Forgotten Borrowers: Protecting Private Student Loan Borrowers Through State Law

Private student loan borrowers arguably have the fewest protections of any users of credit in the United States. In a scarcely debated amendment to federal bankruptcy law in 2005, private student lenders gained the same protections against discharge previously afforded to federal student lenders. Yet private student loan borrowers received none of the rights available to federal student loan borrowers. These include income-driven repayment, relief from repayment on disability, loan discharge for fraud or closed schools, and public service loan forgiveness. Private student loan borrowers thus have neither the bankruptcy protections afforded to nonstudent loan debtors nor the repayment and debt relief rights of student borrowers under the federal loan program. This lack of consumer protection has particular consequence when considering the plight of for-profit school students saddled with private student loans. Some of the worst abuses in the proliferation of higher education debt have been perpetrated against for-profit school attendees. The vast majority of private student loans are cosigned, typically by older family members. This combination of private student loans and for-profit school attendance impacts a much broader range of consumers than would a comparable number of federal student loans. We suggest two types of state legislation to protect these debtors. For prospective for-profit school private borrowers, we propose incorporating some of the protections of federal student loans through the use of a state equivalent to the Federal Trade Commission “Holder Rule.” For all private student loans, we propose a requirement that private lenders engage in a mandatory settlement process, similar to those used by states during the recent foreclosure crisis, as a prerequisite to using state courts for debt collection

The Promise of Neuroprotective Agents in Parkinson’s Disease

Parkinson’s disease (PD) is characterized by loss of dopamine neurons in the substantia nigra of the brain. Since there are limited treatment options for PD, neuroprotective agents are currently being tested as a means to slow disease progression. Agents targeting oxidative stress, mitochondrial dysfunction, and inflammation are prime candidates for neuroprotection. This review identifies Rasagiline, Minocycline, and creatine, as the most promising neuroprotective agents for PD, and they are all currently in phase III trials. Other agents possessing protective characteristics in delaying PD include stimulants, vitamins, supplements, and other drugs. Additionally, combination therapies also show benefits in slowing PD progression. The identification of neuroprotective agents for PD provides us with therapeutic opportunities for modifying the course of disease progression and, perhaps, reducing the risk of onset when preclinical biomarkers become available

Virtual reality for stroke rehabilitation (review)

Published version made available following 12 month embargo from the date of publication [12 Feb 2015] according to publisher policy. Accessed 10/03/2015. Published version available from 13 February 2016

A third-person perspective on co-speech action gestures in Parkinson's disease

A combination of impaired motor and cognitive function in Parkinson’s disease (PD) can impact on language and communication, with patients exhibiting a particular difficulty processing action verbs. Co-speech gestures embody a link between action and language and contribute significantly to communication in healthy people. Here, we investigated how co-speech gestures depicting actions are affected in PD, in particular with respect to the visual perspective—or the viewpoint – they depict. Gestures are closely related to mental imagery and motor simulations, but people with PD may be impaired in the way they simulate actions from a first-person perspective and may compensate for this by relying more on third-person visual features. We analysed the action-depicting gestures produced by mild-moderate PD patients and age-matched controls on an action description task and examined the relationship between gesture-viewpoint, action-naming, and performance on an action observation task (weight judgement). Healthy controls produced the majority of their action-gestures from a first person perspective, whereas PD patients produced a greater proportion of gestures produced from a third person perspective. We propose that this reflects a compensatory reliance on third-person visual features in the simulation of actions in PD. Performance was also impaired in action-naming and weight judgement, although this was unrelated to gesture viewpoint. Our findings provide a more comprehensive understanding of how action-language impairments in PD impact on action communication, on the cognitive underpinnings of this impairment, as well as elucidating the role of action simulation in gesture production

Virtual reality for stroke rehabilitation (Review)

Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This review is made available in accordance with Cochrane Database of Systematic Review's repositories policyBackground Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. Objectives Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. Search methods We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. Selection criteria Randomised and quasi‐randomised trials of virtual reality ("an advanced form of human‐computer interface that allows the user to 'interact' with and become 'immersed' in a computer‐generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. Data collection and analysis Two review authors independently selected trials based on pre‐defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. Main results We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard‐care approach. Primary outcome: results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) ‐0.05 to 0.20, 22 studies, 1038 participants, low‐quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low‐quality evidence). Secondary outcomes: when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate‐quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty‐three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild. Authors' conclusions We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant

Co-speech gestures are a window into the effects of Parkinson’s disease on action representations

Parkinson’s disease impairs motor function and cognition, which together affect language and communication. Co-speech gestures are a form of language-related actions that provide imagistic depictions of the speech content they accompany. Gestures rely on visual and motor imagery, but it is unknown whether gesture representations require the involvement of intact neural sensory and motor systems. We tested this hypothesis with a fine-grained analysis of co-speech action gestures in Parkinson’s disease. 37 people with Parkinson’s disease and 33 controls described two scenes featuring actions which varied in their inherent degree of bodily motion. In addition to the perspective of action gestures (gestural viewpoint/first- vs. third-person perspective), we analysed how Parkinson’s patients represent manner (how something/someone moves) and path information (where something/someone moves to) in gesture, depending on the degree of bodily motion involved in the action depicted. We replicated an earlier finding that people with Parkinson’s disease are less likely to gesture about actions from a first-person perspective preferring instead to depict actions gesturally from a third-person perspective – and show that this effect is modulated by the degree of bodily motion in the actions being depicted. When describing high motion actions, the Parkinson’s group were specifically impaired in depicting manner information in gesture and their use of third-person path-only gestures was significantly increased. Gestures about low motion actions were relatively spared. These results inform our understanding of the neural and cognitive basis of gesture production by providing neuropsychological evidence that action gesture production relies on intact motor network function

Validity of Borg Ratings of Perceived Exertion During Active Video Game Play

International Journal of Exercise Science 6(2) : 164-170, 2013. During physically interactive video game play (e.g., Nintendo Wii), users are exposed to potential distracters (e.g., video, music), which may decrease their ratings of perceived exertion (RPE) throughout game play. The purpose of this investigation was to determine the association between RPE scores and heart rate while playing the Nintendo Wii. Healthy adults (N = 13, 53.5 ± 5.4 years old) participated in two exercise sessions using the Nintendo Wii Fit Plus. During each session participants played a five-minute warm-up game (Basic Run), two separate Wii Fit Plus games (Yoga, Strength Training, Aerobics or Balance Training) for fifteen minutes each, and then a five-minute cool down game (Basic Run). Borg RPE and heart rate were assessed during the final 30 seconds of the warm up and cool down, as well during the final 30 seconds of play for each Wii Fit Plus game. Correlation analysis combining data from both exercise sessions indicated a moderate positive relationship between heart rate and RPE (r = 0.32). Mixed-effects model regression analyses demonstrated that RPE scores were significantly associated with heart rate (p \u3c 0.001). The average percentage of age-predicted heart rate maximum achieved (58 ± 6%) was significantly greater (p = 0.001) than the percentage of maximum RPE indicated (43 ± 11%). Borg RPE scores were positively associated with heart rate in adults during exercise sessions using the Wii Fit Plus. However, this relationship was lower than observed in past research assessing RPE validity during different modes of exercise (e.g. walking, running) without distracters

Virtual reality for stroke rehabilitation: an abridged version of a Cochrane Review.

Published in final form at http://www.minervamedica.it/index2.t?show=R33Y2015N04A0497 Copyright © 2015 EDIZIONI MINERVA MEDICAAim: Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation settings over the last ten years. The primary objective of this review was to determine the effectiveness of virtual reality on upper limb function and activity after stroke. The impact on secondary outcomes including gait, cognitive function and activities of daily living was also assessed. Methods: Randomised and quasi-randomised controlled trials comparing virtual reality with an alternative intervention or no intervention were eligible to be included in the review. The authors searched a number of electronic databases including: the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, clinical trial registers, reference lists, Dissertation Abstracts and contacted key researchers in the field. Search results were independently examined by two review authors to identify studies meeting the inclusion criteria. Results: A total of 37 randomised or quasi randomised controlled trials with a total of 1019 participants were included in the review. Virtual reality was found to be significantly more effective than conventional therapy in improving upper limb function (standardised mean difference (SMD) 0.28, 95% confidence intervals (CI) 0.08 to 0.49)) based on 12 studies and significantly more effective than no therapy in improving upper limber function (SMD 0.44 (95%CI 0.15 to 0.73)) based on nine studies. The use of virtual reality also significantly improved activities of daily living function when compared to more conventional therapy approaches (SMD 0.43 (95%CI 0.18 to 0.69)) based on eight studies. Conclusion: While there are a large number of studies assessing the efficacy of virtual reality they tend to be small and many are at risk of bias. While there is evidence to support the use of virtual reality intervention as part of upper limb training programs, more research is required to determine whether it is beneficial in terms of improving lower limb function and gait and cognitive functio

Preface

Author Posting. © The Author(s), 2014. This is the author's version of the work. It is posted here by permission of Elsevier for personal use, not for redistribution. The definitive version was published in Deep Sea Research Part II: Topical Studies in Oceanography 103 (2014): 1-5, doi:10.1016/j.dsr2.2014.02.007.The Gulf of Maine (GOM) is a continental shelf sea in the northwest Atlantic, USA that supports highly-productive shellfisheries that are frequently contaminated by toxigenic Alexandrium fundyense blooms and outbreaks of paralytic shellfish poisoning (PSP), resulting in significant economic and social impacts. Additionally, an emerging threat to these resources is from blooms of toxic Pseudo-nitzschia species that produce domoic acid, the toxin responsible for amnesic shellfish poisoning (ASP). Nearshore shellfish toxins are monitored by state agencies, whereas most offshore stocks have had little or no routine monitoring. As a result, large areas of federal waters have been indefinitely closed or their shellfish beds underexploited because of the potential risk these toxins pose and the lack of scientific understanding and management tools. Patterns and dynamics of Alexandrium blooms and the resulting shellfish toxicity in nearshore waters were examined in a number of research projects, the largest being the Ecology and Oceanography of Harmful Algal Blooms (ECOHAB)-Gulf of Maine (GOM), a five-year regional program emphasizing field surveys, laboratory studies and numerical modeling. At the completion of the ECOHAB-GOM program (documented in Anderson et al., 2005), great progress was made in understanding A. fundyense blooms and resulting shellfish toxicity in nearshore waters, but there were major unknowns that still required investigation. For example, little was known about A. fundyense bloom dynamics in the waters south and east of Cape Cod, Massachusetts, and in particular, about the link between blooms in surface waters and toxicity in deep offshore shellfish. Large areas of offshore shellfish beds were off limits to harvest, including a 40,000 km2 region closed during the 2005 bloom and a much larger zone (~80,000 km2) including portions of Georges Bank was closed in 1990 after high levels of PSP toxicity were detected. In recent years, pressures were mounting from industry to open those offshore areas and to develop management strategies so that surfclam (Spisula solidissima), ocean quahog (Arctica islandica), and roe-on sea scallop (Placopecten magellanicus) fisheries could be opened. In response to these unknowns and societal needs, a new multi-investigator program, GOMTOX (Gulf of Maine Toxicity), was formulated and ultimately funded through the NOAA ECOHAB program. GOMTOX was a regional observation and modeling program that investigated the patterns and mechanisms underlying A. fundyense and Pseudo-nitzschia blooms and the resulting toxicity in shellfish in the southern GOM and its adjacent New England shelf waters, with special emphasis on the delivery pathways, mechanisms, and dynamics of offshore shellfish toxicity. The GOMTOX team of investigators included 16 principal investigators from eight institutions and, continuing in the ECOHAB-GOM tradition, strong participation from federal and state resource managers as well as representatives of the shellfish industry. This team worked together for over five years, running numerous large-scale survey cruises of Alexandrium cells and cysts, and also supporting industry cruises to collect shellfish from offshore sites including Georges Bank. Other efforts included participation in National Marine Fisheries Service surveys for shellfish (sea scallops, surfclams, and ocean quahogs), numerical modeling studies, deployment of sediment traps, and laboratory and ship-based experiments to investigate grazing and other processes that might regulate blooms and deliver toxins to shellfish in deeper waters. A smaller-scale but concurrent effort collected samples to characterize Pseudo-nitzschia species and their potential toxicity in the region.We gratefully acknowledge the support of NOAA through the ECOHAB program. Partial support for some of the studies contained herein was provided by NSF and NIEHS through the Woods Hole Center for Oceans and Human Health. Funding for J.L. Martin’s contributions from the Bay of Fundy was provided by Fisheries and Oceans Canada and NERACOOS, which is a part of the U.S. Integrated Ocean Observing System, funded in part by National Oceanic and Atmospheric Administration (NOAA)

Translation, cultural adaptation and construct validity of the German version of the Adult Social Care Outcomes Toolkit for informal Carers (German ASCOT-Carer)

Purpose: The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer), developed in England, measures the effects of long-term care (LTC) services and carer support on informal carers’ quality of life (QoL). Translations of the ASCOT-Carer into other languages are useful for national and cross-national studies. The aim of this paper was to report on the translation and cultural adaptation of the original English ASCOT-Carer into German, to assess its content validity and to test for its construct validity (convergent and discriminative/known-group validity). Methods: Translation and cultural adaptation followed the ISPOR TCA guidelines. As part of the translation and adaptation process, five cognitive debriefing interviews with informal carers were used for evaluating linguistic and content validity. In addition, a sample of 344 informal carers of older adults, who received home care services in Austria, was used for hypothesis testing as suggested by the COSMIN checklist to assess convergent and discriminative/known-group validity as part of construct validity. Results: Cognitive interviews provided evidence that questions and response options of the German ASCOT-Carer were understood as intended. Associations between ASCOT-Carer scores/domains and related outcome measures (convergent validity) and expected groups of informal carers and the care service users they care for (discriminative validity) supported construct validity of the translated instrument. Conclusion: The German ASCOT-Carer instrument meets the required standards for content and construct validity which supports its usefulness for (cross-)national studies on LTC-service-related QoL-outcomes in informal carers. Research is encouraged to assess further measurement properties of the translated instrument