Results of a feasibility and initial efficacy clinical trial of a high-intensity interval training program using adaptive equipment in persons with multiple sclerosis who have walking disability.

BACKGROUND: High intensity interval training (HIIT) has been identified as potential stimulus for eliciting health-promoting physical activity in an efficient manner among persons with multiple sclerosis (MS). The current study aimed to examine the feasibility and initial efficacy of a 12-week HIIT program using a recumbent stepper (RSTEP) in persons with MS who have walking disability. Feasibility outcomes of interest included process (i.e., recruitment, adherence, and retention rates), resource (i.e., time and monetary costs), management (i.e., data management and safety reporting assessment), and science (i.e., safety, burden, and treatment effect assessment). We hypothesized that 12-weeks of HIIT will be feasible via meeting a priori benchmarks in process, resource, management, and scientific outcomes. The efficacy outcomes of interest included changes in aerobic fitness, physical activity, walking, upper arm function, cognition, fatigue, and depressive symptoms. We hypothesized that 12 weeks of HIIT would result in improvements in aerobic capacity, walking, upper arm function, cognition, fatigue, and depression. METHODS: A pre-post clinical trial design was applied. Participants (N = 16) were recruited and enrolled in the 12-week RSTEP HIIT program who met the following inclusion criteria: age ≥18 years, self-reported diagnosis of MS, Patient Determined Disability Steps scale score 3.0-7.0, relapse free in past 30 days, willing to visit a University Laboratory for study protocol, asymptomatic status for maximal exercise testing, physician approval, and a self-reported ability to speak, read, and understand English. Measures of efficacy outcomes of interest included Six Minute Walk Test (6MW), Timed 25 Foot Walk Test (T25FW), the Brief International Cognitive Assessment in MS (BICAMS), 9-hole peg test (9-HPT), Expanded Disability Status Scale (EDSS), Fatigue Severity Survey (FSS), Hospital Anxiety and Depression Scale (HADS), Godin Leisure Time Exercise Questionnaire (GLTEQ), Multiple Sclerosis Walking Scale-12 (MSWS-12). Participants completed a graded maximal exercise test for measuring aerobic fitness (VO2peak) and prescription of exercise throughout the intervention. All outcomes were measured at baseline, mid-point (6-weeks), and post-intervention (12-weeks). The intervention involved 12 weeks of supervised, individualized HIIT sessions two times per week using RSTEP. The individual HIIT sessions included 10 cycles of 60 s intervals at the work rate associated with 90 % VO2peak followed by 60 s of active recovery intervals, totaling 20 minutes plus 5-minute warm-up and cool-down periods. Process, resources, management, and scientific feasibility outcomes were examined using descriptive statistics, percentage, and frequency analyses. The efficacy of the intervention was assessed using a 1-factor (Time), repeated measure analysis of variance to identify significant changes over time. RESULTS: Fourteen of 16 participants were retained throughout the full study period and adherence with prescribed exercise sessions was 97 %. Twenty-three staff were comprehensively trained across two sites. There was only one adverse event reported that did not impact participation in the study and overall mean satisfaction rating with the program among participants was 4.7/5. There were statistically significant changes in cognitive processing speed (p = 0.002), GLTEQ (p = 0.005), and MSWS-12 (p = 0.04), but not the other outcomes of fitness, arm function, and walking. Of note, there were large effect sizes noted for peak power output (d = 1.10) and FSS (d = 1.05) despite the lack of statistically significant changes CONCLUSION: Feasibility of a 12-week individualized RSTEP HIIT program was established and participants significantly improved on measures of cognition, physical activity, and walking.

Work Environment Differences Between Outpatient and Inpatient Surgery: A Pilot Study on the Vascular Surgeons' Perceptions.

BACKGROUND: In France, outpatient endovascular surgical procedures have been slowly implemented in hospitals since 2015. Their development has been heterogeneous across France and is not yet the standard of care despite their benefits concerning patients' outcomes and healthcare professionals' satisfaction. However, since the COVID-19 pandemic, the demand for patient beds has been increasing, while human resources have been decreasing. This encouraged the surgery service reorganization and accelerated the shift from inpatient to outpatient surgery. Consequently, services had to adapt rapidly and this may have caused some strain on the hospital medical workforce. The objectives of this pilot study were to document and analyze the nursing staff (nurses and certified assistant nurses) well-being and workload as perceived by the vascular surgeons working with them. It also wanted to assess the link between the nursing staff's psychosocial stress and the surgeons' concentration and serenity in their workplace, based on the assumption that the well-being of both parties is inextricably linked. METHODS: An observational study was conducted using an online questionnaire distributed to the senior members of the French society of vascular and endovascular surgery (n = 490) between October 10 and October 18, 2022. RESULTS: In total, 125 surgeons completed the questionnaire (25% response rate). The main finding was that according to 68% of vascular surgeons, the nursing staff's psychosocial stress significantly impaired their serenity and concentration at work and this frequently affected the surgical procedure safety. The main sources of psychosocial stress were the high work pace (64%), demand for flexibility (56%), lack of anticipation of schedule changes (82%), and difficulties encountered in relaying these concerns to hospital managers (44.6%). CONCLUSIONS: This study demonstrated that concomitantly with the forced acceleration of outpatient activity implementation, the vascular surgeons' perceptions of their working environment are deteriorating, especially in conventional (inpatient) surgery wards where the workload is increasing and patients have more comorbidities. The worsened psychosocial stress of surgeons and staff affects the care provided.

Intra-scan RF power amplifier drift correction.

PURPOSE: The drift in radiofrequency (RF) power amplifiers (RFPAs) is assessed and several contributing factors are investigated. Two approaches for prospective correction of drift are proposed and their effectiveness is evaluated. METHODS: RFPA drift assessment encompasses both intra-pulse and inter-pulse drift analyses. Scan protocols with varying flip angle (FA), RF length, and pulse repetition time (TR) are used to gauge the influence of these parameters on drift. Directional couplers (DICOs) monitor the forward waveforms of the RFPA outputs. DICOs data is stored for evaluation, allowing calculation of correction factors to adjust RFPAs' transmit voltage. Two correction methods, predictive and run-time, are employed: predictive correction necessitates a calibration scan, while run-time correction calculates factors during the ongoing scan. RESULTS: RFPA drift is indeed influenced by the RF duty-cycle, and in the cases examined with a maximum duty-cycle of 66%, the potential drift is approximately 41% or 15%, depending on the specific RFPA revision. Notably, in low transmit voltage scenarios, FA has minimal impact on RFPA drift. The application of predictive and run-time drift correction techniques effectively reduces the average drift from 10.0% to less than 1%, resulting in enhanced MR signal stability. CONCLUSION: Utilizing DICO recordings and implementing a feedback mechanism enable the prospective correction of RFPA drift. Having a calibration scan, predictive correction can be utilized with fewer complexity; for enhanced performance, a run-time approach can be employed.

Hydrogenation of functionalised pyridines with a rhodium oxide catalyst under mild conditions.

Piperidines are one of the most widely used building blocks in the synthesis of pharmaceutical and agrochemical compounds. The hydrogenation of pyridines is a convenient method to synthesise such compounds as it only requires reactant, catalyst, and a hydrogen source. However, this reaction still remains difficult for the reduction of functionalised and multi-substituted pyridines. Here we report the use of a stable, commercially available rhodium compound, Rh2O3, for the reduction of various unprotected pyridines. The reaction only requires mild conditions, and the substrate scope is broad, making it practically useful.

Leptin receptor neurons in the dorsomedial hypothalamus input to the circadian feeding network.

Salient cues, such as the rising sun or availability of food, entrain biological clocks for behavioral adaptation. The mechanisms underlying entrainment to food availability remain elusive. Using single-nucleus RNA sequencing during scheduled feeding, we identified a dorsomedial hypothalamus leptin receptor-expressing (DMHLepR) neuron population that up-regulates circadian entrainment genes and exhibits calcium activity before an anticipated meal. Exogenous leptin, silencing, or chemogenetic stimulation of DMHLepR neurons disrupts the development of molecular and behavioral food entrainment. Repetitive DMHLepR neuron activation leads to the partitioning of a secondary bout of circadian locomotor activity that is in phase with the stimulation and dependent on an intact suprachiasmatic nucleus (SCN). Last, we found a DMHLepR neuron subpopulation that projects to the SCN with the capacity to influence the phase of the circadian clock. This direct DMHLepR-SCN connection is well situated to integrate the metabolic and circadian systems, facilitating mealtime anticipation.

Estimating mussel mound distribution and geometric properties in coastal salt marshes by using UAV-Lidar point clouds.

The Atlantic ribbed mussel (Geukensia demissa) is common in southeastern US salt marshes, where they form dense aggregations (mounds), that occur in the highest densities and sizes on the marsh platform close to the tidal creeks' heads. Within these marshes, mussels help build marsh elevation via their biodeposition of organic and inorganic material, stimulate the growth of the dominant foundation species cordgrass (Spartina alterniflora), and create hotspots of invertebrate biodiversity, nutrient cycling, and drought resilience. Given their powerful role, there is rising interest in assessing natural variation in the distribution of mussel mounds and using such information to guide marsh conservation and restoration strategies. However, gathering such information is challenging, because the small dimension (∼1 m) of the mounds and the presence of overlying vegetation make it difficult to quantify mound distribution on the marsh. Therefore, this study presents a new procedure to compute the distribution, height, radius, volume, and distance of mounds in marsh environments using remote sensing. A high-resolution UAV-Lidar point cloud has been collected over a highly vegetated salt marsh in Georgia, USA, using a custom-built laser scanner system. An original detection algorithm, based on a Random Forest classifier, has been implemented to identify the mounds from the point cloud. The algorithm has been trained and tested on surveyed mounds and provides their location and geometric properties. Results indicate that the classifier can distinguish mussel mounds from non-mussel mound locations with an accuracy of 95 %. The classifier identified ∼8000 mounds, which occupy 10 % of the study domain, and a volume (shells+feces/pseudofeces) of 680 m3. The method is highly useful in efforts to monitor mussel mounds over time and scale up to assess mounds across sites, providing invaluable data for future studies related to the geomorphic evolution of marshes to sea level rise and siting marsh conservation and enhancement projects.

A leptin-responsive hypothalamic circuit inputs to the circadian feeding network.

Salient cues, such as the rising sun or the availability of food, play a crucial role in entraining biological clocks, allowing for effective behavioral adaptation and ultimately, survival. While the light-dependent entrainment of the central circadian pacemaker (suprachiasmatic nucleus, SCN) is relatively well defined, the molecular and neural mechanisms underlying entrainment associated with food availability remains elusive. Using single nucleus RNA sequencing during scheduled feeding (SF), we identified a leptin receptor (LepR) expressing neuron population in the dorsomedial hypothalamus (DMH) that upregulates circadian entrainment genes and exhibits rhythmic calcium activity prior to an anticipated meal. We found that disrupting DMHLepR neuron activity had a profound impact on both molecular and behavioral food entrainment. Specifically, silencing DMHLepR neurons, mis-timed exogenous leptin administration, or mis-timed chemogenetic stimulation of these neurons all interfered with the development of food entrainment. In a state of energy abundance, repetitive activation of DMHLepR neurons led to the partitioning of a secondary bout of circadian locomotor activity that was in phase with the stimulation and dependent on an intact SCN. Lastly, we discovered that a subpopulation of DMHLepR neurons project to the SCN with the capacity to influence the phase of the circadian clock. This leptin regulated circuit serves as a point of integration between the metabolic and circadian systems, facilitating the anticipation of meal times.

Faunal engineering stimulates landscape-scale accretion in southeastern US salt marshes.

The fate of coastal ecosystems depends on their ability to keep pace with sea-level rise-yet projections of accretion widely ignore effects of engineering fauna. Here, we quantify effects of the mussel, Geukensia demissa, on southeastern US saltmarsh accretion. Multi-season and -tidal stage surveys, in combination with field experiments, reveal that deposition is 2.8-10.7-times greater on mussel aggregations than any other marsh location. Our Delft-3D-BIVALVES model further predicts that mussels drive substantial changes to both the magnitude (±<0.1 cm·yr-1) and spatial patterning of accretion at marsh domain scales. We explore the validity of model predictions with a multi-year creekshed mussel manipulation of >200,000 mussels and find that this faunal engineer drives far greater changes to relative marsh accretion rates than predicted (±>0.4 cm·yr-1). Thus, we highlight an urgent need for empirical, experimental, and modeling work to resolve the importance of faunal engineers in directly and indirectly modifying the persistence of coastal ecosystems globally.

The effects of RF coils and SAR supervision strategies for clinically applicable nonselective parallel-transmit pulses at 7 T.

PURPOSE: To investigate the effects of using different parallel-transmit (pTx) head coils and specific absorption rate (SAR) supervision strategies on pTx pulse design for ultrahigh-field MRI using a 3D-MPRAGE sequence. METHODS: The PTx universal pulses (UPs) and fast online-customized (FOCUS) pulses were designed with pre-acquired data sets (B0 , B1 + maps, specific absorption rate [SAR] supervision data) from two different 8 transmit/32 receive head coils on two 7T whole-body MR systems. For one coil, the SAR supervision model consisted of per-channel RF power limits. In the other coil, SAR estimations were done with both per-channel RF power limits as well as virtual observation points (VOPs) derived from electromagnetic field (EMF) simulations using three virtual human body models at three different positions. All pulses were made for nonselective excitation and inversion and evaluated on 132 B0 , B1 + , and SAR supervision datasets obtained with one coil and 12 from the other. At both sites, 3 subjects were examined using MPRAGE sequences that used UP/FOCUS pulses generated for both coils. RESULTS: For some subjects, the UPs underperformed when simulated on a different coil from which they were derived, whereas FOCUS pulses still showed acceptable performance in that case. FOCUS inversion pulses outperformed adiabatic pulses when scaled to the same local SAR level. For the self-built coil, the use of VOPs showed reliable overestimation compared with the ground-truth EMF simulations, predicting about 52% lower local SAR for inversion pulses compared with per-channel power limits. CONCLUSION: FOCUS inversion pulses offer a low-SAR alternative to adiabatic pulses and benefit from using EMF-based VOPs for SAR estimation.

Ultra-high field MRI: parallel-transmit arrays and RF pulse design.

This paper reviews the field of multiple or parallel radiofrequency (RF) transmission for magnetic resonance imaging (MRI). Currently the use of ultra-high field (UHF) MRI at 7 tesla and above is gaining popularity, yet faces challenges with non-uniformity of the RF field and higher RF power deposition. Since its introduction in the early 2000s, parallel transmission (pTx) has been recognized as a powerful tool for accelerating spatially selective RF pulses and combating the challenges associated with RF inhomogeneity at UHF. We provide a survey of the types of dedicated RF coils used commonly for pTx and the important modeling of the coil behavior by electromagnetic (EM) field simulations. We also discuss the additional safety considerations involved with pTx such as the specific absorption rate (SAR) and how to manage them. We then describe the application of pTx with RF pulse design, including a practical guide to popular methods. Finally, we conclude with a description of the current and future prospects for pTx, particularly its potential for routine clinical use.

A building block-based beam-break (B5) locomotor activity monitoring system and its use in circadian biology research.

Locomotor activity is one of the most commonly assayed animal behaviors. It is the gold standard for assessing behavioral circadian rhythmicity. Here, we develop a flexible and affordable locomotor activity monitoring system that does not interfere with the behavior of animals. We validate the reliability of the system in multiple circadian biology research scenarios. This device is customizable and can be used for many animal species.

SARS-CoV-2 Detection in air samples from inside heating, ventilation, and air conditioning (HVAC) systems- COVID surveillance in student dorms.

BACKGROUND: The COVID-19 pandemic affected universities and institutions and caused campus shutdowns with a transition to online teaching models. To detect infections that might spread on campus, we pursued research towards detecting SARS-CoV-2 in air samples inside student dorms. METHODS: We sampled air in 2 large dormitories for 3.5 months and a separate isolation suite containing a student who had tested positive for COVID-19. We developed novel techniques employing 4 methods to collect air samples: Filter Cassettes, Button Sampler, BioSampler, and AerosolSense sampler combined with direct qRT-PCR SARS-CoV-2 analysis. RESULTS: For the 2 large dorms with the normal student population, we detected SARS-CoV-2 in 11 samples. When compared with student nasal swab qRT-PCR testing, we detected SARS-CoV-2 in air samples when a PCR positive COVID-19 student was living on the same floor of the sampling location with a detection rate of 75%. For the isolation dorm, we had a 100% SARS-CoV-2 detection rate with AerosolSense sampler. CONCLUSIONS: Our data suggest air sampling may be an important SARS-CoV-2 surveillance technique, especially for buildings with congregant living settings (dorms, correctional facilities, barracks). Future building designs and public health policies should consider implementation of Heating, Ventilation, and Air Conditioning surveillance.

Design of spectral-spatial phase prewinding pulses and their use in small-tip fast recovery steady-state imaging.

PURPOSE: Spectrally selective "prewinding" radiofrequency pulses can counteract B0 inhomogeneity in steady-state sequences, but can only prephase a limited range of off-resonance. We propose spectral-spatial small-tip angle prewinding pulses that increase the off-resonance bandwidth that can be successfully prephased by incorporating spatially tailored excitation patterns. THEORY AND METHODS: We present a feasibility study to compare spectral and spectral-spatial prewinding pulses. These pulses add a prephasing term to the target magnetization pattern that aims to recover an assigned off-resonance bandwidth at the echo time. For spectral-spatial pulses, the design bandwidth is centered at the off-resonance frequency for each spatial location in a field map. We use these pulses in the small-tip fast recovery steady-state sequence, which is similar to balanced steady-state free precession. We investigate improvement of spectral-spatial pulses over spectral pulses using simulations and small-tip fast recovery scans of a gel phantom and human brain. RESULTS: In simulation, spectral-spatial pulses yielded lower normalized root mean squared excitation error than spectral pulses. For both experiments, the spectral-spatial pulse images are also qualitatively better (more uniform, less signal loss) than the spectral pulse images. CONCLUSION: Spectral-spatial prewinding pulses can prephase over a larger range of off-resonance than their purely spectral counterparts. Magn Reson Med 79:1377-1386, 2018. © 2017 International Society for Magnetic Resonance in Medicine.