TEMPORAL NEUROMUSCULAR ALTERATIONS OF THE QUADRICEPS AFTER UNILATERAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Objective: The primary aim of this research was to examine the temporal pattern of neuromuscular quadriceps deficits in both the involved and uninvolved limbs of patients assigned to the control group after anterior cruciate ligament reconstruction (ACLr), by assessing quadriceps strength, voluntary activation, and corticomotor excitability prior to surgery (baseline), three months after ACLr, and six months after ACLr. A secondary aim of this research was to determine whether quadriceps strength, voluntary activation, and/or corticomotor excitability assessed in patients prior to ACLr and/or at three months after surgery, is predictive of lower extremity postural control and/or self-reported function at six months after ACLr. Lastly, a tertiary aim of this research was to determine if a 12-week home-based neuromuscular electrical stimulation (Home-NMES) program elicits greater bilateral improvements in quadriceps strength, voluntary activation, and corticomotor excitability of patients at three and six months after ACLr compared to a 12-week standard home-exercise program (control group). Participants: Fifty patients scheduled to undergo unilateral ACLr were randomly allocated to the home-NMES group (19 Female, 6 Male; age: 18.9 ± 5.4 years; height: 170.8 ± 9.7 cm; weight: 74.6 ± 18.5 kg; 28.0±20.0 days-post-injury) or control group (14 Female, 11 Male; age: 19.4 ± 4.5 years; height: 171.1 ± 11.5 cm; weight: 70.7 ± 11.9 kg). Methods: A randomized clinical trial design was used in this study. Prior to ACLr, isometric quadriceps strength and voluntary quadriceps activation were assessed in both limbs of patients, and corticomotor excitability was assessed in the involved limb. Three days after ACLr, both groups were instructed to begin their allocated interventions. The Home-NMES group administered NMES to their involved limb’s quadriceps three sessions a day for 15 minutes, and five days a week for 12 weeks using a portable NMES device. The control group was treated according to the current standard-of-care, but they were also instructed to perform volitional isometric quadriceps contractions for the same duration and frequency as the Home-Based NMES protocol. The outcomes measures were reassessed in both groups at three and six months post-ACLr. Main Outcome Measures: Quadriceps strength and voluntary activation were assessed using maximal voluntary isometric contractions and the superimposed burst technique, respectively. Normalized peak knee extension torque and central activation ratio were used to quantify isometric quadriceps strength and activation, respectively. Corticomotor excitability was evaluated with transcranial magnetic stimulation, and quantified with active motor threshold). The Y-balance test anterior reach (YBT-A) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess the patients lower extremity knee function at six months post-ACLr. Statistical Analyses: Specific Aim 1: A 2x3 (limb x time) mixed model, ANOVA with repeated measures was performed in the control group to assess differences between the involved limb and the uninvolved limb for isometric quadriceps strength, and voluntary quadriceps activation over time. A one-way mixed model, ANOVA with repeated measures was performed in the control group to assess differences in corticomotor excitability over time. Post-hoc comparisons were performed when appropriate. Specific Aim 2: Separate, mixed model, linear regression analyses were performed in the control group (involved limb) to determine the effect that the neuromuscular quadriceps outcome measures assessed at baseline and 3 months post-ACLr, had on lower extremity knee functional outcome measures assessed at 6 months post-ACLr. Specific Aim 3: A 2x2x3 (group x limb x time) mixed model, ANOVA with repeated measures was performed to assess group differences between the involved limb and the uninvolved limb in isometric quadriceps strength, and voluntary quadriceps activation over time. A 2x3 (group x time) mixed model, ANOVA with repeated measures was performed to assess group differences in corticomotor excitability over time. Post-hoc comparisons were performed when appropriate. Results: Aim 1: Patients demonstrated lower quadriceps strength on their involved limb compared to their uninvolved limb at baseline, three months post-ACLr, and six months post-ACLr. Quadriceps strength progressively decreased in the involved limb of patients from baseline to 3 months post-ACLr, baseline to 6 months post-ACLr, and increased from 3 months to 6 months post-ACLr. Quadriceps strength was also decreased in the uninvolved limb of patients from baseline to 6 months post-ACLr. ). Irrespective of when it was assessed, voluntary quadriceps activation was higher in the involved limb of patients compared to their uninvolved limb. There were no changes in corticomotor excitability of the involved limb over time. Specific Aim 2: The quadriceps strength of patients at three months post-ACLr had a significant positive effect on their 6-month YBT-A performance KOOS score. ). Neither voluntary quadriceps activation or corticomotor excitability or AMT (at baseline or 3-month post-ACLr) had a significant effect on any of the 6-month lower extremity functional outcome measures. Specific Aim 3: Irrespective of limb or when it was assessed, quadriceps strength was higher in the control group compared to the Home-NMES group. Both groups demonstrated lower quadriceps strength on their involved limbs compared to their uninvolved limbs at baseline, three months post-ACLr, and six months post-ACLr. Quadriceps progressively decreased in the involved limbs of both groups from baseline to three months post-ACLr and baseline to six months post-ACLr, and increased from three months to six months post- ACLr. At baseline, voluntary quadriceps activation was higher in the involved limbs of both groups compared to their uninvolved limbs. There were no group differences or changes over time observed in the involved limb of both groups with corticomotor excitability. Conclusion: Although quadriceps weakness is more apparent in the involved limb of patients after ACLr, the quadriceps strength of their uninvolved limb was also affected. Clinicians are encouraged to not rely on a quadriceps strength limb symmetry index when making return-sport-decisions for their patients after recovering from ACLr. The quadriceps in the uninvolved limb of patients demonstrated more inhibition, which may explain the quadriceps strength deficits observed in the uninvolved limb of patients following ACLr. To reduce the risk of subsequent injury upon return-to-sport and protect against the development of knee OA, we recommend that clinicians incorporate bilateral interventions aimed at restoring quadriceps strength and disinhibiting the quadriceps. Intensive quadriceps strengthening should be performed in the early stages of ACLr rehabilitation, so that lower extremity function can be improved in patients later on. Lastly, the effectiveness of home-based NMES as a modality for restoring quadriceps strength and activation in patients after ACLr is inconclusive. Home-based NMES provides patients with the ability to receive higher doses of NMES to the quadriceps; but its effectiveness may be limited by low contraction intensities and poor treatment compliance in patients

Magneto-elastic oscillations of neutron stars: exploring different magnetic field configurations

We study magneto-elastic oscillations of highly magnetized neutron stars (magnetars) which have been proposed as an explanation for the quasi-periodic oscillations (QPOs) appearing in the decaying tail of the giant flares of soft gamma-ray repeaters (SGRs). We extend previous studies by investigating various magnetic field configurations, computing the Alfv\'en spectrum in each case and performing magneto-elastic simulations for a selected number of models. By identifying the observed frequencies of 28 Hz (SGR 1900+14) and 30 Hz (SGR 1806-20) with the fundamental Alfv\'en QPOs, we estimate the required surface magnetic field strength. For the magnetic field configurations investigated (dipole-like poloidal, mixed toroidal-poloidal with a dipole-like poloidal component and a toroidal field confined to the region of field lines closing inside the star, and for poloidal fields with an additional quadrupole-like component) the estimated dipole spin-down magnetic fields are between 8x10^14 G and 4x10^15 G, in broad agreement with spin-down estimates for the SGR sources producing giant flares. A number of these models exhibit a rich Alfv\'en continuum revealing new turning points which can produce QPOs. This allows one to explain most of the observed QPO frequencies as associated with magneto-elastic QPOs. In particular, we construct a possible configuration with two turning points in the spectrum which can explain all observed QPOs of SGR 1900+14. Finally, we find that magnetic field configurations which are entirely confined in the crust (if the core is assumed to be a type I superconductor) are not favoured, due to difficulties in explaining the lowest observed QPO frequencies (f<30 Hz).Comment: 21 pages, 16 figures, 6 tables, matched to version accepted by MNRAS with extended comparison/discussion to previous wor

Magneto-elastic torsional oscillations of magnetars

We extend a general-relativistic ideal magneto-hydrodynamical code to include the effects of elasticity. Using this numerical tool we analyse the magneto-elastic oscillations of highly magnetised neutron stars (magnetars). In simulations without magnetic field we are able to recover the purely crustal shear oscillations within an accuracy of about a few per cent. For dipole magnetic fields between 5 x 10^13 and 10^15 G the Alfv\'en oscillations become modified substantially by the presence of the crust. Those quasi-periodic oscillations (QPOs) split into three families: Lower QPOs near the equator, Edge QPOs related to the last open field line and Upper QPOs at larger distance from the equator. Edge QPOs are called so because they are related to an edge in the corresponding Alfv\'en continuum. The Upper QPOs are of the same kind, while the Lower QPOs are turning-point QPOs, related to a turning point in the continuous spectrum.Comment: 6 pages, 1 figure, 1 table, Proceedings of NEB14, to appear in J. Phys.: Conf. Se

The Relationship Between Implementation of School-Wide Positive Behavior Intervention and Supports and Performance on State Accountability Measures

This study examined data from 96 schools in a Southeastern U.S. state participating in training and/or coaching on School-Wide Positive Behavioral Interventions and Supports (SWPBIS) provided by the State Personnel Development Grant (SPDG) in their state. Schools studied either received training only (“non-intensive” sites) or training and on-site coaching (“intensive” sites). Fidelity of implementation was self-evaluated by both types of schools using the Benchmarks of Quality (BOQ). Some schools were also externally evaluated using the School-Wide Evaluation Tool (SET), with those scoring 80% or higher determined “model sites.” Using an independent sample t-test, analyses revealed statistically significant differences between intensive and nonintensive schools’ Quality of Distribution Index (QDI) scores and between model sites and nonmodel sites on QDI scores. Correlations were performed to determine whether the fidelity of implementation of SWPBIS as measured by the BOQ was related to any of the state’s accountability measures: performance classification, QDI, or growth

Comparative Characterization of Gluten and Hydrolyzed Wheat Proteins

Hydrolyzed wheat proteins (HWPs) are widely used as functional ingredients in foods and cosmetics, because of their emulsifying and foaming properties. However, in individuals suffering from celiac disease or wheat allergy, HWPs may have a modified immunoreactivity compared to native gluten due to changes in molecular structures. Although a variety of HWPs are commercially available, there are no in-depth comparative studies that characterize the relative molecular mass (M$_{r}$) distribution, solubility, and hydrophilicity/hydrophobicity of HWPs compared to native gluten. Therefore, we aimed to fill this gap by studying the above characteristics of different commercial HWP and gluten samples. Up to 100% of the peptides/proteins in the HWP were soluble in aqueous solution, compared to about 3% in native gluten. Analysis of the Mr distribution indicated that HWPs contained high percentages of low-molecular-weight peptides/proteins and also deamidated glutamine residues. We also found considerable differences between the seven HWPs studied, so that each HWP needs to be studied in detail to help explain its potential immunoreactivit

Synthetic spectra of H Balmer and HeI absorption lines. I: Stellar library

We present a grid of synthetic profiles of stellar H Balmer and HeI lines at optical wavelengths with a sampling of 0.3 A. The grid spans a range of effective temperature 4000 K < Teff < 50000 K, and gravity 0.0 < log g < 5.0 at solar metallicity. For Teff > 25000 K, NLTE stellar atmosphere models are computed using the code TLUSTY (Hubeny 1988). For cooler stars, Kurucz (1993) LTE models are used to compute thesynthetic spectra. The grid includes the profiles of the high-order hydrogen Balmer series and HeI lines for effective temperatures and gravities that have not been previously synthesized. The behavior of H8 to H13 and HeI 3819 with effective temperature and gravity is very similar to that of the lower terms of the series (e.g. Hb) and the other HeI lines at longer wavelengths; therefore, they are suited for the determination of the atmospheric parameters of stars. These lines are potentially important to make predictions for these stellar absorption features in galaxies with active star formation. Evolutionary synthesis models of these lines for starburst and post-starburst galaxies are presented in a companion paper. The full set of the synthetic stellar spectra is available for retrieval at our website http://www.iaa.es/ae/e2.html and http://www.stsci.edu/science/starburst/ or on request from the authors at [email protected]: To be published in ApJS. 28 pages and 12 figure

Postprandial serum endotoxin in healthy humans is modulated by dietary fat in a randomized, controlled, cross-over study

Background: High-fat diets may contribute to metabolic disease via postprandial changes in serum endotoxin and inflammation. It is unclear how dietary fat composition may alter these parameters. We hypothesized that a meal rich in n-3 (ω3) fatty acids would reduce endotoxemia and associated inflammation but a saturated or n-6 (ω6) fatty acid-rich meal would increase postprandial serum endotoxin concentrations and systemic inflammation in healthy adults. Methods: Healthy adults (n = 20; mean age 25 ± 3.2 S.D. years) were enrolled in this single-blind, randomized, cross-over study. Participants were randomized to treatment and reported to the laboratory, after an overnight fast, on four occasions separated by at least one week. Participants were blinded to treatment meal and consumed one of four isoenergetic meals that provided: 1) 20 % fat (control; olive oil) or 35 % fat provided from 2) n-3 (ω3) (DHA = 500 mg; fish oil); 3) n-6 (ω6) (7.4 g; grapeseed oil) or 4) saturated fat (16 g; coconut oil). Baseline and postprandial blood samples were collected. Primary outcome was defined as the effect of treatment meal on postprandial endotoxemia. Serum was analyzed for metabolites, inflammatory markers, and endotoxin. Data from all 20 participants were analyzed using repeated-measures ANCOVA. Results: Participant serum endotoxin concentration was increased during the postprandial period after the consumption of the saturated fat meal but decreased after the n-3 meal (p  0.05). There was no treatment meal effect on participant postprandial serum biomarkers of inflammation. Postprandial serum triacylglycerols were significantly elevated following the n-6 meal compared to the n-3 meal. Non-esterified fatty acids were significantly increased after consumption of the saturated fat meal compared to other treatment meals. Conclusions: Meal fatty acid composition modulates postprandial serum endotoxin concentration in healthy adults. However, postprandial endotoxin was not associated with systemic inflammation in vivo. Trial registration: This study was retrospectively registered at clinicaltrials.gov as NCT02521779 on July 28, 2015

Constraining relativistic models through heavy ion collisions

Relativistic models can be successfully applied to the description of compact star properties in nuclear astrophysics as well as to nuclear matter and finite nuclei properties, these studies taking place at low and moderate temperatures. Nevertheless, all results are model dependent and so far it is unclear whether some of them should be discarded. Moreover, in the regime of hot hadronic matter very few calculations exist using these relativistic models, in particular when applied to particle yields in heavy ion collisions. In the present work we comment on the known constraints that can help the selection of adequate models in this regime and investigate the main differences that arise when the particle production during a Au+Au collision at RHIC is calculated with different models.Comment: 9 pages, 1 figure, 3 table

Magnetorotational supernovae: a nucleosynthetic analysis of sophisticated 3D models

Magnetorotational supernovae are a rare type of core-collapse supernovae where the magnetic field and rotation play a central role in the dynamics of the explosion. We present the post-processed nucleosynthesis of state-of-the-art neutrino-MHD supernova models that follow the post explosion evolution for few seconds. We find three different dynamical mechanisms to produce heavy r-process elements: (i) a prompt ejection of matter right after core bounce, (ii) neutron-rich matter that is ejected at late times due to a reconfiguration of the protoneutronstar shape, (iii) small amount of mass ejected with high entropies in the centre of the jet. We investigate total ejecta yields, including the ones of unstable nuclei such as 26Al, 44Ti, 56Ni, and 60Fe. The obtained 56Ni masses vary between 0.01−1M⊙⁠. The latter maximum is compatible with hypernova observations. Furthermore, all of our models synthesize Zn masses in agreement with observations of old metal-poor stars. We calculate simplified light curves to investigate whether our models can be candidates for superluminous supernovae. The peak luminosities obtained from taking into account only nuclear heating reach up to a few ∼1043ergs−1⁠. Under certain conditions, we find a significant impact of the 66Ni decay chain that can raise the peak luminosity up to ∼38 percent compared to models including only the 56Ni decay chain. This work reinforces the theoretical evidence on the critical role of magnetorotational supernovae to understand the occurrence of hypernovae, superluminous supernovae, and the synthesis of heavy elements