gupta

    2014-01-01

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

  15. Recovery of Dysphagia in lateral medullary stroke.

    Science.gov (United States)

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

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

  16. Recovery of Dysphagia in Lateral Medullary Stroke

    Science.gov (United States)

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

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

  17. Onsite and Electric Backup Capabilities at Critical Infrastructure Facilities in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Phillips, Julia A. [Argonne National Lab. (ANL), Argonne, IL (United States); Wallace, Kelly E. [Argonne National Lab. (ANL), Argonne, IL (United States); Kudo, Terence Y. [Argonne National Lab. (ANL), Argonne, IL (United States); Eto, Joseph H. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2016-04-01

    The following analysis, conducted by Argonne National Laboratory’s (Argonne’s) Risk and Infrastructure Science Center (RISC), details an analysis of electric power backup of national critical infrastructure as captured through the Department of Homeland Security’s (DHS’s) Enhanced Critical Infrastructure Program (ECIP) Initiative. Between January 1, 2011, and September 2014, 3,174 ECIP facility surveys have been conducted. This study focused first on backup capabilities by infrastructure type and then expanded to infrastructure type by census region.

  18. Dissolution off-gases at the marcoule pilot facility: Iodine trapping and off-gas characterization unit

    International Nuclear Information System (INIS)

    Pouyat, D.; Vignau, B.; Roux, J.P.

    1993-01-01

    The Marcoule Pilot Reprocessing Facility (APM) reprocesses spent fuel from light water reactors and fast breeder reactors. A batch dissolution process is used with an annual throughput capacity of 5 metric tons. The off-gas treatment unit is described together with its characterization laboratory in order to highlight the functions and potential of the facilities. The objectives are consistent with the Marcoule site policy regarding diminished iodine release and investigation of the off-gas treatment process. The equipment used to meet these objectives is described from a functional standpoint. The facility implements measurement techniques to allow continuous quantitative measurements of nitrogen oxides, oxygen, iodine and krypton, as well as continuous monitoring of the demister inlet flow by γ spectrometry. Sorbents used for iodine trapping may be tested over a wide range of operating conditions (temperature, flow rate, iodine concentration) with representative dissolution off-gases. An X-ray and γ counting system is used to assess the activity of the adsorbed radionuclides, notably 129 I

  19. Analysis of Unit Process Cost for an Engineering-Scale Pyroprocess Facility Using a Process Costing Method in Korea

    Directory of Open Access Journals (Sweden)

    Sungki Kim

    2015-08-01

    Full Text Available Pyroprocessing, which is a dry recycling method, converts spent nuclear fuel into U (Uranium/TRU (TRansUranium metal ingots in a high-temperature molten salt phase. This paper provides the unit process cost of a pyroprocess facility that can process up to 10 tons of pyroprocessing product per year by utilizing the process costing method. Toward this end, the pyroprocess was classified into four kinds of unit processes: pretreatment, electrochemical reduction, electrorefining and electrowinning. The unit process cost was calculated by classifying the cost consumed at each process into raw material and conversion costs. The unit process costs of the pretreatment, electrochemical reduction, electrorefining and electrowinning were calculated as 195 US$/kgU-TRU, 310 US$/kgU-TRU, 215 US$/kgU-TRU and 231 US$/kgU-TRU, respectively. Finally the total pyroprocess cost was calculated as 951 US$/kgU-TRU. In addition, the cost driver for the raw material cost was identified as the cost for Li3PO4, needed for the LiCl-KCl purification process, and platinum as an anode electrode in the electrochemical reduction process.

  20. Accelerated Clean-up of the United States Department of Energy, Mound Nuclear Weapons Facility in Miamisburg, Ohio

    International Nuclear Information System (INIS)

    Lehew, J.G.; Bradford, J.D.; Cabbil, C.C.

    2006-01-01

    CH2M HILL is executing a performance-based contract with the United States Department of Energy to accelerate the safe closure of the nuclear facilities at the former Mound plant in Miamisburg, Ohio. The contract started in January 2003 with a target completion date of March 31, 2006. Our accelerated baseline targets completion of the project 2 years ahead of the previous baseline schedule, by spring 2006, and for $200 million less than previous estimates. This unique decommissioning and remediation project is located within the City of Miamisburg proper and is designed for transfer of the property to the Miamisburg Mound Community Improvement Corporation for industrial reuse. The project is being performed with the Miamisburg Mound Community Improvement Corporation and their tenants co-located on the site creating significant logistical, safety and stakeholder challenges. The project is also being performed in conjunction with the United States Department of Energy, United States Environmental Protection Agency, and the Ohio Environmental Protection Agency under the Mound 2000 regulatory cleanup process. The project is currently over 95% complete. To achieve cleanup and closure of the Mound site, CH2M HILL's scope includes: - Demolition of 64 nuclear, radiological and commercial facilities - Preparation for Transfer of 9 facilities (including a Category 2 nuclear facility) to the Miamisburg Mound Community Improvement Corporation for industrial reuse - Removal of all above ground utility structures and components, and preparation for transfer of 9 utility systems to Miamisburg Mound Community Improvement Corporation - Investigation, remediation, closure, and documentation of all known Potential Release Sites contaminated with radiological and chemical contamination (73 identified in original contract) - Storage, characterization, processing, packaging and shipment of all waste and excess nuclear materials - Preparation for Transfer of the 306 acre site to the

  1. Communication between United States-Based Firms and Mexican Production Facilities.

    Science.gov (United States)

    Waldman, Lila

    A study examined the types of communication technologies being used by United States-based corporations with operations in Mexico to determine the challenges these companies face when communicating across the border. A total of 703 U.S. corporations doing business with Mexico (culled from lists in two professional directories) were chosen for the…

  2. 77 FR 58470 - Irradiation Treatment; Location of Facilities in the Southern United States; Technical Amendment

    Science.gov (United States)

    2012-09-21

    ... jointly by APHIS and the national plant protection organization (NPPO) of India as part of the required... standard \\2\\ of the International Plant Protection Convention, of which the United States is a contracting... DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service 7 CFR Part 319 [Docket No...

  3. Rehabilitation after stroke.

    Science.gov (United States)

    Knecht, Stefan; Hesse, Stefan; Oster, Peter

    2011-09-01

    Stroke is becoming more common in Germany as the population ages. Its long-term sequelae can be alleviated by early reperfusion in stroke units and by complication management and functional restoration in early-rehabilitation and rehabilitation centers. Selective review of the literature. Successful rehabilitation depends on systematic treatment by an interdisciplinary team of experienced specialists. In the area of functional restoration, there has been major progress in our understanding of the physiology of learning, relearning, training, and neuroenhancement. There have also been advances in supportive pharmacotherapy and robot technology. Well-organized acute and intermediate rehabilitation after stroke can provide patients with the best functional results attainable on the basis of our current scientific understanding. Further experimental and clinical studies will be needed to expand our knowledge and improve the efficacy of rehabilitation.

  4. Code stroke in Asturias.

    Science.gov (United States)

    Benavente, L; Villanueva, M J; Vega, P; Casado, I; Vidal, J A; Castaño, B; Amorín, M; de la Vega, V; Santos, H; Trigo, A; Gómez, M B; Larrosa, D; Temprano, T; González, M; Murias, E; Calleja, S

    2016-04-01

    Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available. We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient. We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score. Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  5. FACILITIES PLANNING WORKSHOP FOR BLASTING SUPPORT THE ACTIVITY OF DEVELOPMENT AND REPAIR SHIP IN PT. JASA MARINA INDAH UNIT II

    Directory of Open Access Journals (Sweden)

    Samuel Samuel

    2012-07-01

    Full Text Available Blasting in the process of planning the workshop production of new building and ship repair to play a role in providing blasting and paint on the block that will be of erection. As a result of blasting workshop facilities that do not have resulted in low production capacity that can be achieved by this workshop, namely three block ships per month. Capacity blasting and paint shop in this low resulted in low productivity process stage (stage the previous workshops which of course result in a decrease in vessel productivity in general.                 In penelitiaan aims to plan for blasting and paint shop facility which has been adjusted to the planned production capacity of PT. JASA MARINA INDAH II units.                 In this study it - thing to note is to understand the data - the data field for research conducted in terms of both technical and economic terms, with the blasting and paint shop facilities on the construction or repair of ships that have been planned, then the effectiveness of the work and production flow at. Jasa Marina Indah II units can be known.                 Based on the analysis and calculation of both technical and economical it can be identified by the workshop on the process of blasting Blasting efficiency is obtained for 2.55 hours, at 10.16 hours during the painting process, while economical in terms of labor costs can be reduced blasting cost is Rp.930000    for          paint       and         Rp.1.23million

  6. Hospital-acquired symptomatic urinary tract infection in patients admitted to an academic stroke center affects discharge disposition.

    Science.gov (United States)

    Ifejika-Jones, Nneka L; Peng, Hui; Noser, Elizabeth A; Francisco, Gerard E; Grotta, James C

    2013-01-01

    To test the role of hospital-acquired symptomatic urinary tract infection (SUTI) as an independent predictor of discharge disposition in the acute stroke patient. A retrospective study of data collected from a stroke registry service. The registry is maintained by the Specialized Programs of Translational Research in Acute Stroke Data Core. The Specialized Programs of Translational Research in Acute Stroke is a national network of 8 centers that perform early phase clinical projects, share data, and promote new approaches to therapy for acute stroke. A single university-based hospital. We performed a data query of the fields of interest from our university-based stroke registry, a collection of 200 variables collected prospectively for each patient admitted to the stroke service between July 2004 and October 2009, with discharge disposition of home, inpatient rehabilitation, skilled nursing facility, or long-term acute care. Baseline demographics, including age, gender, ethnicity, and National Institutes of Health Stroke Scale (NIHSS) score, were collected. Cerebrovascular disease risk factors were used for independent risk assessment. Interaction terms were created between SUTI and known covariates, such as age, NIHSS, serum creatinine level, history of stroke, and urinary incontinence. Because patients who share discharge disposition tend to have similar length of hospitalization, we analyzed the effect of SUTI on the median length of stay for a correlation. Days in the intensive care unit and death were used to evaluate morbidity and mortality. By using multivariate logistic regression, the data were analyzed for differences in poststroke disposition among patients with SUTI. Of 4971 patients admitted to the University of Texas at Houston Stroke Service, 2089 were discharged to home, 1029 to inpatient rehabilitation, 659 to a skilled nursing facility, and 226 to a long-term acute care facility. Patients with an SUTI were 57% less likely to be discharged home

  7. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention.

    Science.gov (United States)

    Cooper, R; Cutler, J; Desvigne-Nickens, P; Fortmann, S P; Friedman, L; Havlik, R; Hogelin, G; Marler, J; McGovern, P; Morosco, G; Mosca, L; Pearson, T; Stamler, J; Stryer, D; Thom, T

    2000-12-19

    A workshop was held September 27 through 29, 1999, to address issues relating to national trends in mortality and morbidity from cardiovascular diseases; the apparent slowing of declines in mortality from cardiovascular diseases; levels and trends in risk factors for cardiovascular diseases; disparities in cardiovascular diseases by race/ethnicity, socioeconomic status, and geography; trends in cardiovascular disease preventive and treatment services; and strategies for efforts to reduce cardiovascular diseases overall and to reduce disparities among subpopulations. The conference concluded that coronary heart disease mortality is still declining in the United States as a whole, although perhaps at a slower rate than in the 1980s; that stroke mortality rates have declined little, if at all, since 1990; and that there are striking differences in cardiovascular death rates by race/ethnicity, socioeconomic status, and geography. Trends in risk factors are consistent with a slowing of the decline in mortality; there has been little recent progress in risk factors such as smoking, physical inactivity, and hypertension control. There are increasing levels of obesity and type 2 diabetes, with major differences among subpopulations. There is considerable activity in population-wide prevention, primary prevention for higher risk people, and secondary prevention, but wide disparities exist among groups on the basis of socioeconomic status and geography, pointing to major gaps in efforts to use available, proven approaches to control cardiovascular diseases. Recommendations for strategies to attain the year 2010 health objectives were made.

  8. Teleneurology to improve stroke care in rural areas: The Telemedicine in Stroke in Swabia (TESS) Project.

    Science.gov (United States)

    Wiborg, Andreas; Widder, Bernhard

    2003-12-01

    Assessing both stroke patients and their CT scans by using a conventional videoconference system offers an interesting opportunity to improve stroke care in rural areas. However, until now there have been no studies to suggest whether this method is feasible in routine stroke management. Seven rural hospitals in the southern part of Germany in Swabia were connected to the stroke unit of Günzburg with the use of a videoconference link (Telemedicine in Stroke in Swabia [TESS] Project). The local physicians are free to present every admitted stroke patient to the Günzburg stroke expert, who can assess the clinical status and CT images, thereafter giving therapeutic recommendations. All teleconsultations are rated concerning transmission quality and relevance of telemedicine for stroke management. A total of 153 stroke patients were examined by teleconsultation. Mean age was 67.5 years. Eighty-seven patients had suffered an ischemic stroke, 9 had an intracerebral hemorrhage, and 17 suffered a transient ischemic attack. Forty patients were revealed to have a diagnosis other than stroke. Duration of teleconsultation was 15 minutes on average. User satisfaction was good concerning imaging and audio quality, and patient satisfaction was very good or good in all cases. Relevant contributions could be made in >75% of the cases concerning diagnostic workup, CT assessment, and therapeutic recommendations. Teleconsultation using a videoconference system seems to be a feasible and promising method to improve stroke care in rural areas where management in a stroke unit is hindered by long transportation distances.

  9. Institutional aspects of siting nuclear waste disposal facilities in the United States

    International Nuclear Information System (INIS)

    Stewart, John Cameron.; Prichard, Clark. W.

    1987-01-01

    This chapter deals with the institutional issues associated with the disposal of nuclear waste in the United States of America. These include socio-economic, financial, land use and especially, political factors. Institutional issues must, however, be resolved, as well as the technological problems of engineering and geology. The general issues are first examined, then the organisation and financing, land use, community acceptance, transport problems and finally, local economic impacts. (UK)

  10. On dosimetry of radiodiagnosis facilities, mainly focused on computed tomography units

    International Nuclear Information System (INIS)

    Ghitulescu, Zoe

    2008-01-01

    The 'talk' refers to the Dosimetry of computed tomography units and it has been thought and structured in three parts, more or less stressed each of them, thus: 1) Basics of image acquisition using computed tomography technique; 2) Effective Dose calculation for a patient and its assessment using BERT concept; 3) Recommended actions of getting a good compromise in between related dose and the image quality. The aim of the first part is that the reader to become acquainted with the CT technique in order to be able of understanding the Effective Dose calculation given example and its conversion into time units using the BERT concept . The drown conclusion is that: 1) Effective dose calculation accomplished by the medical physicist (using a special soft for the CT scanner and the exam type) and, converted in time units through BERT concept, could be then communicated by the radiologist together with the diagnostic notes. Thus, it is obviously necessary a minimum informal of the patients as regards the nature and type of radiation, for instance, by the help of some leaflets. In the third part are discussed the factors which lead to get a good image quality taking into account the ALARA principle of Radiation Protection which states the fact that the dose should be 'as low as reasonable achievable'. (author)

  11. Thermionic system evaluation test (TSET) facility construction: A United States and Russian effort

    International Nuclear Information System (INIS)

    Wold, S.K.

    1993-01-01

    The Thermionic System Evaluation Test (TSET) is a ground test of an unfueled Russian TOPAZ-II in-core thermionic space reactor powered by electric heaters. The facility that will be used for testing of the TOPAZ-II systems is located at the New Mexico Engineering Research Institute (NMERI) complex in Albuquerque, NM. The reassembly of the Russian test equipment is the responsibility of International Scientific Products (ISP), a San Jose, CA, company and Inertek, a Russian corporation, with support provided by engineers and technicians from Phillips Laboratory (PL), Sandia National Laboratories (SNL), Los Alamos National Laboratory (LANL), and the University of New Mexico (UNM). This test is the first test to be performed under the New Mexico Strategic Alliance agreement. This alliance consists of the PL, SNL, LANL, and UNM. The testing is being funded by the Strategic Defense Initiative Organization (SDIO) with the PL responsible for project execution

  12. Establishing a clinical pharmacy technician at a United States Army military treatment facility.

    Science.gov (United States)

    Evans, Jennifer L; Gladd, Ellen M; Gonzalez, Alicia C; Tranam, Salman; Larrabee, Joni M; Lipphardt, Sarah E; Chen, Tina T; Ronn, Michael D; Spain, John

    2016-01-01

    To describe the creation of a clinical pharmacy technician position within the U.S. Army and to identify the personal skills and characteristics required to meet the demands of this role. An outpatient military treatment facility located in Maryland. The clinical pharmacy technician position was designed to support clinical pharmacy services within a patient-centered medical home. Funding and a position description were established to hire a clinical pharmacy technician. Expected duties included administrative (45%), patient education (30%), and dispensing (25%). Local policy, in accordance with federal law and U.S. Army regulations, was developed to define the expanded technician responsibility to deliver patient medication education. In the initial 3 months, the clinical pharmacy technician spent 24 hours per week on clinical activities, affording an additional 10-15 hours per week for clinical pharmacists to provide patient care. Completed consults increased from 41% to 56%, and patient-pharmacist encounters increased from 240 to 290 per month. The technician, acting as a clinical pharmacist extender, also completed an average of 90 patient encounters independently each month. As a result of these improvements, the decision was made to hire a second technician. Currently, the technicians spend 28-40 hours per week on clinical activities, offsetting an average of 26 hours per week for the clinical pharmacists. A patient-centered medical home clinical pharmacy technician can reduce the administrative workload for clinical pharmacists, improve their efficiency, and enhance the use of clinical pharmacy services. Several characteristics, particularly medication knowledge, make pharmacy technicians particularly suited for this role. The results from the implementation of a clinical pharmacy technician at this military treatment facility resulted in an Army-wide expansion of the position and suggested applicability in other practice sites, particularly in federal

  13. Basics of acute stroke treatment

    International Nuclear Information System (INIS)

    Haass, A.

    2005-01-01

    Acute stroke presents an emergency that requires immediate referral to a specialized hospital, preferably with a stroke unit. Disability and mortality are reduced by 30% in patients treated in stroke units compared to those treated on regular wards, even if a specialized team is present on the ward. Systolic blood pressure may remain high at 200-220 mmHg in the acute phase and should not be lowered too quickly. Further guidelines for basic care include: optimal O 2 delivery, blood sugar levels below 100-150 mg%, and lowering body temperature below 37.5 C using physical means or drugs. Increased intracranial pressure should be treated by raising the upper body of the patient, administration of glycerol, mannitol, and/or sorbitol, artificial respiration, and special monitoring of Tris buffer. Decompressive craniectomy may be considered in cases of ''malignant'' media stroke and expansive cerebellar infarction. Fibrinolysis is the most effective stroke treatment and is twice as effective in the treatment of stroke than myocardial infarction. Fibrinolysis may be initiated within 3 h of a stroke in the anterior circulation. If a penumbra is detectable by ''PWI-DWI mismatch MRI,'' specialized hospitals may perform fibrinolysis up to 6 h after symptom onset. In cases of stroke in the basilar artery, fibrinolysis may be performed even later after symptom onset. Intra-arterial fibrinolysis is performed in these cases using rt-PA or urokinase. Follow-up treatment of stroke patients should not only address post-stroke depression and neuropsychological deficits, but also include patient education about risk factors such as high blood pressure, diabetes mellitus, and cardiac arrhythmias. (orig.) [de

  14. Economic and Financial Evaluation of The Irradiation Facility Unit For Some Egyptian Agricultural Exports

    International Nuclear Information System (INIS)

    Amin, S.R.A.

    2014-01-01

    Food irradiation technology strongly enhances quarantine, especially that chemical methods to preserve food and agricultural products are completely banned. The technology of food preservation by irradiation helps increasing Egypt’s agricultural exports to foreign markets as these exports become more competitive due to their long shelf life and decrease of loss. Therefore, food irradiation technology helps avoiding economic loss. The present study aims at conducting a financial analysis and economic evaluation for establishing an irradiation unit for some Egypt’s agricultural exports to enhance their competitiveness and help exporters in marketing them. The study also considers the site location of the unit because of the important role it plays in influencing the project size, production capacity, costs and expected profits. The study consists of four sections namely: Section one: This section includes two chapters. Chapter one presents the theoretical framework of the study. Chapter two displays the literature review. Chapter one includes key concepts and terms of irradiation, purpose of food irradiation, types of irradiation units, application in fruits and vegetables irradiation, radiation doses used in irradiating food and requirements for safety of food irradiation. chapter two reveals the literature review of previous research of the topic showing important results and conclusions made of previous studies and research, studies are divided into two parts, part one relate to agricultural exports, as part two links food irradiation technology. Section Two: This section presents a study of irradiating Egypt’s agricultural exports .This section is divided into two chapters; chapter one reveals the economic importance of irradiating agricultural products, and chapter two illustrates different types of irradiation techniques. The results in this section show the advantages of food irradiation technology in terms of marketing, health, environment and cost

  15. Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED).

    Science.gov (United States)

    Towfighi, Amytis; Cheng, Eric M; Ayala-Rivera, Monica; McCreath, Heather; Sanossian, Nerses; Dutta, Tara; Mehta, Bijal; Bryg, Robert; Rao, Neal; Song, Shlee; Razmara, Ali; Ramirez, Magaly; Sivers-Teixeira, Theresa; Tran, Jamie; Mojarro-Huang, Elizabeth; Montoya, Ana; Corrales, Marilyn; Martinez, Beatrice; Willis, Phyllis; Macias, Mireya; Ibrahim, Nancy; Wu, Shinyi; Wacksman, Jeremy; Haber, Hilary; Richards, Adam; Barry, Frances; Hill, Valerie; Mittman, Brian; Cunningham, William; Liu, Honghu; Ganz, David A; Factor, Diane; Vickrey, Barbara G

    2017-02-06

    Recurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population. In this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost

  16. Preventing stroke

    Science.gov (United States)

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

  17. Stroke Rehabilitation

    Science.gov (United States)

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

  18. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.

    2008-01-01

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

  19. Heat stroke in Hajj ceremonies

    Directory of Open Access Journals (Sweden)

    Sadr Sh

    1995-04-01

    Full Text Available Three hundred and seventy seven patients with different degrees of heat stroke were treated by the haji medical team of the Islamic Republic of Iran in 1371 (1992. Studies were carried out on sex of the patients, time and intensity of occurance and the vital signs after a medical examination. The most important method of treatment employed for intense heat stroke was iced bath. This procedure leads to 64.5% of patients being treated in te specific heat stroke unit and 35% were sent to a general hospital ward for furthur treatment. Morbidity and mortality were seen in less than 0.5% of the patients.

  20. The Small Area Health Statistics Unit: a national facility for investigating health around point sources of environmental pollution in the United Kingdom.

    Science.gov (United States)

    Elliott, P; Westlake, A J; Hills, M; Kleinschmidt, I; Rodrigues, L; McGale, P; Marshall, K; Rose, G

    1992-01-01

    STUDY OBJECTIVE--The Small Area Health Statistics Unit (SAHSU) was established at the London School of Hygiene and Tropical Medicine in response to a recommendation of the enquiry into the increased incidence of childhood leukaemia near Sellafield, the nuclear reprocessing plant in West Cumbria. The aim of this paper was to describe the Unit's methods for the investigation of health around point sources of environmental pollution in the United Kingdom. DESIGN--Routine data currently including deaths and cancer registrations are held in a large national database which uses a post code based retrieval system to locate cases geographically and link them to the underlying census enumeration districts, and hence to their populations at risk. Main outcome measures were comparison of observed/expected ratios (based on national rates) within bands delineated by concentric circles around point sources of environmental pollution located anywhere in Britain. MAIN RESULTS--The system is illustrated by a study of mortality from mesothelioma and asbestosis near the Plymouth naval dockyards during 1981-87. Within a 3 km radius of the docks the mortality rate for mesothelioma was higher than the national rate by a factor of 8.4, and that for asbestosis was higher by a factor of 13.6. CONCLUSIONS--SAHSU is a new national facility which is rapidly able to provide rates of mortality and cancer incidence for arbitrary circles drawn around any point in Britain. The example around Plymouth of mesothelioma and asbestosis demonstrates the ability of the system to detect an unusual excess of disease in a small locality, although in this case the findings are likely to be related to occupational rather than environmental exposure. PMID:1431704

  1. Evaluation of Nuclear Facility Decommissioning Projects. Summary Report. Three Mile Island Unit 2 Polar Crane Recovery

    International Nuclear Information System (INIS)

    Doerge, D. H.; Miller, R. L.

    1984-08-01

    This document summarizes information concerning restoration of the Three Mile Island-Unit 2 Polar Crane to a fully operational condition following the loss of coolant accident experienced on March 28, 1979. The data collected from activity reports, reactor containment entry records, and other sources were placed in a computerized information retrieval/manipulation system which permits extraction/manipulation of specific data which could be utilized in planning for recovery activities should a similar accident occur in a nuclear generating plant. The information is presented in both computer output form and a manually assembled summarization. This report contains only the manpower requirements and radiation exposures actually incurred during recovery operations within the reactor containment and does not include support activities or costs. (author)

  2. Automatic sprinkler system performance and reliability in United States Department of Energy Facilities, 1952 to 1980

    International Nuclear Information System (INIS)

    1982-06-01

    The automatic sprinkler system experiences of the United States Department of Energy and its predecessor agencies are analyzed. Based on accident and incident files in the Office of Operational Safety and on supplementary responses, 587 incidents including over 100 fires are analyzed. Tables and figures, with supplementary narratives discuss fire experience by various categories such as number of heads operating, type of system, dollar losses, failures, extinguished vs. controlled, and types of sprinkler heads. Use is made of extreme value projections and frequency-severity plots to compare past experience and predict future experience. Non-fire incidents are analyzed in a similar manner by cause, system types and failure types. Discussion of no-loss incidents and non-fire protection water systems is included. The author's conclusions and recommendations and appendices listing survey methodology, major incidents, and a bibliography are included

  3. A comment on "bats killed in large numbers at United States wind energy facilities"

    Science.gov (United States)

    Huso, Manuela M.P.; Dalthorp, Dan

    2014-01-01

    Widespread reports of bat fatalities caused by wind turbines have raised concerns about the impacts of wind power development. Reliable estimates of the total number killed and the potential effects on populations are needed, but it is crucial that they be based on sound data. In a recent BioScience article, Hayes (2013) estimated that over 600,000 bats were killed at wind turbines in the United States in 2012. The scientific errors in the analysis are numerous, with the two most serious being that the included sites constituted a convenience sample, not a representative sample, and that the individual site estimates are derived from such different methodologies that they are inherently not comparable. This estimate is almost certainly inaccurate, but whether the actual number is much smaller, much larger, or about the same is uncertain. An accurate estimate of total bat fatality is not currently possible, given the shortcomings of the available data.

  4. Evaluation of nuclear facility decommissioning projects: Summary status report: Three Mile Island Unit 2 radioactive waste and laundry shipments

    International Nuclear Information System (INIS)

    Doerge, D.H.; Haffner, D.R.

    1988-06-01

    This document summarizes information concerning radioactive waste and laundry shipments from the Three Mile Island Nuclear Station Unit 2 to radioactive waste disposal sites and to protective clothing decontamination facilities (laundries) since the loss of coolant accident experienced on March 28, 1979. Data were collected from radioactive shipment records, summarized, and placed in a computerized data information retrieval/manipulation system which permits extraction of specific information. This report covers the period of April 9, 1979 through April 19, 1987. Included in this report are: waste disposal site locations, dose rates, curie content, waste description, container type and number, volumes and weights. This information is presented in two major categories: protective clothing (laundry) and radioactive waste. Each of the waste shipment reports is in chronological order

  5. Closure Report for Corrective Action Unit 254: Area 25, R-MAD Decontamination Facility, Nevada Test Site, Nevada

    Energy Technology Data Exchange (ETDEWEB)

    G. N. Doyle

    2002-02-01

    Corrective Action Unit (CAU) 254 is located in Area 25 of the Nevada Test Site (NTS), approximately 100 kilometers (km) (62 miles) northwest of Las Vegas, Nevada. The site is located within the Reactor Maintenance, Assembly and Disassembly (R-MAD) compound and consists of Building 3126, two outdoor decontamination pads, and surrounding areas within an existing fenced area measuring approximately 50 x 37 meters (160 x 120 feet). The site was used from the early 1960s to the early 1970s as part of the Nuclear Rocket Development Station program to decontaminate test-car hardware and tooling. The site was reactivated in the early 1980s to decontaminate a radiologically contaminated military tank. This Closure Report (CR) describes the closure activities performed to allow un-restricted release of the R-MAD Decontamination Facility.

  6. Description of work vadose drilling at the 1301-N and 1325-N facilities, 100-NR-1 operable unit

    International Nuclear Information System (INIS)

    1994-08-01

    This description of work (DOW) details the field activities associated with the sampling of the vadose zone soils beneath the 1301-N and 1325-N cribs and trenches and will serve as a field guide for those performing the work. These activities are undertaken pursuant to the Hanford Federal Facility Agreement and Consent Order (Ecology et al., 1994a) Milestone M-16-94-01H-Tl and the June 30, 1994 Milestone Change Request M-16-94-02 (Ecology et al., 1994b). Three vadose zone borings, 1301-N-1, 1301-N-2, and 1325-N-1, will be constructed to investigate the vertical and horizontal distribution of radionuclide contamination in sediments beneath the cribs and trenches. The boreholes are also intended to intersect subsurface areas that may have been contaminated by dangerous wastes, i.e., metals, in effluent disposed during past operation of the facilities. This limited field investigation will provide data for the evaluation of remedial alternatives. Data from the investigation are expected to confirm that the cribs and trenches are high priority sites in the 100-NR-1 operable unit. Data, from the investigation will be used to evaluate alternatives for closure of the 1301-N and 1325-N sites. The contaminants of potential concern (COPCs) for the 1301-N/1325-N limited field investigation are presented in Table 1

  7. Corrective Action Plan for Corrective Action Unit 254: Area 25 R-MAD Decontamination Facility Nevada Test Site, Nevada

    International Nuclear Information System (INIS)

    Obi, C.M.

    2000-01-01

    The Area 25 Reactor Maintenance, Assembly, and Disassembly Decontamination Facility is identified in the Federal Facility Agreement and Consent Order (FFACO) as Corrective Action Unit (CAU) 254. CAU 254 is located in Area 25 of the Nevada Test Site and consists of a single Corrective Action Site CAS 25-23-06. CAU 254 will be closed, in accordance with the FFACO of 1996. CAU 254 was used primarily to perform radiological decontamination and consists of Building 3126, two outdoor decontamination pads, and surrounding soil within an existing perimeter fence. The site was used to decontaminate nuclear rocket test-car hardware and tooling from the early 1960s through the early 1970s, and to decontaminate a military tank in the early 1980s. The site characterization results indicate that, in places, the surficial soil and building materials exceed clean-up criteria for organic compounds, metals, and radionuclides. Closure activities are expected to generate waste streams consisting of nonhazardous construction waste. petroleum hydrocarbon waste, hazardous waste, low-level radioactive waste, and mixed waste. Some of the wastes exceed land disposal restriction limits and will require off-site treatment before disposal. The recommended corrective action was revised to Alternative 3- ''Unrestricted Release Decontamination, Verification Survey, and Dismantle Building 3126,'' in an addendum to the Correction Action Decision Document

  8. Study concerning decommissioning of nuclear facilities overseen by the IAEA in the United States and major European countries

    International Nuclear Information System (INIS)

    Hirashima, Shikazoh

    1983-01-01

    The purpose of this investigation was to know generally on the activities of decommissioning nuclear facilities in the IAEA, and to compare the regulation and finance concerning reactor decommissioning in European countries and the United States together with the decommissioning policy and the status of research and development. Recently also in Japan, attention has been paid to reactor decommissioning after the termination of operation, and the report by the Decommissioning Countermeasures Committee was published in March, 1981. In the IAEA, the investigation of Reactor decommissioning has been performed since 1973, and the meetings of the technical committee in 1975 and 1977, the international symposium in 1978, and the publication of ''Various factors concerning the decommissioning of inland nuclear facilities'' in 1980 were held. The regulation and finance concerning the decommissioning have been performed differently in each country, and the features of the main policy of decommissioning are indicated. In foreign countries, the measures of account for the decommissioning expenses have been already taken. In Japan, it is desirable to establish the technical standard for the decommissioning including legislation and finance. (Kako, I.)

  9. Atherosclerosis and Stroke

    Science.gov (United States)

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

  10. Health risks associated with ingesting venison from a uranium enrichment facility with multiple operable units

    International Nuclear Information System (INIS)

    Duncan, J.; Welsh, C.

    1995-01-01

    Ingestion of game, including venison, may be a significant exposure pathway in human health risk assessments at hazardous waste sites. The difficulty associated with modeling contaminant tissue concentrations in a wide-ranging herbivorous mammal is compounded when the home range of the mammal extends over multiple operable units (OUs) of varying size and media contaminant concentration. Using biotransfer factors extracted from the literature and species-specific parameter information (e.g., home range size, diet, forage and water ingestion rates) the authors estimate contaminant concentrations in venison based on soil and surface water contaminant concentrations and determine the contribution of individual OUs to modeled venison tissue concentrations. Estimated tissue concentrations are calculated through the use of site foraging factors (SFFS) that adjust exposure contributions from individual OUs to account for the size of the OU in relation to the animals home range. The authors then use the venison tissue concentrations to estimate human health risk associated with ingesting venison under both a current and future exposure scenario

  11. National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014.

    Science.gov (United States)

    Lecoffre, Camille; de Peretti, Christine; Gabet, Amélie; Grimaud, Olivier; Woimant, France; Giroud, Maurice; Béjot, Yannick; Olié, Valérie

    2017-11-01

    Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management. © 2017 American Heart Association, Inc.

  12. Corrective Action Decision Document for Corrective Action Unit 254: Area 25 R-MAD Decontamination Facility, Nevada Test Site, Nevada

    International Nuclear Information System (INIS)

    2000-01-01

    This Corrective Action Decision Document identifies and rationalizes the US Department of Energy, Nevada Operations Office's selection of a recommended corrective action alternative (CAA) appropriate to facilitate the closure of Corrective Action Unit (CAU) 254, R-MAD Decontamination Facility, under the Federal Facility Agreement and Consent Order. Located in Area 25 at the Nevada Test Site in Nevada, CAU 254 is comprised of Corrective Action Site (CAS) 25-23-06, Decontamination Facility. A corrective action investigation for this CAS as conducted in January 2000 as set forth in the related Corrective Action Investigation Plan. Samples were collected from various media throughout the CAS and sent to an off-site laboratory for analysis. The laboratory results indicated the following: radiation dose rates inside the Decontamination Facility, Building 3126, and in the storage yard exceeded the average general dose rate; scanning and static total surface contamination surveys indicated that portions of the locker and shower room floor, decontamination bay floor, loft floor, east and west decon pads, north and south decontamination bay interior walls, exterior west and south walls, and loft walls were above preliminary action levels (PALs). The investigation-derived contaminants of concern (COCs) included: polychlorinated biphenyls, radionuclides (strontium-90, niobium-94, cesium-137, uranium-234 and -235), total volatile and semivolatile organic compounds, total petroleum hydrocarbons, and total Resource Conservation and Recovery Act (Metals). During the investigation, two corrective action objectives (CAOs) were identified to prevent or mitigate human exposure to COCs. Based on these CAOs, a review of existing data, future use, and current operations at the Nevada Test Site, three CAAs were developed for consideration: Alternative 1 - No Further Action; Alternative 2 - Unrestricted Release Decontamination and Verification Survey; and Alternative 3 - Unrestricted

  13. Economic impacts of oil spills: Spill unit costs for tankers, pipelines, refineries, and offshore facilities. [Task 1, Final report

    Energy Technology Data Exchange (ETDEWEB)

    1993-10-15

    The impacts of oil spills -- ranging from the large, widely publicized Exxon Valdez tanker incident to smaller pipeline and refinery spills -- have been costly to both the oil industry and the public. For example, the estimated costs to Exxon of the Valdez tanker spill are on the order of $4 billion, including $2.8 billion (in 1993 dollars) for direct cleanup costs and $1.125 billion (in 1992 dollars) for settlement of damages claims caused by the spill. Application of contingent valuation costs and civil lawsuits pending in the State of Alaska could raise these costs appreciably. Even the costs of the much smaller 1991 oil spill at Texaco`s refinery near Anacortes, Washington led to costs of $8 to 9 million. As a result, inexpensive waming, response and remediation technologies could lower oil spin costs, helping both the oil industry, the associated marine industries, and the environment. One means for reducing the impact and costs of oil spills is to undertake research and development on key aspects of the oil spill prevention, warming, and response and remediation systems. To target these funds to their best use, it is important to have sound data on the nature and size of spills, their likely occurrence and their unit costs. This information could then allow scarce R&D dollars to be spent on areas and activities having the largest impact. This report is intended to provide the ``unit cost`` portion of this crucial information. The report examines the three key components of the US oil supply system, namely, tankers and barges; pipelines and refineries; and offshore production facilities. The specific purpose of the study was to establish the unit costs of oil spills. By manipulating this key information into a larger matrix that includes the size and frequency of occurrence of oil spills, it will be possible` to estimate the likely future impacts, costs, and sources of oil spills.

  14. Stroke Laterality Bias in the Management of Acute Ischemic Stroke.

    Science.gov (United States)

    McCluskey, Gavin; Wade, Carrie; McKee, Jacqueline; McCarron, Peter; McVerry, Ferghal; McCarron, Mark O

    2016-11-01

    Little is known of the impact of stroke laterality on the management process and outcome of patients with acute ischemic stroke (AIS). Consecutive patients admitted to a general hospital over 1 year with supratentorial AIS were eligible for inclusion in the study. Baseline characteristics and risk factors, delays in hospital admission, imaging, intrahospital transfer to an acute stoke unit, stroke severity and classification, length of hospital admission, as well as 10-year mortality were measured and compared among right and left hemisphere AIS patients. There were 141 patients (77 men, 64 women; median age 73 [interquartile range 63-79] years), There were 71 patients with left hemisphere AIS and 70 with right hemisphere AIS. Delays to hospital admission from stroke onset to neuroimaging were similar among right and left hemisphere AIS patients. Delay in transfer to an acute stroke unit (ASU) following hospital admission was on average 14 hours more for right hemisphere compared to left hemisphere AIS patients (P = .01). Laterality was not associated with any difference in 10-year survival. Patients with mild and nondominant AIS merit particular attention to minimize their intrahospital transfer time to an ASU. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Addendum to the Closure Report for Corrective Action Unit 113: Area 25 R-MAD Facility, Nevada National Security Site, Nevada

    International Nuclear Information System (INIS)

    2011-01-01

    This addendum to the Closure Report for Corrective Action Unit 113: Area 25, Reactor Maintenance, Assembly, and Disassembly Facility, Building 3110, Nevada Test Site, Nevada, DOE/NV--891-VOL I-Rev. 1, dated July 2003, provides details of demolition, waste disposal, and use restriction (UR) modification for Corrective Action Unit 113, Area 25 R-MAD Facility. Demolition was completed on July 15, 2010, when the last of the building debris was disposed. Final field activities were concluded on August 30, 2010, after all equipment was demobilized and UR signs were posted. This work was funded by the American Recovery and Reinvestment Act.

  16. Aphasia As a Predictor of Stroke Outcome.

    Science.gov (United States)

    Lazar, Ronald M; Boehme, Amelia K

    2017-09-19

    Aphasia is a common feature of stroke, affecting 21-38% of acute stroke patients and an estimated 1 million stroke survivors. Although stroke, as a syndrome, is the leading cause of disability in the USA, less is known about the independent impact of aphasia on stroke outcomes. During the acute stroke period, aphasia has been found to increase length of stay, inpatient complications, overall neurological disability, mortality, and to alter discharge disposition. Outcomes during the sub-acute and chronic stroke periods show that aphasia is associated with lower Functional Independence Measures (FIM) scores, longer stays in rehabilitation settings, poorer function in activities of daily living, and mortality. Factors that complicate the analysis of aphasia on post-stroke outcomes, however, include widely different systems of care across international settings that result in varying admission patterns to acute stroke units, allowable length of stays based on reimbursement, and criteria for rehabilitation placement. Aphasia arising from stroke is associated with worse outcomes both in the acute and chronic periods. Future research will have to incorporate disparate patterns in analytic models, and to take into account specific aphasia profiles and evolving methods of post-stroke speech-language therapy.

  17. [Neuro-rehabilitation after stroke].

    Science.gov (United States)

    Murie-Fernández, M; Irimia, P; Martínez-Vila, E; John Meyer, M; Teasell, R

    2010-04-01

    the high incidence of stroke results in significant mortality and disability leading to immense health care costs. These costs lead to socioeconomic, budgetary, and staffing repercussions in developing countries. Improvements in stroke management focus mainly on acute neurological treatment, admission to stroke units, fibrinolytic treatment for ischaemic strokes and rehabilitation processes. Among these, rehabilitation has the longest therapeutic window, can be applied in both ischaemic and haemorrhagic strokes, and can improve functional outcomes months after stroke. Neurologists, because of their knowledge in neuroanatomy, physiopathology, neuro-pharmacology, and brain plasticity, are in an ideal position to actively participate in the neurorehabilitation process. Several processes have been shown to play a role in determining the efficacy of rehabilitation; time from stroke onset to rehabilitation admission and the duration and intensity of treatment. neurorehabilitation is a sub-speciality in which neurologists should be incorporated into multidisciplinary neurorehabilitation teams. Early time to rehabilitation admission and greater intensity and duration of treatment are associated with better functional outcomes, lower mortality/institutionalisation, and shorter length of stay. In order to be efficient, a concerted effort must be made to ensure patients receive neurorehabilitation treatment in a timely manner with appropriate intensity to maximize patient outcomes during both inpatient and outpatient rehabilitation. Published by Elservier España, S.L. All rights reserved.

  18. A comparative cost analysis of polytrauma and neurosurgery Intensive Care Units at an apex trauma care facility in India.

    Science.gov (United States)

    Kumar, Parmeshwar; Jithesh, V; Gupta, Shakti Kumar

    2016-07-01

    Although Intensive Care Units (ICUs) only account for 10% of the hospital beds, they consume nearly 22% of the hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. The aim of this study was to evaluate and compare the cost of intensive care delivery between multispecialty and neurosurgery ICUs at an apex trauma care facility in India. The study was conducted in a polytrauma and neurosurgery ICU at a 203-bedded Level IV trauma care facility in New Delhi, India, from May 1, 2012 to June 30, 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in the study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical analysis was performed by Fisher's two tailed t-test. Total cost/bed/day for the multispecialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU, it was Rs. 14,306.7/-, workforce constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Quantification of expenditure in running an ICU in a trauma center would assist health-care decision makers in better allocation of resources. Although multispecialty ICUs are more cost-effective, other factors will also play a role in defining the kind of ICU that needs to be designed.

  19. Survey and assessment of radioactive waste management facilities in the United States. Section 2.5. Air-cooled vault storage facilities

    International Nuclear Information System (INIS)

    1986-01-01

    There are two basic types of air-cooled vaults for the storage of spent nuclear fuel or vitrified HLRW. The two types, differentiated by the method of air cooling used, are the open-vault concept and the closed-vault concept. The following aspects of these air-cooled vault storage facility concepts are discussed: description and operation of facilities; strucutral design considerations and analysis; nuclear design considerations and analyses; vault environmental design considerations; unique design features; and accident analysis

  20. COR1 Engineering Test Unit Measurements at the NCAR/HAO Vacuum Tunnel Facility, October-November 2002

    Science.gov (United States)

    Thompson, William

    2002-01-01

    The Engineering Test Unit (ETU) of COR1 was made in two configurations. The first configuration, ETU-1, was for vibration testing, while the second, ETU-2, was for optical testing. This is a report on the optical testing performed on ETU-2 at the NCAR/HAO Vacuum Tunnel Facility during the months of October and November, 2002. This was the same facility used to test the two previous breadboard models. In both configurations, the first two tube sections were complete, with all optical elements aligned. The vibration model ETU-1 had the remaining tube sections attached, with mass models for the remaining optics, for the various mechanisms, and for the focal plane assembly. It was then converted into the optical model ETU-2 by removing tube sections 3 to 5, and mounting the remaining optics on commercial mounts. (The bandpass filter was also installed into tube 2, which had been replaced in ETU-1 by a mass model, so that pre- and post-vibration optical measurements could be made.) Doublet 2 was installed in a Newport LP-2 carrier, and aligned to the other optics in the first two tube sections. The LP-2 adjustment screws were then uralened so that the alignment could be maintained during shipping. Because neither the flight polarizer nor Hollow Core Motor were available, they were simulated by a commercial polarizer and rotational mount, both from Oriel corporation. The Oriel rotational stage was not designed for vacuum use, but it was determined after consultation with the company, and lab testing, that the stage could be used in the moderate vacuum conditions at the NCAR/HAO facility. The shutter and focal plane assembly were simulated with the same camera used for the previous two breadboard tests. The focal plane mask was simulated with a plane of BK7 glass with a mask glued on, using the same procedure as for the Lyot spot on Doublet 1, and mounted in an adjustable LP-2 carrier. Two masks were made, one made to the precise specifications of the optical design, the

  1. Management Of Ischaemic Stroke – Recent Advances | Ogun ...

    African Journals Online (AJOL)

    For effective management of stroke (“brain attack”), stroke units are now in vogue in developed nations. Stroke management in our nation should be reprioritized as a time dependent urgent medical emergency just as is currently stressed for major trauma and acute myocardial infarction (heart attack). Efforts should equally ...

  2. Use of computerized tomography in brain stroke

    Energy Technology Data Exchange (ETDEWEB)

    Landmark, K.; Aursnes, I.; Eldvik, P.; Lilleaas, F.G.

    1988-04-01

    In a retrospective study in 115 patients consecutively admitted to a ''stroke unit'', 108 were found to have been subjected to one or more cerebral CT-scans, of which ten revealed cerebral haemorrhage, two tumor cerebri and one subdural haematoma. The latter patient was successfully operated upon. The clinical diagnosis of stroke in progression was made in seven patients, whereas embolic stroke was diagnosed in 22. After haemorrhage had been excluded by CT, anticoagulant therapy (warfarin/heparin) was started for various reasons in 35 patients altogether. It is concluded that CT, if available locally, should be performed routinely during the first days following acute stroke.

  3. Use of computerized tomography in brain stroke

    International Nuclear Information System (INIS)

    Landmark, K.; Aursnes, I.; Eldvik, P.; Lilleaas, F.G.

    1988-01-01

    In a retrospective study in 115 patients consecutively admitted to a ''stroke unit'', 108 were found to have been subjected to one or more cerebral CT-scans, of which ten revealed cerebral haemorrhage, two tumor cerebri and one subdural haematoma. The latter patient was successfully operated upon. The clinical diagnosis of stroke in progression was made in seven patients, whereas embolic stroke was diagnosed in 22. After haemorrhage had been excluded by CT, anticoagulant therapy (warfarin/heparin) was started for various reasons in 35 patients altogether. It is concluded that CT, if available locally, should be performed routinely during the first days following acute stroke

  4. Evaluation of nuclear facility decommissioning projects. Three Mile Island Unit 2 reactor defueling and disassembly. Summary status report. Volume 3

    International Nuclear Information System (INIS)

    Doerge, D.H.; Miller, R.L.; Scotti, K.S.

    1986-05-01

    This document summarizes information relating to the preparations for defueling the Three Mile Island Unit 2 (TMI-2) reactor and disassembly activities being performed concurrently with decontamination of the facility. Data have been collected from activity reports, reactor containment entry records, and other sources and entered in a computerized data sysem which permits extraction/manipulation of specific data which can be used in planning for recovery from a loss of coolant event similar to that experienced at TMI-2 on March 28, 1979. This report contains summaries of man-hours, manpower, and radiation exposures incurred during the period of April 23, 1979 to April 16, 1985, in the completion of activities related to preparation for reactor defueling. Support activities conducted outside of radiation areas are not included within the scope of this report. Computerized reports included in this document are: A chronological summary listing work performed for the period; and summary reports for each major task undertaken in connection with the specific scope of this report. Presented in chronological order for the referenced time period. Manually-assembled table summaries are included for: Labor and exposures by department; and labor and exposures by major activity

  5. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha

    2008-12-01

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

  6. Aerial radiological survey of the United States Department of Energy's Battelle Nuclear Science Facility, West Jefferson, Ohio, date of survey: May 1977

    International Nuclear Information System (INIS)

    Feimster, E.L.

    1979-05-01

    An aerial radiological survey to measure terrestrial gamma radiation was carried out over the United States Department of Energy's Battelle Nuclear Science Facility located in West Jefferson, Ohio. Gamma ray data were collected over a 5.5 km 2 area centered on the facility by flying east-west lines spaced 61 m apart. Processed data indicated that on-site radioactivity was primarily due to radionuclides currently being processed due to the hot lab operations. Off-site data showed the radioactivity to be due to naturally occurring background radiation consistent with variations due to geologic base terrain and land use of similar areas

  7. Depression and Functional Status Among African American Stroke Survivors in Inpatient Rehabilitation.

    Science.gov (United States)

    Harris, Gabrielle M; Collins-McNeil, Janice; Yang, Qing; Nguyen, Vu Q C; Hirsch, Mark A; Rhoads, Charles F; Guerrier, Tami; Thomas, J George; Pugh, Terrence M; Hamm, Deanna; Pereira, Carol; Prvu Bettger, Janet

    2017-01-01

    To examine the prevalence of poststroke depression (PSD) among African American stroke survivors and the association of depression with functional status at inpatient rehabilitation facility (IRF) discharge. Secondary data analysis was conducted of a patient cohort who received care at 3 IRFs in the United States from 2009 to 2011. Functional status was measured by the Functional Independence Measure (FIM). Multiple linear regression models were used to examine associations of PSD and FIM motor and cognitive scores. Of 458 African American stroke survivors, 48.5% were female, 84% had an ischemic stroke, and the mean age was 60.8 ± 13.6 years. Only 15.4% (n = 71) had documentation of PSD. Bivariate analyses to identify factors associated with depression identified a higher percentage of patients with depression than without who were retired due to disability (17.1% versus 11.6%) or employed (31.4% versus 19.6%) prestroke (P = .041). Dysphagia, cognitive deficits, and a lower admission motor FIM score were also significantly more common among those with depression. There was no significant relationship between depression and functional status after adjusting for patient characteristics. In this study, 15% of the African Americans who received rehabilitation after a stroke had documentation of PSD but this was not associated with functional status at discharge. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. Quantitative evaluation of perfusion magnetic resonance imaging hyper-acute ischemic stroke patients comparison with 1.5T and 3.0T units

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Eun Hoe [Dept. of Radiological Science, Cheongju University, Cheongju (Korea, Republic of); Moon, Il Bong; Dong, Kyung Rae [Dept. of Radiological Technology, Gwangju Health University, Gwangju (Korea, Republic of)

    2017-02-15

    Perfusion magnetic resonance image of biological mechanism are independent of magnetic field strength in hyper acute ischemic stroke. 3.0 T magnetic field, however, does affect the SNRs (signal to noise ratio) and artifacts of PMRI (perfusion magnetic resonance image), which basically will influence the quantitative of PMRI. In this study, the effects of field strength on PMRI are analyzed. The effects of the diseases also are discussed. PMRI in WM (white matter), GM (gray matter), hyper acute ischemic stroke were companied with 1.5 T and 3.0 T on SNR. PMRI also was compared to the SI difference after setting ROI (region of interest) in left and right b side of the brain. In conclusion, the SNRs and SI of the 3.0 T PMRI showed higher than those at 1.5 T. In summary, PMRI studies at 3.0 T is provided significantly improved perfusion evaluation when comparing with 1.5 T.

  9. Quantitative evaluation of perfusion magnetic resonance imaging hyper-acute ischemic stroke patients comparison with 1.5T and 3.0T units

    International Nuclear Information System (INIS)

    Goo, Eun Hoe; Moon, Il Bong; Dong, Kyung Rae

    2017-01-01

    Perfusion magnetic resonance image of biological mechanism are independent of magnetic field strength in hyper acute ischemic stroke. 3.0 T magnetic field, however, does affect the SNRs (signal to noise ratio) and artifacts of PMRI (perfusion magnetic resonance image), which basically will influence the quantitative of PMRI. In this study, the effects of field strength on PMRI are analyzed. The effects of the diseases also are discussed. PMRI in WM (white matter), GM (gray matter), hyper acute ischemic stroke were companied with 1.5 T and 3.0 T on SNR. PMRI also was compared to the SI difference after setting ROI (region of interest) in left and right b side of the brain. In conclusion, the SNRs and SI of the 3.0 T PMRI showed higher than those at 1.5 T. In summary, PMRI studies at 3.0 T is provided significantly improved perfusion evaluation when comparing with 1.5 T

  10. Soetomo score: score model in early identification of acute haemorrhagic stroke

    Directory of Open Access Journals (Sweden)

    Moh Hasan Machfoed

    2016-06-01

    Full Text Available Aim of the study: On financial or facility constraints of brain imaging, score model is used to predict the occurrence of acute haemorrhagic stroke. Accordingly, this study attempts to develop a new score model, called Soetomo score. Material and methods: The researchers performed a cross-sectional study of 176 acute stroke patients with onset of ≤24 hours who visited emergency unit of Dr. Soetomo Hospital from July 14th to December 14th, 2014. The diagnosis of haemorrhagic stroke was confirmed by head computed tomography scan. There were seven predictors of haemorrhagic stroke which were analysed by using bivariate and multivariate analyses. Furthermore, a multiple discriminant analysis resulted in an equation of Soetomo score model. The receiver operating characteristic procedure resulted in the values of area under curve and intersection point identifying haemorrhagic stroke. Afterward, the diagnostic test value was determined. Results: The equation of Soetomo score model was (3 × loss of consciousness + (3.5 × headache + (4 × vomiting − 4.5. Area under curve value of this score was 88.5% (95% confidence interval = 83.3–93.7%. In the Soetomo score model value of ≥−0.75, the score reached the sensitivity of 82.9%, specificity of 83%, positive predictive value of 78.8%, negative predictive value of 86.5%, positive likelihood ratio of 4.88, negative likelihood ratio of 0.21, false negative of 17.1%, false positive of 17%, and accuracy of 83%. Conclusions: The Soetomo score model value of ≥−0.75 can identify acute haemorrhagic stroke properly on the financial or facility constrains of brain imaging.

  11. Using drugs in un/safe spaces: Impact of perceived illegality on an underground supervised injecting facility in the United States.

    Science.gov (United States)

    Davidson, Peter J; Lopez, Andrea M; Kral, Alex H

    2018-03-01

    Supervised injection facilities (SIFs) are spaces where people can consume pre-obtained drugs in hygienic circumstances with trained staff in attendance to provide emergency response in the event of an overdose or other medical emergency, and to provide counselling and referral to other social and health services. Over 100 facilities with formal legal sanction exist in ten countries, and extensive research has shown they reduce overdose deaths, increase drug treatment uptake, and reduce social nuisance. No facility with formal legal sanction currently exists in the United States, however one community-based organization has successfully operated an 'underground' facility since September 2014. Twenty three qualitative interviews were conducted with people who used the underground facility, staff, and volunteers to examine the impact of the facility on peoples' lives, including the impact of lack of formal legal sanction on service provision. Participants reported that having a safe space to inject drugs had led to less injections in public spaces, greater ability to practice hygienic injecting practices, and greater protection from fatal overdose. Constructive aspects of being 'underground' included the ability to shape rules and procedures around user need rather than to meet political concerns, and the rapid deployment of the project, based on immediate need. Limitations associated with being underground included restrictions in the size and diversity of the population served by the site, and reduced ability to closely link the service to drug treatment and other health and social services. Unsanctioned supervised injection facilities can provide a rapid and user-driven response to urgent public health needs. This work draws attention to the need to ensure such services remain focused on user-defined need rather than external political concerns in jurisdictions where supervised injection facilities acquire local legal sanction. Copyright © 2017 Elsevier B.V. All

  12. Survival after stroke. Risk factors and determinants in the Copenhagen Stroke Study

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter

    2010-01-01

    stroke unit and recruited from a well-defined area in Copenhagen, Denmark. This thesis focuses on the survival after stroke in relation to several baseline clinical characteristics and risk factors for cardiovascular disease. The thesis comes in three sections with regard to whether factors or clinical...

  13. In-hospital stroke: characteristics and outcomes.

    LENUS (Irish Health Repository)

    Briggs, R

    2015-01-01

    In-hospital stroke (IS) made up 6.5% of strokes recorded in the Irish National Stroke Register in 2012. International research has demonstrated poorer outcomes post IS compared to out of hospital stroke (OS). We aimed to profile all IS and OS over a 22 month period and compare the two groups by gathering data from the HIPE portal stroke register. The study site is a primary stroke centre. IS represented 11% (50\\/458) of total strokes with over half (27\\/50, 54%) admitted initially with medical complaints. IS patients had a significantly longer length of stay (79.2 +\\/- 87.4 days vs. 21.9 +\\/- 45.9 days, p < 0.01) and higher mortality (13\\/50 vs. 39\\/408, p < 0.01). Patients in the IS group were also less likely to receive stroke unit care (1\\/50 vs. 136\\/408, p < 0.01). This study demonstrates the significant morbidity and mortality associated with IS and highlights the need for efforts to be made to optimize identification and management of acute stroke in this cohort.

  14. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

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

  15. Alteration in reactor installations (Unit 1 and 2 reactor facilities) in the Hamaoka Nuclear Power Station of The Chubu Electric Power Co., Inc. (report)

    International Nuclear Information System (INIS)

    1982-01-01

    A report by the Nuclear Safety Commission to the Ministry of International Trade and Industry concerning the alteration in Unit 1 and 2 reactor facilities in the Hamaoka Nuclear Power Station, Chubu Electric Power Co., Inc., was presented. The technical capabilities for the alteration of reactor facilities in Chubu Electric Power Co., Inc., were confirmed to be adequate. The safety of the reactor facilities after the alteration was confirmed to be adequate. The items of examination made for the confirmation of the safety are as follows: reactor core design (nuclear design, mechanical design, mixed reactor core), the analysis of abnormal transients in operation, the analysis of various accidents, the analysis of credible accidents for site evaluation. (Mori, K.)

  16. The prevalence of stroke and associated disability.

    Science.gov (United States)

    O'Mahony, P G; Thomson, R G; Dobson, R; Rodgers, H; James, O F

    1999-06-01

    There are limited data available on the prevalence of stroke in the United Kingdom. Such data are important for the assessment of the health needs of the population. This study aimed to determine the prevalence of stroke and the prevalence of associated dependence in a district of northern England. This was a two-stage point prevalence study. A valid screening questionnaire was used to identify stroke survivors from an age- and sex-stratified sample of the population aged 45 years and over in a family health services authority district. This was followed by assessment of stroke patients with scales of disability and handicap. The overall prevalence of stroke was found to be 17.5/1000 (95 per cent confidence interval (CI) 17.0, 18.0). The prevalence of stroke-associated dependence was 11.7/1000 (95 per cent CI 11.3, 12.1). Self-reported comorbidity was most commonly due to circulatory and musculoskeletal disorders. The prevalence of stroke in this district is considerably higher than current guidelines and previous results suggest. Nevertheless, the result from this study combined with that from a previous study in another district in the United Kingdom should allow those interested in epidemiologically based health needs assessment to make reasonable estimates of the burden of stroke in their area.

  17. A Review of Stroke Research in Malaysia from 2000 - 2014.

    Science.gov (United States)

    Cheah, W K; Hor, C P; Zariah, A A; Looi, I

    2016-06-01

    Over 100 articles related to stroke were found in a search through a database dedicated to indexing all literature with original data involving the Malaysian population between years 2000 and 2014. Stroke is emerging as a major public health problem. The development of the National Stroke Registry in the year 2009 aims to coordinate and improve stroke care, as well as to generate more data on various aspects of stroke in the country. Studies on predictors of survival after strokes have shown potential to improve the overall management of stroke, both during acute event and long term care. Stroke units were shown to be effective locally in stroke outcomes and prevention of stroke-related complications. The limited data looking at direct cost of stroke management suggests that the health economic burden in stroke management may be even higher. Innovative rehabilitation programmes including braincomputer interface technology were studied with encouraging results. Studies in traditional complementary medicine for strokes such as acupuncture, Urut Melayu and herbal medicine were still limited.

  18. Methods for developing seismic and extreme wind-hazard models for evaluating critical structures and equipment at US Department of Energy facilities and commercial plutonium facilities in the United States

    International Nuclear Information System (INIS)

    Coats, D.W.; Murray, R.C.; Bernreuter, D.L.

    1981-01-01

    Lawrence Livermore National Laboratory (LLNL) is developing seismic and wind hazard models for the US Department of Energy (DOE). The work is part of a three-phase effort to establish building design criteria developed with a uniform methodology for seismic and wind hazards at the various DOE sites throughout the United States. In Phase 1, LLNL gathered information on the sites and their critical facilities, including nuclear reactors, fuel-reprocessing plants, high-level waste storage and treatment facilities, and special nuclear material facilities. Phase 2 - development of seismic and wind hazard models - is discussed in this paper, which summarizes the methodologies used by seismic and extreme-wind experts and gives sample hazard curves for the first sites to be modeled. These hazard models express the annual probability that the site will experience an earthquake (or windspeed) greater than some specified magnitude. In the final phase, the DOE will use the hazards models and LLNL-recommended uniform design criteria to evaluate critical facilities. The methodology presented in this paper also was used for a related LLNL study - involving the seismic assessment of six commercial plutonium fabrication plants licensed by the US Nuclear Regulatory Commission (NRC). Details and results of this reassessment are documented in reference

  19. Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities.

    Science.gov (United States)

    Allegranzi, Benedetta; Conway, Laurie; Larson, Elaine; Pittet, Didier

    2014-03-01

    The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign. Copyright © 2014 World Health Organization. Published by Mosby, Inc. All rights reserved.

  20. Driving After a Stroke

    Science.gov (United States)

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

  1. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

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

    1999-01-01

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

  2. Stroke: Working toward a Prioritized World Agenda

    Science.gov (United States)

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

    2010-01-01

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

  3. Stroke: working toward a prioritized world agenda.

    Science.gov (United States)

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

    2010-01-01

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

  4. Stroke: working toward a prioritized world agenda.

    Science.gov (United States)

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

    2010-08-01

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

  5. Returning to paid employment after stroke: the Psychosocial Outcomes In StrokE (POISE cohort study.

    Directory of Open Access Journals (Sweden)

    Maree L Hackett

    Full Text Available OBJECTIVES: To determine which early modifiable factors are associated with younger stroke survivors' ability to return to paid work in a cohort study with 12-months of follow-up conducted in 20 stroke units in the Stroke Services NSW clinical network. PARTICIPANTS: Were aged >17 and <65 years, recent (within 28 days stroke, able to speak English sufficiently to respond to study questions, and able to provide written informed consent. Participants with language or cognitive impairment were eligible to participate if their proxy provided consent and completed assessments on the participants' behalf. The main outcome measure was return to paid work during the 12 months following stroke. RESULTS: Of 441 consented participants (average age 52 years, 68% male, 83% with ischemic stroke, 218 were in paid full-time and 53 in paid part-time work immediately before their stroke, of whom 202 (75% returned to paid part- or full-time work within 12 months. Being male, female without a prior activity restricting illness, younger, independent in activities of daily living (ADL at 28 days after stroke, and having private health insurance was associated with return to paid work, following adjustment for other illnesses and a history of depression before stroke (C statistic 0·81. Work stress and post stroke depression showed no such independent association. CONCLUSIONS: Given that independence in ADL is the strongest predictor of return to paid work within 12 months of stroke, these data reinforce the importance of reducing stroke-related disability and increasing independence for younger stroke survivors. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTRN 12608000459325.

  6. Basic characteristics of hospital stroke services in Eastern Hungary

    International Nuclear Information System (INIS)

    Mihalka, Laszlo; Fekete, Istvan; Csepany, Tuende; Csiba, Laszlo; Bereczki, Daniel

    1999-01-01

    Stroke mortality is extremely high in Central-Eastern European countries. We report basic characteristics of a stroke unit in Eastern Hungary, including age and sex distribution; the proportion of transient ischemic attacks (TIA), ischemic and hemorrhagic strokes; case fatality; application of diagnostic methods; and length of stay for all patients treated with acute cerebrovascular disease over a 12-month period. Records of all patients with acute cerebrovascular disease (n = 522) discharged in 1995 from a stroke unit with a well defined catchment area of 220,000 inhabitants in Eastern Hungary were retrospectively analyzed. Case fatality was 18.6% for all patients and 21.1% after excluding cases with TIA. Computer tomography, duplex carotid ultrasound, cerebrospinal fluid examination and electroencephalography were performed in 79%, 77%, 7% and 2% of the patients, respectively. The database of the university hospital with the same catchment area was electronically searched for patients who were discharged with the diagnosis of stroke from the three departments of internal medicine. Stroke mortality data of the catchment area based on death certificates was obtained from the Central Statistical Bureau. Two hundred twenty-eight stroke deaths were reported in the catchment area in 1995. In the same period 97 stroke deaths occurred at the stroke unit and 76 at the departments of internal medicine. If we aim to treat all patients with acute stroke at the stroke unit, with the present stroke incidence and duration of hospital stay the current capacity of the stroke unit (1 bed per 10.000 inhabitants) should be doubled

  7. Molecular detection of canine parvovirus in flies (Diptera) at open and closed canine facilities in the eastern United States.

    Science.gov (United States)

    Bagshaw, Clarence; Isdell, Allen E; Thiruvaiyaru, Dharma S; Brisbin, I Lehr; Sanchez, Susan

    2014-06-01

    More than thirty years have passed since canine parvovirus (CPV) emerged as a significant pathogen and it continues to pose a severe threat to world canine populations. Published information suggests that flies (Diptera) may play a role in spreading this virus; however, they have not been studied extensively and the degree of their involvement is not known. This investigation was directed toward evaluating the vector capacity of such flies and determining their potential role in the transmission and ecology of CPV. Molecular diagnostic methods were used in this cross-sectional study to detect the presence of CPV in flies trapped at thirty-eight canine facilities. The flies involved were identified as belonging to the house fly (Mucidae), flesh fly (Sarcophagidae) and blow/bottle fly (Calliphoridae) families. A primary surveillance location (PSL) was established at a canine facility in south-central South Carolina, USA, to identify fly-virus interaction within the canine facility environment. Flies trapped at this location were pooled monthly and assayed for CPV using polymerase chain reaction (PCR) methods. These insects were found to be positive for CPV every month from February through the end of November 2011. Fly vector behavior and seasonality were documented and potential environmental risk factors were evaluated. Statistical analyses were conducted to compare the mean numbers of each of the three fly families captured, and after determining fly CPV status (positive or negative), it was determined whether there were significant relationships between numbers of flies captured, seasonal numbers of CPV cases, temperature and rainfall. Flies were also sampled at thirty-seven additional canine facility surveillance locations (ASL) and at four non-canine animal industry locations serving as negative field controls. Canine facility risk factors were identified and evaluated. Statistical analyses were conducted on the number of CPV cases reported within the past year

  8. RCRA facility investigation/corrective measures study work plan for the 200-UP-2 Operable Unit, Hanford Site, Richland, Washington

    International Nuclear Information System (INIS)

    1993-06-01

    The 200-UP-2 Operable Unit is one of two source operable units at the U Plant Aggregate Area at the Hanford Site. Source operable units include waste management units and unplanned release sites that are potential sources of radioactive and/or hazardous substance contamination. This work plan, while maintaining the title RFI/CMS, presents the background and direction for conducting a limited field investigation in the 200-UP-2 Operable Unit, which is the first part of the process leading to final remedy selection. This report discusses the background, prior recommendations, goals, organization, and quality assurance for the 200-UP-2 Operable Unit Work Plan. The discussion begins with a summary of the regulatory framework and the role of the work plan. The specific recommendations leading into the work plan are then addressed. Next, the goals and organization of the report are discussed. Finally, the quality assurance and supporting documentation are presented

  9. RCRA Facility Investigation/Remedial Investigation Report for the Gunsite 113 Access Road Unit (631-24G) - March 1996

    Energy Technology Data Exchange (ETDEWEB)

    Palmer, E. [Westinghouse Savannah River Company, AIKEN, SC (United States)

    1996-03-01

    Gunsite 113 Access Road Unit is located in the northeast corner of SRS. In the mid 1980`s, sparse vegetation, dead trees, and small mounds of soil were discovered on a portion of the road leading to Gunsite 113. This area became the Gunsite 113 Access Road Unit (Gunsite 113). The unit appears to have been used as a spoil dirt and / or road construction debris disposal area. There is no documentation or record of any hazardous substance management, disposal, or any type of waste disposal at this unit. Based upon the available evidence, there are no potential contaminants of concern available for evaluation by a CERCLA baseline risk assessment. Therefore, there is no determinable health risk associated with Gunsite 113. In addition, it is also reasonable to conclude that, since contamination is below risk-based levels, the unit presents no significant ecological risk. It is recommended that no further remedial action be performed at this unit.

  10. RCRA Facility Investigation/Remedial Investigation Report for the Gunsite 113 Access Road Unit (631-24G) - March 1996

    International Nuclear Information System (INIS)

    Palmer, E.

    1996-03-01

    Gunsite 113 Access Road Unit is located in the northeast corner of SRS. In the mid 1980's, sparse vegetation, dead trees, and small mounds of soil were discovered on a portion of the road leading to Gunsite 113. This area became the Gunsite 113 Access Road Unit (Gunsite 113). The unit appears to have been used as a spoil dirt and / or road construction debris disposal area. There is no documentation or record of any hazardous substance management, disposal, or any type of waste disposal at this unit. Based upon the available evidence, there are no potential contaminants of concern available for evaluation by a CERCLA baseline risk assessment. Therefore, there is no determinable health risk associated with Gunsite 113. In addition, it is also reasonable to conclude that, since contamination is below risk-based levels, the unit presents no significant ecological risk. It is recommended that no further remedial action be performed at this unit

  11. Practices And Opinions On In-Center Food Consumption Across 1,223 Facilities In The United States

    Directory of Open Access Journals (Sweden)

    Deborah Benner

    2012-06-01

    The top reasons for facility practices that allowed eating during dialysis were: prevention of hypoglycemia on dialysis, improved kcal intake on dialysis days, and the opportunity to provide counseling on food products currently chosen by the patient. The top reasons for facility practices not permitting eating during dialysis included: potential adverse events associated with hypotension, GI symptoms, choking, infection, pest control, and spills. Further analyses are warranted to determine whether there is a correlation between allowing patients to eat during dialysis treatment and an improvement in the nutritional status of the patients.

  12. Regional variation in acute stroke care organisation.

    Science.gov (United States)

    Muñoz Venturelli, Paula; Robinson, Thompson; Lavados, Pablo M; Olavarría, Verónica V; Arima, Hisatomi; Billot, Laurent; Hackett, Maree L; Lim, Joyce Y; Middleton, Sandy; Pontes-Neto, Octavio; Peng, Bin; Cui, Liying; Song, Lily; Mead, Gillian; Watkins, Caroline; Lin, Ruey-Tay; Lee, Tsong-Hai; Pandian, Jeyaraj; de Silva, H Asita; Anderson, Craig S

    2016-12-15

    Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; Porganisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Nikolai Anatolyevich Shamalov

    2013-01-01

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

  14. United States national prevalence of electrocardiographic abnormalities in black and white middle-age (45- to 64-Year) and older (≥65-Year) adults (from the Reasons for Geographic and Racial Differences in Stroke Study).

    Science.gov (United States)

    Prineas, Ronald J; Le, Anh; Soliman, Elsayed Z; Zhang, Zhu-Ming; Howard, Virginia J; Ostchega, Yechiam; Howard, George

    2012-04-15

    A United States national sample of 20,962 participants (57% women, 44% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study provided general population estimates for electrocardiographic (ECG) abnormalities among black and white men and women. The participants were recruited from 2003 to 2007 by random selection from a commercially available nationwide list, with oversampling of blacks and those from the stroke belt, with a cooperation rate of 49%. The measurement of risk factors and 12-lead electrocardiograms (centrally coded using Minnesota code criteria) showed 28% had ≥1 major ECG abnormality. The prevalence of abnormalities was greater (≥35%) for those ≥65 years old, with no differences between blacks and whites. However, among men <65 years, blacks had more major abnormalities than whites, most notably for atrial fibrillation, major Q waves, and left ventricular hypertrophy. Men generally had more ECG abnormalities than women. The most common ECG abnormalities were T-wave abnormalities. The average heart rate-corrected QT interval was longer in women than in men, similar in whites and blacks, and increased with age. However, the average heart rate was greater in women than in men and in blacks than in whites and decreased with age. The prevalence of ECG abnormalities was related to the presence of hypertension, diabetes, blood pressure, and age. In conclusion, black men and women in the United States have a significantly greater prevalence of ECG abnormalities than white men and women at age 45 to 64 years; however, these proportions, although larger, tended to equalize or reverse after age 65. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. A Stroke Mimic: A Case Report

    Directory of Open Access Journals (Sweden)

    Annia Martínez Rivas

    2016-03-01

    Full Text Available Diseases mimicking a stroke are a major health problem for a large number of hospitals. This paper aims at presenting a disease that has a stroke-like presentation. The case of a 46-year-old man admitted to the stroke unit with a clinical and radiological diagnosis of cerebral infarction is presented. The patient developed fever and a serious deterioration of consciousness. Changes on computed tomography consistent with a brain abscess were observed. Broad-spectrum antibiotics were administered and a follow-up tomography was performed. Once the treatment was completed, the clinical and radiological suspicion of a brain abscess was confirmed.

  16. Treatment of Moderately Intellectually Disabled Delinquent Youth in a Dutch Juvenile Justice Facility with Closed and Open Units

    Science.gov (United States)

    Lodewijks, Henny P. B.

    2011-01-01

    This article will focus on a juvenile justice facility in the Netherlands, targeted at moderately intellectually disabled juveniles, who are sentenced because of serious crimes. All of the juveniles have a disruptive disorder (conduct disorder or oppositional defiant disorder) and 70% have comorbid psychiatric classifications. Treatment amounts to…

  17. 77 FR 11173 - Renewal of Facility Operating License No. NPF-30, Union Electric Company, Callaway Plant, Unit 1

    Science.gov (United States)

    2012-02-24

    ... . NRC's Agencywide Documents Access and Management System (ADAMS): You may access publicly-available... order to serve documents through the Electronic Information Exchange System, users will be required to... NUCLEAR REGULATORY COMMISSION [Docket No. 50-483; NRC-2012-0001] Renewal of Facility Operating...

  18. Professionals’ views on interprofessional stroke team functioning

    Directory of Open Access Journals (Sweden)

    Jane Murray Cramm

    2011-07-01

    Full Text Available Introduction: The quality of integrated stroke care depends on smooth team functioning but professionals may not always work well together. Professionals' perspectives on the factors that influence stroke team functioning remain largely unexamined. Understanding their experiences is critical to indentifying measures to improve team functioning. The aim of this study was to identify the factors that contributed to the success of interprofessional stroke teams as perceived by team members. Methods: We distributed questionnaires to professionals within 34 integrated stroke care teams at various health care facilities in 9 Dutch regions. 558 respondents (response rate: 39% completed the questionnaire. To account for the hierarchical structure of the study design we fitted a hierarchical random-effects model. The hierarchical structure comprised 558 stroke team members (level 1 nested in 34 teams (level 2. Results: Analyses showed that personal development, social well-being, interprofessional education, communication, and role understanding significantly contributed to stroke team functioning. Team-level constructs affecting interprofessional stroke team functioning were communication and role understanding. No significant relationships were found with individual-level personal autonomy and team-level cohesion. Discussion and conclusion: Our findings suggest that interventions to improve team members' social well-being, communication, and role understanding will improve teams' performance. To further advance interprofessional team functioning, healthcare organizations should pay attention to developing professionals' interpersonal skills and interprofessional education.       

  19. Professionals’ views on interprofessional stroke team functioning

    Directory of Open Access Journals (Sweden)

    Jane Murray Cramm

    2011-07-01

    Full Text Available Introduction: The quality of integrated stroke care depends on smooth team functioning but professionals may not always work well together. Professionals' perspectives on the factors that influence stroke team functioning remain largely unexamined. Understanding their experiences is critical to indentifying measures to improve team functioning. The aim of this study was to identify the factors that contributed to the success of interprofessional stroke teams as perceived by team members.  Methods: We distributed questionnaires to professionals within 34 integrated stroke care teams at various health care facilities in 9 Dutch regions. 558 respondents (response rate: 39% completed the questionnaire. To account for the hierarchical structure of the study design we fitted a hierarchical random-effects model. The hierarchical structure comprised 558 stroke team members (level 1 nested in 34 teams (level 2.  Results: Analyses showed that personal development, social well-being, interprofessional education, communication, and role understanding significantly contributed to stroke team functioning. Team-level constructs affecting interprofessional stroke team functioning were communication and role understanding. No significant relationships were found with individual-level personal autonomy and team-level cohesion.  Discussion and conclusion: Our findings suggest that interventions to improve team members' social well-being, communication, and role understanding will improve teams' performance. To further advance interprofessional team functioning, healthcare organizations should pay attention to developing professionals' interpersonal skills and interprofessional education.        

  20. Airplane stroke syndrome.

    Science.gov (United States)

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

    2016-07-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

  2. POST-CLOSURE INSPECTION REPORT FOR CORRECTIVE ACTION UNIT 92: AREA 6 DECON PAD FACILITY, NEVADA. TEST SITE NEVADA, FOR THE PERIOD JANUARY 2004 - DECEMBER 2004

    International Nuclear Information System (INIS)

    BECHTEL NEVADA

    2005-01-01

    This Post-Closure Inspection Report provides an analysis and summary of inspections for Corrective Action Unit (CAU) 92, Area 6 Decon Pond Facility, Nevada Test Site, Nevada. CAU 92 was closed in accordance with the Resource Conservation and Recovery Act (RCRA) Part B Operational Permit (Nevada Division of Environmental Protection, 1995) and the Federal Facility Agreement and Consent Order of 1996 on May 11, 1999. CAU 92 consists of two Corrective Action Sites (CASs): CAS 06-04-01, Decon Pad oil/Water Separator; and CAS 06-05-02, Decontamination Pond (RCRA). Both CASs have use restrictions; however, only CAS 06-05-02, Decontamination Pond (RCRA), requires post-closure inspections. CAS 06-04-01, Decon Pad Oil/Water Separator, is located inside the fence at the Building 6-605 compound. This report covers the annual period January 2004 through December 2004

  3. "FACILS 2014: Microbially-driven facilitation systems in environmental biotechnology" (hereafter "FACILS") presented here by the European Commission (EC)-United States (US) Task Force on Biotechnology Research

    Energy Technology Data Exchange (ETDEWEB)

    Methe, Barbara

    2016-02-03

    As we enter the 21st century, the sustainability of the biosphere is a global challenge that can best be met with a global response. This includes how we train and promote our next generation of research scientists in the emerging arenas of genome-enabled biology and a bio-based economy. It is this fundamental issue that formed the motivation for designing and conducting a shortcourse entitled “FACILIS 2014: Microbially-driven facilitation systems in environmental biotechnology” (hereafter “FACILIS”) presented here by the European Commission (EC)-United States (US) Task Force on Biotechnology Research. This WG was established in 1994 under the umbrella of the US-EC Task Force on Biotechnology Research, a transatlantic collaborative group overseen by the US Office of Science and Technology Policy (OSTP) and the EC. The Environmental Biotechnology Working Group maintains several goals, including establishing research links between scientists in EU countries and the US and fostering the careers of junior scientists from both sides of the Atlantic to the global nature of scientific cooperation. To that end, a shortcourse was held at the University of Milan in Italy on July 12-25 2014 organized around cross-cutting themes of genomic science and designed to attract a stellar group of interdisciplinary early carrier researchers. A total of 22 students, 10 from the US and 12 from the EU participated. The course provided them with hands-on experience with the latest scientific methods in genomics and bioinformatics; using a format that combines lectures, laboratory research and field work with the final goal to enable researchers to finally turn data into knowledge.

  4. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

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

  5. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, Peter Krogh; Husted, Steen; Damsgaard, Else Marie Skjøde

    2007-01-01

    focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. AIMS: To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery......INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have......, length of stay in hospital and infectious complications. SUBJECTS AND METHODS: 89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months...

  6. Performance assessment and licensing issues for United States commercial near-surface low-level radioactive waste disposal facilities

    International Nuclear Information System (INIS)

    Birk, S.M.

    1997-10-01

    The final objective of performance assessment for a near-surface LLW disposal facility is to demonstrate that potential radiological impacts for each of the human exposure pathways will not violate applicable standards. This involves determining potential pathways and specific receptor locations for human exposure to radionuclides; developing appropriate scenarios for each of the institutional phases of a disposal facility; and maintaining quality assurance and control of all data, computer codes, and documentation. The results of a performance assessment should be used to demonstrate that the expected impacts are expected to be less than the applicable standards. The results should not be used to try to predict the actual impact. This is an important distinction that results from the uncertainties inherent in performance assessment calculations. The paper discusses performance objectives; performance assessment phases; scenario selection; mathematical modeling and computer programs; final results of performance assessments submitted for license application; institutional control period; licensing issues; and related research and development activities

  7. A Spatial Hedonic Analysis of the Effects of Wind Energy Facilities on Surrounding Property Values in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Hoen, Ben [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Wiser, Ryan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Cappers, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Brown, Jason P. [Federal Reserve Bank of Kansas City, MO (United States); Jackson, Thomas [Real Analytics Inc. and Texas A & M Univ., College Station, TX (United States); Thayer, Mark A. [San Diego State Univ., CA (United States)

    2013-08-21

    This report summarizes a new analysis, building on previously published research, about wind energy’s effects on residential property values. This study helps fill research gaps by collecting and analyzing data from 27 counties across nine U.S. states, related to 67 different wind facilities, and constructs a pooled model that investigates average effects near the turbines across the sample while controlling for local variables, such as sale prices of nearby homes.

  8. Coordination Between Wind Power, Hydro Storage Facility and Conventional Generating Units According to the Annual Growth Load

    Directory of Open Access Journals (Sweden)

    Shahrokh Shojaeean

    2013-04-01

    Full Text Available Considering the growing trend of the consumption of the electric power and the global tendency to substitute new renewable sources of energy, this paper proposes a Monte Carlo based method to determine an optimal level of this change. Considering the limitation of the wind farms in continuous supply of electric power, hydrostatic power storage facilities are used beside wind farms so that the electric power could be stored and fed in a continuous flow into power systems. Due to the gradual exclusion of conventional generators and 5 percent annual load increments, LOLE index was used in order to calculate the amount of the wind power and the capacity of the necessary power storage facility. To this end, LOLE index was calculated for the first year as the reference index for the estimation of the amount of wind power and the capacity of the storage facility in consequent years. For the upcoming years, calculations have been made to account for the gradual exclusion of conventional generators in proportion to load increments. The proposed method has been implemented and simulated on IEEE-RTS test system.

  9. Geographic Region and Profit Status Drive Variation in Hospital Readmission Outcomes Among Inpatient Rehabilitation Facilities in the United States.

    Science.gov (United States)

    Daras, Laura Coots; Ingber, Melvin J; Deutsch, Anne; Hefele, Jennifer Gaudet; Perloff, Jennifer

    2017-12-22

    To examine whether there are differences in inpatient rehabilitation facilities' (IRFs') all-cause 30-day postdischarge hospital readmission rates vary by organizational characteristics and geographic regions. Observational study. IRFs. Medicare fee-for-service beneficiaries discharged from all IRFs nationally in 2013 and 2014 (N = 1166 IRFs). Not applicable. We applied specifications for an existing quality measure adopted by Centers for Medicare & Medicaid Services for public reporting that assesses all-cause unplanned hospital readmission measure for 30 days postdischarge from inpatient rehabilitation. We estimated facility-level observed and risk-standardized readmission rates and then examined variation by several organizational characteristics (facility type, profit status, teaching status, proportion of low-income patients, size) and geographic factors (rural/urban, census division, state). IRFs' mean risk-standardized hospital readmission rate was 13.00%±0.77%. After controlling for organizational characteristics and practice patterns, we found substantial variation in IRFs' readmission rates: for-profit IRFs had significantly higher readmission rates than did not-for-profit IRFs (Preadmission rates than did IRFs in New England that had the lowest rates. Our findings point to variation in quality of care as measured by risk-standardized hospital readmission rates after IRF discharge. Thus, monitoring of readmission outcomes is important to encourage quality improvement in discharge care planning, care transitions, and follow-up. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  10. Concept of Six Stroke Engine

    OpenAIRE

    P.Naresh

    2015-01-01

    One of the most difficult challenges in engine technology today is the urgent need to increase engine thermal efficiency. Higher efficiencies mean less fuel consumption and lower atmospheric emissions per unit of work produced by the engine. In 1862 a Frenchman Alphouse Beau de Rochas gives his theory regarding the ideal cycle of the internal combustion engine. This theory is applied by a German engineer named Nikolaus A. Otto, who firstly built a successful four-stroke SI engine in 1876. The...

  11. A Case for Telestroke in Military Medicine: A Retrospective Analysis of Stroke Cost and Outcomes in U.S. Military Health-Care System.

    Science.gov (United States)

    Dave, Ajal; Cagniart, Kendra; Holtkamp, Matthew D

    2018-06-07

    The development of primary stroke centers has improved outcomes for stroke patients. Telestroke networks have expanded the reach of stroke experts to underserved, geographically remote areas. This study illustrates the outcome and cost differences between neurology and primary care ischemic stroke admissions to demonstrate a need for telestroke networks within the Military Health System (MHS). All adult admissions with a primary diagnosis of ischemic stroke in the MHS Military Mart database from calendar years 2010 to 2015 were reviewed. Neurology, primary care, and intensive care unit (ICU) admissions were compared across primary outcomes of (1) disposition status and (2) intravenous tissue plasminogen activator administration and for secondary outcomes of (1) total cost of hospitalization and (2) length of stay (LOS). A total of 3623 admissions met the study's parameters. The composition was neurology 462 (12.8%), primary care 2324 (64.1%), ICU 677 (18.7%), and other/unknown 160 (4.4%). Almost all neurology admissions (97%) were at the 3 neurology training programs, whereas a strong majority of primary care admissions (80%) were at hospitals without a neurology admitting service. Hospitals without a neurology admitting service had more discharges to rehabilitation facilities and higher rates of in-hospital mortality. LOS was also longer in primary care admissions. Ischemic stroke admissions to neurology had better outcomes and decreased LOS when compared to primary care within the MHS. This demonstrates a possible gap in care. Implementation of a hub and spoke telestroke model is a potential solution. Published by Elsevier Inc.

  12. Brain Basics: Preventing Stroke

    Science.gov (United States)

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

  13. Stroke Warning Signs

    Science.gov (United States)

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

  14. [Genetics of ischemic stroke].

    Science.gov (United States)

    Gschwendtner, A; Dichgans, M

    2013-02-01

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

  15. The economic costs and benefits of potassium iodide prophylaxis for a reference LWR facility in the United States

    International Nuclear Information System (INIS)

    Behling, U.H.; Behling, K.

    1995-01-01

    Policy decisions relating to radiation protection are commonly based on an evaluation in which the benefits of exposure reduction are compared to the economic costs of the protective measure. A generic difficulty countered in cost-benefit analyses, however, is the quantification of major elements that define the costs and the benefits in commensurate units. In this study, the costs of making KI (potassium iodine) available for public use and the avoidance of thyroidal health effects (i.e., the benefit) in the event of nuclear emergency are defined in the commensurate units of dollars. (Authors). 11 refs., 15 tabs

  16. A real-time material control concept for safeguarding special nuclear material in United States licensed processing facilities

    International Nuclear Information System (INIS)

    Shea, T.E.

    1976-01-01

    This paper describes general safeguards research being undertaken by the United States Nuclear Regulatory Commission. Efforts to improve the ability of United States licensed plants to contend with the perceived threat of covert material theft are emphasized. The framework for this improvement is to break down the internal control and accounting system into subsystems to achieve material isolation, inventory control, inventory characterization, and inventory containment analysis. A general programme is outlined to develop and evaluate appropriate mechanisms, integrate selected mechanisms into subsystems, and evaluate the subsystems in the context of policy requirements. (author)

  17. Neutron research on condensed matter: a study of the facilities and scientific opportunities in the United States

    International Nuclear Information System (INIS)

    1977-01-01

    An in-depth review of the present status and future potential of the applications of low-energy neutron scattering to research in the condensed-matter sciences, including physics, chemistry, biology, and metallurgy is presented. The study shows that neutron scattering technology has proven to be of enormous importance to research in the above areas and especially to those of solid-state physics and chemistry. The main emphasis is on the scattering of low-energy neutrons by condensed matter. Since the same type of neutron source facilities can be used for the study of radiation damage, this related topic has also been included

  18. Patient knowledge on stroke risk factors, symptoms and treatment options.

    Science.gov (United States)

    Faiz, Kashif Waqar; Sundseth, Antje; Thommessen, Bente; Rønning, Ole Morten

    2018-01-01

    Public campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients. This prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway. Patients with previous cerebrovascular disease, patients receiving thrombolytic treatment and patients who were not able to answer the questions in the questionnaire were excluded. Patients were asked two closed-ended questions: "Do you believe that stroke is a serious disorder?" and "Do you believe that time is of importance for stroke treatment?". In addition, patients were asked three open-ended questions where they were asked to list as many stroke risk factors, stroke symptoms and stroke treatment options as they could. A total of 173 patients were included, of whom 158 (91.3%) confirmed that they regarded stroke as a serious disorder and 148 patients (85.5%) considered time being of importance. In all, 102 patients (59.0%) could not name any treatment option. Forty-one patients (23.7%) named one or more adequate treatment options, and they were younger ( p options, which may contribute to reduce prehospital delay and onset-to-treatment-time.

  19. National Solar Thermal Test Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The National Solar Thermal Test Facility (NSTTF) is the only test facility in the United States of its type. This unique facility provides experimental engineering...

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

    OpenAIRE

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

    2004-01-01

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

  1. United Kingdom. Development plan for the eventual closure of the UK Drigg nuclear surface low level waste disposal facility

    International Nuclear Information System (INIS)

    2001-01-01

    The Drigg site, owned and operated by BNFL, is the UK's principal site for the disposal of low level radioactive waste. The site has operated since 1959 and receives wastes from a wide range of sources including nuclear power stations, nuclear fuel cycle facilities, isotope manufacturing sites, universities, general industry and cleanup of historically contaminated sites. Disposals until the late 1980s were solely by tipping essentially loose wastes into excavated trenches. More recently, trench disposals have been phased out in preference to emplacement of containerised, conditioned wastes in concrete vaults. The standardised wasteform consists of high force compacted (or non-compactable) waste immobilised within 20 m 3 steel overpack containers by the addition of cementitious grout. Larger items of wastes are grouted directly, in situ in the vault. The disposal trenches have been completed with an interim cap, as will the vaults when filled. It is currently estimated that sufficient capacity remains at Drigg for disposals to continue until at least 2050. Post-operations it is planned that the site will enter a phase including shut down of operational facilities, emplacement of long term site closure features including a final closure cap and then to an institutional management phase. Planning has therefore been carried out as to the strategy for eventual closure of the site. This closure strategy is also underpinned by an engineering evaluation studies programme to develop and evaluate appropriate closure measures including assessment of the long term performance of such measures. This appendix summarizes some of this work

  2. Developing a Signature Based Safeguards Approach for the Electrorefiner and Salt Cleanup Unit Operations in Pyroprocessing Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, Chantell Lynne-Marie [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-01-27

    Traditional nuclear materials accounting does not work well for safeguards when applied to pyroprocessing. Alternate methods such as Signature Based Safeguards (SBS) are being investigated. The goal of SBS is real-time/near-real-time detection of anomalous events in the pyroprocessing facility as they could indicate loss of special nuclear material. In high-throughput reprocessing facilities, metric tons of separated material are processed that must be accounted for. Even with very low uncertainties of accountancy measurements (<0.1%) the uncertainty of the material balances is still greater than the desired level. Novel contributions of this work are as follows: (1) significant enhancement of SBS development for the salt cleanup process by creating a new gas sparging process model, selecting sensors to monitor normal operation, identifying safeguards-significant off-normal scenarios, and simulating those off-normal events and generating sensor output; (2) further enhancement of SBS development for the electrorefiner by simulating off-normal events caused by changes in salt concentration and identifying which conditions lead to Pu and Cm not tracking throughout the rest of the system; and (3) new contribution in applying statistical techniques to analyze the signatures gained from these two models to help draw real-time conclusions on anomalous events.

  3. Aspirin resistance are associated with long-term recurrent stroke events after ischaemic stroke.

    Science.gov (United States)

    Zhang, Ning; Wang, Zhenhua; Zhou, Lihong

    2017-09-01

    To investigate the prevalent of aspirin resistance (AR) in stroke and its association with recurrent stroke in 214 patients with ischemic stroke who were receiving aspirin before the stroke onset. Two hundreds and fourteen acute stroke patients who previously received aspirin therapy (100mg/day for ≥7days) were enrolled. Whole blood samples were collected for platelet aggregation testing. The result is expressed in aspirin reaction units (ARU). A cutoff of 550 ARU was used to determine the presence of AR. A follow-up period of 1year was performed to record stroke recurrence events. In this study, the median age was 68 years (IQR, 60-77 years), and 118 (55.1%) were men. A total of 43 of 214 enrolled patients (20.1%) were AR. ARU levels were significantly higher in patients with recurrence than those without (514[IQR: 466-592] vs. 454[IQR: 411-499]; P <0.001). The stroke recurrence distribution across the ARU quartiles ranged between 7.41% (first quartile) to 40.74% (fourth quartile). In multivariate analyses, the 3th and 4th quartile of ARU was significantly associated with stroke recurrence during the observation period compared to the 1st quartile group, and the adjusted risk increased by 215% (OR=3.15 [95% CI 1.96-4.33], P=0.007) and 322% (4.22[2.56-7.16], P<0.001). In multivariate logistic regression analysis, AR was associated with a higher risk of stroke recurrence, and the adjusted risk increased by 365% (OR=4.65; 95% CI=2.99-8.16; P<0.001). In conclusion, AR is not uncommon in Chinese stroke patients who receive anti-platelet medications. Patients with AR may have a greater risk of suffering stroke recurrence events. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  5. Neuroserpin polymorphisms and stroke risk in a biracial population: the stroke prevention in young women study

    Directory of Open Access Journals (Sweden)

    Stern Barney J

    2007-10-01

    Full Text Available Abstract Background Neuroserpin, primarily localized to CNS neurons, inhibits the adverse effects of tissue-type plasminogen activator (tPA on the neurovascular unit and has neuroprotective effects in animal models of ischemic stroke. We sought to evaluate the association of neuroserpin polymorphisms with risk for ischemic stroke among young women. Methods A population-based case-control study of stroke among women aged 15–49 identified 224 cases of first ischemic stroke (47.3% African-American and 211 age-matched control subjects (43.1% African-American. Neuroserpin single nucleotide polymorphisms (SNPs chosen through HapMap were genotyped in the study population and assessed for association with stroke. Results Of the five SNPs analyzed, the A allele (frequency; Caucasian = 0.56, African-American = 0.42 of SNP rs6797312 located in intron 1 was associated with stroke in an age-adjusted dominant model (AA and AT vs. TT among Caucasians (OR = 2.05, p = 0.023 but not African-Americans (OR = 0.71, p = 0.387. Models adjusting for other risk factors strengthened the association. Race-specific haplotype analyses, inclusive of SNP rs6797312, again demonstrated significant associations with stroke among Caucasians only. Conclusion This study provides the first evidence that neuroserpin is associated with early-onset ischemic stroke among Caucasian women.

  6. The Texts of the Agreements for the Application of Agency Safeguards to the Bradwell Reactor Facility in the United Kingdom

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1966-09-23

    The texts of the Agreement between the Agency and the Government of the United Kingdom of Great Britain and Northern Ireland for the application of safeguards with regard to the Bradwell Nuclear Power Station, and of the Supplementary Agreement thereto, which were signed on 20 June 1966 and entered into force on 1 September 1966, are reproduced in this document for the information of all Members.

  7. Ensuring radiation safety during construction of the facility ''Ukrytie'' and restoration of unit 3 of the Chernobyl nuclear power station

    International Nuclear Information System (INIS)

    Belovodsky, L.F.; Panfilov, A.P.

    1997-01-01

    On April 26, 1986, an accident at the fourth power unit of the Chernobyl NPS (ChNPS) destroyed the reactor core and part of the power unit building, whereby sizeable amounts of radioactive materials, stored in reactor at operation, were released into the environment, and there were also highly active fragments of fuel elements and pieces of graphite from reactor spread on ChNPS site near to safety block. Information on the accident at ChNPS, including its cause and consequences, was considered at special meeting, conducted by IAEA on August 25-29, 1986, in Vienna. In final report of International Advisory Group for Nuclear Safety (IAGNS), prepared by results of meeting activities, the main stages of the accident effects elimination (AEE) immediately on the station site according to the data, received before August 1, 1986, were discussed. In 1987-1990 the published materials on the later period of AEE, completed by building ''Ukrytie'' installation at the fourth power unit of ChNPS

  8. Nasal Bubble CPAP: One Year Experience in a Neonatal Unit of a Tertiary Health Facility in Northwestern Nigeria.

    Science.gov (United States)

    Abdulkadir, I; Hassan, L; Abdullahi, F; Purdue, S; Ogala, W N

    2015-03-01

    Nasal bubble continuous positive airway pressure (NBCPAP) respiratory support, though decades old, is beginning to gain popularity in developing countries including Nigeria. We reviewed neonates who benefitted from NBCPAP, to describe the demographics and outcome of NBCPAP respiratory support in newborns admitted to the neonatal unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, over a one year period. The study is a descriptive observational review of all neonates who required NBCPAP respiratory support in the neonatal unit of ABUTH Zaria. Data was extracted from a specifically designed proforma used to obtain information on each neonate throughout the period of admission. Twenty babies received NBCPAP respiratory support during the period of study. Seventeen (85%) of the neonates were successfully weaned off CPAP while three (15%) failed CPAP. Three neonates developed complications with two having CPAP belly syndrome and the third had facial swelling which resolved spontaneously after 6 hours. Overall, seven (41%) of the neonates who were successfully weaned off CPAP were discharged home. MajorityofnewbornswhorequirerespiratorysupportwillbenefitfromNBCPAP therefore, this method of respiratory support should be popularized and neonatal units in the country should be supported to efficiently offer the service.

  9. Closure Report for Corrective Action Unit 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada, Revision 0

    International Nuclear Information System (INIS)

    Mark Burmeister

    2007-01-01

    This CR provides documentation and justification for the closure of CAU 118 without further corrective action. This justification is based on process knowledge and the results of the investigative and closure activities conducted in accordance with the CAU 118 SAFER Plan: Streamlined Approach for Environmental Restoration (SAFER) Plan for CAU 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada (NNSA/NSO, 2006). The SAFER Plan provides information relating to site history as well as the scope and planning of the investigation. This CR also provides the analytical and radiological survey data to confirm that the remediation goals were met as specified in the CAU 118 SAFER Plan (NNSA/NSO, 2006). The Nevada Division of Environmental Protection (NDEP) approved the CAU 118 SAFER Plan (Murphy, 2006), which recommends closure in place with use restrictions (URs)

  10. Seizure development after stroke.

    Science.gov (United States)

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

    2006-12-01

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

  11. Registration of acute stroke

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  12. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Jauch, Edward C; Saver, Jeffrey L; Adams, Harold P; Bruno, Askiel; Connors, J J Buddy; Demaerschalk, Bart M; Khatri, Pooja; McMullan, Paul W; Qureshi, Adnan I; Rosenfield, Kenneth; Scott, Phillip A; Summers, Debbie R; Wang, David Z; Wintermark, Max; Yonas, Howard

    2013-03-01

    The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.

  13. Benefits of aerobic exercise after stroke.

    Science.gov (United States)

    Potempa, K; Braun, L T; Tinknell, T; Popovich, J

    1996-05-01

    The debilitating loss of function after a stroke has both primary and secondary effects on sensorimotor function. Primary effects include paresis, paralysis, spasticity, and sensory-perceptual dysfunction due to upper motor neuron damage. Secondary effects, contractures and disuse muscle atrophy, are also debilitating. This paper presents theoretical and empirical benefits of aerobic exercise after stroke, issues relevant to measuring peak capacity, exercise training protocols, and the clinical use of aerobic exercise in this patient population. A stroke, and resulting hemiparesis, produces physiological changes in muscle fibres and muscle metabolism during exercise. These changes, along with comorbid cardiovascular disease, must be considered when exercising stroke patients. While few studies have measured peak exercise capacity in hemiparetic populations, it has been consistently observed in these studies that stroke patients have a lower functional capacity than healthy populations. Hemiparetic patients have low peak exercise responses probably due to a reduced number of motor units available for recruitment during dynamic exercise, the reduced oxidative capacity of paretic muscle, and decreased overall endurance. Consequently, traditional methods to predict aerobic capacity are not appropriate for use with stroke patients. Endurance exercise training is increasingly recognised as an important component in rehabilitation. An average improvement in maximal oxygen consumption (VO2max) of 13.3% in stroke patients who participated in a 10-week aerobic exercise training programme has been reported compared with controls. This study underscored the potential benefits of aerobic exercise training in stroke patients. In this paper, advantages and disadvantages of exercise modalities are discussed in relation to stroke patients. Recommendations are presented to maximise physical performance and minimise potential cardiac risks during exercise.

  14. Clinical Outcomes among Transferred Children with Ischemic and Hemorrhagic Strokes in the Nationwide Inpatient Sample.

    Science.gov (United States)

    Adil, Malik M; Vidal, Gabriel A; Beslow, Lauren A

    2016-11-01

    Children with ischemic stroke (IS) and hemorrhagic stroke (HS) may require interfacility transfer for higher level of care. We compared the characteristics and clinical outcomes of transferred and nontransferred children with IS and HS. Children aged 1-18 years admitted to hospitals in the United States from 2008 to 2011 with a primary discharge diagnosis of IS and HS were identified from the National Inpatient Sample database by ICD-9 codes. Using logistic regression, we estimated the odds ratios (OR) and 95% confidence intervals (CI) for in-hospital mortality and discharge to nursing facilities (versus discharge home) between transferred and nontransferred patients. Of the 2815 children with IS, 26.7% were transferred. In-hospital mortality and discharge to nursing facilities were not different between transferred and nontransferred children in univariable analysis or in multivariable analysis that adjusted for age, sex, and confounding factors. Of the 6879 children with HS, 27.1% were transferred. Transferred compared to nontransferred children had higher rates of both in-hospital mortality (8% versus 4%, P = .003) and discharge to nursing facilities (25% versus 20%, P = .03). After adjusting for age, sex, and confounding factors, in-hospital mortality (OR 1.5, 95% CI 1.1-2.4, P = .04) remained higher in transferred children, whereas discharge to nursing facilities was not different between the groups. HS but not IS was associated with worse outcomes for children transferred to another hospital compared to children who were not transferred. Additional study is needed to understand what factors may contribute to poorer outcomes among transferred children with HS. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Defense Waste Processing Facility (DWPF), Modular CSSX Unit (CSSX), and Waste Transfer Line System of Salt Processing Program (U)

    International Nuclear Information System (INIS)

    CHANG, ROBERT

    2006-01-01

    All of the waste streams from ARP, MCU, and SWPF processes will be sent to DWPF for vitrification. The impact these new waste streams will have on DWPF's ability to meet its canister production goal and its ability to support the Salt Processing Program (ARP, MCU, and SWPF) throughput needed to be evaluated. DWPF Engineering and Operations requested OBU Systems Engineering to evaluate DWPF operations and determine how the process could be optimized. The ultimate goal will be to evaluate all of the Liquid Radioactive Waste (LRW) System by developing process modules to cover all facilities/projects which are relevant to the LRW Program and to link the modules together to: (1) study the interfaces issues, (2) identify bottlenecks, and (3) determine the most cost effective way to eliminate them. The results from the evaluation can be used to assist DWPF in identifying improvement opportunities, to assist CBU in LRW strategic planning/tank space management, and to determine the project completion date for the Salt Processing Program

  16. CLOSURE REPORT FOR CORRECTIVE ACTION UNIT 115: AREA 25 TEST CELL A FACILITY, NEVADA TEST SITE, NEVADA

    International Nuclear Information System (INIS)

    2006-01-01

    This Closure Report (CR) describes the activities performed to close CAU 115, Area 25 Test Cell A Facility, as presented in the NDEP-approved SAFER Plan (NNSA/NSO, 2004). The SAFER Plan includes a summary of the site history, process knowledge, and closure standards. This CR provides a summary of the completed closure activities, documentation of waste disposal, and analytical and radiological data to confirm that the remediation goals were met and to document final site conditions. The approved closure alternative as presented in the SAFER Plan for CAU 115 (NNSA/NSO, 2004) was clean closure; however, closure in place was implemented under a Record of Technical Change (ROTC) to the SAFER Plan when radiological surveys indicated that the concrete reactor pad was radiologically activated and could not be decontaminated to meet free release levels. The ROTC is included as Appendix G of this report. The objectives of closure were to remove any trapped residual liquids and gases, dispose regulated and hazardous waste, decontaminate removable radiological contamination, demolish and dispose aboveground structures, remove the dewar as a best management practice (BMP), and characterize and restrict access to all remaining radiological contamination. Radiological contaminants of concern (COCs) included cobalt-60, cesium-137, strontium-90, uranium-234/235/236/238, and plutonium-239/240. Additional COCs included Resource Conservation and Recovery Act (RCRA) metals, polychlorinated biphenyls (PCBs), and asbestos

  17. Stroke And Substance Abuse

    Directory of Open Access Journals (Sweden)

    A Chitsaz

    2017-02-01

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

  18. Stroke in Commercial Flights.

    Science.gov (United States)

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

    2016-04-01

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

  19. The Importance of Patient Involvement in Stroke Rehabilitation

    DEFF Research Database (Denmark)

    Kristensen, Hanne Kaae; Tistad, Malin; Koch, Lena von

    2016-01-01

    OBJECTIVE: To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. METHOD: Data...... was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess....... CONCLUSIONS: The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs....

  20. Evaluation of nuclear facility decommissioning projects. Three Mile Island Unit 2. Radioactive waste and laundry shipments. Volume 9. Summary status report

    International Nuclear Information System (INIS)

    Doerge, D.H.; Miller, R.L.; Scotti, K.S.

    1986-05-01

    This document summarizes information concerning radioactive waste and laundry shipments from the Three Mile Island Nuclear Station Unit 2 to radioactive waste disposal sites and to protective clothing decontamination facilities (laundries) since the loss of coolant accident experienced on March 28, 1979. Data were collected from radioactive shipment records, summarized, and placed in a computerized data information retrieval/manipulation system which permits extraction of specific information. This report covers the period of April 9, 1979 to May 5, 1985. Included in this report are: waste disposal site locations, dose rates, curie content, waste description, container type and number, volumes and weights. This information is presented in two major categories: protective clothing (laundry) and radioactive waste. Each of the waste shipment reports is in chronological order

  1. Large sample NAA of a pottery replica utilizing thermal neutron flux at AHWR critical facility and X-Z rotary scanning unit

    International Nuclear Information System (INIS)

    Acharya, R.; Dasari, K.B.; Pujari, P.K.; Swain, K.K.; Shinde, A.D.; Reddy, A.V.R.

    2013-01-01

    Large sample neutron activation analysis (LSNAA) of a clay pottery replica from Peru was carried out using low neutron flux graphite reflector position of Advanced Heavy Water Reactor (AHWR) critical facility. This work was taken up as a part of inter-comparison exercise under IAEA CRP on LSNAA of archaeological objects. Irradiated large size sample, placed on an X-Z rotary scanning unit, was assayed using a 40% relative efficiency HPGe detector. The k 0 -based internal monostandard NAA (IM-NAA) in conjunction with insitu relative detection efficiency was used to calculate concentration ratios of 12 elements with respect to Na. Analyses of both small and large size samples were carried out to check homogeneity and to arrive at absolute concentrations. (author)

  2. Design and operational considerations of United States commercial near-surface low-level radioactive waste disposal facilities

    International Nuclear Information System (INIS)

    Birk, S.M.

    1997-10-01

    In accordance with the Low-Level Radioactive Waste Policy Amendments Act of 1985, states are responsible for providing for disposal of commercially generated low-level radioactive waste (LLW) within their borders. LLW in the US is defined as all radioactive waste that is not classified as spent nuclear fuel, high-level radioactive waste, transuranic waste, or by-product material resulting from the extraction of uranium from ore. Commercial waste includes LLW generated by hospitals, universities, industry, pharmaceutical companies, and power utilities. LLW generated by the country''s defense operations is the responsibility of the Federal government and its agency, the Department of Energy. The commercial LLRW disposal sites discussed in this report are located near: Sheffield, Illinois (closed); Maxey Flats, Kentucky (closed); Beatty, Nevada (closed); West Valley, New York (closed); Barnwell, South Carolina (operating); Richland, Washington (operating); Ward Valley, California, (proposed); Sierra Blanca, Texas (proposed); Wake County, North Carolina (proposed); and Boyd County, Nebraska (proposed). While some comparisons between the sites described in this report are appropriate, this must be done with caution. In addition to differences in climate and geology between sites, LLW facilities in the past were not designed and operated to today''s standards. This report summarizes each site''s design and operational considerations for near-surface disposal of low-level radioactive waste. The report includes: a description of waste characteristics; design and operational features; post closure measures and plans; cost and duration of site characterization, construction, and operation; recent related R and D activities for LLW treatment and disposal; and the status of the LLW system in the US

  3. POST-CLOSURE INSPECTION REPORT FOR CORRECTIVE ACTION UNIT 92: AREA 6 DECON POND FACILITY, NEVADA TEST SITE, NEVADA FOR CALENDAR YEAR 2005

    International Nuclear Information System (INIS)

    2006-01-01

    This Post-Closure Inspection Report provides an analysis and summary of inspections for Corrective Action Unit (CAU) 92, Area 6 Decon Pond Facility, Nevada Test Site, Nevada. CAU 92 was closed in accordance with the Resource Conservation and Recovery Act (RCRA) Part B Operational Permit (Nevada Division of Environmental Protection (NDEP), 1995) and the Federal Facility Agreement and Consent Order of 1996. Closure activities were completed on February 16, 1999, and the Closure Report (U.S. Department of Energy, Nevada Operations Office, 1999) was approved and a Notice of Completion issued by the NDEP on May 11, 1999. CAU 92 consists of two Corrective Action Sites (CASs): CAS 06-04-01, Decon Pad Oil/Water Separator; and CAS 06-05-02, Decontamination Pond (RCRA). Both CASs have use restrictions; however, only CAS 06-05-02 requires post-closure inspections. Visual inspections of the cover and fencing at CAS 06-05-02 are performed quarterly. Additional inspections are conducted if precipitation occurs in excess of 1.28 centimeters (cm) (0.50 inches [in]) in a 24-hour period. This report covers calendar year 2005. Quarterly site inspections were performed in March, June, September, and December of 2005. All observations indicated the continued integrity of the unit. No issues or concerns were noted, and no corrective actions were necessary. Copies of the inspection checklists and field notes completed during each inspection are included in Appendix A. Five additional inspections were performed after precipitation events that exceeded 1.28 cm (0.50 in) within a 24-hour period during 2005. No significant changes in site conditions were noted during these inspections, and no corrective actions were necessary. Copies of the inspection checklists and field notes completed during each inspection are included in Appendix A. Precipitation records for 2005 are included in Appendix C

  4. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener

    2005-03-01

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

  5. Manual and oral apraxia in acute stroke, frequency and influence on functional outcome: The Copenhagen Stroke Study.

    Science.gov (United States)

    Pedersen, P M; Jørgensen, H S; Kammersgaard, L P; Nakayama, H; Raaschou, H O; Olsen, T S

    2001-09-01

    To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome. Seven hundred seventy six unselected, acute stroke patients who were admitted within seven days of stroke onset with unimpaired consciousness were included. If possible, the patients were assessed for manual and oral apraxia on acute admission. Neurologic stroke severity including aphasia was assessed with the Scandinavian Stroke Scale, and activities of daily living function was assessed with the Barthel Index. All patients completed their rehabilitation in the same large stroke unit. Six hundred eighteen patients could cooperate with the apraxia assessments. Manual apraxia was found in 7% of subjects (10% in left and 4% in right hemispheric stroke; chi2 = 9.0; P = 0.003). Oral apraxia was found in 6% (9% in left and 4% in right hemispheric stroke; chi2 = 5.4; P = 0.02). Both manual and oral apraxia were related to increasing stroke severity, and manual, but not oral, apraxia was associated with increasing age. There was no gender difference in frequency of apraxia. Patients with either type of apraxia had temporal lobe involvement more often than patients without. When analyzed with multiple linear and logistic regression analyses, neither manual nor oral apraxia had any independent influence on functional outcome. Apraxia is significantly less frequent in unselected patients with acute stroke than has previously been assumed and has no independent negative influence on functional outcome.

  6. MEMORY SONGS DECREASE DEPRESSION FOR STROKE PATIENTS

    Directory of Open Access Journals (Sweden)

    Harmayetty Harmayetty

    2017-07-01

    Full Text Available Introduction: Biological, physical and phsycosocial changes in stroke patient could be a stressor that induced a depression state. There would be an emotional disturbance in stroke patient and stroke attack would be recurrent, if it was not treated. One of the alternative techniques to reduce depression is musical therapy especially memory songs. Method: This study was used a quasy experimental pre-post test purposive sampling design. The population was stroke patients who treated in Neurological Ward A and Stroke Unit Dr Soetomo Hospital Surabaya. There were 12 respondents divided into 6 respondents for treatment group and 6 respondents for control group. The independent variable was music (memory song and dependent variable was depression. Data were collected by using questionnaire which adapted from Hamilton Depression Rating Scale and Geriatric Depression Rating Scale, then analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U Test with significance level α≤0.05. Result: The result showed that there was a difference between pre test and post test in depression (p=0.0196 and there was a difference in the depression between treatment group and control group (p=0.002. Discussion: It can be concluded that music (memory songs has an effect to the depression of stroke patient. Further studies are needed to concerning other factors that may affect the relaxation technique especially in listening music.

  7. The ecological impacts of primary education facilities based on a child-friendly neighborhood unit criteria in Surakarta

    Science.gov (United States)

    Rini, E. F.; Putri, R. A.; Mulyanto; Handayani, N.

    2018-03-01

    A city should accommodate the citizen needs, especially for children. The absence of elementary school in a neighborhood unit (NU) will increase the use of transportation by children in the NU, every day at the same time. This activity will produce large quantities of - carbon dioxide (CO2) that can trigger climate change. This article aims at discovering the ecological impacts of CO2 emitted from the transportation used by children when commuting to their school, based on the conformity of each NU to the criteria of the a child-friendly city. Quantitative and spatial analysis techniques were employed in these four stages: (1) dividing the NU; (2) constructing the NU’s typology based on a child-friendly criteria; (3) identifying the characteristic of children movements in each NU when accessing their elementary school; and (4) analyzing the ecological impacts (in CO2 form). The result shows that 88.14% of CO2 emissions in Surakarta can be reduced by interventions through the fulfillment of all NU’s child-friendly criterias.

  8. Evaluation of nuclear facility decommissioning projects. Three Mile Island Unit 2 reactor building decontamination. Summary status report. Volume 2

    International Nuclear Information System (INIS)

    Doerge, D.H.; Miller, R.L.; Scotti, K.S.

    1986-05-01

    This document summarizes information relating to decontamination of the Three Mile Island Unit 2 (TMI-2) reactor building. The report covers activities for the period of June 1, 1979 through March 29, 1985. The data collected from activity reports, reactor containment entry records, and other sources were entered into a computerized data system which permits extraction/manipulation of specific information which can be used in planning for recovery from an accident similar to that experienced at TMI-2 on March 28, 1979. This report contains summaries of man-hours, manpower, and radiation exposures incurred during decontamination of the reactor building. Support activities conducted outside of radiation areas are excluded from the scope of this report. Computerized reports included in this document are: a chronological summary listing work performed relating to reactor building decontamination for the period specified; and summary reports for each major task during the period. Each task summary is listed in chronological order for zone entry and subtotaled for the number of personnel entries, exposures, and man-hours. Manually-assembled table summaries are included for: labor and exposures by department and labor and exposures by major activity

  9. Early management and outcome of acute stroke in Auckland

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, N.E. [Auckland Hospital, Auckland, (New Zealand); Bonita, R.; Broad, J.B. [University of Auckland, Auckland, (New Zealand). Faculty of Medicine and Health Science

    1997-10-01

    Studies of acute stroke management in stroke units and tertiary referral hospitals may not accurately reflect practice within the population. Reliable information on the management of stroke within a population is sparse. The aims of this study was to compare clinical practice in acute stroke management in Auckland with guidelines for the management and treatment of stroke in other countries; to provide a baseline measure against which future changes in management can be evaluated. All new stroke events in Auckland residents in 12 months were traced through multiple case finding sources. For each patient, a record of investigations and treatment during the first week of hospital admission was kept. One thousand eight hundred and three stroke events (including subarachnoid haemorrhages) occurred in 1761 patients in one year. Twenty-seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of the 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed tomography (CT). Of 376 validated ischaemic strokes, 44% were treated with aspirin and 12% with intravenous heparin. Of the 690 unspecified strokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 28 day in-hospital case fatality for all stroke events admitted to an acute hospital during the first week was 25%. It was concluded that in Auckland, management of acute stroke differed from clinical guidelines in the high proportion of patients managed in the community, the low rate of neurological consultation, and the low frequency of CT scanning. Despite these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high proportion of cases evaluated by a neurologist and CT. (authors). 34 refs., 4 tabs., 2 figs.

  10. Countries with women inequalities have higher stroke mortality.

    Science.gov (United States)

    Kim, Young Dae; Jung, Yo Han; Caso, Valeria; Bushnell, Cheryl D; Saposnik, Gustavo

    2017-10-01

    Background Stroke outcomes can differ by women's legal or socioeconomic status. Aim We investigated whether differences in women's rights or gender inequalities were associated with stroke mortality at the country-level. Methods We used age-standardized stroke mortality data from 2008 obtained from the World Health Organization. We compared female-to-male stroke mortality ratio and stroke mortality rates in women and men between countries according to 50 indices of women's rights from Women, Business and the Law 2016 and Gender Inequality Index from the Human Development Report by the United Nations Development Programme. We also compared stroke mortality rate and income at the country-level. Results In our study, 176 countries with data available on stroke mortality rate in 2008 and indices of women's rights were included. There were 46 (26.1%) countries where stroke mortality in women was higher than stroke mortality in men. Among them, 29 (63%) countries were located in Sub-Saharan African region. After adjusting by country income level, higher female-to-male stroke mortality ratio was associated with 14 indices of women's rights, including differences in getting a job or opening a bank account, existence of domestic violence legislation, and inequalities in ownership right to property. Moreover, there was a higher female-to-male stroke mortality ratio among countries with higher Gender Inequality Index (r = 0.397, p Gender Inequality Index was more likely to be associated with stroke mortality rate in women than that in men (p gender inequality status is associated with women's stroke outcomes.

  11. Early management and outcome of acute stroke in Auckland

    International Nuclear Information System (INIS)

    Anderson, N.E.; Bonita, R.; Broad, J.B.

    1997-01-01

    Studies of acute stroke management in stroke units and tertiary referral hospitals may not accurately reflect practice within the population. Reliable information on the management of stroke within a population is sparse. The aims of this study was to compare clinical practice in acute stroke management in Auckland with guidelines for the management and treatment of stroke in other countries; to provide a baseline measure against which future changes in management can be evaluated. All new stroke events in Auckland residents in 12 months were traced through multiple case finding sources. For each patient, a record of investigations and treatment during the first week of hospital admission was kept. One thousand eight hundred and three stroke events (including subarachnoid haemorrhages) occurred in 1761 patients in one year. Twenty-seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of the 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed tomography (CT). Of 376 validated ischaemic strokes, 44% were treated with aspirin and 12% with intravenous heparin. Of the 690 unspecified strokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 28 day in-hospital case fatality for all stroke events admitted to an acute hospital during the first week was 25%. It was concluded that in Auckland, management of acute stroke differed from clinical guidelines in the high proportion of patients managed in the community, the low rate of neurological consultation, and the low frequency of CT scanning. Despite these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high proportion of cases evaluated by a neurologist and CT. (authors)

  12. Stroke And Substance Abuse

    OpenAIRE

    A Chitsaz

    2017-01-01

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

  13. Stroke Prevention & Treatment: Diet & Nutrition

    Science.gov (United States)

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

  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. Risks for Heart Disease & Stroke

    Science.gov (United States)

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

  16. An evaluation of the Manufacturer And User Facility Device Experience database that inspired the United States Food and Drug Administration's Reclassification of transvaginal mesh

    Directory of Open Access Journals (Sweden)

    Jason M. Sandberg

    2018-03-01

    Full Text Available Purpose: To assess the utility of the Manufacturer And User Facility Device Experience (MAUDE database in objectively capturing adverse events for transvaginal mesh in the United States. Materials and Methods: We reviewed 1,103 individual medical device reports submitted to the MAUDE database that inspired the United States (US Food and Drug Administration's 2008 Public Health Notification. Entries were compiled into a categorical database that reported manufacturer, brand, reporter type, report source, and type of adverse event. Results: There were numerous examples of missing, duplicated, and non-standardized entries. Analysis revealed 64 reports with duplicated information, and six reports representing multiple patients. Forty-seven percent of medical device reports did not identify a reporter source. At least 28% of reported devices are no longer on the US market. There was wide variability in the quality and completeness of submitted reports and true adverse event rates could not be accurately calculated because the number of total cases was unknown. Conclusions: The MAUDE database was limited in its ability to collect, quantify, and standardize real-life adverse events related to transvaginal mesh. While it functions to collect information related to isolated adverse events, systematic limitations of the MAUDE database, that no doubt extend to other medical devices, necessitate the development of new reporting systems. Alternatives are under development, which may allow regulators to more accurately scrutinize the safety profiles of specific medical devices.

  17. An evaluation of the Manufacturer And User Facility Device Experience database that inspired the United States Food and Drug Administration's Reclassification of transvaginal mesh.

    Science.gov (United States)

    Sandberg, Jason M; Gray, Ian; Pearlman, Amy; Terlecki, Ryan P

    2018-03-01

    To assess the utility of the Manufacturer And User Facility Device Experience (MAUDE) database in objectively capturing adverse events for transvaginal mesh in the United States. We reviewed 1,103 individual medical device reports submitted to the MAUDE database that inspired the United States (US) Food and Drug Administration's 2008 Public Health Notification. Entries were compiled into a categorical database that reported manufacturer, brand, reporter type, report source, and type of adverse event. There were numerous examples of missing, duplicated, and non-standardized entries. Analysis revealed 64 reports with duplicated information, and six reports representing multiple patients. Forty-seven percent of medical device reports did not identify a reporter source. At least 28% of reported devices are no longer on the US market. There was wide variability in the quality and completeness of submitted reports and true adverse event rates could not be accurately calculated because the number of total cases was unknown. The MAUDE database was limited in its ability to collect, quantify, and standardize real-life adverse events related to transvaginal mesh. While it functions to collect information related to isolated adverse events, systematic limitations of the MAUDE database, that no doubt extend to other medical devices, necessitate the development of new reporting systems. Alternatives are under development, which may allow regulators to more accurately scrutinize the safety profiles of specific medical devices.

  18. ABO Blood Type and Stroke Risk: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

    Science.gov (United States)

    Zakai, Neil A.; Judd, Suzanne E.; Alexander, Kristine; McClure, Leslie A.; Kissela, Brett M.; Howard, George; Cushman, Mary

    2016-01-01

    Background ABO blood type is an inherited trait associated with coagulation factor levels and vascular outcomes. Objectives To assess the association of blood type with stroke and whether blood type contributes to racial disparities in stroke in the United States. Patients and Methods The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study recruited 30,239 participants between 2003-07. Using a case-cohort design, blood type was genotyped in 646 participants with stroke and a 1,104 participant cohort random sample. Cox models adjusting for Framingham stroke risk factors assessed the association of blood type with stroke. Results Over 5.8 years of follow-up, blood types A or B versus type O were not associated with stroke. Blood type AB versus O was associated with an increased risk of stroke (adjusted HR 1.83; 95% CI 1.01, 3.30). The association of blood type AB versus O was greater in those without diabetes (adjusted HR 3.33; 95% CI 1.61, 6.88) than those with diabetes (adjusted HR 0.49; 95% CI 0.17, 1.44) (p-interaction = 0.02). Factor VIII levels accounted for 60% (95% CI 11%, 98%) of the association of AB blood type and stroke risk. Conclusion Blood type AB is associated with an increased risk of stroke that is not attenuated by conventional stroke risk factors and factor VIII levels were associated with 60% of the association. While blood type AB is rare in the U.S. population, it is a significant stroke risk factor and may play an important role in stroke risk in these individuals. PMID:24444093

  19. A cylindrical salad growth facility with a light-emitting diodes unit as a component for biological life support system for space crews

    Science.gov (United States)

    Erokhin, A. N.; Berkovich, Yu. A.; Smolianina, S. O.; Krivobok, N. M.; Agureev, A. N.; Kalandarov, S. K.

    2006-01-01

    Efficiency of salad production under light-emitting diodes was tested with a prototype space plant growth facility "Phytocycle SD" with a 10-step crop conveyer. The system has a plant chamber in the form of a spiral cylinder. The planting unit inside the chamber is built of 10 root modules which provide a co-axial planting cylinder that rotates relative to the leaf chamber. Twelve panels of the lighting unit on the internal surfaces of the spiral cylinder carry 438 red (660 nm) and 88 blue (470 nm) light-emitting diodes producing average PPF equal 360 μmol m -2 s -1 4 cm below the light source, and 3 panels producing PPF equal 190 μmol m -2 s -1 at the initial steps of the plant conveyer. The system requires 0.44 kW and provides a plant chamber volume of 0.19 m 3, with 0.86 m 2 illuminated crop area. Productive efficiency of the facility was studied in a series of laboratory experiments with celery cabbage ( Brassica pekinensis) ( Lour) ( Rupr.) grown in the conveyer with a one-step period of 3 days. The crop grew in a fiber ion-exchange mineral-rich soil BIONA V3 under the 24-h light. Maximal productivity of the ripe (30-day-old) plants reached 700 g of the fresh edible biomass from one root module. There was a 30% greater biomass production and 3-5 times greater specific productivity per unit of expenditure of consumable resources over plants grown in a flat planting. This improved production was due to the extension of illuminated crop area for the final conveyor steps and concentration of photon flux toward center axis of cylindrical growth chamber. Biomass contents of ascorbic acid and carotene gathered from one root module per day ranged from 250 to 300 mg and 30 to 40 mg respectively. With this productivity, celery cabbage raised in "Phytocycle SD" potentially can satisfy the daily demands in vitamin C, vitamin A for a crew of three. Wider nutritional needs can be satisfied by planting mixed salad crops.

  20. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  1. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2013-01-01

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

  2. Ischemic Stroke: MedlinePlus Health Topic

    Science.gov (United States)

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

  3. Adherence of physical therapy with clinical practice guidelines for the rehabilitation of stroke in an active inpatient setting.

    Science.gov (United States)

    M S, Ajimsha; Kooven, Smithesh; Al-Mudahka, Noora

    2018-03-09

    Clinical guidelines are systematically developed statements designed to help practitioners and patients to make decisions about appropriate health care. Clinical practice guideline adherence analysis is the best way to fine tune the best practices in a health care industry with international benchmarks. To assess the physical therapist's adherence to structured stroke clinical practice guidelines in an active inpatient rehabilitation center in Qatar. Department of Physical therapy in the stroke rehabilitation tertiary referral hospital in Qatar. A retrospective chart audit was performed on the clinical records of 216 stroke patients discharged from the active inpatient stroke rehabilitation unit with a diagnosis of stroke in 2016. The audit check list was structured to record the adherence of the assessment, goal settings and the management domains as per the "Physical Therapy After Acute Stroke" (PAAS) guideline. Of the 216 case files identified during the initial search, 127 files were ultimately included in the audit. Overall adherence to the clinical practice guideline was 71%, a comparable rate with the studies analyzing the same in various international health care facilities. Domains which were shared by interdisciplinary teams than managed by physical therapy alone and treatments utilizing sophisticated technology had lower adherence with the guideline. A detailed strength and weakness breakdown were then conducted. This audit provides an initial picture of the current adherence of physical therapy assessment and management with the stroke physical therapy guideline at a tertiary rehabilitation hospital in the state of Qatar. An evaluation of the guideline adherence and practice variations helps to fine tune the physical therapy care to a highest possible standard of practice. Implications for Rehabilitation  • An evaluation of the guideline adherence and practice variations helps to fine tune the rehabilitation care to the highest possible standard

  4. Exploring the Experiences of Living With Stroke Through Narrative: Stroke Survivors' Perspectives.

    Science.gov (United States)

    Nasr, Nasrin; Mawson, Susan; Wright, Peter; Parker, Jack; Mountain, Gail

    2016-01-01

    Chronic illness models are normally used to explain and predict the experience of living with a long-term condition. The aim of this study was to present the findings of narrative interviews with stroke survivors and their family carers to understand their experiences of stroke. We interviewed five people with stroke and three family carers from the United Kingdom. We used thematic analysis to generate themes from their narrative accounts and then linked them to broader theoretical perspectives while influenced by the concept of reinterpretation of life. The narrative accounts of participants are mainly structured based on how their changed bodies poststroke changed their identities and roles and consequently their relationships with others. In this study, we underline the need for using methods like narrative to explain strategies that people use to make sense of their experiences of living with a long-term condition such as stroke.

  5. Review of experience with a collaborative eye care clinic in inpatient stroke rehabilitation.

    Science.gov (United States)

    Herron, Sarah

    2016-02-01

    Visual deficits following stroke are frequently subtle and are often overlooked. Even though these visual deficits may be less overt in nature, they are still debilitating to survivors. Visual deficits have been shown to negatively impact cognition, mobility, and activities of daily living (ADL). There is little consistency across healthcare facilities regarding protocol for assessing vision following stroke. This research was designed to describe a profile for patients exhibiting visual deficits following stroke, examine the role of occupational therapists in vision assessment, and discuss a potential model to provide a protocol for collaboration with an eye care professional as part of the rehabilitation team. The sample consisted of 131 patients in an inpatient rehabilitation (IPR) unit who were identified as having potential visual deficits. Occupational therapists on an IPR unit administered initial vision screenings and these patients were subsequently evaluated by the consulting optometrist. Frequencies were calculated for the appearance of functional symptoms, diagnoses, and recommendations. Correlations were also computed relating diagnoses and recommendations made. All patients referred by the occupational therapist for optometrist evaluation had at least one visual diagnosis. The most frequent visual diagnoses included: saccades (77.7%), pursuits (61.8%), and convergence (63.4%). There was also a positive correlation between number of functional symptoms seen by occupational therapists and visual diagnoses made by the optometrist (r  =  0.209, P  =  0.016). Results of this study support the need for vision assessment following stroke in IPR, confirm the role of occupational therapists in vision assessment, and support the need for an optometrist as a member of the rehabilitation team.

  6. Promoting Evidence-Based Practice at a Primary Stroke Center: A Nurse Education Strategy.

    Science.gov (United States)

    Case, Christina Anne

    Promoting a culture of evidence-based practice within a health care facility is a priority for health care leaders and nursing professionals; however, tangible methods to promote translation of evidence to bedside practice are lacking. The purpose of this quality improvement project was to design and implement a nursing education intervention demonstrating to the bedside nurse how current evidence-based guidelines are used when creating standardized stroke order sets at a primary stroke center, thereby increasing confidence in the use of standardized order sets at the point of care and supporting evidence-based culture within the health care facility. This educational intervention took place at a 286-bed community hospital certified by the Joint Commission as a primary stroke center. Bedside registered nurse (RN) staff from 4 units received a poster presentation linking the American Heart Association's and American Stroke Association's current evidence-based clinical practice guidelines to standardized stroke order sets and bedside nursing care. The 90-second oral poster presentation was delivered by a graduate nursing student during preshift huddle. The poster and supplemental materials remained in the unit break room for 1 week for RN viewing. After the pilot unit, a pdf of the poster was also delivered via an e-mail attachment to all RNs on the participating unit. A preintervention online survey measured nurses' self-perceived likelihood of performing an ordered intervention based on whether they were confident the order was evidence based. The preintervention survey also measured nurses' self-reported confidence in their ability to explain how the standardized order sets are derived from current evidence. The postintervention online survey again measured nurses' self-reported confidence level. However, the postintervention survey was modified midway through data collection, allowing for the final 20 survey respondents to retrospectively rate their confidence

  7. Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association.

    Science.gov (United States)

    Rodriguez, Carlos J; Allison, Matthew; Daviglus, Martha L; Isasi, Carmen R; Keller, Colleen; Leira, Enrique C; Palaniappan, Latha; Piña, Ileana L; Ramirez, Sarah M; Rodriguez, Beatriz; Sims, Mario

    2014-08-12

    This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA's 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers. Writing group members were nominated by the AHA's Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before consideration and approval by the

  8. Diagnostic neuroimaging in stroke

    International Nuclear Information System (INIS)

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

    1988-01-01

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

  9. Relational Processing Following Stroke

    Science.gov (United States)

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

    2013-01-01

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

  10. Stroke (For Kids)

    Science.gov (United States)

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

  11. Obesity increases risk of ischemic stroke in young adults.

    Science.gov (United States)

    Mitchell, Andrew B; Cole, John W; McArdle, Patrick F; Cheng, Yu-Ching; Ryan, Kathleen A; Sparks, Mary J; Mitchell, Braxton D; Kittner, Steven J

    2015-06-01

    Body mass index has been associated with ischemic stroke in older populations, but its association with stroke in younger populations is not known. In light of the current obesity epidemic in the United States, the potential impact of obesity on stroke risk in young adults deserves attention. A population-based case-control study design with 1201 cases and 1154 controls was used to investigate the relationship of obesity and young onset ischemic stroke. Stroke cases were between the ages of 15 and 49 years. Logistic regression analysis was used to evaluate the association between body mass index and ischemic stroke with and without adjustment for comorbid conditions associated with stroke. In analyses adjusted for age, sex, and ethnicity, obesity (body mass index >30 kg/m(2)) was associated with an increased stroke risk (odds ratio, 1.57; 95% confidence interval, 1.28-1.94) although this increased risk was highly attenuated and not statistically significant after adjustment for smoking, hypertension, and diabetes mellitus. These results indicate that obesity is a risk factor for young onset ischemic stroke and suggest that this association may be partially mediated through hypertension, diabetes mellitus, or other variables associated with these conditions. © 2015 American Heart Association, Inc.

  12. Burden of stroke in Bangladesh.

    Science.gov (United States)

    Islam, Md Nazmul; Moniruzzaman, Mohammed; Khalil, Md Ibrahim; Basri, Rehana; Alam, Mohammad Khursheed; Loo, Keat Wei; Gan, Siew Hua

    2013-04-01

    Stroke is the third leading cause of death in Bangladesh. The World Health Organization ranks Bangladesh's mortality rate due to stroke as number 84 in the world. The reported prevalence of stroke in Bangladesh is 0.3%, although no data on stroke incidence have been recorded. Hospital-based studies conducted in past decades have indicated that hypertension is the main cause of ischaemic and haemorrhagic stroke in Bangladesh. The high number of disability-adjusted life-years lost due to stroke (485 per 10,000 people) show that stroke severely impacts Bangladesh's economy. Although two non-governmental organizations, BRAC and the Centre for the Rehabilitation of the Paralysed, are actively involved in primary stroke prevention strategies, the Bangladeshi government needs to emphasize healthcare development to cope with the increasing population density and to reduce stroke occurrence. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  13. Key performance indicators for stroke from the Ministry of Health of Brazil: benchmarking and indicator parameters.

    Science.gov (United States)

    Lange, Marcos C; Braga, Gabriel Pereira; Nóvak, Edison M; Harger, Rodrigo; Felippe, Maria Justina Dalla Bernardina; Canever, Mariana; Dall'Asta, Isabella; Rauen, Jordana; Bazan, Rodrigo; Zetola, Viviane

    2017-06-01

    All 16 KPIs were analyzed, including the percentage of patients admitted to the stroke unit, venous thromboembolism prophylaxis in the first 48 hours after admission, pneumonia and hospital mortality due to stroke, and hospital discharge on antithrombotic therapy in patients without cardioembolic mechanism. Both centers admitted over 80% of the patients in their stroke unit. The incidence of venous thromboembolism prophylaxis was > 85%, that of in-hospital pneumonia was 70%. Our results suggest using the parameters of all of the 16 KPIs required by the Ministry of Health of Brazil, and the present results for the two stroke units for future benchmarking.

  14. Post-Closure Inspection Report for Corrective Action Unit 92: Area 6 Decon Pond Facility, Nevada Test Site, Nevada, for Calendar Year 2006

    International Nuclear Information System (INIS)

    NSTec Environmental Restoration

    2007-01-01

    This Post-Closure Inspection Report provides an analysis and summary of inspections for Corrective Action Unit (CAU) 92, Area 6 Decon Pond Facility. CAU 92 was closed according to the ''Resource Conservation and Recovery Act'' (RCRA) Part B Operational Permit (Nevada Division of Environmental Protection [NDEP], 1995) and the ''Federal Facility Agreement and Consent Order'' (FFACO) of 1996 (FFACO, 1996). Closure activities were completed on February 16, 1999, and the Closure Report (U.S. Department of Energy, Nevada Operations Office, 1999) was approved and a Notice of Completion issued by NDEP on May 11, 1999. CAU 92 consists of two Corrective Action Sites (CASs), CAS 06-04-01, Decon Pad Oil/Water Separator; and CAS 06-05-02, Decontamination Pond (RCRA). Both CASs have use restrictions; however, only CAS 06-05-02 requires post-closure inspections. Visual inspections of the cover and fencing at CAS 06-05-02 are performed quarterly. Additional inspections are conducted if precipitation occurs in excess of 1.28 centimeters (cm) (0.50 inches [in.]) in a 24-hour period. This report covers calendar year 2006. Quarterly site inspections were performed in March, June, September, and December of 2006. All observations indicated the continued integrity of the unit. No issues or concerns were noted, and no corrective actions were necessary. Copies of the inspection checklists and field notes completed during each inspection are included in Appendix A of this report, and photographs taken during the site inspections are included in Appendix B of this report. One additional inspection was performed after a precipitation event that exceeded 1.28 cm (0.50 in.) within a 24-hour period during 2006. No significant changes in site conditions were noted during this inspection, and no corrective actions were necessary. A copy of the inspection checklist and field notes completed during this additional inspection is included in Appendix A of this report. Precipitation records for 2006

  15. Improving post-stroke recovery: the role of the multidisciplinary health care team.

    Science.gov (United States)

    Clarke, David J; Forster, Anne

    2015-01-01

    Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway.

  16. 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 ...

  17. Effects of Centralizing Acute Stroke Services on Stroke Care Provision in Two Large Metropolitan Areas in England

    Science.gov (United States)

    Morris, Stephen; Hoffman, Alex; Hunter, Rachael M.; Boaden, Ruth; McKevitt, Christopher; Perry, Catherine; Pursani, Nanik; Rudd, Anthony G.; Turner, Simon J.; Tyrrell, Pippa J.; Wolfe, Charles D.A.; Fulop, Naomi J.

    2015-01-01

    Background and Purpose— In 2010, Greater Manchester and London centralized acute stroke care into hyperacute units (Greater Manchester=3, London=8), with additional units providing ongoing specialist stroke care nearer patients’ homes. Greater Manchester patients presenting within 4 hours of symptom onset were eligible for hyperacute unit admission; all London patients were eligible. Research indicates that postcentralization, only London’s stroke mortality fell significantly more than elsewhere in England. This article attempts to explain this difference by analyzing how centralization affects provision of evidence-based clinical interventions. Methods— Controlled before and after analysis was conducted, using national audit data covering Greater Manchester, London, and a noncentralized urban comparator (38 623 adult stroke patients, April 2008 to December 2012). Likelihood of receiving all interventions measured reliably in pre- and postcentralization audits (brain scan; stroke unit admission; receiving antiplatelet; physiotherapist, nutrition, and swallow assessments) was calculated, adjusting for age, sex, stroke-type, consciousness, and whether stroke occurred in-hospital. Results— Postcentralization, likelihood of receiving interventions increased in all areas. London patients were overall significantly more likely to receive interventions, for example, brain scan within 3 hours: Greater Manchester=65.2% (95% confidence interval=64.3–66.2); London=72.1% (71.4–72.8); comparator=55.5% (54.8–56.3). Hyperacute units were significantly more likely to provide interventions, but fewer Greater Manchester patients were admitted to these (Greater Manchester=39%; London=93%). Differences resulted from contrasting hyperacute unit referral criteria and how reliably they were followed. Conclusions— Centralized systems admitting all stroke patients to hyperacute units, as in London, are significantly more likely to provide evidence-based clinical

  18. Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in Black Americans

    Science.gov (United States)

    Judd, Suzanne E; Gutiérrez, Orlando M.; Newby, PK; Howard, George; Howard, Virginia J; Locher, Julie L; Kissela, Brett M; Shikany, James M

    2014-01-01

    Background and Purpose Black Americans and residents of the Southeastern United States, are at increased risk of stroke. Diet is one of many potential factors proposed that might explain these racial and regional disparities. Methods Between 2003–2007, the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30,239 black and white Americans aged 45 years or older. Dietary patterns were derived using factor analysis and foods from food frequency data. Incident strokes were adjudicated using medical records by a team of physicians. Cox proportional hazards models were used to examine risk of stroke. Results Over 5.7 years, 490 incident strokes were observed. In a multivariable-adjusted analysis, greater adherence to the Plant-based pattern was associated with lower stroke risk (HR=0.71; 95% CI=0.56–0.91; ptrend=0.005). This association was attenuated after addition of income, education, total energy intake, smoking, and sedentary behavior. Participants with a higher adherence to the Southern pattern experienced a 39% increased risk of stroke (HR=1.39; 95% CI=1.05, 1.84), with a significant (p = 0.009) trend across quartiles. Including Southern pattern in the model mediated the black-white risk of stroke by 63%. Conclusions These data suggest that adherence to a Southern style diet may increase the risk of stroke while adherence to a more plant-based diet may reduce stroke risk. Given the consistency of finding a dietary impact on stroke risk across studies, discussing nutrition patterns during risk screening may be an important step in reducing stroke. PMID:24159061

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

    Directory of Open Access Journals (Sweden)

    Tirschwell David L

    2012-12-01

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

  20. Design and analysis of hot internals for the reactivity control and reserve shutdown units under test at the helium test facility - HTR2008-58159

    International Nuclear Information System (INIS)

    Beyer, E. J. J.; Craig, K. J.

    2008-01-01

    This paper describes the design process followed by Westinghouse Electric South Africa for the insertion of hot internals into the Reactivity Control System (RCS) and Reserve Shutdown System (RSS) Units Under Test (UUTs) at the Helium Test Facility (HTF) at Pelindaba (South Africa)). The aim of the UUTs is to allow the validation of the high temperature operation of the RCS and RSS systems for implementation into the proposed Demonstration Power Plant of the PBMR. The units use electrical heaters to obtain pebble-bed reactor thermal conditions for both the control rods and small absorber spheres (SAS) under a pressurized helium environment. Design challenges include providing for strength under elevated temperatures (900 deg. C maximum); pressure boundary integrity (9 MPa maximum); separation of different volumes (representing core barrel, reactor citadel and other Reactor Pressure Vessel (RPV) volumes); thermal protection of carbon steel vessels by using thermal insulation; allowing for diverse thermal expansion coefficients of different materials; allowing for de-pressurization events within the insulation and internals having access for temperature, pressure, stress and proximity sensors and electrical wiring through high pressure penetrations; and provision for assembly of the hot internals both on and off-site. thermal analyses using Computational Fluid Dynamics (CFD) were performed to evaluate both worst-case and operational conditions of the UUTs. Factors that were considered include thermal insulation properties, heat transfer modes (internal radiation, external radiation and natural convection, forced internal convection for cooling) and operating pressure (ranging from 1 to 9 MPa). The thermal design uses elements originally proposed for hot gas duct design. The results obtained show that the proposed design satisfies ASME VIII requirements of the pressure boundary and that all challenges are successfully met. (authors)

  1. Stroke in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Greve, Anders Møller; Dalsgaard, Morten; Bang, Casper N

    2014-01-01

    , and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex (CHA2DS2-VASc......], 1.1-6.6), CHA2DS2-VASc score (HR 1.4 per unit; 95% CI, 1.1-1.8), diastolic blood pressure (HR, 1.4 per 10 mm Hg; 95% CI, 1.1-1.8), and AVR with concomitant coronary artery bypass grafting (HR, 3.2; 95% CI, 1.4-7.2, all P≤0.026) were independently associated with stroke. Incident stroke predicted...

  2. Prognostic significance of serum bilirubin in stroke

    International Nuclear Information System (INIS)

    Arslan, A.; Ismail, M.; Khan, F.; Khan, A.; Khattak, M.B.; Anwar, M.J.

    2011-01-01

    Background: Oxidative injury is an important cause of the neurologic lesion in stroke. Serum bilirubin is considered a natural antioxidant that may affect the prognosis of stroke. The purpose of this study was to evaluate the prognostic significance of bilirubin in stroke patients. Methods: A prospective cross-sectional study was conducted in Medical Units of Khyber Teaching Hospital, Peshawar. Inpatients admitted with acute attack of stroke were included in this study. Data regarding serum bilirubin and concurrent cerebrovascular risk factors were collected. National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to analyse stroke's severity and functional outcomes, respectively. Results: Hypertension, diabetes mellitus and heart diseases were the most common risk factors. Patients were divided into 3 groups on the basis of serum bilirubin, i.e., =0.6 mg/dl (Group-1), 0.7-0.9 mg/dl (Group-2), and =1.0 mg/dl (Group-3). The mean pre-hospitalisation NIHSS score for Groups 1, 2 and 3 was 5.62, 11.66 and 25.33, respectively; and post-hospitalisation score was 0.875, 3.76 and 16.26, respectively. The pre-hospitalisation mRS score was 4 for Group-1, 4.52 for Group-2 and 4.93 for Group-3; while post-hospitalisation Mrs Score was 1.50, 2.38 and 4.26, respectively. Average serum bilirubin level was significantly higher in patients with poor outcomes as compared with good outcomes (p<0.01). Conclusions: This study suggests that higher serum bilirubin levels were associated with increased stroke severity, longer hospitalisation and poor prognosis. (author)

  3. Cognitive impairment and stroke in elderly patients

    Directory of Open Access Journals (Sweden)

    Lo Coco D

    2016-03-01

    Full Text Available Daniele Lo Coco,1 Gianluca Lopez,1 Salvatore Corrao,2,31Neurology and Stroke Unit, 2Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, 3Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M., Di.Bi.M.I.S., University of Palermo, Palermo, Italy Abstract: We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the

  4. Stroke Risk Factors and Symptoms

    Science.gov (United States)

    ... » [ pdf, 433 kb ] Order Materials » Stroke Risk Factors and Symptoms Risk Factors for a Stroke Stroke prevention is still ... it. Treatment can delay complications that increase the risk of stroke. Transient ischemic attacks (TIAs). Seek help. ...

  5. Safety analysis report for the Mixed Waste Storage Facility and portable storage units at the Idaho National Engineering Laboratory. Revision 4

    International Nuclear Information System (INIS)

    Peatross, R.

    1997-01-01

    This revision contains Section 2 only which gives a description of the Mixed Waste Storage Facility (MWSF) and its operations. Described are the facility location, services and utilities, process description and operation, and safety support systems. The MWSF serves as a storage and repackaging facility for low-level mixed waste

  6. Dizziness in stroke

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad

    2015-01-01

    Full Text Available Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness. The treatment of patients with stroke-induced dizziness involves a wide range of medications for the reduction of the degree of dizziness and unsteadiness and for the secondary prevention of stroke. Vestibular rehabilitation is an important component of treatment. The paper describes an observation of a patient with poorly controlled hypertension, who developed new-onset acute systemic dizziness. Vestibular neuronitis might be presumed to be a peripheral cause of vestibular disorders, by taking into account the absence of additional obvious neurological symptoms (such as pareses, defective sensation, diplopia, etc. and the nature of nystagmus. However, intention tremor in fingernose and heel-knee tests on the left side, a negative Halmagyi test, and results of Romberg’s test could suggest that stroke was a cause ofdizziness.

  7. Stroke in tuberculous meningitis.

    Science.gov (United States)

    Misra, Usha Kant; Kalita, Jayantee; Maurya, Pradeep Kumar

    2011-04-15

    Stroke in tuberculous meningitis (TBM) occurs in 15-57% of patients especially in advance stage and severe illness. The majority of strokes may be asymptomatic because of being in a silent area, deep coma or associated pathology such as spinal arachnoiditis or tuberculoma. Methods of evaluation also influence the frequency of stroke. MRI is more sensitive in detecting acute (DWI) and chronic (T2, FLAIR) stroke. Most of the strokes in TBM are multiple, bilateral and located in the basal ganglia especially the 'tubercular zone' which comprises of the caudate, anterior thalamus, anterior limb and genu of the internal capsule. These are attributed to the involvement of medial striate, thalamotuberal and thalamostriate arteries which are embedded in exudates and likely to be stretched by a coexistent hydrocephalus. Cortical stroke can also occur due to the involvement of proximal portion of the middle, anterior and posterior cerebral arteries as well as the supraclinoid portion of the internal carotid and basilar arteries which are documented in MRI, angiography and autopsy studies. Arteritis is more common than infarction in autopsy study. The role of cytokines especially tumor necrosis factor (TNFα), vascular endothelial growth factor (VEGF) and matrix metaloproteineases (MMPs) in damaging the blood brain barrier, attracting leucocytes and release of vasoactive autocoids have been suggested. The prothrombotic state may also contribute to stroke in TBM. Corticosteroids with antitubercular therapy were thought to reduce mortality and morbidity but their role in reducing strokes has not been proven. Aspirin also reduces mortality and its role in reducing stroke in TBM needs further studies. Copyright © 2010 Elsevier B.V. All rights reserved.

  8. Hyponatremia in stroke

    Directory of Open Access Journals (Sweden)

    Sheikh Saleem

    2014-01-01

    Full Text Available Introduction: Hyponatremia is a common electrolyte disorder encountered in patients of neurological disorders which is usually either due to inappropriate secretion of Antidiuretic hormone (SIADH or cerebral salt wasting syndrome (CSWS. We conducted this study in a tertiary care hospital to determine the incidence and etiology of hyponatremia in patients of stroke admitted in the hospital. Materials and Methods: It was a prospective study done over a period of two years that included established cases of stroke diagnosed on the basis of clinical history, examination and neuroimaging. 1000 stoke patients were evaluated for hyponatremia (serum sodium <130 meq/l. The data was analysed using Chi-square test using SPSS (Statistical package for social science software. Results: Out of 1000 patients, 353 patients had hyponatremia. Out of this 353 patients, 238 (67% had SIADH and 115 (33% had CSWS. SIADH was seen in 83 patients who had ischemic stroke and 155 patients of hemorrhagic stroke. CSWS was found in 38 patients with ischemic stroke and 77 patients with hemorrhagic stroke. Statistical analysis revealed that hyponatremia significantly affects the outcome of stroke especially when it is due to CSWS rather than SIADH. Conclusion: Incidence of hyponatremia in our study population was 35%. In patients of hyponatremia 67% were having SIADH and 33% were having CSWS. Overall hyponatremia affected the outcome of stroke especially when caused by CSWS. Therefore close monitoring of serum sodium must be done in all patients who are admitted with stroke and efforts must be made to determine the cause of hyponatremia, in order to properly manage such patients thereby decreasing the mortality rate.

  9. Spontaneous Low Frequency Oscillations in Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Phillip, Dorte; Schytz, Henrik Winther; Iversen, Helle Klingenberg

    2014-01-01

    Background and purpose: Continuous wave near infrared spectroscopy (NIRS) is a non-invasive bed-side optical method to detect changes in oxygenated (oxyHb) and deoxygenated hemoglobin (deoxyHb) in the outermost layers of the cerebral cortex. Cortical oxyHb low frequency oscillations (LFOs) in the 0.......09-0.11 Hz range are affected by changes in cerebral autoregulation (CA), which is altered following stroke. We examined oxyHb LFOs at bed-side as a marker of CA in the subacute phase in stroke patients with or without recombinant tissue plasminogen activator thrombolytic therapy. Methods: We recruited 29...... patients admitted to the stroke unit with symptoms of ischemic stroke. 11/29 patients received thrombolytic therapy. NIRS examination was conducted 2 days (median time) from stroke onset. NIRS optodes were placed on each side of the head with a 3 cm source-detector distance. Using transfer function...

  10. Cost of stroke

    DEFF Research Database (Denmark)

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

    2015-01-01

    . The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...

  11. Clinical neurogenetics: stroke.

    Science.gov (United States)

    Rost, Natalia S

    2013-11-01

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

  12. Determinan Penyakit Stroke

    Directory of Open Access Journals (Sweden)

    Woro Riyadina

    2013-02-01

    Full Text Available Penyakit stroke merupakan penyebab kematian dan kecacatan kronik yang paling tinggi pada kelompok umur diatas usia 45 tahun terbanyak di Indonesia. Tujuan penelitian ini untuk mengidentifikasi determinan utama yang berhubungan dengan penyakit stroke pada masyarakat di kelurahan Kebon Kalapa Bogor. Analisis lanjut terhadap 1.912 responden subset baseline data penelitian “Studi Kohort Faktor Risiko Penyakit Tidak Menular” Data dikumpulkan dengan metode wawancara pada penduduk tetap di kelurahan Kebon Kalapa, Kecamatan Bogor Tengah, Bogor tahun 2012. Diagnosis stroke berdasarkan anamnesis dan pemeriksaan dokter spesialis syaraf. Variabel independen meliputi karakteristik sosiodemografi, status kesehatan dan perilaku berisiko. Data dianalisis dengan uji regresi logistik ganda. Penyakit stroke ditemukan pada 49 (2,6% orang. Determinan utama stroke meliputi hipertensi (OR = 4,20; IK 95% = 2,20 – 8,03, penyakit jantung koroner (OR = 2,74; IK 95% = 1,51 – 4,99, diabetes melitus (OR = 2,89; IK 95% = 1,47 – 5,64, dan status ekonomi miskin (OR = 1,83 ; IK 95% = 1,03 – 3,33. Pencegahan penyakit stroke dilakukan dengan peningkatan edukasi (kampanye/penyuluhan melalui pengendalian faktor risiko utama yaitu hipertensi dan pencegahan terjadinya penyakit degeneratif lain yaitu penyakit jantung koroner dan diabetes melitus. Stroke disease is the leading cause of death and chronic disabi lity in most over the age of 45 years in Indonesia. The aim of study was to identify the major determinants of stroke disease in Kebon Kalapa community in Bogor. A deep analyze was conducted in 1.912 respondents based on the subset of baseline data “Risk Factors Cohort Study of Non Communicable Diseases.” Data was collected by interviews on Kebon Kalapa community, Bogor in 2012. Stroke diagnosis was determined by anamnesis and neu-rological examination with specialist. Independent variables were sociodemographic characteristics, health status and risk behavior

  13. The Stroke Assessment of Fall Risk (SAFR): predictive validity in inpatient stroke rehabilitation.

    Science.gov (United States)

    Breisinger, Terry P; Skidmore, Elizabeth R; Niyonkuru, Christian; Terhorst, Lauren; Campbell, Grace B

    2014-12-01

    To evaluate relative accuracy of a newly developed Stroke Assessment of Fall Risk (SAFR) for classifying fallers and non-fallers, compared with a health system fall risk screening tool, the Fall Harm Risk Screen. Prospective quality improvement study conducted at an inpatient stroke rehabilitation unit at a large urban university hospital. Patients admitted for inpatient stroke rehabilitation (N = 419) with imaging or clinical evidence of ischemic or hemorrhagic stroke, between 1 August 2009 and 31 July 2010. Not applicable. Sensitivity, specificity, and area under the curve for Receiver Operating Characteristic Curves of both scales' classifications, based on fall risk score completed upon admission to inpatient stroke rehabilitation. A total of 68 (16%) participants fell at least once. The SAFR was significantly more accurate than the Fall Harm Risk Screen (p Fall Harm Risk Screen, area under the curve was 0.56, positive predictive value was 0.19, and negative predictive value was 0.86. Sensitivity and specificity of the SAFR (0.78 and 0.63, respectively) was higher than the Fall Harm Risk Screen (0.57 and 0.48, respectively). An evidence-derived, population-specific fall risk assessment may more accurately predict fallers than a general fall risk screen for stroke rehabilitation patients. While the SAFR improves upon the accuracy of a general assessment tool, additional refinement may be warranted. © The Author(s) 2014.

  14. The Stroke Assessment of Fall Risk (SAFR): predictive validity in inpatient stroke rehabilitation

    Science.gov (United States)

    Breisinger, Terry P; Skidmore, Elizabeth R; Niyonkuru, Christian; Terhorst, Lauren; Campbell, Grace B

    2014-01-01

    Objective To evaluate relative accuracy of a newly developed Stroke Assessment of Fall Risk (SAFR) for classifying fallers and non-fallers, compared with a health system fall risk screening tool, the Fall Harm Risk Screen. Design and setting Prospective quality improvement study conducted at an inpatient stroke rehabilitation unit at a large urban university hospital. Participants Patients admitted for inpatient stroke rehabilitation (N = 419) with imaging or clinical evidence of ischemic or hemorrhagic stroke, between 1 August 2009 and 31 July 2010. Interventions Not applicable. Main outcome measure(s) Sensitivity, specificity, and area under the curve for Receiver Operating Characteristic Curves of both scales’ classifications, based on fall risk score completed upon admission to inpatient stroke rehabilitation. Results A total of 68 (16%) participants fell at least once. The SAFR was significantly more accurate than the Fall Harm Risk Screen (p stroke rehabilitation patients. While the SAFR improves upon the accuracy of a general assessment tool, additional refinement may be warranted. PMID:24849795

  15. Hypertension and experimental stroke therapies

    OpenAIRE

    O'Collins, Victoria E; Donnan, Geoffrey A; Macleod, Malcolm R; Howells, David W

    2013-01-01

    Hypertension is an established target for long-term stroke prevention but procedures for management of hypertension in acute stroke are less certain. Here, we analyze basic science data to examine the impact of hypertension on candidate stroke therapies and of anti-hypertensive treatments on stroke outcome. Methods: Data were pooled from 3,288 acute ischemic stroke experiments (47,899 animals) testing the effect of therapies on infarct size (published 1978–2010). Data were combined using meta...

  16. Clinical diagnosis of stroke: need for audit | Imam | Annals of African ...

    African Journals Online (AJOL)

    Background: Stroke is a common disease and in developing countries its diagnosis relies heavily on clinical features because of the dearth of radiological facilities. To ensure that the diagnosis of stroke is as accurate as possible, it is imperative that clinical skills are kept at the optimum. One such method of doing this is by ...

  17. ABCD3-I score and the risk of early or 3-month stroke recurrence in tissue- and time-based definitions of TIA and minor stroke.

    Science.gov (United States)

    Mayer, Lukas; Ferrari, Julia; Krebs, Stefan; Boehme, Christian; Toell, Thomas; Matosevic, Benjamin; Tinchon, Alexander; Brainin, Michael; Gattringer, Thomas; Sommer, Peter; Thun, Peter; Willeit, Johann; Lang, Wilfried; Kiechl, Stefan; Knoflach, Michael

    2018-03-01

    Changing definition of TIA from time to a tissue basis questions the validity of the well-established ABCD3-I risk score for recurrent ischemic cerebrovascular events. We analyzed patients with ischemic stroke with mild neurological symptoms arriving TIA or minor stroke, in the prospective multi-center Austrian Stroke Unit Registry. Patients were retrospectively categorized according to a time-based (symptom duration below/above 24 h) and tissue-based (without/with corresponding brain lesion on CT or MRI) definition of TIA or minor stroke. Outcome parameters were early stroke during stroke unit stay and 3-month ischemic stroke. Of the 5237 TIA and minor stroke patients with prospectively documented ABCD3-I score, 2755 (52.6%) had a TIA by the time-based and 2183 (41.7%) by the tissue-based definition. Of the 2457 (46.9%) patients with complete 3-month followup, corresponding numbers were 1195 (48.3%) for the time- and 971 (39.5%) for the tissue-based definition of TIA. Early and 3-month ischemic stroke occurred in 1.1 and 2.5% of time-based TIA, 3.8 and 5.9% of time-based minor stroke, 1.2 and 2.3% of tissue-based TIA as well as in 3.1 and 5.5% of tissue-based minor stroke patients. Irrespective of the definition of TIA and minor stroke, the risk of early and 3-month ischemic stroke steadily increased with increasing ABCD3-I score points. The ABCD3-I score performs equally in TIA patients in tissue- as well as time-based definition and the same is true for minor stroke patients.

  18. Hospital costs of ischemic stroke and TIA in the Netherlands.

    Science.gov (United States)

    Buisman, Leander R; Tan, Siok Swan; Nederkoorn, Paul J; Koudstaal, Peter J; Redekop, William K

    2015-06-02

    There have been no ischemic stroke costing studies since major improvements were implemented in stroke care. We therefore determined hospital resource use and costs of ischemic stroke and TIA in the Netherlands for 2012. We conducted a retrospective cost analysis using individual patient data from a national diagnosis-related group registry. We analyzed 4 subgroups: inpatient ischemic stroke, inpatient TIA, outpatient ischemic stroke, and outpatient TIA. Costs of carotid endarterectomy and costs of an extra follow-up visit were also estimated. Unit costs were based on reference prices from the Dutch Healthcare Insurance Board and tariffs provided by the Dutch Healthcare Authority. Linear regression analysis was used to examine the association between hospital costs and various patient and hospital characteristics. A total of 35,903 ischemic stroke and 21,653 TIA patients were included. Inpatient costs were €5,328 ($6,845) for ischemic stroke and €2,470 ($3,173) for TIA. Outpatient costs were €495 ($636) for ischemic stroke and €587 ($754) for TIA. Costs of carotid endarterectomy were €6,836 ($8,783). Costs of inpatient days were the largest contributor to hospital costs. Age, hospital type, and region were strongly associated with hospital costs. Hospital costs are higher for inpatients and ischemic strokes compared with outpatients and TIAs, with length of stay (LOS) the most important contributor. LOS and hospital costs have substantially declined over the last 10 years, possibly due to improved hospital stroke care and efficient integrated stroke services. © 2015 American Academy of Neurology.

  19. A Typology to Explain Changing Social Networks Post Stroke.

    Science.gov (United States)

    Northcott, Sarah; Hirani, Shashivadan P; Hilari, Katerina

    2018-05-08

    Social network typologies have been used to classify the general population but have not previously been applied to the stroke population. This study investigated whether social network types remain stable following a stroke, and if not, why some people shift network type. We used a mixed methods design. Participants were recruited from two acute stroke units. They completed the Stroke Social Network Scale (SSNS) two weeks and six months post stroke and in-depth interviews 8-15 months following the stroke. Qualitative data was analysed using Framework Analysis; k-means cluster analysis was applied to the six-month data set. Eighty-seven participants were recruited, 71 were followed up at six months, and 29 completed in-depth interviews. It was possible to classify all 29 participants into one of the following network types both prestroke and post stroke: diverse; friends-based; family-based; restricted-supported; restricted-unsupported. The main shift that took place post stroke was participants moving out of a diverse network into a family-based one. The friends-based network type was relatively stable. Two network types became more populated post stroke: restricted-unsupported and family-based. Triangulatory evidence was provided by k-means cluster analysis, which produced a cluster solution (for n = 71) with comparable characteristics to the network types derived from qualitative analysis. Following a stroke, a person's social network is vulnerable to change. Explanatory factors for shifting network type included the physical and also psychological impact of having a stroke, as well as the tendency to lose contact with friends rather than family.

  20. Thrombolysis in acute ischemic stroke: where and when?

    Directory of Open Access Journals (Sweden)

    Giuseppe Micieli

    2007-12-01

    Full Text Available The therapy of acute ischemic stroke remains an open challenge for the clinicians and is closely connected to the ready acknowledgment of symptoms, to the promptness of the instrumental diagnosis and consequently to the rapidity of the pharmacological intervention. Although several studies have validated the effectiveness and the safety profileof the intravenous fibrinolytic treatment, the number of patients who benefit of such therapeutic opportunity is still too little. This data is partially due to the delay within patients arrive to the hospital and to the doubts of the physicians on the possible collateral effects, but it is also related to logistic and organizational-managerial problematic of the patient with acute stroke.These last ones mainly derive from the deficiency on the national territory of dedicated structures (Stroke Unit, from the absence of operative connections between the 118-service and the Stroke Unit, from the delay of the neurologist calling in the emergency room that does not allow an adapted diagnostic evaluation of the ischemic event. The spread of the intravenous fibrinolysis must therefore necessarily pass through the creation of participation protocols between hospitals with stroke unit and primary aid, and between department of emergency/ urgency and staff of the stroke unit also previewing the creation of professional figures like those of the urgency neurologist that could have the full right of the management and the treatment of cerebral ischemic pathology.

  1. Small Engine Repair. Two-Stroke and Four-Stroke Cycle.

    Science.gov (United States)

    Hires, Bill; And Others

    This curriculum guide is intended to assist persons teaching a course in repairing two- and four-stroke cycle small engines. Addressed in the individual units of instruction are the following topics: safety, tools, fasteners, and measurement techniques; basic small engine theory (engine identification and inspection, basic engine principles and…

  2. Stroke: Hope through Research

    Science.gov (United States)

    ... in a compromised state for several hours. With timely treatment these cells can be saved. The ischemic ... this research is the use of transcranial magnetic stimulation (TMS) in stroke rehabilitation. Some evidence suggests that ...

  3. Healthy Living after Stroke

    Science.gov (United States)

    ... Nutrition Cooking for Health Food for Thought: Heart-healthy Diet is Also Good For Your Brain Physical Activity Get Moving and Boost Your Brain Power Understanding Risky Conditions Converging Risk Factors for Stroke ...

  4. Recovering after stroke

    Science.gov (United States)

    ... urine from their body. To prevent skin or pressure sores: Clean up after incontinence Change position often and ... artery surgery - discharge Daily bowel care program Preventing pressure ulcers Stroke - discharge References Dobkin BH. Neurological rehabilitation In: ...

  5. National Stroke Association

    Science.gov (United States)

    ... partnership will offer free access to the RapidSOS Haven app for one year, providing individuals with enhanced ... of care to thrive after stroke. Make your tax-deductible donation today to support the growing needs ...

  6. Strokes (For Parents)

    Science.gov (United States)

    ... paralysis or weakness on one side of the body language or speech delays or changes, such as slurring ... uses many different types of therapy to help children recover from stroke. Outlook At this time, no ...

  7. Stroke - risk factors

    Science.gov (United States)

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

  8. Epilepsy after stroke

    DEFF Research Database (Denmark)

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

    1987-01-01

    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...... with other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex...... was not involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  9. Text Detection in Natural Scene Images by Stroke Gabor Words.

    Science.gov (United States)

    Yi, Chucai; Tian, Yingli

    2011-01-01

    In this paper, we propose a novel algorithm, based on stroke components and descriptive Gabor filters, to detect text regions in natural scene images. Text characters and strings are constructed by stroke components as basic units. Gabor filters are used to describe and analyze the stroke components in text characters or strings. We define a suitability measurement to analyze the confidence of Gabor filters in describing stroke component and the suitability of Gabor filters on an image window. From the training set, we compute a set of Gabor filters that can describe principle stroke components of text by their parameters. Then a K -means algorithm is applied to cluster the descriptive Gabor filters. The clustering centers are defined as Stroke Gabor Words (SGWs) to provide a universal description of stroke components. By suitability evaluation on positive and negative training samples respectively, each SGW generates a pair of characteristic distributions of suitability measurements. On a testing natural scene image, heuristic layout analysis is applied first to extract candidate image windows. Then we compute the principle SGWs for each image window to describe its principle stroke components. Characteristic distributions generated by principle SGWs are used to classify text or nontext windows. Experimental results on benchmark datasets demonstrate that our algorithm can handle complex backgrounds and variant text patterns (font, color, scale, etc.).

  10. Legal Aspects In Stroke Management

    Directory of Open Access Journals (Sweden)

    Reza Hajmanouchehri

    2017-02-01

    Full Text Available Due to increasing the cases of complaint from therapeutic staff, referred to Legal Medicine decided to mention a few examples of these actions and by reviewing them, we want to do something even nothing to prevention. Three cases were given and discussed in this article. 1. Patient is a 68-year-old woman complaining of weakness of her left side and speech disturbance that started about 2 hours earlier, was admitted to hospital at 8 am. Patient with a diagnosis of ischemic stroke in progress is placed in antiplatelet therapy (Plavix 4 initial dose and one per day and an 80 mg aspirin per day and anti-Coagulation Heparin (initial dose of 6000 units and 1000 units per hour.Patient conflicts with loss of consciousness at 17:45. By doing CT, they have found a large hemorrhage in the right parietal Frontó with severe shift from midline, IVH, SAH. Currently, patient has movement disorders and several cerebral complications. 2. The patient took under angiography because of chest pain. Patient had an unpleasant feeling in organs at the time of angiography and the symptoms have been intensified in the afternoon of that day and conflicted with headache and blurred vision. The next day, he also afflicted with weakness of organs and at 8 am neurology consultation is requested, and according to a neurologist takes MRI. The patient was suffered from speech impairment and right hemiparesis. MRI indicates stroke. Two days later, intravenous heparin begins. The Patient discharged on 31/4/ … . 3. The patient hospitalized because of headache and weakness of right organs and with a presumptive diagnosis of stroke. Headache had progressive trend. There were not seen certain lesions on the initial CT. 5000 units of heparin with 1000 units of infusion in an hour starts with telephone orders at 8 am. The morning 1/8 /..., he afflicted with loss of consciousness, and transferred to the ICU. In morning experiment, patient’s platelet is reported low (47000.The patient

  11. Cigarette smoking is an independent risk factor for post-stroke delirium.

    Science.gov (United States)

    Lim, Tae Sung; Lee, Jin Soo; Yoon, Jung Han; Moon, So Young; Joo, In Soo; Huh, Kyoon; Hong, Ji Man

    2017-03-23

    Post-stroke delirium is a common problem in the care of stroke patients, and is associated with longer hospitalization, high short-term mortality, and an increased need for long-term care. Although post-stroke delirium occurs in approximately 10 ~ 30% of patients, little is known about the risk factors for post-stroke delirium in patients who experience acute stroke. A total of 576 consecutive patients who experienced ischemic stroke (mean age, 65.2 years; range, 23-93 years) were screened for delirium over a 2-year period in an acute stroke care unit of a tertiary referral hospital. We screened for delirium using the Confusion Assessment Method. Once delirium was suspected, we evaluated the symptoms using the Korean Version of the Delirium Rating Scale-Revised-98. Neurological deficits were assessed using the National Institutes of Health Stroke Scale at admission and discharge, and functional ability was assessed using the Barthel Index and modified Rankin Scale at discharge and 3 months after discharge. Thirty-eight (6.7%) patients with stroke developed delirium during admission to the acute stroke care unit. Patients with delirium were significantly older (70.6 vs. 64.9 years of age, P = .001) and smoked cigarettes more frequently (40% vs. 24%, P = .033) than patients without delirium. In terms of clinical features, the delirium group experienced a significantly higher rate of major hemispheric stroke (55% vs. 26%, P delirium were older age, history of cigarette smoking, and major hemispheric stroke. Abrupt cessation of cigarette smoking may be a risk factor for post-stroke delirium in ischemic stroke patients. The development of delirium after stroke is associated with worse outcome and longer hospitalization.

  12. Frost Effects Research Facility

    Data.gov (United States)

    Federal Laboratory Consortium — Full-scale study in controlled conditionsThe Frost Effects Research Facility (FERF) is the largest refrigerated warehouse in the United States that can be used for a...

  13. GPS Satellite Simulation Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The GPS satellite simulation facility consists of a GPS satellite simulator controlled by either a Silicon Graphics Origin 2000 or PC depending upon unit under test...

  14. Stroke in patients with diabetes mellitus: a study from North Western ...

    African Journals Online (AJOL)

    and predictors of mortality in a cohort of diabetic patients presenting with stroke in two tertiary health facilities in North West- ..... identification of predictors of death is of paramount ... error of misclassification, is also worthy of mention.46,47.

  15. Patterns of Change in Depression Post Stroke

    Science.gov (United States)

    Ostir, Glenn V.; Berges, Ivonne-M.; Ottenbacher, Allison; Ottenbacher, Kenneth J.

    2011-01-01

    Background Little information is available on depressive symptom change in persons with stroke. Objectives Provide estimates of change in depressive symptoms and determine how depressive symptom change influences recovery of functional status. Design Prospective cohort study. Setting Eleven in-patient medical rehabilitation facilities located across the U.S. Participants 544 persons with a first-time stroke. Measurements General linear regression model estimates assessed associations between depressive symptom change and functional status 3 and 12 months post discharge. Results The majority of persons with stroke were aged 75 and older, white, female and married. The most prevalent stroke type was ischemic. Non-depressed patients at discharge who reported fewer symptoms 12-months later had an adjusted functional status score of 108.2. This compared to adjusted functional status scores of 104.6 for those non-depressed at discharge with increasing symptoms over the 12-month follow-up, 100.3 for those depressed at discharge with fewer symptoms over the 12-month follow-up, and 88.0 for those depressed at discharge with more symptoms over the 12-month follow-up. Conclusion Tracking depressive symptom change in hospital and post discharge is clinically relevant and an important component of patient care and recovery of functional status. PMID:21275930

  16. Autopsy approach to stroke.

    Science.gov (United States)

    Love, Seth

    2011-02-01

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

  17. Prevalence of apraxia among patients with a first left hemisphere stroke in rehabilitation centres and nursing homes.

    OpenAIRE

    Donkervoort, M.; Dekker, J.; Ende, E. van den; Stehmann-Saris, J.C.; Deelman, B.G.

    2000-01-01

    OBJECTIVE: To investigate the prevalence of apraxia in patients with a first left hemisphere stroke. SUBJECTS: Left hemisphere stroke patients staying at an inpatient care unit of a rehabilitation centre or nursing home and receiving occupational therapy (n = 600). MEASURES: A short questionnaire on general patient characteristics and stroke-related aspects was completed by occupational therapists for every left hemisphere stroke patient they treated. A diagnosis of apraxia or nonapraxia was ...

  18. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin

    2018-01-01

    AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...

  19. Coding of significant comorbidities and complications for stroke in rehabilitation.

    Science.gov (United States)

    Murray, Joanne; Pfeiffer, Rhonda; Scholten, Ingrid

    2017-09-01

    Comorbidities and complications of stroke have implications for level of care and hospital resources. It is critical, therefore, that hospital morbidity data accurately reflect the prevalence of these additional diagnoses. This study aimed to measure and describe the concordance between stroke clinicians/researchers and medical record coders when recording stroke and related diagnoses. Diagnoses recorded prospectively, according to defined criteria by a clinical research team, were compared with the coding of stroke comorbidities and complications as per the Australian Coding Standards (ACS) from the separations of 100 inpatients from three rehabilitation facilities in South Australia. Percentage agreement, kappa coefficient, sensitivity and specificity values were calculated. Kappa coefficients for agreement of prospective diagnoses with coding ranged from 0.08 to 0.819. The diagnoses with the highest agreement were stroke, aspiration pneumonia (nil cases), aphasia and dysphagia. The diagnoses with the lowest agreement were apraxia, cognitive impairment, constipation and dehydration. Not all stroke comorbidities are represented accurately in hospital morbidity datasets. Education of stroke clinicians about the current ACS may clarify expectations about medical record documentation for coding purposes which in turn may result in more accurate morbidity data and therefore costings for the rehabilitation sector.

  20. Telestroke a viable option to improve stroke care in India.

    Science.gov (United States)

    Srivastava, Padma V; Sudhan, Paulin; Khurana, Dheeraj; Bhatia, Rohit; Kaul, Subash; Sylaja, P N; Moonis, Majaz; Pandian, Jeyaraj Durai

    2014-10-01

    In India, stroke care services are not well developed. There is a need to explore alternative options to tackle the rising burden of stroke. Telemedicine has been used by the Indian Space Research Organization (ISRO) to meet the needs of remote hospitals in India. The telemedicine network implemented by ISRO in 2001 presently stretches to around 100 hospitals all over the country, with 78 remote/rural/district health centers connected to 22 specialty hospitals in major cities, thus providing treatment to more than 25 000 patients, which includes stroke patients. Telemedicine is currently used in India for diagnosing stroke patients, subtyping stroke as ischemic or hemorrhagic, and treating accordingly. However, a dedicated telestroke system for providing acute stroke care is needed. Keeping in mind India's flourishing technology sector and leading communication networks, the hub-and-spoke model could work out really well in the upcoming years. Until then, simpler alternatives like smartphones, online data transfer, and new mobile applications like WhatsApp could be used. Telestroke facilities could increase the pool of patients eligible for thrombolysis. But this primary aim of telestroke can be achieved in India only if thrombolysis and imaging techniques are made available at all levels of health care. © 2014 World Stroke Organization.

  1. The Nottingham Fatigue After Stroke (NotFAST) study: results from follow-up six months after stroke.

    Science.gov (United States)

    Hawkins, Louise; Lincoln, Nadina B; Sprigg, Nikola; Ward, Nick S; Mistri, Amit; Tyrrell, Pippa; Worthington, Esme; Drummond, Avril

    2017-12-01

    Background Post-stroke fatigue is common and disabling. Objectives The aim of NotFAST was to examine factors associated with fatigue in stroke survivors without depression, six months after stroke. Methods Participants were recruited from four UK stroke units. Those with high levels of depressive symptoms (score ≥7 on Brief Assessment Schedule Depression Cards) or aphasia were excluded. Follow-up assessment was conducted at six months after stroke. They were assessed on the Fatigue Severity Scale, Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Barthel Index, Beck Anxiety Index, Brief Assessment Schedule Depression Cards, Impact of Event Scale-Revised, and Sleep Hygiene Index. Results Of the 371 participants recruited, 263 (71%) were contacted at six months after stroke and 213 (57%) returned questionnaires. Approximately half (n = 109, 51%) reported fatigue at six months. Of those reporting fatigue initially (n = 88), 61 (69%) continued to report fatigue. 'De novo' (new) fatigue was reported by 48 (38%) of those not fatigued initially. Lower Nottingham Extended Activities of Daily Living scores and higher Beck Anxiety Index scores were independently associated with fatigue at six months. Conclusions Half the stroke survivors reported fatigue at six months post-stroke. Reduced independence in activities of daily living and higher anxiety levels were associated with the level of fatigue. Persistent and delayed onset fatigue may affect independence and participation in rehabilitation, and these findings should be used to inform the development of appropriate interventions.

  2. Hanford Facility contingency plan

    International Nuclear Information System (INIS)

    Sutton, L.N.; Miskho, A.G.; Brunke, R.C.

    1993-10-01

    The Hanford Facility Contingency Plan, together with each TSD unit-specific contingency plan, meets the WAC 173-303 requirements for a contingency plan. This plan includes descriptions of responses to a nonradiological hazardous materials spill or release at Hanford Facility locations not covered by TSD unit-specific contingency plans or building emergency plans. This plan includes descriptions of responses for spills or releases as a result of transportation activities, movement of materials, packaging, and storage of hazardous materials

  3. Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 116: Area 25 Test Cell C Facility, Nevada Test Site, Nevada, Revision 1

    International Nuclear Information System (INIS)

    2008-01-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan identifies the activities required for the closure of Corrective Action Unit (CAU) 116, Area 25 Test Cell C Facility. The Test Cell C (TCC) Facility is located in Area 25 of the Nevada Test Site (NTS) approximately 25 miles northwest of Mercury, Nevada (Figure 1). CAU 116 is currently listed in Appendix III of the Federal Facility Agreement and Consent Order (FFACO) of 1996 (as amended February 2008) and consists of two Corrective Action Sites (CASs): (1) CAS 25-23-20, Nuclear Furnace Piping; and (2) CAS 25-41-05, Test Cell C Facility. CAS 25-41-05 is described in the FFACO as the TCC Facility but actually includes Building 3210 and attached concrete shield wall only. CAU 116 will be closed by demolishing Building 3210, the attached concrete shield wall, and the nuclear furnace piping. In addition, as a best management practice (BMP), Building 3211 (moveable shed) will be demolished due to its close proximity to Building 3210. This will aid in demolition and disposal operations. Radiological surveys will be performed on the demolition debris to determine the proper disposal pathway. As much of the demolition debris as space allows will be placed into the Building 3210 basement structure. After filling to capacity with demolition debris, the basement structure will be mounded or capped and closed with administrative controls. Prior to beginning demolition activities and according to an approved Sampling and Analysis Plan (SAP), representative sampling of surface areas that are known, suspected, or have the potential to contain hazardous constituents such as lead or polychlorinated biphenyls (PCBs) will be performed throughout all buildings and structures. Sections 2.3.2, 4.2.2.2, 4.2.2.3, 4.3, and 6.2.6.1 address the methodologies employed that assure the solid debris placed in the basement structure will not contain contaminants of concern (COCs) above hazardous waste levels. The anticipated post

  4. Surveillance for waterborne disease and outbreaks associated with recreational water use and other aquatic facility-associated health events--United States, 2005-2006.

    Science.gov (United States)

    Yoder, Jonathan S; Hlavsa, Michele C; Craun, Gunther F; Hill, Vincent; Roberts, Virginia; Yu, Patricia A; Hicks, Lauri A; Alexander, Nicole T; Calderon, Rebecca L; Roy, Sharon L; Beach, Michael J

    2008-09-12

    Since 1971, CDC, the U.S. Environmental Protection Agency, and the Council of State and Territorial Epidemiologists have collaboratively maintained the Waterborne Disease and Outbreak Surveillance System for collecting and reporting data related to waterborne-disease outbreaks (WBDOs) associated with drinking water. In 1978, WBDOs associated with recreational water (natural and treated water) were added. This system is the primary source of data regarding the scope and effects of disease associated with recreational water in the United States. In addition, data are collected on individual cases of recreational water-associated illnesses and infections and health events occurring at aquatic facilities but not directly related to water exposure. Data presented summarize WBDOs and case reports associated with recreational water use that occurred during January 2005--December 2006 and previously unreported disease reports and outbreaks during 1978--2004. Public health departments in the states, territories, localities, and the Freely Associated States (i.e., the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau, formerly parts of the U.S.-administered Trust Territory of the Pacific Islands) have primary responsibility for detecting, investigating, and voluntarily reporting WBDOs to CDC. Although the surveillance system includes data for WBDOs and cases associated with drinking water, recreational water, and water not intended for drinking, only cases and outbreaks associated with recreational water and health events at aquatic facilities are summarized in this report. During 2005--2006, a total of 78 WBDOs associated with recreational water were reported by 31 states. Illness occurred in 4,412 persons, resulting in 116 hospitalizations and five deaths. The median outbreak size was 13 persons (range: 2--2,307 persons). Of the 78 WBDOs, 48 (61.5%) were outbreaks of gastroenteritis that resulted from infectious agents or

  5. Poultry Slaughtering and Processing Facilities

    Data.gov (United States)

    Department of Homeland Security — Agriculture Production Poultry Slaughtering and Processing in the United States This dataset consists of facilities which engage in slaughtering, processing, and/or...

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

    Science.gov (United States)

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

    2007-01-01

    Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. Stroke risk factor knowledge, perception of lifetime stroke risk and risk factor status were included in the questionnaire, and the determinants of good risk factor knowledge and high stroke risk perception were identified using logistic regression models. Results Overall stroke risk factor knowledge was good with 67–96% of the participants recognizing established risk factors. The two exceptions were diabetes (recognized by 49%) and myocardial infarction (57%). Knowledge of a specific factor was superior among those affected by it. 13% of all participants considered themselves of having a high stroke risk, 55% indicated a moderate risk. All major risk factors contributed significantly to the perception of being at high stroke risk, but the effects of age, sex and education were non-significant. Poor self-rated health was additionally associated with high individual stroke risk perception. Conclusion Stroke risk factor knowledge was high in this study. The self perception of an increased stroke risk was associated with established risk factors as well as low perception of general health. PMID:17371603

  7. Relearning the Basics: Rehabilitation after a Stroke

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Stroke Rehabilitation Relearning the Basics: Rehabilitation After a Stroke Past ... to help them recover successfully. What is post-stroke rehabilitation? Rehab helps stroke survivors relearn skills lost to ...

  8. Early Home Supported Discharge of Stroke Patients:

    DEFF Research Database (Denmark)

    Larsen, Torben; Olsen, T. Skyhøj; Sørensen, Jan

    2006-01-01

    OBJECTIVES: A comprehensive and systematic assessment (HTA) of early home-supported discharge by a multidisciplinary team that plans, coordinates, and delivers care at home (EHSD) was undertaken and the results were compared with that of conventional rehabilitation at stroke units. METHODS......: A systematic literature search for randomized trials (RCTs) on "early supported discharge" was closed in April 2005. RCTs on EHSD without information on (i) death or institution at follow-up, (ii) change in Barthél Index, (iii) length of hospital stay, (iv) intensity of home rehabilitation, or (v) baseline...... are discussed. CONCLUSIONS: EHSD is evidenced as a dominant health intervention. However, financial barriers between municipalities and health authorities have to be overcome. For qualitative reasons, a learning path of implementation is recommended where one stroke unit in a region initiates EHSD...

  9. Key performance indicators for stroke from the Ministry of Health of Brazil: benchmarking and indicator parameters

    Directory of Open Access Journals (Sweden)

    Marcos C Lange

    Full Text Available ABSTRACT The present study aimed to analyze the stroke units in two centers for the key performance indicators (KPIs required by the Ministry of Health in Brazil. Methods All 16 KPIs were analyzed, including the percentage of patients admitted to the stroke unit, venous thromboembolism prophylaxis in the first 48 hours after admission, pneumonia and hospital mortality due to stroke, and hospital discharge on antithrombotic therapy in patients without cardioembolic mechanism. Results Both centers admitted over 80% of the patients in their stroke unit. The incidence of venous thromboembolism prophylaxis was > 85%, that of in-hospital pneumonia was 70%. Conclusion Our results suggest using the parameters of all of the 16 KPIs required by the Ministry of Health of Brazil, and the present results for the two stroke units for future benchmarking.

  10. Late night activity regarding stroke codes: LuNAR strokes.

    Science.gov (United States)

    Tafreshi, Gilda; Raman, Rema; Ernstrom, Karin; Rapp, Karen; Meyer, Brett C

    2012-08-01

    There is diurnal variation for cardiac arrest and sudden cardiac death. Stroke may show a similar pattern. We assessed whether strokes presenting during a particular time of day or night are more likely of vascular etiology. To compare emergency department stroke codes arriving between 22:00 and 8:00 hours (LuNAR strokes) vs. others (n-LuNAR strokes). The purpose was to determine if late night strokes are more likely to be true strokes or warrant acute tissue plasminogen activator evaluations. We reviewed prospectively collected cases in the University of California, San Diego Stroke Team database gathered over a four-year period. Stroke codes at six emergency departments were classified based on arrival time. Those arriving between 22:00 and 8:00 hours were classified as LuNAR stroke codes, the remainder were classified as 'n-LuNAR'. Patients were further classified as intracerebral hemorrhage, acute ischemic stroke not receiving tissue plasminogen activator, acute ischemic stroke receiving tissue plasminogen activator, transient ischemic attack, and nonstroke. Categorical outcomes were compared using Fisher's Exact test. Continuous outcomes were compared using Wilcoxon's Rank-sum test. A total of 1607 patients were included in our study, of which, 299 (19%) were LuNAR code strokes. The overall median NIHSS was five, higher in the LuNAR group (n-LuNAR 5, LuNAR 7; P=0·022). There was no overall differences in patient diagnoses between LuNAR and n-LuNAR strokes (P=0·169) or diagnosis of acute ischemic stroke receiving tissue plasminogen activator (n-LuNAR 191 (14·6%), LuNAR 42 (14·0%); P=0·86). Mean arrival to computed tomography scan time was longer during LuNAR hours (n-LuNAR 54·9±76·3 min, LuNAR 62·5±87·7 min; P=0·027). There was no significant difference in 90-day mortality (n-LuNAR 15·0%, LuNAR 13·2%; P=0·45). Our stroke center experience showed no difference in diagnosis of acute ischemic stroke between day and night stroke codes. This

  11. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

    Science.gov (United States)

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

    2017-07-01

    Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.

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

    Science.gov (United States)

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

    2012-01-01

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

  13. The Importance of Patient Involvement in Stroke Rehabilitation

    Science.gov (United States)

    2016-01-01

    Objective To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. Method Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. Results The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. Conclusions The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health

  14. Perceived barriers to physical activity among Nigerian stroke survivors

    African Journals Online (AJOL)

    The four most reported common barriers among stroke survivors were access to exercise facilities (95.0 %), being embarrassed to exercise (94.2%), economic cost demands of exercise (94.2 %) and notion that people in exercise clothes look funny (94.2%) respectively. There were no significant differences found in barriers ...

  15. Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in the United States. Preliminary background report

    Energy Technology Data Exchange (ETDEWEB)

    Feurer, D.A.; Weaver, C.L.; Gallagher, K.C.; Hejna, D.; Rielley, K.J.

    1980-01-01

    This report is one of a series of preliminary reports describing the laws and regulatory programs of the United States and each of the 50 states affecting the siting and operation of energy generating facilities likely to be used in Integrated Community Energy Systems (ICES). Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES. This report describes laws and regulatory programs in the United States. Subsequent reports will (1) describe public utility rate regulatory procedures and practices as they might affect an ICES, (2) analyze each of the aforementioned regulatory programs to identify impediments to the development of ICES, and (3) recommend potential changes in legislation and regulatory practices and procedures to overcome such impediments.

  16. Diabetes, Heart Disease, and Stroke

    Science.gov (United States)

    ... Disease, & Other Dental Problems Diabetes, Sexual, & Bladder Problems Diabetes, Heart Disease, and Stroke Having diabetes means that ... help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood ...

  17. Preventable Pediatric Stroke via Vaccination?

    Directory of Open Access Journals (Sweden)

    Craig A. Press

    2015-11-01

    Full Text Available Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS group studied the risk of arterial ischemic stroke (AIS associated with minor infection and routine childhood vaccinations.

  18. Heart Disease and Stroke Statistics

    Science.gov (United States)

    ... Media for Heart.org Heart and Stroke Association Statistics Each year, the American Heart Association, in conjunction ... health and disease in the population. Heart & Stroke Statistics FAQs What is Prevalence? Prevalence is an estimate ...

  19. Citation Classics in Stroke: The Top-100 Cited Articles on Hemorrhagic Stroke.

    Science.gov (United States)

    Kim, Yerim; Yoon, Dae Young; Kim, Jee-Eun; Park, Kang Min; Lee, Ju-Hun; Song, Hong-Ki; Bae, Jong Seok

    2017-01-01

    Stroke is a disastrous disease and a major health burden worldwide, especially in Korea. Hemorrhagic stroke (HS) accounts for approximately 20% of all the types of strokes. It is important to be able to evaluate stroke diagnoses and evolving treatments. We aimed to identify the top-100 cited articles and assess a paradigm shift that occurred in the field of HS. We searched all articles that had been cited more than 100 times using the Web of Science citation search tool during January 2016. Among a total of 2,651 articles, we identified the top-100 cited articles on HS. The number of citations for the articles analyzed in this study ranged from 1,746 to 211, and the number of annual citations ranged from 125.6 to 5.5. Most of the articles that were published in Stroke (35%) and Journal of Neurosurgery (22%), originated in the United States (n = 56), were original articles (64%), and dealt with the natural history or etiology (n = 37) and vasospasm in subarachnoid hemorrhage (n = 8). We analyzed the top-100 cited articles in the field of HS based on citation rates. The results provide a unique perspective on historical and academic developments in this field. © 2017 S. Karger AG, Basel.

  20. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara; Rockwood, Alyn; Ghanem, Bernard

    2015-01-01

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

  1. Mortality after hemorrhagic stroke

    DEFF Research Database (Denmark)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann

    2013-01-01

    OBJECTIVE: To investigate short-term case fatality and long-term mortality after intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) using data from The Health Improvement Network database. METHODS: Thirty-day case fatality was stratified by age, sex, and calendar year after ICH...... = 0.03). CONCLUSIONS: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated......, 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend stroke patients...

  2. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara

    2015-10-15

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

  3. Correlative study between neuron-specific enolase and blood sugar level in ischemic stroke patients

    OpenAIRE

    Pandey, Aparna; Saxena, Kiran; Verma, Meena; Bharosay, Anuradha

    2011-01-01

    Background: A study to investigate the level of the neurobiochemical marker, Neuron-Specific Enolase (NSE), at the time of admission and its correlation with the blood sugar level in ischemic stroke patients. Patients and Methods: We investigated 90 patients with complete stroke who were admitted to the Stroke Unit of the Department of Neurology at Sri Aurobindo Institute of Medical Sciences. NSE was measured with commercially available quantitative ′sandwich′ enzyme-linked immunosorbent assa...

  4. Facilities & Leadership

    Data.gov (United States)

    Department of Veterans Affairs — The facilities web service provides VA facility information. The VA facilities locator is a feature that is available across the enterprise, on any webpage, for the...

  5. Inequities in access to inpatient rehabilitation after stroke: an international scoping review.

    Science.gov (United States)

    Lynch, Elizabeth A; Cadilhac, Dominique A; Luker, Julie A; Hillier, Susan L

    2017-12-01

    Background Inequities in accessing inpatient rehabilitation after stroke have been reported in many countries and impact on patient outcomes. Objective To explore variation in international recommendations regarding which patients should receive inpatient rehabilitation after stroke and to describe reported access to rehabilitation. Methods A scoping review was conducted to identify clinical guidelines with recommendations regarding which patients should access inpatient rehabilitation after stroke, and data regarding the proportion of patients accessing stroke rehabilitation. Four bibliographic databases and grey literature were searched. Results Twenty-eight documents were included. Selection criteria for post-acute inpatient rehabilitation were identified for 14 countries or regions and summary data on the proportion of patients receiving inpatient rehabilitation were identified for 14 countries. In Australia, New Zealand, and the United Kingdom, it is recommended that all patients with stroke symptoms should access rehabilitation, whereas guidelines from the United States, Canada, and Europe did not consistently recommend rehabilitation for people with severe stroke. Access to inpatient rehabilitation ranged from 13% in Sweden to 57% in Israel. Differences in availability of early supported discharge/home rehabilitation programs and variations in reporting methods may influence the ability to reliably compare access to rehabilitation between regions. Conclusion Recommendations regarding which patients with moderate and severe strokes should access ongoing rehabilitation are inconsistent. Clinical practice guidelines from different countries regarding post-stroke rehabilitation do not always reflect the evidence regarding the likely benefits to people with stroke. Inequity in access to rehabilitation after stroke is an international issue.

  6. 42 CFR 52b.9 - What is the right of the United States to recover Federal funds when facilities are not used for...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false What is the right of the United States to recover... HEALTH CONSTRUCTION GRANTS § 52b.9 What is the right of the United States to recover Federal funds when... purposes authorized under the Act. (d) The right of recovery of the United States set forth in paragraph (a...

  7. Questions and Answers about Stroke

    Science.gov (United States)

    ... stroke. High blood pressure increases your risk of stroke four to six times. Heart disease, especially a condition ... leading cause of serious, long-term adult disability. Four million Americans are living with the effects of stroke. The length of time to recover from a ...

  8. Stroke and Episodic Memory Disorders

    Science.gov (United States)

    Lim, Chun; Alexander, Michael P.

    2009-01-01

    Memory impairments are common after stroke, and the anatomical basis for impairments may be quite variable. To determine the range of stroke-related memory impairment, we identified all case reports and group studies through the Medline database and the Science Citation Index. There is no hypothesis about memory that is unique to stroke, but there…

  9. Risk of stroke/systemic embolism, major bleeding and associated costs in non-valvular atrial fibrillation patients who initiated apixaban, dabigatran or rivaroxaban compared with warfarin in the United States Medicare population.

    Science.gov (United States)

    Amin, Alpesh; Keshishian, Allison; Trocio, Jeffrey; Dina, Oluwaseyi; Le, Hannah; Rosenblatt, Lisa; Liu, Xianchen; Mardekian, Jack; Zhang, Qisu; Baser, Onur; Vo, Lien

    2017-09-01

    To compare the risk and cost of stroke/systemic embolism (SE) and major bleeding between each direct oral anticoagulant (DOAC) and warfarin among non-valvular atrial fibrillation (NVAF) patients. Patients (≥65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Medicare database from 1 January 2013 to 31 December 2014. Patients initiating each DOAC were matched 1:1 to warfarin patients using propensity score matching to balance demographics and clinical characteristics. Cox proportional hazards models were used to estimate the risks of stroke/SE and major bleeding of each DOAC vs. warfarin. Two-part models were used to compare the stroke/SE- and major-bleeding-related medical costs between matched cohorts. Of the 186,132 eligible patients, 20,803 apixaban-warfarin pairs, 52,476 rivaroxaban-warfarin pairs, and 16,731 dabigatran-warfarin pairs were matched. Apixaban (hazard ratio [HR] = 0.40; 95% confidence interval [CI] 0.31, 0.53) and rivaroxaban (HR = 0.72; 95% CI 0.63, 0.83) were significantly associated with lower risk of stroke/SE compared to warfarin. Apixaban (HR = 0.51; 95% CI 0.44, 0.58) and dabigatran (HR = 0.79; 95% CI 0.69, 0.91) were significantly associated with lower risk of major bleeding; rivaroxaban (HR = 1.17; 95% CI 1.10, 1.26) was significantly associated with higher risk of major bleeding compared to warfarin. Compared to warfarin, apixaban ($63 vs. $131) and rivaroxaban ($93 vs. $139) had significantly lower stroke/SE-related medical costs; apixaban ($292 vs. $529) and dabigatran ($369 vs. $450) had significantly lower major bleeding-related medical costs. Among the DOACs in the study, only apixaban is associated with a significantly lower risk of stroke/SE and major bleeding and lower related medical costs compared to warfarin.

  10. An audit of the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital.

    Science.gov (United States)

    Khalil, Viviane; Li, Matthew; Hua, Qiantong Amanda

    2015-02-01

    According to the Australian Bureau of Statistics, stroke is the second leading cause of death in Australia. The clinical Guidelines for stroke management published by the National Stroke Foundation provide a series of evidence based recommendations to assist clinicians in the management of stroke patients. Appropriate management of patients admitted to stroke units reduces death and disability by 20 %. Moreover, a multidisciplinary team approach also improves patient outcomes. To retrospectively review the pharmacological management of ischaemic stroke patients in a metropolitan Australian hospital, and to compare adherence with the guidelines for stroke management with the national stroke foundation data with and without pharmacist intervention. A retrospective audit of medical records was undertaken of all patients admitted to a large teaching hospital with the diagnosis of stroke or cerebral infarction from January 2013 to May 2013. A total of 124 patients were included in the study. Most patients were discharged on appropriate pharmacological intervention for the prevention of secondary stroke: antihypertensive agents (71 %), lipid lowering agents (67 %) and antithrombotic (85 %) medications. The majority of the cohort was discharged on the appropriate evidence based medications for the management of secondary stroke. Further improvement may be achieved by pharmacist intervening as part of a multidisciplinary team.

  11. Translation and validation of the Malay version of the Stroke Knowledge Test.

    Science.gov (United States)

    Sowtali, Siti Noorkhairina; Yusoff, Dariah Mohd; Harith, Sakinah; Mohamed, Monniaty

    2016-04-01

    To date, there is a lack of published studies on assessment tools to evaluate the effectiveness of stroke education programs. This study developed and validated the Malay language version of the Stroke Knowledge Test research instrument. This study involved translation, validity, and reliability phases. The instrument underwent backward and forward translation of the English version into the Malay language. Nine experts reviewed the content for consistency, clarity, difficulty, and suitability for inclusion. Perceived usefulness and utilization were obtained from experts' opinions. Later, face validity assessment was conducted with 10 stroke patients to determine appropriateness of sentences and grammar used. A pilot study was conducted with 41 stroke patients to determine the item analysis and reliability of the translated instrument using the Kuder Richardson 20 or Cronbach's alpha. The final Malay version Stroke Knowledge Test included 20 items with good content coverage, acceptable item properties, and positive expert review ratings. Psychometric investigations suggest that Malay version Stroke Knowledge Test had moderate reliability with Kuder Richardson 20 or Cronbach's alpha of 0.58. Improvement is required for Stroke Knowledge Test items with unacceptable difficulty indices. Overall, the average rating of perceived usefulness and perceived utility of the instruments were both 72.7%, suggesting that reviewers were likely to use the instruments in their facilities. Malay version Stroke Knowledge Test was a valid and reliable tool to assess educational needs and to evaluate stroke knowledge among participants of group-based stroke education programs in Malaysia.

  12. Regular group exercise is associated with improved mood but not quality of life following stroke

    Directory of Open Access Journals (Sweden)

    Michelle N. McDonnell

    2014-03-01

    Full Text Available Purpose. People with stroke living in the community have an increased prevalence of depression and lower quality of life than healthy older adults. This cross-sectional observational study investigated whether participation in regular exercise was associated with improved mood and quality of life.Methods. We recruited three groups of community dwelling participants: 13 healthy older adults, 17 adults post-stroke who regularly participated in group exercise at a community fitness facility and 10 adults post-stroke who did not regularly exercise. We measured mood using the Depression, Anxiety, Stress Scale (DASS and quality of life using the Assessment of Quality of Life (AQoL scale.Results. Levels of stress and depression were significantly greater in the people with stroke who did not undertake regular exercise (p = 0.004 and p = 0.004 respectively, although this group had more recent strokes (p < 0.001. Both stroke groups had lower quality of life scores (p = 0.04 than the healthy adults.Conclusions. This small, community-based study confirms that people following stroke report poorer quality of life than stroke-free individuals. However, those who exercise regularly have significantly lower stress and depression compared to stroke survivors who do not. Future research should focus on the precise type and amount of exercise capable of improving mood following stroke.

  13. Mridangam stroke dataset

    OpenAIRE

    CompMusic

    2014-01-01

    The audio examples were recorded from a professional Carnatic percussionist in a semi-anechoic studio conditions by Akshay Anantapadmanabhan using SM-58 microphones and an H4n ZOOM recorder. The audio was sampled at 44.1 kHz and stored as 16 bit wav files. The dataset can be used for training models for each Mridangam stroke. /n/nA detailed description of the Mridangam and its strokes can be found in the paper below. A part of the dataset was used in the following paper. /nAkshay Anantapadman...

  14. Stroke and Therapeutic Hypothermia

    Directory of Open Access Journals (Sweden)

    Ozlem Ozkan Kuscu

    2016-09-01

    Full Text Available Stroke is significant cause of morbidity and mortality caused by disruption of blood flow. Neural injury occurs with two stage; while primary neural injury occurs with disruption of blood flow, after days and hours with metabolic processes secondary injury develops in tissues which is non injured in the first stage. Therefore it is important to prevent and treat the secondary injury as much as preventing and treating the primary neural injury. In this article developing pathophysiological changes after stroke, mechanisms of therapeutic hypothermia, application methods, the factors that determine the effectiveness, side effects and complications were reviewed. [Archives Medical Review Journal 2016; 25(3.000: 351-368

  15. Biotherapies in stroke.

    Science.gov (United States)

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

    2014-12-01

    Stroke is the second leading cause of death worldwide and the most common cause of severe disability. Neuroprotection and repair mechanisms supporting endogenous brain plasticity are often insufficient to allow complete recovery. While numerous neuroprotective drugs trials have failed to demonstrate benefits for patients, they have provided interesting translational research lessons related to neurorestorative therapy mechanisms in stroke. Stroke damage is not limited to neurons but involve all brain cell type including the extracellular matrix in a "glio-neurovascular niche". Targeting a range of host brain cells, biotherapies such as growth factors and therapeutic cells, currently hold great promise as a regenerative medical strategy for stroke. These techniques can promote both neuroprotection and delayed neural repair through neuro-synaptogenesis, angiogenesis, oligodendrogliogenesis, axonal sprouting and immunomodulatory effects. Their complex mechanisms of action are interdependent and vary according to the particular growth factor or grafted cell type. For example, while "peripheral" stem or stromal cells can provide paracrine trophic support, neural stem/progenitor cells (NSC) or mature neurons can act as more direct neural replacements. With a wide therapeutic time window after stroke, biotherapies could be used to treat many patients. However, guidelines for selecting the optimal time window, and the best delivery routes and doses are still debated and the answers may depend on the chosen product and its expected mechanism including early neuroprotection, delayed neural repair, trophic systemic transient effects or graft survival and integration. Currently, the great variety of growth factors, cell sources and cell therapy products form a therapeutic arsenal that is available for stroke treatment. Their effective clinical use will require prior careful considerations regarding safety (e.g. tumorgenicity, immunogenicity), potential efficacy, cell

  16. Astrocytes, therapeutic targets for neuroprotection and neurorestoration in ischemic stroke

    Science.gov (United States)

    Liu, Zhongwu; Chopp, Michael

    2015-01-01

    Astrocytes are the most abundant cell type within the central nervous system. They play essential roles in maintaining normal brain function, as they are a critical structural and functional part of the tripartite synapses and the neurovascular unit, and communicate with neurons, oligodendrocytes and endothelial cells. After an ischemic stroke, astrocytes perform multiple functions both detrimental and beneficial, for neuronal survival during the acute phase. Aspects of the astrocytic inflammatory response to stroke may aggravate the ischemic lesion, but astrocytes also provide benefit for neuroprotection, by limiting lesion extension via anti-excitotoxicity effects and releasing neurotrophins. Similarly, during the late recovery phase after stroke, the glial scar may obstruct axonal regeneration and subsequently reduce the functional outcome; however, astrocytes also contribute to angiogenesis, neurogenesis, synaptogenesis, and axonal remodeling, and thereby promote neurological recovery. Thus, the pivotal involvement of astrocytes in normal brain function and responses to an ischemic lesion designates them as excellent therapeutic targets to improve functional outcome following stroke. In this review, we will focus on functions of astrocytes and astrocyte-mediated events during stroke and recovery. We will provide an overview of approaches on how to reduce the detrimental effects and amplify the beneficial effects of astrocytes on neuroprotection and on neurorestoration post stroke, which may lead to novel and clinically relevant therapies for stroke. PMID:26455456

  17. Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia

    Science.gov (United States)

    Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead

    2014-01-01

    Background Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. Methods & Findings In 2010–2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2–8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77–95% alive and on treatment). Conclusions This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation. PMID:25389777

  18. Biochemistry Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The Biochemistry Facility provides expert services and consultation in biochemical enzyme assays and protein purification. The facility currently features 1) Liquid...

  19. Validity of the stroke rehabilitation assessment of movement scale in acute rehabilitation: a comparison with the functional independence measure and stroke impact scale-16.

    Science.gov (United States)

    Ward, Irene; Pivko, Susan; Brooks, Gary; Parkin, Kate

    2011-11-01

    To demonstrate sensitivity to change of the Stroke Rehabilitation Assessment of Movement (STREAM) as well as the concurrent and predictive validity of the STREAM in an acute rehabilitation setting. Prospective cohort study. Acute, in-patient rehabilitation department within a tertiary-care teaching hospital in the United States. Thirty adults with a newly diagnosed, first ischemic stroke. Clinical assessments were conducted on admission and then again on discharge from the rehabilitation hospital with the STREAM (total STREAM and upper extremity, lower extremity, and mobility subscales), Functional Independence Measure (FIM), and Stroke Impact Scale-16 (SIS-16). Sensitivity to change was determined with the Wilcoxon signed rank test and by the calculation of standardized response means. Spearman correlations were used to assess concurrent validity of the total STREAM and STREAM subscales with the FIM and SIS-16 on admission and discharge. We determined predictive validity for all instruments by correlating admission scores with actual and predicted length of stay and by testing associations between admission scores and discharge destination (home vs subacute facility). Not applicable. For all instruments, there was statistically significant improvement from admission to discharge. The standardized response means for the total STREAM and STREAM subscales were large. Spearman correlations between the total STREAM and STREAM subscales and the FIM and SIS-16 were moderate to excellent, both on admission and discharge. Among change scores, only the SIS-16 correlated with the total STREAM. All 3 instruments were significantly associated with discharge destination; however, the associations were strongest for the total STREAM and STREAM subscales. All instruments showed moderate-to-excellent correlations with predicted and actual length of stay. The STREAM is sensitive to change and demonstrates good concurrent and predictive validity as compared with the FIM and SIS-16

  20. Family History in Young Patients With Stroke.

    Science.gov (United States)

    Thijs, Vincent; Grittner, Ulrike; Dichgans, Martin; Enzinger, Christian; Fazekas, Franz; Giese, Anne-Katrin; Kessler, Christof; Kolodny, Edwin; Kropp, Peter; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Rothwell, Peter M; Schmidt, Reinhold; Tanislav, Christian; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt

    2015-07-01

    Family history of stroke is an established risk factor for stroke. We evaluated whether family history of stroke predisposed to certain stroke subtypes and whether it differed by sex in young patients with stroke. We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young patients (aged stroke in whom cardiovascular risk factors and family history of stroke were obtained and detailed stroke subtyping was performed. A family history of stroke was present in 1578 of 4232 transient ischemic attack and ischemic stroke patients (37.3%). Female patients more often had a history of stroke in the maternal lineage (P=0.027) than in the paternal lineage. There was no association with stroke subtype according to Trial of Org 10172 in Acute Stroke Treatment nor with the presence of white matter disease on brain imaging. Patients with dissection less frequently reported a family history of stroke (30.4% versus 36.3%; P=0.018). Patients with a parental history of stroke more commonly had siblings with stroke (3.6% versus 2.6%; P=0.047). Although present in about a third of patients, a family history of stroke is not specifically related to stroke pathogenic subtypes in patients with young stroke. Young women with stroke more often report stroke in the maternal lineage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  1. Exploring the Experiences of Living With Stroke Through Narrative

    Directory of Open Access Journals (Sweden)

    Nasrin Nasr

    2016-04-01

    Full Text Available Chronic illness models are normally used to explain and predict the experience of living with a long-term condition. The aim of this study was to present the findings of narrative interviews with stroke survivors and their family carers to understand their experiences of stroke. We interviewed five people with stroke and three family carers from the United Kingdom. We used thematic analysis to generate themes from their narrative accounts and then linked them to broader theoretical perspectives while influenced by the concept of reinterpretation of life. The narrative accounts of participants are mainly structured based on how their changed bodies poststroke changed their identities and roles and consequently their relationships with others. In this study, we underline the need for using methods like narrative to explain strategies that people use to make sense of their experiences of living with a long-term condition such as stroke.

  2. Exploring the Experiences of Living With Stroke Through Narrative

    Science.gov (United States)

    Nasr, Nasrin; Mawson, Susan; Wright, Peter; Parker, Jack; Mountain, Gail

    2016-01-01

    Chronic illness models are normally used to explain and predict the experience of living with a long-term condition. The aim of this study was to present the findings of narrative interviews with stroke survivors and their family carers to understand their experiences of stroke. We interviewed five people with stroke and three family carers from the United Kingdom. We used thematic analysis to generate themes from their narrative accounts and then linked them to broader theoretical perspectives while influenced by the concept of reinterpretation of life. The narrative accounts of participants are mainly structured based on how their changed bodies poststroke changed their identities and roles and consequently their relationships with others. In this study, we underline the need for using methods like narrative to explain strategies that people use to make sense of their experiences of living with a long-term condition such as stroke. PMID:28462337

  3. Heat Stroke: A Medical Emergency Appearing in New Regions

    Directory of Open Access Journals (Sweden)

    Sofie Søndergaard Mørch

    2017-01-01

    Full Text Available Heat stroke is an acute, life-threatening emergency characterized clinically by elevated body temperature and central nervous system dysfunction. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications are essential to reduce morbidity and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were 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 waves will occur in previously cooler regions. Therefore it is important to raise awareness of heat stroke since outcome depends on early recognition and rapid cooling.

  4. Processes of early stroke care and hospital costs

    DEFF Research Database (Denmark)

    Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H

    2014-01-01

    Background: The relationship between processes of early stroke care and hospital costs remains unclear. Aims: We therefore examined the association in a population-based cohort study. Methods: We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005...... of hospitalization were $23352 (standard deviation 27827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose-response relationship. The adjusted costs were $24566 (95% confidence interval 19364-29769) lower for patients who received 75......-100% of the relevant processes of care compared with patients receiving 0-24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Conclusions: Early care in agreement with key guidelines recommendations for the management...

  5. Development of a model for geomorphological assessment at U.S. DOE chemical/radioactive waste disposal facilities in the central and eastern United States; Weldon spring site remedial action project, Weldon Spring, Missouri

    International Nuclear Information System (INIS)

    Rockaway, J.D.; Smith, R.J.

    1994-01-01

    Landform development and long-term geomorphic stability is the result of a complex interaction of a number of geomorphic processes. These processes may be highly variable in intensity and duration under different physiographic settings. This limitation has influenced the applicability of previous geomorphological stability assessments conducted in the arid or semi-arid western United States to site evaluations in more temperate and humid climates. The purpose of this study was to develop a model suitable for evaluating both long-term and short-term geomorphic processes which may impact landform stability and hence the stability of disposal facilities located in the central and eastern United States. The model developed for the geomorphological stability assessment at the Weldon Spring Site Remedial Action Project (WSSRAP) near St. Louis, Missouri, included an evaluation of existing landforms and consideration of the impact of both long-term and short-term geomorphic processes. These parameters were evaluated with respect to their impact and contribution to three assessment criteria considered most important with respect to the stability analysis; evaluation of landform age, evaluation of present geomorphic process activity and; determination of the impact of the completed facility on existing geomorphic processes. The geomorphological assessment at the Weldon Spring site indicated that the facility is located in an area of excellent geomorphic stability. The only geomorphic process determined to have a potential detrimental effect on long-term facility performance is an extension of the drainage network. A program of mitigating measures has been proposed to minimize the impact that future gully extension could have on the integrity of the facility

  6. Stroke Connection Magazine

    Science.gov (United States)

    ... controlling blood pressure over the long term than exercise, diet, not smoking and reducing alcohol consumption. Combo of Smaller Meds May Just Be the Dose to Lower Blood Pressure Combined smaller doses of blood pressure medications may be effective with ... Exercise May Lessen Stroke Severity Being physically active may ...

  7. Neurorehabilitation after Stroke

    Directory of Open Access Journals (Sweden)

    Rüdiger J. Seitz

    2013-08-01

    Full Text Available Recovery from ischaemic stroke is determined in the acute phase by the lesion impact of ischaemia and subsequently, by functional and structural network changes in the spared brain tissue. Neurorehabilitation supports the restitution of function using repetitive, learning-based and, more recently, technology-based training strategies.

  8. Ischemic strokes and migraine

    Energy Technology Data Exchange (ETDEWEB)

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

    1985-11-01

    Lasting neurological deficits, though most infrequent, do occur in migrainous subjects and are well documented by clinical angiographic computed tomographic (CT scan) and even pathological studies. However the mechanism of cerebral ischemia in migraine remains widely unknown and the precise role of migraine in the pathogenesis of ischemic strokes is still debated. (orig./MG).

  9. The Optimal Golf Stroke

    DEFF Research Database (Denmark)

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

    2006-01-01

    The paper presents a preliminary investigation into aspects of the game of golf. A series of models is proposed for the golf stroke, the momentum transfer between club and ball and the flight of the ball.Numerical and asymptotic solutions are presented reproducing many of the features observed in...

  10. Hypercholesterolemia, Stroke And Statins

    Directory of Open Access Journals (Sweden)

    Prabhakar S

    2005-01-01

    Full Text Available The link between serum cholesterol levels and the incidence of stroke still remain to be established. There are conflicting reports from a series of observational cohort studies. However, clinical trials with HMG CoA reductase inhibitors (also called statins have shown that cholesterol lowering therapy used in the primary and secondary prevention of myocardial infarction significantly reduced cardiovascular events including strokes. Meta analysis of trials with statins have shown a relative risk reduction in stroke of 12 to 48% in patients with coronary heart disease after MI. It has been postulated that the clinical action of statins is the result of pleiotropic / antiatherogenic effects rather than simply a reduction in cholesterol. The putative beneficial effect of statins in stroke involve blocking of macrophage and platelet activation, improvement of endothelial cell vasomotor function, enhancement of endothelial fibrinolytic function, immunosuppressive and anti-inflammatory action, inhibition of smooth muscle cell proliferation and particularly enhancement of endothelial nitric oxide synthase (eNOS.

  11. Stroke? Localized, otogenic meningitis!

    DEFF Research Database (Denmark)

    Ingolfsdottir, Harpa Maria; Thomasen, Per Caye

    2011-01-01

    We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur...

  12. Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial.

    Science.gov (United States)

    Kalra, Lalit; Irshad, Saddif; Hodsoll, John; Simpson, Matthew; Gulliford, Martin; Smithard, David; Patel, Anita; Rebollo-Mesa, Irene

    2015-11-07

    Post-stroke pneumonia is associated with increased mortality and poor functional outcomes. This study assessed the effectiveness of antibiotic prophylaxis for reducing pneumonia in patients with dysphagia after acute stroke. We did a prospective, multicentre, cluster-randomised, open-label controlled trial with masked endpoint assessment of patients older than 18 years with dysphagia after new stroke recruited from 48 stroke units in the UK, accredited and included in the UK National Stroke Audit. We excluded patients with contraindications to antibiotics, pre-existing dysphagia, or known infections, or who were not expected to survive beyond 14 days. We randomly assigned the units (1:1) by computer to give either prophylactic antibiotics for 7 days plus standard stroke unit care or standard stroke unit care only to patients clustered in the units within 48 h of stroke onset. We did the randomisation with minimisation to stratify for number of admissions and access to specialist care. Patient and staff who did the assessments and analyses were masked to stroke unit allocation. The primary outcome was post-stroke pneumonia in the first 14 days, assessed with both a criteria-based, hierarchical algorithm and by physician diagnosis in the intention-to-treat population. Safety was also analysed by intention to treat. This trial is closed to new participants and is registered with isrctn.com, number ISRCTN37118456. Between April 21, 2008, and May 17, 2014, we randomly assigned 48 stroke units (and 1224 patients clustered within the units) to the two treatment groups: 24 to antibiotics and 24 to standard care alone (control). 11 units and seven patients withdrew after randomisation before 14 days, leaving 1217 patients in 37 units for the intention-to-treat analysis (615 patients in the antibiotics group, 602 in control). Prophylactic antibiotics did not affect the incidence of algorithm-defined post-stroke pneumonia (71 [13%] of 564 patients in antibiotics group vs 52

  13. Dance Facilities.

    Science.gov (United States)

    Ashton, Dudley, Ed.; Irey, Charlotte, Ed.

    This booklet represents an effort to assist teachers and administrators in the professional planning of dance facilities and equipment. Three chapters present the history of dance facilities, provide recommended dance facilities and equipment, and offer some adaptations of dance facilities and equipment, for elementary, secondary and college level…

  14. PATHOPHYSIOLOGY STROKE NON-HEMORRHAGIC ET CAUSA THROMBUS

    Directory of Open Access Journals (Sweden)

    Aji Kristianto Wijaya

    2013-10-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Stroke is one of the most common cause of death worldwide and the third leading cause of death in the United States. Stroke composed 90,000 deaths of women and 60,000 men each year. In Indonesia, 8 of 1000 people suffered a stroke. Stroke is divided into two, non-hemorrhagic stroke and hemorrhagic stroke. Most of them (80% is non-hemorrhagic stroke. Non-hemorrhagic stroke can be caused by thrombi or emboli. Understanding the pathophysiology of non-hemorrhagic stroke caused by a thrombus is very important in regard with providing appropriate patient management. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  15. Thrombolysis in Postoperative Stroke.

    Science.gov (United States)

    Voelkel, Nicolas; Hubert, Nikolai Dominik; Backhaus, Roland; Haberl, Roman Ludwig; Hubert, Gordian Jan

    2017-11-01

    Intravenous thrombolysis (IVT) is beneficial in reducing disability in selected patients with acute ischemic stroke. There are numerous contraindications to IVT. One is recent surgery. The aim of this study was to analyze the safety of IVT in patients with postoperative stroke. Data of consecutive IVT patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (February 2003 to October 2014; n=4848) were retrospectively searched for keywords indicating preceding surgery. Patients were included if surgery was performed within the last 90 days before stroke. The primary outcome was defined as surgical site hemorrhage. Subgroups with major/minor surgery and recent/nonrecent surgery (within 10 days before IVT) were analyzed separately. One hundred thirty-four patients underwent surgical intervention before IVT. Surgery had been performed recently (days 1-10) in 49 (37%) and nonrecently (days 11-90) in 85 patients (63%). In 86 patients (64%), surgery was classified as major, and in 48 (36%) as minor. Nine patients (7%) developed surgical site hemorrhage after IVT, of whom 4 (3%) were serious, but none was fatal. One fatal bleeding occurred remotely from surgical area. Rate of surgical site hemorrhage was significantly higher in recent than in nonrecent surgery (14.3% versus 2.4%, respectively, odds ratio adjusted 10.73; 95% confidence interval, 1.88-61.27). Difference between patients with major and minor surgeries was less distinct (8.1% and 4.2%, respectively; odds ratio adjusted 4.03; 95% confidence interval, 0.65-25.04). Overall in-hospital mortality was 8.2%. Intracranial hemorrhage occurred in 9.7% and was asymptomatic in all cases. IVT may be administered safely in postoperative patients as off-label use after appropriate risk-benefit assessment. However, bleeding risk in surgical area should be taken into account particularly in patients who have undergone surgery shortly before stroke onset. © 2017 American Heart Association, Inc.

  16. Rehabilitating the Stroke Collection

    Directory of Open Access Journals (Sweden)

    Mary Grimmond

    2006-06-01

    Full Text Available Objective The aim of this project was to complete an analysis of monograph and audiovisual items held in the Central Coast Health Service (CCHS Libraries and containing information relevant to the treatment of acute stroke. Acute stroke is treated by multidisciplinary teams of clinicians based at two hospitals within the CCHS. The adequacy of the library collection was measured by subject coverage and age. Methods The methodology used consisted of three main steps: a literature review; design, administration, and analysis of a questionnaire to members of the CCHS Acute Stroke Team; and an analysis of the libraries’ collections. The research project utilised project management methodology and an evidence based librarianship framework. Results The questionnaire revealed that electronic resources were by far the most frequently used by participants, followed in order by print journals, books, interlibrary loan articles, and audiovisual items. Collection analysis demonstrated that the monograph and audiovisual collections were adequate in both scope and currency to support the information needs of Acute Stroke Team members, with the exception of resources to support patient education. Conclusion The researchers developed recommendations for future collection development in the area of acute stroke resources. Conducting this project within the evidence based librarianship framework helped to develop library staff members’ confidence in their ability to make future collection development decisions, informed by the target group’s information needs and preferences. The collection analysis methodology was designed to be replicated, and new specialist groups within the client base of the library will be targeted to repeat the collection analysis process.

  17. Imaging of Hemorrhagic Stroke.

    Science.gov (United States)

    Hakimi, Ryan; Garg, Ankur

    2016-10-01

    Hemorrhagic stroke comprises approximately 15% to 20% of all strokes. This article provides readers with an understanding of the indications and significance of various neuroimaging techniques available for patients presenting with hemorrhagic strokes of distinct causes. The most common initial neuroimaging study is a noncontrast head CT, which allows for the identification of hemorrhage. Once an intracranial hemorrhage has been identified, the pattern of blood and the patient's medical history, neurologic examination, and laboratory studies lead the practitioner to pursue further neuroimaging studies to guide the medical, surgical, and interventional management. Given that hemorrhagic stroke constitutes a heterogeneous collection of diagnoses, the subsequent neuroimaging pathway necessary to better evaluate and care for these patients is variable based on the etiology.With an increasing incidence and prevalence of atrial fibrillation associated with the aging population and the introduction of three new direct factor Xa inhibitors and one direct thrombin inhibitor to complement vitamin K antagonists, oral anticoagulant use continues to increase. Patients on oral anticoagulants have a sevenfold to tenfold increased risk for intracerebral hemorrhage (ICH). Furthermore, patients who have an ICH associated with oral anticoagulant use have a higher mortality rate than those with primary ICH. Despite the reduced incidence of hypertension-related ICH over the past decade, it is expected that the incidence of ICH will continue to increase. Neuroimaging studies are integral to the identification of hemorrhagic stroke, determination of the underlying etiology, prevention of hematoma expansion, treatment of acute complications, and treatment of the underlying etiology, if indicated. Neuroimaging is essential for prognostication and thus directly impacts patient care.

  18. Risk factor and etiology analysis of ischemic stroke in young adult patients.

    Science.gov (United States)

    Renna, Rosaria; Pilato, Fabio; Profice, Paolo; Della Marca, Giacomo; Broccolini, Aldobrando; Morosetti, Roberta; Frisullo, Giovanni; Rossi, Elena; De Stefano, Valerio; Di Lazzaro, Vincenzo

    2014-03-01

    Approximately 10%-14% of ischemic strokes occur in young adults. To investigate risk factors and etiologies of strokes of young adults admitted to the "stroke unit" of Policlinico "Gemelli" of Rome from December 2005 to January 2013. In all, 150 consecutive patients younger than 50 years diagnosed with ischemic stroke were enrolled. Clinical evaluation consisted of a complete neurologic examination and the National Institutes of Health Stroke Scale. Diagnostic workup consisted of anamnesis, extensive laboratory, radiologic, and cardiologic examination. Stroke etiologies were classified according to the Trial of Org 10172 in Acute Stroke Treatment. Patients' mean age was 41 ± 8.0 years. The most common risk factors were dyslipidemia (52.7%), smoking (47.3%), hypertension (39.3%), and patent foramen ovale (PFO, 32.8%). Large-artery atherosclerosis was diagnosed as the cause of stroke in 17 patients (11.3%). Cardioembolism was presumed in 36 patients (24%), most of them presented a PFO at transesophageal echocardiography. Small-vessel occlusion was diagnosed in 12 patients (8%); all of them were hypertensive and most of them presented additional risk factors. Forty-one patients (27.3%) presented a stroke of other determined etiology and 44 (29.3%) presented a stroke of undetermined etiology. The 3-year survival was 96.8% and recurrent strokes occurred in only 3 cases. Traditional vascular risk factors are also very common in young adults with ischemic stroke, but such factors increase the susceptibility to stroke dependent to other causes as atherosclerosis and small-artery occlusion represent less than 20% of cases. Prognosis quoadvitam is good, being characterized by low mortality and recurrence rate. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. A geographical assessment of vegetation carbon stocks and greenhouse gas emissions on potential microalgae-based biofuel facilities in the United States.

    Science.gov (United States)

    Quiroz Arita, Carlos; Yilmaz, Özge; Barlak, Semin; Catton, Kimberly B; Quinn, Jason C; Bradley, Thomas H

    2016-12-01

    The microalgae biofuels life cycle assessments (LCA) present in the literature have excluded the effects of direct land use change (DLUC) from facility construction under the assumption that DLUC effects are negligible. This study seeks to model the greenhouse gas (GHG) emissions of microalgae biofuels including DLUC by quantifying the CO 2 equivalence of carbon released to the atmosphere through the construction of microalgae facilities. The locations and types of biomass and Soil Organic Carbon that are disturbed through microalgae cultivation facility construction are quantified using geographical models of microalgae productivity potential including consideration of land availability. The results of this study demonstrate that previous LCA of microalgae to biofuel processes have overestimated GHG benefits of microalgae-based biofuels production by failing to include the effect of DLUC. Previous estimations of microalgae biofuel production potential have correspondingly overestimated the volume of biofuels that can be produced in compliance with U.S. environmental goals. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Outcome Determinants of Stroke in a Brazilian Primary Stroke Center

    Directory of Open Access Journals (Sweden)

    Gustavo W. Kuster

    2014-01-01

    Full Text Available Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS, transient ischemic attack (TIA, and intracerebral hemorrhage (ICH admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.

  1. PUREX facility preclosure work plan

    International Nuclear Information System (INIS)

    Engelmann, R.H.

    1997-01-01

    This preclosure work plan presents a description of the PUREX Facility, the history of the waste managed, and addresses transition phase activities that position the PUREX Facility into a safe and environmentally secure configuration. For purposes of this documentation, the PUREX Facility does not include the PUREX Storage Tunnels (DOE/RL-90/24). Information concerning solid waste management units is discussed in the Hanford Facility Dangerous Waste Permit Application, General Information Portion (DOE/RL-91-28, Appendix 2D)

  2. A cluster randomized trial to assess the impact of clinical pathways for patients with stroke: rationale and design of the Clinical Pathways for Effective and Appropriate Care Study [NCT00673491

    Directory of Open Access Journals (Sweden)

    Barbieri Antonella

    2008-11-01

    Full Text Available Abstract Background Patients with stroke should have access to a continuum of care from organized stroke units in the acute phase, to appropriate rehabilitation and secondary prevention measures. Moreover to improve the outcomes for acute stroke patients from an organizational perspective, the use of multidisciplinary teams and the delivery of continuous stroke education both to the professionals and to the public, and the implementation of evidence-based stroke care are recommended. Clinical pathways are complex interventions that can be used for this purpose. However in stroke care the use of clinical pathways remains questionable because little prospective controlled data has demonstrated their effectiveness. The purpose of this study is to determine whether clinical pathways could improve the quality of the care provided to the patients affected by stroke in hospital and through the continuum of the care. Methods Two-arm, cluster-randomized trial with hospitals and rehabilitation long-term care facilities as randomization units. 14 units will be randomized either to arm 1 (clinical pathway or to arm 2 (no intervention, usual care. The sample will include 238 in each group, this gives a power of 80%, at 5% significance level. The primary outcome measure is 30-days mortality. The impact of the clinical pathways along the continuum of care will also be analyzed by comparing the length of hospital stay, the hospital re-admissions rates, the institutionalization rates after hospital discharge, the patients' dependency levels, and complication rates. The quality of the care provided to the patients will be assessed by monitoring the use of diagnostic and therapeutic procedures during hospital stay and rehabilitation, and by the use of key quality indicators at discharge. The implementation of organized care will be also evaluated. Conclusion The management of patients affected by stroke involves the expertise of several professionals, which can

  3. Facilities for Study and Research in the Offices of the United States Government at Washington. Bulletin, 1909, No. 1. Whole Number 398

    Science.gov (United States)

    Hadley, Arthur Twining

    1909-01-01

    This bulletin contains a report prepared by President Hadley of Yale University on the facilities for advanced study and research in the offices of the National Government at Washington. Especial interest attaches to this publication. It sets forth, in compact form, information which has frequently been sought by institutions and individuals…

  4. Urinary Retention Associated with Stroke.

    Science.gov (United States)

    Umemura, Takeru; Ohta, Hirotsugu; Yokota, Akira; Yarimizu, Shiroh; Nishizawa, Shigeru

    Patients often exhibit urinary retention following a stroke. Various neuropathological and animal studies have implicated the medulla oblongata, pons, limbic system, frontal lobe as areas responsible for micturition control, although the exact area responsible for urinary retention after stroke is not clear. The purpose of this study was to identify the stroke area responsible for urinary retention by localizing the areas where strokes occur. We assessed 110 patients with cerebral infarction and 27 patients with cerebral hemorrhage (78 men, 59 women; mean age, 73.0 years) who had been admitted to our hospital between October, 2012 and September, 2013. We used computed tomography (CT) and magnetic resonance imaging (MRI) to investigate the stroke location, and evaluated whether post-stroke urinary retention occurred. Twelve (8.8%) of the 137 patients (7 men, 5 women; mean age, 78.8 years) exhibited urinary retention after a stroke. Stroke occurred in the right/left dominant hemisphere in 7 patients; nondominant hemisphere in 1; cerebellum in 3; and brainstem in 1. Strokes in the dominant hemisphere were associated with urinary retention (P = 0.0314), particularly in the area of the insula (P < 0.01). We concluded that stroke affecting the insula of the dominant hemisphere tends to cause urinary retention.

  5. The relationship between pneumonia and Glasgow coma scale assessment on acute stroke patients

    Science.gov (United States)

    Ritarwan, K.; Batubara, C. A.; Dhanu, R.

    2018-03-01

    Pneumonia is one of the most frequent medical complications of a stroke. Despite the well-documented association of a stroke associated infections with increased mortality and worse long-term outcome, on the other hand, the limited data available on independent predictors of pneumonia in acute stroke patients in an emergency unit. To determine the independentrelationship between pneumonia and Glasgow Coma Scale assessment on acute stroke patients. The cohort retrospective study observed 55 acute stroke patients who stayed in intensive care unit Adam Malik General Hospital from January until August 2017. Pneumonia was more frequent in patients with Ischemic stroke (OR 5.40; 95% CI: 1.28 – 6.40, p=0.003), higher National Institute of Health Stroke Scale (NIHSS) (p=0.014) and lower Glasgow Coma Scale (p=0.0001). Analysis multivariate logistic regression identified NIHSS as an independent of predictors of pneumonia (95% CI : 1.047 – 1.326, p=0.001). Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficits evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

  6. Improving post-stroke recovery: the role of the multidisciplinary health care team

    Directory of Open Access Journals (Sweden)

    Clarke DJ

    2015-09-01

    Full Text Available David J Clarke, Anne Forster Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK Abstract: Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway. Keywords: stroke care, rehabilitation, multidisciplinary, interdisciplinary, team working

  7. Contingent post-closure plan, hazardous waste management units at selected maintenance facilities, US Army National Training Center, Fort Irwin, California

    International Nuclear Information System (INIS)

    1992-01-01

    The National Training Center (NTC) at Fort Irwin, California, is a US Army training installation that provides tactical experience for battalion/task forces and squadrons in a mid- to high-intensity combat scenario. Through joint exercises with US Air Force and other services, the NTC also provides a data source for improvements of training doctrines, organization, and equipment. To meet the training and operational needs of the NTC, several maintenance facilities provide general and direct support for mechanical devices, equipment, and vehicles. Maintenance products used at these facilities include fuels, petroleum-based oils, lubricating grease, various degreasing solvents, antifreeze (ethylene glycol), transmission fluid, brake fluid, and hydraulic oil. Used or spent petroleum-based products generated at the maintenance facilities are temporarily accumulated in underground storage tanks (USTs), collected by the NTC hazardous waste management contractor (HAZCO), and stored at the Petroleum, Oil, and Lubricant (POL) Storage Facility, Building 630, until shipped off site to be recovered, reused, and/or reclaimed. Spent degreasing solvents and other hazardous wastes are containerized and stored on-base for up to 90 days at the NTC's Hazardous Waste Storage Facility, Building 703. The US Environmental Protection Agency (EPA) performed an inspection and reviewed the hazardous waste management operations of the NTC. Inspections indicated that the NTC had violated one or more requirements of Subtitle C of the Resource Conservation and Recovery Act (RCRA) and as a result of these violations was issued a Notice of Noncompliance, Notice of Necessity for Conference, and Proposed Compliance Schedule (NON) dated October 13, 1989. The following post-closure plan is the compliance-based approach for the NTC to respond to the regulatory violations cited in the NON

  8. Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke

    DEFF Research Database (Denmark)

    Tistad, Malin; Tham, Kerstin; von Koch, Lena

    2012-01-01

    a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses. RESULTS: Unfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds......BACKGROUND: People who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation...... or dissatisfaction with health care services at 12 months after stroke. METHODS: The participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables "unfulfilled needs for rehabilitation" and "dissatisfaction with care" were collected using...

  9. Basics of acute stroke treatment; Grundzuege der akuten Schlaganfalltherapie

    Energy Technology Data Exchange (ETDEWEB)

    Haass, A. [Neurologische Universitaetsklinik Homburg/Saar (Germany)

    2005-05-01

    Acute stroke presents an emergency that requires immediate referral to a specialized hospital, preferably with a stroke unit. Disability and mortality are reduced by 30% in patients treated in stroke units compared to those treated on regular wards, even if a specialized team is present on the ward. Systolic blood pressure may remain high at 200-220 mmHg in the acute phase and should not be lowered too quickly. Further guidelines for basic care include: optimal O{sub 2} delivery, blood sugar levels below 100-150 mg%, and lowering body temperature below 37.5 C using physical means or drugs. Increased intracranial pressure should be treated by raising the upper body of the patient, administration of glycerol, mannitol, and/or sorbitol, artificial respiration, and special monitoring of Tris buffer. Decompressive craniectomy may be considered in cases of ''malignant'' media stroke and expansive cerebellar infarction. Fibrinolysis is the most effective stroke treatment and is twice as effective in the treatment of stroke than myocardial infarction. Fibrinolysis may be initiated within 3 h of a stroke in the anterior circulation. If a penumbra is detectable by ''PWI-DWI mismatch MRI,'' specialized hospitals may perform fibrinolysis up to 6 h after symptom onset. In cases of stroke in the basilar artery, fibrinolysis may be performed even later after symptom onset. Intra-arterial fibrinolysis is performed in these cases using rt-PA or urokinase. Follow-up treatment of stroke patients should not only address post-stroke depression and neuropsychological deficits, but also include patient education about risk factors such as high blood pressure, diabetes mellitus, and cardiac arrhythmias. (orig.) [German] Jeder akute Schlaganfall ist ein Notfall und muss sofort in einer spezialisierten Klinik, am besten einer Stroke Unit, behandelt werden. Die Stroke-Unit-Behandlung senkt den Behinderungsgrad und die Letalitaet um 30% staerker als die

  10. Guidelines for acute ischemic stroke treatment: part II: stroke treatment

    Directory of Open Access Journals (Sweden)

    Sheila Cristina Ouriques Martins

    2012-11-01

    Full Text Available The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br.

  11. Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases.

    Science.gov (United States)

    Sánchez-Larsen, Á; García-García, J; Ayo-Martín, O; Hernández-Fernández, F; Díaz-Maroto, I; Fernández-Díaz, E; Monteagudo, M; Segura, T

    2016-09-16

    We aimed to determine whether the aetiology of ischaemic stroke has changed in recent years and, if so, to ascertain the possible reasons for these changes. We analysed the epidemiological history and vascular risk factors of all patients diagnosed with ischaemic stroke at Complejo Hospitalario Universitario de Albacete (CHUA) from 2009 to 2014. Ischaemic stroke subtypes were established using the TOAST criteria. Our results were compared to data from the classic Stroke Data Bank (SDB); in addition, both series were compared to those of other hospital databases covering the period between the two. We analysed 1664 patients (58% were men) with a mean age of 74 years. Stroke aetiology in both series (CHUA, SDB) was as follows: atherosclerosis (12%, 9%), small-vessel occlusion (13%, 25%), cardioembolism (32%, 19%), stroke of other determined aetiology (3%, 4%), and stroke of undetermined aetiology (40%, 44%). Sixty-three percent of the patients from the CHUA and 42% of the patients from the SDB were older than 70 years. Cardioembolic strokes were more prevalent in patients older than 70 years in both series. Untreated hypertension was more frequent in the SDB (SDB = 31% vs CHUA = 10%). The analysis of other databases shows that the prevalence of cardioembolic stro