Effect of discharge desynchronization on the size of motor evoked potentials: an analysis

OBJECTIVE: Motor evoked potentials (MEPs) after transcranial magnetic brain stimulation (TMS) are smaller than CMAPs after peripheral nerve stimulation, because desynchronization of the TMS-induced motor neurone discharges occurs (i.e. MEP desynchronization). This desynchronization effect can be eliminated by use of the triple stimulation technique (TST; Brain 121 (1998) 437). The objective of this paper is to study the effect of discharge desynchronization on MEPs by comparing the size of MEP and TST responses. METHODS: MEP and TST responses were obtained in 10 healthy subjects during isometric contractions of the abductor digiti minimi, during voluntary background contractions between 0% and 20% of maximal force, and using 3 different stimulus intensities. Additional data from other normals and from multiple sclerosis (MS) patients were obtained from previous studies. RESULTS: MEPs were smaller than TST responses in all subjects and under all stimulating conditions, confirming the marked influence of desynchronization on MEPs. There was a linear relation between the amplitudes of MEPs vs. TST responses, independent of the degree of voluntary contraction and stimulus intensity. The slope of the regression equation was 0.66 on average, indicating that desynchronization reduced the MEP amplitude on average by one third, with marked inter-individual variations. A similar average proportion was found in MS patients. CONCLUSIONS: The MEP size reduction induced by desynchronization is not influenced by the intensity of TMS and by the level of facilitatory voluntary background contractions. It is similar in healthy subjects and in MS patients, in whom increased desynchronization of central conduction was previously suggested to occur. Thus, the MEP size reduction observed may not parallel the actual amount of desynchronization.

Trial-to-trial size variability of motor-evoked potentials. A study using the triple stimulation technique

Motor-evoked potentials (MEPs) vary in size from one stimulus to the next. The objective of this study was to determine the cause and source of trial-to-trial MEP size variability. In two experiments involving 10 and 14 subjects, the variability of MEPs to cortical stimulation (cortical-MEPs) in abductor digiti minimi (ADM) and abductor hallucis (AH) was compared to those responses obtained using the triple stimulation technique (cortical-TST). The TST eliminates the effects of motor neuron (MN) response desynchronization and of repetitive MN discharges. Submaximal stimuli were used in both techniques. In six subjects, cortical-MEP variability was compared to that of brainstem-MEP and brainstem-TST. Variability was greater for MEPs than that for TST responses, by approximately one-third. The variability was the same for cortical- and brainstem-MEPs and was similar in ADM and AH. Variability concerned at least 10-15% of the MN pool innervating the target muscle. With the stimulation parameters used, repetitive MN discharges did not influence variability. For submaximal stimuli, approximately two-third of the observed MEP size variability is caused by the variable number of recruited alpha-MNs and approximately one-third by changing synchronization of MN discharges. The source of variability is most likely localized at the spinal segmental level.

Corticospinal output and loss of force during motor fatigue

The objective of this study was to analyze central motor output changes in relation to contraction force during motor fatigue. The triple stimulation technique (TST, Magistris et al. in Brain 121(Pt 3):437-450, 1998) was used to quantify a central conduction index (CCI = amplitude ratio of central conduction response and peripheral nerve response, obtained simultaneously by the TST). The CCI removes effects of peripheral fatigue from the quantification. It allows a quantification of the percentage of the entire target muscle motor unit pool driven to discharge by a transcranial magnetic stimulus. Subjects (n = 23) performed repetitive maximal voluntary contractions (MVC) of abductor digiti minimi (duration 1 s, frequency 0.5 Hz) during 2 min. TST recordings were obtained every 15 s, using stimulation intensities sufficient to stimulate all cortical motor neurons (MNs) leading to the target muscle, and during voluntary contractions of 20% of the MVC to facilitate the responses. TST was also repetitively recorded during recovery. This basic exercise protocol was modified in a number of experiments to further characterize influences on CCI of motor fatigue (4 min exercise at 50% MVC; delayed fatigue recovery during local hemostasis, "stimulated exercise" by 20 Hz trains of 1 s duration at 0.5 Hz during 2 min). In addition, the cortical silent period was measured during the basic exercise protocol. Force fatigued to approximately 40% of MVC in all experiments and in all subjects. In all subjects, CCI decreased during exercise, but this decrease varied markedly between subjects. On average, CCI reductions preceded force reductions during exercise, and CCI recovery preceded force recovery. Exercising at 50% for 4 min reduced muscle force more markedly than CCI. Hemostasis induced by a cuff delayed muscle force recovery, but not CCI recovery. Stimulated exercise reduced force markedly, but CCI decreased only marginally. Summarized, force reduction and reduction of the CCI related poorly quantitatively and in time, and voluntary drive was particularly critical to reduce the CCI. The fatigue induced reduction of CCI may result from a central inhibitory phenomenon. Voluntary muscle activation is critical for the CCI reduction, suggesting a primarily supraspinal mechanism.

Evaluation of the T-SPOT(RTM).TB test in the diagnosis of latent tuberculosis infection in HIV-infected children in Uganda

Background. About a third of the world’s population is infected with tuberculosis (TB) with sub-Saharan Africa being the worst hit. Uganda is ranked 16th among the countries with the biggest TB burden. The burden in children however has not been determined. The burden of TB has been worsened by the advent of HIV and TB is the leading cause of mortality in HIV infected individuals. Development of TB disease can be prevented if TB is diagnosed during its latent stage and treated with isoniazid. For over a century, latent TB infection (LTBI) was diagnosed using the Tuberculin Skin Test (TST). New interferon gamma release assays (IGRA) have been approved by FDA for the diagnosis of LTBI and adult studies have shown that IGRAs are superior to the TST but there have been few studies in children especially in areas of high TB and HIV endemicity. ^ Objective. The objective of this study was to examine whether the IGRAs had a role in LTBI diagnosis in HIV infected children in Uganda. ^ Methods. Three hundred and eighty one (381) children were recruited at the Baylor College of Medicine-Bristol Meyers Squibb Children’s Clinical Center of Excellence at Mulago Hospital, Kampala, Uganda between March and August 2010. All the children were subjected to a TST and T-SPOT ®.TB test which was the IGRA chosen for this study. Sputum examination and chest x-rays were also done to rule out active TB. ^ Results. There was no statistically significant difference between the tests. The agreement between the two assays was 95.9% and the kappa statistic was 0.7 (95% CI: 0.55–0.85, p-value<0.05) indicating a substantial or good agreement. The TST was associated with older age and higher weight for age z-scores but the T-SPOT®. TB was not. Both tests were associated with history of taking anti-retroviral therapy (ART). ^ Conclusion. Before promoting use of IGRAs in children living in HIV/TB endemic countries, more research needs to be done. ^

Interferon-gamma release assays for latent tuberculosis infection in child and young adult candidates or recipients of tumor necrosis factor inhibitor therapy

Background. Inhibition of tumor necrosis factor (TNF) is associated with progression of latent tuberculosis infection (LTBI) to active disease. LTBI screening prior to starting TNF inhibitor therapy is recommended. Blood tests, collectively known as interferon-gamma release assays (IGRAs), offer a means other than the tuberculin skin test (TST) of screening for LTBI. However, in the setting of immune compromise, anergy may limit the clinical utility of IGRAs. ^ Methods. A cross-sectional study was conducted in children and young adults ≤ 21 years of age who were cared for at Texas Children's Hospital in Houston, TX, during 2011 and who were candidates for, or were receiving, tumor necrosis factor (TNF)-inhibitor therapy. All subjects answered a risk factor questionnaire and were tested for LTBI by two commercially available IGRAs (QuantiFERON-Gold In-Tube assay and the T-SPOT.TB assay), along with the TST. T-cell phenotypes were evaluated through flow cytometry, both at baseline and after antigen stimulation. ^ Results. Twenty-eight subjects were enrolled. All were TST negative and none were IGRA positive. Results were negative for the 27 subjects who were tested with QuantiFERON-Gold In-Tube. However, 26% of subjects demonstrated anergy in the T-SPOT.T. Patients with T-SPOT. TB anergy had lower quantitative IFN-γ responses to mitogen in the QFT assay—the mean IFN-γ level to mitogen in patients without T-SPOT.TB anergy was 9.84 IU/ml compared to 6.91 IU/ml in patients with T-SPOT.TB anergy (P = 0.046). Age and use of TNF inhibitors, corticosteroids, or methotrexate use were not significantly associated with T-SPOT.TB anergy. Antigen stimulation revealed depressed expression of intracellular IFN-γ in subjects with T-SPOT. TB anergy. ^ Conclusions. The frequency of anergy in this population is higher than would be expected from studies in adults. There appears to be inappropriate IFN-γ responses to antigen in subjects with T-SPOT. TB anergy. This immune defect was detected by the T-SPOT. TB assay but not by the QuantiFERON-Gold In-Tube assay. Further data are needed to clarify the utility of IGRAs in this population.^

Economic evaluation of latent tuberculosis infection screening among health care workers in Houston

Since interferon-gamma release assays (IGRAs) were introduced in the 2000's, tuberculin skin testing (TST) and IGRAs have been used in various latent tuberculosis infection (LTBI) screening settings. IGRAs are laboratory-based tests and are considered not to be affected by previous Bacille de Calmette et Guérin (BCG) vaccination; however, they are more costly when compared directly with TST, which does not require specimen processing in a laboratory. This study aimed to examine TST and two types of IGRAs, QuantiFERON-TB Gold in Tube (QFT-GIT) and T-SPOT. TB (TSPOT), from an economic viewpoint. Firstly, a systematic literature review was conducted to identify cost related analyses of LTBI screening. Secondly, specific cost information detailing each test's items and labor was collected from an LTBI screening program of health care workers in Houston, and the cost of each test was computed. Thirdly, using the computed cost estimate of each test, cost-effectiveness analyses were conducted to compare TST and IGRAs.^ A literature search showed that a limited number of studies have been conducted, but the IGRA's economic advantages were common among studies. Cost analyses showed that IGRAs were much more costly than TST. The results were consistent with previous studies. In cost-effectiveness analyses, where test cost and consequential TB-related cost were considered, IGRAs showed variable advantages over TST depending on the targeted population. When only non BCG-vaccinated people were considered, TST was the least costly option among the three tests. On the other hand, when only BCG-vaccinated people were considered, IGRAs were less costly options. These results were mostly consistent even with varying assumption parameters.^ IGRAs can be more costly than TST, but their economic disadvantages are alleviated when the target population was BCG-vaccinated. Based on current knowledge, IGRAs may be recommended in a population where the BCG history is mixed. Additional studies are needed to better understand IGRA's reliability among low-incidence and low-risk populations in which background TB prevalence is low.^

Modelización de reacciones químicas en presencia de un campo electromagnético variable

En esta tesis se aborda el estudio del proceso de isomerización del sistema molecular LiNC/LiCN tanto aislado como en presencia de un pulso láser aplicando la teoría del estado de transición (TST). Esta teoría tiene como pilar fundamental el hecho de que el conocimiento de la dinámica en las proximidades de un punto de silla de la superficie de energía potencial permite determinar los parámetros cinéticos de la reacción objeto de estudio. Históricamente, existen dos formulaciones de la teoría del estado de transición, la versión termodinámica de Eyring (Eyr38) y la visión dinámica de Wigner (Wig38). Ésta última ha sufrido recientemente un amplio desarrollo, paralelo a los avances en sistemas dinámicos que ha dado lugar a una formulación geométrica en el espacio de fases que sirve como base al trabajo desarrollado en esta tesis. Nos hemos centrado en abordar el problema desde una visión fundamentalmente práctica, ya que la teoría del estado de transición presenta una desventaja: su elevado coste computacional y de tiempo de cálculo. Dos han sido los principales objetivos de este trabajo. El primero de ellos ha sido sentar las bases teóricas y computacionales de un algoritmo eficiente que permita obtener las magnitudes fundamentales de la TST. Así, hemos adaptado con éxito un algoritmo computacional desarrollado en el ámbito de la mecánica celeste (Jor99), obteniendo un método rápido y eficiente para la obtención de los objetos geométricos que rigen la dinámica en el espacio de fases y que ha permitido calcular magnitudes cinéticas tales como el flujo reactivo, la densidad de estados de reactivos y productos y en última instancia la constante de velocidad. Dichos cálculos han sido comparados con resultados estadísticos (presentados en (Mül07)) lo cual nos ha permitido demostrar la eficacia del método empleado. El segundo objetivo de esta tesis, ha sido la evaluación de la influencia de los parámetros de un pulso electromagnético sobre la dinámica de reacción. Para ello se ha generalizado la metodología de obtención de la forma normal del hamiltoniano cuando el sistema químico es alterado mediante una perturbación temporal periódica. En este caso el punto fijo inestable en cuya vecindad se calculan los objetos geométricos de interés para la aplicación de la TST, se transforma en una órbita periódica del mismo periodo que la perturbación. Esto ha permitido la simulación de la reactividad en presencia de un pulso láser. Conocer el efecto de esta perturbación posibilita el control de la reactividad química. Además de obtener los objetos geométricos que rigen la dinámica en una cierta vecindad de la órbita periódica y que son la clave de la TST, se ha estudiado el efecto de los parámetros del pulso sobre la reactividad en el espacio de fases global así como sobre el flujo reactivo que atraviesa la superficie divisoria que separa reactivos de productos. Así, se ha puesto de manifiesto, que la amplitud del pulso es el parámetro más influyente sobre la reactividad química, pudiendo producir la aparición de flujos reactivos a energías inferiores a las de aparición del sistema aislado y el aumento del flujo reactivo a valores constantes de energía inicial. ABSTRACT We have studied the isomerization reaction LiNC/LiCN isolated and perturbed by a laser pulse. Transition State theory (TST) is the main tool we have used. The basis of this theory is knowing the dynamics close to a fixed point of the potential energy surface. It is possible to calculate kinetic magnitudes by knowing the dynamics in a neighbourhood of the fixed point. TST was first formulated in the 30's and there were 2 points of view, one thermodynamical by Eyring (Eyr38) and another dynamical one by Wigner (Wig38). The latter one has grown lately due to the growth of the dynamical systems leading to a geometrical view of the TST. This is the basis of the work shown in this thesis. As the TST has one main handicap: the high computational cost, one of the main goals of this work is to find an efficient method. We have adapted a methodology developed in the field of celestial mechanics (Jor99). The result: an efficient, fast and accurate algorithm that allows us to obtain the geometric objects that lead the dynamics close to the fixed point. Flux across the dividing surface, density of states and reaction rate coefficient have been calculated and compared with previous statistical results, (Mül07), leading to the conclusion that the method is accurate and good enough. We have widen the methodology to include a time dependent perturbation. If the perturbation is periodic in time, the fixed point becomes a periodic orbit whose period is the same as the period of the perturbation. This way we have been able to simulate the isomerization reaction when the system has been perturbed by a laser pulse. By knowing the effect of that perturbation we will be able to control the chemical reactivity. We have also studied the effect of the parameters on the global phase space dynamics and on the flux across the dividing surface. It has been prove that amplitude is the most influent parameter on the reaction dynamics. Increasing amplitude leads to greater fluxes and to some flux at energies it would not if the systems would not have been perturbed.

Reconhecimento, mensuração e evidenciação do passivo judicial trabalhista

A má avaliação do passivo judicial pode impactar de modo negativo as disponibilidades financeiras da organização, com consequencias para sua liquidez e para a continuidade das atividades operacionais. O presente trabalho teve como objetivo verificar se o reconhecimento, a mensuração e a evidenciação do Passivo Judicial Trabalhista atendem aos pressupostos da literatura contábil e do direito natural, no que toca ao conceito de fair value. No contexto metodológico, apresentou-se o arcabouço teórico-jurídico do reconhecimento, da mensuração e da evidenciação. Em seguida, dentre as empresas listadas nos segmentos Nível 1, Nível 2 e Novo Mercado da BM&FBovespa foram selecionadas, para a amostra, as 40 empresas com maior quantidade de ações em tramitação no TST. Foram analisadas as Notas Explicativas dessas companhias e verificou-se que, a maior parte não divulga informações alusivas à origem do passivo judicial trabalhista, à forma de mensuração das provisões, à quantidade de ações e ao cronograma de desembolsos. Assim, as práticas adotadas por tais empresas não estão em conformidade plena com os pressupostos da literatura contábil e do direito natural pois as determinações contábeis (CPC 25) tem sido observadas em sua forma menos ampla. Também foi constatado que há possibilidade de melhoria no processo de reconhecimento, mensuração e evidenciação eis que há boas práticas, pontuais, nas companhias examinadas que podem ser generalizadas para as demais.

La caminería en al-Andalus (ss. VIII-XV J.C.): consideraciones metodológicas, históricas y administrativas para su estudio

Este estudio es una síntesis de las últimas aportaciones acerca de las vías en al-Andalus (ss. VIII-XV), cuya estructura inicial es herencia de la época romana. Dadas las limitaciones que imponen los escasos datos que hallamos en las fuentes árabes y los pocos restos camineros conocidos, se hace necesario emplear una nueva metodología de investigación: Se aborda el objeto como un estudio global, no sólo de los caminos, sino de todos los elementos interrelacionados con ellos, denominados como "espacios viales". Luego se presenta la indisoluble relación de los "espacios viales" con los castillos y torres ("espacios de control y defensa") en al-Andalus, como los vigilantes de los caminos, y se enuncia la toponimia árabe relacionada tanto con los "espacios viales" como con los "espacios de control y defensa". Finalmente, se recogen los datos que las diversas crónicas árabes nos proporcionan acerca de la política viaria en al-Andalus a lo largo del tiempo, así como sobre quién era el responsable de velar por el buen estado de los tramos viales.

Latent tuberculosis infection : a diagnostic challenge : Tuberculin skin testing versus interferon-γ release assays

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Sediment temperatures of the Håkon Mosby mud volcano measured continuously with a short temperature lance (LOOME)

The short sediment temperature probe were deployed and recovered with the LOOME observatory in 2009 and 2010, respectively. In addition to temperature, the loggers also recorded bottom water pressure at a sampling interval of 20 minutes. Even though the data obtained from the short temperature probe was strongly disturbed by leakage through a corroded connector, the data shows clearly that the probe was pulled out of the sediment on October 26, 2009, presumably by advancing mud flows.

TRISNET, a network of transportation information services and activities /

"DOT-TST-76-87."

Mass transit development for small urban areas : a case study, Tompkins County, New York : final report first year /

Inserted technica report documentation page designates Arnim H. Meyburg ... [et al.] as "authors."

Dynamic three-dimensional finite element analysis of steel transportation structures : prepared for U.S. Department of Transportation, Office of the Secretary, Office of University Research /

"Final report."