Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

If someone has done this for stroke it is impossible to tell because our fucking failures of stroke associations have not created a database of all stroke related research.
http://journals.lww.com/jtrauma/Abstract/publishahead/Volumetric_analysis_of_day_of_injury_computed.99321.aspx

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Journal of Trauma and Acute Care Surgery:

Post Acceptance: October 31, 2016

doi: 10.1097/TA.0000000000001263

Original Article: PDF Only

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury.

Majercik, Sarah MD, MBA; Bledsoe, Joseph MD; Ryser, David MD; Hopkins, Ramona O. PhD; Fair, Joseph E. M.S.; Frost, R. Brock PhD; MacDonald, Joel MD; Barrett, Ryan MS; Horn, Susan PhD; Pisani, David MD; Bigler, Erin D. PhD; Gardner, Scott PA-C; Stevens, Mark MD; Larson, Michael J. PhD

Published Ahead-of-Print

Abstract

Introduction: Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a Level One Trauma Center.

Methods: Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor FIM scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. DOI quantitative injury lesion volumes and degree of midline shift were obtained from day-of-injury (DOI) brain computed tomography (CT) scans. A multiple step-wise regression model including 13 independent variables was created. This model was used to predict post-rehabilitation outcomes, including FIM scores and ability to return to home. P<0 .05="" considered="" p="" significant.="" was="">

Results: 96 patients were enrolled in the study. Mean age was 43+/-21 years, admission Glasgow Coma Score 8.4+/-4.8, Injury Severity Score 24.7+/-9.9, and head Abbreviated Injury Scale score 3.73+/-0.97. Acute hospital length of stay (LOS) was 12.3+/-8.9 days and rehabilitation LOS was 15.9+/-9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p=0.004) and discharge (p=0.004) and inversely associated with ability to be discharged to home after rehabilitation (p=0.006).

Conclusion: In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may improve surgeons' ultimate outcome predictions in TBI patients.

Level of Evidence/Study Type

Level V, case series, Prognostic/Epidemiological

(C) 2016 Lippincott Williams & Wilkins, Inc.

Low Serum Levels of Brain-Derived Neurotrophic Factor Were Associated with Poor Short-Term Functional Outcome and Mortality in Acute Ischemic Stroke

What is your doctor doing to make sure your BDNF levels are not low? I've only written 97 posts on this.   Followup research is needed for time periods after 3 months, which will never occur.
http://link.springer.com/article/10.1007/s12035-016-0236-1

• Jing Wang
• Li Gao
• Yan-Long Yang
• Yu-Qian Li
• Tao Chang
• Ming-Hao Man
• Xing-Ye Zhang
• Shao-Chun Guo
• Li-Hong LiEmail author

• Jing Wang
  • 1
• Li Gao
  • 1
• Yan-Long Yang
  • 1
• Yu-Qian Li
  • 1
• Tao Chang
  • 1
• Ming-Hao Man
  • 1
• Xing-Ye Zhang
  • 1
• Shao-Chun Guo
  • 1
• Li-Hong Li
  • 1
  Email author

1. 1.Department of NeurosurgeryTangdu Hospital of Fourth Military Medical UniversityXi’anPeople’s Republic of China

Article

First Online:

04 November 2016

DOI: 10.1007/s12035-016-0236-1

Cite this article as:

Wang, J., Gao, L., Yang, YL. et al. Mol Neurobiol (2016). doi:10.1007/s12035-016-0236-1

• 2 Downloads

Abstract

Circulating brain-derived neurotrophic factor (BDNF) has been highlighted as being a key regulator of rehabilitation-induced recovery after stroke. The aim of this study was to evaluate the association between serum levels of BDNF and functional outcome and mortality events in a 3-month follow-up study in a cohort of patients with an acute ischemic stroke (AIS). From January 2015 to December 2015, consecutive first-ever AIS patients admitted to the Department of Emergency of our hospital were identified. Serum BDNF levels were measured at admission. Functional outcome was evaluated at 3 months using the modified Rankin scale (m-Rankin). We used logistic regression models to assess the relationship between BDNF levels and functional outcome or mortality. In this study, 204 patients were included. Patients with poor outcomes and non-survivors had significantly lower BDNF levels on admission (P < 0.0001 all). Multivariate logistic regression analysis adjusted for common risk factors showed that BDNF levels in the lowest interquartile (≤1st 9.2 ng/ml) was an independent predictor of functional outcome (odds ratios [OR] = 3.75; 95 % confidence interval [CI], 2.43–8.12) and mortality (OR = 4.04; 95 % CI, 2.07–9.14). The area under the receiver operating characteristic curve of BDNF was 0.77 (95 % CI, 0.70–0.84) for functional outcome and 0.79 (95 % CI, 0.71–0.86) for mortality. The findings indicated that low serum levels of BDNF at admission were significantly associated with poor short-term functional outcome and mortality, suggesting that BDNF may serve as a biomarker of poor function outcome after stroke.

The effect of growth hormone replacement in patients with hypopituitarism on pituitary tumor recurrence, secondary cancer, and stroke

Question for your doctor.
http://link.springer.com/article/10.1007/s12020-016-1156-6

• Sina Jasim
• Fares Alahdab
• Ahmed T. Ahmed
• Shrikant U. Tamhane
• Anu Sharma
• Diane Donegan
• Todd B. Nippoldt
• M. Hassan MuradEmail author

• Sina Jasim
  • 1
• Fares Alahdab
  • 2
• Ahmed T. Ahmed
  • 2
• Shrikant U. Tamhane
  • 1
• Anu Sharma
  • 1
• Diane Donegan
  • 1
• Todd B. Nippoldt
  • 1
• M. Hassan Murad
  • 2
  Email author

1. 1.Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo ClinicRochesterUSA
2. 2.Mayo Clinic Evidence-Based Practice CenterRochesterUSA

Meta-Analysis

First Online:

04 November 2016

DOI: 10.1007/s12020-016-1156-6

Cite this article as:

Jasim, S., Alahdab, F., Ahmed, A.T. et al. Endocrine (2016). doi:10.1007/s12020-016-1156-6

• 1 Downloads

Abstract

Growth hormone replacement therapy has benefits for patients with hypopituitarism. The safety profile in regard to tumor recurrence or progression, development of secondary malignancies, or cerebrovascular stroke is still an area of debate. A comprehensive search of multiple databases—MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was conducted through August 2015. Eligible studies that evaluated long-term adverse events in adult patients with hypopituitarism treated with growth hormone replacement therapy and reported development of pituitary tumor recurrence or progression, secondary malignancies, or cerebrovascular stroke were selected following a predefined protocol. Reviewers, independently and in duplicate, extracted data and assessed the risk of bias. Random-effects meta-analysis was used to pool relative risks and 95 % confidence intervals. We included 15 studies (published 1995–2015) that reported on 46,148 patients. Compared to non-replacement, growth hormone replacement therapy in adults with hypopituitarism was not associated with statistically significant change in pituitary tumor progression or recurrence (relative risk, 0.77; 95 % confidence interval, 0.53–1.13) or development of secondary malignancy (relative risk, 0.99; 95 % confidence interval, 0.70–1.39). In two retrospective studies, there was higher risk of stroke in patients who did not receive replacement (relative risk, 2.07; 95 % confidence interval, 1.51–2.83). The quality of evidence is low due to study limitations and imprecision. This systematic review and meta-analysis supports the overall safety of growth hormone therapeutic use in adults with hypopituitarism with no clear evidence of increased risk of pituitary tumor recurrence, malignancy, or stroke.

Active video game technologies for balance rehabilitation after stroke

So can these video games be programmed to disrupt your balance so you have to figure out how to recover? That would make you learn how to balance much faster than doing it perfectly every time.
https://minerva-access.unimelb.edu.au/handle/11343/118577

Bower, Kelly Jean

Affiliation: Physiotherapy
Melbourne School of Health Sciences Collected Works

Date: 2016

Document Type: PhD thesis

Keywords: physiotherapy; stroke; balance; assessment; intervention; video games; wii

Access Status: Only available to University of Melbourne staff and students, login required

URI: http://hdl.handle.net/11343/118577

Description:

© 2016 Dr. Kelly Jean Bower

Abstract:

Standing balance deficits are frequent and disabling following stroke; however, optimal assessment and treatment for balance problems remains unclear. The past decade has seen the increasing emergence and clinical uptake of active video game technologies. The purpose of this thesis was to investigate the utility of active video games, in particular the Nintendo Wii, for balance rehabilitation following stroke.
A comprehensive, narrative literature review of balance assessment and treatment following stroke was completed. Force platform technologies were found to provide a higher level of objective information on balance performance than clinical tests, but were inaccessible for most clinical settings. The Wii Balance Board (WBB) presented a valid and potentially feasible alternative; however, its clinimetric properties had not been investigated in a post-stroke sample. Active video games, such as the Wii Fit, demonstrated equivalence or superiority in efficacy to more traditional balance training approaches in emerging recent studies, but trials were generally small. Importantly, they provided little insights into feasibility, nor guidance in clinical implementation.
A cross-sectional study was conducted to investigate the reliability, validity and feasibility of WBB-based tests of balance in an outpatient stroke setting. Thirty participants were tested on two occasions, one week apart. Five WBB-based standing balance tests demonstrated excellent test-retest reliability (ICC2,k = 0.82 to 0.98) and were poorly to moderately associated (r = 0.04 to 0.61) with performance in four clinical tests of balance and mobility. Minimal detectable change scores, floor and ceiling effects were investigated, to further inform the utility of the WBB variables. These tests were deemed feasible in terms of the time to complete and ease of use.
A pilot randomised controlled trial was undertaken to investigate the feasibility and preliminary efficacy of a Wii Fit balance training program in an inpatient setting. Thirty participants (time since stroke, mean (SD) = 25 (18) days), randomised to Wii Fit balance or Wii Sports upper limb training, completed three Wii-based sessions per week over two or four weeks in addition to standard therapy. Feasibility of the Wii training was considered satisfactory based on adherence, acceptability and safety. Greater improvements in balance (i.e., the Step Test and WBB variables) were demonstrated by the Wii Fit balance group.
Finally, a comprehensive, theory-based decision-making framework was developed for implementing active video game game-based balance training following stroke. It provides a resource to guide training decisions considering different aspects of the individual, task and environment, underpinned by motor learning theory. This framework may support future clinical and research applications of these technologies.
This thesis found the WBB to be a reliable and potentially feasible force platform alternative for low-cost research and clinical use. Wii Fit training was found to be acceptable and safe in an inpatient stroke rehabilitation setting, and the efficacy results can inform the design of future trials. A decision-making framework for active video game implementation is proposed as a potentially valuable clinical resource to guide practice and future research. This thesis provides a substantial contribution to the knowledge in this field and may contribute to improved quality of stroke care in the future.

Researchers may have found how high-protein diets cause weight loss

Interesting, although when I recently went to a Brazilian steakhouse I couldn't eat that much meat.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=169704&CultureCode=en
A common end-product of digested protein – phenylalanine – triggers hormones that make rodents feel less hungry and leads to weight loss, according to a new study presented today at the Society for Endocrinology annual conference in Brighton. A better understanding of the mechanism by which protein diets cause weight loss could lead to the development of drugs and diets that tackle the growing obesity epidemic.
Hormones drive our appetite by telling us when we are hungry, and when we are full. Ghrelin is a hormone that tells us when we are hungry. In contrast, high levels of the hormone GLP-1 tell us when we have had enough food and tell our bodies to stop eating. Understanding the mechanisms by which hormones affect our feeding patterns may help identify new ways of treating or preventing obesity. Previous studies have shown that protein-rich diets encourage weight loss by making people feel fuller, though these diets are difficult to adhere to and the mechanisms by which this happens is unknown.
In this study, researchers Mariana Norton and Amin Alamshah from Imperial College London ran a number of experiments on both mice and rats. In the first experiment, they gave 10 rats and mice a single dose of phenylalanine, a chemical produced in the gut when our body breaks down protein-rich foods, such as beef, fish, milk and eggs. In the second experiment, diet-induced obese mice, which are typically used as a model of human obesity, were given phenylalanine repeatedly over seven days. Both experiments compared their results to the same number of rodents that were not given phenylalanine.
The researchers found that the single-dose of phenylalanine reduced food intake, increased levels of GLP-1 and decreased levels of ghrelin. Repeated administration also caused weight loss in the obese mice. The researchers also observed that the rats were moving around more, which might encourage them to lose weight.
To understand the mechanisms by which phenylalanine might be stimulating these hormones, the researchers carried out a final experiment by studying gut cells in a petri dish. They found that phenylalanine interacted with a receptor called the calcium sensing receptor (CaSR), and that it was CaSR in turn causing levels of GLP-1 to increase and appetite to decrease.
“Our work is the first to demonstrate that activating CaSR can suppress appetite,” said lead author of the study Mariana Norton. “It highlights the potential use of phenylalanine or other molecules which stimulate CaSR – like drugs or food components – to prevent or treat obesity.”
According to Miss Norton, the precise mechanisms by which phenylalanine suppresses appetite and body weight still need to be determined, and there are likely to be additional mechanisms which are also involved in the beneficial effects of a high protein diet.
The researcher’s next steps will be to establish whether phenylalanine can produce the same effects in humans as in mice, and to further confirm the importance of CaSR in our response to protein-rich foods.

• Full bibliographic informationThe study L- Phenylalanine modulates gut hormone release, and suppresses food intake in rodents via the Calcium Sensing Receptor will be presented by Miss Mariana Norton at the Society for Endocrinology BES 2016 Conference in Brighton.

The Cancer Moonshot: It’s Time to Engage Patients on Innovation

If we had anything other than fucking failures of stroke associations survivors would be intimately involved in what stroke problem should be attacked next. Researchers really should have no say.  But we have no moonshot or ANY strategy in stroke. Survivors will be screwed for another 50 years with the current stroke lack of leadership.
https://morningconsult.com/opinions/cancer-moonshot-time-engage-patients-innovation/

Last week, the Cancer Moonshot Inter-Agency Task Force released its 2016 report aimed at making a decade’s worth of progress against cancer in the next five years. This report, following the Blue Ribbon Panel’s research-focused recommendations released last month, provides a policy roadmap aimed at catalyzing a “coordinated effort” to “dramatically accelerate the pace of progress in the fight against cancer.”
The Task Force report reminds us that innovation cannot survive if it does not ultimately advance the practice of medicine, and vice versa. While the report emphasizes the need to realign federally-funded research incentives, enhance prevention and screening, and share data, we need to go farther to enact policy that bridges the full spectrum of cancer research and care delivery.
Our organizations have engaged the cancer community over the past five years to explore policy solutions that support high-quality, patient-centered care, specifically in bringing new therapies to patients and improving patient access and care. What we have consistently discovered is that any effort to pursue progress against cancer on behalf of patients must take into consideration the preferences, priorities, and needs of one group — patients. Below are several suggestions for policymakers to consider as we all seek to fuel progress against cancers.
Accelerating Bringing New Therapies to Patients
Patients are the key beneficiaries of cancer innovation. Unfortunately, less than 5 percent of patients with cancer participate in clinical trials; progress against cancers is impossible without their involvement. The success of the Moonshot is incumbent upon meaningful inclusion of patients, early and often, to provide input on the clinical research process. Policymakers should support programs to elicit and include feedback from patients and patient advocates in trial design, so we have trials that not only align with the evolving science of oncology, but also reflect the needs, priorities and outcomes that matter to patients. Additionally, as we work to increase awareness of and enrollment in cancer clinical trials, policies should make patient participation in these trials easier and more affordable — clinical trial participation must be covered by value-based reimbursement models. Coverage could encourage patient participation in trials and enable meaningful generation of evidence.
Making our clinical trials process more efficient is another way to get innovation to patients more quickly. The report recognizes that trials geared toward increasing our understanding of the molecular drivers around various forms of cancer accelerate getting personalized treatments to patients. To foster this kind of innovation, however, we need policies that reduce the uncertainty around both the use and regulatory acceptance of novel clinical trial designs and outcomes measures (i.e., biomarkers and patient-reported outcomes) in the drug development and approval process. Therefore, we applaud the U.S. Food and Drug Administration’s engagement of the cancer community to create a more effective, efficient, and forward-thinking regulatory process that fully supports personalized medicine in oncology.
Improve Patient Access and Care
We need policymakers to provide guidance on coverage and reimbursement for the innovative medicines the Moonshot will undoubtedly generate, particularly as patients continue to face increasing costs for oncology care and medicines. As we move into an era defined by personalized therapy, coverage and reimbursement policies must reflect the heterogeneity of “cancer,” a term that now encompasses more than 200 unique diseases. We need policies that support patient-centered care, reimburse for evidence-based molecular diagnostics, sustain the development and utilization of personalized medicines, support informed patient decision-making and align with value-driven healthcare. Clinically significant enhancements of survival and quality of life are essential for value-based reimbursement to occur. Efforts that impose one-size-fits-all coverage standards or make blunt payment cuts to achieve cost containment will ultimately conflict with personalized medicine innovations and the goals of the Moonshot initiative.
A new era of molecular and genetic testing enables increasingly personalized decisions, which means physicians and patients must be equipped with tools to make informed decisions about treatments, based on evolving clinical evidence and patient differences. We encourage policymakers to engage and listen to all stakeholders in the oncology community, particularly patients, to support the development of these tools, sharing of real world data, and implementation of policies that support patient access to personalized therapies.
Vice President Biden has suggested that the “science is ready” in oncology; we agree. But to move the science from the bench to the bedside, we need policies that reflect not just the basic research challenges, but also the full continuum of cancer research and care delivery. The vice president has worked closely with the scientific research community in the early stages of this initiative. There is an equally passionate and dedicated community focused on translating research discoveries into innovation in practice. As we move into the next phase of the Moonshot, we encourage policymakers to leverage these voices to keep patients at the center of our efforts and make sure that they benefit from scientific innovation.

Edward Abrahams is the president of the Personalized Medicine Coalition; Gilbert S. Omenn is chair of the Health Policy Committee of the American Association for Cancer Research and director of the Center for Computational Medicine and Bioinformatics at the University of Michigan; and Marcia A. Kean is chairman of strategic initiatives for Feinstein Kean Healthcare. They are the co-conveners of the Turning the Tide Against Cancer initiative, which works with members of the cancer community to identify policies that sustain medical innovation while addressing the issue of rising health care costs.
Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Submission guidelines can be found here.

Heath and care services under review in Devon is announced

You have to change the focus of these reviews to how fucking bad stroke rehab is. Bring up all these points And don't let them off the hook for their incompetence.
Doctors are failing stroke patients for these reasons:
1. 12% full tPA efficacy is a failure.
2.  10% full recovery is a failure.
3. No publicly available stroke protocols with efficacy is a failure.
4. Nothing to cure spasticity is a failure.
5. Nothing to cure fatigue is a failure.
6. Nothing to stop the neuronal cascade of death in the first week is a failure.
7. Not able to objectively and accurately identify stroke in the ER is a failure.
8. Nothing to prevent dementia is a failure. 
This focuses on costs, have them focus on results.
http://www.exeterexpressandecho.co.uk/heath-and-care-services-under-review-in-devon-is-announced/story-29873991-detail/story.html

Today marks the first in a series of public meetings being held to discuss which 72 community hospital beds will close across sites in Exeter and East Devon - and more changes are on the way.
A new document has just been released giving greater detail of further draft plans to reshape health and care services across Devon.
The latest submission, as part of the Wider Devon Sustainability and Transformation Plan (STP), has prioritised the following services for review following concerns, including over quality and sustainability ...

Stroke services (including hyper-acute and stroke rehabilitation).

Maternity (including consultant-led and midwife-led care)

Paediatrics and neonatology, (to be reviewed together given their inter-dependency)

Urgent and emergency services (focusing particularly on the acute hospital provision of accident and emergency and co-dependent services)

The first phase of the clinical reviews, beginning with stroke services, will start in mid-November and conclude in mid-January. Two further reviews on maternity, paediatrics & neonatology, and urgent and emergency services, will start in December and conclude in March.

Dates and venues of public meetings to discuss community hospital bed closures...f-

image: http://www.exeterexpressandecho.co.uk/images/localworld/ugc-images/276269/binaries/ccgconsultweb1a.GIF
As well as these large scale reviews, a number of smaller services will be reviewed because they are currently facing particular difficulties in remaining sustainable and safe due to workforce and other challenges.
The most urgent of these 'vulnerable' services to be reviewed are breast services, ear, nose and throat (ENT), interventional radiology, histopathology, neurology, interventional cardiology and vascular surgery.
Due to necessity, early work has started on neurology, vascular and ENT which needs to be extended to be Devon wide.
Any proposed changes will be subject to debate and challenge by the public, service users, local communities and their elected representatives, health and care staff and their trade unions.

Read more at http://www.exeterexpressandecho.co.uk/heath-and-care-services-under-review-in-devon-is-announced/story-29873991-detail/story.html#CfYZmZsM8uektMJi.99

Hospitals fail stroke survivors: report - Australia

Of course they do. And you even got the failure points wrong. Doctors are failing stroke patients for these reasons:
1. 12% full tPA efficacy is a failure.
2.  10% full recovery is a failure.
3. No publicly available stroke protocols with efficacy is a failure.
4. Nothing to cure spasticity is a failure.
5. Nothing to cure fatigue is a failure.
6. Nothing to stop the neuronal cascade of death in the first week is a failure.
7. Not able to objectively and accurately identify stroke in the ER is a failure.
8. Nothing to prevent dementia is a failure.

Hospitals fail stroke survivors: report - Australia

Australian hospitals are failing stroke survivors with poor rehabilitation services, a new report says.

The Stroke Foundation has released the 2016 Rehabilitation Services Report, which says stroke patients in Australia are being denied the best care.(There is no best care, you don't have ANY stroke protocols)
Key findings include that half of stroke patients are discharged from hospital without information about the cause of their stroke, only half are assessed for mental wellbeing and one in five are discharged without getting medication essential to preventing further strokes.
"We know what good care looks like but sadly too few patients are experiencing it," Stroke Foundation chief executive Sharon McGowan said.
The foundation is calling on federal and state governments to invest in quality stroke rehabilitation services across Australia. That would first of all mean firing every stroke doctor and stroke hospital staff for incompetence.

New risk assessment tool may better predict dynamic risk of heart disease

Better than all these other risk calculators? 13 stroke risk calculators.
I couldn't find the tool so you'll have to depend on your doctor for it. 

New risk assessment tool may better predict dynamic risk of heart disease

A new assessment tool—the Million Hearts Model Longitudinal ASCVD Risk Assessment tool—funded by the Centers for Medicare & Medicaid Services (CMS) in partnership with the American College of Cardiology and the American Heart Association— is designed to help predict the 10-year risk of developing atherosclerotic cardiovascular disease (ASVCD) and how that risk may change over time as preventive treatments are initiated. The tool is an extension of the ASCVD Pooled Cohort Equation first published in the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk.

ASCVD is a group of conditions caused by atherosclerosis—a build-up of plaque that can harden and narrow the arteries and lead to heart attack, stroke or death. It is the leading cause of death, a major cause of disability, and a major source of healthcare costs. ASCVD is largely preventable through lifestyle changes and effective therapies.
The Million Hearts Initiative, developed by the United States Department of Health and Human Services (HHS) and supported by the ACC and AHA, aims to prevent 1 million heart attacks and strokes by 2017 through the management of the "ABCS"—aspirin therapy, blood pressure control, cholesterol management and smoking cessation. In support of the Million Hearts Initiative, the Center for Medicare and Medicaid Innovation (Innovation Center), a part of CMS, is testing a large-cluster randomized payment model test of value-based payment—the Million Hearts Cardiovascular Disease (CVD) Risk Reduction Model—to determine whether financially rewarding clinicians for reducing 10-year predicted risk for ASCVD across their patient population is an effective way to reduce first-time heart attacks and strokes. Over 500 applicant organizations were selected to participate in the Million Hearts Model. In order to help test this Model, CMS funded the development of the Million Hearts Longitudinal ASCVD Risk Assessment tool, in partnership with the ACC and AHA, to improve on the ACC/AHA Pooled Cohort Equations risk estimator, currently used by the practices participating in the Model. In the study, the tool aims to provide a framework for delivering appropriate risk-reducing strategies to Medicare patients with a 10-year ASCVD risk >30 percent.
To create the new tool, the Innovation Center's Million Hearts CVD Risk Reduction Model partnered with the chairs of the writing committee for the 2013 guideline, David C. Goff, Jr. MD, PhD, FAHA and Donald M. Lloyd-Jones, MD, ScM, FACC, FAHA. The tool is not a replacement for the ACC/AHA Pooled Cohort Equations risk estimator. Rather, the risk estimator is incorporated into the initial risk assessments of patients in the Model. The committee added existing evidence to extend the risk equation.
"The new tool is based upon a formal systematic review of the evidence of ABCS therapies to define what the expected risk reduction would be from each one, used alone or in combination," said Lloyd-Jones, who is the chair of the writing committee that describes the new tool. "At an initial visit, clinicians can use the tool to project the expected updated risk if one or more of the ABCS interventions were initiated, then it can be used at a subsequent follow-up visit to estimate what is the actual achieved updated risk based on the patient's individual response to those therapies and any lifestyle changes they may have made as well."
This approach to personalized estimation of benefits from risk-reducing therapies may represent the next wave in clinical practice to help target therapies to those in whom they will provide the greatest benefit.
The goal of the tool is to assist not only clinicians, but also patients, in understanding risk, monitoring risk over time, and quantifying potential benefits of preventive therapies.
"This tool will help clinicians and patients with shared-decision making and will aid in the understanding of how the ABCS may help to reduce risk," said Lloyd-Jones.

Explore further: Heart disease, stroke risk estimator app now available for health care professionals

More information: Donald M. Lloyd-Jones et al. Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool, Circulation (2016). DOI: 10.1161/CIR.0000000000000467
David C. Goff et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk, Circulation (2014). DOI: 10.1161/01.cir.0000437741.48606.98

Journal reference: Circulation
Provided by: American Heart Association

One Egg a Day Keeps Stroke Risk at Bay, Study Suggests

I can see no mechanism of action for this conclusion.
http://www.biosciencetechnology.com/news/2016/11/one-egg-day-keeps-stroke-risk-bay-study-suggests?

A systematic review and meta-analysis of studies going back more than three decades linked eating eggs with a 12 percent decrease in the risk of stroke.
The findings were published in the Journal of the American College of Nutrition.
For the study researchers, led by Dr. Dominik Alexander of the EpidStat Institute analyzed the link between eating eggs and stroke in 308,000 people, as well as coronary heart disease in 276,000 people.
They found a daily intake of eggs had no link to coronary heart disease and had benefits related to risk of stroke.
More research is needed to understand the mechanism at work behind the consumption of eggs and reduced risk of stroke, but Alexander proposed a possible theory.
“Eggs do have many positive nutritional attributes, including antioxidants, which have been shown to reduce oxidative stress and inflammation,” Alexander said in a prepared statement. “They are also an excellent source of protein which has been related to lower blood pressure.”
In addition to antioxidants, one egg contains 6 grams of good protein, along with vitamins A, D, and E.
The U.S. Department of Health and Human Services and the U.S. Department of Agriculture’s 2015 Dietary Guidelines for Americans recently added eggs to its recommended sources of protein and also removed dietary cholesterol limits.

stretching out left arm in bed

Tried for the third time last night. It means laying on my left side with my left arm straight out to my side. Putting all the pillows but one on the arm to hold it down, usually 4-5. Then roll onto my back and hope like hell the arm stays flat on the bed.  The first two times I tried this the forearm immediately went perpendicular to the bed, throwing off the pillows.
Last night I did it slower and the arm stayed on the bed. Some muscles were screaming in agony. Only lasted 20 minutes, not enough time to relax anything or fall asleep. I would expect any therapist in the world to have a solution to that problem. It has been known for decades, but our stroke medical professionals are

WAITING ONCE AGAIN FOR SOMEONE ELSE TO SOLVE THE PROBLEM.

Wearable Robotic Limb Helps Patients With Gait Rehab

But is this any better that these 80 posts on exoskeletons? Bet your doctor doesn't know about more than one and your hospital has none in their therapy department.
http://www.asianscientist.com/2016/11/tech/wearable-robot-exoskeleton-rehab/

A prototype of the lower-limb exoskeleton being developed

at Beihang University in Beijing, China. Credit: Beihang University Read more from Asian Scientist Magazine at: http://www.asianscientist.com/2016/11/tech/wearable-robot-exoskeleton-rehab/

AsianScientist (Nov. 7, 2016) - Researchers in China and Denmark have designed a lower-limb wearable robot exoskeleton that features natural knee movement, greatly improving patient comfort and their willingness to wear it for gait rehab. Their design was published in Review of Scientific Instruments. Stroke and spinal cord injury patients often require gait rehabilitation to regain the ability to walk or to help strengthen their muscles. Wearable robot-assisted training is quickly emerging as a method that helps improve this rehab process, but exoskeleton robots aren’t new—they’ve been studied extensively and many designs have focused on lower limbs. Here, researchers from Beihang University and Aalborg University have developed a robotic exoskeleton that is intended to help stroke patients strengthen their physical fitness, aid the rehabilitation training of paralyzed patients, or to assist those who need help performing daily activities. The knee joint’s motion is actuated by several skeletal muscles along its articular surfaces, and its center of rotation moves. It is the first known use of a parallel mechanism at the knee joint to imitate skeletal muscles. A prototype of the lower-limb exoskeleton being developed at Beihang University in Beijing, China. Credit: Beihang University A prototype of the lower-limb exoskeleton being developed at Beihang University in Beijing, China. Credit: Beihang University “Our new design features a parallel knee joint to improve the bio-imitability and adaptability of the exoskeleton,” explained Dr. Chen Weihai, a professor at Beihang University’s School of Automation Science and Electrical Engineering. The article can be found at: Lyu et al. (2016) Design of a Biologically Inspired Lower Limb Exoskeleton for Human Gait Rehabilitation. Read more from Asian Scientist Magazine at: http://www.asianscientist.com/2016/11/tech/wearable-robot-exoskeleton-rehab/

AsianScientist (Nov. 7, 2016) - Researchers in China and Denmark have designed a lower-limb wearable robot exoskeleton that features natural knee movement, greatly improving patient comfort and their willingness to wear it for gait rehab. Their design was published in Review of Scientific Instruments. Stroke and spinal cord injury patients often require gait rehabilitation to regain the ability to walk or to help strengthen their muscles. Wearable robot-assisted training is quickly emerging as a method that helps improve this rehab process, but exoskeleton robots aren’t new—they’ve been studied extensively and many designs have focused on lower limbs. Here, researchers from Beihang University and Aalborg University have developed a robotic exoskeleton that is intended to help stroke patients strengthen their physical fitness, aid the rehabilitation training of paralyzed patients, or to assist those who need help performing daily activities. The knee joint’s motion is actuated by several skeletal muscles along its articular surfaces, and its center of rotation moves. It is the first known use of a parallel mechanism at the knee joint to imitate skeletal muscles. A prototype of the lower-limb exoskeleton being developed at Beihang University in Beijing, China. Credit: Beihang University A prototype of the lower-limb exoskeleton being developed at Beihang University in Beijing, China. Credit: Beihang University “Our new design features a parallel knee joint to improve the bio-imitability and adaptability of the exoskeleton,” explained Dr. Chen Weihai, a professor at Beihang University’s School of Automation Science and Electrical Engineering. The article can be found at: Lyu et al. (2016) Design of a Biologically Inspired Lower Limb Exoskeleton for Human Gait Rehabilitation. Read more from Asian Scientist Magazine at: http://www.asianscientist.com/2016/11/tech/wearable-robot-exoskeleton-rehab/

‘Cafeteria Diet’ one of the prominent reason behind stroke in India: Dr Jeyaraj Durai Pandian

Another goddamned bastard. Blame the victim rather that acknowledging that YOU are not doing one damn thing to stop the neuronal cascade of death by these 5 causes in the first week. 

‘Cafeteria Diet’ one of the prominent reason behind stroke in India: Dr Jeyaraj Durai Pandian

The rising incidence of stroke in India indicates the inadequate levels of awareness and education about the disease.(Wrong, it indicates that you as doctors are giving up on doing your job, solving stroke problems)

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In the recently concluded 10th World Stroke Congress 2016 at Hyderabad, jointly organised by World Stroke Organisation (WSO) and Indian Stroke Association & Medtronic Inc., medical practitioners announced the launch of Stroke Roadmap in India. Currently, stroke incidence in India is much higher than western industrialised countries. With a population of 1.2 billion today and growing, India finds itself staring at a stroke epidemic.
The officials claim that the newly designed roadmap is intended to guide local healthcare officials and stroke care clinical groups in establishing stroke systems of care and will provide the framework for the implementation, monitoring and evaluation of stroke services nationally. In an exclusive interaction with BioSpectrum, Dr Jeyaraj Durai Pandian, Head of Neurology, Christian Medical College & Hospital, Ludhiana elaborates on the subject and how the Stroke Roadmap might prove a perfect shield to doge off the disease.
Q1. Why stroke rate is getting higher in India, specifically among the young generations?
1.8 million Indians out of a population of 1.2 billion suffer from stroke every year. Common risk factors such as hypertension, diabetes, smoking, and dyslipidaemia are prevalent and insufficiently controlled due to low awareness levels of the disease. One of the primary factors of early stroke is the so-called 'cafeteria diet' which is rich in high-calorie, high-sugar and high-salt foods. Smoking and uncontrolled alcohol consumption also serve to exacerbate the situation.
The rising incidence of stroke in India indicates the inadequate levels of awareness and education about the disease. A stroke can strike anyone, at any time. Stroke rates among young and middle-aged people nationwide are increasing, almost 15 to 20 per cent of strokes occur in people in their 30s and 40s.
Q2. What is the general perception of the denizens of the country regarding stroke?
Surveys conducted over the last ten years reveal that about one-fourth of urban and one-third of rural respondents had no knowledge of any warning symptoms of stroke. Only 55 per cent of the urban population were aware of one warning symptom of stroke; 16.2 per cent were aware of two symptoms; and, only 6.2 per cent could identify three symptoms.
Many people affected by stroke are unable to access treatment and rehabilitation due to lack of awareness. People generally tend to ignore the symptoms of stroke. That's why the awareness campaigns undertaken by the World Stroke Organization and Medtronic are so important.

WAITING ONCE AGAIN FOR SOMEONE ELSE TO SOLVE THE PROBLEM. Awareness  campaigns are pure laziness.

Inappropriate nutrients intake is associated with lower functional status and inferior quality of life in older adults with depression

Well fuck, then write up a diet protocol. Don't just write that there is a problem. DO something about it. Get the fuck off your ass and solve the problem. 

Inappropriate nutrients intake is associated with lower functional status and inferior quality of life in older adults with depression

Clinical Interventions in Aging, 11/07/2016 Guligowska A, et al.

For this study, researchers conducted a case–control investigation of whether depression impairs physical and cognitive functioning and quality of life, and whether there is a connection between nutrient deficiencies and these adverse changes. The incidence of falls and poor quality of life might be partially connected with the presence of depression. The improper consumption of chose nutrients may impair the functioning and quality of life of older adults with depression, for example, the excess intake of sucrose and insufficient intake of protein, fiber, eicosapentaenoic acid, niacin and vitamin B6. Particular nutrients ought to be translated into dietary patterns which permit the individual patient to address these nutrient deficiencies.

Methods

• A sum of 130 older subjects were enrolled in this study.
• Half of them (65) diagnosed with depression (16 men and 49 women) and 65 age– and sex–matched controls without depression.
• In this study all patients underwent comprehensive geriatric assessment.
• Nutritional state was examined with the Mini Nutritional Assessment, cognitive performance was assessed by the Mini–Mental State Examination and physical functioning by the Timed “Up & Go” test and handgrip strength.
• The pattern of intake of different nutrients was examined in detail.

Results

• The distinctions in cognitive functioning seen between the gatherings were identified with specific nutrient consumption, as was handgrip strength to some extent.
• The differences in nutritional status, several functional tests and muscle strength were identified with both the presence of depression and inappropriate intake of certain nutrients.

Go to Abstract Print Article Summary Cat 2 CME Report

Stroke survivors want better rehab - Ireland

You are focusing on the wrong failure point. You have your doctors stop the neuronal cascade of death by these 5 causes in the first week, leading to much less death and disability.  If you want to complain about rehab services, complain about the correct thing. Rehab fails to get to almost full recovery a full 90% of the time.
http://www.eveningecho.ie/cork-news/stroke-survivors-want-better-rehab/2562339/
STROKE survivors, including from Cork, have attended an Oireachtas briefing in Leinster House to talk about the lack of rehabilitation services.

Stroke campaigners and survivors, Noel McLoughlin (Tallaght), Brendan Kelly (Clare) and Michael Smithers (Cork) pictured at last week’s Oireachtas briefing in Leinster House ahead of World Stroke Day.

On behalf of 50,000 stroke survivors in Ireland, Cork’s Michael Smithers, from Ballinlough, joined with others from around the country to meet their local TDs and highlight the need for better rehabilitation services.
The information session was organised by the Irish Heart Foundation, with the support of Medtronic, one of the world’s largest medical technology companies, ahead of World Stroke Day.
A study launched on the day, conducted by the Irish Heart Foundation and the HSE’s National Stroke Programme, showed large gaps in vital recovery services for stroke patients around the country, with just one in four rehabilitation hospitals having a dedicated stroke unit; with 60% lacking a stroke specialist to oversee rehabilitation; and with less than one in three having any access to psychological services.
The audit also showed major organisational deficits across the rehabilitation hospital network.
For example, half of the hospitals couldn’t provide accurate information on the numbers of stroke patients they had admitted or discharged in the previous year, whilst bed access was restricted, based on age, in 12 of the 26 hospitals audited.

Combined rehabilitation with scalp cluster acupuncture and constraint-induced movement therapy significantly improved functional recovery in patients with acute ischemic stroke

How the hell can scalp acupuncture have any mechanism of action? Bad research design, you never have two variables. Three in this case; spontaneous recovery, acupuncture, CIMT. The head researcher is incompetent and should never be allowed near research again.
http://www.ijcem.com/files/ijcem0029366.pdf

Yancheng Song, Liqing Kang, Honghuan Dong, Yong Chen

Cangzhou Central Hospital, 16 West Xinhua Road, Yunhe District, Cangzhou 061001, Hebei, China

Received March 29, 2016; Accepted August 19, 2016; Epub October 15, 2016; Published October 30, 2016

Abstract:

Background and purpose: Scalp cluster acupuncture and constraint-induced movement therapy (CIMT)

have been shown to improve functional recovery in patients with acute stroke. However, stroke rehabilitation usually requires a multidisciplinary care which combing different therapeutic approaches. The combined effects of scalp cluster acupuncture and CIMT were unknown. Methods: A prospective randomized clinical trial was performed to compare the functional recovery in acute ischemic stroke patients received either combined therapy of scalp cluster acupuncture and CIMT (experimental group) or body acupuncture and traditional rehabilitation therapy (control group). Patients with first time unilateral cerebral infarction in internal carotid artery system, onset within 3 days, and muscle strength of the affected upper limb less than grade III without obvious sensory disturbance and speech disorder were enrolled. Patients’ functional recovery, as evaluated by Fugl-Meyer assessment (FMA) scale and blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI), was recorded and compared

after two weeks’ interventions. Results: FMA scale and BOLD-fMRI showed statistically significant improvements after intervention rehabilitations in both groups. This improvement was more prominent in the experimental group. Conclusions: A novel therapy which combined scalp cluster acupuncture and CIMT could significantly improve functional recovery in patients with acute ischemic stroke.

Propofol inhibits neurogenesis of rat neural stem cells by upregulating microRNA-141-3p

So don't get this drug that killed Michael Jackson. 

Propofol inhibits neurogenesis of rat neural stem cells by upregulating microRNA-141-3p 

To cite this article:
Dr. Qiliang Jiang, Yingwei Wang, and Xueyin Shi. Stem Cells and Development. October 2016, ahead of print. doi:10.1089/scd.2016.0257.

Online Ahead of Editing: October 31, 2016

• Full Text PDF (1,191.2 KB)
• Full Text PDF with Links (626.2 KB)

Author information

Dr. Qiliang JiangYingwei WangXueyin Shi

Accepted: 08 23 2016
Received: 08 23 2016

ABSTRACT

Prolonged or high-dose exposure to anaesthetics, such as propofol, can cause brain cell degeneration and subsequent long-term learning or memory deficits, particularly in the developing brain. However, the cellular and molecular mechanisms underlying the deleterious effects of propofol at certain stages of development remain unclear. Here we found that propofol inhibited the proliferation, neuronal differentiation, and migration of NSCs while upregulating miR-141-3p. Silencing of miR-141-3p abrogated the effects of propofol on NSC neurogenesis. Propofol treatment downregulated IGF2BP2, a direct target of miR-141-3p, whereas overexpression of IGF2BP2 attenuated the effects of propofol and miR-141-3p on NSC neurogenesis. In short, propofol inhibits NSC neurogenesis via a mechanism involving the miR-141-3p/IGF2BP2 axis. Our results may provide a potential approach for preventing the neurodegenerative effects of propofol in the developing brain.

A Quasi-Randomized Controlled Trial of Brain-Activating Rehabilitation in an Acute Hospital

Would this Brain-Activating Rehabilitation be helpful for stroke survivors? We'll never know.
http://aja.sagepub.com/content/31/8/612?etoc

1. Kenji Tsuchiya, MHSc1⇑
2. Tomoharu Yamaguchi, PhD2
3. Takaaki Fujita, MOT3
4. Maya Taguchi1
5. Aoi Honda1
6. Yuki Satou1
7. Hiroshi Sekiguchi1
8. Noriko Kimura1
9. Tenshi Osawa, PhD1
10. Masanori Terauchi, PhD1

1. ¹Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, Maebashi, Gunma, Japan
2. ²Department of Rehabilitation, Gunma University of Health and Welfare, Maebashi, Japan
3. ³Department of Rehabilitation, Faculty of Health Sciences, Tohoku Fukushi University, Sendai, Japan

1. Kenji Tsuchiya, MHSc, Department of Rehabilitation, Japan Community Healthcare Organization, Gunma Chuo Hospital, 1-7-13 Kouun-cho, Maebashi, Gunma, 371-0025, Japan. Email: kbkjs933@yahoo.co.jp

Abstract

We aimed to confirm the effectiveness of brain-activating rehabilitation (BAR) performed in the day care setting at an acute hospital. Brain-activating rehabilitation is based on 5 principles: developing a pleasant atmosphere, promoting communication, praising patients, giving patients a social role, and providing supportive care. A total of 48 patients with dementia or cognitive impairment were selected and randomly divided into the intervention and control groups. The BAR-based intervention was conducted for 1 hour, 3 times a week. The patients’ score of the Multidimensional Observation Scale for Elderly Subjects (MOSES) were used as outcome measures. Repeated-measures analysis of covariance detected a significant interaction between the MOSES disorientation (F = 4.437, P = .041) and the withdrawal (F = 5.052, P = .030) subscales. A BAR-based intervention performed at our acute hospital was effective at maintaining and improving the cognitive and psychosocial functioning of patients with dementia or cognitive impairment.

Stroke survivors highlight lack of rehab services - Ireland

You are focusing on the wrong failure point. You have your doctors stop the neuronal cascade of death by these 5 causes in the first week, leading to much less death and disability.  If you want to complain about rehab services, complain about the correct thing. Rehab fails to get to almost full recovery a full 90% of the time.
http://www.leitrimobserver.ie/news/home/222561/stroke-survivors-highlight-lack-of-rehab-services.html
Stroke survivors from around the country recently attended an Oireachtas briefing in Leinster House to share their experiences regarding the lack of available rehabilitation services. The information session was hosted by the Irish Heart Foundation with the support of Medtronic, one of the world’s largest medical technology, services and solutions companies.
On behalf of 50,000 stroke survivors in Ireland, survivors and campaigners joined with others from around the country to meet their local TDs and highlight the need for better rehabilitation services. The day was organised by Irish Heart Foundation with support of Medtronic ahead of World Stroke Day.
A study launched on the day, conducted by the Irish Heart Foundation and the HSE’s National Stroke Programme, showed large gaps in vital recovery services for stroke patients around the country, with just one in four rehabilitation hospitals having a dedicated stroke unit; 60% lacking a stroke specialist to oversee rehabilitation; and less than one in three having any access to psychological services.
The audit also showed major organisational deficits across the rehabilitation hospital network. For example, half of the hospitals couldn’t provide accurate information on the numbers of stroke patients they had admitted or discharged in the previous year, whilst bed access was restricted based on age in 12 of the 26 hospitals audited.
 The rehabilitation hospital audit showed:
73% of hospitals couldn’t provide recommended levels of therapy to patients
77% had no dedicated stroke unit compared to just a quarter in the UK
69% had no access to psychology services with access not available within a working week on any site
81% had no access to an Early Supported Discharge team
61% had no access to a Community Rehabilitation team

Expert decries rising cases of stroke in Nigeria

You godamned bastard. Blame the victim rather that acknowledging that YOU are not doing one damn thing to stop the neuronal cascade of death by these 5 causes in the first week. 

Expert decries rising cases of stroke in Nigeria  

 By Davies Iheamnachor, Amarachi Uzoma & Isioma Ananaba EXPERT in the medical field, Prof. Arthur Onwuchekwa, has expressed worries over rise in the cases of hypertension and stroke in the country. Onwuchekwa, who is a lecturer in the Department of Medicine, FacultyNof Clinical Science in the University of Port Harcourt said that the cause of stroke, which is hypertension is preventable. Onwuchekwa expressed this during the 135th Inaugural Lecture of the institution, tagged: ‘A Preventable Disaster Waiting to Happen.’ The Professor stated that stroke is preventable if the people of the nation would maintain a healthy life style. He mentioned too much salt intake, excessive alcohol and poor exercise habit as risk factors that can lead to stroke. Onwuchekwa said: “The prevalence of stroke is high in Nigeria and no age, race or class is spared. There are medical conditions that can be controlled in order to reduce stroke. Hypertension is the commonest cause of stroke. If we reduce hypertension by 10 percent, the mass effect in reduction of stroke will be heart gladdening. “Some kind of life style like excessive intake of salt and alcohol can cause hypertension. Salt and alcohol damage the blood vessels and cell.”

By Davies Iheamnachor, Amarachi Uzoma & Isioma Ananaba EXPERT in the medical field, Prof. Arthur Onwuchekwa, has expressed worries over rise in the cases of hypertension and stroke in the country. Onwuchekwa, who is a lecturer in the Department of Medicine, FacultyNof Clinical Science in the University of Port Harcourt said that the cause of stroke, which is hypertension is preventable. Onwuchekwa expressed this during the 135th Inaugural Lecture of the institution, tagged: ‘A Preventable Disaster Waiting to Happen.’ The Professor stated that stroke is preventable if the people of the nation would maintain a healthy life style. He mentioned too much salt intake, excessive alcohol and poor exercise habit as risk factors that can lead to stroke. Onwuchekwa said: “The prevalence of stroke is high in Nigeria and no age, race or class is spared. There are medical conditions that can be controlled in order to reduce stroke. Hypertension is the commonest cause of stroke. If we reduce hypertension by 10 percent, the mass effect in reduction of stroke will be heart gladdening. “Some kind of life style like excessive intake of salt and alcohol can cause hypertension. Salt and alcohol damage the blood vessels and cell.”

Read more at: http://www.vanguardngr.com/2016/11/expert-decries-rising-cases-stroke-nigeria/

By Davies Iheamnachor, Amarachi Uzoma & Isioma Ananaba EXPERT in the medical field, Prof. Arthur Onwuchekwa, has expressed worries over rise in the cases of hypertension and stroke in the country. Onwuchekwa, who is a lecturer in the Department of Medicine, FacultyNof Clinical Science in the University of Port Harcourt said that the cause of stroke, which is hypertension is preventable. Onwuchekwa expressed this during the 135th Inaugural Lecture of the institution, tagged: ‘A Preventable Disaster Waiting to Happen.’ The Professor stated that stroke is preventable if the people of the nation would maintain a healthy life style. He mentioned too much salt intake, excessive alcohol and poor exercise habit as risk factors that can lead to stroke. Onwuchekwa said: “The prevalence of stroke is high in Nigeria and no age, race or class is spared. There are medical conditions that can be controlled in order to reduce stroke. Hypertension is the commonest cause of stroke. If we reduce hypertension by 10 percent, the mass effect in reduction of stroke will be heart gladdening. “Some kind of life style like excessive intake of salt and alcohol can cause hypertension. Salt and alcohol damage the blood vessels and cell.”

Read more at: http://www.vanguardngr.com/2016/11/expert-decries-rising-cases-stroke-nigeria/

Scientists Hook Up Brain to Tablet—Paralyzed Woman Googles With Ease

Two years ago, patient T6 volunteered for the BrainGate clinical trials and had a 100-channel electrode array implanted into the left side of her brain in regions responsible for movement. So if your motor cortex is dead like mine this would need to be implanted in the premotor cortex, which is also mostly dead in my case. Then you have to move to the executive control area, good luck with that.  

Scientists Hook Up Brain to Tablet—Paralyzed Woman Googles With Ease

For patient T6, 2014 was a happy year.
That was the year she learned to control a Nexus tablet with her brain waves, and literally took her life quality from 1980s DOS to modern era Android OS.
A brunette lady in her early 50s, patient T6 suffers from amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease), which causes progressive motor neuron damage. Mostly paralyzed from the neck down, T6 retains her sharp wit, love for red lipstick and miraculous green thumb. What she didn’t have, until recently, was the ability to communicate with the outside world.

Brain-Machine Interfaces

Like T6, millions of people worldwide have severe paralysis from spinal cord injury, stroke or neurodegenerative diseases, which precludes their ability to speak, write or otherwise communicate their thoughts and intentions to their loved ones.
The field of brain-machine interfaces blossomed nearly two decades ago in an effort to develop assistive devices to help these “locked-in” people. And the results have been fantastic: eye- or head-tracking devices have allowed eye movement to act as an output system to control mouse cursors on computer screens. In some cases, the user could also perform the click function by staring intently at a single spot, known in the field as “dwell time.”
Yet despite a deluge of promising devices, eye-tracking remains imprecise and terribly tiring to the users’ eyes. Since most systems require custom hardware, this jacks up the price of admission, limiting current technology to a lucky select few.
“We really wanted to move these assisted technologies towards clinical feasibility,” said Dr. Paul Nuyujukian, a neuroengineer and physician from Stanford University, in a talk at the 2015 Society for Neuroscience annual conference that took place this week in Chicago.
That’s where the idea of neural prostheses came in, Nuyujukian said.
In contrast to eye-trackers, neural prostheses directly interface the brain with computers, in essence cutting out the middleman — the sensory organs that we normally use to interact with our environment.
Instead, a baby-aspirin-sized microarray chip is directly implanted into the brain, and neural signals associated with intent can be decoded by sophisticated algorithms in real time and used to control mouse cursors.
It’s a technology that’s leaps and bounds from eye-trackers, but still prohibitively expensive and hard to use.
Nuyujukian’s team, together with patient T6, set out to tackle this problem.

A Nexus to Nexus 9

Two years ago, patient T6 volunteered for the BrainGate clinical trials and had a 100-channel electrode array implanted into the left side of her brain in regions responsible for movement.
At the time, the Stanford subdivision was working on a prototype prosthetic device to help paralyzed patients type out words on a custom-designed keyboard by simply thinking about the words they want to spell.
The prototype worked like this: the implanted electrodes recorded her brain activity as she looked to a target letter on the screen, passed it on to the neuroprosthesis, which then interpreted the signals and translated them into continuous control of cursor movements and clicks.
In this way, T6 could type out her thoughts using the interface, in a way similar to an elderly technophobe reluctantly tapping out messages with a single inflexible finger.
The black-and-white setup was state-of-the-art in terms of response and accuracy. But the process was painfully slow, and even with extensive training, T6 often had to move her eyes to the delete button to correct her errors.
What the field needed was a flexible, customizable and affordable device that didn’t physically connect to a computer via electrodes, according to Nuyujukian. We also wanted a user interface that didn’t look like it was designed in the 80s.
The team’s breakthrough moment came when they realized their point-and-click cursor system was similar to finger tapping on a touchscreen, something most of us do every day.
We were going to design our own touchscreen hardware, but then realized the best ones were already on the market, laughed Nuyujukian, so we went on Amazon instead and bought a Nexus 9 tablet.
The team took their existing setup and reworked it so that patient T6’s brain waves could control where she tapped on the Nexus touchscreen. It was a surprisingly easy modification: the neuroprosthetic communicated with the tablet through existing Bluetooth protocols, and the system was up and running in less than a year.
“Basically the tablet recognized the prosthetic as a wireless Bluetooth mouse,” explained Nuyujukian. We pointed her to a web browser app and told her to have fun.
In a series of short movie clips, the team demonstrated patient T6 Googling questions about gardening, taking full advantage of the autocompletion feature to speed up her research. T6 had no trouble navigating through tiny links and worked the standard QWERTY keyboard efficiently.
Think about it, said Nuyujukian, obviously excited. It’s not just a prettier user interface; she now has access to the entire Android app store.
According to previous studies, the device can function at least two years without experiencing any hardware or software issues. The team is trying to make the implant even sturdier to extend its lifespan in the brain.
“We set out to utilize what’s already been perfected in terms of the hardware to make the experience more pleasant,” said Nuyujukian. “We’ve now showed that we can expand the scope of our system to a standard tablet.”
But the team isn’t satisfied. They are now working on ways to implement click-and-drag and multi-touch maneuvers. They also want to expand to other operating systems, enable the patients to use the device 24/7 without supervision, and expand their pilot program to more patients in all three of the BrainGate clinical sites.
“Our goal is to unlock the full user interface common to general-purpose computers and mobile devices,” said Nuyujukian. “This is a first step towards developing a fully-capable brain-controlled communication and computer interface for restoring function for people with paralysis.”