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Doren S, Schwab SM, Bigner K, Calvelage J, Preston K, Laughlin A, Drury C, Tincher B, Carl D, Awosika OO, Boyne P. Evaluating the Neural Underpinnings of Motivation for Walking Exercise. Phys Ther 2024; 104:pzad159. [PMID: 37980613 PMCID: PMC10939334 DOI: 10.1093/ptj/pzad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/19/2023] [Accepted: 09/13/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Motivation is critically important for rehabilitation, exercise, and motor performance, but its neural basis is poorly understood. Recent correlational research suggests that the dorsomedial prefrontal cortex (dmPFC) may be involved in motivation for walking activity and/or descending motor output. This study experimentally evaluated brain activity changes in periods of additional motivation during walking exercise and tested how these brain activity changes relate to self-reported exercise motivation and walking speed. METHODS Adults without disability (N = 26; 65% women; 25 [standard deviation = 5] years old) performed a vigorous exercise experiment involving 20 trials of maximal speed overground walking. Half of the trials were randomized to include "extra-motivation" stimuli (lap timer, tracked best lap time, and verbal encouragement). Wearable near-infrared spectroscopy measured oxygenated hemoglobin responses from frontal lobe regions, including the dmPFC, primary sensorimotor, dorsolateral prefrontal, anterior prefrontal, supplementary motor, and dorsal premotor cortices. RESULTS Compared with standard trials, participants walked faster during extra-motivation trials (2.43 vs 2.67 m/s; P < .0001) and had higher oxygenated hemoglobin responses in all tested brain regions, including dmPFC (+842 vs +1694 μM; P < .0001). Greater dmPFC activity was correlated with more self-determined motivation for exercise between individuals (r = 0.55; P = .004) and faster walking speed between trials (r = 0.18; P = .0002). dmPFC was the only tested brain region that showed both of these associations. CONCLUSION Simple motivational stimuli during walking exercise seem to upregulate widespread brain regions. Results suggest that dmPFC may be a key brain region linking affective signaling to motor output. IMPACT These findings provide a potential biologic basis for the benefits of motivational stimuli, elicited with clinically feasible methods during walking exercise. Future clinical studies could build on this information to develop prognostic biomarkers and test novel brain stimulation targets for enhancing exercise motivation (eg, dmPFC).
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Affiliation(s)
- Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sarah M Schwab
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kaitlyn Bigner
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jenna Calvelage
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Katie Preston
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Abigail Laughlin
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Colin Drury
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brady Tincher
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
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Störk T, Seyler T, Fratz M, Bertz A, Hensel S, Carl D. Detecting vibrations in digital holographic multiwavelength measurements using deep learning. Appl Opt 2024; 63:B32-B41. [PMID: 38437253 DOI: 10.1364/ao.507303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/15/2023] [Indexed: 03/06/2024]
Abstract
Digital holographic multiwavelength sensor systems integrated in the production line on multi-axis systems such as robots or machine tools are exposed to unknown, complex vibrations that affect the measurement quality. To detect vibrations during the early steps of hologram reconstruction, we propose a deep learning approach using a deep neural network trained to predict the standard deviation of the hologram phase. The neural network achieves 96.0% accuracy when confronted with training-like data while it achieves 97.3% accuracy when tested with data simulating a typical production environment. It performs similar to or even better than comparable classical machine learning algorithms. A single prediction of the neural network takes 35 µs on the GPU.
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Boyne P, Billinger SA, Reisman DS, Awosika OO, Buckley S, Burson J, Carl D, DeLange M, Doren S, Earnest M, Gerson M, Henry M, Horning A, Khoury JC, Kissela BM, Laughlin A, McCartney K, McQuaid T, Miller A, Moores A, Palmer JA, Sucharew H, Thompson ED, Wagner E, Ward J, Wasik EP, Whitaker AA, Wright H, Dunning K. Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke: A Randomized Clinical Trial. JAMA Neurol 2023; 80:342-351. [PMID: 36822187 PMCID: PMC9951105 DOI: 10.1001/jamaneurol.2023.0033] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/08/2022] [Indexed: 02/25/2023]
Abstract
Importance For walking rehabilitation after stroke, training intensity and duration are critical dosing parameters that lack optimization. Objective To assess the optimal training intensity (vigorous vs moderate) and minimum training duration (4, 8, or 12 weeks) needed to maximize immediate improvement in walking capacity in patients with chronic stroke. Design, Setting, and Participants This multicenter randomized clinical trial using an intent-to-treat analysis was conducted from January 2019 to April 2022 at rehabilitation and exercise research laboratories. Survivors of a single stroke who were aged 40 to 80 years and had persistent walking limitations 6 months or more after the stroke were enrolled. Interventions Participants were randomized 1:1 to high-intensity interval training (HIIT) or moderate-intensity aerobic training (MAT), each involving 45 minutes of walking practice 3 times per week for 12 weeks. The HIIT protocol used repeated 30-second bursts of walking at maximum safe speed, alternated with 30- to 60-second rest periods, targeting a mean aerobic intensity above 60% of the heart rate reserve (HRR). The MAT protocol used continuous walking with speed adjusted to maintain an initial target of 40% of the HRR, progressing up to 60% of the HRR as tolerated. Main Outcomes and Measures The main outcome was 6-minute walk test distance. Outcomes were assessed by blinded raters after 4, 8, and 12 weeks of training. Results Of 55 participants (mean [SD] age, 63 [10] years; 36 male [65.5%]), 27 were randomized to HIIT and 28 to MAT. The mean (SD) time since stroke was 2.5 (1.3) years, and mean (SD) 6-minute walk test distance at baseline was 239 (132) m. Participants attended 1675 of 1980 planned treatment visits (84.6%) and 197 of 220 planned testing visits (89.5%). No serious adverse events related to study procedures occurred. Groups had similar 6-minute walk test distance changes after 4 weeks (HIIT, 27 m [95% CI, 6-48 m]; MAT, 12 m [95% CI, -9 to 33 m]; mean difference, 15 m [95% CI, -13 to 42 m]; P = .28), but HIIT elicited greater gains after 8 weeks (58 m [95% CI, 39-76 m] vs 29 m [95% CI, 9-48 m]; mean difference, 29 m [95% CI, 5-54 m]; P = .02) and 12 weeks (71 m [95% CI, 49-94 m] vs 27 m [95% CI, 3-50 m]; mean difference, 44 m [95% CI, 14-74 m]; P = .005) of training; HIIT also showed greater improvements than MAT on some secondary measures of gait speed and fatigue. Conclusions and Relevance These findings show proof of concept that vigorous training intensity is a critical dosing parameter for walking rehabilitation. In patients with chronic stroke, vigorous walking exercise produced significant and meaningful gains in walking capacity with only 4 weeks of training, but at least 12 weeks were needed to maximize immediate gains. Trial Registration ClinicalTrials.gov Identifier: NCT03760016.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Sandra A. Billinger
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
- Department of Cell Biology and Integrative Physiology, School of Medicine, University of Kansas Medical Center, Kansas City
- University of Kansas Alzheimer’s Research Disease Center, Fairway
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Darcy S. Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sofia Buckley
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jamiah Burson
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Matthew DeLange
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Melinda Earnest
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Myron Gerson
- Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Cardiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Madison Henry
- Department of Physical Therapy, Rehabilitation Sciences, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City
| | - Alli Horning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brett M. Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Abigail Laughlin
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Kiersten McCartney
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Thomas McQuaid
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Allison Miller
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Alexandra Moores
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Jacqueline A. Palmer
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Heidi Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Elizabeth D. Thompson
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Erin Wagner
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jaimie Ward
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Emily Patton Wasik
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Alicen A. Whitaker
- Department of Physical Therapy, Rehabilitation Sciences, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City
| | - Henry Wright
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
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Boyne P, Miller A, Schwab SM, Sucharew H, Carl D, Billinger SA, Reisman DS. Training parameters and longitudinal adaptations that most strongly mediate walking capacity gains from high-intensity interval training post-stroke. medRxiv 2023:2023.02.20.23286194. [PMID: 36865178 PMCID: PMC9980231 DOI: 10.1101/2023.02.20.23286194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background Locomotor high-intensity interval training (HIIT) has been shown to improve walking capacity more than moderate-intensity aerobic training (MAT) after stroke, but it is unclear which training parameter(s) should be prioritized (e.g. speed, heart rate, blood lactate, step count) and to what extent walking capacity gains are the result of neuromotor versus cardiorespiratory adaptations. Objective Assess which training parameters and longitudinal adaptations most strongly mediate 6-minute walk distance (6MWD) gains from post-stroke HIIT. Methods The HIT-Stroke Trial randomized 55 persons with chronic stroke and persistent walking limitations to HIIT or MAT and collected detailed training data. Blinded outcomes included 6MWD, plus measures of neuromotor gait function (e.g. fastest 10-meter gait speed) and aerobic capacity (e.g. ventilatory threshold). This ancillary analysis used structural equation models to compare mediating effects of different training parameters and longitudinal adaptations on 6MWD. Results Net gains in 6MWD from HIIT versus MAT were primarily mediated by faster training speeds and longitudinal adaptations in neuromotor gait function. Training step count was also positively associated with 6MWD gains, but was lower with HIIT versus MAT, which decreased the net 6MWD gain. HIIT generated higher training heart rate and lactate than MAT, but aerobic capacity gains were similar between groups, and 6MWD changes were not associated with training heart rate, training lactate, or aerobic adaptations. Conclusions To increase walking capacity with post-stroke HIIT, training speed and step count appear to be the most important parameters to prioritize.
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Basler C, Kappeler M, Carl D. Depth-Resolved Elemental Analysis on Moving Electrode Foils with Laser-Induced Breakdown Spectroscopy. Sensors (Basel) 2023; 23:1082. [PMID: 36772122 PMCID: PMC9920707 DOI: 10.3390/s23031082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
In this study, a new method for the inline measurement of depth profiles on a continuously moving sample with laser-induced breakdown spectroscopy is presented. The ablation profile is generated by ablating the sample with a burst of laser pulses, where the emission spectrum of each laser-induced plasma is analyzed on a spectrometer. A Q-switched Nd:YAG laser at 1064 nm with 10 mJ pulse energy, 6 ns pulse duration and 100 Hz repetition rate was used. The focusing lens for the pulsed laser and a deflection mirror are mounted on a moving stage, which is precisely aligned in height and orientation to the movement of a conveyor belt transporting the sample. The stage speed is actively synchronized to the speed of the moving sample by a wheel encoder to assure that all laser pulses hit the same position at the sample. The feasibility for depth-resolved elemental analysis on moving samples is shown for coatings of electrode foils for lithium-ion batteries. The coating homogeneity was measured at a speed up to 17 m/min. For a 100 μm coating, 10 laser pulses were needed to measure a full depth profile.
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Kappeler M, Basler C, Brandenburg A, Carl D, Wöllenstein J. Homogeneity Measurements of Li-Ion Battery Cathodes Using Laser-Induced Breakdown Spectroscopy. Sensors (Basel) 2022; 22:8816. [PMID: 36433409 PMCID: PMC9698991 DOI: 10.3390/s22228816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
We study the capability of nanosecond laser-induced breakdown spectroscopy (ns-LIBS) for depth-resolved concentration measurements of Li-Ion battery cathodes. With our system, which is optimized for quality control applications in the production line, we pursue the goal to unveil manufacturing faults and irregularities during the production process of cathodes as early as possible. Femtosecond laser-induced breakdown spectroscopy (fs-LIBS) is widely considered to be better suited for depth-resolved element analysis. Nevertheless, the small size and intensity of the plasma plume, non-thermal energy distribution in the plasma and high investment costs of fs-LIBS make ns-LIBS more attractive for inline application in the industrial surrounding. The system, presented here for the first time, is able to record quasi-depth-resolved relative concentration profiles for carbon, nickel, manganese, cobalt, lithium and aluminum which are the typical elements used in the binder/conductive additive, the active cathode material and the current collector. LIBS often causes high variations in signal intensity from pulse to pulse, so concentration determination is, in general, conducted on the average of many pulses. We show that the spot-to-spot variations we measure are governed by the microstructure of the cathode foil and are not an expression of the limited precision of the LIBS setup.
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Affiliation(s)
- Moritz Kappeler
- Department of Production Control, Fraunhofer Institute of Physical Measurement Techniques IPM, Georges-Köhler-Allee 301, 79110 Freiburg, Germany
| | - Carl Basler
- Department of Production Control, Fraunhofer Institute of Physical Measurement Techniques IPM, Georges-Köhler-Allee 301, 79110 Freiburg, Germany
| | - Albrecht Brandenburg
- Department of Production Control, Fraunhofer Institute of Physical Measurement Techniques IPM, Georges-Köhler-Allee 301, 79110 Freiburg, Germany
| | - Daniel Carl
- Department of Production Control, Fraunhofer Institute of Physical Measurement Techniques IPM, Georges-Köhler-Allee 301, 79110 Freiburg, Germany
| | - Jürgen Wöllenstein
- Department of Gas and Process Technology, Fraunhofer Institute of Physical Measurement Techniques IPM, Georges-Köhler-Allee 301, 79110 Freiburg, Germany
- Laboratory for Gas Sensors, Department of Microsystems Engineering, University of Freiburg, Georges-Köhler-Allee 102, 79110 Freiburg, Germany
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Boyne P, Doren S, Scholl V, Staggs E, Whitesel D, Carl D, Shatz R, Sawyer R, Awosika OO, Reisman DS, Billinger SA, Kissela B, Vannest J, Dunning K. Preliminary Outcomes of Combined Treadmill and Overground High-Intensity Interval Training in Ambulatory Chronic Stroke. Front Neurol 2022; 13:812875. [PMID: 35185766 PMCID: PMC8854218 DOI: 10.3389/fneur.2022.812875] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Purpose Locomotor high-intensity interval training (HIIT) is a promising intervention for stroke rehabilitation. However, overground translation of treadmill speed gains has been somewhat limited, some important outcomes have not been tested and baseline response predictors are poorly understood. This pilot study aimed to guide future research by assessing preliminary outcomes of combined overground and treadmill HIIT. Materials and Methods Ten participants >6 months post-stroke were assessed before and after a 4-week no-intervention control phase and a 4-week treatment phase involving 12 sessions of overground and treadmill HIIT. Results Overground and treadmill gait function both improved during the treatment phase relative to the control phase, with overground speed changes averaging 61% of treadmill speed changes (95% CI: 33–89%). Moderate or larger effect sizes were observed for measures of gait performance, balance, fitness, cognition, fatigue, perceived change and brain volume. Participants with baseline comfortable gait speed <0.4 m/s had less absolute improvement in walking capacity but similar proportional and perceived changes. Conclusions These findings reinforce the potential of locomotor HIIT research for stroke rehabilitation and provide guidance for more definitive studies. Based on the current results, future locomotor HIIT studies should consider including: (1) both overground and treadmill training; (2) measures of cognition, fatigue and brain volume, to complement typical motor and fitness assessment; and (3) baseline gait speed as a covariate.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
- *Correspondence: Pierce Boyne
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Victoria Scholl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Emily Staggs
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Russell Sawyer
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Darcy S. Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
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Miller A, Reisman DS, Billinger SA, Dunning K, Doren S, Ward J, Wright H, Wagner E, Carl D, Gerson M, Awosika O, Khoury J, Kissela B, Boyne P. Moderate-intensity exercise versus high-intensity interval training to recover walking post-stroke: protocol for a randomized controlled trial. Trials 2021; 22:457. [PMID: 34271979 PMCID: PMC8284012 DOI: 10.1186/s13063-021-05419-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background Stroke results in neurologic impairments and aerobic deconditioning that contribute to limited walking capacity which is a major barrier post-stroke. Current exercise recommendations and stroke rehabilitation guidelines recommend moderate-intensity aerobic training post-stroke. Locomotor high-intensity interval training is a promising new strategy that has shown significantly greater improvements in aerobic fitness and motor performance than moderate-intensity aerobic training in other populations. However, the relative benefits and risks of high-intensity interval training and moderate-intensity aerobic training remain poorly understood following stroke. In this study, we hypothesize that locomotor high-intensity interval training will result in greater improvements in walking capacity than moderate-intensity aerobic training. Methods Using a single-blind, 3-site randomized controlled trial, 50 chronic (> 6 months) stroke survivors are randomly assigned to complete 36 locomotor training sessions of either high-intensity interval training or moderate-intensity aerobic training. Main eligibility criteria are age 40–80 years, single stroke for which the participant received treatment (experienced 6 months to 5 years prior to consent), walking speed ≤ 1.0 m/s, able to walk at least 3 min on the treadmill at ≥ 0.13 m/s (0.3 mph), stable cardiovascular condition (American Heart Association class B), and the ability to walk 10 m overground without continuous physical assistance. The primary outcome (walking capacity) and secondary outcomes (self-selected and fast gait speed, aerobic fitness, and fatigue) are assessed prior to initiating training and after 4 weeks, 8 weeks, and 12 weeks of training. Discussion This study will provide fundamental new knowledge to inform the selection of intensity and duration dosing parameters for gait recovery and optimization of aerobic training interventions in chronic stroke. Data needed to justify and design a subsequent definitive trial will also be obtained. Thus, the results of this study will inform future stroke rehabilitation guidelines on how to optimally improve walking capacity following stroke. Trial registration ClinicalTrials.govNCT03760016. Registered on November 30, 2018.
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Affiliation(s)
- Allison Miller
- Department of Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, 19713, USA
| | - Darcy S Reisman
- Department of Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, 19713, USA.,Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Jaimie Ward
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Henry Wright
- Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - Erin Wagner
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Myron Gerson
- Departments of Cardiology and Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Oluwole Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA.
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Gonzalez A, Krieg R, Massey HD, Carl D, Ghosh S, Gehr TWB, Ghosh SS. Sodium butyrate ameliorates insulin resistance and renal failure in CKD rats by modulating intestinal permeability and mucin expression. Nephrol Dial Transplant 2020; 34:783-794. [PMID: 30085297 PMCID: PMC6503301 DOI: 10.1093/ndt/gfy238] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Indexed: 12/14/2022] Open
Abstract
Background The associated increase in the lipopolysaccharide (LPS) levels and uremic toxins in chronic kidney disease (CKD) has shifted the way we focus on intestinal microbiota. This study shows that a disruption of the intestinal barrier in CKD promotes leakage of LPS from the gut, subsequently decreasing insulin sensitivity. Butyrate treatment improved the intestinal barrier function by increasing colonic mucin and tight junction (TJ) proteins. This modulation further ameliorated metabolic functions such as insulin intolerance and improved renal function. Methods Renal failure was induced by 5/6th nephrectomy (Nx) in rats. A group of Nx and control rats received sodium butyrate in drinking water. The Nx groups were compared with sham-operated controls. Results The Nx rats had significant increases in serum creatinine, urea and proteinuria. These animals had impaired glucose and insulin tolerance and increased gluconeogenesis, which corresponded with decreased glucagon-like peptide-1 (GLP-1) secretion. The Nx animals suffered significant loss of intestinal TJ proteins, colonic mucin and mucin 2 protein. This was associated with a significant increase in circulating LPS, suggesting a leaky gut phenomenon. 5′adenosine monophosphate-activated protein kinase (AMPK) phosphorylation, known to modulate epithelial TJs and glucose metabolism, was significantly reduced in the intestine of the Nx group. Anti-inflammatory cytokine, interleukin 10, anti-bacterial peptide and cathelicidin-related antimicrobial peptide were also lowered in the Nx cohort. Butyrate treatment increased AMPK phosphorylation, improved renal function and controlled hyperglycemia. Conclusions Butyrate improves AMPK phosphorylation, increases GLP-1 secretion and promotes colonic mucin and TJ proteins, which strengthen the gut wall. This decreases LPS leakage and inflammation. Taken together, butyrate improves metabolic parameters such as insulin resistance and markers of renal failure in CKD animals.
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Affiliation(s)
- Austin Gonzalez
- Department of Internal Medicine, Nephrology, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard Krieg
- Department of Anatomy, Virginia Commonwealth University, Richmond, VA, USA
| | - Hugh D Massey
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | - Daniel Carl
- Department of Internal Medicine, Nephrology, Virginia Commonwealth University, Richmond, VA, USA
| | - Shobha Ghosh
- Department of Internal Medicine, Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Todd W B Gehr
- Department of Internal Medicine, Nephrology, Virginia Commonwealth University, Richmond, VA, USA
| | - Siddhartha S Ghosh
- Department of Internal Medicine, Nephrology, Virginia Commonwealth University, Richmond, VA, USA
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10
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Boyne P, Scholl V, Doren S, Carl D, Billinger SA, Reisman DS, Gerson M, Kissela B, Vannest J, Dunning K. Locomotor training intensity after stroke: Effects of interval type and mode. Top Stroke Rehabil 2020; 27:483-493. [PMID: 32063178 DOI: 10.1080/10749357.2020.1728953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and Objectives: High-intensity interval training (HIIT) is a promising strategy for improving gait and fitness after stroke, but optimal parameters remain unknown. We tested the effects of short vs long interval type and over-ground vs treadmill mode on training intensity. Methods: Using a repeated measures design, 10 participants with chronic hemiparesis performed 12 HIIT sessions over 4 weeks, alternating between short and long-interval HIIT sessions. Both protocols included 10 minutes of over-ground HIIT, 20 minutes of treadmill HIIT and another 10 minutes over-ground. Short-interval HIIT involved 30 second bursts at maximum safe speed and 30-60 second rest periods. Long-interval HIIT involved 4-minute bursts at ~90% of peak heart rate (HRpeak) and 3-minute recovery periods at ~70% HRpeak. Results: Compared with long-interval HIIT, short-interval HIIT had significantly faster mean overground speeds (0.75 vs 0.67 m/s) and treadmill speeds (0.90 vs 0.51 m/s), with similar mean treadmill HR (82.9 vs 81.8%HRpeak) and session perceived exertion (16.3 vs 16.3), but lower overground HR (78.4 vs 81.1%HRpeak) and session step counts (1481 vs 1672). For short-interval HIIT, training speeds and HR were significantly higher on the treadmill vs. overground. For long-interval HIIT, the treadmill elicited HR similar to overground training at significantly slower speeds. Conclusions: Both short and long-interval HIIT elicit high intensities but emphasize different dosing parameters. From these preliminary findings and previous studies, we hypothesize that overground and treadmill short-interval HIIT could be optimal for improving gait speed and overground long-interval HIIT could be optimal for improving gait endurance.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Victoria Scholl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center , Kansas City, KS, USA
| | - Darcy S Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware , Newark, DE, USA
| | - Myron Gerson
- Departments of Internal Medicine and Cardiology, College of Medicine, University of Cincinnati , Cincinnati, OH, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati , Cincinnati, OH, USA
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA.,Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
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11
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Boyne P, Meyrose C, Westover J, Whitesel D, Hatter K, Reisman DS, Carl D, Khoury JC, Gerson M, Kissela B, Dunning K. Effects of Exercise Intensity on Acute Circulating Molecular Responses Poststroke. Neurorehabil Neural Repair 2020; 34:222-234. [PMID: 31976813 DOI: 10.1177/1545968319899915] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Exercise intensity can influence functional recovery after stroke, but the mechanisms remain poorly understood. Objective. In chronic stroke, an intensity-dependent increase in circulating brain-derived neurotrophic factor (BDNF) was previously found during vigorous exercise. Using the same serum samples, this study tested acute effects of exercise intensity on other circulating molecules related to neuroplasticity, including vascular-endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF1), and cortisol, with some updated analyses involving BDNF. Methods. Using a repeated-measures design, 16 participants with chronic stroke performed 3 exercise protocols in random order: treadmill high-intensity interval training (HIT-treadmill), seated-stepper HIT (HIT-stepper), and treadmill moderate-intensity continuous exercise (MCT-treadmill). Serum molecular changes were compared between protocols. Mediation and effect modification analyses were also performed. Results. VEGF significantly increased during HIT-treadmill, IGF1 increased during both HIT protocols and cortisol nonsignificantly decreased during each protocol. VEGF response was significantly greater for HIT-treadmill versus MCT-treadmill when controlling for baseline. Blood lactate positively mediated the effect of HIT on BDNF and cortisol. Peak treadmill speed positively mediated effects on BDNF and VEGF. Participants with comfortable gait speed ≥0.4 m/s had significantly lower VEGF and higher IGF1 responses, with a lower cortisol response during MCT-treadmill. Conclusions. BDNF and VEGF are promising serum molecules to include in future studies testing intensity-dependent mechanisms of exercise on neurologic recovery. Fast training speed and anaerobic intensity appear to be critical ingredients for eliciting these molecular responses. Serum molecular response differences between gait speed subgroups provide a possible biologic basis for previously observed differences in training responsiveness.
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Affiliation(s)
| | | | | | | | - Kristal Hatter
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Daniel Carl
- University of Cincinnati, Cincinnati, OH, USA
| | - Jane C Khoury
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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12
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Schiller A, Beckmann T, Fratz M, Bertz A, Carl D, Buse K. Multiwavelength holography: height measurements despite axial motion of several wavelengths during exposure. Appl Opt 2019; 58:G48-G51. [PMID: 31873484 DOI: 10.1364/ao.58.000g48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
Interferometric measurements of rotating objects face an axial motion component if the optical axis of the measurement system is not pointing towards the axis of rotation. In a typical interferometer, axial motion of half a wavelength reduces the interference contrast to zero. Our setup compensates for this axial component by an adapted variation of the reference path length during exposure utilizing a piezoelectric actuator. We present off-center measurements on a cylinder, rotating with different angular velocities. The repeatability of these measurements is dominated by motion blur, which demonstrates that the compensation of the axial motion works accurately.
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13
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Fratz M, Beckmann T, Anders J, Bertz A, Bayer M, Gießler T, Nemeth C, Carl D. Inline application of digital holography [Invited]. Appl Opt 2019; 58:G120-G126. [PMID: 31873492 DOI: 10.1364/ao.58.00g120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Abstract
We describe the inline integration of the digital holographic sensor HoloTop in a precision turning plant. A fully automated part-handling system that fulfills the requirements for cycle time and stability was built and integrated into the production process. The inspection system has been running in multishift operation since 2015. For the first time, to the best of our knowledge, the results of one-year, long-term height measurements of 10 million parts under rough production conditions are presented to verify the suitability for industrial use.
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14
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Seyler T, Bienkowski L, Beckmann T, Fratz M, Bertz A, Carl D. Multiwavelength digital holography in the presence of vibrations: laterally resolved multistep phase-shift extraction. Appl Opt 2019; 58:G112-G119. [PMID: 31873491 DOI: 10.1364/ao.58.00g112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Abstract
With the application of multiwavelength digital holography in rough environments, such as where machine tools are used, we cannot rely on the complete absence of vibrations. The evaluation of temporal phase shifting in multiple interferograms regions allows one to determine and take into account random subwavelength tilt changes during image acquisition of the sensor with respect to a work piece. In this regard, experimental data inside a controlled laboratory setup, as well as data acquired within a five-axis machine tool suffering from random vibrations, are evaluated and affirmed by a simulation model.
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15
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Boyne P, Meyrose C, Westover J, Whitesel D, Hatter K, Reisman DS, Cunningham D, Carl D, Jansen C, Khoury JC, Gerson M, Kissela B, Dunning K. Exercise intensity affects acute neurotrophic and neurophysiological responses poststroke. J Appl Physiol (1985) 2018; 126:431-443. [PMID: 30571289 DOI: 10.1152/japplphysiol.00594.2018] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aerobic exercise may acutely prime the brain to be more responsive to rehabilitation, thus facilitating neurologic recovery from conditions like stroke. This aerobic priming effect could occur through multiple mechanisms, including upregulation of circulating brain-derived neurotrophic factor (BDNF), increased corticospinal excitability, and decreased intracortical inhibition. However, optimal exercise parameters for targeting these mechanisms are poorly understood. This study tested the effects of exercise intensity on acute BDNF and neurophysiological responses. Sixteen ambulatory persons >6 mo poststroke performed three different 20-min exercise protocols in random order, approximately 1 wk apart, including the following: 1) treadmill high-intensity interval training (HIT-treadmill); 2) seated-stepper HIT (HIT-stepper); and 3) treadmill moderate-intensity continuous exercise (MCT-treadmill). Serum BDNF and transcranial magnetic stimulation measures of paretic lower limb excitability and inhibition were assessed at multiple time points during each session. Compared with MCT-treadmill, HIT-treadmill elicited significantly greater acute increases in circulating BDNF and corticospinal excitability. HIT-stepper initially showed BDNF responses similar to HIT-treadmill but was no longer significantly different from MCT-treadmill after decreasing the intensity in reaction to two hypotensive events. Additional regression analyses showed that an intensity sufficient to accumulate blood lactate appeared to be important for eliciting BDNF responses, that the interval training approach may have facilitated the corticospinal excitability increases, and that the circulating BDNF response was (negatively) related to intracortical inhibition. These findings further elucidate neurologic mechanisms of aerobic exercise and inform selection of optimal exercise-dosing parameters for enhancing acute neurologic effects. NEW & NOTEWORTHY Acute exercise-related increases in circulating BDNF and corticospinal excitability are thought to prime the brain for learning. Our data suggest that these responses can be obtained among persons with stroke using short-interval treadmill high-intensity interval training, that a vigorous aerobic intensity sufficient to generate lactate accumulation is needed to increase BDNF, that interval training facilitates increases in paretic quadriceps corticospinal excitability, and that greater BDNF response is associated with lesser intracortical inhibition response.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Colleen Meyrose
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jennifer Westover
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Kristal Hatter
- Schubert Research Clinic, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Darcy S Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware , Newark, Delaware
| | - David Cunningham
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University , Cleveland, Ohio.,MetroHealth Rehabilitation Institute of Ohio, MetroHealth Medical Center, Cleveland Functional Electrical Stimulation Center , Cleveland, Ohio
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Connor Jansen
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jane C Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Myron Gerson
- Departments of Internal Medicine and Cardiology, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
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16
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Patidar KR, Kang L, Bajaj JS, Carl D, Sanyal AJ. Fractional excretion of urea: A simple tool for the differential diagnosis of acute kidney injury in cirrhosis. Hepatology 2018; 68:224-233. [PMID: 29315697 PMCID: PMC6033653 DOI: 10.1002/hep.29772] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/04/2017] [Accepted: 12/29/2017] [Indexed: 12/15/2022]
Abstract
UNLABELLED Current approaches to determine the cause of acute kidney injury (AKI) in patients with cirrhosis are suboptimal. The aim of this study was to determine the utility of fractional excretion of urea (FEUrea) for the differential diagnosis of AKI in patients with cirrhosis. A retrospective analysis was performed in patients (n = 50) with cirrhosis and ascites admitted with AKI. Using adjudicated etiology assessment as the reference standard, receiver operating curves and optimal cutoff, sensitivity (Sn), and specificity (Sp) for the diagnosis of prerenal azotemia (PRA), type 1 hepatorenal syndrome (HRS), and acute tubular necrosis (ATN) were derived. Validation was performed in an independent cohort (n = 50) and by bootstrap analysis. The causes of AKI (derivation:validation cohorts) were: PRA 21:21, HRS 18:15, and ATN 11:14. Median FEUrea was statistically different across all etiologies of AKI in the derivation cohort (PRA 30.1 vs. HRS 20.2 vs. ATN 43.6; P < 0.001) and validation cohort (PRA 23.1 vs. HRS 13.3 vs. ATN 44.7; P < 0.001). The area underneath the curve (cutoff, Sn/Sp) for FEUrea was 0.96 (33.4, 85/100) for ATN versus non-ATN, 0.87 (28.7, 75/83) for HRS versus non-HRS, and 0.81 (21.6, 90/61) for PRA versus HRS. When applied to the validation cohort, Sn/Sp were maintained for ATN versus non-ATN (93/97), HRS versus non-HRS (100/63), and for PRA versus HRS (67/80). After bootstrapping, Sn/Sp for FEUrea in the ATN versus non-ATN, HRS versus non-HRS, and PRA versus HRS was 88/96, 63/97, and 55/87, respectively. CONCLUSION FEUrea is a promising tool for the differential diagnosis of AKI in patients with cirrhosis. (Hepatology 2018;68:224-233).
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Affiliation(s)
- Kavish R. Patidar
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond Virginia, USA
| | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, Richmond Virginia, USA
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond Virginia, USA
| | - Daniel Carl
- Division of Nephrology, Virginia Commonwealth University, Richmond Virginia, USA
| | - Arun J. Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond Virginia, USA
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17
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Dixon DL, Sisson EM, Parod ED, Van Tassell BW, Nadpara PA, Carl D, W. Dow A. Pharmacist-physician collaborative care model and time to goal blood pressure in the uninsured population. J Clin Hypertens (Greenwich) 2018; 20:88-95. [PMID: 29237095 PMCID: PMC8031164 DOI: 10.1111/jch.13150] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/31/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022]
Abstract
Pharmacist-physician collaborative practice models (PPCPMs) improve blood pressure (BP) control, but their effect on time to goal BP is unknown. This retrospective cohort study evaluated the impact of a PPCPM on time to goal BP compared with usual care using data from existing medical records in uninsured patients with hypertension. The primary outcome was time from the initial visit to the first follow-up visit with a BP <140/90 mm Hg. The study included 377 patients (259 = PPCPM; 118 = usual care). Median time to BP goal was 36 days vs 259 days in the PPCPM and usual care cohorts, respectively (P < .001). At 12 months, BP control was 81% and 44% in the PPCPM and usual care cohorts, respectively (P < .001) and therapeutic inertia was lower in the PPCPM cohort (27.6%) compared with usual care (43.7%) (P < .0001). Collaborative models involving pharmacists should be considered to improve BP control in high-risk populations.
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Affiliation(s)
- Dave L. Dixon
- Center for Pharmacy Practice InnovationVirginia Commonwealth University School of PharmacyRichmondVAUSA
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Evan M. Sisson
- Center for Pharmacy Practice InnovationVirginia Commonwealth University School of PharmacyRichmondVAUSA
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Eric D. Parod
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Benjamin W. Van Tassell
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Pramit A. Nadpara
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Daniel Carl
- Department of Internal MedicineVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Alan W. Dow
- Department of Internal MedicineVirginia Commonwealth University School of MedicineRichmondVAUSA
- Center for Interprofessional Education and Collaborative CareVirginia Commonwealth UniversityRichmondVAUSA
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18
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Schiller A, Beckmann T, Fratz M, Belzer D, Bertz A, Carl D, Buse K. Digital holography on moving objects: interference contrast as a function of velocity and aperture width. Appl Opt 2017; 56:4622-4628. [PMID: 29047592 DOI: 10.1364/ao.56.004622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/01/2017] [Indexed: 06/07/2023]
Abstract
Digital holographic measurements on planar moving objects are investigated. We discuss the dependence of the interference contrast on velocity and aperture width for both diffusely and specularly reflecting objects. Using spatial phase shifting, the experimental results for motion in parallel and perpendicular to the optical axis are in good agreement with the theoretical considerations. Measurements with object velocities of up to 100 mm/s are conducted using only less than 1 mW of continuous-wave laser light. These considerations are used to determine the optimal angle between the direction of motion and the illuminating beam, resulting in the lowest decrease in contrast with increasing velocity.
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19
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Jansen CM, Whitesel D, Meyrose C, Westover J, Carl D, Khoury J, Kissela B, Dunning K, Boyne P. Influence of Aerobic Exercise Intensity on Acute Changes in Motor Activation Post-Stroke. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000516898.84116.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Parod ED, Dixon D, Sisson EM, Van Tassell B, Nadpara P, Carl D, Dow A. COMPARISON OF A PHARMACIST-PHYSICIAN COLLABORATIVE CARE MODEL TO STANDARD CARE ON THE TIME TO REACH GOAL BLOOD PRESSURE FOR PATIENTS WITH HYPERTENSION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Dixon DL, Parod E, Sisson E, Van Tassell B, Nadpara P, Savage H, Dow A, Carl D. COMPARISON OF A PHARMACIST-PHYSICIAN COLLABORATIVE CARE MODEL TO STANDARD CARE ON THE TIME TO REACH GOAL BLOOD PRESSURE FOR PATIENTS PRESENTING WITH URGENT HYPERTENSION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35226-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Baumgarten M, Gehr TWB, Carl D. Diseases of the Kidney. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Kang DJ, Betrapally NS, Ghosh SA, Sartor RB, Hylemon PB, Gillevet PM, Sanyal AJ, Heuman DM, Carl D, Zhou H, Liu R, Wang X, Yang J, Jiao C, Herzog J, Lippman HR, Sikaroodi M, Brown RR, Bajaj JS. Gut microbiota drive the development of neuroinflammatory response in cirrhosis in mice. Hepatology 2016; 64:1232-48. [PMID: 27339732 PMCID: PMC5033692 DOI: 10.1002/hep.28696] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/18/2016] [Accepted: 06/21/2016] [Indexed: 12/23/2022]
Abstract
UNLABELLED The mechanisms behind the development of hepatic encephalopathy (HE) are unclear, although hyperammonemia and systemic inflammation through gut dysbiosis have been proposed. The aim of this work was to define the individual contribution of hyperammonemia and systemic inflammation on neuroinflammation in cirrhosis using germ-free (GF) and conventional mice. GF and conventional C57BL/6 mice were made cirrhotic using CCl4 gavage. These were compared to their noncirrhotic counterparts. Intestinal microbiota, systemic and neuroinflammation (including microglial and glial activation), serum ammonia, intestinal glutaminase activity, and cecal glutamine content were compared between groups. GF cirrhotic mice developed similar cirrhotic changes to conventional mice after 4 extra weeks (16 vs. 12 weeks) of CCl4 gavage. GF cirrhotic mice exhibited higher ammonia, compared to GF controls, but this was not associated with systemic or neuroinflammation. Ammonia was generated through increased small intestinal glutaminase activity with concomitantly reduced intestinal glutamine levels. However, conventional cirrhotic mice had intestinal dysbiosis as well as systemic inflammation, associated with increased serum ammonia, compared to conventional controls. This was associated with neuroinflammation and glial/microglial activation. Correlation network analysis in conventional mice showed significant linkages between systemic/neuroinflammation, intestinal microbiota, and ammonia. Specifically beneficial, autochthonous taxa were negatively linked with brain and systemic inflammation, ammonia, and with Staphylococcaceae, Lactobacillaceae, and Streptococcaceae. Enterobacteriaceae were positively linked with serum inflammatory cytokines. CONCLUSION Gut microbiota changes drive development of neuroinflammatory and systemic inflammatory responses in cirrhotic animals. (Hepatology 2016;64:1232-1248).
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Affiliation(s)
- Dae Joong Kang
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | | | - Siddhartha A Ghosh
- Division of Nephrology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - R Balfour Sartor
- National Gnotobiotic Rodent Resource Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Phillip B Hylemon
- Division of Microbiology and Immunology, and, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | | | - Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Douglas M Heuman
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Daniel Carl
- Division of Nephrology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Huiping Zhou
- Division of Microbiology and Immunology, and, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Runping Liu
- Division of Microbiology and Immunology, and, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Xiang Wang
- Division of Microbiology and Immunology, and, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Jing Yang
- Division of Microbiology and Immunology, and, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Chunhua Jiao
- Division of Microbiology and Immunology, and, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | - Jeremy Herzog
- National Gnotobiotic Rodent Resource Center, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - H Robert Lippman
- Division of Pathology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA
| | | | - Robert R Brown
- Microbiome Analysis Center, George Mason University, Manassas, VA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA.
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24
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Boyne P, Reisman D, Brian M, Barney B, Franke A, Carl D, Khoury J, Dunning K. Ventilatory threshold may be a more specific measure of aerobic capacity than peak oxygen consumption rate in persons with stroke. Top Stroke Rehabil 2016; 24:149-157. [PMID: 27454553 DOI: 10.1080/10749357.2016.1209831] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND After stroke, aerobic deconditioning can have a profound impact on daily activities. This is usually measured by the peak oxygen consumption rate achieved during exercise testing (VO2-peak). However, VO2-peak may be distorted by motor function. The oxygen uptake efficiency slope (OUES) and VO2 at the ventilatory threshold (VO2-VT) could more specifically assess aerobic capacity after stroke, but this has not been tested. OBJECTIVES To assess the differential influence of motor function on three measures of aerobic capacity (VO2-peak, OUES, and VO2-VT) and to evaluate the inter-rater reliability of VO2-VT determination post-stroke. METHODS Among 59 persons with chronic stroke, cross-sectional correlations with motor function (comfortable gait speed [CGS] and lower extremity Fugl-Meyer [LEFM]) were compared between the different aerobic capacity measures, after adjustment for covariates, in order to isolate any distorting effect of motor function. Reliability of VO2-VT determination between three raters was assessed with intra-class correlation (ICC). RESULTS CGS was moderately correlated with VO2-peak (r = 0.52, p < 0.0001) and weakly correlated with OUES (r = 0.41, p = 0.002) and VO2-VT (r = 0.37, p = 0.01). LEFM was weakly correlated with VO2-peak (r = 0.26, p = 0.055) and very weakly correlated with OUES (r = 0.19, p = 0.17) and VO2-VT (r = 0.14, p = 0.31). Compared to VO2-peak, VO2-VT was significantly less correlated with CGS (r difference = -0.16, p = 0.02). Inter-rater reliability of VO2-VT determination was high (ICC: 0.93, 95% CI: 0.89-0.96). CONCLUSIONS Motor dysfunction appears to artificially lower measured aerobic capacity. VO2-VT seemed to be less distorted than VO2-peak and had good inter-rater reliability, so it may provide more specific assessment of aerobic capacity post-stroke.
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Affiliation(s)
- Pierce Boyne
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA.,b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA
| | - Darcy Reisman
- c Department of Physical Therapy , College of Health Sciences, University of Delaware , Newark , DE , USA
| | - Michael Brian
- c Department of Physical Therapy , College of Health Sciences, University of Delaware , Newark , DE , USA
| | - Brian Barney
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Ava Franke
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Daniel Carl
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Jane Khoury
- b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA.,d Division of Biostatistics and Epidemiology , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Kari Dunning
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA.,b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA
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Whitesel D, Boyne P, Meyrose C, Westover J, Carl D, Khoury J, Gerson M, Kissela B, Dunning K. Feasibility of a Novel Recumbent Stepper Stress Test in Stroke. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000485786.97237.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Whitesel D, Boyne P, Carl D, Westover J, Meyrose C, Wilkerson J, Khoury JC, Gerson M, Seroogy K, Hatter K, Reisman D, Kissela B, Dunning K. Abstract TP143: Effects of Aerobic Exercise Intensity on Novel Blood Biomarkers of Neuroplasticity After Stroke. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Aerobic exercise (AEX) may facilitate neurologic stroke recovery. Among healthy adults, intense AEX is known to upregulate brain-derived neurotrophic factor (BDNF), a critical facilitator of neuroplasticity, motor learning and cognition. Increased blood lactate during AEX appears to be a key mechanism underlying this effect. Intense AEX also increases blood ionized calcium (Ca++). In animal studies, some of this increased Ca++ has been shown to be transported to the brain and enhance synthesis of monoamine neurotransmitters (e.g. dopamine) that are associated with neuroplasticity and motor learning. Thus, increased blood lactate and Ca++ during AEX represent potentially important biomarkers of central neurologic benefits, but neither has been previously studied in persons with stroke.
Hypothesis:
High intensity AEX will elicit significantly larger lactate and Ca++ responses than moderate intensity in chronic stroke.
Methods:
Using a crossover design, eight subjects (mean ± SD age, 57 ± 8 years; years post stroke, 8.7 ± 2.7) performed one 20 minute session each of moderate and high intensity treadmill AEX in random order. Blood lactate and Ca++ were measured at baseline and multiple time points during and after AEX. Mixed effects models were used to examine changes within and between protocols using an alpha of 0.05.
Results:
Blood lactate response was significantly greater for high vs moderate intensity AEX (p<0.0001). While moderate intensity showed no significant changes with time (p=0.60), high intensity showed significant increases during and immediately after AEX (all p<0.0001). Blood Ca++ showed no significant protocol by time interaction (p=0.08) but did show a significant time effect (p<0.0001) with increases during (p<0.0001) and immediately after (p=0.01) AEX.
Conclusions:
Unlike moderate intensity AEX, high intensity elicited a robust lactate response. This has promising implications for the effects of high-intensity AEX on BDNF post-stroke. Both protocols combined showed an increase in Ca++, which has promising implications for the effects of AEX on monoamine neurotransmitter synthesis after stroke.
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Affiliation(s)
- Dustyn Whitesel
- Dept of Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | - Pierce Boyne
- Dept of Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | - Daniel Carl
- Dept of Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | | | - Colleen Meyrose
- Dept of Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | - Johnny Wilkerson
- Dept of Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | - Jane C Khoury
- Div of Biostatistics and Epidemiology, Cincinnati Children's Hosp Med Cntr, Cincinnati, OH
| | - Myron Gerson
- Depts of Internal Medicine and Cardiology, Univ of Cincinnati, Cincinnati, OH
| | - Kim Seroogy
- Dept of Neurology and Rehabilitation Medicine, Univ of Cincinnati, Cincinnati, OH
| | - Kristal Hatter
- Clinical Translational Rsch Cntr, Cincinnati Children's Hosp Med Cntr, Cincinnati, OH
| | - Darcy Reisman
- Dept of Physical Therapy, Univ of Delaware, Newark, DE
| | - Brett Kissela
- Dept of Neurology and Rehabilitation Medicine, Univ of Cincinnati, Cincinnati, OH
| | - Kari Dunning
- Dept of Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
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Boyne P, Meyrose C, Carl D, Wilkerson J, Dunning K. Feasibility, Intensity and Safety of Recumbent Stepper High-intensity Interval Training in Chronic Stroke. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.10.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ghosh SS, Righi S, Krieg R, Kang L, Carl D, Wang J, Massey HD, Sica DA, Gehr TWB, Ghosh S. High Fat High Cholesterol Diet (Western Diet) Aggravates Atherosclerosis, Hyperglycemia and Renal Failure in Nephrectomized LDL Receptor Knockout Mice: Role of Intestine Derived Lipopolysaccharide. PLoS One 2015; 10:e0141109. [PMID: 26580567 PMCID: PMC4651339 DOI: 10.1371/journal.pone.0141109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/04/2015] [Indexed: 01/06/2023] Open
Abstract
A high fat meal, frequently known as western diet (WD), exacerbates atherosclerosis and diabetes. Both these diseases are frequently associated with renal failure. Recent studies have shown that lipopolysaccharide (LPS) leaks into the circulation from the intestine in the setting of renal failure and after WD. However, it is not clear how renal function and associated disorders are affected by LPS. This study demonstrates that circulatory LPS exacerbates renal insufficiency, atherosclerosis and glucose intolerance. Renal insufficiency was induced by 2/3 nephrectomy in LDL receptor knockout mice. Nx animals were given normal diet (Nx) or WD (Nx+WD). The controls were sham operated animals on normal diet (control) and WD (WD). To verify if LPS plays a role in exaggerating renal insufficiency, polymyxin (PM), a known LPS antagonist, and curcumin (CU), a compound known to ameliorate chronic kidney disease (CKD), was given to Nx animals on western diet (Nx+WD+PM and Nx+WD+CU, respectively). Compared to control, all other groups displayed increased circulatory LPS. The Nx+WD cohort had the highest levels of LPS. Nx group had significant renal insufficiency and glucose intolerance but not atherosclerosis. WD had intense atherosclerosis and glucose intolerance but it did not show signs of renal insufficiency. Compared to other groups, Nx+WD had significantly higher cytokine expression, macrophage infiltration in the kidney, renal insufficiency, glucose intolerance and atherosclerosis. PM treatment blunted the expression of cytokines, deterioration of renal function and associated disorders, albeit not to the levels of Nx, and was significantly inferior to CU. PM is a non-absorbable antibiotic with LPS binding properties, hence its beneficial effect can only be due to its effect within the GI tract. We conclude that LPS may not cause renal insufficiency but can exaggerate kidney failure and associated disorders following renal insufficiency.
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Affiliation(s)
- Siddhartha S. Ghosh
- Divisions of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
- * E-mail:
| | - Samuel Righi
- Divisions of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Richard Krieg
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Daniel Carl
- Divisions of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Jing Wang
- Division of Pulmonary Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - H. Davis Massey
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Domenic A. Sica
- Divisions of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Todd W. B. Gehr
- Divisions of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Shobha Ghosh
- Division of Pulmonary Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
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Boyne P, Buhr S, Rockwell B, Khoury J, Carl D, Gerson M, Kissela B, Dunning K. Predicting Heart Rate at the Ventilatory Threshold for Aerobic Exercise Prescription in Persons With Chronic Stroke. J Neurol Phys Ther 2015; 39:233-40. [PMID: 26371532 DOI: 10.1097/npt.0000000000000102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Treadmill aerobic exercise improves gait, aerobic capacity, and cardiovascular health after stroke, but a lack of specificity in current guidelines could lead to underdosing or overdosing of aerobic intensity. The ventilatory threshold (VT) has been recommended as an optimal, specific starting point for continuous aerobic exercise. However, VT measurement is not available in clinical stroke settings. Therefore, the purpose of this study was to identify an accurate method to predict heart rate at the VT (HRVT) for use as a surrogate for VT. METHODS A cross-sectional design was employed. Using symptom-limited graded exercise test (GXT) data from 17 subjects more than 6 months poststroke, prediction methods for HRVT were derived by traditional target HR calculations (percentage of HRpeak achieved during GXT, percentage of peak HR reserve [HRRpeak], percentage of age-predicted maximal HR, and percentage of age-predicted maximal HR reserve) and by regression analysis. The validity of the prediction methods was then tested among 8 additional subjects. RESULTS All prediction methods were validated by the second sample, so data were pooled to calculate refined prediction equations. HRVT was accurately predicted by 80% HRpeak (R, 0.62; standard deviation of error [SDerror], 7 bpm), 62% HRRpeak (R, 0.66; SDerror, 7 bpm), and regression models that included HRpeak (R, 0.62-0.75; SDerror, 5-6 bpm). DISCUSSION AND CONCLUSIONS Derived regression equations, 80% HRpeak and 62% HRRpeak, provide a specific target intensity for initial aerobic exercise prescription that should minimize underdosing and overdosing for persons with chronic stroke. The specificity of these methods may lead to more efficient and effective treatment for poststroke deconditioning.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A114).
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation Sciences (P.B., S.B., B.R., D.C., K.D.), Department of Environmental Health (P.B., J.K., K.D.), Departments of Internal Medicine and Cardiology (M.G.), and Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, Cincinnati, Ohio; and Division of Biostatistics and Epidemiology (J.K.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Boyne P, Dunning K, Carl D, Gerson M, Khoury J, Kissela B. Within-session responses to high-intensity interval training in chronic stroke. Med Sci Sports Exerc 2015; 47:476-84. [PMID: 24977698 DOI: 10.1249/mss.0000000000000427] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Poststroke hemiparesis often leads to a vicious cycle of limited activity, deconditioning, and poor cardiovascular health. Accumulating evidence suggests that exercise intensity is a critical factor determining gains in aerobic capacity, cardiovascular protection, and functional recovery after stroke. High-intensity interval training (HIT) is a strategy that augments exercise intensity using bursts of concentrated effort alternated with recovery periods. However, there was previously no stroke-specific evidence to guide HIT protocol selection. PURPOSE This study aimed to compare within-session exercise responses among three different HIT protocols for persons with chronic (>6 months after) stroke. METHODS Nineteen ambulatory persons with chronic stroke performed three different 1-d HIT sessions in a randomized order, approximately 1 wk apart. HIT involved repeated 30-s bursts of treadmill walking at maximum tolerated speed, alternated with rest periods. The three HIT protocols were different on the basis of the length of the rest periods, as follows: 30 s (P30), 60 s (P60), or 120 s (P120). Exercise tolerance, oxygen uptake (V˙O2), HR, peak treadmill speed, and step count were measured. RESULTS P30 achieved the highest mean V˙O2, HR, and step count but with reduced exercise tolerance and lower treadmill speed than P60 or P120 (P30: 70.9% V˙O2peak, 76.1% HR reserve (HRR), 1619 steps, 1.03 m·s(-1); P60: 63.3% V˙O2peak, 63.1% HRR, 1370 steps, 1.13 m·s(-1); P120: 47.5% V˙O2peak, 46.3% HRR, 1091 steps, 1.10 m·s(-1)). P60 achieved treadmill speed and exercise tolerance similar to those in P120, with higher mean V˙O2, HR, and step count. CONCLUSIONS For treadmill HIT in chronic stroke, a combination of P30 and P60 may optimize aerobic intensity, treadmill speed, and stepping repetition, potentially leading to greater improvements in aerobic capacity and gait outcomes in future studies.
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Affiliation(s)
- Pierce Boyne
- 1Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH; 2Departments of Internal Medicine and Cardiology, College of Medicine, University of Cincinnati, Cincinnati, OH; 3Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 4Department of Neurology, Physical Medicine and Rehabilitation, College of Medicine, University of Cincinnati, Cincinnati, OH
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Boyne P, Dunning K, Carl D, Khoury JC, Gerson M, Rockwell B, Buhr S, Keaton G, Westover J, Barney B, Wilkerson J, Kissela B. Abstract W MP58: High Intensity Interval Training May Be Superior to Moderate Intensity Continuous Exercise in Chronic Stroke. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wmp58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Aerobic deconditioning is a major barrier to stroke recovery. Post stroke guidelines recommend moderate intensity continuous exercise (MICE) to improve aerobic fitness and mobility. High-intensity interval training (HIT) has been shown to be more effective than MICE for improving aerobic fitness among healthy adults and persons with heart disease. However, no previous study has compared HIT and MICE among persons with stroke. We hypothesized that HIT would elicit significantly greater improvement in both aerobic fitness and gait function relative to MICE in this population.
Methods:
Fourteen subjects (mean ± SD age, 58 ± 10 years; years post stroke, 4.3 ± 2.9) were randomized to HIT (n=11) or MICE (n=5); each 25 min, 3x/week for 4 weeks. HIT involved repeated 30 sec bursts of treadmill (TM) gait at maximum tolerated speed (based on gait stability), alternated with 30-60 sec rest periods. MICE involved continuous TM gait at 45-50% heart rate reserve. Outcomes were measured by a blinded rater before and after intervention, including peak oxygen uptake and ventilatory threshold during graded exercise testing, energy cost of gait, 10m walk test (comfortable and fastest speeds) and TM speed (comfortable and fastest). Mixed effects models tested for significant (p<0.05) differences over time within groups and between the groups. Standardized effect sizes were also calculated.
Results:
In the HIT group, significant improvement was found for all outcomes save peak oxygen uptake. No significant differences were found in the MICE group. Ventilatory threshold and fastest TM speed improved significantly more in HIT compared to MICE and moderate to large effect sizes were found for all outcomes.
Conclusion:
HIT is a potent intervention for improving aerobic fitness and gait function in chronic stroke that appears to be more effective than MICE. Further study with a larger sample is warranted.
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Affiliation(s)
- Pierce Boyne
- Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | - Kari Dunning
- Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | - Daniel Carl
- Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | - Jane C Khoury
- Biostatistics and Epidemiology, Cincinnati Children's Hosp Med Cntr, Cincinnati, OH
| | - Myron Gerson
- Internal Medicine and Cardiology, Univ of Cincinnati, Cincinnati, OH
| | | | - Sarah Buhr
- Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | | | | | - Brian Barney
- Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | - John Wilkerson
- Rehabilitation Sciences, Univ of Cincinnati, Cincinnati, OH
| | - Brett Kissela
- Neurology and Rehabilitation Medicine, Univ of Cincinnati, Cincinnati, OH
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Baumgarten M, Gehr TWB, Carl D. Diseases of the Kidney. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Arteriovenous graft (AVG) thrombosis is a frequent cause of graft failure. We evaluated coagulation protein concentrations, platelet function, and viscoelasticity factors in 20 hemodialysis (HD) patients with AVGs. The goal was to determine whether significant differences in protein concentrations, platelet function, and viscoelasticity factors exist among dialysis patients requiring frequent AVG declot procedures vs. those who do not. Twenty HD patients were enrolled: 10 frequent clotters (>3 declots in the previous year) and 10 were nonclotters. Patients on antiplatelets or chronic anticoagulation were excluded. Laboratories were drawn pretreatment and heparinase was added to counteract any potential heparin effect. Coagulation protein concentrations including tissue factor (TF), thrombin/antithrombin III complex (TAT), and prothrombin fragment 1 + 2 (F(1+2)) were assayed. The time to clot onset was measured by force onset time (FOT). Platelet contractile force (PCF) measured the force produced by platelets during clot retraction, whereas clot rigidity was measured as clot elastic modulus (CEM). FOT, CEM, and PCF were measured by Hemodyne. Both groups had upregulation of the TF pathway, as TF, TAT, and F(1+2) levels were similarly increased over baseline levels. Hemodialysis patients with frequent AVG clotting had higher levels of both PCF and CEM compared with nonclotters. Additionally, the frequent clotters had a lower FOT relative to nonclotters, although both were considered in the normal range. Our study suggests that HD patients with recurrent AVG thrombotic events form clots with higher tensile strength compared with HD patients without recurrent graft thrombosis.
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Affiliation(s)
- Chinedu Nweke
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Rockwell BD, Boyne P, Carl D, Gerson M, Khoury J, Kissela B, Dunning K. Short-interval High-intensity Training In Chronic Stroke. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000495644.44078.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
After stroke, people with weakness enter a vicious cycle of limited activity and deconditioning that limits functional recovery and exacerbates cardiovascular risk factors. Conventional aerobic exercise improves aerobic capacity, function, and overall cardiometabolic health after stroke. Recently, a new exercise strategy has shown greater effectiveness than conventional aerobic exercise for improving aerobic capacity and other outcomes among healthy adults and people with heart disease. This strategy, called high-intensity interval training (HIT), uses bursts of concentrated effort alternated with recovery periods to maximize exercise intensity. Three poststroke HIT studies have shown preliminary effectiveness for improving functional recovery. However, these studies were varied in approach and the safety of poststroke HIT has received little attention. The objectives of this narrative review are to (1) propose a framework for categorizing HIT protocols; (2) summarize the safety and effectiveness evidence of HIT among healthy adults and people with heart disease and stroke; (3) discuss theoretical mechanisms, protocol selection, and safety considerations for poststroke HIT; and (4) provide directions for future research.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
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Wong H, Qian XY, Carl D, Cheung NW, Lieberman MA, Brown IG, Yu KM. Plasma Immersion Ion Implantation for Impurity Gettering in Silicon. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-147-91] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractWe have utilized plasma immersion ion implantation (PIII) to demonstrate effective gettering of metallic impurities in silicon wafers. Metallic impurities such as Ni, Cu or Au were intentionally diffused into Si as marker impurities. The Ar or Ne atoms were ionized in an electron cyclotron resonance (ECR) plasma chamber. The ions were accelerated by a negative voltage applied to the wafer and implanted into the wafer. The as-implanted saturation dose can be as high as 5×1016cm−2. After an annealing step at 1000°C for 1 hour in a N2 ambient, the retained doses and the amount of gettered impurities were measured with Rutherford backscattering spectrometry (RBS). With a retained Ar dose in 1015cm−2 range after annealing, the gettered Ni, Cu and Au were 3.0×1014cm−2, 3.0×1014cm−2 and 4.4×1013cm−2 respectively.
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Blug A, Carl D, Höfler H, Abt F, Heider A, Weber R, Nicolosi L, Tetzlaff R. Closed-loop Control of Laser Power using the Full Penetration Hole Image Feature in Aluminum Welding Processes. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.phpro.2011.03.090] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abt F, Heider A, Weber R, Graf T, Blug A, Carl D, Höfler H, Nicolosi L, Tetzlaff R. Camera Based Closed Loop Control for Partial Penetration Welding of Overlap Joints. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.phpro.2011.03.091] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
| | | | - H Davis Massey
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
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Carl D, Fratz M, Pfeifer M, Giel DM, Höfler H. Multiwavelength digital holography with autocalibration of phase shifts and artificial wavelengths. Appl Opt 2009; 48:H1-H8. [PMID: 19956279 DOI: 10.1364/ao.48.0000h1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A novel implementation of lensless multiwavelength digital holography with autocalibration of temporal phase shifts and artificial wavelength is presented. The algorithm we used to calculate the phase shifts was previously proposed [Opt. Lett.29 183 (2004)] and, to our knowledge, is now used for the first time in lensless holography. Because precise knowledge of the generated artificial wavelength is crucial for absolute measurement accuracy, a simple and efficient method to determine the artificial wavelength directly is presented. The calibration method is based on a simple modification of the experimental setup and needs just one additional image acquisition per wavelength. The results of shape measurement of a metallic test object with a rough surface and steep edges are shown and the measurement accuracy is discussed.
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Affiliation(s)
- Daniel Carl
- Fraunhofer Institute for Physical Measurement Techniques, Heidenhofstrasse 8, D-79110 Freiburg, Germany.
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Kemper B, Höink A, Carl D, von Bally G. Algorithm for fringe independent quantification of noise in wrapped phase distributions obtained by digital holography and speckle interferometry. ACTA ACUST UNITED AC 2006. [DOI: 10.1117/12.695489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kemper B, Carl D, Schnekenburger J, Bredebusch I, Schäfer M, Domschke W, von Bally G. Investigation of living pancreas tumor cells by digital holographic microscopy. J Biomed Opt 2006; 11:34005. [PMID: 16822055 DOI: 10.1117/1.2204609] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Digital holographic microscopy provides new facilities for contactless and marker-free quantitative phase contrast imaging. In this work, a digital holographic microscopy method for the integral refractive index determination of living single cells in cell culture medium is presented. Further, the obtained refractive index information is applied to full field thickness and shape determination of adherent pancreas tumor cells, as well as for analysis of drug-induced dynamic changes of a single cell's cytoskeleton. The results demonstrate that digital holographic microscopy is a quantitative phase contrast technique for living cells under conventional laboratory conditions.
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Affiliation(s)
- Björn Kemper
- University of Muenster, Laboratory of Biophysics, Germany.
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Carl D, Kemper B, Wernicke G, von Bally G. Parameter-optimized digital holographic microscope for high-resolution living-cell analysis. Appl Opt 2004; 43:6536-44. [PMID: 15646774 DOI: 10.1364/ao.43.006536] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
A parameter-optimized off-axis setup for digital holographic microscopy is presented for simultaneous, high-resolution, full-field quantitative amplitude and quantitative phase-contrast microscopy and the detection of changes in optical path length in transparent objects, such as undyed living cells. Numerical reconstruction with the described nondiffractive reconstruction method, which suppresses the zero order and the twin image, requires a mathematical model of the phase-difference distribution between the object wave and the reference wave in the hologram plane. Therefore an automated algorithm is explained that determines the parameters of the mathematical model by carrying out the discrete Fresnel transform. Furthermore the relationship between the axial position of the object and the reconstruction distance, which is required for optimization of the lateral resolution of the holographic images, is derived. The lateral and the axial resolutions of the system are discussed and quantified by application to technical objects and to living cells.
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Affiliation(s)
- Daniel Carl
- Laboratory of Biophysics, University of Münster, Robert-Koch-Strasse 45, D-48129 Münster, Germany.
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Abstract
This article focuses on ways in which helping agents, including family therapists, become part of the problem they are treating. Particular emphasis is placed on triangular patterns that frequently develop when one agency involves another in carrying out its functions and in diffusing conflict with a client and his or her family. We refer to this process as an agency triangle. Case examples of such triangles involving various service systems (e.g., schools, courts, mental health centers) are presented, followed by discussion of how agency triangles can be prevented.
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Carl D. Tuning patients in to health education. Dimens Health Serv 1980; 57:38-40. [PMID: 7399173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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