981 resultados para first-ever seizure
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This essay was presented at the first Seminar on Indo-Portuguese History (ISIPH-I) organized in Goa by Rev. Dr. John Correia-Afonso, S.J. in November 1978. It represented a call for a critical revision of Goan historiography in the post-colonial era, following Goa's liberation and the 25th April 1974 change in Portugal. The essay was a sort of manifesto and definition of research plan for the newly established Xavier Centre of Historical Research. The article surveys critically the documentary sources little tapped until recently. Includes the first ever analysis of the records relating to the Pastoral Visits in Goa, a prized source of information for the socio-economic history of Goa in the 19th century.
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Dissertation presented to obtain the Ph.D degree in Biochemistry
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Stand alone solar powered refrigeration and water desalination, two of the most popular and sought after applications of solar energy systems, have been selected as the topic of research for the works presented in this thesis. The water desalination system based on evaporation and condensation was found to be the most suitable one to be powered by solar energy. It has been established that highoutput fast-response solar heat collectors used to achieve high rates of evaporation and reliable solar powered cooling system for faster rates of condensation are the most important factors in achieving increased outputs in solar powered desalination systems. Comprehensive reviews of Solar powered cooling/refrigeration and also water desalination techniques have been presented. In view of the fact that the Institute of Technology, Sligo has a well-established long history of research and development in the production of state of the art high-efficiency fast-response evacuated solar heat collectors it was decided to use this know how in the work described in this thesis. For this reason achieving high rates of evaporation was not a problem. It was, therefore, the question of the solar powered refrigeration that was envisaged to be used in the solar powered desalination tofacilitate rapid condensation of the evaporated water that had to be addressed first. The principles of various solar powered refrigeration techniques have also been reviewed. The first step in work on solar powered refrigeration was to successfully modify a conventional refrigerator working on Platen-Munters design to be powered by highoutput fast-response evacuated solar heat collectors. In this work, which was the first ever successful attempt in the field, temperatures as low as 19C were achieved in the icebox. A new approach in the use of photovoltaic technology to power a conventional domestic refrigerator was also attempted. This was done by modifying a conventional domestic refrigerator to be powered by photovoltaic panels in the most efficient way. In the system developed and successfully tested in this approach, the power demand has been reduced phenomenally and it is possible to achieve 48 hours of cooling power with exposure to just 7 hours of sunshine. The successful development of the first ever multi-cycle intermittent solar powered icemaker is without doubt the most exciting breakthrough in the work described in this thesis. Output of 74.3kg of ice per module with total exposure area of 2.88 m2, or 25.73kg per m2, per day is a major improvement in comparison to about 5-6kg of ice per m2 per day reported for all the single cycle intermittent systems. This system has then become the basis for the development of a new solar powered refrigeration system with even higher output, named the composite system described in this thesis. Another major breakthrough associated with the works described in this thesis is the successful development and testing of the high-output water desalination system. This system that uses a combination of the high-output fast-response evacuated solar heat collectors and the multi-cycle icemaker. The system is capable of producing a maximum of 141 litres of distilled water per day per module which has an exposure area of 3.24m2, or a production rate of 43.5 litres per m2 per day. Once again when this result is compared to the reported daily output of 5 litres of desalinated water per m per day the significance of this piece of work becomes apparent. In the presentation of many of the components and systems described in this thesis CAD parametric solid modelling has been used instead of photographs to illustrate them more clearly. The multi-cycle icemaker and the high-output desalination systems are the subject of two patent applications.
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Rsum: L'objectif de l'tude est de caractriser la manifestation clinique d'une atteinte vasculaire crbrale ischmique aigu limite au cortex insulaire, rgion intrigante et mconnue du cerveau humain. Dans la pratique clinique, une atteinte vasculaire aigu limite l'insula, sans compromission d'autres rgions crbrales, est exceptionnelle et sa manifestation clinique neurologique est souvent non reconnue. L'tude est focalise sur quatre patients, inscrits dans le Lausanne Stroke Registry, prsentant une nouvelle atteinte vasculaire crbrale avec une lsion unique purement limite au cortex insulaire, objective l'aide de la rsonance magntique (IRM). L'tude a mis en vidence cinq manifestations cliniques principales : 1) Troubles de la sensibilit corporelle sont rvl chez trois patients avec une atteinte insulaire postrieure (deux avec un syndrome pseudothalamique, un avec un dficit distribution partielle). 2) Un patient avec une lsion insulaire postrieure gauche prsent des troubles du got. 3) Un syndrome pseudovestibulaire avec vertiges non rotatoires, instabilit la marche sans nystagmus, est mis en vidence chez trois patients avec une atteinte ischmique insulaire postrieure. 4) Un patient avec atteinte de l'insula postrieure droite prsente des pisodes d'hypertension artrielle d'origine cryptique. 5) Des troubles neuropsychologiques tels qu'aphasie et dysarthrie sont dtects chez les patients avec une atteinte insulaire postrieure gauche, un pisode de somatoparaphrnie est rapport avec une atteinte insulaire postrieure droite. En conclusion, les atteintes vasculaires crbrales ischmiques aigus limites au cortex insulaire postrieur peuvent se manifester principalement avec un tableau clinique caractris par un syndrome pseudothalamique associ une symptomatologie pseudovertigineuse. Les lsions insulaires postrieures peuvent se manifester avec une dysarthrie et des troubles du got, une aphasie (gauche), une somatoparaphrnie et une dysfonction hypertensive (droite). L'tude n'a pas mis en vidence de dysphagie, reporte dans les atteintes insulaires antrieures. Abstract: Objective: To characterize clinically acute insular strokes from four patients with, a first ever acute stroke restricted to the insula on MRI. Methods: The authors studied the clinical presentation of four patients with a first ever acute stroke restricted to the insula on MRI. Results: The authors found five main groups of clinical presentations: 1) somatosensory deficits in three patients with posterior insular stroke (two with a transient pseudothalamic sensory syndrome, one with partial distribution); 2) gustatory disorder in a patient with left posterior insular infarct; 3) vestibular-like syndrome, with dizziness, gait instability, and tendency to fall, but no nystagmus, in three patients with posterior insular strokes; 4) cardiovascular disturbances, consisting of hypertensive episodes in a patient with a right posterior insular infarct; and 5) neuropsychological disorders, including aphasia (left posterior insula), dysarthria, and transient somatoparaphrenia (right posterior insula). Conclusion: Strokes restricted to the posterior insula may present with pseudothalamic sensory and vestibular-like syndromes as prominent clinical manifestations, but also dysarthria and aphasia (in left lesions), somatoparaphrenia (right lesions) and gustatory dysfunction and blood pressure with hypertensive episodes in right lesions; we did not find acute dysphagia reported in anterior, insular strokes.
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BACKGROUND:The Swiss breast cancer screening pilot programme was conducted in 3 districts of theFrench-speaking canton of Vaud (ca. 300,000 resident women) between October 1993 and January 1999.Women aged 50 to 69 were invited by mail every 2 years for a free of charge screening mammography (doubleview, multiple reading). This first ever-organised cancer screening programme in Switzerland showed thefeasibility and acceptability of this kind of public health intervention in the liberal Swiss healthcare system, whichwas the main objective of the pilot programme. This mammographic screening programme was extended to thewhole canton in 1999, and contributed to the implementation of similar programmes in 2 neighbouring cantons. OBJECTIVE:To appraise the use, the quality and the effectiveness of the Swiss screening pilot programme. METHODS:About 15,000 women (aged 50-69) were enrolled. Logistic regression analyses were performedseparately to identify determinants of initial and subsequent attendance. Standard indicators of quality,effectiveness and impact of the programme were assessed and compared with European recommendations. Tothis intent, linkage with data from the Vaud Cancer Registry was performed. RESULTS:About half the target population was screened at least once during the pilot trial. Participation washigher among Swiss than foreigners, among widowed or married women than among single, divorced or separatedones. Attendance also increased with age and decreasing distance between residence and the dedicatedscreening centre. Apart from Swiss citizenship, socio-demographic factors were not associated with reattendance.Intensity of prior recruitment, outcome of previous screening test (positive vs. negative) and indicators of women'shealth behaviour (time of last mammography prior to initial screen, smoking status) were the main determinants ofreattendance. Programme performance and quality indicators were, overall, in line with European Guidelines. Theywere overall more favourable among 60-69 than 50-59 year-olds and improved over time. CONCLUSION:The objectives of the pilot programme were met. Even if participation should increase in order toreach European standards, performance indicators overall met quality requirements. Ways to improve screeninguse, quality and effectiveness were devised and taken into account for the generalisation of the programme.
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Abstract Right hemispheric stroke aphasia (RHSA) rarely occurs in right- or left-handed patients with their language representation in right hemisphere (RH). For right-handers, the term crossed aphasia is used. Single cases, multiple cases reports, and reviews suggest more variable anatomo-clinical correlations. We included retrospectively from our stroke data bank 16 patients (right- and left-handed, and ambidextrous) with aphasia after a single first-ever ischemic RH stroke. A control group was composed of 25 successive patients with left hemispheric stroke and aphasia (LHSA). For each patient, we analyzed four modalities of language (spontaneous fluency, naming, repetition, and comprehension) and recorded eventual impairment: (1) on admission (hyperacute) and (2) between day 3 and 14 (acute). Lesion volume and location as measured on computed tomography (CT) and magnetic resonance imaging (MRI) were transformed into Talairach stereotaxic space. Nonparametric statistics were used to compare impaired/nonimpaired patients. Comprehension and repetition were less frequently impaired after RHSA (respectively, 56% and 50%) than after LHSA (respectively, 84% and 80%, P = 0.05 and 0.04) only at hyperacute phase. Among RHSA, fewer left-handers/ambidextrous than right-handers had comprehension disorders at second evaluation (P = 0.013). Mean infarct size was similar in RHSA and LHSA with less posterior RHSA lesions (caudal to the posterior commissure). Comprehension and repetition impairments were more often associated with anterior lesions in RHSA (Fisher's exact test, P < 0.05). Despite the small size of the cohort, our findings suggest increased atypical anatomo-functional correlations of RH language representation, particularly in non-right-handed patients. Rapport de synthse : Des aphasies secondaires un accident vasculaire ischmique crbral (AVC) hmisphrique droit sont rarement rencontres chez des patients droitiers ou gauchers avec une reprsentation du langage dans l'hmisphre droit. Chez les droitiers, on parle d'aphasie croise. Plusieurs tudes sur le sujet ont suggr des corrlations anatomocliniques plus variables. Dans notre tude, nous avons inclus rtrospectivement, partir d'une base de donnes de patients avec un AVC, seize patients (droitiers, gauchers et ambidextres) souffrant d'une aphasie suite un premier et unique AVC ischmique hmisphrique droit. Un groupe contrle est compos de vingt-cinq patients successifs avec une aphasie suite un AVC ischmique hmisphrique gauche. Pour chaque patient, nous avons analys quatre modalits de langage, savoir la fluence spontane, la dnomination, la rptition et la comprhension et leur ventuelle atteinte deux moments distincts : 1) l'admission (phase hyperaigu) et 2) entre le 3e et le 14e jour (phase aigu). Le volume et la localisation de la lsion mesurs, soit sur un CT-scanner soit sur une imagerie par rsonance magntique crbrale, ont t analyss l'aide de l'chelle strotaxique de Talairach. Des statistiques non paramtriques ont t utilises pour comparer les patients atteints et non atteints. . La comprhension et la rptition taient moins souvent atteintes, seulement en phase hyperaigu, aprs une aphasie suite un AVC hmisphrique droit (resp. 56% et 50%) plutt que gauche (resp. 84 % et 80%, p= 0.05 et 0.04). Parmi les aphasies suite un AVC ischmique hmisphrique droit, moins de gauchers et d'ambidextres que de droitiers avaient des troubles de la comprhension lors de la seconde valuation (p=0.013}. La .taille moyenne de la zone infarcie tait semblable entre les aphasies droites et gauches, avec moins de lsions postrieures (caudale la commissure postrieure) lors des aphasies droites. Les troubles de la rptition et de la comprhension taient plus souvent associs des lsions antrieures lors d'aphasie droite. (Fischer's exact test, p>0.05). Malgr la petite taille de notre cohorte de patients, ces rsultats suggrent une augmentation des corrlations anatomocliniques atypiques lors d'une reprsentation du langage dans l'hmisphre droit, surtout chez les patients non droitiers.
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We demonstrate the use of laser-induced fluorescence confocal spectroscopy to measure analyte-stimulated enhanced green fluorescent protein (egfp) synthesis by genetically modified Escherichia coli bioreporter cells. Induction is measured in cell lysates and, since the spectroscopic focal volume is approximately the size of one bioreporter cell, also in individual live bacteria. This is, to our knowledge, the first ever proof-of-concept work utilizing instrumentation with single-molecule detection capability to monitor bioreporter response. Although we use arsenic inducible bioreporters here, the method is extensible to gfp/egfp bioreporters that are responsive to other substances.
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Background: To study the characteristics of vascular aphasia in a cohort of patients with a first-ever stroke. Methods: All patients admitted to the Lausanne neurology department for a first-ever stroke between 1979 and 2004 were included. Neurological examination including language was performed on admission. Stroke risk factors, stroke origin and location, associated symptoms and Rankin scale scores were recorded for each patient. The influence of these factors on aphasia frequency and subtypes was analyzed using logistic regression models. Results: 1,541 (26%) of patients included in this study had aphasia. The more frequent clinical presentations were expressive-receptive aphasia (38%) and mainly expressive aphasia (37%), whereas mainly receptive aphasia was less frequently observed (25%). In ischemic stroke, the frequency of aphasia increased with age (55% of nonaphasic vs. 61% of aphasic patients were more than 65 years old), female sex (40% of women in the nonaphasia group vs. 44% in the aphasia group) and risk factors for cardioembolic origin (coronary heart disease 20 vs. 26% and atrial fibrillation 15 vs. 24%). Stroke aphasia was more likely associated with superficial middle cerebral artery (MCA) stroke and leads to relevant disability. Clinical subtypes depended on stroke location and associated symptoms. Exceptions to the classic clinical-topographic correlations were not rare (26%). Finally, significant differences were found for patients with crossed aphasia in terms of stroke origin and aphasia subtypes. Conclusions: Risk factors for stroke aphasia are age, cardioembolic origin and superficial MCA stroke. Exceptions to classic clinical-topographic correlations are not rare. Stroke aphasia is associated with relevant disability. Stroke location and associated symptoms strongly influence aphasia subtypes.
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Twelve patients with a catastrophic reaction (CR) (an outburst of frustration, depression, and anger when confronted with a task) were identified in a prospective cohort population (n = 326) with first-ever stroke admitted within 48 hours from onset. The authors' findings suggest that CR is a rare though not exceptional phenomenon in acute stroke and is associated with nonfluent aphasias and left opercular lesions. CR, poststroke depression, and emotionalism are distinct but related disorders.
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SummaryGene duplication and neofunctidnalization are important processes in the evolution of phenotypic complexity. They account for important evolutionary novelties that confer ecological adaptation, such as the major histocompatibility complex (MHC), a multigene family with a central role in vertebrates' adaptive immune system. Multigene families, which evolved in large part through duplication, represent promising systems to study the still strongly depbated relative roles of neutral and adaptive processes in the evolution of phenotypic complexity. Detailed knowledge on ecological function and a well-characterized evolutionary history place the mammals' MHC amongst ideal study systems. However mammalian MHCs usually encompass several million base pairs and hold a large number of functional and non-functional duplicate genes, which makes their study complex. Avian MHCs on the other hand are usually way more compact, but the reconstruction of. their evolutionary history has proven notoriously difficult. However, no focused attempt has been undertaken so far to study the avian MHC evolutionary history in a broad phylogenetic context and using adequate gene regions.In the present PhD, we were able to make important contributions to the understanding of the long-term evolution of the avian MHC class II Β (MHCI1B). First, we isolated and characterized MHCIIB genes in barn owl (Tyto alba?, Strigiformes, Tytonidae), a species from an avian lineage in which MHC has not been studied so far. Our results revealed that with only two functional MHCIIB genes the MHC organization of barn owl may be similar to the 'minimal essential' MHC of chicken (Gallus gallus), indicating that simple MHC organization may be ancestral to birds. Taking advantage of the sequence information from barn owl, we studied the evolution of MHCIIB genes in 13 additional species of 'typical' owls (Strigiformes, Strigidae). Phylogenetic analyses revealed that according to their function, in owls the peptide-binding region (PBR) encoding exon 2 and the non-PBR encoding exon 3 evolve by different patterns. Exon 2 exhibited an evolutionary history of positive selection and recombination, while exon 3 traced duplication history and revealed two paralogs evolving divergently from each other in owls, and in a shorebird, the great snipe {Gallinago media). The results from exon 3 were the first ever from birds to demonstrate gene orthology in species that diverged tens of millions of years ago, and strongly questioned whether the taxa studied before provided an adequate picture of avian MHC evolution. In a follow-up study, we aimed at explaining a striking pattern revealed by phylogenetic trees analyzing the owl sequences along with MHCIIB sequences from other birds: One owl paralog (termed DAB1) grouped with sequences of passerines and falcons, while the other (DAB2) grouped with wildfowl, penguins and birds of prey. This could be explained by either a duplication event preceding the evolution of these bird orders, or by convergent evolution of similar sequences in a number of orders. With extensive phylogenetic analyses we were able to show, that indeed a duplication event preceeded the major avian radiation -100 my ago, and that following this duplication, the paralogs evolved under positive selection. Furthermore, we showed that the divergently evolving amino acid residues in the MHCIIB-encoded β-chain potentially interact with the MHCI I α-chain, and that molecular coevolution of the interacting residues may have been involved in the divergent evolution of the MHCIIB paralogs.The findings of this PhD are of particular interest to the understanding of the evolutionary history of the avian MHC and, by providing essential information on long-term gene history in the avian MHC, open promising perspectives for advances in the understanding of the evolution of multigene families in general, and for avian MHC organization in particular. Amongst others I discuss the importance of including protein structure in the phylogenetic study of multigene families, and the roles of ecological versus molecular selection pressures. I conclude by providing a population genomic perspective on avian MHC, which may serve as a basis for future research to investigate the relative roles of neutral processes involving effective population size effects and of adaptation in the evolution of avian MHC diversity and organization.RsumLa duplication de gnes et leur no-fonctionnalisation sont des processus importants dans l'volution de la complexit phnotypique. Ils sont impliqus dans l'apparition d'importantes nouveauts volutives favorisant l'adaptation cologique, comme c'est le cas pour le complexe majeur d'histocompatibilit <CMH), une famille de gnes jouant un rle central dans le systme immunitaire adaptatif des vertbrs. Les familles multigniques reprsentent des systmes prometteurs pour l'tude controverse des rles relatifs des processus neutres et adaptatifs dans l'volution de la complexit phnotypique. La connaissance dtaille de sa fonction cologique, ainsi que de son histoire volutive, placent le CMH des mammifres parmi les candidats idaux. Toutefois, les CMHs des mammifres comprennent habituellement plusieurs millions de paires de bases et sont forms par un grand nombre de gnes dupliqus, fonctionnels et non-fonctionnels, ce qui rend leur tude complexe. Au contraire, les CMHs des oiseaux sont gnralement plus compacts, mais la reconstruction de leur histoire volutive s'est rvle difficile. Aucune analyse spcifique n'a cependant t entreprise jusqu' prsent pour tudier l'histoire volutive du CMH aviaire dans un large contexte phylogntique et en utilisant des rgions gniques adquates.Ce travail de thse a contribu la comprhension de l'volution long-terme du CMH aviaire classe II Β (CMH II Β). Nous avons isol et caractris les gnes CMH I IB de la chouette effraie (Tyto alba; Strigiformes, Tytonidae), une espce appartenant une ligne aviaire dont le CMH n'avait pas t tudi jusqu'ici. Avec uniquement deux gnes CMHIIB fonctionnels, l'organisation CMH de la chouette effraie semble tre comparable celle "minimale" du poulet (Gallus gallus), ce qui suggre qu'une organisation simple du CMH pourrait tre ancestrale chez les oiseaux. En se basant sur l'information obtenue pour cette espce, nous avons ensuite tudi l'volution des gnes CMHIIB chez 13 espces de chouettes "typiques" (Strigiformes, Strigidae). Les analyses phylogntiques ont rvl que chez les chouettes, selon leur fonction, l'exon 2 codant pour la 'peptide-binding region' (PBR) et l'exon 3 ne codant pas pour la rgion PBR voluent de manire distincte. L'exon 2 montre une histoire volutive de slection positive et recombinaison, tandis que l'exon 3 retrace l'histoire de duplication et rvle deux paralogues voluant de faon divergente chez les chouettes, ainsi que chez un limicole, la bcassine double (Gallinago media). Les rsultats dcoulant de l'analyse de l'exon 3 ont montr pour la premire fois chez les oiseaux une orthologie de gnes chez des espces ayant diverg il y a des dizaines de millions d'annes. Dans une deuxime tude, nous avons voulu expliquer le pattern surprenant rvl par les arbres phylogntiques lorsque les squences CMHIIB des chouettes sont analyses avec les squences d'autres oiseaux: un paralogue de chouette (appel DABI) forme un groupe avec les squences de passereaux et faucons, tandis que l'autre (DAB2) se regroupe avec les gallo-ansriformes, les manchots et les rapaces diurnes. Ceci pourrait tre expliqu soit par une duplication qui a prcd l'volution de ces ordres aviaires soit par volution convergente dans un certain nombre d'ordres. Grce des analyses phylogntiques approfondies, nous avons pu montrer qu'un vnement de duplication a effectivement prcd la radiation aviaire principale d'il y a environ 100 millions d'annes, et qu'aprs cette duplication les paralogues ont volu sous slection positive. De plus, les rsidus d'acides amins voluant de faon divergente dans la chane β code par le CMHIIB interagissent potentiellement avec la chane α code par le CMHII, et que la covolution molculaire de ces rsidus pourrait tre la base de l'volution divergente des paralogues CMHIIB.Dans cette thse sont discuts entre autres l'importance d'inclure la structure des protines dans l'tude phylogntique des familles multigniques, ainsi que les rles respectifs des pressions slectives cologique et molculaire. La conclusion comporte une perspective sur la gnomique des populations du CMH aviaire, qui pourrait servir de base pour de futures recherches sur les rles relatifs jous par es processus neutres comprenant les effets de la taille efficace des populations et l'adaptation dans l'volution de la diversit et l'organisation du MHC aviaire.
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Recently published guidelinesin the UKrelating to sight tests among people with dementia go some of the way to addressing the specific needs of this group. However, there is still a long way to go in terms of improving the provision of eye care services and optimising the visual health of this group.Astudy, published by the Thomas Pocklington Trust,which examines this subject - The development of professional guidelines for the eye examination of people with dementia - was presented at the first ever national “Dementia and Sight Loss conference” in London (1st December) - a forum where 100 dementia and sight loss professionals met to discuss ways to tackle the challenge of concurrent dementia and sight loss. The study, by researchers at the University of Bradford Schools of Optometry and Health Studies, reviewed procedures for sight tests and eye examinations among those with dementia. It found that policy and practice were hampered by a serious lack of basic research into concurrent dementia and sight loss and prompted recommendations which could lead to improved procedures, tools and techniques.Recommendations prompted by the study outline seven steps towards improving policy and practice:Conduct a systematic study of the availability and uptake of sight tests among people with dementia. Set up a website for people with dementia and their carers with information on how dementia affects eye health, and the importance of eye examinations. Develop education and training for optometrists and care home staff. Compile a list of optometrists experienced in providing eye care for people with dementia. Develop a template for recording the results of eye examinations in people with dementia – something which can be endorsed by professional bodies and made available to care homes. Measure the effectiveness of eye care, such as sight tests and cataract removals, on the quality of life of people with dementia. Research clinical testing methods so that guidelines can be strengthened. Measuring contrast sensitivity, for example, in someone with dementia could be vital as an inability to judge contrasts can make daily tasks impossible.To access the discussion paper please follow this link: The development of professional guidelines for the eye examination of people with dementia
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he first ever strategy for the Further Education and Training (FET) sector is being launched by the Minister for Education and Skills, Ruair_ Quinn T.D., and Minister of State for Training and Skills Ciarn Cannon T.D. The overall aim of the Strategy is to develop a world-class integrated system of further education and training in Ireland, which will promote economic development and meet the needs of all citizens. The new strategy was developed by SOLAS with assistance from the ESRI which was commissioned to carry out evidence based research and assist in the development of the Strategy. Five high level strategic goals have been identified: -Skills for the Economy: to address the current and future needs of learners, jobseekers, employers and employees and to contribute to national economic development -Active Inclusion: to support the active inclusion of people of all abilities in society with special reference to literacy and numeracy -Quality Provision: to provide high quality education and training programmes and to meet the appropriate national and international quality standards -Integrated Planning and Funding: FET provision will be planned and funded on the basis of objective analysis of needs and evidence of social and economic impact -Standing of FET: to ensure a valued learning path leading to agreed employment, career, developmental, personal and social options. The Strategy follows a radical overhaul of the structure of the sector by the Government which includes the streamlining of 33 existing VECs into 16 Education and Training Boards (ETBs), the abolition of FS and creation of SOLAS, the Further Education and Training Authority. Speaking at the launch in the Chester Beatty li
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BACKGROUND AND PURPOSE: A new clinical construct termed embolic stroke of undetermined source (ESUS) was recently introduced, but no such population has been described yet. Our aim is to provide a detailed descriptive analysis of an ESUS population derived from a large prospective ischemic stroke registry using the proposed diagnostic criteria. METHODS: The criteria proposed by the Cryptogenic Stroke/ESUS International Working Group were applied to the Athens Stroke Registry to identify all ESUS patients. ESUS was defined as a radiologically confirmed nonlacunar brain infarct in the absence of (a) extracranial or intracranial atherosclerosis causing ≥50% luminal stenosis in arteries supplying the ischemic area, (b) major-risk cardioembolic source, and (c) any other specific cause of stroke. RESULTS: Among 2735 patients admitted between 1992 and 2011, 275 (10.0%) were classified as ESUS. In the majority of ESUS (74.2%), symptoms were maximal at onset. ESUS were of moderate severity (median National Institute Health Stroke Scale score, 5). The most prevalent risk factor was arterial hypertension (64.7%), and 50.9% of patients were dyslipidemic. Among potential causes of the ESUS, covert atrial fibrillation (AF) was the most prevalent: in 30 (10.9%) patients, AF was diagnosed during hospitalization for stroke recurrence, whereas in 50 (18.2%) patients AF was detected after repeated ECG monitoring during follow-up. Also, covert AF was strongly suggested in 38 patients (13.8%) but never recorded. CONCLUSIONS: About 10% of patients with first-ever ischemic stroke met criteria for ESUS; covert paroxysmal AF seems to be a frequent cause of ESUS.
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Quadricuspid aortic valve (QAV) is a rare congenital anomaly associated with aortic valve insufficiency and significant morbidity, and requires the replacement or, rarely, the repair of the malfunctioning heart valve. A QAV associated with an ascending aorta aneurysm is an extremely rare anatomic combination with a hypothetical, but not clear, shared embryological etiology. To date, only two cases of type B QAV with ascending aorta aneurysm have been reported. Herein is described the first ever case of a 38-year-old male suffering from severe symptomatic aortic valve regurgitation due to a type A QAV, associated with an ascending aorta aneurism, who underwent a successful combined replacement of the aortic valve and ascending aorta.
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BACKGROUND AND PURPOSE: We compared among young patients with ischemic stroke the distribution of vascular risk factors among sex, age groups, and 3 distinct geographic regions in Europe. METHODS: We included patients with first-ever ischemic stroke aged 15 to 49 years from existing hospital- or population-based prospective or consecutive young stroke registries involving 15 cities in 12 countries. Geographic regions were defined as northern (Finland, Norway), central (Austria, Belgium, France, Germany, Hungary, The Netherlands, Switzerland), and southern (Greece, Italy, Turkey) Europe. Hierarchical regression models were used for comparisons. RESULTS: In the study cohort (n=3944), the 3 most frequent risk factors were current smoking (48.7%), dyslipidemia (45.8%), and hypertension (35.9%). Compared with central (n=1868; median age, 43 years) and northern (n=1330; median age, 44 years) European patients, southern Europeans (n=746; median age, 41 years) were younger. No sex difference emerged between the regions, male:female ratio being 0.7 in those aged <34 years and reaching 1.7 in those aged 45 to 49 years. After accounting for confounders, no risk-factor differences emerged at the region level. Compared with females, males were older and they more frequently had dyslipidemia or coronary heart disease, or were smokers, irrespective of region. In both sexes, prevalence of family history of stroke, dyslipidemia, smoking, hypertension, diabetes mellitus, coronary heart disease, peripheral arterial disease, and atrial fibrillation positively correlated with age across all regions. CONCLUSIONS: Primary preventive strategies for ischemic stroke in young adults-having high rate of modifiable risk factors-should be targeted according to sex and age at continental level.
