Despite significant decrease in mortality in stroke since 1950, the annual incidence of strokes in thegeneral population remains at 1 or 2 per 1000 each year. There is an estimated of 50 000 new cases ofstroke in Canada annually. There are approximately six to eight survivors of stroke per 1000 each year.Patients live an average of 7 years after stroke.There appears to be low levels of knowledge of both risk factors and stroke warning signs among bothhigh- and low-risk populations. Usually, knowledge about stroke risk factors is por, and as in myocardialinfarction, delays from symptom onset to decision to seek medical attention are the most significantcauses of delay in patients with stroke.The most frequent symptoms are compatible with diagnoses of stroke, transient ischemic attack,intracerebral hemorrhage, or subarachnoid hemorrhage. It is common for the patients don't be unableto respond to questioning due to speech difficulties or an impaired mental status. Non-stroke diagnosesincluded dizziness/ataxia, seizure, dysarthria not otherwise specified (NOS), numbness NOS, syncope,migraine headache, anxiety, subdural hematoma, visual disturbances NOS, hepatic encephalopathy,alcoholic amnesic syndrome, acute poliomyelitis, soft tissue pain NOS, dementia, and other braincondition NOS. The non-stroke patients were like those with a final diagnosis of stroke in terms of age,race, and sex.Supposedly, interventional thrombolytic stroke therapy (recombinant tissue plasminogen activator) isoptimally effective only when administered within 3 hours of the onset of the vascular event.The pharmacological modulation of the unsuspected capacity of eukaryotic cells to generate their ownoxygen, dissociating the water molecules contained inside the cells, as in plants, opens new horizonsregarding the prevention and treatment of one of the most epidemiologically important diseases.

ABSTRACTBackgroundGrowing evidence suggests a close association between circulating micronutrient levels and neuroimmune diseases. Nevertheless, the causal relationship between them remains unclear. Furthermore, due to confounding factors, many micronutrients implicated in these diseases remain unidentified. This study aimed to determine the causal relationship between circulating micronutrients and neuroimmune diseases through genetic association analysis, and to analyze the regulatory role of circulating micronutrients in neuroimmune diseases.MethodIn this study, we used a two‐sample mendelian randomization (MR) analysis to explore the causal relationship between micronutrients levels and neuroimmune disease. Fourteen micronutrients were screened from a published genome‐wide association study (GWAS). Neuroimmune diseases include multiple sclerosis (MS), Guillain–Barre syndrome (GBS), acute disseminated encephalomyelitis (ADEM), acute poliomyelitis (AP), sequelae of poliomyelitis (SP), optic neuritis (ON), and myasthenia gravis (MG). Data on these seven neuroimmune diseases came from the FinnGen database and included 5523 cases and 2,860,006 controls. The inverse variance weighting (IVW) method was used as the main MR analysis method, and sensitivity analysis was performed to determine MR hypotheses.ResultsThrough MR analysis and sensitivity testing, we identified significant causal relationships between four neuroimmune diseases and micronutrient levels. Specifically, MS was causally associated with magnesium levels (OR: 0.467, 95% CI: 0.269–0.809, p = 0.007), ADEM with folate levels (OR: 0.022, 95% CI: 0.001–0.957, p = 0.047), ON with vitamin B6 levels (OR: 0.382, 95% CI: 0.187–0.778, p = 0.008), and MG with iron levels (OR: 0.194, 95% CI: 0.043–0.867, p = 0.032). Sensitivity analysis showed that there was no level pleiotropic or heterogeneity in our study results.ConclusionThis study established the causal relationship between micronutrients and neuroimmune diseases. These findings provide new insights into the etiology of neuroimmune diseases and provide a theoretical basis for micronutrient regulation, prevention, and treatment of neuroimmune diseases.

Background: Acute poliomyelitis is a disease of the anterior horn cells caused by the highly infectious poliovirus. Over recent decades, advancements in medical knowledge and vaccine development have significantly reduced the incidence of paralytic poliomyelitis worldwide, including in Malaysia. However, in October 2019, a case of poliomyelitis was reported in Tuaran, Sabah, marking the emergence of circulating vaccine-derived polioviruses (cVDPVs) in the country. This study aims to describe the clinical presentations of acute poliomyelitis caused by circulating vaccine-derived poliovirus type 1 (cVDPV1) in children. Methods: Data for this case series were obtained through a review of medical records and investigations of all children diagnosed with acute poliomyelitis during the cVDPV1 outbreak in Sabah, from October 2019 to January 2020. Results: Among six patients evaluated, four were confirmed cases of poliomyelitis, while two were classified as polio-compatible cases. All patients were male, with ages ranging from 3 months to 11 years. The majority were children of immigrants with a history of inadequate or no immunization. Fever was the most common initial symptom, followed by asymmetric flaccid paralysis. Two patients developed spinal-bulbar poliomyelitis, resulting in prolonged hospitalization. All patients experienced disabling paralysis, with one child requiring permanent ventilatory support. Poliovirus isolates from confirmed cases were identified as cVDPV1 strains, with nucleotide divergence ranging from 3.6% to 3.8%. Conclusion: The cVDPV1 poliomyelitis outbreak in Sabah underscores the severe consequences of the disease, particularly among vulnerable and socioeconomically disadvantaged populations.

Poliomyelitis is an acute infection caused by a poliovirus. Polio virus reaches, in a small percentage of cases to the central nervous system, causing the appearance of viral meningitis which progress to complete healing, or it can reach to the motor neurons from the anterior spinal horn, evolving to acute paralyzing poliomyelitis. Some patients affected by this virus can develop a post-polio syndrome (PPS), which manifests most frequently-through intense fatigue, recent muscular deficiency myalgia, arthralgia. Halstead introduced the term “post-polio syndrome” in 1986. In the literature, are often used terms, in addition to post-polio syndrome “late effects of polio” and “postpolio muscular atrophy”. Although is not a frequently encountered condition, it is present in the rehabilitation departments. We present the case of a 75 years old patient, with poliomyelitis sequelae and recovery treatment applied.

Cinoterapia is a type of alternative therapy, which is used dogs as therapeutic coadjovantes to improve mental and motor of various pathologies such as paralysis from trauma, infantile paralysis, various syndromes, with a few minutes of weekly visits to a synergy happens between patient and animal through the affection of love, there are significant improvements, representatively lowering medication use. The investigation of the benefits of Animal Assisted Therapy are important because before the medical community validate the need for its implementation as an alternative therapy. Aiming to evaluate the acceptance of animal-assisted therapy in Teresópolis, TJ research was conducted with 50 patients from physiotherapy clinics. There was 100% acceptance of the application of assisted therapy.

Postpoliomyelitis syndrome (PPS) is defined as secondary onset of new neuromuscular symptoms, following recovery from an initial episode of Acute Anterior Poliomyelitis with no other possible causes, which may lead to altered quality of life. To assess the quality of life (QoL) of Tunisian PPS patients and determine its associated factors. A cross-sectional study conducted over a 24 month period. Sociodemographic variables as well as clinical data evaluating the severity of PPS and QoL were collected using SF-36 scale. Associations between different clinical variables and QoL were studied. We included 45 patients with a mean age of 52.4 ± 7.5 years. All aspects of QoL were affected. The most affected domain was PF with an average score of 32.5±11.8. QoL was better for the mental component (MCS) compared to the physical component (PCS) with mean scores of 43.7±7 and 35.6±12.1 respectively. The alteration of the PF and MH domains was significantly associated with MCS score (p = 0.01 and r = -0.38) and increased BMI (p = 0.04; r = -0.31). Pain intensity was associated with an alteration of all the domains of QoL except for the RP domain. QoL was significantly associated with Functional capacity (p = 0.018 and r = 0.35) and vitality (p = 0.038; r = 0.31). Conclusion: All aspects of QoL were affected in PPS patients. The general PCS component was the most affected and the PF domain was the most affected.

Appreciating Frida Kahlo’s paintings requires courage, empathy, and strong psychological resil-ience, as she does not hide the excruciating pain and despair in her life. She spread her bloody wounds naked on the canvas, and all her scars seemed to shimmer with a strange luster in her self-portraits. However, she did not beg for sympathy or pity, she only sincerely expressed her genuine feelings for physical and mental pain. Frida Kahlo suffered infantile paralysis since her childhood, when she was 18 years old, a tram accident destroyed her whole life. In the later years, she experienced an unexpected miscarriage and was told that she could not give birth to children any longer; and she stayed unbelievable long time in bed due to several failed surgeries and horrible health condition. However, none of the above has stopped her to paint. This article fo-cuses on her five paintings composed in 1932, 1944, 1945 and 1946, which highlight an obvious and strong connection between the pain and artistic inspiration. The profound compositions, backgrounds, details, sym-bols, metaphors, and contrasts of light and shadow have transformed the pain she experienced into an art that implies patience.

Poliomyelitis is an acute infectious disease caused by poliovirus in childhood. After the onset of acute poliomyelitis, weakness of limbs occurs 15 to 30 years later, which is defined as post-polio syndrome. Poliomyelitis accompanying head and neck cancer is rare. Microvascular reconstruction is a well-established procedure following extensive tumor resection. Donor-site selection for flap harvest is a very important issue in paralyzed patients, particularly in patients with post-polio syndrome. To date, limited information is available regarding flap harvest in paralyzed patients. We present a case of a 70-year-old male who presented with oral squamous cell carcinoma of the tongue, with both lower extremities paralyzed due to childhood poliomyelitis. Reconstruction was successfully performed with an anterolateral thigh flap despite extensive muscle atrophy. The sizes of the vascular pedicle and the cutaneous perforators were anatomically similar to the ones of healthy limbs. Both donor and recipient sites healed uneventfully; however, a postoperative complication due to pneumonia occurred. The present case demonstrates that flap harvest from paralyzed limbs in post-polio syndrome is safe, which is in line with the sparse evidence from the literature. However, our attention should be drawn to postoperative respiratory complications and management. In order to avoid postoperative complications, it is essential to undertake a precise preoperative assessment.

In the 1940s and 1950s there was significant attention given to the prevention of poliomyelitis (infantile paralysis) in the United States. Ongoing research led to the development of both a ‘killed’ virus vaccine and a live virus vaccine. Researchers made meaningful contributions to the implementation of effective vaccinations in order to eradicate this disease. However, the quiet story is that those researchers required the participation of people in institutions, most often people with intellectual and developmental disabilities, as test subjects. These individuals were critical contributors to the goal of developing and applying the vaccine. As volunteers or not, with permission granted or not, they are necessarily part of story of the success of the development of the polio vaccination.

<i>Background:</i> Acute poliomyelitis has been the ground for several epidemic outbreaks over many years and caused high mortality as well as permanent acute flaccid paralysis. However, the disease is under control nowadays thanks to a well elaborated surveillance strategy. The objective of this study is to evaluate the epidemiologic surveillance system for acute flaccid paralysis in the Bogodogo health district from 2016 to 2018.<i> Methods</i>: We conducted a cross-sectional evaluation with a quantitative approach over a period of 3 years going from January 1<sup>st</sup> 2016 to December 31<sup>st</sup> 2018. Based on the collected data, we estimated the surveillance indicators of the world health organization and the Atlanta Center for Disease Control. The analysis of indicators and surveillance delays did allow the assessment of quality and performance of the surveillance system. <i>Results:</i> During our study time in the Bogodogo health district, we recorded 45 suspected cases of acute flaccid paralysis. The key performance indicators, except for two of them (Proportion of samples that were collected in the laboratory within 72h after collection and proportion of active surveillance reports received) were meeting the criteria of the world health organization. The sensitivity and the positive predictive value were respectively of 94% and 100%. However, the laboratory results were incomplete, only representing 18% of cases, and the mean delay for sample transport to the laboratory was of 11 days which was out of normal range according to the world health organization. <i>Conclusion</i>: Our results show a satisfying global performance of the surveillance system in the Bogodogo district, but the implementation of our recommendations will help improve the current practices.

Acute flaccid paralysis (AFP) caused by acute anterior poliomyelitis (AAP) remains endemic in some Asian and African countries, particularly Niger. Performance indicators defined by the WHO are used to evaluate the AFP surveillance system in affected countries. The objective of this study is to assess its outcomes in Niger from 1998 to 2021. The objective of this study is to assess its outcomes in Niger from 1998 to 2021. This is a cross-sectional study based on all secondary data from AFP case surveillance reported to the Directorate of Surveillance and Epidemic Response in Niger, over a 24-year period from 1998 to 2021. The sample included 9,659 patients of all ages and sexes. The sex ratio was 1.23, and 92.01% of patients were under 5 years old. The Maradi region ranked first among Niger's eight regions in terms of reported cases (32.27%). It hosts a large portion of the population from neighboring Nigeria, a country also endemic for AFP. More than half of the patients (66.59%) had received 1 to 10 doses of oral polio vaccine. From 1998 to 2021, 8,419 stool samples from 9,494 cases (88.70%) were usable upon arrival at the laboratory. Confirmed and compatible poliovirus cases accounted for 0.80% and 2.35%, respectively. Of the 276 patients who presented with paralysis, 71.73% suffered from paralysis in both limbs, and in 94.35% of the cases, the paralysis had progressed within 3 days. This study allowed for an analysis of the performance of the active AFP surveillance system. In Niger, this surveillance is acceptable according to performance indicators, but there is still much progress to be made at both the population level and within the healthcare workforce.

This literature review describes the evolution of ideas about indications for tonsillectomy in children from the early 20th century to the present. Tonsillectomy has been used as a treatment option for more than 3,000 years and remains one of the most common surgical procedures today, but there is still no consensus on the indications for total tonsillectomy and criteria for outcome evaluation. In many countries, including the Russian Federation, the priority of protecting children’s health is one of the basic principles of healthcare, so the question of when to perform tonsillectomy in children is particularly relevant. Researchers believe that no other procedure was performed in children as frequently as tonsillectomy in the first half of the 20th century. During the polio epidemic of the 1950s and 1960s, the number of tonsillectomies performed declined due to a suspected link between the surgery and bulbar poliomyelitis. Later, the discovery of antibiotics and active immune system research changed the approach to tonsillectomy. The available foreign literature describes two main indications for tonsillectomy in children: obstructive sleep apnea and recurrent infection, with obstruction becoming a more important indication in younger children. However, many authors report that the number of tonsillar complications is currently rising, probably due to a shift away from predominantly surgical treatment of tonsillar disorders. Although the history of tonsillectomy goes back several thousand years, there are no consensus guidelines for the treatment of tonsillar disorders in children, so further research are required.

PurposeConsidering the re-emergence of poliomyelitis (PM) in non-endemic regions, it becomes apparent that vaccine preventable diseases can rapidly develop epi- or even pandemic potential. Evaluation of the current vaccination status is required to inform patients, health care providers and policy makers about vaccination gaps.MethodsBetween October 28 2022 and November 23 2022, 5,989 adults from the VACCELEREATE Volunteer Registry completed an electronic case report form on their previous PM vaccine doses including number, types/-valencies and the time of administration based on their vaccination records. A uni-/multivariable regression analysis was performed to assess associations in participant characteristics and immunization status.ResultsAmong German volunteers (n = 5,449), complete PM immunization schedule was found in 1,981 (36%) participants. Uncertain immunization, due to unknown previous PM vaccination (n = 313, 6%), number of doses (n = 497, 9%), types/-valencies (n = 1,233, 23%) or incoherent immunization schedule (n = 149, 3%) was found in 40% (n = 2,192). Out of 1,276 (23%) participants who reported an incomplete immunization schedule, 62 (1%) never received any PM vaccine. A total of 5,074 (93%) volunteers reported having been vaccinated at least once and 2,087 (38%) indicated that they received vaccination within the last ten years. Female sex, younger age, as well as availability of first vaccination record were characteristics significantly associated with complete immunization (p < 0.001).ConclusionFull PM immunization schedule was low and status frequently classified as uncertain due to lack of details on administered doses. There is an obviousneed for improved recording to enable long-term access to detailed vaccination history in the absence of a centralized immunization register.

Abstract Murine ꞵ-coronavirus, RSA59, infection results in meningoencephalitis, demyelination, and axonal loss. CD40-CD40L dyad serves as an important immune checkpoint regulator during this disease pathobiology. C57BL/6 WT, CD4-/-, CD40L-/- and CD40-/- mice were intracranially inoculated with RSA59 to study the acute phase neuroinflammation and chronic phase demyelination. Studies suggested that CD4+ T cells play a protective role against RSA59-induced demyelination because, in the absence of CD4 gene, mice were more susceptible to acute poliomyelitis and chronic demyelination with axonal bulbar vacuolation. CD40L expressed by CD4+ T cells is crucial for host immunity against RSA59. Without CD40L in activated CD4+ T cells, RSA59-infected mice experience increased disease severity, dampened microglia/macrophage activation, reduced T cell infiltration in the CNS, and impaired T cell priming in the cervical lymph node. In the chronic phase, extensive CNS virus replication leads to severe demyelination and axonopathy due to altered microglia/macrophage populations caused by the absence of the CD40L gene. CD40-deficiency revealed increased acute phase encephalitis in the RSA59-infected groups due to increased infiltrating neutrophils, leading to heightened bystander neuroinflammation. Hence, it is evident that the RSA59-induced demyelination model elucidates an extensively robust innate immune system upon which adaptive immunity is built during the chronic stage of infection.

&lt;p&gt;According to World Health Organization, Pakistan and Afghanistan are the last bastions of Poliomyelitis. Rest of the world has become Polio Free. They achieved this freedom after becoming part of Polio Eradication Initiative which was created in 1988 just after the World Health Assembly resolved to eradicate Polio Myelitis from the globe. The woes of Pakistan do not end here. According to &amp;ldquo;Health Financing Progress Matrix Assessment Pakistan 2023. Summary of findings and recommendations&amp;rdquo; by World Health Organization, the service coverage index of Pakistan despite showing a consistent surge over the years was still significantly lower with a score of 45 against an average of 58 amongst the low middle income group countries in year 2021. This calls for a need to revisit our strategic policy making in all spheres of life but especially in health and health education. Dr Vaqar Ahmed in&amp;nbsp;&lt;a href="https://global.oup.com/academic/product/pakistans-agenda-for-economic-reforms-9780199406050?cc=au&amp;amp;lang=en&amp;amp;"&gt;Pakistan&amp;rsquo;s Agenda of Economic Reforms&lt;/a&gt;, identified that this country faces a serious and lingering lack of institutional arrangement within our framework for research-based policy formulation, and post implementation feedback.&lt;/p&gt;

Lessons learned from the successful polio vaccine experience not learned or applied with the development and implementation of the COVID-19 vaccines.

Objective: This study was conducted to determine the clinical characteristics and differential diagnosis of individual cases of acute flaccid paralysis (AFP) reporting to tertiary care teaching hospital of Jaipur. Methods: This prospective observational study was conducted among patients attending outdoor, indoor, and neurology clinics with provisional diagnosis of AFP. The diagnosis was based on the available clinical data, vaccination status, and laboratory results (stool examination, arterial blood gas analysis, thyroid profile, serum electrolytes, electrophysiological studies, cerebrospinal fluid analysis, urinary pH, and imaging). Results: A total of 60 patients were evaluated over a study duration of 1 year. About 81.7% were male. Most common presenting complaint was lower-limb weakness (100%). None of the cases were identified as acute poliomyelitis or polio-compatible. Guillain–Barré syndrome (GBS) was the most common cause of non-poliovirus AFP (75%). Most common nerve conduction velocity findings in our study were bilateral motor axonal affection of common peroneal nerve (55%). Conclusion: The most common cause of AFP was GBS in all age groups. No case was diagnosed as poliomyelitis. All of the patients of GBS had progressive muscle weakness in a roughly symmetrical distribution, with areflexia of lower limbs.

Welcome to the second issue of IASSIST Quarterly for the year 2023 - IQ vol. 47(2). &#x0D; I am very happy with the 'International' in IASSIST. It is important to learn from outside your own center. In this issue we have a focus on the United States and some African countries with a special focus on South Africa. The first article investigates LibGuides across the many states of the United States. The second article is centered on one of the data resources often found in the LibGuides pages, but the data itself is about all of the United States. In the third article we shift to the African continent and the described project has a base in South Africa with a connection to the United Kingdom - still part of Europe although not of the EU - and with research being conducted in several African countries. We can't promise to cover the whole world in each IQ issue – but this issue is quite international. &#x0D; The first article is 'Taking count: A computational analysis of data resources on academic LibGuides in the U.S.'. Cody Hennesy, Alicia Kubas and Jenny McBurney have undertaken the task of collecting links to data and statistical resources from over 10,000 LibGuide pages at 123 R1 research institutions in the United States. The LibGuides platform has become the universal resource discovery platform in academic libraries in the U.S. LibGuides not only support researchers, they also help librarians in orientation among the many resources. The authors reach the conclusion that freely available resources from U.S. government agencies are the most widely used. Resources requiring paid licenses or memberships (like ICPSR) are also frequent. The analysis suggest traditional licensed statistical resources are more likely to be shared than complex microdata resources. Data cleaning of the nearly 200,000 links from the 10,000 guide pages was an essential part of the analysis. The authors cite the data scientist joke that 90% of the work is data cleaning, and they find that the actual number for the cleaning and normalization in this analysis was even larger, performed through Python and OpenRefine. The data process included accessing the LibGuide pages based on the keywords of 'data' and 'statistic' and then extracting the content links. The links were then cleaned, filtered and further normalized. The data cleaning showed a high degree of inconsistency and dead links, leading the authors to suggest a more centralized management of data resources. The most frequently found links to resources are through ICPSR and data.gov, and a table with the 20 most common resources shows that even the most uncommon resource among these 20 are included in more than 73% of the institutions. This demonstrates a high consistency across the institutions. However, the authors remark that they believe that the very few institutions that didn’t include a link to the popular data.gov would benefit from having information about this resource available for their researchers. Cody Hennesy and Jenny McBurney are the Journalism &amp; Digital Media Librarian and a Social Sciences Librarian at the University of Minnesota, Twin Cities, and Alicia Kubas is a librarian at the U.S. Government Publishing Office.&#x0D; The second article concerns metadata from IPUMS projects at the Institute for Social Research and Data Innovation (ISRDI) at the University of Minnesota (note, these are among the central sources of data LibGuides, mentioned several times in the first article). The authors are Diana L. Magnuson, curator and historian at the Institute for Social Research and Data Innovation, and Wendy L. Thomas, now retired curator from the same institution. The title is 'Expanding our perspective: building a sustainable metadata culture'. The article describes the learning obtained by ISRDI through the submission of an application for certification to the Core Trust Seal (CTS). When applying for certification the institution must document that it follows the standards and guidelines for the certification. In the case of the CTS - as in many other cases of certification - the building of a portfolio of documentation of procedures makes the applicant more self-aware of its history, as well as of the routines delivering the final products. The conclusion is also that the certification process has led to a better internal understanding at the ISRDI that can support future development as well as preserve the work done. IPUMS has over the last thirty years created the world’s largest accessible database of census microdata starting with the 1880 Historical Census Project that has been extended in both time directions and now covering more than a hundred years. Naturally, processing of data has changed over the years and keeping track of the documentation proved difficult. The decision to use digital object identifiers (DOIs) led to a persistency and uniqueness that supported the users. This also had internal benefits as references and publications were more easily trackable and the preservation work more accurate and complete for each product version. Among the figures of the article, you will find the workflow using the open archival information system (OAIS) model as well as the IPUMS business process model.&#x0D; The third article concerns the dilemma of personal data protection versus the benefit of using data for life improvement. The title of the submission is 'Data management instruments to protect the personal information of children and adolescents in sub-Saharan Africa' and concerns health research in this group. On the one hand the researchers naturally must follow the data regulations as they appear in the Protection of Personal Information (POPI) Act in South Africa and the General Data Protection Regulation (GDPR) in the European Union, and with special attention to high-risk and vulnerable groups such as children and adolescents. On the other hand, these vulnerable groups are also at risk from a health viewpoint, especially from infectious diseases like infantile paralysis, measles and pneumococci. Research and data collected from children has contributed to the development of vaccines, which has led to a dramatic reduction in child mortality and improvements in the quality of life. The project described is a large-scale one that involves many countries and many researchers, making governance and data management crucial to achieving data availability and data security. The article discusses the strategies and instruments used, and addresses the many considerations from both ethical sides and when building a data management plan and decisions on sharing data. The authors behind the article are Lucas Hertzog, Jenny Chen-Charles, Camille Wittesaele, Kristen de Graaf, Raylene Titus, Jane Kelly, Nontokozo Langwenya, Lauren Baerecke, Boladé Hamed Banougnin, Wylene Saal, John Southall, Lucie Cluver, and Elona Toska. Many of these are affiliated to the Centre for Social Science Research at the University of Cape Town in South Africa and some are connected to the University of Oxford. It is important to mention that in addition to the central participation from South Africa and the UK, the project is based on partnerships with researchers in Zambia, Malawi, Nigeria, Lesotho, Tanzania, and Kenya.&#x0D; Submissions of papers for the IASSIST Quarterly are always very welcome. We welcome input from IASSIST conferences or other conferences and workshops, from local presentations or papers especially written for the IQ. When you are preparing such a presentation, give a thought to turning your one-time presentation into a lasting contribution. Doing that after the event also gives you the opportunity of improving your work after feedback. We encourage you to login or create an author profile at https://www.iassistquarterly.com (our Open Journal System application). We permit authors to have 'deep links' into the IQ as well as deposition of the paper in your local repository. Chairing a conference session or workshop with the purpose of aggregating and integrating papers for a special issue IQ is also much appreciated as the information reaches many more people than the limited number of session participants and will be readily available on the IASSIST Quarterly website at https://www.iassistquarterly.com. Should you be interested in compiling a special issue for the IQ as guest editor(s) you can also contact the IQ. Take a look at the instructions, layout, and contact at:&#x0D; https://www.iassistquarterly.com/index.php/iassist/about/submissions&#x0D; On a personal note, I have since 1997 been the editor of the IASSIST Quarterly. All good things must end. New people will take over and improve the journal. I find there have been many improvements in the IQ during my tenure. Special thanks to my good friends Walter and Jane for their work on the journal. For many years, Walter Piovesan helped with layout and production, and he established contact with the Open Journal System staff before retiring from the IQ editorial team. Jane Roberts turned my Danglish into English in my IQ editorials. I am very happy to quit now, especially because you IASSISTers will have very competent replacements in Michele Hayslett and Ofira Schwartz. They have already for long worked behind the scenes at IQ, and have also edited the recent special issue on Systemic Racism. The IQ is in good hands.&#x0D; Karsten Boye Rasmussen - June 2023

This interesting and well-written book documents the beginning of modern intensive care, focusing on polio epidemics in Copenhagen, Denmark, in the 1940s through the 1950s. These epidemics left many patients dead from respiratory failure when polio paralyzed the muscles needed for ventilation. Little could be done then to support these patients. Danish physicians and others developed artificial ventilation, now an essential aid for our many critically ill patients. This book tells that story, how artificial ventilation came to become an essential part of today's critical care. It is a striking story set in wartime (World War II), with conflict between the main characters and great tragedy playing out as epidemics of polio continued in the absence of any preventive measures, such as immunization. And, what a lasting good result finally came! Patients and physicians owe a lot to what the polio epidemics eventually brought to patient care.The author is a critical care anesthesiologist. She is Professor of Anesthesia and Critical Care Medicine at the University of Toronto (Toronto, Canada), and she first learned of Copenhagen's polio epidemics while completing a master's degree in 2001. More reading on polio came to her attention, and then the COVID-19 epidemic began, leading the author to work to document the history of modern critical care. The result is this book. It is set at Copenhagen's Blegdam Hospital, the city's "fever hospital," founded in 1879 to cope with epidemics arriving in the city, brought by those coming to Denmark by sea. The Blegdam was the only hospital for Copenhagen's patients with infectious diseases and so it became the center of the polio epidemics to come. The hospital also became a center for wartime resistance, after Germany invaded Denmark on April 9, 1940.During World War II, the hospital became a place to escape the Nazi occupation. The large hospital's multiple buildings and many hallways and corridors made hiding and escape easily possible. Thousands of Jewish refugees were sent from the hospital on their way to freedom, crossing by sea in small boats to nearby, neutral Sweden, only 20 miles away. Another route of escape came as the war was ending. Sweden's Red Cross negotiated an evacuation of Danish and Swedish prisoners of war from Nazi prison camps in Northern Germany. This was to be done using a convoy of buses. (The buses were painted white so they would supposedly be protected from Allied bombings; the buses would be vulnerable to bombing because they had to drive far into still-occupied northern Germany to reach the prison camps.) The Blegdam Hospital received the 20,000 liberated but starving and desperately sick evacuees when they arrived in Copenhagen in white buses, and cared for the patients until they were physically able to travel on to their next location—and their freedom.Polio epidemics were rarely seen in Denmark until the 1940s. Annual epidemics then began, appearing each fall, "The Autumn Ghost" of the book's title. The polio epidemics presented overwhelming clinical problems, the worst problem being respiratory paralysis. At the time, there were few resources for patients needing ventilation, and the Danish medical staff had little experience with artificial ventilation. (The United States had "iron lungs" for ventilating paralyzed polio patients after October 1928. These expensive and complicated negative pressure devices were provided in the United States by the National Foundation for Infantile Paralysis, the United States's charitable organization dedicated to polio.) The Blegdam hospital had only one iron lung and six cuirass ventilators. (Cuirass ventilators had a hard plastic shell covering the patient's chest; this was connected to a device to generate negative pressure under the plastic shell. Air was drawn into the lungs and exhalation was passive.) These were marginal techniques and were inadequate for the overwhelming numeric need as the polio epidemics continued. Up to 50 patients needing ventilation arrived each day.1In July 1942, polio started to reappear, and the numbers were staggering. In 1944, there were 1,019 cases, 219 of these in Copenhagen itself. The Blegdam Hospital's chief physician, Henry Cai Alexander Lassen, struggled with what to do, but he had no experience with polio. Anesthesiologist Bjorn Ibsen, then working at the University Hospital, had spent 1 yr learning to give anesthesia at the Massachusetts General Hospital in Boston and was introduced there to a simple ventilating system, the Waters to-and-fro circuit, often used for operating room anesthesia in the United States at that time. This involved a reservoir bag, a metal canister to hold soda lime to remove the patient's exhaled carbon dioxide, and a nonrebreathing bag (squeezed to provide a patient breath), an in-line humidifier device, and a gas source. After being in Boston, Ibsen returned to Copenhagen's University Hospital as an anesthetist. He now had much more experience than the other anesthetists in Copenhagen. He was to lead the way to use this effective and inexpensive positive pressure ventilation technique for those paralyzed in the polio epidemics. Ibsen had, at that point, no practical experience with polio, but he did have anesthesia training. And, he had recently read an article in an obscure American medical journal describing successful use of negative pressure ventilation in polio patients in the United States, during polio epidemics in Los Angeles. Although there was strong reluctance on Lassen's part to try a new way to ventilate polio patients, because of the chance of failure and the risk to his position as Chief Physician, he listened to Ibsen's explanations and finally agreed to try his idea, using a simple nonrebreathing system, the Waters to-and-fro system that he had used in Boston. Given the fact that the hospital only had one iron lung and six cuirass ventilators, there was little choice.The next day, 12-yr-old Vivi Ebert became the first polio patient to use the more modern and easier-to-use delivery system Ibsen envisioned. She was hospitalized with polio the day after Ibsen and Lassen met about how to cope with the many polio patients needing ventilation. The simple to-and-fro system Ibsen had used while at Massachusetts General Hospital was comparatively simple and inexpensive. Fortunately, Ibsen chose to measure Vivi's ventilation during the trial, not an easy task at the time. He borrowed an oximeter and a Brinkman Carbovisor (both were early devices for measuring respiratory gases and were not in common clinical use then) to measure exhaled carbon dioxide and so was able to know what was happening precisely, and he would be able to show others. Vivi first had a tracheostomy to access her airway, and then manual ventilation began by Ibsen. The measurements of Po2 and Pco2 visually documented inadequate ventilation when that occurred and documented improved ventilation when therapy (for example, suctioning) was done. Boluses of intravenous pentothal provided anesthesia as needed. Vivi had a rocky course that day and night, but Ibsen was able to handle each situation. The worst was an episode of difficult ventilation that Ibsen was able to improve by giving a modest dose of pentothal. This happened at lunch time, when most of the observing physicians were away. They left for lunch fearing Vivi would not survive Ibsen's care. They returned from lunch to find Vivi sleeping, her situation much improved. Three physicians shared nighttime duties that first night. Then, the needs were recruiting helpers to ventilate patients and getting needed supplies for the anesthesia system, such as medical gases and soda lime. As the epidemic went on, up to 70 patients at one time received ventilation by hand. The manpower demands for the hand-ventilated polio cases were staggering. The medical students were supplemented with dental students and other hospital personnel, as needed.The process of simple hand ventilation during the patients' time of paralysis seemed possible to manage, as the hospital's organization developed. It became clear that some patients would need permanent ventilation, and various long-term facilities were developed for that outside the hospital. Numerous conferences were held, including ones to teach other physicians about care of polio patients. The World Health Organization began courses in Copenhagen on modern anesthesia, and so modern anesthesia and critical care began to spread to more countries. Little Vivi Ebert, the first patient to receive this improved polio care, needed ventilation for the rest of her life. But she lived another 19 yr (!) after her acute polio, taking school examinations, enjoying her family and a well-loved dog, and a brief marriage. What a legacy this brave little girl left!Anesthesiologists will enjoy this book and will have a better understanding of how critical care medicine developed. What a difference the story of polio in Denmark made, and still makes. The author records this story effectively and briskly; it is a delightful read, well worth spending time on.

The infantile cerebral paralysis is a significant medical social problem and economic burden for family, health care system and state economy in general since such children require organization of accessible environment and life-long rehabilitation maintenance. The purpose of the study is content-analysis of normative legal regulation of medical social rehabilitation of children with infantile cerebral paralysis in the Russian Federation. The analysis of main normative legal documents established that medical social rehabilitation is implemented in concordance with norms of international legislation and is regulated by provisions of Federal laws and other normative legal acts of the Russian Federation and its subjects. It was established that despite noticeable progress the legislation in this area has a number of significant shortcomings that adversely affect accessibility for children with cerebral palsy of high-quality and effective services of comprehensive medical social rehabilitation and requires improvement.