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With the globalization of markets, competition and performance pressure have accelerated. Investors rightfully expect a reasonable return on the capital they make available to others. Since companies often achieve their growth through capital obtained from new shareholders, the pressure on company profitability increases significantly. The capital market rewards companies' good performance and also punishes their bad performance. At this point, Economic Value Added (EVA), Cash Flow Return on Investment (CFROI), Cash Value Added (CVA) and Market Value Added (MVA), which ensure value maximization, have become increasingly important problems. For this reason, company profitability and growth potential are important. Within the scope of this study, the importance of EVA, CFROI, CVA and MVA indicators and their comparison with traditional methods are discussed in the introduction part. Studies on these indicators that embody value maximization are examined through a literature review. In the methodology section, the data of 11 companies active in the healthcare sector listed on Borsa Istanbul are analyzed through regression and correlation analyzes on the basis of the 2015-2021 period, and the effects of these indicators on stock returns. As a result, when MVA, CVA, CFROI and EVA are positive, economic profit is achieved and shareholder value is expected to increase. [ABSTRACT FROM AUTHOR]

Physiotherapists working in hospitals have a key role in decisions about when a person with stroke is safe to walk independently. The aim of this study was to explore the factors influencing decision-making of physiotherapists in this situation. A qualitative design with semi-structured interviews and reflexive thematic analysis was used. Fifteen physiotherapists with recent experience working in inpatient stroke rehabilitation participated. Multiple factors influence decision-making about walking independence after stroke in hospitals. Four themes were identified: (1) Assessment of walking safety involves observation of walking function and consideration of complex individual factors; (2) Perspectives on risk vary, and influence whether a person is considered safe to walk; (3) Institutional culture involves background pressures that may influence decision-making; and (4) Physiotherapists adopt a structured, individualised mobility progression to manage risk. Physiotherapists consistently use observation of walking and understanding of attention and perception in this decision-making. There can sometimes be a conflict between goals of independence and of risk avoidance, and decisions are made by personal judgements. Decision-making about independent walking for people in a hospital after a stroke is complex. Improved guidance about clinical assessment of capacity and determining acceptable risk may enable physiotherapists to engage more in shared decision-making. Regaining independence in walking after a stroke comes with the potential risk of falls. Assessment of walking safety should be specific to the complexity of the situation and consider perception and cognition. Benefits of activity and autonomy, and the risk of falls need to be considered in decisions about walking independence. Patients with the capacity to understand consequences and accept risk can be active participants in determining what is sufficiently safe. [ABSTRACT FROM AUTHOR]

No abstract available. Manuscript truncated after 150 words. History of Present Illness: A 53-year-old man was admitted for acute onset of left hemiparesis, left facial droop and dysarthria witnessed by his wife (a nurse) while they were watching TV that evening. She reported the patient had no previous history of coronary artery disease or cerebral vascular disease, prior to an admission occurring three weeks earlier. The patient presented at that time with acute, severe left-sided chest pain that began while he was doing some heavy yardwork. While being evaluated in the emergency department (ED), he developed left-sided facial numbness, hemiparesis and dysarthria. A CT scan of the brain was normal. Neurological symptoms resolved before lytic therapy could be administered. Troponins and EKG were normal. A D-dimer was >20 mg/L, but a CTA of the chest showed no pulmonary embolism and was otherwise unrevealing. The chest pain resolved without specific therapy. Subsequent CTA of the head and neck and …

Cherry virus A, a capillovirus, can infect different Prunus species and be present as a latent infection in orchards. CVA infection was detected in a Hungarian stock collection of Prunus domestica ‘Besztercei Bt. 2’. In our study, different in vitro virus elimination techniques (thermotherapy combined with shoot tip culture and chemotherapy alone or combined with thermotherapy) were used and compared for their efficiency in eliminating CVA from ‘Besztercei Bt. 2’ plum cultivar. Thermotherapy was carried out at 38/36°C (day/night) in a heat chamber followed by the excision of 1–2 mm long shoot tips for plant regeneration. As a chemotherapy agent, ribavirin or zidovudine was added to the multiplication medium at two different concentrations with or without two weeks of thermotherapy pretreatment. The plum shoots tolerated 14–18 days of heat treatment, 64% of the plants regenerated from shoot tips, and 75% of the tested regenerated plants were confirmed by RT‒PCR to be CVA-free. Ribavirin and zidovudine did not negatively affect the survival of the plum shoots at any applied concentrations. Zidovudine alone was not able to efficiently eradicate virus from the treated plantlets, but when zidovudine was combined with heat treatment, the number of CVA-positive plants decreased to 60%. In contrast, ribavirin alone was very efficient at eliminating CVA from all the tested plants when used at a concentration of 25 mg L− 1. To our knowledge, this is the first report of eliminating CVA from Prunus sp. via in vitro techniques. [ABSTRACT FROM AUTHOR]

The computation of credit risk measures such as exposure and Credit Value Adjustments (CVA) requires the simulation of future portfolio prices. Recent metrics, such as dynamic Initial Margin (IM) and Margin Value Adjustments (MVA) additionally require the simulation of future conditional sensitivities. For portfolios with non-linear instruments that do not admit closed-form valuation formulas, this poses a significant computational challenge. This problem is addressed by proposing a static replication algorithm for interest rate options with early-exercise features under an affine term-structure model. Under the appropriate conditions, we can find an equivalent portfolio of vanilla options that replicate these products. Specifically, we decompose the product into a portfolio of European swaptions. The weights and strikes of the portfolio are obtained by regressing the target option value with interpretable, feed-forward neural networks. Once an equivalent portfolio of European swaptions is determined, we can leverage on closed-form expressions to obtain the conditional prices and sensitivities, which serve as an input to exposure and SIMM-driven MVA quantification. For a consistent forward sensitivity estimation, this involves the differentiation of the portfolio-weights. The accuracy and convergence of the method is demonstrated through several representative numerical examples, benchmarked against the established least-square Monte Carlo method. [ABSTRACT FROM AUTHOR]

A survey was carried out on a commercial sour cherry fruit orchard located in Lublin province in Poland to determine the influence of viruses on the fruit quality of sour cherry cv. Łutówka. Leaf samples from trees of sour cherry cv. Łutówka were tested for Prunus necrotic ringspot virus (PNRSV), Prune dwarf virus (PDV), Little cherry virus 1 (LChV-1), Little cherry virus 2 (LChV-2), Cherry virus A (CVA), Cherry green ring mottle virus (CGRMV), Cherry necrotic rusty mottle virus (CNRMV), Cherry rasp leaf virus (CRLV) and Cherry mottle leaf virus (CMLV) using the RT-PCR technique. The results indicated that PNRSV and PNRSV+CVA infected the samples. PDV, LChV-1, LChV-2, CGRMV, CNRMV, CRLV, and CMLV were not detected in any of the tested sour cherry trees. The effect of virus infection on the chemical composition of sour cherry fruits was investigated. The anthocyanin, total phenolic and vitamin C contents, and antioxidant activity were evaluated. The total phenolic compound, vitamin C contents, and antioxidant activity were significantly higher in PNRSV- and PNRSV+CVA-infected than in virus-free sour cherry fruits. The total anthocyanin content in PNRSV- or PNRSV+CVA-infected fruits was lower than in control trees. To our knowledge, this is the first report in the world about the effect of PNRSV or PNRSV+CVA infection on the anthocyanin compounds, total polyphenolic compounds, vitamin C contents, and the antioxidant activity of sour cherry fruits. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of the leading causes of mortality and morbidity worldwide accounting for 85% of global deaths from stroke. This study aimed to evaluate the role of homocysteine (HCY) in modulating various stroke parameters and its with carotid intima-media thickness (IMT). Methods: 78 patients of radiology-confirmed acute ischemic stroke were recruited for this study and National Institutes of Health Stroke Scale (NIHSS) score was evaluated upon admission. Blood samples were tested for serum HCY, fasting blood glucose (FBG) and lipid profile. Ultrasonography of neck ascertained IMT of Common (CCA) and Internal carotid artery (ICA). Results: Average age of male and female subjects was 57.88 ± 13.97 & 59.16 ± 13.62 years respectively. 71.93% of stroke patients were hyperhomocysteinemic (HHcyc) and 24.36% were hyperlipidemic. Patients with NIHSS ≥ 5 had higher low-density lipoprotein cholesterol (LDLC) than those with NIHSS < 5. HCY cutoff of ≥ 15 μmol/L had 91.7% sensitivity & 66.7% specificity for predicting. HHcyc state was associated with increased ICA IMT. HHcyc state was best predicted by ICA IMT with which it is positively correlated (P-Value = 0.012). Conclusion: HHcyc state holds a good predictive value for severity of stroke. We also came to a conclusion that ICA IMT measurement may also reduce the need for a homocysteine test as it predicts higher HCY levels; this will reduce the burden on resources. We suggest that evaluating HCY and ICA IMT should be made part of the standard protocol for management of stroke.

Desert communities are threatened with species loss due to climate change, and their resistance to such losses is unknown. We constructed a food web of the Mojave Desert terrestrial community (300 nodes, 4080 edges) to empirically examine the potential cascading effects of bird extinctions on this desert network, compared to losses of mammals and lizards. We focused on birds because they are already disappearing from the Mojave, and their relative thermal vulnerabilities are known. We quantified bottom‐up secondary extinctions and evaluated the relative resistance of the community to losses of each vertebrate group. The impact of random bird species loss was relatively low compared to the consequences of mammal (causing the greatest number of cascading losses) or reptile loss, and birds were relatively less likely to be in trophic positions that could drive top‐down effects in apparent competition and tri‐tropic cascade motifs. An avian extinction cascade with year‐long resident birds caused more secondary extinctions than the cascade involving all bird species for randomized ordered extinctions. Notably, we also found that relatively high interconnectivity among avian species has formed a subweb, enhancing network resistance to bird losses. [ABSTRACT FROM AUTHOR]

A survey was carried out on a commercial sour cherry fruit orchard located in Lublin province in Poland to determine the influence of viruses on the fruit quality of sour cherry cv. Łutówka. Leaf samples from trees of sour cherry cv. Łutówka were tested for Prunus necrotic ringspot virus (PNRSV), Prune dwarf virus (PDV), Little cherry virus 1 (LChV-1), Little cherry virus 2 (LChV-2), Cherry virus A (CVA), Cherry green ring mottle virus (CGRMV), Cherry necrotic rusty mottle virus (CNRMV), Cherry rasp leaf virus (CRLV) and Cherry mottle leaf virus (CMLV) using the RT-PCR technique. The results indicated that PNRSV and PNRSV+CVA infected the samples. PDV, LChV-1, LChV-2, CGRMV, CNRMV, CRLV, and CMLV were not detected in any of the tested sour cherry trees. The effect of virus infection on the chemical composition of sour cherry fruits was investigated. The anthocyanin, total phenolic and vitamin C contents, and antioxidant activity were evaluated. The total phenolic compound, vitamin C contents, and antioxidant activity were significantly higher in PNRSV- and PNRSV+CVA-infected than in virus-free sour cherry fruits. The total anthocyanin content in PNRSV- or PNRSV+CVA-infected fruits was lower than in control trees. To our knowledge, this is the first report in the world about the effect of PNRSV or PNRSV+CVA infection on the anthocyanin compounds, total polyphenolic compounds, vitamin C contents, and the antioxidant activity of sour cherry fruits.

ObjectiveTo test the hypothesis that factor eight inhibitor bypassing activity (FEIBA) can be used to control bleeding following left ventricular assist device (LVAD) implantation without increasing the 14-day composite thrombotic outcome of pump thrombus, ischemic cerebrovascular accidents, pulmonary embolism, and deep venous thrombosis.DesignRetrospective cohort study.SettingAcademic hospital.ParticipantsThree hundred nineteen consecutive patients who underwent LVAD implantation (December 1, 2009 to December 30, 2018).InterventionFEIBA administered to control perioperative hemorrhage.Measurements and main resultsThe 82 patients (25.7%) in the FEIBA cohort had more risk factors for perioperative hemorrhage, such as lower preoperative platelet count (169 ± 66 v 194 ± 68 × 103/mL, p = 0.004), prior cardiac surgery (36.6% v 21.9%, p = 0.008), and longer cardiopulmonary bypass (CPB) time (100.3 v 75.2 minutes, p = 0.001) than the 237 controls. After 16.6 units (95% CI: 14.3-18.9) of blood products were given, 992 units (95% CI: 821-1163) of FEIBA were required to control bleeding in the FEIBA cohort. Compared to the controls, there were no differences in the 14-day composite thrombotic outcome (11.0% v 7.6%, p = 0.343) or mortality rate (3.7% v 1.3%, p = 0.179). Multivariate logistical regression identified preoperative international normalized ratio (odds ratio [OR]: 1.30, 95% CI: 1.04-1.62) and CPB time (OR: 1.11, 95% CI: 1.02-1.20) as risk factors for 14-day thrombotic events, but FEIBA usage was not associated with an increased risk.ConclusionsIn this retrospective cohort study, the use of FEIBA (∼1,000 units, ∼13 units/kg) to control perioperative hemorrhage following LVAD implantation was not associated with increases in mortality or composite thrombotic outcome.

Objectives. Stroke is an acute cerebrovascular disease with high morbidity and mortality rate. Many stroke management strategies can improve prognosis and quality of life, but only to a certain extent. Phosphodiesterase inhibitor-5 (PDE-5i) has shown benefits in numerous preclinical studies, but human studies have been inconclusive. Material and Methods. For this narrative review, we conducted a systematic search following the PRISMA statement guideline from inception until November 2022. The search was conducted in PubMed, ScienceDirect, EBSCOhost, and ProQuest. We included all human and animal studies on this topic, including preclinical studies, randomized clinical trials, and case studies. All the excluded studies are reviews or non-English studies. Review. Many PDE-5i have shown benefits in anatomical and functional outcomes in preclinical acute experimental stroke models. PF-03049423 was safe and well tolerated in humans but had no significant impact on neurological or functional outcomes. Sildenafil on acute/subacute was deemed safe to use and demonstrated improvement over baseline, but power remains unknown due to the lack of a control group. Tadalafil use resulted in a reduction in regional cerebral blood flow in subjects with a history of stroke. Conclusions. Despite promising results in preclinical studies, current evidence shows that PDE-5i does not affect clinical or functional recovery in people with acute stroke. The disparity in the intricacy of stroke pathophysiology between human and animal models was crucial. Further research in a larger population with more consistent stroke onset, medicines, and doses is required for a more conclusive result.

Abstract Desert communities are threatened with species loss due to climate change, and their resistance to such losses is unknown. We constructed a food web of the Mojave Desert terrestrial community (300 nodes, 4080 edges) to empirically examine the potential cascading effects of bird extinctions on this desert network, compared to losses of mammals and lizards. We focused on birds because they are already disappearing from the Mojave, and their relative thermal vulnerabilities are known. We quantified bottom‐up secondary extinctions and evaluated the relative resistance of the community to losses of each vertebrate group. The impact of random bird species loss was relatively low compared to the consequences of mammal (causing the greatest number of cascading losses) or reptile loss, and birds were relatively less likely to be in trophic positions that could drive top‐down effects in apparent competition and tri‐tropic cascade motifs. An avian extinction cascade with year‐long resident birds caused more secondary extinctions than the cascade involving all bird species for randomized ordered extinctions. Notably, we also found that relatively high interconnectivity among avian species has formed a subweb, enhancing network resistance to bird losses.

Achtergrond en doel: Eerstelijns zorgverleners geven aan dat ondersteuning nodig is voor het onderkennen en signaleren van cognitieve en emotionele stoornissen na een beroerte. Deze studie beschrijft een nieuw signaleringsinstrument, de CheckLijst voor Cognitieve en Emotionele problemen na een beroerte (CLCE-24). Methode: Bij een groep patie¨nten (N = 69) werd 6 maanden na de beroerte voorafgaand aan het uitgebreid neuropsychologisch onderzoek (waaronder de MMSE en CAMCOG) de CLCE-24 afgenomen. Resultaten: De CLCE-24 werd positief ontvangen door zowel de patie¨nt, de naaste als de interviewer (psycholoog). De gemiddelde afnameduur was 11.1 minuten (5-35 minuten). Tachtig procent van de patie¨nten rapporteerde klachten; 73% cognitieve klachten en 51% emotionele klachten. Patie¨nten met ten minste e´e´n cognitieve klacht scoorden lager op de MMSE (t = 2.52; p=0.01) en de CAMCOG (t = 2.45; p= 0.02) dan patie¨nten zonder klachten. Conclusie: De CLCE-24 is een bruikbaar instrument om cognitieve en emotionele klachten na een beroerte op te sporen, waarna verwijzing naar bijvoorbeeld een neuropsycholoog en/of revalidatiearts kan plaatsvinden. Verder onderzoek moet o.a. gericht zijn op betrouwbaarheid tussen beoordelaars en op implementatie in de zorgketen

One of the very common negative effects experienced by operators and workers of sewing machines is neck pain. The use of sewing machines in a forward-leaning position over an extended period of time contributes to neck strain and promotes bad postures like the Forward Head Posture (FHP). The objective of this study was to determine the prevalence of FHP and neck pain among sewing machine operators in tailors and garment factories of District Swabi, Pakistan. This cross-sectional study was carried out on a total of 223 users of sewing machines while seated (97 women and 126 men). The study was conducted in Swabi District from October 2022 to February 2023. The outcomes were evaluated using a numerical pain rating scale and the Neck Disability Index (NDI). According to the Numerical pain Rating Scale (NPRS) for neck pain, 24 participants (10.8%) reported mild discomfort, 79 participants (35.4%) reported moderate pain, and 120 participants (53.8%) reported severe pain. Only 13.9% (n=31) of the participants (n=192) had a normal head position. The majority of the participants were hunched forward. The NPRS had a mean of 3.43 (± SD 0.49), the NDI mean was 3.43 (± 0.68), and the cranial vertebral angle (CVA) mean was 1.13 (±SD 0.34). According to the findings of the current study, FHP and neck pain are quite common among individuals who use sewing machines, and a large percentage of these people also have FHP and neck discomfort.

BACKGROUND: Stroke is the 2nd largest cause of mortality world over. In the intensive care unit (ICU), severity scales are crucial adjuncts of treatment for anticipating patient outcomes, comparing quality-of-care, and stratification for clinical studies. They're an important aspect of making better healthcare judgments and identifying people with unusual outcomes. This study was conducted to assess and compare GLASGOW COMA SCALE and NIHSS score as predictors of mortality in CVA patients admitted in MICU of Tertiary Care Centre, Rewa. METHODOLOGY: This was a cross sectional, analytical study conducted in the Department of Medicine, Sanjay Gandhi Memorial Hospital (SGMH), associated with Shyam Shah Medical College (SSMC), Rewa, M.P. between January 2020 to June 2021. The GLASGOW COMA SCALE and NIHSS score were calculated for each patient on day of admission and patients were followed-up for a max period of 7 days. The area under ROC curve was used to measure the ability of these scoring systems to forecast the prognosis, in order to find the best dividing value. RESULTS: The mean GCS in Death group was 5.56 ± 4.412, mean NIHSS score in Death Group was 32.45±6.486 and the mean of GCS in Survival group was 11.41 ± 4.413, mean NIHSS score in Survival Group was 14.09±8.099. The GCS score had an AUC of 0.886 which is slightly less than the NIHSS score which had the AUC 0f 0.913. CONCLUSIONS: GLASGOW COMA SCALE and NIHSS scores have good ability to predict the short-term prognosis of CVA patients, and the combination of these two can provide an even better measure of mortality. [ABSTRACT FROM AUTHOR]

Invasive procedures are associated with adverse events that are both hazardous to patients and expensive to treat. A trainee is expected to perform complex sterile invasive procedures in a dynamic environment under time pressure while maintaining patient safety at the highest standard of care. For mastery in performing an invasive procedure, the automatism of the technical aspects is required, as well as the ability to adapt to patient conditions, anatomic variability, and environmental stressors. Virtual reality (VR) simulation training is an immersive technology with immense potential for medical training, potentially enhancing clinical proficiency and improving patient safety. Virtual reality can project near-realistic environments onto a head-mounted display, allowing users to simulate and interact with various scenarios. Virtual reality has been used extensively for task training in various healthcare-related disciplines and other fields, such as the military. These scenarios often incorporate haptic feedback for the simulation of physical touch and audio and visual stimuli. In this manuscript, the authors have presented a historical review, the current status, and the potential application of VR simulation training for invasive procedures. They specifically explore a VR training module for central venous access as a prototype for invasive procedure training to describe the advantages and limitations of this evolving technology. [ABSTRACT FROM AUTHOR]

Background: Epilepsy is one of the most prevalent neurological conditions among the elderly. Age-related epileptogenic disorders as well as the ageing itself pose a risk for seizures in the elderly. The lack of witnesses, non-specific symptoms, and transient symptoms make the diagnosis challenging in the elderly. Aim: This study aimed to assess the various presentation and aetiology for the seizure disorder in the elderly population. Materials and Methods: A total of 125 elderly patients ≥60 years with new onset seizure were included in the study. Demographic data, co-morbidities, and clinical presentation of seizure were elicited. Hemogram, liver and renal function tests, random blood sugar, electrolytes, and serum calcium were analysed. Computed tomography (CT), magnetic resonance imaging (MRI) brain, and electroencephalogram (EEG) were performed. Results: Seizure was seen predominantly in the males with age group of 60–70 years. Generalized tonic-clonic seizure was the commonest presentation, followed by focal seizures. The leading causes of seizures were cerebral vascular accidents, metabolic conditions, and alcohol. CT brain was abnormal in 49%, and 73% of the patients showed abnormality in MRI brain. EEG was abnormal in 17.3% of patients. Temporal lobe infarction was the commonest, trailed by parieto-temporal and frontal lobe involvement. Conclusion: Seizures in the elderly have varied clinical signs and aetiology. An awareness about these atypical presentation and aetiology is essential for the early diagnosis and management to prevent morbidity.

Prunus necrotic ringspot virus (PNRSV) and cherry virus A (CVA) are two viruses that mainly infect plants of the genus Prunus. Full-length sequences of these two viruses, collected in the Czech Republic from Prunus cerasifera plants, were obtained via HTS sequencing. Phylogenetic analyses based on the NJ method and Splitstree tools showed that the Czech PNRSV isolate (ON088600-ON088602) is a divergent isolate from other molecular groups, sharing less than 97% pairwise nucleotide identity with members of other groups. The Czech CVA isolate (ON088603) belonged to molecular subgroup III-2, clustered with isolates from non-cherry hosts, and shared the highest pairwise nucleotide identity (99.7%) with an isolate of Australian origin. [ABSTRACT FROM AUTHOR]

Genetic predisposition, oral contraceptive (OCP) use, tobacco smoking, cancers, and trauma are well-known triggers for hypercoagulability and thromboembolism. Multiple reports have been published on the health risk of combining OCP and traditional cigarettes smoking in the context of thromboembolism. However, limited information is available on the health consequences of combining OCP use with electronic cigarettes. Here, we report a case of a young female patient with a past medical history of ovarian cysts and electronic cigarettes use who came into the hospital with a complaint of "recurrent seizures" and tachycardia. This patient was subsequently diagnosed with bilateral pulmonary emboli, subacute cerebrovascular accident (CVA), and possible patent foramen ovale. Therapeutic Lovenox was initiated. Reasons to educate young females on the risks of combining OCP and electronic cigarettes use were explained. [ABSTRACT FROM AUTHOR]

In this work, three methods for pattern recognition, used as exploratory data analysis, are revisited. A brief review of principal component analysis, PCA, an unsupervised method, is provided. Next, the Mahalanobis distance and the confidence ellipses usually drawn around the scores samples are discussed. Fisher’s canonical variate analysis (a supervised methodology) is the second method revisited in this work. The third exploratory data analysis methodology addressed is ANOVA-PCA, which uses the analysis of variance to separate variations into main effects, interaction and noise followed by principal component analysis. Unlike the other two, ANOVA-PCA was proposed recently and is still not yet explored in all its capabilities. One advantage of this method is the possibility to calculate the variance of each of the effects involved in the experimental design. The mathematical bases of the three methods are discussed as well as examples are presented.

Plain Language summary Whenever possible, including patients as partners in the research process can improve the quality of the research and the relevance of the results. Sometimes, there can be challenges when engaging people with lived experience in health research. For example, after a stroke, some patients can have trouble moving, thinking, or speaking. The purpose of this paper is to describe the processes used by our research team, comprised of two researchers and three patient partners with lived experience who had knowledge and insights into surviving a moderate to severe stroke. The research was a graduate student project exploring what patients think of physical therapy tests and measures used post-stroke. This article describes the process, rather than the outcomes of that research. We collaborated through virtual meetings, which were held every time decisions about the research had to be made or where feedback was required. The patient partners improved the interview question guide, helped to analyze the data, and helped to communicate the research findings. We found several strategies that helped us to be successful, including focusing on the value of the patient perspective and insights, taking time to build relationships, and allowing time to share stories. We also took special care to follow recommendations about communication to make sure that all the patient partners understood the project aim and activities that we were working on together. We feel this paper shows how patients who have had a stroke can collaborate as valued members of health research teams.

Background: Assessment for risks associated with acute stable COVID-19 is important to optimize clinical trial enrollment and target patients for scarce therapeutics. To assess whether healthcare system engagement location is an independent predictor of outcomes we performed a secondary analysis of the ACTIV-4B Outpatient Thrombosis Prevention trial. Methods: A secondary analysis of the ACTIV-4B trial that was conducted at 52 US sites between September 2020 and August 2021. Participants were enrolled through acute unscheduled episodic care (AUEC) enrollment location (emergency department, or urgent care clinic visit) compared to minimal contact (MC) enrollment (electronic contact from test center lists of positive patients).We report the primary composite outcome of cardiopulmonary hospitalizations, symptomatic venous thromboembolism, myocardial infarction, stroke, transient ischemic attack, systemic arterial thromboembolism, or death among stable outpatients stratified by enrollment setting, AUEC versus MC. A propensity score for AUEC enrollment was created, and Cox proportional hazards regression with inverse probability weighting (IPW) was used to compare the primary outcome by enrollment location. Results: Among the 657 ACTIV-4B patients randomized, 533 (81.1%) with known enrollment setting data were included in this analysis, 227 from AUEC settings and 306 from MC settings. In a multivariate logistic regression model, time from COVID test, age, Black race, Hispanic ethnicity, and body mass index were associated with AUEC enrollment. Irrespective of trial treatment allocation, patients enrolled at an AUEC setting were 10-times more likely to suffer from the adjudicated primary outcome, 7.9% vs. 0.7%; p < 0.001, compared with patients enrolled at a MC setting. Upon Cox regression analysis adjustment patients enrolled at an AUEC setting remained at significant risk of the primary composite outcome, HR 3.40 (95% CI 1.46, 7.94). Conclusions: Patients with clinically stable COVID-19 presenting to an AUEC enrollment setting represent a population at increased risk of arterial and venous thrombosis complications, hospitalization for cardiopulmonary events, or death, when adjusted for other risk factors, compared with patients enrolled at a MC setting. Future outpatient therapeutic trials and clinical therapeutic delivery programs of clinically stable COVID-19 patients may focus on inclusion of higher-risk patient populations from AUEC engagement locations. Trial Registration: ClinicalTrials.gov Identifier: NCT04498273. [ABSTRACT FROM AUTHOR]

BACKGROUND: With the effectiveness of post-hospital brain injury rehabilitation clearly demonstrated, research focus has shifted to durability of treatment gains over time. OBJECTIVE: Study objectives were threefold: (1) examined the stability of outcomes following post-hospital rehabilitation for persons with acquired brain injury, (2) compare differences in short and long-term outcome for TBI and CVA groups, and (3) identify predictors of long-term outcomes. METHODS: Subjects (n = 108) were selected from 2,177 neurologically impaired adults with consecutive discharges from 18 post-hospital programs in 12 states from 2011 through 2019. The study sample included TBI, CVA, and Mixed neurological groups. All persons were evaluated using the Mayo Portland Adaptability Inventory –4 Participation Index at four assessment intervals: admission, discharge, and 3 and 12 month follow-up. Additional analyses included repeated measures 2x4 design addressing TBI and CVA by the four measurement periods, and hierarchical multiple regression to identify outcome predictors. RESULTS: The total sample demonstrated a reduction in Participation T-scores (indicating less disability) from admission to discharge. Reductions in disability were maintained at the 3 and 12 month follow-up assessments (Greenhouse-Geisser F (2.37) = 76.87, p < 0.001, partial eta2 = 0.418, power to detect = 0.99). The CVA group demonstrated greater disability at each assessment interval, however, those differences were not statistically significant. Significant predictors of outcome at 12 months post-discharge were length of stay in program and type of injury. TBIs with longer length of stay experienced better outcome at 12 months than non-TBIs with shorter length of stays (hierarchical multiple regression adjusted R2 = 0.085, p < 0.05). CONCLUSION: Post-hospital residential neurorehabilitation programs provide a return on investment. Gains are realized from admission to discharge, and maintained one year following discharge from rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is characterized by neurological deficits of vascular origin. Its incidence has increased in low-to-middle income countries but decreased in high-income countries, while the severity has remained stable. Risk factors for stroke can be non-modifiable (e.g., gender, race, family history) or modifiable (e.g., lifestyle, medical interventions). Nonmodifiable factors cannot be changed, while modifiable factors can be modified through lifestyle changes and medical treatment. Method: This cross-sectional study was conducted at Shyam Shah Medical College, Rewa, involving 154 cases of cerebrovascular accidents (CVAs). Informed consent was obtained from the patients or their close relatives prior to participation in the study. Results: The highest number of cases in our study was observed in the age group of 61-70. prevalence of various risk factors in the study population. Diabetes was found to be present in 44.15% of the participants, hypertension in 20.77%, tobacco chewing in 34.41%, smoking in 41.55%, and alcohol consumption in 40.91%. 54 cases (35.06%) were in the lower socioeconomic class, 38 cases (24.67%) were in the upper-lower socioeconomic class, and 62 cases (40.27%) were in the upper, upper middle, and lower middle socioeconomic classes. that total cholesterol in the cases was 186.91±36.15. Similarly, there were significant elevations in Triglyceride (TG) levels and Low-Density Lipoprotein (LDL) in study group. Conclusion: By managing diabetes and hypertension, quitting tobacco and smoking, and reducing alcohol intake, we can reduce stroke prevalence and improve health outcomes. Collaboration with healthcare professionals is essential for personalized risk factor modification. [ABSTRACT FROM AUTHOR]

Objectives. Stroke is an acute cerebrovascular disease with high morbidity and mortality rate. Many stroke management strategies can improve prognosis and quality of life, but only to a certain extent. Phosphodiesterase inhibitor-5 (PDE-5i) has shown benefi ts in numerous preclinical studies, but human studies have been inconclusive. Material and Methods. For this narrative review, we conducted a systematic search following the PRISMA statement guideline from inception until November 2022. The search was conducted in PubMed, ScienceDirect, EBSCOhost, and ProQuest. We included all human and animal studies on this topic, including preclinical studies, randomized clinical trials, and case studies. All the excluded studies are reviews or non-English studies. Review. Many PDE-5i have shown benefi ts in anatomical and functional outcomes in preclinical acute experimental stroke models. PF-03049423 was safe and well tolerated in humans but had no significant impact on neurological or functional outcomes. Sildenafi l on acute/subacute was deemed safe to use and demonstrated improvement over baseline, but power remains unknown due to the lack of a control group. Tadalafi l use resulted in a reduction in regional cerebral blood flow in subjects with a history of stroke. Conclusions. Despite promising results in preclinical studies, current evidence shows that PDE-5i does not aff ect clinical or functional recovery in people with acute stroke. The disparity in the intricacy of stroke pathophysiology between human and animal models was crucial. Further research in a larger population with more consistent stroke onset, medicines, and doses is required for a more conclusive result. [ABSTRACT FROM AUTHOR]

Background: Epilepsy is one of the most prevalent neurological conditions among the elderly. Age‑related epileptogenic disorders as well as the ageing itself pose a risk for seizures in the elderly. The lack of witnesses, non‑specific symptoms, and transient symptoms make the diagnosis challenging in the elderly. Aim: This study aimed to assess the various presentation and aetiology for the seizure disorder in the elderly population. Materials and Methods: A total of 125 elderly patients ≥60 years with new onset seizure were included in the study. Demographic data, co‑morbidities, and clinical presentation of seizure were elicited. Hemogram, liver and renal function tests, random blood sugar, electrolytes, and serum calcium were analysed. Computed tomography (CT), magnetic resonance imaging (MRI) brain, and electroencephalogram (EEG) were performed. Results: Seizure was seen predominantly in the males with age group of 60–70 years. Generalized tonic‑clonic seizure was the commonest presentation, followed by focal seizures. The leading causes of seizures were cerebral vascular accidents, metabolic conditions, and alcohol. CT brain was abnormal in 49%, and 73% of the patients showed abnormality in MRI brain. EEG was abnormal in 17.3% of patients. Temporal lobe infarction was the commonest, trailed by parieto‑temporal and frontal lobe involvement. Conclusion: Seizures in the elderly have varied clinical signs and aetiology. An awareness about these atypical presentation and aetiology is essential for the early diagnosis and management to prevent morbidity. [ABSTRACT FROM AUTHOR]

The use of upper extremity (UE) access is an accepted and often implemented approach for fenestrated/branched endovascular aortic aneurysm repair (F-BEVAR). The advent of steerable sheaths has enabled the performance of F-BEVAR using a total transfemoral (TF) approach without UE access, potentially decreasing the risks of cerebral embolic events. The purpose of the present study was to assess the outcomes of F-BEVAR using UE vs TF access. Prospectively collected data from nine physician-sponsored investigational device exemption studies at U.S. centers were analyzed using a standardized database. All patients were treated for complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs) using industry-manufactured fenestrated and branched stent grafts between 2005 and 2020. The outcomes were compared between patients who had undergone UE vs total TF access. The primary composite outcome was stroke or transient ischemia attack (TIA) and 30-day or in-patient mortality during the perioperative period. The secondary outcomes included technical success, local access-related complications, and perioperative mortality. Among 1681 patients (71% men; mean age, 73.43 ± 7.8 years) who had undergone F-BEVAR, 502 had had CAAAs (30%), 535 had had extent IV TAAAs (32%), and 644 had had extent I to III TAAAs (38%). UE access was used for 1103 patients (67%). The right side was used for 395 patients (24%) and the left side for 705 patients (42%). UE access was preferentially used for TAAAs (74% vs 47%; P <.001). In contrast, TF access was used more frequently for CAAAs (53% vs 26%; P <.01). A total of 38 perioperative cerebrovascular events (2.5%), including 32 strokes (1.9%) and 6 TIAs (0.4%), had occurred. Perioperative cerebrovascular events had occurred more frequently with UE access than with TF access (2.8% vs 1.2%; P =.036). An individual component analysis of the primary composite outcome revealed a trend for more frequent strokes (2.3% vs 1.2%; P =.13) and TIAs (0.54% vs 0%; P =.10) in the UE access group. On multivariable analysis, total TF access was associated with a 60% reduction in the frequency of perioperative cerebrovascular events (odds ratio, 0.39; P =.029). No significant differences were observed between UE and TF access in the technical success rate (96.5% vs 96.8%; P =.72), perioperative mortality (2.9% vs 2.6%; P =.72), or local access-related complications (6.5% vs 5.5%; P =.43). In the present large, multicenter, retrospective analysis of prospectively collected data, a total TF approach for F-BEVAR was associated with a lower rate of perioperative cerebrovascular events compared with UE access. Although the cerebrovascular event rate was low with UE access, the TF approach offered a lower risk of stroke and TIA. UE access will continue to play a role for appropriately selected patients requiring more complex repairs with anatomy not amenable to the TF approach. [Display omitted] [ABSTRACT FROM AUTHOR]

Most industrial systems today are nonlinear and dynamic. Traditional fault detection techniques show their limits because they can hardly extract both nonlinear and dynamic features simultaneously. Canonical variate analysis (CVA) shows its excellent monitoring performance in fault detection for dynamic processes but is not applicable to nonlinear processes. Inspired by the CVA method, a novel nonlinear dynamic process monitoring method, namely, the "canonical variate kernel analysis" (CVKA), is proposed in this work. The way to extract nonlinear features is different from a traditional kernel canonical variate analysis (KCVA). In a sequential structure, the new approach firstly extracts the linear dynamic features from the data through the CVA method, followed by a kernel principal component analysis to extract nonlinear features from the CVA residual space. The new CVKA method is then applied to a TE process case study, proving the excellent performance of CVKA compared to other common approaches in dynamic nonlinear process monitoring for TE-like processes. [ABSTRACT FROM AUTHOR]

Introduction: Acute ischaemic infarction is the third etiology of death and first etiology of disability across the globe. Cerebrovascular accident is an emergency condition requiring immediate intervention. The blood brain barrier compromised in patients with acute ischaemic stroke, leakage of neuro-biochemical protein markers like NSE into the peripherial circulation allow pathogenesis and prognostication of patient's with CVA to be weighed up additionally. The current work structured to determine the marker of brain damage, NSE in serum of patient's with acute ischaemic infarction as a diagnostic and/or monitoring tool for early prognosis of ischaemic stroke. Materials and Methods: This study conducted at Department of General Medicine, Naraina Medical College And Research center from June 2021 to February 2022. The sample size was 94 of which 47 were acute ischaemic stroke patients who were studied as cases and 47 non ischaemic stroke were taken as controls and there serum NSE, GCS, NIHSS, mRS, infarct volume were estimated and the results obtained were statistically computed. Results: In present study, Mean NSE in cases-5.558.Mean NSE in controls-0.217. In the ROC Curve for NSE, area under ROC of NSE is100% and the optimal cut offivalue is 1.48, SENSITIVITY is 100%. P-value for NSE & GCS is 0.2920.P-value for NSE & NIHSS is <0.001.P-value for NSE & mRS is <0.001.Coefficeint of correlation between NSE and infarct volume r=0.026 Conclusion: Serum NSE can be used for early diagnosis, prognosis of acute ischaemic stroke p atients in the settings were CT scan, MRI scan not available or patients in whom CT sca n or MRIiscan contraindicated or CT scan normal. Serum NSE test may be boon to prima ry health centres and useful to reduce morbidity and mortality associated with ischaemic stroke patients with early treatment initiation. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study to determine the maternal outcomes in women given a modest dosage of magnesium sulphate. Materials and methods: This research was conducted at the Department of Obstetrics and Gynecology, with clearance from the institute's ethical committee. Eclampsia patients were placed into two equal groups of 200. Groups 1 (Dhaka regime) and 2 (Pritchard regime). The trial excluded patients with myasthenia gravis, hepatic coma with danger of renal failure, and magnesium hypersensitivity. Results: There was no recurrence in 92% of the cases, 3 recurrences in 3% of the cases, and more than 2 recurrences in 3% of the cases. In group 1, there were only two recurrences in 2% of the cases, and there were none in 98% of the instances. In group 2, there were one and one recurrence in 1% of the cases, respectively. Maternal problems were noted in 25% of the patients overall. HELLP syndrome and abruption were recorded in 9% of the cases each, DIC in 5% of the cases, PPH and CVA in 1% of the cases each in group 1, and total maternal problems in 33% of the cases. Abruption was recorded in 11% of the patients, HELLP syndrome in 8%, and DIC in 6%. Renal failure and PPH were observed in 3% of the patients, respectively, and CVA in 1% of the cases in Group 2. Maternal mortality was 3% overall. In 1% of the cases, CVA, DIC, and pulmonary oedema were the causes of death. Overall maternal mortality was 8% in groups 1 and 2. In 3% of instances, DIC and acute renal failure were the causes of maternal death, whereas pulmonary oedema and CVA were the causes of mortality in 1% of cases. Conclusion: There was no statistically significant difference between the groups in the rates of maternal complications or maternal death. Women in India tend to have a lower body mass index than their Western counterparts, thus a reduced dosage may be ideal for them. Due to its comparability in efficacy and safety to the Pritchard protocol, this research indicates that low-dose magnesium sulphate should be used instead. [ABSTRACT FROM AUTHOR]

Simple Summary: Natural enemies of cheatgrass, an invasive plant in the western USA that is associated with recent increases in destructive wildfires, were sought as part of a classical biological control program targeting that plant. A population of mites was discovered infesting cheatgrass plants in central Bulgaria and determined to be a new species using morphological, morphometric analysis (i.e., measurement of specific body parts) and DNA barcoding (i.e., comparison of DNA sequences in genes shared by all mite species). Without these modern analytical tools, this mite would probably have been considered as the same species as another mite that infests other plants. This new mite species will now be tested to determine if it is suitable for importation and release in the USA as a biological control agent of cheatgrass. A new species of eriophyoid mite, Aculodes marcellisp. nov., was discovered on cheatgrass, Anisantha tectorum (L.) Nevski (syn. Bromus tectorum L.), an annual grass that is native to Eurasia and Northern Africa. This grass was introduced to North America near the end of the 19th century and now is widespread and associated with the observed increases in the size, frequency, and intensity of wildfires in western N. America. In this paper, A. marcellisp. nov., is morphologically described and illustrated. Compared with other Aculodes spp., it differs based on morphology and the sequence of the mitochondrial cytochrome oxidase gene, subunit I (MT-CO1). Results of morphometric analysis showed clear differentiation between A. marcellisp. nov., and the most similar congener, A. altamurgiensis from Taeniatherum caput-medusae. Analysis of MT-CO1 sequence divergence revealed significant levels of genetic variation (17.7%) and supported the results from the morphometric analysis; therefore, it is determined that they are two different species. Aculodes marcellisp. nov., is a new candidate agent for classical biological control of A. tectorum. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Colombiana is the property of Acta Medica Colombiana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Canadian Strategy for Patient-Oriented Research supports the inclusion of patients as partners throughout the research process. Purposeful and meaningful engagement of patient partners after stroke can present unique challenges due to the potential impacts on cognition, communication, or mobility. The purpose of this paper is to provide a case example of working together with three individuals who bring their post-stroke lived experience, including one person with aphasia, from study design through to dissemination. The designed and executed qualitative research was the purpose of this collaboration; this paper describes the collaborative process rather than the outcomes of the original research. The Strategy for Patient-Oriented Research Patient Engagement Framework was followed to engage the patient partners fully as part of the research team. Patient partners were involved at regularly scheduled team meetings and provided guidance on key aspects of project design and decision-making. The patient partners provided robust and important contributions to many aspects of the research, including shaping interview questions, assisting with thematic analysis, and contributing to the dissemination of research findings. Effective team dynamics were fostered by focusing on the value of the lived experience knowledge, using best-practice communication strategies, as well as taking time for relationship-building and story sharing. With appropriate support and guidance, the individuals who have experienced stroke were valuable contributing members of our research team. Plain Language summary: Whenever possible, including patients as partners in the research process can improve the quality of the research and the relevance of the results. Sometimes, there can be challenges when engaging people with lived experience in health research. For example, after a stroke, some patients can have trouble moving, thinking, or speaking. The purpose of this paper is to describe the processes used by our research team, comprised of two researchers and three patient partners with lived experience who had knowledge and insights into surviving a moderate to severe stroke. The research was a graduate student project exploring what patients think of physical therapy tests and measures used post-stroke. This article describes the process, rather than the outcomes of that research. We collaborated through virtual meetings, which were held every time decisions about the research had to be made or where feedback was required. The patient partners improved the interview question guide, helped to analyze the data, and helped to communicate the research findings. We found several strategies that helped us to be successful, including focusing on the value of the patient perspective and insights, taking time to build relationships, and allowing time to share stories. We also took special care to follow recommendations about communication to make sure that all the patient partners understood the project aim and activities that we were working on together. We feel this paper shows how patients who have had a stroke can collaborate as valued members of health research teams. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) signal changes associated with ischemic stroke are typically described as T2w and FLAIR hyperintense, and T1w isointense lesions. Intralesional T1w hyperintensity is generally attributed to either a hemorrhagic stroke, or an ischemic stroke with hemorrhagic transition, and has an associated signal void on gradient echo (GE) sequences. Cases of ischemic stroke with T1w hyperintense signal in absence of associated signal void on GE sequences have been sporadically demonstrated in human stroke patients, as well as in dogs with experimentally induced ischemia of the middle cerebral artery. This multicenter retrospective descriptive study investigates the presence of T1w hyperintensity in canine stroke without associated signal void on GE sequences. High field (1.5 Tesla) MRI studies of 12 dogs with clinical presentation, MRI features, and cerebrospinal fluid results suggestive of non-hemorrhagic stroke were assessed. The time between the observed onset of clinical signs and MRI assessment was recorded. All 12 patients had an intralesional T1w hyperintense signal compared to gray and white matter, and absence of signal void on T2*w GE or SWI sequences. Intralesional T1w hyperintensities were either homogenously distributed throughout the entire lesion (6/12) or had a rim-like peripheral distribution (6/12). The mean time between the recorded onset of clinical signs and MRI assessment was 3 days; however, the age range of lesions with T1w hyperintense signal observed was 1–21days, suggesting that such signal intensities can be observed in acute, subacute, or chronic stages of ischemic stroke. Follow-up was recorded for 7/12 cases, all of which showed evidence of neurological improvement while in hospital, and survived to discharge. Correlation of the age and MRI appearance of lesions in this study with similar lesions observed in human and experimental studies suggests that these T1w hyperintensities are likely caused by partial tissue infarction or selective neuronal necrosis, providing an alternative differential for these T1w hyperintensities observed.

Prunus necrotic ringspot virus (PNRSV) and cherry virus A (CVA) are two viruses that mainly infect plants of the genus Prunus. Full-length sequences of these two viruses, collected in the Czech Republic from Prunus cerasifera plants, were obtained via HTS sequencing. Phylogenetic analyses based on the NJ method and Splitstree tools showed that the Czech PNRSV isolate (ON088600-ON088602) is a divergent isolate from other molecular groups, sharing less than 97% pairwise nucleotide identity with members of other groups. The Czech CVA isolate (ON088603) belonged to molecular subgroup III-2, clustered with isolates from non-cherry hosts, and shared the highest pairwise nucleotide identity (99.7%) with an isolate of Australian origin.

In the demanding realm of the Emergency Department, addressing every emergency incident efficiently becomes paramount, with time emerging as a critical factor. This paper is dedicated to investigating innovative approaches aimed at diminishing the preparation time required when a patient arrives at the hospital. Our methodology involves the integration of pre-hospital warning data, a valuable resource provided by the National Science and Technology Center for Disaster Reduction (NCDR), with an advanced flashing light alert system. This integration specifically targets a reduction in preparation time for major traumas, Cerebrovascular Accidents (CVAs), Out-Of-Hospital Cardiac Arrests (OHCAs), and Acute Myocardial Infarctions (AMIs) at the South Medical Center in Taiwan. By streamlining these critical processes, our research endeavors to enhance overall efficiency and responsiveness within emergency medical care, achieving an average preparation time of 6.61 minutes. [ABSTRACT FROM AUTHOR]

Copyright of JBES: Brazilian Journal of Health Economics / Jornal Brasileiro de Economia da Saúde is the property of JBES: Brazilian Journal of Health Economics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The novel coronavirus of 2019 (COVID-19) has resulted in a global pandemic; COVID-19 has resulted in significant challenges in the delivery of healthcare, including emergency management of multiple diagnoses, such as stroke and ST-segment myocardial infarction (STEMI). The aim of this study was to identify the impacts of the COVID-19 pandemic on emergency department care of stroke and STEMI patients. In this study a review of the available literature was performed using pre-defined search terms, inclusion criteria, and exclusion criteria. Our analysis, using a narrative review format, indicates that there was not a significant change in time required for key interventions for stroke and STEMI emergent management, including imaging (door-to-CT), tPA administration (door-to-needle), angiographic reperfusion (door-to-puncture), and percutaneous coronary intervention (door-to-balloon). Potential future areas of investigation include how emergency department (ED) stroke and STEMI care has adapted in response to different COVID-19 variants and stages of the pandemic, as well as identifying strategies used by EDs that were successful in providing effective emergency care in the face of the pandemic. [ABSTRACT FROM AUTHOR]

An 8-year-old girl presented to the pediatric emergency department (ED) with left-sided weakness. Workup consisted of labs and imaging including magnetic resonance imaging showing an acute ischemic stroke. Literature regarding pediatric acute ischemic stroke is minimal, and there are few protocols guiding care in the pediatric population. Current recommendations include treatment with unfractionated heparin or low-molecular-weight heparin (LMWH) with subsequent daily aspirin prophylaxis. Further large scale studies are needed to produce protocols and generalizable treatment plans.

Abstract Background The research into the recurrence of cough variant asthma (CVA) in congenital heart disease (CHD) are few in number. The purpose of this study is to investigate the effect of CHD on the risk of the recurrence of CVA. Methods This study was a retrospective cohort study of 489 children with CVA aged between one and 14 years, of whom 67 had CHD complicated with CVA and 134 had CVA without CHD at a ratio of 1:2 according to age, sex and index year. The adjusted hazard ratio (aHR) of CVA recurrence in both the CHD cohort and the non-CHD cohort was determined by multivariate analysis using the Cox proportional hazard regression model. Results Adjusting for CHD classification, Mycoplasma pneumonia (MP) infection and immunoglobulin E (IgE) sensitization, the recurrence hazard of CVA in the complex congenital heart disease (CCHD) group (aHR = 3.281; 95% CI 1.648–6.530; P

Body-shape variability may respond to the interaction between history and environment, particularly in species whose range includes known biogeographical barriers. Central America has traditionally been regarded to have functioned as a complete land-bridge connecting two continents since the Plio-Pleistocene and as an incomplete one since much earlier. This history has helped shape species diversification and distributions. Vieja maculicauda is a widely distributed cichlid, found throughout most of the Atlantic slope of Central America, across three of the four geological blocks that make up this region and whose borders are known dispersal barriers. We asked whether there is an effect of geologic blocks on body shape of V. maculicauda as determined by geometric morphometric assessment of 151 individuals from across its range. We asked how much variance in body shape is explained by environmental variables. We used a CVA and a MANCOVA to determine whether a relationship between body shape and geologic blocks exists. For testing body shape correlation against geographic and environmental variables, we used a Mantel test. Our results suggest that body shape in V. maculicauda can be segregated by geologic blocks, while the correlation results showed no strong correlation between our sets of variables. [ABSTRACT FROM AUTHOR]

Background  Synergy is an outcome of multiple muscles acting in a synchronized pattern, controlled by the central nervous system. After brain insult, a set of deviated movement pattern emerges in the affected limb. The methods to train synchronization of muscles may diminish the deviated movement augmenting neuromotor control. The purpose of this investigation was to develop a synergy-based motor therapy (SBMT) protocol for the paretic upper limb in poststroke subjects. Further, the feasibility and effectiveness of the program was evaluated.. Methods  The design was Pretest–posttest single-group assessor-blinded trial. Department of occupational therapy of a national institute for persons with physical disabilities was the study site. There were 40 study subjects (23 men, ranging from 40 to 60 years, 18 subjects with hemorrhagic cerebrovascular accident, and > 6 months after the accident) exhibiting motor paresis of half side of the body. SBMT is a stage-specific regime based on the linkage between the deviated and usual muscle action. SBMT items were selected considering the strength and magnitude of the deviated motor components. The movement linkages were utilized to dissociate strong coupled components; for instance, forearm pronation-supination with elbow 90-degree flexion. Fugl-Meyer Assessment (upper extremity) (FMA-UE), Wolf Motor Function Test (WMFT), and Barthel Index (BI) were applied to quantify the motor status, motor functional ability of the upper extremity, and self-care activities, respectively. Results  All the enrolled subjects could perform their corresponding SBMT sessions. Posttreatment, FMA-UE improved significantly (p  < 0.001) from mean of 26.30 (standard deviation [SD] 15.02) to 35.20 (SD 17.64). Similarly, the WMFT both time (in seconds) and quality also positively improved significantly (p  < .001) from mean of 76.77 (SD 54.73) to 64.07 (SD 56.99) and 1.34 (SD 1.06) to 1.87 (SD 1.34), respectively. BI improved from 79.88 (SD 17.07) to 92.62 (SD 21.2) after the intervention (p  < 0.001). Conclusion  SBMT protocol was a feasible and effective intervention to facilitate motor function components in chronic hemiparetic subjects. The regime could be considered as a potential intervention for stroke rehabilitation. Further trials and use of sophisticated measures are recommended to authenticate the outcome of this investigation. Clinical Trial Registration  Clinical Trial Registry of India as CTRI/2017/10/010162 on October 23, 2017 (retrospectively). [ABSTRACT FROM AUTHOR]