Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Showing posts with label RFP. Show all posts
Showing posts with label RFP. Show all posts

Tuesday, January 29, 2019

Long-Term Survival and Function After Stroke - Sweden

Wouldn't you think that the stroke associations for each country would have this specific information? Then they could use the causes of death and disability as starting points for RFPs to researchers to solve and prevent those problems. This is blindingly simple to understand and implement. But will never occur since two functioning neurons don't exist in our stroke associations. 

Long-Term Survival and Function After Stroke - Sweden

A Longitudinal Observational Study From the Swedish Stroke Register
Originally publishedhttps://doi.org/10.1161/STROKEAHA.118.022913Stroke. 2018;50:53–61

Background and Purpose—

Longitudinal long-term prognostic data after stroke based on large cohorts are sparse. We report recent survival and functional outcome data on ischemic stroke (IS) and intracerebral hemorrhage (ICH) for up to 5 years poststroke from the Swedish Stroke Register (Riksstroke).

Methods—

Beyond Riksstroke’s regular follow-up surveys at 3 and 12 months, additional surveys were conducted in 2016 on 2 one-year cohorts with stroke 3 and 5 years earlier. Functional dependency was defined as modified Rankin Scale ≥3. Mortality data of the original cohorts were obtained from the Swedish Causes of Death Register. Multiple imputation was used to estimate functional status in nonresponders.

Results—

The study included 22 929 patients, 87.5% with IS and 12.5% with ICH. Loss to follow-up in the 4 surveys was 12.8% to 21.2%. Thirty-day mortality was higher for ICH than for IS (30.7% versus 11.1%; P<0.01), whereas for 30-day survivors, 5-year mortality did not differ significantly (P=0.858). Functional outcome was less favorable for ICH at all follow-up points. At 5 years, poor outcome (death or dependency) was 79% in ICH and 70.6% in IS (including imputed data; P<0.01). Favorable outcome was less common with increasing age and in patients with prestroke functional dependency.

Conclusions—

Despite advances in stroke care, long-term prognosis remains a cause for concern. At 5 years after stroke over 2 in 3 patients with IS, and over 3 in 4 patients with ICH, were dead or dependent. We present robust long-term prognostic data to serve as a reference for further development of healthcare and research in stroke.

Footnotes

Presented in part at the European Stroke Organisation Conference, Gothenburg, Sweden, May 16–18, 2018.
The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.118.022913.
Correspondence to Stefan Sennfält, MD, Neurologimottagningen, Skånes universitetssjukhus, Region Skåne, Getingevägen 4, 222 41 Lund. Email


Friday, January 11, 2019

Determinants of Case Fatality After Hospitalization for Stroke in France 2010 to 2015

My god, this is so simple. Your stroke leaders just have to write up exactly the cause of these deaths, write RFPs to researchers to solve them, write protocols based on the research, distribute those protocols to all stroke hospitals, likely get the Nobel prize in medicine.  If your stroke leaders can't see and implement these steps, replace them with stroke survivors. And look, an email address for your leaders to communicate to.

Determinants of Case Fatality After Hospitalization for Stroke in France 2010 to 2015


Originally publishedhttps://doi.org/10.1161/STROKEAHA.118.023495Stroke. 2019;0:STROKEAHA.118.023495

Background and Purpose—

The aims of this study were to (1) describe early and late case fatality rates after stroke in France, (2) evaluate whether their determinants differed, and (3) analyze time trends between 2010 and 2015.

Methods—

Data were extracted from the Système National des données de santé database. Patients hospitalized for stroke each year from 2010 to 2015, aged ≥18 years, and affiliated to the general insurance scheme were selected. Cox regressions were used to separately analyze determinants of 30-day and 31- to 365-day case fatality rates for each stroke type (ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage).

Results—

In 2015, of the 73 124 persons hospitalized for stroke, 26.8% died in the following year, with the majority of deaths occurring within the first 30 days (56.9%). Nonadmission to a stroke unit, older age, and having comorbidities were all associated with a poorer 30-day and 31- to 365-day prognosis. Female sex was associated with a lower 31- to 365-day case fatality rate for all patients with stroke. Living in an area with a high deprivation index was associated with both higher 30-day and 31- to 365-day case fatality rates for all stroke types. Between 2010 and 2015, significant decreases in both 30-day and 31- to 365-day case fatality rates for ischemic patients were observed.

Conclusions—

Case fatality rates after stroke remained high in 2015 in France, despite major improvements in stroke care and organization. Improvement in stroke awareness and preparedness, particularly in the most deprived areas, together with better follow-up after the acute phase are urgently needed.(Fuck no, you don't need awareness, you need to address and solve why your 30 day deaths remain high.)

Footnotes

The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.118.023495.
Correspondence to Amélie Gabet, MS, 14 rue du Val d’Osne, 94410 St Maurice, France. Email:

Monday, August 6, 2018

These tiny, ultra-low power chips are helping scientists to understand your mind

Now all we need is for our stroke medical leadership to do the following:
1.  Describe the problem exactly How and why does a neuron drop its' current task and take up a neighbors? Neuroplasticity in action?
2.  Write an RFP to researchers to solve that problem.
3.  Fund them with foundation grants.
4.  Write stroke rehab protocols based on the research.
5.  Get the Nobel prize in medicine  

These tiny, ultra-low power chips are helping scientists to understand your mind


Researchers at Purdue University are developing chips that could help scientists understand nerve conditions, and potentially help lay the foundations for neuroprosthetics.


The Google subsidiary has struck a series of deals with organisations in the UK health service -- so what's really happening?
You don't need to be a research scientist to know that the human brain is a sensitive organ: each square millimetre of the brain contains tens of thousands of neurons -- the electrical wiring that communicates messages around the brain.
While measuring the electrical activity of those neurones with external probes or implants can give researchers and medical professionals an insight into the brain's functioning, introducing external hardware to the brain is not without risk.
Brain implants need to be as small as possible to reduce the chance that they could disrupt the brain's functioning. But, thanks to the density of those tightly packed neurons, any chip used to monitor a human brain must be capable of obtaining and processing huge amounts of information.
Tiny, low-power, high-throughput chips that can sit comfortably on the human brain: not exactly the easiest hardware to build, but chips that can do all these things is vital to further research into brain and central nervous system disorders.
By making a chip that can gather information about the workings of the brain, without disturbing or harming the sensitive structures within, researchers at Purdue University, in Indiana are hoping to create a tool that can provide better support to people with neurological disorders.

The researchers have created a tiny chip that picks up signals from the brain or the nervous system, and sends them wirelessly outside the body for analysis, without the need for a battery, according to the university.

Creating the chip was the work of three years, Saeed Mohammadi, an associate professor in Purdue's School of Electrical and Computer Engineering department, told ZDNet.
"The idea was 'can we make this as small as possible?' So we looked at what are the possible ways to make the system small -- it shouldn't have a battery, it shouldn't have any external components, it should just be a small chip, and everything should be on a small chip. So, we worked hard to integrate the antenna on it, we worked hard to replace the battery with wireless power," he said.
In order to keep the chip as small as possible (it's now in the region of 1mm by 0.5mm), the researchers took to redesigning its antenna in a spiral pattern -- a decision that allowed them to keep the antenna as long as possible while still shrinking the volume of space needed to contain it.
"Usually antennas are large, especially as this is a low-frequency [one] at 1Ghz, and when you calculate the size of the antenna, it should be several centimetres... Part of it we spiralled around itself to make it small, while the main part, which is responsible for detecting the majority of the signal, is straight. By doing this trick, we were able to make the antenna small and still very efficient," Mohammadi said.
Currently, Purdue's prototype chip has four channels -- a small fraction of what would be needed for a commercial neural probe, but enough to prove the system could be used.
"We have to add a lot more neural sites to be able to take out many, many more neural signals. Right now, the chip only has four or them, but we need a lot more -- people use probes that have 64 or 128 channels to look at different sites. We're working on expanding the numbers, so we're hoping to be able to add more of these neural sites, and that makes the device a little bit larger," Mohammadi said. Expanding the chip to 64 channels should take another year, he added.
The researchers will also be working on other improvements, such as boosting the speed of the interface circuit that digitises the signal from the neural site without significantly increasing the chip's overall power requirement at the same time. Similarly, as the number of neural sites the chip can read grows, the Purdue researchers are planning to increase the speed of wireless communication between the chip and the external computer that receives the data.

Those aren't the only balancing acts the team will need to pull off before their brain-reading implants can be used on humans. One of the difficulties of making electronics that can interface with brains is accommodating the movement of the organ. Like most non-bony structures in the body, the brain isn't static: it pulsates, so any electronics that touch must have a degree of flexibility to move alongside.
"If this doesn't move with the brain's movement, it could injure the neurons. Over time, people who have used these probes have noticed the signal is lost... if your electrode is flexible and can move with the brain tissue, you'll have less injury and a better chance of getting a signal over a long time," Mohammedi said.
While the Purdue researchers have typically used their chip for only minutes at a time, they've designed it to be flexible enough, and low powered enough, that it could potentially stay in the body for a longer period, and ultimately see later generations of the chip used in the long-term monitoring of brain health.
The dinky chip has its origins in hardware intended to monitor soil conditions, such as temperature and humidity, according to Mohammedi. "The idea was to have a piece of dust that could, if you put it inside the soil, detect the nitrate or nitrite level, or the nutrition of the soil, and monitor the growth condition of the plant. This would be useful for agriculture. We had some work in that area, and it was not too hard to attach the neural sensor to this device to do essentially the same thing."
In the shorter term, the chip is likely to be used in monitoring neurodegenerative diseases such as Parkinson's or ALS in animal models to help better understand and research the conditions.
In the more distant future, however, the chip could help repair nerve injuries by acting as a bridge between two parts of a nerve that have become severed. "If someone has a nerve injury you could put two of these devices on each and reconnect them with wireless communication," Mohammadi said. It could also be used to connect the brain and other parts of the nervous system, underpinning neuroprosthetics. "That would be 20 years down the road, there's a long way to go."

Tuesday, June 12, 2018

Study: 2.6% of pediatric patients hospitalized for stroke die in the hospital

So figure out the EXACT reason for the death and get researchers to solve for that problem. Stroke is not the reason for the death, EXACTLY which brain cells died causing the sequelae to end in death? Since we have NO stroke leaders, everyone in stroke will just throw up their hands and say, 'Oh my, something needs to be done'. Leaders solve problems, they don't 

RUN AWAY!

and ignore them. Is anyone in your hospital a leader? Or are they all CHICKENSHITS?
Oops, I'm not playing by the polite rules of Dale Carnegie, 'How to Win Friends and Influence People'. 
Politeness will never solve anything in stroke.
Study: 2.6% of pediatric patients hospitalized for stroke die in the hospital

A major international study has found that 2.6 percent of infants and children hospitalized for stroke die in the hospital.

Loyola Medicine neurologist José Biller, MD, a nationally known expert on strokes in children, is among the co-authors of the study, published in the journal Pediatrics. First author is Lauren A. Beslow, MD, of the Children's Hospital of Philadelphia.

The retrospective study included 915 infants younger than one month and 2,273 children aged one month to 18 years who were stroke patients at 87 hospitals in 24 countries. The type of stroke examined in the study, called ischemic, is caused by blood clots and is the most common type.

The study found that during their hospitalizations for ischemic stroke, 1.5 percent of the infants and 3.1 percent of the children died, with an overall mortality rate of 2.6 percent.

Researchers classified the causes of death as stroke alone, a combination of an underlying disease and stroke or simply an underlying disease. Nearly two-thirds (65 percent) of hospital deaths with a known cause were related to the stroke and/or subsequent deficits.

Risk factors for dying in the hospital included congenital heart disease and having a severe type of ischemic stroke known as "posterior plus anterior circulation."

Hispanic ethnicity also was associated with higher mortality, but black infants and children were not at higher risk of dying. The reason for the higher Hispanic mortality rate is not known. Future studies "should explore whether ethnic differences in mortality rates are related to disparities in care," researchers wrote.

Also at higher risk of dying were infants and children who did not have seizures. The reason may be that infants who present with seizures might be diagnosed and treated more quickly for their strokes, researchers wrote.

Childhood ischemic strokes affect 1.2 to 2.4 per 100,000 children per year in developed countries. Although deaths from ischemic and other types of stroke appear to have declined, stroke remains among the top 10 causes of death among children in the United States.

Researchers wrote that improved stroke recognition, earlier supportive care, more rapid intervention and neuroprotective treatments "are critical for decreasing mortality after stroke in the pediatric population."

Wednesday, June 6, 2018

Reperfusion Injury after ischemic Stroke Study (RISKS): single-centre (Florence, Italy), prospective observational protocol study

If we don't yet know about the specifics of the reperfusion injury how the hell can we ever solve the problem?
1.  Describe the problems exactly.
2.  Write thousands of RFPs to researchers to solve those problems.
3.  Fund them with foundation grants.
4.  Write stroke rehab protocols based on the research.
5.  Get the Nobel prize in medicine
http://bmjopen.bmj.com/content/8/5/e021183.long
  1. Benedetta Piccardi1,2,
  2. Francesco Arba
1,
  • Mascia Nesi
  • 1,
  • Vanessa Palumbo
  • 1,
  • Patrizia Nencini
  • 1,
  • Betti Giusti
  • 3,
  • Alice Sereni
  • 3,
  • Davide Gadda4,
  • Marco Moretti
  • 4,
  • Enrico Fainardi4,
  • Salvatore Mangiafico5,
  • Giovanni Pracucci
  • 6,
  • Stefania Nannoni6,
  • Francesco Galmozzi
  • 6,
  • Alessandra Fanelli
  • 7,
  • Paola Pezzati7,
  • Simone Vanni8,
  • Stefano Grifoni8,
  • Cristina Sarti6,
  • Maria Lamassa1,
  • Anna Poggesi6,
  • Francesca Pescini1,
  • Leonardo Pantoni9,
  • Anna Maria Gori3,
  • Domenico Inzitari,
  • 6

    Author affiliations

    Abstract

    Introduction Treatments aiming at reperfusion of the acutely ischaemic brain tissue may result futile or even detrimental because of the so-called reperfusion injury. The processes contributing to reperfusion injury involve a number of factors, ranging from blood–brain barrier (BBB) disruption to circulating biomarkers. Our aim is to evaluate the relative effect of imaging and circulating biomarkers in relation to reperfusion injury.
    Methods and analysis Observational hospital-based study that will include 140 patients who had ischaemic stroke, treated with systemic thrombolysis, endovascular treatment or both. BBB disruption will be assessed with CT perfusion (CTP) before treatment, and levels of a large panel of biomarkers will be measured before intervention and after 24 hours. Relevant outcomes will include: (1) reperfusion injury, defined as radiologically relevant haemorrhagic transformation at 24 hours and (2) clinical status 3 months after the index stroke. We will investigate the separate and combined effect of pretreatment BBB disruption and circulating biomarkers on reperfusion injury and clinical status at 3 months. Study protocol is registered at http://www.clinicaltrials.gov (ClinicalTrials.gov ID: NCT03041753).
    Ethics and dissemination The study protocol has been approved by ethics committee of the Azienda Ospedaliero Universitaria Careggi (Università degli Studi di Firenze). Informed consent is obtained by each patient at time of enrolment or deferred when the participant lacks the capacity to provide consent during the acute phase. Researchers interested in testing hypotheses with the data are encouraged to contact the corresponding author. Results from the study will be disseminated at national and international conferences and in medical thesis.
    Trial registration number NCT03041753.
    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

    Monday, May 28, 2018

    Tracking Neuronal Connectivity from Electric Brain Signals to Predict Performance

    With any functioning neurons at all in the stroke medical world this would be looked at as a godsend to monitor in real time the problems in stroke brains. From that we could describe the problem and request researchers to solve it.  This is so fucking easy; Only 5 steps.
    1.  Describe the problem exactly.
    2.  Write an RFP to researchers to solve that problem.
    3.  Fund it with foundation grants.
    4.  Write stroke rehab protocols based on the research.
    5.  Get the Nobel prize in medicine
    http://journals.sagepub.com/doi/abs/10.1177/1073858418776891





    The human brain is a complex container of interconnected networks. Network neuroscience is a recent venture aiming to explore the connection matrix built from the human brain or human “Connectome.” Network-based algorithms provide parameters that define global organization of the brain; when they are applied to electroencephalographic (EEG) signals network, configuration and excitability can be monitored in millisecond time frames, providing remarkable information on their instantaneous efficacy also for a given task’s performance via online evaluation of the underlying instantaneous networks before, during, and after the task. Here we provide an updated summary on the connectome analysis for the prediction of performance via the study of task-related dynamics of brain network organization from EEG signals.

    Tuesday, January 30, 2018

    Pfizer confirms neuro cuts as it swings the ax on a host of other early projects

    We can't expect any private firm to solve stroke, it is way to difficult and costly for them, but stroke survivors can solve this. For stroke this is so simple, that great stroke association writes RFPs to researchers based upon the stroke strategy they are following. Grants from foundations can be used to pay for the research.
    https://www.fiercebiotech.com/biotech/pfizer-confirms-neuro-cuts-as-it-swings-ax-a-host-other-early-projects?

    Monday, January 8, 2018

    Pfizer ends research for new Alzheimer's, Parkinson's drugs

    You as a stroke survivor will likely need these. So start saving your pennies to fund your own researchers or create that great stroke association that will simply write RFPs to researchers to solve this and get foundation grants to pay for it. We stroke survivors are completely on our own to fix stroke. Our doctors aren't doing it, our stroke hospitals aren't doing it, our fucking failures of stroke associations certainly aren't doing it. The solutions are out there, we just need researchers to put them into translational interventions. Everyone so far is not a leader, I expect leaders to try for 100% recovery for all.

    Your chances of getting Parkinsons.

    Parkinson’s Disease May Have Link to Stroke March 2017

    Your chances of getting dementia.

    1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.
    2. Then this study came out and seems to have a range from 17-66%. December 2013.
    3. A 20% chance in this research.   July 2013.

    Pfizer ends research for new Alzheimer's, Parkinson's drugs

    NEW YORK (Reuters) - Pfizer Inc (PFE.N) is abandoning research to find new drugs aimed at treating Alzheimer’s and Parkinson’s disease, the U.S. pharmaceutical company announced on Saturday.



    FILE PHOTO: The Pfizer logo is seen at their world headquarters in New York April 28, 2014. REUTERS/Andrew Kelly/File Photo
    The company said it expects to eliminate 300 positions from the neuroscience discovery and early development programs in Andover and Cambridge, Massachusetts, and Groton, Connecticut, as it redistributes the money spent on research, according to the emailed statement.
    Pfizer is not making any changes to research and development funding for tanezumab, which is marketed as a treatment for joint pain from osteoarthritis, fibromyalgia treatment Lyrica, or its rare disease program.
    “This was an exercise to re-allocate spend across our portfolio, to focus on those areas where our pipeline, and our scientific expertise, is strongest,” the company said.

    PFE.NNew York Stock Exchange
    -0.32(-0.87%)

    PFE.N
    • PFE.N
    • GSK.L
    • LLY.N
    • JNJ.N
    Pfizer has invested heavily in research for Parkinson’s and Alzheimer‘s, and is one of several drugmakers, along with GlaxoSmithKline (GSK.L) and Eli Lilly (LLY.N), that is part of the Dementia Discovery Fund, a venture capital fund launched in 2015 by industry and government groups that seeks to develop treatments for Alzheimer‘s.
    However, some of Pfizer’s investments have resulted in disappointment. In 2012, Pfizer and partner Johnson & Johnson (JNJ.N) called off additional work on the drug bapineuzumab after it failed to help patients with mild to moderate Alzheimer’s in its second round of clinical trials.
    The company said on Saturday that it will launch a new venture fund to invest in neuroscience research projects.
    Pfizer is expected to make a presentation on Monday at the JP Morgan healthcare conference in San Francisco, a key annual event for healthcare investors.
    Reporting By Elizabeth Dilts, Editing by Rosalba O'Brien

    Thursday, December 7, 2017

    Can Industry-Funded Research Be Trusted?

    For stroke this is so simple, that great stroke association writes RFPs to researchers based upon the stroke strategy they are following. Grants from foundations can be used to pay for the research.
    https://www.medpagetoday.com/blogs/revolutionandrevelation/69692
    • by

    In 2001, I led a large clinical trial that showed that carvedilol reduced the risk of death in patients with heart failure.
    The news was carried live on major TV networks. During an interview, I was asked: "This trial was funded by a pharmaceutical company. Right?" I said yes.


    The reporter continued: "Doesn't that make the data suspect?"
    I was stunned by the question. For the record, the FDA audited the trial, verified its findings and expanded the indications for the drug. The trial's database is fully open to academic inquiry. The drug is used by millions of people.
    Most people do not understand the drug development process. Many routinely ask whether industry-sponsored trials can be trusted.
    Some believe: if industry has paid for a trial, it must be biased. Industry must have manipulated the data so the trial would come out with a positive result.
    My reply: "If industry could do that, then why do most clinical trials show that the new drug doesn't work? Does that happen because companies are too incompetent to make the results come out the way they wanted?"

    I have led about 20 major clinical trials. In the vast majority of the trials, the results were a major disappointment for the sponsor.
    Some people love conspiracies. Sometimes they are right. Years ago, I believed the sponsor had manipulated the results of a trial. For the record, I was not involved in the trial, and I reported my concerns to the FDA.
    The FDA had different concerns about the drug and asked for a second trial, which failed to demonstrate a benefit. The FDA never approved the drug.
    But if you think that every industry-sponsored trial is suspect, then you live in a strange world. And a very dark one.
    Some complain that companies design trials that are biased or unnecessary. Sometimes they do. I can think of many post-approval trials that are just silly.

    But the major trials for drug approval are all vetted by the FDA before the trial starts. When the trial is completed, the database is sent to the FDA, and the FDA carries out its audits and does its own analyses. Its analyses may differ from the ones that are published in a peer-review manuscript. Discoveries of discrepancies are all in the public domain.
    Some think that companies aren't asking the questions that really matter.
    I agree.
    Companies conduct trials that serve their interests. Many cardiovascular trials can cost over a quarter of a billion dollars. When you spend that kind of money, your goal is to find out if a drug or device works. Your goal is not to answer big questions in public health.
    Yet, I still hear people say that industry can't be trusted doing trials on their own drugs. They need an independent organization to do them -- like the NIH.

    Such a response makes me smile: "Really?"
    "Do you want the NIH to spend millions of dollars of taxpayers' money to test a drug so that a private company will benefit from the profits?"
    And I remind them. In recent years, the NIH carried out two very large trials in cardiology. One was called TOPCAT in patients with heart failure; the other was called SPRINT in patients with hypertension. Both trials were plagued with major operational problems, which limited the interpretability and usefulness of the trials. The NIH doesn't have the resources to carry out a trial with the monitoring that is needed to ensure integrity.
    So I ask professional cynics: Which organization would you trust to give a reliable result?
    Cynics might say that they wouldn't trust either organization. They will tell you that they only trust other cynics. And of course, cynics want you to trust them.

    That is really scary. Our society is consumed by a crisis of trust. It is destroying our humanity and our potential.
    So if you are reading my blog because you are looking for a professional cynic, I am really going to disappoint you.
    But I can certainly give you a referral.