Interventions for treating anxiety after stroke

Background: Approximately 20% of stroke patients experience anxiety at some point after stroke. Objectives: To determine if any treatment for anxiety after stroke decreases the proportion of patients with anxiety disorders or symptoms, and to determine the effect of treatment on quality of life, disability, depression, social participation, risk of death or caregiver burden. Search methods: We searched the trials register of the Cochrane Stroke Group (October 2010), CENTRAL (The Cochrane Library 2010, Issue 4), MEDLINE (1950 to October 2010), EMBASE (1947 to October 2010), PsycINFO (1806 to October 2010), Allied and Complementary Medicine database (AMED) (1985 to October 2010), Cumulative Index to Nursing and Allied Health (CINAHL) (1982 to October 2010), Proquest Digital Dissertations (1861 to October 2010), and Psychological Database for Brain Impairment Treatment Efficacy (PsycBITE) (2004 to October 2010). In an effort to identify further published, unpublished and ongoing trials, we searched trial registries and major international stroke conference proceedings, scanned reference lists, and contacted select individuals known to the review team who are actively involved in psychological aspects of stroke research, and the Association of the British Pharmaceutical Industry. Selection criteria: Two review authors independently screened and selected titles and abstracts for inclusion in the review. Randomised trials of any intervention in patients with stroke where the treatment of anxiety was an outcome were eligible. Data collection and analysis: Two review authors independently extracted data for analysis. We performed a narrative review. A meta-analysis was planned but not carried out as studies were not of sufficient quality to warrant doing so. Main results: We included two trials (three interventions) involving 175 participants with co-morbid anxiety and depression in the review. Both trials used the Hamilton Anxiety Scale (HAM-A) to assess anxiety, and neither included a placebo control group. One trial randomised 81 patients to paroxetine, paroxetine plus psychotherapy or standard care. Mean level of anxiety severity scores were 58% and 71% lower in the paroxetine, and paroxetine plus psychotherapy groups respectively compared with those in standard care at follow-up (P < 0.01). The second trial randomised 94 stroke patients, also with co-morbid anxiety and depression, to receive buspirone hydrochloride or standard care. At follow-up, the mean level of anxiety was significantly lower for those receiving buspirone relative to controls (P < 0.01). Half of the participants receiving paroxetine experienced adverse events that included nausea, vomiting or dizziness; however, only 14% of those receiving buspirone experienced nausea or palpitations. No information was provided about the duration of symptoms associated with adverse events. Authors' conclusions: There is insufficient evidence to guide the treatment of anxiety after stroke. The data available suggest that pharmaceutical therapy (paroxetine and buspirone) may be effective in reducing anxiety symptoms in stroke patients with co-morbid anxiety and depression. No information was available for stroke patients with anxiety only. Randomised placebo controlled trials are needed

Faraday rotation of the supernova remnant G296.5+10.0: Evidence for a Magnetized Progenitor Wind

We present spectropolarimetric radio images of the supernova remnant (SNR) G296.5+10.0 at frequencies near 1.4 GHz, observed with the Australia Telescope Compact Array. By applying rotation measure (RM) synthesis to the data, a pixel-by-pixel map of Faraday rotation has been produced for the entire remnant. We find G296.5+10.0 to have a highly ordered RM structure, with mainly positive RMs (mean RM of +28 rad/m**2) on the eastern side and negative RMs (mean RM of -14 rad/m**2) on the western side, indicating a magnetic field which is directed away from us on one side and toward us on the other. We consider several possible mechanisms for creating the observed RM pattern. Neither Faraday rotation in foreground interstellar gas nor in a homogeneous ambient medium swept up by the SNR shell can easily explain the magnitude and sign of the observed RM pattern. Instead, we propose that the observed RMs are the imprint of an azimuthal magnetic field in the stellar wind of the progenitor star. Specifically, we calculate that a swept-up magnetized wind from a red supergiant can produce RMs of the observed magnitude, while the azimuthal pattern of the magnetic field at large distances from the star naturally produces the anti-symmetric RM pattern observed. Expansion into such a wind can possibly also account for the striking bilateral symmetry of the SNR's radio and X-ray morphologies.Comment: Accepted for publication in The Astrophysical Journa

Quantifying the impact of avian influenza on the northern gannet colony of Bass Rock using ultra-high-resolution drone imagery and deep learning

Drones are an increasingly popular choice for wildlife surveys due to their versatility, quick response capabilities, and ability to access remote areas while covering large regions. A novel application presented here is to combine drone imagery with neural networks to assess mortality within a bird colony. Since 2021, Highly Pathogenic Avian Influenza (HPAI) has caused significant bird mortality in the UK, mainly affecting aquatic bird species. The world’s largest northern gannet colony on Scotland’s Bass Rock experienced substantial losses in 2022 due to the outbreak. To assess the impact, RGB imagery of Bass Rock was acquired in both 2022 and 2023 by deploying a drone over the island for the first time. A deep learning neural network was subsequently applied to the data to automatically detect and count live and dead gannets, providing population estimates for both years. The model was trained on the 2022 dataset and achieved a mean average precision (mAP) of 37%. Application of the model predicted 18,220 live and 3761 dead gannets for 2022, consistent with NatureScot’s manual count of 21,277 live and 5035 dead gannets. For 2023, the model predicted 48,455 live and 43 dead gannets, and the manual count carried out by the Scottish Seabird Centre and UK Centre for Ecology and Hydrology (UKCEH) of the same area gave 51,428 live and 23 dead gannets. This marks a promising start to the colony’s recovery with a population increase of 166% determined by the model. The results presented here are the first known application of deep learning to detect dead birds from drone imagery, showcasing the methodology’s swift and adaptable nature to not only provide ongoing monitoring of seabird colonies and other wildlife species but also to conduct mortality assessments. As such, it could prove to be a valuable tool for conservation purposes

Oral flora in acute stroke patients: a prospective exploratory observational study

Objective: To describe the bacterial profile of the oral flora during the first two weeks following a stroke, examining changes in the condition of the oral cavity and infections. Background: Dysphagia is common after a stroke and can lead to aspiration pneumonia. Oral flora changes associated with stroke have been implicated as a possible source of bacteria that can cause systemic infections. Materials and methods: Seventy-seven participants were recruited over a period of nine months. Fifty participants had a complete set of swabs taken from four different oral sites and saliva at three time points over a 14 day period. Molecular identification of bacteria was performed on pooled DNA extracted from swabs. Results: A total of 103 bacterial phylotypes were identified, 29 of which were not in the Human Oral Microbiome Database (HOMD). Fourteen of the twenty most common bacterial phylotypes found in the oral cavity were Streptococcal species with Streptococcus salivarius being the most common. The condition of the oral cavity worsened during the study period. Fifteen (30%) patients had at least one infection. Conclusions: It is unknown whether the 29 phylotypes identified that were not in the HOMD indicate a particular change in the oral flora associated with stroke, or the incomplete nature of the HOMD. The Holistic and Reliable Oral Assessment Tool detailed how the condition of the oral cavity following a stroke worsened over the fourteen days in hospital. Further research is needed to explore oral care methods to improve patient safety and comfort following a stroke

Complex Deleterious Interactions Associated with Malic Enzyme May Contribute to Reproductive Isolation in the Copepod Tigriopus californicus

Dobzhansky-Muller incompatibilities can result from the interactions of more than a single pair of interacting genes and there are several different models of how such complex interactions can be structured. Previous empirical work has identified complex conspecific epistasis as a form of complex interaction that has contributed to postzygotic reproductive isolation between taxa, but other forms of complexity are also possible. Here, I probe the genetic basis of reproductive isolation in crosses of the intertidal copepod Tigriopus californicus by looking at the impact of markers in genes encoding metabolic enzymes in F2 hybrids. The region of the genome associated with the locus ME2 is shown to have strong, repeatable impacts on the fitness of hybrids in crosses and epistatic interactions with another chromosomal region marked by the GOT2 locus in one set of crosses. In a cross between one of these populations and a third population, these two regions do not appear to interact despite the continuation of a large effect of the ME2 region itself in both crosses. The combined results suggest that the ME2 chromosomal region is involved in incompatibilities with several unique partners. If these deleterious interactions all stem from the same factor in this region, that would suggest a different form of complexity from complex conspecific epistasis, namely, multiple independent deleterious interactions stemming from the same factor. Confirmation of this idea will require more fine-scale mapping of the interactions of the ME2 region of the genome

Interventions for treating anxiety after stroke

Background Approximately 20% of stroke patients experience clinically significant levels of anxiety at some point after stroke. Physicians can treat these patients with antidepressants or other anxiety-reducing drugs, or both, or they can provide psychological therapy. This review looks at available evidence for these interventions. This is an update of the review first published in October 2011. Objectives The primary objective was to assess the effectiveness of pharmaceutical, psychological, complementary, or alternative therapeutic interventions in treating stroke patients with anxiety disorders or symptoms. The secondary objective was to identify whether any of these interventions for anxiety had an effect on quality of life, disability, depression, social participation, caregiver burden, or risk of death. Search methods We searched the trials register of the Cochrane Stroke Group (January 2017). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2017, Issue 1: searched January 2017); MEDLINE (1966 to January 2017) in Ovid; Embase (1980 to January 2017) in Ovid; the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1937 to January 2017) in EBSCO; and PsycINFO (1800 to January 2017) in Ovid. We conducted backward citation searches of reviews identified through database searches and forward citation searches of included studies. We contacted researchers known to be involved in related trials, and we searched clinical trials registers for ongoing studies. Selection criteria We included randomised trials including participants with a diagnosis of both stroke and anxiety for which treatment was intended to reduce anxiety. Two review authors independently screened and selected titles and abstracts for inclusion. Data collection and analysis Two review authors independently extracted data and assessed risk of bias. We performed a narrative review. We planned to do a meta-analysis but were unable to do so as included studies were not sufficiently comparable. Main results We included three trials (four interventions) involving 196 participants with stroke and co-morbid anxiety. One trial (described as a ’pilot study’) randomised 21 community-dwelling stroke survivors to four-week use of a relaxation CD or to wait list control. This trial assessed anxiety using the Hospital Anxiety and Depression Scale and reported a reduction in anxiety at three months among participants who had used the relaxation CD (mean (standard deviation (SD) 6.9 (± 4.9) and 11.0 (± 3.9)), Cohen’s d = 0.926, P value = 0.001; 19 participants analysed). The second trial randomised 81 participants with co-morbid anxiety and depression to paroxetine, paroxetine plus psychotherapy, or standard care. Mean levels of anxiety severity scores based on the Hamilton Anxiety Scale (HAM-A) at follow-up were 5.4 (SD ± 1.7), 3.8 (SD ± 1.8), and 12.8 (SD ± 1.9), respectively (P value < 0.01). The third trial randomised 94 stroke patients, also with co-morbid anxiety and depression, to receive buspirone hydrochloride or standard care. At follow-up, the mean levels of anxiety based on the HAM-A were 6.5 (SD± 3.1) and 12.6 (SD± 3.4) in the two groups, respectively, which represents a significant difference (P value < 0.01). Half of the participants receiving paroxetine experienced adverse events that included nausea, vomiting, or dizziness; however, only 14% of those receiving buspirone experienced nausea or palpitations. Trial authors provided no information about the duration of symptoms associated with adverse events. The trial of relaxation therapy reported no adverse events. The quality of the evidence was very low. Each study included a small number of participants, particularly the study of relaxation therapy. Studies of pharmacological agents presented details too limited to allow judgement of selection, performance, and detection bias and lack of placebo treatment in control groups. Although the study of relaxation therapy had allocated participants to treatment using an adequate method of randomisation, study recruitment methods might have introduced bias, and drop-outs in the intervention group may have influenced results. Authors’ conclusions Evidence is insufficient to guide the treatment of anxiety after stroke. Further well-conducted randomised controlled trials (using placebo or attention controls) are required to assess pharmacological agents and psychological therapies

Good heart: telling stories of cardiovascular protective and risk factors for Aboriginal women

BACKGROUND:Aboriginal and Torres Strait Islander peoples' perspectives of health and cultural wellbeing encapsulate the spiritual, social and environmental health of individuals, their communities and country. Strategies designed to reduce the cardiovascular burden of Aboriginal and Torres Strait Islander people often fail to consider their unique knowledge and worldview. METHODS:This adapted, grounded theory study sought to explore Aboriginal women's views of cardiovascular protective and risk factors. RESULTS:Twenty-eight (28) women from five women's groups across Central and South Australia participated. Women distinguished the heart as core to their spiritual and physical wellbeing. Women identified six attributes that keep a woman's heart strong, four that can make the heart sick, and eight socio-ecological factors which affect a woman's capacity to care for their heart. Women described having a healthy heart when able to identify as Aboriginal women, being connected to family and community, having a healthy life and body, and being engaged in their health and health care. CONCLUSIONS:There are gaps in the provision of cardiovascular risk assessment and management, gaps in the cultural safety of primary health care services, and gaps in the communication of the sex-specific warning signs of a heart attack, all of which must be addressed.Katharine F.McBride, Christine Franks, Vicki Wade, Veronica King, Janice Rigney, Nyunmiti Burton ... et al

A Prospective Study to Validate the Functional Assessment of Cancer Therapy (FACT) for Epidermal Growth Factor Receptor Inhibitor (EGFRI)-induced Dermatologic Toxicities FACT-EGFRI 18 Questionnaire: SWOG S1013

Background Papulopustular rash is a common class effect of epidermal growth factor receptor inhibitors (EGFRI) that can affect patients’ health-related quality of life and cause disruptions to treatment. SWOG S1013 (NCT01416688) is a multi-center study designed to validate the Functional Assessment of Cancer Therapy EGFRI 18 (FACT-EGFRI 18) using 7-items from the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 to assess EGFRI-induced skin-related toxicities and their impact on functional status. Methods Patients with a diagnosis of colorectal or lung cancer to receive EGFRI therapies for at least 6 weeks were enrolled. Patient self-assessments using the FACT-EGFRI 18 were completed prior to undergoing CTCAE assessment by trained clinicians at baseline, weekly × 6, and then monthly × 3. The psychometric properties of the FACT-EGFRI 14 (skin toxicity items only) and 18 (plus 2 nail and 2 hair items) were established based on criterion validity, known groups validity, internal consistency reliability, and responsiveness to change. Results Of the 146 registered patients, 124 were evaluable. High Cronbach’s alpha (\u3e 0.70) for both FACT-EGFRI 14 and FACT-EGFRI 18 scores across assessment times were observed. Although agreement (i.e. criterion validity) between individual and summary scales of the FACT-EGFRI 18 for assessing skin toxicity was good, agreement with the clinician-reported CTCAE was only fair. The minimal important difference was determined to be 3 points. The results also demonstrated responsiveness to symptom change. Discussion Based on the results of this multi-center validation study, the FACT-EGFRI 18 patient-reported outcome instrument provided data from the patient’s perspective yielding unique information as well as complementing clinician-rated CTCAE grades, especially for the symptoms of pain, pruritus, and paronychia. Conclusions Good to excellent psychometric properties for the FACT-EGFRI 18 were demonstrated, supporting further use of this patient-reported outcomes measure. Additional validation with a more diverse group of patients should be conducted