Total Number Of Strokes Research Articles

Preliminary evaluation of the digital maze test in relation to neuropsychological tests and AD biomarkers

AbstractBackgroundDigital cognitive tools may provide unique opportunities to detect subtle changes in preclinical Alzheimer’s disease (AD). Here, a maze test using a digital pen was evaluated in relation to AD pathological changes measured by amyloid‐β and tau burden.Method172 participants (CN = 161, MCI = 6, dementia = 5) completed the digital maze test, which included multiple “no‐choice” (NC; i.e., no decisions required to complete maze) or “choice” (CH) conditions (i.e., problem‐solving required to complete maze). Maze composite scores were calculated using the total test duration, total number of strokes, and total pen‐off‐page time for the NC and CH conditions separately. Global amyloid‐β PET was quantified with [11C]Pittsburgh‐Compound‐B (PiB) in available participants (n = 171). Entorhinal and inferior temporal tau were quantified with [18F]Flortaucipir (FTP) in available participants (n = 135). Participants completed a battery of traditional neuropsychological tests, with domain factor scores calculated for Executive Functioning (EF), Processing Speed (PS), and Memory (Mem). The associations between maze composite scores, global amyloid‐β, entorhinal tau, and inferior temporal tau were evaluated in separate linear regression models for both the total sample and CN only, correcting for age and education.ResultIn the total sample, CH‐ and NC‐composites were moderately correlated with PS and EF factor scores (r’s = .41‐.46) and less so with Mem factor scores (r’s = 0.2‐0.35). In the total sample, higher PiB was significantly associated with worse performance in NC‐composite (β = 0.543, SE = 0.249, p <.05), but not for CH‐composite (β = 0.467, SE = 0.259, p = .07). Similar results were observed in the CN only sample (NC‐composite: β = 0.468, SE = 0.237, p <.05; CH‐composite: β = 0.469, SE = 0.278, p = .09). PiB was not associated with EF or PS factor scores in the total sample or CN only. Entorhinal and inferior temporal tau were not significantly associated with any maze composites.ConclusionIn a largely cognitively normal sample, performance on the digital maze test was associated with global amyloid‐β burden, particularly in the no‐choice condition, but not with tau. Digitally captured, nuanced performance in EF and PS may be related to early amyloid‐β pathology, but less so with downstream effects of tau.

Polypill: Benefits Seen for Stroke and Other Outcomes.

A polypill-type strategy for primary prevention was first published at the turn of the century and advised that a multi-ingredient pill applied to an adult population would prevent up to 80% of cardiovascular and stroke events. Such a pill should contain small doses of antihypertensives, lipid-lowering drugs, and some nutrients. The startling increase of the global stroke burden has led to a revival of this concept and the propagation of a population-based prevention strategy. Recent cardiovascular fixed-dose combination trials have shown a significant effect in reducing not only blood pressure and cholesterol levels but also in reducing cardiovascular and stroke events. In most of the studies, the study population was for secondary prevention and the total number of strokes was small. Nevertheless, it is now clear that a large proportion of primary prevention must take this path. It is especially promising when combined with community health workers interventions for modifying risk behavior. While a polypill-type approach seems most efficacious in underserved regions of high-income countries as well as in low- and middle-income countries, it seems to have a large overall effect in spite of some problems with nonadherence or potential side effects. It should be available and affordable for large target populations. Larger phase 4 studies are under way.

Initial Evaluation of the Concept-2 Rowing Ergometer's Accuracy Using a Motorized Test Rig.

IntroductionThe Concept 2 (C2) rowing ergometer is used worldwide for home-based training, official competitions, and performance assessment in sports and science. Previous studies reported a disparate underestimation of mechanical power output positively related to an unclearly defined stroke variability. The aim of this study was to quantify the accuracy of the C2 while controlling for the potentially influencing variables of the rowing stroke by using a test rig for air-braked rowing ergometers and thus excluding biological variability.MethodsA unique motorized test rig for rowing ergometers was employed. Accuracy was assessed as the difference in mechanical power output between C2 and a reference system during steady (i.e., minimal variations of stroke power within a series of 50 spacemark, no -strokes) and unsteady simulated rowing (i.e., persistent variations during measurement series) while manipulating the stroke variables shape, force, or rate.ResultsDuring steady simulated rowing, differences between C2 and the reference system ranged 2.9–4.3%. Differences were not significantly affected by stroke shapes (P = 0.153), but by stroke rates ranging 22–28 min−1 (P < 0.001). During unsteady simulated rowing with alterations of stroke force and rate, mean differences of 2.5–3.9% were similar as during steady simulated rowing, but the random error increased up to 18-fold. C2 underestimated mechanical power output of the first five strokes by 10–70%. Their exclusion reduced mean differences to 0.2–1.9%.ConclusionDue to the enormous underestimation of the start strokes, the nominal accuracy of the C2 depends on the total number of strokes considered. It ranges 0.2–1.9%, once the flywheel has been sufficiently accelerated. Inaccuracy increases with uneven rowing, but the stroke shape has a marginal impact. Hence, rowers should row as even as possible and prefer higher stroke rates to optimize C2 readings. We recommend external reference systems for scientific and high-performance assessments, especially for short tests designs where the start strokes will have a major impact.

Decreased Stroke Applications During Pandemic: Collateral Effects of COVID-19

Objective: Our study aimed to investigate the effects of the pandemic on human behavior and stroke management by comparing hospital admissions made due to stroke during the pandemic period with the same period of the previous year. Materials and Methods: This retrospective study was conducted on patients with stroke admitted to our hospital between April 1st, 2020, and May 31st, 2020, and April 1st, 2019, and May 31st, 2019. Strokes were divided into three subgroups: ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA). The total number of strokes, stroke subtypes, vascular risk factors, sociodemographic and clinical characteristics, National Institutes of Health Stroke Scale (NIHSS) scores, presence of large vessel occlusion, thrombolytic therapy use, intensive care unit requirement, and in-hospital mortality values were compared for both periods. Results: A total of 133 patients, 75 males, 58 females, 44 during the pandemic period and 89 in the previous year, were included in the study. The mean age of the patients was 71.29 +/- 13.12 years. During the pandemic period, compared with the same period one year ago, there was a 50% decrease in the number of strokes, a 44% decrease in the number of ischemic strokes, a 62.5% decrease in the number of intracranial hemorrhages, and an 87.5% decrease in the number of TIA. During the pandemic period, the rate of patients who received intravenous thrombolytic therapy, the rate of patients with large vessel occlusion, the inhospital mortality rate, and the mean NIHSS scores were found to be significantly higher during the pandemic, but the rate of patients who had a minor stroke was significantly lower. Conclusion: The pandemic period has brought along many unknowns. It is a matter of curiosity how the effects of the pandemic on human behavior and functioning in health institutions will affect the diagnosis, treatment, and long-term follow-up of diseases other than coronavirus disease-2019.

Using Smart Sensors to Monitor Physical Activity and Technical-Tactical Actions in Junior Tennis Players.

The use of smart devices to obtain real-time data has notably increased in the context of training. These technological tools provide data which monitor the external load and technical–tactical actions related to psychological and physical health in junior tennis players. The purpose of this paper is to monitor technical–tactical actions and physical activity during a current tennis competition in the Green stage using a Zepp Tennis Smart Sensor 2. The participants were 20 junior tennis players (under 10 years of age), with an average age of 9.46 years. The total number of strokes (n= 21,477) during 75 matches was analyzed. The study variables were the following aspects: (a) number of strokes, (b) ball impact in the sweet spot; (c) racket speed; (d) ball spin; (e) calories burned; and (f) match time. The current system of competition, based on knockout, does not meet the World Health Organization’s recommendations for daily physical activity time. Players mainly used flat forehands with a lack of variability in technical–tactical actions which did not meet the current learning opportunity criteria of comprehensive methodologies. The competition system in under-11 tennis should be adapted to the players’ characteristics by improving the variability and quantity of practice.

Clock Drawing Performance Slows for Older Adults After Total Knee Replacement Surgery.

Clock drawing is a neurocognitive screening tool used in preoperative settings. This study examined hypothesized changes in clock drawing to command and copy test conditions 3 weeks and 3 months after total knee arthroplasty (TKA) with general anesthesia. Participants included 67 surgery and 66 nonsurgery individuals >60 years who completed the digital clock drawing test before TKA (or a pseudosurgery date), and 3 weeks and 3 months postsurgery. Generalized linear mixed models assessed digital clock drawing test latency (ie, total time to completion, seconds between digit placement) and graphomotor output (ie, total number of strokes, clock size). Reliable change analyses examined the percent of participants showing change beyond differences found in nonsurgery peers. After adjusting for age, education, and baseline cognition, both digital clock drawing test latency measures were significantly different for surgery and nonsurgery groups, where the surgery group performed slower on both command and copy test conditions. Reliable change analyses 3 weeks after surgery found that total time to completion was slower among 25% of command and 21% of copy constructions in the surgery group. At 3 months, 18% of surgery participants were slower than nonsurgery peers. Neither graphomotor measure significantly changed over time. Clock drawing construction slowed for nearly one-quarter of patients after TKA surgery, whereas nonsurgery peers showed the expected practice effect, ie, speed increased from baseline to follow-up time points. Future research should investigate the neurobiological basis for these changes after TKA.

Effects of Mistletoe Extract Supplementation on Inflammation Markers after Strenuous Exercise in Rowers

Excessive long-term training and extensive exertion during exercise can inflammatory cytokine expression. Various measures have been explored to minimize this, and dietary supplements having anti-inflammatory and antioxidant functions can help athletes recover from repetitive intensive exercises, thereby preventing reduced vitality. PURPOSE: This study aimed to identify the effect of mistletoe extract consumption on inflammatory markers of university male rowing athletes for 8 weeks during the winter training period. METHODS: This study included 20 male rowing athletes divided into the Korean Mistletoe extract supplement group (KME, n = 10) and the control group (CON, n = 10). The KME group took 110 mL of mistletoe extract every morning and evening after meals (total of 220 mL) for eight weeks. Before and after taking mistletoe for eight weeks, 2,000 m rowing performance capabilities were measured, and KME group took 110 mL of mistletoe extract after recovery from the rowing exercise. Blood samples were collected during the rest, immediately after exercise, and after 30 min of recovery. Among inflammatory markers, IL-6 and TNF-α were analyzed. RESULTS: Both groups showed a significantly reduced 2,000-m rowing time (KME; p<0.001, CON; p<0.01), and the total number of strokes were significantly fewer in the KME group than in the CON group (p<0.05). After supplementation the levels of IL-6 and TNF-α were lower in the KME group than in the CON group in all periods of the rest (p<0.001), immediately after exercise (IL-6; p<0.01, TNF- α; p<0.001), and after 30 min of recovery (p<0.01). CONCLUSION: Therefore, mistletoe extract intake can reduce the serum inflammatory cytokine levels (which are otherwise increased due to high-strength exercise) among active individuals, indicating improved anti-inflammatory activity.

Dipeptidyl Peptidase-4 Inhibitors for the Potential Treatment of Brain Disorders; A Mini-Review With Special Focus on Linagliptin and Stroke.

Cerebral stroke is a leading cause of death and persistent disability of elderly in the world. Although stroke prevention by targeting several risk factors such as diabetes and hypertension has decreased the stroke incidence, the total number of strokes is increasing due to the population aging and new preventive therapies are needed. Moreover, post-stroke acute pharmacological strategies aimed to reduce stroke-induced brain injury have failed in clinical trials despite being effective in animal models. Finally, approximately 30% of surviving stroke patients do not recover from stroke and remain permanently dependent on supportive care in activities of daily living. Therefore, strategies to improve stroke recovery in the post-acute phase are highly needed. Linagliptin is a dipeptidyl peptidase-4 inhibitor which is clinically approved to reduce hyperglycemia in type 2 diabetes. The regulation of glycemia by dipeptidyl peptidase-4 inhibition is mainly achieved by preventing endogenous glucagon-like peptide-1 (GLP-1) degradation. Interestingly, linagliptin has also shown glycaemia-independent beneficial effects in animal models of stroke, Parkinson's disease and Alzheimer's disease. In some case the preclinical data have been supported with some clinical data. Although potentially very interesting for the development of new strategies against stroke and neurodegenerative disorders, the mode of action of linagliptin in the brain is still largely unknown and seems to occur in a GLP-1R-independent manner. The purpose of this mini-review is to summarize and discuss the recent experimental and clinical work regarding the effects of linagliptin in the central nervous system, with special emphasis on acute neuroprotection, stroke prevention and post-stroke recovery. We also highlight the main questions in this research field that need to be addressed in clinical perspective.

Synchronized Two‐Station Optical and Electric Field Observations of Multiple Upward Lightning Flashes Triggered by a 310‐kA +CG Flash

AbstractA positive cloud‐to‐ground (+CG) lightning flash containing a single stroke with a peak current of approximately +310 kA followed by a long continuing current triggered seven upward lightning flashes from tall structures. The flashes were observed on 4 June 2016 at the Tall Object Lightning Observatory in Guangzhou, Guangdong Province, China. The optical and electric field characteristics of these flashes were analyzed using synchronized two‐station data from two high‐speed video cameras, one total‐sky lightning channel imager, two lightning channel imagers, and two sets of slow and fast electric field measuring systems. Three upward flashes were initiated sequentially in the field of view of high‐speed video cameras. One of them was initiated approximately 0.35 ms after the return stroke of +CG flash from the Canton Tower, the tallest structure within a 12‐km radius of the +CG flash, while the other two upward flashes were initiated from two other, more distant tall objects, approximately 18 ms after the +CG flash stroke. The initiation of the latter two upward flashes could be caused by the combined effect of the return stroke of +CG flash, its associated continuing current, and K process in the cloud. Each of these three upward flashes contained multiple downward leader/upward return stroke sequences, with the first leader/return stroke sequence of the second and third flashes occurring only after the completion of the last leader/return stroke sequence of the preceding flash. The total number of strokes in the three upward flashes was 13, and they occurred over approximately 1.5 s.

Impact of the Ageing Population on the Burden of Stroke: The Dijon Stroke Registry

Background: We aimed to evaluate the impact of the ageing population on temporal trends in burden of stroke and to provide projections for the coming years. Methods: Stroke cases (ischemic strokes, spontaneous intracerebral hemorrhages, or undetermined strokes) were prospectively identified between 1987 and 2015 in Dijon, France, using a population-based registry. Age-standardized incidence rates of first-ever and recurrent stroke were calculated, and their temporal trends were assessed using age- and sex-adjusted annual incidence rate ratios (RR). Results: The population of Dijon increased by 3.8% over time, with an increase by 28% in the number of residents aged ≥75 years. We recorded 5,899 strokes including 5,101 patients with a first-ever event. Incidence of first-ever stroke was stable both in people < 75 and ≥75 years old, but an increase in standardized incidence rates of total strokes was noted due to a rise in the incidence of recurrent stroke (from 4.7/100,000/year in 1987–1994 to 12.3/100,000/year in 2009–2015 in people < 75 years old, RR 1.036; p < 0.001; from 74/100,000/year in 1987–1994 to 200/100,000/year in 2009–2015 in people ≥75 years, RR 1.040; p < 0.001). The absolute number of first-ever strokes increased by 43%, and that of total stroke events rose by 58% over time, with a more pronounced increase in people ≥75 years old (+47 and +65% respectively). The annual number of patients who survived > 90 days after a first-ever stroke increased by 90%. According to demographic projections, the total number of strokes will increase by 55% (+65% patients ≥75 years, and +25% patients < 75 years) by 2,030 in Dijon. Conclusions: Ageing and growth of the population led to a rise in the absolute number of strokes, especially in the elderly, that is expected to increase dramatically in the coming years. Improved stroke care was accompanied with an increase in stroke survivors that contributed to a rise in recurrent events. Urgent action is needed to meet this epidemiological challenge.

The role of weather conditions and normal level of air pollution in appearance of stroke in the region of Southeast Europe.

We investigated correlation between the normal level of air pollution, weather conditions and stroke occurrence in the region of Southeast Europe with a humid continental climate. This retrospective study included 1963 patients, 1712 (87.2%) with ischemic (IS) and 251 (12.8%) with hemorrhagic stroke (HS) admitted to emergency department. The number of patients, values of weather condition (meteorological parameters) [air temperature (°C), atmospheric pressure (kPa), relative humidity (%)] and concentrations of air pollutants [particulate matter (PM10), nitrogen dioxide (NO2), ozone (O3)], were recorded and evaluated for each season (spring, summer, autumn, winter) during 2years (July 2008-June 2010). The highest rate of IS was observed during spring (28.9%) (p=0.0002) and HS in winter (33.9%) (p=0.0006). We have found negative Spearman's correlations (after Bonferroni adjustment for the multiple correlations) of the number of males with values of relative humidity (%) (day 0, rho=-0.15), the total number of strokes (day 2, rho=-0.12), females (day 2, rho=-0.12) and IS (day 2, rho=-0.13) with concentrations of PM10 (µg/m3), as well as negative correlations of the number of females (day 2, rho=-0.12) and IS (day 2, rho=-0.12) with concentrations of NO2 (µg/m3) (for all p<0.002). In winter, the number of HS (day 0, rho=0.25, p=0.001) positively correlated with concentrations of O3 (µg/m3). The appearance of stroke has seasonal variations, with the highest rates during spring and winter. Positive correlation between the number of HS and values of O3 requires an additional reduction of the legally permitted pollutants concentrations.

Proxies of energy expenditure for marine mammals: an experimental test of \u201cthe time trap\u201d

Direct measures of energy expenditure are difficult to obtain in marine mammals, and accelerometry may be a useful proxy. Recently its utility has been questioned as some analyses derived their measure of activity level by calculating the sum of accelerometry-based values and then comparing this summation to summed (total) energy expenditure (the so-called “time trap”). To test this hypothesis, we measured oxygen consumption of captive fur seals and sea lions wearing accelerometers during submerged swimming and calculated total and rate of energy expenditure. We compared these values with two potential proxies of energy expenditure derived from accelerometry data: flipper strokes and dynamic body acceleration (DBA). Total number of strokes, total DBA, and submergence time all predicted total oxygen consumption ({boldsymbol{sV}}{{boldsymbol{O}}}_{{boldsymbol{2}}} ml kg−1). However, both total DBA and total number of strokes were correlated with submergence time. Neither stroke rate nor mean DBA could predict the rate of oxygen consumption (smathop{{boldsymbol{V}}}limits^{{boldsymbol{.}}}{{boldsymbol{O}}}_{{boldsymbol{2}}} ml min−1 kg−1). The relationship of total DBA and total strokes with total oxygen consumption is apparently a result of introducing a constant (time) into both sides of the relationship. This experimental evidence supports the conclusion that proxies derived from accelerometers cannot estimate the energy expenditure of marine mammals.

Abstract WP200: Post-operative Infection Does not Increase Risk of Post-operative Stroke: Analysis From a Nationwide Quality Initiative Program

Introduction: Infection has been described as a trigger for acute ischemic stroke, but the relationship between postoperative infection and the risk of postoperative stroke is unclear. We investigated the association between postoperative infection and stroke using the American College of Surgeons National Surgical Quality Initiative Program (NSQIP) database. Hypothesis: Postoperative infection is associated with an increased risk of postoperative stroke. Methods: We used the NSQIP database to identify all patients who underwent surgery between the years of 2000 and 2010 and developed a postoperative stroke within 30 days of surgery. The group was further stratified according to the presence of infection preceding stroke. Using a logistic regression model adjusted for age, race, sex, medical comorbidities, surgical type, and dichotomized functional status, we compared the risk of stroke in patients with and without preceding infections, and investigated the risk of infection following stroke. Results: 729,886 surgical patients were identified, of whom 2,703 (0.3%) developed postoperative stroke. 848 (0.12%) patients developed both postoperative stroke and infection. Among patients who had postoperative stroke, 100 (3.7%) had developed an infection prior to developing a stroke. Patients with infection prior to stroke had a lower risk of stroke than patients who did not develop infection prior to stroke (adjusted odds ratio [OR] 0.25, 95%CI 0.20-0.32). 748 patients (0.1%) developed an infection after having a postoperative stroke. These patients had a higher risk of infection (incidence rate ratio 2.76, 95%CI 2.57-2.97) and a higher odds of infection (adjusted odds ratio [OR] 3.47, 95%CI 3.18-3.78) than patients who did not have a stroke. Conclusions: We found that the presence of a preceding infection was associated with a low risk of postoperative stroke in a large surgical inpatient sample. Although the total number of strokes may have been under-reported, these results conflict with other studies that report that infection is a trigger for ischemic stroke. Further analyses using more granular data are needed to investigate the relationship between postoperative infection and the risk of postoperative stroke.

Clinical evaluations for the masticatory efficiency of heat cure resin and flexible types of denture base materials

The aim of this study was for estimation and comparism of masticatory efficiency in patient wearing heat cured acrylic and flexible base partial denture, finding out the role of peanuts and carrots on the measurement of chewing efficiency, and to find out whether the types of P.D. (being single or two opposing each other) has any effect on the masticatory performance. Materials and methods: Twenty partially edentulous patients were selected. Five of these patients were selected having Kennedy class I with no modification against natural dentition, other 5patients having Cl.I against Cl.I. The other 5 patients having Cl.III against natural dentition and the last 5 patients were with Cl.III against Cl.III. several ways were used for measuring masticatory efficiency including: number of chewing strokes, number of swallows, the mastication time, and measure the masticatory performance by sieving method. Differences between the means of the four groups were analyzed with t-test. Results: The differences between the two denture base types in total number of strokes was significant at (p<0.001) in study group (2,3,4), the study group (4)have the highest mean value of the total number of strokes for acrylic denture during chewing carrots food types(47.6)strokes. The highest mean value of the total chewing time is for the fourth group with the acrylic denture during chewing carrots (35.2 sec.), and the highest masticatory performance index was for the flexible denture in all study groups during chewing the two tested food. Conclusion: The flexible partial denture provide better chewing efficiency than heat cure acrylic partial denture, the masticatory performance was higher for flexible partial denture than heat cure acrylic partial denture, there was significant differences between carrots and peanuts in both flexible and heat cure acrylic partial denture, and patient with single denture show better chewing efficiency than patient with paired denture.

Budget impact analysis resulting from the use of dabigatran etexilate in preventing stroke in patients with non-valvular atrial fibrillation in Italy

Background: atrial fibrillation (AF) is the most common form of alteration in cardiac rhythm and associated with more severe episodes of stroke. Treatment with oral anticoagulants vitamin K antagonists (VKA) such as warfarin, is nowadays the therapy of choice for stroke prevention in patients with AF, but dabigatran etexilate (DE) 150 mg twice daily was more clinically effective than warfarin in reducing the risk of stroke or systemic embolism, ischaemic stroke and vascular mortality whereas DE 110 mg twice daily was non-inferior to warfarin.Aim: to assess the affordability of the use of DE for the Italian NHS, in patients with non-valvular AF (NVAF) through a budget impact analysis (BIA).Methods: the BIA in a timeframe of 5 years was divided into 3 scenarios (1: current management of patients with NVAF; 2: all patients with NVAF treated with VKA; 3: all patients with NVAF treated with DE). The population considered is the one with indication for anticoagulation. Analysis is from the NHS perspective: therefore, indirect costs are excluded.Results: the underuse of oral anticoagulation, associated with the difficulty in keeping the patients treated with VKA within an acceptable therapeutic range, results in an enormous social and human cost, represented by a total of more than 63,000 strokes cumulated in the 5-year period considered. The cumulative cost for the scenario 1 over the 5-year period is over € 2.3 billion. In the scenario 2 the number of strokes avoided per year increases by -5,219 compared to no treatment (-2,368 compared to scenario 1), although the number of events remains high (about 10,000 events/year). In the 5-year observation period the scenario 2 would result in a reduction in the total number of strokes (-12,323 events vs. scenario 1), and savings for the NHS of around 95 million Euros compared to scenario 1. In the Scenario 3 there is a reduction of more than 38,600 of the total cumulative number of strokes vs. the scenario 1 and over 26,200 vs. scenario 2, and savings for the NHS at the fifth year of observation of circa 174 million Euros vs. scenario 1 and 123 million Euros vs. scenario 2.Conclusion: DE in Italy is economically sustainable, as it allows savings for the NHS in the management of patients with NVAF from the second year vs. no treatment and vs. treatment with VKA

A comparison of lightning data provided by ZEUS and LINET networks over Western Europe

Abstract. In the framework of this paper, one-year of lightning data from the experimental network ZEUS operated by the National Observatory of Athens is compared to collocated data provided by the LINET detection network. The area of comparison is limited to a part of Central-Western Europe, where LINET data exhibits the highest data quality, permitting thus to be used as the validation dataset. The location error of ZEUS was calculated to be ~6.8 km, while the detection efficiency was ~25%, with a characteristic under-detection during nighttime. Moreover, the analysis revealed that ZEUS is also capable to detect not only cloud-to-ground but also intra-cloud strokes. Analysis of a specific case study revealed that the spatial distribution of ZEUS was very close to that of LINET, although the total number of strokes as seen by ZEUS is much lower than the one from LINET. The overall analysis permitted to assess the main characteristics of ZEUS network, information considered of paramount importance before the use of ZEUS data for a variety of observational and modeling work.

Glucose Blood Levels as a Therapeutic Target in Acute Ischaemic Stroke Setting

Ischaemic stroke is extremely common in western societies contributing to 70-85% of strokes, one of the leading causes of mortality and long-term disability. Despite advancement in preventive measures, the total number of strokes is set to rise in the future due to increasing numbers of aging populations across the world. Diabetes as a risk factor for stroke has been well established. There are also emerging evidence to suggest glucose level management in acute stroke phase as a therapeutic target may be beneficial, albeit remains controversial. One of the issues in difficulty in interpreting study findings is their heterogeneity. In this article, we provide epidemiological, basic science, clinical observational and trial evidence leading to the current practice of regarding blood glucose as the therapeutic target in acute ischaemic stroke setting.

Cross-Cultural Evaluation of Maternal Competence in a Culturally Diverse Society

“Ms. A” is a 27-year-old recent immigrant from China who was hospitalized twice in her early twenties because of psychotic symptoms. She was treated and maintained on antipsychotic medication at low dosages. Ms. A subsequently had a short-lived relationship with a man who disappeared from her life when he learned that she was pregnant. She decided to carry the pregnancy to term and to keep the child, not an easy decision because she had virtually no family support and few friends. However, she was intelligent and resourceful, lived in a relatively comfortable apartment in Toronto, and was able to support herself and her child on a disability pension. She had a good relationship with her psychiatrist and her social worker. Ms. A’s mother and several siblings lived in the same city, but Ms. A did not perceive them as supportive.

Epidemiology of Complications and Total Treatment Costs from Diagnosis of Type 2 Diabetes in Germany (ROSSO 4)

To determine the occurrence of complications and treatment costs in the first 6 years from diagnosis of Type 2 diabetes in the primary care level. The German multi-centre, retrospective epidemiological cohort study ROSSO observed patients from diagnosis in 1995-1999 until the end of 2003 or loss to follow-up. 192 randomly contacted primary care practices and all patient records of newly diagnosed type 2 diabetes patients. All 3,142 patients insured in a public health insurance plan. Diabetes-related complications were documented from patient files. Treatment costs were attributed using the doctor's tariff, hospital DRGs and medication price lists for Germany. At diagnosis, already 22.4% of patients presented with CHD, 15.4% with CHF, 5.8% with pAOD, 3.1% with stroke and 3.9% with AMI, but less than 0.5% with documented microvascular complications. 7.4% of patients were diagnosed with prior depression and, 5.0% with polyneuropathy. Within a mean of 6.5 years of follow-up 114 patients (3.6%) died. The cumulated occurrence of AMI and stroke rose without a lag phase almost linearly from diagnosis reaching 6.7% for AMI and 7.7% for stroke. The total number of strokes was significantly higher than AMI (181 strokes vs. 109 AMI; p</=0.001). As expected, the rate of microvascular complications was low during this early disease stage but nevertheless reached 2.8 % of patients (amputation, dialysis and blindness combined). Mortality and stroke rates did not differ significantly between sexes but men suffered more frequently from AMI (4.8% men, 2.2% women; p < 0.001). Total costs of diabetes care was 1,288 euro (1,610 $)for the first treatment year with diagnosed diabetes and rose to 3,845 euro (4,806 $) in year seven. Costs for treating complications dominated already in the first year after diagnosis. The mean direct treatment costs amounted to 3,210 euro (4,013 $) per patient and year for the first 6.5 years. ROSSO is the first epidemiological cohort study examining longitudinal epidemiological data of the same patients over more than five years (up to eight years) for type 2 diabetes mellitus in primary care practices, starting from diagnosis. The rate of complications rose linearly from diagnosis without a lag phase. Stroke occurred more often than myocardial infarction, the latter more often in men. Total treatment costs were dominated by costs of treating complications from early on, suggesting a costs saving potential by early detection of diabetes as well as by secondary prevention and patient empowerment in the period following diagnosis.

Performance demands of professional male tennis players

Objective: To quantify the performance demands in professional male tennis. Methods: Games from three grand slam tournaments were analysed by an elite tennis player from video recordings. Game related data...