• Are young adults encouraged to join the construction industry?

      Stride, Mark; Chung, Sammy; Subashini, Suresh (University of Wolverhampton, 2018-12-19)
      The construction industry is currently suffering from a lack of skilled workers, from builders and plumbers, to quantity surveyors and architects. Reasons for this include the recession and that the retiring workforce is not being replaced by younger generations. This is having a huge impact on the country’s ability to keep up with the demand for houses that need building; consequently meaning there is a shortage in homes in the country also. The research question addressed in the paper is: What can be done to encourage young adults (14-16 years old) to join the construction industry? The research question is answered through a critical literature review and analysis of questionnaire responses. The results show that there is little education on the construction industry to encourage young adults, and that it is perceived to be a dirty and low status industry to work in. On this basis, it is recommended that the Government and professional bodies need to do more to educate children in schools on what the construction industry truly is, and what opportunities it has for a good career. An initiative that was introduced in 2017 was the apprenticeship levy, which persuades companies to employ apprentices and up skill current employees subsequently encouraging school children to move directly into the construction industry. By schools, universities, colleges and businesses supporting each other it allows longevity and sustainability of the construction industry to be strengthened.
    • Leadership initiatives for health and safety risk management systems in a small construction company – A case study

      Suresh, Subashini; Oduoza, Chike; Renukappa, Suresh (IntechOpen, 2017-05-15)
      In a globalised world the need for leadership in the construction industry has been greater due to the fact that health and safety has become an important business tool to reduce accidents to save lives and minimise injuries. The aim of this chapter is to demonstrate the importance and role of leadership for manging risks associated with health and safety aspects in small construction companies. Therefore, a case study of an Italian family run small construction company is investigated and reported. The chapter dwells in depth with regards to health and safety (H&S) risk management issues such as: commitment, workers engagement, prioritisation of H&S, compliance, measurement and organisational learning from a leadership perspective. As a diagnostic tool Leadership and Worker Involvement toolkit was administrated in the company. The toolkit had assessment levels (walking, running and sprinting). Analysis of the case study company showed they were at walking and running stages in various aspects. But the leadership aspiration of the company was to reach the ‘sprinting’ stage as a long-term target and sustain it to minimise health and safety risk. A holistic approach was developed to achieve the leadership aspirations of the company. An Enterprise Risk Management (ERM) Framework (strategy, process and performance) with a health and safety strand was developed and evaluated. This strand had health and safety at the heart of the organisational vision and objectives which had processes to identify the health and safety risk factors which then lead to health and safety performance measurement. This measurement is based on the Balance Score Card concept which includes H&S risk from aspects such as: financial, clients, business process and learning and growth. Evaluation of framework revealed that violation of H&S laws and regulations have an impact on all the four aspects of Balance Score Card (financial, clients, business process and learning and growth). This then has an overall effect on the ERM which has an impact on leadership decisions on H&S aspects. Therefore, in conclusion, the role of leadership in small companies is to In-doc controls understand the importance of H&S aspects and develop strategies which are then embedded in the processes of the companies to minimise H&S risks for their sustainability and competitiveness. This chapter is beneficial for professional at site (operatives/site trainees), project and programme level (site/project/programme managers) and for leadership team (Directors/board members).
    • Cariprazine: pharmacology and clinical management of psychiatric disorders

      Antoun Reyad, Ayman; Mishriky, Raafat (Healio, 2019-12-31)
      Cariprazine is a new atypical antipsychotic for schizophrenia and bipolar disorders 2 management. In this article, the role of cariprazine, a partial D2 and D3 receptors 3 agonist with a higher D3 affinity, in the management of psychiatric conditions is 4 illustrated. Cariprazine caused significant improvements in psychiatric scales such 5 as Positive and Negative Syndrome scale (PANSS), clinical global impressions 6 (CGI) and young mania rating scales (YMRS) and was associated with side effects 7 such as akathisia, restlessness and insomnia. These findings will guide psychiatrists 8 and pharmacists in their clinical role for supporting psychiatric patients care.
    • Downregulation of early visual cortex excitability mediates oscillopsia suppression

      Ahmad, Hena; Roberts, Ed; Patel, Mitesh; Lobo, Rhannon; Seemungal, Barry M.; Arshad, Qadeer; Bronstein, Adolfo M. (Academic Academy of Neurology, 2017-08-16)
      Objective: To identify in an observational study the neurophysiologic mechanisms that mediate adaptation to oscillopsia in patients with bilateral vestibular failure (BVF). Methods: We directly probe the hypothesis that adaptive changes that mediate oscillopsia suppression implicate the early visual-cortex (V1/V2). Accordingly, we investigated V1/V2 excitability using transcranial magnetic stimulation (TMS) in 12 avestibular patients and 12 healthy controls. Specifically, we assessed TMS-induced phosphene thresholds at baseline and cortical excitability changes while performing a visual motion adaptation paradigm during the following conditions: baseline measures (i.e., static), during visual motion (i.e., motion before adaptation), and during visual motion after 5 minutes of unidirectional visual motion adaptation (i.e., motion adapted). Results: Patients had significantly higher baseline phosphene thresholds, reflecting an underlying adaptive mechanism. Individual thresholds were correlated with oscillopsia symptom load. During the visual motion adaptation condition, no differences in excitability at baseline were observed, but during both the motion before adaptation and motion adapted conditions, we observed significantly attenuated cortical excitability in patients. Again, this attenuation in excitability was stronger in less symptomatic patients. Conclusions: Our findings provide neurophysiologic evidence that cortically mediated adaptive mechanisms in V1/V2 play a critical role in suppressing oscillopsia in patients with BVF.
    • Functional neuroimaging of visuo-vestibular interaction

      Roberts, Ed; Ahmad, Hena; Arshad, Qadeer; Patel, Mitesh; Dima, Dinai; Leech, Robert; Seemungal, Barry M.; Sharp, David J.; Bronstein, Adolfo M. (Springer, 2016-12-10)
      The brain combines visual, vestibular and proprioceptive information to distinguish between self- and world motion. Often these signals are complementary and indicate that the individual is moving or stationary with respect to the surroundings. However, conflicting visual motion and vestibular cues can lead to ambiguous or false sensations of motion. In this study, we used functional magnetic resonance imaging to explore human brain activation when visual and vestibular cues were either complementary or in conflict. We combined a horizontally moving optokinetic stimulus with caloric irrigation of the right ear to produce conditions where the vestibular activation and visual motion indicated the same (congruent) or opposite directions of self-motion (incongruent). Visuo-vestibular conflict was associated with increased activation in a network of brain regions including posterior insular and transverse temporal areas, cerebellar tonsil, cingulate and medial frontal gyri. In the congruent condition, there was increased activation in primary and secondary visual cortex. These findings suggest that when sensory information regarding self-motion is contradictory, there is preferential activation of multisensory vestibular areas to resolve this ambiguity. When cues are congruent, there is a bias towards visual cortical activation. The data support the view that a network of brain areas including the posterior insular cortex may play an important role in integrating and disambiguating visual and vestibular cues.
    • Patients with chronic dizziness following traumatic head injury typically have multiple diagnoses involving combined peripheral and central vestibular dysfunction

      Arshad, Qadeer; Roberts, Ed; Ahmad, Hena; Lobo, Rhannon; Patel, Mitesh; Ham, Timothy; Sharp, David J.; Seemungal, Barry M. (Elsevier, 2017-02-07)
      Objective We hypothesised that chronic vestibular symptoms (CVS) of imbalance and dizziness post-traumatic head injury (THI) may relate to: (i) the occurrence of multiple simultaneous vestibular diagnoses including both peripheral and central vestibular dysfunction in individual patients increasing the chance of missed diagnoses and suboptimal treatment; (ii) an impaired response to vestibular rehabilitation since the central mechanisms that mediate rehabilitation related brain plasticity may themselves be disrupted. Methods We report the results of a retrospective analysis of both the comprehensive clinical and vestibular laboratory testing of 20 consecutive THI patients with prominent and persisting vestibular symptoms still present at least 6 months post THI. Results Individual THI patients typically had multiple vestibular diagnoses and unique to this group of vestibular patients, often displayed both peripheral and central vestibular dysfunction. Despite expert neuro-otological management, at two years 20% of patients still had persisting vestibular symptoms. Conclusion In summary, chronic vestibular dysfunction in THI could relate to: (i) the presence of multiple vestibular diagnoses, increasing the risk of ‘missed’ vestibular diagnoses leading to persisting symptoms; (ii) the impact of brain trauma which may impair brain plasticity mediated repair mechanisms. Apart from alerting physicians to the potential for multiple vestibular diagnoses in THI, future work to identify the specific deficits in brain function mediating poor recovery from post-THI vestibular dysfunction could provide the rationale for developing new therapy for head injury patients whose vestibular symptoms are resistant to treatment.
    • Does outstretching the arms improve postural stability?

      Patel, Mitesh; Buckwell, David; Hawken, Malcolm; Bronstein, Adolfo M. (Elsevier, 2014-07-17)
      We spontaneously outstretch our arms when standing upon challenging surfaces, yet the effect of stretching the arms upon postural stability is unknown. We investigated whether stretching out the arms laterally improves postural control during tandem stance on a narrow beam. Twelve healthy participants stood upon a beam, right foot in front of the left foot, for 30 s with arms outstretched or down to the side, with eyes open and closed. Mediolateral head movement was characterised by Root Mean Square amplitude (RMS), sway path, velocity during the largest excursion and power spectrum. Spectra for lateral forces from a force platform beneath the beam were also recorded. Outstretching the arms significantly reduced RMS, sway path and velocity of maximum displacement of head movement with eyes closed but not with eyes open. A similar trend was present in the power spectra of head motion and sway platform lateral forces. In conclusion, outstretching the arms helps postural stability in challenging situations such as tandem stance on a narrow beam with eyes closed. Although the exact mechanisms require further investigation, the effects are most likely mediated by changes in segmental inertia and the ability to make corrective arm movements.
    • Attention modulates adaptive motor learning in the ‘broken escalator’ paradigm

      Patel, Mitesh; Kaski, Diego; Bronstein, Adolfo M. (Springer, 2014-04-09)
      The physical stumble caused by stepping onto a stationary (broken) escalator represents a locomotor aftereffect (LAE) that attests to a process of adaptive motor learning. Whether such learning is primarily explicit (requiring attention resources) or implicit (independent of attention) is unknown. To address this question, we diverted attention in the adaptation (MOVING) and aftereffect (AFTER) phases of the LAE by loading these phases with a secondary cognitive task (sequential naming of a vegetable, fruit and a colour). Thirty-six healthy adults were randomly assigned to 3 equally sized groups. They performed 5 trials stepping onto a stationary sled (BEFORE), 5 with the sled moving (MOVING) and 5 with the sled stationary again (AFTER). A 'Dual-Task-MOVING (DTM)' group performed the dual-task in the MOVING phase and the 'Dual-Task-AFTEREFFECT (DTAE)' group in the AFTER phase. The 'control' group performed no dual task. We recorded trunk displacement, gait velocity and gastrocnemius muscle EMG of the left (leading) leg. The DTM, but not the DTAE group, had larger trunk displacement during the MOVING phase, and a smaller trunk displacement aftereffect compared with controls. Gait velocity was unaffected by the secondary cognitive task in either group. Thus, adaptive locomotor learning involves explicit learning, whereas the expression of the aftereffect is automatic (implicit). During rehabilitation, patients should be actively encouraged to maintain maximal attention when learning new or challenging locomotor tasks.
    • Sex differences in scent-marking in captive red-ruffed lemurs

      Janda, Ellese D.; Perry, Kate L.; Hankinson, Emma; Walker, David; Vaglio, Stefano (Wiley, 2019-01-21)
      Primate chemical communication remains underappreciated, as primates are considered to rely on other sensory modalities. However, various lines of evidence suggest that olfaction plays an important role in primate societies, including the conspicuous scent-marking behavior of many strepsirrhines and callitrichines. Although lemurs typically show scent-marking, little is known about this behavior in red-ruffed lemurs (Varecia variegata rubra). We combined behavioral observations and semiochemistry analyses to improve our understanding of scent-marking in two captive troops housed at Dudley and Twycross zoos(UK). We collected olfactory behavioral observations by focusing on two family troops (N=7) for 132hr. We investigated the volatile compounds of ano-genital scent-marks using solid-phase microextraction and gas chromatography-mass spectrometry and compared volatile chemical profiles with features of the signaller. Males scent-marked most frequently and predominantly in specific meaningful areas of the enclosure, while within females the occurrence of scent-marking was related to their age. We found behavioral sexual dimorphism, with male predominantly depositing secretions via neck and mandible glands and females via ano-genital glands. We identified a total of 32 volatile components of ano-genital gland secretion, including compounds that have already been found in other mammals as sex pheromones and cues to fitness, in ano-genital scent-marks spontaneously left on filter paper by adult females. Our findings suggest that red-ruffed lemurs might use scent-marking to convey information about sex and female age, with male neck marking behavior playing defensive territorial functions and ano-genital marking related to socio-sexual communication.
    • The adoption of big data concepts for sustainable practices implementation in the construction industry

      Reyes, Paola; Suresh, Subashini; Renukappa, Suresh (IEEE, 2018-12-17)
      The global construction business is on a point of a paradigm shift. The exponential growth of digital technologies, the increasing impacts of climate change, impending Brexit and looming social and environmental pressures are driving change to the construction industry. Increasingly policies press for the adoption of sustainability and construction organisations are realising that small sustainable impacts are no longer enough. Therefore, measurement is one of the keys to the implementation of sustainable construction strategies. Advances in data gathering, computing power and connectivity mean that construction organisations have more information and data than ever before. Collecting, analysing and understanding those large volumes of available data, known as Big Data, about how an organisation operates sustainably leads to knowledge that can improve decision making, refine goals and focus efforts. However, when it comes to sustainability the great thing about big data is that it is unlocking the ability of businesses to understand and act on what is typically their biggest sustainable (i.e. economic, social and environmental) impacts - the ones outside their control. Measuring and understanding how doing business really does affect the natural world will open new opportunities for bringing sustainability inside an organisation: creating change, cutting costs and boosting long-term profitability in a resource-constrained world. Still, there are issues and challenges around gathering sustainability-related data, as well as in analysing and interpreting of data points. Therefore, the aim of this research is to explore the barriers to adopting big data related to sustainable strategies. The relationship between Policy Making, Big Data and sustainability is still in early stages, but already several applications can be mention to the environment, health and construction, such as biodiversity loss monitoring, pollution zones Identification, endangered species location, smart energy management, cost reduction or investment assessment. In the same way, barriers and opportunities were identified, for instance: the lack of financial resources and business case, skills and training, unequal opportunity and security and disclosure issues among the barriers, and partnership, emerging and accessible technology, personalization of the environment among the opportunities. Finally, the biggest challenge presented by the implementation of Big Data is concept standardization, since there are many areas in which one way or another is making use of this technology without being recognized as such. In the same way, the greatest asset that represents the use of Big Data for sustainability is the identification of the future causes and consequences of climate change and its subsequent prevention or mitigation in time.
    • Developments of policies related to smart cities: a critical review

      Keshvardoost, Sina; Renukappa, Suresh; Suresh, Subashini (IEEE, 2019-01-10)
      In recent years, the idea of smart sustainable cities has come to the fore. Furthermore, it is quickly gaining momentum, and worldwide attention as a promising response to the challenge of urban sustainability. This pertains especially to ecologically and technologically advanced nations. This paper provides a comprehensive overview of smart (and) sustainable cities in terms of their underlying foundations, assumptions, state– of–the art research development, policies, and future planning practices. As to the design strategy, the paper reviews existing sustainable city models and smart city approaches. Their strengths and weaknesses are examined by focusing on the degree to which cities to the objectives and whether the latter incorporate these goals. To distinguish the related challenges, these models and adopt methodologies are assessed and contrasted against each other in line with the notion of sustainability. The gaps in the exploration inside the field of smart sustainable cities are recognized as in accordance with the research being proposed. Subsequently, a coordinated approach is proposed in view of an applied theoretical perspective to align the existing problems and solutions identified for future practices in the area of smart, sustainable urban planning and smart cities policy development. With regard to knowledge contribution, the paper demonstrates Policy developments related to smart cities in general and particular problems within the policy development, as well as considering the commitment to the application of the policy. Also, diverse country’s approach on policies for smart cities and their policy related to Governance It also reveals that numerous research opportunities are available and can be realized within the realm of smart sustainable cities.
    • Endemic, endangered, and evolutionarily significant: Cryptic lineages in Seychelles’ frogs (Anura: Sooglossidae)

      Labisko, Jim; Griffiths, Richard A.; Chong-Seng, Lindsay; Bunbury, Nancy; Maddock, Simon T; Bradfield, Kay S.; Taylor, Michelle L. (Oxford University Press, 2019-01-12)
      Cryptic diversity corresponding with island of origin has been previously reported in the endemic, geographically restricted sooglossid frogs of the Seychelles archipelago. The evolutionary pattern behind this has not been fully explored, and given current amphibian declines and the increased extinction risk faced by island species, we sought to identify evolutionarily significant units (ESUs) to address conservation concerns for these highly threatened anurans. We obtained genetic data for two mitochondrial (mtDNA) and four nuclear (nuDNA) genes from all known populations of sooglossid frog (on the islands of Mahé, Praslin and Silhouette) for phylogenetic analyses and to construct nuDNA haplotype networks. Bayesian and maximum likelihood analyses of mtDNA support the monophyly and molecular differentiation of populations in all species that occur on multiple islands. Haplotype networks using statistical parsimony revealed multiple high-frequency haplotypes shared between islands and taxa, in addition to numerous geographically distinct (island-specific) haplotypes for each species. We consider each island-specific population of sooglossid frog as an ESU and advise conservation managers to do likewise. Furthermore, our results identify each island lineage as a candidate species, evidence for which is supported by analyses of mtDNA based on Bayesian Poisson tree processes, and independent analyses of mtDNA and nuDNA using the multispecies coalescent. Our findings add to the growing understanding of the biogeography and hidden diversity within this globally important region.
    • Compaction analysis and optimisation of convex-faced pharmaceutical tablets using numerical techniques

      Baroutaji, Ahmad; Lenihan, Sandra; Bryan, Keith (Elsevier, 2019-12-31)
      Capping failure, edge chipping, and non-uniform mechanical properties of convexfaced pharmaceutical tablets are common problems in pharma industry. In this paper, Finite Element Modelling (FEM) and Design of Experiment (DoE) techniques are adopted to find the optimal shape of convex-faced (CF) pharmaceutical tablet which has more uniform mechanical properties and less capping and chipping tendency. The effects of the geometrical parameters and friction on the compaction responses of convex-faced pharmaceutical tablets were first identified and analysed. The finite element model of the tabletting process was generated using the implicit code (ABAQUS) and validated against experimental measurements. Response Surface Methodology (RSM) was employed to establish the relationship between the design variables, represented by the geometrical parameters and the friction coefficient, and compaction responses of interest including residual die pressure, the variation of relative density within the tablet, and the relative shear stress of the edge of the tablet. A statistical-based optimisation approach is then employed to undertake shape optimisation of CF tablets. The obtained results demonstrated how the geometrical parameters of CF tablet and the friction coefficient have significant effects on the compaction behaviour and quality of the pharmaceutical tablet.
    • Athena SWAN in Higher Education Sector - a Built Environment Perspective

      Suresh, Subashini; Abdul-Aziz, Abdul-Rashid; Renukappa, Suresh (University of Wolverhampton, 2018-12-19)
      Higher education tends to recognise gender equality in terms of representation, progression and success for students and staff. Athena SWAN is a Charter which addresses gender equality. This paper is based on critical review of literature and secondary data analysis. A thorough literature review explores the best practices adopted by Universities in UK who were awarded Gold, Silver and Bronze. In doing so, 39 Universities were identified from the CHOBE members (Council of Heads of the Built Environment Heads of Department of Construction, Property and Surveying) in the year 2017 who have built environment students and staff. The results revealed that none of the Universities had gold award of Athena SWAN whereas 26 Universities had bronze awards. From the secondary data analysis of three years data from Equality in higher education, statistical reports on student and staff shows areas of concern for built environment where the female percent of student and staff are in the lower end of the spectrum. Therefore, initiatives and lessons learnt from other successful awarded Universities will be discussed in this paper so that awareness and adoption of the best practices by the built environment sector is encouraged.
    • Effects of acute exercise on liver function and blood redox status in heavy drinkers

      Georgakouli, K.; Manthou, E.; Fatouros, I.G.; Deli, C.K; Spandidos, D.A; Tsatsakis, A.M; Kouretas, D.; Koutedakis, Y.; Theodorakis, Y.; Jamurtas, A.Z (Spandidos, 2015-10-13)
      Excessive alcohol consumption can induce oxidative stress, resulting in the development of several diseases. Exercise has been reported to prevent and/or improve a number of health issues through several mechanisms, including an improvement in redox status. It has also been previously suggested that exercise can help individuals with alcohol use disorders reduce their alcohol intake; however, research in this field is limited. The aim of the present study was to investigage the effects of acute exercise of moderate intensity on the liver function and blood redox status in heavy drinkers. For this purpose, a total of 17 heavy drinkers [age, 31.6±3.2 years; body mass index (BMI), 27.4±0.8 kg/m2; experimental group (EG)] and 17 controls [age, 33.5±1.3 years; BMI, 26.1±1.4 kg/m2; control group (CG), who did not exceed moderate alcohol consumption], underwent one trial of acute exercise of moderate intensity (50-60% of the heart rate reserve) for 30 min on a cycle ergometer, following an overnight fast, and abstaining from smoking and alcohol consumption. Blood samples were obtained before and immediately after exercise for later determination of the indices of liver function and blood redox status. The subjects in the EG had significantly higher (p<0.05) baseline γ-glutamyl transferase (γ-GT) levels compared to the subjects in the CG. Exercise thus resulted in significantly higher γ-GT levels (p<0.005) only in the EG. No significant differences in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) baseline levels were observed between the 2 groups. Following exercise, the AST levels increased significantly (p<0.001) in both groups, whereas the ALT levels increased significantly (p<0.01) only in the EG. The baseline glutathione (GSH) levels were significantly lower (p<0.05) and remained low following exercise in the EG. In addition, we observed a trend for higher (p=0.07) baseline levels of thiobarbituric acid-reactive substances (TBARS), which remained elevated post-exercise in the EG compared to the CG. Significantly increased post-exercise total antioxidant capacity (TAC; p<0.01) and uric acid (UA; p<0.05) levels were noted in the CG, whereas the TAC (p=0.06) and UA (p=0.08) levels increased and approached significance post-exercise in the EG. No significant differences in the baseline levels of total bilirubin and protein carbonyl were observed between the 2 groups, even post-exercise. Thus, the findings of the present study indicate that even though heavy drinkers may be prone to oxidative stress, their exercise-induced antioxidant response is similar to that of individuals who do not drink heavily.
    • Action observation in the modification of postural sway and gait: Theory and use in rehabilitation

      Patel, Mitesh (Elsevier, 2017-07-24)
      The discovery of cortical neurons responsive to both the observation of another individual’s movement and one’s own physical movement has spurred scientists into utilising this interplay for rehabilitation. The idea that humans can quickly transfer motor programmes or refine existing motor strategies through observation has only recently gained interest in the context of gait rehabilitation but may offer significant promise as an adjunctive therapy to routine balance training. This review is the first dedicated to action observation in postural control or gait in healthy individuals and patients. The traditional use of action observation in rehabilitation is that the observer has to carefully watch pre-recorded or physically performed actions and thereafter imitate them. Using this approach, previous studies have shown improved gait after action observation in stroke, Parkinson’s disease and knee or hip replacement patients. In healthy subjects, action observation reduced postural sway from externally induced balance perturbations. Despite this initial evidence, future studies should establish whether patients are instructed to observe the same movement to be trained (i.e., replicate the observed action(s)) or observe a motor error in order to produce postural countermeasures. The best mode of motor transfer from action observation is yet to be fully explored, and may involve observing live motor acts rather than viewing video clips. Given the ease with which action observation training can be applied in the home, it offers a promising, safe and economical approach as an adjunctive therapy to routine balance training.
    • Intratympanic corticosteroids in Ménière's disease: A mini-review

      Patel, Mitesh (Elsevier, 2017-09-01)
      This article reviews the effectiveness of intratympanic corticosteroids for vertigo control in Ménière's disease at 2-years follow-up according to the guidelines expressed by the American Academy of Otolaryngology-Head & Neck Surgery. Despite the increased use of intratympanic corticosteroids for vertigo control in Ménière's disease there is debate as to their effectiveness, particularly compared to gentamicin. Even so, after just a single course of injections, corticosteroids can reliably provide complete vertigo control (Class A) at 2-years in about 50% of cases as indicated in a recent double-blind randomized controlled clinical trial (Patel et al., 2016). But the effectiveness of intratympanic corticosteroids truly increases when treatment is provided ‘as-needed’, whereby complete vertigo control is established in up to 91% of cases. On the basis of available literature, there is good evidence to recommend the use of intratympanic steroid treatment for vertigo control in Ménière's disease, but patients must be monitored for non-response. The rationale for treating patients as-needed and the possible reasons for corticosteroid non-response are discussed.
    • Multiple sclerosis: Intrathecal inflammation mediates mood in relapsing–remitting multiple sclerosis

      Patel, Mitesh (Springer, 2017-09-15)
      A new study has revealed that subclinical intrathecal inflammation influences anxiety and depression in relapsing–remitting multiple sclerosis (RRMS), and has prognostic relevance in patients with this condition
    • Alzheimer disease: Revising the risk of Alzheimer disease in women

      Patel, Mitesh (Springer, 2017-09-08)
      Among individuals who carry the apolipoprotein E ε4 (APOE*ε4) allele, women are more susceptible to Alzheimer disease (AD) than men only between the ages of 65 and 75 years, according to a new study published in JAMA Neurology.