A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study.

BACKGROUND: Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African. OBJECTIVES: To develop Afrocentric risk-scoring models for stroke occurrence. MATERIALS AND METHODS: We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were randomly split into a training and testing set at the ratio of 85:15. Conditional logistic regression models were constructed by including 17 putative factors linked to stroke occurrence using the training set. Significant risk factors were assigned constant and standardized statistical weights based on regression coefficients (ß) to develop an additive risk scoring system on a scale of 0-100%. Using the testing set, Receiver Operating Characteristics (ROC) curves were constructed to obtain a total score to serve as cut-off to discriminate between cases and controls. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at this cut-off. RESULTS: For stroke occurrence, we identified 15 traditional vascular factors. Cohen's kappa for validity was maximal at a total risk score of 56% using both statistical weighting approaches to risk quantification and in both datasets. The risk score had a predictive accuracy of 76% (95%CI: 74-79%), sensitivity of 80.3%, specificity of 63.0%, PPV of 68.5% and NPV of 76.2% in the test dataset. For ischemic strokes, 12 risk factors had predictive accuracy of 78% (95%CI: 74-81%). For hemorrhagic strokes, 7 factors had a predictive accuracy of 79% (95%CI: 73-84%). CONCLUSIONS: The SIREN models quantify aggregate stroke risk in indigenous West Africans with good accuracy. Prospective studies are needed to validate this instrument for stroke prevention.

Effect of acute heat stress on cognitive performance of chickens in a feed-related discriminant task.

Little is known about immediate and long-lasting effect of acute heat stress on chicken cognition. Thirty-five, 9-week-old birds were trained to differentiate two cone colours; white (rewarded, R; with feed underneath) and black (unrewarded, UR; empty). The sixteen birds that learnt the task were randomly assigned to three temperature regimens (TR: 22-24 °C (control), 30-32 and 36-38 °C for 3h/day) for three consecutive days during which rectal (RT), wing (WT) and eye (ET) temperatures were monitored. After the 3 h of exposure, birds were allowed to rest for 1 h before the commencement of the discriminant task. The latencies to open the cones (R and UR) and proportion of cones opened were recorded. A long-lasting effect was tested a week after exposure to TR. TR had a significant effect on RT, WT and ET. The motivation to turn over R cones was weaker in birds exposed to 36-38 °C than birds exposed to 22-24 °C. Also, the proportion of R cones opened were fewer in birds that experienced TR of 36-38 °C compared to birds exposed to 22-24 °C and 30-32 °C specifically on two out of the three cognitive test days (Days 1 and 3). Latency and proportion of UR cones opened was not affected by TR. RT, WT and ET were all negatively and significantly correlated with latency to open the UR cones. Previous exposure of birds to three TR had no effect on the latency to open both cones but the proportion of R cones opened was greater in birds exposed to 30-32 °C compared to the 22-24 °C birds. In conclusion, an immediate (36-38 °C) and long-lasting effect (30-32 °C) of acute heat stress was associated with a weak motivation to perform feed related discrimination task.

The copy number variation and stroke (CaNVAS) risk and outcome study.

BACKGROUND AND PURPOSE: The role of copy number variation (CNV) variation in stroke susceptibility and outcome has yet to be explored. The Copy Number Variation and Stroke (CaNVAS) Risk and Outcome study addresses this knowledge gap. METHODS: Over 24,500 well-phenotyped IS cases, including IS subtypes, and over 43,500 controls have been identified, all with readily available genotyping on GWAS and exome arrays, with case measures of stroke outcome. To evaluate CNV-associated stroke risk and stroke outcome it is planned to: 1) perform Risk Discovery using several analytic approaches to identify CNVs that are associated with the risk of IS and its subtypes, across the age-, sex- and ethnicity-spectrums; 2) perform Risk Replication and Extension to determine whether the identified stroke-associated CNVs replicate in other ethnically diverse datasets and use biomarker data (e.g. methylation, proteomic, RNA, miRNA, etc.) to evaluate how the identified CNVs exert their effects on stroke risk, and lastly; 3) perform outcome-based Replication and Extension analyses of recent findings demonstrating an inverse relationship between CNV burden and stroke outcome at 3 months (mRS), and then determine the key CNV drivers responsible for these associations using existing biomarker data. RESULTS: The results of an initial CNV evaluation of 50 samples from each participating dataset are presented demonstrating that the existing GWAS and exome chip data are excellent for the planned CNV analyses. Further, some samples will require additional considerations for analysis, however such samples can readily be identified, as demonstrated by a sample demonstrating clonal mosaicism. CONCLUSION: The CaNVAS study will cost-effectively leverage the numerous advantages of using existing case-control data sets, exploring the relationships between CNV and IS and its subtypes, and outcome at 3 months, in both men and women, in those of African and European-Caucasian descent, this, across the entire adult-age spectrum.

Assessing the Coverage of E-Health Services in Sub-Saharan Africa. A Systematic Review and Analysis.

BACKGROUND: E-Health has attracted growing interests globally. The relative lack of facilities, skills, funds and information on existing e-Health initiatives has affected progress on e-Health in Africa. OBJECTIVES: To review publicly available literature on e-Health in sub-Saharan Africa (sSA) towards providing information on existing and ongoing e-Health initiatives in the region. METHODS: Searches of relevant literature were conducted on Medline, EMBASE and Global Health, with search dates set from 1990 to 2016. We included studies on e-Health initiatives (prototypes, designs, or completed projects) targeting population groups in sSA. RESULTS: Our search returned 2322 hits, with 26 studies retained. Included studies were conducted in 14 countries across the four sub-regions in sSA (Central, East, South and West) and spreading over a 12-year period, 2002-2014. Six types of e-Health interventions were reported, with 17 studies (65 %) based on telemedicine, followed by mHealth with 5 studies (19 %). Other e-Health types include expert system, electronic medical records, e-mails, and online health module. Specific medical specialties covered include dermatology (19 %), pathology (12 %) and radiology (8 %). Successes were 'widely reported' (representing 50 % overall acceptance or positive feedbacks in a study) in 10 studies (38 %). The prominent challenges reported were technical problems, poor internet and connectivity, participants' selection biases, contextual issues, and lack of funds. CONCLUSION: E-Health is evolving in sSA, but with poorly published evidence. While we call for more quality research in the region, it is also important that population-wide policies and on-going e-Health initiatives are contextually feasible, acceptable, and sustainable.