The milk samples were collected from local markets of different parts of Peshawar city, Pakistan. Heavy metal concentrations varied significantly depending upon the type of milk. The heavy metal concentrations in most of the samples were within normal and permissible ranges. It was observed that the samples contained considerable amounts of calcium, while magnesium levels were well above the required levels. The results also revealed that copper levels were slightly lower than the permissible limits. The concentration of zinc in dried milk samples was greater than the values for the liquid milk types. Infant milk formulae had higher iron levels as compared to other milk samples because of the added constituents. Significant differences were observed in the mean values of manganese and cadmium in different types of milk. The toxic metals were within the acceptable limits and did not show significant levels leading to toxicity.Various essential and toxic heavy metals  contents in various types of dried ( Milk is the first food that human encounters which serves as a source of essential nutrients required for the biological functions and growth during early stages of life , so commEssential metals”  are those required for the complete life cycle of an organism, and absence or insufficiency of which in human diet could induce modifications of metabolic changes and some diseases. However, some essential metals become “toxic” when their concentration is increased, especially the levels exceeding by 40-to-200-fold [In formula milk, essential elements are added to satisfy nutritional requirements; however, too high additions of certain elements are detrimental, and milk may serve as a vector for the transmission of toxic substances of extrinsic origin . The res200-fold . If thei200-fold , toxicit200-fold . The occ200-fold . The ass++ ions stimulate while Cu and Zn suppress browning of the milk mixtures [Multielement surveys have been carried out on trace element concentrations in infant foods, human milk, and powdered infant formula determining mineral elements in the digestion solutions . Concentmixtures , 21.The objectives of the present study were to determine the levels of various essential and toxic trace elements in cow milk from local markets of Peshawar and also to compare their concentration in infant formula/dried milk with fresh/processed liquid cow milk.3/HClO4 based wet digestion process was adopted for the identification of trace elements by atomic absorption spectrophotometry as described by AOAC (2000). The temperature-time combinations were optimized for each element, and the accuracy, precision, selectivity, and sensitivity were verified by using Perkin Elmer Double Beam 2380 Atomic Absorption Spectrophotometer with reference sample. The blanks were made in the same way without using any sample. The filtrate was stored in properly labeled and sealed plastic bottles. All the samples were prepared in triplicate.A total of forty-six samples from dried, infant formula, fresh, and liquid milk were randomly selected and analyzed in year 2009 for determination of essential and toxic  heavy metals. The samples were procured from the local markets of Peshawar. Individual samples of 50 gm of dried and 100 mL of liquid cow milk were selected in sterile plastic containers and then were labeled, sealed, and stored at suitable cold temperature (0–5°C). The sample treatment involved digestion, extraction, and preparation of samples before atomic absorption analysis. The HNOThe data was analyzed by using Excel data sheets and SPSS computer software version 17. The simple percentages plus mean values + SD of the heavy metals were calculated. One-way analysis of variance (ANOVA/LSD) was applied to find out statistical differences among various parameters in different milk samples. The data was also analyzed in terms of Pearson's logarithmic correlation (<0.05 and <0.01) to indicate the strength level of the correlation among various heavy metals.P < 0.05 ANOVA/LSD) differences in case of manganese. The mean differences of cadmium were significant in the dried and liquid milk groups, while nonsignificant differences among mean values of lead, chromium, and nickel of the types of milk were observed. The results of the correlation coefficient as presented in Milk is a valuable source of essential minerals but some toxic elements may be accidently added during handling, processing, and remixing of milk. The mean concentrations of various essential and toxic heavy metals are presented in Tables The concentrations of calcium in all types of milk were of the same order of magnitude as reported in the literature , and theToxic metals are enzyme toxins that disturb the immune mechanism , so theyThe correlation coefficient analysis  further The results of the study provide valuable data regarding essential and toxic heavy metals in various powdered and liquid milk samples available in the market. It was observed that the determined values were within the acceptable limits with significant differences in mean values of manganese and cadmium in different types of milk. The milk samples contained considerable amounts of calcium, while magnesium levels were well above the required limits. Copper levels were slightly lower than the permissible allowances. The concentrations of zinc in dried milk samples were up to the mark and better than the liquid types. Infant milk formulae had better iron levels as compared to other milk samples. The correlation coefficients showed that most of the metals were significantly correlated (>0.05) with each other.


To investigate the influence of hand dominance on the maintenance of gains afterhome-based modified constraint-induced movement therapy (mCIMT). (MAL),whereas the capacity to perform bimanual tasks was measured using the BilateralActivity Assessment Scale (BAAS). Aprevious randomized controlled trial was conducted to examine the addition oftrunk restraint to the mCIMT. Twenty-two chronic stroke survivors with mild tomoderate motor impairments received individual home-based mCIMT with or withouttrunk restraints, five times per week, three hours daily over two weeks. In thisstudy, the participants were separated into dominant group, which had theirparetic upper limb as dominant before the stroke (n=8), and non-dominant group(n=14) for analyses. The ability to perform unimanual tasks was measured by theWolf Motor Function Test (WMFT) and the Motor Activity Log Analysis revealed significant positive effects on the MAL amount of use andquality of the movement scales, as well as on the BAAS scores after intervention,with no differences between groups. Both groups maintained the bimanualimprovements during follow-ups , howeveronly the dominant group maintained the unilateral improvements . Upper limb dominance did not interfere with the acquisition of upper limb skillsafter mCIMT. However, the participants whose paretic upper limb was dominantdemonstrated better abilities to maintain the unilateral gains. The bilateralimprovements were maintained, regardless of upper limb dominance.  This study followed the design previously described regarding the protocol of arandomized clinical trialData from 22 participants who had completed the two-week intervention of home-basedmCIMT with and without trunk restraint were analyzed to investigate the influences ofhand dominance on the acquisition and maintenance of the improvements. Since nodifferences were found between the groups (with and without trunk restraint), thepresent study included all subjects and took into account only the hand dominanceprior to stroke. For analyses, the participants were separated into two groups:Dominant, for subjects whose paretic upper limb was dominant before the stroke, andnon-dominant, for subjects whose paretic upper limb was non-dominant before thestroke. Hand dominance was reported by the individuals when asked which hand theyused to write a sentence. The severity of the motor impairments was determined basedupon the upper limb items of the Brazilian version of the Fugl-Meyer scale, with mildscores ranging from 51 to 66, and moderate ones, from 26 to 50Chronic stroke survivors were recruited from the general community of the city ofBelo Horizonte, Brazil, and were considered eligible if they met the inclusion andexclusion criteria established according to the protocol of this randomized clinicaltrial,,All participants received individual home-based mCIMT with or without trunkrestraints from well-trained physical therapists, five times per week, three hoursdaily over two weeks. They were encouraged to use a glove to restrict theirnon-paretic wrist and fingers for 90% of the time that they were awake during thetwo-week period. A diary was provided to all participants to record the amount oftime they wore the glove. Three-hour sessions of mCIMT included 30 minutes of thetransfer package exposure and applications of the items of the Motor Activity Log(MAL),,The primary outcome measures included upper limb performance, as determined by theMAL,The MAL was developed to evaluate the effects of CIMT. This scale, adapted to thePortuguese-Brazilian language, contains 30 items related to routine daily activitiesundertaken with the paretic upper limb. The individuals were asked about the amountof use (AOU) and the quality of movement (QOM) with their paretic upper limb duringtheir daily activities. The MAL total scores were obtained by the sum of the answersdivided by the number of the assessed items, which ranged from five to zero. Higherscores are indicative of better performance of the paretic upper limb,Out of the 17 WMFT tasks, 15 were timed, and the maximum time allowed for thecompletion of each task was 120 seconds, which was qualified in accordance with thesescores. The test was always initiated with the examiner explaining and demonstratingthe execution of all of the tasks at both the slow and fast speeds. The evaluationswere videotaped, so that the functional ability, or the qualitative scores, was alsoanalyzed after the completion of the evaluations. All subjects were allowed toperform the tasks with their non-paretic upper limb first for familiarizationpurposes,Secondary outcomes included the speed and the quality of the paretic upper limb useduring bimanual tasks, as determined by the Bilateral Activity Assessment Scale(BAAS) scores. The BAAS was developed to evaluate the interactions between theparetic and non-paretic upper limb during the performance of 13 bimanual activities.All activities were timed and the maximum time allowed for the completion of eachtask was 120 seconds. The evaluations were also videotaped, so that the functionalability scores or the qualitative scores were also analyzed after the completion ofthe evaluations. The test was always initiated with the examiner explaining anddemonstrating the execution of all of the tasks, but no information regarding thespeed of execution was provided,Database management and statistical analyses were performed by an independentresearcher, who was blinded to the group allocations. All measures were analyzed withintention-to-treat analyses, and descriptive statistics were calculated for alloutcome measures. Analyses of covariance (ANCOVA), which controlled for the baselinecharacteristics, were employed to analyze the effects of the intervention. Theresults were reported as means and standard deviations or means and 95% confidenceintervals (CI). Repeated-measures ANOVA, followed by pre-planned contrasts, were usedto verify the main and interaction effects within and between groups for the fourtime points. To better understand the influences of upper limb dominance on theacquisition and maintenance of the improvements, the differences between the groupswere provided as means and 95% CI. This type of analysis was chosen because, whilethe null hypothesis significance tests use probability levels (e.g. p<0.5), effectsize analyses focus on the magnitude of the differences between the groups and theprobability of an effect to report and interpret the results. This type ofdescription assists in determining the clinical interpretation and importance of theobserved differences, as well as the statistical significance of the findingsTwenty-two individuals with chronic unilateral stroke, who had a mean time since theonset of stroke of 81±49 months participated. All participants were right-handdominant prior to stroke. Eight subjects had left hemispheric stroke . Fourteen participants had right hemispheric stroke . Theparticipants' characteristics are described in As shown in The follow-up comparisons between the groups demonstrated that, although similarimprovements were observed for both groups immediately after the intervention, onlythe participants of the dominant group were able to retain the achieved gainsregarding the MAL scores. The time required to perform unimanual or bimanual tasksdid not differ between the groups with the follow-up measurements and the bimanualgains were maintained for both groups . This was the first study to investigate the influence of upper limb dominance prior tostroke on the acquisition and maintenance of upper limb skills after an intensiveunimanual intervention approach. This modality of intervention was chosen due to itscharacteristics  and proven efficacy(short- and long-term effects). Although a previous study with a small sampleThe influence of the dominance of the upper limb in carrying out bimanual functionalactivities was previously evaluated with stroke individuals. McCombe Waller andWhitall-The maintenance of gains appeared to suffer the direct influences of upper limbdominance. This could be explained by the interactions of the individuals in theirenvironment, guided by intrinsic and extrinsic characteristicsAlthough some unilateral gains were lost after the interventions for the non-dominantgroup, the findings of the present study demonstrated that both groups showedsignificant improvements in their abilities to execute bimanual tasks immediately afterthe intervention and that these within-groups gains remained after the cessation of theintervention. These results indicated that intensive unilateral training promotedbimanual ability improvements. Possibly, the achieved gains associated with theintervention were incorporated during the performance of bilateral activities asindicated by the improvements in the time to execute activities measured by the BAAS.The results suggested that the paretic upper limb has the potential to be used afterunilateral intervention to help the non-paretic upper limb to execute bilateralactivities faster. In addition, the present findings suggested that individuals,regardless of their upper limb dominance, managed to incorporate the immediate gainswhen performing bimanual activities in their daily routines. These results suggest thatperformance and capacity for carrying out bimanual tasks are important parameters tomeasure the real effects of any therapy aimed at improving upper limb activity afterstroke. The participants of the non-dominant group lost their abilities to perform unimanualtasks after the end of the intervention, but their abilities to perform bimanual taskswere maintained. Since during bimanual tasks they kept the same AOU of their pareticupper limb, this adaptation was integrated into their daily routines, possibly becominga permanent change. Regarding the maintenance of unimanual gains for the non-dominantgroup, strategies to monitor losses and avoid the return of the learned disusephenomenon would be required. These strategies could include periodic revaluations, homeguidelines or even more specific interventions, depending upon each case. ,Significant gains in unimanual tasks after training, as evaluated by the WMFT, werefound only for the non-dominant group. This could be explained by the small sample size.Considering that the WMFT baseline scores for the dominant group were higher than thoseof the non-dominant, the sample size may have been insufficient to detect significantchanges. For the dominant group, there was a power of 0.12 with an effect size of 0.32,whereas for the non-dominant group, there was a power of 0.26 with a similar effect sizeof 0.38. Although previous studies demonstrated the immediate positive effects of theCMIT on the paretic upper limb's unimanual capacityThere are some limitations of the present study. Since the size of the two groupsdiffered and the values obtained at baseline, mainly for both MAL scores, were alsoheterogeneous, the generalization of the present findings should be taken withcaution. Although there were between-group differences at the baseline MAL scores,the groups were similar regarding the Fugl-Meyer motor assessment scores and themuscle strength. For the confirmation of these results, studies with larger samples,more homogeneous groups with specific criteria are necessary regarding theinterference of upper limb dominance. There was no stratification of the participants regarding hand dominance prior tostroke, which could have interfered with the acquisition of the gains. However, sinceboth groups equally improved after intervention, we believe that the participantswere similar regarding hand dominance prior to stroke or that possible differencesdid not influence the results of the present study. Further studies are recommendedto examine the influence of hand dominance prior to stroke on the acquisition andmaintenance of upper limb skills. Hand dominance did not interfere with the acquisition of upper limb skills, butinfluenced the maintenance of the gains observed after the application of the mCIMT forindividuals with chronic stroke. The participants, whose paretic upper limb was thedominant, reported improved ability in maintaining unimanual gains. The bimanualimprovements were maintained for both groups regardless the upper limb dominanceprevious to stroke.


Cervical spinal loads are predominately influenced by activities of cervical muscles. However, the coordination between deep and superficial muscles and their influence on the spinal loads is not well understood. This study aims to document the changes of cervical spinal loads and the differential contributions of superficial and deep muscles with varying head postures. Electromyography (EMG) of cervical muscles from seventeen healthy adults were measured during maximal isometric exertions for lateral flexion  as well as flexion/extension  neck postures. An EMG-assisted optimization approach was used to estimate the muscle forces and subsequent spinal loads. The results showed that compressive and anterior-posterior shear loads increased significantly with neck flexion. In particular, deep muscle forces increased significantly with increasing flexion. It was also determined that in all different static head postures, the deep muscle forces were greater than those of the superficial muscle forces, however, such pattern was reversed during peak efforts where greater superficial muscle forces were identified with increasing angle of inclination. In summary, the identification of significantly increased spinal loads associated with increased deep muscle activation during flexion postures, implies higher risks in predisposing the neck to occupationally related disorders. The results also explicitly supported that deep muscles play a greater role in maintaining stable head postures where superficial muscles are responsible for peak exertions and reinforcing the spinal stability at terminal head postures. This study provided quantitative data of normal cervical spinal loads and revealed motor control strategies in coordinating the superficial and deep muscles during physical tasks. The normal spinal loads are mainly maintained and regulated by a complex multi-layered cervical muscular system during daily activities involving head movements. Superficial muscles are traditionally assumed to be the motion actuator, whereas deep muscles help to fine tune the curvature and hold an upright posture of the cervical spine . FurtherMany kinds of techniques are proposed to estimate the in vivo muscle forces and corresponding spinal loads, which are traditionally classified into electromyography (EMG) based technique or optimization/equivalent method. A hybrid EMG-assisted optimization approach has been developed to satisfy both muscle activation measured by EMG and moment equations employed in optimization models , and hasTo address these gaps in the research, the purpose of this study was to explore the changes of the cervical spinal loads and how the differential contributions of the superficial and deep muscles vary under maximal neck isometric contractions and at different head postures, utilizing the EMG-assisted optimization model. The results could facilitate better knowledge of the normal cervical spinal loads and the motor control strategies in modulating the superficial and deep muscles imposed by the performance of physical tasks.This study recruited a group of young adults between the age of 20–30 years old with a body mass index of less than 30 and without a history of neck pain or other spinal disorders that required treatment. The criteria were set in order to achieve the best homogenous healthy cervical spine as the basis for normative data. All subjects were informed of the experimental protocols before signing the participation consent forms. The experimental protocol was approved by the institutional medical research ethics committee.Twenty paired muscles and one longus colli-vertical muscle were considered in this study, which included the bilateral sternocleidomastoid , upper trapezius, levator scapulae, splenius , semispinalis , scalenes , erector spinae , longus colli , and longus capitis. These muscles were divided into the superficial muscle group  and the deep muscle group  based on the classification system utilized by Blouin and colleagues .”Three pairs of electrodes of the surface EMG  were placed around the neck. The anterior electrodes were placed at lower 1/3 of the distance between the sternal notch and mastoid process to measure the activations of the sternocleidomastoid and its subvolume muscles . The splThe Trigno Wireless system does not use the reference electrode. The common mode rejection ratio was greater than 80 dB, and the band-pass filter was between 20 Hz and 450 Hz. The low-pass cutoff frequency at 450 Hz truncates the contribution from the baseline noise without removing any significant contribution from the surface EMG signal, and the high-pass cutoff frequency at 20 Hz is recommended to reduce the noise sources from motion artifacts and ECG artifact . The EMGThe head posture was measured using a 3-axis electrogoniometer  attached to the top of subjects’ heads. The electrogoniometer traces the inclination to the gravity line and offers fast-response and high-resolution measurement. The resolution of the transducer was 0.1° over the angular range of ±90°. This gravity-reference instrument was proved to show good reliability and to be feasible for clinical applications .The subjects sat on a chair with the head positioned in a neutral posture, where the line connecting the root of nose to external occipital protuberance is horizontal to the floor . Their hIn the first task, the subject was verbally encouraged to perform maximal voluntary isometric contraction (MVIC) of the cervical muscles by pushing against a fixed surface for 3 seconds in the anterior, posterior, left and right directions, respectively. Before a new repetition, a 2-min rest was taken to minimize the muscle fatigue. Peak forces in each direction were measured by an S-type load cell .In the second task, the subjects were asked to hold the head postures in flexion, extension, and left/right lateral bending for every ten degrees and stopping at the neck terminal position. The terminal range was recognized when the subject felt the stretch of the passive tissues . The ordFi was the ith muscle force (N), NAIEMGi was the normalized average integration of EMG activity of each muscle . A . A 26]. The results demonstrated that although head postures away from the neutral position are generally accompanied by gradual increasing of spinal loads, only flexion at around 46 degrees showed significantly increased compressive loads of up to 634 N. The estimated load is around three times greater than that predicted in previous study using the finite element assessment without considering the muscle forces (i.e. 49 lbs in 45 degrees of neck flexion) [It is worth noting that the terminal range of flexion came with the greatest compressive and anterior-posterior shear loads among the different head postures. This could be due to the fact that the flexion is characterized by the forward shift of the head’s center of gravity. The cervical spine is inherently prone to injury risks when in the flexed position, which is consistent with the rehabilitation focus for populations with the text-neck or forward head posture. Moreover, the loss of control from muscular fatigue or possible neuromuscular error could lead to abnormal muscle recruitments and spinal loading patterns , and necThe results of the sum of the muscle force as well as the force ratios showed that the deep and superficial muscles play different roles in controlling the cervical spine during peak exertions and different head postures. The smaller sum of the superficial muscle forces and greater force ratios of deep muscle forces to superficial muscle forces under different head postures than during peak efforts manifests the importance of the deep muscle in maintaining the spinal curvature, which coincides with the role of posture muscles . On the Some methodologic considerations should be verified. First, the ROM in this study was the range where subjects felt mild resistance so that the EMG attachments would not be affected by the stretching of the soft tissues. It was smaller than the maximal active ROM reported in the literature  . SecondlIn conclusion, this study revealed the changing spinal loads in different head postures as well as the differential contribution of the superficial and deep muscles on the spinal loads. The significantly higher spinal loads during neck flexion posture, which could be attributed to the particularly increased deep muscle activations, may play a role in the development of idiopathic neck disorders. Furthermore, the deep muscles are evidenced to maintain the neck curvature whereas the superficial muscles are responsible for the force generation to augment spinal stability. Further studies are suggested to investigate the relation between the deteriorated muscles and neck disorders clinically, thus facilitating the design of training/rehabilitation protocols.S1 TablePeak exerted forces and terminal posture of the head for each subject.(XLSX)Click here for additional data file.S2 TableActivation levels of the superficial muscles during the maximal voluntary isometric contraction in anterior, posterior and left/right directions for each subject.(XLSX)Click here for additional data file.S3 TableSpinal load, sum of muscle forces, and force ratio of deep muscles to superficial muscles (FR) during the maximal voluntary isometric contraction in anterior, posterior and left/right directions for each subject.(XLSX)Click here for additional data file.S4 TableMuscle forces of the individual cervical muscles among participants during the maximal voluntary isometric contraction in anterior, posterior and left/right directions for each subject.(XLSX)Click here for additional data file.S5 TableActivation levels of superficial muscles during neck posture in flexion, extension, left and right lateral bending for each subject.(XLSX)Click here for additional data file.S6 TableSpinal load, sum of muscle forces, and force ratio of deep muscles to superficial muscles (FR) during flexion, extension, left and right lateral bending for each subject.(XLSX)Click here for additional data file.


This provides a valuable resource for uncovering regulation principles in different human cells. In this paper, the architectures of the 41 regulatory networks and the distributions of housekeeping and specific regulatory interactions are investigated. The TF regulatory networks of different human cell types demonstrate similar global three-layer  hierarchical architectures, which are greatly different from the yeast TF regulatory network. However, they have distinguishable local organizations, as suggested by the fact that wiring patterns of only a few TFs are enough to distinguish cell identities. The TF regulatory network of human embryonic stem cells (hESCs) is dense and enriched with interactions that are unseen in the networks of other cell types. The examination of specific regulatory interactions suggests that specific interactions play important roles in hESCs.Neph  Living cells are the products of transcription programs involving thousands of genes. Sequence-specific transcription factor (TF) proteins regulate target genes by binding to promoter regions adjacent to the DNA sequences of the genes. There are less than 2000 TFs in the human genome –4. They Escherichia coli and Saccharomyces cerevisiae   was usedThe hESC-specific interactions are interactions that are only found in the regulatory network of hESCs. A total of 1509 interactions were identified (Supplementary Table S1).C, and a set of TFs, B, we say that C and B form a regulatory complex-target module if C contains two or more TFs such that all TFs in B are regulated by every TF (in C) only in the hESCs. We detected 55 regulatory complex-target modules (Supplementary Table S2) using the protein complexes reported in . By contrast, TFs that are regulated by STATs in HSCs but not in hESCs are enriched in GO:0048534 .Let us consider the seven mammalian signal transducer and activator of transcription (STAT) proteins. The activation of STATs by the Janus kinase proteins serves as an alternative to the second messenger system, transmitting extracellular signals from a wide spectrum of cytokines, growth factors and other polypeptide ligands to the nuclei ,27. A clet al. mentioned above.The diversity of the downstream TFs of the STATs might indicate their strong distinguishability for the classification of human cell types. Indeed, using the information on how the STAT proteins connect with their targets to classify the cell types, we obtained a grouping with RI = 0.856 Figure , which iE. coli, yeast, rat, mouse and human regulatory networks all exhibit hierarchical organization  and its core layer contains a significantly high number of TFs . However, its bottom layer has a size (9%) similar to those of the other cell type networks (Supplementary Table S3).When compared to the regulatory networks of other cell types, the hESC TF regulatory network has a significantly low number of TFs in the top layer  of TFs in each of the 41 networks . As expeSeventy-six percent of links are distributed within the core layer  except in the networks of hESCs, HSCs, hippocampal astrocytes and mammary fibroblasts . We therefore take these 2041 interactions as HK regulatory interactions. Enrichment analyses show that the proportions of HK links within the core layer and between the core and bottom layers are comparable and higher than those between the top and core layers and between the top and bottom layers . Additionally, the expressions of genes encoding them are much stabler than other TF genes across 79 human tissues  based on the entropy analysis of the gene expression data reported in  based on superenhancers reported in . One of these complexes is given in Figure The ESCSN, the subnetwork induced by specific links in the hESC TF regulatory network, has also been investigated. The 82 hub TFs in the ESCSN Table  seem to Cell type specificity is believed to be the outcome of the interplay of the DNA sequence-binding specificity of TFs, cofactors and epigenetics ,50. ThroSupplementary Data are available at NAR Online.


Neural correlates of working memory (WM) in healthy subjects have been extensively investigated using functional MRI (fMRI). However it still remains unclear how cortical areas forming part of functional WM networks are also connected by white matter fiber bundles, and whether DTI measures, used as indices of microstructural properties and directionality of these connections, can predict individual differences in task performance. fMRI data were obtained from 23 healthy young subjects while performing one visuospatial (square location) and one visuoperceptual (face identification) 2-back task. Diffusion tensor imaging (DTI) data were also acquired. We used independent component analysis (ICA) of fMRI data to identify the main functional networks involved in WM tasks. Voxel-wise DTI analyses were performed to find correlations between structural white matter and task performance measures, and probabilistic tracking of DTI data was used to identify the white matter bundles connecting the nodes of the functional networks. We found that functional recruitment of the fusiform and the inferior frontal cortex was specific for the visuoperceptual working memory task, while there was a high overlap in brain activity maps in parietal and middle frontal areas for both tasks. Axial diffusivity and fractional anisotropy, of the tracts connecting the fusiform with the inferior frontal areas correlated with processing speed in the visuoperceptual working memory task. Although our findings need to be considered as exploratory, we conclude that both tasks share a highly-overlapping pattern of activity in areas of frontal and parietal lobes with the only differences in activation between tasks located in the fusiform and inferior frontal regions for the visuoperceptual task. Moreover, we have found that the DTI measures are predictive of the processing speed. Working Memory (WM) refers to the capacity to maintain, manipulate and store information during short periods of time. It involves a set of brain structures and processes to organize and integrate different kinds of information  signal during working memory tasks has evidenced consistent activation of frontal and parietal cortical regions regardless of the stimulus modality , Radial Diffusivity (RD) and Axial Diffusivity (AD) relate to white matter integrity, since they are thought to reflect the degree of myelination, axonal membrane thickness and axon diameter  to identify the differences in the task-activated networks for spatial and facial working memory, and (2) to describe the structural connectivity of these networks measured with DTI indices.Whereas brain functional connectivity can be studied as the temporal correlation between spatially remote neuropsychological events during the performance of a cognitive task . High resolution T1-weighted images were acquired with the MPRAGE 3D protocol  and diffusion-weighted images were sensitized in 30 non-collinear directions with a b-value = 1000 s/mm2, using an echo-planar (EPI) sequence .Twenty-three healthy young subjects  with no history of psychiatric or neurological pathologies were included in the study. The study was approved by the research ethics committee of the University of Barcelona and participants gave written informed consent. Subjects were scanned on a 3T MRI scanner  during the performance of the working memory tasks, using a single shot gradient-echo EPI sequence .The two cognitive tasks presented during the MRI scanning consisted on 2-back WM paradigms. In each of them, a sequence of stimuli was presented on the screen and the subject was asked to indicate whether the stimulus was identical to the one shown 2 trials before. For the assessment of visuoperceptual working memory, we used facial images from an available database  of 1 s. An instruction screen was presented at the beginning of each block for 2 s. There were 16 blocks, alternating between 0-back and 2-back conditions, presented in the course of the 8-min experiment for each task. Individual responses were collected, and performance scores were computed using the d-prime measure [Z(hits rate) − Z]. Before ICA decomposition, the preprocessing of fMRI data included motion correction using MCFLIRT  . Each IC was composed by a spatial map, an associated time-course and a subjects mode vector, indicating the strength of the component for each subject.For each task-separated analysis, we identified the components related with the 2-back>0-back contrast and we selected the IC with the best fit to the task time-series. This procedure allowed the identification of the main functional network associated with spatial WM processing , and facial WM processing . In addition, with the ICA analysis performed with data from the two tasks, we could identify components of higher activity in one on the two tasks with respect to the other.Z>2.3) to obtain the clusters of task-related activity , the Inferior Frontal ROI , the Insular ROI , the Middle Frontal ROI , the Parietal ROI  and the Temporal ROI . The Fus ROI was specific for the facial task, whereas the other ROIs were calculated as the overlap between the activity maps of the two tasks.Overall, we created 6 ROIs in the right hemisphere and 5 ROIs in the left hemisphere Table : the FusIt should be noted from Table Diffusion MRI Images were analyzed using FDT (FMRIB's Diffusion Toolbox), from FSL  ICA decomposition. These vectors had an score for each subject and task that indicates the activation of a given component. They were introduced into PASW  and we evaluated differences between tasks using paired Correlations between whole-brain DTI indices and performance scores were evaluated using a General Lineal Model (GLM) in FSL. The resulting maps were corrected for multiple comparisons using randomize from FSL .All subjects showed high task performance measured by d prime measure. A summary of behavioral measures for each task and condition is shown in Table Using Tensor-ICA (T-ICA) for the whole group of 23 subjects and separately for each task, we identified the functional pattern for spatial and facial working memory processes . Its spatial map included the left inferior frontal frontal gyrus, a small region in the right middle frontal gyrus, part of the paracingulate gyrus, and a cluster located in the occipital pole, occipital fusiform, the lingual and fusiform gyrii and the inferior division of the lateral occipital cortex.With the ICA analysis of the facial and the spatial task together, we identified a component, associated with the 2-Back>0-back contrast, with higher activity during facial WM than during spatial WM . This cluster was located in the left inferior fronto-occipital fasciculus and left uncinate fasciculus . Axial Diffusivity (AD) of the same pathway (Fus to IF ROIs) also correlated with RT scores of the visuoperceptual  WM task .We conducted exploratory correlational analyses to evaluate associations between task measures and DTI parameters of the tracts identified previously .In addition, we observed a significant correlation between d prime measures of the visuospatial WM task and RD indices in the tracts connecting the Ins ROI and the MF ROI of the left hemisphere (All the previous correlations are reported at the uncorrected level of significance. Using Bonferroni correction for multiple comparisons, we found that only the correlation between mean FA in the right Fus-IF tract and RT in the visuoperceptual WM task remained significant. Given this, it should be mentioned that the correlations between task measures and DTI parameters should be interpreted with caution. Finally, in order to ensure that the correlations were not driven by outliers, we created scatter plots of all the significant results (see Supplementary Figure By using Independent Component Analysis of fMRI data and DTI, we studied patterns of brain activity and structural connectivity related with two working memory tasks: a visuospatial task involving working memory for spatial locations and a visuoperceptual task with facial stimuli. We observed that both tasks share a highly-overlapping pattern of activity in areas of frontal and parietal lobes and that the only differences in activation between tasks were located in the fusiform and inferior frontal regions for the visuoperceptual task. With DTI, we first performed a whole-brain analysis and we found a region in the left inferior fronto-occipital fasciculus and the left uncinate where AD correlated with the response time in the visuoperceptual WM task. Furthermore, we performed a second analysis, which was a ROI-to-ROI tractography in order to confirm the results obtained with whole-brain DTI analyses. We found that FA scores within the tract connecting the fusiform and the inferior frontal ROIs also correlated with reaction time in the visuoperceptual task.The shared pattern of fMRI activity from both tasks coincides with the core working memory network. We observed bilateral activation of the superior parietal lobule, frontal pole, dorsolateral-midventrolateral prefrontal cortex, and the anterior insula. These activated regions coincide with those described in several meta-analyses of the n-back task Fuster, . We alsoIn the spatial task, the shape processing, which could be considered a visuoperceptual process, was controlled by the task design, as the control task involved the same shape and color figure as the target task; therefore, we did not identify the participation of any region of the ventral stream. As expected due to the nature of the task, the superior parietal region of the dorsal stream was involved (Rottschy et al., As regards the DTI analysis, we performed two kinds of analyses, which were a whole-brain analysis of DTI-derived maps and a ROI-based analysis of the tracts depicted from the functional task-activations.In the whole-brain DTI analysis, we found a cluster in the left inferior fronto-occipital fasciculus and the uncinate where AD correlated with RT for the facial WM task. In addition, by doing probabilistic tractography, we identified the main tracts involved in the functional networks and we found that mean FA and mean AD scores within the pathway connecting the fusiform and the inferior frontal ROIs also correlated with facial RT. In all cases, subjects with higher AD or FA scores had faster reaction times. Therefore, exploratory correlational analyses of the tracts support and extend the results obtained with the whole-brain DTI analysis.Previous studies have reported that faster reaction time is associated with higher FA values measured with DTI. In adult subjects, Gold et al.  found thIn our results, the whole-brain analysis showed a negative correlation between AD and response time in the left hemisphere, which differs from other studies showing right hemispheric preference in the correlation between DTI and performance in facial recognition (Tavor et al., As regards the rest of results of tractography analyses, first evidencied that all ROI pairs resulted in tractography maps that included several tracts, and that were in accordance with reported structural brain connections (Catani et al., It should be noted that apart from this correlation, we did not find any strong evidence of a structure-performance relationship in the spatial WM task. We suggest several explanations for this lack of correlation. One possibility is that task-performance may be the result of more complex network interactions between structure and function in both positive and negative task-networks, as suggested in other reports (Burzynska et al., In summary, we have characterized the functional and structural networks of working memory for spatial and facial stimuli. We concluded that these networks share the fronto-parietal connections, and that facial working memory involves additional recruitment of fusiform and inferior frontal regions. Furthermore, the DTI results highlighted the relationship between microstructural properties of the inferior fronto-occipital fasciculus and reaction time in the visuoperceptual working memory.The present study underlines the importance of analyzing both the function and the structure of brain networks.This study has several limitations. First, the number of subjects is relatively small. Other limitations are related to the design of the fMRI study itself, for example, the lack of control for eye movements, which could affect the differences between activity patterns. In this regard, it has been reported that the activity associated with eye movements is located in the precentral sulcus, close to its junction with the superior frontal sulcus (Grosbras et al., To conclude, we recognize that further experiments need to be done to validate our results. For example, it would be very useful to design an experiment with comparable control conditions in each task, able to isolate the facial processing component from the facial memory component. In addition, we suggest that the inclusion of fixation periods in the tasks would facilitate controlling for differences in eye-movements. Finally, another possible improvement to the task would be to mix the visuoperceptual and the visuospatial conditions in a single fMRI-block design, with alternating blocks of each condition. This would imply a longer fMRI acquisition, but it would facilitate the data analysis and interpretation.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Current diagnosis and treatment of movement impairment post-stroke is based on the subjective assessment of select movements by a trained clinical specialist. However, modern low-cost motion capture technology allows for the development of automated quantitative assessment of motor impairment. Such outcome measures are crucial for advancing post-stroke treatment methods. We sought to develop an automated method of measuring the quality of movement in clinically-relevant terms from low-cost motion capture. Unconstrained movements of upper extremity were performed by people with chronic hemiparesis and recorded by standard and low-cost motion capture systems. Quantitative scores derived from motion capture were compared to qualitative clinical scores produced by trained human raters. A strong linear relationship was found between qualitative scores and quantitative scores derived from both standard and low-cost motion capture. Performance of the automated scoring algorithm was matched by averaged qualitative scores of three human raters. We conclude that low-cost motion capture combined with an automated scoring algorithm is a feasible method to assess objectively upper-arm impairment post stroke. The application of this technology may not only reduce the cost of assessment of post-stroke movement impairment, but also promote the acceptance of objective impairment measures into routine medical practice. Fifty percent of stroke survivors suffer from an impairment of motor function that requires prolonged rehabilitation To enable cross-evaluation of home-based treatments and help them move out of research realm into clinical practice, it is important to develop standard quantitative outcome measures that draw on the accumulated clinical experience of impairment assessment. The current state-of-the-art in clinical assessment of movement impairment is based on the subjective scoring of select movements by a trained clinical specialist. Several standard tests exist to assess the impairment of arm function, such as Fugl-Meyer Assessment (FMA) Recent technological improvements have resulted in low cost 3D motion capture systems such as Kinect Sensor (Microsoft). Such technology holds the potential of significantly advancing impairment assessment by providing objective kinematic data with which to guide the development of novel therapies . They were medically stable and could comprehend simple instructions. Infarct locations were identified from MRI scans by the participant's care providers . One subThe participants performed 10 different arm movements  that areData were processed in Matlab . The coordinates of multiple tracked skeletal landmarks were captured at 480 Hz by the standard system and at 30 Hz by the low-cost system . These dThe temporal alignment of the corresponding movements for paretic and non-paretic arms was accomplished in three steps. Firstly, movement start and end was manually identified in a subset of data. Secondly, kinematic data aligned on these onsets were averaged per joint angle to create a mean trace, termed wavelet, for each movement kind. Lastly, the multiple movements per trial were identified using peaks in the correlation coefficient profile for different delays between joint angles and the wavelet. The time of peaks were further used to align movement repetitions within and across trials. Manual creation of the wavelet can be omitted in a fully automated version of this analysis, if a single movement is recorded per trial.1 repetition of the same movement, single-trial errors were drawn repeatedly and randomly with replacement from the dataset for each movement type and each participant. The average squared differences between the mean error and each of the single-trial errors was the estimate of error of low-cost motion capture during a single movement. 2) To estimate the error from 2 repetitions of the same movement, two single-trial error values were drawn repeatedly and randomly with replacement from the dataset for each movement type and each participant. The average squared differences between the overall mean error and the mean of two single-trial errors was the estimate of error of low-cost motion capture after two repetitions of a movement. 3)–20) This bootstrapping was repeated with increasing number of trials (samples drawn from the population), until the maximal number of repetitions was reached for a particular movement and participant.We have used kinematics recorded by both systems to estimate the minimal number of movement repetitions required for sufficiently precise motion capture with the low-cost system. To accomplish this estimation we bootstrapped the data in several steps to estimate errors of averaging one, two, three, etc repetitions of the same movement. The errors were absolute differences between the maximal amplitude of angular motion in a single trial and the maximal amplitude of average angular motion across all corresponding trails. The following steps were carried out to bootstrap these errors: 1) To estimated the error from Lastly, we determined the first bootstrapped error value that fell below the 95% confidence interval of the mean error for each movement and participant. The corresponding number of trials used to calculate this value of error indicated the minimal number of repetitions of the same movement needed for accurate motion capture by the low-cost system.2), which indicated how closely non-paretic principal components represent the movement of paretic arm. Thus, this measure constitutes a quantitative score of impairment (WVU ©2012). The same decomposition was done on non-paretic data from individual trials using the principal components derived from the averaged non-paretic data. This measure showed the inherent variability of scoring using this method. The resulting R2 values for both of these analyses are plotted in Joint angles of the non-paretic arm of each subject were averaged across repetitions of the same movement, and principal components were derived from the averaged temporal profiles across the four joint angles using eigenvalue decomposition of the covariance matrix. Then, individual temporal profiles of the joint angles of paretic arm recorded during each repetition of each movement were reconstructed with the basis of the principal components derived from the averaged profiles of non-paretic arm. The number of principal components chosen for the reconstruction were sufficient to explain ≧95% of variance in the kinematics. The reconstructed joint angle profiles were compared to the original paretic profiles using coefficient of determination  was determined from a statistical table To estimate how many human rates it would take to match automated scoring performance, we bootstrapped the qualitative scores in several steps similarly to the procedure described above. The qualitative scores of 30 human raters and quantitative scores from low-cost motion capture were used for this analysis. The mean qualitative score averaged across all raters represents the most accurate clinical measure of a participant's impairment. The average squared differences between the mean qualitative scores and the qualitative scores of each rater was the estimate of error of individual human raters. The rest of the qualitative scores were bootstrapped using the following approach. To compare the error of 2 human raters to the automated performance, qualitative scores produced by 2 human raters were drawn repeatedly and randomly with replacement from the dataset of qualitative scores for each movement type and each participant. The drawn values were averaged, subtracted from the overall mean qualitative scores and squared. The resulting population of qualitative score errors represented the estimate of errors of 2 human raters. This bootstrapping was repeated with increasing number of raters (samples drawn from the population), until the maximal number of 30 raters was reached for a particular movement and participant.Lastly, we determined the first bootstrapped qualitative score error value that fell below the model performance error for each movement and participant. The corresponding number of raters used to calculate the value of qualitative score error indicated the minimal number of human raters it would take to surpass performance of the automated scoring algorithm.2 = 0.64; The quality of unconstrained 3D movements performed by each subject with paretic and non-paretic arm was automatically scored from kinematics. There was a strong linear relationship between the quantitative scores derived from both motion capture systems  with R = 0.868 . The dec = 0.868 . Regress dataset . This shWe have used the average scores of human raters as the gold standard against which to compare our automatic scoring algorithm. However, the accuracy of human raters varies due to the subjective nature of this approach. The proposed quantitative analysis offers an accurate and unsupervised alternative to the subjective and time-consuming measures. The tuned scoring model has a comparative reliability of combined scores from 30 human raters in our study . The algPCA has shown that different movements typically included in clinical tests have different inter-trial variability. This is illustrated by the changes in the explained variance of decomposition based on mean principal components between different recorded movements . This suThe standard motion capture system was used as the gold standard to assess the kinematic accuracy of the low-end system. To compare the two systems we calculated the root mean squared (RMS) errors between them with single trials aligned on movement onset as described above. RMS errors were averaged across the duration of each movement and across the two limbs for each of the four physiological angles. In addition to the RMS errors, we have also calculated the absolute difference between maximal joint excursions for each movement captured by each of the systems. The mean errors of joint angles recorded by the low-cost motion capture system were considerable . These eThe study results have shown that using low-cost motion capture with an automated scoring algorithm is a feasible method to assess objectively upper-arm impairment post stroke. Several recent studies have demonstrated the usefulness of whole-body kinematics in the assessment of improvements in post-stroke locomotion Results of our study have shown that automated quantitative assessment of movement impairment was as reliable as clinical assessment by thirty senior DPT students. This is consistent with previous studies showing that using motion capture for clinical assessment results in increased inter-rater reliability Traditionally, clinical tests consist of different movements that are performed once by the patient. A single repetition of each movement is done to reduce the time it takes to perform the test, and thus reduce the time spent by a medical specialist on motor assessment. We have shown that to obtain reliable kinematics from Kinect Sensor, each movement has to be repeated three times. While this increases the time it takes for the patient to perform the test, averaging across repetitions of the same movements contributes to the increased reliability of motor assessment. Furthermore, the medical specialist will not need to be present during the test administration, thus his/her time spent on the assessment will be reduced. Therefore, we believe that it is feasible to implement the automated motor assessment in a clinical setting.A limitation of the current study is that we employed a very coarse, although robust, 3-point clinical scale for the assessment of movement quality. Such scale has the resolution of 1/3 or 33% of maximal range of motion. Therefore our data show that while the low-cost motion capture system is less accurate than the laboratory standard, it is more accurate than the 3-point clinical scale . Future Assessment of motor impairment using the FMA is useful for understanding the limitations in motion of individual joints and basic synergy patterns. However, to evaluate the effectiveness of rehabilitation in enabling people to return to their normal lives different kinds of movements prove more useful. For example, clinical tests of functional abilities such as Wolf Motor Function Test


The repairing technology based on laser rapid fusion is becoming an important tool for fixing grey cast iron equipment efficiently. A laser repairing protocol was developed using Fe-based alloy powders as material. The microstructure and fracturing feature of the repaired zone (RZ) were analyzed. The results showed that regionally organized RZ with good density and reliable metallurgical bond can be achieved by laser repairing. At the bottom of RZ, dendrites existed in similar direction and extended to the secondary RZ, making the grains grow extensively with inheritance with isometric grains closer to the surface substrate. The strength of the grey cast iron base material was maintained by laser repairing. The base material and RZ were combined with robust strength and fracture resistance. The prevention and deflection of cracking process were analyzed using a cracking process model and showed that the overall crack toughness of the materials increased. Large quantities of cast iron equipment are widely applied in the industry, such as power supply, and manufacturing. Noticeable cracks are easily initiated at the surface of cast iron equipment because of the working condition of overload and fatigue. Without timely repair, cracks would result in the failure or even equipment breakdown, which leads to enormous economic losses. However, because of poor welding characteristics of cast iron, conventional approaches that have large heat inputs, long repairing cycles, and bad process controllability cannot satisfy the requirements of repairing technology improvement –3. In reVarious researches have been done in terms of laser repairing. Dong investigated problems on the repairing process of complex and free curved surface and studied the repairing paths of three-dimensional laser remanufacturing . The algSome significant studies have been performed on improving surface properties of cast iron by laser surface modification. Laser hardening of grey cast iron was performed by Sridhar et al. . In his The heat responses of grey cast iron substrate are the foundation in laser repairing process. The transient and static response rules of substrate can be revealed by theoretical analysis and numerical methods –17. Howe2 laser  and DL-LPM-IV multifunction NC machine, as shown in A diagram of laser repairing experiment system is demonstrated in In the repairing process, two layers were repaired along the same laser scanning route and direction. The optional laser process parameters are exhibited in Grey cast iron (HT250) is selected as the pending repaired substrate material. The material is made of iron-based high-carbon multielement alloy and its chemical compositions are listed in μm to 250 μm and density 2.8 g/cm3 to 4.8 g/cm3 is exhibited in Alloy powder was preplaced on the U-groove during the laser repairing experiment. The powder and its adjacent substrate material were melted simultaneously when affected by laser radiation. Considering the poor welding characteristics of the grey cast iron, the repair material should have excellent wettability with the substrate and the thermophysical parameters should be well matched. Fe-based self-fluxing powder was selected as the filling material because of the similar composition with grey cast iron and its low cost. The chemical composition of the Fe-based powder with powder size 150 The repaired samples were cooled at room temperature and cut along the vertical direction of the laser repairing path using a DK7725 wire electric discharge machine. The section planes were polished and corroded with 4% Nital. The microstructure of transverse sections under different heat effect treatments was observed and analyzed using HITACHI S-4800 scanning electron microscope (SEM) and MBA-1000 optical microscope (OM), respectively. For convenience of description, the cross-section of the sample was divided into three zones, namely, heat affected zone (HAZ), bond zone (BZ), and repaired zone (RZ).HAZ is located between the BZ and the substrate. The heating temperature of HAZ is between hypoeutectic and eutectoid temperature, and the microstructure only has solid-state phase transition during the repairing process. According to the Fe-C phase diagram and bidirectional transition characteristics of the microstructure, the primitive pearlite in substrate begins to decompose into ferrite and cementite as temperature exceeds the eutectoid point, whereas pearlite transforms into austenite. As temperature continuously increases, the primitive ferrite is converted into austenite with some carbon element decomposing into austenite. The transition of pearlite and ferrite is not complete because of the rapid movement of the molten pool. Therefore, HAZ has unbalanced microstructure including unstable austenite, pearlite, ferrite, and graphite. The temperature declines below the eutectoid point with the passage of molten pool. Austenite begins its transition into ferrite and expands relying on graphite. Some austenite cannot be converted completely and turns into residual austenite because of the rapid cooling rate. After exsolution from austenite, the carbon atom is inactive in solid phase and hardly turns into secondary graphite. Therefore, carbon atom combines with neighboring iron atom into secondary high-carbon cementite. As the temperature decreases to room temperature, a complicated microstructure composed of ferrite, martensite, residual austenite, cementite, and graphite is generated, as illustrated in α-Fe and γ-Fe and generated ferrite and austenite, respectively. Some carbon element has combined reaction with Fe to generate cementite. High cooling rate changes austenite into eutectic ledeburite with cementite. A small number of austenite transform into pearlite and have eutectic reaction with cementite to produce secondary ledeburite. Some unmelted residual graphite is also present. Hence, a complicated multiphase microstructure is generated in BZ.The BZ is located between HAZ and RZ. The peak temperature at this area can reach above the eutectic point and belongs to micromelting zone at molten pool brink. The microstructure of BZ had obvious transition, as BZ composition had attenuated and infiltrated under the direct effect of molten pool. The supercooling degree of BZ was higher than those of the other areas. In addition, BZ is under the coactions of rapid melting, solidification, and material attenuation. Therefore, a complicated microstructure is created as demonstrated in γ-Fe can produce infinite solid solution, which improves the stability of austenite. However, the hard mechanical mixture, which includes high-carbon martensite and ledeburite, is also generated, because of severe graphite dissolution. The microstructure of 316L in Austenite in With the growth of columnar grain and rapid cooling of molten pool in RZ, the dendrite trunk inherits the growth tendency of the columnar grain in BZ and has obvious extensional growth characteristics . FiguresDifferent materials have different grain types. As exhibited in Comparative microstructure of 316L RZ is a typical austenite stainless steel cellular grain, which is more compact than that of Fe314, as illustrated in Figures Both sets of the repaired samples have dense and compact repaired microstructure. As one of the strengthening methods, microstructure refinement can improve the hardness and strength of the material, as well as the plasticity and toughness. Thus, RZ can have higher crack resistance than grey cast iron substrate. In addition, martensite transition in the RZ can lead to volume inflation, which produces residual stress, and modify stress status of material surface.The RZ and substrate have sufficient metallurgical bonding in laser repairing experiment. Although the matching Fe-based alloy powder is selected as the repairing material, the microstructure and composition in different zones have large differences. The unmelted microstructure phase transition in the heat affected zone is observed, which affected the material properties. Thus, investigating the repaired strength is necessary. Considering the lathy shape of RZ and the brittleness of grey cast iron, bending test is considered to be an appropriate test approach. In the bending test, normal stress on sample surface is large and cracks are sensitive. The test is commonly used to inspect fusion layer properties and characterize bonding strength between fusion layer and substrate .To compare with the HT250 substrate without laser treatment, two sets of repaired samples, which have the same repairing process and parameters, were selected for bending test. To fully demonstrate the effect of RZ, the samples of the entire RZ should occupy a certain percentage of the whole volume. The test sample was fabricated using wire electric discharge machine, as exhibited in The WDW-100D testing machine was used in the bending test. The maximum loading force was 100 kN, with an accuracy grade of 0.5. The span of the two supporting points is 20 mm and the surface of RZ is toward the outside direction. The diameter of top indenter is 10 mm. The substrate and repaired samples are placed on the bottom indenter of the testing machine and suffer the steady load from top indenter. The load and displacement data of different samples in fracturing process are extracted and drawn into the load-displacement curves. The fracture appearances of different samples are observed by S-4800 cold field emission SEM.The HT250 substrate fracture appearance is shown in The macro- and microfracture morphologies of the RZ in the bending samples of Fe314 and 316L are shown in Figures To investigate the fracture mechanism at different positions, two positions in BZ and RZ are observed with high magnification, respectively, as shown in Figures The appearance of the 316L repaired sample fracture is shown in F) and displacement (s) curve of fracturing process is illustrated in F-s curve is like a straight line, which indicates that the fracture is typical brittle fracture. The crack propagates quickly under large stress and the load declines rapidly from 2.23 kN to 0 kN. For the repaired samples, the displacement under the same load is larger, which proves that the toughness is increased. The peak values of the load of Fe314 and 316L sample are 2.6 kN and 2.75 kN, respectively, which are both higher than that of substrate. This is because the microstructure of RZ is compact and refined, which mainly includes austenite, pearlite, and residual austenite. Besides, there is little flaky graphite in RZ. These contribute the higher tensile strength of repaired samples. The crack is restrained when it propagates to the boundary of RZ and then followed by a slow propagation. As shown in The load (The main crack remains vertical with maximum tensile stress direction when cast iron substrate fractures. More branches appear at the sides of the main crack and interconnect gradually within the graphite cavity. From the analysis of the fracturing characteristics of samples, laser RZ has positive effect on the fracture prevention when sample is under impact of external concentrated stress. A cracking model is established to depict the fracturing process of the bending test, which is similar to the model for crack propagation process, which is stated in . The crai. The strength of flaky graphite in grey cast iron is extremely low and flaky graphite acts as cavities in substrate. The sharp corners of flaky graphite can cause stress concentration easily, which promote the crack propagation. Therefore, the initiated crack propagates along graphite and substrate between the closest graphite under the external bending stress [Crack propagation  is initig stress . This cag stress . With thg stress . Crack pFrom the analysis of cracking model of the RZ, the characteristic effect of laser RZ is the deflection of cracking direction. Moreover, the effect is clearer when cracking direction is vertical with laser scanning direction. The deflection of crack direction presents the effective function of the material at this area to prevent cracks. Compared with linear cracking, the frequent change of cracking direction prolongs the propagation path and requires more energy to keep the cracking state. Intensity factor of effective stress at crack front end and crack propagation rate declines with decreasing effective stress of cracking. Therefore, the repaired sample exhibits characteristics of good cracking prevention.Laser repairing of grey cast iron surface is achieved with iron-based Fe314 and 316L alloy powder. The microstructure is compact and homogeneous, and the metallurgical bonding is reliable. Large carbon concentration gradient is generated between the RZ and substrate. Fe314 alloy powder is more suitable for laser repairing of grey cast iron surface.The bottom of Fe314 RZ consists of dendrite with similar growth direction that extends continuously to the secondary RZ. The secondary repairing makes the grains extensive with inheritance. Microstructure near the top surface is composed of equiaxed grains group with improved toughness and machinability of substrate. Microstructure of 316L RZ comprises austenite cellular grain and the grains exhibit characteristic of inherited growth.Laser repairing keeps the original strength of cast iron base material. Base material and RZ exhibited good bonding strength and cracking resistance. The cracking prevention and deflection process is obtained using a cracking model of the RZ. Laser repairing improves the crack resistance and toughness of the overall material.


This study explored the effects of an integrated care model aimed at the frail elderly on the perceived health, objective burden, subjective burden and quality of life of informal caregivers.A quasi-experimental design with before/after measurement (with questionnaires) and a control group was used. The analysis encompassed within and between groups analyses and regression analyses with baseline measurements, control variables  and the intervention as independent variables.The intervention significantly contributed to the reduction of subjective burden and significantly contributed to the increased likelihood that informal caregivers assumed household tasks. No effects were observed on perceived, health, time investment and quality of life.This study implies that integrated care models aimed at the frail elderly can benefit informal caregivers and that such interventions can be implemented without demanding additional time investments from informal caregivers. Recommendations for future interventions and research are provided.http://ISRCTN05748494. Registration date: 14/03/2013.Current Controlled Trials  Informal caregivers of the frail elderly often experience the demands placed on them as a heavy burden and a threat to their quality of life. Informal care refers to the unprofessional and unpaid assistance provided by partners, family or close friends . Frail eDespite the potential vulnerability of informal caregivers, their needs are still largely overlooked . MoreoveIntegrated care arrangements targeting the patient- caregiver dyad are believed to reduce the burden and improve the overall quality of life and health of informal caregivers ,13,15. THowever, evidence to substantiate these assumptions is scarce. Whereas the beneficial effects of integrated care on the frail elderly are well established , very feThe scarcity and inconsistency of the evidence call for a more coherent and in-depth investigation of the effects of integrated care arrangements on the informal caregiver. To this end, the current study aims to evaluate the effects on informal caregivers of a specific integrated care intervention for the frail elderly, the Walcheren Integrated Care Model (WICM). This model was recently implemented in Walcheren, a region in the southwest of the Netherlands. The current paper describes the investigation of the effects of this intervention on a selection of outcome measures: perceived health, objective burden, subjective burden and quality of life. While it is expected that the WICM will contribute to improvements in these outcome measures, the occurrence of adverse effects as described in existing literature must also be taken into account. Therefore, the research question guiding the current study is formulated accordingly: What are the effects of the WICM on the perceived health, objective burden, subjective burden and quality of life of informal caregivers?The WICM focuses on frail elderly individuals living independently (living in their own homes or in a specific type of assisted living facility) and their informal caregivers. The study protocol containing an extensive description of the intervention has been published previously . The WICThe WICM entails explicit attention to the potential needs of informal caregivers and recognizes the roles of these individuals in the care process. The involvement of the informal caregiver starts after the patient has been screened for frailty using the Groningen Frailty Indicator (GFI) . After bAvailable services for informal caregivers normally include respite care services aimed at temporary relief, as well as psychosocial interventions, such as education and training or (group) counseling. In the WICM, the case manager provides the informal caregiver with relevant information, advice and suggestions regarding available services based on the caregiver’s specific needs. The case manager functions as a link to all relevant organizations and professionals and if needed, the informal caregiver is brought into contact with them. Case managers may also provide practical advice  or emotional support.The study had a quasi-experimental design included before/after measurements and a control group. A baseline measurement (T0) was performed prior to the intervention; the follow-up measurement (T1) was performed twelve months after T0. The study protocol (protocol number MEC-2013-058) was reviewed by the medical ethics committee of the Erasmus Medical Centre Rotterdam, the Netherlands. They waived further examination as the Medical Research Involving Subjects Act did not apply.Eight GP practices in the Walcheren region participated in this study as intervention practice or control practice. Frail older patients and their informal caregivers were recruited as participants through these practices. Both control and experimental practices provided the researchers with the names and contact information of patients that were 75+ years of age. These patients were mailed an information leaflet, the screening questionnaire (GFI) and an informed consent. Upon return, frailty scores were computed (GFI score of 4+) . InclusiOf the 8 participating GP practices, 3 practices (6 GPs) provided care according to the WICM and constituted the experimental group. The remaining 5 practices (5 GPs) continued to provide care as usual and thus constituted the control group. Care as usual for the frail elderly can be described as reactive, as GPs are usually consulted at the patient’s initiative. As gatekeepers, GPs refer frail elderly patients to both care and curative services in the secondary and tertiary echelons . Care asThe questionnaire .Click here for fileDescription of file: Table showing the contribution of each model to the R2 and their significance.Click here for file


The Ebola epidemic exposed the weak state of health systems in West Africa and their devastating effect on frontline health workers and the health of populations. Fortunately, recent reviews of mobile technology demonstrate that mHealth innovations can help alleviate some health system constraints such as balancing multiple priorities, lack of appropriate tools to provide services and collect data, and limited access to training in health fields such as mother and child health, HIV/AIDS and sexual and reproductive health. However, there is little empirical evidence of mHealth improving health system functions during the Ebola epidemic in West Africa.We conducted quantitative cross-sectional surveys in 14 health facilities in Ondo State, Nigeria, to assess the effect of using a tablet computer tutorial application for changing the knowledge and attitude of health workers regarding Ebola virus disease.P < 0.05) recorded for questions concerning the transmission of the Ebola virus among humans, common symptoms of Ebola fever and whether Ebola fever was preventable. Additionally, there was reinforcement of positive attitudes of avoiding the following: contact with Ebola patients, eating bush meat and risky burial practices as indicated by increases between pre- and post-intervention scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively. Moreover, more participants (from 95 to 97%) reported a willingness to practice frequent hand washing and disinfecting surfaces and equipment following the intervention, and more health workers were willing (from 94 to 97%) to use personal protective equipment to prevent the transmission of Ebola.Of 203 participants who completed pre- and post-intervention surveys, 185 people (or 91%) were female, 94 participants (or 46.3%) were community health officers, 26 people (13 %) were nurses/midwives, 8 people (or 4%) were laboratory scientists and 75 people (37%) belonged to a group called others. Regarding knowledge of Ebola: 178 participants (or 87.7%) had foreknowledge of Ebola before the study. Further analysis showed an 11% improvement in average knowledge levels between pre- and post-intervention scores with statistically significant differences (The modest improvements in knowledge and reported attitudinal change toward Ebola virus disease suggests mHealth tutorial applications could hold promise for training health workers and building resilient health systems to respond to epidemics in West Africa. The Ebola virus disease (EVD) outbreak in West Africa commenced in a remote area of southern Guinea in December 2013 while the first cases were reported in March 2014. Unlike previous outbreaks in East and Equatorial Africa [The initial spread of EVD in West Africa was fuelled by socio-cultural factors and a collective failure to ensure availability of adequate health staff, basic healthcare resources and systems in the most affected countries , 6. SubsUnderstandably, the moral, physical and psychological consequences of the epidemic dampened the enthusiasm of FHWs  to proviThe use of mHealth technology refers to the incorporation of wireless devices such as mobile phones, tablets, personal diagnostic assistants (PDAs), patient-monitoring devices and other wireless devices into medical and public health practice to improve health or ensure healthcare , 11–13. Despite the utility of mHealth for strengthening health systems in a range of health fields including mother and child health (MCH), management of diabetes and HIV treatment , there iAs already mentioned in the preceding paragraphs, mHealth uses wireless devices to support medical and public health practice to improve health or healthcare . mHealthThe aim is to provide intervention participants  with disease-specific information  to increInstrat and Anadach and implemented on the Vecna Cares CliniPAK system under a Qualcomm® Wireless Reach™ grant. The FLEM project was implemented in collaboration with the Ondo State Government in Nigeria with the objective of improving emergency preparedness of the health system to contain the Ebola outbreak.This paper reports an education intervention that used tablet computers as a medium to facilitate the training of frontline health workers. The intervention was a component of the ‘Front Line health worker Education and disease Management (FLEM) project’, developed by The study consisted of quantitative cross-sectional surveys in selected health facilities, with pre- and post-intervention knowledge, attitude and practice (KAP) measurements of health workers.CliniPAK application) to improve data collection and ultimately health outcomes.This research is set in Ondo State, western Nigeria. Ondo State has a population of 3.9 million and is made up of 18 local government areas (LGAs) with Akure as its capital city –25. The Eligible participants were doctors, nurses, midwives, laboratory technicians, CHOs and CHEWs drawn from 14 health facilities across Ondo State purposively selected because the facilities were already supplied with tablet computers loaded with an electronic health record system. We approached the heads of the 14 facilities, explained the objectives of the study and invited FHWs from the facilities to participate in the study. All 14 facilities are equipped with and use Vecna Cares’ CliniPAK health data capture system for the daily documentation of MCH care delivered in the clinics. The application leverages the CommCare Open Data Kit platform to provide an easy-to-use electronic health record system front-end interface that runs on tablet computers.The evaluation of the front line health worker education and disease management (FLEM) application intervention consisted of (i) pilot testing a tablet computer tutorial application for improving diagnostic and management responses to EVD and (ii) conducting before and after surveys to assess changes in the KAP of FHWs regarding EVD. The electronic tutorial application was designed by a multidisciplinary group of ICT and infectious diseases experts and health system researchers to extend and enhance existing CliniPAK electronic health information systems to disseminate critical information to FHWs in real time via tablet computers. The application is unique in that it requires minimal instruction for use after download and installation. Following the development of the FLEM application, an orientation programme was organized for FHWs of the facilities during which potential participants were trained to use tablet computers and the CliniPAK electronic application. As part of the orientation, the objectives of the study were explained to FHWs after which they were invited to participate in the study. Participants were subsequently provided with instructions on completing a pre-tutorial survey, reviewing the electronic Ebola tutorial and completing a post-tutorial survey.Participants were assured of absolute confidentiality and the right to either accept or refuse to participate without consequences. However, due to delays in receiving ethical clearance for the study and the time required for pre-testing the tutorial application, the baseline data collection commenced on 3rd October 2014 during the epidemic while the post-intervention data collection was completed on 25th February 2015 after Nigeria was declared Ebola-free. Ethical clearance for the study (number G.8061/99) was obtained from Ondo State Ethical Review Committee.The study was implemented via the following steps:Step 1: All participants completed a consent form electronically.Step 2: Participants inputted demographic information into the FLEM application.Step 3: Participants were invited to complete a pre-tutorial knowledge and attitude assessment (pre-KAA), to establish a baseline of health workers’ knowledge of and attitudes toward EVD. The assessments contained objective knowledge questions as well as subjective attitudes and perception questions.Step 4: Ebola awareness tutorial (EAT) was launched on all tablet computers deployed in 14 healthcare facilities in Ondo State. This educational intervention/course comprised essential information on EVD namely the source, incubation period, clinical features and route of spread. Other areas covered included transmission, diagnosis of EVD, clinical management and prevention of Ebola transmission in healthcare settings. Health workers that completed the pre-KAA were required to view the EAT at their convenience over a 2-week period. The 2-week period was chosen to keep the duration of the education intervention short in the context of the FLEM project objective of improving emergency preparedness of the health system to contain the Ebola outbreak. Participants were allowed multiple views of the EAT.Step 5: A post-tutorial knowledge and attitude assessment (post-KAA) was launched to establish the effectiveness of the training on the health workers. The questions asked on the post-KAA were exactly the same as those asked during the pre-KAA to facilitate comparison of performance. All participants who completed the post-KAA were expected to have done the pre-KAA and viewed the EAT on at least one occasion. Tablet computers had prepaid annual subscriptions to mobile networks to circumvent the issue of accessing mobile phone networks while health workers were using the tablets. The responses for the pre- and post-KAA were stored electronically for each participant and subsequently analysed.The pre- and post-KAA data and the logs on all frontline workers who viewed the EAT were downloaded from the CommCare survey data repository database to a Microsoft Excel Package (version 14.0.7145.5000 (32-bit). Two hundred and eighty-two frontline workers completed the pre-KAA survey, while 214 workers completed the post-tutorial survey. We excluded data for 11 workers who did not view the tutorial but completed the post-KAA survey. The study analysis was thus conducted on data for 203 workers who completed the pre- and post-tutorial surveys and viewed the tutorial.Z test was done on the means of the pre- and post-tutorial scores for knowledge questions, and the significance level was set at P < 0.05.The knowledge part of the study contained nine objective questions. We assigned scores of 1 for each correct answer and 0 for wrong answers that frontline workers provided. We counted the number of respective responses to arrive at the number of FHWs that selected each outcome and computed a percentage of aggregate counts for each outcome relative to the total and compared the pre- and post-tutorial scores to arrive at the difference in health worker knowledge of the Ebola virus disease. A paired sample The behavioural and attitudinal part of the study contained seven questions with five possible choices: Strongly Agree, Agree, Not Sure, Disagree, and Strongly Disagree. To streamline interpretations of health worker responses, we combined ‘Strongly Agree and Agree’ to derive ‘Agree’ and ‘Strongly Disagree’ and ‘Disagree’ to derive ‘Disagree’. We thus had three possible outcomes: Agree, Not Sure or Disagree. We counted the number of respective responses to arrive at the number of FHWs that selected each outcome from each health facility. We then took simple averages of the response counts across all the facilities to arrive at the average score for each of the seven questions. Finally, we computed the percentage of aggregate counts for each outcome relative to the total and compared the pre- and post-tutorial scores to arrive at the difference in health worker behaviours and attitudes toward the Ebola virus disease.Only 2 of 14 participating facilities were tertiary-level facilities (see Table One hundred and seventy-eight participants (or 87.7% of FHWs) had heard about EVD prior to the study while 25 (12.3%) had not. Most health workers  learnt about Ebola mainly from the radio and television  and lowest among the subgroup of ‘other’ health workers (55.6). However, the general upward trend in average between pre- and post-EAT scores was reflected among all professional categories with the greatest change in average score of 10.1 being recorded among PHC workers Table .Table 4PInterestingly, health workers who feared EVD reduced significantly from 89 to 52%. Positive attitudes, e.g. avoiding handshakes with/touching Ebola patients, avoiding bush meat and avoiding to wash the corpses of diseased patients, were reinforced as indicated by increases between pre- and post-EAT scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively (Table Two questions indirectly assessed health workers’ practices with respect to EVD and infection control. This assessment was built on the premise that the Ebola tutorial may positively influence health workers’ response in the post-EAT survey. As expected, health workers responded more positively in favour of desirable clinical practices of frequent hand washing and disinfection of surfaces and equipment Tables  and 7. SFollowing the Ebola epidemic in West Africa, a number of KAP studies were conducted among the general population and/or health workers in Nigeria , 30, SieOur findings mirror those of other studies in two ways. First, the revelation that most FHWs had heard of EVD before our evaluation is consistent with findings of KAP surveys conducted among the general population which showed that the majority of respondents in Lagos , 35 and The effectiveness of the FLEM application in changing FHWs’ knowledge of EVD may be ascribed to disseminating educational materials in real time combined with the convenience of unfettered access to online learning materials by FHWs over a stipulated time period. This underlines the potential benefits of electronic dissemination of educational information to enhance FHWs’ learning. It is noteworthy that improvements in average knowledge of EVD occurred across all cadres rather than in a given category of FHWs. It is, however, unclear whether the reduction in post-EAT scores relating to questions about the natural host of Ebola virus reflects existing uncertainty in the scientific community on this issue.Besides modest improvements in knowledge, the post-EAT reinforcement of positive attitudes of avoiding handshakes, avoiding bush meat and avoiding risky burial practices during the Ebola epidemic is reassuring. Nevertheless, our findings should be interpreted with caution. Despite a growing recognition in the academic community that it is difficult to obtain reliable information on people’s knowledge and attitudes from KAP surveys , 37, we In clinical settings, hand washing and disinfection of clinical areas and equipment remain the cornerstone of infection control. These practices are applicable to EVD prevention as the Ebola virus can be easily denatured by most standard disinfectants used in healthcare , 40. In In conclusion, the FLEM mHealth tablet application appears to be effective for educating FHWs in the context of an epidemic. The modest changes in knowledge and attitudes recorded from the evaluation of this education intervention suggest that mHealth tutorial applications have potential for information dissemination and training of FHWs during EVD outbreaks. The user-friendly nature of this application and regular access to a limitless amount of educational materials, streamed in real time to FHWs, is a strong selling point of this application. Using mHealth tutorial applications as a means of bolstering the capability of health systems to manage disease conditions and improving health in LMICs should be explored further, especially given the increased global utilization of mobile technology and corresponding reduction in cost of mobile phone subscription.The study has four limitations. First, it is limited by the small sample of 282 FHWs, which reflects the fact that the mHealth intervention was implemented only in health facilities where CliniPAK wireless electronic education and health record systems were already provided in Ondo State. Second, we acknowledge that some of the improvement in knowledge and attitudes observed in this study may arise from parallel exposure of FHWs to, e.g. government-implemented mass media campaign about EVD during our research. Nevertheless, the evidence that the FLEM intervention is effective in improving KAP of FHWs sets the stage for expanding coverage and further testing of the intervention to other health facilities in the state. Third, the study is limited by a 2-month industrial strike during the study period that prevented some participants from completing the post-KAA after taking the pre-KAA survey and viewing the EAT. Fourth, we acknowledge that the accuracy of our findings could have been increased by supporting the KAP survey, e.g. with in-depth interviews and focus group discussions, to provide context to and clarify reasons behind some participant responses.Health Research and Ethics Committee Number: G.8061/99