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In a new book, an anthropologist investigates the makeshift treatment centers that have proliferated during the country's war on drugs. THE WAY THAT LEADS AMONG THE LOST: Life, Death, and [...]

In March 2016, President Salvador Sánchez Cerén of El Salvador announced a set of ''extraordinary measures'' that, he said, would put an end to the gangs that had made his [...]

Early one cold January morning on the high plains of eastern Afghanistan, Maj. Mohammad Qasim and a few of his officers gathered in the rundown barracks that serve as a [...]

Acute stroke due to supratentorial intracerebral haemorrhage is associated with high morbidity and mortality. Open craniotomy haematoma evacuation has not been found to have any benefit in large randomised trials. We assessed whether minimally invasive catheter evacuation followed by thrombolysis (MISTIE), with the aim of decreasing clot size to 15 mL or less, would improve functional outcome in patients with intracerebral haemorrhage.

BackgroundThe angiographic evaluation of previously coiled aneurysms can be difficult yet remains critical for determining re-treatment.ObjectiveThe main objective of this study was to determine the inter-rater reliability for both the Raymond Scale and per cent embolization among a group of neurointerventionalists evaluating previously embolized aneurysms.MethodsA panel of 15 neurointerventionalists examined 92 distinct cases of immediate post-coil embolization and 1 year post-embolization angiographs. Each case was presented four times throughout the study, along with alterations in demographics in order to evaluate intra-rater reliability. All respondents were asked to provide the per cent embolization (0–100%) and Raymond Scale grade (1-3) for each aneurysm. Inter-rater reliability was evaluated by computing weighted kappa values (for the Raymond Scale) and intraclass correlation coefficients (ICC) for per cent embolization.Results10 neurosurgeons and 5 interventional neuroradiologists evaluated 368 simulated cases. The agreement among all readers employing the Raymond Scale was fair (κ=0.35) while concordance in per cent embolization was good (ICC=0.64). Clinicians with fewer than 10 years of experience demonstrated a significantly greater level of agreement than the group with greater than 10 years (κ=0.39 and ICC=0.70 vs κ=0.28 and ICC=0.58). When the same aneurysm was presented multiple times, clinicians demonstrated excellent consistency when assessing per cent embolization (ICC=0.82), but moderate agreement when employing the Raymond classification (κ=0.58).ConclusionsIdentifying the per cent embolization in previously coiled aneurysms resulted in good inter- and intra-rater agreement, regardless of years of experience. The strong agreement among providers employing per cent embolization may make it a valuable tool for embolization assessment in this patient population.

The article reports on the damage caused by Hurricane Matthew in Haiti in October 2016. Topics covered include the estimated number of people left homeless at 175,000 and the death of more than 1,000 people, the geographic factors in the frequency of tropical storms in Haiti, the impact of environmental degradation on the impact of storms, ineffective government leadership, and economic information about Haiti.

BackgroundAlthough race is a social construct without biological meaning, race significantly impacts health outcomes. Race is under-reported in clinical trials making it difficult to identify and address health inequities. In this study, we analyze studies pertaining to cerebrovascular accidents (CVA) with the primary purpose to assess the inclusion of racial data in CVA clinical trials. Our secondary purpose is to assess the representation of the various races in CVA clinical trials.Methods:This meta-analysis study consisted of CVA clinical trial data from ClinicalTrials.gov. Two researchers extracted data independently. Microsoft Excel was used for data collection and analysis. The search term “stroke” was used to search clinical trials from 1995-2021. The primary outcome is the prevalence of trials with racial data reported. The secondary outcome is the prevalence of each racial subgroup and gender subgroups among trials that report race data.Results:7004 trials were identified using “stroke” as a search term. After excluding non-interventional trials, 468 trials remained. A sample of 115 trials were included in preliminary analyses. Out of the 115 trials, 50 studies (43.5%) did not report race. The 65 trials with racial data totaled 7368 participants. 38.7% were female and 61.3% were male. 46.2% of participants were White, 17.3% were Black and 33.8% a “combined other” category (Asian, American Indian, Native Hawaiian, other, and unknown/not reported). Of 12 trials with pharmacologic intervention, 41.7% did not report race. There were a total of 1485 participants from the seven trials with pharmacologic intervention, of which 47.2% were female and 52.7% male. Furthermore, 68.3% of participants were White, 7.5% were Black and 22.9% were the “combined other” category.Conclusions:Of the studies reviewed, 43.5% of stroke clinical trials and 41.7% of stroke studies with pharmacologic interventions did not report racial data. Moreover, women and non-White subjects were significantly underrepresented in the stroke clinical trials. The under-representation of women and non-White subjects in these clinical trials raises the concern regarding access to stroke clinical trials and the need to further study the reason behind these disparities.

The article discusses the renewal of the diplomatic relations between the U.S. and Cuba. Topics include background on the hostilities between the U.S. and Cuba, the failure of the embargo's goal to oust the regime of President Raúl Castro, and campaign promise of U.S. President Barack Obama regarding U.S.-Cuba relations.

Endovascular management of intracranial aneurysms has advanced significantly over the last couple decades and continues to evolve, including aneurysms within the subgroup of supraclinoid internal carotid artery (ophthalmic, superior hypophyseal, posterior communicating, anterior choroidal, dorsal wall/blister, and carotid terminus).

Over the past decade, electrocorticography (ECoG) has been used for a wide set of clinical and experimental applications. Recently, there have been efforts in the clinic to adapt traditional ECoG arrays to include smaller recording contacts and spacing. These devices, which may be collectively called “micro-ECoG” arrays, are loosely defined as intercranial devices that record brain electrical activity on the submillimeter scale. An extensible 3D-platform of thin film flexible microscale ECoG arrays appropriate for Brain-Computer Interface (BCI) application, as well as monitoring epileptic activity, is presented. The designs utilize flexible film electrodes to keep the array in place without applying significant pressure to the brain and to enable radial subcranial deployment of multiple electrodes from a single craniotomy. Deployment techniques were tested in non-human primates, and stimulus-evoked activity and spontaneous epileptic activity were recorded. Further tests in BCI and epilepsy applications will make the electrode platform ready for initial human testing.

The morbidity and mortality associated with spontaneous intracerebral haemorrhage high, with 40% reported mortality at 1 month and fewer than 40% of patients regaining functional independence. Despite advances made in the treatment of ischemic stroke, similar improvements have not been seen with intracerebral hemorrhage. Medical control of blood pressure and intracranial pressure, among other factors, are key to management. The impact of surgical intervention is less clear. This article reviews the data surrounding the surgical management of intracerebral hemorrhage, including open and minimally invasive techniques and discusses the controversies and future directions surrounding surgical management.

Introduction:Surgical intervention for detected intracranial aneurysms (IA) cary risks to patients. Analysis of IA geometry may help clinicians differentiate IAs at high rupture risk versus ones likely to remain stable. Yet traditional geometric indices lack sufficient accuracy, stressing a need for novel indices.Hypothesis:Adding novel Voronoi diagram-based indices (see Fig. 1) will improve IA differentiation.Methods:3D computational models were taken from 47 subjects with one medium-sized (4-10mm) middle cerebral artery (MCA) IA via 3D digital subtraction angiography data. 7 geometric indices for IAs (e.g.size, aspect ratio) were measured, alongside Voronoi analysis. In terms of the Voronoi diagram/sphere, each IA constitutes one or more spherical cores (large Inscribed sphere(s)) and many small protrusions. 2 variant curves denoting the inscribed spheres to small protrusion size’s relationships can be seen in Fig 1. Support vector machine with cross-validation (100 iterations) assessed Voronoi diagram-based curve’s strength for IA differentiation. The parsimonious model was determined as 3 geometric indices (volume, identified bulb, vessel diameter) and Voronoi characteristics.Results:Conventional IA geometric indices for ruptured vs unruptured differentiation showed limitations: 0.80 AUROC, 0.76 total accuracy. The addition of quantified Voronoi characteristics via both Voronoi curves augmented model strength for differentiation: 0.87 AUROC, 0.86 total accuracy.Conclusions:Preliminary analysis suggests including Voronoi characteristics for IA analyses improves rupture status prediction accuracy for medium-sized MCA aneurysms, which are more difficult to manage. Since Voronoi characteristics can be easily done in the clinical workflow, such an analysis may enrich the differentiation of IAs.

The article reports that Muddy Waters Research has issued a report on the forestry company, Sino-Forest Corp., claiming that they are committing a fraud. It states that ever since the report was presented, the stock of the company has fallen more than 70 percent. It mentions that specific group of stocks access the public markets through reverse merger, and in such cases, private companies acquire a public shell company in the U.S. or Canada, and earn billions of dollars.

The article focuses on benefits and concerns regarding virtual education programs at schools in Chicago, Illinois. A pilot program is discussed in which the school day is lengthened and students spend 90 minutes using online courses to catch up or to retake classes they have failed. Other topics include advanced software that adapts to student progress and ability, the social aspects of physical classes, and state-assessment scores of students who used online educational software.

Extracellular matrix (ECM) alterations in the central nervous system (CNS) of multiple sclerosis (MS) patients result from blood-brain barrier breakdown, release and activation of proteases, and synthesis of ECM components. To elucidate their potential pathophysiologic roles, we analyzed expression of major CNS ECM proteoglycans (PGs) in MS and control CNS tissues. In active MS plaque edges, 3 CNS lecticans (versican, aggrecan, and neurocan) and dermatan sulfate PG were increased in association with astrocytosis; in active plaque centers they were decreased in the ECM and accumulated in foamy macrophages, suggesting that these ECM PGs are injured and phagocytosed along with myelin. In inactive lesions they were diminished and in normal-appearing white matter they showed heretofore-unappreciated abnormal heterogeneous aggregation. Phosphacan, an ECM PG abundant in both gray and white matter, was less markedly altered. Since in development the spaciotemporal expression of ECM PGs influences neurite outgrowth, cell migration, axon guidance, and myelination, these data suggest that 1) enhanced white matter lectican and dermatan sulfate PG expression in the pro-inflammatory milieu of expanding lesion edges contributes to their sharp boundaries and the failure of neuronal ingrowth; 2) decreases in plaque centers may preclude regeneration and repair; and 3) diffuse ECM PG damage relates to axon degeneration outside of overt lesions. Thus, ECM PG alterations are specific, temporally dynamic, and widespread in MS patients and may play critical roles in lesion pathogenesis and CNS dysfunction.