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Sample records for stroke unit facilities

  1. From stroke unit care to stroke care unit

    NARCIS (Netherlands)

    De Keyser, J; Sulter, G.

    1999-01-01

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

  2. Sequential strokes in a hyperacute stroke unit.

    Science.gov (United States)

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

    2014-08-01

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

  3. 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.

  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 available in European hospitals treating stroke patients.

    Science.gov (United States)

    Leys, Didier; Ringelstein, E Bernd; Kaste, Markku; Hacke, Werner

    2007-11-01

    Stroke units decrease mortality and need for institutional care, but they are not widely available. The objective of the study was to determine, among European hospitals admitting acute stroke patients, how many are able to provide an appropriate level of care. Method- We randomly selected 886 hospitals in 25 countries. We used definitions derived from a European expert survey for comprehensive stroke centers (CSC), primary stroke centers (PSC), and minimum level required for any hospital ward (AHW) admitting stroke patients. We determined the proportion of hospitals meeting criteria for each category, and which facilities were not available. Participating hospitals treated approximately one-third of all strokes supposed to have occurred in these countries in 2005. Forty-three (4.9%) met criteria for CSC, 32 (3.6%) for PSC, 356 (40.2%) for AHW, and 455 (51.4%) provided a lower level of care. In 2005, hospitals meeting criteria for CSC, PSC, AHW, and none of them admitted 27 644 (8.3%), 17 365 (5.2%), 146 175 (44.1%), and 140 306 (42.3%) patients. There was no 24-hour availability for brain CT scan in 25% of hospitals not meeting criteria for AHW. Of 448 hospitals admitting at least 1 stroke per day, 51 (11.4%) met criteria for PSC or CSC, and 227 (50.7%) for AHW. Less than 10% of European hospitals admitting acute stroke patients have optimal facilities, and in 40% even the minimum level is not available. Because the availability of facilities does not grant their use, our study suggests that only few acute stroke patients are treated in appropriate centers in Europe.

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

    African Journals Online (AJOL)

    ... rehabilitation of the stroke patient. The establishment of stroke units has been found to improve the survival of patients and significantly reduce disability by rendering holistic care. Early intervention to rapidly restore and maintain blood supply to the ischemic area in the brain, minimize brain damage and hence impairment ...

  7. The King's College Hospital Acute Stroke Unit.

    Science.gov (United States)

    Bath, P; Butterworth, R J; Soo, J; Kerr, J E

    1996-01-01

    The King's College Hospital (KCH) Acute Stroke Unit (ASU) was set up in January 1994 in order to provide acute management for patients admitted with stroke and to undertake biomedical research. Of 206 patients admitted to KCH with a stroke or suffering an in-hospital stroke, 141 (68%) patients were admitted to the ASU over its first 6 months of operation: 120 (85%) were from the Accident and Emergency Department and 21 (15%) from other wards. Management included resuscitation and medical stabilisation, investigation, prevention of stroke complications (including aspiration, venous thrombosis, and pressure sores), rehabilitation (physiotherapy, occupational therapy, speech and language therapy), nutrition (dietetics) and initiation of secondary prevention measures (aspirin or anticoagulation, blood pressure and lipid lowering, and carotid endarterectomy). All aspects of management are driven by agreed guidelines. Patients remain under the care of the admitting physician but specific stroke management and guidance is provided by two research doctors and the unit's nurses, therapists and dietician. The unit also facilitates research into stroke pathophysiology and acute therapeutic interventions. Our experience suggests that an ASU is relatively easy to set up and may contribute to improved care. Whether ASUs improve patient survival and functional outcome, and are cost-effective, requires further study.

  8. 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…

  9. Facilities of Early Rehabilitation post Stroke in Poland 2010

    DEFF Research Database (Denmark)

    Opara, Jozef; Langhorne, Peter; Larsen, Torben

    2012-01-01

    ? 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...... admission from neurological wards to rehabilitation departments, about the number of sessions per day, the time duration of one session, the number of sessions per week, the average length of stay in department, the methods of outcome measurement etc. Analysis - We sent out 375 questionnaire and received......-stroke, i.e. within 3 months of stroke. Comment - Taking into account that about half of stroke survivors will need rehabilitation (30 days after stroke onset), the current facilities of early post-stroke rehabilitation in Poland cannot meet this need. We should do our best to introduce rehabilitation...

  10. Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit : a randomized pilot study

    NARCIS (Netherlands)

    Sulter, Geert; Elting, Jan Willem; Langedijk, Marc; Maurits, Natasha M; De Keyser, Jacques

    2003-01-01

    BACKGROUND AND PURPOSE: Pathophysiological considerations and observational studies indicate that elevated body temperature, hypoxia, hypotension, and cardiac arrhythmias in the acute phase of ischemic stroke may aggravate brain damage and worsen outcome. METHODS: Both units were organized with the

  11. Shorter length of stay in the stroke unit

    DEFF Research Database (Denmark)

    Tistad, Malin; Ytterberg, Charlotte; Sjöstrand, Christina

    2012-01-01

    was seen at 6 or 12 months post stroke. CONCLUSION: It seems possible to reduce the number of days spent in the stroke unit after mild to moderate stroke and instead spend days in a rehabilitation unit, and yet achieve similar patient satisfaction and faster recovery in ADL....... the first year post stroke in 2 groups of patients with mild to moderate stroke who received care in the same stroke unit. METHOD: The patients (1993/96, n=40; 2006/07, n=43) in this study received care in the stroke unit at Karolinska University Hospital, Huddinge, Sweden. Data on LOS and on the use...... unit was shorter in the 2006-2007 group (median 8 days) compared to the 1993-1996 group (13 days) (P post stroke in the 2006-2007 group, but no difference...

  12. Facilities available in French hospitals treating acute stroke patients: comparison with 24 other European countries.

    Science.gov (United States)

    Leys, D; Cordonnier, C; Debette, S; Hacke, W; Ringelstein, E B; Giroud, M; Mas, J L; Kaste, M

    2009-06-01

    The purpose of this study was to compare the proportion of French hospitals meeting criteria for primary (PSC) or comprehensive (CSC) stroke centres, with that of 24 other European countries. We surveyed 121 randomly selected hospitals admitting stroke patients routinely in France and 765 in other European countries. We determined the proportion of hospitals meeting criteria for CSC and PSC according to the EUSI experts definition. The 121 selected hospitals had treated 37,778 patients in 2005 (mean 312), i.e. approximately 25% of all strokes supposed to have occurred in France. Eleven hospitals had an acute stroke care unit, versus 448 of 765 other Hospitals (OR 0.07; 95% CI, OR 0.04-0.13). rt-PA was given to 622 patients (2.2% of ischaemic strokes, versus 3.3% for the other countries). No hospital met criteria for CSC, and only 2 (1.7%) met criteria for PSC. Many facilities considered as necessary by experts were less available, especially personnel, brain CT-scan, ECG monitoring and rt-PA protocols. However, CT angiography 24 h/24, and air ambulance were more often available. Only a few French hospitals offer an optimal level of care for stroke patients. This result contrasts with the high cost of stroke care in France, suggesting an inappropriate use of resources. Conclusions useful for health administrators are: (i) to offer more facilities in reasonably equipped hospitals; (ii) to prevent admission of stroke patients in small under-equipped hospitals; (iii) to promote specific stroke nurse instruction; and (iv) to promote a better organisation of stroke care over the territory.

  13. 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.

  14. Do Women With Atrial Fibrillation Experience More Severe Strokes? Results From the Austrian Stroke Unit Registry.

    Science.gov (United States)

    Lang, Clemens; Seyfang, Leonhard; Ferrari, Julia; Gattringer, Thomas; Greisenegger, Stefan; Willeit, Karin; Toell, Thomas; Krebs, Stefan; Brainin, Michael; Kiechl, Stefan; Willeit, Johann; Lang, Wilfried; Knoflach, Michael

    2017-03-01

    Ischemic strokes associated with atrial fibrillation (AF) are more severe than those of other cause. We aim to study potential sex effects in this context. In this cross-sectional study, 74 425 adults with acute ischemic stroke from the Austrian Stroke Unit Registry were included between March 2003 and January 2016. In 63 563 patients, data on the National Institutes of Health Stroke Scale on admission to the stroke unit, presence of AF, vascular risk factors, and comorbidities were complete. Analysis was done by a multivariate regression model. Stroke severity in general increased with age. AF-related strokes were more severe than strokes of other causes. Sex-related differences in stroke severity were only seen in stroke patients with AF. Median (Q 25 , 75 ) National Institutes of Health Stroke Scale score points were 9 (4,17) in women and 6 (3,13) in men ( P stroke severity was independent of age, previous functional status, vascular risk factors, and vascular comorbidities and remained significant in various subgroups. Women with AF do not only have an increased risk of stroke when compared with men but also experience more severe strokes. © 2017 American Heart Association, Inc.

  15. 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....

  16. 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.

  17. Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit

    Directory of Open Access Journals (Sweden)

    Tanya West

    2013-01-01

    Full Text Available Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25 of the day in some form of physical activity and received 58 (SD 34 minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32 hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care.

  18. Time use of stroke patients with stroke admitted for rehabilitation in skilled nursing facilities

    NARCIS (Netherlands)

    Vermeulen, C.J.; Buijck, B.I.; Stegen, J.C. van der; Eijk, M.S. van; Koopmans, R.T.C.M.; Hafsteinsdottir, T.B.

    2013-01-01

    PURPOSE: To describe the time use of patients with stroke in five Skilled Nursing Facilities (SNFs) in the Netherlands, focusing on the time spent on therapeutic activities, nontherapeutic activities, interaction with others, and the location where the activities took place. Evidence suggest that

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

    Directory of Open Access Journals (Sweden)

    Marco Masina

    2016-09-01

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

  20. 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 ini...

  1. Stroke units benefit from work of nutrition assistants.

    Science.gov (United States)

    Evans, Carol

    2009-07-07

    As a support service manager in the stroke and rehabilitation unit at Addenbrooke's Hospital, Cambridge, I manage a team of band 3 nutrition assistants working effectively to meet the nutritional needs of all our patients (letters July 1).

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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.

  4. Time use of stroke patients with stroke admitted for rehabilitation in Skilled Nursing Facilities.

    Science.gov (United States)

    Vermeulen, Chantal J A H R; Buijck, Bianca I; van der Stegen, John C G H; van Eijk, Monica Spruit-; Koopmans, Raymond T C M; Hafsteinsdóttir, Thóra B

    2013-01-01

    To describe the time use of patients with stroke in five Skilled Nursing Facilities (SNFs) in the Netherlands, focusing on the time spent on therapeutic activities, nontherapeutic activities, interaction with others, and the location where the activities took place. Evidence suggest that task-oriented interventions are the most effective for patients with stroke and that some of these interventions are relevant and feasible for use by nurses. The question arises to what extent elderly patients who had a stroke and rehabilitate in a SNF receive therapeutic training and engage in therapeutic activities. Descriptive, observational design. Therapeutic and nontherapeutic activities of patients were observed at 10-minute intervals during one weekday (8 a.m.-4:30 p.m.) using behavioral mapping. Forty-two patients with stroke with a mean age of 76 years participated in the study. The patients spent 56% of the day on therapeutic activities, whereas 44% of the day was spent on nontherapeutic activities. Most therapeutic time was spent on nursing care (9%) and physical therapy (4%). Patients stayed an average 41% of the day in their own room and were alone 49% of the day. Therapeutic time use was significantly related to improved functional status, patients with higher functional status spent more time on therapeutic activities. Patients spent more than half of the day on therapeutic activities. Nurses are faced with the challenge of activating patients with stroke and to assist them to engage in purposeful task-oriented exercises including daily activities. Thereby better rehabilitation results and recovery of patients may be reached. © 2013 Association of Rehabilitation Nurses.

  5. 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

  6. Beneficial Effects of Implementing Stroke Protocols Require Establishment of a Geographically Distinct Unit.

    Science.gov (United States)

    Akhtar, Naveed; Kamran, Saadat; Singh, Rajvir; Cameron, Peter; D'Souza, Atlantic; Imam, Yahya; Bourke, Paula; Joseph, Sujatha; Khan, Rabia; Santos, Mark; Deleu, Dirk; El-Zouki, Abdel; Abou-Samra, Abdul; Butt, Adeel A; Shuaib, Ashfaq

    2015-12-01

    Usefulness of multidisciplinary stroke units in acute stroke patients is well established. There is extensive western literature on usefulness of stroke units in outcome, but limited evidence from the rest of the world. We aim to evaluate the impact of establishing a stroke unit on outcome in patients presenting to a tertiary care facility. This is a retrospective study of 1003 patients with acute stroke admitted to Hamad General Hospital, Qatar, between January 2014 and February 2015. Patients directly admitted to intensive care unit (132) were excluded. We compared outcomes of pre- and poststroke ward (SW) establishment and in SW patients versus those of general medical wards. Before the establishment of the SW, 175 patients were admitted to the hospital. From April 2014 to February 2015, 696 patients were admitted (SW, 545; medical ward, 151). There was a significant reduction in length of stay from 14.7±27.7 to 6.2±20.2 days (P=0.0001) and incidence of complications (23.6% versus 6.4%, P=0.0001) after implementation of stroke-specific protocols. Prognosis at discharge (modified Rankin Scale 0-2 in 56.0% versus 70.4%, P=0.001) and at 90 days (modified Rankin Scale 0-2 in 70.6% versus 95.0%, P=0.001) also significantly improved. Compared with medical ward patients, outcome was significantly better in SW patients with fewer complications (10.9% versus 5.0%, P=0.013) and shorter length of stay (8.9±30.7 versus 5.4±16.1 days, P=0.05). Establishing a distinct SW is essential for achieving full benefits of stroke protocols implementation. SW patients have significantly fewer complications and better prognosis when compared with patients in medical wards. © 2015 American Heart Association, Inc.

  7. Stroke unit care, inpatient rehabilitation and early supported discharge.

    Science.gov (United States)

    Rodgers, Helen; Price, Chris

    2017-04-01

    Stroke units reduce death and disability through the provision of specialist multidisciplinary care for diagnosis, emergency treatments, normalisation of homeostasis, prevention of complications, rehabilitation and secondary prevention. All stroke patients can benefit from provision of high-quality basic medical care and some need high impact specific treatments, such as thrombolysis, that are often time dependent. A standard patient pathway should include assessment of neurological impairment, vascular risk factors, swallowing, fluid balance and nutrition, cognitive function, communication, mood disorders, continence, activities of daily living and rehabilitation goals. Good communication and shared decision making with patients and their families are key to high-quality stroke care. Patients with mild or moderate disability, who are medically stable, can continue rehabilitation at home with early supported discharge teams rather than needing a prolonged stay in hospital. National clinical guidelines and prospective audits are integral to monitoring and developing stroke services in the UK. © Royal College of Physicians 2017. All rights reserved.

  8. The Stroke unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study

    NARCIS (Netherlands)

    Meijer, R.; van Limbeek, J.; Peusens, G.; Rulkens, M.; Dankoor, K.; Vermeulen, M.; de Haan, R. J.

    2005-01-01

    Objective: To investigate which factors during the subacute phase post stroke have predictive value for the discharge outcome from the hospital stroke unit. Methods: In a prospective cohort of 338 patients admitted to a hospital stroke unit 26 potentially prognostic factors, arranged in clinical and

  9. 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.

  10. 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...

  11. From the stroke unit to the stroke competence center: corresponding beneficial clinical and financial effects.

    Science.gov (United States)

    Chatzikonstantinou, A; Förster, A; Hennerici, M G; Bäzner, H

    2011-11-01

    The introduction of the diagnosis related groups (DRG) system in Germany has radically influenced the organization of in-hospital patient treatment. Case-mix-index and duration of treatment in a stroke unit (SU) play a central role. Our SU started in 1998 and was gradually extended to the current "Stroke Competence Center" (SCC), with a total capacity of 29 patients. The SCC combines acute treatment, work-up and post-stroke management by the same specialized team. We aimed primarily at demonstrating the financial effects of this concept. Data from stroke patients treated in our SU/SCC between 2004 and 2009 were analyzed. We analyzed the number of treated stroke patients, number of thrombolytic treatments, the number of cases coded with procedure codes OPS 8-981.x and the ratio of OPS 8-981.0 (24-72 h on SU) to the higher remunerated OPS 8-981.1 (>72 h on SU). The number of treated patients increased by 118.3% (from 469 in 2004 to 1024 in 2009). The number of thrombolyses per year has more than quadrupled (2004: 46, 2009: 253, i.e. 25% of SU patients). The introduction of the stroke center concept lead to a great increase in the ratio of the higher rewarded OPS 8-981.1 to OPS 8-981.0 (from 1.5 in 2005 to 5.21 in 2009). Our data demonstrates that the SCC concept leads to a greater financial potential, while offering considerable medical advantages concerning more effective stroke treatment and work-up as well as improved flow of information and enhanced individual patient-physician relationship.

  12. Triage practices in stroke units: Physicians' perceptions and ethical issues.

    Science.gov (United States)

    Yger, M; Crozier, S; Dubourdieu, S; Vivien, B; Dolveck, F; Samson, Y

    2016-02-01

    We aimed to explore acute stroke admission decisions and to discuss ethical issues in triage practices in stroke units (SUs) in France. In this study, 337 questionnaires were sent to physicians involved in acute admission to SUs in Île-de-France (neurologists and physicians from emergency medical services). The questionnaires comprised questions about physicians' perceptions of the reasonable allocation of SU beds and admission criteria for patients in SU in clinical vignettes illustrating complex situations. In total, 162 questionnaires were fully completed. There were some discrepancies in perceptions and reporting practices between emergency physicians and neurologists concerning patient admission criteria. Triage choices were more frequently declared by emergency physicians than by neurologists and were related to the difficulty of obtaining a positive response for the admission of certain complex patients (particularly those with comorbidities). Despite recommendations stating that all patients with stroke should be admitted to SUs, this study has shown that triage practices exist in stroke admission decisions. The triage depends on the role and perceptions of each physician in acute stroke management. These decisions suggest reflections on the applicability of distributive justice theories and on ethical issues in triage practices in medicine. Copyright © 2015. Published by Elsevier Masson SAS.

  13. Early Seizures After Stroke: Neurology Intensive Care Unit Experience

    OpenAIRE

    Şadiye Gümüşyayla; Gönül Vural

    2018-01-01

    Objective: The aim of this study was to investigate the frequency of early seizures, the affecting factors, and the prognostic effect of seizures in patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and sinus venous thrombosis (SVT) examined in the intensive care unit (ICU). Materials and Methods: In the neurology ICU, the records of patients followed up with AIS, ICH, and SVT within a defined time period were retrospectively examined. Results: Early seizures ...

  14. Bringing Emergency Neurology to Ambulances: Mobile Stroke Unit.

    Science.gov (United States)

    Bowry, Ritvij; Grotta, James C

    2017-12-01

    Ischemic stroke results from blocked arteries in the brain, with earlier thrombolysis with intravenous tissue plasminogen activator (tPA) and/or mechanical thrombectomy resulting in improved clinical outcomes. Mobile Stroke Unit (MSU) can speed up the treatment with tPA and facilitate faster triage for patients to hospitals for mechanical thrombectomy. The first registry-based MSU study in Germany demonstrated faster treatment times with tPA using a MSU, a higher proportion of patients being treated within the first "golden hour," and a suggestion of improved 3-month clinical outcomes. The first multicenter, prospective, randomized clinical trial comparing MSU versus standard care was started in 2014 after the launch of the MSU in Houston, TX, demonstrating the feasibility and safety of MSU operation in the United States, and reliability of telemedicine to evaluate stroke patients for tPA eligibility. Although conclusive evidence from clinical trials to support MSUs as being cost effective and improving clinical outcomes is still needed, there are a myriad of other clinical and research applications of MSUs that could have profound implications for managing patients with neurological emergencies. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Protection after stroke: cellular effectors of neurovascular unit integrity

    Directory of Open Access Journals (Sweden)

    Rafael Andres Posada-Duque

    2014-08-01

    Full Text Available Neurological disorders are prevalent worldwide. Cerebrovascular diseases (CVDs, which account for 55% of all neurological diseases, are the leading cause of permanent disability, cognitive and motor disorders and dementia. Stroke affects the function and structure of blood-brain barrier, the loss of cerebral blood flow regulation, oxidative stress, inflammation and the loss of neural connections. Currently, no gold standard treatments are available outside the acute therapeutic window to improve outcome in stroke patients. Some promising candidate targets have been identified for the improvement of long-term recovery after stroke, such as Rho GTPases, cell adhesion proteins, kinases, and phosphatases. Previous studies by our lab indicated that Rho GTPases (Rac and RhoA are involved in both tissue damage and survival, as these proteins are essential for the morphology and movement of neurons, astrocytes and endothelial cells, thus playing a critical role in the balance between cell survival and death. Treatment with a pharmacological inhibitor of RhoA/ROCK blocks the activation of the neurodegeneration cascade. In addition, Rac and synaptic adhesion proteins (p120 catenin and N-catenin play critical roles in protection against cerebral infarction and in recovery by supporting the neurovascular unit and cytoskeletal remodeling activity to maintain the integrity of the brain parenchyma. Interestingly, neuroprotective agents, such as atorvastatin, and CDK5 silencing after cerebral ischemia and in a glutamate-induced excitotoxicity model may act on the same cellular effectors to recover neurovascular unit integrity. Therefore, future efforts must focus on individually targeting the structural and functional roles of each effector of neurovascular unit and the interactions in neural and non-neural cells in the post-ischemic brain and address how to promote the recovery or prevent the loss of homeostasis in the short, medium and long term.

  16. 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.

  17. 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

    OBJECTIVE: 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...

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

    Science.gov (United States)

    Clarke, David J; Holt, Janet

    2015-01-01

    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. Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills. Implications for Rehabilitation Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care. Views of stroke unit team members on nurses' involvement in rehabilitation have not been reported previously. Nurses can routinely incorporate rehabilitation principles in their care. Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.

  19. Impact of Insurance Precertification on Discharge of Stroke Patients to Acute Rehabilitation or Skilled Nursing Facility.

    Science.gov (United States)

    Smith, Andrew L; Kulhari, Ashish; Wolfram, Julie A; Furlan, Anthony

    2017-04-01

    The purpose of this study is to determine if the common insurance practice of requiring precertification before a medically ready stroke patient can be discharged to a skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) causes a delay in discharge. Eliminating delays in discharge of stroke patients is important given the increasing demands for health-care efficiency after the passage of the Affordable Health Care Act. A retrospective chart review of 1007 patients who were admitted to our comprehensive stroke center with the primary diagnosis of stroke over a 12-month period was performed. Out of the patient pool, 289 patients met the inclusion criterion of a primary diagnosis of stroke that required discharge to a SNF or IRF. All 289 patients were medically cleared for discharge to a SNF or IRF by a board-certified vascular neurologist. Of the 289 patients who met the inclusion criteria, 118 required insurance precertification and 171 did not require precertification before being discharged to a SNF or IRF. All 118 patients who required precertification had private health insurance. The patients who required insurance precertification had an average delay of discharge (DOD) of 1.5 days, and those patients who did not require precertification had an average DOD of .8 days (P value insurance precertification leads to delay in discharge, increased LOS, and increased hospital costs for stroke patients. Copyright © 2017. Published by Elsevier Inc.

  20. 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.

  1. 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.

  2. Challenges in building interpersonal care in organized hospital stroke units: The perspectives of stroke survivors, family caregivers and the multidisciplinary team.

    Science.gov (United States)

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

    2017-10-01

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

  3. Early Seizures After Stroke: Neurology Intensive Care Unit Experience

    Directory of Open Access Journals (Sweden)

    Şadiye Gümüşyayla

    2018-03-01

    Full Text Available Objective: The aim of this study was to investigate the frequency of early seizures, the affecting factors, and the prognostic effect of seizures in patients with acute ischemic stroke (AIS, intracerebral hemorrhage (ICH, and sinus venous thrombosis (SVT examined in the intensive care unit (ICU. Materials and Methods: In the neurology ICU, the records of patients followed up with AIS, ICH, and SVT within a defined time period were retrospectively examined. Results: Early seizures occurred in 48 out of 199 patients who were followed up with AIS, ICH, and SVT in the neurology ICU within the specified time period. The frequency of having early seizures was found to be higher in patients with left hemisphere lesions, cortical lesions, and those with AIS with hemorrhagic transformation. Lesion volume was found to be higher in patients with AIS who had early seizures compared with those who had AIS without seizures. Early seizures were observed in all patients with SVT who were followed up in the ICU. Conclusion: Early seizures are a common complication in patients with stroke followed up in neurology ICUs. Determination of effective factors in early seizures is important for its early diagnosis and treatment

  4. 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

  5. Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital

    OpenAIRE

    Luvizutto, Gustavo José; Gameiro, Mônica de Oliveira Orsi; Schelp, Arthur Oscar; Braga, Gabriel Pereira; Ribeiro, Priscila Watson; Bazan, Rodrigo

    2015-01-01

    [Purpose] The study aimed to characterize patients treated by rehabilitation section after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation records of individuals with ischemic stroke were studied retrospectively, excluding individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1, prior stroke, structural bone deformities, associated neurological disease, and prior cognitive deficit. The data evaluated were age, gender, etiology, ...

  6. 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.

  7. 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...

  8. 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

  9. 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.

  10. Nursing-Based Dysrhythmia Detection on a Dedicated Stroke Unit Using a Unit-Based Cardiac Telemetry Monitoring System.

    Science.gov (United States)

    Jastrzebski, Cheryl; Hernandez, Erika; Nadis, Susan; Lichtenberg, Robert

    Acute stroke care includes cardiac rhythm monitoring in the first 24 hours. The method of monitoring varies, as do the reported findings. The nurses' role in this process can be intensive, including primary response and review of all data. Competency is critical as the acute stroke setting can be associated with life-threatening dysrhythmias as well as the detection of atrial fibrillation that affects therapy. Limited studies exist to evaluate the effectiveness of a unit-based cardiac monitoring system for which the bedside nurse has primary responsibility. The goal was to determine if a unit-based cardiac monitoring system for which the bedside nurse was responsible detected clinically significant dysrhythmias. Stroke unit nurses completed a mandatory education program on identifying common dysrhythmias and using the monitoring equipment along with a structured algorithm for cardiac dysrhythmia detection. The nurse was responsible for all alarms as well as review of their patients' data. Their findings were recorded and reviewed by a cardiology team after the 24-hour monitoring was completed. A total of 300 consecutive stokes, transient ischemic attack, and possible stroke patients were enrolled. Nurses identified 96% of all significant dysrhythmias. Twenty-eight percent of the stroke patients had a dysrhythmia, of which 79% were atrial fibrillation/atrial flutter. The bedside nurses did identify all 8 new atrial fibrillation cases. Stroke unit nurses who complete an educational program can identify dysrhythmias on their patients' unit-based cardiac monitoring systems and can improve patient outcomes.

  11. CHARACTERISTICS AND OUTCOME OF STROKE PATIENTS WITH CEREBROVASCULAR ACCIDENT AT THE INTENSIVE CARE UNIT OF A TERTIARY HOSPITAL IN NIGERIA

    OpenAIRE

    Tobi, KU; Okojie, NQ

    2013-01-01

    Background: Patients with severe stroke defined as NIHSS score >17 constituting about 15-20% of cerebrovascular accident require admission into the Intensive Care Unit (ICU). However the benefit of ICU admission for stroke patients remains controversial.

  12. 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

  13. 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.

  14. 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

  15. Stroke rehabilitation outcome variation in Veterans Affairs rehabilitation units: accounting for case-mix.

    Science.gov (United States)

    Reker, D M; O'Donnell, J C; Hamilton, B B

    1998-07-01

    To assess variation in stroke outcomes and create a case-mix adjustment model for stroke rehabilitation in Veterans Affairs Medical Centers. Observational Within Veteran's Health Administration hospitals, there are 63 acute rehabilitation bedservice units that care for approximately 2,000 stroke patients annually. Functional gain in FIM points, length of stay (LOS), LOS efficiency (FIM gain/LOS). Significant variation in average patient functional gain, LOS, and LOS efficiency was observed among the 37 highest-volume rehabilitation units. Using analysis of covariance, a model was developed that adjusted functional gain and LOS (logged LOS) unit means using 10 potential covariates identified in a literature review and in pilot studies. Four and six covariates, respectively, were retained in the final models for FIM gain and LOS. The R2 for FIM gain and LOS accounted for by rehabilitation unit alone increased from .07 to .31 (FIM gain) and from .13 to .34 (logLOS) with the addition of the significant covariates to each model. As much as 24% of the variation in two important stroke rehabilitation outcomes is attributable to largely immutable patient and system characteristics (eg, patient function on admission, age, days since stroke onset, year of discharge, marital status, and referral source). Hence, controlling for case-mix is critical for accurate comparison of unit outcomes. Further, the variation in LOS efficiency between VA rehabilitation units suggests a large potential for cost and resource utilization savings system-wide.

  16. Impact of spatial neglect on stroke rehabilitation: evidence from the setting of an inpatient rehabilitation facility.

    Science.gov (United States)

    Chen, Peii; Hreha, Kimberly; Kong, Yekyung; Barrett, A M

    2015-08-01

    To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. Inception cohort. Inpatient rehabilitation facility (IRF). Individuals with unilateral brain damage after their first stroke (N=108) were assessed at IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect as measured using the Kessler Foundation Neglect Assessment Process (KF-NAP). Usual and standard IRF care. The FIM, Conley Scale, number of falls, length of stay (LOS), and discharge disposition. The greater the severity of spatial neglect (higher KF-NAP scores) at IRF admission and the lower the FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and lower FIM improvement rate. The presence of spatial neglect (KF-NAP score>0), but not Conley Scale scores, predicted falls such that participants with spatial neglect fell 6.5 times more often than those without symptoms. More severe neglect, indicated by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took spatial neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge. Spatial neglect after a stroke is a prevalent problem and may negatively affect rehabilitation outcome, risk of falls, and LOS. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  17. 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

  18. Accuracy of Physical Therapists' Early Predictions of Upper-Limb Function in Hospital Stroke Units: The EPOS Study

    NARCIS (Netherlands)

    Nijland, R.H.M.; van Wegen, E.E.H.; Harmeling-van Wel, B.; Kwakkel, G.

    2013-01-01

    Background. Early prediction of outcome after stroke is becoming increasingly important, as most patients are discharged from hospital stroke units within several days after stroke. Objectives. The primary purposes of this study were: (1) to determine the accuracy of physical therapists' predictions

  19. Stroke

    Science.gov (United States)

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

  20. The main components of stroke unit care: results of a European expert survey.

    Science.gov (United States)

    Leys, Didier; Ringelstein, E Bernd; Kaste, Markku; Hacke, Werner

    2007-01-01

    Stroke units decrease mortality, handicap and need for institutional care, but there are only sparse evidence-based data showing which components make the difference over general wards. The aim of this survey was to identify from expert opinions what should be the major components of stroke units. A questionnaire was sent to 83 European stroke experts, to ask their opinion on what should be the components of comprehensive stroke centres (CSC), primary stroke centres (PSC) and any hospital ward (AHW) admitting acute stroke patients routinely. It consisted of a list of 107 components (personnel, diagnostic procedures, monitoring, invasive treatments provided, infrastructures, protocols and procedures and their availability for 24 h a day for 7 days a week, 24/7) to be classified as irrelevant, useful but not necessary, desirable, important but not absolutely necessary, or absolutely necessary. 42 questionnaires (50.6%) were returned. Four components were excluded because of a poor level of agreement between experts. Eight components were considered as absolutely necessary by more than 75% of the experts for both CSC and PSC: multidisciplinary team, stroke-trained nurses, brain CT scan 24/7, CT priority for stroke patients, extracranial Doppler sonography, automated electrocardiographic monitoring, intravenous rt-PA protocols 24/7 and in-house emergency department. Eleven other components (in the fields of vascular surgery, neurosurgery, interventional radiology and clinical research) were considered as necessary in CSC by more than 75% of the experts. Only 8 components were considered as important but not absolutely necessary by more than 50% of the experts for AHW. The experts showed a high level of agreement about the essential components of organized acute stroke care, providing useful information to health authorities for the allocation of resources. Copyright 2007 S. Karger AG, Basel.

  1. [Application of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction].

    Science.gov (United States)

    Wang, Zhi-min; Wang, Peng; Chen, Jie; Luo, Dan-hong; Shen, Wang-ming

    2008-07-01

    To evaluate the efficacy of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction. 77 acute cerebral infarction patients were randomly assigned to stroke rehabilitation unit group and 73 to ordinary group. The NIH stroke scale (NIHSS), activities of daily living (ADL) Barthel index and average hospitalized time were compared in two groups before and after the treatment. The average NIHSS in two groups before treatment were 9.26 and 9.12 respectively (P > 0.05) but became 2.62 and 7.64 after treatment (P 0.05) but 87.26 and 64.20 after the treatment (P rehabilitation unit being applied in the acute phase of cerebral infarction, it showed positive results in the following aspects as: improving the neurological function, capabilities of managing daily life, and also shortening the days of hospitalization.

  2. Regulatory, policy and quality update for venous thromboembolism and stroke in United States hospitals.

    Science.gov (United States)

    Mahan, Charles E

    2012-10-01

    Stroke and venous thromboembolism (VTE) have a large impact on the United States (US) healthcare system. It is estimated that up to 1.7million new and recurrent stroke and VTE events are occurring in the US on an annual basis with the combined cost approaching over $200billion per year. A significant amount of stroke and VTE are preventable from appropriate antithrombotic use in at-risk patients and the Center for Medicaid and Medicare Services, the Joint Commission, the National Quality Forum and other key quality and regulatory entities have prioritized minimizing the impact of morbidity, mortality and avoidable costs related to these diseases. This review provides a brief history, overview, and update for the development of quality measures, quality systems, and regulatory and policy changes as related to stroke and VTE within the US healthcare system. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. 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

  4. The axon-glia unit in white matter stroke: mechanisms of damage and recovery.

    Science.gov (United States)

    Rosenzweig, Shira; Carmichael, S Thomas

    2015-10-14

    Approximately one quarter of all strokes in humans occur in white matter, and the progressive nature of white matter lesions often results in severe physical and mental disability. Unlike cortical grey matter stroke, the pathology of white matter stroke revolves around disrupted connectivity and injured axons and glial cells, rather than neuronal cell bodies. Consequently, the mechanisms behind ischemic damage to white matter elements, the regenerative responses of glial cells and their signaling pathways, all differ significantly from those in grey matter. Development of effective therapies for white matter stroke would require an enhanced understanding of the complex cellular and molecular interactions within the white matter, leading to the identification of new therapeutic targets. This review will address the unique properties of the axon-glia unit during white matter stroke, describe the challenging process of promoting effective white matter repair, and discuss recently-identified signaling pathways which may hold potential targets for repair in this disease. This article is part of a Special Issue entitled SI: Cell Interactions In Stroke. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Occurrence and temporal evolution of upper limb spasticity in stroke patients admitted to a rehabilitation unit.

    Science.gov (United States)

    Kong, Keng H; Lee, Jeanette; Chua, Karen S

    2012-01-01

    To document the temporal development and evolution of upper limb spasticity, and to establish clinical correlates and predictors of upper limb spasticity in a cohort of stroke patients. Prospective cohort study. A rehabilitation unit. Patients (N=163) with a first-ever ischemic stroke. Not applicable. Ashworth Scale for measuring upper limb spasticity, Motor Assessment Scale for upper limb activity, Motricity Index for upper limb strength, and Modified Barthel Index for self-care. Upper limb spasticity was defined as an Ashworth Scale score of 1 or greater. Upper limb spasticity occurred in 54 patients (33%) at 3 months after stroke. Development of spasticity at later stages of the stroke was infrequent, occurring in only 28 patients (17%). In patients with mild spasticity (Ashworth Scale score 1) at 3 months after stroke, worsening of spasticity occurred in only 1 patient. On the other hand, almost half of the patients with moderate spasticity (Ashworth Scale score 2) at 3 months progressed to severe spasticity (Ashworth Scale score 3). Poor upper limb activity was the most important correlate of "moderate to severe spasticity" (Ashworth Scale score ≥2) (PAshworth Scale score of 2 or greater at 3 months after stroke, and in patients with severe upper limb weakness on admission to rehabilitation. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. Clustered stroke patients on a general medical unit: what nursing skills and knowledge contribute to optimal patient outcomes?

    Science.gov (United States)

    Clayton, Brenda

    2014-01-01

    The purpose of this paper is to explore the nurse's role in caring for adult stroke patients, both ischemic and hemorrhagic, who are clustered on general medical units. There is evidence in the literature that having patients cared for in a dedicated stroke unit improves patient outcomes by decreasing disability and mortality rates for stroke survivors. However having a dedicated stroke unit may not be practical or feasible because of the population distribution, particularly for smaller urban and rural communities. Therefore, training nurses on the general medical units to provide care to clustered stroke patients requires specific skill training. This will decrease hospital stays and improve patient outcomes, as a result of specialized trained health care workers. A review of the literature indicates that there are specific skills and knowledge the nurse requires to perform evidence-based best practice therapy and have optimal patient outcomes when caringfor patients on general medical units.

  7. [The prevalence and signs of Dysphagia among stroke patients in rehabilitation units].

    Science.gov (United States)

    Ho, Yi-Hui; Liu, Hsiu-Yueh; Huang, Shun-Te

    2014-04-01

    Dysphagia, a very common post-stroke symptom, has been linked to aspiration pneumonia, malnutrition, and increased length of hospitalization. While patients are typically monitored for dysphagia continuously following their transfer to a rehabilitation unit, little is known about the results of dysphagia reassessments. This study investigates the prevalence and signs of dysphagia among stroke patients in rehabilitation units. We analyzed patients with stroke admitted to a rehabilitation unit of a medical center in southern Taiwan. The procedure included chart review, the repetitive saliva swallowing test (RSST), and the modified water swallowing test (MWST). Dysphagia was defined as either RSST or MWST abnormal. JMP 9.0 was used to perform descriptive statistics, t-test, chi-square test and logistic regression analysis. At clinical examination, 53.61% of the study subjects demonstrated dysphagia. Chi-square analysis showed that five abnormal signs (could not close mouth with water, without mastication, food stuck in the throat, obvious sputum sound, and choking after swallowing) are all associated with dysphagia. Multiple logistic regression analysis revealed choking is a significant predictor variable of dysphagia. Over half of the rehabilitation unit stroke patients in this study had dysphagia. Nurses are the primary care providers for dysphagia patients. Therefore, there is a need for ward nurses to have skills to assess, recognize, and manage dysphagia and to enhance patient safety.

  8. United States radiological health activities: inspection results of mammography facilities.

    Science.gov (United States)

    Spelic, Dc; Kaczmarek, Rv; Hilohi, M; Belella, S

    2007-04-01

    The Mammography Quality Standards Act (MQSA) was enacted in 1992 to set national standards for high-quality mammography, including standards for mammographic X-ray equipment, patient dose, clinical image quality, and related technical parameters. The MQSA also requires minimum qualifications for radiologic technologists, interpreting physicians and medical physicists, mandates acceptable practices for quality-control, quality-assurance, and requires processes to audit medical outcomes. This paper presents the findings of MQSA inspections of facilities, which characterize significant factors affecting mammography quality in the United States. Trained inspectors collected data regarding X-ray technical factors, made exposure measurements for the determination of mean glandular dose (MGD), evaluated image quality, and inspected the quality of the film-processing environment. The average annual facility and total U.S. screening exam workloads were computed using workload data reported by facilities. Mammography facilities have made technical improvements as evidenced by a narrower distribution of doses, higher phantom-film background optical densities associated with higher phantom image-quality scores, and better film processing. It is estimated that approximately 36 million screening mammography exams were conducted in 2006, a rate that is almost triple the exam volume estimated for 1997. Digital mammography (DM) is now in use at approximately 14% (1,191 of 8,834) of MQSA-certified mammography facilities. The results indicate that DM can offer lower dose to the patient while providing comparable or better image quality.

  9. 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 < .001), immersion in ice water (63.0% vs 45.4%, respectively; P = .01), or fans (54.3% vs 42.0%, respectively; P = .06) and monitoring the athlete's temperature (60.5% vs 46.2%, respectively; P = .04). Preseason

  10. Disciplinary power and the process of training informal carers on stroke units.

    Science.gov (United States)

    Sadler, Euan; Hawkins, Rebecca; Clarke, David J; Godfrey, Mary; Dickerson, Josie; McKevitt, Christopher

    2018-01-01

    This article examines the process of training informal carers on stroke units using the lens of power. Care is usually assumed as a kinship obligation but the state has long had an interest in framing the carer and caring work. Training carers in healthcare settings raises questions about the power of the state and healthcare professionals as its agents to shape expectations and practices related to the caring role. Drawing on Foucault's notion of disciplinary power, we show how disciplinary forms of power exercised in interactions between healthcare professionals and carers shape the engagement and resistance of carers in the process of training. Interview and observational field note extracts are drawn from a multi-sited study of a training programme on stroke units targeting family carers of people with stroke to consider the consequences of subjecting caring to this intervention. We found that the process of training informal carers on stroke units was not simply a matter of transferring skills from professional to lay person, but entailed disciplinary forms of power intended to shape the conduct of the carer. We interrogate the extent to which a specific kind of carer is produced through such an approach, and the wider implications for the participation of carers in training in healthcare settings and the empowerment of carers. © 2017 Foundation for the Sociology of Health & Illness.

  11. 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.

  12. 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.

  13. Characteristics and outcome of stroke patients with cerebrovascular accident at the intensive care unit of a tertiary hospital in Nigeria.

    Science.gov (United States)

    Tobi, Ku; Okojie, Nq

    2013-01-01

    Patients with severe stroke defined as NIHSS score >17 constituting about 15-20% of cerebrovascular accident require admission into the Intensive Care Unit (ICU). However the benefit of ICU admission for stroke patients remains controversial. Aim & Objectives: To determine the characteristics and outcome of patients with cerebrovascular accident managed at the Intensive Care Unit of University of Benin Teaching Hospital. Demographic characteristics, clinical features and course, treatment options and outcome of all stroke patients admitted in ICU from January 2002 to January 2012 were retrieved from the hospital records and analyzed. A patient before and after each stroke patient were selected as controls for the study. Primary outcome variable was ICU mortality, type of stroke whether ischemic or haemorrhagic, duration of stay, whether patients were transferred from the medical/stroke ward or from the accident and emergency department of the hospital. A total of thirty six (36) stroke patients were admitted into the ICU within the study period accounting for 5.6% of the total ICU admissions. The male: female ratio is 2:1 and patients aged >60 years accounted for 55.6%. Stroke patients admitted into ICU had a mortality rate of 77.8%. Patients with severe stroke admitted into the ICU were 4 times more likely to die compared to non-stroke patients in the ICU (p=0.002, OR=4.472). However, severe stroke had no significant impact on duration of ICU stay (p=0.454, OR=1.464). Stroke patients have a high mortality in the intensive care unit that is independent on the type and route of admission. Provision of the support equipment and instruments required for high dependency service in the intensive care unit and early admission should improve the outcome.

  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. Interdisciplinary communication in inpatient rehabilitation facility: evidence of under-documentation of spatial neglect after stroke

    Science.gov (United States)

    Chen, Peii; McKenna, Cristin; Kutlik, Ann M.; Frisina, Pasquale G.

    2013-01-01

    Purpose Spatial neglect commonly occurs after stroke and predicts poor rehabilitation outcomes. However, this disorder is under-recognized in clinical practices, which may result from the failure to document its presence. This study aimed to identify the predictors for documentation of spatial neglect in inpatient rehabilitation facilities. Method We performed a comprehensive chart review to investigate whether the presence of spatial neglect was documented in 74 neglect patients’ clinical notes recorded by physicians, nurses, or occupational therapists (OTs), or in team conference notes. Independent variables included neglect severity, length of stay, Functional Independence Measure at admission and discharge. Results Of the 74 neglect patients, 75.7% were documented by OTs, 63.5% by physicians, and 17.6% by nurses. Although 93.2% of neglect patients were recognized by at least one clinician group, only 31.1% were discussed in multidisciplinary team conferences. Neglect patients who were documented by physicians were more likely to be documented in team conferences. While no factors predicted whether a neglect patient would be documented by nurses or OTs, we found significant predictors for neglect documentation in physician and team conference notes. The odds of being documented by physicians were increasingly greater with poorer efficiency of cognitive rehabilitation (odds ratio = 0.70). The odds of being discussed in team conferences were increasingly greater with more severe neglect (odds ratio = 0.98), and with longer stay in hospitalization (odds ratio = 1.06). Conclusions Multidisciplinary care may not involve as much interdisciplinary communication as needed to document important disease states. Stroke rehabilitation professionals should be able to recognize spatial neglect independently and document it consistently. PMID:23072734

  16. Physical Therapists' Guideline Adherence on Early Mobilization and Intensity of Practice at Dutch Acute Stroke Units A Country-Wide Survey

    NARCIS (Netherlands)

    Otterman, Nicoline M.; van der Wees, Philip J.; Bernhardt, Julie; Kwakkel, Gert

    2012-01-01

    Background and Purpose-Clinical practice guidelines for patients with stroke recommend early stroke rehabilitation at acute hospital stroke units. The present study aimed to (1) explore the organization of early stroke rehabilitation; (2) investigate current practice with respect to early

  17. Effects of interstate migration on the geographic distribution of stroke mortality in the United States.

    Science.gov (United States)

    Lanska, D J; Peterson, P M

    1995-04-01

    This study examines the effects of lifetime net interstate migration on the geographic distribution of stroke mortality in the United States. National Center for Health Statistics and Bureau of the Census data were used to map the geographic distribution of age-adjusted, race-, and race/sex-specific stroke mortality rates by interstate migration status for natives, outmigrants, nonmigrants, inmigrants, and residents in the United States for 1979 to 1981. High age-adjusted stroke mortality rates were significantly clustered in the southeastern United States for both whites and blacks; in addition, for whites, low-rate states were concentrated in some Mountain and northeastern states. Migrant status did not change this large-scale pattern, but individual states showed significant migration effects, which varied in magnitude and direction. Among whites, states that benefited from migration, with markedly lower stroke mortality rates among residents than natives, included Arizona, Colorado, District of Columbia, and Florida, whereas states that suffered from migration included California, Idaho, Montana, North Dakota, Nevada, and Oklahoma. Among blacks, only Colorado showed an apparent large benefit from migration, whereas 21 states suffered from migration. Although the overall large-scale spatial distribution of resident stroke mortality rates cannot be explained by migration effects, some individual states had rates that were strongly influenced by migration. Patterns of mortality among migrant groups in Sun Belt retirement destination states probably result from differential selection effects for retirement migration in older adults. Patterns of mortality for black migrants to the North are probably influenced by "carryover" effects from their origin states.

  18. 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

  19. 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.

  20. The neurovascular unit in the setting of stroke

    Science.gov (United States)

    del Zoppo, G. J.

    2010-01-01

    Microvessels and neurons respond rapidly and simultaneously in focal regions of ischaemic injury in such a way as to suggest that the responses could be coordinated. The ability of neurons to modulate cerebral blood flow in regions of activation results from neurovascular coupling. But little is known about the microvessel-to-neuron direction of the relationship. The presence and participation of intervening glial cells implies the association of microvessels, glia, and neurons in a ‘neurovascular unit’. The interdependent functions of the cellular and matrix components of this theoretical unit have not been rigorously explored, except under conditions of injury where, for the most part, only single components or tissue samples have been studied. Whereas maintenance or timely re-establishment of flow reduces tissue and neuron injury in both humans and animal models, protection of neuron function in humans has not prevented the evolution of injury despite the inherent mechanisms of neurovascular coupling. However, occlusion of flow to the brain rapidly identifies regions of neuron-vascular vulnerability within the vascular territory-at-risk. These coalesce to become the mature ischaemic lesion. The failure, so far, of clinical trials of neuron protectant agents to achieve detectable tissue salvage could be explained by the vulnerability (and lack of protection) of essential components of the ‘unit’. This presentation summarizes evidence and thoughts on this topic. These support the need to understand component interactions within the neurovascular unit. PMID:20175864

  1. 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

  2. Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital

    Science.gov (United States)

    Luvizutto, Gustavo José; Gameiro, Mônica de Oliveira Orsi; Schelp, Arthur Oscar; Braga, Gabriel Pereira; Ribeiro, Priscila Watson; Bazan, Rodrigo

    2015-01-01

    [Purpose] The study aimed to characterize patients treated by rehabilitation section after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation records of individuals with ischemic stroke were studied retrospectively, excluding individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1, prior stroke, structural bone deformities, associated neurological disease, and prior cognitive deficit. The data evaluated were age, gender, etiology, localization, treatment received, ictus onset, hospitalization time, discharge date, and date of first evaluation at the rehabilitation center. The Modified Rankin Scale in 90 days after ictus was utilized to measure functional incapacity with the individuals divided into two groups, before and after acute stroke unit implementation (2010). Functional incapacity was compared between before and after acute stroke unit implementation by the Mann-Whitney test, χ2 test and Fisher’s exact test. [Results] The medical records of 170 patients were evaluated. In the group evaluated after 2010, the patients were significantly older and presented a shorter time between hospitalization and discharge, shorter time until the first evaluation in rehabilitation, and increased percentage of mild incapacity (Modified Rankin Scale = 0 to 2). [Conclusion] After acute stroke unit implementation, the patients treated in the rehabilitation section presented a shorter hospitalization time and rehabilitation delay and less functional incapacity. PMID:26355915

  3. 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

  4. 77 FR 42621 - Irradiation Treatment; Location of Facilities in the Southern United States

    Science.gov (United States)

    2012-07-20

    .... APHIS-2009-0100] RIN 0579-AD35 Irradiation Treatment; Location of Facilities in the Southern United... amending the phytosanitary treatment regulations to provide generic criteria for new irradiation treatment facilities in the Southern States of the United States. This action will allow irradiation facilities to be...

  5. 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

  6. 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…

  7. 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.

  8. 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.

  9. 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.

  10. Motor deficit outcome in patients with stroke in the neurology unit of the Befelatanana University Hospital in Antananarivo.

    Science.gov (United States)

    Razafindrasata, R S; Rasaholiarison, N F; Razafimahefa, J; Tehindrazanarivelo, A D

    2017-11-01

    A stroke is the sudden onset of focal neurological deficits presumed to have mecanism vascular and is the leading cause of acquired motor disability in adults. To improve stroke management, we examined the motor disability of patients presenting with stroke, their course, and its determinant factors. This retrospective descriptive study reviewed case records from the neurology unit of the Befelatanana University Hospital from january to december 2015. We included all patients who had a stroke with motor impairment of any upper or lower limbs, with or without computed tomography of the brain, that is, 227 (36.50 %) of the 622 patients admitted to the neurology unit. The mean age of onset was 55.41 years with a sex-ratio 1.16. Predominantly, we found perforating artery strokes (51.54 %), ischemic strokes (36.12 %), and right limb location deficits (50.22 %). Stroke patients were managed with physical therapy from the beginning of the acute stage, that is, from the admission (77.53 %). Two third of the motor deficits were steady (67.84 %), with a median NIHSS=8 and MRS=4 at hospital discharge. The mortality rate was 8.37 % (6.60 % during the first week and 1.77 % after that). We found no significant determinant factors. Hospital mortality decreased during the study. The lack of overcoming of motor disability was due to the short follow-up period, which included only the acute stage. These findings point out the utility of a neurovascular unit (UNV) for reducing disabilities and developing a network for stroke management during the acute stage in Madagascar.

  11. 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

  12. Results of Clinicians Using a Therapeutic Robotic System in an Inpatient Stroke Rehabilitation Unit

    Directory of Open Access Journals (Sweden)

    Barreca Susan

    2011-08-01

    Full Text Available Abstract Background 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. Methods 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. Results 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

  13. Results of Clinicians Using a Therapeutic Robotic System in an Inpatient Stroke Rehabilitation Unit

    Science.gov (United States)

    2011-01-01

    Background 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. Methods 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. Results 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

  14. 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...

  15. 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

  16. 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.

  17. Autonomous Electrothermal Facility for Oil Recovery Intensification Fed by Wind Driven Power Unit

    Science.gov (United States)

    Belsky, Aleksey A.; Dobush, Vasiliy S.

    2017-10-01

    This paper describes the structure of autonomous facility fed by wind driven power unit for intensification of viscous and heavy crude oil recovery by means of heat impact on productive strata. Computer based service simulation of this facility was performed. Operational energy characteristics were obtained for various operational modes of facility. The optimal resistance of heating element of the downhole heater was determined for maximum operating efficiency of wind power unit.

  18. Occurrence of Depressive Symptoms Among Older Adults after a Stroke in the Nursing Home Facility.

    Science.gov (United States)

    Kowalska, Joanna; Bojko, Ewa; Szczepańska-Gieracha, Joanna; Rymaszewska, Joanna; Rożek-Piechura, Krystyna

    2016-01-01

    The aim of the study was to analyze the prevalence of depressive symptoms among older adults after stroke in a nursing home (NH). The study was conducted in a NH and included 50 patients after stroke with a mean age of 74.62 (±8.2). The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Acceptance Illness Scale (AIS) and Barthel Index (BI) were used. Mean GDS was 7.60 (±2.75); 74% of patients had depressive symptoms. The study showed a significant relationship between GDS and marital status (p = .043). A negative correlations between GDS and MMSE (p = .029), GDS and BI (p = .049), and GDS and AIS (p stroke depends on their mental and functional status, degree of acceptance of illness, and marital status. Early detection of depressive symptoms in stroke patients allows rehabilitation nurses to optimize the therapeutic effects. © 2015 Association of Rehabilitation Nurses.

  19. Inequities in access to rehabilitation: exploring how acute stroke unit clinicians decide who to refer to rehabilitation.

    Science.gov (United States)

    Lynch, Elizabeth A; Luker, Julie A; Cadilhac, Dominique A; Hillier, Susan L

    2016-07-01

    Less than half of the patients with stroke in Australian hospitals are assessed by rehabilitation specialists. We sought to explore how clinicians working in acute stroke units (ASUs) determine which patients to refer to rehabilitation services. Qualitative descriptive study. Team meetings were observed and medical records were reviewed over four weeks at two ASUs. Focus groups were conducted with staff from eight ASUs in two states of Australia. Rehabilitation was mentioned in team meetings for 50/64 patients (78%) during the observation period. Rehabilitation referrals were organised for 47 patients (94%) for whom rehabilitation was discussed (74% of the sample); and for no patients when rehabilitation was not discussed. Factors identified that influenced whether referrals were organised included the anticipated discharge destination; severity of stroke; staff expectations of the patient's recovery; and if there was advocacy by families about rehabilitation. Clinicians tended to refer the patients they considered would be accepted by the rehabilitation service. Staff at two ASUs expressed concern that referring all patients with stroke-related deficits to rehabilitation would be unfavourable with rehabilitation providers. Decisions made by ASU staff regarding who to refer to stroke rehabilitation are often not solely based on patients' rehabilitation requirements. Implications for Rehabilitation Not all patients on acute stroke units (ASUs) who may have benefited from rehabilitation were offered rehabilitation referrals. Criteria for rehabilitation referrals need to be made explicit and discussed openly with consumers, ASU clinicians and rehabilitation specialists. A change in rehabilitation assessment practices is required to provide data regarding the unmet rehabilitation needs of patients with stroke. New models of rehabilitation service delivery or increased rehabilitation services may be required to meet the rehabilitation needs of all patients with stroke.

  20. Acute ischemic stroke update.

    Science.gov (United States)

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

    2010-05-01

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

  1. Drip-and-ship thrombolytic treatment paradigm among acute ischemic stroke patients in the United States.

    Science.gov (United States)

    Tekle, Wondwossen G; Chaudhry, Saqib A; Hassan, Ameer E; Rodriguez, Gustavo J; Suri, M Fareed K; Qureshi, Adnan I

    2012-07-01

    To provide a national assessment of thrombolytic administration using drip-and-ship treatment paradigm. Patients treated with the drip-and-ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment were identified within the Nationwide Inpatient Sample. Thrombolytic utilization, patterns of referral, comparative in-hospital outcomes, and hospitalization charges related to drip-and-ship paradigm were determined. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Of the 22 243 ischemic stroke patients who received thrombolytic treatment, 4474 patients (17%) were treated using drip-and-ship paradigm. Of these 4474 patients, 81% were referred to urban teaching hospitals for additional care, and 7% of them received follow-up endovascular treatment. States with a higher proportion of patients treated using the drip-and-ship paradigm had higher rates of overall thrombolytic utilization (5.4% versus 3.3%; Pcare was significantly higher in patients treated with drip-and-ship paradigm compared with those who received thrombolytics through primary emergency department arrival in the multivariate analysis (OR, 1.198; 95% CI, 1.019-1.409; P=0.0286). One of every 6 thrombolytic-treated patients in United States is treated using drip-and-ship paradigm. States with the highest proportion of drip-and-ship cases were also the states with the highest thrombolytic utilization.

  2. 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...

  3. Is patient-grouping on basis of condition on admission indicative for discharge destination in geriatric stroke patients after rehabilitation in skilled nursing facilities? The results of a cluster analysis.

    Science.gov (United States)

    Buijck, Bianca I; Zuidema, Sytse U; Spruit-van Eijk, Monica; Bor, Hans; Gerritsen, Debby L; Koopmans, Raymond T C M

    2012-12-04

    Geriatric stroke patients are generally frail, have an advanced age and co-morbidity. It is yet unclear whether specific groups of patients might benefit differently from structured multidisciplinary rehabilitation programs. Therefore, the aims of our study are 1) to determine relevant patient characteristics to distinguish groups of patients based on their admission scores in skilled nursing facilities (SNFs), and (2) to study the course of these particular patient-groups in relation to their discharge destination. This is a longitudinal, multicenter, observational study. We collected data on patient characteristics, balance, walking ability, arm function, co-morbidity, activities of daily living (ADL), neuropsychiatric symptoms, and depressive complaints of 127 geriatric stroke patients admitted to skilled nursing facilities with specific units for geriatric rehabilitation after stroke. Cluster analyses revealed two groups: cluster 1 included patients in poor condition upon admission (n = 52), and cluster 2 included patients in fair/good condition upon admission (n = 75). Patients in both groups improved in balance, walking abilities, and arm function. Patients in cluster 1 also improved in ADL. Depressive complaints decreased significantly in patients in cluster 1 who were discharged to an independent- or assisted-living situation. Compared to 80% of the patients in cluster 2, a lower proportion (46%) of the patients in cluster 1 were discharged to an independent- or assisted-living situation. Stroke patients referred for rehabilitation to SNFs could be clustered on the basis of their condition upon admission. Although patients in poor condition on admission were more likely to be referred to a facility for long-term care, this was certainly not the case in all patients. Almost half of them could be discharged to an independent or assisted living situation, which implied that also in patients in poor condition on admission, discharge to an independent or

  4. [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.

  5. The associations between insomnia and health-related quality of life in rehabilitation units at 1month after stroke.

    Science.gov (United States)

    Kim, Won-Hyoung; Jung, Han-Young; Choi, Ha-Yoon; Park, Chan-Hyuk; Kim, Eun-Suk; Lee, Sook-Joung; Ko, Sung-Hwa; Kim, Soo-Yeon; Joa, Kyung-Lim

    2017-05-01

    The principal objective of this study was to investigate the relationship between insomnia and health-related quality of life (HRQoL) during the early stage of stroke rehabilitation. The subjects were 214 first-time stroke patients admitted to a rehabilitation unit at one of three Korean hospitals. Within 7days after stroke, functions were evaluated using; the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, the Frontal Assessment Battery, Screening Tests for Aphasia and Neurologic-Communication Disorders, and the National Institute of Health Stroke Scale. Insomnia, depression, anxiety, and HRQoL were investigated at one month after stroke. Insomnia was defined as presence of at least one of the four following; difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and non-restorative sleep. HRQoL was assessed using the Short Form Health survey SF-8. Depression and anxiety were measured using the Hospital Anxiety Depression Scale. Multivariate linear regression analysis was conducted to examine the association between insomnia and HRQoL. The prevalence of insomnia at one month after stroke was 59.5%. Patients with insomnia were more likely to be older and female and to have depression and anxiety. Patients with insomnia had poorer physical and mental HRQoL. By multivariate analyses, physical HRQoL was significantly associated with type of stroke, hypnotic usage, balancing function, and insomnia. Mental HRQoL was significantly associated with balancing function, depression, and insomnia. Insomnia was found to be negatively associated with physical and mental HRQoL in stroke patients during the early stage of rehabilitation. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. 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...... labour market affiliation compared to patients transported by a ground unit. Trial registration: The study was registered at ClinicalTrials.gov (NCT02576379)....

  7. Logic units for complex experimental facilities with inter-unit connections

    International Nuclear Information System (INIS)

    Borejko, V.F.; Baluev, Yu.M.; Grebenyuk, V.M.; Zinov, V.G.; Rudenko, A.I.; Selikov, A.V.

    1984-01-01

    The description and technical characteristics of logic units realized in the CAMAC standard are given. For units connected with the trunck the logical functions control unit is unified. The signal shaper circuits, delay unit, coincidence unit, level matching unit, coincided signals detecting unit, pulse bursts generator for detector signal imitation are considered

  8. 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

  9. Family history as a risk factor for early-onset stroke/transient ischemic attack among adults in the United States.

    Science.gov (United States)

    Mvundura, Mercy; McGruder, Henraya; Khoury, Muin J; Valdez, Rodolfo; Yoon, Paula W

    2010-01-01

    Stroke is a major cause of morbidity and death in the United States. We tested the association between familial risk for stroke and prevalence of the disease among US adults and assessed the use of family history of stroke as a risk assessment tool for the disease. Using data from the 2005 HealthStyles survey (n = 4,819), we explored the association between familial stroke risk (stratified as high, moderate or low) and the prevalence of stroke and related health conditions. We evaluated the clinical validity (sensitivity, specificity) of family history of stroke as an indicator of stroke risk. Stroke and the related medical conditions were self-reported. Independent of other risk factors, people with a high familial risk for stroke were 4 times more likely to have had a stroke (95% confidence interval, CI, 2.6-6.0) than people with moderate or low familial risk. They were also 1.3 times (95% CI 1.1-1.6) more likely to have high blood pressure and 1.5 times (95% CI 1.3-2.0) more likely to have congestive heart failure. The sensitivity and specificity of using family history alone, high blood pressure alone or both risk factors to estimate stroke risk were 52 and 83%, 53 and 74%, and 29 and 95%, respectively. Despite several limitations typical of self-reported surveys, we find that in this sample of US adults, family history of stroke was significantly associated with the risk for stroke and high blood pressure as well as related conditions. Family history of stroke, alone or combined with other risk factors, can be a useful tool in assessing stroke risk among US adults. Copyright © 2009 S. Karger AG, Basel.

  10. 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.

  11. 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.

  12. 77 FR 58470 - Irradiation Treatment; Location of Facilities in the Southern United States; Technical Amendment

    Science.gov (United States)

    2012-09-21

    .... APHIS-2009-0100] RIN 0579-AD35 Irradiation Treatment; Location of Facilities in the Southern United... things, allow for irradiation treatment of mangoes from India upon arrival in the mainland United States... 20, 2012, we amended the regulations in Sec. 319.56-46 to allow for irradiation treatment of mangoes...

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

    International Nuclear Information System (INIS)

    1964-01-01

    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

  14. 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

  15. 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.

  16. 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.

  17. Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit.

    Science.gov (United States)

    Viña Soria, L; Martín Iglesias, L; López Amor, L; Astola Hidalgo, I; Rodríguez García, R; Forcelledo Espina, L; Gonzalo Guerra, J A; de Cima Iglesias, S; Murias Quintana, E; Vega Valdés, P; Calleja Puerta, S; Escudero Augusto, D

    2017-11-11

    To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. Observational prospective study. Mixed ICU. Third level hospital. Sixty adult patients. Consecutive sample. None. Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  18. A survey of facilities for high risk women in consultant obstetric units.

    Science.gov (United States)

    Cordingley, J J; Rubin, A P

    1997-07-01

    Reports on Confidential Enquiries into Maternal Deaths and the Obstetric Anaesthetists' Association have made recommendations about the provision of staff and facilities in consultant obstetric units. We have carried out a postal survey of all units in the UK concerning provision of recovery facilities, high dependency and intensive care, and anaesthetic staffing. Replies were received from 232 units (89%). The results show that although many units had achieved recommended standards, this was not universal. In particular, only 62% had a designated and staffed recovery area, only 41% had specific obstetric high dependency beds and there were a number of units with no consultant anaesthetic sessions or trained anaesthetic assistants available around the clock. Despite the practical and financial difficulties in achieving recommended standards, it should be noted that purchasers of health care have been encouraged to ensure that the recommendations are implemented.

  19. 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.

  20. 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...

  1. 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'.

  2. Awareness of heart attack and stroke symptoms among Hispanic male adults living in the United States.

    Science.gov (United States)

    Lutfiyya, May Nawal; Bardales, Ricardo; Bales, Robert; Aguero, Carlos; Brady, Shelly; Tobar, Adriana; McGrath, Cynthia; Zaiser, Julia; Lipsky, Martin S

    2010-10-01

    There is evidence that Hispanic men are a high risk group for treatment delay for both heart attack and stroke. More targeted research is needed to elucidate this specific population's knowledge of warning signs for these acute events. This study sought to describe within-group disparities in Hispanic men's knowledge of heart attack and stroke symptomology. Multivariate techniques were used to analyze a multi-year Behavioral Risk Factor Surveillance Heart and Stroke module database. The data were cross-sectional and focused on health risk factors and behaviors. The research participants were U.S. male Hispanic adults aged 18-99. The main outcome measure for the study was heart attack and stroke symptom knowledge score. Multivariate logistic regression analysis yielded that Hispanic men aged >or=18 years who earned low scores on the composite heart attack and stroke knowledge questions (range 0-8 points) were more likely to: have less than a high school education, have deferred medical care because of cost, not have an identified health care provider, and be uninsured. There were significant within-group differences. Targeting educational efforts toward older (>or=55 years) Hispanic men with less than high school education, those who do not have an identified health care provider or health insurance, and who defer health care because of cost could be ways to improve the outcome of acute vascular events among the U.S. Hispanic adult male population.

  3. 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.

  4. 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

  5. Effect of an evidence-based mobility intervention on the level of function in acute intracerebral and subarachnoid hemorrhagic stroke patients on a neurointensive care unit.

    Science.gov (United States)

    Rand, Maxine L; Darbinian, Jeanne A

    2015-07-01

    To explore the effect of an evidence-based mobility intervention on the level of function (LOF) achieved by patients with intracerebral hemorrhage (ICH) stroke and subarachnoid hemorrhage (SAH) stroke and to identify clinical characteristics and measures associated with walking distances >15.24m. Retrospective pre- and postintervention study. Regional neurointensive care unit. Adult patients with ICH and SAH (N=361). Daily mobility intervention based on patient's current LOF. Walking >15.24m (LOF 5) by neurointensive care unit discharge. Electronic health records for 361 patients (52.6% women; mean age, 62.1y; ICH stroke, 63.2%; aphasia, 35%; hemiplegia, 33%) were included. There was a 2.3-fold increase in patients with hemorrhagic stroke achieving a LOF of 5 by neurointensive care unit discharge after introduction of a mobility intervention. In the multivariable logistic regression model including neurointensive care unit length of stay (LOS) as a covariate, the intervention, LOF of 5 at admission, SAH stroke type, third (vs lowest) quartile of neurointensive care unit LOS, and absence of aphasia and/or hemiplegia were associated with higher likelihood of achieving a LOF of 5 (odds ratio [OR]=5.28; 95% confidence interval [CI], 2.52-11.06; OR=6.02; 95% CI, 1.45-24.96; OR=3.78; 95% CI, 1.83-7.80; OR=2.94; 95% CI, 1.16-7.47; OR=17.77; 95% CI, 6.59-47.92, respectively). A mobility intervention was strongly associated with increased distance walked by neurointensive care unit patients with acute hemorrhage at discharge and can be applied in any intensive care unit setting to promote stroke recovery. Future studies directed at building predictive models for walking achievement in patients with acute hemorrhagic stroke may provide insight into individualized treatment goal setting and discharge planning. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  6. Closure of hazardous and mixed radioactive waste management units at DOE facilities. [Contains glossary

    Energy Technology Data Exchange (ETDEWEB)

    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.

  7. 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

  8. Single motor unit firing rate after stroke is higher on the less-affected side during stable low-level voluntary contractions

    Directory of Open Access Journals (Sweden)

    Penelope A Mcnulty

    2014-07-01

    Full Text Available Muscle weakness is the most common outcome after stroke and a leading cause of adult-acquired motor disability. Single motor unit properties provide insight into the mechanisms of post-stroke motor impairment. Motor units on the more-affected side are reported to have lower peak firing rates, reduced discharge variability and a more compressed dynamic range than healthy subjects. The activity of 169 motor units was discriminated from surface EMG in 28 stroke patients during sustained voluntary contractions 10% of maximal and compared to 110 units recorded from 16 healthy subjects. Motor units were recorded in three series: ankle dorsiflexion, wrist flexion and elbow flexion. Mean firing rates after stroke were significantly lower on the more-affected than the less-affected side (p< 0.001 with no between-side differences for controls. When data were combined, firing rates on the less-affected side were significantly higher than those either on the more-affected side or healthy subjects (p< 0.001. Motor unit mean firing rate was higher in the upper-limb than the lower-limb (p< 0.05. The coefficient of variation of motor unit discharge rate was lower for motor units after stroke compared to controls for wrist flexion (p< 0.05 but not ankle dorsiflexion. However, the dynamic range of motor units was compressed only for motor units on the more-affected side during wrist flexion. Our results show that the pathological change in motor unit firing rate occurs on the less-affected side after stroke and not the more-affected side as previously reported, and suggest that motor unit behavior recorded in a single muscle after stroke cannot be generalized to muscles acting on other joints even within the same limb. These data emphasize that the less-affected side does not provide a valid control for physiological studies on the more-affected side after stroke and that both sides should be compared to data from age- and sex-matched healthy subjects.

  9. 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.

  10. 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

  11. An Evaluation of the United States Coast Guard’s Enlisted Dining Facility Accounting and Reporting System.

    Science.gov (United States)

    1980-09-01

    three or more SS in their authorized personnel allowance ( APA ) and which have adequate market facilities from which to obtain provisions. 3. Class C...Units with two SS in their APA and have adequate market facilities; also includes units with three or more SS without adequate market facilities. 4...1.1500 t0 % 3tandard Class -r Inaresse (subparagapb )....... n Norma Class IO ratian allolance ................ ............ (2) BaBi

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. Multi-purpose research facility: 60Co gamma irradiation unit at Centrum vyzkumu Rez

    International Nuclear Information System (INIS)

    Miklos, M.; Namburi, H. K.

    2014-01-01

    It is well know from 1950's till date, that the users, demand and network of gamma irradiation facility centers are growing rapidly to support industries as well as research due to its versatility. At present, its applications are in the fields of biological, chemical, solid state physics, medical, food and sterilization etc. The Gamma Irradiation Facility of the CVREZ is a dry-storage irradiator, which reached source end of life. The facility is now under refurbishment as a multi-purpose research center, fulfilling the requirements of international standards to support primarily the research sector and industries. Apart from the classical usage of gamma irradiation facility there is great scientific interest to use them to characterize the materials that are used in Nuclear Power Plants (NPP's). Electrical system unit in a nuclear power plants consists of several components. For instance some of them are light emitting diodes, pin-type photo-detectors and optical fibers, rubber seals, electrical insulation, thermal insulation, polymeric composites and metallic components etc. Under normal environmental conditions these materials possess good mechanical properties/chemical stability. The qualification of these materials for usage in NPPs under radiation environments and at high temperatures are desired for their better performance. Another feasibility of using gamma irradiation facility in the contest of NPP's is radiation hardening of robots that are used time-to-time in inspection of NPP's. Overall objective of our project is to support research activities aiming to understand the materials modification due to ionizing radiation. Upgraded facility will provide high-fidelity simulation of nuclear radiation environments for materials and component testing. We present our work by providing the information on (i) our objectives in utilizing the gamma facility, (ii) specific experimental test set-up under development to perform tests at elevated

  18. 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.

  19. An Examination of Care Practices of Pregnant Women Incarcerated in Jail Facilities in the United States.

    Science.gov (United States)

    Kelsey, C M; Medel, Nickole; Mullins, Carson; Dallaire, Danielle; Forestell, Catherine

    2017-06-01

    The number of incarcerated women in the United States has been steadily increasing over the last 30 years. An estimated 6-10% of these women are pregnant at intake. Previous studies on the health needs and care of pregnant incarcerated women have focused mainly on prison settings. Therefore, we examined the pregnancy-related accommodations and health care provided for regional jail populations. The present study is a quantitative survey (administered through phone or email to employees of predominately jail medical facilities) of common practices and policies employed across 53 jail facilities in the United States as a function of geographic region (North vs. South; West vs. Central vs. East). We examined provision of pregnancy screening, special diets, and drug rehabilitation and prohibition of shackling. Strikingly, across all aspects of the care of pregnant incarcerated women there are areas to be improved upon. Notably, only 37.7% of facilities pregnancy test all women upon entry, 45.7% put opioid addicted women through withdrawal protocol, and 56.7% of facilities use restraints on women hours after having a baby. In this first study to examine practices in regional jails nationwide, we found evidence that standards of care guidelines to improve health and well-being of pregnant incarcerated women, set by agencies such as American College of Obstetricians and Gynecologists, are not being followed in many facilities. Because not following these guidelines could pose major health risks to the mother and developing fetus, better policies, better enforcement of policies, and better common practices are needed to improve the health and welfare of pregnant incarcerated women.

  20. 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

  1. 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.

  2. Risk-Based Ranking Experiences for Cold War Legacy Facilities in the United States

    International Nuclear Information System (INIS)

    Droppo, James G.

    2003-01-01

    Over the past two decades, a number of government agencies in the United States have faced increasing public scrutiny for their efforts to address the wide range of potential environmental issues related to Cold War legacies. Risk-based ranking was selected as a means of defining the relative importance of issues. Ambitious facility-wide risk-based ranking applications were undertaken. However, although facility-wide risk-based ranking efforts can build invaluable understanding of the potential issues related to Cold War legacies, conducting such efforts is difficult because of the potentially enormous scope and the potentially strong institutional barriers. The U.S. experience is that such efforts are worth undertaking to start building a knowledge base and infrastructure that are based on a thorough understanding of risk. In both the East and the West, the legacy of the Cold War includes a wide range of potential environmental issues associated with large industrial complexes of weapon production facilities. The responsible agencies or ministries are required to make decisions that could benefit greatly from information on the relative importance of these potential issues. Facility-wide risk-based ranking of potential health and environmental issues is one means to help these decision makers. The initial U.S. risk-based ranking applications described in this chapter were ''ground-breaking'' in that they defined new methodologies and approaches to meet the challenges. Many of these approaches fit the designation of a population-centered risk assessment. These U.S. activities parallel efforts that are just beginning for similar facilities in the countries of the former Soviet Union. As described below, conducting a facility-wide risk-based ranking has special challenges and potential pitfalls. Little guidance exists to conduct major risk-based rankings. For those considering undertaking such efforts, the material contained in this chapter should be useful

  3. 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)

  4. 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

  5. Patient with a devastating embolic stroke: using weekly multidisciplinary ethics rounds in the neuroscience intensive care unit to facilitate care and communication.

    Science.gov (United States)

    Jehle, Jonathan; Jurchak, Martha

    2014-01-01

    The challenges families face in making decisions for loved ones after a severe stroke are best supported when the treatment team has the opportunity to share information and perspectives. Weekly multidisciplinary ethics rounds provides a very good forum for just such discussions. Using a case example, this article describes the framework for ethics rounds and its utility in a neuroscience intensive care unit.

  6. 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…

  7. Stroke Treatments

    Science.gov (United States)

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

  8. 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

    regulator, the suprachiasmatic nucleus, is mainly controlled by natural daylight, and the blue spectrum is considered the most powerful. During stroke rehabilitation, patients typically are mostly indoors and therefore not exposed to the natural daytime variation in light intensity. Furthermore, several...... rehabilitation hospitals may be exposed to powerful light in the blue spectrum, but at a time that is adversely related to their endogenous circadian phase, for example in the late evening instead of the daytime. Hypothesis: Naturalistic light that mimics the natural daytime spectrum variation will have...... 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...

  9. 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

  10. 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

  11. 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.

  12. 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

  13. 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.

  14. Heat Stroke

    DEFF Research Database (Denmark)

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

    2017-01-01

    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...

  15. Overview of United States coal export terminals. [Includes description of present coal port terminal facilities

    Energy Technology Data Exchange (ETDEWEB)

    1980-09-01

    Existing coal export ports in the United States are in general not designed to the standards compatible with the current state of the art. The United States has a current coal export capacity in the order of 83 million tons per year. This could be increased to 138 million tons per year through a process of modernization and expansion which would take about six to eight years for full realization. Even if this expansion program took place it would not result in an overall coal export system that was economically competitive due to the fact that our export terminals are generally outmoded and cannot accommodate the large vessels engaged in the world coal trade and which can be accommodated at the major coal destination ports in Europe and Japan. In order for the United States to achieve an economically competitive posture in the world coal trade, new ports that will handle 150,000 to 250,000 DWT ships are needed. The new terminals must be designed to receive coal efficiently and minimize the demurrage costs for both railcars on the delivery side and ships on the load out side. There are port sites available in the US which could be developed to effectively handle the increased requirements. Each major new port could easily be designed to handle 20 to 50 million tons per year at ultimate capacity subject to the availability of coal from the source at a reasonable cost. New port construction is needed to satisfy the projected demand at a reasonable cost and to provide for the obsolescence of existing facilities. Decisions are needed now so that the ports will be operating 20 years from now and serve as replacements for present facilities which are becoming obsolete. The government of the United States can and must play a major role if success is to be achieved.

  16. 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.

  17. Neuropsychiatric symptoms in geriatric patients admitted to skilled nursing facilities in nursing homes for rehabilitation after stroke: a longitudinal multicenter study.

    Science.gov (United States)

    Buijck, Bianca I; Zuidema, Sytse U; Spruit-van Eijk, Monica; Geurts, Alexander C H; Koopmans, Raymond T C M

    2012-07-01

    To investigate the prevalence and course of neuropsychiatric symptoms (NPS) in geriatric patients admitted to skilled nursing facilities (SNFs) for rehabilitation after stroke. This was a longitudinal multicenter study within 15 SNFs in the Netherlands. NPS were assessed in 145 patients with stroke through the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) with measurements on admission and at discharge. The prevalence and course of NPS were described in terms of cumulative prevalence (symptoms either on admission or at discharge), conversion (only symptoms at discharge), remission (only symptoms on admission), and persistence (symptoms both on admission and at discharge) for patients who were discharged to an independent living situation within one year after admission and patients who had to stay in the SNF for long term care. Eighty percent had a first-ever stroke and 74% could be successfully discharged. Overall, the most common NPS were depression (33%), eating changes (18%), night-time disturbances (19%), anxiety (15%), irritability (12%), and disinhibition (12%). One year after admission, the patients who were still in the SNF showed significantly more hallucinations (p = 0.016), delusions (p = 0.016), agitation (p = 0.004), depression (p = 0.000), disinhibition (p = 0.004), irritability (p = 0.018), and night-time disturbances (p = 0.001) than those who had been discharged. The overall prevalence of NPS in this study was lower than reported by other studies in different settings. There was a high prevalence of NPS in patients that could not be successfully discharged. The findings suggest that NPS should be optimally treated to improve outcome of rehabilitation. Copyright © 2011 John Wiley & Sons, Ltd.

  18. 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....

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. Integrative rehabilitation of residents chronic post-stroke in skilled nursing facilities: the design and evaluation of the BrightArm Duo.

    Science.gov (United States)

    House, G; Burdea, G; Polistico, K; Roll, D; Kim, J; Grampurohit, N; Damiani, F; Keeler, S; Hundal, J; Pollack, S

    2016-11-01

    To describe the novel BrightArm Duo bimanual upper extremity (UE) rehabilitation system; to determine its technology acceptance and clinical benefit for older hemiplegic participants. The system table tilted to adjust arm gravity loading. Participants wore arm supports that sensed grasp strength and wrist position on the table. Wrist weights further increased shoulder exertion. Games were designed to improve UE strength, motor function, cognition and emotive state and adapted automatically to each participant. The system underwent feasibility trials spanning 8 weeks in two skilled nursing facilities (SNFs). Participants were evaluated pre-therapy and post-therapy using standardized clinical measures. Computerized measures of supported arm reach, table tilt and number of arm repetitions were stored on a remote server. Seven participants had significant improvements in their active range of shoulder movement, supported arm reach, shoulder strength, grasp strength and their ability to focus. The group demonstrated higher arm function measured with FMA (p = 0.01) and CAHAI (p = 0.05), and had an improvement in depression (Becks Depression Inventory, II). BrightArm Duo technology was well accepted by participants with a rating of 4.4 out of 5 points. Given these findings, it will be beneficial to evaluate the BrightArm Duo application in SNF maintenance programs. Implications for Rehabilitation Integrative rehabilitation that addresses both physical and cognitive domains is promising for post-stroke maintenance in skilled nursing facilities. Simultaneous bilateral arm exercise may improve arm function in older hemiplegic patients several years after stroke. Virtual reality games that adapt to the patient can increase attention and working memory while decreasing depression in elderly.

  4. 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....

  5. 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

  6. 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 )

  7. 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.

  8. Imaging facilities for basic medical units: a case in the state of Guerrero, Mexico.

    Science.gov (United States)

    Azpiroz-Leehan, Joaquín; Licona, Fabiola Martínez; Méndez, Miguel Cadena

    2011-10-01

    This work presents the methodology to design a small imaging unit in a small regional hospital that takes into account the real imaging needs in the region regardless of current administrative guidelines. The situation of the imaging facilities in Mexico's states is studied and compared with other countries, and a project plan is designed for the specific state (Guerrero) where the clinic is to be located. The proposal includes the acquisition of a basic suite of modalities that include an ultrasound system, a mammography unit, and a conventional X-ray system in addition to a CT system that is not available anywhere within the state. The system should be primarily digital and should incorporate a simple picture archiving and communications system that can be the basis of a future telemedicine unit. The conclusion of this study also proposes changes in the segmented and pyramidal structure of the Mexican health system in order to provide higher quality care at the lower level, to reduce bottlenecks, and to provide higher quality health care near the patient's home.

  9. 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.

  10. The effects of increased therapy time on cognition and mood in frail patients with a stroke who rehabilitate on rehabilitation units of nursing homes in the Netherlands: a protocol of a comparative study

    NARCIS (Netherlands)

    Schoenmakers, H.C.M.; Rademaker, A.C.H.J.; van Rooden, P.; Scherder, E.J.A.

    2014-01-01

    Background: Recovery after stroke is dependent on how much time can be spent on rehabilitation. Recently, we found that therapy time for older stroke patients on a rehabilitation unit of a nursing home could be increased significantly from 8.6 to at least 13 hours a week. This increase was attained

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. Increasing Area Deprivation and Socioeconomic Inequalities in Heart Disease, Stroke, and Cardiovascular Disease Mortality Among Working Age Populations, United States, 1969-2011

    Directory of Open Access Journals (Sweden)

    Gopal K. Singh, PhD

    2015-04-01

    Full Text Available Objectives: We examined the extent to which area- and individual-level socioeconomic inequalities in cardiovascular-disease (CVD, heart disease, and stroke mortality among United States men and women aged 25-64 years changed between 1969 and 2011. Methods: National vital statistics data and the National Longitudinal Mortality Study were used to estimate area- and individual-level socioeconomic gradients in mortality over time. Rate ratios and log-linear and Cox regression were used to model mortality trends and differentials. Results: Area socioeconomic gradients in mortality from CVD, heart disease, and stroke increased substantially during the study period. Compared to those in the most affluent group, individuals in the most deprived area group had, respectively 35%, 29%, and 73% higher CVD, heart disease, and stroke mortality in 1969, but 120-121% higher mortality in 2007-2011. Gradients were steeper for women than for men. Education, income, and occupation were inversely associated with CVD, heart disease, and stroke mortality, with individual-level socioeconomic gradients being steeper during 1990-2002 than in 1979-1989. Individuals with low education and incomes had 2.7 to 3.7 times higher CVD, heart disease, and stroke mortality risks than their counterparts with high education and income levels. Conclusions and Global Health Implications: Although mortality declined for all US groups during 1969-2011, socioeconomic disparities in mortality from CVD, heart disease and stroke remained marked and increased over time because of faster declines in mortality among higher socioeconomic groups. Widening disparities in mortality may reflect increasing temporal areal inequalities in living conditions, behavioral risk factors such as smoking, obesity and physical inactivity, and access to and use of health services. With social inequalities and prevalence of smoking, obesity, and physical inactivity on the rise, most segments of the working

  17. Increasing Area Deprivation and Socioeconomic Inequalities in Heart Disease, Stroke, and Cardiovascular Disease Mortality Among Working Age Populations, United States, 1969-2011.

    Science.gov (United States)

    Singh, Gopal K; Siahpush, Mohammad; Azuine, Romuladus E; Williams, Shanita D

    2015-01-01

    We examined the extent to which area- and individual-level socioeconomic inequalities in cardiovascular-disease (CVD), heart disease, and stroke mortality among United States men and women aged 25-64 years changed between 1969 and 2011. National vital statistics data and the National Longitudinal Mortality Study were used to estimate area- and individual-level socioeconomic gradients in mortality over time. Rate ratios and log-linear and Cox regression were used to model mortality trends and differentials. Area socioeconomic gradients in mortality from CVD, heart disease, and stroke increased substantially during the study period. Compared to those in the most affluent group, individuals in the most deprived area group had, respectively 35%, 29%, and 73% higher CVD, heart disease, and stroke mortality in 1969, but 120-121% higher mortality in 2007-2011. Gradients were steeper for women than for men. Education, income, and occupation were inversely associated with CVD, heart disease, and stroke mortality, with individual-level socioeconomic gradients being steeper during 1990-2002 than in 1979-1989. Individuals with low education and incomes had 2.7 to 3.7 times higher CVD, heart disease, and stroke mortality risks than their counterparts with high education and income levels. Although mortality declined for all US groups during 1969-2011, socioeconomic disparities in mortality from CVD, heart disease and stroke remained marked and increased over time because of faster declines in mortality among higher socioeconomic groups. Widening disparities in mortality may reflect increasing temporal areal inequalities in living conditions, behavioral risk factors such as smoking, obesity and physical inactivity, and access to and use of health services. With social inequalities and prevalence of smoking, obesity, and physical inactivity on the rise, most segments of the working-age population in low- and middle-income countries will likely experience increased cardiovascular

  18. Non-Health Care Facility Cardiovascular Medication Errors in the United States.

    Science.gov (United States)

    Kamboj, Amrit K; Spiller, Henry A; Casavant, Marcel J; Hodges, Nichole L; Chounthirath, Thiphalak; Smith, Gary A

    2017-10-01

    Prior studies have not examined national trends and characteristics of unintentional non-health care facility (HCF) medication errors associated with cardiovascular drugs. To investigate non-HCF medication errors associated with cardiovascular drugs reported to poison control centers in the United States. A retrospective analysis of non-HCF medication errors associated with cardiovascular drugs from 2000 to 2012 was conducted using the National Poison Data System database. There were 278 444 medication errors associated with cardiovascular drugs reported to US poison control centers during the study period, averaging 21 419 exposures annually. The overall rate of cardiovascular medication errors per 100 000 population increased 104.6% from 2000 to 2012 ( P medical outcomes were reported in 4.0% of exposures. The cardiovascular drugs most commonly implicated in medication errors were β-blockers (28.2%), calcium antagonists (17.7%), and angiotensin-converting enzyme inhibitors (15.9%). Most of the 114 deaths were associated with cardiac glycosides (47.4%) or calcium antagonists (29.8%). Most medication errors involved taking or being given a medication twice (52.6%). This study describes characteristics and trends of non-HCF cardiovascular medication errors over a 13-year period in the United States. The number and rate of cardiovascular medication errors increased steadily from 2000 to 2012, with the highest error rates among older adults. Further research is needed to identify prevention strategies for these errors, with a particular focus on the older adult population.

  19. Development of the Plant Growth Facility for Use in the Shuttle Middeck and Test Units for Ground-Based Experiments

    Science.gov (United States)

    Chapman, David K.; Wells, H. William

    1996-01-01

    The plant growth facility (PGF), currently under development as a Space Shuttle middeck facility for the support of research on higher plants in microgravity, is presented. The PGF provides controlled fluorescent lighting and the active control of temperature, relative humidity and CO2 concentration. These parameters are designed to be centrally controlled by a dedicated microprocessor. The status of the experiment can be displayed for onboard analysis, and will be automatically archived for post-flight analysis. The facility is designed to operate for 15 days and will provide air filtration to remove ethylene and trace organics with replaceable potassium permanganate filters. Similar ground units will be available for pre-flight experimentation.

  20. 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

  1. 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.

  2. Acute ischemic stroke--from symptom recognition to thrombolysis.

    Science.gov (United States)

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

    2013-01-01

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

  3. 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).

  4. Socioeconomic and air pollution correlates of adult asthma, heart attack, and stroke risks in the United States, 2010-2013.

    Science.gov (United States)

    Cox, Louis Anthony Tony

    2017-05-01

    Asthma in the United States has become an important public health issue, with many physicians, regulators, and scientists elsewhere expressing concern that criterion air pollutants have contributed to a rising tide of asthma cases and symptoms. This paper studies recent associations (from 2008 to 2012) between self-reported asthma experiences and potential predictors, including age, sex, income, education, smoking, and county-level average annual ambient concentrations of ozone (O3) and fine particulate matter (PM2.5) levels recorded by the U.S. Environmental Protection Agency, for adults 50 years old or older for whom survey data are available from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS). We also examine associations between these variables and self-reported heart attack and stroke experience; all three health outcomes are positively associated with each other. Young divorced women with low incomes are at greatest risk of asthma, especially if they are ever-smokers. Income is an important confounder of other relations. For example, in logistic regression modeling, PM2.5 is positively associated (pheart attack risk when these are regressed only against PM2.5, sex, age, and ever-smoking status, but not when they are regressed against these variables and income. In this data set, PM2.5 is significantly negatively associated with asthma risk in regression models, with a 10μg/m 3 decrease in PM2.5 corresponding to about a 6% increase in the probability of asthma, possibly because of confounding by smoking, which is negatively associated with PM2.5 and positively associated with asthma risk. A variety of non-parametric methods are used to quantify these associations and to explore potential causal interpretations. Copyright © 2017. Published by Elsevier Inc.

  5. Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review.

    Science.gov (United States)

    Hanna, K L; Rowe, F J

    2017-06-01

    The aim of this study was to report on the health inequalities facing stroke survivors with visual impairments as described in the current literature. A systemic review of the literature was conducted to investigate the potential health inequalities facing stroke survivors with subsequent visual impairments. A quality-of-evidence and risk-of-bias assessment was conducted for each of the included articles using the appropriate tool dependent on the type of article. Only four articles discussed health inequalities affecting stroke survivors with visual impairment specifically. A further 23 articles identified health inequalities after stroke, and 38 reported on health inequalities within the visually impaired UK or Irish population. Stroke survivors with visual impairment face inconsistency in eye care provision nationally, along with variability in the assessment and management of visual disorders. The subgroups identified as most at risk were females; black ethnicity; lower socioeconomic status; older age; and those with lower education attainment. The issue of inconsistent service provision for this population must be addressed in future research. Further research must be conducted in order to firmly establish whether or not stroke survivors are at risk of the aforementioned sociodemographic and economic inequalities.

  6. Dementia and Transitioning from Assisted Living to Memory Care Units: Perspectives of Administrators in Three Facility Types

    Science.gov (United States)

    Kelsey, Susan G.; Laditka, Sarah B.; Laditka, James N.

    2010-01-01

    Purpose: This study examines transitioning residents with Alzheimer's disease or a related disorder (ADRD) from assisted living facilities (ALFs) to memory care units (MCUs) from the perspective of 3 ALF organizational models: freestanding ALFs, ALFs with MCUs, and ALFs in continuing care retirement communities (CCRCs) with MCUs. Design and…

  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. A study protocol for performance evaluation of a new academic intensive care unit facility: impact on patient care.

    Science.gov (United States)

    Ferri, Mauricio; Zygun, David A; Harrison, Alexandra; Stelfox, Henry T

    2013-01-01

    Healthcare facility construction is increasing because of population demand and the need to replace ageing infrastructure. Research suggests that there may be a relationship between healthcare environment and patient care. To date, most evaluations of new healthcare facilities are derived from techniques used in other industries and focus on physical, financial and architectural performance. However, few studies have evaluated the impact of healthcare facility design on processes and outcomes of patient care. The primary objective of this study was to investigate the impact of relocation to a new intensive care unit (ICU) facility on clinical performance measures. This study also proposes to develop and test a framework for facility performance evaluation using accepted ICU design guidelines and Donabedian's model for healthcare quality. We will utilise a mixed-methods, observational, retrospective, controlled, before-and-after design to take advantage of the quasiexperimental conditions created with the construction of a new ICU facility in Calgary, Canada. For the qualitative substudy, we will conduct individual interviews with end-users to understand their impressions and experiences with the new environment and perform thematic analysis. For the quantitative substudy, we will compare process of care indicators and patient outcomes for the 12-month period before and after relocation to the new facility. Two other local ICU facilities that did not undergo structural change during the study period will serve as controls. We will triangulate qualitative and quantitative results utilising a novel framework. The results of this study will contribute in understanding the impact of new ICU facilities on clinical performance measures centred on patients, their families and healthcare providers. The framework will complement existing building performance evaluation techniques and help healthcare administrators plan new ICU facilities. The University of Calgary Research

  9. 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

  10. Qualitative investigation of the perceptions and experiences of nursing and allied health professionals involved in the implementation of an enriched environment in an Australian acute stroke unit.

    Science.gov (United States)

    Rosbergen, Ingrid C M; Brauer, Sandra G; Fitzhenry, Sarah; Grimley, Rohan S; Hayward, Kathryn S

    2017-12-21

    An enriched environment embedded in an acute stroke unit can increase activity levels of patients who had stroke, with changes sustained 6 months post-implementation. The objective of this study was to understand perceptions and experiences of nursing and allied health professionals involved in implementing an enriched environment in an acute stroke unit. A descriptive qualitative approach. An acute stroke unit in a regional Australian hospital. We purposively recruited three allied health and seven nursing professionals involved in the delivery of the enriched environment. Face-to-face, semistructured interviews were conducted 8 weeks post-completion of the enriched environment study. One independent researcher completed all interviews. Voice-recorded interviews were transcribed verbatim and analysed by three researchers using a thematic approach to identify main themes. Three themes were identified. First, staff perceived that 'the road to recovery had started' for patients. An enriched environment was described to shift the focus to recovery in the acute setting, which was experienced through increased patient activity, greater psychological well-being and empowering patients and families. Second, 'it takes a team' to successfully create an enriched environment. Integral to building the team were positive interdisciplinary team dynamics and education. The impact of the enriched environment on workload was diversely experienced by staff. Third, 'keeping it going' was perceived to be challenging. Staff reflected that changing work routines was difficult. Contextual factors such as a supportive physical environment and variety in individual enrichment opportunities were indicated to enhance implementation. Key to sustaining change was consistency in staff and use of change management strategies. Investigating staff perceptions and experiences of an enrichment model in an acute stroke unit highlighted the need for effective teamwork. To facilitate staff in their

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

    Science.gov (United States)

    Danielson, L.; Righter, K.; McCubbin, F.

    2016-01-01

    proposal to the NASA Emerging Worlds solicitation for the full cost of a press, with competitive bids submitted from Sumitomo, Rockland Research, and Voggenreiter. Additional funding is currently being sought from industry sources through the Strategic Partnerships Office at NASA JSC, External Pursuits Program Office on the JETS contract, and Jacobs corporate in the United States. Internal funding is available for JETS contract personnel to travel to large press locations worldwide to study set-up and operations. We also anticipate a fortuitous cost savings in installation of the large press because plans are already underway for major renovations to the entire experimental petrology suite within the next 2 years in order to accommodate our growing user base. 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 proposed facility, such as the press type and design, access management, immediate projects, and future innovation initiatives.

  12. 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...... 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...... defined. Further education is needed to strengthen the contribution of nursing staff to patients' rehabilitation. Furthermore, focus on developing a professional language and a framework that supports continuity within daily care and rehabilitation is needed....

  13. 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.

  14. 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

  15. 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.

  16. 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 ...

  17. 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.

  18. 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.

  19. 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

  20. Preventing stroke

    Science.gov (United States)

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

  1. Stroke Rehabilitation

    Science.gov (United States)

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

  2. 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

  3. 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.

  4. 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.

  5. 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.

  6. Developing a Predictive Model for Facility Repair Costs on United States Air Force Installations

    Science.gov (United States)

    2011-06-01

    what impact making the decision to defer maintenance will have for future facility repairs. Therefore, one of the independent variables for this...DoD budgetary resources. This predictive model is relevant to making sound financial decisions at the corporate Air Force level. Making resource...July/August). Budgeting for facility maintenance and repair II: Multicriteria process for model selection. Journal of Management in Engineering , 71

  7. The PRE-hospital Stroke Treatment Organization.

    Science.gov (United States)

    Audebert, Heinrich; Fassbender, Klaus; Hussain, M Shazam; Ebinger, Martin; Turc, Guillaume; Uchino, Ken; Davis, Stephen; Alexandrov, Anne; Grotta, James

    2017-12-01

    Background The PRE-hospital Stroke Treatment Organization was formed in 2016 as an international consortium of medical practitioners involved in pre-hospital treatment of patients with acute stroke. Aims PRE-hospital Stroke Treatment Organization's mission is to improve stroke outcomes by supporting research and advocacy for pre-hospital stroke treatment in Mobile Stroke Units. PRE-hospital Stroke Treatment Organization will provide a platform to enhance collaborative research across the spectrum of acute stroke management in the pre-hospital setting. PRE-hospital Stroke Treatment Organization will also facilitate the appropriate proliferation and distribution of Mobile Stroke Units by providing a forum for professional communication, resource for public education, and stimulus for government, industry, and philanthropic support. Summary of review In this "white paper", we describe the evidence supporting pre-hospital stroke treatment, progress to date, practical issues such as application in various environments and staffing, planned research initiatives, and organizational structure. Conclusions PRE-hospital Stroke Treatment Organization is not-for-profit, with membership open to anyone involved (or hoping to become involved) in pre-hospital stroke care. PRE-hospital Stroke Treatment Organization has a Steering Committee comprised of members from Europe, U.S., Canada, Australia, and other regions having a Mobile Stroke Unit in operation. PRE-hospital Stroke Treatment Organization convenes satellite meetings for membership at the International Stroke Conference and European Stroke Congress each year to address the PRE-hospital Stroke Treatment Organization mission. The first research collaborations agreed upon are to: (1) develop a list of common data elements to be collected by all Mobile Stroke Unit programs and entered into a common research database, and (2) develop a protocol for investigating the natural history of hyper-acute Intracerebral Hemorrhage.

  8. 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...

  9. Paediatric stroke

    African Journals Online (AJOL)

    2011-04-02

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

  10. 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.

  11. Evaluation of a telephone advice system for remote intravenous thrombolysis in ischemic stroke: data from a United kingdom network.

    Science.gov (United States)

    Dutta, Dipankar; Kendall, Jason; Holmes, Clare; Murphy, Peter; Black, Toby; Whiting, Robert; Aujla, Kash; Caine, Sarah; Hellier, Kate; Walters, David

    2015-03-01

    There is limited evidence for remote stroke thrombolysis using telephone consultation and teleradiology. Results from a UK network using this treatment model are presented. Retrospective study of consecutive patients thrombolysed in 5 hospitals, with well organized stroke services, between 2012 and 2013. Remote thrombolysis was compared with thrombolysis delivered in person for symptomatic intracerebral hemorrhage, death within 7 days, and 90-day modified Rankin scores. Of 586 patients, 220 (37.5%) were thrombolysed remotely. The 2 groups were well matched (median age 77 years, NIHSS 12). Remote thrombolysis increased treatment time by 22 minutes. Outcomes were no different in the 2 groups (remote versus standard): symptomatic intracerebral hemorrhage (3.6% versus 4.6%), death within 7 days (6.4% versus 7.1%), modified Rankin score Telephone advice and teleradiology, within an organized system of care, can be an effective method of delivery of intravenous thrombolysis. © 2015 American Heart Association, Inc.

  12. 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)

  13. 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

  14. 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

  15. 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.

  16. 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...

  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. 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

  20. Editorial for the Third Pangu Stroke Conference.

    Science.gov (United States)

    Chen, Gang; Chen, Jun; Ji, Xunming; Xi, Guohua; Zhang, John

    2015-10-01

    The Pangu Stroke Conference has been held annually in China since 2012 and is based on the successful templates of the Princeton Stroke Conference in the United States and the Marburg Conference on Cerebral Ischemia in Germany. All participants in the Pangu Stroke Conference are expert stroke clinicians or stroke basic science researchers of Chinese origin. This conference promotes collaboration between clinicians and basic science researchers and between stroke researchers in mainland China and other parts of the world. The Pangu Stroke Conference fosters translational stroke research, discussions of stroke research milestones, and proposals for future directions. Some of the keynote presentations in the third Pangu Stroke Conference are included in this special issue. Copyright © 2015. Published by Elsevier Inc.

  1. 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

  2. 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

  3. 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

  4. Guantanamo Bay Detainees: Facilities and Factors for Consideration If Detainees Were Brought to the United States

    Science.gov (United States)

    2012-11-01

    Terre Haute, Indiana 45 Abbreviations ADX U.S. Penitentiary Florence Administrative-Maximum AUMF Authorization for Use of Military...punishable by imprisonment for more than one year may be confined in any United States penitentiary .”). BOP officials noted that under this statute...in double-bunk cells. Inmates in the Communications Management Unit at Marion U.S. Penitentiary (Marion, Illinois) are ordinarily housed in single

  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. 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

  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. Stroke - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100218.htm Stroke - series—Part 1 To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Ischemic Stroke A.D.A.M., Inc. is accredited by ...

  9. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Jeremy Gwin and Douglas Frenette

    2010-09-30

    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

  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. British Association of Stroke Physicians: benchmarking survey of stroke services.

    Science.gov (United States)

    Rodgers, Helen; Dennis, Martin; Cohen, David; Rudd, Anthony

    2003-03-01

    the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004. to describe the organisation and staffing of specialist hospital-based stroke services in the UK. a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services. the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25. significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.

  13. 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.

  14. 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

  15. The effects of increased therapy time on cognition and mood in frail patients with a stroke who rehabilitate on rehabilitation units of nursing homes in the Netherlands: a protocol of a comparative study.

    Science.gov (United States)

    Huijben-Schoenmakers, Marleen; Rademaker, Arno; van Rooden, Peter; Scherder, Erik

    2014-05-23

    Recovery after stroke is dependent on how much time can be spent on rehabilitation. Recently, we found that therapy time for older stroke patients on a rehabilitation unit of a nursing home could be increased significantly from 8.6 to at least 13 hours a week. This increase was attained by the implementation of interventions, focused on strength, mobility and balance. Nurses carried out these exercises with the patients during their daily activities. The aim of the present study is to investigate if increased therapy time has a positive effect on cognition, mood (depression and anxiety), and ADL in stroke patients. A comparative single blind controlled study will be applied. Patients suffering from a stroke and staying on one of the rehabilitation units of the nursing homes are eligible for participation. Participants belong to the intervention group if they stay in two nursing homes where four interventions of the Clinical Nursing Rehabilitation Stroke Guideline were implemented. Participants who stay in two nursing homes where therapy is given according to the Dutch stroke Guideline, are included in the control group. Clinical neuropsychologists will assess patients' cognitive functioning, level of depression (mood) and anxiety. Nurses will assess a Barthel Index score on a weekly basis (ADL). These variables are measured at baseline, after 8 weeks and at the moment when participants are discharged from the nursing home. The present study evaluates the effect of increased therapy time on cognition, mood (level of depression and anxiety), and ADL in stroke patients. When positive effects will be found this study can guide policy makers and practitioners on how to implement more therapy time on rehabilitation wards of nursing homes. TNR Our study has been documented in the Dutch Trial Registration, TC = 3871.

  16. 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.

  17. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

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

  18. 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

  19. 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)

  20. Closure Report for Corrective Action Unit 117: Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Burmeister

    2009-06-01

    This Closure Report (CR) presents information supporting the closure of Corrective Action Unit (CAU) 117: Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada. This CR complies with the requirements of the Federal Facility Agreement and Consent Order that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. Corrective Action Unit 117 comprises Corrective Action Site (CAS) 26-41-01, Pluto Disassembly Facility, located in Area 26 of the Nevada Test Site. The purpose of this CR is to provide documentation supporting the completed corrective actions and provide data confirming that the closure objectives for CAU 117 were met. To achieve this, the following actions were performed: • Review the current site conditions, including the concentration and extent of contamination. • Implement any corrective actions necessary to protect human health and the environment. • Properly dispose of corrective action and investigation wastes. • Document Notice of Completion and closure of CAU 117 issued by the Nevada Division of Environmental Protection. From May 2008 through February 2009, closure activities were performed as set forth in the Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 117, Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada. The purpose of the activities as defined during the data quality objectives process were: • Determine whether contaminants of concern (COCs) are present. • If COCs are present, determine their nature and extent, implement appropriate corrective actions, and properly dispose of wastes. Analytes detected during the closure activities were evaluated against final action levels to determine COCs for CAU 117. Assessment of the data generated from closure activities indicated that the final action levels were exceeded for polychlorinated biphenyls (PCBs) reported as total Aroclor and

  1. 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

  2. Post-stroke urinary incontinence.

    Science.gov (United States)

    Mehdi, Z; Birns, J; Bhalla, A

    2013-11-01

    To provide a comprehensive review of the current evidence on post-stroke urinary incontinence. An electronic database search was performed to identify relevant studies and review articles related to Urinary Incontinence (UI) in the stroke population between the years 1966 and 2012. Urinary incontinence following stroke is a common problem affecting more than one-third of acute stroke patients and persisting in up to a quarter at 1 year. It is well established that this condition is a strong marker of stroke severity and is associated with poorer functional outcomes and increased institutionalisation and mortality rates compared with those who remain continent. Despite evidence linking better outcomes to those patients who regain continence, the results of national audits have demonstrated that the management of UI following stroke is suboptimal, with less than two-thirds of stroke units having a documented plan to promote continence. Current evidence supports a thorough assessment to categorise the type and severity of post-stroke urinary incontinence. An individually tailored, structured management strategy to promote continence should be employed. This has been associated with better stroke outcomes and should be the aim of all stroke health professionals. © 2013 John Wiley & Sons Ltd.

  3. Antibiotic resistance among cultured bacterial isolates from bioethanol fermentation facilities across the United States.

    Science.gov (United States)

    Murphree, Colin A; Heist, E Patrick; Moe, Luke A

    2014-09-01

    Bacterial contamination of fuel ethanol fermentations by lactic acid bacteria (LAB) can have crippling effects on bioethanol production. Producers have had success controlling bacterial growth through prophylactic addition of antibiotics to fermentors, yet concerns have arisen about antibiotic resistance among the LAB. Here, we report on mechanisms used by 32 LAB isolates from eight different US bioethanol facilities to persist under conditions of antibiotic stress. Minimum inhibitory concentration assays with penicillin, erythromycin, and virginiamycin revealed broad resistance to each of the antibiotics as well as high levels of resistance to individual antibiotics. Phenotypic assays revealed that antibiotic inactivation mechanisms contributed to the high levels of individual resistances among the isolates, especially to erythromycin and virginiamycin, yet none of the isolates appeared to use a β-lactamase. Biofilm formation was noted among the majority of the isolates and may contribute to persistence under low levels of antibiotics. Nearly all of the isolates carried at least one canonical antibiotic resistance gene and many carried more than one. The erythromycin ribosomal methyltransferase (erm) gene class was found in 19 of 32 isolates, yet a number of these isolates exhibit little to no resistance to erythromycin. The erm genes were present in 15 isolates that encoded more than one antibiotic resistance mechanism, suggestive of potential genetic linkages.

  4. Non-health Care Facility Medication Errors Associated with Hormones and Hormone Antagonists in the United States.

    Science.gov (United States)

    Magal, Pranav; Spiller, Henry A; Casavant, Marcel J; Chounthirath, Thitphalak; Hodges, Nichole L; Smith, Gary A

    2017-12-01

    Hormones and hormone antagonists are frequently associated with medication errors and may result in important adverse outcomes. The purpose of this study is to investigate non-health care facility (non-HCF) medication errors associated with hormones and hormone antagonists in the United States (US). A retrospective analysis of National Poison Data System data was conducted to identify characteristics and trends of unintentional non-HCF therapeutic errors involving hormones and hormone antagonists among individuals of all ages from 2000 to 2012. From 2000 to 2012, US poison control centers received 169,695 calls regarding unintentional non-HCF therapeutic errors associated with hormone therapies, averaging 13,053 medication error calls annually. The rate of reported errors increased significantly by 162.6% (p hormones and hormone antagonists in the US. While most errors did not result in adverse outcomes, their increasing frequency places a greater burden on the health care system.

  5. 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

  6. 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.

  7. Evaluation of nuclear facility decommissioning projects. Summary report: Three Mile Island Unit 2 polar crane recovery

    Energy Technology Data Exchange (ETDEWEB)

    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.

  8. 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

  9. 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.

  10. 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

  11. Using embedded systems for the remote delivery and recovery of National Ignition Facility and optical line replaceable units

    International Nuclear Information System (INIS)

    Perez, M. L.

    1999-01-01

    This paper describes the design and development of the embedded control systems used to deliver and recover the National Ignition Facility (NIF) optical line replaceable units (LRUs). As part of the NIF Operations Special Equipment Control System (OSECS), the embedded control systems form a part of the front end processor (FEP) layer of the OSECS. During the start-up and operations phases of the NIF project, it is anticipated that a significant number of LRUs will be delivered to the laser beamline structure. The frequency of LRU delivery combined with the design of the facility pose severe constraints for human-only delivery and recovery operations. To reduce the risks to personnel and to allow for safe and efficient delivery of equipment, LLNL engineers are designing and developing embedded control systems for the low-level device control of NIF Transport and Handling mechanical delivery system components. The design of the embedded control system makes use of advanced PC-based motion control technology commonly found in industrial applications. The PC-based platform consists of commercial-off-the-shelf (COTS) hardware and software such as industrial computers, motion controllers, data acquisition boards, sensors technology, networking capabilities, development languages and operating system. Wireless networking technology is also being employed in the design to achieve a distributed control architecture for operator mobility during operations. Additionally, the PC-based platform provides the greatest degree of flexibility in satisfying a diverse set of motion control requirements and helps to maintain low maintenance and future upgrade costs

  12. 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.)

  13. 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

  14. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 114: Area 25 EMAD Facility Nevada Test Site, Nevada

    Energy Technology Data Exchange (ETDEWEB)

    Mark Krauss

    2010-06-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 114, Area 25 EMAD Facility, identified in the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 114 comprises the following corrective action site (CAS) located in Area 25 of the Nevada Test Site: • 25-41-03, EMAD Facility This plan provides the methodology for field activities needed to gather the necessary information for closing CAS 25-41-03. There is sufficient information and process knowledge from historical documentation and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closure of CAU 114 using the SAFER process. Additional information will be obtained by conducting a field investigation before selecting the appropriate corrective action for CAS 25-41-03. It is anticipated that the results of the field investigation and implementation of corrective actions will support a defensible recommendation that no further corrective action is necessary. If it is determined that complete clean closure cannot be accomplished during the SAFER, then a hold point will have been reached and the Nevada Division of Environmental Protection (NDEP) will be consulted to determine whether the remaining contamination will be closed under the alternative corrective action of closure in place. This will be presented in a closure report that will be prepared and submitted to NDEP for review and approval. The CAS will be investigated based on the data quality objectives (DQOs) developed on April 30, 2009, by representatives of NDEP and the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office. The DQO process was used to identify and define the type, amount, and quality of data needed to determine and implement appropriate corrective actions for CAS 25-41-03. The following text summarizes the SAFER

  15. 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

  16. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    U.S. Department of Energy, Nevada Operations Office

    2000-06-01

    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

  18. Recovering after stroke

    Science.gov (United States)

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

  19. 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.

  20. 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.

  1. 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.

  2. Stroke Rehabilitation

    Science.gov (United States)

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

  3. Pediatric Stroke

    Science.gov (United States)

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

  4. 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

  5. Determinants of rehabilitation outcome in geriatric patients admitted to skilled nursing facilities after stroke : a Dutch multi-centre cohort study

    NARCIS (Netherlands)

    Spruit-van Eijk, Monica; Zuidema, Sytse U.; Buijck, Bianca I.; Koopmans, Raymond T. C. M.; Geurts, Alexander C. H.

    2012-01-01

    Objective: to identify important demographic, clinical and functional determinants of successful discharge of geriatric patients from skilled nursing facilities (SNFs), particularly the role of multi-morbidity. Design: prospective cohort study with data collection at baseline and at discharge.

  6. Stroke and Cerebrovascular Diseases Registry

    Science.gov (United States)

    2017-09-11

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

  7. A cross-sectional assessment of primary healthcare facilities for provision of antenatal care: calling for improvements in Basic Health Units in Punjab, Pakistan.

    Science.gov (United States)

    Majrooh, Muhammad Ashraf; Hasnain, Seema; Akram, Javaid; Siddiqui, Arif

    2015-11-25

    There are two types of barriers to the utilisation of maternal health and antenatal care (ANC) services, including the supply-side barriers operating at the health facility level and demand-side, affecting the utilisation ANC services by pregnant women. The purpose of the study was to assess the essential resources required for the provision of ANC services in primary healthcare facilities in Punjab, Pakistan. A cross-sectional facility assessment was conducted in primary healthcare facilities across Punjab. A multi-stage sampling was used to randomly select nine districts from three stratifications and 19 primary healthcare facilities in the public sector (17 Basic Health Units (BHUs) and two Rural Health Centres (RHCs)) from each district. A total of 171 health facilities were included. Data on infrastructure and availability of equipment, essential supplies, medicines, treatment protocols, and infection control items was collected through pre-tested, semi-structured questionnaires. Univariate analysis was carried out to describe the frequency and percentages of facilities across three ratings (good, average, and poor) by type of facility. Overall, 28% of facilities had poor infrastructure and the availability of equipment was poor in 16% of the health facilities. Essential supply items, such as urine strips for albumin, blood sugar testing strips, and haemoglobin reagents, were particularly poorly stocked. However, infrastructure and the availability of equipment and supplies were generally better in RHCs compared to BHUs. Health facilities lacked the resources required to provide quality ANC services, particularly in terms of infrastructure, equipment, supply items, and medicines. The availability of these resources needs to be urgently addressed.

  8. 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

  9. 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.

  10. 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 control of other vascular 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

  11. 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

  12. 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

  13. Stroke awareness among inpatient nursing staff at an academic medical center.

    Science.gov (United States)

    Adelman, Eric E; Meurer, William J; Nance, Dorinda K; Kocan, Mary Jo; Maddox, Kate E; Morgenstern, Lewis B; Skolarus, Lesli E

    2014-01-01

    Because 10% of strokes occur in hospitalized patients, we sought to evaluate stroke knowledge and predictors of stroke knowledge among inpatient and emergency department nursing staff. Nursing staff completed an online stroke survey. The survey queried outcome expectations (the importance of rapid stroke identification), self-efficacy in recognizing stroke, and stroke knowledge (to name 3 stroke warning signs or symptoms). Adequate stroke knowledge was defined as the ability to name ≥2 stroke warning signs. Logistic regression was used to identify the association between stroke symptom knowledge and staff characteristics (education, clinical experience, and nursing unit), stroke self-efficacy, and outcome expectations. A total of 875 respondents (84% response rate) completed the survey and most of the respondents were nurses. More than 85% of respondents correctly reported ≥2 stroke warning signs or symptoms. Greater self-efficacy in identifying stroke symptoms (odds ratio, 1.13; 95% confidence interval, 1.01-1.27) and higher ratings for the importance of rapid identification of stroke symptoms (odds ratio, 1.23; 95% confidence interval, 1.002-1.51) were associated with stroke knowledge. Clinical experience, educational experience, nursing unit, and personal knowledge of a stroke patient were not associated with stroke knowledge. Stroke outcome expectations and self-efficacy are associated with stroke knowledge and should be included in nursing education about stroke.

  14. Driving After a Stroke

    Science.gov (United States)

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

  15. 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 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.

  16. 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

  17. In-hospital stroke recurrence and stroke after transient ischemic attack: frequency and risk factors.

    Science.gov (United States)

    Erdur, Hebun; Scheitz, Jan F; Ebinger, Martin; Rocco, Andrea; Grittner, Ulrike; Meisel, Andreas; Rothwell, Peter M; Endres, Matthias; Nolte, Christian H

    2015-04-01

    We aimed to assess the risk of recurrent ischemic events during hospitalization for stroke or transient ischemic attack (TIA) with optimal current management and to identify associated risk factors. We performed a retrospective analysis of all patients treated for acute ischemic stroke or TIA in 3 stroke units between 2010 and 2013. Recurrent stroke was defined as new persisting (≥24 hours) neurological deficit occurring >24 hours after the index event and not attributable to other causes of neurological deterioration. Cox proportional hazard regression identified risk factors associated with recurrent stroke. The study included 5106 patients. During a median length of stay of 5 days (interquartile range, 4-8), stroke recurrence (or stroke after TIA) occurred in 40 patients (0.8%) and was independently associated with history of TIA, symptomatic carotid stenosis (≥70%), or other determined etiology. Patients with recurrent stroke and other determined etiology had cervical arterial dissection (n=2), primary angiitis of the central nervous system (n=1), giant cell arteritis (n=1), and lung cancer with nonbacterial thrombotic endocarditis (n=1). In patients with initial TIA or minor stroke (National Institutes of Health Stroke Scale ≤5) recurrence was associated additionally with pneumonia after the inciting ischemic event but before stroke recurrence. Patients with initial stroke and aphasia had a lower stroke recurrence rate and there were no recurrences in patients with lacunar stroke. Recurrence was associated with significantly higher in-hospital mortality (17.5% versus 3.1%; Pstroke recurrence was low with optimal current management. Patients with a history of TIA, severe symptomatic carotid stenosis, or uncommon causes of stroke were at higher risk. Pneumonia was associated with a higher risk of stroke recurrence in patients with initial TIA or minor stroke but not in the overall population studied. Aphasia may bias the detection rate by concealing new

  18. 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.

  19. 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.

  20. [Plan for stroke healthcare delivery].

    Science.gov (United States)

    Alvarez Sabín, J; Alonso de Leciñana, M; Gállego, J; Gil-Peralta, A; Casado, I; Castillo, J; Díez Tejedor, E; Gil, A; Jiménez, C; Lago, A; Martínez-Vila, E; Ortega, A; Rebollo, M; Rubio, F

    2006-12-01

    All stroke patients should receive the same degree of specialized healthcare attention according to the stage of their disease, independently of where they live, their age, gender or ethnicity. To create an organized healthcare system able to offer the needed care for each patient, optimizing the use of the existing resource. A committee of 14 neurologists specialized in neurovascular diseases representing different regions of Spain evaluated the available scientific evidence according to the published literature. During the acute phase, all stroke patients must be evaluated in hospitals that offer access to specialized physicians (neurologists) and the indicated diagnostic and therapeutic procedures. Hospitals that deliver care to acute stroke patients must be prepared to attend these patients and need to arrange a predefined transferring circuit coordinated with the extrahospitalary emergency service. Since resources are limited, they should be structured into different care levels according to the target population. Thus, three types of hospitals will be defined for stroke care: reference stroke hospital, hospital with stroke unit, hospital with stroke team.

  1. New Pump and Treat Facility Remedial Action Work Plan For Test Area North Final Groundwater Remediation, Operable Unit 1-07B

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, L. O.

    2007-06-12

    This remedial action work plan identifies the approach and requirements for implementing the medial zone remedial action for Test Area North, Operable Unit 1-07B, at the Idaho National Laboratory. This plan details the management approach for the construction and operation of the New Pump and Treat Facility (NPTF). As identified in the remediatial design/remedial action scope of work, a separate remedial design/remedial action work plan will be prepared for each remedial component of the Operable Unit 1-07B remedial action.

  2. 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

  3. Evaluating Fuel Leak and Aging Infrastructure at Red Hill, Hawaii, the Largest Underground Fuel Storage Facility in the United States

    Science.gov (United States)

    Learn about how EPA Region 9, Hawaii’s Department of Health, U.S. Navy, and Defense Logistics Agency are working tprotect human health and the environment at the Red Hill Bulk Fuel Storage Facility in Hawaii.

  4. Spontaneous Low Frequency Oscillations in Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Phillip, Dorte; Schytz, Henrik Winther; Iversen, Helle Klingenberg

    2014-01-01

    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...

  5. Acute MRI changes in progressive ischemic stroke

    DEFF Research Database (Denmark)

    Kalowska, E.; Rostrup, E.; Rosenbaum, S.

    2008-01-01

    aimed to assess if acute MRI findings could be used for the prediction of stroke in progression (SIP). METHODS: Prospectively 41 patients, 13 with lacunar infarcts and 28 with territorial infarcts, were admitted to an acute stroke unit within 24 h of stroke onset (median 11 h, range 3- 22). Diffusion...... the modified Rankin Scale, Barthel Index and SSS score. Patients with and without SIP were compared using both clinical and MRI data obtained on admission, on day 7 and after 3 months. RESULTS: Fifteen patients (37%) developed SIP. Increased DWI lesion volume on day 7 in all strokes was associated with SIP...

  6. Disability pensions in relation to stroke: a population study

    DEFF Research Database (Denmark)

    Teasdale, T W; Engberg, A W

    2002-01-01

    PRIMARY OBJECTIVE: This study aimed to establish prevalence levels of disability pensions among stroke patients within a national population. RESEARCH DESIGN: From a Danish National register of hospitalizations, 72 673 patients were identified who had a discharge diagnosis of stroke between the y...... of stroke units and post-acute rehabilitation programmes may justify greater optimism.......PRIMARY OBJECTIVE: This study aimed to establish prevalence levels of disability pensions among stroke patients within a national population. RESEARCH DESIGN: From a Danish National register of hospitalizations, 72 673 patients were identified who had a discharge diagnosis of stroke between...... OUTCOMES AND RESULTS: Being in possession of a disability pension prior to stroke (n = 8565, 12%), rarely at the highest level, was not associated with elevated risk for stroke, or with elevated stroke mortality. It was, however, associated with a greater mortality subsequent to stroke. Disability pensions...

  7. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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. 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.

  10. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

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

  11. New Pump and Treat Facility Remedial Action Work Plan for Test Area North (TAN) Final Groundwater Remediation, Operable Unit 1-07B

    Energy Technology Data Exchange (ETDEWEB)

    D. Vandel

    2003-09-01

    This remedial action work plan identifies the approach and requirements for implementing the medical zone remedial action for Test Area North, Operable Unit 1-07B, at the Idaho National Engineering and Environmental Laboratory (INEEL). This plan details management approach for the construction and operation of the New Pump and Treat Facility. As identified in the remedial design/remedial action scope of work, a separate remedial design/remedial action work plan will be prepared for each remedial component of the Operable Unit 1-07B remedial action. This work plan was originally prepared as an early implementation of the final Phase C remediation. At that time, The Phase C implementation strategy was to use this document as the overall Phase C Work Plan and was to be revised to include the remedial actions for the other remedial zones (hotspot and distal zones). After the completion of Record of Decision Amendment: Technical Support Facility Injection Well (TSF-05) and Surrounding Groundwater Contamination (TSF-23) and Miscellaneous No Action Sites, Final Remedial Action, it was determined that each remedial zone would have it own stand-alone remedial action work plan. Revision 1 of this document converts this document to a stand-alone remedial action plan specific to the implementation of the New Pump and Treat Facility used for plume remediation within the medical zone of the OU 1-07B contaminated plume.

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

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter

    2010-01-01

    -based surveys is emphasized. For factors such as sex, and most cardiovascular risk factors further studies are necessary to clarify the relation to survival because studies disagree. Conclusions from studies of the relation between survival and alcohol intake are still debatable, mostly because of diverging...... definitions of the intensity of exposure. Smoking is uniformly associated with a poorer survival after stroke. Stroke unit treatment improves both short- and longterm survival regardless of stroke type, severity, age, and cardiovascular risk factor profile....

  13. 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…

  14. 76 FR 20368 - Llano Seco Riparian Sanctuary Unit Restoration and Pumping Plant/Fish Screen Facility Protection...

    Science.gov (United States)

    2011-04-12

    ... mitigation measures, and the nature and extent of potential environmental impacts. DATES: To ensure that we... Restoration and Pumping Plant/Fish Screen Facility Protection Project. FOR FURTHER INFORMATION CONTACT: Kelly..., the angle of flow and velocity of the water passing the screens will change, trapping fish against the...

  15. 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.

  16. 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

  17. 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

    Energy Technology Data Exchange (ETDEWEB)

    Feurer, D.A.; Weaver, C.L.; Gallagher, K.C.; Hejna, D.; Rielley, K.J.

    1980-03-01

    This report is a summary 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 likley to be used in Integrated Community Energy Systems (ICES). A brief summary of public utility regulatory programs, energy facility siting programs, and municipal franchising authority is presented in this report to identify how such programs and authority may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES. 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.

  18. 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.

  19. "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.

  20. Preventing Stroke Deaths

    Science.gov (United States)

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

  1. Two Kinds of Stroke

    Science.gov (United States)

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

  2. Healthy Living after Stroke

    Science.gov (United States)

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

  3. Understanding Life After Stroke

    OpenAIRE

    Hjelmblink, Finn

    2008-01-01

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

  4. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

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

  5. 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

  6. 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...

  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. 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.

  10. 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.

  11. 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

    , 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...... variables was 31 (35 %) at 1 week and was reduced to 20 (22 %) at 6 months. CONCLUSION: 35 % of elderly patients with ischemic stroke admitted to a geriatric rehabilitation unit were malnourished 1 week after stroke. Particularly serum proteins and body fat were affected. Follow-up of nutritional variables......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...

  12. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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. (GHT)

  14. 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)

  15. Geriatric rehabilitation of stroke patients in nursing homes: a study protocol.

    Science.gov (United States)

    Spruit-van Eijk, Monica; Buijck, Bianca I; Zuidema, Sytse U; Voncken, Frans L M; Geurts, Alexander C H; Koopmans, Raymond T C M

    2010-03-27

    Geriatric patients are typically underrepresented in studies on the functional outcome of rehabilitation after stroke. Moreover, most geriatric stroke patients do probably not participate in intensive rehabilitation programs as offered by rehabilitation centers. As a result, very few studies have described the successfulness of geriatric stroke rehabilitation in nursing home patients, although it appears that the majority of these patients are being discharged back to the community, rather than being transferred to residential care. Nevertheless, factors associated with the successfulness of stroke rehabilitation in nursing homes or skilled nursing facilities are largely unknown. The primary goal of this study is, therefore, to assess the factors that uniquely contribute to the successfulness of rehabilitation in geriatric stroke patients that undergo rehabilitation in nursing homes. A secondary goal is to investigate whether these factors are similar to those associated with the outcome of stroke rehabilitation in the literature. This study is part of the Geriatric Rehabilitation in AMPutation and Stroke (GRAMPS) study in the Netherlands. It is a longitudinal, observational, multicenter study in 15 nursing homes in the Southern part of the Netherlands that aims to include at least 200 patients. All participating nursing homes are selected based on the existence of a specialized rehabilitation unit and the provision of dedicated multidisciplinary care. Patient characteristics, disease characteristics, functional status, cognition, behavior, and caregiver information, are collected within two weeks after admission to the nursing home. The first follow-up is at discharge from the nursing home or one year after inclusion, and focuses on functional status and behavior. Successful rehabilitation is defined as discharge from the nursing home to an independent living situation within one year after admission. The second follow-up is three months after discharge in

  16. Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals.

    Science.gov (United States)

    Dimitrov, Nikolay; Koenig, William; Bosson, Nichole; Song, Sarah; Saver, Jeffrey L; Mack, William J; Sanossian, Nerses

    2015-09-01

    Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Each county's local emergency medical services agency (LEMSA) was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45%) had stroke routing protocols, covering 23 counties (40%) and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile). In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources.

  17. 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.

  18. Tooele Army Depot - South Area Suspected Release Units. RCRA Facility Investigation - Phase 2, for SWMUs 1, 25, and 27

    National Research Council Canada - National Science Library

    Kamp, Susan; Tate, D. J; Zigich, Daniel; Moss, Pamela; Warner, Alan; Leslie, Mark; Bieniulis, Carol

    1995-01-01

    ... Waste Management Units (SWMUs) 1 and 25 and an RFI-Phase I program to determine the presence or absence of contamination at SWMU 37 at Tooele Army Depot South Area (TEAD-S), near Tooele, Utah. SWMUs 1 and 25...

  19. Multidisciplinary rehabilitation outcomes of stroke patients in the ...

    African Journals Online (AJOL)

    Multidisciplinary rehabilitation can be implemented to address disability post stroke. The aim of this study was to determine outcomes of stroke patients managed by a multidisciplinary team at a step-down facility in the Western Cape. A longitudinal observational study was used to measure outcomes at baseline and ...

  20. How can we improve the management of stroke in Nigeria, Africa ...

    African Journals Online (AJOL)

    Training of stroke experts in collaboration with experts in the developed world with provision of neuro-imaging facilities would improve the outlook of stroke management in Nigeria. The focus in Nigeria must be on preventive strategies and ways to harness local resources in the acute treatment of stroke patients. Health ...

  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: First Aid

    Science.gov (United States)

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

  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, 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

  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. Adapting the Home After a Stroke

    Science.gov (United States)

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

  6. 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)

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

    International Nuclear Information System (INIS)

    1966-01-01

    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

  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. 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

  10. Post-acute referral of stroke victims in a French urban area: Results of a specific program.

    Science.gov (United States)

    Cassoudesalle, H; Nozères, A; Petit, H; Cressot, V; Muller, F; Rouanet, F; Sibon, I; Joseph, P-A; Dehail, P

    2016-09-01

    The main objective of this study was to describe the distribution of referrals offered to patients assessed in the "Post-Acute Stroke program" of Bordeaux University Hospital (France). This program was developed in 2008 to organize the dispensation of care in rehabilitation units specialized in neurological diseases. This was a single-centre observational study. Between July 2008 and December 2012, data on the number of stroke patients hospitalized at the Bordeaux University Hospital and their post-acute referral were collected from the local hospital discharge database. Some of these patients were assessed by Physical Rehabilitation and Medicine physicians participating in the program. Proposed and actual referrals, time from admission to assessment and functional status were also collected. Among 4189 stroke patients, 1465 (35%) survivors were assessed, of whom 932 (22.2%) were discharged to inpatient rehabilitation facilities. There were no patients discharged to this type of unit without an assessment. Among the 1465 patients who were assessed, 57.2% were referred to specialized rehabilitation units, 6.3% were discharged to non-specialized rehabilitation units and 26% returned home directly. The median total length of stay in acute units varied from 10 to 15days depending on referral orientation. Patients that were assessed were more likely to be transferred to specialized rehabilitation units than to non-specialized rehabilitation units. The Post-Acute Stroke program has the particularity of combining private and public specialized rehabilitation units in a common collaborative referral system while retaining the control and flexibility of personalised referral for each patient in the light of local care availability. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. 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.

  12. 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.        

  13. 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.       

  14. 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

  15. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    NA

    2006-03-01

    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. Safety Assessment Of The Centralized Storage Facility For Disused Sealed Radioactive Sources In United Republic Of Tanzania

    Energy Technology Data Exchange (ETDEWEB)

    Abel, Vitus [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of); Lee, JaeSeong [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2014-10-15

    SRS are no longer in use, they are declared as disused, and they are transferred to the central radioactive management facility (CRMF) belonging to Tanzania Atomic Energy Commission (regulatory body) and managed as radioactive waste. In order to reduce the risk associated with disused sealed radioactive sources (DSRS), the first priority would be to bring them to appropriate controls under the regulatory body. When DSRS are safely managed, regulatory body need to make assessment of the likelihood and potential impact of incidents, accidents and hazards for proper management plan. The paper applies Analytical Hierarchy Process (AHP) for assessing and allocating weights and priorities for solving the problem of mult criteria consideration for management plan. Using pairwise comparisons, the relative importance of one criterion over another can be expressed. The method allows decision makers to provide judgments about the relative importance of each criterion and to estimate radiological risk by using expert's judgments or probability of occurrence. AHP is the step by step manner where the resulting priorities are shown and the possible inconsistencies are determined. The Information provided by experts helps to rank hazards according to probability of occurrence, potential impact and mitigation cost. The strength of the AHP method lies in its ability to incorporate both qualitative and quantitative data in decision making. AHP present a powerful tool for weighting and prioritizing hazards in terms of occurrence probability. However, AHP also has some weak points. AHP requires data based on experience, knowledge and judgment which are subjective for each decision-maker.

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

    Energy Technology Data Exchange (ETDEWEB)

    CHANG, ROBERT

    2006-02-02

    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.

  19. Daily Variation in the Occurrence of Different Subtypes of Stroke

    Directory of Open Access Journals (Sweden)

    Luciana Ripamonti

    2017-01-01

    Full Text Available Three thousand two hundred and ninety-eight patients admitted to our Stroke Unit with hemorrhagic, large artery atherosclerosis, cardioembolic, small-vessel occlusion, and undetermined etiology-cryptogenic strokes were included in the study. The circadian variability in onset in each stroke subgroup and the associations with various risk factors were analyzed. In each subgroup, a significant minority of patients suffered from stroke during sleep. In the ischemic group, hypercholesterolemia, paroxysmal atrial fibrillation, and previous myocardial infarction facilitated the onset during waking. During waking, stroke onset was significantly higher in the morning compared to the afternoon both in the hemorrhagic and in the ischemic type. In hemorrhagic stroke, a previous stroke was associated with a lower early morning occurrence. In large artery atherosclerosis stroke, males were at higher risk of early morning occurrence (p<0.01. In small-vessel occlusion stroke, hypertension is significantly more present in the morning compared to the afternoon onset (p<0.005. Circadian patterns of stroke onset were observed both in hemorrhagic and in ischemic stroke, irrespective of the ischemic subgroup. In all groups, stroke was more likely to occur during waking than during sleep and, in the diurnal period, during morning than during afternoon. Moreover, sex and some clinical factors influence the diurnal pattern.

  20. 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.

  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. 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

  3. 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

  4. 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.

  5. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada, Rev. No.: 1

    Energy Technology Data Exchange (ETDEWEB)

    David Strand

    2006-09-01

    This Streamlined Approach for Environmental Restoration (SAFER) plan addresses closure for Corrective Action Unit (CAU) 118, Area 27 Super Kukla Facility, identified in the ''Federal Facility Agreement and Consent Order''. Corrective Action Unit 118 consists of one Corrective Action Site (CAS), 27-41-01, located in Area 27 of the Nevada Test Site. Corrective Action Site 27-41-01 consists of the following four structures: (1) Building 5400A, Reactor High Bay; (2) Building 5400, Reactor Building and access tunnel; (3) Building 5410, Mechanical Building; and (4) Wooden Shed, a.k.a. ''Brock House''. This plan provides the methodology for field activities needed to gather the necessary information for closing the CAS. There is sufficient information and process knowledge from historical documentation and site confirmation data collected in 2005 and 2006 to recommend closure of CAU 118 using the SAFER process. The Data Quality Objective process developed for this CAU identified the following expected closure option: closure in place with use restrictions. This expected closure option was selected based on available information including contaminants of potential concern, future land use, and assumed risks. There are two decisions that need to be answered for closure. Decision I is to determine the nature of contaminants of concern in environmental media or potential source material that could impact human health or the environment. Decision II is to determine whether or not sufficient information has been obtained to confirm that closure objectives were met. This decision includes determining whether the extent of any contamination remaining on site has been defined, and whether actions have been taken to eliminate exposure pathways.

  6. 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

  7. Changes in risk factor profile after ischemic stroke

    DEFF Research Database (Denmark)

    Hornnes, Nete

    Background and aims. Adherence to preventive medication and to a healthy life style reduces stroke survivors’ risk of recurrent stroke. We investigated risk factor management in patients admitted to 3 Copenhagen hospitals with ischemic stroke (IS) Methods. 320 patients with acute IS were followed...... up 1 year after stroke. We constructed a baseline risk factor profile (RFP) of 6 variables: smoking, excessive drinking, physical inactivity, untreated hypertension, no cholesterol-lowering, and no antithrombotic treatment/warfarin at discharge from hospital. Each item was rated 0 or 1 giving......-fatal recurrent stroke or myocardial infarction Conclusions. We suggest the organisation of secondary prevention clinics within the stroke units for life style modification and treatment to target of risk factors immediately after discharge, thus extending the success of TIA clinics to all stroke survivors...

  8. Risks for Heart Disease & Stroke

    Science.gov (United States)

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

  9. Epidemiology and in-hospital outcome of stroke in South Ethiopia.

    Science.gov (United States)

    Deresse, Birrie; Shaweno, Debebe

    2015-08-15

    Although the burden of stroke in Sub-Saharan Africa, including Ethiopia, is increasing, there are few available data on stroke in Ethiopia. To describe the magnitude of risk factors, sub-types and in-hospital outcome of stroke at Hawassa University Referral Hospital, Ethiopia. A prospective hospital-based study was conducted with all adult patients admitted to Hawassa University Referral Hospital with stroke diagnosis between May 2013 and April 2014. Computerized tomography scan was performed in all patients to confirm the type of stroke. Stroke severity at admission was assessed by the National Institute of Health Stroke Scale. Stroke outcome at discharge was measured using the modified Rankin stroke scale. A total of 163 stroke patients were recruited during the study period, of which 82 (50.3%) patients had ischemic stroke while 81 (49.7%) had hemorrhagic stroke. Stroke risk factors included hypertension (50.9%), cardiac diseases (16.6%), diabetes mellitus (7.4%), alcohol (10.4%), cigarette smoking (4.9%) and tuberculous meningitis (3.1%). In-hospital stroke mortality was 14.7%. The main predictors of in-hospital stroke mortality were stroke severity at admission, hemorrhagic stroke, decreased level of consciousness and seizure. The proportion of hemorrhagic stroke is higher than in Western countries. Hypertension is the most common risk factor for stroke. More than half of the patients were discharged with severe disability. We recommend establishing stroke units in resource limited countries like Ethiopia in order to reduce stroke mortality and post stroke disability. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. 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.

  11. 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

  12. Providers' Note-Writing Practices for Post-traumatic Stress Disorder at Five United States Veterans Affairs Facilities.

    Science.gov (United States)

    Tuepker, Anaïs; Zickmund, Susan L; Nicolajski, Cara E; Hahm, Bridget; Butler, Jorie; Weir, Charlene; Post, Lori; Hickam, David H

    2016-07-01

    The capacity of electronic health records (EHRs) to capture desired information depends on the practices of health care providers. These practices have not been well studied in relation to post-traumatic stress disorder (PTSD). This qualitative study investigated how providers write EHR notes on PTSD through 38 interviews with providers working at five Veterans Affairs (VA) hospitals across the United States of America. Two overarching themes were prominent in the results. Providers used progress notes primarily to remember and access details for direct patient care, but only rarely for care coordination. Providers infrequently recorded information not judged to directly contribute to improved care, sometimes deliberately omitting information perceived to jeopardize patients' access to, or quality of, care. Omitted information frequently included sexual or non-military trauma. Understanding providers' thought processes can help clinicians be aware of the limitations of EHR notes as a tool for learning the histories of new patients. Similarly, researchers relying on EHR data for PTSD research should be aware of likely areas of missing data.

  13. 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...

  14. Post-stroke seizures are clinically underestimated.

    Science.gov (United States)

    Bentes, Carla; Martins, Hugo; Peralta, Ana Rita; Casimiro, Carlos; Morgado, Carlos; Franco, Ana Catarina; Fonseca, Ana Catarina; Geraldes, Ruth; Canhão, Patrícia; Pinho E Melo, Teresa; Paiva, Teresa; Ferro, José M

    2017-09-01

    Cerebrovascular disease is the leading cause of epilepsy in adults, although post-stroke seizures reported frequency is variable and few studies used EEG in their identification. To describe and compare EEG and clinical epileptic manifestations frequency in patients with an anterior circulation ischaemic stroke. Prospective study of acute anterior circulation ischaemic stroke patients, consecutively admitted to a Stroke Unit over 24 months and followed-up for 1 year. All patients underwent standardized clinical and diagnostic assessment. Seizure occurrence was clinically evaluated during hospitalization and by a telephone interview at 6 months and a clinical appointment at 12 months after stroke. Video-EEG was performed in the first 72 h (1st EEG), daily after the 1st EEG for the first 7 days after the stroke, or later if neurological worsening, at discharge, and at 12 months. 151 patients were included (112 men) with a mean age of 67.4 (11.9) years. In the 1st year after stroke, 38 patients (25.2%) had an epileptic seizure. During hospitalization, 27 patients (17.9%) had epileptiform activity (interictal or ictal) in the EEG, 7 (25.9%) of them electrographic seizures. During the first week after stroke, 22 (14.6%) patients had a seizure and 4 (2.6%) non-convulsive status epilepticus criteria. Five (22.7%) acute symptomatic seizures were exclusively electrographic. At least one remote symptomatic seizure occurred in 23 (16%) patients. In the first 7 days after stroke, more than one-fifth of patients with seizures had exclusively electrographic seizures. Without a systematic neurophysiological evaluation the frequency of post-stroke seizures are clinically underestimated.

  15. 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.

  16. The Effects of Various Weather Conditions as a Potential Ischemic Stroke Trigger in Dogs.

    Science.gov (United States)

    Meadows, Kristy L; Silver, Gena M

    2017-11-16

    Stroke is the fifth leading cause of death in the United States, and is the leading cause of serious, long-term disability worldwide. There are at least 795,000 new or recurrent strokes each year, and approximately 85% of all stroke occurrences are ischemic. Unfortunately, companion animals are also at risk for ischemic stroke. Although the exact incidence of ischemic stroke in companion animals is unknown, some studies, and the veterinary information network (VIN), report that approximately 3% of neurological case referrals are due to a stroke. There is a long list of predisposing factors associated with the risk of ischemic stroke in both humans and canines; however, these factors do not explain why a stroke happens at a particular time on a particular day. Our understanding of these potential stroke "triggers" is limited, and the effect of transient environmental exposures may be one such "trigger". The present study investigated the extent to which the natural occurrence of canine ischemic stroke was related to the weather conditions in the time-period immediately preceding the onset of stroke. The results of the present study demonstrated that the change in weather conditions could be a potential stroke trigger, with the strokes evaluated occurring after periods of rapid, large fluctuations in weather conditions. There are currently no epidemiological data on the seasonal variability of ischemic stroke in dogs, and determining whether canine stroke parallels human stroke would further validate the use of companion dogs as an appropriate naturally occurring model.

  17. Test Your Stroke Knowledge

    Science.gov (United States)

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

  18. Heart and Stroke Encyclopedia

    Science.gov (United States)

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

  19. Stroke Connection Magazine

    Science.gov (United States)

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

  20. Stroke (For Kids)

    Science.gov (United States)

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

  1. Stroke Trials Registry

    Science.gov (United States)

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

  2. A review of post-stroke urinary incontinence.

    Science.gov (United States)

    Tuong, Nicole E; Klausner, Adam P; Hampton, Lance J

    2016-06-01

    Cerebrovascular accidents, or strokes, are a common cause of morbidity and mortality in the United States. Urinary incontinence is a prevalent morbidity experienced by post-stroke patients that is associated with long term disability and institutionalization effects on these patients. An extensive literature review was conducted using multiple academic search engines using the keywords: 'stroke,' 'CVA,' 'urinary incontinence,' 'urodynamics,' 'pharmacologic treatments,' and 'conservative treatments.' Articles were reviewed and summarized to explain incidence, assessment, and treatments of urinary incontinence in post-stroke individuals. Twenty-eight percent to seventy-nine percent of stroke survivors experience urinary incontinence with detrusor overactivity being the most common type of incontinence assessed by urodynamic studies. There continues to be insufficient data studying the effects and benefits of non-pharmacologic and pharmacologic treatments in post-stroke patients. Similarly, urinary incontinence remains an indicator of increased morbidity, disability, and institutionalization rates in the post-stroke patient. Stroke is a debilitating disease which causes urinary incontinence in many patients. As a result, patients have increased rates of hospitalization and disability compared to post-stroke patients without urinary incontinence. The history and physical exam are key in diagnosing the type of urinary incontinence with urodynamic studies being an adjunctive study. Non-pharmacologic treatment, such as behavioral therapy, and pharmacologic agents including antimuscarinics and beta adrenergic medications, are not well studied in the post-stroke patient. Urinary incontinence in stroke patients needs to be further studied to help decrease morbidity and mortality rates within this population.

  3. [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.

  4. Hemorrhagic Stroke in Children

    OpenAIRE

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

    2007-01-01

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

  5. Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 114: Area 25 EMAD Facility Nevada Test Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Mark Burmeister

    2009-08-01

    This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 114, Area 25 EMAD Facility, identified in the Federal Facility Agreement and Consent Order (FFACO). Corrective Action Unit 114 comprises the following corrective action sites (CASs) located in Area 25 of the Nevada Test Site: • 25-41-03, EMAD Facility • 25-99-20, EMAD Facility Exterior Releases This plan provides the methodology for field activities needed to gather the necessary information for closing each CAS. There is sufficient information and process knowledge from historical documentation and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closure of CAU 114 using the SAFER process. Additional information will be obtained by conducting a field investigation before selecting the appropriate corrective action for each CAS. It is anticipated that the results of the field investigation and implementation of a corrective action of clean closure will support a defensible recommendation that no further corrective action is necessary. If it is determined that complete clean closure cannot be accomplished during the SAFER, then a hold point will have been reached and the Nevada Division of Environmental Protection (NDEP) will be consulted to determine whether the remaining contamination will be closed under the alternative corrective action of closure in place. This will be presented in a closure report that will be prepared and submitted to NDEP for review and approval. The sites will be investigated based on the data quality objectives (DQOs) developed on April 30, 2009, by representatives of NDEP; U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data

  6. 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.

  7. Early home-supported discharge of stroke patients

    DEFF Research Database (Denmark)

    Larsen, T.; Olsen, Tom Skyhøj; Sørensen, J.

    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...... 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...... for dissemination of new experience to the other stroke units....

  8. 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

  9. 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.

  10. Detection of paroxysmal atrial fibrillation in acute stroke patients

    NARCIS (Netherlands)

    Rizos, T.; Rasch, C.; Jenetzky, E.; Hametner, C.; Kathoefer, S.; Reinhardt, R.; Hepp, T.; Hacke, W.; Veltkamp, R.

    2010-01-01

    Atrial fibrillation (AF) is a frequent cause of stroke, but detecting paroxysmal AF (pAF) poses a challenge. We investigated whether continuous bedside ECG monitoring in a stroke unit detects pAF more sensitively than 24-hour Holter ECG, and tested whether examining RR interval dynamics on

  11. 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...

  12. Persistent shoulder pain in the first 6 months after stroke: results of a prospective cohort study

    NARCIS (Netherlands)

    Roosink, M.; Renzenbrink, G.J.; Buitenweg, J.R.; Dongen, R.T. van; Geurts, A.C.H.; IJzerman, M.J.

    2011-01-01

    OBJECTIVE: To identify factors associated with persistent poststroke shoulder pain (pPSSP) in the first 6 months after stroke. DESIGN: Prospective inception cohort study. SETTING: Stroke units of 2 teaching hospitals. PARTICIPANTS: Patients (N=31) with a clinical diagnosis of stroke. INTERVENTIONS:

  13. Persistent shoulder pain in the first 6 months after stroke: results of a prospective cohort study.

    NARCIS (Netherlands)

    Roosink, M.; Renzenbrink, Gerbert J.; Buitenweg, Jan R.; van Dongen, Robert T.; Geurts, Alexander C.; IJzerman, Maarten Joost

    2011-01-01

    OBJECTIVE: To identify factors associated with persistent poststroke shoulder pain (pPSSP) in the first 6 months after stroke. DESIGN: Prospective inception cohort study. SETTING: Stroke units of 2 teaching hospitals. PARTICIPANTS: Patients (N=31) with a clinical diagnosis of stroke. INTERVENTIONS:

  14. Stroke in patients with diabetes mellitus: a study from North Western ...

    African Journals Online (AJOL)

    Method: Out of all stroke patients seen from June 2007 to February 2011, persons with diabetes mellitus presenting with stroke in the emergency unit of the two ... of data on the prevalence of diabetes in Nigeria. How- ever, available data ... were treated in accordance with Aminu Kano Teaching. Hospital guideline on stroke ...

  15. 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...

  16. Sleep and Stroke

    Directory of Open Access Journals (Sweden)

    M V Padma Srivastav

    2014-03-01

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

  17. 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

  18. Nursing care for stroke patients: A survey of current practice in 11 European countries.

    Science.gov (United States)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin; Jönsson, Ann-Cathrin

    2018-02-01

    To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies 2006 and to examine to what extent the European Stroke Strategies have been implemented in stroke care nursing in Europe. Stroke is a leading cause of death and disability globally. Optimal organisation of interdisciplinary stroke care is expected to ameliorate outcome after stroke. Consequently, universal access to stroke care based on evidence-based guidelines is a priority. This study is a descriptive cross-sectional survey. A questionnaire comprising 61 questions based on the European Stroke Strategies 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: organisation of stroke services, management of acute stroke and prevention including basic care and nursing, and secondary prevention. Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hr after stroke onset, 95% monitor patients regularly, 94% start mobilisation after 24 hr when patients are stable, and 89% assess patients' ability to swallow. Change of position for immobile patients is followed by 73%, and postvoid residual urine volume is measured by 85%. Some aspects needed improvement, for example, staff education (70%), education for patients/families/carers (55%) and individual care plans in secondary prevention (62%). The participating European countries comply well with the European Stroke Strategies guidelines, particularly in the acute stroke care, but not all stroke units have reached optimal development in all aspects of stroke care nursing. Our study may provide clinical administrators and nurses in stroke care with information that may contribute to improved compliance with the European Stroke Strategies and evidence

  19. Epidemiology of Stroke in Costa Rica: A 7-Year Hospital-Based Acute Stroke Registry of 1319 Consecutive Patients.

    Science.gov (United States)

    Torrealba-Acosta, Gabriel; Carazo-Céspedes, Kenneth; Chiou, Sy Han; O'Brien, Anthony Terrence; Fernández-Morales, Huberth

    2017-12-25

    Limited data on stroke exist for Costa Rica. Therefore, we created a stroke registry out of patients with stroke seen in the Acute Stroke Unit of the Hospital Calderon Guardia. We analyzed 1319 patients enrolled over a 7-year period, which incorporated demographic, clinical, laboratory, and neuroimaging data. The mean age of patients with stroke was 68.0 ± 15.5 years. Seven hundred twenty-five were men and the age range was 13-104 years. The most prevalent risk factors were hypertension (78.8%), dyslipidemia (36.3%), and diabetes (31.9%). Fifteen percent had atrial fibrillation and 24.7% had a previous stroke or transient ischemic attack. Prevalence of hypertension and atrial fibrillation increased with age; however, younger patients were more associated with thrombophilia. We documented 962 (72.9%) ischemic and 270 (20.5%) hemorrhagic strokes. Of the ischemic strokes, 174 (18.1%) were considered secondary to large-artery atherothrombosis, 175 (18.2%) were due to cardiac embolism, 19 (2.0%) were due to lacunar infarcts, and 25 (2.6%) were due to other determined causes. Five hundred sixty-nine (59.1%) remained undetermined. Atherothrombotic strokes were mostly associated with dyslipidemia, diabetes, metabolic syndrome, and obesity, whereas lacunar infarcts were associated with hypertension, smoking, sedentary lifestyle, and previous stroke or transient ischemic attack. Of our patients, 69.9% scored between 0 and 9 in the initial National Institutes of Health Stroke Scale (NIHSS). We found differences in sociodemographic features, risk factors, and stroke severity among stroke subtypes. Risk factor prevalence was similar to other registries involving Hispanic populations. Copyright © 2017 National Stroke Association. All rights reserved.

  20. National implementation of acute stroke care centers in the Veterans Health Administration (VHA): formative evaluation of the field response.

    Science.gov (United States)

    Damush, Teresa M; Miller, Kristine K; Plue, Laurie; Schmid, Arlene A; Myers, Laura; Graham, Glenn; Williams, Linda S

    2014-12-01

    In 2011, the Veterans Health Administration (VHA) released the Acute Ischemic Stroke (AIS) Directive, which mandated reorganization of acute stroke care, including self-designation of stroke centers as Primary (P), Limited Hours (LH), or Supporting (S). In partnership with the VHA Offices of Emergency Medicine and Specialty Care Services, the VA Stroke QUERI conducted a formative evaluation in a national sample of three levels of stroke centers in order to understand barriers and facilitators. The evaluation consisted of a mixed-methods assessment that included a qualitative assessment of data from semi-structured interviews with key informants and a quantitative assessment of stroke quality-of-care data reporting practices by facility characteristics. The final sample included 38 facilities (84 % participation rate): nine P, 24 LH, and five S facilities. In total, we interviewed 107 clinicians and 16 regional Veterans Integrated Service Network (VISN) leaders. Across all three levels of stroke centers, stroke teams identified the specific need for systematic nurse training to triage and initiate stroke protocols. The most frequently reported barriers centered around quality-of-care data collection. A low number of eligible veterans arriving at the VAMC in a timely manner was another major impediment. The LH and S facilities reported some unique barriers: access to radiology and neurology services; EMS diverting stroke patients to nearby stroke centers, maintaining staff competency, and a lack of stroke clinical champions. Solutions that were applied included developing stroke order sets and templates to provide systematic decision support, implementing a stroke code in the facility for a coordinated response to stroke, and staff resource allocation and training. Data reporting by facility evaluation demonstrated that categorizing site volume did indicate a lower likelihood of reporting among VAMCs with 25-49 acute stroke admissions per year. The AIS Directive

  1. 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...

  2. 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...

  3. Community-based case-control study of childhood stroke risk associated with congenital heart disease.

    Science.gov (United States)

    Fox, Christine K; Sidney, Stephen; Fullerton, Heather J

    2015-02-01

    A better understanding of the stroke risk factors in children with congenital heart disease (CHD) could inform stroke prevention strategies. We analyzed pediatric stroke associated with CHD in a large community-based case-control study. From 2.5 million children (aged hemorrhagic strokes and randomly selected age- and facility-matched stroke-free controls (3 per case). We determined exposure to CHD (diagnosed before stroke) and used conditional logistic regression to analyze stroke risk factors. CHD was identified in 15 of 412 cases (4%) versus 7 of 1236 controls (0.6%). Cases of childhood stroke (occurring between ages 29 days to 20 years) with CHD had 19-fold (odds ratio, 19; 95% confidence interval 4.2-83) increased stroke risk compared to controls. History of CHD surgery was associated with >30-fold (odds ratio, 31; confidence interval 4-241) increased risk of stroke in children with CHD when compared with controls. After excluding perioperative strokes, the history of CHD surgery still increased the childhood stroke risk (odds ratio, 13; confidence interval 1.5-114). The majority of children with stroke and CHD were outpatients at the time of stroke, and almost half the cases who underwent cardiac surgery had their stroke >5 years after the most recent procedure. An estimated 7% of ischemic and 2% of hemorrhagic childhood strokes in the population were attributable to CHD. CHD is an important childhood stroke risk factor. Children who undergo CHD surgery remain at elevated risk outside the perioperative period and would benefit from optimized long-term stroke prevention strategies. © 2014 American Heart Association, Inc.

  4. Post-stroke depression: Prevalence and relationship with disability in chronic stroke survivors

    Directory of Open Access Journals (Sweden)

    Srivastava Abhishek

    2010-01-01

    Full Text Available Objectives: To evaluate (1 the prevalence of operationally defined depressive disorder (ICD-10 in chronic stroke subjects and (2 the relationship of post-stroke depression (PSD with disability. Design: Cross-sectional, descriptive study. Setting: Neurological rehabilitation unit of a tertiary care university research center. Materials and Methods: Participants were those with first episode of supratentorial stroke of more than 3 months′ duration with impaired balance and gait who had been referred for rehabilitation. Data were collected on demographic data, stroke data (side and type of lesion and post-stroke duration, cognition (mini mental state examination, depressive ideation (Hamilton Depression Rating Scale - HRDS, impairment (Scandinavian Stroke Scale, balance (Berg Balance Scale, ambulatory status (Functional Ambulation Category, walking ability (speed, and independence in activities of daily living (Barthel Index. Statistical analysis was done using SPSS 13.0. We carried out the chi-square test for ordinal variables and the independent t test for continuous variables. Results: Fifty-one patients (M:F: 41:10 of mean age 46.06 ± 11.19 years and mean post-stroke duration of 467.33 ± 436.39 days were included in the study. Eighteen of the 51 participants (35.29% met the criteria for depression. Demographic variables like male gender, being married, living in a nuclear family, urban background, and higher HRDS score were significantly correlated with PSD (P < 0.05. Depression was related to functional disability after stroke but to a statistically insignificant level (P > 0.05 and was unrelated to lesion-related parameters. Conclusion: Depression occurs in one-third of chronic stroke survivors and is prevalent in subjects referred for rehabilitation. PSD is related primarily to demographic variables and only to a lesser extent to functional disability following stroke.

  5. 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

  6. Turnley Unit

    Data.gov (United States)

    Federal Laboratory Consortium — Facilities at this unit include cattle working pens, hydraulic squeeze chute and electronic scale, a maintenance building, and four hay storage sheds. There is one...

  7. 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.

  8. 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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

  11. 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.

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

    African Journals Online (AJOL)

    Alasia Datonye

    complications which will reduce the risk of death is more ... and Nurses trained in providing supportive care. The challenges of ..... The nursing and physiotherapist requirements for such patients are usually more than that for the average patient in the general medical ward. Equipments and infrastructures including the quick.

  13. 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...

  14. 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.

  15. 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.

  16. Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil Estudo comparativo dos desfechos entre uma unidade de AVC e uma enfermaria geral: estudo randomizado em Joinville, Brasil

    Directory of Open Access Journals (Sweden)

    Norberto L. Cabral

    2003-06-01

    Full Text Available BACKGROUND AND PURPOSE: To assess the impact of a stroke unit (SU on acute phase treatment when compared to a conventional general ward treatment (GW. METHOD: Seventy-four patients with acute stroke were randomized between a SU and conventional general ward (GW. We compared both groups regarding the length of hospital stay, lethality and functional and clinical status within 6 months, using the Scandinavian scale and Barthel index. RESULTS: Thirty-five and thirty-nine patients were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW achieved 8.5% and 12.8% respectively (p= 0.41, whereas 30-days mortality rates achieved 14.2% and 28.2% (p= 0.24, 17.4% and 28.7% on the 3rd month (p= 0.39, and 25.7% and 30.7% on the 6th month (p= 0.41. Thirty-day survival curve achieved 1.8 log rank (p= 0.17, with a trend for lower lethality in the SU. In order to save one death in 6 months in SU, NNT (the number need to treat was 20; to get one more home independent patient NNT was 15. No significant difference was found between the length of hospital stay and morbidity. CONCLUSION: No significant benefit was found in SU patients compared to GW group. However,an evident benefit in absolute numbers was observed in lethality, survival curve and NNT in thirty days period after stroke. Further collaborative studies or incresead number of patients are required to define the role of SU.OBJETIVO: Avaliar se o tratamento da fase aguda em uma unidade de acidente vascular cerebral (U-AVC reduz a morbi-mortalidade quando comparado a uma enfermaria geral. MÉTODO: Pacientes com AVC agudo foram randomizados entre a U-AVC e uma enfermaria geral (EG. Comparou-se tempo de internação, letalidade e dependência funcional e clínica no período de 6 meses. RESULTADOS: Obtivemos 35 pacientes na U-AVC e 39 pacientes na EG. A letalidade encontrada na U-VAC e na EG foram respectivamente 8,5% e 12,8% no décimo dia (p=,41, 14,2% e 28,2% no trigésimo dia (p=,24

  17. 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)

  18. Perlecan domain V therapy for stroke: a beacon of hope?

    Science.gov (United States)

    Bix, Gregory J

    2013-03-20

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

  19. 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

  20. European Stroke Science Workshop

    Science.gov (United States)

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

    2012-01-01

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

  1. Formation and function of acute stroke-ready hospitals within a stroke system of care recommendations from the brain attack coalition.

    Science.gov (United States)

    Alberts, Mark J; Wechsler, Lawrence R; Jensen, Mary E Lee; Latchaw, Richard E; Crocco, Todd J; George, Mary G; Baranski, James; Bass, Robert R; Ruff, Robert L; Huang, Judy; Mancini, Barbara; Gregory, Tammy; Gress, Daryl; Emr, Marian; Warren, Margo; Walker, Michael D

    2013-12-01

    Many patients with an acute stroke live in areas without ready access to a Primary or Comprehensive Stroke Center. The formation of care facilities that meet the needs of these patients might improve their care and outcomes and guide them and emergency responders to such centers within a stroke system of care. The Brain Attack Coalition conducted an electronic search of the English medical literature from January 2000 to December 2012 to identify care elements and processes shown to be beneficial for acute stroke care. We used evidence grading and consensus paradigms to synthesize recommendations for Acute Stroke-Ready Hospitals (ASRHs). Several key elements for an ASRH were identified, including acute stroke teams, written care protocols, involvement of emergency medical services and emergency department, and rapid laboratory and neuroimaging testing. Unique aspects include the use of telemedicine, hospital transfer protocols, and drip and ship therapies. Emergent therapies include the use of intravenous tissue-type plasminogen activator and the reversal of coagulopathies. Although many of the care elements are similar to those of a Primary Stroke Center, compliance rates of ≥67% are suggested in recognition of the staffing, logistical, and financial challenges faced by rural facilities. ASRHs will form the foundation for acute stroke care in many settings. Recommended elements of an ASRH build on those proven to improve care and outcomes at Primary Stroke Centers. The ASRH will be a key component for patient care within an evolving stroke system of care.

  2. 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

  3. 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

  4. [Nursing expertise in post-stroke rehabilitation].

    Science.gov (United States)

    Jonniaux, Sandrine; Schmid, Olivier

    2016-01-01

    The pathway of a patient after a stroke involves a continuation of care, from their admission to the emergency department to their discharge from the rehabilitation unit. Here, a Genevan hospital team shares its experience in the creation of a video of information for the patients and their family about the process of rehabilitation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. 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

  6. Streamlined Approach for Environmental Restoration Plan for Corrective Action Unit 116: Area 25 Test Cell C Facility, Nevada Test Site, Nevada, Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NSTec Environmental Restoration

    2008-12-01

    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

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

  8. 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....

  9. 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...

  10. 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

  11. 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...

  12. 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.

  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. Obstructive Sleep Apnea as an Independent Stroke Risk Factor: A Review of the Evidence, Stroke Prevention Guidelines, and Implications for Neuroscience Nursing Practice.

    Science.gov (United States)

    King, Sharon; Cuellar, Norma

    2016-06-01

    Stroke is a leading cause of death and disability affecting nearly 800,000 people in the United States every year. Obstructive sleep apnea (OSA) is found in over 60% of patients with stroke/transient ischemic attack (TIA) and identified as an independent stroke risk factor in large epidemiology studies and Canadian Stroke Prevention Guidelines (SPG) but not in the United States. The 2014 Secondary SPG recommend OSA screening and treatment as a consideration only, not a requirement. The twofold purpose of this article is, first, to present the evidence supporting OSA as an independent stroke risk factor in national SPG with mandatory recommendations and, second, to engage neuroscience nurses to incorporate OSA assessment and interventions into the nursing process and thereby promote excellence in stroke/TIA patient care. A systematic literature search was conducted in Medline, CINAHL, and PubMed to identify research from 2003 through 2013 on the independent risk, mortality, and prevalence relationship between OSA and stroke/TIA including recurrence and recovery outcomes with continuous positive airway pressure (CPAP) therapy. Twenty-eight research articles were reviewed: 14 observational cohorts, five case-control studies, four cross-sectional studies, and four randomized control trials representing 12 countries and 10,671 subjects. OSA is highly prevalent in patients with stroke/TIA independently increasing stroke risk. CPAP studies revealed reduced stroke recurrence and improved recovery with feasible initiation in stroke units. Patients with stroke/TIA have less OSA-associated daytime sleepiness and obesity, making the usual screening tools insufficient and CPAP adherence challenging. Treating OSA decreases stroke prevalence and mortality. OSA initiatives empower neuroscience nurses to integrate this OSA evidence into clinical practice and improve stroke/TIA patient outcomes.

  15. 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

  16. 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.

  17. Health, function and disability in stroke patients in the community

    Directory of Open Access Journals (Sweden)

    Bárbara P. B. Carvalho-Pinto

    2016-01-01

    Full Text Available ABSTRACT Background Stroke patients commonly have impairments associated with reduction in functionality. Among these impairments, the motor impairments are the most prevalent. The functional profile of these patients living in the community who are users of the primary health-care services in Brazil has not yet been established Objective To describe the functional profile of stroke patients who are users of the primary health-care services in Brazil, looking at one health-care unit in the city of Belo Horizonte, Brazil. Method From medical records and home visits, data were collected regarding health status, assistance received following the stroke, personal and environmental contextual factors, function and disability, organized according to the conceptual framework of the International Classification of Functioning, Disability and Health (ICF. Test and instruments commonly applied in the assessment of stroke patients were used. Results Demographic data from all stroke patients who were users of the health-care unit (n=44, age: 69.23±13.12 years and 67±66.52 months since the stroke participated of this study. Most subjects presented with disabilities, as changes in emotional function, muscle strength, and mobility, risks of falling during functional activities, negative self-perception of quality of life, and perception of the environment factors were perceived as obstacles. The majority of the patients used the health-care unit to renew drug prescriptions, and did not receive any information on stroke from health professionals, even though patients believed it was important for patients to receive information and to provide clarifications. Conclusion Stroke patients who used primary health-care services in Brazil have chronic disabilities and health needs that require continuous health attention from rehabilitation professionals. All of these health needs should be considered by health professionals to provide better management as part of

  18. Immune interventions in stroke

    Science.gov (United States)

    Fu, Ying; Liu, Qiang; Anrather, Josef

    2016-01-01

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

  19. 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…

  20. National Stroke Association

    Science.gov (United States)

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

  1. 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

  2. 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 the golf stroke of a professional golfer....

  3. 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.

  4. The Danish Stroke Registry

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  5. Post-stroke depression among stroke survivors attending two ...

    African Journals Online (AJOL)

    Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a ...

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

    African Journals Online (AJOL)

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

  7. Risk factors, clinical presentation, and neuroimaging findings of neonatal perforator stroke.

    Science.gov (United States)

    Ecury-Goossen, Ginette M; Raets, Marlou M A; Lequin, Maarten; Feijen-Roon, Monique; Govaert, Paul; Dudink, Jeroen

    2013-08-01

    To date, studies on neonatal stroke have mainly focused on cortical stroke. We have focused on perforator strokes, noncortical strokes in the arterial vascular perforator area. We sought to identify risk factors and evaluate clinical presentation and neuroimaging findings for neonatal perforator stroke, which seems to be under-recognized. All infants admitted to our tertiary intensive care unit in ≈12 years, whose perforator stroke was diagnosed with postnatal brain imaging, were enrolled in this study. Demographic, perinatal, and postnatal data were evaluated. Seventy-nine perforator strokes were detected in 55 patients (28 boys), with a median gestational age of 37 1/7 weeks (range 24 1/7 to 42 1/7 weeks, 25 preterm). Perforator stroke was asymptomatic in most patients (58%). Initial diagnosis was predominantly made with cranial ultrasound (80%) in the first week of life (60%). Risk factors for stroke were present in all cases: maternal, fetal, and perinatal. Likely pathogenic mechanisms were prolonged birth asphyxia (16%), hypoxia or hypotension (15%), embolism (15%), infection (15%), acute blood loss (9%), and birth trauma (9%). Previously described risk factors for developing neonatal main artery stroke are probably also associated with neonatal perforator stroke. Perforator stroke is often asymptomatic, but cranial ultrasound is a reliable diagnostic tool in diagnosing perforator stroke.

  8. 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

  9. Cerebrorenal interaction and stroke.

    Science.gov (United States)

    Toyoda, Kazunori

    2013-01-01

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

  10. Using a complex adaptive system lens to understand family caregiving experiences navigating the stroke rehabilitation system.

    Science.gov (United States)

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

    2016-10-01

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

  11. 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 ...

  12. Stroke Patients Communicating Their Healthcare Needs in Hospital: A Study within the ICF Framework

    Science.gov (United States)

    O'Halloran, Robyn; Worrall, Linda; Hickson, Louise

    2012-01-01

    Background: Previous research has identified that many patients admitted into acute hospital stroke units have communication-related impairments such as hearing, vision, speech, language and/or cognitive communicative impairment. However, no research has identified how many patients in acute hospital stroke units have difficulty actually…

  13. 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

    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. 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). 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.

  14. Multi-country analysis of treatment costs for HIV/AIDS (MATCH: facility-level ART unit cost analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia.

    Directory of Open Access Journals (Sweden)

    Elya Tagar

    Full Text Available 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.

  15. 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

  16. Third European Stroke Science Workshop

    NARCIS (Netherlands)

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

    2016-01-01

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

  17. Obstructive sleep apnea in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Aliye Tosun

    2008-01-01

    Full Text Available OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started.

  18. 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.

  19. 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.

  20. 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

  1. Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities - United States.

    Science.gov (United States)

    Slayton, Rachel B; Toth, Damon; Lee, Bruce Y; Tanner, Windy; Bartsch, Sarah M; Khader, Karim; Wong, Kim; Brown, Kevin; McKinnell, James A; Ray, William; Miller, Loren G; Rubin, Michael; Kim, Diane S; Adler, Fred; Cao, Chenghua; Avery, Lacey; Stone, Nathan T B; Kallen, Alexander; Samore, Matthew; Huang, Susan S; Fridkin, Scott; Jernigan, John A

    2015-08-07

    Treatments for health care-associated infections (HAIs) caused by antibiotic-resistant bacteria and Clostridium difficile are limited, and some patients have developed untreatable infections. Evidence-supported interventions are available, but coordinated approaches to interrupt the spread of HAIs could have a greater impact on reversing the increasing incidence of these infections than independent facility-based program efforts. Data from CDC's National Healthcare Safety Network and Emerging Infections Program were analyzed to project the number of health care-associated infections from antibiotic-resistant bacteria or C. difficile both with and without a large scale national intervention that would include interrupting transmission and improved antibiotic stewardship. As an example, the impact of reducing transmission of one antibiotic-resistant infection (carbapenem-resistant Enterobacteriaceae [CRE]) on cumulative prevalence and number of HAI transmission events within interconnected groups of health care facilities was modeled using two distinct approaches, a large scale and a smaller scale health care network. Immediate nationwide infection control and antibiotic stewardship interventions, over 5 years, could avert an estimated 619,000 HAIs resulting from CRE, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA), or C. difficile. Compared with independent efforts, a coordinated response to prevent CRE spread across a group of inter-connected health care facilities resulted in a cumulative 74% reduction in acquisitions over 5 years in a 10-facility network model, and 55% reduction over 15 years in a 102-facility network model. With effective action now, more than half a million antibiotic-resistant health care-associated infections could be prevented over 5 years. Models representing both large and small groups of interconnected health care facilities illustrate that a coordinated approach to interrupting

  2. 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

  3. 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.

  4. 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...

  5. 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

  6. 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.

  7. The Migraine?Stroke Connection

    OpenAIRE

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

    2016-01-01

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

  8. 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…

  9. Diagnostic value of prehospital ECG in acute stroke patients.

    Science.gov (United States)

    Bobinger, Tobias; Kallmünzer, Bernd; Kopp, Markus; Kurka, Natalia; Arnold, Martin; Heider, Stefan; Schwab, Stefan; Köhrmann, Martin

    2017-05-16

    To investigate the diagnostic yield of prehospital ECG monitoring provided by emergency medical services in the case of suspected stroke. Consecutive patients with acute stroke admitted to our tertiary stroke center via emergency medical services and with available prehospital ECG were prospectively included during a 12-month study period. We assessed prehospital ECG recordings and compared the results to regular 12-lead ECG on admission and after continuous ECG monitoring at the stroke unit. Overall, 259 patients with prehospital ECG recording were included in the study (90.3% ischemic stroke, 9.7% intracerebral hemorrhage). Atrial fibrillation (AF) was detected in 25.1% of patients, second-degree or greater atrioventricular block in 5.4%, significant ST-segment elevation in 5.0%, and ventricular ectopy in 9.7%. In 18 patients, a diagnosis of new-onset AF with direct clinical consequences for the evaluation and secondary prevention of stroke was established by the prehospital recordings. In 2 patients, the AF episodes were limited to the prehospital period and were not detected by ECG on admission or during subsequent monitoring at the stroke unit. Of 126 patients (48.6%) with relevant abnormalities in the prehospital ECG, 16.7% received medical antiarrhythmic therapy during transport to the hospital, and 6.4% were transferred to a cardiology unit within the first 24 hours in the hospital. In a selected cohort of patients with stroke, the in-field recordings of the ECG detected a relevant rate of cardiac arrhythmia. The results can add to the in-hospital evaluation and should be considered in prehospital care of acute stroke. © 2017 American Academy of Neurology.

  10. 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.

  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. 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 ...

  13. 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

  14. Cerebrovascular accident (stroke) in captive, group-housed, female chimpanzees.

    Science.gov (United States)

    Jean, Sherrie M; Preuss, Todd M; Sharma, Prachi; Anderson, Daniel C; Provenzale, James M; Strobert, Elizabeth; Ross, Stephen R; Stroud, Fawn C

    2012-08-01

    Over a 5-y period, 3 chimpanzees at our institution experienced cerebrovascular accidents (strokes). In light of the increasing population of aged captive chimpanzees and lack of literature documenting the prevalence and effectiveness of various treatments for stroke in chimpanzees, we performed a retrospective review of the medical records and necropsy reports from our institution. A survey was sent to other facilities housing chimpanzees that participate in the Chimpanzee Species Survival Plan to inquire about their experience with diagnosing and treating stroke. This case report describes the presentation, clinical signs, and diagnosis of stroke in 3 recent cases and in historical cases at our institution. Predisposing factors, diagnosis, and treatment options of cerebral vascular accident in the captive chimpanzee population are discussed also.

  15. 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.

  16. 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.

  17. Wind Energy Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Laurie, Carol

    2017-02-01

    This book takes readers inside the places where daily discoveries shape the next generation of wind power systems. Energy Department laboratory facilities span the United States and offer wind research capabilities to meet industry needs. The facilities described in this book make it possible for industry players to increase reliability, improve efficiency, and reduce the cost of wind energy -- one discovery at a time. Whether you require blade testing or resource characterization, grid integration or high-performance computing, Department of Energy laboratory facilities offer a variety of capabilities to meet your wind research needs.

  18. Stroke - risk factors

    Science.gov (United States)

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

  19. Post-Stroke Rehabilitation

    Science.gov (United States)

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

  20. A Stroke of Language

    Science.gov (United States)

    Blaisdell, Bob

    2011-01-01

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

  1. 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....

  2. Fabrication Facilities

    Data.gov (United States)

    Federal Laboratory Consortium — The Fabrication Facilities are a direct result of years of testing support. Through years of experience, the three fabrication facilities (Fort Hood, Fort Lewis, and...

  3. Waste Facilities

    Data.gov (United States)

    Vermont Center for Geographic Information — This dataset was developed from the Vermont DEC's list of certified solid waste facilities. It includes facility name, contact information, and the materials...

  4. Stroke in Indigenous Africans, African Americans, and European Americans: Interplay of Racial and Geographic Factors.

    Science.gov (United States)

    Owolabi, Mayowa; Sarfo, Fred; Howard, Virginia J; Irvin, Marguerite R; Gebregziabher, Mulugeta; Akinyemi, Rufus; Bennett, Aleena; Armstrong, Kevin; Tiwari, Hemant K; Akpalu, Albert; Wahab, Kolawole W; Owolabi, Lukman; Fawale, Bimbo; Komolafe, Morenikeji; Obiako, Reginald; Adebayo, Philip; Manly, Jennifer M; Ogbole, Godwin; Melikam, Ezinne; Laryea, Ruth; Saulson, Raelle; Jenkins, Carolyn; Arnett, Donna K; Lackland, Daniel T; Ovbiagele, Bruce; Howard, George

    2017-05-01

    The relative contributions of racial and geographic factors to higher risk of stroke in people of African ancestry have not been unraveled. We compared stroke type and contributions of vascular risk factors among indigenous Africans (IA), African Americans (AA), and European Americans (EA). SIREN (Stroke Investigative Research and Educational Network) is a large multinational case-control study in West Africa-the ancestral home of 71% AA-whereas REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a cohort study including AA and EA in the United States. Using harmonized assessments and standard definitions, we compared data on stroke type and established risk factors for stroke in acute stroke cases aged ≥55 years in both studies. There were 811 IA, 452 AA, and 665 EA stroke subjects, with mean age of 68.0±9.3, 73.0±8.3, and 76.0±8.3 years, respectively ( P stroke was more frequent among IA (27%) compared with AA (8%) and EA (5.4%; P strokes were more prevalent in IA (47.1%), followed by AA (35.1%) and then EA (21.0%; P risk factors such as sedentary lifestyle may contribute to the higher proportion of ischemic stroke in AA compared with IA, whereas racial factors may contribute to the higher proportion of hypertension and diabetes mellitus among stroke subjects of African ancestry. © 2017 American Heart Association, Inc.

  5. Telestroke in stroke survivors.

    Science.gov (United States)

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

    2009-01-01

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

  6. 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.

  7. Post-stroke dyskinesias

    Directory of Open Access Journals (Sweden)

    Nakawah MO

    2016-11-01

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

  8. 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…

  9. 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...

  10. Improving public education about stroke.

    Science.gov (United States)

    Alberts, Mark J

    2012-09-01

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

  11. Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction.

    Science.gov (United States)

    Bravata, Dawn M; Daggy, Joanne; Brosch, Jared; Sico, Jason J; Baye, Fitsum; Myers, Laura J; Roumie, Christianne L; Cheng, Eric; Coffing, Jessica; Arling, Greg

    2018-02-01

    The Veterans Health Administration has engaged in quality improvement to improve vascular risk factor control. We sought to examine blood pressure (stroke or acute myocardial infarction (AMI). We identified patients who were hospitalized (fiscal year 2011) with ischemic stroke, AMI, congestive heart failure, transient ischemic attack, or pneumonia/chronic obstructive pulmonary disease. The primary analysis compared risk factor control after incident ischemic stroke versus AMI. Facilities were included if they cared for ≥25 ischemic stroke and ≥25 AMI patients. A generalized linear mixed model including patient- and facility-level covariates compared risk factor control across diagnoses. Forty thousand two hundred thirty patients were hospitalized (n=75 facilities): 2127 with incident ischemic stroke and 4169 with incident AMI. Fewer stroke patients achieved blood pressure control than AMI patients (64%; 95% confidence interval, 0.62-0.67 versus 77%; 95% confidence interval, 0.75-0.78; P stroke patients (odds ratio, 1.39; 95% confidence interval, 1.21-1.51). There were no statistical differences for AMI versus stroke patients in hyperlipidemia ( P =0.534). Among patients with diabetes mellitus, the odds of glycemic control were lower for AMI than ischemic stroke patients (odds ratio, 0.72; 95% confidence interval, 0.54-0.96). Given that hypertension control is a cornerstone of stroke prevention, interventions to improve poststroke hypertension management are needed. © 2017 The Authors.

  12. 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

  13. 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 a summary 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). A brief summary of public utility regulatory programs, energy facility siting programs, and municipal franchising authority is presented in this report to identify how such programs and authority may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES. 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.

  14. The Role of Echocardiography in the Management of Stroke | Kolo ...

    African Journals Online (AJOL)

    Patients were examined echocardiographically for evidence of intramural thrombus, congenital defects, valvular heart disease, wall motion abnormalities and intra-cardiac masses using twodimensional, m-Mode and Doppler facilities. RESULTS: Potential cardiac source of emboli (CSE) was identified in 23.0% of the stroke ...

  15. 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 ...

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

    African Journals Online (AJOL)

    This has led to the philosophy of “watch and intervene from ischaemie damage. Thrombolytic therapy given within 3 hours of ictus has been effective but this is not feasible in Africa because of time delay and lack of neuro-imaging facilities in most centers. Contemporary management of stroke is divided into 4 phases; acute, ...

  17. RNA Expression Profiles from Blood for the Diagnosis of Stroke and its Causes

    Science.gov (United States)

    Sharp, Frank R; Jickling, Glen C; Stamova, Boryana; Tian, Yingfang; Zhan, Xinhua; Ander, Bradley P; Cox, Christopher; Kuczynski, Beth; Liu, DaZhi

    2013-01-01

    A blood test to detect stroke and its causes would be particularly useful in babies, young children, and patients in intensive care units, and for emergencies when imaging is difficult to obtain or unavailable. Using whole genome microarrays, we first showed specific gene expression profiles in rats 24 hours after ischemic and hemorrhagic stroke, hypoxia, and hypoglycemia. These proof-of-principle studies revealed that groups of genes (called gene profiles) can distinguish ischemic stroke patients from controls 3 hours to 24 hours after the strokes. In addition, gene expression profiles have been developed that distinguish stroke due to large-vessel atherosclerosis from cardioembolic stroke. These profiles will be useful for predicting the causes of cryptogenic stroke. Our results in adults suggest similar diagnostic tools could be developed for children. PMID:21636778

  18. 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 ...

  19. Mini-Stroke vs. Regular Stroke: What's the Difference?

    Science.gov (United States)

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

  20. 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

  1. Stroke syndromes in young people.

    Science.gov (United States)

    Chambers, B R; Bladin, P F; McGrath, K; Goble, A J

    1981-01-01

    All contributory factors to the unusual occurrence of stroke in young people were evaluated in patients under age 40 admitted to the Stroke Unit of the Austin Hospital in Melbourne, Australia. Over the August 1977 to December 1980 period there were 700 admissions. Of these 14 patients were under the age of 40. There were 7 males and 7 females whose ages ranged from 17-38 years. Each patient was screened for factors which might contribute to premature vascular disease including hypertension, diabetes, smoking, obesity, and hyperlipidemia. In addition, the following tests were performed to exclude an arteritic process: full blood examination; ESR; protein electrophoresis; syphilis serology; and the presence of antinuclear factor. Each of the 14 patients suffered cerebral infarction. A summary of each case is presented in a table. In 9 patients, infarction occurred in the carotid territory of supply. Large cortical infarcts with or without subcortical involvement occurred in cases 1-8, of whom 5 had major vessel occlusion demonstrated angiographically and another had stenosing and ulcerative atheromatous disease at the extracranial carotid bifurcation. In a further 4 patients, infarction occurred within the vertebrobasilar territory and was either confined to the brain stem, the occiptal cortex, or involved both. Angiograms were performed in 2 of these patients and showed irregular narrowing of the vertebral artery which was interpreted as spasm and segmentally narrowing of the basilar artery. The final patient had several ischemic events which included right sided amaurosis fugax, and left frontal, right parieto-occipital and left occipital infarctions. Angiography was normal. All patients survived the stroke and were able to go home. There may be an interrelationship between the pathological findings of Irey et al. (1978) and the effect oral contraceptives (OCs) has on migraine. This is relevant to Case 13. Sustained exposure to OCs may produce the pathological

  2. Implementation of evidence-based stroke care: enablers, barriers, and the role of facilitators

    Directory of Open Access Journals (Sweden)

    Purvis T

    2014-09-01

    Full Text Available Tara Purvis,1,2 Karen Moss,2 Sonia Denisenko,3 Chris Bladin,2,5 Dominique A Cadilhac1,2,4 1Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Monash Medical Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; 2Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia; 3Commission for Hospital Improvement, Department of Health Victoria, VIC, Australia; 4Department of Medicine, University of Melbourne, Parkville, VIC, Australia; 5Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia Abstract: A stroke care strategy was developed in 2007 to improve stroke services in Victoria, Australia. Eight stroke network facilitators (SNFs were appointed in selected hospitals to enable the establishment of stroke units, develop thrombolysis services, and implement protocols. We aimed to explain the main issues being faced by clinicians in providing evidence-based stroke care, and to determine if the appointment of an SNF was perceived as an acceptable strategy to improve stroke care. Face-to-face semistructured interviews were used in a qualitative research design. Interview transcripts were verified by respondents prior to coding. Two researchers conducted thematic analysis of major themes and subthemes. Overall, 84 hospital staff participated in 33 interviews during 2008. The common factors found to impact on stroke care included staff and equipment availability, location of care, inconsistent use of clinical pathways, and professional beliefs. Other barriers included limited access to specialist clinicians and workload demands. The establishment of dedicated stroke units was considered essential to improve the quality of care. The SNF role was valued for identifying gaps in care and providing capacity to change clinical processes. This is the first large, qualitative multicenter study to

  3. 6th July 2010 - United Kingdom Science and Technology Facilities Council W. Whitehorn signing the guest book with Head of International relations F. Pauss, visiting the Computing Centre with Information Technology Department Head Deputy D. Foster, the LHC superconducting magnet test hall with Technology Department P. Strubin,the Centre Control Centre with Operation Group Leader M. Lamont and the CLIC/CTF3 facility with Project Leader J.-P. Delahaye.

    CERN Multimedia

    Teams : M. Brice, JC Gadmer

    2010-01-01

    6th July 2010 - United Kingdom Science and Technology Facilities Council W. Whitehorn signing the guest book with Head of International relations F. Pauss, visiting the Computing Centre with Information Technology Department Head Deputy D. Foster, the LHC superconducting magnet test hall with Technology Department P. Strubin,the Centre Control Centre with Operation Group Leader M. Lamont and the CLIC/CTF3 facility with Project Leader J.-P. Delahaye.

  4. 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.

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

    OpenAIRE

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

    2007-01-01

    Abstract Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. S...

  6. 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.

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

    OpenAIRE

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

    2014-01-01

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

  8. Prevalence and impact of disability and sexual dysfunction on Health-Related Quality of Life of Nigerian stroke survivors.

    Science.gov (United States)

    Oyewole, Olufemi O; Ogunlana, Michael O; Gbiri, Caleb A O; Oritogun, Kolawole S

    2017-10-01

    To investigate the impact of disability and sexual dysfunction on Health-Related Quality of Life (HRQoL) among Nigerian stroke survivors (SSv) and to determine their association using sexual functioning (SF), Global Disability Measure and Function (GDMF), and demographic profiles. This study involved 121 consecutive SSv attending healthcare services in two tertiary health facilities in Nigeria. Demographic details were obtained through interview while HRQoL, SF, and Global Disability (GD) were assessed using Stroke-Specific Quality of Life (SS-QoL-12), Changes in Sexual Functioning Questionnaire (CSFQ-14), and World Health Organization Disability Assessment Schedule (WHODAS-2.0), respectively. Determinants of HRQoL were explored using the Poisson regression analysis. Most of the SSv had moderate/severe GD (95%) and low SF (86.8%). Their HRQoL decreased with increase in their age (p = 0.005) and with increase in GD (p = 0.001). This association remained unchanged even when adjusted for SF (p = 0.001). Those with low SF but with mild GD had relatively better HRQoL than those with moderate/severe GD even when they had higher SF. Their HRQoL was negatively impacted by their GD but not by their SF despite direct correlation between SF and HRQoL. With a unit increase in level of GD, there was 8% decrease in HRQoL scores in psychosocial and 17% decrease in physical domains. Although sexual dysfunction and global disability are prevalent among Nigerian SSv, their low HRQoL is determined by their disability and not by SF. Hence, effort at reducing global disability should be the focus of rehabilitation after stroke. Implication for Rehabilitation Global functional and sexual deficiencies abound in stroke survivors and they impact negatively on their overall quality of life. Sexual dysfunction correlates negatively on physical and psychosocial wellbeing of stroke survivors. Rehabilitation goal(s) should focus disability reduction and improvement of sexual

  9. Rasch Analysis of a New Hierarchical Scoring System for Evaluating Hand Function on the Motor Assessment Scale for Stroke

    Directory of Open Access Journals (Sweden)

    Joyce S. Sabari

    2014-01-01

    Full Text Available Objectives. (1 To develop two independent measurement scales for use as items assessing hand movements and hand activities within the Motor Assessment Scale (MAS, an existing instrument used for clinical assessment of motor performance in stroke survivors; (2 To examine the psychometric properties of these new measurement scales. Design. Scale development, followed by a multicenter observational study. Setting. Inpatient and outpatient occupational therapy programs in eight hospital and rehabilitation facilities in the United States and Canada. Participants. Patients (N=332 receiving stroke rehabilitation following left (52% or right (48% cerebrovascular accident; mean age 64.2 years (sd 15; median 1 month since stroke onset. Intervention. Not applicable. Main Outcome Measures. Data were tested for unidimensionality and reliability, and behavioral criteria were ordered according to difficulty level with Rasch analysis. Results. The new scales assessing hand movements and hand activities met Rasch expectations of unidimensionality and reliability. Conclusion. Following a multistep process of test development, analysis, and refinement, we have redesigned the two scales that comprise the hand function items on the MAS. The hand movement scale contains an empirically validated 10-behavior hierarchy and the hand activities item contains an empirically validated 8-behavior hierarchy.

  10. Child-Mediated Stroke Communication: Findings from Hip Hop Stroke

    Science.gov (United States)

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

    2011-01-01

    Background and Purpose Low thrombolysis rates for acute ischemic stroke is linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether “Child-Mediated Stroke Communication” (CMSC) could improve stroke literacy parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke (HHS). Methods Parents of children aged 9 to 12 years from two public schools in Harlem, NYC, were recruited to participate in stroke literacy questionnaires before and after their child’s participation in HHS, a novel CMSC intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week following the intervention. Results Fifth and Sixth grade students (n =182) were enrolled into HHS. 102 parents were approached in person to participate; 75 opted to participate and 71 completed both pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program: before the program, 3 parents of 75 (3.9%) were able to identify the five cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911), compared to 21 of 71 parents (29.6%) post-intervention (pstroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that schoolchildren aged 9-12 may be effective conduits of critical stroke knowledge to their Parents. PMID:22033995

  11. Natural Gas Storage Facilities, US, 2010, Platts

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Platts Natural Gas Storage Facilities geospatial data layer contains points that represent locations of facilities used for natural gas storage in the United...

  12. 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.

  13. 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.

  14. Developing a community-based stroke prevention intervention course in minority communities: the DC Angels Project.

    Science.gov (United States)

    Covington, Carolyn Frances; King, Joyce A; Fennell, Irnise; Jones, Chanel; Hutchinson, Charmaine; Evans, Annette

    2010-06-01

    Despite advances in stroke treatment in the United States, stroke remains the third leading cause of death among Americans and the leading cause of serious, long-term disability in the United States. About 780,000 Americans will have a new or recurrent stroke this year. Each year, about 60,000 more women than men have a stroke. African Americans have almost twice the risk of first-ever strokes compared with Whites. Minority populations are less likely to know all stroke symptoms and far less likely to know all heart attack symptoms. There are many benefits of early treatment of stroke, yet most minorities do not get this treatment because they do not recognize the warning signs, risk factors, and prevention of stroke. The objective of this intervention course was to increase the students' knowledge and awareness of stroke, warning signs, risk factors, and prevention. Developing community-based stroke prevention intervention courses in minority communities is a good strategy to reduce morbidity and mortality and help to eliminate health disparities in minority communities.

  15. Diabetes, Heart Disease, and Stroke

    Science.gov (United States)

    ... Disease, & Other Dental Problems Diabetes & Sexual & Urologic Problems Diabetes, Heart Disease, and Stroke Having diabetes means that ... help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood ...

  16. The obesity paradox in stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

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

  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 routin