Transition-of-care program from emergency department to gastroenterology clinics improves follow-up

OBJECTIVES

Patients discharged from the emergency department (ED) with gastrointestinal (GI) symptoms need to appropriately transition their care to a GI outpatient clinic in a timely manner to have their health needs met and avoid significant morbidity. When this transition isn't optimal, patients are lost to follow-up, potentially placing them at risk for adverse events. We sought to study the effectiveness of implementing an electronic medical record (EMR) based transition-of-care (TOC) program from the ED to outpatient GI clinics.

METHODS

We performed a retrospective single center cohort study of patients discharged from the ED of a tertiary care academic medical center referred to outpatient GI clinic before (Pre-TOC patients) and after implementation of an EMR based TOC program (TOC patients). We further stratified patients based on the Distressed Communities Index (DCI), which is a composite measure of economic well-being. We compared rates of appointment scheduling and appointment attendance between the two groups, as well as 30-day readmission rates to the ED. We also performed a subgroup analysis to determine if socioeconomic status would affect patient follow-up rates.

RESULTS

We included 380 Pre-TOC and 399 TOC patients in our analysis. TOC patients were found to both schedule appointments (50% vs 27% p-value <0.01) as well as show up to appointments (34% vs 24% p-value <0.01) at significantly higher rates compared to Pre-TOC patients. There was no significant difference between 30-day readmission rates between the two groups. In addition, TOC patients from At-Risk and Distressed Communities were over 22 times more likely to schedule an appointment compared to Pre-TOC patients from similar neighborhoods (OR 22.18, 95% CI 4.23-116.32).

CONCLUSION

Our study shows that patients who are discharged from the ED with outpatient GI follow-up are more likely to both schedule and show up to appointments with implementation of an EMR-based direct referral program compared to no patient navigation, particularly among patients of lower socioeconomic status.

Incidental diagnosis of intestinal spirochetosis in a patient with chronic hepatitis B: A case report

BACKGROUND

Intestinal spirochetosis (IS) is caused by Brachyspira colonization of the gastrointestinal tract. Some patients are asymptomatic, while others present with gastrointestinal complaints such as abdominal pain, diarrhea, or gastrointestinal bleeding. However, the clinical significance of asymptomatic IS is unclear, and guidelines are lacking regarding decision to treat.

CASE SUMMARY

A 73-year-old male with peptic ulcer disease and gastroesophageal reflux was evaluated for elevated liver enzymes. He was diagnosed with chronic hepatitis B virus and prescribed entecavir. Additionally, he was leukopenic and had stage 4 liver fibrosis on transient elastography. After 5 mo, the patient returned for esophagogastroduodenoscopy and screening colonoscopy. He denied any gastrointestinal symptoms at that time. Findings included grade I distal esophageal varices, mild portal hypertensive gastropathy, and patchy nodular gastric antral mucosa. On colonoscopy, several polyps were removed. Hematoxylin and eosin stain of mucosa adjacent to the polyps revealed a “false brush border,” and Steiner stain identified spirochetes adherent to the mucosa. These pathology findings confirmed the diagnosis of IS. He was managed conservatively with careful observation and without antibiotic therapy via a multidisciplinary approach between gastroenterology and infectious disease. He remained asymptomatic at the 7-wk follow-up.

CONCLUSION

This case reports the finding of incidental, asymptomatic IS in a leukopenic patient with hepatitis B virus. Conservative management was appropriate.

Neuro-mechanical aspects of playing-related mobility disorders in orchestra violinists and upper strings players: a review

Orchestra musicians are at high risk of neuro-mechanical disorders due to the intense stresses their body withstand, leading to pain and injury. This review presents a comprehensive account of the works on the circumstances and types of playing related mobility disorders of upper strings players, as well as on the relevant neuro-mechanical factors and perspectives to those disorders. The following aspects are considered: asymmetry and imbalance in the musculo-skeletal system, muscle-bone-joint interactions, repetitive overloading and fatigue. An additional factor relates to neuro-muscular redundancy in the motor system, whereby more muscles and tendons than strictly necessary are engaged in performing a motor task, thus making the system indeterminate, with no unique solution. This same task can be performed with different muscle combinations. It is thus of interest to verify whether playing disorders may be alleviated by considering alternative techniques of performance.

Neuro-mechanical aspects of playing-related mobility disorders in orchestra violinists and upper strings players: a review

Orchestra musicians are at high risk of neuro-mechanical disorders due to the intense stresses their body withstand, leading to pain and injury. This review presents a comprehensive account of the works on the circumstances and types of playing related mobility disorders of upper strings players, as well as on the relevant neuro-mechanical factors and perspectives to those disorders. The following aspects are considered: asymmetry and imbalance in the musculo-skeletal system, muscle-bone-joint interactions, repetitive overloading and fatigue. An additional factor relates to neuro-muscular redundancy in the motor system, whereby more muscles and tendons than strictly necessary are engaged in performing a motor task, thus making the system indeterminate, with no unique solution. This same task can be performed with different muscle combinations. It is thus of interest to verify whether playing disorders may be alleviated by considering alternative techniques of performance.

Low daily MEWS scores as predictors of low-risk hospitalized patients

BACKGROUND

The Modified Early Warning System (MEWS) is a well-validated tool used by hospitals to identify patients at high risk for an adverse event to occur. However, there has been little evaluation into whether a low MEWS score can be predictive of patients with a low likelihood of an adverse event.

AIM

The present study aims to evaluate the MEWS score as a method of identifying patients at low risk for adverse events.

DESIGN

Retrospective cohort study of 5676 patient days and analysis of associated MEWS scores, medical comorbidities and adverse events. The primary outcome was the association of average daily MEWS scores in those who had an adverse event compared with those who did not.

RESULTS

Those with an average MEWS score of >2 were over 9 times more likely to have an adverse event compared with those with an average MEWS score of 1-2, and over 15 times more likely to have an adverse event compared to those with an average MEWS score of <1.

CONCLUSIONS

Our study shows that those with average daily MEWS scores <2 are at a significantly lower likelihood of having an adverse event compared with a score of >2, deeming them 'low-risk patients'. Formal recognition of such patients can have major implications in a hospital setting, including more efficient resource allocation in hospitals and better patient satisfaction and safety by adjusting patient monitoring according to their individual risk profile.

Benchmarking an 11-qubit quantum computer

The field of quantum computing has grown from concept to demonstration devices over the past 20 years. Universal quantum computing offers efficiency in approaching problems of scientific and commercial interest, such as factoring large numbers, searching databases, simulating intractable models from quantum physics, and optimizing complex cost functions. Here, we present an 11-qubit fully-connected, programmable quantum computer in a trapped ion system composed of 13 ¹⁷¹Yb⁺ ions. We demonstrate average single-qubit gate fidelities of 99.5\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}%, average two-qubit-gate fidelities of 97.5\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}%, and SPAM errors of 0.7\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}%. To illustrate the capabilities of this universal platform and provide a basis for comparison with similarly-sized devices, we compile the Bernstein-Vazirani and Hidden Shift algorithms into our native gates and execute them on the hardware with average success rates of 78\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}% and 35\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\%$$\end{document}%, respectively. These algorithms serve as excellent benchmarks for any type of quantum hardware, and show that our system outperforms all other currently available hardware.

The growing complexity of quantum computing devices makes presents challenges for benchmarking their performance as previous, exhaustive approaches become infeasible. Here the authors characterise the quality of their 11-qubit device by successfully computing two quantum algorithms.

Fibrinogen-Based Hydrogel Modulus and Ligand Density Effects on Cell Morphogenesis in Two-Dimensional and Three-Dimensional Cell Cultures

There is a need to further explore the convergence of mechanobiology and dimensionality with systematic investigations of cellular response to matrix mechanics in 2D and 3D cultures. Here, a semisynthetic hydrogel capable of supporting both 2D and 3D cell culture is applied to investigate cell response to matrix modulus and ligand density. The culture materials are fabricated from adducts of polyethylene glycol (PEG) or PluronicF127 and fibrinogen fragments, formed into hydrogels by free-radical polymerization, and characterized by shear rheology. Control over the modulus of the materials is accomplished by changing the concentration of synthetic PEG-diacrylate crosslinker (0.5% w/v), and by altering the molecular length of the PEG (10 and 20 kDa). Control over ligand density is accomplished by changing fibrinogen concentrations from 3 to 12 mg mL^-1 . In 2D culture, cell motility parameters, including cell speed and persistence time are significantly increased with increasing modulus. In both 2D and 3D culture, cells express vinculin and there is evidence of focal adhesion formation in the high stiffness materials. The modulus- and ligand-dependent morphogenesis response from the cells in 2D culture is contradictory to the same measured response in 3D culture. In 2D culture, anchorage-dependent cells become more elongated and significantly increase their size with increasing ligand density and matrix modulus. In 3D culture, the same anchorage-dependent cells become less spindled and significantly reduce their size in response to increasing ligand density and matrix modulus. These differences arise from dimensionality constraints, most notably the encapsulation of cells in a non-porous hydrogel matrix. These insights underscore the importance of mechanical properties in regulating cell morphogenesis in a 3D culture milieu. The versatility of the hydrogel culture environment further highlights the significance of a modular approach when developing materials that aim to optimize the cell culture environment.

Red white and blue - bright light effects in a diurnal rodent model for seasonal affective disorder

Despite the common use of bright light exposure for treatment of seasonal affective disorder (SAD), the underlying biology of the therapeutic effect is not clear. Moreover, there is a debate regarding the most efficacious wavelength of light for treatment. Whereas according to the traditional approach full-spectrum light is used, recent studies suggest that the critical wavelengths are within the range of blue light (460 and 484 nm). Our previous work shows that when diurnal rodents are maintained under short photoperiod they develop depression- and anxiety-like behavioral phenotype that is ameliorated by treatment with wide-spectrum bright light exposure (2500 lux at the cage, 5000 K). Our current study compares the effect of bright wide-spectrum (3,000 lux, wavelength 420- 780 nm, 5487 K), blue (1,300 lux, wavelength 420-530 nm) and red light (1,300 lux, wavelength range 600-780 nm) exposure in the fat sand rat (Psammomys Obesus) model of SAD. We report results of experiments with six groups of sand rats that were kept under various photoperiods and light treatments, and subjected to behavioral tests related to emotions: forced swim test, elevated plus maze and social interactions. Exposure to either intense wide-spectrum white light or to blue light equally ameliorated depression-like behavior whereas red light had no effect. Bright wide-spectrum white light treatment had no effect on animals maintained under neutral photoperiod, meaning that light exposure was only effective in the pathological-like state. The resemblance between the effects of bright white light and blue light suggests that intrinsically photosensitive retinal ganglion cells (ipRGCs) are involved in the underlying biology of SAD and light therapy.

Diabetes Mellitus and Age are Risk Factors of Interval Colon Cancer: A Case-Control Study

BACKGROUND AND AIMS

Interval colorectal cancer (CRC) is largely related to a poor endoscopic performance or different biology in the development of the polyp. However, patient-related factors were less investigated for their association with interval cancer. We thus evaluated tumor and patient characteristics as predictors of interval cancer in a population from Israel.

METHODS

In this retrospective study, patients that were diagnosed with colon cancer in our institution and had 2 colonoscopies were included. Demographic parameters and tumor characteristics were compared between 84 cases with interval cancer, occurring 1-10 years after a negative colonoscopy, and 983 patients with primary CRC. In addition, patient-related features, including diabetes and diverticulosis, were compared between 51 patients with interval cancer after negative colonoscopy and 255 controls with no cancer and a previous negative colonoscopy.

RESULTS

Compared to "positive" controls with primary cancer, patients with interval cancer were older (age 71.3 vs. 67.6, p = 0.003), had proximal tumor location (57 vs. 34%, p < 0.001) and non-advanced (0-2) tumor staging (78.5 vs. 64.8%, p = 0.014). Compared with -"negative" healthy controls, cases with interval cancer had only higher prevalence of diabetes (31 vs. 15%, p = 0.002). No significant differences were seen between patients with interval cancer occurring < 3 years and after 3-10 years.

CONCLUSIONS

Patients with Interval cancer tend to be older and have diabetes. These patient groups should be more carefully or more frequently screened for pre-malignant lesions.

Ultrafast creation of large Schrödinger cat states of an atom

Mesoscopic quantum superpositions, or Schrödinger cat states, are widely studied for fundamental investigations of quantum measurement and decoherence as well as applications in sensing and quantum information science. The generation and maintenance of such states relies upon a balance between efficient external coherent control of the system and sufficient isolation from the environment. Here we create a variety of cat states of a single trapped atom’s motion in a harmonic oscillator using ultrafast laser pulses. These pulses produce high fidelity impulsive forces that separate the atom into widely separated positions, without restrictions that typically limit the speed of the interaction or the size and complexity of the resulting motional superposition. This allows us to quickly generate and measure cat states larger than previously achieved in a harmonic oscillator, and create complex multi-component superposition states in atoms.

Generation of mesoscopic quantum superpositions requires both reliable coherent control and isolation from the environment. Here, the authors succeed in creating a variety of cat states of a single trapped atom, mapping spin superpositions into spatial superpositions using ultrafast laser pulses.

Active stabilization of ion trap radiofrequency potentials

We actively stabilize the harmonic oscillation frequency of a laser-cooled atomic ion confined in a radiofrequency (rf) Paul trap by sampling and rectifying the high voltage rf applied to the trap electrodes. We are able to stabilize the 1 MHz atomic oscillation frequency to be better than 10 Hz or 10 ppm. This represents a suppression of ambient noise on the rf circuit by 34 dB. This technique could impact the sensitivity of ion trap mass spectrometry and the fidelity of quantum operations in ion trap quantum information applications.

Sensing Atomic Motion from the Zero Point to Room Temperature with Ultrafast Atom Interferometry

We sense the motion of a trapped atomic ion using a sequence of state-dependent ultrafast momentum kicks. We use this atom interferometer to characterize a nearly pure quantum state with n=1 phonon and accurately measure thermal states ranging from near the zero-point energy to n[over ¯]~10^{4}, with the possibility of extending at least 100 times higher in energy. The complete energy range of this method spans from the ground state to far outside of the Lamb-Dicke regime, where atomic motion is greater than the optical wavelength. Apart from thermometry, these interferometric techniques are useful for characterizing ultrafast entangling gates between multiple trapped ions.

Mechanical Impedance and Its Relations to Motor Control, Limb Dynamics, and Motion Biomechanics

The concept of mechanical impedance represents the interactive relationship between deformation kinematics and the resulting dynamics in human joints or limbs. A major component of impedance, stiffness, is defined as the ratio between the force change to the displacement change and is strongly related to muscle activation. The set of impedance components, including effective mass, inertia, damping, and stiffness, is important in determining the performance of the many tasks assigned to the limbs and in counteracting undesired effects of applied loads and disturbances. Specifically for the upper limb, impedance enables controlling manual tasks and reaching motions. In the lower limb, impedance is responsible for the transmission and attenuation of impact forces in tasks of repulsive loadings. This review presents an updated account of the works on mechanical impedance and its relations with motor control, limb dynamics, and motion biomechanics. Basic questions related to the linearity and nonlinearity of impedance and to the factors that affect mechanical impedance are treated with relevance to upper and lower limb functions, joint performance, trunk stability, and seating under dynamic conditions. Methods for the derivation of mechanical impedance, both those for within the system and material-structural approaches, are reviewed. For system approaches, special attention is given to methods aimed at revealing the correct and sufficient degree of nonlinearity of impedance. This is particularly relevant in the design of spring-based artificial legs and robotic arms. Finally, due to the intricate relation between impedance and muscle activity, methods for the explicit expression of impedance of contractile tissue are reviewed.

Beat note stabilization of mode-locked lasers for quantum information processing

We stabilize a chosen radio frequency beat note between two optical fields derived from the same mode-locked laser pulse train in order to coherently manipulate quantum information. This scheme does not require access or active stabilization of the laser repetition rate. We implement and characterize this external lock, in the context of two-photon stimulated Raman transitions between the hyperfine ground states of trapped 171Yb(+) quantum bits.

Methods for Dynamic Characterization of the Major Muscles Activating the Lower Limb Joints in Cycling Motion

The functional activation, through electrical stimulation, of the lower limb consisting of several deficient muscles requires well-patterned and coordinated activation of these muscles. This study presents a method for characterizing the parameters of the major muscle groups controlling the ankle and knee joints in cycling motion, the latter having particular significance in the rehabilitation of locomotion. To lower mechanical indeterminacy in the joints the system is reduced by grouping the muscles acting in synergism. The joint torques were calculated by inverse dynamics methods from cycling motion data, including kinematics and foot/pedal reaction loads (forces, moments). The mechanical indeterminacy was resolved by applying optimization criteria and the individual muscle torques were parceled-out from the joint torques. System identification of the individual muscles, part of which being bi-articular, in this non-isometric condition was performed from the relationship between the evaluated force and the measured EMG of each the muscles, using both first and second order linear transfer functions. Feasibility of the presented method was demonstrated through the computation of the coefficients of the muscles involved and validating the results on the experimental data obtained from one subject.

Ultrafast spin-motion entanglement and interferometry with a single atom

We report entanglement of a single atom's hyperfine spin state with its motional state in a time scale of less than 3 ns. We engineer a short train of intense laser pulses to impart a spin-dependent momentum transfer of ± 2 ħk. Using pairs of momentum kicks, we create an atomic interferometer and demonstrate collapse and revival of spin coherence as the motional wave packet is split and recombined. The revival after a pair of kicks occurs only when the second kick is delayed by an integer multiple of the harmonic trap period, a signature of entanglement and disentanglement of the spin with the motion. Such quantum control opens a new regime of ultrafast entanglement in atomic qubits.

Effects of the dual PPAR-α/γ agonist aleglitazar on glycaemic control and organ protection in the Zucker diabetic fatty rat

AIMS

To evaluate the effects of aleglitazar, a dual peroxisome proliferator-activated receptor-α/γ agonist, on the development of diabetes-related organ dysfunction, in relation to glycaemic and lipid changes, in Zucker diabetic fatty (ZDF) rats.

METHODS

Six-week-old, male ZDF rats received aleglitazar 0.3 mg/kg/day or vehicle as food admix for 13 weeks (n = 10 per group). Age-matched male Zucker lean rats served as non-diabetic controls. Plasma and renal markers were measured at several time points. Histopathology and quantitative immunohistochemistry were performed at 13 weeks.

RESULTS

Glycated haemoglobin (5.4 vs. 9.2%) and blood glucose (8.3 ± 0.3 vs. 26.1 ± 1.0 mmol/l) were significantly reduced at 12 weeks with aleglitazar versus vehicle-treated ZDF rats (both p < 0.01), while aleglitazar preserved near-normal plasma insulin levels. Aleglitazar prevented the development of hypertriglyceridaemia (1.4 ± 0.1 vs. 8.5 ± 0.9 mmol/l) and reduced plasma non-esterified fatty acids (0.09 ± 0.02 vs. 0.26 ± 0.04 mmol/l) relative to vehicle-treated animals (both p < 0.01). Urinary glucose and protein concentrations were significantly reduced at 13 weeks with aleglitazar versus vehicle-treated rats (both p < 0.01). Consistent with its effect on glycaemic control, aleglitazar protected β-cell morphology, as evidenced by preservation of islet integrity, and reduction of β-cell apoptosis and islet fibrosis. Aleglitazar prevented renal glomerular hypertrophy, podocyte degeneration, glomerulosclerosis, tubulo-interstitial lesions and development of cataracts.

CONCLUSIONS

Aleglitazar strongly improved glycaemic and lipid parameters while protecting key tissues, including the pancreas, kidneys and eyes, against diabetes-associated structural and functional changes in the ZDF rat.

A Finite Element Model of Cell-Matrix Interactions to Study the Differential Effect of Scaffold Composition on Chondrogenic Response to Mechanical Stimulation

Mechanically induced cell deformations have been shown to influence chondrocyte response in 3D culture. However, the relationship between the mechanical stimulation and cell response is not yet fully understood. In this study a finite element model was developed to investigate cell-matrix interactions under unconfined compression conditions, using a tissue engineered encapsulating hydrogel seeded with chondrocytes. Model predictions of stress and strain distributions within the cell and on the cell boundary were shown to exhibit space-dependent responses that varied with scaffold mechanical properties, the presence of a pericellular matrix (PCM), and the cell size. The simulations predicted that when the cells were initially encapsulated into the hydrogel scaffolds, the cell size hardly affected the magnitude of the stresses and strains that were reaching the encapsulated cells. However, with the inclusion of a PCM layer, larger cells experienced enhanced stresses and strains resulting from the mechanical stimulation. It was also noted that the PCM had a stress shielding effect on the cells in that the peak stresses experienced within the cells during loading were significantly reduced. On the other hand, the PCM caused the stresses at the cell-matrix interface to increase. Based on the model predictions, the PCM modified the spatial stress distribution within and around the encapsulated cells by redirecting the maximum stresses from the periphery of the cells to the cell nucleus. In a tissue engineered cartilage exposed to mechanical loading, the formation of a neo-PCM by encapsulated chondrocytes appears to protect them from initially excessive mechanical loading. Predictive models can thus shed important insight into how chondrocytes remodel their local environment in order to redistribute mechanical signals in tissue engineered constructs.

The influence of biological motifs and dynamic mechanical stimulation in hydrogel scaffold systems on the phenotype of chondrocytes

Primary bovine chondrocytes and PEG-based hydrogels were used to investigate the effects of scaffold composition and architecture on the cellular response to large dynamic compressive strain stimulation. Proteins and proteoglycans were conjugated to functionalized poly(ethylene glycol) (PEG) and immobilized in PEG hydrogels to create bio-synthetic scaffolds. Second passage articular chondrocytes were encapsulated into four different scaffold compositions: PEG-Proteoglycan (PP), PEG-Fibrinogen (PF), PEG-Albumin (PA), and PEG only and subjected to 15% dynamic compressive strain at 1-Hz frequency. Cellular response was evaluated in terms of cell number, glycosaminoglycans (GAGs), collagen type II and collagen type I accumulation in the constructs following 24h and 28 days of stimulated and static culture. Stimulation of the constructs resulted in an increase in the cell number in all scaffolds, with no statistical difference measured among them. Dynamic stimulation of PP, PF, PA and PEG constructs resulted in a respective increase in the GAGs by 33%, 53.4%, 240.5%, and 284.5%, compared to their static controls. The permissive PEG and PA scaffolds showed a significantly larger relative increase in the GAGs in comparison to the other scaffolds tested. Collagen type II content in the PF, PA and PEG constructs increased by 78%, 1266% and 896% respectively, compared to their static controls. Permissive constructs showed a significantly larger relative increase and final absolute values of GAGs and type II collagen, compared to the PF constructs. Immunostaining for collagen type I, an indicator for chondrocyte de-differentiation, indicated that stimulation inhibited its production. Correlation maps between scaffold properties highlighted the major differences between permissive and instructive scaffolds. These results support the hypothesis that both compressive strain and scaffold bioactivity have an important effect on the chondrocyte metabolic response to mechanical stimulation, and that the 3-D environment surrounding chondrocytes can actively participate in translating mechanical stimulation to the resident cells.

Ultrafast gates for single atomic qubits

We demonstrate single-qubit operations on a trapped atom hyperfine qubit using a single ultrafast pulse from a mode-locked laser. We shape the pulse from the laser and perform a π rotation of the qubit in less than 50 ps with a population transfer exceeding 99% and negligible effects from spontaneous emission or ac Stark shifts. The gate time is significantly shorter than the period of atomic motion in the trap (Ω(Rabi)/ν(trap)>10(4)), demonstrating that this interaction takes place deep within the strong excitation regime.

Entanglement of atomic qubits using an optical frequency comb

We demonstrate the use of an optical frequency comb to coherently control and entangle atomic qubits. A train of off-resonant ultrafast laser pulses is used to efficiently and coherently transfer population between electronic and vibrational states of trapped atomic ions and implement an entangling quantum logic gate with high fidelity. This technique can be extended to the high field regime where operations can be performed faster than the trap frequency. This general approach can be applied to more complex quantum systems, such as large collections of interacting atoms or molecules.

The differential effect of scaffold composition and architecture on chondrocyte response to mechanical stimulation

This study aims to explore the differential effect of scaffold composition and architecture on chondrogenic response to dynamic strain stimulation using encapsulating PEG-based hydrogels and primary bovine chondrocytes. Proteins and proteoglycans were conjugated to functionalized poly(ethylene glycol) (PEG) and immobilized in PEG hydrogels to create bio-synthetic materials to be used as scaffolds. Four different compositions were tested, including: PEG-Proteoglycan (PP), PEG-Fibrinogen (PF), PEG-Albumin (PA), and PEG only. Primary articular chondrocytes were encapsulated in the hydrogel scaffolds and subjected to 15% dynamic compressive strain stimulation at 1-Hz frequency for 28 days. Stimulation of PP, PF, PA and PEG constructs resulted in a respective increase in the unconfined true compressive modulus by 32%, 45.4%, 33.6%, and 28.2%, compared to their static controls. The PF showed a significantly larger relative increase in the modulus in comparison to all other scaffolds tested. These results support the hypothesis that mechanical stimulation and material bioactivity have a significant effect on the reported chondrocyte response. Similar trends were observed with the swelling ratio of the constructs. These findings indicate that while stimulation causes metabolic changes in chondrocytes seeded in PEG hydrogels, the matrix bioactivity has a significant role in enhancing chondrocyte mechanotransduction in encapsulating scaffolds subjected to physical deformations.

Enhancement of muscle activity by electrical stimulation in cerebral palsy: a case-control study

The objectives of this study were to compare the effects of low-intensity electrical stimulation of the quadriceps muscle in children with cerebral palsy in the following 2 modes: reconditioning by long-term training of the muscle versus real-time assist to the muscle during motion. To evaluate the force enhancement in the assist mode, we developed a method to dissociate the volitional and the induced components from the total electromyographic signal. The study group, including 5 children with cerebral palsy (mean age, 3.3 years; 0.4 SD), underwent 2 testing sessions: 1 before and 1 after 3-month training by electrical stimulation. Each session included 2 series of trials: 1 with electrical stimulation, as an orthotic assist, and 1 without electrical stimulation. The tests included flexion-extension movements of the knee at a self-selected pace. The results showed that, compared to before training, there was a significant increase in the average motion velocity and a decrease in motion jerk and in knee torque after training in both the electrical stimulation- assisted and -unassisted modes. Of special interest was the significant decrease in quadriceps-hamstrings co-contraction following training by electrical stimulation but not during electrical stimulation-assisted motion. The results obtained for the group with cerebral palsy were statistically different from those of the control group, but this difference decreased after long-term training by electrical stimulation. It was concluded that, in children with cerebral palsy, electrical stimulation is more beneficial in long-term training than when used as a real-time motion assist. Although muscle strength is not affected, more centrally controlled attributes such as co-contraction are improved.

Reduced plaque formation induced by rosiglitazone in an STZ-diabetes mouse model of atherosclerosis is associated with downregulation of adhesion molecules

Adhesion molecules have been implicated in the development and progression of cardiovascular disease, which is highly prevalent in people with diabetes. Adhesion molecules can mediate adhesion of leukocytes to the endothelium. Furthermore, P-selectin expressed on platelets is able to mediate the adhesion of leukocytes to platelets. In this study, we examine the in-vivo and in-vitro effects of rosiglitazone with particular emphasis on three important adhesion molecules (VCAM-1, ICAM-1 and P-selectin). In the aorta of STZ-diabetic apolipoprotein E-deficient (apoE KO) mice, rosiglitazone significantly reduced both total and arch plaque area. The mechanism for this appeared to be reduced macrophage infiltration into the atherosclerotic plaque which was also associated with reduced mRNA levels for VCAM-1, ICAM-1, MCP-1 and P-selectin in the aorta. In-vitro studies revealed reduced cell adhesion of monocytic cells (THP-1) to fibrinogen and endothelial cells (HUVEC) after incubation with rosiglitazone. Furthermore, the reduction in leukocyte adhesion also correlated with significant reductions in mRNA levels for VCAM-1, ICAM-1 and P-selectin indicating that reduced macrophage infiltration in atherosclerotic plaques may occur as a result of a direct effect of rosiglitazone on adhesion molecules in both monocytes and endothelial cells. Thus, we have shown that rosiglitazone appears to have direct anti-atherosclerotic effects in an animal model of diabetes-associated atherosclerosis which are at least partly due to effects on VCAM-1, ICAM-1, MCP-1 and P-selectin expression which leads to decreased leukocyte adhesion and macrophage infiltration.

PPARs and diabetes-associated atherosclerosis

Peroxisome proliferator-activated receptors (PPARs) are ligand-dependent transcription factors affecting the regulation of various genes relevant to the pathogenesis of diabetic complications. A number of drugs have been developed to act as agonists of the three PPARs. To date, PPAR isoforms that have been identified are the alpha, beta/delta, and gamma isosforms. Fenofibrate and gemfibrozil are two drugs that act as PPARalpha agonists and are currently in use in the clinical setting. Rosiglitazone is a PPARgamma agonist also in clinical use. These drugs have proved very useful in regulation of either glucose or lipid metabolism and consequently are used in patients with type 2 diabetes. Here, we will review the anti-atherosclerotic potential of PPAR agonists with particular emphasis on recent studies in an animal model of diabetes-associated atherosclerosis, the streptozotocin diabetic apolipoprotein E deficient mouse. These studies have shown both PPARalpha agonists, gemfibrozil and fenofibrate, confer anti-atherosclerotic effects, partly independent of their metabolic effects. Similar positive findings have also been detected in a dose-dependent manner with the PPARgamma agonist, rosiglitazone. The potential clinical implications of these findings are also discussed in view of the recently reported results of the PROACTIVE and FIELD clinical trials with the PPAR agonists rosiglitazone and fenofibrate respectively.

Differential response of adult and embryonic mesenchymal progenitor cells to mechanical compression in hydrogels

Cells in the musculoskeletal system can respond to mechanical stimuli, supporting tissue homeostasis and remodeling. Recent studies have suggested that mechanical stimulation also influences the differentiation of MSCs, whereas the effect on embryonic cells is still largely unknown. In this study, we evaluated the influence of dynamic mechanical compression on chondrogenesis of bone marrow-derived MSCs and embryonic stem cell-derived (human embryoid body-derived [hEBd]) cells encapsulated in hydrogels and cultured with or without transforming growth factor beta-1 (TGF-beta1). Cells were cultured in hydrogels for up to 3 weeks and exposed daily to compression for 1, 2, 2.5, and 4 hours in a bioreactor. When MSCs were cultured, mechanical stimulation quantitatively increased gene expression of cartilage-related markers, Sox-9, type II collagen, and aggrecan independently from the presence of TGF-beta1. Extracellular matrix secretion into the hydrogels was also enhanced. When hEBd cells were cultured without TGF-beta1, mechanical compression inhibited their differentiation as determined by significant downregulation of cartilage-specific genes. However, after initiation of chondrogenic differentiation by administration of TGF-beta1, the hEBd cells quantitatively increased expression of cartilage-specific genes when exposed to mechanical compression, similar to the bone marrow-derived MSCs. Therefore, when appropriately directed into the chondrogenic lineage, mechanical stimulation is beneficial for further differentiation of stem cell tissue engineered constructs.

Effect of selective fatiguing of the shank muscles on single-leg-standing sway

Control of standing requires the continuous activity of the leg muscles. In single leg standing the system is less redundant and muscular activity is more intensive. The objective of this study was to examine the effect of force imbalance of the shank muscles, evoked by their selective fatiguing, on postural control in single-leg standing. Five healthy subjects performed two single-leg standing trials, lasting as long as the subject could maintain steady balance, and separated by a 240s quasi-isotonic sustained effort to induce fatigue of the Tibialis Anterior and Peroneus muscles. The following were on-line monitored: sway-related parameters, e.g., ground reaction force and center of pressure in the standing trials; and electromyogram of the Tibialis Anterior, Peroneus and Gastrocnemius muscles in all experiments. Simple and multiple linear regressions served to study the fatigue effects on the relationship between muscle activity and postural sway. The results indicate that the evoked muscle imbalance leads to (a) increased postural sway; (b) increased correlation between muscle activity, and sway-related parameters. Thus, with the reduction of the level of redundancy the system becomes more synchronized. These results have potential relevance for cases of muscle impairment, in which electrical stimulation is required to augment muscle activity.

Transmission-line model for myelinated nerve fiber

Herein, the well-known cable equation for non-myelinated axon model is extended analytically for myelinated axon formulation. The classical cable equation is thereby modified into a linear second order ordinary differential equation with periodic coefficient, known as Hill's equation. Hill's equation exhibits periodic solutions, known as Floquet's modes. The Floquet's modes are recognized as the nerve fiber activation modes, which are conventionally associated with the nonlinear Hodgkin-Huxley formulation. They can also be incorporated in our linear model.

Muscle force augmentation by low-intensity electrical stimulation

In cases of muscle partial deficiency, force augmentation can be achieved by hybrid activation, i.e., by combining electrical stimulation (ES) with volitional activation. In the present study the volitional and electrically-induced torque components are resolved under visual-feedback activation. Isometric contraction of the tibialis anterior (TA) muscle was studied on 5 healthy subjects, using an activation protocol combining ES alone, volitional activation alone and hybrid activation. Ankle torque and TA EMG were measured. A computational algorithm was developed to dissociate the volitional from the overall torque, based on EMG filtering and on pre-measured calibration curves of volitional torque versus EMG. Based on a defined facilitation factor, the results indicate that within the range of stimulation intensities, there exist regions of increased facilitation of the volitional activation of the TA muscle, in which the torque contribution due to the induced activation is higher compared that of the recruitment curve.

Immobilized fibrinogen in PEG hydrogels does not improve chondrocyte-mediated matrix deposition in response to mechanical stimulation

The present investigation aims to explore the role of cell-scaffold interactions and whole cell compression in chondrocyte mechanotransduction using encapsulating poly(ethylene glycol) (PEG) hydrogel scaffolds and primary bovine chondrocytes. Scaffolds made from PEG hydrogels with immobilized fibrinogen molecules were seeded with chondrocytes and subjected to 15% dynamic compressive strain at 1-Hz frequency. Dynamic strain stimulation resulted in a 37% increase in the levels of sulfated glycosaminoglycan (sGAG) after 2 weeks of stimulation, when compared to static controls. Comparing results of the PEG-fibrinogen scaffolds with their respective PEG control group did not show significant differences between the two, even following 2 weeks of dynamic mechanical stimulation. Accordingly, these findings indicate that while cell deformations cause metabolic changes in chondrocytes seeded in PEG hydrogels, it is difficult to ascertain the role of matrix bioactivity in enhancing chondrocyte mechanotransduction in encapsulating scaffolds subjected to physical deformations. This study shows how interactions between mechanical stimulation and scaffold composition are evaluated using an experimental approach and customized biomaterial scaffolds.

Evaluation of methods for extraction of the volitional EMG in dynamic hybrid muscle activation

Background

Hybrid muscle activation is a modality used for muscle force enhancement, in which muscle contraction is generated from two different excitation sources: volitional and external, by means of electrical stimulation (ES). Under hybrid activation, the overall EMG signal is the combination of the volitional and ES-induced components. In this study, we developed a computational scheme to extract the volitional EMG envelope from the overall dynamic EMG signal, to serve as an input signal for control purposes, and for evaluation of muscle forces.

Methods

A "synthetic" database was created from in-vivo experiments on the Tibialis Anterior of the right foot to emulate hybrid EMG signals, including the volitional and induced components. The database was used to evaluate the results obtained from six signal processing schemes, including seven different modules for filtration, rectification and ES component removal. The schemes differed from each other by their module combinations, as follows: blocking window only, comb filter only, blocking window and comb filter, blocking window and peak envelope, comb filter and peak envelope and, finally, blocking window, comb filter and peak envelope.

Results and conclusion

The results showed that the scheme including all the modules led to an excellent approximation of the volitional EMG envelope, as extracted from the hybrid signal, and underlined the importance of the artifact blocking window module in the process.

The results of this work have direct implications on the development of hybrid muscle activation rehabilitation systems for the enhancement of weakened muscles.

Partition between volitional and induced forces in electrically augmented dynamic isometric muscle contractions

Augmentation of force in partially deficient muscles can be achieved by combining electrical stimulation (ES) with their volitional activation (hybrid activation). However, while the overall torque results from the combination of the volitional and the electrically-induced torque components, the exact share between these components is not known. In a previous work, we described a method to resolve the share between the torque components under isometric static contractions. In this work, we extend our analysis to the case of isometric dynamic contractions. Five healthy subjects were instructed to contract their Tibialis Anterior (TA) muscles according to a typical gait-like dynamic torque pattern, that was visually displayed to them, while monitoring their actual ankle torque and TA electromyography (EMG). These experiments were done with and without augmented activation by means of ES. A computational algorithm was developed to dissociate the volitional from the overall torque, based on EMG signal processing and on precalibration of the dynamic system of the volitional torque versus EMG. The results indicated the quantitative relations between decrease in the volitional torque and the required increase in ES enhancement. The developed method also demonstrated what ES intensity profile is necessary to produce a desired overall torque output. This provides the means for designing an adaptive rehabilitation device for the hybrid activation of deficient muscles.

Muscle enhancement using closed-loop electrical stimulation: volitional versus induced torque

In cases of partial deficiency of muscle activation capacity, force augmentation can be achieved by hybrid activation, i.e., by combining electrical stimulation (ES) with volitional activation. In this activation modality the shares of the volitional and induced torques within the overall hybrid torque are unknown. The purpose of this study was to suggest a computational approach to parcel out the volitional and stimulation induced components of joint torque generated during combined voluntary and electrical activation of the Tibialis Anterior muscle (TA). For this purpose, isometric contraction of the TA was studied on 5 healthy subjects, using an activation protocol involving ES alone, volitional activation alone and hybrid activation. Ankle torque and TA EMG were measured. A computational algorithm was developed to dissociate the volitional from the overall torque, based on EMG filtering and on pre-measured calibration curves of volitional torque versus EMG. The results indicated that for a certain hybrid torque there is a linear decaying relationship between the induced torque and the volitional torque shares. Moreover, based on a defined enhancement ratio, the results indicate that within the range of stimulation intensities, there exist regions of increased facilitation, in which the stimulation efficiency is higher under combined compared to isolated conditions.

Synthesis and biological evaluation of novel hexahydro-pyrido[3′,2′:4,5]pyrrolo[1,2-a]pyrazines as potent and selective 5-HT2C receptor agonists

Further lead optimization efforts on previously described 1,2,3,4,10,10a-hexahydro-1H-pyrazino[1,2-a]indoles led to the new class of 5,5a,6,7,8,9-hexahydro-pyrido[3',2':4,5]pyrrolo[1,2-a]pyrazines culminating in the discovery of (5aR,9R)-2-[(cyclopropylmethoxy)methyl]-5,5a,6,7,8,9-hexahydro-9-methyl-pyrido[3', 2':4,5]pyrrolo[1,2-a]pyrazine 18 as a potent, full 5-HT(2C) receptor agonist with an outstanding selectivity profile and excellent hERG and phospholipidosis properties.

Objective measurement of knee extension force based on computer adaptive testing

False impairment is encountered when tested subjects either unintentionally or deliberately put an artificial upper limit on their force, in which case their true capacity cannot be disclosed in a straight forward measurement. The aim of this study was to develop a computer adaptive testing (CAT) system for directing subjects into generating greater forces than they intended. The system was tested on eleven cooperative female subjects who volunteered to take part in this study. The CAT consisted of interactive testing cycles, each containing a series of isometric tasks of differing intensities. While fulfilling these tasks, the tested subjects were asked to take care not to exceed a self-selected upper force limit (F(ssl)) that they were previously trained to memorize (order of 40% of the maximal voluntary contraction). Visual feedback, displaying the applied force exertions, was provided to the tested subjects but was modified by re-scaling the display in an un-anticipated manner. To confirm the subject's ability to remember her F(ssl), repeatability of joint memory was tested one week after the CAT. The CAT results were successful in causing ten out of the eleven tested participants to exert a higher force than they intended to. Additionally, the CAT algorithm caused a statistically significant higher force than the repeatability test. These results demonstrate the potential of CAT methods in improving the clinical evaluation of muscle strength, particularly in those cases where the subject's cooperation is not sufficient.

Generalized Cable Equation Model for Myelinated Nerve Fiber

Herein, the well-known cable equation for nonmyelinated axon model is extended analytically for myelinated axon formulation. The myelinated membrane conductivity is represented via the Fourier series expansion. The classical cable equation is thereby modified into a linear second order ordinary differential equation with periodic coefficients, known as Hill's equation. The general internal source response, expressed via repeated convolutions, uniformly converges provided that the entire periodic membrane is passive. The solution can be interpreted as an extended source response in an equivalent nonmyelinated axon (i.e., the response is governed by the classical cable equation). The extended source consists of the original source and a novel activation function, replacing the periodic membrane in the myelinated axon model. Hill's equation is explicitly integrated for the specific choice of piecewise constant membrane conductivity profile, thereby resulting in an explicit closed form expression for the transmembrane potential in terms of trigonometric functions. The Floquet's modes are recognized as the nerve fiber activation modes, which are conventionally associated with the nonlinear Hodgkin-Huxley formulation. They can also be incorporated in our linear model, provided that the periodic membrane point-wise passivity constraint is properly modified. Indeed, the modified condition, enforcing the periodic membrane passivity constraint on the average conductivity only leads, for the first time, to the inclusion of the nerve fiber activation modes in our novel model. The validity of the generalized transmission-line and cable equation models for a myelinated nerve fiber, is verified herein through a rigorous Green's function formulation and numerical simulations for transmembrane potential induced in three-dimensional myelinated cylindrical cell. It is shown that the dominant pole contribution of the exact modal expansion is the transmembrane potential solution of our generalized model.

Identification of 4-methyl-1,2,3,4,10,10a-hexahydropyrazino[1,2-a]indoles as 5-HT2C receptor agonists

Synthesis and evaluation of the activity of new 4-methyl-1,2,3,4,10,10a-hexahydropyrazino[1,2-a]indoles as 5-HT(2C) receptor agonists are described. Appropriately substituted, several analogs displayed selectivity against the other 5-HT(2) receptor subtypes of 1 order of magnitude or more. Selectivity was improved for several compounds versus the lead 1, increasing the therapeutic interest in this series of 5-HT(2C) receptor agonists.

Constant and variable stiffness and damping of the leg joints in human hopping

The present study deals with the stiffness and damping profiles of the leg joints during the ground-contact phase of hopping. A two-dimensional (sagittal plane) jumping model, consisting of four linked rigid segments and including the paired feet, shanks, thighs, and the head-arms-trunk segment, was developed. The segments were interconnected by damped torsional springs, representing the action of the muscles, tendons and ligaments across the joint and of the other joint tissues. A regressive function was used to express stiffness and damping, and included second-order dependence on angle and first-order dependence on angular velocity. By eliminating redundancies in the numerical solution using multicollinearity diagnostic algorithms, the model results revealed that the correct and sufficient nonlinearity for the joint stiffness is of the first order. Damping was found negligible. The stiffness profiles obtained were bell-shaped with a maximum near midstance and nonzero edge values. In predicting the joint moments, the obtained variable joint stiffnesses provided a closer agreement compared to a constant stiffness model. The maximal stiffness was found to be in linear correlation with the initial stiffness in each joint, providing support to the of muscles' preactivation strategy during the flight phase of hopping. All stiffnesses increased with increasing hopping frequency. The model presented provides an effective tool for future designing of artificial legs and robots and for the development of more accurate control strategies.

Joint torques during sit-to-stand in healthy subjects and people with Parkinson's disease

OBJECTIVES

To compare lower limb joint torques during sit-to-stand in normal elderly subjects and people with Parkinson's disease, using a developed biomechanical model simulating all phases of sit-to-stand.Design. A cross-sectional study utilizing a Parkinsonian and a control group.

BACKGROUND

Subjects with Parkinson's disease were observed to experience difficulty in performing sit-to-stand. The developed model was used to calculate the lower limb joint torques in normal elderly subjects and subjects with Parkinson's disease, to delineate possible causes underlying difficulties in initiating sit-to-stand task.

METHODS

Six normal elderly subjects and seven age-matched subjects with Parkinson's disease performed five sit-to-stand trials at their self-selected speed. Anthropometric data, two-dimensional kinematic and foot-ground and thigh-chair reactive forces were used to calculate, via inverse dynamics, the joint torques during sit-to-stand in both before and after seat-off phases. The difference between the control and Parkinson's disease group was analysed using independent t-tests.

RESULTS

Both control and Parkinson's disease groups had a similar joint kinematic pattern, although the Parkinson's disease group demonstrated a slower angular displacement. The latter subjects produced significantly smaller normalized hip flexion torque and presented a slower torque build-up rate than the able-bodied subjects (P<0.05).

CONCLUSION

Slowness of sit-to-stand in people with Parkinson's disease could be due to a reduced hip flexion joint torque and a prolonged rate of torque production.

Rigorous Green's function formulation for transmembrane potential induced along a 3-D infinite cylindrical cell

The quasi-static electromagnetic field interaction with three-dimensional infinite-cylindrical cell is investigated for both intracellular (IPS) and extracellular (EPS) current point-source excitation. The induced transmembrane potential (TMP), expressed conventionally via Green's function, may alternatively be expanded into a faster-converging representation using a complex contour integration, consisting of an infinite-discrete set of exponentially decaying oscillating modes (corresponding to complex eigenvalues) and a continuous source-mode convolution integral. The dominant contributions for both the IPS and EPS problems are obtained in simple closed-form expressions, including well documented special mathematical functions. In the IPS case, the dominant modal contribution (of order zero)--an exact solution of the well-known cable equation--is explicitly and analytically corrected by the imaginary part of its eigenvalue and the source-mode convolution contribution. However, the TMP along a fiber was shown to decay at infinity algebraically and not exponentially, as predicted by the classic cable equation solution. In the EPS case, the dominant contribution is expressed as a source-mode convolution integral. However, for a long EPS distance (e.g., >10 cable length constant) the order-one-modes involved in the convolution is not a solution of the cable equation. Only for shorter EPS distance should the cable equation solution (i.e., the order zero dominant mode) be included in addition to the modes of order one. For on-membrane EPS location, additional modes should be included as well. In view of our EPS result, we suggest that the cable equation modeling existing in the literature and related to functional electrical stimulation for EPS problems, should be critically reviewed and corrected.

Open-chain analysis of single stance

In this study we present a model by which the kinematics of single stance standing can be formulated and solved from forceplate measurements. A three-segment model with four rotation coordinates, two at the ankle and two at the hip, was developed as an open chain of linkages, with the trunk treated as the end-effector. Using the Denavit-Hartenberg notation, the trajectory of the center of mass (CoM) was evaluated by an iteration procedure, combining angular momentum principles with direct integration of the equations of motion. Kinematics and torques in the joints were thereafter solved. Single stance standing experiments were made on six healthy subjects and forceplate measurements served as input data for the model. The results show that the typical CoM excursion is within 2-3 cm roughly one order of magnitude higher than in double stance standing. Average oscillations of the joint angles ranged from 0.79 to 4.57 deg, with the higher values taking place in the hip sagittal rotation. The highest torques were coronal, at the hip, amounting to an average of 141 Nm. It was also found that when moving from ankle to hip the sequence of torque and angular displacement is inverted, indicating that the power delivered to the muscles at the distal/proximal joint is taken back by the muscles acting about the upper/lower joint. This provides evidence for the central strategy of the body to keep the CoM in a stable position.