Impact of Frailty on Healthcare Outcomes after Cardioembolic Ischaemic Stroke Due to Atrial Fibrillation.

Stroke due to atrial fibrillation (AF) is more common in older adults. Frailty is associated with AF. As little is known about the impact of frailty on cardioembolic stroke, we examined its association with important healthcare outcomes including mortality and functional outcome in stroke with AF. Data were collected from patients presenting consecutively to a regional university hospital to assess pre-admission frailty using the Clinical Frailty Scale (CFS) and function with the Modified Rankin Scale (mRS). Stroke severity was assessed on the National Institute of Health Stroke Scale (NIHSS). In total, 113 patients presenting between August 2014 and July 2016 were identified with cardioembolic stroke, median age 80 years; 60% were male. Their median NIHSS score was 6. The median pre-admission CFS score was 3; 26.5% scored ≥5/9, indicating frailty. The median pre-admission mRS scores increased significantly from 1 to 3 at discharge (p < 0.001). Frailty was associated with worse mRS scores at discharge, odds ratio 1.5, (p = 0.03). While no patients with frailty were suitable to avail of early supported discharge, 10% of those without frailty were (p = 0.02). There was no significant difference in 30-day mortality. Frailty is prevalent among patients with cardioembolic stroke due to AF and was associated with poorer functional outcomes. Although the numbers were small, these data suggest that brief frailty assessments are useful to risk-stratify patients with acute cardioembolic stroke. Frailty status on admission with stroke due to AF can help identify those more likely to have poorer outcomes, to benefit from intervention, to require prolonged rehabilitation, and to avail of ESD.

Acute stress symptoms 1-2 weeks after stroke predict the subsequent development of post-traumatic stress symptoms: A prospective cohort study.

OBJECTIVE: To date no research has examined the potential influence of acute stress symptoms (ASD) on subsequent development of post-traumatic stress disorder (PTSD) symptoms in stroke survivors. Our objective was to examine whether acute stress symptoms measured 1-2 weeks post-stroke predicted the presence of post-traumatic stress symptoms measured 6-12 weeks later. DESIGN: Prospective within-groups study. METHODS: Fifty four participants who completed a measure of acute stress disorder at 1-2 weeks following stroke (time 1) and 31 of these participants completed a measure of posttraumatic stress disorder 6-12 weeks later (time 2). Participants also completed measures of stroke severity, functional impairment, cognitive impairment, depression, anxiety, pre-morbid intelligence and pain across both time points. RESULTS: Some 22% met the criteria for ASD at baseline and of those, 62.5% went on to meet the criteria for PTSD at follow-up. Meanwhile two of the seven participants (28.6%) who met the criteria for PTSD at Time 2, did not meet the ASD criteria at Time 1 (so that PTSD developed subsequently). A hierarchical multiple regression analysis indicated that the presence of acute stress symptoms at baseline was predictive of post-traumatic stress symptoms at follow-up (R2 = .26, p < .01). Less severe stroke was correlated with higher levels of post-traumatic stress symptoms at Time 2 (rho = .42, p < .01). CONCLUSIONS: The results highlight the importance of early assessment and identification of acute stress symptoms in stroke survivors as a risk factor for subsequent PTSD. Both ASD and PTSD were prevalent and the presence of both disorders should be assessed.

Demography and space-use of Eastern Red-backed Salamanders (Plethodon cinereus) between mature and successional forests.

Space-use and demographic processes are critical to the persistence of populations across space and time. Despite their importance, estimates of these processes are often derived from a limited number of populations spanning broad habitat or environmental gradients. With increasing appreciation of the role fine-scale environmental variation in microgeographic adaptation, there is a need and value to assessing within-site variation in space-use and demographic patterns. In this study, we analyze 3 years of spatial capture-recapture data on the Eastern Red-backed Salamander collected from a mixed-use deciduous forest site in central Ohio, USA. Study plots were situated in both a mature forest stand and successional forest stand separated by <100-m distance. Our results showed that salamander density was reduced on successional plots, which corresponded with greater distance between nearest neighbors, less overlap in core use areas, greater space-use, and greater shifts in activity centers when compared to salamanders occupying the mature habitat. By contrast, individual growth rates of salamanders occupying the successional forest were significantly greater than salamanders in the mature forest. These estimates result in successional plot salamanders reaching maturity more than 1 year earlier than salamanders on the mature forest plots and increasing their estimated lifetime fecundity by as much as 43%. The patterns we observed in space-use and individual growth are likely the result of density-dependent processes, potentially reflecting differences in resource availability or quality. Our study highlights how fine-scale, within-site variation can shape population demographics. As research into the demographic and population consequences of climate change and habitat loss and alteration continue, future research should take care to acknowledge the role that fine-scale variation may play, especially for abiotically sensitive organisms with limited vagility.