Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial

OBJECTIVE: To establish if a brief programme of domiciliary occupational therapy could improve the recovery of patients with stroke discharged from hospital. DESIGN: Single blind randomised controlled trial. SETTING: Two hospital sites within a UK teaching hospital. SUBJECTS: 138 patients with stroke with a definite plan for discharge home from hospital. INTERVENTION: Six week domiciliary occupational therapy or routine follow up. MAIN OUTCOME MEASURES: Nottingham extended activities of daily living score and "global outcome" (deterioration according to the Barthel activities of daily living index, or death). RESULTS: By eight weeks the mean Nottingham extended activities of daily living score in the intervention group was 4.8 points (95% confidence interval -0.5 to 10.0, P=0.08) greater than that of the control group. Overall, 16 (24%) intervention patients had a poor global outcome compared with 30 (42%) control patients (odds ratio 0.43, 0.21 to 0.89, P=0.02). These patterns persisted at six months but were not statistically significant. Patients in the intervention group were more likely to report satisfaction with a range of aspects of services. CONCLUSION: The functional outcome and satisfaction of patients with stroke can be improved by a brief occupational therapy programme carried out in the patient's home immediately after discharge. Major benefits may not, however, be sustained

Disability in young people and adults one year after head injury: prospective cohort study

OBJECTIVE: To determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community. DESIGN: Prospective, hospital based cohort study, with one year follow up of sample stratified by coma score. SETTING: Five acute hospitals in Glasgow. SUBJECTS: 2962 patients (aged 14 years or more) with head injury; 549 (71%) of the 769 patients selected for follow up participated. MAIN OUTCOME MEASURES: Glasgow outcome scale and problem orientated questionnaire. RESULTS: Survival with moderate or severe disability was common after mild head injury (47%, 95% confidence interval 42% to 52%) and similar to that after moderate (45%, 35% to 56%) or severe injury (48%, 36% to 60%). By extrapolation from the population identified (90% of whom had mild injuries), it was estimated that annually in Glasgow (population 909 498) 1400 young people and adults are still disabled one year after head injury. CONCLUSION: The incidence of disability in young people and adults admitted with a head injury is higher than expected. This reflects the high rate of sequelae previously unrecognised in the large number of patients admitted to hospital with an apparently mild head injury

Linear Stability of Triangular Equilibrium Points in the Generalized Photogravitational Restricted Three Body Problem with Poynting-Robertson Drag

In this paper we have examined the linear stability of triangular equilibrium points in the generalised photogravitational restricted three body problem with Poynting-Robertson drag. We have found the position of triangular equilibrium points of our problem. The problem is generalised in the sense that smaller primary is supposed to be an oblate spheroid. The bigger primary is considered as radiating. The equations of motion are affected by radiation pressure force, oblateness and P-R drag. All classical results involving photogravitational and oblateness in restricted three body problem may be verified from this result. With the help of characteristic equation, we discussed the stability. Finally we conclude that triangular equilibrium points are unstable.Comment: accepted for publication in Journal of Dynamical Systems & Geometric Theories Vol. 4, Number 1 (2006

Functional MRI entropy measurements of age-related brain changes

As we age there is a decline in cognitive abilities such as processing speed, memory, executive function and reasoning. The basis for this decline is not well understood. In this study, the physiological complexity of resting state fMRI signals in a group of healthy volunteers was investigated. Twenty volunteers ranging from age 25 to 60 years underwent functional magnetic resonance imaging (fMRI). Physiological complexity was measured by calculating approximate entropy (ApEn) maps for all volunteers. Maps were statistically analysed globally and regionally with Statistical Package for Social Sciences (SPSS) and Statistical Parametric Mapping (SPM8) software respectively. Comparing the older participants (> 40 years) with the younger ones, the older group exhibited significantly lower signal ApEn in areas of white matter, grey matter, frontal lobe, sub-lobar, brainstem, limbic lobe and temporal lobe. Decline in fMRI brain complexity is a feature of normal ageing beyond the age of 40 years

Are markers of inflammation more strongly associated with risk for fatal than for nonfatal vascular events?

<p><b>Background:</b> Circulating inflammatory markers may more strongly relate to risk of fatal versus nonfatal cardiovascular disease (CVD) events, but robust prospective evidence is lacking. We tested whether interleukin (IL)-6, C-reactive protein (CRP), and fibrinogen more strongly associate with fatal compared to nonfatal myocardial infarction (MI) and stroke.</p> <p><b>Methods and Findings:</b> In the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER), baseline inflammatory markers in up to 5,680 men and women aged 70-82 y were related to risk for endpoints; nonfatal CVD (i.e., nonfatal MI and nonfatal stroke [n = 672]), fatal CVD (n = 190), death from other CV causes (n = 38), and non-CVD mortality (n = 300), over 3.2-y follow-up. Elevations in baseline IL-6 levels were significantly (p = 0.0009; competing risks model analysis) more strongly associated with fatal CVD (hazard ratio [HR] for 1 log unit increase in IL-6 1.75, 95% confidence interval [CI] 1.44-2.12) than with risk of nonfatal CVD (1.17, 95% CI 1.04-1.31), in analyses adjusted for treatment allocation. The findings were consistent in a fully adjusted model. These broad trends were similar for CRP and, to a lesser extent, for fibrinogen. The results were also similar in placebo and statin recipients (i.e., no interaction). The C-statistic for fatal CVD using traditional risk factors was significantly (+0.017; p<0.0001) improved by inclusion of IL-6 but not so for nonfatal CVD events (p = 0.20).</p> <p><b>Conclusions:</b> In PROSPER, inflammatory markers, in particular IL-6 and CRP, are more strongly associated with risk of fatal vascular events than nonfatal vascular events. These novel observations may have important implications for better understanding aetiology of CVD mortality, and have potential clinical relevance.</p&gt

Optimal low-thrust trajectories to asteroids through an algorithm based on differential dynamic programming

In this paper an optimisation algorithm based on Differential Dynamic Programming is applied to the design of rendezvous and fly-by trajectories to near Earth objects. Differential dynamic programming is a successive approximation technique that computes a feedback control law in correspondence of a fixed number of decision times. In this way the high dimensional problem characteristic of low-thrust optimisation is reduced into a series of small dimensional problems. The proposed method exploits the stage-wise approach to incorporate an adaptive refinement of the discretisation mesh within the optimisation process. A particular interpolation technique was used to preserve the feedback nature of the control law, thus improving robustness against some approximation errors introduced during the adaptation process. The algorithm implements global variations of the control law, which ensure a further increase in robustness. The results presented show how the proposed approach is capable of fully exploiting the multi-body dynamics of the problem; in fact, in one of the study cases, a fly-by of the Earth is scheduled, which was not included in the first guess solution

Secular dynamics of a planar model of the Sun-Jupiter-Saturn-Uranus system; effective stability into the light of Kolmogorov and Nekhoroshev theories

We investigate the long-time stability of the Sun-Jupiter-Saturn-Uranus system by considering a planar secular model, that can be regarded as a major refinement of the approach first introduced by Lagrange. Indeed, concerning the planetary orbital revolutions, we improve the classical circular approximation by replacing it with a solution that is invariant up to order two in the masses; therefore, we investigate the stability of the secular system for rather small values of the eccentricities. First, we explicitly construct a Kolmogorov normal form, so as to find an invariant KAM torus which approximates very well the secular orbits. Finally, we adapt the approach that is at basis of the analytic part of the Nekhoroshev's theorem, so as to show that there is a neighborhood of that torus for which the estimated stability time is larger than the lifetime of the Solar System. The size of such a neighborhood, compared with the uncertainties of the astronomical observations, is about ten times smaller.Comment: 31 pages, 2 figures. arXiv admin note: text overlap with arXiv:1010.260

Missing values: sparse inverse covariance estimation and an extension to sparse regression

We propose an l1-regularized likelihood method for estimating the inverse covariance matrix in the high-dimensional multivariate normal model in presence of missing data. Our method is based on the assumption that the data are missing at random (MAR) which entails also the completely missing at random case. The implementation of the method is non-trivial as the observed negative log-likelihood generally is a complicated and non-convex function. We propose an efficient EM algorithm for optimization with provable numerical convergence properties. Furthermore, we extend the methodology to handle missing values in a sparse regression context. We demonstrate both methods on simulated and real data.Comment: The final publication is available at http://www.springerlink.co

Klotho gene polymorphism, brain structure and cognition in early-life development

Variation in the klotho gene is linked to differences in health outcomes: klotho allele KL-VS heterozygosity is associated with longevity, better cognition and greater right frontal grey matter volume in late life. Contradicting reports, however, suggest that KL-VS’s effect on health might be age-dependent. Here we examine the relationship between KL-VS genotype, cognition and brain structure in childhood and adolescence. We hypothesized that KL-VS has early influences on cognitive and brain development. We investigated the associations of KL-VS carrier status with cognition and brain morphology in a cohort of 1387 children and adolescents aged 3–21 years, examining main effects and interactions between age, sex and socioeconomic circumstance. KL-VS had no main effect on either cognition or brain structure, though there was a significant KL-VS × age interaction for cognition (specifically executive function, attention, episodic memory, and general cognition), total grey matter and total brain volume. KL-VS heterozygotes had better cognition than non-carriers before age 11, but lower cognition after age 11. Heterozygotes had smaller brains than non-carriers did in early childhood. Sex moderated the association between KL-VS and white matter volume. Among girls, KL-VS heterozygotes had smaller white matter volumes than non-carriers. Among boys, heterozygotes had greater white matter volumes than non-carriers. However, a replication in a cohort of 2306 children aged 6–12 years showed no significant associations. In contrast to findings in late life, these results show that KL-VS does not have a main effect on cognition and brain structure. Furthermore, KL-VS’s influence may depend on age and sex