Determining whether a person with stroke has reached their full potential for recovery is difficult. While techniques such as transcranial magnetic stimulation (TMS) and MRI have some prognostic value, their role in rehabilitation is undefined. This study used TMS and MRI to determine which factors predict functional potential, defined as an individual's capacity for further functional improvement at least 6 months following stroke. We studied 21 chronic stroke patients with upper limb impairment. The functional integrity of the corticospinal tracts (CSTs) was assessed using TMS and functional MRI. The presence or absence of motor-evoked responses (MEPs) to TMS in the affected upper limb, and the lateralization of cortical activity during affected hand use were determined. The structural integrity of the CST was assessed using MRI, and diffusion tensor imaging was used to measure the asymmetry in fractional anisotropy (FA) of the internal capsules. A multiple linear regression analysis was performed, to predict both clinical score at inception and change in clinical score for 17 patients who completed a 30 day programme of motor practice with the affected upper limb. The main findings were that in patients with MEPs, meaningful gains were still possible 3 years after stroke, although the capacity for improvement declined with time. In patients without MEPs, functional potential declines with increasing CST disruption, with no meaningful gains possible if FA asymmetry exceeds a value of 0.25. This study is the first to demonstrate the complementary nature of TMS and MRI techniques in predicting functional potential in chronic stroke patients. An algorithm is proposed for the selection of individualized rehabilitation strategies, based on the prediction of functional potential. These strategies could include neuromodulation using a range of emerging techniques, to prime the motor system for a plastic response to rehabilitation.

We characterize the radial and angular variance of the Hubble flow in the COMPOSITE sample of 4534 galaxies, on scales in which much of the flow is in the nonlinear regime. With no cosmological assumptions other than the existence of a suitably averaged linear Hubble law, we find with decisive Bayesian evidence (ln B >> 5) that the Hubble constant averaged in independent spherical radial shells is closer to its asymptotic value when referred to the rest frame of the Local Group, rather than the standard rest frame of the Cosmic Microwave Background. An exception occurs for radial shells in the range 40/h-60/h Mpc. Angular averages reveal a dipole structure in the Hubble flow, whose amplitude changes markedly over the range 32/h-62/h Mpc. Whereas the LG frame dipole is initially constant and then decreases significantly, the CMB frame dipole initially decreases but then increases. The map of angular Hubble flow variation in the LG rest frame is found to coincide with that of the residual CMB temperature dipole, with correlation coefficient -0.92. These results are difficult to reconcile with the standard kinematic interpretation of the motion of the Local Group in response to the clustering dipole, but are consistent with a foreground non-kinematic anisotropy in the distance-redshift relation of 0.5% on scales up to 65/h Mpc. Effectively, the differential expansion of space produced by nearby nonlinear structures of local voids and denser walls and filaments cannot be reduced to a local boost. This hypothesis suggests a reinterpretation of bulk flows, which may potentially impact on calibration of supernovae distances, anomalies associated with large angles in the CMB anisotropy spectrum, and the dark flow inferred from the kinematic Sunyaev-Zel'dovich effect. It is consistent with recent studies that find evidence for a non-kinematic dipole in the distribution of distant radio sources.Comment: 37 pages, 9 tables, 13 figures; v2 adds extensive new analysis (including additional subsections, tables, figures); v3 adds a Monte Carlo analysis (with additional table, figure) which further tightens the statistical robustness of the dipole results; v4 adds further clarifications, small corrections, references and discussion of Planck satellite results; v5 typos fixed, matches published versio

The timescape cosmology has been proposed as a viable alternative to homogeneous cosmologies with dark energy. It realises cosmic acceleration as an apparent effect that arises in calibrating average cosmological parameters in the presence of spatial curvature and gravitational energy gradients that grow large with the growth of inhomogeneities at late epochs. Recently Kwan, Francis and Lewis [arXiv:0902.4249] have claimed that the timescape model provides a relatively poor fit to the Union and Constitution supernovae compilations, as compared to the standard Lambda CDM model. We show this conclusion is a result of systematic issues in supernova light curve fitting, and of failing to exclude data below the scale of statistical homogeneity, z < 0.033. Using all currently available supernova datasets (Gold07, Union, Constitution, MLCS17, MLCS31, SDSS-II, CSP, Union2), and making cuts at the statistical homogeneity scale, we show that data reduced by the SALT/SALT-II fitters provides Bayesian evidence that favours the spatially flat Lambda CDM model over the timescape model, whereas data reduced with MLCS2k2 fitters gives Bayesian evidence which favours the timescape model over the Lambda CDM model. We discuss the questions of extinction and reddening by dust, and of intrinsic colour variations in supernovae which do not correlate with the decay time, and the likely impact these systematics would have in a scenario consistent with the timescape model.Comment: 21 pages, 9 figures; v2 small clarifications, figures and references added; accepted by MNRA

Gamma‐ray bursts can potentially be used as distance indicators, providing the possibility of extending the Hubble diagram to redshifts ∼7. Here we follow the GRB analysis of Schaefer, with the aim of distinguishing the timescape cosmological model from the Λ cold dark matter (ΛCDM) model by means of the additional leverage provided by Gamma‐ray bursts (GRBs) in the range 2 ≲z≲ 7. We find that the timescape model fits the GRB sample slightly better than the ΛCDM model, but that the systematic uncertainties are still too little understood to distinguish the models.

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