Examining the Use of VR as a Study Aid for University Students with ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by patterns of inattention and impulsivity, which lead to difficulties maintaining concentration and motivation while completing academic tasks. University settings, characterized by a high student-to-staff ratio, make treatments relying on human monitoring challenging. One potential replacement is Virtual Reality (VR) technology, which has shown potential to enhance learning outcomes and promote flow experience. In this study, we investigate the usage of VR with 27 university students with ADHD in an effort to improve their performance in ctableompleting homework, including an exploration of automated feedback via a technology probe. Quantitative results show significant increases in concentration, motivation, and effort levels during these VR sessions and qualitative data offers insight into considerations like comfort and deployment. Together, the results suggest that VR can be a valuable tool in leveling the playing field for university students with ADHD.

Evaluation of the guideline-adherence of coronary angiography in patients with suspected chronic coronary syndrome - Results from the German prospective multicentre ENLIGHT-KHK project.

Background: With 900'000 coronary angiographies (CA) per year, Germany has the highest annual per capita volume in Europe. Until now there are no prospective clinical data on the degree of guideline-adherence in the use of CA in patients with suspected chronic coronary syndrome (CCS) in Germany. Methods: Between January 2019 and August 2021, 458 patients with suspected CCS were recruited in nine German centres. Guideline-adherence was evaluated according to the current European Society of Cardiology and German guidelines. Pre-test probability (PTP) for CAD was determined using age, gender, and a standardized patient questionnaire to identify symptoms. Data on the diagnostic work-up were obtained from health records. Results: Patients were in mean 66.6 years old, male in 57.3 %, had known CAD in 48.4 % and presented with typical, atypical, non-anginal chest pain or dyspnoea in 35.7 %, 41.3 %, 23.0 % and 25.4 %, respectively. PTP according to the European guidelines was in mean 24.2 % (11.9 %-36.5 % 95 % CI). 20.9 % of the patients received guideline-recommended preceding non-invasive image guided testing. The use of CA was adherent to the European and German guideline recommendations in 20.4 % and 25.4 %, respectively. In multivariate-analysis, arterial hypertension and prior revascularization were predictors of guideline non-adherence. Conclusion: These are the first prospective clinical data which demonstrated an overall low degree of guideline-adherence in the use of CA in patients with suspected CCS in the German health care setting. To improve adherence rates, the availability of and access to non-invasive image guided testing needs to be strengthened. (German Clinical Trials Registry DRKS00015638 - Registration Date: 19.02.2019).

Cholinergic-related pupil activity reflects level of emotionality during motor performance.

Pupil size covaries with the diffusion rate of the cholinergic and noradrenergic neurons throughout the brain, which are essential to arousal. Recent findings suggest that slow pupil fluctuations during locomotion are an index of sustained activity in cholinergic axons, whereas phasic dilations are related to the activity of noradrenergic axons. Here, we investigated movement induced arousal (i.e., by singing and swaying to music), hypothesising that actively engaging in musical behaviour will provoke stronger emotional engagement in participants and lead to different qualitative patterns of tonic and phasic pupil activity. A challenge in the analysis of pupil data is the turbulent behaviour of pupil diameter due to exogenous ocular activity commonly encountered during motor tasks and the high variability typically found between individuals. To address this, we developed an algorithm that adaptively estimates and removes pupil responses to ocular events, as well as a functional data methodology, derived from Pfaffs' generalised arousal, that provides a new statistical dimension on how pupil data can be interpreted according to putative neuromodulatory signalling. We found that actively engaging in singing enhanced slow cholinergic-related pupil dilations and having the opportunity to move your body while performing amplified the effect of singing on pupil activity. Phasic pupil oscillations during motor execution attenuated in time, which is often interpreted as a measure of sense of agency over movement.

Effects of active musical engagement during physical exercise on anxiety, pain and motivation in patients with chronic pain.

The experience of anxiety is central to the development of chronic pain. Music listening has been previously shown to exert analgesic effects. Here we tested if an active engagement in music making is more beneficial than music listening in terms of anxiety and pain levels during physical activity that is often avoided in patients with chronic pain. We applied a music feedback paradigm that combines music making and sports exercise, and which has been previously shown to enhance mood. We explored this method as an intervention to potentially reduce anxiety in a group of patients with chronic pain (N = 24, 20 female and 4 men; age range 34-64, M = 51.67, SD = 6.84) and with various anxiety levels. All participants performed two conditions: one condition, Jymmin, where exercise equipment was modified with music feedback so that it could be played like musical instruments by groups of three. Second, a conventional workout condition where groups of three performed exercise on the same devices but where they listened to the same type of music passively. Participants' levels of anxiety, mood, pain and self-efficacy were assessed with standardized psychological questionnaires before the experiment and after each condition. Results demonstrate that exercise with musical feedback reduced anxiety values in patients with chronic pain significantly as compared to conventional workout with passive music listening. There were no significant overall changes in pain, but patients with greater anxiety levels compared to those with moderate anxiety levels were observed to potentially benefit more from the music feedback intervention in terms of alleviation of pain. Furthermore, it was observed that patients during Jymmin more strongly perceived motivation through others. The observed diminishing effects of Jymmin on anxiety have a high clinical relevance, and in a longer term the therapeutic application could help to break the Anxiety Loop of Pain, reducing chronic pain. The intervention method, however, also has immediate benefits to chronic pain rehabilitation, increasing the motivation to work out, and facilitating social bonding.

Corrigendum: Musical feedback system Jymmin® leads to enhanced physical endurance in the elderly-A feasibility study.

[This corrects the article DOI: 10.3389/fspor.2022.915926.].

Enhanced Short-Term Memory Function in Older Adults with Dementia Following Music-Feedback Physical Training: A Pilot Study.

Prior research demonstrates that music making, physical exercise, and social activity have unique, positive effects on cognition and mood. One intervention, "Jymmin®", was developed incorporating these approaches and found effective for decreased pain perception and increased endurance, self-efficacy, mood, and muscle efficiency. Previously, Jymmin was not piloted with older adults with dementia. The current study is a randomized pilot study of the Jymmin® with an older adult population in a long-term care facility (n = 38), evaluated across dementia levels (mild, moderate, or severe). Results found significant improvements in scores on a confrontation naming task across all conditions (p = 0.047) and a significant interaction effect for short-term memory scores (p = 0.046), suggesting higher scores at Time 2 for the experimental group and at Time 3 for the control group. There were no significant changes in mood ratings. Findings are discussed in the context of neural activity and musical agency.

Musical feedback system Jymmin® leads to enhanced physical endurance in the elderly-A feasibility study.

Background and objectives: Active music-making in combination with physical exercise has evoked several positive effects in users of different age groups. These include enhanced mood, muscular effectivity, pain threshold, and decreased perceived exertion. The present study tested the applicability of this musical feedback system, called Jymmin ®, in combination with strength-endurance exercises in a population of healthy older adults. Research design and methods: Sixteen healthy, physically inactive older adults (5 males, 11 females) at the mean age of 70 years performed physical exercise in two conditions: A conventional work-out while listening passively music and a Jymmin ® work-out, where musical sounds were created with one's work-out movements. According to the hypothesis that strength-endurance is increased during musical feedback exercise, parameters relating to strength-endurance were assessed, including exercise duration, number of repetitions, perceived exertion (RPE), and participants' mental state (Multidimensional Mood State Questionnaire; MDMQ). Results: Results show that participants exercised significantly longer while doing Jymmin ® (Mdn = 248.75 s) as compared to the conventional work-out (Mdn = 182.73 s), (Z = 3.408, p = 0.001). The RPE did not differ between conventional work-out and the Jymmin ® condition, even though participants worked out significantly longer during the Jymmin ® condition (Mdn = 14.50; Z = -0.905; p = 0.366). The results of the MDMQ showed no significant differences between both conditions (Z = -1.037; p = 0.300). Discussion and implications: Results show that participants could work out longer while showing the same perceived exertion, relating to increased physical endurance. Music feedback work-out encouraged a greater degree of isometric contractions (muscle actively held at fixed length) and, therefore, less repetitions in this condition. In addition to the previously described effect on muscle effectivity, this non-stereotypic contraction pattern during music feedback training may have enhanced endurance in participants supporting them to better proportion energetic reserves during training (pacing). Clinical trial registration: Identifier: DRKS00023645.

Triplanar U-Net with lesion-wise voting for the segmentation of new lesions on longitudinal MRI studies.

We present a deep learning method for the segmentation of new lesions in longitudinal FLAIR MRI sequences acquired at two different time points. In our approach, the 3D volumes are processed slice-wise across the coronal, axial, and sagittal planes and the predictions from the three orientations are merged using an optimized voting strategy. Our method achieved best F1 score (0.541) among all participating methods in the MICCAI 2021 challenge Multiple sclerosis new lesions segmentation (MSSEG-2). Moreover, we show that our method is on par with the challenge's expert neuroradiologists: on an unbiased ground truth, our method achieves results comparable to those of the four experts in terms of detection (F1 score) and segmentation accuracy (Dice score).

Components of Active Music Interventions in Therapeutic Settings-Present and Future Applications.

Musical interventions in therapy have become increasingly relevant for rehabilitation in many clinics. What was long known for physiotherapy training-that the agency of the participant is crucial and moving is much more efficient for rehabilitation success than being moved-has over recent years also been shown to be true for music therapy. Accumulating evidence suggests that active musical interventions are especially efficient at helping rehabilitation success. Here, we review various approaches to active music therapy. Furthermore, we present several components that allow for manipulating musical expressiveness and physical engagement during active musical interventions, applying a technology-based music feedback paradigm. This paper will allow for a transfer of insights to other domains of music-based therapeutic interventions.

Myocardial mechanics in dilated cardiomyopathy: prognostic value of left ventricular torsion and strain.

BACKGROUND: Data on the prognostic value of left ventricular (LV) morphological and functional parameters including LV rotation in patients with dilated cardiomyopathy (DCM) using cardiovascular magnetic resonance (CMR) are currently scarce. In this study, we assessed the prognostic value of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and LV torsion using CMR feature tracking (FT). METHODS: CMR was performed in 350 DCM patients and 70 healthy subjects across 5 different European CMR Centers. Myocardial strain parameters were retrospectively assessed from conventional balanced steady-state free precession cine images applying FT. A combined primary endpoint (cardiac death, heart transplantation, aborted sudden cardiac death) was defined for the assessment of clinical outcome. RESULTS: GLS, GCS, GRS and LV torsion were significantly lower in DCM patients than in healthy subjects (all p < 0.001). The primary endpoint occurred in 59 (18.7%) patients [median follow-up 4.2 (2.0-5.6) years]. In the univariate analyses all strain parameters showed a significant prognostic value (p < 0.05). In the multivariate model, LV strain parameters, particularly GLS provided an incremental prognostic value compared to established CMR parameters like LV ejection fraction and late gadolinium enhancement. A scoring model including six categorical variables of standard CMR and strain parameters differentiated further risk subgroups. CONCLUSION: LV strain assessed with CMR FT has a high prognostic value in patients with DCM, surpassing routine and dedicated functional parameters. Thus, CMR strain imaging may contribute to the improvement of risk stratification in DCM.

Estimating cardiac active tension from wall motion-An inverse problem of cardiac biomechanics.

The contraction of the human heart is a complex process as a consequence of the interaction of internal and external forces. In current clinical routine, the resulting deformation can be imaged during an entire heart beat. However, the active tension development cannot be measured in vivo but may provide valuable diagnostic information. In this work, we present a novel numerical method for solving an inverse problem of cardiac biomechanics-estimating the dynamic active tension field, provided the motion of the myocardial wall is known. This ill-posed non-linear problem is solved using second order Tikhonov regularization in space and time. We conducted a sensitivity analysis by varying the fiber orientation in the range of measurement accuracy. To achieve RMSE <20% of the maximal tension, the fiber orientation needs to be provided with an accuracy of 10°. Also, variation was added to the deformation data in the range of segmentation accuracy. Here, imposing temporal regularization led to an eightfold decrease in the error down to 12%. Furthermore, non-contracting regions representing myocardial infarct scars were introduced in the left ventricle and could be identified accurately in the inverse solution (sensitivity >0.95). The results obtained with non-matching input data are promising and indicate directions for further improvement of the method. In future, this method will be extended to estimate the active tension field based on motion data from clinical images, which could provide important insights in terms of a new diagnostic tool for the identification and treatment of diseased heart tissue.

Dissonance in Music Impairs Spatial Gait Parameters in Patients with Parkinson's Disease.

BACKGROUND: It is known that music influences gait parameters in Parkinson's disease (PD). However, it remains unclear whether this effect is merely due to temporal aspects of music (rhythm and tempo) or other musical parameters. OBJECTIVE: To examine the influence of pleasant and unpleasant music on spatiotemporal gait parameters in PD, while controlling for rhythmic aspects of the musical signal. METHODS: We measured spatiotemporal gait parameters of 18 patients suffering from mild PD (50%men, mean±SD age of 64±6 years; mean disease duration of 6±5 years; mean Unified PD Rating scale [UPDRS] motor score of 15±7) who listened to eight different pieces of music. Music pieces varied in harmonic consonance/dissonance to create the experience of pleasant/unpleasant feelings. To measure gait parameters, we used an established analysis of spatiotemporal gait, which consists of a walkway containing pressure-receptive sensors (GAITRite®). Repeated measures analyses of variance were used to evaluate effects of auditory stimuli. In addition, linear regression was used to evaluate effects of valence on gait. RESULTS: Sensory dissonance modulated spatiotemporal and spatial gait parameters, namely velocity and stride length, while temporal gait parameters (cadence, swing duration) were not affected. In contrast, valence in music as perceived by patients was not associated with gait parameters. Motor and musical abilities did not relevantly influence the modulation of gait by auditory stimuli. CONCLUSION: Our observations suggest that dissonant music negatively affects particularly spatial gait parameters in PD by yet unknown mechanisms, but putatively through increased cognitive interference reducing attention in auditory cueing.

Evaluation of Guideline Adherence for Cardiac Catheterization in Patients With Presumed Obstructive Coronary Artery Disease in Germany (ENLIGHT-KHK) - A Multicentre, Prospective, Observational Study.

INTRODUCTION: The diagnosis or exclusion of obstructive stable coronary artery disease (SCAD) in clinical practice is challenging and therefore clinical guidelines provide recommendations on the use of non-invasive and invasive testing. For Germany, data obtained from the OECD and health insurances indicate a potential non-adherence to guideline-recommended diagnostic pathways. However, there is a lack of prospective and reliable evidence for appropriate use of invasive coronary angiography (CA) in Germany. OBJECTIVE: To provide evidence on the nature and extent of guideline non-adherence in patients undergoing CA with presumed obstructive SCAD in Germany and, to evaluate the clinical and economic consequences of potential deviations in guideline adherence. METHODS: ENLIGHT-KHK is a multicentre, prospective observational study recruiting 1500 patients being admitted for CA with presumed obstructive SCAD and exclusion of acute myocardial infarction (DRKS00015638). The primary outcome measure is the adherence to clinical guidelines in the decision-making process for use of CA. Therefore, the patients' diagnostic pathways and adherence to German and European guidelines will be assessed using clinical data, health-claims data, and a patient questionnaire. The primary safety outcome is a composite of myocardial infarction, stroke and all-cause death. Secondary outcome measures are periprocedural complications and costs. Using a decision-analytic model, the clinical and economic impact of observed guideline adherence in clinical practice will be assessed. Potential barriers and facilitators of guideline-adherent decision-making will be evaluated via semi-structured interviews. CONCLUSIONS: ENLIGHT-KHK will give insights into the appropriateness of invasive CA in Germany and enable the development of concepts to improve guideline-adherence in the German health-care setting.

Increasing Divergent Thinking Capabilities With Music-Feedback Exercise.

Divergent thinking is an essential aspect of creativity and has been shown to be affected both by music and physical exercise. While it has been shown that making music and physical exercise can be beneficial for Divergent Thinking in isolation, it is unclear whether the effects can be combined. The present experiment investigated the relation of physical exertion and being in control of music on Divergent Thinking and the possibility of an interaction effect. Seventy-seven predominantly young, German participants were tested with measurements of Divergent Thinking collected after either (1) physical exercise with music listening, (2) making music with a knob setup without physical effort (music control only), or (3) making physical exercise with musical feedback (Jymmin™). Results showed greater increases in Divergent Thinking scores following music-feedback exercise compared to conditions of physical exercise with music listening and music control only. The data thus demonstrate that making music part of a physical exercise routine more strongly leads to the benefit of increased creative capacities, which we argue will be beneficial for athletes to prepare for certain types of competition/performance and as part of regeneration training.

Comparison of short-stem with conventional-stem prostheses in total hip arthroplasty: an 8-year follow-up study.

PURPOSE: Coxarthrosis is a common disease of the adult hip joint. Elderly patients have mainly been treated with total hip arthroplasty (THA); however, younger patients are increasingly affected. Short-stem prostheses were developed for this special patient group. There have been few studies on the clinical outcomes of this type of prosthesis. This study compared the mid-term results of a short-stem prosthesis and a standard-stem prosthesis 8 years after implantation. METHODS: According to our clinical registry, patients who received a short-stem prosthesis before 2011 were identified. Patients in the standard-stem prosthesis group were matched based on the sex, age, height, weight, and degree of arthrosis. At the follow-up time, the modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score and visual analog scale (VAS) pain score were collected and compared with the preoperative values. RESULTS: Fifty-five patients could be matched and analyzed for both groups. No patients needed revision surgery. In both groups, there were significant improvements at the follow-up time. The pre- and postoperative mHHSs, UCLA scores, and VAS scores were 41.9 and 95 (p < 0.0001), 3.75 and 7.9 (p < 0.0001), and 7.6 and 0.9 (p < 0.0001), respectively, in the short-stem group and 44.8 and 96.25 (p < 0.0001), 3.6 and 7.7 (p < 0.0001), and 7.7 and 0.9 (p < 0.0001), respectively, in the control group, with no significant differences between the groups at the follow-up time. CONCLUSION: The short-stem prosthesis provides mid-term results comparable to those of a standard-stem prosthesis. In both groups, excellent patient-reported outcomes were achieved after an average of 8 years. LEVEL OF EVIDENCE: IV.

Brain networks underlying aesthetic appreciation as modulated by interaction of the spectral and temporal organisations of music.

Music is organised both spectrally and temporally, determining musical structures such as musical scale, harmony, and sequential rules in chord progressions. A number of human neuroimaging studies investigated neural processes associated with emotional responses to music investigating the influence of musical valence (pleasantness/unpleasantness) comparing the response to music and unpleasantly manipulated counterparts where harmony and sequential rules were varied. Interactions between the previously applied alterations to harmony and sequential rules of the music in terms of emotional experience and corresponding neural activities have not been systematically studied although such interactions are at the core of how music affects the listener. The current study investigates the interaction between such alterations in harmony and sequential rules by using data sets from two functional magnetic resonance imaging (fMRI) experiments. While replicating the previous findings, we found a significant interaction between the spectral and temporal alterations in the fronto-limbic system, including the ventromedial prefrontal cortex (vmPFC), nucleus accumbens, caudate nucleus, and putamen. We further revealed that the functional connectivity between the vmPFC and the right inferior frontal gyrus (IFG) was reduced when listening to excerpts with alterations in both domains compared to the original music. As it has been suggested that the vmPFC operates as a pivotal point that mediates between the limbic system and the frontal cortex in reward-related processing, we propose that this fronto-limbic interaction might be related to the involvement of cognitive processes in the emotional appreciation of music.

Surface Modification of Nanoparticles and Nanovesicles via Click-Chemistry.

Surface modification of nanocarriers offers the possibility of targeted drug delivery, which is of major interest in modern pharmaceutical science. Click-chemistry affords an easy and fast way to modify the surface with targeting structures under mild reaction conditions. Here we describe our current method for the post-preparational surface modification of multifunctional sterically stabilized (stealth) liposomes via copper-catalyzed azide-alkyne cycloaddition (CuAAC) and inverse electron demand Diels-Alder norbornene-tetrazine cycloaddition (IEDDA). We emphasize the use of these in a one-pot orthogonal reaction for deep investigation on stability and targeting of nanocarriers. As the production of clickable amphiphilic polymers is a limiting factor in most cases, we also describe our nanocarrier preparation technique called dual centrifugation, which enables the formulation of liposomes on a single-digit milligram scale of total lipid mass.

Musical meaning modulates word acquisition.

Musical excerpts have been shown to have the capacity to prime the processing of target words and vice versa, strongly suggesting that music can convey concepts. However, to date no study has investigated an influence of musical semantics on novel word acquisition, thus corroborating evidence for a similarity of underlying semantic processing of music and words behaviourally. The current study investigates whether semantic content of music can assist the acquisition of novel words. Forty novel words and their German translation were visually presented to 26 participants accompanied by either semantically congruent or incongruent music. Semantic congruence between music and words was expected to increase performance in the subsequent forced-choice recognition test. Participants performed significantly better on the retention of novel words presented with semantically congruent music compared to those presented with semantically incongruent music. This provides first evidence that semantic "enrichment" by music during novel word learning can augment novel word acquisition. This finding may lead to novel approaches in foreign language acquisition and language rehabilitation, and further strongly supports the concept that music has a strong capacity to iconically convey meaning.