Diagnostic contribution and therapeutic perspectives of transcranial magnetic stimulation in dementia.

Transcranial magnetic stimulation (TMS) is a powerful tool to probe in vivo brain circuits, as it allows to assess several cortical properties such asexcitability, plasticity and connectivity in humans. In the last 20 years, TMS has been applied to patients with dementia, enabling the identification of potential markers of thepathophysiology and predictors of cognitive decline; moreover, applied repetitively, TMS holds promise as a potential therapeutic intervention. The objective of this paper is to present a comprehensive review of studies that have employed TMS in dementia and to discuss potential clinical applications, from the diagnosis to the treatment. To provide a technical and theoretical framework, we first present an overview of the basic physiological mechanisms of the application of TMS to assess cortical excitability, excitation and inhibition balance, mechanisms of plasticity and cortico-cortical connectivity in the human brain. We then review the insights gained by TMS techniques into the pathophysiology and predictors of progression and response to treatment in dementias, including Alzheimer's disease (AD)-related dementias and secondary dementias. We show that while a single TMS measure offers low specificity, the use of a panel of measures and/or neurophysiological index can support the clinical diagnosis and predict progression. In the last part of the article, we discuss the therapeutic uses of TMS. So far, only repetitive TMS (rTMS) over the left dorsolateral prefrontal cortex and multisite rTMS associated with cognitive training have been shown to be, respectively, possibly (Level C of evidence) and probably (Level B of evidence) effective to improve cognition, apathy, memory, and language in AD patients, especially at a mild/early stage of the disease. The clinical use of this type of treatment warrants the combination of brain imaging techniques and/or electrophysiological tools to elucidate neurobiological effects of neurostimulation and to optimally tailor rTMS treatment protocols in individual patients or specific patient subgroups with dementia or mild cognitive impairment.

Effects of Breastfeeding, Formula Feeding, and Complementary Feeding on Rapid Weight Gain in the First Year of Life.

OBJECTIVE: To determine whether proportion of breast versus formula feeding and timing of complementary food introduction affect the odds of rapid gain in weight status in a diverse sample of infants. METHODS: Using data from Greenlight Intervention Study, we analyzed the effects of type of milk feeding (breastfeeding, formula, or mixed feeding) from the 2- to 6-month well visits, and the introduction of complementary foods before 4 months on rapid increase in weight-for-age z-score (WAZ) and weight-for-length z-score (WLZ) before 12 months using multivariable logistic regression models. RESULTS: Of the 865 infants enrolled, 469 had complete data on all variables of interest, and 41% and 33% of those infants had rapid increases in WAZ and WLZ, respectively. Odds of rapid increase in WAZ remained lowest for infants breastfeeding from 2 to 6 months (adjusted odds ratio [aOR] 0.34; 95% confidence interval [CI]: 0.17, 0.69) when compared to infants who were formula-fed. Adjusted for feeding, introduction of complementary foods after 4 months was associated with decreased odds of rapid increase in WLZ (aOR 0.64; 95% CI: 0.42, 0.96). CONCLUSIONS: Feeding typified by predominant breastfeeding and delaying introduction of complementary foods after 4 months reduces the odds of rapid increases in WAZ and WLZ in the first year of life.

Deploying Fourier Coefficients to Unravel Soybean Canopy Diversity.

Soybean canopy outline is an important trait used to understand light interception ability, canopy closure rates, row spacing response, which in turn affects crop growth and yield, and directly impacts weed species germination and emergence. In this manuscript, we utilize a methodology that constructs geometric measures of the soybean canopy outline from digital images of canopies, allowing visualization of the genetic diversity as well as a rigorous quantification of shape parameters. Our choice of data analysis approach is partially dictated by the need to efficiently store and analyze large datasets, especially in the context of planned high-throughput phenotyping experiments to capture time evolution of canopy outline which will produce very large datasets. Using the Elliptical Fourier Transformation (EFT) and Fourier Descriptors (EFD), canopy outlines of 446 soybean plant introduction (PI) lines from 25 different countries exhibiting a wide variety of maturity, seed weight, and stem termination were investigated in a field experiment planted as a randomized complete block design with up to four replications. Canopy outlines were extracted from digital images, and subsequently chain coded, and expanded into a shape spectrum by obtaining the Fourier coefficients/descriptors. These coefficients successfully reconstruct the canopy outline, and were used to measure traditional morphometric traits. Highest phenotypic diversity was observed for roundness, while solidity showed the lowest diversity across all countries. Some PI lines had extraordinary shape diversity in solidity. For interpretation and visualization of the complexity in shape, Principal Component Analysis (PCA) was performed on the EFD. PI lines were grouped in terms of origins, maturity index, seed weight, and stem termination index. No significant pattern or similarity was observed among the groups; although interestingly when genetic marker data was used for the PCA, patterns similar to canopy outline traits was observed for origins, and maturity indexes. These results indicate the usefulness of EFT method for reconstruction and study of canopy morphometric traits, and provides opportunities for data reduction of large images for ease in future use.

Mothers' expectations for shared reading after delivery: implications for reading activities at 6 months.

OBJECTIVE: To determine whether mothers with plans related to shared reading and baby books in the home at the time of delivery of their newborns would be more likely to engage in shared reading behaviors at age 6 months. METHODS: This was a cohort study with enrollment after birth and follow-up at 6 months in an urban public hospital. Predictors included mothers' attitudes and resources related to shared reading during the postpartum period. Outcomes included mothers' shared reading activities and resources at 6 months, as assessed by the StimQ-READ measure. RESULTS: A total of 173 mother-infant dyads were assessed. In multiple regression analyses adjusting for sociodemographics and maternal depression and literacy, StimQ-READ score at 6 months was increased in association with all 3 postpartum predictors: plans for reading as a strategy for school success (adjusted mean 1.7-point increase in 6-month score; 95% confidence interval [95% CI], 0.3-3.0), plans to read in infancy (3.1-point increase; 95% CI, 1.6-4.6), and having baby books in the home (2.3-point increase; 95% CI, 0.9-3.6). In multiple logistic regression analysis, mothers with 2 or more attitudes and resources had an adjusted odds ratio of 6.2 (95% CI, 2.0-18.9) for having initiated reading at 6 months. CONCLUSIONS: Maternal attitudes and resources in early infancy related to shared reading are important predictors of reading behaviors by 6 months. Cumulative postnatal attitudes and resources are the strongest predictors of later behaviors. Additional research is needed regarding whether guidance about shared reading in early infancy or pregnancy would enhance programs such as Reach Out and Read.

Biomechanical simulation of manual lifting using spacetime optimization.

Previous optimization techniques for the prediction of lifting motion patterns often require a change in either the number of variables or the order of the mathematical functions used to express the angular displacement of selected joints in response to change in variant conditions. The resolution of predicted results can also be seriously constrained by the number of variables used. These restrictions may often limit the applicability of these methodologies. In this paper, we proposed a new methodology for generating the optimum motion patterns for para-sagittal lifting tasks. A detailed description of this methodology is introduced. An example of an analysis using this methodology is presented. The computer program generated lifting motion patterns with a reduction of the overall objective function values. The actual versus predicted lifting motion patterns are compared. Using this method, constraints can be added anywhere within the lifting cycle without the need of rewriting the whole program. These features provide for a more flexible and efficient prediction of the lifting motion.

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.

Human-centred approaches in slipperiness measurement.

A number of human-centred methodologies--subjective, objective, and combined--are used for slipperiness measurement. They comprise a variety of approaches from biomechanically-oriented experiments to psychophysical tests and subjective evaluations. The objective of this paper is to review some of the research done in the field, including such topics as awareness and perception of slipperiness, postural and balance control, rating scales for balance, adaptation to slippery conditions, measurement of unexpected movements, kinematics of slipping, and protective movements during falling. The role of human factors in slips and falls will be discussed. Strengths and weaknesses of human-centred approaches in relation to mechanical slip test methodologies are considered. Current friction-based criteria and thresholds for walking without slipping are reviewed for a number of work tasks. These include activities such as walking on a level or an inclined surface, running, stopping and jumping, as well as stair ascent and descent, manual exertion (pushing and pulling, load carrying, lifting) and particular concerns of the elderly and mobility disabled persons. Some future directions for slipperiness measurement and research in the field of slips and falls are outlined. Human-centred approaches for slipperiness measurement do have many applications. First, they are utilized to develop research hypotheses and models to predict workplace risks caused by slipping. Second, they are important alternatives to apparatus-based friction measurements and are used to validate such methodologies. Third, they are used as practical tools for evaluating and monitoring slip resistance properties of footwear, anti-skid devices and floor surfaces.

A method for dynamic measurement of lumbar lordosis.

Trunk flexion-extension is accomplished with pelvic and thoracic rotation in the sagittal plane and a smooth coordination of lumbar vertebral translation and rotation. Several systems exist that measure gross trunk movements, but they typically do not track changes in lumbar arc length or curvature. A method for dynamic measurement of changes in lumbar arc length that uses a lordosimeter is presented. A static validation study of postures showed that the measurements are repeatable and compare favorably with a standard measure of lumbar curvature. In a dynamic validation study of a lifting task with a 23-kg load, the measurement method was highly correlated with thoracic and pelvic angular displacement. A discussion of the utility of this measure in biomechanical modeling is presented. A clinical or field version of the lordosimeter is also described.

The relation between pain intensity, disability, and the episodic nature of chronic and recurrent low back pain.

STUDY DESIGN: An observational study on the course of chronic and recurrent low back pain and its relation to disability and medication use performed on the basis of daily diary recording. OBJECTIVES: To provide a description of daily pain reporting by individuals with self-reported chronic and recurrent low back pain, to study how the intensity and episodic nature of low back pain is related to disability and medication use, and to classify subjects according to Von Korff's categories of chronic low back pain. SUMMARY OF BACKGROUND DATA: The natural history of low back pain has been described, and some classification schemes have been proposed, but little has been reported on pain characteristics and their relation to self-report of disability. METHODS: Daily self-reports of pain intensity, social and work disability, and medication use were collected from 94 participants with self-reported chronic or recurrent low back pain over a 6-month period. A metric for describing the episodic nature of chronic low back pain was developed. RESULTS: A significant effect of pain intensity on disability was found. During an episode, participants had significantly greater disability and medication use. Work-related disability and medication use was significantly greater in the latter half of an episode. CONCLUSIONS: Pain intensity can affect disability, but the episodic nature of low back pain also affects the ability to function in both work and personal life. Intermittent increases in pain can markedly alter disability. Chronic low back pain should not be treated as a static phenomenon.

Prevalence and implication of TT virus infection: minimal role in patients with non-A-E hepatitis in Taiwan.

TT virus (TTV) is a newly identified human DNA virus and little is known about its clinical significance. The aim of the study was to explore the prevalence of TTV infection in different risk populations and in patients with various liver diseases. Viral DNA was studied in 190 high-risk individuals, 97 household contacts, 52 patients with acute hepatitis A, 32 patients with non-A-E hepatitis including 13 fulminant hepatitis, 200 asymptomatic hepatitis B surface antigen (HBsAg) carriers, 100 patients with chronic hepatitis C, and 100 healthy adults. TTV infection was more frequent in high-risk groups (26-70%), patients with acute or fulminant non-A-E hepatitis (42-45%), and hepatitis C carriers (36%) than in healthy adults (10%) and hepatitis B carriers (15%). However, most of subjects with TTV infection alone had no or only mild hepatitis, and the same rate of TTV DNA in pre-hepatitis serum samples and constant serum TTV titers during hepatitis episodes were observed in two patients with acute non-A-E hepatitis. Phylogenetic analysis of the Taiwanese TTV isolates showed genetic heterogeneity and most (68%) isolates were TTV type 1. No particular strain was found to be associated with fulminant non-A-E hepatitis.

Development of a set of equations describing joint trajectories during para-sagittal lifting.

Given a lifting task with predetermined starting and ending positions, the angular trajectories are usually very consistent with a distinctive pattern. This paper derives a set of equations that can describe the joint trajectories during a para-sagittal lifting task. Three optimal motion patterns were also expressed by the polynomials: minimal hand jerk, minimal center of gravity (CG) jerk, and minimal muscle utilization rate (MUR). The variability of the joint movements were synthesized by overlapping the optimal patterns.

The effect of industrial back belts and breathing technique on trunk and pelvic coordination during a lifting task.

STUDY DESIGN: Relative phase angle was used to study segmental motion patterns during a lifting and lowering task. OBJECTIVES: To investigate the effect of back belts, breathing technique, and their interaction on lumbar and pelvic motion patterns. SUMMARY OF BACKGROUND DATA: Trunk and pelvic coordination has been investigated in healthy and low back pain populations. Back belts have been shown to alter range of motion and intra-abdominal pressure. Little has been reported about belts and coordination during lifting and lowering. Phase angle has been used for quantifying segmental coordination. METHODS: Six individuals performed lifting/lowering tasks with a 23-kg load under elastic, rigid, and no belt conditions. During a second session, individuals were trained in Valsalva's maneuver and repeated the protocol. Cinematography was used to track trunk and pelvis displacements. RESULTS: Segmental coordination during lowering generally was found to be the inverse of lifting. Significant differences in the relation between lumbar and pelvis phase angles were found during the initial stage of lifting because of the interaction of belt use and breathing. Lumbar range of motion decreased significantly with belt use during lifting and lowering. No significant change in pelvis range of motion was observed. CONCLUSIONS: Back belt use and breathing technique interacted during the initial stage of lifting to significantly alter the lumbar and pelvis phase angles. The change in segmental kinematics was similar to that previously reported for patients with a history of low back pain. Lumbar range of motion significantly decreased with belt use during both lifting and lowering.

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.

Video based lifting technique coding system.

Despite automation and improved working conditions, many materials in industry are still handled manually. Among the basic activities involved in manual materials handling, lifting is the one most frequently associated with low-back pain (LBP). Biomechanical analysis techniques have been used to better understand the risk factors associated with manual handling, but because these techniques require specialized equipment, highly trained personnel, and interfere with normal business operations, they are limited in their usefulness. A video based lifting technique analysis system (the VidLiTeCTM System) is presented that provides for quantifiable non-invasive biomechanical analysis of the dynamic features of lifting with high inter-coder reliability and low sensitivity to absolute errors. Analysis of results from a laboratory experiment and from field-collected videotape are described that support the reliability, sensitivity, and accuracy claims of the VidLiTeCTM System. The VidLiTeCTM System allows technicians with minimal training and low-tech equipment (a camcorder) to collect large sets of lifting data without interfering with normal business operations. A reasonably accurate estimate of the peak compressive force on the L5/S1 joint can be made from the data collected. Such a system can be used to collect quantified data on lifting techniques that can be related to LBP reporting.

Three different lifting strategies for controlling the motion patterns of the external load.

Co-ordination of various components of the human body during the course of lifting are very complex and difficult to control. This study hypothesized that strategies used to control the motion patterns of the external load may be applied to control co-ordination and also to control the level of compressive force on the lumbosacral joint. A simulation of lifting based on the optimization approach was introduced to generate three classes of unique dynamic motion patterns of the external load directed by three different objective functions. The first objective function was to maximize the smoothness of the motion pattern of the external load. The second objective function was to minimize the sudden change of the centre of gravity of the body-load system. The third objective was to minimize the integration over time of the sum of the square of the ratio of the predicted joint moments to the corresponding joint strength during the course of lifting. Eight subjects were recruited to perform 40 lifts using each of the three optimal motion patterns of the load. Compressive forces on the lumbosacral joint were computed and compared. The data showed with statistical significance that subjects using the motion patterns of the external load suggested by the first objective function had the lowest compressive force peaks. Thus, this study satisfied two goals: (1) it indexed and synthesized three motion patterns of the external load by three biomechanically unique objective functions, and (2) it established the association between the spinal loading and the control of the motion patterns of the external load during lifting.

Amplification of GB virus-C/hepatitis G virus RNA with primers from different regions of the viral genome.

GB virus-C/hepatitis G virus (GBV-C/HGV) is a newly identified RNA virus. The aim of the study was to compare three primer pairs from the 5' untranslated region (5'UTR), envelope region 2 (E 2) and nonstructural region 3 (NS 3) of GBV-C/HGV genome for their ability to detect GBV-C/HGV RNA by polymerase chain reaction (PCR) assays. By using PCR with primers from different regions of the viral genome, serum GBV-C/HGV RNA was assayed in 200 at-risk individuals. The sensitivity of this assay was assessed by a titration experiment, and nucleotide sequences of the amplified products were determined directly. Of 200 serum samples, 43 (21.5%) were positive for GBV-C/HGV RNA with at least one of the primer pairs. The positive rates by 5'UTR, NS 3, and E 2 primers were 100%, 98%, and 84%, respectively, and the sensitivity of PCR assays using 5'UTR primers was 10 to 100 times more likely to detect GBV-C/HGV RNA than that of NS 3 and E 2 primers. The average homology of amplified targets to the prototype HGV genome was 89%, 80%, and 85% and the similarity between each amplified target was up to 100%, 90%, and 92% in the 5'UTR, E 2, and NS 3 regions, respectively. Therefore, the 5'UTR of GBV-C/HGV genome is highly conserved and primers deduced from this region can provideva sensitive and specific PCR assay for GBV-C/HGV RNA.

The use of Taguchi's methods for the evaluation of industrial knife design.

Knives are used in industry, and particularly on meat packaging assembly lines, where a premium is placed on the speed of cutting. One consequence of this is that knife design and selection has been based on the speed of cutting as the most significant measure of a knife. In industry the cuts that knives make vary in difficulty with many factors such as thickness, contour, and temperature of the material being cut. These factors may change the speed with which these cuts are made. According to Taguchi's methods, a robust design is one that maintains high performance while remaining insensitive to changes in its environment. This means that a robust knife design would enable an employee to cut not only with as much speed as possible in one particular cutting scenario, but also with a consistently high speed in as many cutting scenarios as possible. An experiment with various knife designs was evaluated with Taguchi's method. Ten subjects cut outlined clay patterns in 15 min with each one of nine different knives. The nine different designs were generated from the following combinations; three grip sizes (44.4, 50.8 and 63.5 mm), three coupling angles between the grip and the blade (0, 45 and 90 degrees), three blade heights measured from the middle of the blade (10, 13 and 15 mm), and three blade lengths (85, 125 and 155 mm). Eight conditions of cutting material were used to generate 'noise'. They are combinations of temperature of the clay to be cut (from temperature (R) approximately 25 degrees C, frozen for 1 h (F) approximately 5 degrees C), thickness of the clay to be cut (15 and 25 mm), and orientation of the work surface (0 and 30 degrees). The result shows that the knife design of 63.5 mm grip size, 0 degree coupling angle, 13 mm blade height, and 85 mm blade length provides the highest number of cuts, the knife design of 50.8 mm grip size, 45 degrees coupling angle, 15 mm blade height, and 85 mm blade length gives the highest signal to noise ratio. The shorter blade (85 mm) is suggested by both designs, but the two designs are different in the other three variables. Further analysis of the noise variables shows that lowering clay temperature significantly reduces cutting speed. Although there is more than one design that can resolve changes in clay thickness and clay orientation, a 15 mm blade height is the only design insensitive to the clay temperature change.