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Statistically and clinically significant cognitive declines are observed in a small subset of individuals with Parkinson's Disease (PD) following treatment with Deep Brain Stimulation (DBS).We examine the association between multi-domain cognitive decline (MCD) and demographic and baseline clinical variables and the incidence of serious adverse events (SAE) arising within a six-month interval following DBS for PD.Study participants with PD who displayed MCD at 6-month follow-up evaluation after DBS (n = 18) were contrasted with individuals with PD from the same study who did not show cognitive decline after DBS (n = 146). Logistic regression analyses were employed to assess relationship between predictors, including age (70 years old), pre-DBS cognitive screening test performance, SAE, and MCD. MCD+ and MCD-groups were also compared on other baseline clinical and demographic variables.MCD showed modest association with older age and lower baseline neurocognitive screening performance, whereas the groups did not differ on most other baseline clinical and demographic variables. SAEs during the study interval were the most robust predictor of MCD in the DBS group. A variety of SAEs were documented in study participants experiencing MCD after DBS surgery, including, but not limited to, infections and small intracranial hemorrhages.Older age and lower baseline cognition measured prior to treatment are associated with MCD measured at six-months after DBS. SAE occurring following DBS surgery are also predictive of MCD. These predictors may reflect aspects of "frailty" in advanced PD. Risk factors for SAE warrant careful consideration in clinical trials.

ObjectiveWhile excessive daytime sleepiness (EDS) can predate the clinical diagnosis of Parkinson disease (PD), associations with underlying PD pathogenesis are unknown. Our objective is to determine if EDS is related to brain Lewy pathology (LP), a marker of PD pathogenesis, using clinical assessments of EDS with postmortem follow-up.MethodsIdentification of LP was based on staining for α-synuclein in multiple brain regions in a sample of 211 men. Data on EDS were collected at clinical examinations from 1991 to 1999 when participants were aged 72–97 years.ResultsAlthough EDS was more common in the presence vs absence of LP (p = 0.034), the association became stronger in neocortical regions. When LP was limited to the olfactory bulb, brainstem, and basal forebrain (Braak stages 1–4), frequency of EDS was 10% (4/40) vs 17.5% (20/114) in decedents without LP (p = 0.258). In contrast, compared to the absence of LP, EDS frequency doubled (36.7% [11/30], p = 0.023) when LP reached the anterior cingulate gyrus, insula mesocortex, and midfrontal, midtemporal, and inferior parietal neocortex (Braak stage 5). With further infiltration into the primary motor and sensory neocortices (Braak stage 6), EDS frequency increased threefold (51.9% [14/27], p < 0.001). Findings were similar across sleep-related features and persisted after adjustment for age and other covariates, including the removal of PD and dementia with Lewy bodies.ConclusionsThe association between EDS and PD includes relationships with extensive topographic LP expansion. The neocortex could be especially vulnerable to adverse relationships between sleep disorders and aggregation of misfolded α-synuclein and LP formation.

PURPOSE: The purpose of this study was twofold: (1) to determine whether exercise training adds to the benefit of a dyspnea self-management (DM) program; and (2) to determine if there is a “dose response” to supervised exercise training (0, 4, or 24 sessions) in dyspnea, exercise performance, and health-related quality of life. METHODS: Subjects with chronic obstructive pulmonary disease (n = 103, 46 men, 57 women; age 66 ± 8 years; forced expiratory volume in 1 second 44.8 ± 14% predicted) were randomized to DM, DM-exposure, or DM-training. Dyspnea self-management included individualized education about dyspnea management strategies, a home-walking prescription, and daily logs. Outcomes were measured at baseline and 2 months as part of a 1-year longitudinal randomized clinical trial. Outcomes included dyspnea during laboratory exercise and with activities of daily living (Chronic Respiratory Questionnaire [CRQ]), Shortness of Breath Questionnaire, Baseline/Transitional Dyspnea Index), exercise performance (incremental treadmill tests (ITTs) and endurance treadmill tests (ETTs), 6-minute walk (6MW), and health-related quality of life (SF-36). RESULTS: The DM-training group had significantly greater improvements than the DM-exposure and the DM groups in dyspnea at isotime during ITT (P = .006); exercise performance during ITT (P = .005), ETT (P = .003), and 6MW (P = .01); SF-36 Vitality (P = .031); and CRQ mastery (P = .007). There was a dose-dependent improvement in CRQ dyspnea scores (P < .05) with significant improvements only in the DM-training and DM-exposure groups. CONCLUSION: Exercise training substantially improved the impact of a dyspnea self-management program with a home walking prescription (DM). This impact tended to be dependent on the “dose” of exercise.

Background—Few studies have evaluated an individualized home-based exercise prescription during and after cancer treatment. Objective—The purpose was to evaluate the effectiveness of a home-based exercise training intervention, the PRO-SELF FATIGUE CONTROL PROGRAM on the management of cancer related fatigue. Interventions/Methods—Participants (N=119) were randomized into one of three groups: Group 1 (EE) received the exercise prescription throughout the study; Group 2 (CE) received their exercise prescription after completing cancer treatment; Group 3 (CC) received usual care. Patients completed the Piper Fatigue Scale, General Sleep Disturbance Scale, Center for Epidemiological StudiesDepression scale, and Worst Pain Intensity Scale. Results—All groups reported mild fatigue levels, sleep disturbance and mild pain, but not depression. Using multilevel regression analysis significant linear and quadratic trends were found for change in fatigue and pain (i.e., scores increased, then decreased over time). No group differences were found in the changing scores over time. A significant quadratic effect for the trajectory of sleep disturbance was found, but no group differences were detected over time. No significant time or group effects were found for depression. Conclusions—Our home-based exercise intervention had no effect on fatigue or related symptoms associated with cancer treatment. The optimal timing of exercise remains to be determined. Implications for practice—Clinicians need to be aware that some physical activity is better than none, and there is no harm in exercise as tolerated during cancer treatment. Further analysis is needed to examine the adherence to exercise. More frequent assessments of fatigue, sleep disturbance, depression, and pain may capture the effect of exercise. Cancer-related fatigue (CRF) is a common problem in oncology patients and survivors that has received attention during the last two decades. Although the reported prevalence of CRF varies across studies, a consensus exists that it is high both during and after cancer treatment.

To identify falling risk factors that are potentially modifiable among individuals who have idiopathic Parkinson's disease.A between group comparison of 19 fallers and 21 nonfallers who have Parkinson's disease, across an array of variables that have been identified as falling risk factors among the elderly and among those who have Parkinson's disease.Several variables were demonstrated significantly to distinguish fallers: disease duration and severity; dyskinesias associated with the use of dopaminergic agents; freezing; postural instability; depression; fear of falling; impaired fine motor control and motor planning in the feet; decreased proximal strength and muscular endurance in the legs; and a higher level of disability.Several of these variables can be viewed a potentially modifiable during a future intervention trial that aims to reduce falls in those who have Parkinson's disease using multidimensional risk factor modification.

The results of an experimental performance evaluation of a Metadyne chamber in both full anechoic and hemi-anechoic configurations over the frequency range from 60 to 10,000 Hz are presented. The Metadyne anechoic wedge, a fiberglas-filled wedge fully encapsulated in a perforated metal casing, was developed several years ago as an alternative to conventional fiberglas and foam wedges. The results of this evaluation show that the Metadyne chamber meets or exceeds all acoustic performance requirements for proper free field environmental conditions, noise reduction, and inside ambient levels. They also indicate that free field conditions exist much closer than a quarter wavelength from the wedge tips which allows use of nearly all the chamber volume for measurements. This chamber provides an environment for conducting highly accurate sound measurement tests.

The prehospital management of severe hypertension is limited by a paucity of pharmacologic agents suitable for field use. This prospective study was designed to test the safety and efficacy of intraoral nifedipine therapy in 50 patients with severe hypertension being transported by an urban emergency medical service system. Ten milligrams of nifedipine were administered. Serial blood pressure determinations were obtained at 3, 5, 10, and 15 minutes and patients were observed for possible side effects. A marked effect on systolic blood pressure (SP), diastolic blood pressure (DP), and mean arterial pressure (MAP) was evident and was statistically significant in all three categories by 3 minutes. MAP decreased from 169 to 129 mm Hg (delta MAP of 40 mm Hg) at 15 minutes with parallel changes in the SP (55 mm Hg) and delta DP (32 mm Hg). These changes were highly significant (P less than .01) when compared with those of 50 historical controls. No evidence of severe adverse effects were noted. Nifedipine appears to be a promising agent for the prehospital treatment of severe hypertension, but its proper role is not yet defined.

Staphylococcal bacterial suspensions were streaked on Trypticase soy agar with 5% sheep blood culture plates. Paper discs containing alphazurine A, a triphenylmethane dye, were placed on the inoculated plates which were incubated at 37 degrees C for 24 hours. A wide zone of inhibition of growth of Staphylococcus aureus was present around the paper discs. Growth of Staphylococcus epidermidis and Staphylococcus saprophyticus was not inhibited.

Although anechoic wedges with absorption coefficients of 0.99 as tested in typical impedance tubes meet ISO inverse square‐law standards, they may not be satisfactory for anechoic rooms used for measurements of microphone response characteristics. Due to size restrictions, impedance tube tests are limited to frequencies below about 250 Hz and there is no standard method to test wedges for absorption at higher frequencies. This paper describes how pulse signal and reverberation room tests were employed to rank the high‐frequency performance of three types of anechoic wedges considered for a microphone test facility: Standard patented MetadyneTM (perforated metal) wedges—conventional fiberglass wedges and an improved high performance Metadyne wedge system. The results of laboratory tests and tests conducted in anechoic rooms are presented. In all cases the preferred system, high‐performance Metadyne wedges, is shown to meet the stringent acoustic absorption requirements needed for this application. The paper indicates the need for new standards for laboratory testing of anechoic wedges at high frequencies and an alternate method to inverse square‐law tests for evaluating anechoic room performance such as stepped frequency sweep tests. Such a new standard will be proposed in the presentation.

A substantially enclosed sound absorbing unit (21) for an anechoic chamber is disclosed. The sound absorbing unit (12) includes a substantially flat panel member (25) comprising a layer of sound absorptive material. An anechoic member (21) is disposed adjacent to the flat panel member (25). The anechoic member (21) is disposed adjacent to a base (29) and a generally spaced apart sound transparent wall member (26). The wall member (26) includes a layer of sound absorptive material (27) and a cover sheet (20) made of perforated, substantially sound reflective material. The free space (30) of the perforated cover sheet (20) is at least 7 percent of the total area of the cover sheet (20).

For the past 16 years, the design of anechoic chambers has been the subject of a good deal of acoustic research. Prior research has yielded a design employing a large number of light‐density wedges (2.S lb/ft3) which had to be supported a fixed distance from the chamber wall. The design considerations which formed the nucleus of a research program by the Industrial Acoustics Company, Inc., were the following: (1) The wedge had to be made of a rigid material. (2) The over‐all length of any anechoic wedge must be maintained as short as physically possible. (3) The wall area covered by a single wedge should be made as large as possible. The first series of investigations made was to determine whether or not the conventional air space could be eliminated. Two figures showing test results of two particular experiments indicate that, if the wedge sizes were maintained constant, there is no advantage in having the air space behind them. It was also observed that the low‐frequency absorption could be matched to t...

The thrust of the jet engine is theoretically shown to be related to the over‐all sound pressure of the jet exhaust regardless of environmental conditions. Within the range of tolerances required to measure thrust accurately on a competitive basis with existing systems, it is found that over‐all sound‐pressure‐level measurements are not satisfactory. Numerous experiments have indicated that specific frequency regions of sound can be utilized to determine a correlation between sound and thrust. An instrument, the Jet Thrust Indicator (JTD), is described as having special filters such that the sound‐pressure level of the frequency ranges correlates with thrust. The JTD provides direct readout in pounds of thrust. Actual field‐test data are provided for aircraft and test stand‐mounted jet engines. Thrust‐measurement comparisons are made of the JTD with the conventional thrust‐measuring techniques presently employed. Data obtained from field tests conducted over a wide range of atmospheric conditions and with various engines are reviewed. Results of the test program indicate an average accuracy of 2%. Applications including measurement of jet‐engine thrust for ground check out on test stands and aircraft, go/no‐go indications, and other uses are discussed.