Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial

Background Most people with stroke in India have no access to organised rehabilitation services. The effectiveness of training family members to provide stroke rehabilitation is uncertain. Our primary objective was to determine whether family-led stroke rehabilitation, initiated in hospital and continued at home, would be superior to usual care in a low-resource setting. Methods The Family-led Rehabilitation after Stroke in India (ATTEND) trial was a prospectively randomised open trial with blinded endpoint done across 14 hospitals in India. Patients aged 18 years or older who had had a stroke within the past month, had residual disability and reasonable expectation of survival, and who had an informal family-nominated caregiver were randomly assigned to intervention or usual care by site coordinators using a secure web-based system with minimisation by site and stroke severity. The family members of participants in the intervention group received additional structured rehabilitation training—including information provision, joint goal setting, carer training, and task-specific training—that was started in hospital and continued at home for up to 2 months. The primary outcome was death or dependency at 6 months, defined by scores 3–6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) as assessed by masked observers. Analyses were by intention to treat. This trial is registered with Clinical Trials Registry-India (CTRI/2013/04/003557), Australian New Zealand Clinical Trials Registry (ACTRN12613000078752), and Universal Trial Number (U1111-1138-6707). Findings Between Jan 13, 2014, and Feb 12, 2016, 1250 patients were randomly assigned to intervention (n=623) or control (n=627) groups. 33 patients were lost to follow-up (14 intervention, 19 control) and five patients withdrew (two intervention, three control). At 6 months, 285 (47%) of 607 patients in the intervention group and 287 (47%) of 605 controls were dead or dependent (odds ratio 0·98, 95% CI 0·78–1·23, p=0·87). 72 (12%) patients in the intervention group and 86 (14%) in the control group died (p=0·27), and we observed no difference in rehospitalisation (89 [14%]patients in the intervention group vs 82 [13%] in the control group; p=0·56). We also found no difference in total non-fatal events (112 events in 82 [13%] intervention patients vs 110 events in 79 [13%] control patients; p=0·80). Interpretation Although task shifting is an attractive solution for health-care sustainability, our results do not support investment in new stroke rehabilitation services that shift tasks to family caregivers, unless new evidence emerges. A future avenue of research should be to investigate the effects of task shifting to health-care assistants or team-based community care

Improvement in the voltage grading (axial and radial) of the generator column of a Van de Graaf generator by the use of a resistor chain

It is well known that the use of a series of resistors, connected between the equipotential rings of a Van de Graaff generator, improves the axial voltage grading of the generator. The work reported in this paper shows how the resistor chain also improves the radial voltage gradient. The electrolytic field mapping technique was adopted in the present work

Generation of uni-directional and bi-directional oscillatory switching impulse voltages

Recent investigations show that switching impulses are oscillatory in nature. This paper has succeeded in developing unidirectional and bidirectional switching impulse voltages to carry out breakdown studies. Oscillatory switching impulse voltages were produced by modification of a basic Marx impulse generator circuit

Modeling of Prebreakdown VI Characteristics of a Wire-Plate Electrostatic Precipitator Operating Under Combined Dc-pulse Energization

With the advent of pulse energization in electrostatic precipitators, the need for developing a model to simulate the physical processes in the prebreakdown region, at which the precipitator normally operates, is also increasing. The development of such a model helps in predicting the VI characteristics of a precipitator, which will be important to diagnose the electrical problems associated with the precipitator during its operation. The paper reports the details of a proposed model to predict the VI characteristics of a wire-plate precipitator operating under the influeuce of repetitive pulses superposed on a dc bias. The model begins with the calculation of space charge density near the HV electrode during the pulse-on period and then proceeds with the drift of space charges in the pulse-off period aided by the dc bias. The pulse duration was ~250 ns. The pulse repetition rate was 50 Hz. The predicted results were validated against the experimental results conducted on a laboratory model of a wire-plate precipitator. The studies were conducted for dust free conditions

Voltage-Current Characteristics of Plate Type Precipitator Geometry Under Combined DC/Pulse Energizations

An attempt has been made to study the voltage-current characteristics of a wire-plate precipitator geometry under clean air conditions. Helical wires have been used as corona electrodes. The studies were conducted with DC and DC superposed on nanosecond pulse respectively. The repetitive pulses with a rise time of the order of nanoseconds were generated from a MARX type impulse voltage generator. A comparative study of effect of pulse repetition rate, pulse width and effect of DC bias has been made on the voltage-current characteristics. The obtained results were discussed and compared with previous investigations

Measurement of resistivity and dielectric constant of beach-sand minerals

Resistivity and dielectric constant are important parameters which influence the separation of particles in a drum-type electrostatic separator. The paper provides details of the measurement of the parameters and data on the magnitude of resistivity and dielectric constant of the minerals of beach sand

Epoxy resin chamber for high voltage breakdown studies in high vacuum

As the study of electrical breakdown phenomena in vacuum systems, gains more importance, a thorough understanding of the breakdown mechanism at high voltages necessitates a chamber for experimental studies. An epoxy-resin chamber has been constructed by casting ring sections which were joined together. The advantages of such a chamber over the conventional metal or glass chamber are given especially as regards the electric field configuration, high voltage lead-in, and the ease of construction. Special facilities can be incorporated while constructing the chamber which makes it more versatile; for example, in pre-breakdown current measurements, electron beam focusing studies, etc