833 resultados para stroke survivor


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A reliable protection against direct lightning hit is very essential for satellite launch pads. In view of this, suitable protection systems are generally employed. The evaluation of efficacy of the lightning protection schemes among others requires an accurate knowledge of the consequential potential rise at the struck point and the current injected into soil at the earth termination. The present work has made a detailed effort to deduce these quantities for the lightning protection scheme of the Indian satellite launch pad-I. A reduced scale model of the system with a frequency domain approach is employed for the experimental study. For further validation of the experimental approach, numerical simulations using numerical electromagnetic code-2 are also carried out on schemes involving single tower. The study results on the protection system show that the present design is quite safe with regard to top potential rise. It is shown that by connecting ground wires to the tower, its base current and, hence, the soil potential rise can be reduced. An evaluation of an alternate design philosophy involving insulated mast scheme is also made. The potential rise in that design is quantified and the possibility of a flashover to supporting tower is briefly looked into. The supporting tower is shown to have significant induced currents.

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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.

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The aim of the present study was to investigate the influence of different manifestations of cerebral SVD on poststroke survival and ischemic stroke recurrence in long-term follow-up. The core imaging features of small-vessel disease (SVD) are confluent and extensive white matter changes (WMC) and lacunar infarcts. These are associated with minor motor deficits but a major negative influence on cognition, mood, and functioning in daily life, resulting from small-vessel lesions in the fronto-subcortical brain network. These sub-studies were conducted as part of the Helsinki Stroke Aging Memory (SAM) study. The SAM cohort consisted of 486 consecutive patients aged 55 to 85 years who were admitted to Helsinki University Central Hospital with acute ischemic stroke. The study included comprehensive clinical, neuropsychological, psychiatric and radiological assessment three months poststroke. The patients were followed up up for 12 years using extensive national registers. The effect of different manifestations of cerebral SVD on poststroke survival and stroke recurrence was analyzed controlling for factors such as age, education, and cardiovascular risk factors. Poststroke dementia and cognitive impairment relate to poor long-term survival. In particular, deficits in executive functions as well as visuospatial and constructional abilities predict poor outcome. The predictive value of cognitive deficits is further underlined by the finding that depression-executive dysfunction syndrome (DES), but not depression in itself, is associated with poor poststroke survival. Delirium is not independently associated with increased risk for long-term poststroke mortality, although it is associated with poststroke dementia. Furthermore, acute index stroke attributable to SVD is associated with poorer long-term survival and a higher risk for cardiac death than other stroke subtypes. Severe WMC, a surrogate of SVD, is independently related to an increased risk of stroke recurrence at five years. In summary, cognitive poststroke outcomes reflecting changes in the executive network brain, and the presence of cerebral SVD are important determinants of poststroke mortality and ischemic stroke recurrence, regardless of whether SVD is the cause of the index stroke or a condition concurrent to some other etiology.

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The insulated mast scheme for the lightning protection system can be found in a few practical designs. Many advantages over conventional protection system are some times envisaged. However, the technical literature on the analysis of such schemes and further quantification of their protection efficacy is rather scarce. As a first step to address this problem, the present work is taken up and the potential rise at the top and ground end currents in insulating mast scheme with single tower is investigated for several tower heights and pertinent values of other parameters. The quantities that are investigated are the potential difference across the insulation and ground end currents for both tower and the ground wires. Quantifications are carried out for the relevant range of stroke current front times. The influence of number of ground wires, their earthing location and to a limited extent, the length of the insulating support have been ascertained. Some relevant discussion on insulation strength is made. These findings are quite novel and aid in quantification of the practical efficacy of the insulated mast scheme. The level of induction to the support tower and possible flashover to the same are not in favour of this scheme.

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A lightning return stroke model for a downward flash is proposed. The model includes underlying physical phenomena governing return stroke evolution, namely, electric field due to charge distributed along the leader and cloud, transient enhancement of series channel conductance at the bridging regime, and the nonlinear variation of channel conductance, which supports the return stroke current evolution. Thermal effects of free burning arc at the stroke wave front and its impact on channel conductance are studied. A first-order arc model for determining the dynamic channel conductance along with a field-dependent conductivity for corona sheath is used in the model. The model predicts consistent current propagation along the channel with regard to current amplitude and return stroke velocity. The model is also capable of predicting the remote electromagnetic fields that are consistent with the experimental observations.

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The channel dynamics at the wavefront is quite complex and is basically responsible for the evolution of return stroke current. The physical processes that actually contribute to the current evolution are not very clearly known. The enhancement of channel conductance at the wavefront is necessary for the current evolution and hence, return stroke. With regard to this, several questions arise like: (i) what causes the enhancement of this conductance, (ii) as the channel core temperature and electrical conductance are closely related, does one support the other and (iii) is the increase in core temperature on the nascent section of the channel is the result of free burning arc of the wavefront just below. These questions are investigated in detail in this work with appropriate transient thermal analysis and a macroscopic physical model for the lightning return stroke. Results clearly indicate that the contribution from the thermal field of the wavefront region to the adjacent nascent channel section is negligible as compared to the field enhancement brought in by the same. In other words, the whole process of return stroke evolution is dependent on the local heat generation at the nascent section caused by the enhancement of the electric field due to the arrival of the wavefront.

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The gross characteristics of spatio-temporal current evolution in the return stroke phase of a cloud-to-ground lightning are rather well defined. However, they by themselves do not ensure the salient features for the resulting remote Electro- Magnetic Fields (EMFs). In spite of significant efforts in the engineering models wherein, the spatio-temporal current distribution all along the channel is specified by the design, all the salient features of remote EMFs could not be achieved. Only the current evolution that ensures the basic characteristics along with its ability to reproduce all the salient features of remote EMFs ranging from 50 m – 200 km from the lightning channel, can be considered as a realistic return stroke channel current. In view of this, the present work intends to investigate on the required fine features of the return stroke current evolution that yields all the desired features. To ensure that the current evolution is not arbitrary but obeys the involved basic physical processes, a recently developed physical model will be employed for the analysis.