Longitudinal dyadic data analysis of stroke survivors and their spousal caregivers

Approximately 795,000 new and recurrent strokes occur each year. Because of the resulting functional impairment, stroke survivors are often discharged into the care of a family caregiver, most often their spouse. This dissertation explored the effect that mutuality, a measure of the perceived positive aspects of the caregiving relationship, had on the stress and depression of 159 stroke survivors and their spousal caregivers over the first 12 months post discharge from inpatient rehabilitation. Specifically, cross-lagged regression was utilized to investigate the dyadic, longitudinal relationship between caregiver and stroke survivor mutuality and caregiver and stroke survivor stress over time. Longitudinal meditational analysis was employed to examine the mediating effect of mutuality on the dyads’ perception of family function and caregiver and stroke survivor depression over time.^ Caregivers’ mutuality was found to be associated with their own stress over time but not the stress of the stroke survivor. Caregivers who had higher mutuality scores over the 12 months of the study had lower perceived stress. Additionally, a partner effect of stress for the stroke survivor but not the caregiver was found, indicating that stroke survivors’ stress over time was associated with caregivers’ stress but caregivers’ stress over time was not significantly associated with the stress of the stroke survivor.^ This dissertation did not find mutuality to mediate the relationship between caregivers’ and stroke survivors’ perception of family function at baseline and their own or their partners’ depression at 12 months as hypothesized. However, caregivers who perceived healthier family functioning at baseline and stroke survivors who had higher perceived mutuality at 12 months had lower depression at one year post discharge from inpatient rehabilitation. Additionally, caregiver mutuality at 6 months, but not at baseline or 12 months, was found to be inversely related to caregiver depression at 12 months.^ These findings highlight the interpersonal nature of stress in the context of caregiving, especially among spousal relationships. Thus, health professionals should encourage caregivers and stroke survivors to focus on the positive aspects of the caregiving relationship in order to mitigate stress and depression. ^

Are anatomic brain locations important in determining the clinical outcomes in acute ischemic stroke? --- An exploratory analysis of the NINDS Stroke Trial data

Background and purpose. Brain lesions in acute ischemic stroke measured by imaging tools provide important clinical information for diagnosis and final infarct volume has been considered as a potential surrogate marker for clinical outcomes. Strong correlations have been found between lesion volume and clinical outcomes in the NINDS t-PA Stroke Trial but little has been published about lesion location and clinical outcomes. Studies of the National Institute of Neurological Disorders and Stroke (NINDS) t-PA Stroke Trial data found the direction of the t-PA treatment effect on a decrease in CT lesion volume was consistent with the observed clinical effects at 3 months, but measure of t-PA treatment benefits using CT lesion volumes showed a diminished statistical significance, as compared to using clinical scales. ^ Methods. We used the global test to evaluate the hypothesis that lesion locations were strongly associated with clinical outcomes within each treatment group at 3 months after stroke. The anatomic locations of CT scans were used for analysis. We also assessed the effect of t-PA on lesion location using a global statistical test. ^ Results. In the t-PA group, patients with frontal lesions had larger infarct volumes and worse NIHSS score at 3 months after stroke. The clinical status of patients with frontal lesions in t-PA group was less likely to be affected by lesion volume, as compared to those who had no frontal lesions in at 3 months. For patients within the placebo group, both brain stem and internal capsule locations were significantly associated with a lower odd of having favorable outcomes at 3 months. Using a global test we could not detect a significant effect of t-PA treatment on lesion location although differences between two treatment groups in the proportion of lesion findings in each location were found. ^ Conclusions. Frontal, brain stem, and internal capsule locations were significantly related to clinical status at 3 months after stroke onset. We detect no significant t-PA effect on all 9 locations although proportion of lesion findings in differed among locations between the two treatment groups.^

A mathematical model of a criminal-prone society

Criminals are common to all societies. To fight against them the community takes different security measures as, for example, to bring about a police. Thus, crime causes a depletion of the common wealth not only by criminal acts but also because the cost of hiring a police force. In this paper, we present a mathematical model of a criminal-prone self-protected society that is divided into socio-economical classes. We study the effect of a non-null crime rate on a free-of-criminals society which is taken as a reference system. As a consequence, we define a criminal-prone society as one whose free-of-criminals steady state is unstable under small perturbations of a certain socio-economical context. Finally, we compare two alternative strategies to control crime: (i) enhancing police efficiency, either by enlarging its size or by updating its technology, against (ii) either reducing criminal appealing or promoting social classes at risk

Wearable soft robotic device for post-stroke shoulder rehabilitation: identifying misalignments

Stroke is the leading cause of long-term disability in the United States, affecting over 795,000 people annually. In order to regain motor function of the upper body, patients are usually treated by regular sessions with a dedicated physical therapist. A cost-effective wearable upper body orthotics system that can be used at home to empower both the patients and physical therapists is described. The system is composed of a thin, compliant, lightweight, cost-effective soft orthotic device with an integrated cable actuation system that is worn over the upper body, an embedded limb position sensing system, an electric actuator package and controller. The proposed device is robust to misalignments that may occur during actuation of the compliant brace or when putting on the system. Through simulations and experimental evaluation, it was demonstrated i) that the soft orthotic cable-driven shoulder brace can be successfully actuated without the production of off-axis torques in the presence of misalignments and ii) that the proposed model can identify linear and angular misalignments online.

The Advantage of Arriving First: Characteristic Times in Finite Size Populations of Error-Prone Replicators

We study the evolution of a finite size population formed by mutationally isolated lineages of error-prone replicators in a two-peak fitness landscape. Computer simulations are performed to gain a stochastic description of the system dynamics. More specifically, for different population sizes, we compute the probability of each lineage being selected in terms of their mutation rates and the amplification factors of the fittest phenotypes. We interpret the results as the compromise between the characteristic time a lineage takes to reach its fittest phenotype by crossing the neutral valley and the selective value of the sequences that form the lineages. A main conclusion is drawn: for finite population sizes, the survival probability of the lineage that arrives first to the fittest phenotype rises significantly

Agreement Abstractions in Anonymous and Homonymous Distributed Systems Prone to Failures

The distributed computing models typically assume every process in the system has a distinct identifier (ID) or each process is programmed differently, which is named as eponymous system. In such kind of distributed systems, the unique ID is helpful to solve problems: it can be incorporated into messages to make them trackable (i.e., to or from which process they are sent) to facilitate the message transmission; several problems (leader election, consensus, etc.) can be solved without the information of network property in priori if processes have unique IDs; messages in the register of one process will not be overwritten by others process if this process announces; it is useful to break the symmetry. Hence, eponymous systems have influenced the distributed computing community significantly either in theory or in practice. However, every thing in the world has its own two sides. The unique ID also has disadvantages: it can leak information of the network(size); processes in the system have no privacy; assign unique ID is costly in bulk-production(e.g, sensors). Hence, homonymous system is appeared. If some processes share the same ID and programmed identically is called homonymous system. Furthermore, if all processes shared the same ID or have no ID is named as anonymous system. In homonymous or anonymous distributed systems, the symmetry problem (i.e., how to distinguish messages sent from which process) is the main obstacle in the design of algorithms. This thesis is aimed to propose different symmetry break methods (e.g., random function, counting technique, etc.) to solve agreement problem. Agreement is a fundamental problem in distributed computing including a family of abstractions. In this thesis, we mainly focus on the design of consensus, set agreement, broadcast algorithms in anonymous and homonymous distributed systems. Firstly, the fault-tolerant broadcast abstraction is studied in anonymous systems with reliable or fair lossy communication channels separately. Two classes of anonymous failure detectors AΘ and AP∗ are proposed, and both of them together with a already proposed failure detector ψ are implemented and used to enrich the system model to implement broadcast abstraction. Then, in the study of the consensus abstraction, it is proved the AΩ′ failure detector class is strictly weaker than AΩ and AΩ′ is implementable. The first implementation of consensus in anonymous asynchronous distributed systems augmented with AΩ′ and where a majority of processes does not crash. Finally, a general consensus problem– k-set agreement is researched and the weakest failure detector L used to solve it, in asynchronous message passing systems where processes may crash and recover, with homonyms (i.e., processes may have equal identities), and without a complete initial knowledge of the membership.

Agreement Abstractions in Anonymous and Homonymous Distributed Systems Prone to Failures

The distributed computing models typically assume every process in the system has a distinct identifier (ID) or each process is programmed differently, which is named as eponymous system. In such kind of distributed systems, the unique ID is helpful to solve problems: it can be incorporated into messages to make them trackable (i.e., to or from which process they are sent) to facilitate the message transmission; several problems (leader election, consensus, etc.) can be solved without the information of network property in priori if processes have unique IDs; messages in the register of one process will not be overwritten by others process if this process announces; it is useful to break the symmetry. Hence, eponymous systems have influenced the distributed computing community significantly either in theory or in practice. However, every thing in the world has its own two sides. The unique ID also has disadvantages: it can leak information of the network(size); processes in the system have no privacy; assign unique ID is costly in bulk-production(e.g, sensors). Hence, homonymous system is appeared. If some processes share the same ID and programmed identically is called homonymous system. Furthermore, if all processes shared the same ID or have no ID is named as anonymous system. In homonymous or anonymous distributed systems, the symmetry problem (i.e., how to distinguish messages sent from which process) is the main obstacle in the design of algorithms. This thesis is aimed to propose different symmetry break methods (e.g., random function, counting technique, etc.) to solve agreement problem. Agreement is a fundamental problem in distributed computing including a family of abstractions. In this thesis, we mainly focus on the design of consensus, set agreement, broadcast algorithms in anonymous and homonymous distributed systems. Firstly, the fault-tolerant broadcast abstraction is studied in anonymous systems with reliable or fair lossy communication channels separately. Two classes of anonymous failure detectors AΘ and AP∗ are proposed, and both of them together with a already proposed failure detector ψ are implemented and used to enrich the system model to implement broadcast abstraction. Then, in the study of the consensus abstraction, it is proved the AΩ′ failure detector class is strictly weaker than AΩ and AΩ′ is implementable. The first implementation of consensus in anonymous asynchronous distributed systems augmented with AΩ′ and where a majority of processes does not crash. Finally, a general consensus problem– k-set agreement is researched and the weakest failure detector L used to solve it, in asynchronous message passing systems where processes may crash and recover, with homonyms (i.e., processes may have equal identities), and without a complete initial knowledge of the membership.

Bone mineral density and incidence of stroke: European Prospective Investigation into Caner-Norfolk population-based study, systematic review and meta-analysis : European Prospective Investigation into Cancer - Norfolk population–based study, systematic review, and meta-analysis

Peer reviewed

Stroke following percutaneous coronary intervention : type-specific incidence, outcomes and determinants seen by the British Cardiovascular Intervention Society 2007-12

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Derivation and Validation of a Novel Prognostic Scale (Modified–Stroke Subtype, Oxfordshire Community Stroke Project Classification, Age, and Prestroke Modified Rankin) to Predict Early Mortality in Acute Stroke

© 2015 American Heart Association, Inc.

Role of lipid polymorphism in G protein-membrane interactions: Nonlamellar-prone phospholipids and peripheral protein binding to membranes

Heterotrimeric G proteins (peripheral proteins) conduct signals from membrane receptors (integral proteins) to regulatory proteins localized to various cellular compartments. They are in excess over any G protein-coupled receptor type on the cell membrane, which is necessary for signal amplification. These facts account for the large number of G protein molecules bound to membrane lipids. Thus, the protein-lipid interactions are crucial for their cellular localization, and consequently for signal transduction. In this work, the binding of G protein subunits to model membranes (liposomes), formed with defined membrane lipids, has been studied. It is shown that although G protein α-subunits were able to bind to lipid bilayers, the presence of nonlamellar-prone phospholipids (phosphatidylethanolamines) enhanced their binding to model membranes. This mechanism also appears to be used by other (structurally and functionally unrelated) peripheral proteins, such as protein kinase C and the insect protein apolipophorin III, indicating that it could constitute a general mode of protein-lipid interactions, relevant in the activity and translocation of some peripheral (amphitropic) proteins from soluble to particulate compartments. Other factors, such as the presence of cholesterol or the vesicle surface charge, also modulated the binding of the G protein subunits to lipid bilayers. Conversely, the binding of G protein-coupled receptor kinase 2 and the G protein β-subunit to liposomes was not increased by hexagonally prone lipids. Their distinct interactions with membrane lipids may, in part, explain the different cellular localizations of all of these proteins during the signaling process.

Immunologic tolerance to myelin basic protein decreases stroke size after transient focal cerebral ischemia

Immune mechanisms contribute to cerebral ischemic injury. Therapeutic immunosuppressive options are limited due to systemic side effects. We attempted to achieve immunosuppression in the brain through oral tolerance to myelin basic protein (MBP). Lewis rats were fed low-dose bovine MBP or ovalbumin (1 mg, five times) before 3 h of middle cerebral artery occlusion (MCAO). A third group of animals was sensitized to MBP but did not survive the post-stroke period. Infarct size at 24 and 96 h after ischemia was significantly less in tolerized animals. Tolerance to MBP was confirmed in vivo by a decrease in delayed-type hypersensitivity to MBP. Systemic immune responses, characterized in vitro by spleen cell proliferation to Con A, lipopolysaccharide, and MBP, again confirmed antigen-specific immunologic tolerance. Immunohistochemistry revealed transforming growth factor β1 production by T cells in the brains of tolerized but not control animals. Systemic transforming growth factor β1 levels were equivalent in both groups. Corticosterone levels 24 h after surgery were elevated in all sham-operated animals and ischemic control animals but not in ischemic tolerized animals. These results demonstrate that antigen-specific modulation of the immune response decreases infarct size after focal cerebral ischemia and that sensitization to the same antigen may actually worsen outcome.