Industrial Perspective on Deep Brain Stimulation: History, Current State, and Future Developments

Deep brain stimulation (DBS) emerged in the late 1960s as a possible therapeutic alternative to lesioning in patients with severe, chronic, intractable pain. DBS devices in the era were based on cardiac pacing technology but were greatly modified in implementation due to the unique needs of DBS. Clinical studies in the 1970s and early 1980s have revealed a technique with modest results which did not lead to regulatory approval for the treatment of pain. In the 1980s a new application for DBS emerged in the treatment of movement disorders. Clinical trials confirmed the robustness of the therapy leading to approvals by regulatory authorities in the US and Europe for the treatment of tremor and the symptoms of Parkinson’s disease. Technology based on that used for earlier clinical research in pain was improved by leveraging advances in cardiac pacing technology resulting in the sophisticated and reliable systems available today. In the 1990s scientific exploration began in the treatment of psychiatric disorders which is ongoing today. Simultaneously, studies into the treatment of epilepsy were begun which resulted in regulatory approval in Europe. Suggestions have been made to expand these scientific explorations to other central nervous system dysfunctions. Opportunity remains to improve the technology including individualized and symptom specific stimulation patterns, more physician and patient friendly programming, and possibly closed-loop systems for more situation dependent and effective therapy

A Turke turn'd Quaker: conversion from Islam to radical dissent in early modern England

The study of the relationship between the anglophone and Islamic worlds in the seventeenth century has been the subject of increas- ing interest in recent years, and much attention has been given to the cultural anxiety surrounding “Turning Turke”, conversion from Christianity to Islam, especially by English captives on the Barbary coast. Conversion in the other direction has attracted far less scrutiny, not least because it appears to have been far less com- mon. Conversion from Islam to any form of radical dissent has attracted no scholarship whatsoever, probably because it has been assumed to be non-existent. However, the case of Bartholomew Cole provides evidence that such conversions did take place, and examining the life of this “Turke turn’d Quaker” provides an insight into the dynamics of cross-cultural conversion of an exceptional kind

An Electronic Health Record Data-driven Model for Identifying Older Adults at Risk of Unintentional Falls

Screening for risk of unintentional falls remains low in the primary care setting because of the time constraints of brief office visits. National studies suggest that physicians caring for older adults provide recommended fall risk screening only 30 to 37 percent of the time. Given prior success in developing methods for repurposing electronic health record data for the identification of fall risk, this study involves building a model in which electronic health record data could be applied for use in clinical decision support to bolster screening by proactively identifying patients for whom screening would be beneficial and targeting efforts specifically to those patients. The final model, consisting of priority and extended measures, demonstrates moderate discriminatory power, indicating that it could prove useful in a clinical setting for identifying patients at risk of falls. Focus group discussions reveal important contextual issues involving the use of fall-related data and provide direction for the development of health systems–level innovations for the use of electronic health record data for fall risk identification