Culture

An eight-week programme of mindfulness meditation improves quality of life and reduces fear of activity in heart attack patients, according to research presented today at ESC Acute CardioVascular Care 2021, an online scientific congress of the European Society of Cardiology (ESC).1

"A heart attack is a serious life-threatening event and survivors can suffer from low quality of life," said study author Dr. Canan Karadas of Hacettepe University, Ankara, Turkey. "One reason is a fear of movement, called kinesiophobia, which limits daily activity due to concerns of another heart attack."

"Mindfulness refers to the mental state achieved by focusing awareness on the present moment, including thoughts, feelings, and physical sensations," continued Dr. Karadas. "It has drawn increasing attention for treating chronic conditions such as high blood pressure. Our study examined its effect on fatigue, kinesiophobia, and quality of life after an acute myocardial infarction."

The study included 56 patients who had experienced a heart attack. The average age at enrolment was 55 years. Participants were randomly assigned to a mindfulness or control group for eight weeks. Patients in the control group attended one 15-minute individual education session on the structure and function of the heart, the coronary arteries, and diseases of the heart.

Patients assigned to the mindfulness intervention attended an individual session which included a 15-minute description of the technique. This was followed by 15 minutes of supervised practice: patients were asked to sit comfortably on a chair with their backs straight and eyes closed. They were then instructed to breathe deeply - inhaling through the nose and exhaling through the mouth using the diaphragm - and focus on their breathing and the present moment. Participants received a recording of the instructions via WhatsApp and were asked to repeat the 15-minute session every day at home in a quiet room. Daily reminders (text messages or phone calls) were used to motivate patients to practice the meditation and to evaluate their compliance with the study protocol.

Fatigue, kinesiophobia, and quality of life were assessed at baseline and weeks four, eight and 12 using the Piper Fatigue Scale, Tampa Scale for Kinesiophobia Heart questionnaire, and MacNew Heart Disease Health-Related Quality of Life questionnaire which examines patients' feelings about how their heart condition affects daily function overall and in three areas (physically, emotionally, and socially).

At baseline, there were no differences in the three variables between the intervention and control groups. By week four, patients in the mindfulness group had less fear of movement compared to the control group - a benefit that was sustained at weeks eight and 12. Patients in the mindfulness group had better quality of life overall and in all three areas than those in the control group at week eight, while at week 12 they continued to report better emotional function. Measurements of fatigue did not vary between the two groups at any time point.

Dr. Karadas noted that participants only reported mild fatigue at the beginning of the study which may explain why meditation did not have any impact.

She said: "Our study shows that mindfulness can reduce fear of movement and improve quality of life in heart attack survivors, with effects extending beyond the completion of the intervention. One explanation may be that meditation replaces catastrophic thinking with positive thoughts, making patients feel less emotionally and physically vulnerable. The findings suggest that mindfulness may be considered in the rehabilitation of patients after a heart attack. These results are very encouraging but more studies are needed to confirm our findings."

Results published today show it is possible to identify Parkinson's based on compounds found on the surface of skin. The findings offer hope that a pioneering new test could be developed to diagnose the degenerative condition through a simple and painless skin swab.

Scientists at The University of Manchester have developed a technique which works by analysing compounds found in sebum - the oily substance that coats and protects the skin - and identifying changes in people with Parkinson's Disease. Sebum is rich in lipid-like molecules and is one of the lesser studied biological fluids in the diagnosis of the condition. People with Parkinson's may produce more sebum than normal - a condition known as seborrhoea.

The research has been funded by charities Parkinson's UK and the Michael J. Fox Foundation as well as The University of Manchester Innovation Factory. The work was originally funded following an observation by Joy Milne, whose husband was diagnosed with Parkinson's at the age of 45. Working with Dr Tilo Kunath at the University of Edinburgh, Joy demonstrated an incredible ability to distinguish a distinctive Parkinson's odour in individuals using her sense of smell, even before symptoms emerge in those affected.

The team, led by Professor Perdita Barran, The University of Manchester, and the clinical lead Professor Monty Silverdale at Salford Royal Foundation Trust, recruited 500 people with and without Parkinson's. Samples of sebum were taken from their upper backs for analysis. Using different mass spectrometry methods, 10 chemical compounds in sebum were identified which are elevated or reduced in people with Parkinson's. This allows scientists to distinguish people with Parkinson's with 85 per cent accuracy.

The team confirmed their earlier findings published in ACS Central Science that the volatile compounds on skin can be used to diagnose the condition, increasing the number of people sampled and including participants from the Netherlands, as well as the UK.

In a new study published today in Nature Communications, high resolution mass spectrometry was used to profile the complex chemical signature in sebum of people with Parkinson's and show subtle but fundamental changes as the condition progresses. Detailed analysis showed changes in people with Parkinson's in lipid (fat) processing and mitochondria. Problems with mitochondria - the tiny energy-producing batteries that power cells - are one of the hallmarks of Parkinson's.

This means this 'world first' testing strategy is not only useful in diagnosing Parkinson's but also in monitoring the development of the condition. The skin swab could provide an incredibly important new tool in clinical trials helping researchers measure whether new, experimental treatments are able to slow, stop or reverse the progression of Parkinson's.

The study unveiled novel diagnostic sebum-based biomarkers for Parkinson's, provides insight into understanding of how the condition develops, and links lipid dysregulation to altered mitochondrial function.

These promising results published today could lead to a definitive test to diagnose Parkinson's accurately, speedily and cost effectively. The team is now seeking funding to further develop the test and explore the potential for using the test to 'stratify' patients.

Working with the University of Manchester Innovation Factory, the team has patents filed for their diagnostic techniques and are planning to create a spin-out company to commercialise the new tests. They are also working to use this approach to develop tests for COVID-19 as shown in research last week in EClinical Medicine as well as other conditions and are actively seeking investors interested in supporting the drive to bring this technology to market.

Professor Perdita Barran, Professor of Mass Spectrometry at The University of Manchester, said:
"We believe that our results are an extremely encouraging step towards tests that could be used to help diagnose and monitor Parkinson's.

"Not only is the test quick, simple and painless but it should also be extremely cost-effective because it uses existing technology that is already widely available.

"We are now looking to take our findings forwards to refine the test to improve accuracy even further and to take steps towards making this a test that can be used in the NHS and to develop more precise diagnostics and better treatment for this debilitating condition."

Parkinson's tends to develop gradually and it may be many months, even years, before the symptoms become obvious enough for an individual to visit their GP. A DaTscan is regularly used to help specialists confirm the loss of dopamine-producing cells that cause the development of Parkinson's. However, similar loss may also occur in some other rarer neurological conditions. With no molecular test for the condition, diagnosis is made by a neurologist based on a combination of symptoms such as tremor, slowness, stiffness and balance issues. However, many of the symptoms of Parkinson's can overlap with other conditions, especially in the early stages when progression is gradual and symptoms are more subtle.

In a recent survey of more than 2,000 people with Parkinson's carried out by Parkinson's UK, more than a quarter (26 per cent) reported they were misdiagnosed with a different condition before receiving the correct Parkinson's diagnosis.¹

Professor David Dexter, Associate Director of Research at Parkinson's UK, said:

"We are proud to have part-funded this groundbreaking research which marks a significant step towards developing a quick and accurate test that can not only revolutionise the way we diagnose Parkinson's, but also allow us to monitor how this debilitating condition progresses.

"Every hour, two more people in the UK are diagnosed with Parkinson's and a significant portion of these people may well have been misdiagnosed with, and treated for, another condition before receiving their correct diagnosis. This has been compounded in the COVID-19 pandemic where people have been left waiting and have faced months of anxiety to confirm their diagnosis by a health professional. However, with this innovative test, we could see people being diagnosed quickly and accurately enabling them to access vital treatment and support to manage their Parkinson's symptoms sooner."

56-year-old Daxa Kalayci lives in Leicester and was diagnosed with Parkinson's in September 2019. She was misdiagnosed several times over four years before finally finding out she had the condition.

"I was misdiagnosed with anxiety, stress-related tremors and told that my problems stemmed from going through the menopause. I embarked on a 4-month cruise across the globe not knowing I had Parkinson's. Just two weeks into the trip, my symptoms worsened and my dream holiday turned into a nightmare. Without confirmation that it was Parkinson's, which I had suspected for a long time, I was left with unpleasant side-effects caused by different medications prescribed to manage my symptoms.

"Despite my diagnosis eventually being confirmed by a DaTscan, a quick and simple diagnostic test for Parkinson's would have given me the chance to start my treatment earlier and enjoy life a lot more. But instead, I lost so many years not being able to pursue a career as a paramedic or go back to Nursing.

"This test could be a game-changer for people living with Parkinson's and searching for answers like I was. I am so happy with this news because it will mean that in future people won't have to experience the anxiety of multiple appointments, long waiting times and sleepless nights. The sooner this test is available, the better. Anything that can help people looking for a diagnosis is a bonus."

Several years after scientists discovered what was considered the oldest crater a meteorite made on the planet, another team found it's actually the result of normal geological processes.

During fieldwork at the Archean Maniitsoq structure in Greenland, an international team of scientists led by the University of Waterloo's Chris Yakymchuk found the features of this region are inconsistent with an impact crater. In 2012, a different team identified it as the remnant of a three-billion-year-old meteorite crater.

"Zircon crystals in the rock are like little time capsules," said Yakymchuk, a professor in Waterloo's Department of Earth and Environmental Sciences. "They preserve ancient damage caused by shockwaves you get from a meteorite impact. We found no such damage in them."

Additionally, there are multiple places where the rocks melted and recrystallized deep in the Earth. This process--called metamorphism--would occur almost instantaneously if produced from an impact. The Waterloo-led team found it happened 40 million years later than the earlier group proposed.

"We went there to explore the area for potential mineral exploration, and it was through close examination of the area and data collected since 2012 that we concluded the features are inconsistent with a meteorite impact," Yakymchuk said. "While we were disappointed that we weren't working in a structure that was the result of a meteorite hitting the planet three billion years ago, science is about advancing knowledge through discovery, and our understanding of the Earth's ancient history continues to evolve. Our findings provide scientific data for resource companies and Greenlandic prospectors to find new mineral resources."

Around three times as many males are diagnosed with autism than females. This suggests that biological sex factors may play a role in the development and presentation of autism.

Studies on the neurobiology (brain biology) of males and females with autism have begun to examine brain networks but results have been mixed. This is largely due to the limited availability of data from autistic females.

In response, researchers from Child Mind Institute and colleagues involved in the AIMS2TRIALS, have combined thousands of MRI data openly available for scientific discovery in the Autism Brain Imaging Exchange (ABIDE) repository to explore brain network differences between autistic and neurotypical control males and females. They used the ABIDE sample for discovery of new information and two additional large samples to see if those findings could be repeated (i.e., replicated). These included one sample derived from the Gender Explorations of Neurogenetics and Development to Advance Autism Research made available through the National Database for Autism Research and another one shared by the collaborators of the AIMS2TRIALS.

Across these three samples, the researchers found that both neurotypical males and autistic people showed reduced resting-state brain function in the so-called 'default network', a network that is active when we engage in social cognition or thoughts about ourselves. Additionally, in the discovery sample and in one of the largest of the two replication samples, it was shown that connections between hemispheres (the two halves of the brain) in the visual cortex are reduced in autistic females, while autistic males are not different from males who are not autistic. The results suggest that many autistic people may have different interactions between the two hemispheres of their brain when compared to non-autistic people. This reflects a combination of effects, including some that appear to be unrelated to sex, and some in which there is an interaction between sex and autism diagnosis. Each of these effects appears specific to a different system in the brain.

This study highlights the importance of data sharing and collaboration for implementing discovery science and addressing critical challenges related to reproducibility of findings - which affect all of fields of science. The researchers suggest that there remains an urgent need for more research with similarly large groups of participants, as only then do studies have enough statistical power to reliably account for sources of variability and therefore generate robust conclusions. Until now, limited replication of imaging findings has hampered brain imaging research in autism. The open sharing policies of the Autism Brain Imaging Data Exchange and the NIMH Data Archive, through which the Gender Explorations of Neurogenetics Development to Advance Autism Research was made available, are particularly promising for accelerating the pace of advancement.

DALLAS, March 11, 2021 — For every 10-minute delay between arrival at the emergency room (ER) and starting stroke treatment, patients with severe strokes may lose eight weeks of healthy life, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Delays between the onset of stroke symptoms and arrival at the hospital have long been known to cost lives and brain cells.

“Our study showed that delays in treatment at the hospital may have even more severe consequences on stroke recovery than pre-hospital arrival delays,” said lead study author Mohammed A. Almekhlafi, M.D., M.Sc., assistant professor of clinical neurosciences, radiology and community health sciences in the Cumming School of Medicine at the University of Calgary in Canada.

To examine the timeliness of in-hospital stroke care, researchers examined the time between ER arrival to the start of mechanical clot-removal treatment among 406 patients who participated in seven international stroke trials (Highly Effective Reperfusion evaluated in Multiple Endovascular Stroke trials - HERMES) comparing mechanical clot retrieval (endovascular thrombectomy) with or without clot-busting medication to clot-busting medication alone. The seven studies were published between 2010 and 2015 with different start and end dates.

The patients had their stroke-causing clots removed at comprehensive stroke centers as participants in one of the seven international clinical trials. All the patients in this sub-analysis had experienced a severe stroke with blockage of one of the large brain arteries, and all were treated within four hours of the time they were last known to be well. Outcomes were calculated in terms of healthy life-years lost, an indicator of quality-of-life after stroke that considers a patients’ life expectancy and the extent of their post-stroke disability.

The researchers found:

The median time between symptom onset and arrival at the ER was just over three hours at 188 minutes.
The median time between ER arrival and an artery being punctured to start the clot-removal procedure was more than an hour-and-a-half at 105 minutes.
Every one-hour delay in the hospital resulted in 11 months of healthy life lost.
Every 10-minute delay in the hospital resulted in eight weeks of healthy life lost.

“I was surprised with the degree to which delays in the hospital impacted stroke outcome even in those who arrived at the hospital early following stroke symptoms,” Almekhlafi said.

After a likely stroke patient arrives at the emergency room of a comprehensive stroke center, they should be evaluated by members of the stroke team and rushed into brain imaging to confirm the stroke diagnosis and identify the site of the blockage in the brain vessels. If eligible, clot-busting medications are administered as quickly as possible. Patients are then rushed to a special operating room for the emergency endovascular therapy.

“Delays could occur if brain scanners or angiography suites are occupied by another patient when the stroke patient arrives, or if there are delays in the notification or arrival of the endovascular team to the hospital (such as during overnight hours or weekends),” Almekhlafi said.

Many national and international professional organizations including the American Stroke Association have suggested benchmarks to monitor the time from emergency room arrival until blood flow is restored to the blocked brain artery in order to reduce the risk of severe disability and death.

“Our findings emphasize the importance of continuously monitoring these time metrics to ensure that the speed of care is optimized,” Almekhlafi said.

A limitation of the study is that all patients were taken directly to a comprehensive stroke center capable of delivering endovascular therapy. There may be different consequences of delays for those who are assessed in the ER at a community hospital and then transferred to another hospital or comprehensive stroke center to receive endovascular therapy.

“Fast, urgent delivery of stroke care is crucial for all stroke patients in order to reduce the risk of death and serious disability,” Almekhlafi said.

DALLAS, March 11, 2021 — Pictures of the retina may someday provide early warning signs that a person is at an increased risk of stroke and dementia, making it possible to take preventive measures, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Studies have shown that people with severe retinopathy, damage to the light-sensing tissue at the back of the eye, are more likely to have a diseased-looking brain on magnetic resonance imaging (MRI).

“The retina is a window to the brain,” said Michelle P. Lin, M.D., M.P.H., lead author of the study and a neurologist at Mayo Clinic Jacksonville in Jacksonville, Florida. “A retinal photo that shows a magnified look at the back of the eye, including the retina and optic nerve, is cheaper and faster to perform than an MRI, so we’re wondering if it might be a good screening tool to see who could benefit from a referral to a neurologist for a brain MRI.”

In addition to the eye doctor’s office, retinal photos could be taken by a smart phone camera or via a smart phone adapter, Lin said.

In this study, researchers examined the association of retinopathy with stroke, dementia, and the risk of death in 5,543 adults (average age of 56 years) who participated in the annual U.S. National Health and Nutrition Examination Surveys (NHANES) between 2005 and 2008. Participants during those years were interviewed about many aspects of their medical history and health behaviors, and in addition, they received a retinal scan photo to look for signs of retinopathy.

Compared with participants not diagnosed with retinopathy, those with retinopathy were:

more than twice as likely to have had a stroke;
almost 70% more likely to have dementia; and
more likely to die within the next 10 years, with each increase in the severity of retinopathy conferring a higher risk of death.

The odds were calculated after adjusting for risk factors including age, high blood pressure, diabetes and if they smoke.

“If you have retinopathy, work closely with your primary care doctor to alter your vascular risk factors and ask to be screened for cognitive impairment. You may be referred to a neurologist for evaluation and possibly a brain MRI,” said Lin, who is also an assistant professor of neurology at the Mayo Clinic College of Medicine.

The study is limited because the NHANES data does not differentiate between various types of stroke. In addition, because the surveys rely on self-reported memory problems as an indicator of dementia, the occurrence of dementia may be overestimated.

DALLAS, March 11, 2021 -- African American women have a significantly increased risk of stroke and death during pregnancy and childbirth or in the period right after birth, compared to the risk of stroke among white women, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

"Each year, thousands of American women have a stroke or die from a stroke during pregnancy. The risk of stroke is also high following childbirth," said lead study author Mohamed M. Gad, M.D., a resident physician in the department of internal medicine at the Cleveland Clinic in Cleveland, Ohio. "Even so, we lack data on the racial disparities in cardiovascular disease and stroke outcomes for women during and post-pregnancy in the U.S."

Using the Nationwide Inpatient Sample, a hospital database across the U.S., researchers analyzed data on nearly 40 million pregnant and post-partum women hospitalized during pregnancy regardless of cause between 2002 and 2017. Nearly 22% of the women included were African American.

Researchers evaluated stroke outcomes among the pregnant women and found:

While pregnancy-related stroke was very rare, occurring in just 0.03% of the overall study population, 41% of the women who experienced a stroke during pregnancy were African American.

The highest number of in-hospital deaths for women with pregnancy-associated stroke occurred among African American women, 7.8% versus 5% for white women.

Compared with white women, African American women with pregnancy-associated stroke faced nearly two times the risk of dying from stroke, and the increased risk of death was consistent across age groups. There was little change in these results after accounting for multiple risk factors.

When comparing pregnancy-associated stroke outcomes by income levels, African American women in the lowest income group were 1.91 times more likely to die than white women in the same income group. In the highest income group, African American women were 2.38 times more likely to die compared to their white counterparts.

"We found that serious disparities exist despite adjusting for socioeconomic variables. This means that there is no single socioeconomic factor such as income or access to health care that puts a woman more at-risk. Those factors can contribute, yet they do not explain the whole story," Gad said. "We need to understand and address other potential causes of pregnancy-associated stroke and death. If addressed, we can lower the overall burden of disease in the U.S."

Gad said the study provides evidence that can help improve understanding and guide interventions that could help minimize these racial gaps.

DALLAS, March 11, 2021 — A long-term look at Medicare patients shows that Black patients who have an ischemic stroke (blocked blood flow to the brain) die at a higher rate than white patients, even after accounting for preexisting health conditions, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

“So much of what we know is limited to the early or acute phase — the first two weeks after a stroke,” said lead study author Judith H. Lichtman, Ph.D., M.P.H., professor and chair of the department of epidemiology at the Yale School of Public Health in New Haven, Connecticut. “When you have a stroke, it’s not just about the acute event, it’s about the early recovery period to secondary prevention visits that affect your long-term chances of survival.”

Researchers analyzed data on 744,044 Medicare beneficiaries (ages 65 and older) who had been treated at U.S. hospitals for ischemic stroke between 2005 and 2007. Overall, 85.6% were white, 9.9% were Black and 4.5% were of other races or ethnic groups. Black patients had higher rates of kidney failure, dementia and diabetes. Atherosclerosis and chronic obstructive pulmonary disease (COPD) were more common in white patients.

Patients were followed over a 10-year period, and analysis of the data found:

Overall, the death rate was about 75%. Black patients had the highest death rate at 76.4%, followed by whites at 75.4%; and the death rate for those of other races or other ethnic groups was 70.3%.
Even after adjusting for differences in preexisting health problems, the risk of death within 10 years after stroke was about 4% higher for Black patients than white patients. However, the stroke death risk was about 8% lower for those of other races.
Importantly, within the first year after hospital discharge for ischemic stroke, the death rate for Black patients started to climb slightly in comparison to whites and other races, and these differences continued over the decade.

“These are racial differences in long-term stroke survivorship, and these differences start within the first year after a stroke,” Lichtman said. “We need to take a closer look at the recovery period and think about how we can optimize secondary prevention and post-stroke care for everybody. Stroke care during the first year after a stroke plays an important role in the long run.”

Future research will need to investigate the reasons behind these differences in death rates among Black patients and white patients. “Currently, much of the focus is on the acute stroke event, itself, yet we need to find out more – are there racial differences using rehab services, are some people not seeing neurologists and getting follow up care?” Lichtman said. “Stroke is an acute event, but it’s just as important to focus on early follow-up care that will support patients for better long-term outcomes and survival.”

DALLAS, March 11, 2021-- Silent heart attacks appear to increase stroke risk in adults 65 and older, according to preliminary research to be presented at the American Stroke Association International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

A silent heart attack, also known as a silent myocardial infarction, has no, minimal or unrecognized symptoms. An electrocardiogram (ECG) or some form of imaging of the heart like an echocardiogram or a cardiac magnetic resonance imaging (MRI) is needed for diagnosis.

"Long-term risk of death can be as high after a silent heart attack as it is with a recognized heart attack, and it turns out silent heart attacks are more frequent than traditional chest-crushing heart attacks in older adults," said study author Alexander E. Merkler, M.D., assistant professor of neurology at Weill Cornell Medicine in New York City. "We found having a silent heart attack increases stroke risk, suggesting silent heart attacks may need to be recognized as a new risk factor for stroke."

Merkler and colleagues analyzed health information on more than 4,200 adults who participated in the Cardiovascular Health Study. Participants were 65 years old or older at the start of the study and were enrolled from 1989-1990. Participants had annual study visits from 1989-1999 at multiple centers across the U.S. Researchers evaluated participants' stroke risk for an average of 10 years, with follow-up through June 30, 2015.

Researchers found:

Participants who had evidence of a silent heart attack had a 47% increased risk of developing a stroke, compared to adults who did not have a silent heart attack. Participants who had classic symptoms for a heart attack had an 80-fold increased risk of stroke within one month after their heart attack, compared to participants who were heart attack-free. After the high-risk, one-month period, participants with classic symptoms for a heart attack had a 60% increased risk of having a stroke.

"Our research suggests the increased risk for having a stroke in those with silent heart attacks is similar to the risk found in traditional heart attacks. A silent heart attack may be capable of causing clots in the heart that dislodge and travel to the brain causing a stroke," Merkler said.

The research indicates patients with evidence of a silent heart attack found on an ECG should be considered as having an increased risk of stroke.

"More research is needed to understand how best to treat patients with silent heart attacks to prevent stroke," Merkler noted. "It may also be worthwhile to conduct studies aimed at evaluating whether routine cardiac evaluation for silent heart attacks is warranted in order to help stratify the risk of stroke."

A major limitation of the study is that the majority of study participants were white. The results might not be applicable to younger adults or adults of other races or ethnic groups.

DALLAS, March 11, 2021 — Ambulances with specialized staff and equipment to provide rapid stroke treatment report financial difficulties due to limited reimbursement from health care insurers, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the most recent comprehensive data from the Centers for Disease Control and Prevention (CDC), stroke is the fifth leading cause of death in the United States and a major contributor to long-term disability. Stroke occurs when a blood vessel to or in the brain either becomes blocked or bursts, preventing blood and oxygen from reaching all of the brain. Treatment to quickly restore blood flow to the brain is essential to improve outcomes and survival.

Mobile stroke units are ambulances with specialized staff and equipment to quickly diagnose and treat stroke on the way to the hospital. When every minute is critical, the mobile stroke unit staff can administer medications to restore blood flow, control bleeding or lower high blood pressure before reaching the emergency department. However, mobile stroke units are not widely available, in part because there are no established means for the government or insurance companies to reimburse the costs of care provided by mobile stroke units, especially when specialized tests (CT scans, etc.) and medications are administered outside of a hospital.

“If mobile stroke units cannot be reimbursed for the important care they provide, this vital service will be lost unless private donors are willing to continually step up to support these programs,” said study lead author Kenneth Reichenbach, M.S.N., F.N.P.-C., A.G.A.C.N.P.-B.C., B.S.R.T.-(R), PHRN, program director of the Mobile Stroke Unit at Lehigh Valley Health Network in Allentown, Pennsylvania. “We need overwhelming, united support for this to change within federal entities including the Centers for Medicare and Medicaid Services to explore appropriate pathways for Medicare reimbursement for the full range of advanced mobile stroke unit services.”

Through a blinded survey, researchers collected information in June 2019 (to reflect the previous 12 months of their operation) from all 20 U.S. mobile stroke unit programs. Of the 19 units that responded, 18 reported negative financial status while one, classified as an outpatient clinic and not an ambulance, reported a positive financial status. All mobile stroke programs depend at least partly on funding from personal gifts, grants or institutional support because of billing restrictions from health care insurers.

In other findings, the programs reported administering critical clot-busting medications to stroke patients an average of 72 times per year (median of 30) over the 12 months surveyed for all mobile stroke unit programs combined. Each program is open and available nearly every day of the month, with 600 responses per year, on average, for all programs combined. All mobile stroke units can perform CT scans (computed tomography) to image the brain, and 21% have an additional certification as certified CT mobile laboratories. Each mobile stroke unit has an average of four staff members on board at a time, which may include a CT technologist, paramedic/emergency medical technician, stroke nurse and a stroke expert. Individuals working as stroke experts vary by program: 37% have medical doctors and 16% have an advanced practice health care professional. In 47% of the programs, telemedicine is used instead of an on-board expert to connect remotely to a stroke expert.

“Mobile stroke units diagnose and treat patients with acute stroke safely and considerably faster than patients arriving to an emergency department by regular ambulance or private auto,” Reichenbach said. “Saving brain tissue could translate into better functional outcome and quality of life for many more stroke patients.”

The American Heart Association’s 2019 Recommendations for the Establishment of Stroke Systems of Care suggests reimbursement is an issue that warrants further investigation before there is widespread use of mobile stroke units.

To recognize stroke symptoms requiring immediate treatment, the American Stroke Association recommends everyone remember the acronym F.A.S.T. for face drooping, arm weakness, speech difficulty, time to call 9-1-1. Fortunately, most strokes are preventable through healthy lifestyle choices: not smoking; eating healthy foods; being physically active; maintaining a healthy body weight; and controlling high blood sugar, cholesterol and blood pressure.

DALLAS, March 11, 2021 -- Black and Hispanic women ages 65-74 years old hospitalized with stroke had more severe strokes than their white counterparts, according to preliminary research to be presented at the American Stroke Association International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the American Heart Association, Black women have a higher rate of stroke (3.8%) when compared to white women (2.5%) of similar age, which could lead to a higher death rate or worse quality of life.

"The Black and Hispanic female stroke survivors 65-84 years old were younger and had a greater chance of being sent to a skilled nursing or rehabilitation center when compared to older white females who were discharged home after their stroke," said study author Trudy R. Gaillard, Ph.D., R.N., an associate professor at Florida International University's College of Nursing and Health Sciences in Miami, Florida.

Researchers analyzed Get With The Guidelines® Stroke health information in 1,587 female patients who were discharged after a stroke from Baptist Hospital of Miami from April 2014 to March 2019. The female stroke patients were categorized by age group: 65-74 years old (young), 75-84 years old (middle) and 85 years or older (older). The data analyzed included stroke type and severity; other health issues; age; race/ethnicity; and discharge information - whether patients were discharged home, to a skilled nursing center or to a rehabilitation facility. Black women with stroke accounted for about 27% of all patients; while 37.5% were Hispanic and about 35% were white. Among the participants ages 85 years or older hospitalized for stroke, 18.4% were Black women, 36% were Hispanic women and about 40% were white women.

Researchers found:

Black and Hispanic women ages 65-74 years old hospitalized with stroke had more severe strokes than white women of the same age group. Nearly 99% of the women had health insurance, although Black women were the most likely to be without health insurance. After controlling for age, race, and stroke severity, Black and Hispanic women in the younger (65-74 years) and middle age (75-84 years) groups had a greater chance of being sent to a skilled nursing or rehabilitation center when compared to white women in the oldest age group (85 years and older).

"Future studies are needed to explore the type of health care facilities that women are discharged to after stroke and to examine the quality of care received," Gaillard said. "This type of study should be done in multiple cities, across care settings, including inpatient rehabilitation facilities, skilled nursing facilities or home with or without home health and outpatient rehabilitation services."

Limitations of the study include that it was done in only one hospital and the researchers did not examine patients' outcomes after discharge.

A team of researchers from the Agency for Science, Technology and Research's (A*STAR) Genome Institute of Singapore (GIS) have developed a CRISPR-based gene editor, C-to-G Base Editor (CGBE), to correct mutations that cause genetic disorders. Their research was published in Nature Communications on 2 March 2021.

One in seventeen people in the world suffers from some type of genetic disorder. Chances are, you or someone you know - a relative, friend, or colleague - is one of approximately 450 million people affected worldwide. Mutations responsible for these disorders can be caused by multiple mutagens - from sunlight to spontaneous errors in your cells. The most common mutation by far is the single-based substitution, in which a single-base in the DNA (such as G) is replaced by another base (such as C). Countless cystic fibrosis patients worldwide have C instead of G, leading to defective proteins that cause the genetic disease. In another case, replacing A with T in haemoglobin causes sickle cell anaemia.

To fix these substitutions, the team invented a CRISPR-based gene editor that precisely changes the defective C within the genome to the desired G. This C-to-G base editor (CGBE) invention opens up treatment options for approximately 40 per cent of the single-base substitutions that are associated with human diseases such as the aforementioned cystic fibrosis, cardiovascular diseases, musculoskeletal diseases, and neurological disorders.

The CGBE editor advances the widely adopted CRISPR-Cas9 technology to enable molecular surgery on the human genome. The CRISPR-Cas9 technology is routinely used to disrupt target genes, but it is inefficient when a precise change to particular sequences is desired. The CGBE editor resolves a key aspect of this challenge by enabling efficient and precise genetic changes. CGBE consists of three parts: 1) a modified CRISPR-Cas9 will pinpoint the mutant gene and focus the entire editor on that gene; 2) a deaminase (an enzyme that removes the amino group from a compound) will then target the defective C, and mark it for replacement, and 3) finally, a protein will initiate cellular mechanisms to replace that defective C with a G. This enables a previously unachievable direct conversion from C to G, correcting the mutation and, consequently, treating the genetic disorder.

Dr Chew Wei Leong, Senior Research Scientist at GIS, said, "The CGBE gene editor is a ground-breaking invention that for the first time, directly converts C to G in genes, which potentially opens up treatment avenues for a substantial fraction of genetic disorders associated with single-nucleotide mutations."

"The safety of patients is critical," Dr Chew emphasised. "We are working to ensure our CGBE and CRISPR-Cas modalities are both effective and safe in disease models before we can further develop such modalities for the clinic." For his scientific endeavours in gene editing therapy, he was one of the three young researchers that clinched the prestigious Young Scientist Award (YSA) 2020.

Prof Patrick Tan, Executive Director of GIS, said, "Novel editors such as CGBE are expanding the growing suite of precise genome-editing tools that include cytidine base editors (CBEs), adenine base editors (ABEs), CGBEs, and prime editors. Together, they enable the precise and efficient engineering of DNA for research, biological interrogation, and disease correction, thereby ushering a new age of genetic medicine."

Today, machine learning based methods are of our everyday life, with millions of users every day unlocking their phones through facial recognition or passing through AI-enabled automated security checks at airports and train stations. Traditionally, the processing of information native to the optical domain is being executed in the electronic domain, requiring energy-hungry specialized electronic hardware and conversion between the two realms. Optical machine learning is emerging as an important field, where the processing of optical information is done directly within the optical domain, power-efficient and at the speed of light.

Machine learning tasks, such as pattern recognition or image classification, rely heavily on the multiplication of large matrices, a resource-hungry computational task. Through machine-learning based design of optical elements with sub-wavelength feature sizes it is possible to perform these matrix operations directly in the optical domain, power-efficient through passive optical components. However, these passive optical elements are currently restricted in neuron size and density, while relying on bulky free-space optical systems, making them unsuitable for optical machine learning tasks in the visible wavelength regime and integration into compact designs.

In a new paper published in Light Science & Application, a team of scientists, led by Professor Min Gu from the Centre for Artificial Intelligence Nanophotonics (CAIN), School of Optical, Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China, in collaboration with RMIT University in Melbourne (Australia) has developed a new concept for compact optical machine-learning decryptors (MLDs) that process information at the speed of light trough all-optical inference, without consuming any power and can be directly integrated on a CMOS chips. This energy-efficient commixture of optics and electronics paves a path towards machine learning based analysis of optical information for a new generation of edge devices enhanced by artificial intelligence.

In their work, the scientists use computer-based machine learning methods to train thin holographic perceptrons with nanometer feature size, that are capable of recognizing images and perform critical decryption of messages. Using Galvo-Dithered Two Photon Lithography (GD-TPN), a state-of-the-art laser 3D-nanoprinting technology, the researchers fabricate decryptors for operation in the near infrared region with a neuron density of over 500 million neurons per square centimetre with a height resolution down to 10 nm. The nanoscale feature size of these nanoprinted perceptrons not only leads to a higher neuron density and opens the diffractive neural networks up to process information in the visible and near infrared wavelength regime, it also enables highly compact devices through wide diffraction angles and short operative distances. Hence, the upper limit for the computational power for the nanoprinted decryptors lies at 400 ExaFLOPS (1018 FLOPS, floating operations per second), an increase in the operations per second compared with diffractive devices operating in the THz region and integrated photonic hardware of three and five orders of magnitude, respectively.

By printing the MLDs directly on a CMOS chip, the researchers achieve compact and highly integrated devices, which not only outperform current optical decryption methods, but show the potential for application of full optical inference devices in a wide range of fields from computer vision to medical diagnostics. Through the targeted wavelength region, the compactness, the possibility to perform a multitude of tasks, combined with the intrinsic compatibility with electronic-chip manufacturing, including but not limited to CMOS chips, the machine learning decryptors pave the way for a completely new generation of fast and power-efficient functional optical elements for a new generation of edge devices with a wide range of applications.

It was not the fly itself that caught the scientists' attention, but its bulging abdomen suggesting it was still full with the fly's last food intake. Surprisingly, analysis of the stomach content revealed it was full with pollen from different plants. The fossil pollen from the fly's stomach was used to reconstruct the ancient environment inhabited by the fly, the biotic interactions between plant and fly, and the fly's behaviour during feeding.

Flies as pollinators

Today, bees, butterflies and bumblebees are the typical pollinators, which are also known to feed on pollen. That flies also play an important role in pollination is rarely addressed. "The rich pollen content we discovered in the fly's stomach suggests that flies were already feeding and transporting pollen 47 million years ago and shows it played an important role in the pollen dispersal of several plant taxa", says Fridgeir Grímsson from the Department of Botany and Biodiversity Research of the University of Vienna. "Flies were major pollinators in ancient (sub-)tropical equivalent ecosystems and might even have outshined the bees", the scientist concludes.

Short-distance flights for food

The extracted pollen was dominated by grains of Decodon (waterwillow) and Parthenocissus (virgin ivy). Today, the waterwillow is a sub-shrub growing in wetlands and the shallows of lakes, suggesting open low canopy habitat. The co-dominance of virgin ivy also suggests that the fly fed on plants growing at the forest margin surrounding the ancient Messel lake. "It is likely that the fly avoided long-distance flights between food sources and sought pollen from closely associated plants", says Grímsson.

An international collaboration headed by researchers from iPSYCH has found genetic variants that increase the risk of aggression in children with ADHD. In the same study, the researchers also discovered that the genetics which increase aggression in some children with ADHD, are the same genetics that affect aggression in children without a diagnosis.

For the first time, researchers have found positions in the genome that increase the risk of getting ADHD with disruptive behaviour disorders (DBDs). DBDs are child psychiatric disorders characterised by antisocial and aggressive behaviours. The findings have been made by the Danish iPSYCH consortium and the Psychiatric Genomics Consortium.

The results can be used to gain an understanding of the biology that leads to ADHD with DBDs, which 20-30 per cent of children with ADHD have.

The researchers analysed the genome from 3,802 children with ADHD and DBDs and 31,305 without and identified three specific locations in the genome that increase the risk of having ADHD with DBDs. One particular genetic variant located on chromosome 11 increases the risk of seems to specific to the aggressive behaviour.

The new study also show that the aggressive behaviour in children with ADHD and DBDs in part can be explained by genetics.

"We've also compared our results with results from another large genetic study of aggression in children who do not have a child psychiatric disorder. We discovered that the genetics involved in ADHD with DBDs to a great extent is shared with the genetics involved in aggression in the general population," says Ditte Demontis, who is one of the researchers behind the study. She is associate professor at Aarhus University and part of the iPSYCH research project, which is where a major part of the data used in the study comes from.

"In other words the genetics that affect aggression in children with ADHD with DBDs are the same as the genetics that underlie aggression in general. Children with ADHD with behavioural disorders have been unlucky and have received many of the genetic variants that increase the risk of aggressive behaviour," says Ditte Demontis.

The results have been published in the scientific journal Nature Communications.

"The results of our study have revealed a small part of the biological mechanisms in the body involved in ADHD with DBDs," says Ditte Demontis.

ADHD and DBDs are both complex disorders in which both environment and genetics affect the risk.

"The genetic risk is comprised of many genetic variants, each of which increases the risk slightly. This means that the genetic variants we have identified in this study only represents the tip of the iceberg," says Ditte Demontis, and emphasises that this is only the first step on the road towards fully understanding the biological mechanisms underlying ADHD with DBDs.

The research results - more information

The study is a genome-wide association study. That is to say, a study in which genetic variants distributed across the entire genome (more than eight million genetic variants in each person) are analysed in order to identify variants that are over-represented in people with ADHD with DBDs compared with people who do not have the disorders.