Feasibility of heating metal implants with alternating magnetic fields (AMF) in scaled up models.

Aim: Treatment of infected orthopedic implants remains a major medical challenge, involving prolonged antibiotic therapy and revision surgery, and adding a >$1 billion annual burden to the health care system in the US alone. Exposure of metallic implants to alternating magnetic fields (AMF) generates heat that can provide a noninvasive means to target biofilm adhered to the surface. In this study, an AMF system with a solenoid coil was constructed for targeting a metal plate surgically implanted in a sheep model.Methods: A tissue-mimicking phantom of the sheep leg was developed along with simulation model of phantom and the live sheep leg. This was used evaluate heating with the AMF system and to compare experimental results with numerical simulations. Comparative AMF exposures were performed/simulated in these model for feasibility of design, verification, and validation of simulations.Results: The system produced magnetic field strengths up to 12mT and achieved plate temperatures of 65-80 °C within 10-14 s. Single and intermittent AMF exposures of a tissue-mimicking phantom agreed with numerical simulations within 5 °C. Similar agreement between experimental measurements and simulations was also observed in the live sheep metal implant model. The simulations also predicted 2-3 mm of tissue damage using a CEM43 thermal dose model for 1-h AMF exposures targeting 65 °C for pulse delays of 2.5 and 5 mins.Conclusion: This study confirmed that AMF technology can be scaled up to treat implants in a large animal model with the same rates of heating and peak temperatures achieved in prior in vitro studies. Further, numerical simulations provided accurate predictions of the heating produced by AMF on metal implants and surrounding tissues, and can be used to design AMF coils for treating human prosthetic joint implants with more complex geometrical shapes.

The Columbia Behavior Scale for Dementia (CBS-8): Validity and Reliability of a Rapidly Administered New Instrument for Dementia-Related Behaviors in Long-Term Care Settings.

We developed and evaluated the psychometric properties of the Columbia Behavior Scale for Dementia (CBS-8), a rapid instrument that assesses positive symptoms, to enhance behavioral and psychological symptoms of dementia (BPSD) assessment and treatment in long-term care. Psychometric analyses were performed on CBS-8 data from residents (N = 350, age ≥50 years) in 47 Maryland long-term care facilities referred for neurocognitive and mood evaluation. The CBS-8 demonstrated acceptable internal consistency (α = 0.78) and strong interrater reliability (intraclass correlation coefficient = 1.00). CBS-8 scores were correlated with greater cognitive impairment severity (r = -0.34). The diagnosis of dementia with behavioral disturbance had higher CBS-8 scores than other dementia types (e.g., vascular, unspecified) (p < 0.001, η2 = 0.40). Three CBS-8 factors-motor disinhibition, aggression, and psychosis-explained 65% of the variance in overall BPSD. The CBS-8 could enhance BPSD tracking and treatment, strengthen interdisciplinary collaboration, and aid nursing homes in meeting regulations on unnecessary medication use. [Research in Gerontological Nursing, 14(3), 160-168.].

A New Tool for Detecting COVID-19 Psychological Burden Among Postacute and Long-term Care Residents (Mood-5 Scale): Observational Study.

BACKGROUND: Older adults are at high risk for developing serious somatic and psychological symptoms associated with COVID-19. Currently available instruments may not be sensitive to the concerns about COVID-19 in postacute and long-term care and their applications in telehealth remain to be clarified. OBJECTIVE: We investigated the psychometric properties of the Mood-5 Scale (M5) as a rapid self-assessment of the COVID-19 psychological burden among postacute and long-term care residents. METHODS: Residents (N=131), aged 50 years and above, from 20 postacute and long-term care facilities in Maryland, USA, were evaluated in-person or via telehealth (43/131, 32.8%) across a 4-week period (May 11 to June 5, 2020) during the COVID-19 pandemic. The COVID-19 psychological burden experienced by the residents was rated by geriatric psychologists who independently reviewed their clinical documentation. Psychometric analyses were performed on the M5 in relation to psychological tests, COVID-19 psychological burden, and diagnostic data collected during the evaluation. RESULTS: The M5 demonstrated acceptable internal consistency (Cronbach α=.77). M5 scores were not confounded by demographic variables or telehealth administration (P>.08). Convergent validity for the M5 was established via positive associations with anxiety (r=0.56, P<.001) and depressive (r=0.49, P<.001) symptoms. An M5 cutoff score of 3 demonstrated strong sensitivity (0.92) and adequate specificity (0.75) for identifying COVID-19 psychological distress among postacute and long-term care residents (area under the curve of 0.89, positive predictive value=0.79, negative predictive value=0.91). CONCLUSIONS: The M5 is a reliable and valid tool for self-assessment of mood that can help identify postacute and long-term care residents with significant psychological burden associated with COVID-19. It can be completed in less than 1 minute and is appropriate for use in both in-person and virtual visits.

A path to early diagnosis of mild cognitive impairment and dementia: validity and reliability of the myMemCheck® self-administered screening tool.

BACKGROUND: Barriers to the early detection of mild cognitive impairment (MCI) and dementia can delay diagnosis and treatment. myMemCheck® was developed as a rapid free cognitive self-assessment tool that can be completed at home to identify older adults that would benefit from a more comprehensive cognitive evaluation. OBJECTIVE: Two prospective cross-sectional studies were conducted to examine the psychometric properties and clinical utility of myMemCheck®. METHODS: In Study 1, participants were independent living residents referred to an outpatient memory clinic (N = 59); older adults in the community and post-acute nursing home residents (N = 357) comprised Study 2. RESULTS: Psychometric analyses were performed on cognitive and psychological testing data, including myMemCheck®. myMemCheck® evidenced adequate reliability and strong construct validity. Receiver operating characteristic analysis evidenced an optional myMemCheck® cut score for identifying older adults at risk for MCI or dementia. myMemCheck® explained 25% of cognitive status beyond basic patient information. CONCLUSIONS: myMemCheck® may help fast-track the diagnostic process, facilitate appropriate referrals for cognitive and neuropsychological evaluation, reduce assessment burden in health care and prevent negative outcomes associated with undetected cognitive impairment.

Verbal test of practical judgment (VPJ): a new test of judgment that predicts functional skills for older adults.

OBJECTIVES: The clinical assessment of older adults' judgment is important for mitigating safety risks that often precipitate loss of independence. Our national survey of geriatric healthcare providers (N = 496; M years of experience = 17.11 ± 10.60) indicated that formal judgment tests are underutilized in clinical practice. We developed the Verbal Test of Practical Judgment (VPJ) as a new test of judgment for older adults intended to identify difficulty performing instrumental activities of daily living (IADL). METHOD: In two prospective studies, participants were long-term care facility residents (age ≥ 50) in Maryland, USA (Study 1, N = 51; Study 2, N = 110) referred to licensed psychologists for neuro-cognitive and mood evaluation by facility attending physicians. Psychometric analyses were performed to examine the construct validity of the VPJ. RESULTS: The VPJ evidenced adequate reliability and strong construct validity across both studies. Receiver operating characteristic analysis yielded an optimal VPJ cut score for identifying impaired judgment. The VPJ significantly predicted IADL performance beyond clinician and participant ratings. CONCLUSION: The VPJ appears to be a valid tool for assessing judgment among older adults with suspected cognitive impairment. VPJ score inferences can inform clinicians on the odds of requiring assistance for specific IADLs.

Association of cotherapy supervision with client outcomes, attrition, and trainee effectiveness in a psychotherapy training clinic.

OBJECTIVE: Cotherapy supervision has been hypothesized to enhance client outcomes and trainee effectiveness, but there is little empirical evidence relevant to either claim. This study tested both hypotheses, using data from the supervision of psychology doctoral students conducting cognitive behavioral therapy in a university-based clinic. METHOD: Groups of clients treated by supervisor-trainee duos and groups of clients treated by solo trainees with varying exposure to cotherapy supervision were compared on changes in symptoms as measured with the Outcome Questionnaire (OQ-45) and on dropout rates. RESULTS: Clients showed statistically significant reductions in symptoms from pretreatment to posttreatment. However, there were no significant group differences in the magnitude of change or in client retention. CONCLUSIONS: No support was obtained for the hypothesized benefits of cotherapy supervision. Clients treated by a cotherapy (supervisor and supervisee) team did not improve more than did clients treated by solo trainees. Furthermore, clients treated by (solo) trainees who had received cotherapy supervision did not improve more than did clients treated by trainees who had not received cotherapy supervision.

Variation of female prolactin levels with menopausal status and phase of menstrual cycle.

BACKGROUND: Prolactin is not commonly recognised as a hormone that changes significantly within the menstrual cycle or after menopause. The aim of this study was to determine the degree of variability of prolactin in these physiological states. METHOD: Prolactin levels obtained from 6540 subjects between January 2006 and November 2008 were divided into five groups: men, postmenopausal women and premenopausal women in follicular/non-cycling, ovulatory and luteal phases. The median and 97.5th centile was determined for each group. The 97.5th centile was used to define the upper limit of prolactin. RESULTS: The prolactin median and upper limits were not significantly different in men and postmenopausal women. They were significantly higher in premenopausal women compared to men and postmenopausal women. Within premenopausal women, the prolactin median and upper limits were significantly higher in ovulatory phase compared to follicular/non-cycling and luteal phases and in luteal phase compared to follicular/non-cycling phase. CONCLUSIONS: Prolactin levels varied significantly throughout the menstrual cycle, and the utility and accuracy of prolactin testing may be improved by applying specific reference intervals for each phase of the menstrual cycle. Alternatively, a single reference interval could be used if prolactin is only measured in the follicular phase, well before midcycle. Prolactin levels in postmenopausal women and men were not significantly different, and a common prolactin reference interval may be appropriate. Further studies to confirm formal reference ranges for these groups may be clinically helpful.

Effects of the Transcendental Meditation Program on Substance Use among University Students.

A randomized wait-list controlled trial (N = 295 university students) of the effects of the Transcendental Meditation program was conducted in an urban setting. Substance use was assessed by self-report at baseline and 3 months later. For smoking and illicit drug use, there were no significant differences between conditions. For alcohol use, sex X intervention condition interactions were significant; TM instruction lowered drinking rates among male but not female students. TM instruction could play a valuable role in reducing alcohol use among male university students. Limitations are noted, along with suggestions for further research.

A linear systems analysis of the yaw dynamics of a dynamically scaled insect model.

Recent studies suggest that fruit flies use subtle changes to their wing motion to actively generate forces during aerial maneuvers. In addition, it has been estimated that the passive rotational damping caused by the flapping wings of an insect is around two orders of magnitude greater than that for the body alone. At present, however, the relationships between the active regulation of wing kinematics, passive damping produced by the flapping wings and the overall trajectory of the animal are still poorly understood. In this study, we use a dynamically scaled robotic model equipped with a torque feedback mechanism to study the dynamics of yaw turns in the fruit fly Drosophila melanogaster. Four plausible mechanisms for the active generation of yaw torque are examined. The mechanisms deform the wing kinematics of hovering in order to introduce asymmetry that results in the active production of yaw torque by the flapping wings. The results demonstrate that the stroke-averaged yaw torque is well approximated by a model that is linear with respect to both the yaw velocity and the magnitude of the kinematic deformations. Dynamic measurements, in which the yaw torque produced by the flapping wings was used in real-time to determine the rotation of the robot, suggest that a first-order linear model with stroke-average coefficients accurately captures the yaw dynamics of the system. Finally, an analysis of the stroke-average dynamics suggests that both damping and inertia will be important factors during rapid body saccades of a fruit fly.

A self-referential default brain state: patterns of coherence, power, and eLORETA sources during eyes-closed rest and Transcendental Meditation practice.

Activation of a default mode network (DMN) including frontal and parietal midline structures varies with cognitive load, being more active during low-load tasks and less active during high-load tasks requiring executive control. Meditation practices entail various degrees of cognitive control. Thus, DMN activation patterns could give insight into the nature of meditation practices. This 10-week random assignment study compared theta2, alpha1, alpha2, beta1, beta2 and gamma EEG coherence, power, and eLORETA cortical sources during eyes-closed rest and Transcendental Meditation (TM) practice in 38 male and female college students, average age 23.7 years. Significant brainwave differences were seen between groups. Compared to eyes-closed rest, TM practice led to higher alpha1 frontal log-power, and lower beta1 and gamma frontal and parietal log-power; higher frontal and parietal alpha1 interhemispheric coherence and higher frontal and frontal-central beta2 intrahemispheric coherence. eLORETA analysis identified sources of alpha1 activity in midline cortical regions that overlapped with the DMN. Greater activation in areas that overlap the DMN during TM practice suggests that meditation practice may lead to a foundational or 'ground' state of cerebral functioning that may underlie eyes-closed rest and more focused cognitive processes.

A randomized controlled trial on effects of the Transcendental Meditation program on blood pressure, psychological distress, and coping in young adults.

BACKGROUND: Psychological distress contributes to the development of hypertension in young adults. This trial assessed the effects of a mind-body intervention on blood pressure (BP), psychological distress, and coping in college students. METHODS: This was a randomized controlled trial (RCT) of 298 university students randomly allocated to either the Transcendental Meditation (TM) program or wait-list control. At baseline and after 3 months, BP, psychological distress, and coping ability were assessed. A subgroup of 159 subjects at risk for hypertension was analyzed similarly. RESULTS: Changes in systolic BP (SBP)/diastolic BP (DBP) for the overall sample were -2.0/-1.2 mm Hg for the TM group compared to +0.4/+0.5 mm Hg for controls (P = 0.15, P = 0.15, respectively). Changes in SBP/DBP for the hypertension risk subgroup were -5.0/-2.8 mm Hg for the TM group compared to +1.3/+1.2 mm Hg for controls (P = 0.014, P = 0.028, respectively). Significant improvements were found in total psychological distress, anxiety, depression, anger/hostility, and coping (P values < 0.05). Changes in psychological distress and coping correlated with changes in SBP (P values < 0.05) and DBP (P values < 0.08). CONCLUSIONS: This is the first RCT to demonstrate that a selected mind-body intervention, the TM program, decreased BP in association with decreased psychological distress, and increased coping in young adults at risk for hypertension. This mind-body program may reduce the risk for future development of hypertension in young adults.

The effects of the transcendental meditation program on mindfulness.

Mindfulness is associated with low levels of neuroticism, anxiety, and depressive symptoms, as well as high levels of self-esteem and satisfaction with life (Brown & Ryan, 2003). As part of a 3-month randomized waitlist-controlled trial of the effects of the Transcendental Meditation (TM) program on university students (N=295), we examined the impact of TM practice on mindfulness as measured by the Kentucky Inventory of Mindfulness Skills (KIMS; Baer, Smith, & Allen, 2004). A repeated measures ANOVA on total KIMS scores showed a significant timextreatment interaction, with the TM participants reporting greater increases in mindfulness than the waitlist participants. All KIMS subscales were positively intercorrelated at pretreatment, and there were no differences over time or as a function of treatment condition in subscale intercorrelations. Therefore, previously published findings of a positive correlation between subscales measuring the skills of observing and accepting-without-judgment one's inner experiences only among those with meditation experience may have reflected a self-selection effect rather than a change in the relation of these mindfulness components resulting directly from meditation practice.

Effects of Transcendental Meditation practice on brain functioning and stress reactivity in college students.

This randomized controlled trial investigated effects of Transcendental Meditation (TM) practice on Brain Integration Scale scores (broadband frontal coherence, power ratios, and preparatory brain responses), electrodermal habituation to 85-dB tones, sleepiness, heart rate, respiratory sinus arrhythmia, and P300 latencies in 50 college students. After pretest, students were randomly assigned to learn TM immediately or learn after the 10-week posttest. There were no significant pretest group differences. A MANOVA of students with complete data (N=38) yielded significant group vs treatment interactions for Brain Integration Scale scores, sleepiness, and habituation rates (all p<.007). Post hoc analyses revealed significant increases in Brain Integration Scale scores for Immediate-start students but decreases in Delayed-start students; significant reductions in sleepiness in Immediate-start students with no change in Delayed-start students; and no changes in habituation rates in Immediate-start students, but significant increases in Delayed-start students. These data support the value of TM practice for college students.

Stability of common biochemical analytes in serum gel tubes subjected to various storage temperatures and times pre-centrifugation.

BACKGROUND: Blood samples collected in rural and remote areas of Australasia are often exposed to a range of environmental conditions prior to analysis in a laboratory. The aim of this study was to determine analyte stability of venous blood specimens in serum gel tubes exposed to a range of storage temperatures and times prior to centrifugation. METHODS: Thirty healthy adult volunteers were enrolled in the study. Blood was collected into 11 serum gel separator tubes. All samples were allowed to clot at room temperature for 30 min. Two samples were centrifuged and analysed as controls. Nine samples were stored at 15, 25 or 35 degrees C for 4, 8 or 24 h, respectively, before centrifugation. Thirty-five biochemical analytes were measured on each sample. RESULTS: Most analytes remained stable in all storage conditions including sodium, total protein, albumin, bilirubin, alanine transferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamyl transferase, creatinine kinase, lipase, cholesterol, triglycerides, transferrin, urate, C-reactive protein, vitamin B(12), thyroid-stimulating hormone, free thyroxine, free triiodothyronine, follicle-stimulating hormone, oestradiol, prostate-specific antigen, cortisol and vitamin D. Potassium, glucose, phosphate, creatinine, urea, ferritin, iron, lactate dehydrogenase, magnesium and calcium were not stable in at least one of the storage conditions. CONCLUSIONS: These results can be used to determine which analytes produce valid results despite exposure to variable storage conditions for up to 24 h prior to centrifugation. The majority of analytes were unaffected by a delay in centrifugation at a variety of temperatures, however, some important analytes were significantly affected.

Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life: results of a double-blind, randomized clinical trial.

CONTEXT: In patients with primary hypothyroidism, anecdotal evidence suggests that well-being is optimized by fine adjustment of T(4) dosage, aiming for a serum TSH concentration in the lower reference range. This has not been tested in a clinical trial. OBJECTIVE: Our objective was to test whether adjustment of T(4) dosage aiming for a serum TSH concentration less than 2 mU/liter improves well-being compared with a serum TSH concentration in the upper reference range. DESIGN: We conducted a double-blind, randomized clinical trial with a crossover design. PARTICIPANTS: Fifty-six subjects (52 females) with primary hypothyroidism taking T(4) (>/=100 microg/d) with baseline serum TSH 0.1-4.8 mU/liter participated. INTERVENTIONS: Each subject received three T(4) doses (low, middle, and high in 25-microg increments) in random order. OUTCOME MEASURES: Outcome measures included visual analog scales assessing well-being (the primary endpoint) and hypothyroid symptoms, quality of life instruments (General Health Questionnaire 28, Short Form 36, and Thyroid Symptom Questionnaire), cognitive function tests, and treatment preference. RESULTS: Mean (+/- sem) serum TSH concentrations were 2.8 +/- 0.4, 1.0 +/- 0.2, and 0.3 +/- 0.1 mU/liter for the three treatments. There were no significant treatment effects on any of the instruments assessing well-being, symptoms, quality of life, or cognitive function and no significant treatment preference. CONCLUSIONS: Small changes in T(4) dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life, despite the expected changes in serum TSH and markers of thyroid hormone action. These data do not support the suggestion that the target TSH range for the treatment of primary hypothyroidism should differ from the general laboratory range.