Background and Purpose-Patients with suspected stroke first assessed by ambulance paramedics require early recognition to facilitate appropriate triage and early treatment. We determined paramedic's accuracy in detecting acute stroke signs by comparing agreement between neurological signs recorded in the Face Arm Speech Test (FAST), a stroke recognition instrument, by paramedics on the scene and by stroke physicians after admission. Methods-Suspected stroke patients admitted by ambulance paramedics directly to an acute stroke unit through a rapid ambulance protocol were examined by a trainee stroke neurologist or admitting stroke physician over a 1-year period. Recorded neurological signs (facial weakness, arm weakness, speech disturbance) in confirmed acute stroke/transient ischemic attack (TIA) cases were compared between paramedics and the stroke neurologist/physician. Results-Ambulance crews referred 278 suspected stroke patients of whom 217 (78%) had confirmed stroke (nϭ189) or TIA (nϭ28); 95% were examined by the stroke neurologist (median 18 hours after paramedic assessment). Recorded signs and agreement between paramedics and stroke physicians in confirmed stroke group were: facial weakness, 68% versus 70% (ϭ0.49; 95% CI: 0.36 to 0.62); arm weakness, 96% versus 95% (ϭ0.77; 95% CI: 0.55 to 0.99); and speech disturbance, 79% versus 77% (ϭ0.69; 95% CI: 0.56 to 0.82). Interrater agreement was complete for arm weakness in 98% cases. Conclusions-Recognition of neurological deficits by ambulance paramedics using FAST shows good agreement with physician assessment, even allowing for temporal evolution of deficits. The high prevalence and good agreement for arm weakness suggest that this sign may have the greatest usefulness for prehospital ambulance triage and paramedic-based neuroprotective trials.
SUMMARYPercent germination and length of hyphae of germinated Glomus mosseae spores, cultivated on water agar, decreased significantly in the presence of Aspergillus niger; this decrease was independent of any change in pH of the medium. Soluble and volatile compounds produced by A. niger significantly decreased percentage spore germination and the hyphal length of G. mosseae on water agar. The decrease caused by volatile compounds was significantly greater when A. niger was grown on malt extract agar. Shoot dry weights of maize and lettuce plants cultivated in soil in pots, and percentage arbuscular mycorrhizal (AM) root colonization of plants grown either in sand: vermiculite tubes inoculated with G. mosseae spores or in soil in pots with soil inoculum, were unaffected by A. niger when this saprobe was inoculated 2 wk after G. mosseae. Shoot dry weights and percentage AM colonization of plants decreased when the saprobic fungus was inoculated at the same time or 2 wk before G. mosseae. However, the metabolic activity resulting from AM colonization, measured as the percentage of mycelium showing succinate dehydrogenase activity, decreased in all treatments. The population of A. niger decreased when inoculated to the rhizosphere of plants at the same time as, or 2 wk after, G. mosseae, but not when it was inoculated 2 wk before G. mosseae. Our results show that G. mosseae decreases the saprobic fungal population through its effect on the plant, whereas A. niger, by the production of soluble or volatile substances, inhibits G. inosseae'in its extramatrical stage.
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