PERFECT Stroke : PERFormance, Effectiveness, and Costs of treatment episodes in Stroke

Stroke is a major cause of death and disability, incurs significant costs to healthcare systems, and inflicts severe burden to the whole society. Stroke care in Finland has been described in several population-based studies between 1967 and 1998, but not since. In the PERFECT Stroke study presented here, a system for monitoring the Performance, Effectiveness, and Costs of Treatment episodes in Stroke was developed in Finland. Existing nationwide administrative registries were linked at individual patient level with personal identification numbers to depict whole episodes of care, from acute stroke, through rehabilitation, until the patients went home, were admitted to permanent institutional care, or died. For comparisons in time and between providers, patient case-mix was adjusted for. The PERFECT Stroke database includes 104 899 first-ever stroke patients over the years 1999 to 2008, of whom 79% had ischemic stroke (IS), 14% intracerebral hemorrhage (ICH), and 7% subarachnoid hemorrhage (SAH). A 18% decrease in the age and sex adjusted incidence of stroke was observed over the study period, 1.8% improvement annually. All-cause 1-year case-fatality rate improved from 28.6% to 24.6%, or 0.5% annually. The expected median lifetime after stroke increased by 2 years for IS patients, to 7 years and 7 months, and by 1 year for ICH patients, to 4 years 5 months. No change could be seen in median SAH patient survival, >10 years. Stroke prevalence was 82 000, 1.5% of total population of Finland, in 2008. Modern stroke center care was shown to be associated with a decrease in both death and risk of institutional care of stroke patients. Number needed to treat to prevent these poor outcomes at one year from stroke was 32 (95% confidence intervals 26 to 42). Despite improvements over the study period, more than a third of Finnish stroke patients did not have access to stroke center care. The mean first-year healthcare cost of a stroke patient was ~20 000 , and among survivors ~10 000 annually thereafter. Only part of this cost was incurred by stroke, as the same patients cost ~5000 over the year prior to stroke. Total lifetime costs after first-ever stroke were ~85 000 . A total of 1.1 Billion , 7% of all healthcare expenditure, is used in the treatment of stroke patients annually. Despite a rapidly aging population, the number of new stroke patients is decreasing, and the patients are more likely to survive. This is explained in part by stroke center care, which is effective, and should be made available for all stroke patients. It is possible, in a suitable setting with high-quality administrative registries and a common identifier, to avoid the huge workload and associated costs of setting up a conventional stroke registry, and still acquire a fairly comprehensive dataset on stroke care and outcome.

Steady flow of couple stress fluid through tubes of slowly varying cross-sections--application to blood flows

Steady laminar flow of a non-Newtonian fluid based on couple stress fluid theory, through narrow tubes of varying cross-sections has been studied theoretically. Asymptotic solutions are obtained for the basic equations and the expressions for the velocity field and the wall shear stress are derived for a general cross-section. Computation and discussions are carried out for the geometries which occur in the context of physiological flows or in particular blood flows. The tapered tubes and constricted tubes are of special importance. It is observed that increase in certain parameters results in erratic flow behaviour proximal to the constricted areas which is further enhanced by the increase in the geometric parameters. This elucidates the implications of the flow in the development of vascular lesions.

An unsteady flow due to eccentrically rotating porous disk and a fluid at infinity

An exact solution of the unsteady Navier-Stokes equations is obtained for the flow due to non-coaxial rotations of a porous disk, executing non-torsional oscillations in its own plane, and a fluid at infinity. It is shown that the infinite number of solutions existing for a flow confined between two disks reduce to a single unique solution in the case of a single disk. The adjustment of the unsteady flow near the rotating disk to the flow at infinity rotating about a different axis is explained.

Cooling of a composite slab in a two-fluid medium

A mixed boundary value problem associated with the diffusion equation that involves the physical problem of cooling of an infinite parallel-sided composite slab in a two-fluid medium, is solved completely by using the Wiener-Hopf technique. An analytical solution is derived for the temperature distribution at the quench fronts being created by two different layers of cold fluids having different cooling abilities moving on the upper surface of the slab at constant speedv. Simple expressions are derived for the values of the sputtering temperatures of the slab at the points of contact with the respective layers, assuming the front layer of the fluid to be of finite width and the back layer of infinite extent. The main problem is solved through a three-part Wiener-Hopf problem of a special type and the numerical results under certain special circumstances are obtained and presented in the form of a table.

Study Of Fluid-Flow And Residence-Time Distribution In A Continuous Slab Casting Mold

The fluid-flow pattern and residence-time distribution (r.t.d.) of the fluid in a continuous casting mould have been studied using a water model. The two recirculating zones below the discharge ports have been found to be asymmetric. The effect of casting speed, discharge port diameter, shroud well depth and the immersion depth on r.t.d. have been investigated. The r.t.d. curve has been well represented by a model of two backmix cells of equal volume in series. The exist of the fluid has been found to be non-uniform across the cross-section of the mould. The fluid-flow pattern has been observed to change with time in a random fashion. Dead volume of upto 31.8% has been found with smaller discharge ports.

A mathematical analysis of nonlinear waves in a fluid filled visco-elastic tube

Our investigations in this paper are centred around the mathematical analysis of a ldquomodal waverdquo problem. We have considered the axisymmetric flow of an inviscid liquid in a thinwalled viscoelastic tube under certain simplifying assumptions. We have first derived the propagation space equations in the long wave limit and also given a general procedure to derive these equations for arbitrary wave length, when the flow is irrotational. We have used the method of operators of multiple scales to derive the nonlinear Schrödinger equation governing the modulation of periodic waves and we have elaborated on the ldquolong modulated wavesrdquo and the ldquomodulated long wavesrdquo. We have also examined the existence and stability of Stokes waves in this system. This is followed by a discussion of the progressive wave solutions of the long wave equations. One of the most important results of our paper is that the propagation space equations are no longer partial differential equations but they are in terms of pseudo-differential operators.Die vorliegenden Untersuchungen beziehen sich auf die mathematische Behandlung des ldquorModalwellenrdquo-Problems. Die achsensymmetrische Strömung einer nichtviskosen Flüssigkeit in einem dünnwandigen viskoelastischen Rohr, unter bestimmten vereinfachenden Annahmen, wird betrachtet. Zuerst werden die Gleichungen des Ausbreitungsraumes im Langwellenbereich abgeleitet und eine allgemeine Methode zur Herleitung dieser Gleichungen für beliebige Wellenlängen bei nichtrotierender Strömung angegeben. Eine Operatorenmethode mit multiplem Maßstab wird verwendet zur Herleitung der nichtlinearen Schrödinger-Gleichung für die Modulation der periodischen Wellen, und die ldquorlangmodulierten Wellenrdquo sowie die ldquormodulierten Langwellenrdquo werden aufgezeigt. Weiters wird die Existenz und die Stabilität der Stokes-Wellen im System untersucht. Anschließend werden die progressiven Wellenlösungen der Langwellengleichungen diskutiert. Eines der wichtigsten Ergebnisse dieser Arbeit ist, daß die Gleichungen des Ausbreitungsraumes keine partiellen Differentialgleichungen mehr sind, sondern Ausdrücke von Pseudo-Differentialoperatoren.

Exact solution for the unsteady motion of a viscous-fluid in a porous annulus

An exact solution to the problem of time-dependent motion of a viscous fluid in an annulus with porous walls is obtained under the assumption that the rate of suction at one wall is equal to the rate of injection at the other. Finite Hankel transform is used to obtain a closed-form solution for the axial velocity. The average axial velocity profiles are depicted graphically.

Computational Fluid Dynamics in Combustion

Computational fluid dynamics has reached a stage where flow field in practical situation can be predicted to aid the design and to probe into the fundamental flow physics to understand and resolve the issues in fundamental fluid mechanics The study examines the computation of reacting flows After exploring the conservation equations for species and energy, the methods of closing the reaction rate terms in turbulent flow have been examined briefly Two cases of computation where combustion-flow interaction plays important role, have been discussed to illustrate the computational aspects and the physical insight that can be gained by the reacting flow computation

Channel Volatiles Of South Indian Cordierites As Indicators Of Metamorphic Fluid Composition

The channel volatiles in cordierites of the Precambrian high-grade metapelites from southern and eastern Karnataka northern Tamil Nadu and southern Kerala were analyzed in an attempt to use them as metamorphic fluid fugacity indicators. Infrared powder absorption spectra, used to characterize the channel volatiles, showed that all the 21 analyzed cordierites have H2O and CO2 as the channel volatiles, indicating the predominantly H2O-CO2 composition of the metamorphic fluids. The H2O fraction in the metamorphic fluid was computed using a published thermodynamic method in conjunction with gravimetrically determined cordierite channel H2O content, available P - T estimates and an appropriate equation of state for the H2O - CO2 fluids. The IR data and these calculated X(H2O) values indicate an overall correlation between the variation in the relative proportion of H2O and CO2 in the fluids and the metamorphic grade. The average computed X(H2O) values are: 0.78 for the amphibolite facies eastern Karnataka pelites, 0.36 for the amphibolite facies southern Karnataka pelites, 0.19 for the southern Karnataka transitional zone rocks and 0.13 for the northern Tamil Nadu granulites. Consistently low X(H2O) values, at about 0.2, were obtained for the orthopyroxene-bearing assemblages.

Cooling of an infinite slab in a two-fluid medium

A mixed boundary-valued problem associated with the diffusion equation, that involves the physical problem of cooling of an infinite slab in a two-fluid medium, is solved completely by using the Wiener-Hopf technique. An analytical solution is derived for the temperature distribution at the quench fronts being created by two different layers of cold fluids having different cooling abilities moving on the upper surface of the slab at constant speed. Simple expressions are derived for the values of the sputtering temperatures of the slab at the points of contact with the respective layers, assuming one layer of the fluid to be of finite extent and the other of infinite extent. The main problem is solved through a three-part Wiener - Hopf problem of a special type, and the numerical results under certain special circumstances are obtained and presented in the form of a table.

Effect of 80 kDa protein of porcine follicular fluid on gonadotropin stimulated progesterone production in rat granulosa cells in vitro

We reported the presence of a 80 kDa polypeptide in porcine follicular fluid that inhibited the binding of 125I-radiolabelled hFSH as well as hCG to the rat ovarian gonadotropin receptors. In the present study, the biological activity of the receptor binding inhibitor is determined using an in vitro bioassay procedure. Granulosa cells isolated from PMSG primed immature rat ovaries respond to exogenously added gonadotropins in terms of progesterone production. Addition of fractions containing the gonadotropin receptor binding inhibitory activity inhibited progesterone production stimulated by the gonadotropins in a dose-dependent fashion. The receptor binding inhibitory activity was also capable of inhibiting progesterone production stimulated by PMSG, which has both FSH- and LH-like activities in rats. In contrast, progesterone production stimulated by dbcAMP was not inhibited by the receptor binding inhibitor. This result indicates that the site of action of the inhibitor is proximal to the formation of the cAMP. The above observations point out to a possible role for this factor in modulating gonadotropin activity at the ovarian level.

Detection and characterisation of circulating cysticercal antigens in human cerebrospinal fluid

With biotin labelled and unlabelled immunoglobulin fraction of anticysticercal antibodies raised in rabbits, tandem-enzyme linked immunosorbent assay (T-ELISA), capture-dot immunobinding assay (C-DIA) and reverse passive haemagglutination (RPHA) tests were developed for the detection of cysticercal antigens. The sensitivity levels were respectively, 9 ng ml−1, 2 ng ml−1 and 45 ng ml−1. All three methods were of equal specificity as none of the antigens of Mycobacterium tuberculosis, Japanese encephalitis virus and Echinococcus granulosus reacted with anticysticercal IgG. Cysticercal antigens were detected in the cerebrospinal fluid (CSF) of confirmed neurocysticercosis at sensitivity levels of 91·6% by T-ELISA, 83·33% by C-DIA and 75% by RPHA and specificity levels of >93%. Western analysis of these antigens in CSF showed mainly antigens of 64–68 kDa and 24–28 kDA. By crossed immunoelectrophoresis (CIE) with an intermediate gel technique, five circulating antigens were found to be released from scolex and fluid.