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Cover -- Half-title -- Series-title -- Title -- Copyright -- Dedication -- Contents -- Acknowledgements -- Editor's introduction -- Note on texts and translations -- Bibliographical note -- Principal events in the life of Marsiglio of Padua -- Defensor minor -- De translatione Imperii -- Table of biblical citations -- Index of proper names -- Index of subjects -- Cambridge Texts in the History of Political Thought.

The costs for stroke management and reduced health related quality of life (QoL) can extend throughout life as mental and physical disabilities are common. The aim of this thesis was to quantify this stroke-related burden with data from Riks-Stroke (RS), the Swedish stroke register. Costs for hospital and primary care, secondary drug prevention, home and residential care services, and production losses were estimated for first-ever stroke patients registered in the RS. The present value lifetime costs were estimated from the expected survival and discounted by 3%. Quality of life was estimated with the EQ-5D instrument on a subset of patients at 3 months after the index event and mapped to patient-reported outcome measures in the RS. Standard descriptive and analytic (multivariate regressions) statistical methods were used. The life-time societal present value cost per patient in 2009 was approximately €69,000 whereof home and residential care due to stroke was 59% and indirect costs for productivity losses accounted for 21% (year 2009 prices). Women had higher costs than men in all age groups. Treatment at stroke units had a low incremental cost per life-year gained compared to patients who were not treated at such facilities. The estimated disutility from stroke was greatest for women and the oldest, and compared to 1997 the cost per patient increased after a revised assumption. Hospitalisation costs were stable while long-term costs for ADL support increased in part due to a changed age structure. Patients with atrial fibrillation (AF; 24%) had €367 higher inpatient costs compared to non-AF stroke patients €8,914 (P<0.01; year 2001 prices). As the index case fatality was higher among AF patients, the cost difference was higher for patients surviving the first 28 days. A multivariate regression showed that AF, diabetes, stroke severity, and death during the 3-year follow-up period were independent cost drivers. Three regression techniques (OLS, Tobit, CLAD) were chosen for mapping EQ-5D utilities to patient-reported outcome measures in the RS. The mean utility was overestimated with all models and had lower variance than the original data. In conclusion, total societal lifetime cost for 22,000 first-ever stroke patients in 2009 amounted to €1.5 billion (whereof production losses were €314 million). About 56,600 QALYs were lost due to premature death and disability. Including a preference-based QoL instrument in the RS would allow cost-utility analyses, but it is important to control for confounders in comparator arms to avoid bias.

Post-stroke fatigue (PSF) could have a negative impact on the rehabilitation potential, quality of life, and work capacity of younger ischemic stroke patients. The available quantitative and qualitative research on the prevalence, predictors, and interventions associated with PSF have not explicitly focused on young adults. This scoping review aimed to summarise the available evidence on PSF in young adults after ischemic stroke (prevalence, predictors, and consequences, assessment tools, as well as interventions to reduce fatigue in young stroke survivors). The following methodological procedures were used for this scoping review: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Joanna Briggs Institute updated methodological guidance. A total of 3483 studies were identified through a bibliographic search in the Ovid MEDLINE, PubMed, Scopus, ProQuest Central, APA PsycINFO, SocINDEX, and CINAHL Plus databases. Ten studies that met the inclusion criteria were included in the scoping review. Only four studies explicitly addressed PSF in young adults after ischemic stroke. The prevalence of fatigue among young adults who had suffered an ischemic stroke ranged from 41.0% to 57.8%. Seven studies found a significant association between PSF, depression, and anxiety. Fatigue in young stroke survivors significantly affects their return to work and it is an independent predictor of poor quality of life. The number of research studies on fatigue in young adults after ischemic stroke is small and they mainly focus on fatigue as a predictor of quality of life after stroke. There is a need for further studies that address the phenomenon of fatigue after ischemic stroke and validate the effectiveness of interventions to reduce fatigue in young stroke survivors.

Purpose: To analyse structural and non-structural modifications of acute stroke care pathways undertaken at healthcare institutions across the regions of Italy due to the coronavirus disease 2019 (COVID-19) pandemic. Methods: Research on National decrees specific for the pandemic was carried out. The stroke pathways of four Italian regions from North to South, such as Lombardy, Veneto, Lazio and Campania, were analysed before and after the pandemic outbreak. Findings: On 29 February 2020, the Italian Minister of Health issued national guidelines on how to address the COVID-19 emergency. Stroke management was affected and required changes, basically resulting in the need to prioritise the ongoing COVID-19 emergency. In the most affected regions, the closure of departments and hospitals led to a complete reorganisation of previously functioning stroke networks. With the closure of several Stroke Units and Stroke Centres, the transportation time to hospital lengthened significantly, especially for the outlying populations. Discussion: The COVID-19 pandemic outbreak has been spreading rapidly in Italy and placing an overwhelming burden on healthcare systems. In response to this, political and healthcare decision-makers worked together to develop and implement efforts to sustain the national healthcare system while fighting the pandemic. Stroke care pathways changed during the pandemic and different organisational models were applied in the most affected regions. Conclusions: Stroke treatment pathways will need to be redesigned so to guarantee that severe and acute disease patients do not lose their rights to the access and delivery of care during the COVID-19 pandemics.

Home is as old as one's skin but as elusive as an object seen through the wrong end of a telescope. It is this sense of a view, skewed, intangible, which echoes throughout Karen Lazar's Hemispheres. Waking in hospital after a post-operative stroke, she finds one side of her body paralysed and her world knocked out of kilter. Spatial, perceptual and subjective changes force her to view her new life in facets. The fragmented view is made apparent by means of a triptych of clusters which charts Karen's experience from Metamorphosis, through Rehabilitation and Adaptation. Quietly reflective, deepl

•The delay on search for emergency services is related directly to a worse outcome.•It is a priority for patients to know the warning signs of stroke.•A survey was conducted to identify stroke knowledge in lay Brazilian population.•The analyzed population has a low level of knowledge about stroke.•Improve the stroke management and contributing to public health politics.