The efficacy of computerized cognitive rehabilitation in improving attention and executive functions in acquired brain injury patients, in acute and postacute phase.

BACKGROUND: Cognitive deficits, particularly executive dysfunction is common following acquired brain injury (ABI) and has detrimental effect on functional status and autonomy in daily life. Among various cognitive training methods, computerized cognitive rehabilitation (CCR) has been investigated as an alternative method to therapist-driven cognitive rehabilitation (TCR). However, previous studies have shown conflicting results on the superiority or inferiority of CCR and TCR. AIM: To investigate the efficacy of TCR and CCR in improving executive function in patients with acute-to-subacute ABI. DESIGN: A prospective, assessor-blinded randomized controlled trial. SETTING: Hospitalized care setting in the department of rehabilitation in a university hospital. POPULATION: Thirty-two acute-to-subacute (less than 3 months after onset) ABI patients with executive dysfunctions were included in this study. The mean time after injury was 25.1±18.1 days. METHODS: Participants were assigned to the TCR group (N.=14) or the CCR group (N.=18). Each group performed TCR or CCR for 30 minutes each day for two weeks in addition to routine rehabilitation. Neurocognitive function tests to assess complex attention, executive function, general cognitive function (mini-mental status examination [MMSE] and Montreal Cognitive Assessment [MoCA]), and functional evaluations [modified Barthel Index, MBI]) were performed at baseline (T0) and at the end of treatment (T1). RESULTS: The TCR and CCR groups showed significant improvements in the MMSE (P=0.004, 0.000), MoCA (P=0.003, 0.006), and MBI (P=0.000, 0.000) scores. TCR and CCR groups both showed significant improvements in some of the complex attention tests (trail-making test A, P=0.002, 0.005) and executive function tests (trail-making test B, P=0.016, 0.016). The TCR group showed significant improvements in the additional executive function tests (phonemic fluency test, P=0.004, semantic fluency test, P=0.001), while the CCR group showed significant improvements in the additional complex attention tests (symbol search, P=0.02, digit symbol coding, P=0.002). In the intergroup comparison of the changes from pre- to postintervention, only the TCR group showed a significant improvement in the phonemic fluency test (P=0.013). CONCLUSIONS: TCR might be more effective than CCR in improving frontal lobe-related executive function in ABI patients. CCR might be beneficial for improving psychomotor speed and working memory. CLINICAL REHABILITATION IMPACT: TCR or CCR should be chosen according to the targeted domain of cognitive dysfunction in acute-to-subacute ABI patients.

COWAT Performance of Persons with Alzheimer Dementia, Vascular Dementia, and Parkinson Disease Dementia According to Stage of Cognitive Impairment.

BACKGROUND: The Controlled Oral Word Association Test (COWAT) evaluates frontal lobe and executive function. Therefore, it can be helpful in differentiating cognitive deficits. However, there are no studies comparing the COWAT performance according to the type and stage of cognitive impairment. OBJECTIVE: To compare performance among persons with Alzheimer dementia (AD), vascular dementia (VaD), and Parkinson disease dementia (PDD) on the COWAT according to stage of cognitive impairment. DESIGN: Retrospective chart review. SETTINGS: University hospital rehabilitation psychology center. PATIENTS: We reviewed the medical records of 246 persons diagnosed with mild cognitive impairment (MCI) or dementia using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Korean-Instrumental Activities of Daily Living (K-IADL). Patients were divided into a control group, Alzheimer groups (amnestic mild cognitive impairment [aMCI] + AD), Vascular groups (vascular mild cognitive impairment [VaMCI] + VaD), and Parkinson groups (Parkinson disease-mild cognitive impairment [PD-MCI] + PDD). METHODS: Total scores (ie, total number of words produced in 60 seconds on the semantic and phonemic fluency tests of the COWAT) were analyzed. Secondary analysis included calculating percentage scores of words produced during each of the four, 15-second segments from the total number of words produced in each trial. RESULTS: All MCI groups scored significantly lower than the control group on both semantic and phonemic fluency tests. Among the dementia groups, the VaD (mean ± SD, 5.6 ± 5.1) and PDD (5.5 ± 5.5) groups' scores were significantly lower and worse than that of the AD (11.0 ± 8.8) group on the phonemic test (P < .001). The difference in percentage scores was most marked between the PD-MCI (17.0 ± 2.2) and PDD (1.2 ± 3.1) groups, followed by the VaMCI (13.3 ± 1.9) and VaD (5.6 ± 1.8) groups on the latter phonemic test (P = .007). CONCLUSIONS: The COWAT is a sensitive test of frontal-lobe and executive function impairment in persons with MCI. Decreased verbal output in the last 15 seconds of phonemic fluency test is significantly decreased and impaired in persons with VaMCI and PD-MCI compared to persons with aMCI as they progress to dementia. LEVEL OF EVIDENCE: III.

Industrial-grade anti-reflection coatings with extreme scratch resistance.

Anti-reflection coatings are widely used throughout the field of optical technology such as in corrective eyeglasses, camera lenses, and microscope optics, to improve the transmittance and reduce the reflectance of glass and other transparent materials. To date, these coatings have suffered from relatively poor scratch resistance and high scratch visibility compared to standard glasses. This has limited their use in applications requiring high mechanical durability such as on the chemically strengthened glasses widely used in modern touch screen devices. Here extremely scratch-resistant anti-reflection coatings are fabricated using industrially scalable reactive sputtering processes. These coatings provide a combination of surface reflectance below 0.7%, low color shifts, nanoindentation hardness as high as 18 GPa, and levels of scratch resistance which dramatically exceed commercial chemically strengthened glasses. An interdisciplinary opto-mechanical design approach has enabled a significant paradigm shift in the use of high-precision optical coatings for mechanically demanding applications. As a direct outcome of the work reported in this Letter, similar coating designs have been successfully deployed on millions of consumer electronics devices with very robust field performance.

Exposure dose reduction during lateral spine test with water filter.

To minimize exposure dose during lateral spine X-Ray testing and obtain optimal image for diagnosis a water filter was made to measure and evaluate dose distribution. When applying the water filter, as thickness increased exposure dose decreased. When applying 2 cm of water filter, clarity of contrast and boundary was found to be 4.5 ± 0.5 and resolution was found to be 2.00 ± 0.5 Lp/mm which was almost identical image quality compared to not applying water filter which showed clarity of contrast and boundary of 5.0 ± 0.0, and resolution of 2.50 ± 0.0 Lp/mm, while reducing exposure dose by 55%. This result is expected to have many uses as important basic data to predict exposure dose of patients and to minimize medical exposure dose through applying water filters during lateral spine X-Ray testing.

Mismatch negativity is a stronger indicator of functional outcomes than neurocognition or theory of mind in patients with schizophrenia.

OBJECTIVES: Mismatch negativity (MMN) is known to be associated with neurocognition, social cognition, and functional outcomes. The present study explored the relationships of MMN with neurocognition, theory of mind, and functional outcomes in patients with schizophrenia, first-degree relatives of patients with schizophrenia, and healthy controls. METHODS: Twenty-five patients with schizophrenia, 21 first-degree relatives of patients with schizophrenia, and 29 healthy controls were recruited. We examined symptom severity, neurocognition, theory of mind, functional outcomes, and MMN. RESULTS: MMN amplitudes decreased in order of patients with schizophrenia, then first-degree relatives, then healthy controls. MMN amplitude was significantly correlated with measures of neurocognition, theory of mind, and functional outcome measurements in patients with schizophrenia. However, the most powerful correlations were those between MMN in the frontal region and measures of functional outcomes. The power and frequency of the correlations were weaker in first-degree relatives and healthy controls than in patients with schizophrenia. Hierarchical regression analysis revealed that functional outcomes (relative to measures of neurocognition and theory of mind) constituted the most powerful predictor of MMN. CONCLUSIONS: Our results suggest that MMN reflects functional outcomes more efficiently than do measures of neurocognition and theory of mind in patients with schizophrenia.

Influence of the delivery systems using a microneedle array on the permeation of a hydrophilic molecule, calcein.

Despite the advantages of drug delivery through the skin, such as easy accessibility, convenience, prolonged therapy, avoidance of the liver first-pass metabolism and a large surface area, transdermal drug delivery is only used with a small subset of drugs because most compounds cannot cross the skin at therapeutically useful rates. Recently, a new concept was introduced known as microneedles and these could be pierced to effectively deliver drugs using micron-sized needles in a minimally invasive and painless manner. In this study, biocompatible polycarbonate (PC) microneedle arrays with various depths (200 and 500 microm) and densities (45, 99 and 154 ea/cm2) were fabricated using a micro-mechanical process. The skin permeability of a hydrophilic molecule, calcein (622.5D), was examined according to the delivery systems of microneedle, drug loading, depth of the PC microneedle, and density of the PC microneedle. The skin permeability of calcein was the highest when the calcein gel was applied to the skin with the 500 microm-depth PC microneedle, simultaneously. In addition, the skin permeability of calcein was the highest when 0.1g of calcein gel was coupled to the 500 microm-depth PC microneedle (154 ea/cm2) as well as longer microneedles and larger density of microneedles. Taken together, this study suggests that a biocompatible PC microneedle might be a suitable tool for transdermal drug delivery system of hydrophilic molecules with the possible applications to macromolecules such as proteins and peptides.