This guideline provides an overview of the evidence on established and emerging risk factors for stroke to provide evidence-based recommendations for the reduction of risk of a first stroke.
Writing ...group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council Scientific Statement Oversight Committee and the AHA Manuscript Oversight Committee. The writing group used systematic literature reviews (covering the time since the last review was published in 2006 up to April 2009), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate recommendations using standard AHA criteria (Tables 1 and 2). All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. The guideline underwent extensive peer review by the Stroke Council leadership and the AHA scientific statements oversight committees before consideration and approval by the AHA Science Advisory and Coordinating Committee.
Schemes for assessing a person's risk of a first stroke were evaluated. Risk factors or risk markers for a first stroke were classified according to potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Nonmodifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic predisposition. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Less well-documented or potentially modifiable risk factors include the metabolic syndrome, excessive alcohol consumption, drug abuse, use of oral contraceptives, sleep-disordered breathing, migraine, hyperhomocysteinemia, elevated lipoprotein(a), hypercoagulability, inflammation, and infection. Data on the use of aspirin for primary stroke prevention are reviewed.
Extensive evidence identifies a variety of specific factors that increase the risk of a first stroke and that provide strategies for reducing that risk.
In automotive construction, adhesive bonding can be used for joining metals, plastics or combinations of the two, and it offers the further advantage that, because the joints are continuous, an ...overall increase in body stiffness is achieved, thus enabling thinner material to be used. Because of their ability to absorb energy adhesive joints can also contribute to the impacted system. The objective of this work is to investigate the behavior of a flexible adhesive under impact loading using the single lap joint configuration. This adhesive showed a high strain to failure with good strength. These features of the adhesive under impact loading improve structural crashworthiness. Results showed that the lap joint strength increases considerably under impact loading compared with those under quasi-static loading and that there is a relationship between the joint performance and the loading speeds.
On-call research and guidance materials typically focus on 'traditional' on-call work (e.g., emergency services, healthcare). However, given the increasing prevalence of non-standard employment ...arrangements (e.g., gig work and casualisation), it is likely that a proportion of individuals who describe themselves as being on-call are not included in current on-call literature. This study therefore aimed to describe the current sociodemographic and work characteristics of Australian on-call workers.
A survey of 2044 adults assessed sociodemographic and work arrangements. Of this population, 1057 individuals were workforce participants, who were asked to provide information regarding any on-call work they performed over the last three months, occupation type, weekly work hours, and the presence or absence of non-standard work conditions.
Of respondents who were working, 45.5% reported working at least one day on-call in the previous month. There was a high prevalence of on-call work in younger respondents (63.1% of participants aged 18-24 years), and those who worked multiple jobs and more weekly work hours. Additionally, high prevalence rates of on-call work were reported by machinery operators, drivers, community and personal service workers, sales workers, and high-level managers.
These data suggest that on-call work is more prevalent than previously recorded and is likely to refer to a broad set of employment arrangements. Current classification systems may therefore be inadequate for population-level research. A taxonomy for the classification of on-call work is proposed, incorporating traditional on-call work, gig economy work, relief, or unscheduled work, and out of hours work.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Evidence linking OSA with hypertension in population studies is conflicting. We examined longitudinal and cross-sectional associations of previously unrecognized OSA, including OSA ...occurring in rapid eye movement (REM) sleep, with hypertension. Methods The Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) study is a longitudinal study of community-dwelling men in Adelaide, South Australia. Biomedical assessments at baseline (2002-2006) and follow-up (2007-2010) identified hypertension (systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg, or medication) and risk factors. In 2010 to 2011, 837 men without a prior diagnosis of OSA underwent full in-home unattended polysomnography of whom 739 recorded ≥ 30 min of REM sleep. Hypertension at follow-up (concomitant with OSA status) was defined as prevalent hypertension. Recent-onset hypertension was defined as hypertension at biomedical follow-up (56 months mean follow-up range, 48-74) in men free of hypertension at baseline. Results Severe REM OSA (apnea hypopnea index ≥30/h) showed independent adjusted associations with prevalent (OR, 2.40, 95% CI, 1.42-4.06), and recent-onset hypertension (2.24 1.04-4.81). Significant associations with non-REM AHI were not seen. In men with AHI < 10, REM OSA (apnea hypopnea index) ≥ 20/h was significantly associated with prevalent hypertension (2.67 1.33-5.38) and the relationship with recent-onset hypertension was positive but not statistically significant (2.32 0.79-6.84). Similar results were seen when analyses were confined to men with non-REM AHI < 10. Conclusions In men not considered to have OSA (AHI < 10), hypertension was associated with OSA during REM sleep. REM OSA may need consideration as an important clinical entity requiring treatment but further systematic assessment and evidence is needed.
Stroke prevention guidelines for sickle cell anemia (SCA) recommend transcranial Doppler (TCD) screening to identify children at stroke risk; however, TCD screening implementation remains poor. This ...report describes results from Part 1 of the 28-site DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) study, a baseline assessment of TCD implementation rates. This report describes TCD implementation by consortium site characteristics; characteristics of TCDs completed; and TCD results based on age. The cohort included 5247 children with SCA, of whom 5116 were eligible for TCD implementation assessment for at least 1 study year. The majority of children were African American or Black, non-Hispanic and received Medicaid. Mean age at first recorded TCD was 5.9 and 10.5 years at study end. Observed TCD screening rates were unsatisfactory across geographic regions (mean 49.9%; range: 30.9% to 74.7%) independent of size, institution type, or previous stroke prevention trial participation. The abnormal TCD rate was 2.9%, with a median age of 6.3 years for first abnormal TCD result. Findings highlight real-world TCD screening practices and results from the largest SCA cohort to date. Data informed the part 3 implementation study for improving stroke screening and findings may inform clinical practice improvements.
A Weighted Average Adaptive Cross Approximation Blackburn, Jordon N.; Young, John C.; Adams, Robert J.
IEEE transactions on antennas and propagation,
10/2023, Letnik:
71, Številka:
10
Journal Article
Recenzirano
The adaptive cross approximation (ACA) is considered for matrix structures where error control is lost. A weighted average form of the adaptive cross approximation is presented that mitigates the ...loss of error control. In the averaged ACA algorithm, the ACA is applied to a matrix comprising linear combinations of the rows and columns of the original matrix. An efficient implementation of the weighted average algorithm is outlined. The performance of the ACA and averaged ACA are examined for both static and time-harmonic integral equation solutions of problems for which loss of error control by the ACA is observed. The behaviors of the ACA and averaged ACA are compared and discussed, and the averaged ACA is observed to maintain error control for many matrices for which the ACA fails.
Findings from observational studies investigating the association between Dietary Inflammatory Index (DII®) scores and depression symptoms (DepS) are inconsistent. This study aims to assess the ...association between energy-adjusted DII (E-DII™) and DepS using the North West Adelaide Health Study (NWAHS) cohort as well as update a previous meta-analysis.
A total of 1743 (mean ± SD age: 56.6 ± 13.6 years, 51% female) study participants from NWAHS were included in the cross-sectional study and 859 (mean ± SD age: 58.4 ± 12.1 years, 52.6% female) in the longitudinal analyses. The Center for Epidemiological Studies Depression Scale (CES-D) was used for the measurement of DepS. E-DII scores were calculated from the dietary data collected using a validated food frequency questionnaire (FFQ). Data from two stages Stage 3 (2008–10) and North West 15 (NW15) (2015) were used. Log- and negative binomial regression were used to assess the association between quartiles of E-DII and DepS. A recent meta-analysis was updated by including 12 publications (six cross-sectional and six cohort studies) on the association between DII and DepS.
In the cross-sectional analysis, a higher E-DII score (i.e., more pro-inflammatory diet) was associated with a 79% increase in odds of reporting DepS ORQuartile4vs1: 1.79; 95% CI: 1.14–2.81; p = 0.01; p for trend (ptrend) = 0.03. Males with higher E-DII had a more than two-fold higher odds of DepS (ORQuartile4vs1: 2.27; 95% CI: 1.02–5.06; p = 0.045; ptrend = 0.09). Females with higher E-DII had an 81% increase in odds of DepS (ORQuartile4vs1: 1.81; 95% CI: 1.01–3.26; p = 0.046; ptrend = 0.07). These associations were consistent in the longitudinal analysis. Comparing highest to lowest quintiles of E-DII, the updated meta-analysis showed that a pro-inflammatory diet is associated with a 45% increase in odds of having DepS (OR: 1.45; 95% CI: 1.20–1.74; p < 0.01) with higher odds in females (OR: 1.53; 95% CI: 1.16–2.01; p = 0.01) compared to their male counterparts (OR: 1.29; 95% CI: 0.98–1.69; p = 0.15).
The data from the NWAHS and the updated meta-analysis of observational studies provide further evidence that a pro-inflammatory diet is positively associated with increased risk of DepS. These findings support the current recommendation on consuming a less inflammatory diet to improve DepS.
Most people, including philosophers, tend to classify human motives as falling into one of two categories: the egoistic or the altruistic, the self-interested or the moral. According to Susan Wolf, ...however, much of what motivates us does not comfortably fit into this scheme. Often we act neither for our own sake nor out of duty or an impersonal concern for the world. Rather, we act out of love for objects that we rightly perceive as worthy of love--and it is these actions that give meaning to our lives. Wolf makes a compelling case that, along with happiness and morality, this kind of meaningfulness constitutes a distinctive dimension of a good life. Written in a lively and engaging style, and full of provocative examples,Meaning in Life and Why It Mattersis a profound and original reflection on a subject of permanent human concern.
This study examines the risk of recurrent stroke, myocardial infarction (MI), vascular death, or all-cause death after hospitalized stroke in South Carolina.
Patients with a primary diagnosis of ...stroke discharged from the year 2002 were identified from the state hospital discharge database. Kaplan-Meier estimates of recurrent stroke, MI, vascular death, all-cause death, and composite events were calculated at 1 month, 6 months, 1 year, 2 years, 3 years, and 4 years. Prognostic factors were assessed with multivariate Cox proportional hazard models.
The search strategy identified 10,399 patients in 2002. The Kaplan-Meier estimate of cumulative risk at 1 month, 6 months, 1 year, 2 years, 3 years, and 4 years for recurrent stroke is 1.8%, 5.0%, 8.0%, 12.1%, 15.2%, and 18.1%; MI, 0.3%, 1.0%, 2.1%, 3.7%, 5.0%, and 6.2%; all-cause death, 14.6%, 20.6%, 24.5%, 30.9%, 36.2%, and 41.3%; vascular death, 11.4%, 14.8%, 17.1%, 20.7%, 23.8%, and 26.7%; and composite events of recurrent stroke, MI, or vascular death 13.6%, 19.5%, 24.7%, 31.6%, 36.8%, and 41.3%. The hazard ratio for composite events (recurrent stroke, MI, or death) increases with age (1.38, 1.35-1.41), is 1.12 (1.05-1.19) for African Americans compared to Caucasians, is 1.67 (1.57-1.77) for patients with a higher comorbidity index (> or = 2 vs <2), and is 1.34 (1.28-1.39) for patients with subarachnoid hemorrhage or intracerebral hemorrhage compared with ischemic stroke.
These findings suggest there is room for further improvement in secondary stroke prevention in South Carolina.
Aims
National 30‐day mortality and readmission rates after heart failure (HF) hospitalisations are a focus of US policy intervention and yet have rarely been assessed in other comparable countries. ...We examined the frequency, trends and institutional variation in 30‐day mortality and unplanned readmission rates after HF hospitalisations in Australia and New Zealand.
Methods and results
We included patients >18 years hospitalised with HF at all public and most private hospitals from 2010–15. The primary outcomes were the frequencies of 30‐day mortality and unplanned readmissions, and the institutional risk‐standardised mortality rate (RSMR) and readmission rate (RSRR) evaluated using separate cohorts. The mortality cohort included 153 592 patients (mean age 78.9 ± 11.8 years, 51.5% male) with 16 442 (10.7%) deaths within 30 days. The readmission cohort included 148 704 patients (mean age 78.6 ± 11.9 years, 51.7% male) with 33 158 (22.3%) unplanned readmission within 30 days. In 392 hospitals with at least 25 HF hospitalisations, the median RSMR was 10.7% (range 6.1–17.3%) with 59 hospitals significantly different from the national average. Similarly, in 391 hospitals with at least 25 HF hospitalisations, the median RSRR was 22.3% (range 17.7–27.1%) with 24 hospitals significantly different from the average. From 2010–15, the adjusted 30‐day mortality odds ratio (OR) 0.991/month, 95% confidence interval (CI) 0.990–0.992, P < 0.01 and unplanned readmission (OR 0.998/month, 95% CI 0.998–0.999, P < 0.01) rates declined.
Conclusion
Within 30 days of a HF hospitalisation, one in 10 patients died and almost a quarter of those surviving experienced an unplanned readmission. The risk of these outcomes varied widely among hospitals suggesting disparities in HF care quality. Nevertheless, a substantial decline in 30‐day mortality and a modest decline in readmissions occurred over the study period.
In this population‐wide study of early outcomes following heart failure (HF) hospitalisations in Australia and New Zealand, we found that one in 10 patients died, and almost a quarter experienced an unplanned readmission, within 30 days. We also observed a significant decline in 30‐day all‐cause mortality and a modest reduction in readmissions over the study period despite the absence of broad policy efforts to improve HF outcomes. However, 30‐day mortality and unplanned readmission rates varied two to threefold among hospitals suggesting disparities in care quality, highlighting the need for coordinated efforts to standardise care.
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