Acute Stroke: Present and Future of Catheter-Based Interventions

Acute ischemic stroke is a major cause of morbidity and mortality in industrialized nations. The sequel of stroke ranges from mild to severe disability and even death. Since the impairment may be permanent, the costs to society from work incapacity and the need for long-term care can be high. Additionally, the burden of suffering associated with the disease may have devastating effects on individuals and families.Following the occlusion of a cerebral vessel, the full extent of the infarction may not become clinically and radiologically apparent until days after. By then, the surrounding watershed zone, or penumbra, either survives or succumbs to necrosis over time. The natural history of this "tissue at risk" is determined by two factors: the collateralization from other vascular territories and the possible occurrence of spontaneous recanalization of the occluded vessel. The current treatment options for acute ischemic stroke are aiming at an early and sustained restoration of flow to the penumbra. The effect of the treatment is therefore time-dependent and the neurologic outcome is a function of the time span between onset of symptoms and recanalization therapy as well as of the recanalization rate associated with a specific treatment.This report summarizes the results of the major trials on catheter-based interventions, either using thrombolytic drugs or novel mechanical approaches being developed to treat patients with acute ischemic stroke.

Attempting to improve standardized test results using Study Islands' web-based mastery program

State standardized testing has always been a tool to measure a school’s performance and to help evaluate school curriculum. However, with the school of choice legislation in 1992, the MEAP test became a measuring stick to grade schools by and a major tool in attracting school of choice students. Now, declining enrollment and a state budget struggling to stay out of the red have made school of choice students more important than ever before. MEAP scores have become the deciding factor in some cases. For the past five years, the Hancock Middle School staff has been working hard to improve their students’ MEAP scores in accordance with President Bush's “No Child Left Behind” legislation. In 2005, the school was awarded a grant that enabled staff to work for two years on writing and working towards school goals that were based on the improvement of MEAP scores in writing and math. As part of this effort, the school purchased an internet-based program geared at giving students practice on state content standards. This study examined the results of efforts by Hancock Middle School to help improve student scores in mathematics on the MEAP test through the use of an online program called “Study Island.” In the past, the program was used to remediate students, and as a review with an incentive at the end of the year for students completing a certain number of objectives. It had also been used as a review before upcoming MEAP testing in the fall. All of these methods may have helped a few students perform at an increased level on their standardized test, but the question remained of whether a sustained use of the program in a classroom setting would increase an understanding of concepts and performance on the MEAP for the masses. This study addressed this question. Student MEAP scores and Study Island data from experimental and comparison groups of students were compared to understand how a sustained use of Study Island in the classroom would impact student test scores on the MEAP. In addition, these data were analyzed to determine whether Study Island results provide a good indicator of students’ MEAP performance. The results of the study suggest that there were limited benefits related to sustained use of Study Island and gave some indications about the effectiveness of the mathematics curriculum at Hancock Middle School. These results and implications for instruction are discussed.

Can a novel web-based computer test predict poor simulated driving performance? A pilot study with healthy and cognitive-impaired participants

BACKGROUND Driving a car is a complex instrumental activity of daily living and driving performance is very sensitive to cognitive impairment. The assessment of driving-relevant cognition in older drivers is challenging and requires reliable and valid tests with good sensitivity and specificity to predict safe driving. Driving simulators can be used to test fitness to drive. Several studies have found strong correlation between driving simulator performance and on-the-road driving. However, access to driving simulators is restricted to specialists and simulators are too expensive, large, and complex to allow easy access to older drivers or physicians advising them. An easily accessible, Web-based, cognitive screening test could offer a solution to this problem. The World Wide Web allows easy dissemination of the test software and implementation of the scoring algorithm on a central server, allowing generation of a dynamically growing database with normative values and ensures that all users have access to the same up-to-date normative values. OBJECTIVE In this pilot study, we present the novel Web-based Bern Cognitive Screening Test (wBCST) and investigate whether it can predict poor simulated driving performance in healthy and cognitive-impaired participants. METHODS The wBCST performance and simulated driving performance have been analyzed in 26 healthy younger and 44 healthy older participants as well as in 10 older participants with cognitive impairment. Correlations between the two tests were calculated. Also, simulated driving performance was used to group the participants into good performers (n=70) and poor performers (n=10). A receiver-operating characteristic analysis was calculated to determine sensitivity and specificity of the wBCST in predicting simulated driving performance. RESULTS The mean wBCST score of the participants with poor simulated driving performance was reduced by 52%, compared to participants with good simulated driving performance (P<.001). The area under the receiver-operating characteristic curve was 0.80 with a 95% confidence interval 0.68-0.92. CONCLUSIONS When selecting a 75% test score as the cutoff, the novel test has 83% sensitivity, 70% specificity, and 81% efficiency, which are good values for a screening test. Overall, in this pilot study, the novel Web-based computer test appears to be a promising tool for supporting clinicians in fitness-to-drive assessments of older drivers. The Web-based distribution and scoring on a central computer will facilitate further evaluation of the novel test setup. We expect that in the near future, Web-based computer tests will become a valid and reliable tool for clinicians, for example, when assessing fitness to drive in older drivers.

Internet-Based Interventions for Social Anxiety Disorder - an Overview

Internet-based interventions hold specific advantages and disadvantages in the treatment of social anxiety disorder (SAD). The present review examines different approaches in the internet-based treatment of SAD and reviews their efficacy and effectiveness. 21 studies investigated the potential of guided and unguided internetbased cognitive-behavioral treatments (ICBT) for SAD, comprising a total of N = 1,801 socially anxious individuals. The large majority of these trials reported substantial reductions of social anxiety symptoms through ICBT programs. Within effect sizes were mostly large and comparisons to waitlist and more active control groups were positive. Treatment gains were stable from 3 months to 5 years after treatment termination. In conclusion, ICBT is effective in the reduction of social anxiety symptoms. At the same time, not all participants benefit from these treatments to a sufficient degree. Future research should focus on what makes these interventions work in which patient populations, and at the same time, examine ways to implement internet-based treatment in the routine care for socially anxious patients

3D Face Reconstruction from 2D Pictures: First Results of a Web-Based Computer Aided System for Aesthetic Procedures

The human face is a vital component of our identity and many people undergo medical aesthetics procedures in order to achieve an ideal or desired look. However, communication between physician and patient is fundamental to understand the patient’s wishes and to achieve the desired results. To date, most plastic surgeons rely on either “free hand” 2D drawings on picture printouts or computerized picture morphing. Alternatively, hardware dependent solutions allow facial shapes to be created and planned in 3D, but they are usually expensive or complex to handle. To offer a simple and hardware independent solution, we propose a web-based application that uses 3 standard 2D pictures to create a 3D representation of the patient’s face on which facial aesthetic procedures such as filling, skin clearing or rejuvenation, and rhinoplasty are planned in 3D. The proposed application couples a set of well-established methods together in a novel manner to optimize 3D reconstructions for clinical use. Face reconstructions performed with the application were evaluated by two plastic surgeons and also compared to ground truth data. Results showed the application can provide accurate 3D face representations to be used in clinics (within an average of 2 mm error) in less than 5 min.

Developing a Web-Based Course in Phases

Introduction: Distance education has grown in popularity and usage. At the same time, enrollments at postsecondary institutions continue to increase. This places significant growth pressures on institutions of higher learning. Institutions providing nursing education have historically faced limited faculty resources. This has made it difficult to meet demand for distance education; and an “all-at-once” approach to course development does little to ease this problem. In this approach, resources are expended up front before a course is offered. [See PDF for complete abstract].

Integrating Web-based Curricula into Allied Health Programs

This workshop will include \"Best Practices\" related to the integration of web-based instruction into allied health programs or courses. [See PDF for complete abstract]

Key Aspects Affecting Students’ Perception Regarding the Instructional Quality of Online and Web Based Courses

This study assessed the perceptions of college students regarding the instructional quality of online and web based courses via a content management system. [See PDF for complete abstract]

Developing and Integrating the Management of Elder Abuse in Primary Practice: A Case Study Using A Web-Based CME Course Format

Introduction: As the population in the United States continues to age, more attention in primary practice settings is now devoted toward managing the care of the elderly. The occurrence of elder abuse is a growing problem. It is a condition many professionals in primary care may be ill prepared with the knowledge or resources to identify and manage. [See PDF for complete abstract]