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This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy of different non‐pharmacological interventions for people with primary progressive aphasia (PPA) on global language abilities, word retrieval, functional communication, cognition, depressive symptoms, quality of life, and adverse events. To use network meta‐analysis to compare and rank non‐pharmacological interventions for PPA on the key outcomes of word retrieval and quality of life.

Background and purpose Several studies have described an association between insular infarction and mortality. Large infarcts often include the insula and lesion size is associated with mortality. We hypothesized that there is an association between insular infarction and mortality independent of lesion volume. Methods We included consecutive stroke patients between 1 September 2008 and 11 November 2012 from the 1000Plus database with an acute ischaemic lesion on diffusion-weighted imaging on day 1 and a completed 90-day follow-up. Insular infarct location was determined using the in-house software Stroke Lesion Atlas. In multiple Cox regression analysis (dependent variable: mortality), we adjusted for insular infarcts, age, lesion volume, history of atrial fibrillation, National Institutes of Health Stroke Scale and previous stroke. Results We included 736 patients, of whom 168 had an insular infarction. Within a medium follow-up time of 107 days, cumulative survival was 90% in patients with insular infarction and 99% in patients without insular infarction (P < 0.001). Right insular infarction was independently associated with mortality (hazard ratio, 2.60; confidence interval, 1.3–5.4; P = 0.010). Conclusions In our study, right insular involvement was a prognostic marker for mortality after ischaemic stroke. A selection bias towards patients able to give informed consent warrants further studies.

BACKGROUND AND PURPOSE: Acute lesions in patients with transient ischaemic attack (TIA) are important as they are associated with increased risk for recurrence. Characteristics associated with acute lesions in young TIA patients were therefore investigated.METHODS: The sifap1 study prospectively recruited a multinational European cohort (n = 5023) of patients aged 18-55 years with acute cerebrovascular event. The detection of acute ischaemic lesions was based on diffusion-weighted imaging (DWI). The frequency of DWI lesions was assessed in 829 TIA patients who met the criteria of symptom duration

BACKGROUND C-terminal Agrin Fragment (CAF) has been proposed as a novel biomarker for sarcopenia originating from the degeneration of the neuromuscular junctions. In patients with stroke muscle wasting is a common observation that predicts functional outcome. We aimed to evaluate agrin sub-fragment CAF22 as a marker of decreased muscle mass and physical performance in the early phase after acute stroke. METHODS Patients with acute ischaemic or haemorrhagic stroke (n = 123, mean age 70 ± 11 y, body mass index BMI 27.0 ± 4.9 kg/m(2)) admitted to inpatient rehabilitation were studied in comparison to 26 healthy controls of similar age and BMI. Functional assessments were performed at begin (23 ± 17 days post stroke) and at the end of the structured rehabilitation programme (49 ± 18 days post stroke) that included physical assessment, maximum hand grip strength, Rivermead motor assessment, and Barthel index. Body composition was assessed by bioelectrical impedance analysis (BIA). Serum levels of CAF22 were measured by ELISA. RESULTS CAF22 levels were elevated in stroke patients at admission (134.3 ± 52.3 pM) and showed incomplete recovery until discharge (118.2 ± 42.7 pM) compared to healthy controls (95.7 ± 31.8 pM, p

Introduction: We analyzed the impact of myasthenia gravis (MG) on decision-making in family planning by women with the disease. Methods: In a cross-sectional, anonymous survey, a standardized questionnaire was sent or handed out to 1,637 women with MG. Results: In total, 801 questionnaires were eligible for analysis. Over fifty percent of the patients had abstained from having children due to MG. The concern mentioned most often was the possible influence of MG medication on the unborn child (87.1%). Spouses/partners (91.8%) and MG treating physicians (82.9%) were the most important persons involved in the decision-making process. Higher age and personal experience of intensive-care treatment for MG were independently associated with the decision to abstain from having children. Lower level of knowledge was independently associated with the probability of discouraging other MG patients from having children. Conclusions: Women with MG need specific guidance about family planning issues, which may lead to lower rates of voluntary childlessness. On the basis of our data, more specific hypotheses can be generated that require prospective investigation. Muscle Nerve 52:371–379, 2015

BACKGROUND AND PURPOSE Visibility of lesions on fluid attenuated inversion recovery (FLAIR) images appears indicative of the time window in acute ischemic stroke. We compared two published methods for calculation of relative FLAIR signal intensities (rSI) regarding their association with time from symptom onset in a longitudinal fashion. METHODS We prospectively included patients receiving serial MRI examinations between 4.5 and 35 hours from symptom onset. FLAIR rSI was determined using two methods: a whole regions-of-interest (ROI) method and a hotspot method, selecting only a single area of visually highest signal. Signal intensity (rSI) was calculated relative to the contralateral side for each time point. RESULTS We included 21 patients with 3-6 MRI examinations on the first 2 days after stroke onset. FLAIR rSI determined with both methods shows a linear association with time from onset, although the hotspot results showed higher variability. Both methods with their previously published thresholds are reliable for identifying patients outside the 4.5 hours time window. CONCLUSION Both methods show a similar performance, and might be a suitable help for the visual assessment of FLAIR lesion visibility.

BACKGROUND Isthmic-vaginal cytology is a follow-up method in patients who have undergone radical vaginal trachelectomy (RVT) for early cervical cancer. However, to the authors' knowledge, little is known regarding its ability to monitor patients and diagnose disease recurrence. Herein, the authors report their experience with cytology after RVT compared with cytology in patients after cone biopsy and women undergoing screening. METHODS A database of 563 specimens from 303 patients was analyzed retrospectively (RVT in 361 specimens, conization in 102 specimens, and screening in 100 specimens). The following criteria were applied: Bethesda system, the presence of endocervical and metaplasia cells, regeneration criteria, vaginal flora, and morphological signs of human papillomavirus. The analysis was performed by 2 cytopathologists. Differences between the groups and correlation between the cytopathologists were analyzed. RESULTS Smears without endocervical and metaplasia cells were significantly less frequent among the patients who underwent RVT. There was no difference in regeneration signs, vaginal flora, and morphologic signs of human papillomavirus between the groups. After RVT, 26/23 smears (cytopathologist 1/cytopathologist 2) smears were diagnosed as abnormal. Biopsies revealed 7 cases of dysplasia and 1 case of disease recurrence. After conization, 1 patient was diagnosed with a low-grade lesion on cytology; follow-up cytology was normal. In the screening, 10/13 smears were diagnosed with lesions on cytology; biopsy revealed dysplasia in 2 cases. The correlation between both cytopathologists was high. CONCLUSIONS After RVT, histological verification of cytology is frequently needed. The reasons might include alterations of anatomy, regeneration, and inflammation process after RVT. Cytopathologists should become familiar with the spectrum of changes in post-RVT cytology and communication between cytopathologists and clinicians should be improved. This might reduce false-positive results. Cancer (Cancer Cytopathol) 2014;122:349–358. © 2014 American Cancer Society.

Cigarette smoking is a severe health burden being related to a number of chronic diseases. Frequently, smokers report about sleep problems. Sleep disturbance, in turn, has been demonstrated to be involved in the pathophysiology of several disorders related to smoking and may be relevant for the pathophysiology of nicotine dependence. Therefore, determining the frequency of sleep disturbance in otherwise healthy smokers and its association with degree of nicotine dependence is highly relevant. In a population-based case-control study, 1071 smokers and 1243 non- smokers without lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorder were investigated. Sleep quality (SQ) of participants was determined by the Pittsburgh Sleep Quality Index. As possible confounders, age, sex and level of education and income, as well as depressiveness, anxiety, attention deficit hyperac- tivity, alcohol drinking behaviour and perceived stress, were included into multiple regression analyses. Significantly more smokers than non-smokers (28.1% versus 19.1%; P < 0.0001) demonstrated a disturbed global SQ. After con- trolling for the confounders, impaired scores in the component scores of sleep latency, sleep duration and global SQ were found significantly more often in smokers than non-smokers. Consistently, higher degrees of nicotine dependence and intensity of smoking were associated with shorter sleep duration. This study demonstrates for the first time an elevated prevalence of sleep disturbance in smokers compared with non-smokers in a population without lifetime history of psychiatric disorders even after controlling for potentially relevant risk factors. It appears likely that smoking is a behaviourally modifiable risk factor for the occurrence of impaired SQ and short sleep duration.

Aims and objectives. The aim of the study was to investigate factors related to the use of restraints and to explore whether the rate of nurses was an influencing factor regarding the use of restraints in German nursing homes and hospitals. Background. Restraints are frequently used measures in hospitals and nursing homes. Risks for falls and small nurse workforces are discussed in relation to the use of restraints. Design. A secondary analysis of a cross-sectional study was carried out. Methods. Data were collected by trained nurses using standardised questionnaires in 76 nursing homes (n = 5521) and 15 hospitals (n = 2827). For data analysis, a 3-level random intercept logistic model was used. Results. The prevalence of restraints (bed rails and/or belts) was 9·3% for hospital patients and 26·3% for nursing home residents. Amongst hospital patients, restraint use was more prevalent in women, older patients, patients with a high care dependency, patients who fell during the last two weeks, patients with a perceived risk of falls, polypharmacy, urinary incontinence, disorientation and confinement to bed. In the nursing homes, the restrained residents were significantly younger, more care dependent, had less falls and were more often urinary incontinent, disoriented and bedfast. The rate of nurses was not significantly related to the use of restraints in hospitals, and nursing homes according to the three-level random intercept model. Conclusions. Hospital patients with previous falls were more often restrained, but in the nursing homes, the restrained residents experienced less falls. The number of qualified nursing staff had no significant influence on the use of physical restraints. Relevance to clinical practice. Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study.

Pressschweisnahte oder auch Langspressnahte entstehen beim Strangpressen mit sogenannten Kammer- oder Bruckenwerkzeugen. Diese sind bei der Herstellung der industriell relevanten Hohlprofile unvermeidbar, stellen jedoch fur mechanisch anspruchsvolle Anwendungen oftmals die kritische Schwachstelle dar. Eine Charakterisierung der Pressnahtqualitat, mit den dazugehorigen mechanischen Kennwerten, ist auf Grund der komplexen Profilgeometrien jedoch haufig schwer oder unmoglich. Bisherige Forschungen nutzten hierfur Aufdornproben, Biege- oder Zugversuche an Profilen bzw. Profilabschnitten, welche allerdings keine grundlegenden Aussagen zulassen. In den hier dargestellten Untersuchungen wurde dieses Problem durch das Pressen flacher Bander aus EN-AW 6060 und EN-AW 6082 mit einer mittig liegenden Langsnaht umgangen. Die Pressungen wurden mit unterschiedlichen Blockeinsatztemperaturen und Pressgeschwindigkeiten durchgefuhrt, um den Einfluss der Parameter auf die Pressnahteigenschaften feststellen zu konnen. Die flachen gepressten Bander ermoglichen standardisierte Zugversuche zur Ermittlung der mechanischen Kennwerte. Hauptaugenmerk wurde bei den weiterfuhrenden Untersuchungen auf das mikrostrukturelle Gefuge gelegt, um eine visuelle Charakterisierung von Pressnahten zu ermoglichen. Weld seams form when profiles are extruded using porthole or bridge dies. These are inevitable when producing industrial relevant hollow profiles but imply the weak spot if the profiles are used for applications with high mechanical requirements. The characterization of formed weld seams together with their mechanical properties is problematic or sometimes even impossible due to the complex profile geometries. Expansion, bending or tensile tests of profiles or parts of the same were hitherto often used for their analysis lacking the possibility of basic assumptions about their properties. The investigations described herein circumvent the problem by using a flat profile exhibiting the weld seam in the middle. Flat profiles offer the possibility of standardised specimens for tensile testing. The extrusion experiments focused on the aluminium alloys EN-AW 6060 and EN-AW 6082. During the experiments billet temperature and extrusion speed have been varied. The microstructure was analysed subsequent to explain the obtained results and to offer a possibility of characterisation.

Attrition in longitudinal studies can lead to biased results. The study is motivated by the unexpected observation that alcohol consumption decreased despite increased availability, which may be due to sample attrition of heavy drinkers. Several imputation methods have been proposed, but rarely compared in longitudinal studies of alcohol consumption. The imputation of consumption level measurements is computationally particularly challenging due to alcohol consumption being a semi‐continuous variable (dichotomous drinking status and continuous volume among drinkers), and the non‐normality of data in the continuous part. Data come from a longitudinal study in Denmark with four waves (2003–2006) and 1771 individuals at baseline. Five techniques for missing data are compared: Last value carried forward (LVCF) was used as a single, and Hotdeck, Heckman modelling, multivariate imputation by chained equations (MICE), and a Bayesian approach as multiple imputation methods. Predictive mean matching was used to account for non‐normality, where instead of imputing regression estimates, "real" observed values from similar cases are imputed. Methods were also compared by means of a simulated dataset. The simulation showed that the Bayesian approach yielded the most unbiased estimates for imputation. The finding of no increase in consumption levels despite a higher availability remained unaltered.

Aims and objectives. The objective of this study was to describe the relationship between the German National Expert Standard Pressure Ulcer Prevention and the pressure ulcer prevalence in German nursing homes and hospitals. Background. The patient outcome pressure ulcer does not only depend on individual characteristics of patients, but also on institutional factors. In Germany, National Expert Standards are evidence-based instruments that build the basis of continuing improvement in health care quality. It is expected that after having implemented the National Expert Standard Pressure Ulcer Prevention, the number of pressure ulcers should decrease in health care institutions. Design. The analysed data were obtained from two cross-sectional studies from 2004–2005. Methods. A multilevel analysis was performed to show the impact of the National Expert Standard Pressure Ulcer Prevention on pressure ulcer prevalence. Results. A total of 41·5% of hospitals and 38·8% of the nursing homes claimed to use the National Expert Standard in the process of developing their local protocols. The overall pressure ulcer prevalence grade 2–4 was 4·7%. Adjusted for hospital departments, survey year and individual characteristics, there was no significant difference in the prevalence of pressure ulcers between institutions that refer to the National Expert Standard or those referring to other sources in developing their local protocols (OR = 1·14, 95% CI = 0·90–1·44). Conclusions. There was no empirical evidence demonstrating that local protocols of pressure ulcer prevention based on the National Expert Standard were superior to local protocols which refer other sources of knowledge with regard to the pressure ulcer prevalence. Relevance to clinical practice. The use of the National Expert Standard Pressure Ulcer Prevention can neither be recommended nor be refused. The recent definition of implementation of Expert Standards should be mandatory for all health care institutions which introduce Expert Standards.

Several series of benzofurans, benzothiophenes, and benzothiazoles, all featuring the thioamide group, were synthesized and tested as novel K(ATP) channel openers in artificial cell systems: CHO cells transfected with SUR1/Kir6.2, and HEK 293 cells transfected with SUR2B/Kir6.1; these served as model systems for insulin-secreting pancreatic β cells and smooth muscle cells, respectively. All compounds were investigated with respect to their binding affinity for the SUR2B-type K(ATP) channels using [(3)H]P1075 as radioligand. Selected compounds were also tested as agonists in intact cells using DiBAC(4)(3) and DyeB (R7260) as membrane potential dyes. Remarkable affinity for SUR2B/Kir6.1 channels in the single-digit micromolar range was observed. In addition, benzothiazole-derived thioamides with sterically demanding, lipophilic substituents showed >100-fold selectivity in favor of SUR2B/Kir6.1. A one-carbon spacer between the heterocyclic skeleton and the thioamide moiety was observed to be crucial for affinity and selectivity. Two of the most potent and selective compounds were studied by crystal structure analyses.

Durch die Kombination von unterschiedlichen metallischen Werkstoffen lassen sich masgeschneiderte Konstruktionen mit optimierten Eigenschaften herstellen. Die Herstellung von Werkstoffverbunden ist jedoch haufig mit hohen Anforderungen an die Fertigungstechnik verbunden. Schwerpunkt dieser Untersuchung ist das Verbundstrangpressen von Aluminium und Titan. Neben den mechanischen Eigenschaften des Verbundes wurden die Ausbildung der Bindungszone sowie die beim Haftungsaufbau wirksamen Bindungsmechanismen untersucht. Hierbei war neben dem Einfluss der Probenvorbereitung vor allem die Wirksamkeit von unterschiedlichen Haftvermittlerschichten von Interesse. Wahrend Schichten aus Kupfer oder Nickel den Haftungsaufbau aufgrund von Oxidschichtbildung verhindern, konnen durch Umformung eingegossener Titankerne Festigkeiten von uber 100 MPa erreicht werden. Im Vergleich zu alternativen Fugeverfahren tritt eine Beeintrachtigung des Werkstoffgefuges in Form von Warmeeinflusszonen, Porenbildung oder Grobkornbildung hier nicht auf. Rod Extrusion of Titanium-Aluminum Composites The combination of different metals enables the processing of materials with local optimized properties. Thus, the production of metallic composites is associated with high standards in manufacturing technologie. Focus of the following investigations is the rod extrusion process of titanium-aluminum-composites. Besides the mechanical properties, the formation of the bonding zone and the mechanisms of adhesion in the bonding zone were investigated. The influence of specimens’ preparation and of different coatings used improve bonding were a matter of particular interest. Whereas coatings of copper or nickel inhibit the formation of a strong bonding due to the formation of oxide layers, sealed titanium cores can reach a mechanical strength of up to 100 MPa after rod extrusion. Compared to other joining technologies, an impairment of the base metal via formation of heat affected zones, pores or grain coarsening does not occur.

Aims Falls and fall-related injuries are major problems in hospitals. The aim of this study was to examine the impact of fall prevention guidelines on falls and fall-related injuries in hospitals. Method A cross-sectional study was conducted in German hospitals. Some 28 hospitals participated with a total of 5046 patients. Eleven of these hospitals had already implemented a fall prevention guideline, 10 were in the process of developing such a guideline and seven hospitals were not using any fall prevention guideline at all. A standardized questionnaire was used on the individual patient level to obtain details regarding the socio-demographic background, falls, fall-related injuries and other problems relevant to nursing. A further questionnaire referred to the use of fall prevention guidelines in the individual hospitals. Data specific to falls were analysed both on hospital level and on ward and patient level by means of a multilevel logistic model. Results The univariate analyses suggest that patients in hospitals that are using guidelines are more likely to fall [odds ratios (OR) = 1.19, confidential interval (CI) = 0.65–2.18] than in hospitals that do not use any guideline (reference category) or are still in the developing stage (OR = 0.82, KI = 0.77–0.87). If, in a multivariate analysis, the ward level and individual patient variables (age, disorientation, confusion, incontinence) are included, the following results are obtained: the probability of falls in hospitals not using guidelines (reference category) is higher than in hospitals developing a guideline (OR = 0.86, KI = 0.58–1.28) or using a guideline (OR = 0.71, KI = 0.44–1.14). The differences are even more distinct regarding the injuries resulting from a fall that require medical treatment. The probability of these injuries is significantly lower in hospitals using guidelines (OR = 0.27, KI = 0.09–0.85) than in hospitals developing a guideline (OR = 0.61, KI = 0.24–1.54) or not using any guidelines at all (reference category). Conclusion The present results of the multilevel analysis show that falls and fall-related injuries can be reduced by the implementation of fall prevention guidelines.