Zhen Zheng

Background: Motor evoked potential (MEP) amplitude elicited by single-pulse transcranial magnetic stimulation (TMS) is widely used as an indirect index of corticospinal excitability (CSE). Averaged MEP amplitudes are commonly used to improve measurement stability, but averaging may obscure some trial-level information across the recording sequence. As trial-level and hierarchical modelling approaches become increasingly common, it remains important to determine how averaged and trial-level MEP amplitudes should be interpreted as measures of CSE. Objective: This study compared the intra-session and inter-session reliability of averaged and trial-level MEP amplitudes, with exploratory block analyses used to examine whether trial-order structure was obscured by averaging. Methods: Twelve healthy adults completed two sessions with three CSE assessments at T1, T2, and T3 (T1 and T2 20 min apart; T3 at least 48 h later). At each time point, 25 single-pulse MEPs were elicited at 120% resting motor threshold and recorded from the right first dorsal interosseous muscle. Reliability was assessed using intraclass correlation coefficients (ICC), coefficients of variation (CV), minimal detectable change at the 95% confidence level (MDC95), Bland–Altman analysis, linear mixed-effects models, exploratory sequential block analyses, and Bayesian variance decomposition. Results: Average MEP amplitudes remained stable across T1, T2, and T3. Average-level reliability was good across all timepoints (ICC = 0.899) and excellent within session (T1 vs. T2: ICC = 0.992, CV = 4.935%, MDC95 = 0.191 mV). Inter-session average-level reliability remained good (ICC = 0.844–0.852). In contrast, trial-level analyses revealed substantial within-participant variability, with low ICCs, high CVs, and large MDC95 values. Bland–Altman analyses showed minimal mean bias but substantially wider limits of agreement for trial-level data. Exploratory sequential block analyses showed that, in the late block, T1 differs significantly from T3. Bayesian modelling indicated that residual trial-level variability exceeded between-subject variability, with a posterior ICC of 0.336. Conclusions: Averaging 25 MEPs provides a reliable estimate of corticospinal excitability, but it masks variability. Trial-level and exploratory block analyses suggest that this variability may contain meaningful temporal structure, supporting trial-level modelling as a complementary approach for validating and interpreting averaged MEP estimates.

As the acute response to the COVID-19 pandemic shifts to long-term management, the lasting effects of infection are becoming increasingly evident. Long COV

Background: Cancer survivorship is increasing, and many people living with and beyond cancer seek supportive care such as Traditional Chinese Medicine (TCM), where tongue inspection is routinely used. This exploratory study examined whether visually assessed tongue features differ between cancer survivors and those without a self-reported history of cancer. Methods: Matched case–control ( N = 120): 60 adults diagnosed with cancer vs. 60 without a self-reported cancer history. Three standardized tongue photographs were taken for each participant. Three blinded TCM practitioners scored 20 predefined features. Logistic models with Benjamini–Hochberg false discovery rate (FDR) control estimated associations; Fleiss’ κ quantified inter-rater reliability. Nested logistic models explored discrimination; 10-fold cross-validation assessed area under the curve (AUC) and calibration. Results: Six features were found to be associated with cancer presence with an FDR of q < 0.05: peeled coating (odds ratio (OR) = 3.66, 95% confidence intervals (CI) 1.40–9.60), spider sublingual veins (OR = 2.74, 95% CI 1.53–4.92), thick coating (OR = 2.56, 95% CI 1.50–4.36), purple body (OR = 2.29, 95% CI 1.44–3.63), tooth marks (OR = 1.87, 95% CI 1.19–2.95), and thin coating (OR = 0.38, 95% CI 0.22–0.65; inverse). Reliability was slight to moderate (κ ≈ 0.01–0.48). Discrimination was modest (AUC 0.676–0.736). Conclusion: Selected tongue features, particularly spider sublingual veins and tooth marks, were associated with current cancer in exploratory analyses. However, discrimination was modest, and inter-rater reliability varied across features. These findings should be interpreted cautiously and do not support diagnostic utility. Standardized definitions, rater training, and external validation in larger prospective, multi-center cohorts are required before clinical translation.

Physical inactivity among older adults is a major public health concern linked to various chronic conditions. Digitally delivered physical activity (PA) programs offer a promising solution to overcome traditional barriers. This scoping review aimed to explore the feasibility, acceptability, and engagement factors of these programs for older adults. A comprehensive search was conducted on PubMed, Embase (OVID), and Scopus on 22 May 2024, adhering to PRISMA guidelines. Inclusion criteria targeted older adults (≥60 years) engaged in healthy digital PA interventions. Data analysis was guided by the FAME Framework, TSQ, and the COM-B model. A total of 16 studies met the inclusion criteria, involving 901 older adults. Most studies reported moderate to high adherence rates with programs being well-received. However, several implementation challenges were found, such as inadequate digital literacy, concerns regarding program quality, participant safety, and lack of perceived relevance. Despite these implementation challenges, they may be overcome using the TAM and UTAUT frameworks for technology acceptance and usage to address digital literacy, ensuring high-quality interactions and participant safety, and incorporating social support. Future interventions should leverage similar theoretical frameworks to enhance design and implementation.

Background: Complementary and Alternative Medicine (CAM) interventions may prove to be an attractive option for the treatment of depression. The aim of this scientometric analysis is to determine the global scientific output of research regarding managing depression with CAM and identify the hotspots and frontiers within this theme.Methods: Publications regarding the utilization of CAM for treating depression were collected from the Web of Science Core Collection from 1993 to 2022, and analyzed and visualized by Bibliometrix R-package, VOSviewer, and CiteSpace.Results: A total of 1,710 publications were acquired. The number of annual publications showed an overall rapid upward trend, with the figure peaking at 179 in 2021. The USA was the leading research center. Totally 2,323 distinct institutions involving 7,638 scholars contributed to the research theme. However, most of the cooperation was limited to within the same country, institution or research team. The Journal of Alternative and Complementary Medicine was the most productive periodical. The CAM therapies of most interest to researchers were acupuncture and body–mind techniques, such as yoga, meditation and mindfulness. Systematic review and meta-analysis are commonly used methods. “Inflammation,” “rating scale” and “psychological stress” were identified as the most studied trend topics recently.Conclusion: Managing depression with evidence-based CAM treatment is gaining attention globally. Body–mind techniques and acupuncture are growing research hotspots or emerging trending topics. Future studies are predicted to potentially investigate the possible mechanisms of action underlying CAM treatments in reducing depression in terms of modulation of psychological stress and inflammation levels. Cross-countries/institutes/team research collaborations should be encouraged and further enhanced.

Objective: To identify gaps among Australian Long COVID support services and guidelines alongside recommendations for future health programs.Methods: Electronic databases and seven government health websites were searched for Long COVID-specific programs or clinics available in Australia as well as international and Australian management guidelines.Results: Five Long COVID specific guidelines and sixteen Australian services were reviewed. The majority of Australian services provided multidisciplinary rehabilitation programs with service models generally consistent with international and national guidelines. Most services included physiotherapists and psychologists. While early investigation at week 4 after contraction of COVID-19 is recommended by the Australian, UK and US guidelines, this was not consistently implemented.Conclusion: Besides Long COVID clinics, future solutions should focus on early identification that can be delivered by General Practitioners and all credentialed allied health professions. Study findings highlight an urgent need for innovative care models that address individual patient needs at an affordable cost. We propose a model that focuses on patient-led self-care with further enhancement via multi-disciplinary care tools.