Causes and Risk of Stroke: the Rotterdam Study

It is not easy to imagine that the essence of our being is enclosed in a single organ: the brain. In addition to its miraculous function, also the immensely delicate anatomical and chemical structure of the brain is astounding. In order to maintain its structure and function, the brain needs a constant supply of blood. If the blood flow is interrupted by the occlusion of an artery, the affected part of the brain immediately stops functioning. The brain tissue becomes irreversibly damaged within seconds and the area of irreversible brain damage expands in the course of several hours, resulting in what is called an ischemic stroke (figure 1). A hemorrhagic stroke occurs when blood leaks from an artery into the brain, which has the same detrimental effect on brain tissue as ischemia. Strokes usually take patients completely by surprise. In the normal brain, the input from all of our senses is collected, thoughts and emotions arise, and all voluntary body actions are initiated and coordinated, therefore all these functions can be affected by a stroke. For example, a patient who has a stroke may become unable to utter or understand language, become paralyzed on one side of the body, experience half-sided blindness or difficulties with swallowing, and his or her personality may change dramatically

U(1) Chern-Simons Theory and c=1 Conformal Blocks

The quantization of the U ( 1 ) Chern-Simons action in three dimensions is carried out in a coherent state representation. The wave functionals obtained are generating functionals for the current correlator blocks of two-dimensional c= 1 rational conformal field theories, explicitly realizing a connection found by Witten

Explicit Calculation of the Renormalized Singlet Axial Anomaly

A careful and complete discussion is given of the renormalization of the singlet axial anomaly equation in a vector-like nonabelian gauge theory such as QCD regularized by ordinary dimensional regularization. Pseudotensorial structures are treated with the 't Hooft-Veltman prescription. A general framework for calculations is developed, and subsequently verified by explicit computations through two loops. This is followed by a discussion of the matrix elements obtained.Comment: harvmac, 28 pages plus 4 tables (figures not included, available upon request), UCLA/92/TEP/4

Do malpractice claim clinical case vignettes enhance diagnostic accuracy and acceptance in clinical reasoning education during GP training?

Abstract Background Using malpractice claims cases as vignettes is a promising approach for improving clinical reasoning education (CRE), as malpractice claims can provide a variety of content- and context-rich examples. However, the effect on learning of adding information about a malpractice claim, which may evoke a deeper emotional response, is not yet clear. This study examined whether knowing that a diagnostic error resulted in a malpractice claim affects diagnostic accuracy and self-reported confidence in the diagnosis of future cases. Moreover, suitability of using erroneous cases with and without a malpractice claim for CRE, as judged by participants, was evaluated. Methods In the first session of this two-phased, within-subjects experiment, 81 first-year residents of general practice (GP) were exposed to both erroneous cases with (M) and erroneous cases without (NM) malpractice claim information, derived from a malpractice claims database. Participants rated suitability of the cases for CRE on a five-point Likert scale. In the second session, one week later, participants solved four different cases with the same diagnoses. Diagnostic accuracy was measured with three questions, scored on a 0–1 scale: (1) What is your next step? (2) What is your differential diagnosis? (3) What is your most probable diagnosis and what is your level of certainty on this? Both subjective suitability and diagnostic accuracy scores were compared between the versions (M and NM) using repeated measures ANOVA. Results There were no differences in diagnostic accuracy parameters (M vs. NM next step: 0.79 vs. 0.77, p = 0.505; differential diagnosis 0.68 vs. 0.75, p = 0.072; most probable diagnosis 0.52 vs. 0.57, p = 0.216) and self-reported confidence (53.7% vs. 55.8% p = 0.390) of diagnoses previously seen with or without malpractice claim information. Subjective suitability- and complexity scores for the two versions were similar (suitability: 3.68 vs. 3.84, p = 0.568; complexity 3.71 vs. 3.88, p = 0.218) and significantly increased for higher education levels for both versions. Conclusion The similar diagnostic accuracy rates between cases studied with or without malpractice claim information suggests both versions are equally effective for CRE in GP training. Residents judged both case versions to be similarly suitable for CRE; both were considered more suitable for advanced than for novice learners

View the label before you view the movie: A field experiment into the impact of Portion size and Guideline Daily Amounts labelling on soft drinks in cinemas

<p>Abstract</p> <p>Background</p> <p>Large soft drink sizes increase consumption, and thereby contribute to obesity. Portion size labelling may help consumers to select more appropriate food portions. This study aimed to assess the effectiveness of portion size and caloric Guidelines for Daily Amounts (GDA) labelling on consumers' portion size choices and consumption of regular soft drinks.</p> <p>Methods</p> <p>A field experiment that took place on two subsequent evenings in a Dutch cinema. Participants (n = 101) were asked to select one of five different portion sizes of a soft drink. Consumers were provided with either portion size and caloric GDA labelling (experimental condition) or with millilitre information (control condition).</p> <p>Results</p> <p>Labelling neither stimulated participants to choose small portion sizes (<it>OR </it>= .75, <it>p </it>= .61, CI: .25 - 2.25), nor did labelling dissuade participants to choose large portion sizes (<it>OR </it>= .51, <it>p </it>= .36, CI: .12 - 2.15).</p> <p>Conclusions</p> <p>Portion size and caloric GDA labelling were found to have no effect on soft drink intake. Further research among a larger group of participants combined with pricing strategies is required. The results of this study are relevant for the current public health debate on food labelling.</p

The potential for prevention of dementia across two decades: The prospective, population-based Rotterdam Study

Background: Cardiovascular factors and low education are important risk factors of dementia. We provide contemporary estimates of the proportion of dementia cases that could be prevented if modifiable risk factors were eliminated, i.e., population attributable risk (PAR). Furthermore, we studied whether the PAR has changed across the last two decades. Methods: We included 7,003 participants of the original cohort (starting in 1990) and 2,953 participants of the extended cohort (starting in 2000) of the Rotterdam Study. Both cohorts were followed for dementia until ten years after baseline. We calculated the PAR of overweight, hypertension, diabetes mellitus, cholesterol, smoking, and education. Additionally, we assessed the PAR of stroke, coronary heart disease, heart failure, and atrial fibrillation. We calculated the PAR for each risk factor separately and the combined PAR taking into account the interaction of risk factors. Results: During 57,996 person-years, 624 participants of the original cohort developed dementia, and during 26,177 person-years, 145 participants of the extended cohort developed dementia. The combined PAR in the original cohort was 0.23 (95 % CI, 0.05-0.62). The PAR in the extended cohort was slightly higher at 0.30 (95 % CI, 0.06-0.76). The combined PAR including cardiovascular diseases was 0.25 (95 % CI, 0.07-0.62) in the original cohort and 0.33 (95 % CI, 0.07-0.77) in the extended cohort. Conclusions: A substantial part of dementia cases could be prevented if modifiable risk factors would be eliminated. Although prevention and treatment options of cardiovascular risk factors and diseases have improved, the preventive potential for dementia has not declined over the last two decades

Effectiveness of Personal Protective Equipment and Oseltamivir Prophylaxis during Avian Influenza A (H7N7) Epidemic, the Netherlands, 2003

TOC Summary: Only oseltamivir use significantly reduced the risk for human infection

Effects of adolescent sociocognitive development on the cortisol response to social evaluation.

Pathways through Adolescenc