Imaging and Modeling C2 Radical Emissions from Microwave Plasma-Activated Methane/Hydrogen Gas Mixtures: Contributions from Chemiluminescent Reactions and Investigations of Higher-Pressure Effects and Plasma Constriction.

Wavelength and spatially resolved imaging and 2D plasma chemical modeling methods have been used to study the emission from electronically excited C2 radicals in microwave-activated dilute methane/hydrogen gas mixtures under processing conditions relevant to the chemical vapor deposition (CVD) of diamond. Obvious differences in the spatial distributions of the much-studied C2(d3Πg-a3Πu) Swan band emission and the little-studied, higher-energy C2(C1Πg-A1Πu) emission are rationalized by invoking a chemiluminescent (CL) reactive source, most probably involving collisions between H atoms and C2H radicals, that acts in tandem with the widely recognized electron impact excitation source term. The CL source is relatively much more important for forming C2(d) state radicals and is deduced to account for >40% of C2(d) production in the hot plasma core under base operating conditions, which should encourage caution when estimating electron or gas temperatures from C2 Swan band emission measurements. Studies at higher pressures (p ≈ 400 Torr) offer new insights into the plasma constriction that hampers efforts to achieve higher diamond CVD rates by using higher processing pressures. Plasma constriction is proposed as being inevitable in regions where the local electron density (ne) exceeds some critical value (nec) and electron-electron collisions enhance the rates of H2 dissociation, H-atom excitation, and related associative ionization processes relative to those prevailing in the neighboring nonconstricted plasma region. The 2D modeling identifies a further challenge to high-p operation. The radial uniformities of the CH3 radical and H-atom concentrations above the growing diamond surface both decline with increasing p, which are likely to manifest as less spatially uniform diamond growth (in terms of both rate and quality).

Injection Technique: Development of a Novel Questionnaire and User Guide.

OBJECTIVE: Approximately 200 million people worldwide use injectable therapies as part of diabetes management. There appears to be a significant gap between insulin injection technique recommendations and injection practice for many. We aimed to develop and validate a novel, brief, self-administered injection technique assessment questionnaire. RESEARCH DESIGN AND METHODS: An iterative codesign process was conducted. Focus groups and interviews with adults (or parents of children) with type 1 or type 2 diabetes and health care providers (HCPs) elicited views and refined the tool for broader distribution to the target audience. Questions addressed ease of understanding; relevance; included items and potential missing questions; feelings about diabetes; and any discomfort or judgment felt when completing the tool. A user guide was developed with cognitive interviewing performed to ensure relevance, acceptability, readability, and understanding. Statistical analyses included propensity score matching to identify a subset of the Worldwide Injection Technique Questionnaire with similar characteristics. Boruta feature selection, Cramér's V, and multiple correspondence analysis were conducted. RESULTS: HCPs and 16 people with diabetes participated in the initial focus groups and interviews. Questions were reported as clinically relevant, simple to complete, "about the right length," relevant, and easy to understand. A total of 267 participants completed the survey reviewing the questionnaire. A further 16 participants underwent cognitive interviews. The complete resource was then reviewed by another 23 people with diabetes as a final check for completeness and usability. Statistical analyses demonstrated high validity and reliability. CONCLUSION: This novel resource is clinically relevant, acceptable, and easy to use as both a clinical tool and a self-assessment tool for people using injectable therapies for diabetes.

Optical Emission Imaging and Modeling Investigations of Microwave-Activated SiH4/H2 and SiH4/CH4/H2 Plasmas.

Silicon is a known trace contaminant in diamond grown by chemical vapor deposition (CVD) methods. Deliberately Si-doped diamond is currently attracting great interest because of the attractive optical properties of the negatively charged silicon-vacancy (SiV-) defect. This work reports in-depth studies of microwave-activated H2 plasmas containing trace (10-100 ppm) amounts of SiH4, with and without a few % of CH4, operating at pressures and powers relevant for contemporary diamond CVD, using a combination of experiment (spatially resolved optical emission (OE) imaging) and two-dimensional plasma chemical modeling. Key features identified from analysis and modeling of the OE from electronically excited H, H2, Si, and SiH species in the dilute Si/H plasmas include the following: (i) fast H-shifting reactions ensure that Si atoms are the most abundant silicon-containing species throughout the entire reactor volume, (ii) the low ionization potentials of all SiHx (x ≤ 4) species and efficient ion conversion reactions ensure that even trace SiH4 additions cause a change in the dominant ions in the plasma volume (from H3+ to SiHx+), with consequences for electron-ion recombination rates and ambipolar diffusion coefficients, and (iii) the total silicon content in the reactor volume can be substantially perturbed by silicon deposition and H atom etching reactions at the reactor walls. The effects of adding trace amounts of SiH4 to a pre-existing C/H plasma are shown to be much less dramatic but include the following: (i) a Si substrate or fused silica components within the reactor are a ready (unintended) source of gas-phase Si-containing species, (ii) OE from electronically excited Si atoms should provide a reliable measure of the Si content in the hot plasma region, and (iii) Si atoms and/or SiC2 species are the most abundant gas-phase Si-containing species just above the growing diamond surface and thus the most likely carriers of the silicon incorporated into CVD diamond.

Combined Spatially Resolved Optical Emission Imaging and Modeling Studies of Microwave-Activated H2/Ar and H2/Kr Plasmas Operating at Powers and Pressures Relevant for Diamond Chemical Vapor Deposition.

Microwave (MW) activated H2/Ar (and H2/Kr) plasmas operating under powers and pressures relevant to diamond chemical vapor deposition have been investigated experimentally and by 2-D modeling. The experiments return spatially and wavelength resolved optical emission spectra of electronically excited H2 molecules and H and Ar(/Kr) atoms for a range of H2/noble gas mixing ratios. The self-consistent 2-D( r, z) modeling of different H2/Ar gas mixtures includes calculations of the MW electromagnetic fields, the plasma chemistry and electron kinetics, heat and species transfer and gas-surface interactions. Comparison with the trends revealed by the spatially resolved optical emission measurements and their variations with changes in process conditions help guide identification and refinement of the dominant plasma (and plasma emission) generation mechanisms and the more important Ar-H, Ar-H2, and H-H2 coupling reactions. Noble gas addition is shown to encourage radial expansion of the plasma, and thus to improve the uniformity of the H atom concentration and the gas temperature just above the substrate. Noble gas addition in the current experiments is also found to enhance (unwanted) sputtering of the copper base plate of the reactor; the experimentally observed increase in gas phase Cu* emission is shown to correlate with the near substrate ArH+ (and KrH+) ion concentrations returned by the modeling, rather than with the relatively more abundant H3+ (and H3O+) ions.

Imaging and Modeling the Optical Emission from CH Radicals in Microwave Activated C/H Plasmas.

We report a combined experimental/modeling study of optical emission from the A2Δ, B2Σ-, and C2Σ+ states of the CH radical in microwave (MW) activated CH4/H2 gas mixtures operating under a range of conditions relevant to the chemical vapor deposition of diamond. The experiment involves spatially and wavelength resolved imaging of the CH(C → X), CH(B → X), and CH(A → X) emissions at different total pressures, MW powers, C/H ratios in the source gas, and substrate diameters. The results are interpreted by extending an existing 2D (r, z) plasma model to include not just electron impact excitation but also chemiluminescent (CL) bimolecular reactions as sources of the observed CH emissions. Three possible CL reactions (of H atoms with CH2(a1A1) and CH2(X3B1) radicals and of C(1D) atoms with H2) are identified as plausible sources of electronically excited CH radicals (particularly of the lowest energy CH(A) state radicals). Each or all of these could contribute to the observed emissions and, collectively, are deduced to be the major source of the CH(A) emissions observed at the high temperatures (Tgas ∼ 3000 K) and pressures (75 ≤ p ≤ 275 Torr) explored in the present study. We suggest that such CL contributions are likely to be commonplace in such high pressure, high temperature plasma environments and highlight some of the risks associated with using relative emission intensities as an indicator of the electron characteristics in such plasmas.

Spatially Resolved Optical Emission and Modeling Studies of Microwave-Activated Hydrogen Plasmas Operating under Conditions Relevant for Diamond Chemical Vapor Deposition.

A microwave (MW) activated hydrogen plasma operating under conditions relevant to contemporary diamond chemical vapor deposition reactors has been investigated using a combination of experiment and self-consistent 2-D modeling. The experimental study returns spatially and wavelength resolved optical emission spectra of the d → a (Fulcher), G → B, and e → a emissions of molecular hydrogen and of the Balmer-α emission of atomic hydrogen as functions of pressure, applied MW power, and substrate diameter. The modeling contains specific blocks devoted to calculating (i) the MW electromagnetic fields (using Maxwell's equations) self-consistently with (ii) the plasma chemistry and electron kinetics, (iii) heat and species transfer, and (iv) gas-surface interactions. Comparing the experimental and model outputs allows characterization of the dominant plasma (and plasma emission) generation mechanisms, identifies important coupling reactions between hydrogen atoms and molecules (e.g., the quenching of H( n > 2) atoms and electronically excited H2 molecules (H2*) by the alternate ground-state species and H3+ ion formation by the associative ionization reaction of H( n = 2) atoms with H2), and illustrates how spatially resolved H2* (and Hα) emission measurements offer a detailed and sensitive probe of the hyperthermal component of the electron energy distribution function.

Reduced Anxiety and Depression in Patients With Advanced Heart Failure After Left Ventricular Assist Device Implantation.

BACKGROUND: Despite the high prevalence of depression and anxiety in patients with advanced heart failure, the effects of left ventricular assist device (LVAD) implantation on these critically important aspects of mental health are not well understood. OBJECTIVE: We sought to assess changes in depression and anxiety following LVAD implantation. METHODS: The Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) were administered to 54 patients by a clinical psychologist at a mean of 12 days before LVAD implantation and 251 days after implantation. Patient demographics and clinical data were collected concurrently to psychologic testing. Changes in BDI-II, BAI, and clinical markers of heart failure were assessed using paired t-tests. A p < 0.05 was considered significant. RESULTS: The average age of the group was 56.63 years with a mean ejection fraction 20.8%. Before implantation, mean BAI and BDI scores indicated mild depression and anxiety. Following LVAD implantation, average scores for both BDI-II and BAI decreased significantly, indicating minimal depression and anxiety (12.6-8.54, p = 0.001 and 12.06-6.6, p < 0.001, respectively). Mean scores were significantly lowered in 11 and 8 of the 21 subdomains tested by the BAI and BDI, respectively. Significant improvements were noted in post-LVAD B-type natriuretic peptide, serum sodium, and blood urea nitrogen. CONCLUSION: Depression and anxiety scores improved significantly after LVAD implantation. Factors contributing to changes in depression and anxiety after LVAD could be related to the improvement in acute heart failure symptoms, functional capacity, and quality of life. Prospective studies with larger sample sizes are warranted.

Psychosocial Evaluation in Patients Undergoing Left Ventricular Assist Device Implantation Using the Transplant Evaluation Rating Scale.

BACKGROUND: It has been recommended that all candidates for left ventricular assist device (LVAD) implantation undergo preoperative psychologic evaluation for risk assessment. OBJECTIVE: We used the transplant evaluation rating scale (TERS) that was established for pretransplant evaluation to investigate the psychosocial assessment of patients undergoing LVAD implantation. METHODS: This study retrospectively analyzed data from 125 patients with advanced heart failure who were evaluated by the TERS before LVAD implantation. Postoperative follow-up included survival, total length of hospital stay, readmissions, and post-LVAD out-of-hospital days after discharge. The cohort was stratified according to the TERS scores into low-, moderate-, and high-risk groups. The outcomes were analyzed to evaluate whether the TERS score was associated with post-LVAD adverse events. RESULTS: The TERS, when stratified into 3 risk groups showed significant difference in 8 of the 10 psychosocial domains (p < 0.001). The mean number of outpatient days after discharge was significantly different between the low-, moderate-, and high-risk groups (p < 0.001). All other outcomes were not significantly different. CONCLUSIONS: This study showed that the TERS is successful in stratifying our patients with an LVAD into 3 risk groups, indicating the internal validity of this test. The number of out-of-hospital (outpatient) days after discharge was significantly shorter in the TERS high-risk group, which may affect the quality of life and cost of post-LVAD care.

Rescuing vasculature with intravenous angiopoietin-1 and alpha v beta 3 integrin peptide is protective after spinal cord injury.

Blood vessel loss and inflammation cause secondary degeneration following spinal cord injury. Angiopoietin-1 through the Tie2 receptor, and other ligands through alphavbeta3 integrin, promote endothelial cell survival during developmental or tumour angiogenesis. Here, daily intravenous injections with an alphavbeta3-binding peptide named C16 or an angiopoietin-1 mimetic following a spinal cord contusion at thoracic level 9 in mice rescued epicentre blood vessels, white matter and locomotor function, and reduced detrimental inflammation. Preserved vascularity and reduced inflammation correlated with improved outcomes. C16 and angiopoietin-1 reduced leukocyte transmigration in vitro. Growth factor receptors and integrins facilitate each others' function. Therefore, angiopoietin-1 and C16 were combined and the effects were additive, resulting in almost complete functional recovery. The treatment had lasting effects when started 4 h following injury and terminated after one week. These results identify alphavbeta3 integrin and the endothelial-selective angiopoietin-1 as vascular and inflammatory regulators that can be targeted in a clinically relevant manner for neuroprotection after central nervous system trauma.

Demographic and Admission Predictors of Students with Perceived Difficulty in Entry-Level Doctor of Physical Therapy Programs.

BACKGROUND: Admission committees have the difficult task of selecting candidates with the greatest likelihood of success for their programs and the profession. Because of limitations in defining the successful candidate, we attempted to predict who will become a "student with perceived difficulty" within a doctor of physical therapy (DPT) program using data available during the time of application. METHODS: A retrospective analysis of 479 students from three entry-level DPT programs. The dependent variable was student with perceived difficulty status. Student characteristics were compared using unpaired t-tests (or non-parametric equivalent) and chi-squared tests. Receiver operating characteristic curves were constructed for variables significantly associated with student status to compare the predictive capabilities of the student characteristics and identify cutpoints that maximized sensitivity and specificity. We examined the predictive capabilities of clusters of characteristics that differed significantly between groups by calculating likelihood ratios and estimating odds ratios from logistic regression. RESULTS: The cluster of characteristics that best identified students with perceived difficulty was prerequisite GPA <3.7, Analytical Writing GRE <4, and attended >2 undergraduate institutions. Twenty students met these criteria and 8 (40%) were identified as students with perceived difficulty. The positive likelihood ratio for this cluster of characteristics was 6.9 and the odds ratio was 8.7 (95% CI: 3.2, 23.0). CONCLUSIONS: These results suggest that this cluster of variables, available at the time of admission, can be used to identify students whose progress in the program may need to be more closely monitored and who may benefit from additional services to minimize difficulties for the student and faculty.

Safety and Effectiveness of an Investigational Insulin Delivery Device Providing Basal/Bolus Therapy with Rapid-Acting or Regular Human Insulin in Adults with Type 2 Diabetes.

Background: This study undertook to assess usability, 24-h glycemic profiles, and safety of an investigational basal/bolus insulin delivery device (IDD) providing rapid-acting or regular human insulin (RHI) for people with type 2 diabetes (T2D) transitioning from multiple daily insulin injections (MDIs). Methods: This prospective, single-center, open-label two-period study enrolled adults with T2D and glycated hemoglobin (HbA1c) 7%-11% (53-97 mmol/M). Participants continued the usual MDI therapy during a 2- to 3-day in-clinic MDI period and then within 7 days were switched to the IDD, using current insulin dose, for a 6-day in-clinic IDD period, with blinded continuous glucose monitoring throughout the in-clinic periods. Results: We enrolled 21 participants (mean ± standard deviation age 57 ± 8 years; HbA1c 8.2% ± 0.9% [66 ± 9.8 mmol/M]) using U-100 insulin lispro (n = 11) or who switched to U-100 RHI (n = 10). Glycemic measures improved from the MDI to IDD period, including fasting blood glucose (BG), 141.2 ± 38.3 mg/dL (7.8 ± 2.1 mmol/L) versus 121.2 ± 35.0 mg/dL (6.7 ± 1.9 mmol/L; P = 0.002), respectively; 24-h mean BG, 137.0 ± 20.5 mg/dL (7.6 ± 1.1 mmol/L) versus 125.0 ± 16.5 mg/dL (6.9 ± 0.9 mmol/L; P = 0.004); and time in range (at 70-180 mg/dL; 3.9-10 mmol/L), 81.0% ± 14.4% versus 87.5% ± 10.6% (P = 0.008). No significant differences between MDIs and IDD use were recorded for time <70 mg/dL (1.6% ± 2.7% vs. 3.1% ± 2.7%, P = 0.08), CV%, or mean of daily differences. Mean amplitude of glycemic excursions was significantly lower with the IDD (P = 0.011). There were no significant differences between insulin lispro and RHI for any glycemic measure. No serious adverse events were recorded. Conclusions: In the context of this exploratory study, the IDD was safe and effective to administer insulin lispro and RHI for adults with T2D.

Small-molecule protein tyrosine phosphatase inhibition as a neuroprotective treatment after spinal cord injury in adult rats.

Spinal cord injury causes progressive secondary tissue degeneration, leaving many injured people with neurological disabilities. There are no satisfactory neuroprotective treatments. Protein tyrosine phosphatases inactivate neurotrophic factor receptors and downstream intracellular signaling molecules. Thus, we tested whether the peroxovanadium compound potassium bisperoxo(1,10-phenanthroline)oxovanadate (V) [bpV(phen)], a stable, potent and selective protein tyrosine phosphatase inhibitor, would be neuroprotective after a thoracic spinal cord contusion in adult rats. Intrathecal bpV(phen) infusions through a lumbar puncture rescued dorsal column sensory axons innervating the nucleus gracilis and white matter at the injury epicenter. At the most effective dose, essentially all of these axons and most of the white matter at the epicenter were spared (vs approximately 60% with control infusions). bpV(phen) treatments started 4 h after contusion were fully effective. This treatment greatly improved and normalized sensorimotor function in a grid-walking test and provided complete axonal protection over 6 weeks. The treatment rescued sensory-evoked potentials that disappeared after dorsal column transection. bpV(phen) affected early degenerative mechanisms, because the main effects were seen at 7 d and lasted beyond the treatment period. The neuroprotection appeared to be mediated by rescue of blood vessels. bpV(phen) reduced apoptosis of cultured endothelial cells. These results show that a small molecule, used in a clinically relevant manner, reduces loss of long-projecting axons, myelin, blood vessels, and function in a model relevant to the most common type of spinal cord injury in humans. They reveal a novel mechanism of spinal cord degeneration involving protein tyrosine phosphatases that can be targeted with therapeutic drugs.

Low-frequency fatigue in individuals with spinal cord injury.

BACKGROUND/OBJECTIVE: This study examined magnitude and recovery of low-frequency fatigue (LFF) in the quadriceps after electrically stimulated contractions in spinal cord-injured (SCI) and able-bodied subjects. SUBJECTS: Nine SCI (ASIA A-C, levels C5-T9, injured 13.6 +/- 12.2 years) and 9 sedentary able-bodied subjects completed this study. METHODS: Fatigue was evoked in 1 thigh, and the nonfatigued leg served as a control. The fatigue test for able-bodied subjects lasted 15 minutes. For SCI, stimulation was adjusted so that the relative drop in force was matched to the able-bodied group. Force was assessed at 20 (P20) and 100 Hz (P100), and the ratio of P20/P100 was used to evaluate LFF in thighs immediately after, at 10, 20, and 60 minutes, and at 2, 4, 6, and 24 hours after a fatigue test. RESULTS: The magnitude of LFF (up to 1 hour after fatigue) was not different between able-bodied and patients with SCI. However, recovery of LFF over 24 hours was greater in able-bodied compared with patients with SCI in both the experimental (P < 0.001) and control legs (P < 0.001). The able-bodied group showed a gradual recovery of LFF over time in the experimental leg, whereas the SCI group did not. CONCLUSIONS: These results show that individuals with SCI are more susceptible to LFF than able-bodied subjects. In SCI, simply assessing LFF produced considerable LFF and accounted for a substantial portion of the response. We propose that muscle injury is causing the dramatic LFF in SCI, and future studies are needed to test whether "fatigue" in SCI is actually confounded by the effects of muscle injury.

What [plasma used for growing] diamond can shine like flame?

Diamond synthesis by chemical vapour deposition (CVD) from carbon-containing gas mixtures has by now long been an industrial reality, but commercial interest and investment into the technology has grown dramatically in the last several years. This Feature Article surveys recent advances in our understanding of the gas-phase chemistry of microwave-activated methane/hydrogen plasmas used for diamond CVD, including that of added boron-, nitrogen- and oxygen-containing dopant species. We conclude by considering some of the remaining challenges in this important area of contemporary materials science.

Oxygen cost of dynamic or isometric exercise relative to recruited muscle mass.

BACKGROUND: Oxygen cost of different muscle actions may be influenced by different recruitment and rate coding strategies. The purpose of this study was to account for these strategies by comparing the oxygen cost of dynamic and isometric muscle actions relative to the muscle mass recruited via surface electrical stimulation of the knee extensors. METHODS: Comparisons of whole body pulmonary delta VO2 were made in seven young healthy adults (1 female) during 3 minutes of dynamic or isometric knee extensions, both induced by surface electrical stimulation. Recruited mass was quantified in T2 weighted spin echo magnetic resonance images. RESULTS: The delta VO2 for dynamic muscle actions, 242 +/- 128 ml x min(-1) (mean +/- SD) was greater (p = 0.003) than that for isometric actions, 143 +/- 99 ml x min(-1). Recruited muscle mass was also greater (p = 0.004) for dynamic exercise, 0.716 +/- 282 versus 0.483 +/- 0.139 kg. The rate of oxygen consumption per unit of recruited muscle (VO2(RM)) was similar in dynamic and isometric exercise (346 +/- 162 versus 307 +/- 198 ml x kg(-1) x min(-1); p = 0.352), but the VO2(RM) calculated relative to initial knee extensor torque was significantly greater during dynamic exercise 5.1 +/- 1.5 versus 3.6 +/- 1.6 ml x kg(-1) x Nm(-1) x min(-1) (p = 0.019). CONCLUSION: These results are consistent with the view that oxygen cost of dynamic and isometric actions is determined by different circumstances of mechanical interaction between actin and myosin in the sarcomere, and that muscle recruitment has only a minor role.

Cognitive function and left ventricular assist device implantation.

BACKGROUND: Cognitive impairment is frequent in patients with heart failure (HF) and can lead to poor quality of life and increased risk of mortality. The Montreal Cognitive Assessment (MoCA) is a simple screening tool that is sensitive to mild cognitive impairment (MCI) and that has been validated in the settings of neurologic and cardiovascular disease. This study determined the extent of cognitive impairment in patients with HF undergoing evaluation for advanced surgical therapy and evaluated changes in MoCA score with follow-up cognitive assessment at 8 months after left ventricular assist device (LVAD) implantation. METHODS: As part of routine assessment for LVAD candidacy, 176 patients with advanced HF were administered the MoCA; 56 patients were reevaluated 8 months after LVAD implantation. RESULTS: Patients with MCI, indicated by MoCA score <26 out of 30, made up 67% of the study cohort. MCI was associated with significantly older age, higher CHADS2 (congestive HF, hypertension, age >75 years, diabetes mellitus, prior stroke or transient ischemic attack) risk score, statin use, history of stroke and hypertension, and reduced serum cholesterol levels. In 56 patients who underwent follow-up evaluation after LVAD implantation, total MoCA score and visuospatial, executive, and delayed recall cognitive domains were significantly improved. CONCLUSIONS: This study assessed the use of the MoCA in patients with end-stage HF being evaluated for advanced surgical therapy. We found the MoCA to be a rapid, simple, and powerful tool for detecting cognitive impairment in these patients. MCI was highly prevalent in the cohort. Significant improvement in overall MoCA score was noted after LVAD implantation.

Family caregivers' perspectives on dementia-related dressing difficulties at home: The preservation of self model.

Alzheimer's caregiving literature acknowledges dressing as a major daily stressor but research on this topic is negligible. A qualitative grounded theory approach was used to explore Alzheimer's family caregivers' perspectives about issues that arise when their family members lose the ability to dress independently. Three focus groups and seven individual interviews were conducted and audio recorded with 25 information rich caregivers. Constant comparative analyses and coding of the transcripts identified six major themes leading to a 'Preservation of Self Model: Care Recipient to Care Giver' that portrays the caregiving trajectory. Initially, caregivers tried to protect the self dignity of the family member by maintaining usual routines and absorbing blame for difficulties. Dressing 'battles' occurred and caregivers learned management through trial and error. Crossing adult-child-gender role boundaries escalated discomfort. When facing unrelenting demands, concern shifted to preservation of the caregivers' health and self. Results suggest that caregivers would benefit from more pro-active dressing counseling to shorten the trial and error periods, dressing aids more relevant to dementia and more knowledgeable helpers. The preservation model can facilitate understanding of the caregiving trajectory and guide intervention support.

Neuromuscular Electrical Stimulation-Induced Resistance Training After SCI: A Review of the Dudley Protocol.

BACKGROUND: Neuromuscular electrical stimulation (NMES), often referred to as functional electrical stimulation (FES), has been used to activate paralyzed skeletal muscle in people with spinal cord injury (SCI). The goal of NMES has been to reverse some of the dramatic losses in skeletal muscle mass, to stimulate functional improvements in people with incomplete paralysis, and to produce some of the health benefits associated with exercise. OBJECTIVE: The purpose of this brief review is to describe a quantifiable resistance training form of NMES developed by Gary A. Dudley. METHODS: People with motor complete SCI were first tested to confirm that an NMES-induced muscle contraction of the quadriceps muscle could be achieved. The contraction stimulus consisted of biphasic pulses at 35 Hz performed with increasing current up to what was needed to produce full knee extension. Four sets of 10 knee extensions were elicited, if possible. Training occurred biweekly for 3 to 6 months, with ankle weights being increased up to an added weight of 9.1 kg if the 40 repetitions could be performed successfully for 2 sessions. RESULTS: Many participants have performed this protocol without adverse events, and all participants showed progression in the number of repetitions and/or the amount of weight lifted. Large increases in muscle mass occur, averaging 30% to 40%. Additional physiological adaptations to stimulated muscle have also been reported. CONCLUSIONS: These results demonstrate that the affected skeletal muscle after SCI responds robustly to progressive resistance training many years after injury. Future work with NMES should determine whether gains in lean mass translate to improved health, function, and quality of life.

Prototype Development of a Responsive Emotive Sensing System (DRESS) to aid older persons with dementia to dress independently.

BACKGROUND: Prior research has critiqued the lack of attention to the stressors associated with dementia related dressing issues, stigmatizing patient clothing, and wearable technology challenges. This paper describes the conceptual development and feasibility testing of an innovative 'smart dresser' context aware affective system (DRESS) to enable dressing by people with moderate memory loss through individualized audio and visual task prompting in real time. METHODS: Mixed method feasibility study involving qualitative focus groups with 25 Alzheimer's family caregivers experiencing dressing difficulties to iteratively inform system design and a quantitative usability trial with 10 healthy subjects in a controlled laboratory setting to assess validity of technical operations. RESULTS: Caregivers voiced the need for tangible dressing assistance to reduce their frustration from time spent in repetitive cueing and power struggles over dressing. They contributed 6 changes that influenced the prototype development, most notably adding a dresser top iPad to mimic a familiar 'TV screen' for the audio and visual cueing. DRESS demonstrated promising overall functionality, however the validity of identification of dressing status ranged from 0% for the correct pants dressing to 100% for all shirts dressing scenarios. Adjustments were made to the detection components of the system raising the accuracy of detection of all acted dressing scenarios for pants from 50% to 82%. CONCLUSIONS: Findings demonstrate family caregiver acceptability of the proposed system, the successful interoperability of the built system's components, and the system's ability to interpret correct and incorrect dressing actions in controlled laboratory simulations. Future research will advance the system to the alpha stage and subsequent testing with end users in real world settings.

Peak exercise capacity of electrically induced ambulation in persons with paraplegia.

INTRODUCTION: Persons with spinal cord injury (SCI) are generally limited to exercise activities using the relatively smaller, less productive upper extremities with limited benefits as compared with leg exercise training. Functional electrical stimulation (FES) assisted ambulation has previously been demonstrated to allow persons with paraplegia to stand and ambulate limited distances. PURPOSE: This study compared the peak physiological responses of persons with paraplegia during FES ambulation and voluntary arm exercise. METHODS: Fifteen subjects (T -T ) previously habituated to FES ambulation, completed peak testing of both arm cranking (AC) and FES walking to the point of exhaustion. The AC tests were performed using a graded incremental protocol to exhaustion in 3-min stages and 10-W power output increments. The FES walking test consisted of successive 10-m walking bouts, each trial progressively increased in pace. Metabolic activity was continuously monitored via open-circuit spirometry with heart rate (HR) determined by a 12-lead electrocardiograph for AC and by direct palpation during FES. RESULTS: Peak VO(2) did not differ between AC (22.9 +/- 3.8 mL x kg x min(-1)) and FES (22.7 +/- 3.9 mL x kg x min(-1)). FES ambulation elicited significantly greater peak values of HR (191 beats x min(-1) versus 179 beats x min(-1)) and lower peak values of respiratory exchange ratio (1.06 vs 1.12) compared with AC. There were no significant differences in peak values of any other variables. CONCLUSION: This study indicates that FES ambulation performance, in persons with paraplegia, elicits similar exercise capacity, as indicated by similar peak oxygen consumption, as voluntary arm exercise.