The effects of multi-day rTMS and cardiorespiratory fitness on working memory and local GABA concentration

AbstractWorking memory (WM) refers to the capacity to temporarily retain and manipulate finite amounts of information; a critical process in complex behaviours such as reasoning, comprehension, and learning. This cognitive function is supported by a parietal-prefrontal network and linked to the activity of key brain neurotransmitters, such as gamma-aminobutyric acid (GABA). Impairments in WM are seen in a range of psychiatric and neurological disorders, and there are currently no effective methods of remediating WM deficits. In this study, we analysed secondary outcome measures from a trial investigating the effects of multi-day rTMS on cognition. Participants received four days of 20 Hz rTMS to an individualised region of left parietal cortex in one week, and an individualised region of pre-supplementary motor area (pre-SMA) in a separate week. We assessed changes to WM function before and after each week of stimulation (N = 39), and changes to GABA concentration before and after stimulation in week one using MR spectroscopy (N = 18 per stimulation condition). We hypothesised that multi-day parietal rTMS would enhance WM and reduce GABA concentration, but this was not observed. Instead, we report some evidence of improved WM function and increased GABA concentration following pre-SMA rTMS, although this effect was variable across individuals. Additionally, we found that higher cardiorespiratory fitness was associated with greater WM improvement following pre-SMA stimulation. While there are a number of factors known to influence the response to rTMS, increasing cardiorespiratory fitness may provide a novel approach to enhance cognitive outcomes. Given the clinical utility of both exercise and rTMS, future studies are required to determine whether additive effects may be achieved when applied in tandem.

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Visual cortex cTBS increases mixed percept duration while a-tDCS has no effect on binocular rivalry

10.1101/2020.09.07.285999 ◽

2020 ◽

Author(s):

Dania Abuleil ◽

Daphne McCulloch ◽

Benjamin Thompson

Keyword(s):

Visual Cortex ◽

Binocular Rivalry ◽

Gamma Aminobutyric Acid ◽

Gaba Concentration ◽

Excitatory Neurotransmitter ◽

Inhibitory Neurotransmitter ◽

Before And After ◽

Visual Cortices ◽

Cortical Excitation ◽

Theta Burst

AbstractNeuromodulation of the primary visual cortex using anodal transcranial direct current stimulation (a-tDCS) can alter visual perception and enhance neuroplasticity. However, the mechanisms that underpin these effects are currently unknown. When applied to the motor cortex, a-tDCS reduces the concentration of the inhibitory neurotransmitter gamma aminobutyric acid (GABA), an effect that has been linked to increased neuroplasticity. The aim of this study was to assess whether a-tDCS also reduces GABA-mediated inhibition when applied to the human visual cortex. Changes in visual cortex inhibition were measured using the mixed percept duration in binocular rivalry. Binocular rivalry mixed percept duration has recently been advocated as a direct and sensitive measure of visual cortex inhibition whereby GABA agonists decrease mixed percept durations and agonists of the excitatory neurotransmitter acetylcholine increase them. Our hypothesis was that visual cortex a-tDCS would increase mixed percept duration by reducing GABA-mediated inhibition and increasing cortical excitation. In addition, we measured the effect of continuous theta-burst transcranial magnetic stimulation (cTBS) of the visual cortex on binocular rivalry dynamics. When applied to the motor or visual cortex, cTBS increases GABA concentration and we therefore hypothesized that visual cortex cTBS would decrease the mixed percept duration. Binocular rivalry dynamics were recorded before and after active and sham a-tDCS (N=15) or cTBS (N=15). Contrary to our hypotheses, a-tDCS had no effect, whereas cTBS significantly increased mixed percepts during rivalry. These results suggest that the neurochemical mechanisms of a-tDCS may differ between the motor and visual cortices.

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Visual cortex cTBS increases mixed percept duration while a-tDCS has no effect on binocular rivalry

PLoS ONE ◽

10.1371/journal.pone.0239349 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0239349

Author(s):

Dania Abuleil ◽

Daphne McCulloch ◽

Benjamin Thompson

Keyword(s):

Visual Cortex ◽

Binocular Rivalry ◽

Gamma Aminobutyric Acid ◽

Gaba Concentration ◽

Excitatory Neurotransmitter ◽

Inhibitory Neurotransmitter ◽

Before And After ◽

Visual Cortices ◽

Cortical Excitation ◽

Theta Burst

Neuromodulation of the primary visual cortex using anodal transcranial direct current stimulation (a-tDCS) can alter visual perception and enhance neuroplasticity. However, the mechanisms that underpin these effects are currently unknown. When applied to the motor cortex, a-tDCS reduces the concentration of the inhibitory neurotransmitter gamma aminobutyric acid (GABA), an effect that has been linked to increased neuroplasticity. The aim of this study was to assess whether a-tDCS also reduces GABA-mediated inhibition when applied to the human visual cortex. Changes in visual cortex inhibition were measured using the mixed percept duration in binocular rivalry. Binocular rivalry mixed percept duration has recently been advocated as a direct and sensitive measure of visual cortex inhibition whereby GABA agonists decrease mixed percept durations and agonists of the excitatory neurotransmitter acetylcholine (ACH) increase them. Our hypothesis was that visual cortex a-tDCS would increase mixed percept duration by reducing GABA-mediated inhibition and increasing cortical excitation. In addition, we measured the effect of continuous theta-burst transcranial magnetic stimulation (cTBS) of the visual cortex on binocular rivalry dynamics. When applied to the motor or visual cortex, cTBS increases GABA concentration and we therefore hypothesized that visual cortex cTBS would decrease the mixed percept duration. Binocular rivalry dynamics were recorded before and after active and sham a-tDCS (N = 15) or cTBS (N = 15). Contrary to our hypotheses, a-tDCS had no effect, whereas cTBS increased mixed percepts during rivalry. These results suggest that the neurochemical mechanisms of a-tDCS may differ between the motor and visual cortices.

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The effects of multi-day rTMS and cardiorespiratory fitness on working memory and local GABA concentration

Neuroimage: Reports ◽

10.1016/j.ynirp.2021.100049 ◽

2021 ◽

Vol 1 (4) ◽

pp. 100049

Author(s):

Joshua Hendrikse ◽

Sarah Thompson ◽

Chao Suo ◽

Murat Yücel ◽

Nigel C. Rogasch ◽

...

Keyword(s):

Working Memory ◽

Cardiorespiratory Fitness ◽

Gaba Concentration

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Correction to: cardiorespiratory fitness in adolescents before and after the COVID-19 confinement: a prospective cohort study

European Journal of Pediatrics ◽

10.1007/s00431-021-04107-x ◽

2021 ◽

Author(s):

Rubén López-Bueno ◽

Joaquín Calatayud ◽

Lars Louis Andersen ◽

José Casaña ◽

Yasmín Ezzatvar ◽

...

Keyword(s):

Cohort Study ◽

Cardiorespiratory Fitness ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Before And After

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A Random Forest Model for the Prediction of FOG Content in Inlet Wastewater from Urban WWTPs

Water ◽

10.3390/w13091237 ◽

2021 ◽

Vol 13 (9) ◽

pp. 1237

Author(s):

Vanesa Mateo Pérez ◽

José Manuel Mesa Fernández ◽

Joaquín Villanueva Balsera ◽

Cristina Alonso Álvarez

Keyword(s):

Random Forest ◽

Wastewater Treatment Plants ◽

Learning Algorithm ◽

Global Improvement ◽

Treatment Processes ◽

Early Adoption ◽

Novel Approach ◽

Number Of Factors ◽

Initial Stage ◽

Correct Design

The content of fats, oils, and greases (FOG) in wastewater, as a result of food preparation, both in homes and in different commercial and industrial activities, is a growing problem. In addition to the blockages generated in the sanitary networks, it also represents a difficulty for the performance of wastewater treatment plants (WWTP), increasing energy and maintenance costs and worsening the performance of downstream treatment processes. The pretreatment stage of these facilities is responsible for removing most of the FOG to avoid these problems. However, so far, optimization has been limited to the correct design and initial installation dimensioning. Proper management of this initial stage is left to the experience of the operators to adjust the process when changes occur in the characteristics of the wastewater inlet. The main difficulty is the large number of factors influencing these changes. In this work, a prediction model of the FOG content in the inlet water is presented. The model is capable of correctly predicting 98.45% of the cases in training and 72.73% in testing, with a relative error of 10%. It was developed using random forest (RF) and the good results obtained (R2 = 0.9348 and RMSE = 0.089 in test) will make it possible to improve operations in this initial stage. The good features of this machine learning algorithm had not been used, so far, in the modeling of pretreatment parameters. This novel approach will result in a global improvement in the performance of this type of facility allowing early adoption of adjustments to the pretreatment process to remove the maximum amount of FOG.

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Relationship between Apgar scores and long-term cognitive outcomes in individuals with Down syndrome

Scientific Reports ◽

10.1038/s41598-021-90651-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Laura del Hoyo Soriano ◽

Tracie C. Rosser ◽

Debra R. Hamilton ◽

Danielle J. Harvey ◽

Leonard Abbeduto ◽

...

Keyword(s):

Working Memory ◽

Down Syndrome ◽

Cognitive Functioning ◽

Apgar Score ◽

Visual Memory ◽

Receptive Vocabulary ◽

Cognitive Outcomes ◽

Cognitive Testing ◽

Cognitive Measures ◽

Verbal Comprehension

AbstractThis study examined the contribution of the Apgar score at 1 and 5 min after birth to later cognitive functioning in 168 individuals with Down syndrome who were between 6 and 25 years of age at time of cognitive testing. Our results showed that a lower Apgar score at 1 min was related to a worse performance in later cognitive measures of receptive vocabulary, verbal comprehension and production, visual memory and working memory. Results also showed that a lower Apgar score at 5 min was only related to worse later outcomes of verbal comprehension and production and auditory working memory. Our findings suggest a need for future studies investigating how specific perinatal events reflected in the Apgar score are linked to later cognitive functioning in individuals with Down syndrome.

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Food Should not be Forgotten: Impacts of Combined Cash Transfer Receipt and Food Security on Child Education and Cognition in South Africa and Malawi

AIDS and Behavior ◽

10.1007/s10461-021-03317-6 ◽

2021 ◽

Author(s):

Lorraine Sherr ◽

Kathryn J. Roberts ◽

Mark Tomlinson ◽

Sarah Skeen ◽

Helen Mebrahtu ◽

...

Keyword(s):

Working Memory ◽

Food Security ◽

Cognitive Development ◽

Social Protection ◽

Cash Transfers ◽

Cognitive Outcomes ◽

Protection Measures ◽

Food Security Status ◽

Child Cognitive Development ◽

Cash Grant

AbstractSocial protection can take many forms. Both cash transfers and food security may have important contributions to child cognitive development. This study examines the potential impact of combinations of cash transfers and food security status on child cognitive development and educational outcomes. Cross-sectional data for 796 HIV-affected children in the Child Community Care study were utilised for this analysis. Children and caregivers completed interview schedules comprised of standardised items on socio-demographics, household data, cash grant receipt and food security status, school achievement, and cognition. A series of logistic and linear regression models and marginal effects analyses were undertaken to explore the impacts of differing levels of social protection (none; either cash grant receipt or food secure status or, both in combination) on child educational and cognitive outcomes. Although all children lived in poverty-stricken households, 20% (157/796) of children did not live in a household in receipt of a cash grant and did not report food security; 32.4% (258/796) reported either component of social protection and, 47.9% (381/796) received both measures of social protection in combination. Compared to no social protection, being in receipt of either component of social protection was found to be significantly associated with being in the correct class for age, higher scores of non-verbal cognition, and higher working memory scores. Receiving both social protection measures in combination was found to be significantly associated with reduced educational risk scores, improved odds of being in the correct class for age, regular school attendance, missing less than a week of school in the previous two weeks, higher scores on measures of nonverbal cognition, higher working memory scores, and learning new things more easily. Educational and cognitive outcomes for children can be bolstered by social protection measures (cash grant receipt or food security). Benefits are enhanced when social protection is received in combination. Such findings support the notion of synergistic social protection responses for children living in environments impacted by high levels of HIV burden and deprivation.

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Use of connected digital products in clinical research following the COVID-19 pandemic: a comprehensive analysis of clinical trials

BMJ Open ◽

10.1136/bmjopen-2020-047341 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047341

Author(s):

Caroline Marra ◽

William J Gordon ◽

Ariel Dora Stern

Keyword(s):

Clinical Trials ◽

Clinical Research ◽

Outcome Measures ◽

Remote Monitoring ◽

Search Algorithm ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Digital Products ◽

Clinical Trial Registry ◽

Before And After

ObjectivesIn an effort to mitigate COVID-19 related challenges for clinical research, the US Food and Drug Administration (FDA) issued new guidance for the conduct of ‘virtual’ clinical trials in late March 2020. This study documents trends in the use of connected digital products (CDPs), tools that enable remote patient monitoring and telehealth consultation, in clinical trials both before and after the onset of the pandemic.DesignWe applied a comprehensive text search algorithm to clinical trial registry data to identify trials that use CDPs for remote monitoring or telehealth. We compared CDP use in the months before and after the issuance of FDA guidance facilitating virtual clinical trials.SettingAll trials registered on ClinicalTrials.gov with start dates from May 2019 through February 2021.Outcome measuresThe primary outcome measure was the overall percentage of CDP use in clinical trials started in the 10 months prior to the pandemic onset (May 2019–February 2020) compared with the 10 months following (May 2020–February 2021). Secondary outcome measures included CDP usage by trial type (interventional, observational), funder type (industry, non-industry) and diagnoses (COVID-19 or non-COVID-19 participants).ResultsCDP usage in clinical trials increased by only 1.65 percentage points, from 14.19% (n=23 473) of all trials initiated in the 10 months prior to the pandemic onset to 15.84% (n=26 009) of those started in the 10 months following (p<0.01). The increase occurred primarily in observational studies and non-industry funded trials and was driven entirely by CDP usage in trials for COVID-19.ConclusionsThese findings suggest that in the short-term, new options created by regulatory guidance to stimulate telehealth and remote monitoring were not widely incorporated into clinical research. In the months immediately following the pandemic onset, CDP adoption increased primarily in observational and non-industry funded studies where virtual protocols are likely medically necessary due to the participants’ COVID-19 diagnosis.

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139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.184 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S81-S81

Author(s):

Sarah Norman ◽

Sara Jones ◽

Cara Acklin ◽

Christian Cheatham

Keyword(s):

Antimicrobial Stewardship ◽

Healthcare Providers ◽

Hospital Setting ◽

Secondary Outcome ◽

Quality Improvement Initiative ◽

Oral Antibiotic ◽

Ambulatory Care Setting ◽

Community Based ◽

Before And After ◽

Physician Network

Abstract Background Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative. Methods This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions. Results There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year. Conclusion These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

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Cardiac Rehabilitation Based on the Walking Test and Telerehabilitation Improved Cardiorespiratory Fitness in People Diagnosed with Coronary Heart Disease during the COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052241 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2241

Author(s):

Ladislav Batalik ◽

Vladimir Konecny ◽

Filip Dosbaba ◽

Daniela Vlazna ◽

Kristian Brat

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Cardiac Rehabilitation ◽

Cardiorespiratory Fitness ◽

Test Time ◽

Target Heart Rate ◽

Walking Test ◽

Novel Approach ◽

Home Based ◽

Study Participants

This study investigated an alternative home-based cardiac telerehabilitation model in consideration of the recommendations for the COVID-19 quarantine of people diagnosed with coronary heart disease (CHD). We hypothesized that using a 200 m fast walking test (200 mFWT) and telerehabilitation would create an effective alternative cardiac rehabilitation (CR) intervention that could improve cardiorespiratory fitness. Participants (n = 19, mean age 60.4 ± 9.6) of the 8-week intervention performed regular physical exercise at the target heart rate zone determined by calculations based on the 200 mFWT results. In our study, the participants were supervised using telerehabilitation. A total of 84% of participants completed the 8-week intervention. No adverse events were reported during telerehabilitation. The study participants noted a significant improvement (p < 0.001) in cardiorespiratory fitness expressed by an 8% reduction in the walking test time (Δ 8.8 ± 5.9 s). Home-based telerehabilitation based on 200 mFWT effectively increased the cardiorespiratory fitness in people with CHD with a low to moderate cardiovascular risk. This was a novel approach in CR during the COVID-19 pandemic. As research in this area is justified, this paper may serve as an alternative method of providing healthcare during the COVID-19 pandemic and as a basis for further upcoming randomized controlled trials.

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