Visuospatial and Attentional Abilities Predict Driving Simulator Performance Among Older HIV-infected Adults.

OBJECTIVES: To examine the effects of aging and neuropsychological (NP) impairment on driving simulator performance within a human immunodeficiency virus (HIV)-infected cohort. METHODS: Participants included 79 HIV-infected adults (n = 58 > age 50, n = 21 ≤ 40) who completed a NP battery and a personnel computer-based driving simulator task. Outcome variables included total completion time (time) and number of city blocks to complete the task (blocks). RESULTS: Compared to the younger group, the older group was less efficient in their route finding (blocks over optimum: 25.9 [20.1] vs 14.4 [16.9]; P = .02) and took longer to complete the task (time: 1297.6 [577.6] vs 804.4 [458.5] seconds; P = .001). Regression models within the older adult group indicated that visuospatial abilities (blocks: b = -0.40, P <.001; time: b = -0.40, P = .001) and attention (blocks: b = -0.49, P = .001; time: b = -0.42, P = .006) independently predicted simulator performance. The NP-impaired group performed more poorly on both time and blocks, compared to the NP normal group. CONCLUSIONS: Older HIV-infected adults may be at risk of driving-related functional compromise secondary to HIV-associated neurocognitive decline.

Operationalization of the updated diagnostic algorithm for classifying HIV-related cognitive impairment and dementia.

BACKGROUND: This study applies the updated HIV-Associated Neurocognitive Disorders (HAND) diagnostic algorithm. METHODS: Participants were 210 HIV-infected-adults, classified using proposed HAND criteria: HIV-Associated Dementia (HAD), Mild Neurocognitive Disorder (MND), Asymptomatic Neurocognitive Impairment (ANI). RESULTS: The algorithm yielded: normal = 32.8%, ANI = 21.4%, MND = 34.3%, and HAD = 11.4%. Normal participants performed superior to HAND-defined participants on cognition, and HAD participants performed more poorly on global cognition and executive functioning. Two distinct subgroups of interest emerged: (1) functional decline without cognitive impairment; (2) severe cognitive impairment and minimal functional compromise. CONCLUSIONS: The algorithm discriminates between HIV-infected cognitively impaired individuals. Diagnosis yields two unique profiles requiring further investigation. Findings largely support the algorithm's utility for diagnosing HIV-cognitive-impairment, but suggest distinct subsets of individuals with discrepant cognitive/functional performances that may not be readily apparent by conventional application of HAND diagnosis.

MRI evaluation of topical heat and static stretching as therapeutic modalities for the treatment of eccentric exercise-induced muscle damage.

The aim of this study was to monitor the effects of topical heat and/or static stretch treatments on the recovery of muscle damage by eccentric exercise. For this purpose, 32 untrained male subjects performed intense eccentric knee extension exercise, followed by 2 weeks of treatment (heat, stretch, heat plus stretch) or no treatment (control, n=8/group). Isometric strength testing, pain ratings, and multi-echo magnetic resonance imaging of the thigh were performed before and at 2, 3, 4, 8, and 15 days following the exercise. Increased T2 relaxation time, muscle swelling, pain ratings, and strength loss confirmed significant muscle damage during the post-exercise period. Pain ratings and muscle volume recovered to baseline by 15 days, although muscle strength remained lower [77 (4) vs. 95 (3) kg pre-exercise, mean (SE)] and T2 values higher [32.2 (0.8) vs. 28.6 (0.2) ms pre-exercise]. Our results indicate that heat and/or static stretching does not consistently reduce soreness, swelling or muscle damage. The practical implication of our findings is that clinicians should be aware that prescribing heat and/or static stretching following intense eccentric or unaccustomed exercise will not enhance the recovery of damaged muscles.

Biarticular and monoarticular muscle activation and injury in human quadriceps muscle.

We hypothesized that activation of the quadriceps femoris muscle group during eccentric exercise is related to the increase in magnitude of several markers of muscle injury that developed during the next week. Fourteen male subjects performed six to eight sets of five to ten repetitions of single-leg eccentric-only seated knee extension exercise. Magnetic resonance (MR) images were collected before and immediately after exercise and on days 2-4 and 6 after eccentric exercise. Changes in maximal voluntary contraction (MVC), perceived soreness, muscle volume and muscle transverse relaxation of water protons (T2) were determined for the quadriceps femoris muscle group each day. Changes in muscle volume and T2 were determined every day for each muscle [vastus lateralis (VL), vastus medialis (VM), vastus intermedius (VI), rectus femoris (RF)] of the quadriceps femoris group. Post-exercise T2 was greater than pre-exercise T2 (P < 0.05) for all muscles. The acute deltaT2 (Post-Pre) was similar (P>0.05) among VL, VM, VI, and RF [5.5 (0.3) ms], suggesting that the four muscles were equally activated during eccentric exercise. In the week after eccentric exercise, subjects experienced delayed-onset muscle soreness (DOMS) and all muscles demonstrated a delayed increase in T2 above pre-exercise values (P < 0.05), suggesting that muscle injury had occurred. For the quadriceps femoris muscle group, there was no correlation between acute deltaT2 and delayed (peak T2 during days 2, 3, 4, 6 minus pre-exercise T2) deltaT2 (r=0.04, P>0.05). Similar results were obtained when VL, VM, VI and RF were examined separately. Of the four muscles in quadriceps femoris, the biarticular RF experienced greater muscle injury [delayed deltaT2= 15.2 (2.0) ms] compared to the three monoarticular vasti muscles [delayed deltaT2 = 7.7 (1.3) ms; P< 0.05]. We propose that the disproportionate muscle injury to RF resulted from an ineffective transfer of torque from the knee to hip joint during seated eccentric knee extension exercise, thus causing RF to dissipate greater energy than normal. We conclude that in humans, muscle activation is not a unique determinant of muscle injury.

Effect of aerobic capacity on the T(2) increase in exercised skeletal muscle.

The increase in nuclear magnetic resonance transverse relaxation time (T(2)) of muscle water measured by magnetic resonance imaging after exercise has been correlated with work rate in human subjects. This study compared the T(2) increase in thigh muscles of trained (cycling VO(2 max) = 54.4 +/- 2.7 ml O(2). kg(-1). min(-1), mean +/- SE, n = 8, 4 female) vs. sedentary (31.7 +/- 0.9 ml O(2). kg(-1). min(-1), n = 8, 4 female) subjects after cycling exercise for 6 min at 50 and 90% of the subjects' individually determined VO(2 max). There was no significant difference between groups in the T(2) increase measured in quadriceps muscles within 3 min after the exercises, despite the fact that the absolute work rates were 60% higher in the trained group (253 +/- 15 vs. 159 +/- 21 W for the 90% exercise). In both groups, the increase in T(2) of vastus muscles was twofold greater after the 90% exercise than after the 50% exercise. The recovery of T(2) after the 90% exercise was significantly faster in vastus muscles of the trained compared with the sedentary group (mean recovery half-time 11.9 +/- 1.2 vs. 23.3 +/- 3.7 min). The results show that the increase in muscle T(2) varies with work rate relative to muscle maximum aerobic power, not with absolute work rate.

Detection of chromoluminance patterns on chromoluminance pedestals I: threshold measurements.

Measurement of the detection thresholds of patterns on pedestals of various kinds has the potential of providing insight into the mechanisms that mediate pattern vision. This study is concerned with chromoluminance patterns, that is, patterns that vary over space in luminance, chromaticity, or both. Contrast thresholds for 1 c/deg Gabor patterns (targets) were measured as a function of the contrast of Gabor pedestal patterns (TvC functions), where the pedestals paired with each target were modulated in a wide range of directions in color space. For most target-pedestal pairs, the TvC function decreased (facilitation) and then increased as pedestal contrast increased. The increase went above the absolute contrast threshold (masking) for all target-pedestal pairs except in cases where facilitation occurred at the upper end of the pedestal contrast range. The specific form of the TvC function varied greatly with the target and pedestal, consistent with a general model of pedestal effects proposed by Foley [Journal of the Optical Society of America A, 1994, 11(6)]. There were two sets of target-pedestal pairs for which facilitation did not occur, but masking did occur: pairs in which the target was a luminance modulation and the pedestals were individually isoluminant and pairs in which the pedestal was blue/yellow and the target was in any of our directions except blue/yellow.

Detection of chromoluminance patterns on chromoluminance pedestals II: model.

A model for chromoluminance pattern detection and pedestal effects is described. This model has five stages. The stimulus is first processed by the cone array and then by color-spatial linear operators. The outputs of the linear operators may be expressed as weighted sums of cone contrasts over space. There are three opposite sign pairs of linear spatial operators in the model. Their spectral tuning at each point in space is similar to the luminance, green/red and blue/yellow mechanisms in color opponent models, but their sensitivity to cone inputs varies as a function of space. The operators in each pair are the same except that the signs of the cone inputs in one are the opposite of those in the other. A non-linear response operator follows each linear operator. It receives two inputs, one excitatory and the other divisive inhibitory. The excitatory input is the half-wave rectified output of one of the linear operators. The inhibitory input is a non-linear sum of all linear operator outputs. The non-linear response operator raises the excitatory input to a power, and divides it by the inhibitory input plus a constant to produce the response. The detection variable is computed by combining the difference in response to target-plus-pedestal and pedestal alone across the three non-linear operators. The model accounts well for the large data set presented in the companion paper and is generally consistent with other results in the literature. The spectral sensitivities of the inferred chromoluminance pattern mechanisms are similar to those obtained with different methods. The data set is shown to be inconsistent with several other models.

Pixel T2 distribution in functional magnetic resonance images of muscle.

Increases in skeletal muscle (1)H-NMR transverse relaxation time (T2) observed by magnetic resonance imaging have been used to map whole muscle activity during exercise. Some studies further suggest that intramuscular variations in T2 after exercise can be used to map activity on a pixel-by-pixel basis by defining an active T2 threshold and counting pixels that exceed the threshold as "active muscle." This implies that motor units are nonrandomly distributed across the muscle and, therefore, that the distribution of pixel T2 values ought to be substantially broader after moderate exercise than at rest or after more intense exercise, since moderate-intensity exercise should recruit some motor units, and hence some pixels, but not others. This study examined the distribution of pixel T2 values in three muscles (quadriceps, anterior tibialis, and biceps/brachialis) of healthy subjects (5 men and 2 women, 18-46 yr old) at rest, after exercise to fatigue (50% 1 repetition maximum at 20/min to failure = Max), and at 1/2Max (25% 1 repetition maximum, same number of repetitions as Max). Although for each muscle there was a linear relationship between exercise intensity and mean pixel T2, there was no significant difference in the variance of pixel T2 between 1/2Max and Max exercise. There was a modest (10-43%) increase in variance of pixel T2 after both exercises compared with rest, but this was consistent with a Monte Carlo simulation of muscle activity that assumed a random distribution of motor unit territories across the muscle and a random distribution of muscle cells within each motor unit's territory. In addition, 40% of the pixel-to-pixel muscle T2 variations were shown to be due to imaging noise. The results indicate that magnetic resonance imaging T2 cannot reliably map active muscle on a pixel-by-pixel basis in normal subjects.

MR measurements of muscle damage and adaptation after eccentric exercise.

The purposes of this study were, first, to clarify the long-term pattern of T2 relaxation times and muscle volume changes in human skeletal muscle after intense eccentric exercise and, second, to determine whether the T2 response exhibits an adaptation to repeated bouts. Six young adult men performed two bouts of eccentric biceps curls (5 sets of 10 at 110% of the 1-repetition concentric maximum) separated by 8 wk. Blood samples, soreness ratings, and T2-weighted axial fast spin-echo magnetic resonance images of the upper arm were obtained immediately before and after each bout; at 1, 2, 4, 7, 14, 21, and 56 days after bout 1; and at 2, 4, 7 and 14 days after bout 2. Resting muscle T2 [27.6 +/- 0.2 (SE) ms] increased immediately postexercise by 8 +/- 1 ms after both bouts. T2 peaked 7 days after bout 1 at 47 +/- 4 ms and remained elevated by 2.5 ms at 56 days. T2 peaked lower (37 +/- 4 ms) and earlier (2-4 days) after bout 2, suggesting an adaptation of the T2 response. Peak serum creatine kinase values, pain ratings, and flexor muscle swelling were also significantly lower after the second bout (P < 0.05). Total volume of the imaged arm region increased transiently after bout 1 but returned to preexercise values within 2 wk. The exercised flexor compartment swelled by over 40%, but after 2 wk it reverted to a volume 10% smaller than that before exercise and maintained this volume loss through 8 wk, consistent with partial or total destruction of a small subpopulation of muscle fibers.

Reliability and validity of body composition measures in female athletes.

The purpose of this investigation was to determine the reliability and validity of bioelectrical impedance (BIA) and near-infrared interactance (NIR) for estimating body composition in female athletes. Dual-energy X-ray absorptiometry was used as the criterion measure for fat-free mass (FFM). Studies were performed in 132 athletes [age = 20.4 +/- 1.5 (SD) yr]. Intraclass reliabilities (repeat and single trial) were 0.987-0.997 for BIA (resistance and reactance) and 0.957-0.980 for NIR (optical densities). Validity of BIA and NIR was assessed by double cross-validation. Because correlations were high (r = 0.969-0.983) and prediction errors low, a single equation was developed by using all 132 subjects for both BIA and NIR. Also, an equation was developed for all subjects by using height and weight only. Results from dual-energy X-ray absorptiometry analysis showed FFM = 49.5 +/- 6.0 kg, which corresponded to %body fat (%BF) of 20.4 +/- 3.1%. BIA predicted FFM at 49.4 +/- 5.9 kg (r = 0.981, SEE = 1.1), and NIR prediction was 49. 5 +/- 5.8 kg (r = 0.975, SEE = 1.2). Height and weight alone predicted FFM at 49.4 +/- 5.7 kg (r = 0.961, SEE = 1.6). When converted to %BF, prediction errors were approximately 1.8% for BIA and NIR and 2.9% for height and weight. Results showed BIA and NIR to be extremely reliable and valid techniques for estimating body composition in college-age female athletes.

Temporal sensitivity of human luminance pattern mechanisms determined by masking with temporally modulated stimuli.

Target contrast thresholds were measured using vertical spatial Gabor targets in the presence of full field maskers of the same spatial frequency and orientation. In the first experiment both target and masker were 2 cpd. The target was modulated at a frequency of 1 or 10 Hz and the maskers varied in temporal frequency from 1 to 30 Hz and in contrast from 0.03 to 0.50. In the second experiment both target and masker had a spatial frequency of 1, 5 or 8 cpd. The target was modulated at 7.5 Hz and the same set of maskers was used as in the first experiment. The results are not consistent with a widely used model that is based on mechanisms in which excitation is summed linearly and the sum is transformed by an S-shaped nonlinear excitation-response function. A new model of human pattern vision mechanisms, which has excitatory and divisive inhibitory inputs, describes the results well. Parameters from the best fit of the new model to the results of the first experiment show that the 1 Hz and 10 Hz targets were detected by mechanisms with temporal low-pass and band-pass excitatory sensitivity, respectively. Fits to the second experiment suggest that at 1 cpd, the excitatory tuning of the detecting mechanism is band-pass. At 5 and 8 cpd, the mechanisms are excited by a broad range of temporal frequencies. Mechanism sensitivity to divisive inhibition depends on temporal frequency in the same general way as sensitivity to excitation. Mechanisms are more broadly tuned to divisive inhibition than to excitation, except when the target temporal frequency is high.

An integrated model of discharge planning for acutely-ill elderly patients.

Prior research has demonstrated that current discharge-related practices present resource-related and ethical problems for all those involved. The purpose of this 9-month qualitative study was to develop a more resource efficient and compassionate discharge planning model for acutely-ill, elderly patients. The focus group interviewing method was used to elicit 99 participants' perceptions of an ideal approach to discharge planning. Focus group participants included professionals from acute-care hospitals and community organizations. Telephone interviews were also completed with 25 patients and 6 family members. Themes identified in the analysis revealed that an ideal approach to discharge planning would incorporate seven elements. According to participants, the approach is ideal because it potentially addresses both resource utilization and ethical issues. Program evaluation of the model is underway in order to determine its effectiveness.

Pattern detection in the presence of maskers that differ in spatial phase and temporal offset: threshold measurements and a model.

Four experiments are described in which brief Gabor patterns are detected in the presence of full-field gratings or Gabor patterns that are superimposed in space, but vary in spatial phase and temporal offset (SOA). E1: Threshold versus masker contrast (TvC) functions were determined for relative phases of 0, 90, 180 and 270 degrees at SOA = 0. For 0 degree relative phase, TvC functions decrease (facilitation) and then increase (masking) as contrast increases. For 90 degrees, there is little or no facilitation and thresholds increase with masker contrast. For 180 degrees, the form of the TvC function varies with observer and conditions. E2: Like E1, except that maskers are Gabor patterns. TvC functions are similar in form to those for full-field maskers, but there is less masking. E3: Forward masking. TvC functions were determined for relative phases of 0, 90, and 180 degrees at SOA = -33 ms. The forms of the TvC functions for 0 and 180 degrees are reversed relative to those at SOA = 0. E4: TvP (threshold versus phase) functions were determined for SOA's of -100, -67, -33, 0 and 33 ms at a constant masker contrast of 0.063. Masking occurs at all relative phases. For simultaneous and backward masking, the threshold is minimum for a relative phase of 0 and maximum at 180 degrees. For forward masking, the form of the function is inverted. A model of pattern masking and facilitation (Foley, J. M. (1994a) Journal of the Optical Society of America A, 11, 1710-1719) is extended to account for masker phase and SOA effects. The model assumes four mechanisms tuned to phases 90 degrees apart, and divisively inhibited by stimuli of all phases. Performance depends on the detection strategy of the observer.

Analysis of the effect of pattern adaptation on pattern pedestal effects: a two-process model.

Pattern contrast thresholds for vertical Gabor patterns were measured on pattern pedestals that were vertical or horizontal. Contrast of the pedestal was varied to measure the function relating target contrast threshold to pedestal contrast (TvC function). TvC functions were measured without an adaptor and after adaptation to vertical, horizontal and plaid patterns. For a pedestal with the same orientation as the target, the vertical and plaid adapters increased thresholds at low pedestal contrasts, but not high. For the pedestal orthogonal to the target, the same two adaptors increased thresholds over the whole range of pedestal contrasts. These asymmetric effects are described by a model of adaptation and masking derived from a model of masking (Foley, 1994a) by allowing two parameters to vary with the adapt state; one of them is an additive parameter in the denominator of the response function, which can be interpreted as adaptor-produced divisive inhibition that persists after adaptor offset; the other is the sensitivity to pedestal-produced divisive inhibition, which is changed by adaptation for the pedestal orthogonal to the target. Other models do not account for both effects.

Linear dependence of muscle phosphocreatine kinetics on oxidative capacity.

The influence of muscle oxidative capacity on phosphocreatine (PCr) changes during and after stimulation was examined in the superficial (fast-twitch) section of rat gastrocnemius muscles. Muscle mitochondrial enzymes were increased in one group of rats by 8-10 wk of training on a running wheel (to a final regimen of 50 min/day at 38 m/min, 5 days/wk) and decreased in another group by chemical thyroidectomy [0.025% methimazole (MMI) in drinking water for 8 wk]. After these treatments, muscle citrate synthase activity was 179 and 29%, respectively, of that in corresponding control groups. Muscle PCr and pH were measured by 31P-nuclear magnetic resonance spectroscopy before, during, and after 8 min of isometric twitch stimulation at 0.33 Hz (MMI) or 0.75 Hz (trained) and 2 Hz. There was a significant linear correlation (r = 0.84, P < 0.01) between the rate constant for PCr recovery after submaximal stimulation (0.33 or 0.75 Hz) and citrate synthase activity. Within the control groups, there was a significant correlation (r = 0.72, P < 0.01) between the rate constant for PCr recovery and intracellular pH at the end of stimulation. The results are quantitatively consistent with linear/quasilinear models of respiratory control by the cytoplasmic free energy of ATP hydrolysis but not with respiratory control by cytoplasmic ADP.

Contrast detection, discrimination and adaptation in patients with Parkinson's disease and multiple system atrophy.

Visual spatial contrast thresholds and suprathreshold contrast matches were measured before and after adaptation to high-contrast sinewave gratings in patients with Parkinson's disease (n = 27), patients with multiple system atrophy (n = 6) and a group of age-matched control patients without CNS disease (n = 27). Contrast thresholds were higher in the Parkinson's disease patients than in either the multiple system atrophy patients or control patients. The effect of contrast adaptation on both contrast thresholds and matches was approximately equal in the three groups. This suggests that contrast adaptation is not affected by these CNS disorders and is consistent with the hypothesis that the loss in contrast sensitivity in Parkinson's disease is mediated by retinal effects. The results are discussed in terms of the underlying pathology of the visual deficits in Parkinson's disease and the possible diagnostic implications for differentiating Parkinson's disease and multiple system atrophy.

Effect of acute head-down tilt on skeletal muscle cross-sectional area and proton transverse relaxation time.

This study investigated changes in skeletal muscle cross-sectional area (CSA) evoked by fluid shifts that accompany short-term 6 degrees head-down tilt (HDT) or horizontal bed rest, the time course of the resolution of these changes after resumption of upright posture, and the effect of altered muscle CSA, in the absence of increased contractile activity, on proton transverse relaxation time (T2). Average muscle (CSA and T2 were determined by standard spin-echo magnetic resonance imaging. Analyses were performed on contiguous transaxial images of the neck and calf. After a day of normal activity, 24 h of HDT increased neck muscle CSA 19 +/- 4(SE)% (P < 0.05) while calf muscle CSA decreased 14 +/- 3% (P < 0.05). The horizontal posture (12 h) induced about one-half of these responses: an 11 +/- 2% (P < 0.05) in the neck muscle CSA and an 8 +/- 2% decrease (P < 0.05) in the calf. Within 2 h after resumption of upright posture, neck and calf muscle CSA returned to within 0.5% (P > 0.05) of the values assessed after a day of normal activity, with most of the change occurring within the first 30 min. No further change in muscle CSA was observed through 6 h of upright posture. Despite these large alterations in muscle CSA, T2 was not altered by more than 1.1 +/- 0.6% (P > 0.05) and did not relate to muscle size. These results suggest that postural manipulations and subsequent fluid shifts modeling micro-gravity elicit marked changes in muscle size. Because these responses were not associated with alterations in muscle T2, it does not appear that simple movement of water into muscle can explain the contrast shift observed after exercise.

Contractile and metabolic effects of increased creatine kinase activity in mouse skeletal muscle.

The effects of increased expression of creatine kinase (CK) in skeletal muscle were studied in control and transgenic animals homozygous for expression of the B subunit of CK. CK activity was 47% higher in transgenic gastrocnemius muscle. The CK activity was distributed as follows: 45 +/- 1% MM dinner, 31 +/- 4% MB dimer, and 22 +/- 5% BB dimer. No significant differences in metabolic or contractile proteins were detected except for a 22% decrease in lactate dehydrogenase activity and a 9% decrease in adenylate kinase activity. The only significant effect in contractile activity was that the rise time of a 5-s isometric contraction was 28% faster in the transgenic muscle. 31P nuclear magnetic resonance (NMR) spectra were obtained from control and transgenic muscles during mechanical activation, and there were no NMR measurable differences detected. These results indicate that a 50% increase in CK activity due to expression of the B subunit does not have large effects on skeletal muscle metabolism or contractile function. Therefore, control muscle has sufficient CK activity to keep up with changes in cellular high-energy phosphates except during the early phase of intense contractile activity.