The Dynamic Interplay of Objective and Subjective Balance and Subsequent Task Performance: Implications for Fall Risk in Older Adults.

INTRODUCTION: Falls occur in daily life when an activity results in a loss of balance that is too great to recover from. Our purpose in this study was to examine how fall risk differentiates the dynamic interplay of objective and subjective balance on a given day and subsequent task performance on that day. METHODS: For 30 consecutive days, following a baseline fall risk assessment, 41 older adults (56% female, Age M = 75.22, SD = 6.75) self-assessed balance and task performance using a smartphone. The Activity-specific Balance Confidence scale measured subjective balance. Postural sway and chair-stand performance were measured within a smartphone using accelerometry. Data were analyzed using multilevel random coefficient models. RESULTS: Tests of heterogeneity in level one residuals showed day-to-day variability in balance confidence and postural sway to be greater in individuals with higher fall risk at baseline. Baseline fall risk differentiated how the interplay of balance confidence and postural sway on a given day related to chair-stand performance on that day. For those with higher fall risk, on days that balance confidence was higher, greater postural sway was followed by greater chair-stand performance. CONCLUSION: Findings indicate that older adults, especially those with higher fall risk, may be unaware of subtle fluctuations in balance, which could lead to engaging in activities that exceed the capacity to maintain balance at that moment. Fall prevention efforts should address older adults' understanding of and responses to fluctuations of physical function in daily life.

The effectiveness of exergames on fear of falling in community-dwelling older adults: a systematic review.

ObjectivesFear of falling is common among older adults and can increase fall-risk through premature activity restriction. Exergames, an emerging tool in fall prevention, combine exercise with interactive and adaptive game elements. This review examines the extent to which exergame interventions reduce fear of falling among community-dwelling older adults. Method: Guided by the PRISMA methodology, we reviewed peer-reviewed studies that were published in English between 2006 and 2019 and employed a comparative design to test the effect of exergames on fear of falling in community-dwelling older adults. Two reviewers screened the literature and extracted data on the exergame platform, participants, study design, and results. A modified PEDro scale was used to assess study quality. Disagreements were resolved through discussion with the third reviewer. Results: Our literature search resulted in 23 eligible studies on exergame interventions where fear of falling was the primary or secondary outcome. Most interventions (35%) occurred within hospitals and were delivered via a Wii-based system (61%). Fear of falling was most commonly measured using the Falls Efficacy Scale, the Activities-specific Balance Scale and their modified versions. A total of 15 of the 23 studies reported statistically significant changes in fear of falling. Quality assessment showed 10 studies to be rated as 'good.' Conclusion: This review showed that exergame may have a positive effect in reducing fear of falling in community-dwelling older adults. The finding provides a direction for clinical practice in the research area of intervention on fear of falling in older adults.

Use of Discrete Wavelet Transform to Assess Impedance Fluctuations Obtained from Cellular Micromotion.

Electric cell-substrate impedance sensing (ECIS) is an attractive method for monitoring cell behaviors in tissue culture in real time. The time series impedance fluctuations of the cell-covered electrodes measured by ECIS are the phenomena accompanying cellular micromotion as cells continually rearrange their cell-cell and cell-substrate adhesion sites. Accurate assessment of these fluctuations to extract useful information from raw data is important for both scientific and practical purposes. In this study, we apply discrete wavelet transform (DWT) to analyze the concentration-dependent effect of cytochalasin B on human umbilical vein endothelial cells (HUVECs). The sampling rate of the impedance time series is 1 Hz and each data set consists of 2048 points. Our results demonstrate that, in the Daubechies (db) wavelet family, db1 is the optimal mother wavelet function for DWT-based analysis to assess the effect of cytochalasin B on HUVEC micromotion. By calculating the energy, standard deviation, variance, and signal magnitude area of DWT detail coefficients at level 1, we are able to significantly distinguish cytotoxic concentrations of cytochalasin B as low as 0.1 µM, and in a concentration-dependent manner. Furthermore, DWT-based analysis indicates the possibility to decrease the sampling rate of the micromotion measurement from 1 Hz to 1/16 Hz without decreasing the discerning power. The statistical measures of DWT detail coefficients are effective methods for determining both the sampling rate and the number of individual samples for ECIS-based micromotion assays.

[A study on quality of Paridis Rhizoma and consideration on standards of Paridis Rhizoma in Chinese Pharmacopoeia].

Thin layer chromatography, high performance liquid chromatography and multivariate statistical analysis were integrated in current study to provide a basis for the quality evaluation and the standard improvement of Paridis Rhizoma(Chinese name: Chong-lou). The results demonstrated that the primary saponins in the two authorized sources of Paridis Rhizoma were polyphyllinsⅠ, Ⅱ and Ⅶ, while the rhizome of Trillium tschonoskii an adulterant of Paridis Rhizoma was rich of polyphyllin Ⅵ. Therefore, the apparent content of polyphyllin Ⅵ plays a determinant role towards the source authentication of raw materials and decoction slices of Paridis Rhizoma, whose adulterants frequently occur in the market. Moreover, the contents of polyphyllin Ⅵ in the two authorized sources could meet the requirements of Chinese Pharmacopoeia. Therefore, we suggested that polyphyllin Ⅵ should not be omitted from the quality standard of Paridis Rhizoma in the Chinese Pharmacopoeia, and on the other side, polyphyllinsⅠ, Ⅱ and Ⅶ should be the eligible quality indicators. The study aims to sound information and evidences for the quality evaluation of Paridis Rhizoma, and also to provide a theoretical basis for the standard revision of Paridis Rhizoma in the future Chinese Pharmacopoeia.

Infrared thermography in the evaluation of meibomian gland dysfunction.

BACKGROUND/PURPOSE: To evaluate meibomian gland dysfunction (MGD) by infrared thermography. METHODS: An observational study was conducted at the Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan. Participants included 89 MGD patients (30 in Grade 1, 49 in Grade 2, and 10 in Grade 3) and 65 controls. The close-eye thermographic images of the eyelid were obtained noninvasively by infrared thermography. Temperatures at 8 regions of interest (ROIs) of the eyelid margin and a reference temperature at the center of the upper eyelid were measured. The temperature ratio was defined as the temperature of ROI divided by the reference temperature. RESULTS: Eyelid margin temperature measured by infrared thermography increased from temporal side (ROI 1) to the nasal side (ROI 8) of the eye in both MGD patients and control groups. The temperature ratios were significantly higher in MGD participants than in controls, especially at ROI 8. CONCLUSION: The eyelid margin temperature measured by infrared thermography was higher in MGD participants. Further development of this infrared thermography system may become a rapid and non-invasive tool for MGD screening.

Influence of ocular features and incision width on surgically induced astigmatism after cataract surgery.

PURPOSE: To identify factors associated with surgically induced astigmatism (SIA) following phacoemulsification. METHODS: Six hundred five eyes underwent phacoemulsification with a 2.2-mm (the 2.2-mm group, n = 248) or 2.75-mm (the 2.75-mm group, n = 357) superior limbal incision. Preoperative axial length, anterior chamber depth, corneal curvature, and intra-ocular pressure were measured. Corneal curvature and intraocular pressure were measured at 1 day, 1 week, and 1, 2, and 3 months postoperatively. SIA, corneal flattening, and torque were calculated using the Alpins method. The effect of preoperative corneal astigmatism meridian on SIA was also examined. Differences in SIA between the 2.2- and 2.75-mm groups were explored, and correlations between SIA and preoperative corneal astigmatism, anterior chamber depth, axial length, age, and intraocular pressure were analyzed. RESULTS: SIA, corneal flattening, and torque were smaller in the 2.2-mm group than in the 2.75-mm group at 1 week (P = .003, .006, and .014, respectively), but not statistically different thereafter. Higher preoperative corneal astigmatism, older age, and shallower anterior chamber depth were associated with greater SIA in both groups. The effect of astigmatism meridian on SIA was more noticeable in the 2.75-mm group. Shorter axial length and lower intraocular pressures were associated with greater SIA in the 2.75-mm group but not in the 2.2-mm group. CONCLUSIONS: Reducing limbal incision width and considering patient age, the meridian and magnitude of corneal astigmatism, anterior chamber depth, axial length, and intraocular pressure, and adjusting the flattening component of SIA input for toric intraocular lens power calculation could potentially improve the astigmatism control in refractive lens surgery.

Capturing multiple assistive technology use and its impact in later life: lessons learned from distinct measurement approaches.

PURPOSE: Assistive technology (AT) use is prevalent in older adulthood and can accommodate activity difficulties to support well-being. However, within the context of multiple activity difficulties and multiple technology use, it is unclear how to best assess their combined effects on older adults' health outcomes. This study proposed four distinct approaches to quantify multiple AT use and examined their respective impact in later life. MATERIAL AND METHODS: Using data from the 2015 round of the National Health and Aging Trends Study (n = 6,936), we compared four indices to summarize the state of multiple AT use among the U.S. older population: binary, item-specific, cumulative, and accommodative. Separate regression analyses tested the impact of each index on older adults' well-being and restricted participation in meaningful activities. RESULTS: In 2015, 59.9% of the respondents were identified as AT users. Among these users, 53.8% reported using two or more technologies when performing daily self-care and mobility activities. The implications of multiple AT use for health outcomes varied across the four indices. Approaches that captured elements of person-technology fit provided the most nuanced and actionable insights on the benefits of using AT to support well-being. CONCLUSIONS: ATs were commonly adopted by older adults in everyday activities. Overall, findings suggest that there are multiple approaches to conceptualize the independent, cumulative, or balanced effects of multiple AT use. Each measurement approach has unique implications for understanding the impacts of using ATs on older adults' health outcomes.

Multiple assistive technology (AT) use is observed and prevalent in later life, highlighting that there is great need for older adults to deploy different technologies to help with different daily activities.The concept of multiple AT use can be approached in various ways (e.g., where effects of each AT are independent, cumulative, or dependent on fit), with each conceptualization based on distinct assumptions and capable of serving different purposes in rehabilitation research.This study demonstrates that information on person-technology fit plays a critical role in helping rehabilitation engineers and clinical practitioners assess the effects of AT use on health and well-being outcomes among older adults.

The Impact of Disability and Assistive Technology Use on Well-Being in Later Life: Findings From the National Health and Aging Trends Study.

BACKGROUND AND OBJECTIVES: Although assistive technologies have the potential to bridge the gap between personal capabilities and environmental demands, they may not always fully accommodate disability. This study examined the implications of change in the extent of accommodation provided by assistive technology for well-being in older adulthood. RESEARCH DESIGN AND METHODS: Data from 5 waves (2015-2019) of the National Health and Aging Trends Study provided information on disability and assistive technology use among older adults aged 65 and older in the United States (n = 7,057). An eight-level index that jointly characterized the spectrum of disability and assistive technology use was applied to 7 activities of daily living (ADLs). Fixed-effects panel model assessed within-person associations between well-being and the extent of assistive technology accommodation along different levels of the disability spectrum. RESULTS: At baseline, bathing (28.7%; 95% confidence interval [CI]: 27.6, 29.8) and toileting (37.9%; 95% CI: 36.2, 39.6) were the 2 activities in which most older adults successfully accommodated their limitations with assistive technologies. Longitudinally, the level of support provided by assistive technology changed widely across activities and over time. Within-person analyses showed that for all ADLs except for eating, there was a significant decline in well-being when the adopted assistive technology no longer supported users' needs and successfully resolved their disabilities. DISCUSSION AND IMPLICATIONS: Our findings highlight the utility of technology-based interventions and underscore the imperative that assistive technologies attend to the specific needs of older adults and support independence in everyday activities.

Innovative utilization of ultra-wide field fundus images and deep learning algorithms for screening high-risk posterior polar cataract.

PURPOSE: To test a cataract shadow projection theory and validate it by developing a deep learning algorithm that enables automatic and stable posterior polar cataract (PPC) screening using fundus images. SETTING: Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei, Taiwan. DESIGN: Retrospective chart review. METHODS: A deep learning algorithm to automatically detect PPC was developed based on the cataract shadow projection theory. Retrospective data (n = 546) with ultra-wide field fundus images were collected, and various model architectures and fields of view were tested for optimization. RESULTS: The final model achieved 80% overall accuracy, with 88.2% sensitivity and 93.4% specificity in PPC screening on a clinical validation dataset (n = 103). CONCLUSIONS: This study established a significant relationship between PPC and the projected shadow, which may help surgeons to identify potential PPC risks preoperatively and reduce the incidence of posterior capsular rupture during cataract surgery.

Everyday Experiences of Physical Function and Awareness of Fall Risk in Older Adulthood.

Background and Objectives: Falls, the leading cause of death and disability among older adults, occur in daily life when the demands of daily activities surpass the ability to maintain balance. An estimated 30% of older adults misestimate their physical function, placing them at greater risk of falling. This study examined how experiences of physical function are linked to awareness of fall risk in daily life. Research Design and Methods: For 30 consecutive days following a fall-risk assessment, 41 older adults (observations = 1,135; 56% women; age: 65-91) self-assessed objective and subjective fall risk using a custom smartphone application. Alignment of objective and subjective fall risk was indexed as awareness of fall risk. Postural sway was measured by the application. Physical and mobility symptoms and fear of falling were reported daily. Results: At baseline, 49% of participants misestimated their fall risk. Awareness of fall risk varied from day to day and fall risk was misestimated on 40% of days. Multilevel multinomial models showed individual differences in the level of daily symptoms to increase the tendency to misestimate fall risk. Daily symptoms and fear of falling increased awareness of high fall risk, but daily symptoms threatened awareness of low fall risk. Discussion and Implications: Findings suggest that misestimation of fall risk is common in older adulthood and informed by appraisals of physical function. Fall prevention strategies could support older adults in understanding their everyday physical function and provide tools to adjust the demands of activities in daily life.

The Context of Caring and Concern for Falling Differentiate Which Mobile Fall Technology Features Chinese Family Caregivers Find Most Important.

Falls are not only a leading cause of death and disability, but also a strain on the capacity for caregivers to provide care. This study examined how the context of caregiving relates to the importance of caregiver-defined mobile fall prevention feature sets. A sample of 266 family caregivers, recruited from a Chinese social media platform, reported care for an older adult and interest in mobile fall prevention technology features. Factor analysis identified three caregiver-defined feature sets: automatic fall response, digitized fall prevention tools, and social features. Multiple regression showed caregivers' concern about falling was the most robust predictor of a feature set's importance. Poisson regression revealed that caregiver concern and assistance with instrumental activities of daily living were associated with rating more features as important. Our findings suggest that caregivers are interested in mobile fall prevention technologies that support older adults' independence while also alleviating concerns about falling.

Nucleus Near-Infrared (nNIR) Irradiation of Single A549 Cells Induces DNA Damage and Activates EGFR Leading to Mitochondrial Fission.

There has been great interest in identifying the biological substrate for light-cell interaction and their relations to cancer treatment. In this study, a near-infrared (NIR) laser is focused into the nucleus (nNIR) or cytoplasm (cNIR) of a single living cell by a high numerical aperture condenser to dissect the novel role of cell nucleus in mediating NIR effects on mitochondrial dynamics of A549 non-small cell lung cancer cells. Our analysis showed that nNIR, but not cNIR, triggered mitochondrial fission in 10 min. In contrast, the fission/fusion balance of mitochondria directly exposed to cNIR does not change. While the same phenomenon is also triggered by single molecular interactions between epidermal growth factor (EGF) and its receptor EGFR, pharmacological studies with cetuximab, PD153035, and caffeine suggest EGF signaling crosstalk to DNA damaging response to mediate rapid mitochondrial fission as a result of nNIR irradiation. These results suggest that nuclear DNA integrity is a novel biological target for cellular response to NIR.

Normalized ocular surface temperature models for tear film characteristics and dry eye disease evaluation.

PURPOSE: To construct normalized ocular surface temperature (NOST) models for different tear film characteristics and evaluate its potential in dry-eyes screening. METHODS: We included 227 right eyes of 227 patients. Tear film characteristics were categorized into 4 types according to fluorescein tear film breakup time (FTBUT) and Schirmer test results, namely type 1: FTBUT >5 s and Schirmer >5 mm; type 2: FTBUT ≤5 s and Schirmer >5 mm; type 3: FTBUT ≤5 s and Schirmer ≤5 mm; and type4: FTBUT >5 s and Schirmer ≤5 mm. Ocular surface temperature was measured by a video-thermographer. Mean temperatures of the central cornea were calculated from the videos of each frame during the 4-s blink interval. We first constructed individual NOST model for every tear characteristic. Participants were included for further analysis when their OSDI was ≥23, FTBUT ≤5 s, and Schirmer >5 mm. They were subdivided into short-BUT and short BUT with SPK subgroups according to the absence or presence of corneal fluorescein-stain. The NOST models of the normal, short-BUT and short BUT with SPK groups were separately constructed and the potential of screening analyzed via ROC curves. RESULTS: Each tear film type had a different NOST model. At 3 s after blinking, the order of NOST was type 4 >type 1 >type 3 >type 2. In dry-eye screening, the NOST was normal > short-BUT > short BUT with SPK. The NOST displayed a sensitivity 0.87, specificity 0.80, and AUC 0.88 for diagnosing short BUT with SPK. CONCLUSION: NOST models are useful in differentiating tear film characteristics and screening dry-eyes. It alleviates the discomfort and inconvenience encountered during conventional dry-eye diagnosis.

Two-Step Approach Using Degradable Magnesium to Inhibit Surface Biofilm and Subsequently Kill Planktonic Bacteria.

Bacterial infection remains a great risk in medical implantation surgery. In this paper, we found that degradable metals may be a feasible alternative option of antibacterial implantation materials. It is known that the spalling mechanism of magnesium (Mg) during degradation leads to Mg ions-induced alkaline environment, which is harmful to planktonic bacteria. In this study, we showed that alkaline pH environment is almost harmless to those adhesive bacteria protected in well-formed biofilms. Moreover, experimental results demonstrated that the biofilm formed in the place where Mg spalls are destroyed, releasing the covered bacteria to be planktonic in the alkaline environment. As a result, the colonization of biofilms continues to shrink during the degradation of Mg. It implies that if degradable metal is employed as implantation material, even if bacterial infection occurs, it may be possibly cured without second surgery.

Selective Regulation of Neurons, Glial Cells, and Neural Stem/Precursor Cells by Poly(allylguanidine)-Coated Surfaces.

Poly(allylguanidine) (PAG) was synthesized and characterized as a polycationic coating material for culturing neurons, glial cells, and neural stem/precursor cells (NSPCs) to apply PAG for neural tissue engineering. For comparison, poly-d-lysine (PDL), the golden benchmark of the neuron cell culture system, was also used in this study. When PAG was subjected to a mixed culture of neurons and glial cells, cell adhesion and neurite extension of neuronal cells were clearly observed but only few glial cells could be found alongside the neurons. Compared to PDL, the significantly lower density of the glial fibrillary acidic protein-positive cells implied that PAG suppressed the glial cell development. Likewise, PAG was demonstrated to dominate the differentiation of NSPCs principally into neurons. To investigate whether the different effects of PAG and PDL on neuron and glial cell behaviors resulted from the difference of guanidinium cations and ammonium cations, poly-l-arginine (PLA) was included and compared in this study. Similar to PDL, PLA supported high neuron and glial cell viability simultaneously. Consequently, glial cell growth and viability restrained on PAG was not only affected by the side-chain guanidino groups but also by the backbone structure property. The absence of the peptide structure in the backbone of PAG and the conformation of coated PAG on tissue culture polystyrene possibly determined the polycationic biomaterial to limit the growth of glial cells.

Association of the DISC1 and NRG1 genetic polymorphisms with schizophrenia in a Chinese population.

Polymorphisms in Disrupted-in-Schizophrenia 1 (DISC1) and Neuregulin 1 (NRG1) might be associated with schizophrenia; however, the conclusions of relevant studies were inconsistent across different ethnic populations. This population-based case-control study was carried out to determine whether polymorphisms in these two genes could be associated with schizophrenia in the Chinese population. A case-control study of 248 schizophrenia patients and 236 controls was performed with the Sequenom MassARRAY platform. The results revealed that the DISC1 rs821616 heterozygous (AT vs. AA: adjusted OR, 1.98, 95%CI: 1.30-3.02) and co-dominant (AT/TT vs. AA: adjusted OR=1.94; 95%CI: 1.29-2.92) patterns were associated with increased risk for developing schizophrenia in all participants and subgroups (stratified by sex and age at onset), respectively. Moreover, in the male subgroup, the DISC1 rs821597 genotype GA or GA/AA exhibited increased risk of schizophrenia. For NRG1 polymorphisms, in the early onset subgroup (≤25years), the rs3924999 G/G genotype was susceptible to schizophrenia. The interaction of DISC1 rs821616 T allele with the NRG1 rs3924999 A allele or that of DISC1 rs821597 A allele with NRG1 rs3924999 A allele had synergic effects on the development of schizophrenia. This study concluded that carriers of the DISC1 rs821616 T allele have increased risk for developing schizophrenia, and that the DISC1 rs821597 A allele was susceptible to schizophrenia for the male, and that there are marked interactions between the DISC1 rs821616 T and/or rs821597 A alleles and the NRG1 rs3924999 A allele for the development of schizophrenia.

Correlations among ocular surface temperature difference value, the tear meniscus height, Schirmer's test and fluorescein tear film break up time.

PURPOSE: To report the use of a thermographer for measuring ocular surface temperature, and to evaluate the correlation among the obtained temperature difference values (TDVs) and dry eye parameters (tear meniscus height (TMH); Schirmer's test results; fluorescent tear breakup time (FTBUT)). METHODS: Forty-three participants (age 40.2±14.7 years; range 21-67 years) from Far Eastern Memorial Hospital, Taiwan were recruited for the study. The surface temperature was measured at the centre of the ocular surface for 4 s after blinking. TDV was defined as the change in corneal surface temperature relative to that of the preceding eye opening, where TDV01, TDV02, TDV03, and TDV04 represent the values obtained 1, 2, 3, and 4 s after blinking, respectively. Anterior segment optical coherence tomography (AS-OCT) was employed to measure the lower TMH. Schirmer's test with topical anaesthetic was conducted to measure the basal tear secretion. The FTBUT was recorded using a digital camera. RESULTS: TDV measurement exhibited high reliability (intraclass correlation coefficient=0.91). TDV03 exhibited the highest significance and strongest positive correlation with the TMH (r=0.52, p=0.0003) and Schirmer's test value (r=0.39, p=0.008), whereas the TDV03-FTBUT correlation was non-significant. Age correlated negatively and significantly with the TDV (r= -0.35, p=0.021), TMH (r= -0.33, p=0.031), and Schirmer's test value (r= -0.31, p=0.044). TDV03 remained significantly correlated with the TMH and Schirmer's test value after adjustment for age. CONCLUSIONS: The thermographer was effective in capturing temperature changes in the ocular surface. The temperature difference 3 s after blinking appears to be correlated with lower TMH and Schirmer test values.

Direct observation and validation of fluorescein tear film break-up patterns by using a dual thermal-fluorescent imaging system.

The fluorescein tear film break-up test is a common tear film stability test for dry eye diagnosis. This test requires applying fluorescein sodium drops to a tear film to observe the tear film break-up. However, this test is limited by using the fluorescein sodium drops, which can induce reflex tearing and reduce the reliability of the diagnosis results. This paper proposes that tear film evaporation accelerates on the fluorescein tear film break-up area (FTBA), resulting in a lower temperature area (LTA) on the tear film. A dual modality system was established to capture the thermal and fluorescent image of fluorescein-stain tear films for 48 participants. Observations showed that the LTA and FTBA were highly correlated in their location (r = 0.82) and size (r = 0.91). This is first study to show that the FTBA and LTA are essentially the same region. This study demonstrated the feasibility of using the noncontact thermograph method to evaluate tear film stability without using a fluorescein sodium drop.

Noncontact detection of dry eye using a custom designed infrared thermal image system.

Dry eye syndrome is a common irritating eye disease. Current clinical diagnostic methods are invasive and uncomfortable for patients. This study developed a custom designed noncontact infrared (IR) thermal image system to measure the spatial and temporal variation of the ocular surface temperature over a 6-second eye-open period. This research defined two parameters: the temperature difference value and the compactness value to represent the temperature change and the irregularity of the temperature distribution on the tear film. Using these two parameters, this study achieved discrimination results for the dry eye and the normal eye groups; the sensitivity is 0.84, the specificity is 0.83, and the receiver operating characteristic area is 0.87. The results suggest that the custom designed IR thermal image system may be used as an effective tool for noncontact detection of dry eye.