Stroke: epidemiology and outcomes

Objective: To determine the frequency of mortality, length of stay and nosocomial pneumonia outcomes, as well as their distribution according to predictor variables, in stroke patients treated at the emergency room of a tertiary hospital. Methods: A retrospective cohort study, with a sample of patients attended between January 1 and December 31, 2018. Based on the data collected in the medical records, the sample was characterized. Therefore, the frequency of each outcome was checked, as well as its distribution according to the predictor variables. Results: The sample population consisted of 210 patients. The frequencies observed in death and nosocomial pneumonia were 17.6% and 17.1%, respectively. The general mean length of stay was 13.8 ±12.9 days. Statistically significant differences were observed both in the occurrence of nosocomial pneumonia and atrial fibrillation (AF); days of hospitalization in intensive care unit; total days of hospitalization; orotracheal intubation; use of nasoenteral tube and surgical procedure secondary to stroke. Morever, there was also the relation of total time of hospitalization regarding dyslipidemia; orotracheal intubation; use of nasoenteral tube and surgical procedure secondary to stroke. Conclusion: The results found in the frequency of mortality, nosocomial pneumonia and mean total number of days of hospitalization are comparable with other Brazilian studies. However, it is possible to optimize the time of care provided for patients who arrive in the emergency room. In addition, the decrease of hospitalization days in dyslipidemic patients and the increase of nosocomial pneumonia in AF patients require further studies to verify such findings

School Climate: Parents\u2019, Students\u2019 And Teachers\u2019 Perceptions

Because of the importance of individual perceptions, schools often assess how students or teachers or parents feel about their school, and school climate has often been associated with improved school achievement, but rarely they take into account all these \u201cactors\u201d at the same time. The main aim of this work is to compare the results obtained in a population study on school climate that involves students, parents, teachers and non-teaching staff. In this paper, we will present the results of parents\u2019, students\u2019, teachers\u2019 and no-teacher personnel's perception. We have administered 13,500 structured questionnaires addressed to students, parents, teachers, educational assistance personnel, involved in the four orders of schools (Pre-school, Elementary, Middle, High) of the province of Bolzano. Parental permission was obtained for young people. The present study has been conducted in the province of Bolzano, northern Italy, between January and April 2012. A School Climate Perception Questionnaire (SCPQ), that can be completed in 10 minutes, has been developed to assess environments and climate of all Italian language schools. In order to determine the interrelationships among the questionnaire items, a Principal-Axis Factor Analysis was performed. The final scale was used for Confirmatory Factor Analysis that was done to assess its construct validity. We will present the results regarding the school climate perceptions of teachers, parents and students and their comparison

How do drivers negotiate intersections with pedestrians? The importance of pedestrian time-to-arrival and visibility

Forward collision warning (FCW) and autonomous emergency braking (AEB) systems are increasingly available and prevent or mitigate collisions by alerting the driver or autonomously braking the vehicle. Threat-assessment and decision-making algorithms for FCW and AEB aim to find the best compromise for safety by intervening at the “right” time: neither too early, potentially upsetting the driver, nor too late, possibly missing opportunities to avoid the collision.Today, the extent to which activation times for FCW and AEB should depend on factors such as pedestrian speed and lane width is unknown. To guide the design of FCW and AEB intervention time, we employed a fractional factorial design, and determined how seven factors (crossing side, car speed, pedestrian speed, crossing angle, pedestrian size, zebra-crossing presence, and lane width) affect the driver’s response process and comfort zone when negotiating an intersection with a pedestrian. Ninety-four volunteers drove through an intersection in a fixed-base driving simulator, which was based on open-source software (OpenDS). Several parameters, including pedestrian time-to-arrival and driver response time, were calculated to describe the driver response process and define driver comfort boundaries.Linear mixed-effect models showed that driver responses depended mainly on pedestrian time-to-arrival and visibility, whereas factors such as pedestrian size, zebra-crossing presence, and lane width did not significantly influence the driver response process. Some drivers changed their negotiation strategy (proportion of pedal braking to engine braking) to minimize driving effort over the course of the experiment. Experienced drivers changed more than less experienced drivers; nevertheless, all drivers behaved similarly, independent of driving experience. The flexible and customizable driving environment provided by OpenDS may be a viable platform for behavioural experiments in driving simulators.Results from this study suggest that visibility and pedestrian time-to-arrival are the most important variables for defining the earliest acceptable FCW and AEB activations. Fractional factorial design effectively compared the influence of several factors on driver behaviour within a single experiment; however, this design did not allow in-depth data analysis. In the future, OpenDS might become a standard platform, enabling crowdsourcing and favouring repeatability across studies in traffic safety. Finally, this study advises future design and evaluation procedures (e.g. new car assessment programs) for FCW and AEB by highlighting which factors deserve further investigation and which ones do not

Modelling discomfort: How do drivers feel when cyclists cross their path?

Introduction: Even as worldwide interest in bicycling continues to grow, cyclists constitute a large part of road fatalities. A major part of the fatalities occurs when cyclists cross a vehicle path. Active safety systems and automated driving systems may already account for these interactions in their control algorithms. However, the driver behaviour models that these systems use may not be optimal in terms of driver acceptance. If the systems could estimate driver discomfort, their acceptance might be improved.Method: This study investigated the degree of discomfort experienced by drivers when cyclists crossed their travel path. Participants were instructed to drive through an intersection in a fixed-base simulator or on a test track, following the same experimental protocol. The effects of demographic variables (age, gender, driving frequency, and yearly mileage), controlled variables (car speed, bicycle speed, and bicycle-car configuration), and a visual cue (car’s time-to-arrival at the intersection when the bicycle appears; TTAvis) on self-reported discomfort were analysed using cumulative link mixed models (CLMM).Results: Results showed that demographic variables had a significant effect on the discomfort felt by drivers—and could explain the variability observed between drivers. Across both experimental environments, the controlled variables were shown to significantly influence discomfort. TTAvis was shown to have a significant effect on discomfort as well; the closer to zero TTAvis was (i.e., the more critical the situation), the more likely the driver red great discomfort. The prediction accuracies of the CLMM with controlled variables and the CLMM with the visual cue were similar, with an average accuracy between 40 and 50%. Surprise trials in the simulator experiment, in which the bicycle appeared unexpectedly, improved the prediction accuracy of the models, more notably the CLMM including TTAvis. Conclusions: The results suggest that the discomfort was mainly driven by the visual cue rather than the deceleration cues. Thus, it is suggested that an algorithm that estimates driver discomfort be included in active safety systems and autonomous driving systems. The CLMM including TTAvis was presented as a potential candidate to serve this purpose

Tomato (Solanum lycopersicum L.) accumulation and allergenicity in response to nickel stress

Vegetables represent a major source of Ni exposure. Environmental contamination and cultural practices can increase Ni amount in tomato posing significant risk for human health. This work assesses the tomato (Solanum lycopersicum L.) response to Ni on the agronomic yield of fruits and the related production of allergens. Two cultivars were grown in pots amended with Ni 0, 30, 60, 120, and 300 mg kg 121, respectively. XRF and ICP-MS analyses highlighted the direct increase of fruit Ni content compared to soil Ni, maintaining a stable biomass. Leaf water content increased at Ni 300 mg kg 121. Total protein content and individual allergenic components were investigated using biochemical (RP-HPLC and N-terminal amino acid sequencing) and immunological (inhibition tests of IgE binding by SPHIAa assay on the FABER testing system) methodologies. Ni affected the fruit tissue concentration of pathogenesis-related proteins and relevant allergens (LTP, profilin, Bet v 1-like protein and TLP). This study elucidates for the first time that tomato reacts to exogenous Ni, uptaking the metal while changing its allergenic profiles, with potential double increasing of exposure risks for consumers. This evidence highlighted the importance of adequate choice of low-Ni tomato cultivars and practices to reduce Ni uptake by potentially contaminated matrices

Role of serum-free light chain assay for defining response and progression in immunoglobulin secretory multiple myeloma

The International Myeloma Working Group (IMWG) guidelines recommend using electrophoresis and immunofixation to define response and progressive disease (PD) in immunoglobulin (Ig) secretory multiple myeloma (Ig-MM), whereas the role of serum-free light chain (sFLC) is controversial. We retrospectively analyzed the value of adding sFLC assays in the definition of response and PD according to IMWG criteria in 339 Ig-MM patients treated with a first-line novel agent-based therapy (median follow-up 54 months). sFLC PD was defined according to conventional criteria plus increased sFLC levels, or sFLC escape (sFLCe); progression/sFLCe-free survival (ePFS) was the time from the start of treatment to the date of first PD or sFLCe, or death; overall survival after PD/sFLCe (OS after Pe) was the time from first PD or sFLCe to the date of death. 148 (44%) patients achieved a complete response and 198 (60%) a normal sFLC ratio (sFLCR). sFLCR normalization was an independent prognostic factor for extended PFS (HR = 0.46, p = 0.001) and OS (HR = 0.47, p = 0.006) by multivariable analysis. 175 (52%) patients experienced PD according to the IMWG criteria, whereas 180 (53%) experienced PD or sFLCe. Overall, a sFLCe was observed in 31 (9%) patients. Median PFS and ePFS were both equal to 36 (95% CI = 32–42, and 32–40, respectively) months. sFLC PD adversely affected the OS after Pe compared to PD with increasing monoclonal Ig only (HR = 0.52, p = 0.012). Our results support the inclusion of the sFLC assay for defining response and PD in Ig-MM

Biofeedback for training balance and mobility tasks in older populations: a systematic review

<p>Abstract</p> <p>Context</p> <p>An effective application of biofeedback for interventions in older adults with balance and mobility disorders may be compromised due to co-morbidity.</p> <p>Objective</p> <p>To evaluate the feasibility and the effectiveness of biofeedback-based training of balance and/or mobility in older adults.</p> <p>Data Sources</p> <p>PubMed (1950-2009), EMBASE (1988-2009), Web of Science (1945-2009), the Cochrane Controlled Trials Register (1960-2009), CINAHL (1982-2009) and PsycINFO (1840-2009). The search strategy was composed of terms referring to biofeedback, balance or mobility, and older adults. Additional studies were identified by scanning reference lists.</p> <p>Study Selection</p> <p>For evaluating effectiveness, 2 reviewers independently screened papers and included controlled studies in older adults (i.e. mean age equal to or greater than 60 years) if they applied biofeedback during repeated practice sessions, and if they used at least one objective outcome measure of a balance or mobility task.</p> <p>Data Extraction</p> <p>Rating of study quality, with use of the Physiotherapy Evidence Database rating scale (PEDro scale), was performed independently by the 2 reviewers. Indications for (non)effectiveness were identified if 2 or more similar studies reported a (non)significant effect for the same type of outcome. Effect sizes were calculated.</p> <p>Results and Conclusions</p> <p>Although most available studies did not systematically evaluate feasibility aspects, reports of high participation rates, low drop-out rates, absence of adverse events and positive training experiences suggest that biofeedback methods can be applied in older adults. Effectiveness was evaluated based on 21 studies, mostly of moderate quality. An indication for effectiveness of visual feedback-based training of balance in (frail) older adults was identified for postural sway, weight-shifting and reaction time in standing, and for the Berg Balance Scale. Indications for added effectiveness of applying biofeedback during training of balance, gait, or sit-to-stand transfers in older patients post-stroke were identified for training-specific aspects. The same applies for auditory feedback-based training of gait in older patients with lower-limb surgery.</p> <p>Implications</p> <p>Further appropriate studies are needed in different populations of older adults to be able to make definitive statements regarding the (long-term) added effectiveness, particularly on measures of functioning.</p

Prospective Evaluation of Clinico-Pathological Predictors of Postoperative Atrial Fibrillation

Background: Postoperative atrial fibrillation (POAF) occurs in 30% to 50% of patients undergoing cardiac surgery and is associated with increased morbidity and mortality. Prospective identification of structural/molecular changes in atrial myocardium that correlate with myocardial injury and precede and predict risk of POAF may identify new molecular pathways and targets for prevention of this common morbid complication. Methods: Right atrial appendage samples were prospectively collected during cardiac surgery from 239 patients enrolled in the OPERA trial (Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation), fixed in 10% buffered formalin, and embedded in paraffin for histology. We assessed general tissue morphology, cardiomyocyte diameters, myocytolysis (perinuclear myofibril loss), accumulation of perinuclear glycogen, interstitial fibrosis, and myocardial gap junction distribution. We also assayed NT-proBNP (N-terminal pro-B-type natriuretic peptide), hs-cTnT, CRP (C-reactive protein), and circulating oxidative stress biomarkers (F2-isoprostanes, F3-isoprostanes, isofurans) in plasma collected before, during, and 48 hours after surgery. POAF was defined as occurrence of postcardiac surgery atrial fibrillation or flutter of at least 30 seconds duration confirmed by rhythm strip or 12-lead ECG. The follow-up period for all arrhythmias was from surgery until hospital discharge or postoperative day 10. Results: Thirty-five percent of patients experienced POAF. Compared with the non-POAF group, they were slightly older and more likely to have chronic obstructive pulmonary disease or heart failure. They also had a higher European System for Cardiac Operative Risk Evaluation and more often underwent valve surgery. No differences in left atrial size were observed between patients with POAF and patients without POAF. The extent of atrial interstitial fibrosis, cardiomyocyte myocytolysis, cardiomyocyte diameter, glycogen score or Cx43 distribution at the time of surgery was not significantly associated with incidence of POAF. None of these histopathologic abnormalities were correlated with levels of NT-proBNP, hs-cTnT, CRP, or oxidative stress biomarkers. Conclusions: In sinus rhythm patients undergoing cardiac surgery, histopathologic changes in the right atrial appendage do not predict POAF. They also do not correlate with biomarkers of cardiac function, inflammation, and oxidative stress

Could sound be used as a strategy for reducing symptoms of perceived motion sickness?

<p>Abstract</p> <p>Background</p> <p>Working while exposed to motions, physically and psychologically affects a person. Traditionally, motion sickness symptom reduction has implied use of medication, which can lead to detrimental effects on performance. Non-pharmaceutical strategies, in turn, often require cognitive and perceptual attention. Hence, for people working in high demand environments where it is impossible to reallocate focus of attention, other strategies are called upon. The aim of the study was to investigate possible impact of a mitigation strategy on perceived motion sickness and psychophysiological responses, based on an artificial sound horizon compared with a non-positioned sound source.</p> <p>Methods</p> <p>Twenty-three healthy subjects were seated on a motion platform in an artificial sound horizon or in non-positioned sound, in random order with one week interval between the trials. Perceived motion sickness (Mal), maximum duration of exposure (ST), skin conductance, blood volume pulse, temperature, respiration rate, eye movements and heart rate were measured continuously throughout the trials.</p> <p>Results</p> <p>Mal scores increased over time in both sound conditions, but the artificial sound horizon, applied as a mitigation strategy for perceived motion sickness, showed no significant effect on Mal scores or ST. The number of fixations increased with time in the non-positioned sound condition. Moreover, fixation time was longer in the non-positioned sound condition compared with sound horizon, indicating that the subjects used more time to fixate and, hence, assumingly made fewer saccades.</p> <p>Conclusion</p> <p>A subliminally presented artificial sound horizon did not significantly affect perceived motion sickness, psychophysiological variables or the time the subjects endured the motion sickness triggering stimuli. The number of fixations and fixation times increased over time in the non-positioned sound condition.</p