Ultrasensitive microarray bioassays using cyanine5 dye-doped silica nanoparticles.

Herein we report the use of high brightness Cyanine5-doped silica nanoparticles (NPs) for the detection of antibodies or DNA in microarray bioassays. NP labels showed negligible non-specific binding, greater sensitivity and lower limits of detection when compared to free dye-labelled biomolecules. Moreover, the spotted microarrays used in this study required low NP and antibody concentrations to generate large data sets with improved statistical accuracy. These NPs have significant potential for use in biosensing for disease detection.

Multivalent linkers for improved covalent binding of oligonucleotides to dye-doped silica nanoparticles.

This paper describes the fabrication of oligonucleotide-coated Cy5-doped silica nanoparticles using a combination of multivalent linkers and their use in surface-based DNA sandwich hybridization assays. Dipodal silane is introduced as a means to fabricate amine-coated silica nanoparticles and its advantages compared to monopodal silanes are discussed. The use of dipodal silane in conjunction with three different polymer linkers (oxidized dextran, linear and 8-arm polyethylene glycol (PEG)) to immobilize single-stranded DNA to Cy5-doped nanoparticles is investigated and dynamic light scattering measurements and Fourier transform infrared spectroscopy are used to follow the progression of the functionalization of the nanoparticles. We observe a significant improvement in the binding stability of the single-stranded DNA when the dipodal silane and 8-arm PEG are used in combination, when compared to alternative conjugation strategies. Both 8mer and 22mer oligonucleotides are securely conjugated to the high-brightness nanoparticles and their availability to hybridize with a complementary strand is confirmed using solution-based DNA hybridization experiments. In addition, a full surface-based sandwich assay demonstrates the potential these nanoparticles have in the detection of less than 500 femtomolar of a DNA analogue of micro RNA, miR-451.

Visual EMG Biofeedback to Improve Ankle Function in Hemiparetic Gait.

Spasticity in stroke patients interferes with coordinated muscle firing patterns of the lower extremity leading to gait abnormalities. The goal of this study was to improve ankle function during walking by augmenting treadmill gait retraining with a visual EMG biofeedback technique. Eight stroke patients who could ambulate between 0.5 and 0.9 m/s participated in the study. The training consisted of 12 sessions of treadmill walking during which the activity of the tibialis anterior and gastrocnemius lateralis muscles of the affected side was displayed on a computer screen. Targets were shown to indicate to the subject when to activate the monitored muscles. Gait evaluations were performed before and after the training period to test the hypothesis that ankle mechanics improved following the intervention. Improvements in gait function were characterized by changes in temporal gait parameters and lower extremity kinematics and kinetics. Subjects showed an increase in gait speed, time of single leg support on the affected side, ankle power generation at push-off and a reduction in knee extensor moment. These results indicate that treadmill gait retraining augmented via visual EMG-biofeedback facilitates improvements in hemiparetic gait.

Sampling, noise-reduction and amplitude estimation issues in surface electromyography.

This paper reviews data acquisition and signal processing issues relative to producing an amplitude estimate of surface EMG. The paper covers two principle areas. First, methods for reducing noise, artefact and interference in recorded EMG are described. Wherever possible noise should be reduced at the source via appropriate skin preparation, and the use of well designed active electrodes and signal recording instrumentation. Despite these efforts, some noise will always accompany the desired signal, thus signal processing techniques for noise reduction (e.g. band-pass filtering, adaptive noise cancellation filters and filters based on the wavelet transform) are discussed. Second, methods for estimating the amplitude of the EMG are reviewed. Most advanced, high-fidelity methods consist of six sequential stages: noise rejection/filtering, whitening, multiple-channel combination, amplitude demodulation, smoothing and relinearization. Theoretical and experimental research related to each of the above topics is reviewed and the current recommended practices are described.

Client donation program for acquiring dogs and cats to teach veterinary gross anatomy.

A donor program for procuring dogs and cats to meet the needs of anatomical instruction was initiated six years ago at Tufts University School of Veterinary Medicine. The program was initiated in order to comply with state regulations that preclude the use of shelter animals and to satisfy ethical objections of students and faculty. The donor program has successfully met the animal needs for teaching gross anatomy and, in addition, provides opportunities to integrate clinical perspectives and ethics beginning from the first year of veterinary education.

Timing of activation of the erector spinae and hamstrings during a trunk flexion and extension task.

STUDY DESIGN: Timing of activation of the hamstrings and erector spinae was assessed using surface electromyography. OBJECTIVES: To investigate the influence of posture and movement speed during trunk flexion-extension on the flexion-relaxation response and trunk muscle activation patterns. SUMMARY OF BACKGROUND DATA: The literature contains numerous reports on coactivity and synergistic behavior of major muscle groups during trunk flexion-extension. There are few reports on the timing of muscle activation. METHODS: Six subjects were recruited for a training session and six biweekly test sessions. Ten surface electromyogram electrodes and a lordosimeter were used to record timing of lumbar motion and muscle recruitment in the hamstrings and at four sites in the thoracolumbar region. A 3 x 2 within-subject factorial design was used to test the effects of posture and speed on activation patterns. RESULTS: Patterns of muscle activation were found to be dependent on posture and the direction of movement. The flexion-relaxation response was pervasive in the lumbar region but was less consistent at the T9 and hamstring sites. Significant differences in the delay between electromyogram activation and lumbar motion were found for the standing postures at initiation of extension, in which activation progressed in the caudad-to-cephalad direction. CONCLUSIONS: The flexion-relaxation response is ubiquitous in the lumbar erector spinae and is present in the hamstrings and lower thoracic erector spinae, although not consistently in all subjects. In standing, timing of activation differed significantly by site in extension but not in flexion. Muscle activation patterns and flexion-relaxation were consistent over six biweekly test sessions.

Estimation and application of EMG amplitude during dynamic contractions.

The sections above have described an EMG amplitude estimator and an initial application of this estimator to the EMG-torque problem. The amplitude estimator consists of six stages. In the first stage, motion artifact and power-line interference are attenuated. Motion artifact is typically removed with a highpass filter. Elimination of power-line noise is more difficult. Commercial systems tend to use notch filters, accepting the concomitant loss of "true" signal power in exchange for simplicity and robustness. Adaptive methods may be preferable, however, to preserve more "true" signal power. In stage two, the signal is whitened. One fixed whitening technique and two adaptive whitening methods were described. For low-amplitude levels, the adaptive whitening technique that includes adaptive noise cancellation may be necessary. In stage three, multiple EMG channels (all overlying the same muscle) are combined. For most applications, simple gain normalization is all that is required. Stage four rectifies the signal and then applies the power law required to demodulate the signal. In stage six, the inverse of the power law is applied to relinearize the signal. Direct comparison of MAV (first power) to RMS (second power) processing demonstrates little difference between the two. Therefore, unless there is reason to believe that the EMG density departs strongly from that found in the existing studies, RMS and MAV processing are essentially identical. In stage five, the demodulated samples are averaged across all channels and then smoothed (time averaged) to reduce the variance of the amplitude estimate, but at the expense of increasing the bias. For best performance, the window length that best trades off variance and bias error is selected. The advanced EMG processing was next applied to dynamic EMG-torque estimation about the elbow joint. Results showed that improved EMG amplitude estimates led to improved EMG-torque estimates. An initial comparison of different system-identification techniques and model orders was reported. It is expected that these advanced processing and identification algorithms will also improve performance in other EMG applications, including myoelectrically controlled prostheses, biofeedback, and ergonomic assessment.

Adaptive whitening of the electromyogram to improve amplitude estimation.

Previous research showed that whitening the surface electromyogram (EMG) can improve EMG amplitude estimation (where EMG amplitude is defined as the time-varying standard deviation of the EMG). However, conventional whitening via a linear filter seems to fail at low EMG amplitude levels, perhaps due to additive background noise in the measured EMG. This paper describes an adaptive whitening technique that overcomes this problem by cascading a nonadaptive whitening filter, an adaptive Wiener filter, and an adaptive gain correction. These stages can be calibrated from two, five second duration, constant-angle, constant-force contractions, one at a reference level [e.g., 50% maximum voluntary contraction (MVC)] and one at 0% MVC. In experimental studies, subjects used real-time EMG amplitude estimates to track a uniform-density, band-limited random target. With a 0.25-Hz bandwidth target, either adaptive whitening or multiple-channel processing reduced the tracking error roughly half-way to the error achieved using the dynamometer signal as the feedback. At the 1.00-Hz bandwidth, all of the EMG processors had errors equivalent to that of the dynamometer signal, reflecting that errors in this task were dominated by subjects' inability to track targets at this bandwidth. Increases in the additive noise level, smoothing window length, and tracking bandwidth diminish the advantages of whitening.

Electromyogram amplitude estimation with adaptive smoothing window length.

Typical electromyogram (EMG) amplitude estimators use a fixed window length for smoothing the amplitude estimate. When the EMG amplitude is dynamic, previous research suggests that varying the smoothing length as a function of time may improve amplitude estimation. This paper develops optimal time-varying selection of the smoothing window length using a stochastic model of the EMG signal. Optimal selection is a function of the EMG amplitude and its derivatives. Simulation studies, in which EMG amplitude was changed randomly, found that the "best" adaptive filter performed as well as the "best" fixed-length filter. Experimental studies found the advantages of the adaptive processor to be situation dependent. Subjects used real-time EMG amplitude estimates to track a randomly-moving target. Perhaps due to task difficulty, no differences in adaptive versus fixed-length processors were observed when the target speed was fast. When the target speed was slow, the experimental results were consistent with the simulation predictions. When the target moved between two constant levels, the adaptive processor responded rapidly to the target level transitions and had low variance while the target dwelled on a level.

Probability density of the surface electromyogram and its relation to amplitude detectors.

When the surface electromyogram (EMG) generated from constant-force, constant-angle, nonfatiguing contractions is modeled as a random process, its density is typically assumed to be Gaussian. This assumption leads to root-mean-square (RMS) processing as the maximum likelihood estimator of the EMG amplitude (where EMG amplitude is defined as the standard deviation of the random process). Contrary to this theoretical formulation, experimental work has found the signal-to-noise-ratio [(SNR), defined as the mean of the amplitude estimate divided by its standard deviation] using mean-absolute-value (MAV) processing to be superior to RMS. This paper reviews RMS processing with the Gaussian model and then derives the expected (inferior) SNR performance of MAV processing with the Gaussian model. Next, a new model for the surface EMG signal, using a Laplacian density, is presented. It is shown that the MAV processor is the maximum likelihood estimator of the EMG amplitude for the Laplacian model. SNR performance based on a Laplacian model is predicted to be inferior to that of the Gaussian model by approximately 32%. Thus, minor variations in the probability distribution of the EMG may result in large decrements in SNR performance. Lastly, experimental data from constant-force, constant-angle, nonfatiguing contractions were examined. The experimentally observed densities fell in between the theoretic Gaussian and Laplacian densities. On average, the Gaussian density best fit the experimental data, although results varied with subject. For amplitude estimation, MAV processing had a slightly higher SNR than RMS processing.

Meteorological conditions and self-report of low back pain.

STUDY DESIGN: Six months of daily low back pain ratings for 94 individuals were tested for the influence of prevailing weather conditions during the spring, summer, and fall seasons. Intergroup differences were tested for study participants who reported weather sensitivity and for those who did not. OBJECTIVES: To investigate the relation between pain ratings and prevailing weather conditions in a population with chronic or recurrent low back pain. SUMMARY OF BACKGROUND DATA: Weather conditions have been reported to influence pain perception in some disease states, including low back pain. Investigations of this relation in chronic or recurrent low back pain have involved varied methodologies, and conflicting results have been reported. METHODS: The effects of eight weather variables reported to influence musculoskeletal pain were tested on daily pain ratings. A post hoc weather sensitivity questionnaire was used to disperse 73 individuals into groups based on perceived weather sensitivity, and group differences were tested. RESULTS: Significant effects on pain scores were found, most notably for temperature and vapor pressure. The magnitude of the effects were small compared with autocorrelation of an individual's own pain scores. Significant differences were found between the group of individuals who were insensitive to weather conditions and that of individuals with perceived sensitivity to cold temperatures. No significant intergroup differences were found for damp, rainy conditions or changes in barometric pressure. CONCLUSIONS: Weather conditions may influence subjective reporting of low back pain significantly. Although the effects are small in magnitude, they should be considered in clinical treatment of the patient with chronic, nonspecific low back pain. Pain scores may demonstrate greater interaction with certain weather conditions in individuals perceiving sensitivity to those conditions.

A descriptive study of U.S. OSHA penalties and inspection frequency for musculoskeletal disorders in the workplace.

Information on the frequency and cost of OSHA enforcement penalties for musculoskeletal disorders (MSD) in the literature is limited. Such information would be of value to organizations in estimating the likelihood and financial impact of enforcement activity in their operations. This descriptive study utilized data from federal Occupational Safety and Health Administration (OSHA) inspections to examine the distribution of penalty costs arising from inspections with MSD-related citations from January 1985 to June 1994 and to estimate the probability of OSHA inspection in general and OSHA citation for MSD hazards from October 1985 to September 1993. The mean and median values of proposed penalties were $47,707 and $3600 respectively. A substantial influence of 1991 changes to the penalty structure was noted with decreasing mean and increasing median penalty values. Penalty values increased with establishment size and were higher for unplanned than for planned inspections. The probability of a federal OSHA inspection for any establishment ranged from 1:50 in 1986 to 1:100 in 1993 whereas the estimated probability of an inspection with MSD-related citations ranged from 1:167,000 in 1996 to as much as 1:38,000 during the peak of enforcement activity in 1990. The probability of an inspection with MSD citations for the largest establishments during the period was more than 1000 times greater than that for the smallest. The results of this study may be utilized by organizations seeking to demonstrate the advantages of reducing musculoskeletal morbidity in the workplace.

Influence of smoothing window length on electromyogram amplitude estimates.

A systematic, experimental study of the influence of smoothing window length on the signal-to-noise ratio (SNR) of electromyogram (EMG) amplitude estimates is described. Surface EMG waveforms were sampled during nonfatiguing, constant-force, constant-angle contractions of the biceps or triceps muscles, over the range of 10%-75% maximum voluntary contraction. EMG amplitude estimates were computed with eight different EMG processor schemes using smoothing length durations spanning 2.45-500 ms. An SNR was computed from each amplitude estimate (deviations about the mean value of the estimate were considered as noise). Over these window lengths, average +/- standard deviation SNR's ranged from 1.4 +/- 0.28 to 16.2 +/- 5.4 for unwhitened single-channel EMG processing and from 3.2 +/- 0.7 to 37.3 +/- 14.2 for whitened, multiple-channel EMG processing (results pooled across contraction level). It was found that SNR increased with window length in a square root fashion. The shape of this relationship was consistent with classic theoretical predictions, however none of the processors achieved the absolute performance level predicted by the theory. These results are useful in selecting the length of the smoothing window in traditional surface EMG studies. In addition, this study should contribute to the development of EMG processors which dynamically tune the smoothing window length when the EMG amplitude is time varying.

Influence of joint angle on the calibration and performance of EMG amplitude estimators.

Multiple-channel electromyogram (EMG) amplitude estimators incorporating temporal whitening filters and/or spatial uncorrelation filters contain a characterization of the EMG waveform (specifically, auto- and cross-correlation information) which may vary with joint angle. This paper reports on an experimental study which investigated the influence of joint angle on these EMG amplitude estimators. It was found that little or no relative improvement in estimator performance resulted from altering either temporal whitening or spatial uncorrelation filters as a function of joint angle. Also, the absolute performance level of these estimators did not vary with joint angle.

Length of disability and cost of work-related musculoskeletal disorders of the upper extremity.

There is little information on the length of disability (LOD) reported for work-related musculoskeletal disorders of the upper extremity (WMSDUE). For this study, LOD, cost, and the relationship between LOD and cost were derived from a large workers' compensation company's claims data for 1994 WMSDUE (n = 21,338). The average LOD was 87 days, with a median of zero days. For those claims with at least one day of compensable disability (25.2%), the average and median LOD were 294 and 99 days, respectively. The distribution of cost was skewed, with the average cost of a claim being 13 times higher than its median. Approximately 60% of the claims cost $1000 or less. Additionally, the 6.8% of the claims with an LOD greater than one year accounted for 59.9% of the cost and 75% of the total disability days. The majority of WMSDUE claimants did not lose sufficient time to qualify for indemnity. For those who did receive lost time wages, a disability duration of more than three months was typical.

A PC-based workstation for real-time acquisition, processing, and display of electromyogram signals.

A system for real-time acquisition, processing, display, and logging of multiple channels of the EMG waveform has been described. By designing this system around the configuration of a standard PC, custom hardware was avoided. Similarly, software was designed in a higher-level language (C), simplifying the programming burden and minimizing custom software development. Components of the software are available off the shelf. The computational capacity of generic PCs facilitates very high rates of numeric calculation, as required by some advanced EMG amplitude estimation algorithms. Computational capacity is expected to increase, facilitating ever more numerically intensive EMG algorithms that are likely to be developed in the future. The system described here has been used in the development of an adaptive window EMG amplitude-estimation algorithm. The system is extensible and can be altered for many uses related to EMG and biosignal processing.

Trends in disability duration and cost of workers' compensation low back pain claims (1988-1996).

Previously published epidemiologic studies of low back pain (LBP) have reported that the prevalence of low back disability has increased dramatically. These studies based their findings on either the number of disability claims filed, the disability duration, or both. This information was from countries other than the United States or from the US Social Security Disability Insurance data, with findings reported only to the early 1980s. More recent studies of US workers' compensation LBP claims reported a decrease in the incidence rate from the late 1980s to the mid-1990s. No studies have been found that report on the trends of disability duration for workers' compensation LBP claims. This study examined recent trends in the length of disability (LOD) for LBP claims and associated costs, using a large sample of claims from the privately insured US workers' compensation market. LOD and cost information were derived for injuries from 1988, 1990, 1992, 1994, and 1996. For each year, the distributions of LOD and cost were skewed, with the small percentage of claims that lasted more than one year (4.6%-8.8%, depending on the year) accounting for a large percentage of the total disability days (77.6%-90.1%) and cost (64.9%-84.7%). From 1988 to 1996, the average LOD decreased 60.9%, from 156 days to 61 days. The probability of being on disability for a long period of time has decreased over the years. Over the study period, the average cost of a claim decreased 41.4%, while the median cost increased 19.7%. The most influential change in the LOD and cost distributions was a reduction in expensive claims with a long disability duration. The evolution of LOD and cost is also detailed for different disability durations for the study period.

Relating agonist-antagonist electromyograms to joint torque during isometric, quasi-isotonic, nonfatiguing contractions.

This paper describes an experimental study which relates simultaneous elbow flexor-extensor electromyogram (EMG) amplitude to joint torque. Investigation was limited to the case of isometric, quasi-isotonic (slowly force-varying), nonfatiguing contractions. For each of the flexor and extensor muscle groups, the model relationship between muscle group torque contribution and EMG amplitude was constrained to be a sum of basis functions which had a linear dependence on a set of fit parameters. With these constraints, the problem of identifying the EMG-to-torque relationship was reduced to a linear least squares problem. Surface EMG's from elbow flexors and extensors, and joint torque were simultaneously recorded for nonfatiguing, quasi-isotonic, isometric contractions spanning 0-50% maximum voluntary contraction. Single-/multiple-channel unwhitened/whitened/adaptively whitened EMG amplitude processors were used to identify an EMG-to-torque relation, and then estimate joint torque based on this relation. Each unwhitened multiple-channel EMG-to-torque estimator had a standard error (SE) approximately 70% of its respective single-channel estimator. The adaptively whitened multiple-channel joint torque estimator had an SE approximately 90% of the unwhitened multiple-channel estimator, providing an estimation error approximately 3% of the combined flexion/extension torque range. The experimental studies demonstrated that higher fidelity EMG amplitude processing led to improved joint torque estimation.

Length of disability and cost of workers' compensation low back pain claims.

Although information exists on the cost of workers' compensation low back pain (LBP), there is limited information on the duration of lost work time as well as the association between cost and duration. For this study, cost and duration of lost work time information were derived from a large workers' compensation company's database for 1992 LBP claims (n = 106,961). The distribution of cost was skewed, with an average cost of a claim being 20 times higher than its median. A disproportionately small percentage of the costliest LBP claims (10%) were responsible for a large percentage of the total cost (86%). The distribution of length of disability (LOD) was also skewed, with an average of 102 days and a median of zero. The average and median LOD for those claims with at least one day of compensable disability was 303 and 39 days, respectively. As a "rule of thumb," it was found that of those claimants who remain on disability at the end of n weeks, approximately 50% will be off disability at the end of 6.n weeks. Additionally, the 7% of the claims with an LOD greater than one year accounted for 75.1% of the cost and 84.2% of the total disability days. Disability days that were accrued after one year of disability accounted for 59.3% of the total number of disability days. This result suggests that other LOD estimation techniques, which may not account for disability days beyond one calendar year (e.g., the Bureau of Labor Statistics Annual Survey of Occupational Injuries and Illnesses), may result in a marked underestimation of LOD.

A descriptive study of recurrent low back pain claims.

This is the first large-scale study of US workers that describes the demographic and cost differences between recurrent and nonrecurrent low back pain (LBP) disability claimants, using data from a large workers' compensation insurer. Persons with at least one LBP claim in 1990 and one or more additional claims in 1990 to 1996 were defined as recurrent. Persons with at least one LBP claim in 1990 but no subsequent claims were defined as nonrecurrent. Fourteen percent of claimants were recurrent. The percentage of recurrent claimants who were male (77.2%) was higher than the percentage that were female (22.8%). This difference was more pronounced in the younger age groups. The median total cost for recurrent LBP claims in 1990 was 4% greater than for nonrecurrent 1990 LBP claims, whereas the mean cost was 48% less. Most studies of LBP recurrence among US workers have followed single-corporation employees. Our rate of recurrence was lower than these previously reported rates. However, analysis of independent workers' compensation insurance company data may provide a more accurate assessment of LBP claim recurrence among US workers.