A Parallel Thrombolysis Protocol with Nurse Practitioners As Coordinators Minimized Door-to-Needle Time for Acute Ischemic Stroke

Introduction. Quick thrombolysis after stroke improved clinical outcomes. The study objective was to shorten door-to-needle time for thrombolysis. Methods. After identifying the sources of in-hospital delays, we developed a protocol with a parallel algorithm and recruited nurse practitioners into the acute stroke team. We applied the new protocol on stroke patients from October 2009 to September 2010. Patients from the previous two years were used for comparison. Results. For ischemic stroke patients within 3 hours of onset, the median time from arrival to computed tomography scanning was reduced from 29 to 20 minutes (P < 0.001) and the median time from arrival to neurology evaluation decreased from 61 to 43 minutes (P < 0.001). For those patients who received thrombolysis, the median door-to-needle time was shortened from 68.5 to 58 minutes (P < 0.05). Conclusions. The parallel thrombolysis protocol successfully improved the median door-to-needle time to below the guideline-recommended 60 minutes

The Impact of Timing and Dose of Rehabilitation Delivery on Functional Recovery of Stroke Patients

BackgroundTo investigate the impact of both timing and dose of rehabilitation delivery on the functional recovery of stroke patients.MethodsFrom chart review, we included 76 patients who were admitted to a regional hospital for first-ever stroke, and who had received multidisciplinary rehabilitation programs including physical therapy (PT) and occupational therapy (OT) at the inpatient department, and continuous rehabilitation therapy at the outpatient department for at least 3 months. The collected data included age, sex, type of stroke (hemorrhage/infarction), onset of stroke, initial motor status by Brunnstrom's motor recovery stages, time to rehabilitation intervention (from onset of stroke), length of stay, existence of aphasia, craniotomy (yes/no), and total units of rehabilitation. Main outcome measures were serial Barthel Index (BI) at initial assessment, 1 month, 3 months, 6 months, and 1 year post-stroke.ResultsAge was inversely correlated with BI and BI improvement at 3 months and 6 months post-stroke. Rehabilitation intervention time from onset was negatively correlated with BI improvement at 1 month and 1 year, and with BI at 1 month, 3 months, 6 months, and 1 year post-stroke. The total units of inpatient PT and/or OT were positively correlated with BI improvement at 1 month, 3 months, and 6 months post-stroke. The total units of PT and/or OT were positively correlated with BI improvement at 3 months and 6 months post-stroke. And the initial BI was positively correlated with BI at 1 month, 3 months, and 6 months post-stroke. The total units of OT can significantly predict BI improvement at 3 months and 6 months post-stroke, while the initial BI capacity can significantly predict BI status at 1 month, 3 months, and 6 months post-stroke.ConclusionThere is a dose-dependent effect of rehabilitation on functional improvement of stroke patients for the first 6 months post-stroke, and earlier delivery of rehabilitation has lasting effects on the functional recovery of stroke patients up to 1 year

Syntax and Parametric Analysis of Superblock Patterns

A particular kind of street network is examined, where strong differentiation between scales of syntactic structure is evident: supergrids of primary roads, with inserted local streets. Computational formulae are provided to describe simple regular systems and clarify the nature of the syntactic differentiation of scales. The focus is on the linear extension of streets and also on distances measured according to direction changes. A small sample of examples from Chicago, Los Angeles, Beijing and Seoul as well as the Doxiadis plan for sector G7 of Islamabad and the Perry-Whitten neighborhood plan for New York are also analyzed, leading to estimates of a number of remarkably consistent parameters that can function as benchmarks for design exploration or theoretical experimentation. An experiment whereby the fabric of the historic centers of small French towns is inserted into a supergrid at 0.5 mile intervals is also described to explore the scale and character of inserted systems in comparison to historic urban fabrics. The work leads to a methodological proposition. Supergrids can best be conceptualized by decomposing the analysis of closeness centrality (integration) into two components: the mean directional distances associated with the supergrid as an independent system, and the mean directional distances from inserted streets to the nearest supergrid element (step depth in DepthMap). Decomposition responds to a theoretical idea: cognitive maps comprise a skeleton system relative to which other parts can be ‘placed’ and related. Decomposition also responds to a practical purpose: in order to design one must work with intuitively accessible parameters that can be controlled within the site and scope of the design

Editorial: Consequences of the COVID-19 Pandemic on Care for Neurological Conditions

The coronavirus disease 2019 (COVID-19) pandemic has caused a wide range of unprecedentedconsequences, including social, economic, and health disruptions. From the point of view ofhealthcare assistance, COVID-19 has deeply impacted usual practice at all levels since the beginningof 2020. In this setting, neurological assistance has adapted to the circumstances of the pandemic. Infact, because COVID-19 involves neurological symptoms, affected patients require the attention ofneurologists, and the high demand for clinical care entailed the recruitment ofmany neurologists tofrontline assistance (1). In addition, the pandemic has impacted the management of patients withneurological disorders, with changes in the management of relapses, usual follow-up, diagnosticprocedures, implementation or generalization of telemedicine, etc. Lockdown and social isolationwere also very harmful in patients with neurological disorders (2). Furthermore, the treatment ofneurological emergencies, such as stroke, was also compromised because of resource re-allocationduring the emergency, and the fear of patients to attend the hospital.The neurological community needed to share experiences about how to face this globalchallenge. Accordingly, this Research Topic was launched in April 2020 to address these issues.Over 117 manuscripts were submitted, and 76 papers have been published, including originals,reviews, and case reports. Studies have covered the main areas of neurological care, includinggeneral neurological care, stroke, epilepsy, multiple sclerosis, movement disorders, cognitiveneurology, neuromuscular disorders, headache, and neuropediatricsFil: Matias Guiu, Jordi A.. Universidad Complutense de Madrid; EspañaFil: Sung, Sheng Feng. No especifíca;Fil: Hsieh, Cheng Yang. No especifíca;Fil: Nezu, Tomohisa. No especifíca;Fil: Porta Etessam, Jesús. Universidad Complutense de Madrid; EspañaFil: Allegri, Ricardo Francisco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Clinical Study Underestimated Rate of Status Epilepticus according to the Traditional Definition of Status Epilepticus

properly cited. Purpose. Status epilepticus (SE) is an important neurological emergency. Early diagnosis could improve outcomes. Traditionally, SE is defined as seizures lasting at least 30 min or repeated seizures over 30 min without recovery of consciousness. Some specialists argued that the duration of seizures qualifying as SE should be shorter and the operational definition of SE was suggested. It is unclear whether physicians follow the operational definition. The objective of this study was to investigate whether the incidence of SE was underestimated and to investigate the underestimate rate. Methods. This retrospective study evaluates the difference in diagnosis of SE between operational definition and traditional definition of status epilepticus. Between July 1, 2012, and June 30, 2014, patients discharged with ICD-9 codes for epilepsy (345.X) in Chia-Yi Christian Hospital were included in the study. A seizure lasting at least 30 min or repeated seizures over 30 min without recovery of consciousness were considered SE according to the traditional definition of SE (TDSE). A seizure lasting between 5 and 30 min was considered SE according to the operational definition of SE (ODSE); it was defined as underestimated status epilepticus (UESE). Results. During a 2-year period, there were 256 episodes of seizures requiring hospital admission. Among the 256 episodes, 99 episodes lasted longer than 5 min, out of which 61 (61.6%) episodes persisted over 30 min (TDSE) and 38 (38.4%) episodes continued between 5 and 30 min (UESE). In the 38 episodes of seizure lasting 5 to 30 minutes, only one episode was previously discharged as SE (ICD-9-CM 345.3). Conclusion. We underestimated 37.4% of SE. Continuing education regarding the diagnosis and treatment of epilepsy is important for physicians

Striatopallidal dysfunction underlies repetitive behavior in Shank3-deficient model of autism

The postsynaptic scaffolding protein SH3 and multiple ankyrin repeat domains 3 (SHANK3) is critical for the development and function of glutamatergic synapses. Disruption of the SHANK3-encoding gene has been strongly implicated as a monogenic cause of autism, and Shank3 mutant mice show repetitive grooming and social interaction deficits. Although basal ganglia dysfunction has been proposed to underlie repetitive behaviors, few studies have provided direct evidence to support this notion and the exact cellular mechanisms remain largely unknown. Here, we utilized the Shank3B mutant mouse model of autism to investigate how Shank3 mutation may differentially affect striatonigral (direct pathway) and striatopallidal (indirect pathway) medium spiny neurons (MSNs) and its relevance to repetitive grooming behavior in Shank3B mutant mice. We found that Shank3 deletion preferentially affects synapses onto striatopallidal MSNs. Striatopallidal MSNs showed profound defects, including alterations in synaptic transmission, synaptic plasticity, and spine density. Importantly, the repetitive grooming behavior was rescued by selectively enhancing the striatopallidal MSN activity via a Gq-coupled human M3 muscarinic receptor (hM3Dq), a type of designer receptors exclusively activated by designer drugs (DREADD). Our findings directly demonstrate the existence of distinct changes between 2 striatal pathways in a mouse model of autism and indicate that the indirect striatal pathway disruption might play a causative role in repetitive behavior of Shank3B mutant mice.National Institute of Mental Health (U.S.) (Grant 5R01MH097104

ATOMS : ALMA three-millimeter observations of massive star-forming regions - II. Compact objects in ACA observations and star formation scaling relations

We report studies of the relationships between the total bolometric luminosity (L-bol or L-TIR) and the molecular line luminosities of J = 1 - 0 transitions of (HCN)-C-13, (HCO+)-C-13, HCN, and HCO+ with data obtained from ACA observations in the 'ATOMS' survey of 146 active Galactic star-forming regions. The correlations between L-bol and molecular line luminosities L-mol' of the four transitions all appear to be approximately linear. Line emission of isotopologues shows as large scatters in L-bol-L-mol' relations as their main line emission. The log(L-bol/L-mol') for different molecular line tracers have similar distributions. The L-bol-to-L-mol' ratios do not change with galactocentric distances (R-GC) and clump masses (M-clump). The molecular line luminosity ratios (HCN-to-HCO+, (HCN)-C-13-to-(HCO+)-C-13, HCN-to-(HCN)-C-13, and HCO+-to-(HCO+)-C-13) all appear constant against L-bol, dust temperature (T-d), M-clump, and R-GC. Our studies suggest that both the main lines and isotopologue lines are good tracers of the total masses of dense gas in Galactic molecular clumps. The large optical depths of main lines do not affect the interpretation of the slopes in star formation relations. We find that the mean star formation efficiency (SFE) of massive Galactic clumps in the 'ATOMS' survey is reasonably consistent with other measures of the SFE for dense gas, even those using very different tracers or examining very different spatial scales.Peer reviewe

ATOMS : ALMA three-millimeter observations of massive star-forming regions - III. Catalogues of candidate hot molecular cores and hyper/ultra compact H II regions

A correction has been published: Monthly Notices of the Royal Astronomical Society, Volume 511, Issue 1, March 2022, Pages 501–505, https://doi.org/10.1093/mnras/stac039We have identified 453 compact dense cores in 3mm continuum emission maps in the ALMA Three-millimetre Observations of Massive Star-forming regions survey, and compiled three catalogues of high-mass star-forming cores. One catalogue, referred to as hyper/ultra compact (H/UC)-HII catalogue, includes 89 cores that enshroud H/UC HII regions as characterized by associated compact H40 alpha emission. A second catalogue, referred to as pure s-cHMC, includes 32 candidate hot molecular cores (HMCs) showing rich spectra (N >= 20 lines) of complex organic molecules (COMs) and not associated with H/UC-HII regions. The third catalogue, referred to as pure w-cHMC, includes 58 candidate HMCs with relatively low levels of COM richness and not associated with H/UC-Hii regions. These three catalogues of dense cores provide an important foundation for future studies of the early stages of high-mass star formation across the Milky Way. We also find that nearly half of H/UC-HII cores are candidate HMCs. From the number counts of COM-containing and H/UC-HII cores, we suggest that the duration of high-mass protostellar cores showing chemically rich features is at least comparable to the lifetime of H/UC-HII regions. For cores in the H/UC-HII catalogue, the width of the H40 alpha line increases as the core size decreases, suggesting that the non-thermal dynamical and/or pressure line-broadening mechanisms dominate on the smaller scales of the H/UC-HII cores.Peer reviewe