A systematic review investigating fatigue, psychological and cognitive impairment following TIA and minor stroke:protocol paper

Approximately 20,000 people have a transient ischemic attack (TIA) and 23,375 have a minor stroke in England each year. Fatigue, psychological and cognitive impairments are well documented post-stroke. Evidence suggests that TIA and minor stroke patients also experience these impairments; however, they are not routinely offered relevant treatment. This systematic review aims to: (1) establish the prevalence of fatigue, anxiety, depression, post-traumatic stress disorder (PTSD) and cognitive impairment following TIA and minor stroke and to investigate the temporal course of these impairments; (2) explore impact on quality of life (QoL), change in emotions and return to work; (3) identify where further research is required and to potentially inform an intervention study

The Comprehensive Post-Acute Stroke Services (COMPASS) study: design and methods for a cluster-randomized pragmatic trial

Background: Patients discharged home after stroke face significant challenges managing residual neurological deficits, secondary prevention, and pre-existing chronic conditions. Post-discharge care is often fragmented leading to increased healthcare costs, readmissions, and sub-optimal utilization of rehabilitation and community services. The COMprehensive Post-Acute Stroke Services (COMPASS) Study is an ongoing cluster-randomized pragmatic trial to assess the effectiveness of a comprehensive, evidence-based, post-acute care model on patient-centered outcomes. Methods: Forty-one hospitals in North Carolina were randomized (as 40 units) to either implement the COMPASS care model or continue their usual care. The recruitment goal is 6000 patients (3000 per arm). Hospital staff ascertain and enroll patients discharged home with a clinical diagnosis of stroke or transient ischemic attack. Patients discharged from intervention hospitals receive 2-day telephone follow-up; a comprehensive clinic visit within 2 weeks that includes a neurological evaluation, assessments of social and functional determinants of health, and an individualized COMPASS Care PlanTM integrated with a community-specific resource database; and additional follow-up calls at 30 and 60 days post-stroke discharge. This model is consistent with the Centers for Medicare and Medicaid Services transitional care management services provided by physicians or advanced practice providers with support from a nurse to conduct patient assessments and coordinate follow-up services. Patients discharged from usual care hospitals represent the control group and receive the standard of care in place at that hospital. Patient-centered outcomes are collected from telephone surveys administered at 90 days. The primary endpoint is patient-reported functional status as measured by the Stroke Impact Scale 16. Secondary outcomes are: caregiver strain, all-cause readmissions, mortality, healthcare utilization, and medication adherence. The study engages patients, caregivers, and other stakeholders (including policymakers, advocacy groups, payers, and local community coalitions) to advise and support the design, implementation, and sustainability of the COMPASS care model. Discussion: Given the high societal and economic burden of stroke, identifying a care model to improve recovery, independence, and quality of life is critical for stroke survivors and their caregivers. The pragmatic trial design provides a real-world assessment of the COMPASS care model effectiveness and will facilitate rapid implementation into clinical practice if successful

NUDT2 Disruption Elevates Diadenosine Tetraphosphate (Ap4A) and Down-Regulates Immune Response and Cancer Promotion Genes.

Regulation of gene expression is one of several roles proposed for the stress-induced nucleotide diadenosine tetraphosphate (Ap4A). We have examined this directly by a comparative RNA-Seq analysis of KBM-7 chronic myelogenous leukemia cells and KBM-7 cells in which the NUDT2 Ap4A hydrolase gene had been disrupted (NuKO cells), causing a 175-fold increase in intracellular Ap4A. 6,288 differentially expressed genes were identified with P < 0.05. Of these, 980 were up-regulated and 705 down-regulated in NuKO cells with a fold-change ≥ 2. Ingenuity® Pathway Analysis (IPA®) was used to assign these genes to known canonical pathways and functional networks. Pathways associated with interferon responses, pattern recognition receptors and inflammation scored highly in the down-regulated set of genes while functions associated with MHC class II antigens were prominent among the up-regulated genes, which otherwise showed little organization into major functional gene sets. Tryptophan catabolism was also strongly down-regulated as were numerous genes known to be involved in tumor promotion in other systems, with roles in the epithelial-mesenchymal transition, proliferation, invasion and metastasis. Conversely, some pro-apoptotic genes were up-regulated. Major upstream factors predicted by IPA® for gene down-regulation included NFκB, STAT1/2, IRF3/4 and SP1 but no major factors controlling gene up-regulation were identified. Potential mechanisms for gene regulation mediated by Ap4A and/or NUDT2 disruption include binding of Ap4A to the HINT1 co-repressor, autocrine activation of purinoceptors by Ap4A, chromatin remodeling, effects of NUDT2 loss on transcript stability, and inhibition of ATP-dependent regulatory factors such as protein kinases by Ap4A. Existing evidence favors the last of these as the most probable mechanism. Regardless, our results suggest that the NUDT2 protein could be a novel cancer chemotherapeutic target, with its inhibition potentially exerting strong anti-tumor effects via multiple pathways involving metastasis, invasion, immunosuppression and apoptosis

Comparative Marital Adjustment of a Selected Sample of Active and Inactive L.D.S. Church Members

This thesis is a study dealing with active and inactive L.D.S. couples and their comparative Marital adjustment. The couples were selected from the geographic areas of Enterprise and Logan, Utah, and Preston, Idaho. Respondents consisted of couples who had at least one child, but no children beyond high school age. Their religiosity was determined by the bishop of the L.D.S. Ward of which they were a member. The bishop considered such factors as attendance at regularly scheduled church meetings and contributions made in the form of tithes in determining whether a couple was considered active or inactive. The sample consisted of 40 active couples and 20 inactive couples. Hypotheses tested in this study were (1) L.D.S. couples who are active in church activities have a higher degree of marital adjustment than those couples who are inactive. (2) L.D.S. couples who are active will rate their marriages as happier on the continuum scale of happiness than will couples who are inactive. (3) Church activity of the part of both husband and wife contributes to the rapport and marital success of the couple. (4) Couples who are least active will be less likely to participate in the study; therefore their marriage adjustment may not be discovered. In testing the hypotheses subjects were given a modified marital adjustment inventory used by Locke, plus questions pertaining to church activity and a set of background questions. The questionnaires were given directly to the subjects by the investigator or were sent by mail to subjects with a letter of instructions. Findings of this study appeared to indicate that active couples had a better marital adjustment. Adjustment scores for active couples ranged from a low of 71 to a high of 123 with an arithmetic mean of 107.80. Adjustment scores for inactive couples ranged from a low of 60 to a high of 121 with an arithmetic mean of 99.15. A t ratio of 3.86 was obtained, which is significant at the level of .01 level of significance. It is to be noted that when adjustment scores of active husbands were compared with inactive, the difference was not so significant. It only approached significance at the .05 level of significance; still active husbands had somewhat higher adjustment scores the arithmetic mean of active husbands was 108.45 compared with 100.95 which was the arithmetic mean for inactive husbands. The difference between active and inactive wives was more significant. Active wives had an arithmetic mean of 107.15 as compared with 97.35 for the inactive. This difference approached significance at the .01 level of significance. A conclusion of the study is, church activity appears to be a factor contributing to the happiness of the couples and to the adjustments of their marriages

Reuse of laundry greywater as affected by its interaction with saturated soil

We conducted laboratory experiments on a well aggregated, non-swelling clay soil to measure water retention, saturated hydraulic conductivity (Ks) and salts present in the irrigation and drainage water to study the impacts of reusing untreated laundry greywater (GW) to irrigate soils in the residential garden beds. We used undisturbed (field) and disturbed (loose and compacted) soil cores to represent situations typical in old and recently established garden beds. Using tap water (TW), soil water retention within 0-10 kPa matric suction was found to be significantly lower and hysteresis significantly higher for the loose soil than the field or compacted soil. Measured values of Ks with TW were in the order loose >field >compacted soil, but these values were reduced to 5-16% when GW was used. Further measurements of Ks with application of TW to soil cores which had been previously saturated with GW, greater reduction in Ks occurred with Ks - 0 for the compacted soil. A comparison of the quality of GW with TW as irrigation water indicated an approx. increase in pH of GW by 3 pH units over TW, two-fold increase in EC, 5-fold increase in Na concentration and a 10-fold increase in Sodium Adsorption Ratio (SAR). Measurements of drainage water during the water flux measurements for Ks showed that the soil was able to reduce pH and EC of infiltrating water, store some salts (Na and K) and released Ca and Mg from soil so that the quality of drainage water improved substantially to become similar in quality to TW. Thus, long-term use of untreated laundry greywater may reduce salt contamination of groundwater, but predispose soils to future environmental hazards from excess sodium accumulation

The ocular manifestations of syphilis in the human immunodeficiency virus type 1-infected host

Nine patients with active ocular or optic nerve involvement by syphilis who also had concurrent human immunodeficiency virus type-1 (HIV-1) infection are described. The ocular manifestations of syphilis led to the discovery of HIV-1 seropositivity in four of nine cases. Fifteen eyes were affected. Ocular manifestations were: iridocyclitis in three eyes, vitreitis in one eye, retinitis or neuroretinitis in five eyes, papillitis in two eyes, optic perineuritis in two eyes, and retrobulbar optic neuritis in two eyes. Three patients diagnosed with acquired immune deficiency syndrome (AIDS) had the worst initial visual acuities. Six of nine patients had evidence of concomitant central nervous syndrome (CNS) involvement with syphilis. Benzathine penicillin was administered intramuscularly to three patients. All three had relapses. Seven of nine patients treated intravenously with high-dose penicillin had dramatic responses to therapy with improvement in vision and serologies and no evidence of relapse. Regimens accepted for the treatment of neurosyphilis appear to be adequate for the treatment of ocular syphilis in HIV-1-infected patients though further long-term follow-up will be required

Body Weight Independently Affects Articular Cartilage Catabolism

Although obesity is associated with osteoarthritis, it is unclear whether body weight (BW) independently affects articular cartilage catabolism (i.e., independent from physiological factors that also accompany obesity). The primary purpose of this study was to evaluate the independent effect of BW on articular cartilage catabolism associated with walking. A secondary purpose was to determine how decreased BW influenced cardiovascular response due to walking. Twelve able-bodied subjects walked for 30 minutes on a lower-body positive pressure treadmill during three sessions: control (unadjusted BW), +40%BW, and -40%BW. Serum cartilage oligomeric matrix protein (COMP) was measured immediately before (baseline) and after, and 15 and 30 minutes after the walk. Heart rate (HR) and rate of perceived exertion (RPE) were measured every three minutes during the walk. Relative to baseline, average serum COMP concentration was 13% and 5% greater immediately after and 15 minutes after the walk. Immediately after the walk, serum COMP concentration was 14% greater for the +40%BW session than for the -40%BW session. HR and RPE were greater for the +40%BW session than for the other two sessions, but did not differ between the control and -40%BW sessions. BW independently influences acute articular cartilage catabolism and cardiovascular response due to walking: as BW increases, so does acute articular cartilage catabolism and cardiovascular response. These results indicate that lower-body positive pressure walking may benefit certain individuals by reducing acute articular cartilage catabolism, due to walking, while maintaining cardiovascular response