Preconditioning tDCS facilitates subsequent tDCS effect on skill acquisition in older adults.

Functional motor declines that often occur with advancing age-including reduced efficacy to learn new skills-can have a substantial impact on the quality of life. Recent studies using noninvasive brain stimulation indicate that priming the corticospinal system by lowering the threshold for the induction of long-term potentiation-like plasticity before skill training may facilitate subsequent skill learning. Here, we used "priming" protocol, in which we used transcranial direct current stimulation (tDCS) applying the cathode over the primary motor cortex (M1) before the anode placed over M1 during unimanual isometric force control training (FORCEtraining). Older individuals who received tDCS with the cathode placed over M1 before tDCS with the anode placed over M1 concurrent with FORCEtraining showed greater skill improvement and corticospinal excitability increases following the tDCS/FORCEtraining protocol compared with both young and older individuals who did not receive the preceding tDCS with the cathode placed over M1. The results suggested that priming tDCS protocols may be used in clinical settings to improve motor function and thus maintain the functional independence of older adults

Clean environments as a social norm: a field experiment on cigarette littering

Cigarette littering in public spaces is an environmental and aesthetic problem. Broken windows theory posits that visible signs of anti-social behavior such as littering create the perception of a social norm in built environments. Cigarette butts on the ground then encourage people to drop theirs as well. We test this theory on benches of a university campus in a field experiment with two treatments: (1) a clean environment with no cigarette butts on the ground and (2) a dirty environment with 25 cigarette butts on the ground. Our outcome variable is the number of additional cigarette butts on the ground after two hours. We find a small effect of approximately 0.5 butts less per 2-hour period on clean grounds. Increased cleaning efforts can thus reduce littering, but the effect is probably too small to justify additional cleaning costs

Enhanced motor learning following task-concurrent dual transcranial direct current stimulation.

OBJECTIVE:Transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) has beneficial effects on motor performance and motor learning in healthy subjects and is emerging as a promising tool for motor neurorehabilitation. Applying tDCS concurrently with a motor task has recently been found to be more effective than applying stimulation before the motor task. This study extends this finding to examine whether such task-concurrent stimulation further enhances motor learning on a dual M1 montage. METHOD:Twenty healthy, right-handed subjects received anodal tDCS to the right M1, dual tDCS (anodal current over right M1 and cathodal over left M1) and sham tDCS in a repeated-measures design. Stimulation was applied for 10 mins at 1.5 mA during an explicit motor learning task. Response times (RT) and accuracy were measured at baseline, during, directly after and 15 mins after stimulation. Motor cortical excitability was recorded from both hemispheres before and after stimulation using single-pulse transcranial magnetic stimulation. RESULTS:Task-concurrent stimulation with a dual M1 montage significantly reduced RTs by 23% as early as with the onset of stimulation (p<0.01) with this effect increasing to 30% at the final measurement. Polarity-specific changes in cortical excitability were observed with MEPs significantly reduced by 12% in the left M1 and increased by 69% in the right M1. CONCLUSION:Performance improvement occurred earliest in the dual M1 condition with a stable and lasting effect. Unilateral anodal stimulation resulted only in trendwise improvement when compared to sham. Therefore, task-concurrent dual M1 stimulation is most suited for obtaining the desired neuromodulatory effects of tDCS in explicit motor learning

The experimental protocol for every session.

<p>The measurements of reaction times the motor task (RT) and the measurements of motor cortical excitability (MEP) were acquired following the same systematic order as shown in this diagram. There were a total of four measurements of motor performance and three measurements of motor cortical excitability.</p

Evolution of reaction times at baseline (PRE), during tDCS (DURING) and at post-intervention (POST1 and POST2) for each active stimulation condition (anodal, dual) compared to sham.

<p>* = p<0.05 and ** = p<0.01 from the ANOVA; # = p<0.05 and ## = p<0.01 from the ANCOVA; Error bars are 95% confidence intervals (CI) calculated on the transformed data and transformed back to the original scale.</p

Changes in motor cortical excitability in the LEFT hemisphere for each stimulation condition (anodal, dual and sham).

<div><p>There was a significant reduction in MEPs in the dual condition in the left hemisphere.</p> <p>**=p<0.01, *=p<0.05; Error bars are 95% confidence intervals (CI) calculated on the transformed data and transformed back to the original scale.</p></div

There was very little fluctuation of accuracy across the time points and across stimulation conditions.

<p>Error bars are 95% confidence intervals (CI) calculated on the transformed data and transformed back to the original scale.</p

Assistive technologies for home NIV in patients with COPD: feasibility and positive experience with remote-monitoring and volume-assured auto-EPAP NIV mode

Background: Outcomes for patients with chronic obstructive pulmonary disease (COPD) with persistent hypercapnic respiratory failure are improved by long-term home non-invasive ventilation (NIV). Provision of home-NIV presents clinical and service challenges. The aim of this study was to evaluate outcomes of home-NIV in hypercapnic patients with COPD who had been set-up at our centre using remote-monitoring and iVAPS-autoEPAP NIV mode (Lumis device, ResMed). Methods: Retrospective analysis of a data set of 46 patients with COPD who commenced remote-monitored home-NIV (AirView, ResMed) between February 2017 and January 2018. Events including time to readmission or death at 12 months were compared with a retrospectively identified cohort of 27 patients with hypercapnic COPD who had not been referred for consideration of home-NIV. Results: The median time to readmission or death was significantly prolonged in patients who commenced home-NIV (median 160 days, 95% CI 69.38 to 250.63) versus the comparison cohort (66 days, 95% CI 21.9 to 110.1; p&lt;0.01). Average time to hospital readmission was 221 days (95% CI, 47.77 to 394.23) and 70 days (95% CI, 55.31 to 84.69; p&lt;0.05), respectively. Median decrease in bicarbonate level of 4.9 mmol/L (p&lt;0.0151) and daytime partial pressure of carbon dioxide 2.2 kPa (p&lt;0.032) in home-NIV patients with no required increase in nurse home visits is compatible with effectiveness of this service model. Median reduction of 14 occupied bed days per annum was observed per patient who continued home-NIV throughout the study period (N=32). Conclusion: These findings demonstrate the feasibility and provide initial utility data for a technology-assisted service model for the provision of home-NIV therapy for patients with COPD