Effects of Community Exercise Therapy on Metabolic, Brain, Physical, and Cognitive Function Following Stroke : A Randomized Controlled Pilot Trial

© The Author(s) 2014.Peer reviewedPostprintPostprin

Quantum Inequalities for the Electromagnetic Field

A quantum inequality for the quantized electromagnetic field is developed for observers in static curved spacetimes. The quantum inequality derived is a generalized expression given by a mode function expansion of the four-vector potential, and the sampling function used to weight the energy integrals is left arbitrary up to the constraints that it be a positive, continuous function of unit area and that it decays at infinity. Examples of the quantum inequality are developed for Minkowski spacetime, Rindler spacetime and the Einstein closed universe.Comment: 19 pages, 1 table and 1 figure. RevTex styl

Exercise Induces Peripheral Muscle But Not Cardiac Adaptations After Stroke: A Randomized Controlled Pilot Trial

Objective To explore the physiological factors affecting exercise-induced changes in peak oxygen consumption and function poststroke. Design Single-center, single-blind, randomized controlled pilot trial. Setting Community stroke services. Participants Adults (N=40; age>50y; independent with/without stick) with stroke (diagnosed >6mo previously) were recruited from 117 eligible participants. Twenty participants were randomized to the intervention group and 20 to the control group. No dropouts or adverse events were reported. Interventions Intervention group: 19-week (3times/wk) progressive mixed (aerobic/strength/balance/flexibility) community group exercise program. Control group: Matched duration home stretching program. Main Outcome Measures (1) Pre- and postintervention: maximal cardiopulmonary exercise testing with noninvasive (bioreactance) cardiac output measurements; and (2) functional outcome measures: 6-minute walk test; timed Up and Go test, and Berg Balance Scale. Results Exercise improved peak oxygen consumption (18±5 to 21±5mL/(kg⋅min); P<.01) and peak arterial-venous oxygen difference (9.2±2.7 to 11.4±2.9mL of O2/100mL of blood; P<.01), but did not alter cardiac output (17.2±4 to 17.7±4.2L/min; P=.44) or cardiac power output (4.8±1.3 to 5.0±1.35W; P=.45). A significant relation existed between change in peak oxygen consumption and change in peak arterial-venous oxygen difference (r=.507; P<.05), but not with cardiac output. Change in peak oxygen consumption did not strongly correlate with change in function. Conclusions Exercise induced peripheral muscle, but not cardiac output, adaptations after stroke. Implications for stroke clinical care should be explored further in a broader cohort

Enterococcus faecalis overcomes foreign body-mediated inflammation to establish urinary tract infections

Urinary catheterization elicits major histological and immunological changes that render the bladder susceptible to microbial invasion, colonization, and dissemination. However, it is not understood how catheters induce these changes, how these changes act to promote infection, or whether they may have any protective benefit. In the present study, we examined how catheter-associated inflammation impacts infection by Enterococcus faecalis, a leading cause of catheter-associated urinary tract infection (CAUTI), a source of significant societal and clinical challenges. Using a recently optimized murine model of foreign body-associated UTI, we found that the implanted catheter itself was the primary inducer of inflammation. In the absence of the silicone tubing implant, E. faecalis induced only minimal inflammation and was rapidly cleared from the bladder. The catheter-induced inflammation was only minimally altered by subsequent enterococcal infection and was not suppressed by inhibitors of the neurogenic pathway and only partially by dexamethasone. Despite the robust inflammatory response induced by urinary implantation, E. faecalis produced biofilm and high bladder titers in these animals. Induction of inflammation in the absence of an implanted catheter failed to promote infection, suggesting that the presence of the catheter itself is essential for E. faecalis persistence in the bladder. Immunosuppression prior to urinary catheterization enhanced E. faecalis colonization, suggesting that implant-mediated inflammation contributes to the control of enterococcal infection. Thus, this study underscores the need for novel strategies against CAUTIs that seek to reduce the deleterious effects of implant-mediated inflammation on bladder homeostasis while maintaining an active immune response that effectively limits bacterial invaders

Object Substitution Masking in Schizophrenia: An Event-Related Potential Analysis

Schizophrenia patients exhibit deficits on visual processing tasks, including visual backward masking, and these impairments are related to deficits in higher-level processes. In the current study we used electroencephalography techniques to examine successive stages and pathways of visual processing in a specialized masking paradigm, four-dot masking, which involves masking by object substitution. Seventy-six schizophrenia patients and 66 healthy controls had event-related potentials (ERPs) recorded during four-dot masking. Target visibility was manipulated by changing stimulus onset asynchrony (SOA) between the target and mask, such that performance decreased with increasing SOA. Three SOAs were used: 0, 50, and 100 ms. The P100 and N100 perceptual ERPs were examined. Additionally, the visual awareness negativity (VAN) to correct vs. incorrect responses, an index of reentrant processing, was examined for SOAs 50 and 100 ms. Results showed that patients performed worse than controls on the behavioral task across all SOAs. The ERP results revealed that patients had significantly smaller P100 and N100 amplitudes, though there was no effect of SOA on either component in either group. In healthy controls, but not patients, N100 amplitude correlated significantly with behavioral performance at SOAs where masking occurred, such that higher accuracy correlated with a larger N100. Healthy controls, but not patients, exhibited a larger VAN to correct vs. incorrect responses. The results indicate that the N100 appears to be related to attentional effort in the task in controls, but not patients. Considering that the VAN is thought to reflect reentrant processing, one interpretation of the findings is that patients’ lack of VAN response and poorer performance may be related to dysfunctional reentrant processing

Optimisation of absorption efficiency for varying dielectric spherical nanoparticles

Abstract-In this paper we compare the optical absorption for nanospheres made from a range of transition and alkali metals from Li (A=3) to Au (A=79). Numerical solutions to Mie theory were used to calculate the absorption efficiency, Q abs , for nanospheres varying in radii between 5 nm and 100 nm in vacuum. We show that, although gold is the most commonly used nanoparticle material, its absorption efficiency at the plasmon resonance is not as strong as materials such as the alkali metals. Of all the materials tried, potassium spheres with a radius of 21 nm have an optimum absorption efficiency of 14.7. In addition we also show that, unlike gold, the wavelength of the plasmon peak in other materials is sensitive to the sphere radius. In potassium the peak position shifts by 100 nm for spheres ranging from 5 nm to 65 nm, the shift is less than 10 nm for gold spheres

Retired A Stars and Their Companions. III. Comparing the Mass-Period Distributions of Planets Around A-Type Stars and Sun-Like Stars

We present an analysis of ~5 years of Lick Observatory radial velocity measurements targeting a uniform sample of 31 intermediate-mass subgiants (1.5 < M*/Msun < 2.0) with the goal of measuring the occurrence rate of Jovian planets around (evolved) A-type stars and comparing the distributions of their orbital and physical characteristics to those of planets around Sun-like stars. We provide updated orbital solutions incorporating new radial velocity measurements for five known planet-hosting stars in our sample; uncertainties in the fitted parameters are assessed using a Markov Chain Monte Carlo method. The frequency of Jovian planets interior to 3 AU is 26 (+9,-8)%, which is significantly higher than the ~5-10% frequency observed around solar-mass stars. The median detection threshold for our sample includes minimum masses down to {0.2, 0.3, 0.5, 0.6, 1.3} MJup within {0.1, 0.3, 0.6, 1.0, 3.0} AU. To compare the properties of planets around intermediate-mass stars to those around solar-mass stars we synthesize a population of planets based on the parametric relationship dN ~ M^{alpha}P^{beta} dlnM dlnP, the observed planet frequency, and the detection limits we derived. We find that the values of alpha and beta for planets around solar-type stars from Cumming et al. fail to reproduce the observed properties of planets in our sample at the 4 sigma level, even when accounting for the different planet occurrence rates. Thus, the properties of planets around A stars are markedly different than those around Sun-like stars, suggesting that only a small (~ 50%) increase in stellar mass has a large influence on the formation and orbital evolution of planets.Comment: Accepted by the Astrophysical Journal; 15 pages, 15 figure

Vacuum Polarization and Energy Conditions at a Planar Frequency Dependent Dielectric to Vacuum Interface

The form of the vacuum stress-tensor for the quantized scalar field at a dielectric to vacuum interface is studied. The dielectric is modeled to have an index of refraction that varies with frequency. We find that the stress-tensor components, derived from the mode function expansion of the Wightman function, are naturally regularized by the reflection and transmission coefficients of the mode at the boundary. Additionally, the divergence of the vacuum energy associated with a perfectly reflecting mirror is found to disappear for the dielectric mirror at the expense of introducing a new energy density near the surface which has the opposite sign. Thus the weak energy condition is always violated in some region of the spacetime. For the dielectric mirror, the mean vacuum energy density per unit plate area in a constant time hypersurface is always found to be positive (or zero) and the averaged weak energy condition is proven to hold for all observers with non-zero velocity along the normal direction to the boundary. Both results are found to be generic features of the vacuum stress-tensor and not necessarily dependent of the frequency dependence of the dielectric.Comment: 16 pages, 4 figures, Revtex style Minor typographic corrections to equations and tex

Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials: Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-MOST)

&lt;p&gt;&lt;b&gt;Background and Purpose:&lt;/b&gt; The Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-MOST) unadjusted results demonstrated that intravenous alteplase is well tolerated and that the effects were comparable with those seen in randomized, controlled trials (RCTs) when used in routine clinical practice within 3 hours of ischemic stroke onset. We aimed to identify outcome predictors and adjust the outcomes of the SITS-MOST to the baseline characteristics of RCTs.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods:&lt;/b&gt; The study population was SITS-MOST (n=6483) and pooled RCTs (n=464) patients treated with intravenous alteplase within 3 hours of stroke onset. Multivariable, backward stepwise regression analyses (until P&#8804;0.10) were performed to identify the outcome predictors for SITS-MOST. Variables appearing either in the final multivariable model or differing (P&#60;0.10) between SITS-MOST and RCTs were included in the prediction model for the adjustment of outcomes. Main outcome measures were symptomatic intracerebral hemorrhage, defined as National Institutes of Health Stroke Scale deterioration &#8805;1 within 7 days with any hemorrhage (RCT definition), mortality, and independency as defined by modified Rankin Score of 0 to 2 at 3 months.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; The adjusted proportion of symptomatic intracerebral hemorrhage for SITS-MOST was 8.5% (95% CI, 7.9 to 9.0) versus 8.6% (6.3 to 11.6) for pooled RCTs; mortality was 15.5% (14.7 to 16.2) versus 17.3% (14.1 to 21.1); and independency was 50.4% (49.6 to 51.2) versus 50.1% (44.5 to 54.7), respectively. In the multivariable analysis, older age, high blood glucose, high National Institutes of Health Stroke Scale score, and current infarction on imaging scans were related to poor outcome in all parameters. Systolic blood pressure, atrial fibrillation, and weight were additional predictors of symptomatic intracerebral hemorrhage. Current smokers had a lower rate of symptomatic intracerebral hemorrhage. Disability before current stroke (modified Rankin Score 2 to 5), diastolic blood pressure, antiplatelet other than aspirin, congestive heart failure, patients treated in new centers, and male sex were related to high mortality at 3 months.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; The adjusted outcomes from SITS-MOST were almost identical to those in relevant RCTs and reinforce the conclusion drawn previously in the unadjusted analysis. We identified several important outcome predictors to better identify patients suitable for thrombolysis.&lt;/p&gt