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Li Y, Yang T, Wang X, He X, Dong J, Qian Q, Zhang X, Zheng J, Fan X, Ma Y. The ability of decline in intrinsic capacity to indicate the risk of mortality in older adults: A meta-analysis. Maturitas 2024; 189:108109. [PMID: 39293255 DOI: 10.1016/j.maturitas.2024.108109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 06/28/2024] [Accepted: 08/27/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVE To evaluate the ability of decline in intrinsic capacity to indicate the risk of mortality in older adults. DESIGN Meta-analysis. METHODS PubMed, EMBASE, Web of Science, the Cochrane Library, Wanfang Database, CNKI, VIP, and CBM were searched for relevant studies published from inception to October 31, 2023. Stata17.0 software was used to perform the meta-analysis. A random effects model was used to pool the results of the risk of mortality (as hazard ratios, HRs) in older adults and decline in intrinsic capacity. The Newcastle Ottawa Scale was used to evaluate the quality of studies. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to determine the confidence in the estimated effect of pooled outcomes. RESULTS Twelve studies, with a total of 38,531 participants, were included in this meta-analysis. The findings show that older adults with intrinsic capacity decline have a higher risk of mortality (HR = 1.11, 95 % CI 1.08-1.14, I2 = 95.9 %, P<0.001) than older adults with normal intrinsic capacity. The pooled HR estimates for the locomotion, vitality, and cognitive dimensions of intrinsic capacity in the prediction of mortality were 0.89 (HR = 0.89, 95%CI 0.83-0.96, I2 = 41.3 %, P = 0.146), 0.76 (HR = 0.98, 95 % CI 0.59-0.97, I2 = 60.8 %, P = 0.078), and 0.99 (HR = 0.99, 95 % CI 0.98-1.00, I2 = 0.0 %, P = 0.664), respectively. The pooled HR estimates of the psychological dimension to predict mortality were not statistically significant (P > 0.05). GRADE evaluations of outcome indicators were of moderate confidence. CONCLUSIONS Decline in intrinsic capacity is a significant predictor of mortality. Locomotion, vitality, and cognition dimensions can all predict mortality. Clinical personnel should early assess the intrinsic capacity of older adults, focusing on changes in the dimensions of locomotion and vitality, to identify the risk of mortality, avoid adverse health outcomes, and improve the quality of life of older adults. Review protocol registered in PROSPERO: CRD42023481246.
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Affiliation(s)
- Yidan Li
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Tingting Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Xuedan Wang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Xiang He
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Jianhui Dong
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Qiuxia Qian
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Xingxia Zhang
- Department of Nursing, The Third People's Hospital of Gansu Province, Lanzhou City, Gansu Province, China
| | - Jie Zheng
- Department of Nursing, The Third People's Hospital of Gansu Province, Lanzhou City, Gansu Province, China
| | - Xiangping Fan
- Department of Nursing, The Third People's Hospital of Lanzhou, Lanzhou, Gansu, China.
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China.
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Vitello DJ, Logan CD, Zaza NN, Bates KR, Jacobs R, Feinglass J, Merkow RP, Bentrem DJ. Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection. J Surg Oncol 2024. [PMID: 39387593 DOI: 10.1002/jso.27861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/02/2024] [Indexed: 10/15/2024]
Abstract
INTRODUCTION While frailty has gained attention for its utility in risk stratification, no studies have directly compared them to existing risk calculators. The objective of this study was to compare the risk stratification of the American College of Surgeons Surgical Risk Calculator (ACS-SRC), the Revised Risk Analysis Index (RAI-rev), and the Modified Frailty Index (5-mFI). The primary outcomes were 30-day postoperative morbidity, 30-day postoperative mortality, unplanned readmission, unplanned reoperation, and discharge disposition other than home. METHODS Patients undergoing anatomic lung resection for primary, nonsmall cell lung cancer were identified within the ACS National Quality Improvement Program (ACS NSQIP) database. Tools were compared for discrimination in the primary outcomes. RESULTS 9663 patients undergoing anatomic lung resection for cancer between 2012 and 2014 were included. The cohort was 53.1% female. Median age at diagnosis was 67 (IQR 59-74) years. Perioperative morbidity and mortality rates were 10.9% (n = 1048) and 1.6% (n = 158). Rates of 30-day postoperative unplanned readmission and reoperation were 7.5% (n = 725) and 4.8% (n = 468). The ACS-SRC had the highest discrimination for all measured outcomes, as measured by the area under the receiver operating curve (AUC) and corresponding confidence interval (95% CI). This included perioperative mortality (AUC 0.74, 95% CI 0.71-0.78), compared to RAI-rev (AUC 0.66, 95% CI 0.62-0.69) and 5-mFI (AUC 0.61, 95% CI 0.57-0.65; p < 0.001). The RAI-rev and 5-mFI had similar discrimination for all measured outcomes. CONCLUSION ACS-SRC was the perioperative risk stratification tool with the highest predictive discrimination for adverse, 30-day, postoperative events for patients with cancer treated with anatomic lung resection.
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Affiliation(s)
- Dominic J Vitello
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Charles D Logan
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Norah N Zaza
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Kelly R Bates
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan Jacobs
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Surgery, Canning Thoracic Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph Feinglass
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan P Merkow
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - David J Bentrem
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
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Yamagata M, Kiyono K, Kimura T. Long-range cross-correlations between center of pressure velocity and colored noises provided during quiet standing. Neurosci Lett 2024; 842:138008. [PMID: 39369840 DOI: 10.1016/j.neulet.2024.138008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 09/14/2024] [Accepted: 10/03/2024] [Indexed: 10/08/2024]
Abstract
Unperceivable electrical noise stimulation has been applied to improve postural control through the enhancement of somatosensory feedback. It has been observed that stimulation with a pink noise (1/f) structure is more effective than stimulation with other noise structures. In addition, the 1/f structure embedded in the postural control system may have a superior effect on postural control stabilization. However, the direct relationship between the long-range correlations of the pink-noise signal applied to somatosensory receptors and those of the postural control system has not been elucidated. Thus, we aimed to explore a common long-range correlation factor shared in the time series of the provided noise and foot center of pressure (CoP) during quiet standing. Sixteen young adults stood quietly on the force platform for 65 s. Four noise conditions (no stimulation and stimulation of knee joints with white-, pink-, and red-noise-like signals) were employed during the standing trials. The detrending moving-average cross-correlation analysis revealed that in each of the anteroposterior and mediolateral directions, the CoP velocity time series displayed significant long-range cross-correlations with the white and pink noise signals provided at that time, whereas such an effect was not observed in the red noise signal. This result indicates that pink and white noise signals would alter the temporal behavior of the CoP during quiet standing, although the mechanism remains to be elucidated.
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Affiliation(s)
- Momoko Yamagata
- Faculty of Rehabilitation, Kansai Medical University, 18-89 Uyama Higashimachi, Hirakata, Osaka 573-1136, Japan; Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka 560-8531, Japan
| | - Tetsuya Kimura
- Graduate School of Human Development and Environment, Kobe University, 3-11 Tsurukabuto, Nada-ku, Kobe, Hyogo 657-0011, Japan
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Lipsitz LA. Introduction to Special Issue on Complexity. J Gerontol A Biol Sci Med Sci 2024; 79:glae213. [PMID: 39312642 DOI: 10.1093/gerona/glae213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Affiliation(s)
- Lewis A Lipsitz
- Hebrew SeniorLife, Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, USA
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Cohen AA, Olde Rikkert MGM. The Power of a Complex Systems Perspective to Elucidate Aging. J Gerontol A Biol Sci Med Sci 2024; 79:glae210. [PMID: 39352172 PMCID: PMC11443544 DOI: 10.1093/gerona/glae210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024] Open
Abstract
It is becoming highly accepted that aging, age-related diseases, and geriatric healthcare can move forward if reductionist research is complemented by integrative research uniting knowledge on specific aging mechanisms, multiple biomedical, social, psychological, lifestyle, and environmental factors and their interactions. In this special issue, we present exciting papers that illustrate how complexity science theory and practice can be applied to aging research and provide a better understanding and quantification of healthy aging and vulnerability to disease. Recent insights on biomarkers, clocks of aging, frailty, and resilience are covered and studied in interaction with a dynamic multiscale perspective. The editorial and closing viewpoint guide you through basic principles of gerontological complexity science and shed light on new research horizons, including innovative systems-based interventions.
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Affiliation(s)
- Alan A Cohen
- Robert N. Butler Columbia Aging Center and Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Sabido R, García-Aguilar F, Caballero C, Moreno FJ. How does fatigue affect handstand balance? a non-linear approach to study fatigue influence in handstand performance. J Neuroeng Rehabil 2024; 21:171. [PMID: 39334356 PMCID: PMC11430115 DOI: 10.1186/s12984-024-01442-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/08/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The handstand is an essential skill in acrobatic sports. This skill requires the athlete to maintain an inverted upright stance with only the hands supported, which requires a great effort of muscular coordination and motor control. Several factors influence the ability to control the posture, including fatigue, which is a bit studied constraint of handstand performance. RESEARCH QUESTION With the aim to find out whether variability in movement control can be an indicator of fatigue, the present study was carried out. METHOD Fourteen male acrobatic gymnasts were required to perform handstands. The time series for analyzing variability were capturing using Force Platforms, which is a traditional laboratory instrument, and Inertial Measurement Units (IMU), which is a more recent and less widely used, but more accessible tool. For this purpose, an analysis of the amount of variability was carried out, using the standard deviation. And analysis of the structure of variability (or complexity), using Detrended Fluctuation Analysis (DFA) and Fuzzy Entropy (FuEn). RESULTS Our results reveal that fatigue causes significant increases in the amount of variability in the medio-lateral axis on the force platform, and in the IMU located in the area of the L5 vertebra. These changes are accompanied by increased auto-correlation in the medio-lateral axis of the force platform, and more unpredictable behavior in the L5 IMU.
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Affiliation(s)
- Rafael Sabido
- Sport Sciences Department, Miguel Hernández University. Building CID, Av. de la Universidad s/n, 03202, Elche, Alicante, Spain
| | - Fernando García-Aguilar
- Sport Sciences Department, Miguel Hernández University. Building CID, Av. de la Universidad s/n, 03202, Elche, Alicante, Spain.
| | - Carla Caballero
- Sport Sciences Department, Miguel Hernández University. Building CID, Av. de la Universidad s/n, 03202, Elche, Alicante, Spain
| | - Francisco J Moreno
- Sport Sciences Department, Miguel Hernández University. Building CID, Av. de la Universidad s/n, 03202, Elche, Alicante, Spain
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Vitello DJ, Logan CD, Zaza NN, Bates KR, Jacobs R, Feinglass J, Merkow RP, Bentrem DJ. Comparison of a risk calculator with frailty indices in patients undergoing lung cancer resection. J Surg Oncol 2024. [PMID: 39206522 DOI: 10.1002/jso.27815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/20/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Perioperative risk stratification is an essential component of preoperative planning for cancer surgery. While frailty has gained attention for its utility in risk stratification, no studies have directly compared it to existing risk calculators. Therefore, the objective of this study was to compare the risk stratification of the American College of Surgeons Surgical Risk Calculator (ACS-SRC), the Revised Risk Analysis Index (RAI-rev), and the Modified Frailty Index (5-mFI). The primary outcomes were 30-day postoperative morbidity, 30-day postoperative mortality, unplanned readmission, unplanned reoperation, and discharge disposition other-than-home. METHODS Patients undergoing anatomic lung resection for primary, non-small cell lung cancer were identified within the American College of Surgeons National Quality Improvement Program (ACS NSQIP) database. The ACS-SRC, RAI-rev, and 5-mFI tools were used to predict adverse postoperative events. Tools were compared for discrimination in the primary outcomes. RESULTS 9663 patients undergoing anatomic lung resection for cancer between 2012 and 2014 were included. The cohort was 53.1% female. Median age at diagnosis was 67 (interquartile range = 59-74) years. Cardiothoracic surgeons performed 89% and general surgeons performed 11.0% of the operations. Perioperative morbidity and mortality rates were 10.9% (n = 1048) and 1.6% (n = 158). Rates of 30-day postoperative unplanned readmission and reoperation were 7.5% (n = 725) and 4.8% (n = 468). The ACS-SRC had the highest discrimination for all measured outcomes, as measured by the area under the receiver operating curve (AUC) and corresponding confidence interval (95% confidence interval [CI]). This included perioperative mortality (AUC = 0.74, 95% CI = 0.71-0.78), compared to RAI-rev (AUC = 0.66, 95% CI = 0.62-0.69) and 5-mFI (AUC = 0.61, 95% CI = 0.57-0.65; p < 0.001). The RAI-rev and 5-mFI had similar discrimination for all measured outcomes. CONCLUSION ACS-SRC was the perioperative risk stratification tool with the highest predictive discrimination for adverse, 30-day, postoperative events for patients with cancer treated with anatomic lung resection.
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Affiliation(s)
- Dominic J Vitello
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Charles D Logan
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Surgery, Canning Thoracic Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Norah N Zaza
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Kelly R Bates
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ryan Jacobs
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Surgery, Canning Thoracic Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joseph Feinglass
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ryan P Merkow
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - David J Bentrem
- Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Surgery Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
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Dewangan GC, Singhal S, Chandran DS, Khan MA, Dey AB, Chakrawarty A. Short-term heart rate variability: A potential approach to frailty assessment in older adults. Aging Med (Milton) 2024; 7:456-462. [PMID: 39234194 PMCID: PMC11369330 DOI: 10.1002/agm2.12353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/31/2024] [Indexed: 09/06/2024] Open
Abstract
Objectives This study aimed to evaluate cardiac autonomic modulation using short-term heart rate variability (HRV) and compare it among frailty statuses in older Indian adults. Methods A total of 210 subjects aged 60 years and above were recruited into three groups: frail (n = 70), pre-frail (n = 70), and non-frail (n = 70) from the outpatient department of Geriatric Medicine at a tertiary care hospital in India. Frailty status was assessed using the Rockwood frailty index (FI) criteria. HRV was derived from a 5-min ECG recording of standard limb leads and assessed using time domain, frequency domain, and nonlinear analysis of cardiac interval variability. Results The HRV parameters indicative of parasympathetic modulation such as SDNN, SDSD, rMSSD, NN50, pNN50, absolute HF power, and SD1 were significantly lower in frail subjects compared with both pre-frail and non-frail subjects (P < 0.05). Absolute LF power and SD2 were also lower in frail subjects compared with pre-frail and non-frail subjects (P < 0.05). Measures of sympatho-vagal balance (LF/HF and SD1/SD2 ratios) did not show statistical significance. The FI demonstrated negative correlations with all HRV parameters. Conclusions Frail individuals exhibit decreased sympathetic and parasympathetic modulation compared with pre-frail and non-frail individuals, although maintaining a balanced sympatho-vagal state. Furthermore, autonomic modulation declines progressively with increasing frailty.
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Affiliation(s)
- Gevesh Chand Dewangan
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
- Department of General MedicineEmployee's State Insurance Corporation HospitalRaipurChhattisgarhIndia
| | - Sunny Singhal
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
- Department of Geriatric MedicineSawai Man Singh Medical CollegeJaipurRajasthanIndia
| | - Dinu S. Chandran
- Department of PhysiologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Maroof Ahmad Khan
- Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia
| | - Aparajit Ballav Dey
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
- Venu Geriatric InstituteNew DelhiIndia
| | - Avinash Chakrawarty
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
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Shannick J, Armstrong-Harper L, Sheppard E, Larson DJ, Brown SHM. Can training to dissociate trunk and pelvic motion influence thorax-pelvis coordination and lumbar spine dynamic stability? Musculoskelet Sci Pract 2024; 72:102955. [PMID: 38636346 DOI: 10.1016/j.msksp.2024.102955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/21/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The large number of articulating joints within the spinal column provides an abundance of options to control its movement. However, the ability of individuals to consciously manipulate these movement options is poorly understood. OBJECTIVES To determine if short-term training can improve the ability to consciously dissociate motion between the pelvis and thorax during repetitive pelvic tilting movements. DESIGN Cross-over design with young healthy individuals. METHOD Seventeen participants performed trials consisting of 35 continuous lift/lowers followed by 35 continuous anterior/posterior pelvic tilts while spine kinematics were recorded. Participants then underwent a 20-min training protocol designed to improve the control of pelvic motion and in particular the dissociation of pelvic and trunk motion. Post-training, the continuous pelvic tilt and lift/lower trials were repeated. Thorax-pelvis movement coordination was analyzed via vector coding and lumbar spine local dynamic stability was analyzed via Lyapunov exponents. Participants were grouped as being either high or low skill movers based on their ability to perform the pre-training pelvic tilt movements. RESULTS The low skill movement group demonstrated statistically significant increases in the time spent using in-phase pelvic dominant (p = 0.028) and anti-phase pelvic dominant (p = 0.043) coordination patterns during the pelvic tilt movements after the completion of the training protocol. The high skill movement group showed no differences in their movement patterns post-training. CONCLUSIONS Short-term training, targeted to improve the ability to dissociate pelvic from thorax motion, had a beneficial effect on the group of individuals who initially lacked skill performing the pelvic tilting task.
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Affiliation(s)
- Jordan Shannick
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Liam Armstrong-Harper
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Emma Sheppard
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Dennis J Larson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada; Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada.
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Kirishima A, Anan M. Interjoint Coordination at Different Squatting Speeds in Healthy Adults. Cureus 2024; 16:e67620. [PMID: 39310612 PMCID: PMC11416855 DOI: 10.7759/cureus.67620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
Background Squatting is commonly used in various settings to enhance muscle strength and performance. Both fast and slow squats have advantages as training to improve muscle function in the lower extremity muscles. Movement speed affects the variability of interjoint coordination and decreased variability can lead to overuse injuries owing to repetitive mechanical loading on the lower extremity joints. However, only a few studies have focused on interjoint coordination during squatting. This study aimed to clarify the kinematic and kinetic differences, as well as the interjoint coordination, during squatting at different speeds. Methodology Healthy young participants with no locomotor disease were recruited to perform descending parallel squats at different speeds (one, three, and five seconds) using a 3D motion analysis system and force plates. Joint moments and continuous relative phases were calculated and compared between the conditions. Results There were no significant differences in the mean values of lower limb joint moments among the three speed conditions. However, the mean absolute values of the continuous relative phase between the ankle and hip joints and the mean standard deviation of the continuous relative phase between each lower limb joint were significantly lower in the high-speed condition than in the medium- and low-speed conditions. Additionally, in the high-speed condition, the knee joint moved ahead of the hip joint in the knee-hip joint phase coordination pattern. Conclusions The joint load per unit time remained constant across all speed conditions. High-speed squatting may adapt to mechanical loading on the joints, although the knee joint moves ahead of the hip joint, exhibiting a highly coordinated movement. Conversely, low-speed squatting may reduce the risk of disability owing to the high variability of interjoint coordination. Therefore, squatting training should be based on individual characteristics and objectives.
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Affiliation(s)
- Akihiko Kirishima
- Department of Rehabilitation Medicine, Nishi-Hiroshima Rehabilitation Hospital, Hiroshima, JPN
| | - Masaya Anan
- Faculty of Welfare and Health Science, Oita University, Oita, JPN
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R K Roy A, Noohi F, Morris NA, Ljubenkov P, Heuer H, Fong J, Hall M, Lario Lago A, Rankin KP, Miller BL, Boxer AL, Rosen HJ, Seeley WW, Perry DC, Yokoyama JS, Lee SE, Sturm VE. Basal parasympathetic deficits in C9orf72 hexanucleotide repeat expansion carriers relate to smaller frontoinsula and thalamus volume and lower empathy. Neuroimage Clin 2024; 43:103649. [PMID: 39098187 PMCID: PMC11342757 DOI: 10.1016/j.nicl.2024.103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/16/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024]
Abstract
Diminished basal parasympathetic nervous system activity is a feature of frontotemporal dementia that relates to left frontoinsula dysfunction and empathy impairment. Individuals with a pathogenic expansion of the hexanucleotide repeat in chromosome 9 open reading frame 72 (C9orf72), the most common genetic cause of frontotemporal dementia and amyotrophic lateral sclerosis, provide a unique opportunity to examine whether parasympathetic activity is disrupted in genetic forms of frontotemporal dementia and to investigate when parasympathetic deficits manifest in the pathophysiological cascade. We measured baseline respiratory sinus arrhythmia, a parasympathetic measure of heart rate variability, over two minutes in a sample of 102 participants that included 19 asymptomatic expansion carriers (C9+ asymp), 14 expansion carriers with mild cognitive impairment (C9+ MCI), 16 symptomatic expansion carriers with frontotemporal dementia (C9+ FTD), and 53 expansion-negative healthy controls (C9- HC) who also underwent structural magnetic resonance imaging. In follow-up analyses, we compared baseline respiratory sinus arrhythmia in the C9+ FTD group with an independent age-, sex-, and clinical severity-matched group of 26 people with sporadic behavioral variant frontotemporal dementia. The Frontotemporal Lobar Degeneration-modified Clinical Dementia Rating-Sum of Boxes score was used to quantify behavioral symptom severity, and informant ratings on the Interpersonal Reactivity Index provided measures of participants' current emotional (empathic concern) and cognitive (perspective-taking) empathy. Results indicated that the C9+ FTD group had lower baseline respiratory sinus arrhythmia than the C9+ MCI, C9+ asymp, and C9- HC groups, a deficit that was comparable to that of sporadic behavioral variant frontotemporal dementia. Linear regression analyses indicated that lower baseline respiratory sinus arrhythmia was associated with worse behavioral symptom severity and lower empathic concern and perspective-taking across the C9orf72 expansion carrier clinical spectrum. Whole-brain voxel-based morphometry analyses in participants with C9orf72 pathogenic expansions found that lower baseline respiratory sinus arrhythmia correlated with smaller gray matter volume in the left frontoinsula and bilateral thalamus, key structures that support parasympathetic function, and in the bilateral parietal lobes, occipital lobes, and cerebellum, regions that are also vulnerable in individuals with C9orf72 expansions. This study provides novel evidence that basal parasympathetic functioning is diminished in FTD due to C9orf72 expansions and suggests that baseline respiratory sinus arrhythmia may be a potential non-invasive biomarker that is sensitive to behavioral symptoms in the early stages of disease.
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Affiliation(s)
- Ashlin R K Roy
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Fate Noohi
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Nathaniel A Morris
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Peter Ljubenkov
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Hilary Heuer
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Jamie Fong
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Matthew Hall
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | | | - Katherine P Rankin
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Adam L Boxer
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Howard J Rosen
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - William W Seeley
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - David C Perry
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Jennifer S Yokoyama
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Suzee E Lee
- Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Virginia E Sturm
- Department of Neurology, University of California, San Francisco, CA 94158, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94143, USA.
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12
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Anghileri E, Tramacere I, Morlino S, Leuzzi C, Gutierrez LP, Motta S, Silvani A, Amato A, Berrini FR. Critical Issues for Patients and Caregivers in Neuro-Oncology during the COVID-19 Pandemic: What We Have Learnt from an Observational Study. Curr Oncol 2024; 31:3895-3907. [PMID: 39057160 PMCID: PMC11275436 DOI: 10.3390/curroncol31070288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/21/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE The COVID-19 pandemic affected neuro-oncological patients and their caregivers regarding tumor care and emotional functioning, including Quality of Life (QoL). This study aimed to understand how COVID-19 affected their psychological state and the relations between patients and health personnel in neuro-oncology. METHODS A cross-sectional study was conducted on neuro-oncological patients and their caregivers. RESULTS A total of 162 patients and 66 caregivers completed the questionnaire. Altogether, 37.5% of patients perceived a greater risk of contracting COVID-19 compared to the general population. On a 0-10 scale, the patients' tumor-related anxiety score was 5.8, and their COVID-19-related score was 4.6. The caregivers reported 7.7 and 5.5, respectively. QoL was described as at least good in 75% of both patients and caregivers; the caregivers' care burden increased in 22.7% of cases during the pandemic, with no correlation with QoL. Future perception often changed, both in patients and caregivers. In 18% of cases, the cancer treatment schedule was changed, either by patient decision or by medical decision. However, 93.5% of patients were satisfied with their overall care. CONCLUSIONS A considerable proportion of patients and caregivers still perceived the tumor disease as more burdensome than the pandemic, and their future as more uncertain. Such data suggest the need to build a productive alliance between patients and health professionals.
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Affiliation(s)
- Elena Anghileri
- Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy;
| | - Irene Tramacere
- Department of Research and Clinical Development, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Sara Morlino
- Radiotherapy Unit, Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Catia Leuzzi
- Clinical Neuro-Science Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.L.); (L.P.G.)
| | - Lorena Pareja Gutierrez
- Clinical Neuro-Science Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.L.); (L.P.G.)
| | - Saba Motta
- Scientific and Patients Library, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Antonio Silvani
- Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy;
| | - Anna Amato
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Francesca Romana Berrini
- AITC-Associazione Italiana Tumori Cerebrali (Italian Brain Tumor Association), 20133 Milan, Italy;
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13
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van der Kruk E, Geijtenbeek T. A planar neuromuscular controller to simulate compensation strategies in the sit-to-walk movement. PLoS One 2024; 19:e0305328. [PMID: 38870249 PMCID: PMC11175457 DOI: 10.1371/journal.pone.0305328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
Standing up from a chair is a key daily life activity that is sensitive to functional limitations as we age and associated with falls, frailty, and institutional living. Predictive neuromusculoskeletal models can potentially shed light on the interconnectivity and interdependency of age-related changes in neuromuscular capacity, reinforcement schemes, sensory integration, and adaptation strategies during stand-up. Most stand-up movements transfer directly into walking (sit-to-walk). The aim of this study was to develop and validate a neuromusculoskeletal model with reflex-based muscle control that enables simulation of the sit-to-walk movement under various conditions (seat height, foot placement). We developed a planar sit-to-walk musculoskeletal model (11 degrees-of-freedom, 20 muscles) and neuromuscular controller, consisting of a two-phase stand-up controller and a reflex-based gait controller. The stand-up controller contains generic neural pathways of delayed proprioceptive feedback from muscle length, force, velocity, and upper-body orientation (vestibular feedback) and includes both monosynaptic an antagonistic feedback pathways. The control parameters where optimized using a shooting-based optimization method, based on a high-level optimization criterium. Simulations were compared to recorded kinematics, ground reaction forces, and muscle activation. The simulated kinematics resemble the measured kinematics and muscle activations. The adaptation strategies that resulted from alterations in seat height, are comparable to those observed in adults. The simulation framework and model are publicly available and allow to study age-related compensation strategies, including reduced muscular capacity, reduced neural capacity, external perturbations, and altered movement objectives.
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Affiliation(s)
- Eline van der Kruk
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology, Delft, the Netherlands
| | - Thomas Geijtenbeek
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology, Delft, the Netherlands
- Goatstream, Utrecht, the Netherlands
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14
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Schumock G, Bandeen-Roche K, Chia CW, Kalyani RR, Ferrucci L, Varadhan R. Nonlinear modeling of oral glucose tolerance test response to evaluate associations with aging outcomes. PLoS One 2024; 19:e0302381. [PMID: 38753665 PMCID: PMC11098391 DOI: 10.1371/journal.pone.0302381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/02/2024] [Indexed: 05/18/2024] Open
Abstract
As people age, their ability to maintain homeostasis in response to stressors diminishes. Physical frailty, a syndrome characterized by loss of resilience to stressors, is thought to emerge due to dysregulation of and breakdowns in communication among key physiological systems. Dynamical systems modeling of these physiological systems aims to model the underlying processes that govern response to stressors. We hypothesize that dynamical systems model summaries are predictive of age-related declines in health and function. In this study, we analyze data obtained during 75-gram oral-glucose tolerance tests (OGTT) on 1,120 adults older than 50 years of age from the Baltimore Longitudinal Study on Aging. We adopt a two-stage modeling approach. First, we fit OGTT curves with the Ackerman model-a nonlinear, parametric model of the glucose-insulin system-and with functional principal components analysis. We then fit linear and Cox proportional hazards models to evaluate whether usual gait speed and survival are associated with the stage-one model summaries. We also develop recommendations for identifying inadequately-fitting nonlinear model fits in a cohort setting with numerous heterogeneous response curves. These recommendations include: (1) defining a constrained parameter space that ensures biologically plausible model fits, (2) evaluating the relative discrepancy between predicted and observed responses of biological interest, and (3) identifying model fits that have notably poor model fit summary measures, such as [Formula: see text], relative to other fits in the cohort. The Ackerman model was unable to adequately fit 36% of the OGTT curves. The stage-two regression analyses found no associations between Ackerman model summaries and usual gait speed, nor with survival. The second functional principal component score was associated with faster gait speed (p<0.01) and improved survival (p<0.01).
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Affiliation(s)
- Grant Schumock
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Chee W. Chia
- Clinical Research Unit, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ravi Varadhan
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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15
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Cho H, Rietdyk S. The effect of visual sensory interference during multitask obstacle crossing in younger and older adults. PLoS One 2024; 19:e0302838. [PMID: 38753863 PMCID: PMC11098502 DOI: 10.1371/journal.pone.0302838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
When older adults step over obstacles during multitasking, their performance is impaired; the impairment results from central and/or sensory interference. The purpose was to determine if sensory interference alters performance under low levels of cognitive, temporal, and gait demand, and if the change in performance is different for younger versus older adults. Participants included 17 younger adults (20.9±1.9 years) and 14 older adults (69.7±5.4 years). The concurrent task was a single, simple reaction time (RT) task: depress button in response to light cue. The gait task was stepping over an obstacle (8 m walkway) in three conditions: (1) no sensory interference (no RT task), (2) low sensory interference (light cue on obstacle, allowed concurrent foveation of cue and obstacle), or (3) high sensory interference (light cue away from obstacle, prevented concurrent foveation of cue and obstacle). When standing, the light cue location was not relevant (no sensory interference). An interaction (sensory interference by task, p<0.01) indicated that RT was longer for high sensory interference during walking, but RT was not altered for standing, confirming that sensory interference increased RT during obstacle approach. An interaction (sensory interference by age, p<0.01) was observed for foot placement before the obstacle: With high sensory interference, younger adults placed the trail foot closer to the obstacle while older adults placed it farther back from the obstacle. The change increases the likelihood of tripping with the trail foot for younger adults, but with the lead limb for older adults. Recovery from a lead limb trip is more difficult due to shorter time for corrective actions. Overall, visual sensory interference impaired both RT and gait behavior with low levels of multitask demand. Changes in foot placement increased trip risk for both ages, but for different limbs, reducing the likelihood of balance recovery in older adults.
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Affiliation(s)
- HyeYoung Cho
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
- Center for Aging and the Life Course, Purdue University, West Lafayette, IN, United States of America
- Department of Kinesiology, University of Northern Iowa, Cedar Falls, IA, United States of America
| | - Shirley Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
- Center for Aging and the Life Course, Purdue University, West Lafayette, IN, United States of America
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16
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Keshmiri S, Tomonaga S, Mizutani H, Doya K. Respiratory modulation of the heart rate: A potential biomarker of cardiorespiratory function in human. Comput Biol Med 2024; 173:108335. [PMID: 38564855 DOI: 10.1016/j.compbiomed.2024.108335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
In recent decade, wearable digital devices have shown potentials for the discovery of novel biomarkers of humans' physiology and behavior. Heart rate (HR) and respiration rate (RR) are most crucial bio-signals in humans' digital phenotyping research. HR is a continuous and non-invasive proxy to autonomic nervous system and ample evidence pinpoints the critical role of respiratory modulation of cardiac function. In the present study, we recorded longitudinal (7 days, 4.63 ± 1.52) HR and RR of 89 freely behaving human subjects (Female: 39, age 57.28 ± 5.67, Male: 50, age 58.48 ± 6.32) and analyzed their dynamics using linear models and information theoretic measures. While HR's linear and nonlinear characteristics were expressed within the plane of the HR-RR directed flow of information (HR→RR - RR→HR), their dynamics were determined by its RR→HR axis. More importantly, RR→HR quantified the effect of alcohol consumption on individuals' cardiorespiratory function independent of their consumed amount of alcohol, thereby signifying the presence of this habit in their daily life activities. The present findings provided evidence for the critical role of the respiratory modulation of HR, which was previously only studied in non-human animals. These results can contribute to humans' phenotyping research by presenting RR→HR as a digital diagnosis/prognosis marker of humans' cardiorespiratory pathology.
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Affiliation(s)
- Soheil Keshmiri
- Optical Neuroimaging Unit, Okinawa Institute of Science and Technology, Okinawa, Japan.
| | - Sutashu Tomonaga
- Neural Computation Unit (NCU), Okinawa Institute of Science and Technology, Okinawa, Japan.
| | - Haruo Mizutani
- Suntory Global Innovation Center Limited (SGIC), Suntory, Kyoto, Japan.
| | - Kenji Doya
- Neural Computation Unit (NCU), Okinawa Institute of Science and Technology, Okinawa, Japan.
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17
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Hua A, Wang G, Bai J, Hao Z, Liu J, Meng J, Wang J. Nonlinear dynamics of postural control system under visual-vestibular habituation balance practice: evidence from EEG, EMG and center of pressure signals. Front Hum Neurosci 2024; 18:1371648. [PMID: 38736529 PMCID: PMC11082324 DOI: 10.3389/fnhum.2024.1371648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Human postural control system is inherently complex with nonlinear interaction among multiple subsystems. Accordingly, such postural control system has the flexibility in adaptation to complex environments. Previous studies applied complexity-based methods to analyze center of pressure (COP) to explore nonlinear dynamics of postural sway under changing environments, but direct evidence from central nervous system or muscular system is limited in the existing literature. Therefore, we assessed the fractal dimension of COP, surface electromyographic (sEMG) and electroencephalogram (EEG) signals under visual-vestibular habituation balance practice. We combined a rotating platform and a virtual reality headset to present visual-vestibular congruent or incongruent conditions. We asked participants to undergo repeated exposure to either congruent (n = 14) or incongruent condition (n = 13) five times while maintaining balance. We found repeated practice under both congruent and incongruent conditions increased the complexity of high-frequency (0.5-20 Hz) component of COP data and the complexity of sEMG data from tibialis anterior muscle. In contrast, repeated practice under conflicts decreased the complexity of low-frequency (<0.5 Hz) component of COP data and the complexity of EEG data of parietal and occipital lobes, while repeated practice under congruent environment decreased the complexity of EEG data of parietal and temporal lobes. These results suggested nonlinear dynamics of cortical activity differed after balance practice under congruent and incongruent environments. Also, we found a positive correlation (1) between the complexity of high-frequency component of COP and the complexity of sEMG signals from calf muscles, and (2) between the complexity of low-frequency component of COP and the complexity of EEG signals. These results suggested the low- or high-component of COP might be related to central or muscular adjustment of postural control, respectively.
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Affiliation(s)
- Anke Hua
- Department of Sports Science, Zhejiang University, Hangzhou, China
- Sciences Cognitives et Sciences Affectives, University of Lille, Lille, France
| | - Guozheng Wang
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
- Taizhou Key Laboratory of Medical Devices and Advanced Materials, Research Institute of Zhejiang University, Taizhou, China
| | - Jingyuan Bai
- Department of Sports Science, Zhejiang University, Hangzhou, China
| | - Zengming Hao
- Department of Rehabilitation Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Liu
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Jun Meng
- College of Control Science and Engineering, Zhejiang University, Hangzhou, China
| | - Jian Wang
- Department of Sports Science, Zhejiang University, Hangzhou, China
- Center for Psychological Science, Zhejiang University, Hangzhou, China
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18
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Mangalam M, Seleznov I, Kolosova E, Popov A, Kelty-Stephen DG, Kiyono K. Postural control in gymnasts: anisotropic fractal scaling reveals proprioceptive reintegration in vestibular perturbation. FRONTIERS IN NETWORK PHYSIOLOGY 2024; 4:1393171. [PMID: 38699200 PMCID: PMC11063314 DOI: 10.3389/fnetp.2024.1393171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024]
Abstract
Dexterous postural control subtly complements movement variability with sensory correlations at many scales. The expressive poise of gymnasts exemplifies this lyrical punctuation of release with constraint, from coarse grain to fine scales. Dexterous postural control upon a 2D support surface might collapse the variation of center of pressure (CoP) to a relatively 1D orientation-a direction often oriented towards the focal point of a visual task. Sensory corrections in dexterous postural control might manifest in temporal correlations, specifically as fractional Brownian motions whose differences are more and less correlated with fractional Gaussian noises (fGns) with progressively larger and smaller Hurst exponent H. Traditional empirical work examines this arrangement of lower-dimensional compression of CoP along two orthogonal axes, anteroposterior (AP) and mediolateral (ML). Eyes-open and face-forward orientations cultivate greater variability along AP than ML axes, and the orthogonal distribution of spatial variability has so far gone hand in hand with an orthogonal distribution of H, for example, larger in AP and lower in ML. However, perturbing the orientation of task focus might destabilize the postural synergy away from its 1D distribution and homogenize the temporal correlations across the 2D support surface, resulting in narrower angles between the directions of the largest and smallest H. We used oriented fractal scaling component analysis (OFSCA) to investigate whether sensory corrections in postural control might thus become suborthogonal. OFSCA models raw 2D CoP trajectory by decomposing it in all directions along the 2D support surface and fits the directions with the largest and smallest H. We studied a sample of gymnasts in eyes-open and face-forward quiet posture, and results from OFSCA confirm that such posture exhibits the classic orthogonal distribution of temporal correlations. Head-turning resulted in a simultaneous decrease in this angle Δθ, which promptly reversed once gymnasts reoriented their heads forward. However, when vision was absent, there was only a discernible negative trend in Δθ, indicating a shift in the angle's direction but not a statistically significant one. Thus, the narrowing of Δθ may signify an adaptive strategy in postural control. The swift recovery of Δθ upon returning to a forward-facing posture suggests that the temporary reduction is specific to head-turning and does not impose a lasting burden on postural control. Turning the head reduced the angle between these two orientations, facilitating the release of postural degrees of freedom towards a more uniform spread of the CoP across both dimensions of the support surface. The innovative aspect of this work is that it shows how fractality might serve as a control parameter of adaptive mechanisms of dexterous postural control.
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Affiliation(s)
- Madhur Mangalam
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, United States
| | - Ivan Seleznov
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | - Elena Kolosova
- National University of Ukraine on Physical Education and Sport, Scientific Research Institute, Kyiv, Ukraine
- Department of Movement Physiology, Bogomoletz Institute of Physiology, Kyiv, Ukraine
| | - Anton Popov
- Department of Electronic Engineering, Igor Sikorsky Kyiv Polytechnic Institute, Kyiv, Ukraine
- Faculty of Applied Sciences, Ukrainian Catholic University, Lviv, Ukraine
| | - Damian G. Kelty-Stephen
- Department of Psychology, State University of New York at New Paltz, New Paltz, NY, United States
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
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19
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Kelty-Stephen DG, Kiyono K, Stergiou N, Mangalam M. Spatial variability and directional shifts in postural control in Parkinson's disease. Clin Park Relat Disord 2024; 10:100249. [PMID: 38803658 PMCID: PMC11129103 DOI: 10.1016/j.prdoa.2024.100249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Individuals with Parkinson's disease exhibit tremors, rigidity, and bradykinesia, disrupting normal movement variability and resulting in postural instability. This comprehensive study aimed to investigate the link between the temporal structure of postural sway variability and Parkinsonism by analyzing multiple datasets from young and older adults, including individuals with Parkinson's disease, across various task conditions. We used the Oriented Fractal Scaling Component Analysis (OFSCA), which identifies minimal and maximal long-range correlations within the center of pressure time series, allowing for detecting directional changes in postural sway variability. The objective was to uncover the primary directions along which individuals exerted control during the posture. The results, as anticipated, revealed that healthy adults predominantly exerted control along two orthogonal directions, closely aligned with the anteroposterior (AP) and mediolateral (ML) axes. In stark contrast, older adults and individuals with Parkinson's disease exhibited control along suborthogonal directions that notably diverged from the AP and ML axes. While older adults and those with Parkinson's disease demonstrated a similar reduction in the angle between these two control directions compared to healthy older adults, their reliance on this suborthogonal angle concerning endogenous fractal correlations exhibited significant differences from the healthy aging cohort. Importantly, individuals with Parkinson's disease did not manifest the sensitivity to destabilizing task settings observed in their healthy counterparts, affirming the distinction between Parkinson's disease and healthy aging.
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Affiliation(s)
- Damian G. Kelty-Stephen
- Department of Psychology, State University of New York at New Paltz, New Paltz, NY 12561, USA
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka 560-8531, Japan
| | - Nick Stergiou
- Division of Biomechanics and Research Development, Department of Biomechanics, Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Department of Physical Education & Sport Science, Aristotle University, Thessaloniki 570 01, Greece
| | - Madhur Mangalam
- Division of Biomechanics and Research Development, Department of Biomechanics, Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE 68182, USA
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20
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Park S, Laskow TC, Chen J, Guha P, Dawn B, Kim D. Microphysiological systems for human aging research. Aging Cell 2024; 23:e14070. [PMID: 38180277 PMCID: PMC10928588 DOI: 10.1111/acel.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Recent advances in microphysiological systems (MPS), also known as organs-on-a-chip (OoC), enable the recapitulation of more complex organ and tissue functions on a smaller scale in vitro. MPS therefore provide the potential to better understand human diseases and physiology. To date, numerous MPS platforms have been developed for various tissues and organs, including the heart, liver, kidney, blood vessels, muscle, and adipose tissue. However, only a few studies have explored using MPS platforms to unravel the effects of aging on human physiology and the pathogenesis of age-related diseases. Age is one of the risk factors for many diseases, and enormous interest has been devoted to aging research. As such, a human MPS aging model could provide a more predictive tool to understand the molecular and cellular mechanisms underlying human aging and age-related diseases. These models can also be used to evaluate preclinical drugs for age-related diseases and translate them into clinical settings. Here, we provide a review on the application of MPS in aging research. First, we offer an overview of the molecular, cellular, and physiological changes with age in several tissues or organs. Next, we discuss previous aging models and the current state of MPS for studying human aging and age-related conditions. Lastly, we address the limitations of current MPS and present future directions on the potential of MPS platforms for human aging research.
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Affiliation(s)
- Seungman Park
- Department of Mechanical EngineeringUniversity of Nevada, Las VegasLas VegasNevadaUSA
| | - Thomas C. Laskow
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jingchun Chen
- Nevada Institute of Personalized MedicineUniversity of Nevada, Las VegasLas VegasNevadaUSA
| | - Prasun Guha
- Nevada Institute of Personalized MedicineUniversity of Nevada, Las VegasLas VegasNevadaUSA
- School of Life SciencesUniversity of Nevada, Las VegasLas VegasNevadaUSA
| | - Buddhadeb Dawn
- Department of Internal Medicine, Kirk Kerkorian School of MedicineUniversity of Nevada, Las VegasLas VegasNevadaUSA
| | - Deok‐Ho Kim
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Center for Microphysiological SystemsJohns Hopkins UniversityBaltimoreMarylandUSA
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21
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Roy L, Pan N, Ghosh R, Hasan MN, Mondal S, Banerjee A, Das M, Sen O, Bhattacharya K, Chattopadhyay A, Pal SK. A Mutagen Acts as a Potent Reducing Agent of Glycated Hemoglobin: a Combined Ultrafast Electron Transfer and Computational Studies. Chembiochem 2024; 25:e202300721. [PMID: 38226959 DOI: 10.1002/cbic.202300721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 01/17/2024]
Abstract
Glycated hemoglobin (GHb) found in mammals undergoes irreversible damage when exposed to external redox agents, which is much more vulnerable than its normal counterpart hemoglobin (Hb). Besides the oxygen regulation throughout the body, Hb plays a vital role in balancing immunological health and the redox cycle. Photoinduced ultra-fast electron transfer phenomena actively participate in regulation of various kind of homeostasis involved in such biomacromolecules. In the present study we have shown that a well-known mutagen Ethidium Bromide (EtBr) reduces GHb in femtosecond time scale (efficiently) upon photoexcitation after efficient recognition in the biomolecule. We have performed similar experiment by colocalizing EtBr and Iron (Fe(III)) on the micellar surface as Hb mimic in order to study the excited state EtBr dynamics to rationalize the time scale obtained from EtBr in GHb and Hb. While other experimental techniques including Dynamic Light Scattering (DLS), Zeta potential, absorbance and emission spectroscopy have been employed for the confirmation of structural perturbation of GHb compared to Hb, a detailed computational studies involving molecular docking and density functional theory (DFT) have been employed for the explanation of the experimental observations.
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Affiliation(s)
- Lopamudra Roy
- Department of Applied Optics and Photonics, University of Calcutta, JD-2, Sector-III, Salt Lake, Kolkata, West Bengal, 700 106, India
| | - Nivedita Pan
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block-JD, Sector-III, Salt Lake, Kolkata, 700106
| | - Ria Ghosh
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block-JD, Sector-III, Salt Lake, Kolkata, 700106
| | - Md Nur Hasan
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block-JD, Sector-III, Salt Lake, Kolkata, 700106
| | - Susmita Mondal
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block-JD, Sector-III, Salt Lake, Kolkata, 700106
| | - Amrita Banerjee
- Department of Physics, Jadavpur University, 188, Raja S.C. Mallick Rd, Kolkata, 700032, India
| | - Monojit Das
- Department of Zoology, Vidyasagar University Rangamati, Midnapore, 721102, India
- Department of Zoology, Uluberia College, University of Calcutta, Uluberia, Howrah, 711315, India
| | - Oyshi Sen
- Department of Biochemistry and Biophysics, University of Kalyani Nadia, Kalyani, West Bengal, 741245
| | - Kallol Bhattacharya
- Department of Applied Optics and Photonics, University of Calcutta, JD-2, Sector-III, Salt Lake, Kolkata, West Bengal, 700 106, India
| | - Arpita Chattopadhyay
- Department of Basic Science and Humanities, Techno International New Town Block, DG 1/1, Action Area 1 New Town, Rajarhat, Kolkata, 700156, India
| | - Samir Kumar Pal
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Block-JD, Sector-III, Salt Lake, Kolkata, 700106
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22
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Mangalam M, Kelty-Stephen DG, Seleznov I, Popov A, Likens AD, Kiyono K, Stergiou N. Older adults and individuals with Parkinson's disease control posture along suborthogonal directions that deviate from the traditional anteroposterior and mediolateral directions. Sci Rep 2024; 14:4117. [PMID: 38374371 PMCID: PMC10876602 DOI: 10.1038/s41598-024-54583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
A rich and complex temporal structure of variability in postural sway characterizes healthy and adaptable postural control. However, neurodegenerative disorders such as Parkinson's disease, which often manifest as tremors, rigidity, and bradykinesia, disrupt this healthy variability. This study examined postural sway in young and older adults, including individuals with Parkinson's disease, under different upright standing conditions to investigate the potential connection between the temporal structure of variability in postural sway and Parkinsonism. A novel and innovative method called oriented fractal scaling component analysis was employed. This method involves decomposing the two-dimensional center of pressure (CoP) planar trajectories to pinpoint the directions associated with minimal and maximal temporal correlations in postural sway. As a result, it facilitates a comprehensive assessment of the directional characteristics within the temporal structure of sway variability. The results demonstrated that healthy young adults control posture along two orthogonal directions closely aligned with the traditional anatomical anteroposterior (AP) and mediolateral (ML) axes. In contrast, older adults and individuals with Parkinson's disease controlled posture along suborthogonal directions that significantly deviate from the AP and ML axes. These findings suggest that the altered temporal structure of sway variability is evident in individuals with Parkinson's disease and underlies postural deficits, surpassing what can be explained solely by the natural aging process.
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Affiliation(s)
- Madhur Mangalam
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA.
| | - Damian G Kelty-Stephen
- Department of Psychology, State University of New York at New Paltz, New Paltz, NY, 12561, USA
| | - Ivan Seleznov
- Graduate School of Engineering Science, Osaka University, Osaka, 560-8531, Japan
| | - Anton Popov
- Department of Electronic Engineering, Igor Sikorsky Kyiv Polytechnic Institute, Kyiv, 03056, Ukraine
- Faculty of Applied Sciences, Ukrainian Catholic University, Lviv, 79011, Ukraine
| | - Aaron D Likens
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka, 560-8531, Japan
| | - Nick Stergiou
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
- Department of Department of Physical Education, and Sport Science, Aristotle University, 570 01, Thessaloniki, Greece
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23
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Roediger DJ, Butts J, Falke C, Fiecas MB, Klimes-Dougan B, Mueller BA, Cullen KR. Optimizing the measurement of sample entropy in resting-state fMRI data. Front Neurol 2024; 15:1331365. [PMID: 38426165 PMCID: PMC10902163 DOI: 10.3389/fneur.2024.1331365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction The complexity of brain signals may hold clues to understand brain-based disorders. Sample entropy, an index that captures the predictability of a signal, is a promising tool to measure signal complexity. However, measurement of sample entropy from fMRI signals has its challenges, and numerous questions regarding preprocessing and parameter selection require research to advance the potential impact of this method. For one example, entropy may be highly sensitive to the effects of motion, yet standard approaches to addressing motion (e.g., scrubbing) may be unsuitable for entropy measurement. For another, the parameters used to calculate entropy need to be defined by the properties of data being analyzed, an issue that has frequently been ignored in fMRI research. The current work sought to rigorously address these issues and to create methods that could be used to advance this field. Methods We developed and tested a novel windowing approach to select and concatenate (ignoring connecting volumes) low-motion windows in fMRI data to reduce the impact of motion on sample entropy estimates. We created utilities (implementing autoregressive models and a grid search function) to facilitate selection of the matching length m parameter and the error tolerance r parameter. We developed an approach to apply these methods at every grayordinate of the brain, creating a whole-brain dense entropy map. These methods and tools have been integrated into a publicly available R package ("powseR"). We demonstrate these methods using data from the ABCD study. After applying the windowing procedure to allow sample entropy calculation on the lowest-motion windows from runs 1 and 2 (combined) and those from runs 3 and 4 (combined), we identified the optimal m and r parameters for these data. To confirm the impact of the windowing procedure, we compared entropy values and their relationship with motion when entropy was calculated using the full set of data vs. those calculated using the windowing procedure. We then assessed reproducibility of sample entropy calculations using the windowed procedure by calculating the intraclass correlation between the earlier and later entropy measurements at every grayordinate. Results When applying these optimized methods to the ABCD data (from the subset of individuals who had enough windows of continuous "usable" volumes), we found that the novel windowing procedure successfully mitigated the large inverse correlation between entropy values and head motion seen when using a standard approach. Furthermore, using the windowed approach, entropy values calculated early in the scan (runs 1 and 2) are largely reproducible when measured later in the scan (runs 3 and 4), although there is some regional variability in reproducibility. Discussion We developed an optimized approach to measuring sample entropy that addresses concerns about motion and that can be applied across datasets through user-identified adaptations that allow the method to be tailored to the dataset at hand. We offer preliminary results regarding reproducibility. We also include recommendations for fMRI data acquisition to optimize sample entropy measurement and considerations for the field.
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Affiliation(s)
- Donovan J. Roediger
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota (UMN), Minneapolis, MN, United States
| | - Jessica Butts
- Division of Biostatistics and Health Data Science, School of Public Health, UMN, Minneapolis, MN, United States
| | - Chloe Falke
- Division of Biostatistics and Health Data Science, School of Public Health, UMN, Minneapolis, MN, United States
| | - Mark B. Fiecas
- Division of Biostatistics and Health Data Science, School of Public Health, UMN, Minneapolis, MN, United States
| | - Bonnie Klimes-Dougan
- Psychology Department, College of Liberal Arts, UMN, Minneapolis, MN, United States
| | - Bryon A. Mueller
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota (UMN), Minneapolis, MN, United States
| | - Kathryn R. Cullen
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota (UMN), Minneapolis, MN, United States
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24
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Wada N, Abe Y, Nakazawa R, Sakamoto M, Tajika T. Relationship between coordination variability and Osgood-Schlatter disease in male junior youth soccer players -cross-sectional study using an inertial measurement unit. Clin Biomech (Bristol, Avon) 2024; 112:106182. [PMID: 38237217 DOI: 10.1016/j.clinbiomech.2024.106182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/21/2023] [Accepted: 01/11/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Osgood-Schlatter disease is a common overuse injury, and motor coordination is discussed as a risk factor; however, no reports have examined motor coordination in young soccer players with Osgood-Schlatter disease. This study aimed to investigate the difference in motor coordination between Osgood-Schlatter disease-affected and non-affected soccer players on a junior youth soccer team. METHODS This cross-sectional study investigated 35 young soccer players of 12-15 years of age, who completed a self-administered questionnaire covering general information, injury history, and athletic experience. An inertial measurement unit was attached to the participant's thoracic spine, lumbar spine, pelvis, thigh, and lower leg. The sagittal plane tilt angle of each body segment during squatting was analyzed. The continuous relative phase was calculated using the sagittal plane tilt angle. The mean absolute relative phase and continuous relative phase variabilities were calculated and compared between Osgood-Schlatter disease-affected and non-affected players. FINDINGS The sagittal plane tilt angle of each body segment during static standing and maximum flexion did not differ between the two groups. However, the Osgood-Schlatter disease group had significantly less continuous relative phase variability between the lumbar spine and pelvis (P < 0.01, Cohen's d = 0.91). The Osgood-Schlatter disease group had significantly fewer participants with other sports experience (P = 0.032, φ = 0.36). INTERPRETATION Dysfunctional lower trunk and hip muscles may be leading to Osgood-Schlatter disease. It is suggested that a variety of physical activities should be performed in the junior age group to allow players to acquire a variety of movement patterns.
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Affiliation(s)
- Naoya Wada
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514, Japan; Department of Rehabilitation, Jobu Hospital for Respiratory Diseases, Japan.
| | - Yota Abe
- Department of Rehabilitation, Asakura Sports Rehabilitation Clinic, Japan
| | - Rie Nakazawa
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514, Japan
| | - Masaaki Sakamoto
- Department of Physiotherapy, Takasaki University of Health and Welfare, Japan
| | - Tsuyoshi Tajika
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514, Japan
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25
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Sciacchitano S, Carola V, Nicolais G, Sciacchitano S, Napoli C, Mancini R, Rocco M, Coluzzi F. To Be Frail or Not to Be Frail: This Is the Question-A Critical Narrative Review of Frailty. J Clin Med 2024; 13:721. [PMID: 38337415 PMCID: PMC10856357 DOI: 10.3390/jcm13030721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new "science of frailty" has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy;
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department of Life Sciences, Health and Health Professions, Link Campus University, 00165 Rome, Italy
| | - Valeria Carola
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00189 Rome, Italy; (V.C.); (G.N.)
| | - Giampaolo Nicolais
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00189 Rome, Italy; (V.C.); (G.N.)
| | - Simona Sciacchitano
- Department of Psychiatry, La Princesa University Hospital, 28006 Madrid, Spain;
| | - Christian Napoli
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Monica Rocco
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Flaminia Coluzzi
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy
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26
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Wang G, Yang Y, Dong K, Hua A, Wang J, Liu J. Multisensory Conflict Impairs Cortico-Muscular Network Connectivity and Postural Stability: Insights from Partial Directed Coherence Analysis. Neurosci Bull 2024; 40:79-89. [PMID: 37989834 PMCID: PMC10774487 DOI: 10.1007/s12264-023-01143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/16/2023] [Indexed: 11/23/2023] Open
Abstract
Sensory conflict impacts postural control, yet its effect on cortico-muscular interaction remains underexplored. We aimed to investigate sensory conflict's influence on the cortico-muscular network and postural stability. We used a rotating platform and virtual reality to present subjects with congruent and incongruent sensory input, recorded EEG (electroencephalogram) and EMG (electromyogram) data, and constructed a directed connectivity network. The results suggest that, compared to sensory congruence, during sensory conflict: (1) connectivity among the sensorimotor, visual, and posterior parietal cortex generally decreases, (2) cortical control over the muscles is weakened, (3) feedback from muscles to the cortex is strengthened, and (4) the range of body sway increases and its complexity decreases. These results underline the intricate effects of sensory conflict on cortico-muscular networks. During the sensory conflict, the brain adaptively decreases the integration of conflicting information. Without this integrated information, cortical control over muscles may be lessened, whereas the muscle feedback may be enhanced in compensation.
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Affiliation(s)
- Guozheng Wang
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310058, China
- Taizhou Key Laboratory of Medical Devices and Advanced Materials, Research Institute of Zhejiang University-Taizhou, Taizhou, 318000, China
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, 310058, China
| | - Yi Yang
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, 310058, China
| | - Kangli Dong
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310058, China
| | - Anke Hua
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, 310058, China
| | - Jian Wang
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, 310058, China.
- Center for Psychological Science, Zhejiang University, Hangzhou, 310058, China.
| | - Jun Liu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310058, China.
- Taizhou Key Laboratory of Medical Devices and Advanced Materials, Research Institute of Zhejiang University-Taizhou, Taizhou, 318000, China.
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27
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Tang SY, Ma HP, Lin C, Lo MT, Lin LY, Chen TY, Wu CK, Chiang JY, Lee JK, Hung CS, Liu LYD, Chiu YW, Tsai CH, Lin YT, Peng CK, Lin YH. Heart rhythm complexity analysis in patients with inferior ST-elevation myocardial infarction. Sci Rep 2023; 13:20861. [PMID: 38012168 PMCID: PMC10681979 DOI: 10.1038/s41598-023-41261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 08/23/2023] [Indexed: 11/29/2023] Open
Abstract
Heart rhythm complexity (HRC), a subtype of heart rate variability (HRV), is an important tool to investigate cardiovascular disease. In this study, we aimed to analyze serial changes in HRV and HRC metrics in patients with inferior ST-elevation myocardial infarction (STEMI) within 1 year postinfarct and explore the association between HRC and postinfarct left ventricular (LV) systolic impairment. We prospectively enrolled 33 inferior STEMI patients and 74 control subjects and analyzed traditional linear HRV and HRC metrics in both groups, including detrended fluctuation analysis (DFA) and multiscale entropy (MSE). We also analyzed follow-up postinfarct echocardiography for 1 year. The STEMI group had significantly lower standard deviation of RR interval (SDNN), and DFAα2 within 7 days postinfarct (acute stage) comparing to control subjects. LF power was consistently higher in STEMI group during follow up. The MSE scale 5 was higher at acute stage comparing to control subjects and had a trend of decrease during 1-year postinfarct. The MSE area under scale 1-5 showed persistently lower than control subjects and progressively decreased during 1-year postinfarct. To predict long-term postinfarct LV systolic impairment, the slope between MSE scale 1 to 5 (slope 1-5) had the best predictive value. MSE slope 1-5 also increased the predictive ability of the linear HRV metrics in both the net reclassification index and integrated discrimination index models. In conclusion, HRC and LV contractility decreased 1 year postinfarct in inferior STEMI patients, and MSE slope 1-5 was a good predictor of postinfarct LV systolic impairment.
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Affiliation(s)
- Shu-Yu Tang
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Hsi-Pin Ma
- Department of Electrical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Chen Lin
- Department of Biomedical Sciences and Engineering, National Central University, No. 300, Zhongda Road, Taoyuan, Taiwan.
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering, National Central University, No. 300, Zhongda Road, Taoyuan, Taiwan
| | - Lian-Yu Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Yan Chen
- Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Cho-Kai Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiun-Yang Chiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Kuang Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Yu Daisy Liu
- Department of Agronomy, Biometry Division, National Taiwan University, Taipei, Taiwan
| | - Yu-Wei Chiu
- Department of Computer Science and Engineering, Yuan Ze university, Taoyuan, Taiwan
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan.
| | - Yen-Tin Lin
- Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan.
- Department of Inderal Medicine, Division of Cardiology, Taoyuan General Hospital, 1492 Zhongshan Road, Taoyuan, 33004, Taiwan.
| | - Chung-Kang Peng
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, USA
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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28
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Kalra K, Moumneh MB, Nanna MG, Damluji AA. Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease. Front Cardiovasc Med 2023; 10:1276370. [PMID: 38045910 PMCID: PMC10690830 DOI: 10.3389/fcvm.2023.1276370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks.
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Affiliation(s)
- Kriti Kalra
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
| | - Mohamad B. Moumneh
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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29
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Rantala A, Sterner A, Frank C, Heinrich E, Holmberg B. Older patients' perceptions of the Swedish ambulance service: A qualitative exploratory study. Australas Emerg Care 2023; 26:249-253. [PMID: 36764911 DOI: 10.1016/j.auec.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND As worldwide life expectancy increases, the Swedish Ambulance Service is likely to be affected by the demographic shift towards a larger proportion of older persons. An older population tends to increase the demand for ambulances, indicating a need to illuminate older patients' perspective. Thus, the aim of this study was to explore older patients' perceptions of the Swedish Ambulance Service. METHODS This interview study employed a descriptive qualitative design with a phenomenographic approach in accordance with Dahlgren and Fallsberg. RESULTS Three main descriptive categories emerged to describe the underlying conceptions in the interviews; A double-edged encounter, Trust is created by perceived competence, and Safety through accessibility in vulnerable situations. CONCLUSION Older patients described trust in ambulance clinicians as a prerequisite for feeling safe enough to share their feelings and allow a bodily examination. However, they also criticized the care provided because they questioned the need for certain actions.
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Affiliation(s)
- Andreas Rantala
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Department of Ambulance Service, Region Skåne, Helsingborg, Sweden; Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden.
| | - Anders Sterner
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Catharina Frank
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Elsa Heinrich
- Department of Ambulance Service, Region Skåne, Malmö, Sweden
| | - Bodil Holmberg
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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30
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Gerber ED, Giraldo C, Whorley B, Nichols P, Ring S, Luchies CW. Subthreshold white noise vibration alters trembling sway in older adults. Hum Mov Sci 2023; 90:103119. [PMID: 37390770 DOI: 10.1016/j.humov.2023.103119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/14/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Somatosensory deficit is a significant contributor to falls in older adults. Stochastic resonance has shown promise in recent studies of somatosensation-based balance disorders, improving many measures of stability both inside and outside of the clinic. However, our understanding of this effect from a physiological perspective is poorly understood. Therefore, the primary goal of this study is to explore the influence of subthreshold vibratory stimulation on sway under the rambling-trembling framework. METHODS 10 Healthy older adults (60-65 years) volunteered to participate in this study. Each participant underwent two randomized testing sessions on separate days, one experimental and one placebo. During each session, the participants' baseline sway was captured during one 90-s quiet standing trial. Their sensation threshold was then captured using a custom vibratory mat and 4-2-1 vibration perception threshold test. Finally, participants completed another 90-s quiet standing trial while the vibratory mat vibrated at 90% of their measured threshold (if experimental) or with the mat off (if placebo). While they completed these trials, an AMTI force plate collected force and moment data in the anteroposterior (AP) and mediolateral (ML), from which the center of pressure (COP), rambling (RM), and trembling (TR) time series were calculated. From each of these time series, range, variability (root-mean-square), and predictability (sample entropy) were extracted. One-tailed paired t-tests were used to compare baseline and during-vibration measures. RESULTS No significant differences were found during the placebo session. For the experimental session, significant increases were found in AP TR range, ML TR RMS, AP COP predictability, and AP & ML TR predictability. The TR time series was particularly sensitive to vibration, suggesting a strong influence on peripheral/spinal mechanisms of postural control. SIGNIFICANCE Though it is unclear whether observed effects are indicative of "improvements" or not, it does suggest that there was a measurable effect of subthreshold vibration on sway. This knowledge should be utilized in future studies of stochastic resonance, potentially acting as a mode of customization, tailoring vibration location, duration, magnitude, and frequency content to achieve the desired effect. One day, this work may aid in our ability to treat somatosensation-based balance deficits, ultimately reducing the incidence and severity of falls in older adults.
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Affiliation(s)
- Eryn D Gerber
- Bioengineering Graduate Program, School of Engineering, University of Kansas, Lawrence, KS, USA
| | - Camilo Giraldo
- Department of Engineering, Messiah University, Mechanicsburg, PA, USA
| | - Brett Whorley
- Bioengineering Graduate Program, School of Engineering, University of Kansas, Lawrence, KS, USA
| | - Paris Nichols
- Department of Mechanical Engineering, School of Engineering, University of Kansas, Lawrence, KS, USA
| | - Scott Ring
- Department of Mechanical Engineering, School of Engineering, University of Kansas, Lawrence, KS, USA
| | - Carl W Luchies
- Bioengineering Graduate Program, School of Engineering, University of Kansas, Lawrence, KS, USA; Department of Mechanical Engineering, School of Engineering, University of Kansas, Lawrence, KS, USA.
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Nakamura T, Kodama K, Sakazaki J, Higuchi T. Relationship between adaptability during turning and the complexity of walking before turning in older adults. J Mot Behav 2023; 55:331-340. [PMID: 37040902 DOI: 10.1080/00222895.2023.2199692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/02/2023] [Accepted: 04/02/2023] [Indexed: 04/13/2023]
Abstract
In this study, the relationship between behavioral complexity (sample entropy, SEn) during steady walking and the quickness of subsequent turning performance in older adults. Herein, healthy older and younger adults (n = 12 each) were instructed to walk straight and then turn into an intersection surrounded by four pylons. This walking task was performed under two turning conditions: reactive and pre-planned turning, where the direction of turning was unknown until immediately before turning or was informed beforehand, respectively. For older adults, behavioral complexity was comparable under both conditions, but was higher under reactive than pre-planned turning condition for younger adults. This suggests that older adults cannot adapt their walking patterns in response to turning conditions. Correlation analysis showed that older adults with lower SEn had more difficulty in turning rapidly under reactive turning condition, indicating a relationship between the two variables. Thus, deterioration of the reactive turning performance in older adults is related to stereotyped movements during steady walking.
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Affiliation(s)
- Takahito Nakamura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Kentaro Kodama
- University Education Center, Tokyo Metropolitan University, Tokyo, Japan
| | - Juntaro Sakazaki
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Takahiro Higuchi
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
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Lundstrom CJ, Biltz GR, Uithoven KE, Snyder EM. Effects of marathon training on heart rate variability during submaximal running: a comparison of analysis techniques. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-023-01062-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Jiang X, Zhou J, Yu C, Chen W, Huang B, Chen Y, Zhong L, Guo Y, Geng Q, Cai Y. The alterations in multiple neurophysiological procedures are associated with frailty phenotype in older adults. Front Aging Neurosci 2023; 15:1063322. [PMID: 37056686 PMCID: PMC10086197 DOI: 10.3389/fnagi.2023.1063322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundOlder adults oftentimes suffer from the conditions in multiple physiologic systems, interfering with their daily function and thus contributing to physical frailty. The contributions of such multisystem conditions to physical frailty have not been well characterized.MethodsIn this study, 442 (mean age = 71.4 ± 8.1 years, 235 women) participants completed the assessment of frailty syndromes, including unintentional weight loss, exhaustion, slowness, low activity, and weakness, and were categorized into frail (≥3 conditions), pre-frail (1 or 2 conditions), and robust (no condition) status. Multisystem conditions including cardiovascular diseases, vascular function, hypertension, diabetes, sleep disorders, sarcopenia, cognitive impairment, and chronic pain were assessed. Structural equation modeling examined the interrelationships between these conditions and their associations with frailty syndromes.ResultsFifty (11.3%) participants were frail, 212 (48.0%) were pre-frail, and 180 (40.7%) were robust. We observed that worse vascular function was directly associated with higher risk of slowness [standardized coefficient (SC) = −0.419, p < 0.001], weakness (SC = −0.367, p < 0.001), and exhaustion (SC = −0.347, p < 0.001). Sarcopenia was associated with both slowness (SC = 0.132, p = 0.011) and weakness (SC = 0.217, p = 0.001). Chronic pain, poor sleep quality, and cognitive impairment were associated with exhaustion (SC = 0.263, p < 0.001; SC = 0.143, p = 0.016; SC = 0.178, p = 0.004, respectively). The multinomial logistic regression showed that greater number of these conditions were associated with increased probability of being frail (odds ratio>1.23, p < 0.032).ConclusionThese findings in this pilot study provide novel insights into how multisystem conditions are associated with each other and with frailty in older adults. Future longitudinal studies are warranted to explore how the changes in these health conditions alter frailty status.
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Affiliation(s)
- Xin Jiang
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
- *Correspondence: Xin Jiang,
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Chengyuan Yu
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Wenbo Chen
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Baofeng Huang
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yurong Chen
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
| | - Lilian Zhong
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yi Guo
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
- Department of Neurology, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
- Yi Guo,
| | - Qingshan Geng
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
- Qingshan Geng,
| | - Yurun Cai
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States
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Bodkin SG, Pethick JT, Dooley EA, Russell SD, Hart JM. Torque complexity of maximal knee extensor isometric contraction in individuals following anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2023; 104:105932. [PMID: 36931165 DOI: 10.1016/j.clinbiomech.2023.105932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Current rehabilitation goals following anterior cruciate ligament reconstruction are structured around the maximal force generating capabilities of the muscle. Force fluctuations, an index of force control, have been observed to alter post- anterior cruciate ligament reconstruction. The temporal structure, or "complexity" of force fluctuations may provide important insight into the post-operative muscular recovery. The aims of this study were 1) to compare quadriceps torque complexity in anterior cruciate ligament reconstructed patients to the contralateral limb and to healthy, controls and 2) to assess the relationships between torque complexity to patient outcomes. METHODS Data from 120 anterior cruciate ligament reconstructed participants (65 Females, 21.0 ± 8.3 years, 5.96 ± 0.48-months post-surgery) and 95 healthy controls (50 Females, 21.5 ± 2.9 years) were collected. A 30-s knee extensor maximal isometric contraction was completed to calculate approximate entropy, a measure of torque complexity. FINDINGS Approximate entropy was found to decrease throughout the 30-s trial (P < .001, Cohen's d = 1.87 [1.64,2.10]). The anterior cruciate ligament reconstructed limb demonstrated greater approximate entropy compared to the contralateral limb or to healthy controls (P < .001, Cohen's d = 0.64 [0.38,0.90]). approximate entropy at the end of the trial demonstrated weak, negatively relationships with peak torque, patient reported outcome measures, and knee extensor fatigue (r = -0.21 to -0.32, P < .05). INTERPRETATION A greater torque complexity in individuals following anterior cruciate ligament reconstruction was weakly related to lower quadriceps strength, lower subjective function, and quadriceps fatigue resistance. The complexity of force fluctuations during a sustained maximal task may draw clinical insight into the recovery of motor function following anterior cruciate ligament reconstruction.
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Affiliation(s)
- S G Bodkin
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA.
| | - J T Pethick
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK
| | - E A Dooley
- Depatment of Biomedical Engineering, University of Virginia, Charlottesville, VA. USA
| | - S D Russell
- Depatment of Biomedical Engineering, University of Virginia, Charlottesville, VA. USA
| | - J M Hart
- Deparment of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Scholer AJ, Marcus R, Garland-Kledzik M, Chang SC, Khader A, Santamaria-Barria J, Jutric Z, Wolf R, Goldfarb M. Validating biologic age in selecting elderly patients with pancreatic cancer for surgical resection. J Surg Oncol 2023; 127:394-404. [PMID: 36321409 PMCID: PMC10092356 DOI: 10.1002/jso.27121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/03/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Selecting frail elderly patients with pancreatic cancer (PC) for pancreas resection using biologic age has not been elucidated. This study determined the feasibility of the deficit accumulation frailty index (DAFI) in identifying such patients and its association with surgical outcomes. METHODS The DAFI, which assesses frailty based on biologic age, was used to identify frail patients using clinical and health-related quality-of-life data. The characteristics of frail and nonfrail patients were compared. RESULTS Of 242 patients (median age, 75.5 years), 61.2% were frail and 32.6% had undergone pancreas resection (surgery group). Median overall survival (mOS) decreased in frail patients (7.13 months, 95% confidence interval [CI]: 5.65-10.1) compared with nonfrail patients (16.1 months, 95% CI: 11.47-34.40, p = 0.001). In the surgery group, mOS improved in the nonfrail patients (49.4%; 49.2 months, 95% CI: 29.3-79.9) compared with frail patients (50.6%, 22.1 months, 95% CI: 18.3-52.4, p = 0.10). In the no-surgery group, mOS was better in nonfrail patients (54%; 10.81 months, CI 7.85-16.03) compared with frail patients (66%; 5.45 months, 95% CI: 4.34-7.03, p = 0.02). CONCLUSIONS The DAFI identified elderly patients with PC at risk of poor outcomes and can identify patients who can tolerate more aggressive treatments.
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Affiliation(s)
- Anthony J Scholer
- Division of Surgical Oncology, University of South Carolina School of Medicine, Greenville, South Carolina, USA
| | - Rebecca Marcus
- Department of Surgery, Saint John's Cancer Institute at Providence St. John's Health Center, Santa Monica, California, USA
| | - Mary Garland-Kledzik
- Division of Surgical Oncology, West Virginia University, Morgantown, West Virginia, USA
| | - Shu-Chin Chang
- Department of Surgery, Medical Data Research Center, Providence Saint Joseph Health, Oregon, Portland, USA
| | - Adam Khader
- Department of Surgery, Division of Surgical Oncology, Hunter Holmes McGuire Veterans Affair Medical Center, Richmond, Virginia, USA
| | - Juan Santamaria-Barria
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Zeljka Jutric
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California Irvine Medical Center, Orange, California, USA
| | - Ronald Wolf
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California Irvine Medical Center, Orange, California, USA
| | - Melanie Goldfarb
- Department of Surgery, Saint John's Cancer Institute at Providence St. John's Health Center, Santa Monica, California, USA
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Graph approaches for analysis of brain connectivity during dexmedetomidine sedation. Neurosci Lett 2023; 797:137060. [PMID: 36626961 DOI: 10.1016/j.neulet.2023.137060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/22/2022] [Accepted: 01/05/2023] [Indexed: 01/08/2023]
Abstract
Sedation is commonly used to relieve fear and anxiety during procedures. Dexmedetomidine (DEX), approved by the US Food and Drug Administration in 1999 for short-term sedation, is a selective alpha2-adrenoreceptor agonist. The use of DEX is increasing due to minimal respiratory depression and easy and quick awakening from sedation. Its sedative mechanisms are suggested to be related to changes in the interaction between brain regions. In this study, we used graph theory to investigate whether the altered network connection is associated with sedation. Electroencephalogram (EEG) recordings of 32 channels were acquired during awake and DEX-induced sedation for 20 participants. We extracted EEG epochs from the awake and the DEX sedation state. Using the graph theory, we compared the changes in the network connection parameters with the awake state. We observed that the slopes in 1/f dynamics, which indicate overall brain network characteristics, were greater during DEX-induced sedation compared to the awake state, suggesting a transition towards a random network behavior. In addition, network connections from the perspective of information processing were significantly disturbed in the alpha frequency band, unlike other frequency bands augmenting network connections. The alpha frequency band plays a prominent role in the function and interaction of cognitive activities. These results collectively indicate that changes in the brain network critical to cognition during DEX administration may also be related to the mechanism of sedation.
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Wollner G, Weihs V, Frenzel S, Aldrian S, Negrin LL. Musculus psoas major morphology - a novel predictor of mortality in elderly polytraumatized patients. BMC Emerg Med 2023; 23:13. [PMID: 36750772 PMCID: PMC9903455 DOI: 10.1186/s12873-023-00783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Numerous papers in different fields have already shown that CT imaging of the Musculus Psoas Major (MPM) can be used to predict patient outcome. Unfortunately, most of the methods presented in the literature are very complex and not easy to perform in the clinic. Therefore, the objectives of the study were to introduce a novel and convenient method for measuring the MPM to trauma surgeons and to prove the association between MPM morphology and mortality in elderly polytraumatized patients. MATERIAL AND METHODS The retrospective outcome study was conducted at our level I trauma center. All patients admitted from 2006 to 2020 were included if they (1) presented with multiple injuries (≥2 body regions) and an Injury Severity Score (ISS) ≥16, (2) were at least 65 years of age, and (3) were diagnosed using a whole-body computed tomography. Subsequently, the ratios of short-axis to long-axis of both MPM were measured, and their mean value was evaluated as a candidate predictor of 31-day mortality. RESULTS Our study group consisted of 158 patients (63.3% male; median age, 76 years; median ISS, 25). In the survivors (55.7%), the mean MPM score was significantly higher compared to the fatalities (0.57 versus 0.48; p < 0.0001). Multivariate binary logistic regression analysis identified the MPM score as a protective predictor of 31 day-mortality (OR = 0.92, p < 0.001), whereas age (OR 1.08, p = 0.002 and ISS (OR 1.06, p = 0.006) revealed as significant risk factors for mortality. ROC statistics provided an AUC = 0.724 (p < 0.0001) and a cut-off level of 0,48 (sensitivity, 80.7%; specificity, 54.3%). CONCLUSION The present study demonstrated that MPM score levels lower than 0.48 might be considered an additional tool to identify elderly patients at high risk of death following major trauma. In our opinion, the assessment of the MPM score is an easy, convenient, and intuitive method to gain additional information quickly after admission to the hospital that could be implemented without great effort into daily clinical practice.
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Affiliation(s)
- Gregor Wollner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
| | - Valerie Weihs
- grid.22937.3d0000 0000 9259 8492Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephan Frenzel
- grid.22937.3d0000 0000 9259 8492Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Silke Aldrian
- grid.22937.3d0000 0000 9259 8492Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Lukas Leopold Negrin
- grid.22937.3d0000 0000 9259 8492Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
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Zhou J, Manor B, McCarten JR, Wade MG, Jor’dan AJ. The effects of cognitive impairment on the multi-scale dynamics of standing postural control during visual-search in older men. Front Aging Neurosci 2023; 15:1068316. [PMID: 36761178 PMCID: PMC9905142 DOI: 10.3389/fnagi.2023.1068316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
Background Cognitive impairment disrupts postural control, particularly when standing while performing an unrelated cognitive task (i.e., dual-tasking). The temporal dynamics of standing postural sway are "complex," and such complexity may reflect the capacity of the postural control system to adapt to task demands. We aimed to characterize the impact of cognitive impairment on such sway complexity in older adults. Methods Forty-nine older adult males (Alzheimer's disease (AD): n = 21; mild cognitive impairment (MCI): n = 13; cognitively-intact: n = 15) completed two 60-s standing trials in each of single-task and visual-search dual-task conditions. In the dual-task condition, participants were instructed to count the frequency of a designated letter in a block of letters projected on screen. The sway complexity of center-of-pressure fluctuations in anterior-posterior (AP) and medial-lateral (ML) direction was quantified using multiscale entropy. The dual-task cost to complexity was obtained by calculating the percent change of complexity from single- to dual-task condition. Results Repeated-measures ANOVAs revealed significant main effects of group (F > 4.8, p < 0.01) and condition (F = 7.7, p < 0.007) on both AP and ML sway complexity; and significant interaction between group and condition for ML sway complexity (F = 3.7, p = 0.03). The AD group had the lowest dual-task ML complexity, as well as greater dual-task cost to ML (p = 0.03) compared to the other two groups. Visual-search task accuracy was correlated with ML sway complexity in the dual-task condition (r = 0.42, p = 0.007), and the dual-task cost to ML sway complexity (r = 0.39, p = 0.01) across all participants. Conclusion AD-related cognitive impairment was associated with a greater relative reduction in postural sway complexity from single- to dual-tasking. Sway complexity appears to be sensitive to the impact of cognitive impairment on standing postural control.
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Affiliation(s)
- Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States,*Correspondence: Junhong Zhou,
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - John Riley McCarten
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Health Care System, Minneapolis, MN, United States,School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Michael G. Wade
- School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
| | - Azizah J. Jor’dan
- Department of Exercise and Health Sciences, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
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Abbas M, Le Bouquin Jeannès R. A review of frailty analysis in older adults: from clinical tools towards fully automated preventive systems. Ing Rech Biomed 2022. [DOI: 10.1016/j.irbm.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Peña M, Petrillo K, Bosset M, Fain M, Chou YH, Rapcsak S, Toosizadeh N. Brain function complexity during dual-tasking is associated with cognitive impairment and age. J Neuroimaging 2022; 32:1211-1223. [PMID: 35843726 PMCID: PMC9649845 DOI: 10.1111/jon.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Early diagnosis of cognitive impairment is important because symptoms can be delayed through therapies. Synaptic disconnections are the key characteristics of dementia, and through nonlinear complexity analysis of brain function, it is possible to identify long-range synaptic disconnections in the brain. METHODS We investigated the capability of a novel upper-extremity function (UEF) dual-task paradigm in the functional MRI (fMRI) setting, where the participant flexes and extends their arm while counting, to differentiate between cognitively normal (CN) and those with mild cognitive impairment (MCI). We used multiscale entropy (MSE) complexity analysis of the blood oxygen-level dependent time-series across neural networks and brain regions. Outside of the fMRI, we used the UEF dual-task test, while the elbow kinematics were measured using motion sensors, to record the motor function score. RESULTS Results showed 34% lower MSE values in MCI compared to CN (p<.04 for all regions and networks except cerebellum when counting down by one; effect size = 1.35±0.15) and a negative correlation between MSE values and age (average r2 of 0.30 for counting down by one and 0.36 for counting backward by three). Results also showed an improvement in the logistic regression model sensitivity by 14-24% in predicting the presence of MCI when brain function measure was added to the motor function score (kinematics data). CONCLUSIONS Current findings suggest that combining measures of neural network and motor function, in addition to neuropsychological testing, may provide an accurate tool for assessing early-stage cognitive impairment and age-related decline in cognition.
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Affiliation(s)
- Miguel Peña
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ
| | - Kelsi Petrillo
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ
| | - Mark Bosset
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ
| | - Mindy Fain
- Arizona Center on Aging, Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ
- Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ
| | - Ying-hui Chou
- Department of Psychology, University of Arizona, Tucson, AZ
- Arizona Center on Aging, Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ
| | - Steve Rapcsak
- Department of Neurology, University of Arizona, Tucson, AZ
- Banner Alzheimer’s Institute, Tucson, AZ
| | - Nima Toosizadeh
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ
- Arizona Center on Aging, Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ
- Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ
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Kafantaris E, Lo TYM, Escudero J. Stratified Multivariate Multiscale Dispersion Entropy for Physiological Signal Analysis. IEEE Trans Biomed Eng 2022; 70:1024-1035. [PMID: 36121948 DOI: 10.1109/tbme.2022.3207582] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Multivariate entropy quantification algorithms are becoming a prominent tool for the extraction of information from multi-channel physiological time-series. However, in the analysis of physiological signals from heterogeneous organ systems, certain channels may overshadow the patterns of others, resulting in information loss. Here, we introduce the framework of Stratified Entropy to prioritize each channels' dynamics based on their allocation to respective strata, leading to a richer description of the multi-channel time-series. As an implementation of the framework, three algorithmic variations of the Stratified Multivariate Multiscale Dispersion Entropy are introduced. These variations and the original algorithm are applied to synthetic time-series, waveform physiological time-series, and derivative physiological data. Based on the synthetic time-series experiments, the variations successfully prioritize channels following their strata allocation while maintaining the low computation time of the original algorithm. In experiments on waveform physiological time-series and derivative physiological data, increased discrimination capacity was noted for multiple strata allocations in the variations when benchmarked to the original algorithm. This suggests improved physiological state monitoring by the variations. Furthermore, our variations can be modified to utilize a priori knowledge for the stratification of channels. Thus, our research provides a novel approach for the extraction of previously inaccessible information from multi-channel time series acquired from heterogeneous systems.
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Affiliation(s)
- Evangelos Kafantaris
- School of Engineering, Institute for Digital Communications, University of Edinburgh, Edinburgh, U.K
| | - Tsz-Yan Milly Lo
- Centre of Medical Informatics, Usher Institute, University of Edinburgh, U.K
| | - Javier Escudero
- School of Engineering, Institute for Digital Communications, University of Edinburgh, U.K
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Nóbrega LR, Cabral AM, Oliveira FHM, de Oliveira Andrade A, Krishnan S, Pereira AA. Wrist Movement Variability Assessment in Individuals with Parkinson's Disease. Healthcare (Basel) 2022; 10:healthcare10091656. [PMID: 36141268 PMCID: PMC9498573 DOI: 10.3390/healthcare10091656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Parkinson’s disease (PD) is a neurodegenerative disorder represented by the progressive loss of dopamine-producing neurons, it decreases the individual’s motor functions and affects the execution of movements. There is a real need to include quantitative techniques and reliable methods to assess the evolution of PD. (2) Methods: This cross-sectional study assessed the variability of wrist RUD (radial and ulnar deviation) and FE (flexion and extension) movements measured by two pairs of capacitive sensors (PS25454 EPIC). The hypothesis was that PD patients have less variability in wrist movement execution than healthy individuals. The data was collected from 29 participants (age: 62.13 ± 9.7) with PD and 29 healthy individuals (60.70 ± 8). Subjects performed the experimental tasks at normal and fast speeds. Six features that captured the amplitude of the hand movements around two axes were estimated from the collected signals. (3) Results: The movement variability was greater for healthy individuals than for PD patients (p < 0.05). (4) Conclusion: The low variability seen in the PD group may indicate they execute wrist RUD and FE in a more restricted way. The variability analysis proposed here could be used as an indicator of patient progress in therapeutic programs and required changes in medication dosage.
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Affiliation(s)
- Lígia Reis Nóbrega
- Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, MG, Brazil
| | - Ariana Moura Cabral
- Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, MG, Brazil
| | | | | | - Sridhar Krishnan
- Electrical and Computer Engineering, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Adriano Alves Pereira
- Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, MG, Brazil
- Correspondence: ; Tel.: +55-34-3239-4711
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Padhye N, Rios D, Fay V, Hanneman SK. Pressure Injury Link to Entropy of Abdominal Temperature. ENTROPY (BASEL, SWITZERLAND) 2022; 24:1127. [PMID: 36010790 PMCID: PMC9407490 DOI: 10.3390/e24081127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
This study examined the association between pressure injuries and complexity of abdominal temperature measured in residents of a nursing facility. The temperature served as a proxy measure for skin thermoregulation. Refined multiscale sample entropy and bubble entropy were used to measure the irregularity of the temperature time series measured over two days at 1-min intervals. Robust summary measures were derived for the multiscale entropies and used in predictive models for pressure injuries that were built with adaptive lasso regression and neural networks. Both types of entropies were lower in the group of participants with pressure injuries (n=11) relative to the group of non-injured participants (n=15). This was generally true at the longer temporal scales, with the effect peaking at scale τ=22 min for sample entropy and τ=23 min for bubble entropy. Predictive models for pressure injury on the basis of refined multiscale sample entropy and bubble entropy yielded 96% accuracy, outperforming predictions based on any single measure of entropy. Combining entropy measures with a widely used risk assessment score led to the best prediction accuracy. Complexity of the abdominal temperature series could therefore serve as an indicator of risk of pressure injury.
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Nguyen AT, Nguyen HTT, Nguyen HTT, Nguyen TX, Nguyen TN, Nguyen TTH, Nguyen AL, Pham T, Vu HTT. Walking Speed Assessed by 4-Meter Walk Test in the Community-Dwelling Oldest Old Population in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169788. [PMID: 36011423 PMCID: PMC9407834 DOI: 10.3390/ijerph19169788] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 05/25/2023]
Abstract
This study aims to provide data on usual walking speed in individuals aged 80 years or older and determine the association between walking speed and related factors in community-dwelling older adults. A cross-sectional study design was conducted to measure walking speed on community-dwelling elders aged 80 years or older in Soc Son district, Vietnam. Walking speed was assessed by a 4-Meter Walk Test with a usual-pace walking mode. Health-related characteristics of participants including risk of falls (The Timed Up and Go test, activities of daily living (ADL), instrumental activities of daily living (IADLs), cognitive impairment (Mini-Cog test) and frailty syndrome (The Reported Edmonton Frail Scale (REFS)). Multiple logistic regression was used to analyze the association between a slow walking speed and selected factors. A total of 364 older people were recruited, and the majority were female (65.4%). The overall average walking speed was 0.83 ± 0.27 m/s. The proportion of participants with a slow walking speed (<0.8 m/s) was 40.4%. Multiple logistic regression analyses showed that age, female, high fall risk (assessed by TUG test), ADL/IADL dependence and frailty syndrome had a negative effect on slow walking speed in this population. The results could provide useful reference data for further investigations and measures in clinical practice.
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Affiliation(s)
- Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huong Thi Thanh Nguyen
- Dinh Tien Hoang Institute of Medicine, Hanoi 100000, Vietnam
- Physiology Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
- Dinh Tien Hoang Institute of Medicine, Hanoi 100000, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Anh Lan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Thang Pham
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi 100000, Vietnam
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Berry NT, Rhea CK, Wideman L. Cardio-Hypothalamic-Pituitary Coupling during Rest and in Response to Exercise. ENTROPY 2022; 24:e24081045. [PMID: 36010709 PMCID: PMC9407513 DOI: 10.3390/e24081045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 12/10/2022]
Abstract
The objective of this study was to examine cardio hypothalamic-pituitary coupling and to better understand how the temporal relations between these systems are altered during rest and exercise conditions. An intensive within subjects study design was used. Seven adult males completed two visits, each consisting of either a 24 h period of complete rest or a 24 h period containing a high-intensity exercise bout. An intravenous catheter was used to collect serum samples every 10 min throughout the 24 h period (i.e., 145 samples/person/condition) to assess growth hormone (GH) dynamics throughout the 24 h period. Cardiac dynamics were also collected throughout the 24 h period and epoched into 3 min windows every 10 min, providing serial short-time measurements of heart rate variability (HRV) concurrent to the GH sampling. The standard deviation of the normal RR interval (SDNN), the root mean square of successive differences (rMSSD), and sample entropy (SampEn) was calculated for each epoch and used to create new profiles. The dynamics of these profiles were individually quantified using SampEn and recurrence quantification analysis (RQA). To address our central question, the coupling between these profiles with GH was assessed using cross-SampEn and cross-RQA (cRQA). A comparison between the epoched HRV profiles indicated a main effect between profiles for sample entropy (p < 0.001) and several measures from RQA. An interaction between profile and condition was observed for cross-SampEn (p = 0.04) and several measures from cRQA. These findings highlight the potential application of epoched HRV to assess changes in cardiac dynamics, with specific applications to assessing cardio hypothalamic-pituitary coupling.
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Álvarez-Millán L, Lerma C, Castillo-Castillo D, Quispe-Siccha RM, Pérez-Pacheco A, Rivera-Sánchez J, Fossion R. Chronotropic Response and Heart Rate Variability before and after a 160 m Walking Test in Young, Middle-Aged, Frail, and Non-Frail Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148413. [PMID: 35886265 PMCID: PMC9320251 DOI: 10.3390/ijerph19148413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
The frailty syndrome is characterized by a decreased capacity to adequately respond to stressors. One of the most impaired physiological systems is the autonomous nervous system, which can be assessed through heart rate (HR) variability (HRV) analysis. In this article, we studied the chronotropic response (HR and HRV) to a walking test. We also analyzed HRV indices in rest as potential biomarkers of frailty. For this, a 160 m-walking test and two standing rest tests (before and after the walking) were performed by young (19−29 years old, n = 21, 57% women), middle-aged (30−59 years old, n = 16, 62% women), and frail older adults (>60 years old, n = 28, 40% women) and non-frail older adults (>60 years old, n = 15, 71% women), classified with the FRAIL scale and the Clinical Frailty Scale (CFS). Frequency domain parameters better allowed to distinguish between frail and non-frail older adults (low-frequency power LF, high-frequency power HF (nu), LF/HF ratio, and ECG-derived respiration rate EDR). Frail older adults showed an increased HF (nu) and EDR and a reduced LF (nu) and LF/HF compared to non-frail older adults. The increase in HF (nu) could be due to a higher breathing effort. Our results showed that a walk of 160 m is a sufficient cardiovascular stressor to exhibit an attenuated autonomic response in frail older adults. Several HRV indices showed to be potential biomarkers of frailty, being LF (nu) and the time required to reach the maximum HR the best candidates.
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Affiliation(s)
- Lesli Álvarez-Millán
- Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico;
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
| | - Claudia Lerma
- Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Daniel Castillo-Castillo
- Servicio de Geriatría, Hospital General de México Dr. Eduardo Liceaga, Mexico City 06720, Mexico;
| | - Rosa M. Quispe-Siccha
- Unidad de Investigación y Desarrollo Tecnológico, Hospital General de México Dr. Eduardo Liceaga, Mexico City 06720, Mexico; (R.M.Q.-S.); (A.P.-P.); (J.R.-S.)
| | - Argelia Pérez-Pacheco
- Unidad de Investigación y Desarrollo Tecnológico, Hospital General de México Dr. Eduardo Liceaga, Mexico City 06720, Mexico; (R.M.Q.-S.); (A.P.-P.); (J.R.-S.)
| | - Jesús Rivera-Sánchez
- Unidad de Investigación y Desarrollo Tecnológico, Hospital General de México Dr. Eduardo Liceaga, Mexico City 06720, Mexico; (R.M.Q.-S.); (A.P.-P.); (J.R.-S.)
| | - Ruben Fossion
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
- Correspondence: ; Tel.: +52-55-5622-4672 (ext. 5104)
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Cohen AA, Ferrucci L, Fülöp T, Gravel D, Hao N, Kriete A, Levine ME, Lipsitz LA, Olde Rikkert MGM, Rutenberg A, Stroustrup N, Varadhan R. A complex systems approach to aging biology. NATURE AGING 2022; 2:580-591. [PMID: 37117782 DOI: 10.1038/s43587-022-00252-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/08/2022] [Indexed: 04/30/2023]
Abstract
Having made substantial progress understanding molecules, cells, genes and pathways, aging biology research is now moving toward integration of these parts, attempting to understand how their joint dynamics may contribute to aging. Such a shift of perspective requires the adoption of a formal complex systems framework, a transition being facilitated by large-scale data collection and new analytical tools. Here, we provide a theoretical framework to orient researchers around key concepts for this transition, notably emergence, interaction networks and resilience. Drawing on evolutionary theory, network theory and principles of homeostasis, we propose that organismal function is accomplished by the integration of regulatory mechanisms at multiple hierarchical scales, and that the disruption of this ensemble causes the phenotypic and functional manifestations of aging. We present key examples at scales ranging from sub-organismal biology to clinical geriatrics, outlining how this approach can potentially enrich our understanding of aging.
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Affiliation(s)
- Alan A Cohen
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada.
- Research Center on Aging and Research Center of Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
- Butler Columbia Aging Center and Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Luigi Ferrucci
- Intramural Research Program of the National Institute on Aging, Baltimore, MD, USA
| | - Tamàs Fülöp
- Research Center on Aging and Research Center of Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Geriatric Division, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Dominique Gravel
- Department of Biology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nan Hao
- Section of Molecular Biology, Division of Biological Sciences, University of California, San Diego, San Diego, CA, USA
| | - Andres Kriete
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Morgan E Levine
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Lewis A Lipsitz
- Beth Israel Deaconess Medical Center, Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, and Harvard Medical School, Boston, MA, USA
| | | | - Andrew Rutenberg
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nicholas Stroustrup
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Ravi Varadhan
- Department of Oncology, Quantitative Sciences Division, Johns Hopkins University, Baltimore, MD, USA
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RANTALAINEN TIMO, KOIVUNEN KAISA, PORTEGIJS ERJA, RANTANEN TAINA, PALMBERG LOTTA, KARAVIRTA LAURA, CHASTIN SEBASTIEN. Is Complexity of Daily Activity Associated with Physical Function and Life-Space Mobility among Older Adults? Med Sci Sports Exerc 2022; 54:1210-1217. [PMID: 35220366 PMCID: PMC9208811 DOI: 10.1249/mss.0000000000002883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Information about mobility and physical function may be encoded in the complexity of daily activity pattern. Therefore, daily activity pattern complexity metrics could provide novel insight into the relationship between daily activity behavior and health. The purpose of the present study was to examine the association between the complexity of daily activity behavior and the mobility and physical function among community-dwelling older adults 75, 80, and 85 yr of age. METHODS A total of 309 participants wore accelerometers concurrently on the thigh and the trunk for at least three consecutive days. Five activity states (lying, sitting, standing, walking, or activity other than walking) were defined in three different temporal grains (5 s, 1 min, and 5 min), and Lempel-Ziv complexity was evaluated. We assessed complexity of daily activity behavior using the life-space mobility and physical function with distance in preferred pace 6-min walk and the Short Physical Performance Battery. RESULTS Weak positive associations were observed between the complexity of daily activity and the mobility and physical function at the finest temporal grains in both sexes (Spearman rho = 0.19 to 0.27, P < 0.05). No significant associations were observed in the coarsest temporal grain in either sex. CONCLUSIONS Lempel-Ziv estimates of daily activity complexity with a fine temporal grain seem to be associated with community-dwelling older adults' physical function. The coarsest 5-min temporal grain may have smoothed out physiologically meaningful short activity bouts. Because complexity encodes information related to timing, intensity, and patterning of behavior, complexity of activity could be an informative indicator of future physical function and mobility.
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Affiliation(s)
- TIMO RANTALAINEN
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - KAISA KOIVUNEN
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - ERJA PORTEGIJS
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, THE NETHERLANDS
| | - TAINA RANTANEN
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - LOTTA PALMBERG
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - LAURA KARAVIRTA
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, FINLAND
| | - SEBASTIEN CHASTIN
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
- Department of movement and sport sciences, Ghent University, Ghent, BELGIUM
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Soangra R, Jiang P, Haik D, Xu P, Brevik A, Peta A, Tapiero S, Landman J, John EB, Clayman R. Beyond Efficiency: Surface Electromyography Enables Further Insights into the Surgical Movements of Urologists. J Endourol 2022; 36:1355-1361. [PMID: 35726396 DOI: 10.1089/end.2022.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Surgical skill evaluation while performing minimally invasive surgeries is a highly complex task. It is important to objectively assess an individual's technical skills throughout surgical training to monitor progress and to intervene when skills are not commensurate with the year of training. The miniaturization of wireless wearable platforms integrated with sensor technology has made it possible to non-invasively assess muscle activations and movement variability during performance of minimally invasive surgical tasks. Our objective was to use electromyography to deconstruct the motions of a surgeon during robotic suturing and distinguish quantifiable movements that characterize the skill of an experienced, expert urologic surgeon from trainees. METHODS Three skill groups of participants: novice (n=11), intermediate (n=12) and expert (n=3) were enrolled in the study. A total of 12 wireless wearable sensors consisting of surface electromyograms (EMGs) and accelerometers were placed along upper extremity muscles to assess muscle activations and movement variability, respectively. Participants then performed a robotic suturing task. RESULTS EMG-based parameters: total time, dominant frequency, cumulative muscular workload (CMW were significantly different across the three skill groups. We also found nonlinear movement variability parameters such as correlation dimension, Lyapunov exponent trended differently across the three skill groups. CONCLUSIONS These findings suggest that economy of motion variables and nonlinear movement variabilities are affected by surgical experience level. Wearable sensor signal analysis could make it possible to objectively evaluate surgical skill level periodically throughout the residency training experience.
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Affiliation(s)
- Rahul Soangra
- Chapman University System, 240092, Orange, California, United States;
| | - Pengbo Jiang
- University of California Irvine, 8788, Urology, Irvine, California, United States;
| | - Daniel Haik
- University of California Irvine, 8788, Irvine, California, United States;
| | - Perry Xu
- University of California Irvine, 8788, 3800 Chapman Avenue - Suite 7200, Irvine, California, United States, 92697;
| | - Andrew Brevik
- University of California Irvine, 8788, Urology, 333 City Blvd West, Orange, California, United States, 92868.,Kansas City University of Medicine and Biosciences, 32959, Kansas City, Missouri, United States, 64106-1453;
| | - Akhil Peta
- University of California Irvine, 8788, Urology, 333 City Blvd, Suite 2170, Orange, California, United States, 92868;
| | - Shlomi Tapiero
- University of California Irvine, 8788, Urology, 333 City Blvd W, Suite 2100, Irvine, California, United States, 92697;
| | - Jaime Landman
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | | | - Ralph Clayman
- University of California Irvine, 8788, Urology, Orange, California, United States;
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50
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Pedroli E, Mancuso V, Stramba-Badiale C, Cipresso P, Tuena C, Greci L, Goulene K, Stramba-Badiale M, Riva G, Gaggioli A. Brain M-App’s Structure and Usability: A New Application for Cognitive Rehabilitation at Home. Front Hum Neurosci 2022; 16:898633. [PMID: 35782042 PMCID: PMC9248351 DOI: 10.3389/fnhum.2022.898633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Cognitive frailty is defined as a clinical condition characterized by both physical frailty and cognitive impairment, without reaching the criteria for dementia. The major goal of rehabilitation intervention is to assist patients in performing ordinary personal duties without the assistance of another person, or at the very least to remove the need for additional support, using adaptive approaches and facilities. In this regard, home-based rehabilitation allows patients to continue an intervention begun in a hospital setting while also ensuring support and assistance when access to healthcare systems is limited, such as during the present pandemic situation. We thus present Brain m-App, a tablet-based application designed for home-based cognitive rehabilitation of frail subjects, addressing spatial memory, attention, and executive functions. This app exploits the potential of 360° videos which are well-suited to home-based rehabilitation. The Brain m-app is made up of 10 days of activities that include a variety of exercises. The activities were chosen based on those patients used to do during their clinical practice in the hospital with the aim to improve their independence and autonomy in daily tasks. The preliminary usability test, which was conducted on five older people, revealed a sufficient level of usability, however, the sample size was modest. Results from the clinical study with 10 patients, revealed that Brain m-App improved especially executive functions and memory performances.
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Affiliation(s)
- Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy
- Faculty of Psychology, eCampus University, Novedrate, Italy
| | - Valentina Mancuso
- Faculty of Psychology, eCampus University, Novedrate, Italy
- *Correspondence: Valentina Mancuso,
| | - Chiara Stramba-Badiale
- Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
| | - Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Universitá Cattolica del Sacro Cuore, Milan, Italy
| | - Luca Greci
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing – National Research Council, Milan, Italy
| | - Karine Goulene
- Department of Geriatrics and Cardiovascular Medicine, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy
| | - Marco Stramba-Badiale
- Department of Geriatrics and Cardiovascular Medicine, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy
- Humane Technology Lab, Universitá Cattolica del Sacro Cuore, Milan, Italy
| | - Andrea Gaggioli
- Applied Technology for Neuro-Psychology Lab, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Universitá Cattolica del Sacro Cuore, Milan, Italy
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