Tolerability of Switching Cholinesterase Inhibitors to Memantine Monotherapy Versus Adding Memantine as Combination Therapy for All-Cause Neurodegenerative Disorders

Background: Prior studies have focused on the clinical efficacy of combination therapy, Donepezil and Memantine, for patient’s diagnosed with Alzheimer’s disease. However, the potential adverse drug reactions while described as mild can have serious sequelae in older adults who are already managing the side effects of polypharmacy. Objective: This study looks to explore the tolerability of switching cholinesterase inhibitors to memantine monotherapy versus adding memantine as combination therapy for all-cause neurodegenerative disorders. Methods: The study is a retrospective chart review that includes 175 patients aged 50 and older diagnosed with neurocognitive disorders (ICD 10 F00-F03.91 and ICD10 G30-G31.84) managed on combination therapy, memantine monotherapy and CI monotherapy from 2016-2019. Results: The odds of a patient reporting side effects on combination therapy in comparison with those patients on memantine monotherapy reporting side effects were significantly greater (OR = 4.33, CI 95% (1.62, 11.52), p=0.003). There was marginal significance in variables such as polypharmacy (p=0.057) and dosing of cholinesterase inhibitors (p = 0.087) in a binary logistic regression model (Table 1). Of the patient population who qualified as excessive polypharmacy (\u3e10), more than half 60% reported side effects. Discussion: The likelihood of reporting side effects is significantly increased for patients on combination therapy when compared to those on monotherapy(p=0.003). Sample size was a limiting factor in determining significant predictors for those reporting side effects on combination therapy; however, there was marginal significance for patients on \u3e 4 other medications while on combination therapy (p=0.057) in predicting outcomes. In our patient sample, more than 80% of the patients reporting side effects qualified as polypharmacy or excessive polypharmacy

Mortalidade infantil e acesso geográfico ao parto nos municípios brasileiros

OBJETIVO: Analisar o acesso geográfico ao parto hospitalar nos municípios brasileiros. MÉTODOS: Foram analisadas informações de óbitos e nascimentos quanto à sua adequação para o cálculo do coeficiente de mortalidade infantil no período de 2005 a 2007 para os 5.564 municípios brasileiros. O acesso geográfico foi expresso por indicadores de deslocamento, oferta e acesso aos serviços de saúde. A associação entre o acesso geográfico ao parto e o coeficiente de mortalidade infantil em municípios com adequação de suas informações vitais foi avaliada por meio de regressão múltipla. RESULTADOS: Dentre os municípios analisados, 56% apresentaram adequação das informações vitais, correspondendo a 72% da população brasileira. O deslocamento geográfico ao parto mostrou-se inversamente associado ao porte populacional, à renda per capita, e à mortalidade infantil, mesmo controlado por fatores demográficos e socioeconômicos. CONCLUSÕES: Embora tenham sido desenvolvidas estratégias importantes para a melhoria da qualidade do atendimento às gestantes no Brasil, as ações para garantir o acesso igualitário à assistência ao parto ainda são insuficientes. O maior deslocamento intermunicipal para o parto se mostrou como um fator de risco para a mortalidade infantil, aliado à desigualdade de oferta de serviços qualificados e à falta de integração com a atenção básica de saúde

Effectiveness of 3D-printed Upper Extremity Device for Chronic Neurological Impairment

Report on the results of the five adults with UE mobility impairment due to stroke experiences with a lightweight, customized, powered hand orthosis. Study measures utilized were Canadian Occupational Performance Measure, Box and Blocks, and Action Research Arm Test

A simulation study on the effects of neuronal ensemble properties on decoding algorithms for intracortical brain-machine interfaces

Background: Intracortical brain-machine interfaces (BMIs) harness movement information by sensing neuronal activities using chronic microelectrode implants to restore lost functions to patients with paralysis. However, neuronal signals often vary over time, even within a day, forcing one to rebuild a BMI every time they operate it. The term "rebuild" means overall procedures for operating a BMI, such as decoder selection, decoder training, and decoder testing. It gives rise to a practical issue of what decoder should be built for a given neuronal ensemble. This study aims to address it by exploring how decoders' performance varies with the neuronal properties. To extensively explore a range of neuronal properties, we conduct a simulation study. Methods: Focusing on movement direction, we examine several basic neuronal properties, including the signal-to-noise ratio of neurons, the proportion of well-tuned neurons, the uniformity of their preferred directions (PDs), and the non-stationarity of PDs. We investigate the performance of three popular BMI decoders: Kalman filter, optimal linear estimator, and population vector algorithm. Results: Our simulation results showed that decoding performance of all the decoders was affected more by the proportion of well-tuned neurons that their uniformity. Conclusions: Our study suggests a simulated scenario of how to choose a decoder for intracortical BMIs in various neuronal conditions

Toward a model-based predictive controller design in brain-computer interfaces

A first step in designing a robust and optimal model-based predictive controller (MPC) for brain-computer interface (BCI) applications is presented in this article. An MPC has the potential to achieve improved BCI performance compared to the performance achieved by current ad hoc, nonmodel-based filter applications. The parameters in designing the controller were extracted as model-based features from motor imagery task-related human scalp electroencephalography. Although the parameters can be generated from any model-linear or non-linear, we here adopted a simple autoregressive model that has well-established applications in BCI task discriminations. It was shown that the parameters generated for the controller design can as well be used for motor imagery task discriminations with performance (with 8-23% task discrimination errors) comparable to the discrimination performance of the commonly used features such as frequency specific band powers and the AR model parameters directly used. An optimal MPC has significant implications for high performance BCI applications.Grants K25NS061001 (MK) and K02MH01493 (SJS) from the National Institute of Neurological Disorders And Stroke (NINDS) and the National Institute of Mental Health (NIMH), the Portuguese Foundation for Science and Technology (FCT) Grant SFRH/BD/21529/2005 (NSD), the Pennsylvania Department of Community and Economic Development Keystone Innovation Zone Program Fund (SJS), and the Pennsylvania Department of Health using Tobacco Settlement Fund (SJS)

Integrative Brain Health

Overall Goals and Objectives: Following this activity, a participant should be able to: Identify recent advances in integrative medical care and discuss their application to clinical practice. Describe the latest data on complementary and alternative medical therapies that could improve patient outcomes. Discuss core integrative medicine topics that patients frequently ask physicians about. Presentation: 56:4