Effects of augmented exercise therapy time after stroke: a meta-analysis

<p><b>Background and Purpose:</b> To present a systematic review of studies that addresses the effects of intensity of augmented exercise therapy time (AETT) on activities of daily living (ADL), walking, and dexterity in patients with stroke.</p> <p><b>Summary of Review:</b> A database of articles published from 1966 to November 2003 was compiled from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE, and PiCarta using combinations of the following key words: stroke, cerebrovascular disorders, physical therapy, physiotherapy, occupational therapy, exercise therapy, rehabilitation, intensity, dose–response relationship, effectiveness, and randomized controlled trial. References presented in relevant publications were examined as well as abstracts in proceedings. Studies that satisfied the following selection criteria were included: (1) patients had a diagnosis of stroke; (2) effects of intensity of exercise training were investigated; and (3) design of the study was a randomized controlled trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for ADL, walking speed, and dexterity using fixed and random effect models. Correlation coefficients were calculated between observed individual effect sizes on ADL of each study, additional time spent on exercise training, and methodological quality. Cumulative meta-analyses (random effects model) adjusted for the difference in treatment intensity in each study was used for the trials evaluating the effects of AETT provided. Twenty of the 31 candidate studies, involving 2686 stroke patients, were included in the synthesis. The methodological quality ranged from 2 to 10 out of the maximum score of 14 points. The meta-analysis resulted in a small but statistically significant SES with regard to ADL measured at the end of the intervention phase. Further analysis showed a significant homogeneous SES for 17 studies that investigated effects of increased exercise intensity within the first 6 months after stroke. No significant SES was observed for the 3 studies conducted in the chronic phase. Cumulative meta-analysis strongly suggests that at least a 16-hour difference in treatment time between experimental and control groups provided in the first 6 months after stroke is needed to obtain significant differences in ADL. A significant SES supporting a higher intensity was also observed for instrumental ADL and walking speed, whereas no significant SES was found for dexterity.</p> <p><b>Conclusion:</b> The results of the present research synthesis support the hypothesis that augmented exercise therapy has a small but favorable effect on ADL, particularly if therapy input is augmented at least 16 hours within the first 6 months after stroke. This meta-analysis also suggests that clinically relevant treatment effects may be achieved on instrumental ADL and gait speed.</p&gt

Comparison of assessments of fitness to drive for people with dementia

Cognitive tests are used to inform recommendations about the fitness to drive of people with dementia. The Rookwood Driving Battery (RDB) and Dementia Drivers' Screening Assessment (DDSA) are neuropsychological batteries designed to assist in this process. The aim was to assess the concordance between the classifications (pass/fail) of the RDB and DDSA in individuals with dementia, and to compare any discordant classifications against on-road driving ability. Participants were identified by community mental health teams and psychiatrists. Twenty four participants were recruited. The mean age was 74.1 (SD 8.9) years and 18 (75%) were men. Each participant was assessed on the RDB and DDSA in an order determined by random allocation. Those with discrepant results also had an on-road assessment. The agreement between the tests was 54% using a cut-off of > 6 on the RDB, and 75% using the cut-off to > 10 on the RDB. Three participants with discrepant results agreed to be assessed on the road and all were found to be safe to drive. The findings suggested that there was poor concurrent validity between the RDB and DDSA. This raises questions about the choice of assessments in making clinical recommendations about fitness to drive in people with dementia

Under-reactive but easily distracted: An fMRI investigation of attentional capture in autism spectrum disorder

For individuals with autism spectrum disorder (ASD), salient behaviorally-relevant information often fails to capture attention, while subtle behaviorally-irrelevant details commonly induce a state of distraction. The present study used functional magnetic resonance imaging (fMRI) to investigate the neurocognitive networks underlying attentional capture in sixteen high-functioning children and adolescents with ASD and twenty-one typically developing (TD) individuals. Participants completed a rapid serial visual presentation paradigm designed to investigate activation of attentional networks to behaviorally-relevant targets and contingent attention capture by task-irrelevant distractors. In individuals with ASD, target stimuli failed to trigger bottom-up activation of the ventral attentional network and the cerebellum. Additionally, the ASD group showed no differences in behavior or occipital activation associated with contingent attentional capture. Rather, results suggest that to-be-ignored distractors that shared either task-relevant or irrelevant features captured attention in ASD. Results indicate that individuals with ASD may be under-reactive to behaviorally-relevant stimuli, unable to filter irrelevant information, and that both top-down and bottom-up attention networks function atypically in ASD. Lastly, deficits in target-related processing were associated with autism symptomatology, providing further support for the hypothesis that non-social attentional processes and their neurofunctional underpinnings may play a significant role in the development of sociocommunicative impairments in ASD. © 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-NDlicense

Being Healthy: a Grounded Theory Study of Help Seeking Behaviour among Chinese Elders living in the UK

The health of older people is a priority in many countries as the world’s population ages. Attitudes towards help seeking behaviours in older people remain a largely unexplored field of research. This is particularly true for older minority groups where the place that they have migrated to presents both cultural and structural challenges. The UK, like other countries,has an increasingly aging Chinese population about who relatively little is known. This study used a qualitative grounded theory design following the approach of Glaser (1978). Qualitative data were collected using semi-structured interviews with 33 Chinese elders who were aged between 60 and 84, using purposive and theoretical sampling approaches. Data were analysed using the constant comparative method until data saturation occurred and a substantive theory was generated. ‘Being healthy’ (the core category) with four interrelated categories: self-management, normalizing/minimizing, access to health services, and being cured form the theory. The theory was generated around the core explanations provided by participants and Chinese elders’ concerns about health issues they face in their daily life. We also present data about how they direct their health-related activities towards meeting their physical and psychological goals of being healthy. Their differential understanding of diseases and a lack of information about health services were potent predictors of non�help seeking and ‘self’ rather than medical management of their illnesses. This study highlights the need for intervention and health support for Chinese elders

The Resurgence of the Adora2b Receptor as an Immunotherapeutic Target in Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a dense desmoplastic stroma that impedes drug delivery, reduces parenchymal blood flow, and suppresses the anti-tumor immune response. The extracellular matrix and abundance of stromal cells result in severe hypoxia within the tumor microenvironment (TME), and emerging publications evaluating PDAC tumorigenesis have shown the adenosine signaling pathway promotes an immunosuppressive TME and contributes to the overall low survival rate. Hypoxia increases many elements of the adenosine signaling pathway, resulting in higher adenosine levels in the TME, further contributing to immune suppression. Extracellular adenosine signals through 4 adenosine receptors (Adora1, Adora2a, Adora2b, Adora3). Of the 4 receptors, Adora2b has the lowest affinity for adenosine and thus, has important consequences when stimulated by adenosine binding in the hypoxic TME. We and others have shown that Adora2b is present in normal pancreas tissue, and in injured or diseased pancreatic tissue, Adora2b levels are significantly elevated. The Adora2b receptor is present on many immune cells, including macrophages, dendritic cells, natural killer cells, natural killer T cells, γδ T cells, B cells, T cells, CD

A Binary Millisecond Pulsar in Globular Cluster NGC6544

We report the detection of a new 3.06 ms binary pulsar in the globular cluster NGC6544 using a Fourier-domain ``acceleration'' search. With an implied companion mass of ~0.01 solar masses and an orbital period of only P_b~1.7 hours, it displays very similar orbital properties to many pulsars which are eclipsed by their companion winds. The orbital period is the second shortest of known binary pulsars after 47 Tuc R. The measured flux density of 1.3 +/- 0.4 mJy at 1332 MHz indicates that the pulsar is almost certainly the known steep-spectrum point source near the core of NGC6544.Comment: Accepted by ApJ Letters on 11 October 2000, 5 page

Understanding children’s constructions of meanings about other children: implications for inclusiveeducation

This paper explores the factors that influence the way children construct meanings about other children, and especially those who seem to experience marginalisation, within school contexts. The research involved an ethnographic study in a primary school in Cyprus over a period of 5 months. Qualitative methods were used, particularly participant observations and interviews with children. Interpretation of the data suggests that children's perceptions about other children, and especially those who come to experience marginalisation, are influenced by the following factors: other children and the interactions between them; adults’ way of behaving in the school; the existing structures within the school; and the cultures of the school and the wider educational context. Even though the most powerful factor was viewed to be the adults’ influence, it was rather the interweaving between different factors that seemed to lead to the creation of particular meanings for other children. In the end, it is argued that children's voices should be seen as an essential element within the process of developing inclusive practices.<br/

Discovery of Water Maser Emission in Five AGN and a Possible Correlation Between Water Maser and Nuclear 2-10 keV Luminosities

We report the discovery of water maser emission in five active galactic nuclei (AGN) with the 100-m Green Bank Telescope (GBT). The positions of the newly discovered masers, measured with the VLA, are consistent with the optical positions of the host nuclei to within 1 sigma (0.3 arcsec radio and 1.3 arcsec optical) and most likely mark the locations of the embedded central engines. The spectra of three sources, 2MASX J08362280+3327383, NGC 6264, and UGC 09618 NED02, display the characteristic spectral signature of emission from an edge-on accretion disk with maximum orbital velocity of ~700, ~800, and ~1300 km s^-1, respectively. We also present a GBT spectrum of a previously known source MRK 0034 and interpret the narrow Doppler components reported here as indirect evidence that the emission originates in an edge-on accretion disk with orbital velocity of ~500 km s^-1. We obtained a detection rate of 12 percent (5 out of 41) among Seyfert 2 and LINER systems with 10000 km s^-1 < v_sys < 15000 km s^-1. For the 30 nuclear water masers with available hard X-ray data, we report a possible relationship between unabsorbed X-ray luminosity (2-10 keV) and total isotropic water maser luminosity, L_{2-10} proportional to L_{H2O}^{0.5+-0.1}, consistent with the model proposed by Neufeld and Maloney in which X-ray irradiation and heating of molecular accretion disk gas by the central engine excites the maser emission.Comment: 16 pages, 5 tables, 3 figures, to appear in the November 10, 2006, v651n2 issue of the Astrophysical Journa