Highlights from Day One of the World Congress of Neurology 2019 – WFN News

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Report byProf. Tissa Wijeratne MD FRACP FRCP (Edin) FRCP (London) FAHA FAAN (USA)

Over four thousand neurologists from a hundred and twenty-six countries gathered in Dubai for the 24th World Congress of Neurology.

The beautiful, warm Dubai was greeted with a real treat on the Battle to Beat Parkinsons Disease by Professor Patric Brundin, honoured recipient of the Fulton award on 27th October 2019.

Professor Brundin discussed several recent studies that have shed new light and new clues on the pathogenesis of Parkinson's. These suggest that prion-like propagation, neuroinflammation and cellular energy deficits play key roles in the pathogenesis of PD.

The plenary lecture on molecular precision in neurology and contributions by autozygome was exemplary.

The 24th World Congress of Neurology is the largest conference of its kind in this region.This massive task is a byproduct of collaboration between the Emirates Society of Neurology (EMINS) and the World Federation of Neurology. We are proud to deliver aprogram featuring 232 lectures, 158 workshops, and 1438 posters on numerous aspects of cutting edge research findings, to promote better brain health worldwide.

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Highlights from Day One of the World Congress of Neurology 2019 - WFN News

Rare genetic mutations protected a woman from developing Alzheimer’s – Quartz

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Most of the time when we think about genetic mutations, we think about the ones that spell disaster. But sometimes, our genes can have the opposite effect: Instead of increasing our risk for certain diseases, they can protect us from them.

This has turned out to be the case with a Colombian woman in her 70s. By all indications, she shouldhave developed Alzheimers disease by her mid-40s. She has one of three rare mutations that lead to early-onset Alzheimers diseasepeople with this mutation only make up about 1% the 44 million individuals living with Alzheimers globally. And yet, by the time she turned 70 she was still mostly healthy; although she has developed mild cognitive impairment, which can be a warning sign for Alzheimers, she may never experience dementia.

The reason for her continued health? A super rare mutation to both copies of anothergene related to Alzheimers, called APOE. Called the Christchurch mutation (for the town in New Zealand where scientists discovered it in the 1980s), it seems to somehow counteract the risk of Alzheimers diseaseand could inspire future treatments or preventions for it. Researchers in the US and in Colombia published the womans case study on Monday, Nov. 4 in the journal Nature Medicine.

The woman, who is still alive and living in Colombia, comes from a family where dominantly-inherited Alzheimers is common. She and some 6,000 members of her kindred participate in the Colombia Alzheimers Prevention Registry, which is run by Francisco Lopera, a neurologist at the University of Antioquia in Colombia. Some 1,200 people in the registry have a mutation that causes them to over-produce amyloid protein in the brain, one of the hallmark signs of the disease. Everyone in the registry can enroll in clinical research trials for Alzheimers.

This particular woman, however, never got sick. When researchers maintaining the registry noticed that it took her three decades to even develop mild cognitive impairment, they flew her to Boston, where she agreed to let researchers at Harvard University conduct a series of tests.

What they found in her brain imaging shocked them. She had the highest amyloid beta burden of anyone else in the cohort, says Eric Reiman, a neurologist with the Banner Alzheimers Institute in Arizona, who co-authored the paper. This was consistent with her dominantly-inherited Alzheimers mutation. Normally, these high levels of amyloid are thought to lead to buildups of another deformed protein, called tau, along with inflammation and the ultimate destruction of neurons.

But the woman didnt have the characteristic tangles of tau. And the regions of her brain that are most commonly affected by Alzheimers still seemed to be working just like they would in an otherwise healthy adult.

When they sequenced her whole genome, researchers found that her APOE gene had two copies of the Christchurch mutation: a single basepair switch that tweaks the protein produced by the gene. Somehow, this tweaked version of the protein seemed to mitigate the effects of the extra amyloid in her brain.

That means targeting these downstream effects, in addition to amyloid itself, may be a viable treatment for Alzheimersalthough its not clear how to go about that just yet. The vast majority of drug trials targeting amyloid have failed, with the notable exception of one trial from the drug company Biogen that appears to have had positive results. Having more targets increases the likelihood of having more successful treatments that work for more people, or even combination therapies.

This case study leads us to think about the importance of such studies in relatively understudied populations, says Nilufer Ertekin-Taner, a neurogeneticist with the Mayo Clinic in Jacksonville, Florida, who was not involved with the study. Scientific knowledge of the Christchurch mutation suggests that its incredibly rare, but that could be because the majority of research on Alzheimers and dementia has been done on white populations. By including more diverse populations in future research, scientists can get a better idea of how this mutation works in other healthy populationsand ultimately, how it could mitigate the disease overall.

Correction (Nov. 4): An earlier version of this story accidentally mis-named Eric Reiman as Dan Reiman.

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Rare genetic mutations protected a woman from developing Alzheimer's - Quartz

Neurology Residency Program Conferences | Lewis Katz …

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Morning Report is a daily clinical conference discussing admissions and consults of the previous night. This conference takes place every morning from 8:00 to 9:00 a.m., and is directed by the Chairperson and other faculty members. The conference discusses medical, social and pathophysiological aspects of admitted patients. Attendance is required by all residents, medical students and rotating house staff from other departments.

Grand Rounds is a weekly clinical conference that takes place every Friday in conjunction with the Department of Neurosurgery and basic neurosciences. Our Triple "N" (Neurology/Neurosurgery/Neuroradiology) Conference follows Grand Rounds and is a multi-specialty endeavor.

Subspecialty conferences are held weekly on stroke, epilepsy, movement disorders, neuromuscular diseases, etc. for residents and medical students. These conferences are presented to the residents and medical students by the respective experts on these topics. The conferences are scheduled by the chief residents, the Residency Program Director and the Chairperson of Neurology.

Basic neurosciences are currently taught by Dr. Ausim Azizi on Tuesdays to neurology, neurosurgery and psychiatry residents.

The department participates and organizes continuing neurological education programs for community physicians and neurologists.

Finally, and most importantly, bedside clinical teaching to house staff and medical students takes place on a daily basis by Department of Neurology faculty.

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Neurology Residency Program Conferences | Lewis Katz ...

Neurosurgery Residency Research | Lewis Katz School of …

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Resident Research Requirements

Residents are expected to be academically productive appropriate to their level of training within the program. Junior residents are expected to work on case reports, book chapters, and/or assist senior residents with ongoing projects. Senior residents are expected to produce academic publications based on their laboratory and clinical experience prior to graduation from the program. Notably, residents have recieved the Synthes Award for Resident Research on Spinal Cord and Spinal Column Injury for three consecutive years for excellent clinical and laboratory work done during their research year.

The Neurosurgery Department has worked with several labs at Temple, covering a variety of areas in research. Some examples include:

Dr. Ronald Tuma, Department of Physiology:Focus on investigations of inflammatory reactions that contribute to CNS injury following stroke, trauma or autoimmune disease via the use of experimental animal models.

Dr. S. Ausim Azizi, Department of Neurology:Focus on cell-based therapies for repair and regeneration of the damaged CNS, signaling pathways of differentiation of adult stem cells into useful neuroal cells, and the feasibility of neurotransplantation.

Dr. Weaver/Dr. Khalili, Departments of Neurosurgery/Neuroscience:Several topics including molecular biology of neurotropic viruses in the brain, and a program in viral oncology focusing on CNS neoplasms.

Several clinical trials are also in progress at TUH under the guidance of the Neurosurgery faculty.

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Professionalism: A Proposed ACGME Curriculum in Telemedicine for Neurology Residents – LWW Journals

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ARTICLE IN BRIEF

Five training modules in telemedicine skills are proposed for neurologists in training.

Teleneurology practice has been gaining steam for more than a decade, driven by the huge successes of remote stroke care (telestroke), the ongoing neurologist shortage, the aging of the U.S. population, and the demands of rural health care. Yet while training exists as part of some residency programs and continuing medical education (CME) offerings, there are no national standards for teleneurology curriculum and certification.

A paper published in the August 2 online issue of Neurology with input from the AAN's Telemedicine Work Group hopes to address that, by proposing a curricular framework that could become the nationally standardized basis to train residents in teleneurology and ultimately medical students, practicing physicians, and allied health professionals as well.

We are hearing from residency program directors that residents are starting to practice and are being asked for documentation of teleneurology training for credentialing purposes when no formal training curricula exist, said the lead author of the paper, Raghav Govindarajan, MD, assistant professor of neurology at the University of Missouri School of Medicine and chair of the Telemedicine Work Group. That's the gap we're trying to address with this curriculum.

Establishing a curriculum will help create national teleneurology practice standards, replacing the existing patchwork of state and local parameters. As physicians, we traditionally practice in one geographic location, and our practice is regulated by the state medical board, said Eric Anderson, MD, PhD, a study co-author, vice chair of the AAN Practice Committee, and director of telemedicine at CortiCare, a US-based telemetry diagnostic company. In telemedicine, most states have taken it upon themselves to set varying rules and regulations regarding the practice, resulting in potentially 50 differing sets of rules.

We want to present a compelling argument and recommendations to the Accreditation Council for Graduate Medical Education [ACGME] to make the teleneurology curriculum an elective for all residencies, said Bart M. Demaerschalk, MD, MSc, FRCPC, professor of neurology at the Mayo Clinic College of Medicine in Phoenix, AZ, medical director of Synchronous Telemedicine Services at the Mayo Clinic Center for Connected Care, and a member of the AAN Telemedicine Work Group. Mayo has specified a telestroke requirement in our vascular neurology training, and ACGME will hold us accountable to that, but that's not coming from the top down. There remains an opportunity for ACGME to standardize teleneurology training.

Among his goals, Dr. Demaerschalk said he would like to see the teleneurology curriculum integrated into all aspects of training, addressing acute and chronic conditions, as well as both hospitals and clinics across neurology specialties.

The Neurology paper divides teleneurology training into five basic equivalencies, beginning with fluency with the technology itself both its abilities and its limitations.

Seeing your first patients via teleneurology can be a clumsy process, and it is easy for us to forget this once we become more experienced, said Amanda Jagolino-Cole, MD, assistant professor of neurology at the McGovern Medical School at the University of Texas Health Sciences Center at Houston, whose work in developing telestroke/teleneurology training in the University of Texas's vascular neurology fellowship appeared in a paper last year in Neurology. Fellows must demonstrate that they are comfortable using the camera, opening images, and completing a note prior to seeing patients and every trainee starts with different skill sets that pertain to teleneurology.

The proposed teleneurology curriculum stresses the importance of knowing not only what teleneurology can efficiently do, but also what it may not be best for vestibular testing, for example, or a comprehensive neuromuscular exam. Parts of the neurology exam are one of the pitfalls of teleneurology, said Scott Vota, DO, a co-author on the paper and interim chair of the department of neurology and director of the adult neurology residency program at Virginia Commonwealth University (VCU). We know it's very helpful in acute stroke and in movement disorders. In neuromuscular diseases, there are some limitations. Evaluating the strength of a muscle or assessing tone are difficult to do over telemedicine.

Dr. Vota's residents initiated the drive for teleneurology training within the VCU program, which started four years ago. Learners today want to understand this and know how to use these tools, he said. They understand that this is the future of neurology practice.

Another training module addresses licensure and medicolegal issues and ethics, which become exponentially more complex when teleneurology providers practice across state lines. The Neurology paper suggests a case-based didactic approach to teaching these issues that includes input from legal and regulatory advisors at individual teaching hospitals. Training also touches on interstate reimbursement issues. Residents and practicing physicians need to stay up to date on constantly changing regulations of all types in the states in which they practice, the authors of the paper wrote.

Dr. Anderson pointed out that different risks may apply in different settings. When you're treating acute stroke patients in an emergency department (ED) setting, for example, you are co-managing a patient with a physician on the other end, he said. When you're remotely treating patients in their homes, there isn't necessarily another physician present with the patient, or a telepresenter, and there's potentially a higher legal liability.

Webside manners, the technique of building and maintaining a rapport with patients who are seen remotely, is another critical part of the curriculum. Even in-person bedside manners can be challenging to some residents, and those challenges are often shifted and amplified over video, with touch and physical presence removed from the clinical encounter. Technology can make it harder to build a relationship, said Dr. Vota. Not being in the room, it can be harder to understand non-verbal cues, to know when to pause, when to let the patient speak.

Something as simple as introducing yourself as a neurologist, stating where you are located, and explaining why you are seeing the patient via telemedicine rather than in person, can go a long way in establishing rapport, said Dr. Jagolino-Cole. We encourage neurovascular fellows and neurology residents to work out proper verbiage for patients and families before getting on the camera.

Another training module focuses on informed consent, patient privacy, and disclosure. Questions arise about what information the patient is disclosing and who will have access to it, or how much of the patient's environment can be seen on camera, and what that might reveal if they are being examined from their home. And finally, the suggested curriculum addresses skills in remote examination and taking a remote history either with or without a telepresenter, a health care provider in the room with the patient who can assist with hands-on aspects of the exam, and clinical documentation of telemedicine exams.

As teleneurology training advances, a key question will be how to adapt a basic curriculum to the needs of subspecialties and specialized patient populations. Probably 90 percent or more of teleneurology practice right now is telestroke, said Dr. Anderson, adding that how telestroke is practiced and its benefits for patients are well-defined. But, he said, Telemedicine for other neurological conditions like headache, or epilepsy is promising, but still relatively lacking. We don't have the same overwhelming body of evidence for those uses yet.

We'll need training on telemedicine in critical care; in epilepsy, with remote monitoring of EEGs; in MS; in dementias, said Dr. Demaerschalk. There will also need to be some unique facets of working with children via connected care, just as treating them in-person is not the same as treating adults.

It is already clear that teleneurology is especially valuable for certain patient populations. Steven S. Schreiber, MD, chief of neurology at the Tibor Rubin VA Medical Center in Long Beach, CA, and professor of neurology in residence at the University of California, Irvine, has studied the successes of teleneurology among veterans living in urban areas. In more rural areas, telemedicine is really crucial because patients often live hundreds of miles away from care sites, he said. Our patients in the Veterans Administration health system are only about 40 miles away from our location, but we find that they actually prefer to have their appointments via teleneurology and avoid logistical inconveniences like heavy traffic.

Teleneurology also makes a marked difference for patients with advanced movement disorders and other incapacitating neurological diseases. For patients with motor neuron disease, for example, who are on a ventilator, getting out of the house to a medical appointment can consume an entire day, Dr. Schreiber said. Being examined in their own homes through a 30- to 60-minute teleneurology encounter is far easier and much less stressful for those patients, and visiting nurses can be trained to assist in those exams.

Geographically isolated Native American patients are another group for whom technology can sometimes be the only way to access care. In Arizona, Dr. Demaerschalk has worked with the Indian Health Service to gradually and respectfully introduce technology to Indian health care provider sites, an endeavor that he says has been very successful. Tribal hospitals have been some of our most fabulous partners, and especially given the remoteness of many Native American communities, technology has been extremely useful, he said.

Between easing logistics for patients who can't get to care sites, caring for an aging population, and coping with the ongoing dearth of neurologists, remote care will become more and more essential. People are increasingly becoming aware that telemedicine is an integral part of value-based patient care, said Dr. Anderson. The writing is on the wall.

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Professionalism: A Proposed ACGME Curriculum in Telemedicine for Neurology Residents - LWW Journals

Adult Neurology Residency Program – New Jersey Medical School

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Machteld Hillen, MD

Program Director, Adult Neurology

Hello and welcome to the Neurology Residency Program at Rutgers, New Jersey Medical School. The goal of our program is to prepare residents for a successful career in clinical or academic neurology, and its related subspecialties. We strive to provide our residents with a supportive environment and the best training available. This is achieved through our broad clinical experience and a strong commitment of teaching from our faculty. Our didactic curriculum covers all aspects of Neurology Medicine equipping our graduating residents with the knowledge required for successful board certification.

Success for both the program and the resident is a balance between a residents needs, ability and attitude as well as the programs ability to help the resident develop into a competent and caring neurologist. Our Department seeks motivated residents with a desire to make a positive impact on a patients life. One who is dependable, possesses a strong work ethic, and maintains a positive and professional attitude.

We hope you consider our residency program as you prepare for your next phase of training in your career. We sincerely thank you for your interest in our program and encourage you to contact us if you have additional questions not covered here on our website.

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Adult Neurology Residency Program - New Jersey Medical School

Epilepsy | Neurology | University Hospitals | Northeast …

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University Hospitals is a National Association of Epilepsy Centers Tier 4 treatment centerthe highest designation for epilepsy care. Our board-certified neurology team provides expert care from relatively mild epilepsy cases to the most complex.

Our epilepsy specialists, called epileptologists, are involved in innovative research, conducting clinical trials and participating in national and international programsthat dig deeper into epilepsys causes and therapies. We also have a dedicated team focused on pediatric epilepsy to make sure we meet the unique needs of children of all ages.

The science around epilepsy is evolving, and our knowledgeable team is committed to staying on top of new developments to make sure the epilepsy treatment we offer can help our patients live a comfortable and fulfilling life.

Epilepsy is a brain disorder that causes a person to have sudden, recurring seizures. These can result in a loss of consciousness, convulsions or other serious physical effects.

If you or your loved one has had a seizure, it is critical to see an epileptologist right away. With specialized training in the diagnosis and treatment of epilepsy, our UH epileptolgists have the experience and expertise to care for your specific needs.

The majority of people diagnosed with epilepsy can be effectively treated with medication. There are many different epilepsy medications available, and our specialists are well-versed in the benefits and side effects of epilepsy medications available.

Some patients are more prone to epilepsy medication side effects, including elderly patients and pregnant women. Future moms also can have an increased risk of seizures, and depending on the medication, there may be an elevated chance for birth defects. At University Hospitals, our team takes a multidisciplinary approach to effective epilepsy management for expectant moms by bringing together a team of specialists. For women with epilepsy that are considering starting a family, or are already pregnant, our high-risk maternal fetal medicine specialists are part of your care team.

By coming to a specialty team of epileptologists, with the advanced training in epileptic seizures and seizure disorders, you will receive the most appropriate path of care for your epilepsy management.

If your medications are not managing your seizures effectively, you may be referred to UHs epilepsy monitoring unit (EMU) that uses advanced technology to continuously monitor brain activity. EMU patients either stop taking or reduce their dose of anti-seizure medications to induce a seizure in a medically supervised, safe environment. This helps our experts determine more information about your disease, including where in the brain seizures are occurring. Our team then pursues more targeted therapy ranging from different medications to possibly surgery.

Some epileptic patients do not respond well to medications despite trying multiple therapies. The good news is there are procedures available that can effectively treat epilepsy and reduce the number of seizures - and even possibly leave the patient seizure free with limited loss of memory. University Hospitals is one of only a few facilities in the country that has the expertise to perform multiple hippocampal transection. Unlike traditional epilepsy procedures, this treatment can limit the spread and synchronization of seizures while leaving the brain intact. For many patients, this procedure can completely eliminate seizures and significantly improve quality of life.

Before any procedure, our neurosurgery team uses the latest imaging technology to make sure we have a clear vision of the surgical area, improving the likelihood of positive outcomes. We also provide advanced Surgical Theater technology, allowing our neurosurgeons to discuss the procedure with patients during a virtual reality walk through of a 3-D simulation of their brain.

Our virtual reality technology eases patient concerns by allowing a visualization of the details of their specific brain surgery before it happens. Through an interactive discussion between patient and surgeon, patients better understand what to expect with surgery and recovery.

Once our team has created and implemented a care plan that works for you, we provide follow-up care, medication management and access to other therapies at many of our locations throughout northeast Ohio. Even if you are referred to us from outside the UH system, we will work with your primary care doctor to manage your condition over the long-term, letting you remain close to home while receiving state-of-the-art treatment from the experts at UH.

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Epilepsy | Neurology | University Hospitals | Northeast ...

Schulman IRB Launches Central Neurology Review (CNR) Service – PR Newswire (press release)

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"As neurology research continues to evolve at a rapid rate, we saw the need to create a specialized IRB model that conducts neurology-focused scientific and regulatory review for multi-site studies," said Eli Alford, Schulman's Chief Operating Officer. "Together with NBREC, we're excited to launch CNR and look forward to supporting the development of the latest techniques, methodologies and discoveries in neurology research."

CNR features a scientific review committee to complement Schulman's best-in-class IRB review. CNR is therapeutically focused and comprised of distinguished scientists and industry leaders who have experience conducting neurology research. By combining the robust expertise of a local IRB, the collaborative capabilities of a central IRB, and the leading minds in neurology research, CNR delivers independent, objective and authoritative review services.

About Schulman IRB

Schulman IRB has been a leader in the protection of human research participants in the U.S., Puerto Rico and Canada since 1983. Schulman offers thorough, timely IRB review services including dedicated review capabilities for all phases of research across all therapeutic areas to clinical trial sponsors, CROs, investigators and institutions. Schulman also provides global consulting services in clinical quality assurance (CQA) and human research protections (HRP), and it also offers a commercial institutional biosafety committee (IBC) service. Fully accredited by the Association for the Accreditation of Human Research Protection Programs (AAHRPP), Schulman has an unparalleled clean audit history with the Food and Drug Administration (FDA).

For more information, please visit http://www.sairb.com or follow @SchulmanIRB on Twitter or on LinkedIn.

About NBREC

Established in 2012as a Nevada-based 501(c)(3)not-for-profitorganization, the National Biomedical Research Ethics Council (NBREC) is committed tothe goals of assuringindividual researchvolunteer safety through the expanded use of single ethics committees, expanding international awareness for research ethics and improving population public health efforts allied with disease surveillance and control.

For more information, please visit http://nbrec.org.

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Schulman IRB Launches Central Neurology Review (CNR) Service - PR Newswire (press release)

Increasing Quality of Life for Neurology Inpatients is Goal of Newly Established Metrics – UCSF News Services

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To improve the quality of life for neurology inpatients, a panel of experts, led by UC San Francisco neurologist S. Andrew Josephson, MD, has released quality measurements.

Increased scrutiny on quality and safety in hospitals nationwide has led to the development of multiple metrics for inpatients across a variety of specialties [but] few quality metrics exist specifically for disorders of the nervous system, said Josephson, chair of the UCSF Department of Neurology, in an article he authored in the journal Neurology, published on July 21, 2017.

Quality measurements are defined as a diagnostic or treatment activity that should be performed in the majority of patients and can be measured using objective criteria.

While there are thousands of guidelines published for treating patients in the hospital, most physicians are unaware of these and do not track their adherence, according to Josephson. To address this, Josephson, together with 30 or so national experts assembled by the American Academy of Neurology and two other national societies, have established these quality measurements.

Josephson and other members of the Inpatient and Emergency Neurology Quality Measurement Set Work Group identified 12 areas in which quality metrics will be used to drive improvements in patient care. These run the gamut from the percentage of neurology inpatients in which brain death was diagnosed using proper procedures, to the percentage of patients suspected of having meningitis who were given a steroid to reduce inflammation at the same time as they were given the first dose of antibiotics.

Rather than allow insurers or non-neurologists to define quality across neurologic conditions, this effort aims to garner neurologic expertise by defining measures that were supported by evidence and were relevant to the practicing neurologist.

The metrics have since been distributed to every neurologist in the nation.

These metrics have the potential to launch a new era in neurologic inpatient medicine, where attention is carefully paid to practicing consistency of evidence-based care, said Josephson, who is also professor of neurology, and director and founder of the UCSF Neurohospitalist Program. This effort will enable physicians and health care systems to work together, reporting rates of adherence to quality metrics that can be easily accessible to other providers, payors and the public at large, driving better care for our patients.

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How the ‘OK, Boomer’ Comment Sparked Conversation on Managing Generational Differences – Gallup

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Story Highlights

When Chle Swarbrick, an MP in New Zealand's Parliament, responded to a colleague's interruption of her speech with "Ok, boomer," media outlets around the world scrambled to explain Swarbrick's remark.

Many of them chastised Swarbrick for insulting baby boomers -- and were criticized in turn by their own audiences. "Ok, boomer" originated on social media platform TikTok to mock condescending closed-mindedness, not age.

The confusion around Swarbrick's comment confirms what leaders of a multigenerational workforce already know: Different generations in the workplace -- and there can be five in the same office -- have very different perspectives. Smoothing them over is a challenge.

Gallup analytics has a solution: Don't.

Instead, focus on your employees' most important differences.

Giving up on smoothing over has important implications. To begin with, those five generations really do expect different things from work.

As Gallup analytics shows, millennials are more likely than the previous generation to say that development opportunities and "quality of manager" are extremely important in a new job.

Millennial employees are dead serious about advancement, are motivated more by mission than money and want coaching, not bossing. Maybe that's not so different than what people of all generations really want but millennials' high quit rate shows they'll leave rather than accept the kind of management the baby boomer generation has tolerated.

That seems like a major generational difference -- and leaders should take it seriously -- but it's really small potatoes compared to the differences between employees' CliftonStrengths. A reflection of deep neurology, our CliftonStrengths influence the way we think, feel and behave, the way we see the world and react to it. That influence is orders of magnitude stronger than any generational characteristic. And each person's unique strengths explain -- and predict -- performance with such acuity that generational labels seem feeble by comparison.

A reflection of deep neurology, our CliftonStrengths influence the way we think, feel and behave, the way we see the world and react to it.

Managers make differences good. And effective.

When team members understand the way their brains work, the way they relate to each other changes. They can't claim Sharon's extreme productivity is due to her baby boomer work ethic (and neither can Sharon, for that matter) -- it's because Achiever is among her top five CliftonStrengths themes. Jason's aversion to forced ranking is not some kind of Gen Xer apathy -- it's because Competition is last on his CliftonStrengths profile. Intense Command, not the infamous "millennial entitlement," drives Taylor to take charge.

Knowing coworkers in this profoundly meaningful way doesn't make differences seem unimportant -- it makes differences seem even more important. It makes differences good.

A canny manager uses a team's understanding of these deep, intractable differences to bring people together: An employee who needs help hitting a deadline needs Sharon. Jason should be part of designing the onboarding routine. Taylor will rally the troops when a project is going to pieces. And even though Sharon thinks paycheck is purpose enough while Taylor feels work ought to have real meaning, high-Command Taylor may be Achiever-driven Sharon's saving grace when she isn't getting enough achieved.

Strengths' influence on behavior is orders of magnitude stronger than any generational characteristic. And strengths explain -- and predict -- performance with such acuity that generational labels seem feeble by comparison.

And if that canny manager coaches people to use their strengths deliberately, the team's performance can be extraordinary: On average, workgroups that receive strengths coaching have up to 19% increased sales, 29% increased profit, 7% higher customer engagement, 16% lower turnover (in low-turnover organizations), 72% lower turnover (in high-turnover organizations), a 15% increase in engagement and 59% fewer safety incidents than teams that don't receive strengths coaching.

Sure, generational expectations in the workplace are real and can have a real impact on your business. Leaders should not ignore them. But talents -- which define us on a profoundly meaningful level -- prove our differences are a thing to admire and use, not insult.

It's all a matter of approach.

Which brings us back to New Zealand. Insults aren't uncommon within its Parliament, and MPs often respond with more heat than Chle Swarbrick did. Nonetheless, Swarbrick got worldwide flak for her remark, which she responded to in a Guardian op-ed. "My 'OK, boomer' comment in Parliament was off the cuff, albeit symbolic of the collective exhaustion of multiple generations," she said, "set to inherit ever-amplifying problems in an ever-diminishing window of time."

Her eagerness to solve big problems is laudable, and likely why constituents voted for her. They may feel she's doing the right thing the right way.

But if she were your employee, you probably wouldn't. You might commend her zeal, you might be relieved that she noted "multiple generations." But you'd know that whatever "Ok, boomer" originally meant, it sounds like an insult. It sounds like prejudice.

Yes, people will always make presumptions about others. No, you can't change that. But you can change what people presume of each other. Indeed, you have the rare power to make people's presumptions accurate. CliftonStrengths gives it to you. Use it.

As the generational composition shifts within companies, the potential for miscommunication and misunderstanding grows. Things could get ugly. Or a lot better -- it depends on your approach.

Show people how they're really different, and you'll show them why they're valuable. Why everyone is valuable. That perspective is a lot more meaningful than demographics, and far better for your business.

Jennifer Robison is a Senior Editor at Gallup.

Klayton Kasperbauer contributed to this article.

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How the 'OK, Boomer' Comment Sparked Conversation on Managing Generational Differences - Gallup

Back to the Drawing Board: MedDay’s MS Therapy Fails in Phase III Trial – BioSpace

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France-based MedDay Pharmaceuticals announced its MED1003 failed to meet its primary and secondary endpoints in the second pivotal Phase III trial for progressive multiple sclerosis (MS).

The trial, dubbed SPI2, evaluated the safety and efficacy of three daily doses of 100mg of MD1003 compared to placebo in 642 patients with progressive MS without recent relapses, which is also called not-active progressive MS. The primary endpoint was reversal of functional disability, which was measured by the proportion of patients with an improvement in either the Expanded Disability Status Scale (EDSS) or in how long it took patients to walk 25 feet (TW25) over a 12-month time frame and then confirmed at 15 months.

Secondary endpoints were the relative decrease in the risk of disability progression, global impression of response to the drug as evaluated by both the patient and their physician, and the mean change in TW25. Other exploratory endpoints included brain MRI measures, quality of life measures and measurements of ambulation using a Fitbit wearable device.

MD1003 is a neurometabolic modulator that targets both neurodegenerative and demyelination processes through a non-immunological mechanism.

We are clearly disappointed that SPI2 did not meet its primary and secondary endpoints, said Catherine Moukheibir, MedDays chief executive officer. Going forward, we will continue to evaluate the trial data and confer with regulators. We would like to thank our collaborators including the participating clinicians, medical staff and, most importantly, the patients for all of their efforts and participation in the trial. All were invaluable partners throughout the process of completing the SPI2 trial.

MD1003 is also being evaluated in Charcot-Marie-Tooth disease and in hepatic encephalopathy. The company also acquired the SPECMET metabolic platform that is in preclinical development for amyotrophic lateral sclerosis (ALS) and brain aging. In 2018, the company acquired the health division of Profilomic SA, a spin-off company from the Comite dEnergie Atomique (CEA). This allowed MedDay to extend its database and laboratory equipment with a team of researchers with expertise in metabolomics and lipidomics. SPECMET created a biobank of 700 cerebrospinal fluid (CSF) samples from all major neurodegenerative diseases, including rare inborn errors of metabolism.

MS is an autoimmune disease where the patients immune system attacks myelin, the substance that coats nerve fibers in the brain and spinal cord. Most clinical therapies involve tweaking the immune system, but MD1003 targets metabolic pathways, stimulating the Krebs cycle to give more energy to demyelinated nerve fibers with the hopes of boosting the developing of an insulating layer of myelin. The Krebs cycle, also known as the citric acid cycle or the TCA cycle, is a chain of chemical reactions used by all aerobic organisms to release stored energy.

We will review the findings in detail to understand these outcomes to help inform future clinical research in progressive MS and other neurological diseases, said Frederic Sedel, chief scientific officer and co-founder of MedDay. I remain confident of the importance of the neurometabolic approach to neurodegenerative diseases with high unmet medical need.

The company is presenting detailed data from the trial on April 29 in Toronto, Ontario, Canada, at the American Academy of Neurology (AAN) 2020 Annual Meeting.

Link:
Back to the Drawing Board: MedDay's MS Therapy Fails in Phase III Trial - BioSpace

What’s in NICE Guidance on Neurological Conditions for GPs? – Medscape

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GP Dr Nassif Mansour explains why the latest National Institute for Health and Care Excellence (NICE) guidance on neurological conditions is so useful for GPs.

Adapted from Univadis from Medscape. This transcript has been edited for clarity.

My name is Nassif Mansour. I am a GP from south-west London. I was one of the two GPs who sat and advised NICE in developing the guidelines on suspected Neurological conditions.

One in 10 people who present in general practice are coming in with neurological symptoms.

So NICE produced an overarching set of guidelines that will help us in primary care in order to be able to identify those patients and recognise the conditions that can be managed safely in primary care but also those that need to be referred in a timely fashion to secondary care.

This short film will help us as GPs and trainees to be able to use these guidelines practically during the consultation.

Neurological Condition Assessment

The neurological condition assessment starts from calling the patient from the waiting room. The way they walk in and the way they sit in front of us in general practice.

The best way to start the consultation in my opinion would be to put them at rest and to help them to share the information that they want to share with us.

The important clues are all in the history of any neurological condition. We can then do a brief examination in order to confirm certain aspects from the history.

Red Flags

Also, it is important to identify the red flags. This will determine the urgency of the referrals and the guidelines help us to achieve that.

A couple of examples of red flags would be for example a patient presenting with blackouts. If there are features in the history to suggest that they might have had epilepsy, then this is something we should take note of.

Another example would be patients coming in presentingwith poor balance and whilst the patient is sitting there in front of me shows resting tremor on the left or the right side. That to me would indicate Parkinsons disease.

Thirty percent of referrals to secondary care are for patients with transient loss of consciousness and the vast majority of them have got syncopal attack, which is a simple fainting attack that is very common in the population, but it is filling up the neurology clinics up and down the country.

So the guideline was designed to try and help us identify between the vasovagal attacks and the epilepsy, or to think of these 2 conditions mainly. And if it is likely to be a syncopal attack then we dont need to refer unless there are other conditions related to it.

I would suggest that if the patient presents with a blackout and this is the opening complaint, thats when I would very quickly have the guidelines ready and opened in order to just view the evidence that is there.

Another example, and I believe a useful area covered by the guidelines, are tremors and different movement disorders. So patients will present with all sorts of different movement disorders, for example shaking of the hands, or abnormal tics, or facial movements, or rippling of muscles.

Movement Disorders

The guidelines help us to at least remember the important ones. The important ones are the Parkinson's tremors because this helps us reach the diagnosis of Parkinson's disease, and as well as the essential tremors because these are probably the most common movement disorder.

Essential tremors are usually symmetrical. Both hands are affected at the same time, whilst with Parkinson's disease the vast majority of patients will present with a tremor on one side before it marches onto the second side of the body.

The essential tremors are tremors in action, so when the patients are actually using their hands, picking up a cup of tea for example, it will shake.

Unlike the Parkinson's tremor, which is usually at rest, so when they actually use their hand the tremor might disappear.

The guidelines from NICE are very clear that if we suspect Parkinson's disease, we need to refer patients on for a confirmation of diagnosis and treatment.

However, for essential tremors, these guidelines help us and protect us and support us as GPs that we do not need to refer the patients unless they are not responding to the first-line treatment.

The guidelines protect us if we did not refer the patient. So if I did not refer the patient with classical essential tremors, and later on he developed Parkinson's disease, I have the guidelines to fall back on, to support me, that I have managed you as the patient according to the guidelines.

Sleep Disorders

Another area that I believe was well covered in the guidelines is sleep and sleep disorders. It is a very challenging problem that faces us as GPs. The commonest one of them would be lack of sleep (insomnia), and the guidelines make it clear that we do not need to refer patients with insomnia.

Also, it encourages us not to refer patients for example when they get, for the first time or repeatedly, jerking movements, for example one of their limbs, a leg or an arm when they go off to sleep. This is a normal physiological phenomenon and it is not epilepsy.

The guidelines make it very clear however that we need to make sure that we are not missing epilepsy and if there is any doubt, the guidelines will easily direct us through the hyperlink to the epilepsy evidence which will help us differentiate between a simple physiological phenomenon and from epilepsy.

Other sleep disorders that are commonly, and possibly inappropriately, referred to the neurology clinic are sleep disorders related to sleep apnoea.

We use the Epworth scale to reach our diagnosis and if it is suspected then we use the sleep apnoea referral pathway that is agreed locally.

Similarly, conditions like narcolepsy and catalepsy, if they are suspected and sleep apnoea is excluded, then they are happy for us to refer, and it encourages us to refer to secondary care.

I am very excited about these guidelines, not just because it covered a very challenging area in general practice, it also gives us the support we need to be able to manage patients safely and effectively.

These guidelines are very useful as they link to other common neurological problems that are challenging, that need our urgent attention.

I would encourage you all to use the guidelines, to embrace them, to have them in the background on your desktop, to assist you during the consultation. I promise you it will help you to feel confident and comfortable managing patients who are presenting with neurological symptoms.

Thank you for watching.

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What's in NICE Guidance on Neurological Conditions for GPs? - Medscape

Monkeys Wake From Anaesthetic When Brain Region Linked to Consciousness Is Stimulated – ScienceAlert

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Later today I'll lose consciousness for a few hours to rest and repair. There's a good chance you will, too. Yet as ubiquitous as sleep is, we know very little about which parts of the brain are fundamental to staying awake.

Thanks to a recent experiment that stimulated the brains of anaesthetised macaques, we have a clearer idea of just which neurological structures might be primarily responsible for switching us on each day.

The results not only help us to better understand the processes behind anaesthesia;for those trapped in vegetative or comatose states by illness or injury it could mean a pathway out again.

While we can use brain-scanning technologies to watch how different parts of the brain activate as a subject falls unconscious, it's a lot harder to work out how any single area produces a specific response, let alone which are the most crucial.

Studies on sleeping and comatose patients have given researchers a sound idea of the kinds of structures involved, from the brain stem to the prefrontal cortex. Needless to say, many different parts of our nervous system determine our state of awareness.

Researchers from the University of Wisconsin in the US and the Israel Institute of Technology noticed one tiny piece of tissue deep inside our forebrain the central lateral thalamus had a rather prominent role in directing our neurological affairs.

Based on its connectivity, it seemed to be pivotal in influencing how signals were passed from the higher-order 'thinking' sections such as the cortex to deeper structures such as the thalamus and back again areas known to be integral to consciousness.

Researchers often focus on different parts of the brain in relative isolation to work out how relevant they might be to any given task.

In this case, the team were interested in the precise way this tiny piece of brain tissue communicated with other areas during different states of activity, requiring a more holistic approach.

"We decided to go beyond the classical approach of recording from one area at a time," says neuroscientist Yuri Saalmann from the University of Wisconsin.

"We recorded from multiple areas at the same time to see how the entire network behaves."

To get past the hurdles of using human subjects for such a task, the researchers used the macaque as their model, imaging the animals' brain structures before inserting specially tailored electrodes.

These electrodes were then used to monitor activity while the monkeys were awake, asleep, and under the effects of a strong anaesthetic.

The variations in electrical activity confirmed suspicions that the central lateral thalamus played a role in maintaining consciousness, at least in macaques. But it's one thing to find activity, and another to prove that a part of the brain is responsible for causing it.

To do this, the team used their remarkably fine electrodes to stimulate the small patch of neurons with incredible precision, tickling them into action while the macaques were knocked out with a good dose of ketamine.

"We found that when we stimulated this tiny little brain area, we could wake the animals up and reinstate all the neural activity that you'd normally see in the cortex during wakefulness," says Saalmann.

"They acted just as they would if they were awake."

Incredibly, once the stimulation stopped, the macaques drifted right back off to sleep within seconds. It was like the central lateral thalamus acted like a consciousness switch, directing mental traffic when active to give rise to awareness, and reinstating unconsciousness when it was quiet.

None of this helps much with the big questions around what consciousness is on a more philosophical level, and of course drawing conclusions about our own species based on non-human models is also problematic.

But this is one more piece of evidence we can use to fine-tune a physical model of how a brain like ours switches between different states of function.

Given we're still unclear on how anaesthesia renders us oblivious and, shockingly, even if it's always effective it helps having precise knowledge of how the smallest bundles of nerves affect one another while we're slipping in and out of awareness.

As for people whose brains are permanently locked into a state of consciousness, having avenues for treatment would be a welcome product of studies like this one.

Previous research has already provided strong evidence that stimulating the thalamus could help some comatose patients regain awareness.

In 2007, deep brain stimulation saw a patient who'd been minimally conscious for 6 years following a traumatic brain injury slowly regain movements and control over some body functions, including a small improvement in speech.

"There are many exciting implications for this work," says University of Wisconsin psychologist Michelle Redinbaugh.

"It's possible we may be able to use these kinds of deep-brain stimulating electrodes to bring people out of comas. Our findings may also be useful for developing new ways to monitor patients under clinical anaesthesia, to make sure they are safely unconscious."

This research was published in Neuron.

Link:
Monkeys Wake From Anaesthetic When Brain Region Linked to Consciousness Is Stimulated - ScienceAlert

Focus on Diversity Boosts Number of Women Speakers at ISC – TCTMD

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LOS ANGELES, CAA concerted effort by the American Heart Association/American Stroke Association (AHA/ASA) and the program planning committee of the International Stroke Conference (ISC) successfully increased the number of women who were invited as speakers at the 2019 meeting, a new study shows.

Between 2014 and 2018, only 28% of invited speakers at the annual stroke meeting were women, but that number jumped to 47% in 2019, Anjail Sharrief, MD (McGovern Medical School at UTHealth, Houston, TX), reported at the ISC here last week.

A particularly large gain in the proportion of women was seen among physician speakersincreasing from 17.7% in 2014-2018 to 37.9% in 2019.

Its important for . . . the [meeting] committees to acknowledge the disparities and enhance focus on diversity among speakers, and this influences change, Sharrief, director of stroke prevention for the UTHealth Institute of Stroke and Cerebrovascular Disease, said during her presentation. Increased opportunities to speak at major scientific conferences for women may help to address factors that contribute to gender differences in academic advancement and promotion.

She noted, however, that more work must be done to increase speaker diversity by race and country, and across different presentation categories.

Women Underrepresented in Multiple Areas

Its known that at the faculty level in neurology, men exceed women in terms of academic positions, rank, and number of publications. The proportion of women is highest among assistant professors (47%), falling to 38% among associate professors and 21% among full professors, according to Sharrief.

Speaker lineups at meetings are also male-dominated, she pointed out. As reported at ISC 2019 by Sharriefs colleague Lauren Fournier, MD (McGovern Medical School at UTHealth), women made up only about one-quarter of invited speakers in the prior 5 years of the meeting despite representing 37.7% of all attendees, with no changes over that span. Representation was particularly problematic when it came to physician speakers and women from racial/ethnic minority groups.

Its important to have different perspectives and different lenses through which we look. Anjail Sharrief

The ISC program planning committee encouraged Sharriefs team to look into the issue, and between 2018 and 2019, put a focus on increasing diversity among speakers and recruiting more qualified women to present. At the 2019 meeting, ISC included a mentoring lunch for women and a special event around womens issues in stroke, and at this years meeting, there were even more programming activities around womens issues, Sharrief said.

To find out if those efforts had an impact, Sharrief and her colleagues obtained data from the American Heart Association/American Stroke Association on invited speakers who presented at the 2019 meeting.

The gains in the proportion of women speakers from 2014-2018 to 2019 seemed to be evident across various academic-degree categories, although numbers were small for certain categories.

Women were more likely to be invited for debate in 2019 than in the prior 5 years (37.5% vs 13.1%) and to be invited to speak in the acute, in-hospital care category (39.8% vs 19.0%). Of the speakers who presented more than once in 2019, 46% were women, an improvement over the 21.3% rate seen in prior years.

Increases in the proportion of women were also seen across racial/ethnic categories, with substantial jumps among whites (32.7% to 48.2%) and Asians (20.0% to 41.2%). There were apparent improvements among Hispanic and African-American women as well, although overall numbers of speakers from these groups remained small.

Geographically, female representation was improved among speakers from North America and Europe, but speakers from other parts of the world remained less common. There were no female speakers from Africa.

I think theres still work to do in terms of further diversity, Sharrief told TCTMD.

Importance of More-Diverse Speakers

Sharrief said that having a more diverse lineup of speakers at major medical meetings is important for a number of reasons. For one, it makes for better science, because there are issues in stroke that differentially affect women and people from racial/ethnic minority groups. Its important to have different perspectives and different lenses through which we look, Sharrief said. So by having a diversity of speakers presenting you really are looking things from different perspectives.

Then, on a professional level, data presented by Sharriefs colleague, Pamela Zelnick, MD (McGovern Medical School at UTHealth), showed that even women account for half of medical students, they remain less likely than men to go into neurology or vascular neurology. If we want to continue to attract the brightest and the best students and residents, then we have to show that there are opportunities for them in leadership, and having opportunities to speak at conferences gives people opportunities for leadership within the organization but also for academic advancement, Sharrief said.

To that last point, she noted that contributions to science and recognitions of achievement are important when it comes to being promoted. Being invited to conferences [is something] that you can list there as being evidence of peer esteem, evidence that you have had an impact on a national/international level, Sharrief said.

Thus, its important to continue to track diversity among speakers and report the findings, and ensure that the leaders of the AHA/ASA and ISC maintain their focus on the issue every year so the gains are not lost, Sharrief said, adding that it seems they are committed to doing so.

Bruce Ovbiagele, MD (University of California, San Francisco), a co-author on Sharriefs study and ISC program committee chair in 2017 and 2018, told TCTMD that its gratifying to see that in such a short period of time things seem to have improvedmaybe because were highlighting it morebut it would be nice to have a systematic way of making sure that is always the case and a way of obviously measuring later on to see if the effect is actually sustained.

The key to ensuring a lasting effect is the attention factor, he said, noting that Louise McCullough, MD, PhD (McGovern Medical School at UTHealth), who was vice chair of ISC 2019 and 2020 and will be chair of the meeting for the next 2 years, has a number of strategies she wants to incorporate. One, for example, is making sure each invited speaker panel has at least one woman. He noted that inviting more women is one thing, but ensuring that the speakers who actually attend the meeting are more diverse is another. McCullough, he said, has promised to intensify efforts to replace women who decline invitations with other women whenever possible.

The ASA is definitely doing a lot to make sure that there are more womanels and not manels, Ovbiagele said.

What Sharrief takes away from this look into representation of women at the ISC is that change can happen if we think to look and see where the differences are. Diversity is important for many reasons.

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Focus on Diversity Boosts Number of Women Speakers at ISC - TCTMD

Association of Clusterin Levels in Cerebrospinal Fluid with Synaptic D | NDT – Dove Medical Press

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Jun Wang,* Xin Zhang,* Bihong Zhu, Pan Fu On the behalf of Alzheimers Disease Neuroimaging Initiative

Department of Neurology, Taizhou First Peoples Hospital, Zhejiang, Peoples Republic of China

*These authors contributed equally to this work

Correspondence: Pan FuDepartment of Neurology, Taizhou First Peoples Hospital, 218 Hengjie Road, Huangyan District, Taizhou City, Zhejiang Province, Peoples Republic of ChinaEmail fp7154515@163.com

Purpose: Although emerging evidence has suggested that clusterin is involved in the pathogenesis of Alzheimers disease (AD), the association of clusterin with synaptic degeneration in living human is unclear. In the present study, we aimed to examine the association of CSF clusterin levels with synaptic degeneration in individuals with different severities of cognitive impairment.Patients and Methods: In the present study, we compared levels of clusterin in CSF among individuals with normal cognition (NC), mild cognitive impairment (MCI), and AD. Further, linear regression models were performed to examine the association of CSF clusterin with neurogranin (NG, reflecting synaptic degeneration) with adjustment of several potential confounders.Results: We found that CSF clusterin levels were positively correlated with NG in the NC and MCI groups, but not the AD group. In all subjects, linear regression models suggested that clusterin levels were positively associated with NG levels independent of age, gender, apolipoprotein E4 (APOE4) genotype, clinical diagnosis, and CSF A 42 levels.Conclusion: Our data indicated that clusterin was associated with CSF NG levels among older individuals with different severities of cognitive impairment.

Keywords: clusterin, neurogranin, synaptic degeneration, Alzheimers disease, mild cognitive impairment

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Association of Clusterin Levels in Cerebrospinal Fluid with Synaptic D | NDT - Dove Medical Press

Interventional Neurology Professional Inspection Report and Forecast 2020-2026 Dagoretti News – Dagoretti News

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Global Interventional Neurology MarketIndustry Analysts 2020. The report has been put together using primary and secondary research methodologies, which offer an accurate and precise understanding of the Interventional Neurology market. The report offers an overview of the market, which briefly describes the market condition and the leading segments. It also mentions the top players present in the global Interventional Neurology market. The research report on the global Interventional Neurology market includes a SWOT analysis and Porters five forces analysis, which help in providing the precise trajectory of the market.

Get Free Sample Copy of This Business Report: https://www.coherentmarketinsights.com/insight/request-sample/56

Points Covered in The Report:

The points that are discussed within the report are the major market players that are involved in the market such as manufacturers, raw material suppliers, equipment suppliers, end users, traders, distributors and etc.

The complete profile of the companies is mentioned. And the capacity, production, price, revenue, cost, gross, gross margin, sales volume, sales revenue, consumption, growth rate, import, export, supply, future strategies, and the technological developments that they are making are also included within the report. The historical data from 2012 to 2017 and forecast data from 2019 to 2026.

The growth factors of the market is discussed in detail wherein the different end users of the market are explained in detail.

Data and information by manufacturer, by region, by type, by application and etc, and custom research can be added according to specific requirements.

The report contains the SWOT analysis of the market. Finally, the report contains the conclusion part where the opinions of the industrial experts are included.

The Interventional Neurology Market report incorporates analysis of new advancements in innovation, detailed profiles of fundamental industry players, and outstanding model investigation. It provides a market forecast for the forthcoming years. The report covers up the evaluation of macro and micro features vital for the already established Interventional Neurology market players and the newly emerging players in various regions all across the world.

Major Players in the Interventional Neurology Market:Medtronic, Inc. (Covidien), Penumbra, Inc., Stryker Corporation, Johnson & Johnson and Terumo Corporation

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Interventional Neurology Market: Regional Overview

Geographically, the Interventional Neurology market is segmented into seven regions, namely North America, Latin America, Western Europe, Eastern Europe, Asia Pacific Excluding Japan (APEJ), Japan and the Middle East and Africa (MEA). The growth of the Asia-Pacific market is supposed to be comparatively high as compared to other regions across the globe due to increasing inclination of consumers towards convenient in the regions. Interventional Neurology Market in the fast-developing nations such as China and India are estimated to witness robust revenue growth and trend to continue over the forecast period. Production of polymers such as polyethylene and polyethylene terephthalate used in manufacturing in flexible pouches is highest in North America and Europe region.

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Global Gene Therapy Market is Projected to Reach USD 13.0 Billion by 2024 from USD 3.8 Billion in 2019, at a CAGR of 27.8% – ResearchAndMarkets.com -…

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The "Gene Therapy Market by Vectors [Non-viral (Oligonucleotides), Viral (Retroviral (Gammaretroviral, Lentiviral)), Adeno-associated], Indication (Cancer, Neurological Diseases), Delivery Method (In Vivo, Ex Vivo), Region - Global Forecast to 2024" report has been added to ResearchAndMarkets.com's offering.

High incidence of cancer & other target diseases is a major factor driving the growth of the gene therapy market

The high incidence of cancer and other target diseases, availability of reimbursement, and the launch of new products are the major factors driving the growth of this market. In addition, the strong product pipeline of market players is expected to offer significant growth opportunities in the coming years. However, the high cost of treatment is expected to hamper the market growth to a certain extent in the coming years.

Neurological diseases segment accounted for the largest share of the gene therapy market, by indication, in 2018

Based on indication, the market is segmented into neurological diseases, cancer, hepatological diseases, Duchenne muscular dystrophy, and other indications. The neurological diseases segment accounted for the largest share of the market in 2018. This can be attributed to the increasing number of gene therapy products being approved for the treatment of neurological diseases and the high market penetration of oligonucleotide-based gene therapies.

Viral vectors segment to register the highest growth in the gene therapy market during the forecast period

The gene therapy market, by vector, has been segmented into viral and non-viral vectors. In 2018, the non-viral vectors segment accounted for the largest share of this market. However, the viral vectors segment is estimated to grow at the highest CAGR during the forecast period, primarily due to the increasing demand for CAR T-based gene therapies and the rising incidence of cancer.

North America will continue to dominate the gene therapy market during the forecast period

Geographically, the market is segmented into North America, Europe, the Asia Pacific, and the Rest of the World. In 2018, North America accounted for the largest share of the gene therapy market, followed by Europe. Factors such as the rising prevalence of chronic diseases, high healthcare expenditure, presence of advanced healthcare infrastructure, favorable reimbursement scenario, and the presence of major market players in the region are driving market growth in North America.

Key Benefits of Buying the Report:

This report will help market leaders/new entrants by providing them with the closest approximations of the revenue numbers for the overall gene therapy market and its subsegments. It will also help stakeholders better understand the competitive landscape and gain more insights to position their business better and make suitable go-to-market strategies. Also, this report will enable stakeholders to understand the pulse of the market and provide them with information on the key market drivers, challenges, and opportunities.

Key Topics Covered:

1 Introduction

1.1 Objectives of the Study

1.2 Market Definition

1.3 Market Scope

1.4 Currency

1.5 Limitation

1.6 Stakeholders

2 Research Methodology

2.1 Research Data

2.2 Secondary Data

2.3 Primary Data

2.4 Market Size Estimation

2.5 Market Breakdown and Data Triangulation

2.6 Assumptions for the Study

3 Executive Summary

4 Premium Insights

4.1 Gene Therapy Market Overview

4.2 North America: Market, By Vector (2018)

4.3 Geographical Snapshot of the Market

5 Market Overview

5.1 Introduction

5.2 Market Dynamics

5.2.1 Drivers

5.2.1.1 High Incidence of Cancer and Other Target Diseases

5.2.1.2 Product Approvals

5.2.1.3 Funding for Gene Therapy Research

5.2.2 Opportunities

5.2.2.1 Strong Product Pipeline

5.2.3 Challenges

5.2.3.1 High Cost of Treatments

6 Gene Therapy Market, By Vector

6.1 Introduction

6.2 Non-Viral Vectors

6.3 Viral Vectors

7 Gene Therapy Market, By Indication

7.1 Introduction

7.2 Neurological Diseases

7.3 Cancer

7.4 Hepatological Diseases

7.5 Duchenne Muscular Dystrophy

7.6 Other Indications

8 Gene Therapy Market, By Delivery Method

8.1 Introduction

8.2 In Vivo Gene Therapy

8.3 Ex Vivo Gene Therapy

9 Gene Therapy Market, By Region

9.1 Introduction

9.2 North America

9.3 Europe

9.4 Asia Pacific

9.5 Rest of the World

Story continues

10 Competitive Landscape

10.1 Overview

10.2 Market Share Analysis, 2018

10.3 Key Strategies

10.4 Competitive Leadership Mapping (2018)

10.4.1 Visionary Leaders

10.4.2 Innovators

10.4.3 Dynamic Differentiators

10.4.4 Emerging Companies

11 Company Profiles

11.1 Biogen

11.2 Gilead Sciences, Inc.

11.3 Amgen, Inc.

11.4 Novartis AG

11.5 Orchard Therapeutics Plc

11.6 Spark Therapeutics, Inc. (A Part of Hoffmann-La Roche)

11.7 Molmed S.P.A.

11.8 Anges, Inc.

11.9 Bluebird Bio, Inc.

11.10 Human Stem Cells Institute (HSCI)

11.11 SIBIONO Genetech Co., Ltd.

11.12 Shanghai Sunway Biotech Co., Ltd

11.13 Uniqure N.V.

11.14 Gensight Biologics S.A.

11.15 Celgene Corporation (A Bristol-Myers Squibb Company)

11.16 Cellectis

11.17 Sangamo Therapeutics

11.18 Mustang Bio

11.19 AGTC (Applied Genetic Technologies Corporation)

11.20 Poseida Therapeutics, Inc.

For more information about this report visit https://www.researchandmarkets.com/r/xhxwrm

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Global Gene Therapy Market is Projected to Reach USD 13.0 Billion by 2024 from USD 3.8 Billion in 2019, at a CAGR of 27.8% - ResearchAndMarkets.com -...

Should aspirin be given to all stroke victims? – Quartz

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First sold commercially 119 years ago, aspirin is a remarkable drug. Cheap and with few side effects, its benefits include the ability to prevent blood cells from clotting. As a result, its given to patients who have suffered heart attacks, which are caused by clots blocking arteries leading to the heart.

Aspirin can also help prevent strokesspecifically ischemic strokes, the most common kind, which are caused by clots that block the flow of blood in the brain. Giving ischemic stroke victims aspirin can reduce the chances of a second stroke after two to four weeks by about 12%, and by about 17% over the next three years.

But not all stroke patients receive aspirin. For hemorrhagic strokesthe other main form of stroke, cause by a ruptured blood vessel in the brainpatients need their blood to clot to stop uncontrolled bleeding. So doctors never give aspirin to hemorrhagic patients out of fear of causing another stroke.

For decades, if the type of stroke is unknown, standard practice has been to deny aspirin to prevent unintended harm to hemorrhagic stroke victims. CT scans are necessary to make the right diagnosis and guide the course of treatmentbut they are often unavailable in rural hospitals and clinics across the developing world. Thats one reason fewer than 4% of stroke patients in low-income countries are on anti-platelet therapies like aspirin, compared to more than half in high-income countries.

Aaron Berkowitz, a neurologist specializing in treating stroke in poor countries, wants to turn that conventional wisdom on its head. In a 2014 paper, he argued the harm caused by giving aspirin to hemorrhagic stroke patients is overstated, and that it make sense to give aspirin to all stroke victims when the type of stroke is unknown.

Berkowitz started with data from pair of massive studies in the 1990s that looked at the effect of aspirin on a total of 40,000 stroke patients. While those studies were designed for ischemic stroke victims, 773 hemorrhagic victims were inadvertently included, enough to provide a baseline understanding of how those patients respond to aspirin.

He then ran computer simulations that modeled the impact of aspirin treatment on a large population of stroke patients when the type of stroke was unknown. In the model, Berkowitz dialed the percentage of hemorrhagic strokes up to 34%, the highest known rate in the world, found in sub-Saharan Africa (in the US, its more like 15%).

The results showed that, on balance, giving aspirin to stroke patients reduced a secondary stroke by about eight per 1,000 victims, and reduce deaths by about four per 1,000. While the numbers are small, Berkowitz says, they are statistically significant enough to reconsider how stroke treatment is approached in resource-poor settings.

Stroke is the second-leading killer globally, claiming 5.8 million lives a year, and is both more common and more fatal in low-income countries. Even if aspirin offers only slight improvements in patient outcomes, prescribing it widely could mean saving hundreds of thousands of lives over decades.

Unless there is reason to suspect a hemorrhagic stroke, such as a prior history, Berkowitz recommends giving aspirin after 24 hours when the type of stroke is unknown, even though professional medical associations recommend against it.

The American Heart Association and American Stroke Association guidelines for treating stroke are very useful, he says. There are 100 pages for ischemic stroke and 100 pages for hemorrhagic stroke, but for most countries and for most patients in the world, you wont know what guidelines to open.

Until recently, Berkowitz headed the global neurology program at the Harvard-affiliated Brigham and Womens Hospital, and spent time treating stroke patients in Haiti. He acknowledges theres a difference between prescribing a treatment for patients at the population level and on an individual basis. While it may make sense to give aspirin to hundreds of stroke patients, giving it to the wrong patient, and seeing them suffer the consequences, can be difficult for a doctor. Medicine is this constant tension between what you know is globally correct, and tailoring that to an individual patient, he said.

There is no clear ethical choice, says Christine Mitchell, the director for the center of bioethics at Harvard Medical School. If you took a direct, utilitarian approach, its pretty clear from an aggregate public health perspective, if you can save more lives then you should give aspirin, she said.

But, according to a duty-based framework (also called deontological reasoning), a doctors ethical responsibility is to the patient in front of him or her, not to a theoretical aggregation of patients.

According to that reasoning, you have a duty not to add to the harm of these patients, she said. If theres substantial identifiable risk in advance, if you know a percentage of your patients will have had hemorrhagic strokes, you should not give them aspirin.

While the actual risk of giving aspirin to hemorrhagic patient is unclearthe large 1990s trials suggest there was no adverse affect, and more recent trials suggests it may actually benefit patientsmost doctors are taught its harmful. Changing the course of global treatment is a slow process that could take decades, even if they are endorsed by groups such as the Geneva-based World Health Organization. People can sit in Geneva and write guidelines and put them online, but a lot of people will never know they exist, Berkowitz says.

The challenge is clear in Zambia, a fairly typical low-income country with high rates of stroke. Deanna Saylor, an assistant professor at Johns Hopkins who leads a neurology training program in Lusaka, started giving aspirin to patients with unknown types of stroke in the last year. While they havent formally studied the results, she believes the current research justifies the new protocol. However, when she presented the evidence at a national stroke conference for Zambian physicians there was a lot of dismay and reticence about this recommendation, as it is so counter-intuitive and against what we learned in medical school, she said in an email.

Ultimately, she said, what is needed is a randomized, controlled trial in a setting like Zambia. Until then, a simple, effective drug that can prevent the recurrence of stroke may be overlooked.

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Should aspirin be given to all stroke victims? - Quartz

Largest US Outbreak of Neurologic Disease to Date Uncovered We Need to Watch This Very Closely – SciTechDaily

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The Lancet Infectious Diseases recently published the results of an observational study led by researchers on Childrens Hospital Colorado Infectious Disease and Neurology teams, along with counterparts at the Centers for Disease Control and Colorado Department of Public Health and Environment. The study was conducted from March 1 to November 30, 2018, and led to a discovery of the largest outbreak of enterovirus A71 (EV-A71) in the United States.

We need to watch this very closely. Kevin Messacar, MD

Since the 1990s, every 1 to 3 years, EV-A71 has caused large-scale, and sometimes deadly epidemics in the Asia-Pacific region, which has prompted the development of EV-A71 vaccines. In the United States, detections of this virus have been small-scale and sporadic. However, the unique symptoms, unusually high number of cases, and the geographic clustering of children who were observed during this study, indicated an outbreak.

We need to watch this very closely, said Kevin Messacar, MD, pediatric infectious disease physician and researcher at Childrens Hospital Colorado and University of Colorado Anschutz Medical Campus. Enhanced surveillance is needed in order to determine whether this outbreak was an isolated event, or a warning of impending cyclic outbreaks of EV-A71 neurological disease in the U.S.

In addition to highlighting the need to improve enterovirus surveillance, the observational study also helped identify what other medical providers should be looking for. Children with EV-A71 disease were best differentiated from children with other enteroviruses by the neurological findings of myoclonus (quick, involuntary muscle jerks), ataxia (dizziness), weakness and autonomic instability (dysregulation of heart rate, blood pressure and perfusion). Often times these symptoms can be misunderstood or misattributed to other diagnoses especially among young children.

Finally, its important to note that these viruses tend to appear in seasonal waves. If through additional surveillance efforts, the United States continues to see enteroviruses circulating that cause neurological illness, the development of antivirals and vaccines may need to become a priority.

Were it not for Childrens Hospital Colorados ongoing interest and commitment to the study of enteroviruses, this outbreak would probably not have been detected, noted Drs. Carol Glaser and Mike Wilson in a commentary published alongside the Lancet study. The USA has yet to have large-scale epidemics of enteroviruses as are seen in Asia and other countries, but it should take steps to become better prepared.

References:

Clinical characteristics of enterovirus A71 neurological disease during an outbreak in children in Colorado, USA, in 2018: an observational cohort study by Kevin Messacar, MD; Emily Spence-Davizon, MPH; Christina Osborne, MD; Craig Press, MD; Teri L Schreiner, MD; Jan Martin, MD; Ricka Messer, MD; John Maloney, MD; Alexis Burakoff, MD; Meghan Barnes, MSPH; Shannon Rogers, MS; Adriana S Lopez, MPH; Janell Routh, MD; Susan I Gerber, MD; M Steven Oberste, PhD; W Allan Nix, BS; Prof Mark J Abzug, MD; Prof Kenneth L Tyler, MD; Rachel Herlihy, MD and Samuel R Dominguez, MD, 16 December 2019, The Lancet Infectious Diseases.DOI: 10.1016/S1473-3099(19)30632-2

Enteroviruses: the elephants in the room by Carol Glaser and Michael R Wilson, 16 December 2019, The Lancet Infectious Diseases.DOI: 10.1016/S1473-3099(19)30679-6

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Largest US Outbreak of Neurologic Disease to Date Uncovered We Need to Watch This Very Closely - SciTechDaily

In the News: St. Louis startup co-founded by WashU neurologist raises $6.6M in funding | WashU Fuse – Washington University in St. Louis Newsroom

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Dosenbach

A St. Louis-based startup co-founded by a Washington University in St. Louis neurologist has raised a combined $6.6 million in federal grant funding and private investment, reports the St. Louis Business Journal.

NOUS Imaging was co-founded by Nico Dosenbach, a pediatric neurologist at St. Louis Childrens Hospital and assistant professor of neurology and radiology at Washington University School of Medicine.

The startup, which is headquartered in the Cortex Innovation Community, has developed a software, called FIRMM, which monitors patient motion in real-time during MRI scans. According to NOUS, about 20% of MRI scans annually are rendered useless because of patient movement during the procedure. The FIRMM software can minimize the need for repeat scans or anesthesia, which increases patient safety and saves time and money.

The bulk of the financing stems from a $5.6 million Small Business Innovation Research (SBIR) grant recently awarded to the startup by the National Institutes of Health. NOUS also has raised private financing from CICA Inc., a San Diego-based biotechnology and medical technology investment family office.

The company plans to use the funding to hire additional developers and administrative staff.

Read the full article in the St. Louis Business Journal (subscription required).

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In the News: St. Louis startup co-founded by WashU neurologist raises $6.6M in funding | WashU Fuse - Washington University in St. Louis Newsroom