David Howard, M.D.

Cecocentral scotoma as the initial manifestation of subacute bacterial endocarditis
Strauss, Danielle Savitsky; Baharestani, Samuel; Nemiroff, Julia; Amesur, Kiran; Howard, David
2011 ;5:287-290, Clinical ophthalmology (Auckland, N.Z.)
INTRODUCTION: We report a case of a 67-year-old male who presented with a cecocentral scotoma caused by a septic embolus from subacute bacterial endocarditis (SBE). METHODS: A 67-year-old man presented with sudden, painless decreased vision in the left eye. A dilated fundoscopic exam, Humphrey visual field test, transthoracic echocardiogram, abdominal computed tomography (CT), and blood cultures were all performed. RESULTS: A dilated fundoscopic exam revealed temporal segmental optic disc pallor on the left, and Humphrey visual field testing demonstrated a dense left cecocentral scotoma. When the patient developed fever (103. 9 degrees F) and palpitations, transthoracic echocardiogram revealed valvular vegetations, and contrast CT of the abdomen revealed an abscess in the dome of the liver likely due to an infectious thrombus. Blood cultures grew viridians group streptococci in three separate peripheral collections. CONCLUSION: This case illustrates that a sudden cecocentral scotoma may be the initial manifestation of SBE
— id: 130312, year: 2011, vol: 5, page: 287, stat: Journal Article,

The future of restorative neurosciences in stroke: driving the translational research pipeline from basic science to rehabilitation of people after stroke
Cheeran, Binith; Cohen, Leonardo; Dobkin, Bruce; Ford, Gary; Greenwood, Richard; Howard, David; Husain, Masud; Macleod, Malcolm; Nudo, Randolph; Rothwell, John; Rudd, Anthony; Teo, James; Ward, Nicholas; Wolf, Steven
2009 Feb;23(2):97-107, Neurorehabilitation & neural repair
BACKGROUND: Major advances during the past 50 years highlight the immense potential for restoration of function after neural injury, even in the damaged adult human brain. Yet, the translation of these advances into clinically useful treatments is painstakingly slow. OBJECTIVE: Here, we consider why the traditional model of a 'translational research pipeline' that transforms basic science into novel clinical practice has failed to improve rehabilitation practice for people after stroke. RESULTS: We find that (1) most treatments trialed in vitro and in animal models have not yet resulted in obviously useful functional gains in patients; (2) most clinical trials of restorative treatments after stroke have been limited to small-scale studies; (3) patient recruitment for larger clinical trials is difficult; (4) the determinants of patient outcomes and what patients want remain complex and ill-defined, so that basic scientists have no clear view of the clinical importance of the problems that they are addressing; (5) research in academic neuroscience centers is poorly integrated with practice in front-line hospitals and the community, where the majority of patients are treated; and (6) partnership with both industry stakeholders and patient pressure groups is poorly developed, at least in the United Kingdom where research in the translational restorative neurosciences in stroke depends on public sector research funds and private charities. CONCLUSIONS: We argue that interaction between patients, front-line clinicians, and clinical and basic scientists is essential so that they can explore their different priorities, skills, and concerns. These interactions can be facilitated by funding research consortia that include basic and clinical scientists, clinicians and patient/carer representatives with funds targeted at those impairments that are major determinants of patient and carer outcomes. Consortia would be instrumental in developing a lexicon of common methods, standardized outcome measures, data sharing and long-term goals. Interactions of this sort would create a research-friendly, rather than only target-led, culture in front-line stroke rehabilitation services
— id: 96680, year: 2009, vol: 23, page: 97, stat: Journal Article,

An instance-based algorithm with auxiliary similarity information for the estimation of gait kinematics from wearable sensors
Goulermas, John Y; Findlow, Andrew H; Nester, Christopher J; Liatsis, Panos; Zeng, Xiao-Jun; Kenney, Laurence P J; Tresadern, Phil; Thies, Sibylle B; Howard, David
2008 Sep;19(9):1574-1582, IEEE transactions on neural networks
Wearable human movement measurement systems are increasingly popular as a means of capturing human movement data in real-world situations. Previous work has attempted to estimate segment kinematics during walking from foot acceleration and angular velocity data. In this paper, we propose a novel neural network [GRNN with Auxiliary Similarity Information (GASI)] that estimates joint kinematics by taking account of proximity and gait trajectory slope information through adaptive weighting. Furthermore, multiple kernel bandwidth parameters are used that can adapt to the local data density. To demonstrate the value of the GASI algorithm, hip, knee, and ankle joint motions are estimated from acceleration and angular velocity data for the foot and shank, collected using commercially available wearable sensors. Reference hip, knee, and ankle kinematic data were obtained using externally mounted reflective markers and infrared cameras for subjects while they walked at different speeds. The results provide further evidence that a neural net approach to the estimation of joint kinematics is feasible and shows promise, but other practical issues must be addressed before this approach is mature enough for clinical implementation. Furthermore, they demonstrate the utility of the new GASI algorithm for making estimates from continuous periodic data that include noise and a significant level of variability
— id: 96681, year: 2008, vol: 19, page: 1574, stat: Journal Article,

Traumatic retrobulbar hemorrhage: emergent decompression by lateral canthotomy and cantholysis
Vassallo, Susi; Hartstein, Morris; Howard, David; Stetz, Jessica
2002 Apr;22(3):251-256, Journal of emergency medicine
Traumatic retrobulbar hemorrhage may result in acute loss of vision that is reversible when recognized and treated promptly. A case of traumatic retrobulbar hemorrhage is presented. The technique of emergent orbital decompression by lateral canthotomy and cantholysis is described. The anatomy of the lateral canthus and the surgical procedure are illustrated by gross dissection
— id: 39685, year: 2002, vol: 22, page: 251, stat: Journal Article,

Amitriptyline and hydroxylated metabolite plasma levels in depressed outpatients
Robinson, D S; Cooper, T B; Howard, D; Corcella, J; Albright, D
1985 Apr;5(2):83-88, Journal of clinical psychopharmacology
As part of a double-blind clinical trial comparing phenelzine and amitriptyline in outpatients with predominantly major depressive disorder, plasma tricyclic antidepressant drug concentrations were measured in 83 amitriptyline-treated patients. In 29 of these patients, hydroxymetabolites were also assayed. Patients were treated for 6 weeks at a fixed dose of 150 mg/day of amitriptyline after the first 5 days. Therapeutic outcome was assessed with a structured depression interview schedule, the Symptom Checklist-90, a side effects checklist, and a global improvement scale. Steady state plasma levels of 10-hydroxynortriptyline were in the same range as amitriptyline or nortriptyline concentrations. Clinical response did not relate significantly to plasma levels of either the parent drug, its metabolites, or the sum of all four pharmacologically active substances. Minimum threshold tricyclic antidepressant levels for therapeutic effect were not found. Assay of its active hydroxymetabolites does not appear to improve the clinical utility of routine amitriptyline level monitoring in patients with major depression in an outpatient setting
— id: 137609, year: 1985, vol: 5, page: 83, stat: Journal Article,

Plasma levels of catecholamines and dihydroxyphenylglycol during antidepressant drug treatment
Robinson, D S; Johnson, G A; Nies, A; Corcella, J; Cooper, T B; Albright, D; Howard, D
1983 Oct;3(5):282-287, Journal of clinical psychopharmacology
Plasma norepinephrine, epinephrine, and 3,4-dihydroxyphenylglycol levels were measured in depressed outpatients treated in a double-blind controlled clinical trial with 150 mg/day of amitriptyline or 60 mg/day of phenelzine for 6 weeks. Both antidepressant drug treatments were associated with a significant decline in plasma dihydroxyphenylglycol concentrations, which was more pronounced with phenelzine. Plasma norepinephrine levels also declined during phenelzine but not amitriptyline treatment, and the posttreatment values correlated with clinical improvement with the monoamine oxidase inhibiting drug. Reductions in norepinephrine and dihydroxyphenylglycol correlated highly with the degree of platelet monoamine oxidase inhibition. Mechanisms of these antidepressant drug effects on amine metabolism and their implications are discussed
— id: 137624, year: 1983, vol: 3, page: 282, stat: Journal Article,