Abstract TP379: “Build It and They Will Come”: How Comprehensive Stroke Certification Increases the Number of Transfers

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Betty Robertson
Keyword(s):  
Research Question ◽  
Heart Association ◽  
Fold Increase ◽  
Joint Commission ◽  
Level Of Care ◽  
Stroke Patients ◽  
Full Spectrum ◽  
Specialized Care ◽  
High Level

Introduction/Background: Stroke is the leading cause of long-term disability affecting 800,000 people in the U.S. each year. In September 2012 The Joint Commission, in collaboration with the American Heart Association/American Stroke Association’s Brain Attack Coalition, launched the Advanced Certification for Comprehensive Stroke Centers (CSCs). This new level of certification recognizes the significant resources in staff and training that comprehensive stroke centers must have to treat complex stroke. Certification is available only to comprehensive stroke centers in Joint Commission-accredited acute care hospitals. For CSC eligibility, there are numerous requirements and volumes that must be met. The most complicated stroke cases should be treated at the centers best equipped to provide specialized care that lead to better outcomes. Cedar-Sinai became the 4 th program in the nation to receive this prestigious certification. By providing expert care, numerous clinical trials, and high level treatment and procedures, we have become the center of choice for patients in need of a higher level of care. Research Question: Does comprehensive stroke certification lead to an increased number of transfers for higher level of care? Methods: Retrospective analysis of the number of acute strokes transferred to Cedars-Sinai between the first years of Comprehensive Stroke Certification in 2012 through 2015. Results: 2012 yielded a total transfer of 97 patients. In 2015 the volume had risen to 194, a 50% increase in 4 years. It is important to note that in 2014, 4 patients were transferred post TPA infusion (Drip and Ship), the gold standard for treatment of ischemic stroke. 2015 resulted in 25 such transfers, a six fold increase. Conclusion: The full spectrum and coordination of services that a CSC is equipped to provide contributes to increased access of specialized care for complex stroke patients. This in turn leads to better outcomes. This not only translates to delivery of timely optimal treatment for stroke patients, but also increases our expertise in delivery of this care.

scholarly journals Phenobarbital induction of cytochromes P-450. High-level long-term responsiveness of primary rat hepatocyte cultures to drug induction, and glucocorticoid dependence of the phenobarbital response

1990 ◽  
Vol 271 (1) ◽  
pp. 113-119 ◽  
Author(s):  
D J Waxman ◽  
J J Morrissey ◽  
S Naik ◽  
H O Jauregui
Keyword(s):  
Rat Hepatocytes ◽  
Fold Increase ◽  
Drug Induction ◽  
Fetal Bovine ◽  
Mechanistic Basis ◽  
High Level ◽  
Male Specific ◽  
Cytochrome P 450

The induction of hepatic cytochromes P-450 by phenobarbital (PB) was studied in rat hepatocytes cultured for up to 5 weeks on Vitrogen-coated plates in serum-free modified Chee's medium then exposed to PB (0.75 mM) for an additional 4 days. Immunoblotting analysis indicated that P-450 forms PB4 (IIB1) and PB5 (IIB2) were induced dramatically (greater than 50-fold increase), up to levels nearly as high as those achieved in PB-induced rat liver in vivo. The newly synthesized cytochrome P-450 was enzymically active, as shown by the major induction of the P-450 PB4-dependent steroid 16 β-hydroxylase and pentoxyresorufin O-dealkylase activities in the PB-induced hepatocyte microsomes (up to 90-fold increase). PB induction of these P-450s was markedly enhanced by the presence of dexamethasone (50 nM-1 microM), which alone was not an affective inducing agent, and was inhibited by greater than 90% by 10% fetal bovine serum. The PB response was also inhibited (greater than 85%) by growth hormone (250 ng/ml), indicating that this hormone probably acts directly on the hepatocyte when it antagonizes the induction of P-450 PB4 in intact rats. In untreated hepatocytes, P-450 RLM2 (IIA2), P-450 3 (IIA1) and NADPH P-450 reductase levels were substantially maintained in the cultures for 10-20 days. The latter two enzymes were also inducible by PB to an extent (3-4 fold elevation) that is comparable with that observed in the liver in vivo. Moreover, P-450c (IA1) and P-450 3 (IIA1) were highly inducible by 3-methylcholanthrene (5 microM; 48 h exposure) even after 3 weeks in culture. In contrast, the male-specific pituitary-regulated P-450 form 2c (IIC11) was rapidly lost upon culturing the hepatocytes, suggesting that supplementation of appropriate hormonal factors may be necessary for its expression. The present hepatocyte culture system exhibits a responsiveness to drug inducers that is qualitatively and quantitatively comparable with that observed in vivo, and should prove valuable for more detailed investigations of the molecular and mechanistic basis of the response to PB and its modulation by endogenous hormones.

scholarly journals A Rat Model of Prenatal Zika Virus Infection and Associated Long-Term Outcomes

Viruses ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2298
Author(s):  
Morgan L. Sherer ◽  
Elise A. Lemanski ◽  
Rita T. Patel ◽  
Shannon R. Wheeler ◽  
Mark S. Parcells ◽  
...  
Keyword(s):  
Rat Model ◽  
Zika Virus ◽  
Fold Increase ◽  
Interferon Response ◽  
Motor Deficits ◽  
Long Term Outcomes ◽  
Zikv Infection ◽  
Full Spectrum ◽  
The Brain

Zika virus (ZIKV) is a mosquito-borne flavivirus that became widely recognized due to the epidemic in Brazil in 2015. Since then, there has been nearly a 20-fold increase in the incidence of microcephaly and birth defects seen among women giving birth in Brazil, leading the Centers for Disease Control and Prevention (CDC) to officially declare a causal link between prenatal ZIKV infection and the serious brain abnormalities seen in affected infants. Here, we used a unique rat model of prenatal ZIKV infection to study three possible long-term outcomes of congenital ZIKV infection: (1) behavior, (2) cell proliferation, survival, and differentiation in the brain, and (3) immune responses later in life. Adult offspring that were prenatally infected with ZIKV exhibited motor deficits in a sex-specific manner, and failed to mount a normal interferon response to a viral immune challenge later in life. Despite undetectable levels of ZIKV in the brain and serum in these offspring at P2, P24, or P60, these results suggest that prenatal exposure to ZIKV results in lasting consequences that could significantly impact the health of the offspring. To help individuals already exposed to ZIKV, as well as be prepared for future outbreaks, we need to understand the full spectrum of neurological and immunological consequences that could arise following prenatal ZIKV infection.

High-level resistance to oxidative stress in Lactococcus lactis conferred by Bacillus subtilis catalase KatE

Microbiology ◽  
2005 ◽  
Vol 151 (9) ◽  
pp. 3011-3018 ◽  
Author(s):  
T. Rochat ◽  
A. Miyoshi ◽  
J. J. Gratadoux ◽  
P. Duwat ◽  
S. Sourice ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Bacillus Subtilis ◽  
Lactococcus Lactis ◽  
Fold Increase ◽  
Inducible Promoter ◽  
Optimization Strategy ◽  
High Level ◽  
The Impact ◽  
Level Resistance

Lactococcus lactis, a lactic acid bacterium widely used for food fermentations, is often exposed to damaging stress conditions. In particular, oxidative stress leads to DNA, protein and membrane damages that can be lethal. As L. lactis has no catalase, the impact of production of the Bacillus subtilis haem catalase KatE on its oxidative stress resistance was tested. This cytoplasmic catalase was engineered for extracellular expression in L. lactis with an optimization strategy based on fusion to the nisin-inducible promoter and a lactococcal signal peptide (SPUsp45). The production of KatE by L. lactis conferred an 800-fold increase in survival after 1 h exposure to 4 mM hydrogen peroxide, and a 160-fold greater survival in long-term (3 days) survival of aerated cultures in a cydA mutant, which is unable to respire. The presence of KatE protected DNA from oxidative damage and limited its degradation after long-term aeration in a cydA/recA mutant, defective in DNA repair. L. lactis is thus able to produce active catalase that can provide efficient antioxidant activity.

Abstract 3005: Stroke Support: Survivors Become Givers of Support

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Kathy Morrison ◽  
Gayle Watson ◽  
Judith Dillon
Keyword(s):  
Support Group ◽  
Heart Association ◽  
Time Spectrum ◽  
Recovery Process ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Full Spectrum ◽  
Phone Calls ◽  
Group Members

Background: Stroke recovery is a different experience for every survivor. The recovery process can continue for many years after the initial event. Reintegration into the community can be difficult, as stroke patients have both short and long-term needs. A stroke support group must be flexible enough to assist patients over the time spectrum of their recovery. Our stroke support group was established 21 years ago and has many of its original members still active as leaders. Because younger people are having strokes and have different recovery demands, we were concerned that our program had not evolved to meet the full spectrum of our patients’ needs. Purpose: To evaluate our current program with the goal to update and expand its programming. Methods: Stroke group members were asked for their suggestions to improve the program. A multidisciplinary team then met to review ideas and design action plans. Results: As a result of the suggestions, the following program changes have been made: 1) a new program brochure was created with snapshots of members to reinforce that strokes do not always make people invalids; 2) support group meetings are now scheduled at two times on the same day of the month: during the afternoon for members who want to be home before dark, and in the evening for members (younger stroke survivors/caregivers) who want to attend after work; 3) the older group has changed their name to “Stroke Survivors & Thrivers”, and its members have volunteered to visit patients in the hospital and to make phone calls to stroke patients and their caregivers; 4) creation of a steering committee to facilitate meeting organization; 5) meeting content selection is done by group members; 6) quarterly sessions devoted to open discussions for idea sharing and questions; 7) information is provided via social media sites, email, and the stroke center web site in addition to traditional mailings; and 8) both groups join together to participate in the annual American Heart Association Heart & Stroke Walk. Conclusions: Involving members of the Stroke Support Group to participate in the structure and function of the program has increased member satisfaction, improved attendance at meetings, and allowed the program to reach a broader range of survivors. As a result, the Support Group has become empowered to meet the needs of more stroke survivors and their caregivers in our community - helping them to become Thrivers as well.

Abstract W P263: Rapidly Resolving Symptoms..Stop the Race! No Symptoms, No Alteplase!

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shannon L Smith ◽  
Mark C Schultz
Keyword(s):  
Ischemic Stroke ◽  
Clinical Symptoms ◽  
Research Question ◽  
Heart Association ◽  
Home Health ◽  
Joint Commission ◽  
Poor Outcomes ◽  
Negative Imaging ◽  
The Joint Commission

Background: Research has shown that one-third of patients not treated with thrombolytic therapy due to minor or rapidly improving symptoms have poor outcomes that are considered disabling. The purpose of this study was to determine if opportunities were missed to treat with Alteplase. Research Question: What is the outcome of patients arriving to the emergency room with symptoms of an ischemic stroke not treated with Alteplase because of rapidly improving symptoms? Method: A retrospective analysis of patients between January 2012 and February 2013 with ischemic stroke or TIA, whose ICD-9 coding at discharge is in alignment with the Joint Commission and the American Heart Association. STK 4 from the Joint Commission was used to define the population. Patients with documentation from the physician stating that no Alteplase was given due to rapidly resolving symptoms were included. Magnetic resonance imaging and National Institute of Health scores were used along with clinical symptoms to diagnose potential stroke. Results: Of 47 patients reviewed, 34% had positive imaging and were coded with an ischemic stroke code and 66% had negative imaging and were coded with a transient ischemic attack code. Of the 34% with positive imaging, 38% were discharged to home with home health for therapy follow-up. Of the 66% with negative imaging, 19% were discharged home with home health for therapy follow-up. Of the 47 patients, 6% had a National Institute of Health stroke scale score of 1-3 with positive imaging and 4% had a score of 4 or greater with positive imaging.13% had a score of 0 on admit and 0 on discharge with positive imaging. Conclusion: We found a third of patients who did not receive Alteplase due to rapidly resolving symptoms did have a stroke and several required therapy services after discharge for residual deficits that were potentially disabling. In addition, the National Institute of Health Stroke Scale was not consistently beneficial in diagnosing acute stroke for patients with normal or low scores who were ultimately diagnosed with stroke.

Vivid Imagers Are Better at Detecting Salient Changes

2006 ◽  
Vol 27 (4) ◽  
pp. 218-228 ◽  
Author(s):  
Paul Rodway ◽  
Karen Gillies ◽  
Astrid Schepman
Keyword(s):  
Individual Differences ◽  
Change Detection ◽  
Visual Imagery ◽  
Detection Task ◽  
Level Of Detail ◽  
Detection Accuracy ◽  
Change Detection Task ◽  
Term Change ◽  
High Level

This study examined whether individual differences in the vividness of visual imagery influenced performance on a novel long-term change detection task. Participants were presented with a sequence of pictures, with each picture and its title displayed for 17  s, and then presented with changed or unchanged versions of those pictures and asked to detect whether the picture had been changed. Cuing the retrieval of the picture's image, by presenting the picture's title before the arrival of the changed picture, facilitated change detection accuracy. This suggests that the retrieval of the picture's representation immunizes it against overwriting by the arrival of the changed picture. The high and low vividness participants did not differ in overall levels of change detection accuracy. However, in replication of Gur and Hilgard (1975) , high vividness participants were significantly more accurate at detecting salient changes to pictures compared to low vividness participants. The results suggest that vivid images are not characterised by a high level of detail and that vivid imagery enhances memory for the salient aspects of a scene but not all of the details of a scene. Possible causes of this difference, and how they may lead to an understanding of individual differences in change detection, are considered.

The Fiscal Effects of Economic Immigration on Subnational Government Finance in Poland

e-Finanse ◽  
2019 ◽  
Vol 15 (1) ◽  
pp. 45-58
Author(s):  
Marzanna Poniatowicz ◽  
Agnieszka Piekutowska
Keyword(s):  
Social Policy ◽  
Income Tax ◽  
Research Question ◽  
Personal Income Tax ◽  
Government Finance ◽  
Subnational Government ◽  
Migration Research ◽  
The Impact ◽  
High Share

AbstractThe aim of the paper is to analyse the effects of economic immigration on subnational government finance (SNG) in Poland. The goal to achieve is to answer the following research question: what are the fiscal effects of immigration on SNG budget revenues and expenditures. To answer this question, logarithmic models were developed. The analysis refers to the years 2007-2016. In this respect, data from Statistics Poland - referring to budget revenues and expenditures of communes, cities of district status, districts and voivodeships - were used. As far as immigration statistics are concerned, data from the Ministry of Family, Labour and Social Policy were used. The results indicate an increase in both revenues and expenditures of SNG as a result of immigration. Such results can be explained inter alia by the nature of migration - research were focused on economic immigration. Results confirm that the level of employment of foreigners is one of the determinants shaping the fiscal effect of immigration. Moreover, the impact of economic immigration on SNG budget revenues and expenditures depends on the structure of this budget. This explains the differentiated results of the analysis of the impact of immigration on SNG in different countries. The positive correlation between immigration and SNG revenues in Poland can be associated with a high share of subnational governments in personal income tax revenues as this tax is one of the main categories of SNG revenues. Furthermore, results show that the impact of immigration on local government budgets in Poland is modest. This confirms the conclusions drawn by other authors (e.g. Auerbach and Oreopoulos), that in the long term, immigration cannot be considered as a potential instrument for resolving fiscal imbalances.

Method of virtual reality for early comprehensive rehabilitation of patients with acute stroke

2020 ◽  
pp. 39-45
Author(s):  
N. Nozdryukhina ◽  
E. Kabayeva ◽  
E. Kirilyuk ◽  
K. Tushova ◽  
A. Karimov
Keyword(s):  
Virtual Reality ◽  
Literature Review ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Recovery Process ◽  
Stroke Patients ◽  
Post Stroke ◽  
Stroke Disability ◽  
Comprehensive Rehabilitation ◽  
High Level

Despite significant advances in the treatment and rehabilitation of stroke, level of post-stroke disability remains at a fairly high level. Recent innovative developments in the rehabilitation of these patients provide good results in terms of functional outcome. One of such developments is method of virtual reality (VR), which affects not only the speed and volume of regaining movement, as well as coordination, but also normalizes the psycho-emotional background, increasing the motivation of patients to improve the recovery process. This article provides a literature review of the use of the VR method in the rehabilitation of post-stroke patients, neurophysiological aspects of recovery of lost functions using this method are considered.

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