Predicting long-term outcome after acute ischemic stroke: a simple index works in patients from controlled clinical trials

Background and Purpose—An early and reliable prognosis for recovery in stroke patients is important for initiation of individual treatment and for informing patients and relatives. We recently developed and validated models for predicting survival and functional independence within 3 months after acute stroke, based on age and the National Institutes of Health Stroke Scale score assessed within 6 hours after stroke. Herein we demonstrate the applicability of our models in an independent sample of patients from controlled clinical trials. Methods—The prognostic models were used to predict survival and functional recovery in 5419 patients from the Virtual International Stroke Trials Archive (VISTA). Furthermore, we tried to improve the accuracy by adapting intercepts and estimating new model parameters. Results—The original models were able to correctly classify 70.4% (survival) and 72.9% (functional recovery) of patients. Because the prediction was slightly pessimistic for patients in the controlled trials, adapting the intercept improved the accuracy to 74.8% (survival) and 74.0% (functional recovery). Novel estimation of parameters, however, yielded no relevant further improvement. Conclusions—For acute ischemic stroke patients included in controlled trials, our easy-to-apply prognostic models based on age and National Institutes of Health Stroke Scale score correctly predicted survival and functional recovery after 3 months. Furthermore, a simple adaptation helps to adjust for a different prognosis and is recommended if a large data set is available. (Stroke. 2008;39:000-000.

COOPERATIVISMO E DESENVOLVIMENTO NO OESTE PARANAENSE: O CASO DA C.VALE NA REGIÃO DE PALOTINA/ PR

O objetivo deste artigo é analisar o desenvolvimento sócio-econômico ocorrido na região de atuação da C Vale Cooperativa Agroindustrial, após a industrialização avícola ocorrida em 1997. A pesquisa foi realizada com os cooperados da C. Vale, especialmente os que desenvolvem atividade avícola. O questionário contou com questões que avaliavam os motivos da associação do cooperado, a geração de renda, as condições sócio-econômicas, e a percepção do cooperado da importância da C. Vale para o desenvolvimento sócio-econômico da região. As cooperativas contribuem para a evolução dos seus associados em duas grandes dimensões, a econômica e a social. Na dimensão econômica com o melhoramento da renda através da melhor disponibilidade do produto ou serviços do cooperado para o mercado consumidor. Na dimensão social através da inclusão social e da disponibilização, ao cooperado, de novos conhecimentos, além de aproximá-lo de uma rede de contato com outros cooperados. A cooperativa foi apontada na pesquisa como fomentadora da educação local, através de cursos, palestras e seminários que são ministrados aos cooperados e colaboradores. A pesquisa demonstrou, de forma indireta, que há ganho de escolaridade comparando os cooperados e seus filhos maiores de 17 anos.----------------------------------------------The objective of this paper is to analyze the socio-economical development occurred in the action area of the C Vale Cooperativa Agroindustrial, after the poultry industrialization that occurred in 1997. The research was carried out with the members/associates of the cooperative society of the C. Vale, especially the ones developing the poultry activity. The questionnaire included questions that evaluated the reasons for association of its members, the generation of income, the socio-economic conditions, and their perception of the importance of C. Vale for the socio-economic development of the region. The cooperative contributes for the evolution of the associates in two big dimensions: economical and social. In the economical dimension contributes with the improvement of the income, through the best availability of the product or service of the associate to the consumer market. In the social dimension through the social inclusion, and through the availability, for the associate, of new knowledge, besides approaching him to a network of contact with other associates. The cooperative was appointed in the research as a promoter of the local education, through courses, lectures and seminaries that are administered to the associates and its co-workers. The research showed, in an indirect way, that there was improvement in education when comparing the cooperated and their sons over 17.Cooperativismo agropecuário, integração avícola, desenvolvimento local, Paraná, Co-operativism, aviculture integration, regional development, Paraná, Agribusiness,

Outcome after intracranial hemorrhage under dabigatran and reversal with idarucizumab versus under vitamin-K-antagonists – the RIC-ICH study

BackgroundIntracranial hemorrhage (ICH) is a rare but serious side effect associated with the use of oral anticoagulants, such as dabigatran. The specific reversal agent for dabigatran, idarucizumab, is available for the management of individuals with ICH. The aim of this study was to provide real-world evidence on patients with ICH and effective treatment with dabigatran and reversal with idarucizumab in clinical routine compared to those under effective treatment with vitamin-K-antagonist (VKA).MethodsRegistration of Idarucizumab for Patients with IntraCranial Hemorrhage (RIC-ICH) is a non-interventional study conducted in 22 German stroke units that prospectively enrolled dabigatran patients treated with idarucizumab. Retrospective data from VKA patients served as reference population. Main objective was in-hospital mortality. Further objectives included change in bleeding volume, stroke severity, and functional status.ResultIn-hospital mortality was 26.7% in 15 dabigatran and 27.3% in 88 VKA patients (hazard ratio 1.00, 95% CI 0.29–2.60). In patients with bleeding volume > 60 ml, mortality was lower in the dabigatran group (N = 6, 33%) compared to the VKA group (N = 15, 67%; HR 0.24, 95% CI 0.04–0.96). No differences were observed in secondary endpoints between dabigatran and VKA patients.ConclusionThese results, based on data from routine clinical practice, suggest that in-hospital mortality after idarucizumab treatment is comparable to that in patients pretreated with VKA. Due to the low precision of estimates, the results must be interpreted with caution

OESTE PARANAENSE: O CASO DA C.VALE NA REGIÃO DE PALOTINA/ PR

O objetivo deste artigo é analisar o desenvolvimento sócio-econômico ocorrido na região de atuação da C Vale Cooperativa Agroindustrial, após a industrialização avícola ocorrida em 1997. A pesquisa foi realizada com os cooperados da C. Vale, especialmente os que desenvolvem atividade avícola. O questionário contou com questões que avaliavam os motivos da associação do cooperado, a geração de renda, as condições sócio- econômicas, e a percepção do cooperado da importância da C. Vale para o desenvolvimento sócio econômico da região. As cooperativas contribuem para a evolução dos seus associados em duas grandes dimensões, a econômica e a social. Na dimensão econômica com o melhoramento da renda através da melhor disponibilidade do produto ou serviços do cooperado para o mercado consumidor. Na dimensão social através da inclusão social e da disponibilização, ao cooperado, de novos conhecimentos, além de aproximá-lo de uma rede de contato com outros cooperados. A cooperativa foi apontada na pesquisa como fomentadora da educação local, através de cursos, palestras e seminários que são ministrados aos cooperados e colaboradores. A pesquisa demonstrou, de forma indireta, que há ganho de escolaridade comparando os cooperados e seus filhos maiores de 17 anos

Agricultura Familiar e Desenvolvimento Paranaense entre 1996 e 2006

The family farm is relevant to the technological modernization of Brazilian agribusiness, and especially has strong regional ties. Thus, family farming is damping of crises in agriculture and local development agent, but wonders, with this work, where family farming constitutes a modern and competitive, increasing local sustainable development and improving the quality of life in the field. The objective of this study was to assess whether the geographical regions of Paraná with a predominantly agricultural model family ruled in agriculture have better social and economic indicators. This is a research method applied, with descriptive statistics and a correlation between socioeconomic indicators and the Agricultural Census data from 1995/1996 to 2006. As a result it was observed that where family farming is prevalent there is better economic and social indicators. Still, the study showed how this method of production is characterized by being the largest generator of jobs in rural areas and promote environmental sustainability in agriculture.A agricultura familiar é relevante para o processo de modernização tecnológica do agronegócio brasileiro e, principalmente, tem fortes laços regionais. Dessa forma, a agricultura familiar é amortecedora das crises no setor agrícola e agente de desenvolvimento local, mas questiona-se, com este trabalho, se a agricultura familiar constitui-se moderna e competitiva, potencializando o desenvolvimento local sustentável e a melhoria da qualidade de vida no campo. O objetivo geral deste trabalho foi avaliar se as regiões geográficas paranaenses com um modelo agrícola predominante pautado na agricultura familiar possuem melhores indicadores sociais e econômicos. Trata-se de um método de pesquisa aplicado, com estatística descritiva e de correlação entre indicadores socioeconômicos e dos dados do censo Agropecuário de 1995/1996 e 2006.  Como resultado observou-se que onde a agricultura familiar é predominante verifica-se melhores indicadores econômicos e sociais. Ainda, o estudo demonstrou como esse modo de produção caracteriza-se por ser o maior gerador de empregos no meio rural e promover a sustentabilidade ambiental na agricultura

Anisotropy and Mechanistic Elucidation of Wet-Chemical Gallium Nitride Etching at the Atomic Level

Etching of gallium nitride is a key step in the production of blue and white light-emitting diodes (LEDs). Etching in aqueous KOH solution creates a rough surface on the LED chip to facilitate outcoupling of the photons generated, drastically increasing the resulting LED’s efficiency. Compared with the common technique of dry etching, wet-chemical etching using aqueous KOH solution has significant advantages, e.g., lower complexity and cost and less remaining surface damage. An in-depth analysis of the molecular etch reaction by characterization of the reaction products is reported. The mechanism identified explains the cause of anisotropic etching, which leads to the formation of hexagonal pyramids. The concept of hydroxide repulsion by protruding NH and NH2 groups established in the literature is adapted and further developed. The susceptibility of several polar, semipolar, and nonpolar crystal facets may also be explained, as well as the commonly observed increase in average pyramid size over etch time.OSRAM Opto Semiconductors GmbHDeutsche ForschungsgemeinschaftMinisterio de Ciencia, Innovación y Universidade

O sistema agroindustrial do biodiesel no Paraná: o potencial do mercado fornecedor de matérias-primas vegetais e a participação da agricultura familiar

This article aims to analyze the market potential supplier of raw materials plant to produce biodiesel between 2003 and 2010, and verify the inclusion of family farming in the agroindustrial system of biodiesel in Paraná. The institutional environment consists of the National Program of Biodiesel Production and Use (PNPB) can support family farmers in Parana and increase the biodiesel production in the state to promote regional development by generating income, taxes and setting the man on field. In contrast state and local public policies must do your part and encourage the most varied raw materials for biodiesel production due to climate and soil diversity existing in Parana. This situation can only be auspicious if successful stimulation and integration between the public (federal, state and municipal) and private.Resumo: Este artigo tem por objetivo analisar o potencial do mercado fornecedor de matérias-primas vegetais para a produção de biodiesel entre os anos 2003 e 2010, e verificar a inserção da agricultura familiar no sistema agroindustrial do biodiesel do Paraná. O ambiente institucional constituído pelo Programa Nacional de Produção e Uso do Biodiesel (PNPB) pode subsidiar os agricultores familiares paranaenses e gerar uma dinâmica de produção de biodiesel no estado com a promoção do desenvolvimento regional com a geração de renda, impostos, além de fixar o homem no campo. Em contrapartida, políticas públicas estaduais e municipais devem fazer a sua parte e estimular a produção das mais variadas matérias-primas para a geração de biodiesel, dada a diversidade edafoclimática existente no Paraná. Este panorama alvissareiro só poderá ser bem sucedido se houver estímulo e integração entre os setores públicos (federal, estadual e municipal) e privado

Extent of hypoattenuation on CT angiography source images in Basilar Artery occlusion: prognostic value in the Basilar Artery International Cooperation Study

<p><b>Background and Purpose:</b> The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS).</p> <p><b>Methods:</b> BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion. Functional outcome was assessed at 1 month. We applied pc-ASPECTS to CT angiography source images of patients with CT angiography for confirmation of basilar artery occlusion. We calculated unadjusted and adjusted risk ratios (RRs) of pc-ASPECTS dichotomized at ≥8 versus <8. Primary outcome measure was favorable outcome (modified Rankin Scale scores 0–3). Secondary outcome measures were mortality and functional independence (modified Rankin Scale scores 0–2).</p> <p><b>Results:</b> Of 158 patients included, 78 patients had a CT angiography source images pc-ASPECTS ≥8. Patients with a pc-ASPECTS ≥8 more often had a favorable outcome than patients with a pc-ASPECTS <8 (crude RR, 1.7; 95% CI, 0.98–3.0). After adjustment for age, baseline National Institutes of Health Stroke Scale score, and thrombolysis, pc-ASPECTS ≥8 was not related to favorable outcome (RR, 1.3; 95% CI, 0.8–2.2), but it was related to reduced mortality (RR, 0.7; 95% CI, 0.5–0.98) and functional independence (RR, 2.0; 95% CI, 1.1–3.8). In post hoc analysis, pc-ASPECTS dichotomized at ≥6 versus <6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2–7.5).</p> <p><b>Conclusions:</b> pc-ASPECTS on CT angiography source images independently predicted death and functional independence at 1 month in the CT angiography subgroup of patients in the BASICS registry.</p&gt

Distribution and evolution of acute interventional ischemic stroke treatment in Germany from 2010 to 2016

Background: Mechanical thrombectomy (MT) is a new evidence-based treatment option for large vessel occlusion in the anterior brain circulation. Using comprehensive administrative data from Germany, we analysed the nationwide development of intravenous thrombolysis (IVT) and MT in Germany between 2010 and 2016. Methods: We considered all documented cases (n = 1,515,634) with a main diagnosis of the ICD-10-GM code I63 (ischemic stroke) and identified specific stroke recanalization therapy by using the corresponding Operating and Procedure Key for systemic thrombolysis and mechanical thrombectomy out of the DRG statistics. Regional analyses are based on data from the 413 German administrative districts and cities and the obligatory quality reports of all hospitals. We distinguished between rates of MT related to place of residence of patients and place of treatment. Results: Coded ischemic strokes increased by 10.2% from 2010 (n = 206.688) to 2016 (n = 227.687). The rate of IVT increased from 8.9% in 2010 to 14.9% in 2016 and the rate of MT increased from 0.8% in 2010 to 4.7% in 2016 with a strong increase in 2015 and 2016. There was a high regional variability of MT according to place of residence of patients between 0 and 11.2% in 2016 with significant lower treatment rates in rural compared to urban areas (3.8 vs 5.4%). Mean age of patients treated with MT increased from 67.8 years in 2010 to 73.3 years in 2016 and almost reached the mean age of IVT treated patients (74.4 years). The number of hospitals coding MT increased from 91 to 193 from 2010 to 2016, but 80% of all MT procedures were performed in neurointerventional centers with ≥50 procedures/year in 2016. Conclusions: The rate of IVT in patients with acute ischemic stroke in Germany continues to rise and has reached 14.9% nationwide. The increase of MT is even more pronounced and was triggered by the evidence after publication of the MT randomized trials. There is still a high regional variability with significant lower MT rates in rural areas