Background:
Widespread quick access to mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is one of the main challenges in stroke care. It is unclear if newly established MT units are ...required 24 h/7 d. We explored the diurnal admission rate of patients with AIS potentially eligible for MT to provide a basis for discussion of daytime-adapted stroke care concepts.
Methods:
Data collected from the Baden-Württemberg Stroke Registry in Germany were assessed (2008–2012). We analyzed the admission rate of patients with AIS stratified by the National Institutes of Health Stroke Scale (NIHSS) score at admission in 3-h intervals. An NIHSS score ≥10 was considered a predictor of large vessel occlusion. The average annual admission number of patients with severe AIS were stratified by stroke service level and calculated for a three-shift model and working/non-working hours.
Results:
Of 91,864, 22,527 (21%) presented with an NIHSS score ≥10. The average admission rates per year for a hospital without Stroke Unit (SU), with a local SU, with a regional SU and a stroke center were 8, 52, 90 and 178, respectively. Approximately 61% were admitted during working hours, 54% in the early shift, 36% in the late shift and 10% in the night shift.
Conclusions:
A two-shift model, excluding the night shift, would cover 90% of the patients with severe AIS. A model with coverage during working hours would miss ~40% of the patients with severe AIS. To achieve a quick and area-wide MT, it seems preferable for newly implemented MT-units to offer MT in a two-shift model at a minimum.
To assess the incidence and the trend in incidence of Type 1 diabetes (T1DM) in children and adolescents < 15 years of age in Baden-Württemberg (BW), Germany.
BW is Germany's third largest federal ...state. All 31 paediatric departments in BW and one diabetes centre participated in the study. Case registration was done according to the EURODIAB criteria. The degree of ascertainment was 97.2%.
From 1987 to 2003, the age- and sex-standardized incidence rate was 14.1/100,000 per year 95% confidence interval (CI) 13.7, 14.6, n = 4017. The estimated annual increase in incidence was 3.8% (95% CI 1.1, 6.6). Compared with the first years of our registry, the current mean number of new cases of T1DM has doubled (1987-1989, n = 153; 2000-2003, n = 302). Generally, the highest rise in incidence occurred in the youngest age group of 0-4-year-old patients (5.8%; 95% CI 2.5, 9.3), followed by the age groups 5-9 (3.4%; 95% CI 0.8, 6.0) and 10-14 (2.7%; 95% CI 0.3, 5.1).
In Germany, the number of children and adolescents with new-onset T1DM has been rising at a faster pace than expected. A distinct shift to younger age at onset has been observed in Germany.
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•Upscaled MW-driven structured reactor developed: 6-fold MW power increase required to run a 150-fold scaled prototype & feed rate.•450-fold C6H6 productivity and 125-fold CH4 ...conversion attained with respect to bench scale.•295 h continuous unmanned operation under 4 -h cyclic MDA-regeneration on 4%Mo/ZSM-5@SiC monoliths attained.•Stable MDA performance for 7 consecutive reaction cycles (35 h). Benzene productivity: 0.17 LSTP/h.•5 m3CH4/h conversion required for favourable MW-MDA business case using renewables as energy vector.
Microwave-assisted gas-phase conversion on structured catalysts is emerging as a promising process intensification technology in the field of heterogeneous catalysis. The combination of selective heating and structured catalytic materials induces a temperature difference between the heated catalytic sample and the surrounding void regions to avoid non-selective gas-phase reactions. This operational principle allowed inhibiting thermal cracking in alkane dehydrogenation processes as well as retarding catalyst deactivation by coking in methane dehydroaromatization (MDA) processes. However, its effectiveness has not been reported so far out of the laboratory scale conditions. This work addresses the scaling of the microwave-assisted MDA process from lab scale experiments to a scaled-up configuration capable of stable operation with a 150-fold higher feeding rate. The scaling-up potential and main obstacles to overcome for this technology are critically discussed. In addition, a techno-economic assessment of the MW-MDA process is presented. The catalytic activity was kept for seven consecutive reaction cycles, i.e. 35 h MW-MDA, prior to a progressive decay due to permanent deactivation caused by zeolite dealumination and active metal loss. The scaled set-up operated for up to 295 consecutive hours under unmanned operation conducting 4 -h MDA-regeneration cycles on Mo/ZSM-5@SiC monoliths and resulting in 125-fold increase of converted methane and a 450-fold increase of benzene (0.17 LC6H6/h) in comparison with the laboratory scale tests. Scaled set-up experiments were run using only a 6-fold microwave input power, thus, highlighting the non-linearity between energy consumption and scaling factor for this technology and the importance of microwave cavity design.
Periorbital Contact Sensitization Landeck, Lilla; Schalock, Peter C; Baden, Lynn A ...
American journal of ophthalmology,
09/2010, Letnik:
150, Številka:
3
Journal Article
Recenzirano
Purpose To identify frequency and pattern of contact sensitization among patients with periorbital dermatitis. Design Cross-sectional retrospective investigation of 1247 patients referred for patch ...testing over a 17-year period. Methods Data were collected for patients undergoing patch testing to the standard and customized trays between January 1990 and December 2006 at the Massachusetts General Hospital, Contact Dermatitis Clinic. Our study group consisted of 266 patients affected by periorbital dermatitis. Findings were compared to 981 referrals without periorbital dermatitis (controls). Patch test results were read after 48 and 72 hours and classified as allergic, questionable, irritant, or negative. Statistical analyses were carried out by using χ2 test and Fisher exact test. Results General epidemiologic data among periorbital dermatitis patients showed significant predominance of female gender (87.6%) and of individuals aged 40 to 59 years (45.9%). Nickel (16.5%) and fragrance mix (13.2%) were the top-ranking sensitizers. Ingredients of topical ophthalmologic products did not result in significant sensitization. Comparison of the periorbital dermatitis group to the controls did not reveal significant differences in sensitization pattern. Patch testing confirmed the likelihood of allergic contact dermatitis in 50.8% of the periorbital dermatitis patients tested. Conclusions Allergic contact dermatitis is a common cause of periorbital dermatitis. Patch testing should be considered in all patients with periorbital dermatitis when suspecting contact allergy in order to identify and avoid offending allergens.
OBJECTIVE: To predict the frequency of type 1 diabetes in childhood and adolescence (<15 years of age) in Germany for the next 20 years. RESEARCH DESIGN AND METHODS: Data on diabetes onset has been ...collected by means of a registry in the federal German state of Baden-Württemberg (documentation period, 1987-2006; n = 5,108; completeness of data 98.1%). RESULTS: The current incidence rate (2000-2006) is 19.4 per 100,000 per year (95% CI 18.6-20.2). The annual incidence rate can be expressed as a square of a linear function of the calendar year X y = (3.05 + 0.0778 x {X-1986})²; r² = 0.90. The highest increase per year was observed in the age-groups comprising 2- and 3-year-olds (12 and 13% per year, respectively). The incidence rate for the year 2026 is estimated to be 37.9 per 100,000 per year (95% CI 33.3-42.9). CONCLUSIONS: The increase that we found in younger children is characteristic of a left shift toward an earlier age.
Based on data from the Baden-Wuerttemberg stroke registry, we aimed to explore the diurnal variation of acute ischemic stroke (IS) care delivery.
92,530 IS patients were included, of whom 37,471 ...(40%) presented within an onset-to-door time ≤4.5 h. Daytime was stratified in 3-h time intervals and working vs. non-working hours. Stroke onset and hospital admission time, rate of door-to-neurological examination time ≤30 min, onset-/door-to-imaging time IV thrombolysis (IVT) rates, and onset-/door-to-needle time were determined. Multivariable regression models were used stratified by stroke onset and hospital admission time to assess the relationship between IVT rates, quality performance parameters, and daytime. The time interval 0:00 h to 3:00 h and working hours, respectively, were taken as reference.
The IVT rate of the whole study population was strongly associated with the sleep-wake cycle. In patients presenting within the 4.5-h time window and potentially eligible for IVT stratification by hospital admission time identified two time intervals with lower IVT rates. First, between 3:01 h and 6:00 h (IVT rate 18%) and likely attributed to in-hospital delays with the lowest diurnal rate of door-to-neurological examination time ≤30 min and the longest door-to-needle time Second, between 6:01 h and 15:00 h (IVT rate 23-25%) compared to the late afternoon and evening hours (IVT rate 27-29%) due to a longer onset-to-imaging time and door-to-imaging time. No evidence for a compromised stroke service during non-working hours was observed.
The analysis provides evidence that acute IS care is subject to diurnal variation which may affect stroke outcome. An optimization of IS care aiming at constantly high IVT rates over the course of the day therefore appears desirable.
On Destiny Ransford, Chris H
Dialogo (Constanţa),
12/2022, Letnik:
9, Številka:
1
Journal Article
Recenzirano
Odprti dostop
If some intelligence underlies the universe, as is suggested by a host of modern-day considerations, then why does not that intelligence intervene to allay the oft-horrible destinies that are the lot ...of so many sentient beings?
While the precise timing and intensity of very early rehabilitation (VER) after stroke onset is still under discussion, its beneficial effect on functional disability is generally accepted. The ...recently published randomized controlled AVERT trial indicated that patients with severe stroke might be more susceptible to harmful side effects of VER, which we hypothesized is contrary to current clinical practice. We analyzed the Baden-Wuerttemberg stroke registry to gain insight into the application of VER in acute ischemic stroke (IS) and intracerebral hemorrhage (ICH) in clinical practice.
99,753 IS patients and 8824 patients with ICH hospitalized from January 2008 to December 2012 were analyzed. Data on the access to physical therapy (PT), occupational therapy (OT), and speech therapy (ST), the time from admission to first contact with a therapist and the average number of therapy sessions during the first 7 days of admission are reported. Multiple logistic regression models adjusted for patient and treatment characteristics were carried out to investigate the influence of VER on clinical outcome.
PT was applied in 90/87% (IS/ICH), OT in 63/57%, and ST in 70/65% of the study population. Therapy was mostly initiated within 24 h (PT 87/82%) or 48 h after admission (OT 91/89% and ST 93/90%). Percentages of patients under therapy and also the average number of therapy sessions were highest in those with a discharge modified Rankin Scale score of 2 to 5 and lowest in patients with complete recovery or death during hospitalization. The outcome analyses were fundamentally hindered due to biases by individual decision making regarding the application and frequency of VER.
While most patients had access to PT we noticed an undersupply of OT and ST. Only little differences were observed between patients with IS and ICH. The staff decisions for treatment seem to reflect attempts to optimize resources. Patients with either excellent or very unfavorable prognosis were less frequently assigned to VER and, if treated, received a lower average number of therapy sessions. On the contrary, severely disabled patients received VER at high frequency, although potentially harmful according to recent indications from the randomized controlled AVERT trial.
Objective: To assess the prevalence of type 2 diabetes mellitus (T2DM) and maturity onset diabetes of the young (MODY) in children and adolescents aged 0−20 yr in Baden‐Württemberg (BW), Germany, and ...to compare our results with those from other European countries.
Methods: Our study involved every children's hospital (n = 31), each diabetologist in private practice (n = 122), and every internal medicine unit (n = 164) in BW. A written questionnaire and a telephone survey were used to identify children with T2DM and MODY who had been examined at any of these institutions between 2004 and 2005. Population data were drawn from the national census of 1987 and the subsequent annual updates.
Results: The prevalence of T2DM for the age range from 0 to 20 yr is 2.30/100 000, whereas the prevalence of MODY in the same age range is 2.39/100 000. The median age of patients with T2DM was 15.8 yr, and 13.9 yr for MODY patients. The majority of patients with either T2DM or MODY were treated in children's hospitals and by consultant diabetologists. A molecular genetic analysis was done to substantiate the clinical diagnosis in less than half of the recruits (14.3% of T2DM and 44.8% of MODY patients).
Conclusions: The prevalence of T2DM and MODY is considerably lower than the prevalence of type 1 diabetes. Type 2 diabetes thus continues to be a rare disease in children and adolescents in Germany, as is also the case in other European countries.
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