Developing home-based cardiac rehabilitation for people post-transient ischaemic attack (TIA) or ischaemic stroke

The 90 day risk of vascular events following a TIA or ‘minor’ stroke can be as high as 18%. This is therefore a key time to initiate secondary prevention, which can be provided by an adapted cardiac rehabilitation programme, ‘The Healthy Brain Rehabilitation Manual’, as shown by recent feasibility and pilot studies. The programme uses specific behaviour change techniques to support the adoption of healthy lifestyles and secondary prevention.The 90 day risk of vascular events following a TIA or ‘minor’ stroke can be as high as 18%. This is therefore a key time to initiate secondary prevention, which can be provided by an adapted cardiac rehabilitation programme, ‘The Healthy Brain Rehabilitation Manual’, as shown by recent feasibility and pilot studies. The programme uses specific behaviour change techniques to support the adoption of healthy lifestyles and secondary prevention

ExoMol molecular line lists - XXVII: spectra of C2H4

A new line list for ethylene, $^{12}$C$_2$$^1$H$_4$ is presented. The line list is based on high level ab initio potential energy and dipole moment surfaces. The potential energy surface is refined by fitting to experimental energies. The line list covers the range up to 7000 cm$^{-1}$ (1.43 $\mu$m) with all ro-vibrational transitions (50 billion) with the lower state below 5000 cm$^{-1}$ included and thus should be applicable for temperatures up to 700 K. A technique for computing molecular opacities from vibrational band intensities is proposed and used to provide temperature dependent cross sections of ethylene for shorter wavelength and higher temperatures. When combined with realistic band profiles (such as the proposed three-band model), the vibrational intensity technique offers a cheap but reasonably accurate alternative to the full ro-vibrational calculations at high temperatures and should be reliable for representing molecular opacities. The C$_2$H$_4$ line list, which is called MaYTY, is made available in electronic form from the CDS

The associations of "fatness," "fitness," and physical activity with all-cause mortality in older adults: A systematic review.

OBJECTIVE: This review explored whether cardiorespiratory fitness or physical activity act as either confounders or effect modifiers of the relationship between adiposity markers and all-cause mortality in older adults. METHODS: Systematic searches were carried out to identify observational studies that examined the association of adiposity markers (BMI, waist circumference, and waist-hip ratio) with all-cause mortality in adults aged ≥ 60 which took into account cardiorespiratory fitness or physical activity. Data from each included study was analyzed to produce a graphical representation of this relationship. RESULTS: Fourteen of the fifteen identified studies found that increasing BMI had a non-positive association with all-cause mortality, with persistence of the obesity paradox despite adjustment for physical activity or cardiorespiratory fitness. Physical activity measurement methods were all subjective and often unvalidated. The two studies stratifying for cardiorespiratory fitness did not find that fitness had a significant impact on the relationship between excess adiposity and mortality but found that overweight and fit people had better survival than normal-weight unfit people, CONCLUSIONS: The predominant use of poor physical activity measurement suggests that studies are currently not adequately accounting for possible physical activity confounding. More studies are needed for addressing the modification of the relationship between adiposity markers and mortality by cardiorespiratory fitness.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1002/oby.2118

Transient neurological symptoms in the older population:report of a prospective cohort study--the Medical Research Council Cognitive Function and Ageing Study (CFAS)

Transient ischaemic attack (TIA) is a recognised risk factor for stroke in the older population requiring timely assessment and treatment by a specialist. The need for such TIA services is driven by the epidemiology of transient neurological symptoms, which may not be caused by TIA. We report prevalence and incidence of transient neurological symptoms in a large UK cohort study of older people

Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study.

Funder: Wellcome TrustObjectiveTo describe patterns of anticoagulation prescription and persistence for those aged ≥65 years with atrial fibrillation (AF).MethodsDescriptive cohort study using electronic general practice records of patients in England, who attended an influenza vaccination aged ≥65 years and were diagnosed with AF between 2008 and 2018. Patients were stratified by 10-year age group and year of diagnosis. Proportion anticoagulated, type of anticoagulation (direct oral anticoagulant (DOAC) or warfarin) initiated at diagnosis and persistence with anticoagulation over time are reported.Results42 290 patients (49% female), aged 65-74 (n=11 722), 75-84 (n=19 055) and 85+ (n=11 513) years at AF diagnosis are included. Prescription of anticoagulation at diagnosis increased over the time period from 55% to 86% in people aged 65-74 years, from 54% to 86% in people aged 75-84 years and from 27% to 75% in people aged 85 years and over. By 2018, 92% of patients with newly diagnosed AF were started on a DOAC. Survivor function for 5-year persistence in patients prescribed DOAC was 0.80 (95% CI 0.77 to 0.82) and for warfarin 0.71 (95% CI 0.70 to 0.72). Survivor function for any anticoagulation at 5 years was 0.79 (95% CI 0.78 to 0.81), 0.73 (95% CI 0.72 to 0.75) and 0.58 (95% CI 0.59 to 0.64) for people aged 65-74, 75-84 and 85+ years, respectively.ConclusionsRates of anticoagulation in AF in those aged ≥65 years have increased from 2008 to 2018, over which time period there has been a shift from initiating anticoagulation with warfarin to DOAC. Persistence with anticoagulation is higher in people on DOACs than on warfarin and in people aged <85 years

Training in positivity for stroke? A qualitative study of acceptability of use of Positive Mental Training (PosMT) as a tool to assist stroke survivors with post-stroke psychological problems and in coping with rehabilitation.

BACKGROUND: Post-stroke psychological problems predict poor recovery, while positive affect enables patients to focus on rehabilitation and may improve functional outcomes. Positive Mental Training (PosMT), a guided self-help audio shows promise as a tool in promoting positivity, optimism and resilience. OBJECTIVE: To assess acceptability of training in positivity with PosMT for prevention and management of post-stroke psychological problems and to help with coping with rehabilitation. METHODS: A modified PosMT tool consisted of 12 audio tracks each lasting 18 minutes, one listened to every day for a week. Survivors and carers were asked to listen for 4 weeks, but could volunteer to listen for more. Interviews took place about experiences of the tool after 4 and 12 weeks. SUBJECTS: 10 stroke survivors and 5 carers from Stroke Support Groups in the UK. RESULTS: Three stroke survivors did not engage with the tool. The remainder reported positive physical and psychological benefits including improved relaxation, better sleep and reduced anxiety after four weeks. Survivors who completed the programme gained a positive outlook on the future, increased motivation, confidence and ability to cope with rehabilitation. No adverse effects were reported. CONCLUSIONS: The PosMT shows potential as a tool for coping with rehabilitation and overcoming post-stroke psychological problems including anxiety and depression.This work was supported through the Royal College of General Practitioners (RCGP), UK Scientific Foundation Board, United Kingdom.This is the author accepted manuscript. The final version is available from IOS Press via https://doi.org/10.3233/NRE-16141

Acquiring Wearable Photoplethysmography Data in Daily Life:The PPG Diary Pilot Study

The photoplethysmogram (PPG) signal is widely measured by smart watches and fitness bands for heart rate monitoring. New applications of the PPG are also emerging, such as to detect irregular heart rhythms, track infectious diseases, and monitor blood pressure. Consequently, datasets of PPG signals acquired in daily life are valuable for algorithm development. The aim of this pilot study was to assess the feasibility of acquiring PPG data in daily life. A single subject was asked to wear a wrist-worn PPG sensor six days a week for four weeks, and to keep a diary of daily activities. The sensor was worn for 75.0% of the time, signals were acquired for 60.6% of the time, and signal quality was high for 30.5% of the time. This small pilot study demonstrated the feasibility of acquiring PPG data during daily living. Key lessons were learnt for future studies: (i) devices which are waterproof and require charging less frequently may provide signals for a greater proportion of the time; (ii) data should either be stored on the device or streamed via a reliable connection to a second device for storage; (iii) it may be beneficial to acquire signals during the night or during periods of low activity to achieve high signal quality; and (iv) there are several promising areas for PPG algorithm development including the design of pulse wave analysis techniques to track changes in cardiovascular properties in daily life.</p

Barriers and facilitators to staying in work after stroke: insight from an online forum.

OBJECTIVE: To explore barriers and facilitators to staying in work following stroke. DESIGN: Qualitative analysis of posts regarding staying in work following stroke using the archives of an online forum for stroke survivors. PARTICIPANTS: 60 stroke survivors (29 male, 23 female, 8 not stated; mean age at stroke 44 years) who have returned to work, identified using terms 'return to work' and 'back at work'. SETTING: Posts from UK stroke survivors and family members on Talkstroke, the forum of the Stroke Association, between 2004 and 2011. RESULTS: Stroke and transient ischaemic attack (TIA) survivors reported residual impairments that for many had impact on work. Most impairments were 'invisible', including fatigue, problems with concentration, memory and personality changes. Participants described positive (eg, back at work being better than expected) and negative work experiences, including being at risk of losing the job because of stroke-related impairments. Barriers to successfully staying in work included lack of understanding of stroke--in particular invisible impairments--of survivors, employers and general practitioners (GPs), and lack of support in terms of formal adjustments, and 'feeling supported'. Stroke survivors described how they developed their own coping strategies, and how workplace and employer helped them to stay in work. CONCLUSIONS: Despite having been able to return to work after a stroke, people may still experience difficulties in staying in work and risking losing their job. There is a need to improve awareness, in particular of invisible stroke-related impairments, among stroke survivors, work personnel and clinicians. This might be achieved through improved assessments of residual impairments in the workplace and in general practice. Future studies should investigate the effect of unrecognised fatigue and invisible impairments on staying in work following stroke, and explore the potential role for primary care in supporting stroke survivors who have returned to employment.This study was funded by the Evelyn Trust. Anna De Simoni is funded by a NIHR Academic Clinical Lectureship. Andrew Bateman was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.This is the final published version. It first appeared at http://bmjopen.bmj.com/content/6/4/e009974.abstract

Stroke survivors and their families receive information and support on an individual basis from an online forum: descriptive analysis of a population of 2348 patients and qualitative study of a sample of participants.

OBJECTIVE: To describe the characteristics of participants of an online stroke forum, their reasons for posting in the forum and whether responses addressed users' needs. METHODS: Descriptive analysis of the population of 2004-2011 archives of Talkstroke, the online forum of the Stroke Association, and comparison with patients admitted to hospital with stroke (Sentinel Stroke National Audit Programme, SSNAP). Thematic analysis of posts from a sample of 59 participants representative of age at stroke and sex. SETTINGS: UK. MAIN OUTCOME MEASURES: Characteristics of participants: age, sex, survivor versus patient by third party, side of stroke (R, L), social class; (from the sample of 59 participants): level of disability, stroke type, classification of users' intents for writing a post in the forum, quantification of needs addressed by the forum, topics of discussion. PARTICIPANTS: 2348 participants (957 stroke survivors, 1391 patients with stroke talked about by third party). RESULTS: Patients of both sexes and from a wide range of ages at stroke (0 to 95 years) and degrees of disability were represented in the forum, although younger than the UK stroke population (mean age 52 years vs 77 years in SSNAP). Analysis of 841 posts showed that the main users' intents for writing in the forum were requests/offers of information and support (58%) and sharing own experiences of stroke (35%). Most information needs were around stroke-related physical impairments, understanding the cause of stroke and the potential for recovery. Up to 95% of the users' intents were met by the replies received. CONCLUSIONS: Patients' needs expressed in the online forum confirm and widen the evidence from traditional research studies, showing that such forums are a potential resource for studying needs in this population. The forum provided an opportunity for patients and families to give and receive advice and social support.This study was funded by a NIHR Academic Clinical Lectureship to Anna De Simoni. The Evelyn Trust funded Chantal Balasooriya-Smeekens’s work.This is the final published version. It first appeared at http://bmjopen.bmj.com/content/6/4/e010501.abstract