DOCSLIB.ORG

For Peer Review Only

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
For Peer Review Only BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-005276 on 7 November 2014. Downloaded from FAST Warning Signs in Younger Stroke Patients: Implications for Stroke Education Campaigns ForJournal: peerBMJ Open review only Manuscript ID: bmjopen-2014-005276 Article Type: Research Date Submitted by the Author: 17-Mar-2014 Complete List of Authors: Kaps, M; JustusLiebig Universit�t Giessen Grittner, Ulrike; Department of Biostatistics and Clinical Epidemiology, Charité- University Medicine Berlin, Germany, Tanislav, Christian; Justus Liebig University , Neurology Jungehuelsing, Gerhard; Charit� Berlin, Department of Neurology Tatlisumak, Turgut; Helsinki University Central Hospital, Department of Neurology Kessler, Christof; University Greifswald, Neurology Schmidt, Reinhold; Department of Neurology, University of Graz, Austria, Putaala, Jukka; University of Helsinki, Department of Neurological Sciences; Helsinki University Central Hospital, Department of Neurology Norrving, Bo; Lund University Hospital Rolfs, Arndt; University of Rostock, Department of Neurology <b>Primary Subject http://bmjopen.bmj.com/ Health services research Heading</b>: Cardiovascular medicine, Diagnostics, Epidemiology, Health services Secondary Subject Heading: research, Neurology Stroke < NEUROLOGY, HEALTH SERVICES ADMINISTRATION & Keywords: MANAGEMENT, EPIDEMIOLOGY, MEDICAL EDUCATION & TRAINING, NEUROLOGY on September 25, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 25 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-005276 on 7 November 2014. Downloaded from 1 2 3 FAST Warning Signs in Younger Stroke Patients: Implications for Stroke Education 4 5 Campaigns 6 7 8 9 Manfred Kaps professor1*, Ulrike Grittner PhD2*, Christian Tanislav MD1*, Gerhard 10 3 4 5 11 Jungehülsing, MD , Turgut Tatlisumak, PhD , Christoph Kessler professor , Reinhold 8 4 7 8 12 Schmidt professor , Putaala Jukka MD , Bo Norrving professor , Arndt Rolfs professor , on TM 13 behalf of the sifap1 Investigators 14 15 *equal contributionFor peer review only 16 17 1Department of Neurology, Justus Liebig University, Giessen, Germany 18 2Department of Biostatistics and Clinical Epidemiology, Charité- University Medicine Berlin, 19 Germany 20 3 21 Department of Neurology, Charité, Berlin, Germany 4 22 Department of Neurology, University, Helsinki, Finland 5 23 Department of Neurology, Moritz Arndt University Greifswald, Germany 24 6Department of Neurology, University of Graz, Austria 25 7Department of Neurology, Lund, Sweden 26 8Albrecht-Kossel Institute for Neuroregeneration, University of Rostock, Rostock, Germany 27 28 29 30 31 32 33 34 http://bmjopen.bmj.com/ 35 36 37 Corresponding author: 38 Christian Tanislav, MD 39 40 Department of Neurology 41 Justus Liebig University, Giessen, Germany 42 Klinikstr. 33 on September 25, 2021 by guest. Protected copyright. 43 35385 Giessen 44 Germany 45 Tel.: +49/641 98545301; Fax: +49/641 98545409 46 E-mail: [email protected]; 47 48 49 50 51 Key words: young stroke, awareness signs, FAST, clinical presentation. 52 Word count (manuscript): 2882 53 References: 14 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 25 BMJ Open: first published as 10.1136/bmjopen-2014-005276 on 7 November 2014. Downloaded from 1 2 3 Abstract 4 5 6 7 Background Clinical recognition instruments are important in a complex chain towards 8 timely treatment management in acute stroke. The present study aimed to evaluate the 9 10 frequency of individual warning signs reflected by the ‘FAST’ public stroke recognition 11 12 instrument (face, arm, speech, act timely) in younger stroke patients. 13 14 15 Methods InFor a multinational peer prospective review cross sectional study only (Stroke in Young Fabry 16 17 Patients; sifap1) including stroke patients aged below 56 the frequency of presenting 18 symptoms was analysed. The performance of the FAST scheme was investigated. 19 20 21 22 Results 5023 patients were enrolled in the study between 2007 and 2010. Information of 4535 23 patients with TIA (n=1071), ischemic stroke (n=3396) or other (n=68) were selected for this 24 25 analysis. FAST symptoms could be traced in 76.5% of all cases. 35% of those with at least 26 27 one FAST symptom had all three symptoms. The FAST instrument performed better in older 28 age groups: At least one FAST symptom could be recognised in 69.1% of 18-24 years old 29 30 patients, in 74.0% of those aged 25-34 years, in 75.4% of those aged 35-44 years, and77.8% 31 32 in 45-55 years old patients. Patients severely disabled (NIHSS<5: 69.0%, NIHSS 6-15: 33 98.9%, NIHSS>15: 100.0%) FAST signs were less sensitive for indicating cerebrovascular 34 http://bmjopen.bmj.com/ 35 events as well as in the posterior circulation (65.2%) and in patients with transient ischemic 36 37 attacks (62.3%). 38 39 40 Conclusions Nearly one-quarter of young stroke patients is not targeted by the FAST scheme; 41 the performance is higher in patients with worse stroke severity addressing almost all these 42 on September 25, 2021 by guest. Protected copyright. 43 individuals. 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 25 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2014-005276 on 7 November 2014. Downloaded from 1 2 3 Article Summary 4 5 6 Warning signs of stroke are probably the most important step in the complex chain towards 7 timely treatment management. For this purpose different stroke recognition instruments with 8 9 different symptoms and different wording have been developed, offering criteria to identify 10 11 stroke for public education. Currently many distinguished awareness campaigns to propagate 12 the signs of stroke use the simplified FAST message, which adopts weakness of face, arm as 13 14 well as speech and essentially time. In the present study we aimed to ascertain the 15 For peer review only 16 performance of FAST criteria in the sifap1 cohort, a unique prospectively collected 17 population of young (18-55 years) stroke victims. 18 19 The main finding indicates nearly one quarter of young strokes is not targeted by the FAST 20 21 scheme. However FAST fits very well to capture patients with acute stroke eligible for 22 thrombolysis due to the increasing performance in worse disability. It performs far less 23 24 sensitive for the large number of cases not eligible for thrombolysis but for secondary 25 26 prevention, for young stroke and for the posterior circulation. However, the main purpose of 27 sifap1 was not to validate a stroke recognition instrument. This might by the main limitation 28 29 of the present investigation. The “FAST wording” was primarily not covered with a specific 30 31 slot in the case report form. FAST items were derived from different sources after the 32 cerebrovascular event (e.g. after employing the NIH Stroke Scale immediately after hospital 33 34 admission (median delay: one day)). http://bmjopen.bmj.com/ 35 36 In conclusion we confirm FAST as a useful tool in the recognition of strokes in this specific 37 group of young strokes. Because risk factors and aetiology profiles in the sifap1 cohort 38 39 resembled those found in elderly stroke patients, conclusions from our study may be also 40 41 valid in older age groups. 42 on September 25, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 25 BMJ Open: first published as 10.1136/bmjopen-2014-005276 on 7 November 2014. Downloaded from 1 2 3 Introduction 4 5 6 Getting stroke patients to the acute care hospital on time is the major requirement for effective 7 8 stroke therapy. Knowing warning signs of stroke is the first and most important step in a 9 10 complex chain towards timely treatment management. Effective public education follows 11 simple rules: the message must be simple to remember, effective and consistent. For this 12 13 purpose different stroke recognition instruments with different symptoms and different wording 14 15 have been developedFor [1-6], peer offering criteria review to identify stroke only for public education [1-3;7;8]. 16 Currently many distinguished awareness campaigns to propagate the signs of stroke use the 17 18 simplified FAST message [9], which adopts weakness of face, arm as well as speech and 19 20 essentially time (National Health Service: “When stroke strikes act FAST”). Although the 21 mnemonic FAST is most frequently adopted, there are so far no prospective multicentre studies 22 23 from large cohorts, which evaluate distinct stroke signs for the use in public campaigns. 24 25 26 The aim of the present study is to ascertain the performance of FAST signs in a large cohort of 27 28 younger stroke patients the Stroke in Young Fabry Patients study (sifap1) [10] and to analyse 29 30 factors which influence the affectivity in identifying CVEs. This is a secondary analysis of the 31 sifap1 data which was originally supposed to investigating the relation of juvenile stroke and a 32 33 genetic disorder known as Fabry disease. Fabry disease was diagnosed in 0.9% of all patients 34 http://bmjopen.bmj.com/ 35 (n=45) [11]. 36 37 38 Methods 39 40 41 The protocol of the sifap1 study was published recently [10]. Described briefly, the sifap1 42 on September 25, 2021 by guest. Protected copyright. 43 study was designed as a multicenter multinational prospective observational study of young 44 45 stroke patients across Europe (Table 1). A total of 5023 stroke patients below 56 years were 46 enrolled in the sifap1 study, 271 patients with primary haemorrhages and 217 patients without 47 48 classification of the cerebrovascular event (CVE) were excluded.
Load more

Recommended publications
  • Supplementary Note ‐ Novel Genetic Loci for Atrial Fibrillation
    Supplementary Note ‐ Novel genetic loci for atrial fibrillation SUPPLEMENTARY NOTE Large‐scale analyses of common and rare variants identify 12 new loci associated with atrial fibrillation INDEX 1. Supplementary tables Supplementary Table 1. Baseline characteristics GWAS Supplementary Table 2. Baseline characteristics ExWAS Supplementary Table 3. Detailed description of the genes at novel atrial fibrillation loci Supplementary Table 4. Results from Asian ancestry SKAT gene based test Supplementary Table 5. Single variant association results for the variants that were analyzed in the two significant gene‐based tests for SH3PDX2A in the Asian ancestry group Supplementary Table 6. Results from ancestry‐specific GWAS meta‐analyses Supplementary Table 7. Results from European and Asian ancestry ExWAS meta‐ analyses Supplementary Table 8. Results from European incident atrial fibrillation GWAS meta‐ analysis Supplementary Table 9. Results from European prevalent atrial fibrillation GWAS meta‐ analysis Supplementary Table 10. Comparison of results for common variant loci between the AFGen Consortium combined ancestry analysis and the Biobank Japan study Supplementary Table 11. Comparison of results for common variant loci between the AFGen Consortium combined ancestry analysis and the UK Biobank study. Supplementary Table 12. Approximate and joint conditional analysis in European ancestry results identify 20 independent genetic loci associated with atrial fibrillation Supplementary Table 13. Overlap with atrial fibrillation risk factor GWAS loci Supplementary Table 14. Association between novel atrial fibrillation loci and stroke subtypes in the Neuro‐CHARGE Stroke Consortium Supplementary Note ‐ Novel genetic loci for atrial fibrillation Supplementary Table 15. Association between novel atrial fibrillation loci and stroke subtypes in the Metastroke Consortium Supplementary Table 16.
    [Show full text]
  • Annex 5. Data Sheets A. Office of Internal Oversight Services (OIOS)
    Annex 5. Data Sheets a. Office of Internal Oversight Services (OIOS) Anti-corruption Strategy OIOS, through independent, professional and timely audit, inspection, evaluation, monitoring and investigation activities, provides the United Nations management, the Secretary-General and the General Assembly with objective and useful information, advice and reports that support the achievement of organizational goals in the most cost-effective manner. As an agent of positive change, OIOS assists managers in promoting: 1. Accountability for the stewardship of resources 2. Efficiency and productivity 3. Cost-effective controls to ensure compliance with authority minimise waste and deter fraud and dishonesty. The Audit and Management Consulting Division (AMCD) is represented in Geneva and Nairobi. The Investigations Section is only represented in Nairobi. The other OIOS units, the Central Evaluation Unit and the Central Monitoring and Inspection Unit, do not have regional offices. Activities in the past Place Sectors Components Date Budget Coordinator Partners Progress of the investigation and action 02 Feb thereon to Determine Responsibility for the 1995 theft of US$3.9 million in UNOSOM II Investigation of allegations of irregularities 05 Apr and mismanagement in MINURSO 1995 Audit of the UNPROFOR personnel pilot 06 Jun project 1995 Audit report on the United Nations Access 30 Control System project Nov 1995 Strengthening the role of evaluation 04 Apr findings in programme design, delivery and 1996 policy directives Audit of procurement handled
    [Show full text]
  • Genome-Wide Association Analysis of Young Onset Stroke Identifies a Locus on Chromosome 10Q25 Near HABP2
    Original Contribution Genome-Wide Association Analysis of Young Onset Stroke Identifies a Locus on Chromosome 10q25 Near HABP2 Yu-Ching Cheng, PhD; Tara M. Stanne, PhD; Anne-Katrin Giese, MD; Weang Kee Ho, PhD; Matthew Traylor, PhD; Philippe Amouyel, MD, PhD; Elizabeth G. Holliday, PhD; Rainer Malik, PhD; Huichun Xu, MD, PhD; Steven J. Kittner, MD; John W. Cole, MD; Jeffrey R. O’Connell, PhD; John Danesh, DPhil, FRCP; Asif Rasheed, MBBS; Wei Zhao, MSc; Stefan Engelter, MD; Caspar Grond-Ginsbach, PhD; Yoichiro Kamatani, MD, PhD; Mark Lathrop, PhD; Didier Leys, MD, PhD; Vincent Thijs, MD, PhD; Tiina M. Metso, MD, PhD; Turgut Tatlisumak, MD, PhD; Alessandro Pezzini, MD; Eugenio A. Parati, MD; Bo Norrving, MD, PhD; Steve Bevan, PhD; Peter M. Rothwell, MD, PhD, FRCP; Cathie Sudlow, DPhil, FRCP; Agnieszka Slowik, MD, PhD; Arne Lindgren, MD, PhD; Matthew R. Walters, MD; WTCCC-2 Consortium; Jim Jannes, PhD; Jess Shen, MSc; David Crosslin, PhD; Kimberly Doheny, PhD; Cathy C. Laurie, PhD; Sandip M. Kanse, PhD; Joshua C. Bis, PhD; Myriam Fornage, PhD; Thomas H. Mosley, PhD; Jemma C. Hopewell, PhD; Konstantin Strauch, PhD; Martina Müller-Nurasyid, MD, PhD; Christian Gieger, PhD; Melanie Waldenberger, PhD, MPH; Annette Peters, PhD; Christine Meisinger, MD; M. Arfan Ikram, MD, PhD; W.T. Longstreth Jr, MD, MPH; James F. Meschia, MD; Sudha Seshadri, MD; Pankaj Sharma, PhD, MD; Bradford Worrall, MD, MSc; Christina Jern, MD, PhD; Christopher Levi, MBBS; Martin Dichgans, MD; Giorgio B. Boncoraglio, MD; Hugh S. Markus, MD; Stephanie Debette, MD, PhD; Arndt Rolfs, MD; Danish Saleheen, MBBS, PhD; Braxton D. Mitchell, PhD Received August 27, 2015; final revision received November 6, 2015; accepted November 18, 2015.
    [Show full text]
  • HHS Public Access Author Manuscript
    HHS Public Access Author manuscript Author Manuscript Author ManuscriptMol Genet Author Manuscript Metab. Author Author Manuscript manuscript; available in PMC 2016 February 01. Published in final edited form as: Mol Genet Metab. 2015 February ; 114(2): 248–258. doi:10.1016/j.ymgme.2014.11.004. The alpha-galactosidase A p.Arg118Cys variant does not cause a Fabry disease phenotype: data from individual patients and family studies Susana Ferreira1, Alberto Ortiz2, Dominique P. Germain3, Miguel Viana-Baptista4, António Caldeira Gomes5, Marta Camprecios6, Maria Fenollar-Cortés7, Ángel Gallegos-Villalobos8, Diego Garcia9, José Antonio García-Robles10, Jesús Egido11, Eduardo Gutiérrez-Rivas12, José Antonio Herrero13, Sebastián Mas14, Raluca Oancea15, Paloma Péres16, Luis Manuel Salazar-Martín17, Jesús Solera-Garcia18, Helena Alves19, Scott C. Garman20, and João Paulo Oliveira1,21,22 Susana Ferreira: [email protected]; Alberto Ortiz: [email protected]; Dominique P. Germain: [email protected]; Miguel Viana-Baptista: [email protected]; António Caldeira Gomes: [email protected]; Maria Fenollar-Cortés: [email protected]; Ángel Gallegos-Villalobos: [email protected]; Jesús Egido: [email protected]; Sebastián Mas: [email protected]; Helena Alves: [email protected]; Scott C. Garman: [email protected]; João Paulo Oliveira: [email protected] 1Departamento de Genética, Faculdade de Medicina, Universidade do Porto; 4200-319 Porto, Portugal 2Servicio de Nefrología, Instituto de Investigación Sanitaria
    [Show full text]
  • Fabry Disease: a Review of Current Management Strategies
    Revised submission June 2010 Fabry disease: a review of current management strategies A. MEHTA1, M. BECK2, F. EYSKENS3, C. FELICIANI4, I. KANTOLA5, U. RAMASWAMI6, A. ROLFS7, A. RIVERA8, S. WALDEK9, D.P. GERMAIN10 1Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital and University College London School of Medicine, London, UK 2Children’s Hospital, University of Mainz, Mainz, Germany 3Department of Metabolic Diseases, ZNA Middelheim General Hospital, Antwerp, Belgium 4Department of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy 5Department of Medicine, Turku University Hospital, Turku, Finland 6Paediatric Metabolic Unit, Addenbrooke's Hospital, Cambridge, UK 7Albrecht-Kossel-Institute for Neuroregeneration, Medical Faculty, University of Rostock, Rostock, Germany 8Department of Internal Medicine, Complejo Hospitalario, Universitario de Vigo, Hospital Xeral de Vigo, Vigo, Spain 9Department of Adult Metabolic Diseases, Salford Royal NHS Foundation Trust, Salford, UK 10University of Versailles – St Quentin en Yvelines, Division of Medical Genetics, Hôpital Raymond Poincaré (AP-HP), 92380 Garches, France Corresponding author: Dr Atul Mehta, Lysosomal Storage Disorders Unit, Department of Academic Haematology, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK Tel: +44 (0) 20 7830 2814 Email: [email protected] Revised submission June 2010 Abstract Fabry disease is an X-linked inherited condition due to the absence or reduction of - galactosidase activity in lysosomes, that results in accumulation of globotriaosylceramide (Gb3) and related neutral glycosphingolipids. Manifestations of Fabry disease include serious and progressive impairment of renal and cardiac function. In addition, patients experience pain, gastrointestinal disturbance, transient ischaemic attacks and strokes. Additional effects on the skin, eyes, ears, lungs and bones are often seen.
    [Show full text]
  • Ischaemic Stroke in Young Adults: a Global Perspective
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp-2019-322424 on 3 February 2020. Downloaded from Cerebrovascular disease REVIEW Ischaemic stroke in young adults: a global perspective Esther Boot,1 Merel Sanne Ekker ,1 Jukka Putaala,2 Steven Kittner,3 Frank-­Erik De Leeuw,1 Anil M Tuladhar 1 ► Additional material is ABSTRact Furthermore, we will review the more traditional published online only. To view Ischaemic stroke at young age is an increasing problem vascular risk factors and geographical and racial/ please visit the journal online ethnic differences in their prevalence and strength (http:// dx. doi. org/ 10. 1136/ in both developing and developed countries due to jnnp- 2019- 322424). rising incidence, high morbidity and mortality and long- of association with stroke. term psychological, physical and social consequences. 1Department of Neurology, Compared with stroke in older adults, stroke in young METHODS Radboud Univerisity Medical adults is more heterogeneous due to the wide variety Centre, Donders Institute for For this review, we searched in MEDLINE and Brain, Cognition and Behaviour, of possible underlying risk factors and aetiologies. In WHO Database for articles published from 1 Centre for Neuroscience, this review, we will provide an overview of the global January 2008 to 1 January 2020. The following Nijmegen, The Netherlands variation in the epidemiology of stroke in young adults, 2 search terms (including MedicalSubject Headings) Department of Neurology, with special attention to differences in geography, Helsinki University Central were used in multiple combinations: ‘ischemic Hospital, Helsinki, Finland ethnicity/race and sex, as well as traditional and novel stroke, young adults, incidence, global, epidemi- 3 Department of Neurology, risk factors for early- onset ischaemic stroke, such ology, infection, sex differences, race, ethnicity, University of Maryland School of as air pollution.
    [Show full text]
  • Clinically Relevant Depressive Symptoms in Young Stroke Patients – Results of the Sifap1 Study
    Original Paper Neuroepidemiology 2015;44:30–38 Received: September 28, 2014 DOI: 10.1159/000371389 Accepted: December 4, 2014 Published online: January 31, 2015 Clinically Relevant Depressive Symptoms in Young Stroke Patients – Results of the sifap1 Study a b c, d c Christian Tanislav Peter Kropp Ulrike Grittner Martin Holzhausen e d f Franz Fazekas Gerhard Jan Jungehülsing Turgut Tatlisumak g f h i Bettina von Sarnowski Jukka Putaala Roman Huber Vincent Thijs e a e, j k Reinhold Schmidt Manfred Kaps Christian Enzinger Martin Dichgans l m Bo Norrving Arndt Rolfs a b Neurology, Justus Liebig University, Giessen , Institute of Medical Psychology and Medical Sociology, University c of Rostock, Rostock , Department for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, d e and Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin , Germany; Department of Neurology, f Medical University of Graz, Graz , Austria; Department of Neurology, Helsinki University Central Hospital, g h Helsinki , Finland; Department of Neurology, University of Greifswald, Greifswald , Department of Neurology, i j Friedrichshafen , Germany; Clinical and Experimental Neurology, Leuven , Belgium; Department of Radiology, k Division of Neuroradiology, Medical University of Graz, Graz , Austria; Institute for Stroke and Dementia Research, l Klinikum Grosshadern, Munich , Germany; Department of Clinical Neuroscience, Neurology, Lund University, Lund , m Sweden; Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock , Germany Key Words relevant depressive symptoms (CRDS, defined by a BDI- Young stroke · Depression · Acute cerebral ischemia · score ≥ 18) the self-reporting Beck Depression Inventory sifap1 · Risk factors (BDI) was obtained on inclusion in the study. Associations with baseline parameters, stroke severity (National Institutes of Health Stroke Scale, NIHSS), and brain MRI findings were Abstract analyzed.
    [Show full text]
  • FOR OFFICIAL USE ONLY Public Disclosure Authorized Report No
    Document of The World Bank FOR OFFICIAL USE ONLY Public Disclosure Authorized Report No. 52691-MZ PROJECT APPRAISAL DOCUMENT ON A PROPOSED CREDIT Public Disclosure Authorized IN THE AMOUNT OF SDR 19.6 MILLION (US$30.4 MILLION EQUIVALENT) TO THE REPUBLIC OF MOZAMBIQUE FOR A NATIONAL DECENTRALIZED PLANNING AND FINANCE PROJECT Public Disclosure Authorized March 4,2010 Urban and Water Country Department AFCS2 Africa Region Public Disclosure Authorized This document has a restricted distribution and may be used by recipients only in the performance of their official duties. Its contents may not otherwise be disclosed without World Bank authorization. CURRENCY EQUIVALENTS (Exchange Rate Effective as January 3 1,201 0) Currency Unit = New Meticais (Mtn) 31.07Mtn = US$l US$1.55 = SDR1 FISCAL YEAR January 1 - December 31 ABBREVIATIONS AND ACRONYMS AD Administraqclo Distrital (District Administration) AT Assistzncia Te'cnica(Technical Assistance) AWPB Annual Work Plan and Budget BdPES Balanqo do Plano Econdmico Social (Monitoring System of the Annual Government Plan) CCD Conselho Consultivo Distrital (District Consultative Council) CdS Comite' de Supewisclo (Supervision Committee) CdSP Comite' de Supervisclo Provincial (Provincial Supervision Committee) CFAA Country Financial Accountability Assessment CFFM Common Fund Financing Mechanism CL Conselho Locais-CLs (Local Councils) CNCS Conselho Nacinal de Combate ao HIV/SIDA (National AIDS Council) CPAR Country Procurement Assessment Report CPS Country Partnership Strategy CQS Consultants' Qualification
    [Show full text]
  • Catalysing Ocean Finance
    Empowered lives. Resilient nations. Catalysing Ocean Finance Volume II Methodologies and Case Studies United Nations Development Programme Empowered lives. Resilient nations. UNDP partners with people at all levels of society to help build nations that can withstand crisis, and drive and sustain the kind of growth that improves the quality of life for everyone. On the ground in 177 countries and territories, we offer global perspective and local insight to help empower lives and build resilient nations. www.undp.org The GEF unites 182 countries in partnership with international institutions, non-governmental organizations (NGOs), and the private sector to address global environmental issues while supporting national sustainable development initiatives. Today the GEF is the largest public funder of projects to improve the global environment. An independently operating financial organization, the GEF provides grants for projects related to biodiversity, climate change, international waters, land degradation, the ozone layer, and persistent organic pollutants. Since 1991, GEF has achieved a strong track record with developing countries and countries with economies in transition, providing $9.2 billion in grants and leveraging $40 billion in co-financing for over 2,700 projects in over 168 countries. www.thegef.org September 2012 Catalysing Ocean Finance Volume II Methodologies and Case Studies Copyright © 2012 United Nations Development Programme United Nations Development Programme Global Environment Facility Bureau of Development Policy GEF Secretariat 304 East 45th Street , 1818 H Street, NW 9th Floor MSN P4-400 New York, NY 10017, USA Washington CD 20433, USA www.undp.org www.thegef.org All right reserved. This publication or parts of it may not be reproduced, stored by means of any system or transmitted, in any form or by any medium, whether electronic, mechanical, photocopied, recorded or of any other type, without the prior permission of the United Nations Development Programme.
    [Show full text]
  • Acute Cerebrovascular Disease in the Young the Stroke in Young Fabry Patients Study
    Acute Cerebrovascular Disease in the Young The Stroke in Young Fabry Patients Study Rolfs, Arndt; Fazekas, Franz; Grittner, Ulrike; Dichgans, Martin; Martus, Peter; Holzhausen, Martin; Boettcher, Tobias; Heuschmann, Peter U.; Tatlisumak, Turgut; Tanislav, Christian; Jungehulsing, Gerhard J.; Giese, Anne-Katrin; Putaala, Jukaa; Huber, Roman; Bodechtel, Ulf; Lichy, Christoph; Enzinger, Christian; Schmidt, Reinhold; Hennerici, Michael G.; Kaps, Manfred; Kessler, Christof; Lackner, Karl; Paschke, Eduard; Meyer, Wolfgang; Mascher, Hermann; Riess, Olaf; Kolodny, Edwin; Norrving, Bo Published in: Stroke: a journal of cerebral circulation DOI: 10.1161/STROKEAHA.112.663708 2013 Link to publication Citation for published version (APA): Rolfs, A., Fazekas, F., Grittner, U., Dichgans, M., Martus, P., Holzhausen, M., Boettcher, T., Heuschmann, P. U., Tatlisumak, T., Tanislav, C., Jungehulsing, G. J., Giese, A-K., Putaala, J., Huber, R., Bodechtel, U., Lichy, C., Enzinger, C., Schmidt, R., Hennerici, M. G., ... Norrving, B. (2013). Acute Cerebrovascular Disease in the Young The Stroke in Young Fabry Patients Study. Stroke: a journal of cerebral circulation, 44(2), 340-349. https://doi.org/10.1161/STROKEAHA.112.663708 Total number of authors: 28 General rights Unless other specific re-use rights are stated the following general rights apply: Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise
    [Show full text]
  • THE CONTRIBUTIONS of MARINE and COASTAL AREA-BASED MANAGEMENT APPROACHES to SUSTAINABLE DEVELOPMENT GOALS and TARGETS Supplementary Annex
    THE CONTRIBUTIONS OF MARINE AND COASTAL AREA-BASED MANAGEMENT APPROACHES TO SUSTAINABLE DEVELOPMENT GOALS AND TARGETS Supplementary Annex UN ENVIRONMENT REGIONAL SEAS REPORTS AND STUDIES NO. 205 Contents Introduction .................................................................................................................................................... 3 Case Study 1. Area of Particular Environmental Interest: Clarion-Clipperton Zone Areas of Particular Environmental Interest, Mid Pacific .............................................................................................................. 6 Case Study 2. Fisheries Closure and Conservation Area: Lyme Bay Reserve, United Kingdom ............... 16 Case Study 3. Integrated Coastal Zone Management: Coastal and Marine Spatial Planning in Belize ... 24 Case Study 4. Integrated Coastal Zone Management: Patagonian Coastal Zone Management Plan, Argentina ...................................................................................................................................................... 33 Case Study 5. Integrated Coastal Zone Management: Mediterranean Integrated Coastal Zone Management Protocol ................................................................................................................................. 43 Case Study 6. Large Marine Ecosystem: Bay of Bengal Large Marine Ecosystem Project (BOBLME)..... 54 Case Study 7. Locally Managed Marine Area: Madagascar Locally Managed Marine Area Network (MIHARI) ......................................................................................................................................................
    [Show full text]
  • Clinically Relevant Depressive Symptoms in Young Stroke Patients – Results of the Sifap1 Study
    Original Paper Neuroepidemiology 2015;44:30–38 Received: September 28, 2014 DOI: 10.1159/000371389 Accepted: December 4, 2014 Published online: January 31, 2015 Clinically Relevant Depressive Symptoms in Young Stroke Patients – Results of the sifap1 Study a b c, d c Christian Tanislav Peter Kropp Ulrike Grittner Martin Holzhausen e d f Franz Fazekas Gerhard Jan Jungehülsing Turgut Tatlisumak g f h i Bettina von Sarnowski Jukka Putaala Roman Huber Vincent Thijs e a e, j k Reinhold Schmidt Manfred Kaps Christian Enzinger Martin Dichgans l m Bo Norrving Arndt Rolfs a b Neurology, Justus Liebig University, Giessen , Institute of Medical Psychology and Medical Sociology, University c of Rostock, Rostock , Department for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, d e and Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin , Germany; Department of Neurology, f Medical University of Graz, Graz , Austria; Department of Neurology, Helsinki University Central Hospital, g h Helsinki , Finland; Department of Neurology, University of Greifswald, Greifswald , Department of Neurology, i j Friedrichshafen , Germany; Clinical and Experimental Neurology, Leuven , Belgium; Department of Radiology, k Division of Neuroradiology, Medical University of Graz, Graz , Austria; Institute for Stroke and Dementia Research, l Klinikum Grosshadern, Munich , Germany; Department of Clinical Neuroscience, Neurology, Lund University, Lund , m Sweden; Albrecht-Kossel-Institute for Neuroregeneration, University of Rostock, Rostock , Germany Key Words relevant depressive symptoms (CRDS, defined by a BDI- Young stroke · Depression · Acute cerebral ischemia · score ≥ 18) the self-reporting Beck Depression Inventory sifap1 · Risk factors (BDI) was obtained on inclusion in the study. Associations with baseline parameters, stroke severity (National Institutes of Health Stroke Scale, NIHSS), and brain MRI findings were Abstract analyzed.
    [Show full text]