Principles of precision medicine in stroke

The era of precision medicine has arrived and conveys tremendous potential, particularly for stroke neurology. The diagnosis of stroke, its underlying aetiology, theranostic strategies, recurrence risk and path to recovery are populated by a series of highly individualised questions. Moreover, the phenotypic complexity of a clinical diagnosis of stroke makes a simple genetic risk assessment only partially informative on an individual basis. The guiding principles of precision medicine in stroke underscore the need to identify, value, organise and analyse the multitude of variables obtained from each individual to generate a precise approach to optimise cerebrovascular health. Existing data may be leveraged with novel technologies, informatics and practical clinical paradigms to apply these principles in stroke and realise the promise of precision medicine. Importantly, precision medicine in stroke will only be realised once efforts to collect, value and synthesise the wealth of data collected in clinical trials and routine care starts. Stroke theranostics, the ultimate vision of synchronising tailored therapeutic strategies based on specific diagnostic data, demand cerebrovascular expertise on big data approaches to clinically relevant paradigms. This review considers such challenges and delineates the principles on a roadmap for rational application of precision medicine to stroke and cerebrovascular health

Habitat selection of the Black-shouldered Kite Elanus caeruleus in agroecosystems of Swaziland

A decline in many African raptor populations may contribute to loss of ecosystem services such as pest control. The Black-shouldered Kite (Elanus caeruleus) stands out as an exception, experiencing range expansions due to its proclivity for agricultural landscapes. We surveyed roads throughout Swaziland agroecosystems for Black-shouldered Kites and looked at habitat selection in a used versus available framework. We found that kites selected for savannahs and tall herbaceous vegetation but did not show preferences for or against land use types. We also found a significant relationship with kite presence and low tree densities in the immediate vicinity of a perch site. Singles, pairs and fledgling kites were observed in agricultural landscape, suggesting that although they are not selecting for these areas in proportion to its availability, they are foraging in it. This may be a boon for farmers who implement ecologically based rodent management programs.United States Department of Agriculture National Institute for Food and Agriculture and Tarleton State University.http://www.tandfonline.com/loi/tost202017-05-31hb2016Mammal Research Institut

Extent of hypoattenuation on CT angiography source images in Basilar Artery occlusion: prognostic value in the Basilar Artery International Cooperation Study

<p><b>Background and Purpose:</b> The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS).</p> <p><b>Methods:</b> BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion. Functional outcome was assessed at 1 month. We applied pc-ASPECTS to CT angiography source images of patients with CT angiography for confirmation of basilar artery occlusion. We calculated unadjusted and adjusted risk ratios (RRs) of pc-ASPECTS dichotomized at ≥8 versus <8. Primary outcome measure was favorable outcome (modified Rankin Scale scores 0–3). Secondary outcome measures were mortality and functional independence (modified Rankin Scale scores 0–2).</p> <p><b>Results:</b> Of 158 patients included, 78 patients had a CT angiography source images pc-ASPECTS ≥8. Patients with a pc-ASPECTS ≥8 more often had a favorable outcome than patients with a pc-ASPECTS <8 (crude RR, 1.7; 95% CI, 0.98–3.0). After adjustment for age, baseline National Institutes of Health Stroke Scale score, and thrombolysis, pc-ASPECTS ≥8 was not related to favorable outcome (RR, 1.3; 95% CI, 0.8–2.2), but it was related to reduced mortality (RR, 0.7; 95% CI, 0.5–0.98) and functional independence (RR, 2.0; 95% CI, 1.1–3.8). In post hoc analysis, pc-ASPECTS dichotomized at ≥6 versus <6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2–7.5).</p> <p><b>Conclusions:</b> pc-ASPECTS on CT angiography source images independently predicted death and functional independence at 1 month in the CT angiography subgroup of patients in the BASICS registry.</p&gt

Prison officer self-legitimacy and support for rehabilitation in Ghana

Legitimacy refers to the moral recognition of power, and prison legitimacy remains a principal issue for prison researchers and managers. However, the prison legitimacy literature tends to focus on the views held by individuals in custody. Research on prison officer Self-Legitimacy – that is, the powerholders’ belief that the authority vested in them is morally right – remains scanty. Drawing on data from a survey of 1,062 prison officers in Ghana, this study examined both the correlates of prison officer Self-Legitimacy and the links between Self-Legitimacy and Support for Rehabilitation of individuals in custody. The results of multivariate analyses showed that having good Relations with Colleagues and being treated fairly by supervisors enhance prison officers’ Self-Legitimacy. In turn, Self-Legitimacy was found to increase officers’ Support for Rehabilitation. Finally, perceived Fair Treatment by Supervisors and positive Relations with Individuals in Custody were associated with increased Support for Rehabilitation. The implications of these findings are discussed

Comparative analysis of the lambda-interferons IL-28A and IL-29 regarding their transcriptome and their antiviral properties against hepatitis C virus.

Specific differences in signaling and antiviral properties between the different Lambda-interferons, a novel group of interferons composed of IL-28A, IL-28B and IL-29, are currently unknown. This is the first study comparatively investigating the transcriptome and the antiviral properties of the Lambda-interferons IL-28A and IL-29. Expression studies were performed by microarray analysis, quantitative PCR (qPCR), reporter gene assays and immunoluminometric assays. Signaling was analyzed by Western blot. HCV replication was measured in Huh-7 cells expressing subgenomic HCV replicon. All hepatic cell lines investigated as well as primary hepatocytes expressed both IFN-λ receptor subunits IL-10R2 and IFN-λR1. Both, IL-28A and IL-29 activated STAT1 signaling. As revealed by microarray analysis, similar genes were induced by both cytokines in Huh-7 cells (IL-28A: 117 genes; IL-29: 111 genes), many of them playing a role in antiviral immunity. However, only IL-28A was able to significantly down-regulate gene expression (n = 272 down-regulated genes). Both cytokines significantly decreased HCV replication in Huh-7 cells. In comparison to liver biopsies of patients with non-viral liver disease, liver biopsies of patients with HCV showed significantly increased mRNA expression of IL-28A and IL-29. Moreover, IL-28A serum protein levels were elevated in HCV patients. In a murine model of viral hepatitis, IL-28 expression was significantly increased. IL-28A and IL-29 are up-regulated in HCV patients and are similarly effective in inducing antiviral genes and inhibiting HCV replication. In contrast to IL-29, IL-28A is a potent gene repressor. Both IFN-λs may have therapeutic potential in the treatment of chronic HCV

Endovascular equipoise shift in a phase III randomized clinical trial of sonothrombolysis for acute ischemic stroke

Background: Results of our recently published phase III randomized clinical trial of ultrasound-enhanced thrombolysis (sonothrombolysis) using an operator-independent, high frequency ultrasound device revealed heterogeneity of patient recruitment among centers. Methods: We performed a post hoc analysis after excluding subjects that were recruited at centers reporting a decline in the balance of randomization between sonothrombolysis and concurrent endovascular trials. Results: From a total of 676 participants randomized in the CLOTBUST-ER trial we identified 52 patients from 7 centers with perceived equipoise shift in favor of endovascular treatment. Post hoc sensitivity analysis in the intention-to-treat population adjusted for age, National Institutes of Health Scale score at baseline, time from stroke onset to tPA bolus and baseline serum glucose showed a significant (p < 0.01) interaction of perceived endovascular equipoise shift on the association between sonothrombolysis and 3 month functional outcome [adjusted common odds ratio (cOR) in centers with perceived endovascular equipoise shift: 0.22, 95% CI 0.06–0.75; p = 0.02; adjusted cOR for centers without endovascular equipoise shift: 1.20, 95% CI 0.89–1.62; p = 0.24)]. After excluding centers with perceived endovascular equipoise shift, patients randomized to sonothrombolysis had higher odds of 3 month functional independence (mRS scores 0–2) compared with patients treated with tPA only (adjusted OR: 1.53; 95% CI 1.01–2.31; p = 0.04). Conclusion: Our experience in CLOTBUST-ER indicates that increasing implementation of endovascular therapies across major academic stroke centers raises significant challenges for clinical trials aiming to test noninterventional or adjuvant reperfusion strategies

On the relevance of animal behavior to the management and conservation of fishes and fisheries

There are many syntheses on the role of animal behavior in understanding and mitigating conservation threats for wildlife. That body of work has inspired the development of a new discipline called conservation behavior. Yet, the majority of those synthetic papers focus on non-fish taxa such as birds and mammals. Many fish populations are subject to intensive exploitation and management and for decades researchers have used concepts and knowledge from animal behavior to support management and conservation actions. Dr. David L. G. Noakes is an influential ethologist who did much foundational work related to illustrating how behavior was relevant to the management and conservation of wild fish. We pay tribute to the late Dr. Noakes by summarizing the relevance of animal behavior to fisheries management and conservation. To do so, we first consider what behavior has revealed about how fish respond to key threats such as habitat alteration and loss, invasive species, climate change, pollution, and exploitation. We then consider how behavior has informed the application of common management interventions such as protected areas and spatial planning, stock enhancement, and restoration of habitat and connectivity. Our synthesis focuses on the totality of the field but includes reflections on the specific contributions of Dr. Noakes. Themes emerging from his approach include the value of fundamental research, management-scale experiments, and bridging behavior, physiology, and ecology. Animal behavior plays a key role in understanding and mitigating threats to wild fish populations and will become more important with the increasing pressures facing aquatic ecosystems. Fortunately, the toolbox for studying behavior is expanding, with technological and analytical advances revolutionizing our understanding of wild fish and generating new knowledge for fisheries managers and conservation practitioners.publishedVersio