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Evaluation of beneficial effect of a dua...
Evaluation of beneficial effect of a dual-task exercise based on Japanese transitional games in older adults: a pilot study
Jieun Yoon1, , Hiroko Isoda1,2,3, , Tomohiro Okura1,4, ,
1 R&D Center for Tailor-Made QOL, University of Tsukuba, Tsukuba, Ibaraki, Japan
2 Alliance for Research on the Mediterranean and North Africa (ARENA), University of Tsukuba, Tsukuba, Ibaraki, Japan
3 Faculty of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
4 Faculty of Health and Sport Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
Received: May 15, 2020 Accepted: July 21, 2020 Published: October 11, 2020
Yoon J, Isoda H, Okura T, . Evaluation of beneficial effect of a dual-task exercise based on Japanese transitional games in older adults: a pilot study. Aging (Albany NY). 2020; 12:18957-18969. https://doi.org/10.18632/aging.103908
Provider: TY - JOUR AU - Yoon, Jieun AU - Isoda, Hiroko AU - Okura, Tomohiro TI - Evaluation of beneficial effect of a dual-task exercise based on Japanese transitional games in older adults: a pilot study JO - JA - Aging (Albany NY) VL - 12 IS - 19 PB - SN - UR - https://doi.org/10.18632/aging.103908 DO - 10.18632/aging.103908 SP - 18957 EP - 18969 PY - ER -
Provider: TY - JOUR AU - Yoon, Jieun AU - Isoda, Hiroko AU - Okura, Tomohiro TI - Evaluation of beneficial effect of a dual-task exercise based on Japanese transitional games in older adults: a pilot study JO - JA - Aging (Albany NY) VL - 12 IS - 19 PB - SN - UR - https://doi.org/10.18632/aging.103908 DO - 10.18632/aging.103908 SP - 18957 EP - 18969 PY - AB - Not only does Japan has the world's longest healthy life expectancy, but also the world's longest average life span. This study investigated the effect of a novel dual-task (DT) exercise called "Synapsology" (SYNAP), developed as a game-like activity to improve older adults' physical and cognitive functions. Participants (n=24) with a mean age of 70.6 years (65–77 years) were randomly assigned to the SYNAP exercise group (SG, n=15) and the control group (CG, n=9). The SG participated in the DT intervention consisting of 60-minute sessions, twice a week, for 8 weeks. Physical function in timed-up-and-go had significant pre- and post- trial differences (P=0.017) in SG. In addition, cognitive function results in the a 25-hole trail-making peg test (P=0.004) and an oxidative stress marker (P=0.039) had a statistically significant difference within the SG. However, there were no significant differences in the physical and cognitive functions between SG and CG. In the study, older adults who participated in cognitive-motor DT intervention improved significantly with regard to motor ability and cognitive function results. Thus, a game-like DT exercise may help maintain the healthy life of older adults compared to no intervention. ER -
Copyright: © 2020 Yoon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Not only does Japan has the world's longest healthy life expectancy, but also the world's longest average life span. This study investigated the effect of a novel dual-task (DT) exercise called "Synapsology" (SYNAP), developed as a game-like activity to improve older adults' physical and cognitive functions. Participants (n=24) with a mean age of 70.6 years (65–77 years) were randomly assigned to the SYNAP exercise group (SG, n=15) and the control group (CG, n=9). The SG participated in the DT intervention consisting of 60-minute sessions, twice a week, for 8 weeks. Physical function in timed-up-and-go had significant pre- and post- trial differences (P=0.017) in SG. In addition, cognitive function results in the a 25-hole trail-making peg test (P=0.004) and an oxidative stress marker (P=0.039) had a statistically significant difference within the SG. However, there were no significant differences in the physical and cognitive functions between SG and CG. In the study, older adults who participated in cognitive-motor DT intervention improved significantly with regard to motor ability and cognitive function results. Thus, a game-like DT exercise may help maintain the healthy life of older adults compared to no intervention.
According to the World Health Organization (WHO) report (2016), the population of Japan has the longest average human life span at 83.7 years [1]. The population of adults aged over 65 reached 34.61 million in 2017, which comprised 27.3% of the total population. Japan has become a "super-aging" society. As the elderly population has grown faster than expected, the burden of social care insurance on the public due to the welfare policy implemented since 2001 has increased. Therefore, the extension of "healthy lifespan" that aim to maintain a healthy life among Japanese is one of the major goals of the Japanese government.
In 2012, the estimated number of adults over 65 years suffering from dementia in Japan reached 4.42 million, which was about 1 in 7 people with dementia (prevalence rate 15.0%) [2]. Moreover, the estimate for people who may suffer from dementia in 2025 is 37%. That is 1 in every 5 people with dementia. Therefore, the risk of cognitive impairment in older adults is a serious problem in Japan.
Since older people with a risk of chronic disease are often prescribed several medications, they also have a greater risk of adverse medication events, and they may experience side effects [3]. Therefore, the ideal treatment for them may be a combination of natural supplements and exercise, instead of medications [4].
Older adults experience a decrease in physical and social activities due to physical, physiological, and cognitive changes [5]. Several observational studies on older adults revealed that greater physical activity reduces the incidence of dementia [6, 7]. Recently, some reports claimed that physical exercise is associated with improved exercise in various cognitive domains, including novel object recognition memory [8], and cognitive flexibility [9]. Furthermore, studies show that interventional exercises not only improve the essential physical elements needed to avoid falling, such as balance, muscle strength, and agility, but also the cognitive function, even when started at the age where one is most prone to dementia [10]. A meta-analytic study on exercise and cognition indicated that an evaluation result is dependent upon cognitive assessment instruments, exercise protocols (including type of exercise, length, and intensity of exercise programs), and subject-selection criteria [11]. In this respect, the authors suggested performing larger and better controlled studies to characterize important individual differences that moderate exercise produces on cognitive and brain health. Using both cognitive and motor assessments would allow the clinician to make better estimates of functional exercise as seen in other neurocognitive disorders, such as Parkinson's disease and dementia [12].
Dual-task (DT) exercise is said to be followed when specific cognitive and/or motor tasks are performed simultaneously with the goal of improving selected cognitive or physical domains and it is better than performing the individual exercise or cognitive training alone [13, 14]. Because of this, cognitive-motor DT programs are an emerging modality for reaping the largest cognitive health benefits.
Synapsology (SYNAP) program is a novel, game-like, DT exercise program that is both safe and effective for older adults with cognitive dysfunction [15] when compared with the conventional DT study, which consists of simple tasks, such as stepping exercise while sitting, combined with word enumerating exercise [16–18].
SYNAP activates the brain's cognitive functioning (calculation, memory/learning, attention/concentration, thinking/problem-solving, visual space recognition, and language, etc.) and its corresponding movements (Figure 1). However, the effects of SYNAP have not been verified, and this study is the first study to evaluate it quantitatively.
Figure 1. Basic movements of "Synapsology" (games combined with number counting, calculation, memory, problem-solving, visual color recognition, enumerating words, etc.). (A) First session: Rock, Paper, Scissors (RPS) game, (B) Second session: Pass the colored balls game. (See details in Supplementary Table 1). SG: Synapsology exercise group; CG: control group; Effect size (Cohen's d): |0.2≤d<0.5|=small, |0.5≤d<0.8|=moderate, |0.8≤d|=large. Asterisk shows statistical significance at P<0.05. SG: Synapsology exercise group; CG: control group. Effect size (Cohen's d): |0.2≤d<0.5|=small, |0.5≤d<0.8|=moderate, |0.8≤d|=large. Asterisk shows statistical significance at P<0.05. SG: Synapsology exercise group; CG: control group. Effect size (Cohen's d): |0.2≤d<0.5|=small, |0.5≤d<0.8|=moderate, |0.8≤d|=large. Asterisk shows statistical significance at P<0.05. SG: Synapsology exercise group; CG: control group; Effect size (Cohen's d): |0.2≤d<0.5|=small, |0.5≤d<0.8|=moderate, |0.8≤d|=large. Asterisk shows statistical significance at P<0.05. SG: Synapsology exercise group; CG: control group. Effect size (Cohen's d): |0.2≤d<0.5|=small, |0.5≤d<0.8|=moderate, |0.8≤d|=large. Asterisk shows statistical significance at P<0.05. SG: Synapsology exercise group; CG: control group. Effect size (Cohen's d): |0.2≤d<0.5|=small, |0.5≤d<0.8|=moderate, |0.8≤d|=large. Asterisk shows statistical significance at P<0.05.
Considering the relationship of DT exercise and cognitive function, we hypothesized that a novel DT exercise method, Synapsology, would improve physical and cognitive functions of older adults. In the current pilot study, we comprehensively investigated both physical and cognitive functions in our subjects to assess the efficacy of SYNAP for older adults.
Participants and baseline characteristics
A total of 50 older adults agreed to participate in our study (Figure 2). Among them, 20 applicants did not meet the inclusion criteria (intake of dietary supplements purported to aid cognition, having an acute phase of a disease). Thus, a total of healthy 30 older adults who lived in the local community participated in the study. During the training period, six participants (CG) dropped out during the physical function evaluation because of conflicting schedules or their participation in strength training twice a week. Twenty-four participants (SYNAP exercise group (SG): 15, Control group (CG): 9) completed the 8-week trial.
There was a significant difference in the number of education years (P=0.043) between the SG and CG (Table 1). Three participants in SG had a very high education background (19 years of education), which is the reason for the significant difference in the results. On the other hand, there were no significant differences in the baseline characteristics between groups. The mean ages of the participants were 69.7 years (65–76 years) for SG and 71.9 years (65–77) for CG. Their mean BMIs were 22.5 (17.8–26.8) for SG and 22.9 (21.1–25.5) for CG. The Japanese Ministry of Health, Labor, and Welfare (2013) lists the average BMI at 22.7 kg/m2 for adults between 60–69 years and 23.0 kg/m2 for those aged 70 years and above. Therefore, the participants' average BMI was typical of the Japanese population for these ages.
Table 1. Participant characteristics.
Items (unit) SG (n=15) CG (n=9) P-value
Mean ± SD Range Mean ± SD Range
Age (years) 69.7 ± 3.3 65-76 71.9 ± 5.0 65-77 0.314
Women (%) 8 (53.3) 4 (44.4) 0.650†
Education (years) 14.6 ± 3.0 9-19 11.9 ± 1.6 9-14 0.043
Height (cm) 161.5 ± 8.1 145.5-172.2 162.1 ± 7.6 147.2-168.6 0.865
Body weight (kg) 58.8 ± 9.6 47.2-71.0 60.6 ± 8.9 49.2-72.1 0.674
Body mass index (kg/m2) 22.5 ± 2.9 17.8-26.8 22.9 ± 1.8 21.1-25.5 0.710
Systolic blood pressure (mmHg) 137.9 ± 15.8 104-162 133.9 ± 25.3 90-161 0.674
Diastolic blood pressure (mmHg) 77.4 ± 8.5 63-93 78.1 ± 9.2 69-92 0.854
Stroke 1 (6.7) 0 (0.0) 0.202†
Hypertension (%) 6 (40.0) 4 (44.4) 0.940†
Hyperlipidemia (%) 0 (0.0) 4 (44.4) 0.006†
Diabetes (%) 1 (6.7) 2 (22.2) 0.295†
Heart disease (%) 2 (13.3) 1 (11.1) 0.825†
SG: Synapsology exercise group, CG: control group, SD: standard deviation, P-value: Student's t-test, †P-value: Chi-squared test
The mean blood pressures were similar with no significant difference between the two groups. The average blood pressure of older Japanese adults is 140/90 mm Hg, placing our participants' mean blood pressures within the normal range. In addition, there was a difference between the groups in the history of hyperlipidemia alone, and four participants experienced this in CG. Six participants had a history of diabetes treatment (SG:1, CG:2) and heart disease (SG:2, CG:1).
Performance of Synapsology (see details in Supplementary Table 1)
Synapsology is an 8-week DT intervention consisting of 60-minute sessions performed twice a week for a total of 16 intervention sessions. There were 240 participant- training hours available for SG (15 participants, 16 sessions). The members of SG attended 232 hours, which was a 96.7% attendance rate.
Physical function
In Table 2, there were no significant differences in the timed-up-and-go (TUG, P=0.114), five times-sit-to-stand movement test (P=0.778), and 5-meter habitual walk (P=0.257) between groups (SG and CG). In the SG, the pre- and post- trial result showed a significant improvement after SYNAP intervention in TUG performance (P=0.017). There were no significant changes in the CG (P=0.779). In addition, the effect size (Cohen's d) in the SG was "moderate" (d=0.51) in TUG and there were "no effect" in five times-sit-to-stand (d=0.10) and in the 5-meter habitual walk test (d=0.07). The effect size in CG was "small" in 5-meter habitual walk (d=0.44), "no effect" in TUG (d=0.03), and "small" in five times sit-to-stand (d=0.17).
Table 2. Physical and cognitive function by groups at baseline and follow-up.
Item (unit) SG (n=15) CG (n=9) †P-value(SG vs. CG)
Pre-test Post-test Effect size (d) P-value Pre-test Post-test Effect size (d) P-value
Median Range Median Range Median Range Median Range
Timed up and go (sec.) 4.90 4.42-5.90 4.55 3.89-5.86 0.51 0.017* 4.89 4.23-7.97 5.00 4.22-6.90 0.03 0.779 0.114
Five-times-sit-to stand movement test (sec.) 5.89 4.59-7.96 5.47 4.55-8.67 0.10 0.950 5.73 4.95-6.64 5.54 4.79-7.88 0.17 0.678 0.778
5 m habitual walk test (sec.) 3.08 2.80-4.70 3.15 2.87-4.70 0.07 0.925 3.15 2.60-4.71 3.16 2.60-3.75 0.44 0.271 0.257
Trail making peg test (sec.) 68.51 51.75-99.75 54.38 46.02-95.50 0.54 0.004* 67.71 47.81-84.65 67.97 47.81-114.65 0.12 0.779 0.084
d-ROMs (U CARR) 394.00 307.00-476.00 389.00 285.00-486.00 0.28 0.039* 417.00 309.00-594.00 426.00 358.00-594.00 0.06 0.889 0.570
BDNF (ng/ml) 188.27 157.79-248.27 202.31 136.82-259.89 0.01 0.790 190.53 107.15-253.92 166.50 116.18-239.89 0.59 0.069 0.148
SG: Synapsology exercise group, CG: control group, Effect size (d): Cohen's d=|0.2≤d<0.5|=small, |0.5≤d<0.8|=moderate, |0.8≤d|=large. P-value: Wilcoxon signed-rank test (pre- vs. post- trial), †P-value: Mann-Whitney u test (post Δ pre- trial). Asterisks show statistical significance at P<0.05.
Trail-making peg test (TMPT, 25-hole peg test)
In Table 2 and Figure 3, the results suggest a progressive improvement of TMPT (P=0.004) after SYNAP intervention. The differences on the TMPT between the SG and CG were not significant (P=0.084). However, the effect size of SG (d=0.54; moderate) was higher than that of CG (d=0.12; no effect).
Oxidative stress markers (d-ROMs) and brain-derived neurotrophic factor (BDNF)
In Table 2 and Figure 3, the differences on d-ROMs and BDNF between groups were not significant (P=0.570 in d-ROMs and P=0.148 in BDNF). In SG, the result was significantly decreased in oxidative stress markers (d-ROMs) (P=0.039) after SYNAP intervention. In addition, the effect size (Cohen's d) was "small" (d=0.28) in d-ROMs and "no effect" in BDNF (d=0.01). The effect size in CG was "moderate" in BDNF (d=0.59) and "no effect" in d-ROMs (d=0.06).
In Japan, adults aged over 65 comprise 27.3% of the total population. Thus, the population structure has changed drastically to an elderly society. In 2000, the Nursing Care Insurance Act system was implemented to support various elderly problems in society as a whole. Half of the financial resources is secured by collecting insurance premiums from workers aged 40 and over, and the other half is covered by the government. In the system, the older adults with dementia need long-term care (so-called, Long-Term Care Insurance System), which imposes a heavy financial burden [19] on them.
The risk of cognitive impairment in older adults is a serious problem in Japanese society. Moreover, the older adults often experience medication problems. For example, they may experience medication side effects such as gastrointestinal problems, kidney damage or even kidney failure with the administration of medications such as painkillers and anti-inflammatory medications [3]. The most common illnesses among the elderly are heart and gastrointestinal problems, nerve damage, muscle pain and weakness, bone loss, and joint pain, etc. Consequently, the ideal solution for the QOL (Quality of Life) of older adults may be a combination of a non-pharmacological intervention such as a cognitive dual-task (DT) exercise and effective/natural supplements instead of medication.
In the study, thus, the cognitive and motor DT exercise program, Synapsology (SYNAP), was evaluated and its the beneficial effect for older adults was studied through physical and cognitive function measurements.
Previous studies reported that cognitive DT exercises indicated a high correlation between cognitive tasks and motor tasks [20, 21]. Our study using SYNAP was designed for older adults to participate in a DT exercise program with relatively complex task exercises based on Japanese transitional games. Thus, although the program consisted of 60-minute sessions over 8 weeks, the participants enjoyed the sessions and had a 96.7% participation rate. Participants expressed that they could continue this intervention because it was fun, like a game.
Although there was a significant difference in the education item (P=0.043) (Table 1) between the SG and CG, there was no significant difference in the timed-up-and-go (TUG, P=0.921), 25-hole peg test (TMPT, P=0.550), oxidative stress markers (d-ROMs, P=0.823), and brain-derived neurotrophic factor (BDNF, P=0.910) between groups, when considering education as a covariant. Therefore, education was not directly relevant for the items measured in this study. In other words, d-ROMs and BDNF levels in serum can be evaluated objectively as a cognitive function indicator. Indeed, most studies have typically used participants' education (number of years/background) as a cognitive function covariant. Many cases showed that education was correlated with cognitive function [22, 23], but in some cases, they were not related to cognitive function [24, 25]. Therefore, it is still unclear whether education always affects cognitive changes or not.
The TUG provides more information regarding mobility and risk of falling because it measures cognitive capacity while performing a motor task [26]. In other words, TUG was strongly related to cognitive capacity and effectively performing the TUG depends on the person's cognitive function. Although there was no significant difference in TUG, among the five times sit-to-stand movement test, and 5-meter habitual walk between groups (SG and CG), only the result of TUG in SG was significant (P=0.017). It suggests a progressive improvement of TUG in motor task exercise after SYNAP intervention. Therefore, SYNAP leads to an improvement in the participants' TUG ability in connection with an improved cognitive function. However, SYNAP includes light daily movements and not high-intensity exercises. This 8-week intervention study did not increase the leg strength of the participants. Thus, the result of the five times sit-to-stand movement and the 5-meter habitual walk test in both groups were not improved by SYNAP intervention.
Kellor et al. originally introduced the peg test in 1971 as a measurement of dexterity [27]. It generally consists of a 9-hole peg board, which is considered vital for measuring dexterity. It is widely used in the assessment of cognitive function for neurological disorders together with a commercial version. More detailed information was gathered regarding the change in cognitive function from pre- to post- trial using a complicated 25-hole peg test called the "trail-making peg test" (TMPT). It was a fast and convenient tool for assessing cognitive function and is often used in Japan [28]. Okura and Yoon showed that the correlation coefficient of cognitive function was higher with this TMPT method (r=-0.682, P<0.001) than with the general trail-making peg test [29]. There was no significant difference between SG and CG in the 25-hole TMPT results. However, in SG, we observed a remarkable improvement (P=0.004). In addition, the effect size (Cohen's d) was "moderate" (d=0.54) in SG, but there was "no effect" in CG (d=0.12). In other words, the median of SG after SYNAP intervention was increased but CG did not change (Figure 3). The results suggested that the participant's brain was activated by SYNAP intervention, and movement speed in the task improved because of faster peg number recognition, since cognitive function had improved.
In a similar Japanese dual-task (DT) study [20], they conducted a calculation task, a visual search task and a verbal fluency task. The cognitive task was done simultaneously during the balance training in the DT group (n=21, 72.9 years) for twice a week within three months. Comparing the results of their DT, our TUG result was 1.2 times faster, and the TMPT result was 3.1 times faster. In our results, TUG and 25-TMPT showed a significant difference and the effect size also showed a "moderate" size difference (TUG: d=0.51, TMPT: d=0.54) after SYNAP intervention. However, the previous study showed no significant difference in those items and also, the effect size was "small". This difference suggests that the results of physical and cognitive function may be influenced by the content of DT program rather than the DT intervention period. (i.e., it may be important that the elderly enjoy DT)
A simple method of detecting hydroperoxide levels in serum is to measure derivative-reactive oxygen metabolites (d-ROMs); this has been reported as a useful method for evaluating oxidative stress [30]. Oxidative stress and the level of serum oxidative stress markers are inversely associated with global cognition [31]. Thus, measuring d-ROMs is a simple and convenient assay method for assessing cognitive function changes. To our best knowledge, this is the first study to evaluate cognitive function changes using d-ROMs in DT intervention. As shown in Table 2, the levels of d-ROMs in both groups were not significant (P=0.570). However, the result of d-ROMs in SG was significant (P=0.039) after DT intervention (Figure 4). The effect size (Cohen's d) was "small" (d=0.28) in SG, but there was "no effect" in CG (d=0.06). The levels of d-ROMs would indicate improved cognitive function, since d-ROMs are inversely associated with global cognition [31, 32]. Therefore, from the obtained result of TMPT and d-ROMs, we can conclude that SYNAP led to an improved cognitive function in SG compared to no SYNAP participants in the CG.
However, we did not see remarkable changes in BDNF. Interestingly, there was no change in the mean value of BDNF in SG, whereas it decreased in CG from 193.7 ng/ml in the pre- test to 168.6 ng/ml in the post- trial with "moderate" effect size (d=0.59). This decrease occurred in CG in only 8 weeks, but it may be impossible for cognitive function to decrease by such a level due to aging in such a short span of time. Without high-intensity exercise, there will be no change in BDNF level in blood serum. Thus, the BDNF levels in blood serum in this study were not affected or not measurable. Since BDNF responds to activities and stress that all individuals experience during their daily life, it might be difficult to distinguish changes in BDNF levels using the results from relatively short exercise/activity trials such as the DT trial.
Based on our results, this study suggests that SYNAP could be an effective DT program in adults aged over 65 years to improve and maintain their physical and cognitive function and to improve their quality of life. For this reason, SYNAP should be established as a social exercise in retirement homes and municipal sports facilities in Japan.
We could only include a small number of participants in this initial study, which was a limitation. We determined the number of participants we could accommodate in our study, in part, by considering our space requirements and availability in the university. Actually, we conducted SYNAP intervention in groups of 5 to 7 participants in a circle, and this required an area of 2.25 m2 or more per person. This study required not only activity space available for the exercise classroom, but also the number of skilled program instructors, nurses, and other assistants. This is the reason it was difficult to conduct a large-scale examination. Therefore, we cannot generalize the study findings as a system for the improvement of physical and cognitive functions for older adults.
Recently, a method was developed for quantitatively measuring amyloid beta (Aβ), a substance related to cognitive function changes, from a small amount of serum sample [33]. In our future studies, we will use this method to investigate the relationship between DT and cognitive function. Also, we plan to evaluate the effectiveness of Synapsology in the near future using fMRI or FDG-PET measurement.
This research represents the first evaluation of a game-like DT exercise "Synapsology" (SYNAP). There was no significant difference between groups (SG and CG) in this study. However, by participating in SYNAP, older adult participants exhibited positive changes in the TUG, TMPT, and d-ROMs but not in BDNF levels. The participants' motor ability and cognitive function were better than before they followed SYNAP.
This study suggests that participation in SYNAP for over 8 weeks may slow or prevent cognitive deterioration in older adults as compared to no intervention. Therefore, SYNAP would be a useful addition to the social and recreational activities of older adults, especially in a "super-aging" society like Japan.
The older adults, who participated in this study, were recruited through an advertisement in the local newspaper (JOYO Living). The inclusion criteria for participants were adults aged over 65 years who did not regularly engage in organized physical activities, sports, or cognitive training. The power analysis with settings at α=0.05, power (1–β)=0.80 and effect size=0.64 [34] showed that a group of 30 participants was the required sample size for SG. However, since this was a pilot study, only half of the 30 people were sampled. Initially, patients with dementia were excluded. The exclusion criteria were as follows: (1) those using a pacemaker; (2) those undergoing an acute phase of a disease; (3) those with severe diabetes; (4) those participating in strength training two or more times per week; or (5) those unable to attend the study briefing or continuously attend the training sessions. In Figure 2, the CONSORT flow chart provides more information on participant flow and distribution. We enrolled 30 healthy participants in the trial and put them into two groups randomly using the blocked randomization method [35]. The information collected from the participants included baseline characteristics such as age, height, weight, body mass index (BMI), and blood pressure (Table 1).
The Ethics Committee of the University of Tsukuba approved this study (No., Tai 26-95). All participants provided written, informed consent. The authors confirm that the trials for this intervention were registered with the University Hospital Medical Information Network (UMIN) Clinical Trial Registry (UMIN000034350). The experimental procedures were fully explained to each participant before they gave their written informed consent. All data are available from the University of Tsukuba Ethics Committee for researchers who met the criteria for access to confidential data.
Synapsology program (see details in Supplementary Table 1)
Synapsology (SYNAP), an advanced DT program for stimulating brain activity, was developed in 2011 [15]. It has been applied, in particular, to older adults, including those living in group homes and participating in cognitive support programs.
The SYNAP program uses physical and mental game-playing in a multidisciplinary approach to stimulate brain activity and cognitive performance, as well as improve physical function. In Japan, "Janken," or the rock-paper-scissors (RPS) game as it is called in other parts of the world, was a very popular and familiar traditional game among children and even adults. It was helpful and desirable for the DT program to be simple and enjoyable like a game (Figure 1). The SYNAP program has the participant play physical games mildly using colored balls or make the RPS symbols with the left and right hands while performing a series of cognitive tasks; they may need to call out related or memorized words or count and add numbers while tossing a ball or making the RPS symbols. Stretching, lower body exercises, and walking were included in our SYNAP program.
The program consisted of 60-minute sessions twice a week as an intervention for 8 weeks. The sessions were conducted with in groups of five to seven participants with one instructor, to maintain their concentration. The SG begins with a 10-minute warm-up of breathing and flexibility exercises for the upper and lower body, followed by a 45-minute SYNAP program. Then, the program ends with a 5-minute cooling down with breathing and stretching exercises. The first main session was an RPS game, and the second main session was a "pass the colored balls" game with exercises, calculations, words, memorization, and other tasks. The first and second sessions were conducted on the same day. It was structured so that the difficulty level of the task became higher each week or two. The first main session consisted of an RPS game (1st–2nd week), RPS calculation exercise (3rd week), confrontation exercise (4th–5th week), RPS variant-calculation (6th week), memory RPS (7th–8th week), and the second main session consisted of "pass the colored balls" game (self-introduction) (1st–2nd week), four movements (housework) (3rd week), four actions with a partner (4th–5th week), partner hand touch (6th week), and mimicry with a partner (7th–8th week). In total, our participants attended 16 sessions. The CG did not receive the intervention at all, but they performed normal and regular activities of daily living during the study period. The purpose of the CG was to compare changes in the physical and cognitive functions of elderly participants who did not perform the SYNAP program with those who did.
Physical function evaluation
Timed-up-and-go-test (TUG)
TUG is a commonly used performance test to evaluate functional mobility or dynamic balance. According to the modified method [36], the participants were instructed to rise from their chair, walk 3 m to a marker, go around it, and sit down on a chair as fast as possible. The time taken to complete the task was recorded; the faster time of the two trials was used for the analysis.
Five times sit-to-stand movement test
The participants were asked to sit on their chair with arms folded over their chests and then to stand up and sit down 5 times as fast as possible.
5-m habitual walk test
Participants walked at their typical speed on an 11-m straight course. To eliminate acceleration phases, we calculated the walking time between the 3-m and 8-m marks of the course. The time taken to complete the task was recorded, with the faster time among the two trials was used for the analysis.
Cognitive function evaluation
In the TMPT, the participants were asked to place 25 pegs in 25 randomly numbered holes on a board in numerical order from 1 to 25 and subsequently remove them as quickly as possible (Figure 5). This requires a visual-scanning task to locate the numbered holes and move the 25 pegs. We used the TTKK 1306 peg board (Takei Scientific Instruments Co. Ltd., Niigata, Japan), and recorded the time required for participants to finish moving 25 pegs.
BDNF and d-ROM measurements
We collected blood from the participants of both groups, a BDNF assay as a marker for cognitive function, and a d-ROMs assay as an oxidative reaction indicator, in the morning after fasting overnight. We collected the blood and ran these tests about 1 week prior to the intervention (pre- trial, measurement point 1) and about 8 weeks after starting the intervention (post- trial, measurement point 2).
Measurement of brain-derived neurotrophic factor (BDNF)
After collecting 4 mL of blood from each participant by venipuncture, the blood was allowed to coagulate at room temperature for 30 minutes and was subsequently centrifuged for 15 minutes at 3000 rpm to collect the serum. We performed an enzyme-linked immunosorbent assay (ELISA) to quantitatively determine the BDNF concentrations (DuoSet ELISA Development Kit from RD Systems, AVISCERA BIOSCIENCE, INC.). No significant cross reactivity or interference was observed in this assay. Serum samples were diluted 1:50. The samples of BDNF concentrations were then determined by non-linear regression from the standard curves. We prepared "low" and "high" concentration quality control pools by adding 10 ng and 100 ng to 5 ml portions of human serum (Innovative Research, Novi, MI, USA), giving us nominal concentrations of 2 and 20 ng/ml, respectively. The repeatability of the BDNF ELISA, as measured by intra-assay precision, was 3.8%, and the reproducibility, as measured by inter-assay precision, was 7.6%.
Measurement of serum oxidative stress markers (d-ROMs)
The serum concentrations of d-ROMs were used to assess oxidative stress markers. Twenty microliters of serum were added to a pH 4.8 buffer in a cuvette and mixed by inversion to separate Fe2β and Fe3β from the blood proteins and allow the Fe2β and Fe3β radicals to catalyze the degradation of hydroperoxides in the blood into alkoxyl and peroxy radicals, to measure the d-ROMs level. Next, when 20 mL of a coloring chromogen (N, N-diethyl-paraphenylenediamine) was added to the solution, the free radicals oxidized the chromogen substrate to yield red-colored radical cations. The solution was mixed again by inversion, and the cuvette was placed in a photometer for optical measurement at 505 nm.
The G*Power 3.1.3 was used to perform the power analysis for the supposed sample size. All data were checked for normality of distribution with the Shapiro-Wilk test.
We used baseline characteristics as the mean and compared it to standard deviation or the frequency count between the groups using Student's t-test and χ2 test.
Comparisons of the baseline values with those 8 weeks after each exercise training session were performed using the nonparametric Wilcoxon signed-rank test for each group. We also performed comparisons between both the groups using the nonparametric Mann-Whitney U test. A Δ value was obtained from the Mann-Whitney U test by subtracting post- trial from pre- trial and was used to estimate whether the changes in the parameters were clinically meaningful and to examine the effect size. The effect sizes (Cohen's d) of the pre- and post- trial data were determined using the average changes and excluding the pre- test standard deviation. A value of 0.2–0.5 was considered "small;" 0.5–0.8, "moderate;" and above 0.8, "large". In addition, 95% confidence intervals were used for all resulting measures of the pre- and post- trial. Data were analyzed using the Windows statistical package for IBM SPSS Statistics 22 software (IBM, Armonk, NY, USA) with the level of statistical significance set at P<0.05.
Supplementary Table 1
Conception and design of the experiments: J.Y., T.O. Performing the experiments: J.Y., H.I. Analysis of data: J.Y., H.I. Paper writing: J.Y. All authors discussed the results and contributed to the final manuscript.
We thank the participants for their time and dedication.
The authors declare that there are no conflicts of interest.
This work was supported by the Japan Science and Technology Agency Grant Number AZA30104.
1. World Health Organization. World health statastics. 2016.
2. Japanese Cabinet Office. Health and Welfare of the Elderly. The White Book of the Aged Society in 2016 (Summary Version). 2016.
3. Phueanpinit P, Pongwecharak J, Krska J, Jarernsiripornkul N. Knowledge and perceptions of the risks of non-steroidal anti-inflammatory drugs among orthopaedic patients in Thailand. Int J Clin Pharm. 2016; 38:1269–76. https://doi.org/10.1007/s11096-016-0363-9 [PubMed]
4. Yoon J, Kanamori A, Fujii K, Isoda H, Okura T. Evaluation of maslinic acid with whole-body vibration training in elderly women with knee osteoarthritis. PLoS One. 2018; 13:e0194572. https://doi.org/10.1371/journal.pone.0194572 [PubMed]
5. Byun JE, Kang EB. The effects of senior brain health exercise program on basic physical fitness, cognitive function and BDNF of elderly women - a feasibility study. J Exerc Nutrition Biochem. 2016; 20:8–18. https://doi.org/10.20463/jenb.2016.06.20.2.2 [PubMed]
6. Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K. A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med. 2001; 161:1703–08. https://doi.org/10.1001/archinte.161.14.1703 [PubMed]
7. Etgen T, Sander D, Huntgeburth U, Poppert H, Förstl H, Bickel H. Physical activity and incident cognitive impairment in elderly persons: the INVADE study. Arch Intern Med. 2010; 170:186–93. https://doi.org/10.1001/archinternmed.2009.498 [PubMed]
8. Hopkins ME, Davis FC, Vantieghem MR, Whalen PJ, Bucci DJ. Differential effects of acute and regular physical exercise on cognition and affect. Neuroscience. 2012; 215:59–68. https://doi.org/10.1016/j.neuroscience.2012.04.056 [PubMed]
9. Pesce C, Audiffren M. Does acute exercise switch off switch costs? a study with younger and older athletes. J Sport Exerc Psychol. 2011; 33:609–26. https://doi.org/10.1123/jsep.33.5.609 [PubMed]
10. Kemoun G, Thibaud M, Roumagne N, Carette P, Albinet C, Toussaint L, Paccalin M, Dugué B. Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia. Dement Geriatr Cogn Disord. 2010; 29:109–14. https://doi.org/10.1159/000272435 [PubMed]
11. Kramer AF, Colcombe S. Fitness effects on the cognitive function of older adults: a meta-analytic study-revisited. Perspect Psychol Sci. 2018; 13:213–17. https://doi.org/10.1177/1745691617707316 [PubMed]
12. Bronnick K, Ehrt U, Emre M, De Deyn PP, Wesnes K, Tekin S, Aarsland D. Attentional deficits affect activities of daily living in dementia-associated with Parkinson's disease. J Neurol Neurosurg Psychiatry. 2006; 77:1136–42. https://doi.org/10.1136/jnnp.2006.093146 [PubMed]
13. Falbo S, Condello G, Capranica L, Forte R, Pesce C. Effects of physical-cognitive dual task training on executive function and gait performance in older adults: a randomized controlled trial. Biomed Res Int. 2016; 2016:5812092. https://doi.org/10.1155/2016/5812092 [PubMed]
14. Tait JL, Duckham RL, Milte CM, Main LC, Daly RM. Influence of sequential vs. Simultaneous dual-task exercise training on cognitive function in older adults. Front Aging Neurosci. 2017; 9:368. https://doi.org/10.3389/fnagi.2017.00368 [PubMed]
15. Mochiduki M. Synapsology for the prevention of cognitive decline. Japanese Journal of Cognitive Neuroscience. 2015; 17:155–58.
16. Yamada M, Aoyama T, Tanaka B, Nagai K, Ichihashi N. Seated stepping exercise in a dual-task condition improves ambulatory function with a secondary task: a randomized controlled trial. Aging Clin Exp Res. 2011; 23:386–92. https://doi.org/10.1007/BF03337763 [PubMed]
17. Gobbo S, Bergamin M, Sieverdes JC, Ermolao A, Zaccaria M. Effects of exercise on dual-task ability and balance in older adults: a systematic review. Arch Gerontol Geriatr. 2014; 58:177–87. https://doi.org/10.1016/j.archger.2013.10.001 [PubMed]
18. Heiden E, Lajoie Y. Games-based biofeedback training and the attentional demands of balance in older adults. Aging Clin Exp Res. 2010; 22:367–73. https://doi.org/10.1007/BF03337732 [PubMed]
19. Japanese Ministry of Health Law. Long-term care benefits: Monthly report. 2015.
20. Hiyamizu M, Morioka S, Shomoto K, Shimada T. Effects of dual task balance training on dual task performance in elderly people: a randomized controlled trial. Clin Rehabil. 2012; 26:58–67. https://doi.org/10.1177/0269215510394222 [PubMed]
21. Kim GY, Han MR, Lee HG. Effect of dual-task rehabilitative training on cognitive and motor function of stroke patients. J Phys Ther Sci. 2014; 26:1–6. https://doi.org/10.1589/jpts.26.1 [PubMed]
22. Guerra-Carrillo B, Katovich K, Bunge SA. Does higher education hone cognitive functioning and learning efficacy? findings from a large and diverse sample. PLoS One. 2017; 12:e0182276. https://doi.org/10.1371/journal.pone.0182276 [PubMed]
23. Stern Y. The concept of cognitive reserve: a catalyst for research. J Clin Exp Neuropsychol. 2003; 25:589–93. https://doi.org/10.1076/jcen.25.5.589.14571 [PubMed]
24. Parisi JM, Rebok GW, Xue QL, Fried LP, Seeman TE, Tanner EK, Gruenewald TL, Frick KD, Carlson MC. The role of education and intellectual activity on cognition. J Aging Res. 2012; 2012:416132. https://doi.org/10.1155/2012/416132 [PubMed]
25. Wilson RS, Yu L, Lamar M, Schneider JA, Boyle PA, Bennett DA. Education and cognitive reserve in old age. Neurology. 2019; 92:e1041–50. https://doi.org/10.1212/WNL.0000000000007036 [PubMed]
26. Alexandre TS, Meira DM, Rico NC, Mizuta SK. Accuracy of timed up and go test for screening risk of falls among community-dwelling elderly. Rev Bras Fisioter. 2012; 16:381–88. https://doi.org/10.1590/s1413-35552012005000041 [PubMed]
27. Kellor M, Frost J, Silberberg N, Iversen I, Cummings R. Hand strength and dexterity. Am J Occup Ther. 1971; 25:77–83. [PubMed]
28. Abe T, Jindo T, Soma Y, Tsunoda K, Kitano N, Yoon JY, Okura T. [Validity and reliability of the "trail making peg" test as a performance measurement for evaluating the cognitive function]. Nihon Ronen Igakkai Zasshi. 2015; 52:71–78. https://doi.org/10.3143/geriatrics.52.71 [PubMed]
29. Okura T, Yoon JY. A novel performance test foe evaluating cignitive function in older adults: Trail making peg test. Japanese Society of Test and Measurement in Health and Physical Education 2015; 14:59–68. https://doi.org/10.14859/jjtehpe.14.59
30. Sugiura T, Dohi Y, Takase H, Yamashita S, Tanaka S, Kimura G. Increased reactive oxygen metabolites is associated with cardiovascular risk factors and vascular endothelial damage in middle-aged Japanese subjects. Vasc Health Risk Manag. 2011; 7:475–82. https://doi.org/10.2147/VHRM.S23097 [PubMed]
31. Horvat P, Kubinova R, Pajak A, Tamosiunas A, Schöttker B, Pikhart H, Peasey A, Kozela M, Jansen E, Singh-Manoux A, Bobak M. Blood-based oxidative stress markers and cognitive performance in early old age: the HAPIEE study. Dement Geriatr Cogn Disord. 2016; 42:297–309. https://doi.org/10.1159/000450702 [PubMed]
32. Pesce M, Tatangelo R, La Fratta I, Rizzuto A, Campagna G, Turli C, Ferrone A, Franceschelli S, Speranza L, Patruno A, Ballerini P, De Lutiis MA, Felaco M, Grilli A. Aging-related oxidative stress: positive effect of memory training. Neuroscience. 2018; 370:246–55. https://doi.org/10.1016/j.neuroscience.2017.09.046 [PubMed]
33. Nakamura A, Kaneko N, Villemagne VL, Kato T, Doecke J, Doré V, Fowler C, Li QX, Martins R, Rowe C, Tomita T, Matsuzaki K, Ishii K, et al. High performance plasma amyloid-β biomarkers for Alzheimer's disease. Nature. 2018; 554:249–54. https://doi.org/10.1038/nature25456 [PubMed]
34. Teixeira CV, Gobbi S, Pereira JR, Ueno DT, Shigematsu R, Gobbi LT. Effect of square-stepping exercise and basic exercises on functional fitness of older adults. Geriatr Gerontol Int. 2013; 13:842–48. https://doi.org/10.1111/ggi.12011 [PubMed]
35. Kelly ME, Loughrey D, Lawlor BA, Robertson IH, Walsh C, Brennan S. The impact of exercise on the cognitive functioning of healthy older adults: a systematic review and meta-analysis. Ageing Res Rev. 2014; 16:12–31. https://doi.org/10.1016/j.arr.2014.05.002 [PubMed]
36. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther. 2000; 80:896–903. [PubMed]
Jieun Yoon
yoon.jieun.fu@u.tsukuba.ac.jp
dual-task exercise rock-paper-scissors (RPS) game physical function cognitive function


text:
Juliana over the moon at visa news
Juliana Costa and husband Armindo Machado
It took thousands of signatures and lobbying from both the mayor and MP, but Queenstowner Juliana Costa's finally learned she'll be allowed to return to New Zealand.
And it's fair to say she's pretty happy.
"I'm delighted that I will have the chance to go back to NZ, live with my husband and go ahead with our dreams," she tells
Earlier this month, Costa and her husband, Armindo Machado Junior, returned to their native Brazil for what was supposed to be a holiday.
But with Costa's immigration status up in the air, she was unsure when she'd be able to return to Queenstown.
She learned in March that her working visa would not be renewed, leading her to start a petition for her case to be reviewed so she could apply for a medical waiver.
That petition reached more than 8000 signatures.
This week she learned she's been granted a 24-month working visa, and will have the opportunity to apply for a partnership visa when Machado Junior becomes eligible.
Costa's been active in fundraising for the Cancer Society ever since she was diagnosed with breast cancer last year.
"I have plans to keep helping the community whenever I can, and we are going to start to organise the second Gratitude Music Festival to help raise money for the Cancer Society."
She also wants to thank everyone who supported the pair.
Both Queenstown mayor Jim Boult and Clutha-Southland MP Hamish Walker wrote to the government, calling for Costa to be allowed to stay.
Walker, who lobbied the Immigration Minister and asked him to intervene, says he's "absolutely thrilled" by the decision.
"Like many people who come from overseas and make Queenstown home, they contribute a huge amount to our community and we are very lucky to have them."
Daisy Hudson

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: How to remap ctrl+arrow keys to move word to word for mac I'm coming from windows editors and I'm used to moving word to word in an editor (notepad, visual studio) or any application for that matter
Can somebody tell me how to remap the ctrl+rightarrow and ctrl+leftarrow to move word to word on my mac book pro retina running lion?
Currently the ctrl+leftarrow moves to the other dsktop on mac no matter what application I'm currently using. How can I disable that for one...
...and more importantly get the word for word traverse working in an application via ctrl+leftarrow and ctrl_rightarrow?

A: You can change the keyboard shortcuts for changing spaces from System Preferences:

Then create ~/Library/KeyBindings/ and save a property list like this as DefaultKeyBinding.dict:
{
  "^\UF702" = moveWordLeft:;
  "^\UF703" = moveWordRight:;
  "^$\UF702" = moveWordLeftAndModifySelection:;
  "^$\UF703" = moveWordRightAndModifySelection:;
}

You have to quit and reopen applications to apply changes to DefaultKeyBinding.dict.
See http://www.hcs.harvard.edu/~jrus/site/cocoa-text.html or http://lri.me/keybindings.html for more information.

redpajama_set_name: RedPajamaStackExchange


text:
Home » Packer Insider
Packer Insider
April 29, 2011 transcript
Tom Silverstein Friday morning NFL draft chat transcript
Journal Sentinel beat writer Tom Silverstein reviewed the first round of the NFL draft and previewed Rounds 2 and 3 during a chat Friday morning.
Q: John Casper, Milwaukee - Tom, any speculation about why this first-round was one of the fastest in recent memory?
A: Tom Silverstein - Good morning, everybody. What a long night. Let's get to your questions right away. John, I think the rounds go in cycles and it depends on how many trades there are. There weren't that many last night. Plus, I think teams are getting better at the 10-minute format (except the Bears and Ravens, apparently). It was just one of those drafts where there wasn't a lot of movement and apparently not a lot of trade discussion.
Q: DW, Minnesota - I remember the year Clifton was drafting. I thought he was a real tweener...probably not a LT...maybe a RT or guard (although a bit tall for that spot)....Sherrod seems similar to me coming out although I did not study him as closely as Clifton coming out. I think if you look back there were many saying Clifton was very questionable as a LT...could this be similar? I'd love to see this work out the same.
A: Tom Silverstein - There were questions about Clifton, although I think some of them were about whether he was quick enough or could run block. The big difference between Clifton and Sherrod is lower body strength. Clifton is a big-hipped man with a very solid base. He's not going to be knocked off balance. If you're going to beat him it's with quickness, not power. Sherrod doesn't have that kind of base and I can see him getting knocked around early on.
Q: Johnny, Utah - Tom, Thanks for the draft chat! Of all the players drafter between 20-31, which player(s) do you think caused the biggest groan(s) in the Packers' draft room as a missed out on prospect?
A: Tom Silverstein - There's no question it was RB Mark Ingram. I know that Thompson liked him. There might have been some in the draft room who liked him better than Thompson did, but I think there was general agreement that he would be a steal late in the draft. New Orleans obviously thought so. I think Thompson thought there was a chance New England would take a defensive player and Ingram would fall to him. But then New Orleans jumped in and it was over.
Q: Jon E, Ankeny, IA - If Da'Quan Bowers slips any further...say another 8 picks or so, do you think Thompson may maneuver the Packers up to get him?
A: Tom Silverstein - No. He had a chance to take him with No. 32 and he passed. I don't think he'd ever move up for a guy with medical issues like Bowers has. If he wasn't willing to move up a couple spots for Ingram, I don't think he's going to move up 3/4 of the board to take Bowers.
Q: gene, chicago - Tom, thanks for taking my question. While I think Sherrod is the right choice, do you think anything will be done in the draft to upgrade the pass rush? last year at this time they signed Zombo, but I was thinking of more dynamic change
A: Tom Silverstein - You're not going to get the kind of guy you would like. They could get a tweener in the middle rounds and see if he can develop into a pass rusher. I don't think this is as much of a priority to Thompson as it is to everyone else. I think he likes the guys he has at ROLB, so it would have to be a guy with really good pass rush ability. I don't know if there are any sure things like that, but I'm sure he'll take a guy somewhere.
Q: JohnKay, Kenosha - What happened w/ pick 26? The NFL.com people said the Ravens were talking trade w/ the Bears and must not have consumated it before the deadline. Can you add anything?
A: Tom Silverstein - Apparently, the Bears didn't call into the NFL office in time to consummate the trade. The Ravens thought they had a deal, called the league office and reported it. But the deal isn't official until both teams call in to the league office. The Bears never did. Bears GM Jerry Angelo accepted the blame for the mistake and apologized to the Ravens. Ozzie Newsome wanted the league to grant him the fourth-round pick the Bears were offering even though the trade didn't go down, but the league declined.
Q: JZ, Aurora, IL - Hi Tom, I just got down reading the scouts take on Sherrod. He can play right...he can't play right....he's a good athlete.....he's not athletic...can really bend,,,,,he is stiff in hips. How can trained, professional scouts look at the same guy and say things 180 degrees from the other?
A: Tom Silverstein - Well, if they all agreed, you'd have a bunch of teams all going after the same guy. A lot of scouting is subjective. What measuring stick do you have for an offensive linemen other than the human eye. You can't judge him by his batting average or ERA. You can't say he was a 1,000-yard rusher. Scouts try to poke holes into every player they evaluate so they know all of the risk. Just because they identify these weaknesses doesn't mean they don't think the guy has talent. A lot of the guys who downgraded Sherrod still thought he had first-round ability.
Q: Digger, Andover - Hi Tom: Left or right?
A: Tom Silverstein - Left.
Q: edward, fort myers, FL - RB or OLB next? p.s. i called the bowers drop, you can look it up... :)
A: Tom Silverstein - There are a lot of good running backs in this draft, so conceivably Thompson could wait until the third to get one. But I think there's a shot he goes with one in the second. I want to see how the tight ends go in the second round. I know the Packers don't really need one, but I still think if Kendricks is around they're going to have to think long and hard about him.
Q: Brett, Fort - Do you feel like either Reed, Houston, or Moch will fall to Green Bay's pick in round two ? Witht he failed drug test how far do you see Houston falling ? Do you know if Ted was in discussions with teams to trade up for Ingram ?
A: Tom Silverstein - Houston is not going to go until the third or fourth. He really blew it with his failed drug test. Reed might be a guy who falls to the Packers. I never thought he was a first-round player and I'm not sure he's a second-round guy. But there probably is someone who is enamored with his effort and thinks they might be getting another Clay Matthews. He is not Clay Matthews. Not even close.
Q: Mike, Wonder Lake, IL - Teams always say they got the guy they wanted all along. Do you think that's the case with Sherrod? Do you think they were giddy in the war room as the round played out so they could get him?
A: Tom Silverstein - No, I don't think they were giddy. I think this was a case of just playing the board the way it was. I think they would have been happy with Carimi, too, although Sherrod has a better chance of playing LT than Carimi. Thompson said they were very happy in the draft room after getting Sherrod. I think they would have been happier if Ingram had slipped to them.
Q: Jerry, Des Moines, Iowa - With Daquan Bowers still on the board are you suprised the Packers selected Derek Sherrod? Is this the Justin Harrell effect, the Pack didn't want to take a chance on an injured player with upside or did they have Sherrod higher on the board to begin with?
A: Tom Silverstein - I think the knee injury really scared them. The Justin Harrell pick probably was in Thompson's mind when he was grading Bowers. And Harrell's injuries weren't nearly as bad. Some teams think Bowers' knee isn't going to hold up for more than five or six years. Of course, they thought Brett Favre's hip was going to deteriorate, too. This was a much safer pick and it fills a need.
Q: Cheesehead Sports Nut, Chicago, IL - Do you think the Bills, Bengals, etc called the Packers about getting back into the first round or were things quiet?
A: Tom Silverstein - It sounds like Thompson got some offers, but none of them knocked his socks off. I think teams wanted to regroup after the first round and assess their boards again before giving up picks. They knew the last half dozen teams or so weren't going to take quarterbacks and both the Bills and Bengals will have shots at quarterbacks when they pick today. So I don't think the market was that hot.
Q: Dallas Houston, Austin, TX - So are you going to be the blog man this season again? That's what we all want, man! Also, what do you think of the Vikings' D1 pick?
A: Tom Silverstein - Geez, thanks a lot. I had no idea. I will be doing a lot of the blogging this year. But we're still looking to hire another guy and he will take part of the role. I hope to be blogging during games. I really enjoyed doing that and hope you did, too. As for the Vikings' pick, it's a reach, but sometimes you just go for the guy you really want and don't mess around. Bedard pointed out that Rick Spielman made a similar decision in Miami when he traded for Jay Feeley, so I'm wondering if this is going to be deja vu. Ponder's an interesting guy, but I really think they could have gotten him much later.
Q: Dame Edna, London, UK - So did Ted Thompson and the rest of the "war room" guys stay up all night to watch the royal wedding? If so, how will it impact the quality of their decision-making in the draft this evening?
A: Tom Silverstein - I heard that they served steak and kidney pie in the draft room and sprinkled rose pedals on the floor. Other than that, I don't think they did much.
Q: Brennan, Charlotte NC - Tom, long time reader, first day as a subscription holder. I really love the Packers first pack, as it appears they have now solidified their line for years to come. What , if any possibilities do you see in round 2 to trade up for a Akeem Ayers, or Brooks Reed to bookend CM3?
A: Tom Silverstein - Congratulations, Brennan. Let me be the first to welcome you and thank you for joining. I hope you'll find it worthy your money. I really think the second round will be used for addressing the defensive line. I think their next priority is an end to replace Cullen Jenkins. They have to come out of this draft with at least one guy who can play end. There are still some quality players out there. I could also see a running back going, but as I said earlier that could happen in the third or fourth. I don't see Thompson trading up in the second.
Q: John Rehor, Wheeling, IL - Thanks for the chat Tom. What do you think the chances are Thompson tries to make a trade to move up in the 2nd and pick up one of the big names still sitting out there on the board, in particular Akeem Ayers? And what would the cost be?
A: Tom Silverstein - It would probably cost him his third to move up. If he wanted to move up from No. 64 to say, No. 52, it would cost him 110 points, which is six points fewer than his third round pick at No. 96. He's done well in the third and I can't see there being a guy worth trading for that far up in the round. If it gets toward the end of the round and he can deal his fourth or his seventh, maybe he would do it.
Q: Jesse, Atlanta - Tom, Thanks for the chat. I am curious about 2 things. If Justin Houston had not tested positive for marijuana at combine, do you think he would have been our pick at 32? Kind of glad we drafted a left tackle high since we need some talent there behind Clifton, but leading up to draft I kept hearing Ted would take the best player on his board. So do you really think Derek Sherrod was rated higher on Ted's board than Da'Quan Bowers? Or did he actually take a need.
A: Tom Silverstein - Jesse, I think Houston would have been long gone if he hadn't tested positive at the combine. The guy is one of those players scouts get enamored with because he tests so well athletically. But there were some red flags with him. Sherrod was the best player on his board or he wouldn't have taken him. Bowers might not even be on his board because of the knee. We don't know that for sure. Bob McGinn reported that the Packers passed him, so I believe he was on the board. But they probably downgraded him significantly because of the knee.
Q: JohnKay, Kenosha - How has what happened in the first round changed your view of what will happen in round two? Do you think it changes at all what TT does w/ pick 64?
A: Tom Silverstein - The biggest surprises were Locker and Ponder going in the first round. I wouldn't have predicted that. As a result, you're going to see some scrambling for quarterbacks early on and I think some quality linebackers and defensive linemen might drop a few spots as a result. But really we're only talking about a couple of surprise picks, so it should eventually even out, even by the time the Packers pick at the end of the second.
Q: Matt, St. Cloud, MN - If Ingram and Sherrod were both available to GB at 32, do you think the pick would have been the same?
A: Tom Silverstein - No, I think Ingram would have been the pick. I think his value on the board was significantly higher than Sherrod's. The guy is going to be a 1,000-yard rusher for five or six years in my opinion. There aren't a lot of holes in his game other than he doesn't have great speed. Teams don't like to draft running backs in the first unless they're Adrian Peterson types and this is a very strong draft at RB. So Ingram slipped quite a bit. But if you're putting a grade on him, you have to say he's way better than No. 32 overall. That's why New Orleans paid such a heavy price for him.
Q: Cheesehead Sports Nut, Chicago, IL - How does taking a guy like Sherrod impact Tauscher and Clifton? I assume that Tauscher will "retire" but Clifton will be back. Assume Clifton is healthy, the preliminary 2011 Packer offensive line left to right will be: Clifton, Bulaga, Wells, Sitton, and Sherrod. What do you think?
A: Tom Silverstein - I agree that Tauscher won't be back. Clifton will be the starter at left tackle, but I wouldn't put Sherrod in the starting lineup yet. I still think T.J. Lang will have something to say about the left guard position and I could see Bulaga staying at right tackle. I think ultimately that's going to be his position. He and Sitton can be a pretty formidable pair on that side. Sherrod, I think, will be the left tackle behind Clifton and will be groomed to be the starter next season.
Q: gene, chicago - thanks for taking my question. Christian Ponder is probably not ready to start on day one. Fraziers bold statement notwithstanding, do you think that they will go after one of the veteran QB's, or maybe even send the plane back to Hattiesburg?
A: Tom Silverstein - Gene, I think they'll probably make a run for Donovan McNabb. It makes sense, especially since the Vikings' offensive line is getting a little long in the tooth. You don't want to traumatize your quarterback of the future by throwing him out there behind a suspect offensive line. I don't see them making a deal for Kevin Kolb unless the Eagles get rid of him in a fire sale. But who knows if Jacksonville gets rid of David Garrard once they see that Gabbert is ready to start. I don't think the Vikings will stand pat.
Q: JohnKay, Kenosha - I liked the Sherrod pick and think he'll be very good. Yet, I was a little surprised w/Sherrod, 4 OLB's, Bowers, 2 QB's, and CB's Williams and Harris still on the board he didn't trade down a handful of spots and pick up an extra pick. Thoughts?
A: Tom Silverstein - I was a little surprised as well. I thought he could have moved down, but from his comments last night, the market was pretty soft. He didn't like the offers he was getting so he just decided to take Sherrod. It's a good pick. He needs a left tackle of the future and now he has a candidate for it. As he said, anytime you can get a big, athletic guy that late in the round, you go for it. And when he plays left tackle, you definitely go for it. It was the right move at the time.
Q: Mike, Rockford, IL - Can you give us an idea what to expect with the Packers' picks today?
A: Tom Silverstein - I wish I could tell you. Thompson's in a position of strength now that he has the LT position addressed. I look for him to draft a defensive end today and maybe a running back. He has to address the defensive line at some point, but I'm not sure how the second round is going to fall. I could see him adding a skill player today, too. Well, that's it folks, I've got to do a video in a little bit and then I'm going to rest up for rounds 2 and 3. Join me tonight on the blog and I'll be back to answer more questions in the chat tomorrow. Have a good day.
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UPDATE: Business Aviation Operations and Cuba – Part 1: U.S. Sanction Considerations
Destinations, Regulatory Compliance
By Kathy Self
This business aviation blog post is part of a series on updated regulatory changes for travel to Cuba.
The recent January 2015 regulatory changes in the U.S. – Cuba relations will no doubt encourage future business and investment opportunities between these two countries. However, for the time being there will continue to be assorted operating challenges and compliance issues to deal with for general aviation (GA) operators.
The following is an overview of what you need to know:
1.	U.S. sanctioned countries
Many countries are currently under sanctions to U.S.-registered aircraft. These policies range from comprehensive sanctions set by the U.S. government to various Federal Aviation Administration (FAA)-imposed airspace restrictions. Currently, Cuba and Iran are under the most comprehensive U.S. sanctions. Other nations with different types of sanctions include Syria, North Korea, Sudan, Iraq, Somalia, Russia and Ukraine (sanctions on individuals and certain industries) and Myanmar (sanctions on banking).
2.	Small first steps in easing restrictions
Restrictions related to U.S. sanctioned countries do not change frequently and, in the case of Cuba, have been in place for more than 50 years. However, certain small changes and requirement relaxations came into effect on January 16, 2015. Further changes may be anticipated over the long term, but such information is unknown at this time.
3.	Current Cuba sanctions
Even though some regulatory changes have occurred, Cuba still remains heavily sanctioned. There are still payment issues to consider, as many U.S. banks aren't yet facilitating payments directly to Cuba even though regulations permit it for services incident to travel. The Office of Foreign Asset Control (OFAC) maintains many requirements for certain U.S. nationals, or resident persons, to obtain specific licenses if these persons don't meet the general license criteria (see section 6). Also, currently U.S. nationals and residents are prohibited from traveling to Cuba for tourism purposes.
4.	January 2015 changes
In the past all U.S. nationals and residents were required to obtain specific OFAC licenses in order to travel to Cuba. This has changed somewhat as of January 16, 2015. It is no longer necessary to obtain a specific license to travel to Cuba if you fit one of the 12 qualifying categories described in Part 515.560(a) of the Cuban Asset Control Regulations (CACR). U.S. persons are now generally licensed to engage in travel listed in 515.560(a) if they satisfy the specific requirements of the CACR. A general license doesn't require approval from OFAC, but you must be able to demonstrate compliance with the requirements of each general license. In addition you'll need to have a complete detailed itinerary on whom you're meeting with and why – religious, humanitarian or qualified business purposes, etc. This information must be readily available in case OFAC requests proof that the passenger is qualified to travel under a general license.
5.	U.S. Travel Service Provider (TSP) limitations
U.S. Travel Service Providers (TSPs) no longer require specific OFAC licenses to assist with providing services incident to travel to Cuba. For example, if a U.S. national or resident is traveling to Cuba, under a general license, U.S. TSP can now arrange all associated services incident to travel. For qualifying flights to Cuba, U.S. service providers are able to arrange, and make payment for all services incident to travel including items such as local transportation, hotel accommodations, ground handling, fuel uplifts, in-flight catering and airport fees. If you're unsure if the service you require is or is not covered it's best to confirm this with TSP.
6.	Cuban Overflight Permits
Overflying Cuba is of particular interest to many business aircraft operators. It's important to understand that at the time of this article being published there have been no changes to the Cuban overflight process. See our previous article Understanding Cuban Overflight Permits for more information on the current process.
7.	Authority to travel to Cuba under a general license
Qualified passengers are no longer required to obtain specific licenses from OFAC, but rather are authorized to travel to Cuba under a general license, if they satisfy all of the requirements of the general license noted in the regulations. These changes are outlined in section 515.560. Below is a list of the 12 types of travel eligible for a general license:
Official business of the U.S. government, foreign governments, and certain intergovernmental organizations
Public performances, clinics, workshops, athletic and other competitions, and exhibitions
Support of the Cuban people
Exportation, importation, or transmission of information or informational materials
Certain export transactions that may be considered for authorization under existing Department of Commerce regulations and guidelines with respect to Cuba or engaged in by U.S.-owned or –controlled foreign firms
8.	Specific license requirements and items permitted for transport to Cuba
If your travel to Cuba does not satisfy the general license requirements outlined in the CACR, the passenger is required to obtain a specific license from OFAC before traveling to Cuba or engaging in travel-related transactions.
It's also important for operators to review 15 CFR part 740.19 for an outline of what may and may not be transported into Cuba and 15 CFR part 746.2, which outlines the Cuba embargo.
9.	Temporary sojourn licenses
Operators of private non-revenue U.S.-registered civil aircraft may be required to obtain a temporary sojourn license from the Commerce Department's Bureau of Industry and Security (BIS) for operations to Cuba under license exception Aircraft and Vessels (AVS). Specifically, some exports of U.S.-owned civil aircraft may qualify for the license exception outlined in 15 CFR Section 740.15.
10.	Additional considerations
Mandatory U.S. departure and return entry points flights all to/from Cuba remain in place. Upon arrival in Cuba the aircraft and crew is only permitted to drop and go and may not remain in country. Current approved list of qualifying airports that U.S.-operators may use when departing to/returning from Cuba is:
Atlanta Hartsfield-Jackson (KATL)
Austin (KAUS)
Baltimore (KBWI)
Chicago O'Hare (KORD)
Dallas-Fort Worth (KDFW)
Fort Lauderdale (KFLL)
George Bush (KIAH)
John F. Kennedy (KJFK)
Los Angeles (KLAX)
Key West (KEYW)
Miami (KMIA)
New Orleans (KMSY)
Oakland (KOAK)
Orlando (KMCO)
Palm Beach (KPBI)
Pittsburgh (KPIT)
San Juan (TJSJ)
Ft. Myers (KRSW)
Tampa (KTPA)
While these early steps in normalization of business, investment and travel between the U.S. and Cuba are enticing for operators, don't expect changes or regulation relaxation to progress quickly. As of January it's become a little easier, and more straight-forward, for travel to Cuba, but it will likely be many years before business aviation operations become significantly eased.
Please note that this article and the materials available herein are for informational purposes only and not for the purpose of providing legal advice. You should contact your attorney to obtain legal advice before operating any travel to Cuba.
If you have any questions about this article or would like information on U.S. sanctions, contact me at kathyself@univ-wea.com.
Stay tuned for Part 2, which covers general aviation considerations to travel to Cuba.
Got a question for Kathy about this article?
Tagsbischarter flightscubanorth americaofacsanctioned countriestemporary sojourn licenseunited states
Kathy Self
Kathlynn Self (Kathy) is the Vice President and Chief Compliance Officer, Corporate Compliance, for Universal Weather and Aviation, Inc. where she provides advice and recommendations concerning regulatory compliance assessments and internal audits. Having been with Universal for fifteen years and in a Compliance role for the last eight years, Kathy has extensive experience with compliance and international business issues and is a speaker on subjects such as the Foreign Corrupt Practices Act (FCPA), global anti-bribery, business ethics, 3rd party due diligence, economic sanctions, export controls, anti-boycott, policy management and the like.
Charter Flight Documents: Key Considerations for Charter Operators (Part 2)
FAA's Data Comm Program: Overview and Effects for Operators
Universal News
Progress! NBAA – FAA Overhaul Bill Stirs Uproar – WSJ
Business Aviation Operations to Iran – U.S. Sanctioned Countries Series
Bizav Best Practice, High-Traffic Events
Business Aviation Ops to Austin, Texas, for the 2013 US Grand Prix
Business Aviation in Venezuela Series: Flight Planning, Weather, & NOTAMs
Why Most Airplane Sales Never Make It to Closing


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81. Role of liver transplantation in severe alcoholic hepatitis (PubMed)
Role of liver transplantation in severe alcoholic hepatitis Severe alcoholic hepatitis has very high short term mortality and corticosteroids have been the mainstay of treatment for decades. Patients with Lille score >0.45 are considered non-responders to steroids and have poor outcome. Recently Orthotopic Liver Transplantation (OLT) is being increasingly used as rescue treatment for these patients, without waiting for 6 months of abstinence. Liver transplant is the only rescue treatment which (...) can potentially provide long term benefit for patients who are steroid non-responders. However, with scarcity of organs being a concern, all patients of severe alcoholic hepatitis cannot be chosen for transplantation in an arbitrary way. There is a need for development of predictive tools and objective protocols to select patients who can justify the use of precious liver grafts. With a stringent criteria for selection of patients receiving the graft, liver transplantation in severe alcoholic
2018 Clinical and molecular hepatology
82. SPARC expression is associated with hepatic injury in rodents and humans with non-alcoholic fatty liver disease (PubMed)
SPARC expression is associated with hepatic injury in rodents and humans with non-alcoholic fatty liver disease Mechanisms that control progression from simple steatosis to steato-hepatitis and fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) are unknown. SPARC, a secreted matricellular protein, is over-expressed in the liver under chronic injury. Contribution of SPARC accumulation to disease severity is largely unknown in NAFLD. We assessed the hypothesis that SPARC (...) expression. High expression of SPARC paralleled hepatocellular damage and increased mRNA expression of pro-fibrogenic factors in the liver. In line with these findings, in the NASH animal model SPARC knockout mice were protected from inflammatory injury, and showed less inflammation and fibrosis. Hepatic SPARC expression is associated with liver injury and fibrogenic processes in NAFLD. SPARC has potential as preventive or therapeutic target in NAFLD patients.
83. Time course of compromised urea synthesis in patients with alcoholic hepatitis. (PubMed)
Time course of compromised urea synthesis in patients with alcoholic hepatitis. Alcoholic hepatitis (AH) markedly decreases the urea synthesis capacity. We aimed to investigate the time course of this compromised essential liver function in patients with AH and its relation to treatment and survival.Thirty patients with AH were included in a prospective cohort study. We measured the substrate-independent urea synthesis capacity, i.e., the functional hepatic nitrogen clearance (FHNC (...) ), in the patients at study entry and again at three months (survivors/available: n = 17). Patients with severe disease (Glasgow Alcoholic Hepatitis Score ≥9, n = 17) were randomized to receive either prednisolone or pentoxifylline and were in addition examined after 14 days (n = 9).FHNC (normal range = 25-45 L/h) was markedly decreased at study entry (median = 5.6 (IQR = 3.0-9.6) L/h) and increased by three-fold in survivors at three months (15.1 (12.0-22.9) L/h; p < .001). In patients with severe AH, FHNC
2018 Scandinavian journal of gastroenterology Controlled trial quality: uncertain
84. Extracorporeal cellular therapy (ELAD) in severe alcoholic hepatitis: A multinational, prospective, controlled, randomized trial. (PubMed)
Extracorporeal cellular therapy (ELAD) in severe alcoholic hepatitis: A multinational, prospective, controlled, randomized trial. 29385313 2018 05 01 2018 12 02 1527-6473 24 5 2018 05 Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Liver Transpl. Extracorporeal cellular therapy (ELAD) in severe alcoholic hepatitis: A multinational, prospective, controlled, randomized trial. 711 10.1002 (...) /lt.25026 Sussman Norman L NL Abdominal Transplant and Liver Disease Clinic, Baylor College of Medicine, Houston, TX. Kelly James H JH Cell Machines, Inc., Houston, TX. eng Letter Comment 2018 04 06 United States Liver Transpl 100909185 1527-6465 IM Liver Transpl. 2018 Mar;24(3):380-393 29171941 Hepatitis, Alcoholic Humans Liver Transplantation Prospective Studies 2017 12 25 2018 01 29 2018 2 1 6 0 2018 5 2 6 0 2018 2 1 6 0 ppublish 29385313 10.1002/lt.25026
2018 Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Controlled trial quality: uncertain
85. Effect of Omega 5 Fatty Acid as an Adyuvant Treatment to Prednisone in Patients With Severe Alcoholic Hepatitis
Effect of Omega 5 Fatty Acid as an Adyuvant Treatment to Prednisone in Patients With Severe Alcoholic Hepatitis Effect of Omega 5 Fatty Acid as an Adyuvant Treatment to Prednisone in Patients With Severe Alcoholic Hepatitis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved (...) studies (100). Please remove one or more studies before adding more. Effect of Omega 5 Fatty Acid as an Adyuvant Treatment to Prednisone in Patients With Severe Alcoholic Hepatitis The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov
86. GCSF in Alcoholic Hepatitis
GCSF in Alcoholic Hepatitis GCSF in Alcoholic Hepatitis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. GCSF in Alcoholic Hepatitis The safety and scientific validity of this study is the responsibility (...) , Postgraduate Institute of Medical Education and Research Study Details Study Description Go to Brief Summary: Alcoholic hepatitis is related to very high mortality rate. About 40% of the patients are died within first 6 months after the detection of the clinical syndrome. Therefore, it is very essential for proper diagnosis and early treatment. In response to acute or chronic liver damage, bone marrow derived stem cells can spontaneously populate liver and differentiate into hepatic cells. Animal and human
87. Evaluation of hepatic integrin αvβ3 expression in non-alcoholic steatohepatitis (NASH) model mouse by 18F-FPP-RGD2 PET (PubMed)
Evaluation of hepatic integrin αvβ3 expression in non-alcoholic steatohepatitis (NASH) model mouse by 18F-FPP-RGD2 PET Activated hepatic stellate cells (HSCs), which express integrin αvβ3, are a major fibrogenic factor in NASH pathophysiology. 18F-labeled cyclic arginine-glycine-aspartic acid penta-peptide (18F-FPP-RGD2) has been used as a PET probe for tumors expressing integrin αvβ3. The aim of this study was to assess the potential of PET with 18F-FPP-RGD2 to detect hepatic integrin αvβ3 (...) expression in non-alcoholic steatohepatitis (NASH) model mice.Thirty-two male C57BL/6 mice aged 6 weeks were fed a choline-deficient, L-amino acid-defined, high-fat diet (CDAHFD) for 3 and 8 weeks. 18F-FPP-RGD2 PET imaging of the liver was performed at 3 and 8 weeks after CDAHFD feeding. After PET scanning, levels of hepatic integrin αvβ, 3α-smooth muscle actin (α-SMA), and collagen type 1 alpha 1(col1a1) were measured. Histopathological analysis of hepatic steatosis, inflammation, and fibrosis, as well
2018 EJNMMI research
88. Evaluation of hepatitis A, B, and C serology in patients with cirrhosis and intensive alcohol consumption (PubMed)
Evaluation of hepatitis A, B, and C serology in patients with cirrhosis and intensive alcohol consumption The objective of this study was to evaluate the serology of hepatitis A, B, and C in patients with cirrhosis and intensive alcohol consumption.We retrospectively reviewed the viral serology results of 817 patients with cirrhosis and intensive alcohol consumption who presented to the Gastroenterology Clinic of Atatürk Training and Research Hospital of Izmir Katip Çelebi University between (...) in three patients. Of the patients with HBV, 10.0% had HBeAg and 7.6% had anti-delta. One-hundred and two (12.5%) patients had HCC, and of these, six (5.9%) were HCV-positive and 53 (52.0%) were HBsAg-positive.Patients with cirrhosis and intensive alcohol consumption have an increased hepatitis B and C prevalence. Patients with chronic viral hepatitis with alcohol habit are at a higher risk for HCC. Therefore, patients with cirrhosis and intensive alcohol consumption should be screened for hepatitis B
2018 Northern clinics of Istanbul
89. Male-specific association between subclinical hypothyroidism and the risk of non-alcoholic fatty liver disease estimated by hepatic steatosis index: Korea National Health and Nutrition Examination Survey 2013 to 2015 (PubMed)
Male-specific association between subclinical hypothyroidism and the risk of non-alcoholic fatty liver disease estimated by hepatic steatosis index: Korea National Health and Nutrition Examination Survey 2013 to 2015 Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disease encompassing a broad spectrum of pathologic changes in the liver. Metabolic derangements are suggested to be main causes of NAFLD. As thyroid hormone is a main regulator of energy metabolism, there may be a link (...) between NAFLD and thyroid function. In previous studies, the association between NAFLD and thyroid function was not conclusive. The aim of this study was to clarify the relationship between NAFLD and thyroid function, focusing on subclinical hypothyroidism, using nationwide survey data representing the Korean population. NAFLD was defined as a hepatic steatosis index of 36 or higher. Based on the analysis of nationwide representative data, subclinical hypothyroidism was related to a high risk of NAFLD
90. A Novel Curcumin-Galactomannoside Complex Delivery System Improves Hepatic Function Markers in Chronic Alcoholics: A Double-Blinded, randomized, Placebo-Controlled Study (PubMed)
A Novel Curcumin-Galactomannoside Complex Delivery System Improves Hepatic Function Markers in Chronic Alcoholics: A Double-Blinded, randomized, Placebo-Controlled Study Considering the recent interest in free (unconjugated) curcuminoids delivery, the present study investigated the efficacy of a novel food-grade free-curcuminoids delivery system (curcumin-galactomannoside complex; CGM) in improving the hepatic function markers (inflammation and oxidative stress) in chronic alcoholics (...) from the significant increase (p <0.001) in endogenous antioxidants (GSH, SOD, and GPx) and decrease in inflammatory markers (IL-6 and CRP) levels (p <0.001) as compared to both the baseline and placebo group. To summarize, the nutritional intervention of CGM-curcumin was found to offer a significant hepatoprotective effect to attenuate the alcohol induced alterations to hepatic function markers. The Indian Medical Council and Drug Controller General of India approved Clinical Trial Registry
2018 BioMed research international Controlled trial quality: uncertain
91. Decreased monocyte shedding of the migration inhibitor soluble CD18 in alcoholic hepatitis (PubMed)
Decreased monocyte shedding of the migration inhibitor soluble CD18 in alcoholic hepatitis During alcoholic hepatitis (AH) monocytes traverse the vascular boundaries and massively invade the liver. In principle, tissue extravasation can be limited through shedding of CD18 integrins from leukocytes, including monocytes. The soluble (s) product sCD18 conceals adhesion receptors on the endothelium, which reduces monocyte extravasation. In AH, monocytes are dysfunctional, but whether this involves (...) % and in vitro by 120% (p < 0.01). Ethanol reduced the in vitro shedding of CD18 in the patients only. TNFα increased sCD18 concentration per monocyte, but less so in the patients (p < 0.04). P-sCD18 per monocyte was inversely related to disease severity. In early alcoholic liver disease, P-sCD18 was decreased in the mouse model.The monocyte CD18 integrins are highly activated in AH and the single monocyte shedding of CD18 was decreased favoring tissue extravasation. Alcohol in itself and altered monocyte
2018 Clinical and translational gastroenterology
92. Complements are involved in alcoholic fatty liver disease, hepatitis and fibrosis (PubMed)
Complements are involved in alcoholic fatty liver disease, hepatitis and fibrosis The complement system is a key component of the body's immune system. When abnormally activated, this system can induce inflammation and damage to normal tissues and participate in the development and progression of a variety of diseases. In the past, many scholars believed that alcoholic liver disease (ALD) is induced by the stress of ethanol on liver cells, including oxidative stress and dysfunction
2018 World journal of hepatology
93. A case of non‐alcoholic steatohepatitis complicated with severe acute pancreatitis induced by decreased lipoprotein lipase and hepatic triglyceride lipase activity levels in a young Japanese woman (PubMed)
A case of non‐alcoholic steatohepatitis complicated with severe acute pancreatitis induced by decreased lipoprotein lipase and hepatic triglyceride lipase activity levels in a young Japanese woman We report a case of non-alcoholic steatohepatitis complicated with acute pancreatitis induced by hypertriglyceridemia in a young Japanese woman. A precise examination of the lipid profile showed decreased lipoprotein lipase (LPL) and hepatic triglyceride lipase activity levels, while the LPL mass
2018 Clinical Case Reports
94. Iron-Overload triggers ADAM-17 mediated inflammation in Severe Alcoholic Hepatitis (PubMed)
Iron-Overload triggers ADAM-17 mediated inflammation in Severe Alcoholic Hepatitis Severe alcoholic hepatitis (SAH) is associated with iron accumulation in hepatocytes/macrophages. This possibly correlates with inflammation and stress but the exact mechanism still remains obscure. To understand the role of iron and the mechanisms of systemic iron-overload, a transcriptomic study of liver and Peripheral Blood -Mononuclear-Cells (PBMCs) was undertaken in SAH patients, with and without hepatic
95. Pomegranate prevents binge alcohol-induced gut leakiness and hepatic inflammation by suppressing oxidative and nitrative stress (PubMed)
Pomegranate prevents binge alcohol-induced gut leakiness and hepatic inflammation by suppressing oxidative and nitrative stress Alcoholic liver disease (ALD) is a major chronic liver disease worldwide and can range from simple steatosis, inflammation to fibrosis/cirrhosis possibly through leaky gut and systemic endotoxemia. We investigated whether pomegranate (POM) protects against binge alcohol-induced gut leakiness, endotoxemia, and inflammatory liver damage. After POM pretreatment for 10 (...) days, rats were exposed to 3 oral doses of binge alcohol (5 g/kg/dose) or dextrose (as control) at 12-h intervals. Binge alcohol exposure induced leaky gut with significantly elevated plasma endotoxin and inflammatory fatty liver by increasing the levels of oxidative and nitrative stress marker proteins such as ethanol-inducible CYP2E1, inducible nitric oxide synthase, and nitrated proteins in the small intestine and liver. POM pretreatment significantly reduced the alcohol-induced gut barrier
2018 Redox biology
96. Molecular mechanisms of hepatic lipid accumulation in non-alcoholic fatty liver disease (PubMed)
Molecular mechanisms of hepatic lipid accumulation in non-alcoholic fatty liver disease Non-alcoholic fatty liver disease (NAFLD) is currently the world's most common liver disease, estimated to affect up to one-fourth of the population. Hallmarked by hepatic steatosis, NAFLD is associated with a multitude of detrimental effects and increased mortality. This narrative review investigates the molecular mechanisms of hepatic steatosis in NAFLD, focusing on the four major pathways contributing (...) to lipid homeostasis in the liver. Hepatic steatosis is a consequence of lipid acquisition exceeding lipid disposal, i.e., the uptake of fatty acids and de novo lipogenesis surpassing fatty acid oxidation and export. In NAFLD, hepatic uptake and de novo lipogenesis are increased, while a compensatory enhancement of fatty acid oxidation is insufficient in normalizing lipid levels and may even promote cellular damage and disease progression by inducing oxidative stress, especially with compromised
2018 Cellular and Molecular Life Sciences
97. Influence of Chronic Alcohol Use on Osteoblastic Differentiation of Bone Marrow Cells, Bone Properties, and Hepatic and Renal Morphology of Rats (PubMed)
Influence of Chronic Alcohol Use on Osteoblastic Differentiation of Bone Marrow Cells, Bone Properties, and Hepatic and Renal Morphology of Rats Chronic alcohol exposure can affect the osteoblastic activity and the proliferation and differentiation of cells due to its toxic effect, which can affect negatively bone repair and bone microarchitecture. The aim of this study was to evaluate the effects of chronic use of 20% alcohol on rats regarding osteoblastic differentiation, extrinsic (...) and intrinsic properties of the tibia, and hepatic and renal morphology. Wistar rats were divided into three groups (n = 9) in accordance with a 24-week diet. After euthanasia, kidneys, liver, and tibias were removed for analysis and femurs mesenchymal cells were collected. The results showed that chronic use of 20% alcohol influenced neither the alkaline phosphatase production nor total protein (p > 0.05) in rats, with similar formation of nodules in all groups (p > 0.05). However, significant changes
2018 The Scientific World Journal
98. Correction to: Proteomic identification and characterization of hepatic glyoxalase 1 dysregulation in non-alcoholic fatty liver disease (PubMed)
Correction to: Proteomic identification and characterization of hepatic glyoxalase 1 dysregulation in non-alcoholic fatty liver disease [This corrects the article DOI: 10.1186/s12953-018-0131-y.].
2018 Proteome science
99. Hepatitis C infection substantially reduces survival of alcohol-dependent patients (PubMed)
Hepatitis C infection substantially reduces survival of alcohol-dependent patients Heavy alcohol use is associated with life-threatening complications including progressive liver disease. We aimed to analyze the impact of hepatitis C virus (HCV) infection on survival and liver-related death in alcohol-dependent patients.This is a longitudinal study in patients seeking treatment of alcohol abuse between 2000 and 2010. Information on alcohol use characteristics, alcoholic liver disease, and HCV (...) infection were obtained at entry. Cumulated mortality and causes of death were ascertained through clinical records and death registry.A total of 819 patients (81.6% men) underwent ethanol detoxification; age was 44 (inter-quartile range [IQR] 38-51) years; the duration of heavy alcohol use was 14 (IQR 6-24) years; and the alcohol consumption was 190 (IQR 120-250) g/day. The prevalence of HCV infection was 15.8%. There were 129 (16.9%) deaths during 5,117 persons-year (p-y) of follow-up (median follow
2018 Clinical epidemiology
100. Pentoxifylline vs. Prednisolone: A Comparison of Efficacy in the Treatment of Severe Alcoholic Hepatitis in Adult Patients
Pentoxifylline vs. Prednisolone: A Comparison of Efficacy in the Treatment of Severe Alcoholic Hepatitis in Adult Patients "Pentoxifylline vs. Prednisolone: A Comparison of Efficacy in the Treat" by Ashley A. Hilliker < > > > > > Title Author Date of Graduation Summer 8-13-2016 Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies First Advisor Professor Sommers Rights . Abstract Background: Alcoholic hepatitis is a chronic, inflammatory liver disease (...) that is on the rise in the United States. Traditionally, the progression of severe alcoholic hepatitis has been slowed with a 28-day course of prednisolone. However, since corticosteroids such as prednisolone have been associated with increased risk of infection and multiple unpleasant side effects, newer research is aimed at using pentoxifylline (PTX) as an alternative treatment. PTX has been shown to have a better safety profile than prednisolone, but its effectiveness in the treatment of severe alcoholic
2016 Pacific University EBM Capstone Project


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Customer experience enhanced by process transformation.
A leading provider of prepaid debit cards and financial services.
Our client is a trusted brand in providing primary transaction accounts to people turned away by banks. It grew significantly year-over-year by mergers and acquisitions of other prepaid debit card companies. Disruptions caused by acquisition and process alignment challenges caused this leader in the prepaid and payments market's Net Promoter Score (NPS) ratings to reduce significantly. As a flexible, deeply engaged, and high-performing service provider, Sutherland immediately set out to lift scores back to positive and improve the customer experience.
The Sutherland Transformation
Sutherland was engaged to transform the customer experience and raise NPS by expertly handling all new business and inbound customer service calls related to refund transfers, or anticipation loans made in advance of an IRS tax refund.
Our familiarity with the client's business helped us pinpoint the disconnects between the old and new systems and procedures after the grew through acquisition. To regain momentum in answering calls within SLA standards, we deployed 100% recording technology along with screen-capture CRM tools to record all calls and customer interactions for review and analysis. This helps pinpoint gaps and make recommendations for transformations in process. We also access the client's technology through a Citrix interface, reducing the risk of security or data breaches of confidential customer information, enabling us to operate in an environment that is PCI-Level 1 compliant. Our approach has ensured that quality standards, service levels, and abandon rates are consistently met throughout the year, as well as service levels and abandon rates.
Our familiarity with the client's business helped us pinpoint the disconnects between the old and new systems and procedures after the grew through acquisition.
Through delivering on our partnership, we have driven the following results for our client:
of all calls are answered within 60 seconds, per client standards
reduced abandon rate
average customer satisfaction rate
Sutherland Expands Partnership with University of West Indies to Build National Workforce
The company with a purpose to create great experiences and to impact lives in Jamaica, announced today that it has expanded its partnership with the University of West Indies at Mona, Jamaica (UWI), to offer a degree program that features a world-class curriculum.
Saudi Aramco Partners with Sutherland and IAU on Social Development Program for Women in Saudi Arabia
Dammam, Saudi Arabia, May 17, 2018 – Thousands of information worker jobs to be designed using all-female workforce operating from inside Kingdom of Saudi Arabia
Top 10 Banking Technology Solutions Providers - 2017
To enhance their customers' experience further and to remain at the front of the field, banks are beginning to look at other industry successes and are using big data and customer analytics to retain their customers.