Stroke

Stroke is a preventable and treatable disease. It can present with the sudden onset of any neurological disturbance, including limb weakness or numbness, speech disturbance, visual loss or disturbance of balance. Over the last two decades, a growing body of evidence has overturned the traditional perception that stroke is simply a consequence of aging which inevitably results in death or severe disability. Evidence is accumulating for more effective primary and secondary prevention strategies, better recognition of people at highest risk and thus most in need of active intervention, interventions that are effective so on after the onset of symptoms, and an understanding of the processes of care that contribute to a better outcome. In addition, there is now good evidence to support interventions and care processes in stroke rehabilitation. In the UK, the National Sentinel Stroke Audits 2,3 have documented changes in secondary care provision over the last 10 years, with increasing numbers of patients being treated in stroke units, more evidence-based practice, and reductions in mortality and length of stay. In order for evidence from research studies to improve outcomes for patients, it needs to be put into practice. National guidelines provide clinicians, managers and service users with summaries of evidence and recommendations for clinical practice. Implementation of guidelines in practice, supported by regular audit, improves the processes of care and clinical outcome. This guideline covers interventions in the acute stage of a stroke (‘acute stroke’) or transient ischaemic attack (TIA). Most of the evidence considered relates to interventions in the first 48 hours after onset of symptoms, although some interventions of up to 2 weeks are covered as well. This guideline is a stand-alone document, but is designed to be read alongside the Intercollegiate Stroke Working Party guideline ‘National clinical guideline for stroke’* which considers evidence for interventions from the acute stage into rehabilitation and life after stroke. The Intercollegiate Stroke Working Party guideline is an update of the 2004 2nd edition and includes all the recommendations contained within this guideline. This acute stroke and TIA guideline is also designed to be read alongside the Department of Health’s (DH) ‘National stroke strategy’ (NSS). Where there are differences between the recommendations made within this acute stroke and TIA guideline and the NSS, the Guideline Development Group (GDG) members feel that their recommendations are derived from systematic methodology to identify all of the relevant literature.

Role of the neurotransmitters dopamine and acetylcholine during the interaction of working memory and attention

Magdeburg, Univ., Fak. für Naturwiss., Diss., 2015

Labour market frictions, social policies, and barriers to technology adoption

Barriers to technological changes have recently been shown to be a key element in explaining differences in output per worker across countries. This study examines the role that labour market features and institutions have in explaining barriers to technology adoption. I build a model that includes labour market frictions, capital market imperfections and heterogeneity in workers' skills. I found that the unemployment rate together with the welfare losses that workers experiment after displacement are key factors in explaining the existence of barriers to technology adoption. Moreover, I found that none of these factors alone is sufficient to build these barriers. The theory also suggests that welfare policies like the unemployment insurance system may enhance these kinds of barriers while policies like a severance payment system financed by an income tax seem to be more effective in eliminating them.

Learning the ropes and embracing the rules: CFSP institutions as arenas for learning and strategic socialisation

The aim of this article is to analyse those situations in which learning and socialisation take place within the context of the Common Foreign and Security Policy (CFSP), in particular, at the level of experts in the Council Working Groups. Learning can explain the institutional development of CFSP and changes in the foreign policies of the Member States. Some scope conditions for learning and channels of institutionalisation are identified. Socialisation, resulting from learning within a group, is perceived as a strategic action by reflective actors. National diplomats, once they arrive in Brussels, learn the new code of conduct of their Working Groups. They are embedded in two environments and faced with two logics: the European one in the Council and the national one in the Ministries of Foreign Affairs (MFA). The empirical evidence supports the argument that neither rational nor sociological approaches alone can account for these processes.

The Measurement of social polarization in a multi-group context

Polarization indices presented up to now have only focused their attention on the distribution of income/wealth. However, in many circumstances income is not the only relevant dimension that might be the cause of social conflict, so it is very important to have a social polarization index able to cope with alternative dimensions. In this paper we present an axiomatic characterization of one of such indices: it has been obtained as an extension of the (income) polarization measure introduced in Duclos, Esteban and Ray (2004) to a wider domain. It turns out that the axiomatic structure introduced in that paper alone is not appropriate to obtain a fully satisfactory characterization of our measure, so additional axioms are proposed. As a byproduct, we present an alternative axiomatization of the aforementioned income polarization measure.

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume.

The 2009 International Society of Urological Pathology consensus conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the substaging of pT2 prostate cancers according to the TNM 2002/2010 system, reporting of tumor size/volume and zonal location of prostate cancers were coordinated by working group 2. A survey circulated before the consensus conference demonstrated that 74% of the 157 participants considered pT2 substaging of prostate cancer to be of clinical and/or academic relevance. The survey also revealed a considerable variation in the frequency of reporting of pT2b substage prostate cancer, which was likely a consequence of the variable methodologies used to distinguish pT2a from pT2b tumors. Overview of the literature indicates that current pT2 substaging criteria lack clinical relevance and the majority (65.5%) of conference attendees wished to discontinue pT2 substaging. Therefore, the consensus was that reporting of pT2 substages should, at present, be optional. Several studies have shown that prostate cancer volume is significantly correlated with other clinicopathological features, including Gleason score and extraprostatic extension of tumor; however, most studies fail to demonstrate this to have prognostic significance on multivariate analysis. Consensus was reached with regard to the reporting of some quantitative measure of the volume of tumor in a prostatectomy specimen, without prescribing a specific methodology. Incorporation of the zonal and/or anterior location of the dominant/index tumor in the pathology report was accepted by most participants, but a formal definition of the identifying features of the dominant/index tumor remained undecided.

Oximetry alone versus portable polygraphy for sleep apnea screening before bariatric surgery.

BACKGROUND: Screening for obstructive sleep apnea (OSA) is recommended as part of the preoperative assessment of obese patients scheduled for bariatric surgery. The objective of this study was to compare the sensitivity of oximetry alone versus portable polygraphy in the preoperative screening for OSA. METHODS: Polygraphy (type III portable monitor) and oximetry data recorded as part of the preoperative assessment before bariatric surgery from 68 consecutive patients were reviewed. We compared the sensitivity of 3% or 4% desaturation index (oximetry alone) with the apnea-hypopnea index (AHI; polygraphy) to diagnose OSA and classify the patients as normal (<10 events per hour), mild to moderate (10-30 events per hour), or severe (>30 events per hour). RESULTS: Using AHI, the prevalence of OSA (AHI > 10 per hour) was 57.4%: 16.2% of the patients were classified as severe, 41.2% as mild to moderate, and 42.6% as normal. Using 3% desaturation index, 22.1% were classified as severe, 47.1% as mild to moderate, and 30.9% as normal. With 4% desaturation index, 17.6% were classified as severe, 32.4% as mild, and 50% as normal. Overall, 3% desaturation index compared to AHI yielded a 95% negative predictive value to rule out OSA (AHI > 10 per hour) and a 100% sensitivity (0.73 positive predictive value) to detect severe OSA (AHI > 30 per hour). CONCLUSIONS: Using oximetry with 3% desaturation index as a screening tool for OSA could allow us to rule out significant OSA in almost a third of the patients and to detect patients with severe OSA. This cheap and widely available technique could accelerate preoperative work-up of these patients.