Interdisciplinary Cardiovascular and Neurologic Outpatient Rehabilitation in Patients Surviving Transient Ischemic Attack or Stroke With Minor or No Residual Deficits

Objective To evaluate the feasibility and effectiveness of a comprehensive outpatient rehabilitation program combining secondary prevention and neurorehabilitation to improve vascular risk factors, neurologic functions, and health-related quality of life (HRQOL) in patients surviving a transient ischemic attack (TIA) or stroke with minor or no residual deficits. Design Prospective interventional single-center cohort study. Setting University hospital. Participants Consecutive consenting patients having sustained a TIA or stroke with 1 or more vascular risk factors (N=105) were included. Interventions Three-month hospital-based secondary prevention and neurorehabilitation outpatient program with therapeutic and educational sessions twice a week. Patients were evaluated at entry and program end. Main Outcome Measures Impact on vascular risk factors, neurological outcome, and HRQOL. Results A total of 105 patients entered the program and 95 patients completed it. Exercise capacity (P<.000), smoking status (P=.001), systolic (P=.001) and diastolic (P=.008) blood pressure, body mass index (P=.005), low-density lipoprotein cholesterol (P=.03), and triglycerides (P=.001) improved significantly. Furthermore, the 9-Hole-Peg-Test (P<.000), Six-minute Walking Test (P<.000), and One Leg Stand Test (P<.011) values as well as HRQOL improved significantly. The program could be easily integrated into an existing cardiovascular prevention and rehabilitation center and was feasible and highly accepted by patients. Conclusions Comprehensive combined cardiovascular and neurologic outpatient rehabilitation is feasible and effective to improve vascular risk factors, neurologic functions, and HRQOL in patients surviving TIA or stroke with minor or no residual deficits.

Attitudes of Parents at risk of inheriting Li-Fraumeni Syndrome towards predictive genetic testing in their minor-aged children.

Li-Fraumeni Syndrome (LFS) is a hereditary cancer syndrome which predisposes individuals to cancer beginning in childhood. These risks are spread across a lifetime, from early childhood to adulthood. Mutations in the p53 tumor suppressor gene are known to cause the majority of cases of LFS. The risk for early onset cancer in individuals with Li-Fraumeni Syndrome is high. Studies have shown that individuals with LFS have a 90% lifetime cancer risk. Children under 18 have up to a 15% chance of cancer development. Effectiveness of cancer screening and management in individuals with Li-Fraumeni Syndrome is unclear. Screening for LFS-associated cancers has not been shown to reduce mortality. Due to the lack of effective screening techniques for childhood cancers, institutions vary with regard to their policies on testing children for LFS. There are currently no national guidelines regarding predictive testing of children who are at risk of inheriting LFS. No studies have looked at parental attitudes towards predictive p53 genetic testing in their children. This was a cross-sectional pilot study aimed at describing these attitudes. We identified individuals whose children were at risk for inheriting p53 genetic mutations. These individuals were provided with surveys which included validated measures addressing attitudes and beliefs towards genetic testing. The questionnaire included qualitative and quantitative measures. Six individuals completed and returned the questionnaire with a response rate of 28.57%. In general, respondents agreed that parents should have the opportunity to obtain p53 genetic testing for their child. Parents vary in regard to their attitudes towards who should be involved in the decision making process and at what time and under what considerations testing should occur. Testing motivations cited most important by respondents included family history, planning for the future and health management. Concern for insurance genetic discrimination was cited as the most important “con” to genetic testing. Although limited by a poor response rate, this study can give health care practitioners insight into testing attitudes and beliefs of families considering pediatric genetic testing.

Domestic Minor Sex Trafficking: The Challenges Faced In Prosecuting Those Who Prey on America’s Youth

This commentary is a discussion of the article "Human Trafficking, Sex Tourism, and Child Exploitation on the Southern Border." Most importantly, it is a comment on the lack of attention given to American children prostituted in our own backyards. All forms of sex trafficking are deplorable but the plight of the American child victim creates unique challenges for prosecutors, law enforcement and non-governmental agencies working hard to bring the crimes involved with domestic minor sex trafficking to the forefront. To that end, this commentary attempts to provide resources and guidance.

The HARPS search for southern extra-solar planets

The meter-per-second precision achieved by today’s velocimeters enables us to search for 1−10 M⊕ planets in the habitable zone of cool stars. This paper reports on the detection of three planets orbiting GJ 163 (HIP 19394), a M3 dwarf monitored by our ESO/HARPS search for planets. We made use of the HARPS spectrograph to collect 150 radial velocities of GJ 163 over a period of eight years. We searched the radial-velocity time series for coherent signals and found five distinct periodic variabilities. We investigated the stellar activity and called into question the planetary interpretation for two signals. Before more data can be acquired we concluded that at least three planets are orbiting GJ 163. They have orbital periods of Pb = 8.632 ± 0.002, Pc = 25.63 ± 0.03, and Pd = 604 ± 8 days and minimum masses msini = 10.6 ± 0.6, 6.8 ± 0.9, and 29 ± 3 M⊕, respectively. We hold our interpretations for the two additional signals with periods P(e) = 19.4 and P(f) = 108 days. The inner pair presents an orbital period ratio of 2.97, but a dynamical analysis of the system shows that it lays outside the 3:1 mean motion resonance. The planet GJ 163c, in particular, is a super-Earth with an equilibrium temperature of Teq = (302 ± 10)(1 − A)1/4 K and may lie in the so-called habitable zone for albedo values (A = 0.34 − 0.89) moderately higher than that of Earth (A⊕ = 0.2−0.3).

The HARPS search for southern extra-solar planets

The vast diversity of planetary systems detected to date is defying our capability of understanding their formation and evolution. Well-defined volume-limited surveys are the best tool at our disposal to tackle the problem, via the acquisition of robust statistics of the orbital elements. We are using the HARPS spectrograph to conduct our survey of ≈850 nearby solar-type stars, and in the course of the past nine years we have monitored the radial velocity of HD 103774, HD 109271, and BD-061339. In this work we present the detection of five planets orbiting these stars, with msin   (i) between 0.6 and 7 Neptune masses, four of which are in two multiple systems, comprising one super-Earth and one planet within the habitable zone of a late-type dwarf. Although for strategic reasons we chose efficiency over precision in this survey, we have the capability to detect planets down to the Neptune and super-Earth mass range as well as multiple systems, provided that enough data points are made available.