Migraine surgery for teens — good results in initial experience

first_imgShare on Twitter LinkedIn As in adults, migraine surgery is effective for selected adolescent patients with severe migraine headaches that don’t respond to standard treatments, reports a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).ASPS Member Surgeon Bahman Guyuron, MD, Emeritus professor of plastic surgery at Case School of Medicine, Cleveland, and colleagues report good outcomes in an initial experience with migraine surgery in younger patients. They write, “Our data demonstrate that surgery for refractory migraine headaches in the adolescent population may improve and potentially completely ameliorate symptoms for some.”Young Patients Can Benefit from Migraine Surgery Too The researchers describe their experience with migraine surgery in 14 patients under age 18. Dr. Guyuron developed the migraine surgery techniques after noticing that some migraine patients had reduced headache activity after undergoing cosmetic forehead lift procedures going back to year 2000.The surgery targets “trigger sites” in the nerve branches that produce headaches, identified by preoperative evaluation. Trigger sites are detected using a constellation of symptoms, nerve blocks, ultrasound Doppler and CT scans. Dr. Guyuron and his team have published 24 articles in peer-reviewed journals on this topic and efficacy of the surgery, and have another 12 research projects in process. Five additional independent centers have confirmed Dr. Guyuron’s findings.All teen patients in the experience had debilitating migraine attacks that continued despite recommended medications. The patients were 11 females and three males, average age 16 years. One patient underwent two procedures targeting different trigger sites. Average follow-up was about three years, and at least one year in all patients.In this group of young patients, surgery was highly effective in reducing migraine headaches. Average headache frequency decreased from 25 per month before surgery to five per month afterward. Average migraine severity score decreased from 8.2 to 4.3 on a ten-point scale.The average time of migraine attacks also decreased from about 12 hours to 4 hours. Five of the 14 patients were completely free of migraines after surgery. One patient had no change in migraine frequency, although attacks were shorter and less severe.Migraine headaches are a common problem in children and adolescents, and have a significant impact on mental and physical health for patients and their families. Treatment options are limited. One study has reported that nearly one-fourth of children with neurologist-diagnosed migraine don’t respond to recommended medications. “This represents a large group of adolescent migraine patients with continued symptoms in spite of specialized medical treatment,” Dr. Guyuron and coauthors write.Although the experience is small and preliminary, the results suggest that migraine surgery, like in adults, is safe and effective in teenaged patients. No complications were encountered in this group of young patients. As in adults, surgery is performed only after careful evaluation in patients who don’t respond to standard migraine treatments, who have identifiable trigger points and the family history confirms continuation of migraine headaches from childhood to the adult age.“Identifying the adolescent patient who would benefit from surgery is the most important aspect of surgical intervention,” Dr. Guyuron and colleagues write. They emphasize the need for “more in-depth and prospective studies” to confirm the effectiveness of migraine surgery, and to weigh the risks and benefits of surgery for younger patients. Share on Facebookcenter_img Share Pinterest Emaillast_img read more

Three-minute test detects common form of dementia that’s hard to diagnose

first_imgLinkedIn Share on Twitter Share Although Lewy Body disease (LBD) is the second-most-common degenerative disease after Alzheimer’s disease, it’s not exactly a household name. It affects more than 1.3 million Americans, is poorly recognized, and diagnosis is often significantly delayed. Patients with LBD simultaneously experience losses in cognitive function, mobility and behavior. The late Robin Williams had this form of dementia as did legendary NHL coach Alger Joseph “Radar” Arbour, which also can cause visual hallucinations and make depression worse. Until now, there has been no way to assess or operationalize many of the cognitive and behavioral symptoms of LBD in clinical practice.A leading neuroscientist at Florida Atlantic University has developed the “Lewy Body Composite Risk Score” (LBCRS) to quickly and effectively diagnose LBD and Parkinson’s disease dementia (PDD) in about three minutes. The LBCRS is a brief rating scale that can be completed by a clinician to assess clinical signs and symptoms highly associated with the pathology of this disease. With this important tool, a clinician can assess whether the patient has bradykinesia, rigidity, postural instability, or rest tremor without having to grade each extremity. This simple, one-page survey provides structured yes/no questions for six non-motor features that are present in patients with LBD, but are much less commonly found in other forms of dementia.The LBCRS study, “Improving the Clinical Detection of Lewy Body Dementia with the Lewy Body Composite Risk Score,” recently published in Alzheimer’s & Dementia, the journal of the Alzheimer’s Association, involved 256 patients who were compared with the clinical dementia rating and gold standard measures of cognition, motor symptoms, function and behavior. The test was administered in a “real-world” clinic setting with patients who were referred from the community rather than in a research sample. The clinic sample had a mixture of gender, education, comorbidities, behavioral, affective, motor symptoms, and diagnoses. The LBCRS was able to discriminate between Alzheimer’s disease and LBD with 96.8 percent accuracy, and provided sensitivity of 90 percent and specificity of 87 percent. Share on Facebookcenter_img Pinterest Email For the study, caregivers completed evaluations to determine the presence and severity of non-cognitive symptoms observed in the patient and their impact on the caregiver. Each patient was administered a 30-minute test battery at the time of the office visit to assess their cognitive status. The LBCRS was completed after all other rating scales were scored and the diagnosis was presented to the patient and family.“Most patients never receive an evaluation by a neurologist skilled in the diagnosis of Lewy body dementia, and significant delays and misdiagnoses occur in most patients with this disease,” said James E. Galvin, M.D., M.P.H., one of the most prominent neuroscientists in the country who developed the LBCRS, and a professor of clinical biomedical science in FAU’s Charles E. Schmidt College of Medicine and a professor in FAU’s Christine E. Lynn College of Nursing. “This new tool has the potential to provide a clearer, more accurate picture for those patients who are unable to be seen by specialists, hastening the correct diagnosis and reducing the strain and burden placed on patients and caregivers.”Another important aspect of the LBCRS is its ability to improve the sensitivity of diagnosis, thereby reducing the risk of exposure to patients with LBD to medications that can have potentially serious adverse consequences. The survey also increases the potential opportunity to receive appropriate symptomatic therapies in a timely fashion, and lessens the inappropriate exclusion from and inclusion into clinical trials.“Early detection of Lewy body dementias will be important to enable future interventions at the earliest stages when they are likely to be most effective,” said Galvin. “Our study provides evidence-based methodology that will have applications in clinical practice, participation in clinical trials, prevention studies, community surveys, and biomarkers research.”Galvin is one of the leading international experts on LBD, and has been working to improve clinical detections by combining biomarkers including high density EEG, functional and structural MRI, PET scans and CSF biomarkers to characterize and differentiate LBD from healthy aging and other neurodegenerative diseases.Galvin has led efforts to develop a number of dementia screening tools, including the Quick Dementia Rating System (QDRS), AD8, a brief informant interview to translate research findings to community settings. He has done cross-cultural validation of dementia screening methods in comparison with Gold Standard clinical evaluations and biomarker assays. His team also has developed sophisticated statistical models to explore transition points in clinical, cognitive, functional, behavioral and biological markers of disease in healthy aging, mild cognitive impairment, Alzheimer disease, and Parkinson’s disease.last_img read more

Udall, Senators Introduce Comprehensive Bill To Break Up Cozy Relationship Between FAA And Aviation Industry

first_imgU.S. Sen. Tom UdallU.S. SENATE News:WASHINGTON, D.C. — Wednesday, U.S. Sen. Tom Udall (D-N.M.) along with Senators Richard Blumenthal (D-Conn.), Edward J. Markey (D-Mass.), members of the Senate Committee on Commerce, Science and Transportation, introduced comprehensive legislation to improve safety for aviation passengers by revitalizing oversight of the aviation industry. The Restoring Aviation Accountability Act would reform the federal government’s role to implement strong safety standards for and oversight over the aviation industry in the wake of two Boeing 737 MAX 8 crashes – Lion Air Flight 610 and Ethiopian Airlines Flight 302 – that resulted in the deaths of 346 people. Udall has been an advocate of strong oversight and accountability in aviation safety, calling for the first Senate aviation safety hearing in years following the 2018 after the engine failure of a Southwest Airlines flight that caused the death of Jennifer Riordan, a beloved member of the Albuquerque community, and pushing for subsequent FAA action to ensure safer airplane engines. In October 2019, Udall pressed then-CEO of Boeing, Dennis Muilenberg, to hold the company accountable for its “cozy” relationship with FAA regulators and demonstrate clear concrete steps to reform a lax safety culture. Udall and Blumenthal sent a letter to Muilenberg following the October hearing, demanding that Muilenberg clarify his testimony about Boeing’s response to the crashes and effort to hide the significance of the MCAS system from FAA officials. The Restoring Aviation Accountability Act effectively reverses the provisions enacted by the Federal Aviation Administration (FAA) Reauthorization Act of 2018, which allowed the aviation industry to regulate many of its own safety certification processes. As a result, Boeing’s automated system MCAS, which has been widely recognized as the cause of the deadly Boeing 737 MAX 8 crashes, was never fully analyzed by the FAA while Boeing downplayed its risks.“The two tragic Boeing 737 MAX 8 crashes revealed substantial weakness in the FAA certification process and a cozy culture with industry that pushed speed and profit at the expense of safety. This utter debacle cost hundreds of lives and billions of dollars—proving that we cannot rely on aircraft manufacturers to regulate their own safety standards.” said Udall. “The American people expect the FAA to be tough, independent and uncompromising when it comes to their safety, and this new bill would restore integrity in the FAA’s certification process while restoring the flying public’s faith in American aviation. I hope the Senate Commerce Committee can come together and approve a strong bill in the near future to protect all people who use air travel to visit their families, conduct business, and see the world.” This legislation is supported by a number of aviation industry groups, including the Air Line Pilots Association (ALPA), Government Accountability Project (GAP), the Association of Flight Attendants (AFA), and the Transport Workers Union of America (TWU).“The Restoring Aviation Accountability Act of 2020 upgrades aviation whistleblowing protections to parity with all other federal whistleblowing statutes passed in the last two decades. Beyond implementing an incentive system for reporting and ensuring individuals aren’t gagged from reporting wrongdoing, the bill offers best practice retaliation protections for an expanded class of whistleblowers, and in certain cases allows these folks to make their case before a jury of their peers. The Government Accountability Project is proud to endorse this legislation and heartily recommends its passage. We thank Senator Blumenthal and his staff for their dedication to protecting and encouraging overseers’ eyes and ears on the ground and in the air,” said Irvin McCullough, Deputy Legislative Director of the Government Accountability Project. “ALPA applauds Senator Blumenthal for his work on the Restoring Aviation Accountability Act of 2020. This bill is a safety-first measure that makes a number of improvements in the aviation system, including aircraft certification, delegated authority and the oversight of the FAA’s certification process. In addition, the legislation more directly involves those on the front of lines of keeping our skies safe – airline pilots – in the aircraft certification process. ALPA looks forward to working with other safety-minded leaders like Senator Blumenthal to see this bill enacted into law,” said president of the Air Line Pilots Association, Int’l Capt. Joe DePete. “TWU was the first union to call for grounding the MAX because our members saw how unsafe the system that approved that plane was. This bill would address those systemic problems and help ensure that airline workers and travelers have a safe experience on our aircraft,” said TWU International President John Samuelsen. “The type certification process needs serious correction as highlighted by the 737 MAX accidents. AFA joins concerns expressed by Congress, the NTSB, DOT IG, and others. It is critical to establish a commission to recommend a transition from the ODA program,” said Sara Nelson, International President of the Association of Flight Attendants-CWA. “Aviation regulation is often written in blood – we must learn and change to protect future lives and our industry. We support the legislation introduced by Senators Blumenthal, Markey and Udall.” The Restoring Aviation Accountability Act would: Establish a commission to review the current FAA safety delegation program (ODA) to determine and evaluate if alternative certification programs would provide more robust oversight.Increase the accountability measures of the current safety oversight system by requiring that pay, compensation, and bonuses for officers and employees of the FAA are not contingent on delivery of airplanes, the number of aircraft certified, or the number of audits completed.  Prohibits safety certification system employees of manufacturers from having performance standards tied to delivery of aircraft. Bolster whistleblower incentives and protections in the aviation industry for employees, contractors, and subcontractors of aircraft manufacturers, aircraft repair stations, and the FAA by providing whistleblowers with access to court for a jury trial and monetary incentives for information that leads to a successful resolution of a complaint. The full text of the legislation can be found HERE.last_img read more

South coast checks into hotels

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The Montauk Playhouse: A New Community Center

first_imgHundreds headed down to the Montauk Playhouse for a gala on Saturday, August 4, to raise funds for the Playhouse’s new community center, the Cultural Arts and Aquatic Centers. The centers will add an expansive performance theater, various exercise pools for all ages, and more. While additional funds still need to be raised, the center is expected to be completed in no more than three years. The gala was headlined by Nancy Atlas and Friends and Seth Herzog was the emcee.For more information about the Montauk Playhouse, visit www.montaukplayhouse.org. Sharelast_img read more

Glimpses of the future: Hydrogen sources for tomorrow

first_imgGet instant access to must-read content today!To access hundreds of features, subscribe today! At a time when the world is forced to go digital more than ever before just to stay connected, discover the in-depth content our subscribers receive every month by subscribing to gasworld.Don’t just stay connected, stay at the forefront – join gasworld and become a subscriber to access all of our must-read content online from just $270. Subscribelast_img

Joint hydrogen venture finalised

first_imgGet instant access to must-read content today!To access hundreds of features, subscribe today! At a time when the world is forced to go digital more than ever before just to stay connected, discover the in-depth content our subscribers receive every month by subscribing to gasworld.Don’t just stay connected, stay at the forefront – join gasworld and become a subscriber to access all of our must-read content online from just $270. Subscribelast_img

Solicitors From Hell slander action is thrown out

first_imgThe High Court has thrown out a defamation claim by the founder of the Solicitors from Hell website against Law Society chief executive Desmond Hudson. Rick Kordowski began legal proceedings after a blog from Professor John Flood had alleged that Hudson claimed Kordowski was a ‘criminal’. The exchange had been made after Prof Flood, from the University of Westminster, and Hudson had finished appearing on a Radio 4 discussion programme about the website, which publishes claims about solicitors’ alleged wrongdoing. Flood had suggested to Hudson that the Law Society’s attempt to sue SfH could be seen as ‘muzzling free speech’, a suggestion the chief executive denied. Hudson said the Society’s legal action focused on Kordowski’s methods of collecting payment to remove comments from the website. In a High Court judgment today, Mr Justice Tugendhat dismissed Kordowski’s application and ruled that the libel action against Hudson be struck out. The judge said there was ‘no evidence of any real or substantial harm to Mr Kordowski’ and that proceedings amounted to an abuse of the process of the court. It also pointed out that Kordowski had repeated the allegation against himself on the SfH website in September. The judgment added: ‘It is an unusual feature of this case that Mr Kordowski is not concerned to prevent republication, but has himself participated in republication of the words he complains of. ‘That suggests that he does not share the objective that defamation claimants usually have, namely to prevent republication of the words complained of.’ A Law Society spokesperson said: ‘Mr Kordowski, the owner of the Solicitors from Hell website, had brought a claim for slander against the Law Society’s chief executive. An application was made for the claim to be struck out. The court granted the application, on the basis the proceedings were an abuse of process. ‘Mr Kordowski was ordered to pay £14,000 in costs and his application for permission to appeal was refused.’last_img read more

The final word

first_imgSubscribe to Building today and you will benefit from:Unlimited access to all stories including expert analysis and comment from industry leadersOur league tables, cost models and economics dataOur online archive of over 10,000 articlesBuilding magazine digital editionsBuilding magazine print editionsPrinted/digital supplementsSubscribe now for unlimited access.View our subscription options and join our community Stay at the forefront of thought leadership with news and analysis from award-winning journalists. Enjoy company features, CEO interviews, architectural reviews, technical project know-how and the latest innovations.Limited access to building.co.ukBreaking industry news as it happensBreaking, daily and weekly e-newsletters Subscribe now for unlimited access To continue enjoying Building.co.uk, sign up for free guest accessExisting subscriber? LOGIN Get your free guest access  SIGN UP TODAYlast_img read more

Be ashamed (i)

first_imgStay at the forefront of thought leadership with news and analysis from award-winning journalists. Enjoy company features, CEO interviews, architectural reviews, technical project know-how and the latest innovations.Limited access to building.co.ukBreaking industry news as it happensBreaking, daily and weekly e-newsletters Get your free guest access  SIGN UP TODAY Subscribe now for unlimited access To continue enjoying Building.co.uk, sign up for free guest accessExisting subscriber? LOGIN Subscribe to Building today and you will benefit from:Unlimited access to all stories including expert analysis and comment from industry leadersOur league tables, cost models and economics dataOur online archive of over 10,000 articlesBuilding magazine digital editionsBuilding magazine print editionsPrinted/digital supplementsSubscribe now for unlimited access.View our subscription options and join our communitylast_img read more