Medicine and Health Sciences Commons^™

Studies Of Forward Projection Algorithms And Implementation On Pc And Fpga, Minsung Cho

UNLV Theses, Dissertations, Professional Papers, and Capstones

This thesis first aims to understand how a part of the computed tomography (CT) algorithm called “forward projector” (FP) works and how it can be accelerated at a hardware level. Two methods of FP are defined and studied: pixel-driven and ray-driven. Both methods fundamentally use the property of line integral and Bresenham’s algorithm. As the result of the study of the two FP methods, the ray-driven algorithm implemented in C++ performed 35% faster than the pixe-driven algorithm implemented in Python.This thesis implements the ray-driven forward projector algorithm using field-programmable gate array (FPGA), making use of hardware-acceleration techniques. The result shows …

Artificial Intelligence In The Radiomic Analysis Of Glioblastomas: A Review, Taxonomy, And Perspective, Ming Zhu, Sijia Li, Yu Kuang, Virigina B. Hill, Amy B. Heimberger, Lijie Zhai, Shenjie Zhai

Electrical & Computer Engineering Faculty Research

Radiological imaging techniques, including magnetic resonance imaging (MRI) and positron emission tomography (PET), are the standard-of-care non-invasive diagnostic approaches widely applied in neuro-oncology. Unfortunately, accurate interpretation of radiological imaging data is constantly challenged by the indistinguishable radiological image features shared by different pathological changes associated with tumor progression and/or various therapeutic interventions. In recent years, machine learning (ML)-based artificial intelligence (AI) technology has been widely applied in medical image processing and bioinformatics due to its advantages in implicit image feature extraction and integrative data analysis. Despite its recent rapid development, ML technology still faces many hurdles for its broader applications …

Monte Carlo Simulation Of Thallium-Bromide Semiconductor Detector For Range Verification Of A Carbon Ion Radiotherapy Beam Through Prompt Gamma-Ray Detection, Peter Dimpfl

UNLV Theses, Dissertations, Professional Papers, and Capstones

Thallium-Bromide is a semiconductor material which is well suited for photon detection. Composed of high atomic number elements and a high mass density of 7.56 g/cm3, TlBr has superb photon stopping power. External beam radiation therapy is an ever-changing environment with technology rapidly improving. With proton therapy facilities becoming more widely available, and carbon ion facilities showcasing the benefits of carbon ion radiation therapy, there is an industry need toprovide accurate dosimetric treatment plans to verify patients are receiving proper care. Current clinical practices apply safety margins to clinical target volumes to safe treatment. Through research to improve detection techniques, …

Endo-Sponge In Management Of Anastomotic Colorectal Leaks: A Systematic Review And Meta-Analysis, Banreet S. Dhindsa, Yassin Naga, Syed M. Saghir, Sarav Gunjit Singh Daid, Saurabh Chandan, Harmeet Mashiana, Amaninder Dhaliwal, Abhitej Sidhu, Harlan Sayles, Daryl Ramai, Ishfaq Bhat, Shailender Singh, Stephanie Mcdonough, Douglas G. Adler

School of Medicine Faculty Publications

Background and study aims Following colorectal surgery, anastomotic dehiscence and leak formation has an incidence of 2 % to 7 %. Endo-SPONGE has been applied in the management of anastomatic leaks (ALs) after colorectal surgery. This is the first systematic review and meta analysis to evaluate the efficacy and safety of Endo-SPONGE in the management of colorectal ALs. Patients and methods: The primary outcomes assessed were the technical and clinical success of Endo-SPONGE placement in colorectal ALs. The secondary outcomes assessed were the overall adverse events (AEs) and the AE subtypes. Pooled estimates were calculated using random-effects models with 95 …

Robotic Bronchoscopy For Peripheral Pulmonary Lesion Biopsy: Evidence-Based Review Of The Two Platforms, Abhishek Kumar, Jose D. Caceres, Siddharthan Vaithilingham, Gurshan Sandhu, Nikhil K. Meena

School of Medicine Faculty Publications

Despite many advancements in recent years for the sampling of peripheral pulmonary lesions, the diagnostic yield remains low. Initial excitement about the current electromagnetic navigation platforms has subsided as the real-world data shows a significantly lower diagnostic sensitivity of ~70%. “CT-to-body divergence” has been identified as a major limitation of this modality. In-tandem use of the ultrathin bronchoscope and radial endobronchial ultrasound probe has yielded only comparable results, attributable to the limited peripheral reach, device maneuverability, stability, and distractors like atelectasis. As such, experts have identified three key steps in peripheral nodule sampling—navigation (to the lesion), confirmation (of the correct …

Developing Methods To Detect And Diagnose Chronic Traumatic Encephalopathy During Life: Rationale, Design, And Methodology For The Diagnose Cte Research Project, Jeffrey Cummings, Numerous Authors, See Full List Below

School of Medicine Faculty Publications

Background: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been neuropathologically diagnosed in brain donors exposed to repetitive head impacts, including boxers and American football, soccer, ice hockey, and rugby players. CTE cannot yet be diagnosed during life. In December 2015, the National Institute of Neurological Disorders and Stroke awarded a seven-year grant (U01NS093334) to fund the “Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project.” The objectives of this multicenter project are to: develop in vivo fluid and neuroimaging biomarkers for CTE; characterize its clinical presentation; refine …

Turning Up The Sound! Senior-Level Sonographers' Perspectives On The Workforce Readiness/Competency Of Entry-Level Sonographers In The Workplace, Janice L. Glasper

UNLV Theses, Dissertations, Professional Papers, and Capstones

There has been a longstanding preoccupation with the workforce readiness and competency of our nation’s graduates since the release of the National Commission on Excellence in Education’s, April 1983 landmark report, A Nation at Risk: “The Imperative for Educational Reform”, which indicated that the educational foundations of our society were being eroded by a rising tide of mediocrity that threatened our very future as a Nation and a people. Now, more than 35 years since the release of A Nation at Risk, it appears that little has changed. Extensive research continues to report that graduates of post-secondary institutions are unprepared …

Photonic Designs To Reduce Morbidity And Mortality For Icu Patients On Ventilators, Jacob C. Lomonaco, Noah R. Baker, C. David Melville, Catherine A. Olivo, Matthew D. Carson, Eric J. Seibel

School of Medicine Faculty Publications

Ventilator-associated pneumonia (VAP) is pneumonia that occurs >48hrs after initiation of mechanical ventilation and is a significant cause of morbidity and mortality in patients that are hospitalized in intensive care units (ICU). The risk of developing VAP increases during use, and a diagnosis of VAP has been associated with a substantial cost. There are up to hundreds of thousands of cases in the US per year, costing the healthcare system billions annually. Patients who suffer from VAP frequently require longer ICU stays, higher exposure to antibiotics, and more hospital care at the risk of increased mortality. The SARS-CoV-2 pandemic has …

Factors Affecting The Characterization Of Post-Exertional Malaise Derived From Patient Input, Carly S. Holtzman, Claire Fisher, Shaun Bhatia, Leonard A. Jason

Journal of Health Disparities Research and Practice

The National Institutes of Health/Center for Disease Control and Prevention (NIH/CDC) Common Data Elements (CDE) established a post-exertional malaise (PEM) workgroup with the task of describing PEM and recommending a standardized way of assessing it in patients with myalgic encephalomyelitis and chronic fatigue syndrome (ME/CFS). As a stigmatized group, patients with ME/CFS are in need of instruments which can properly describe their symptomatic experiences, which can help reduce the disparity between illness seriousness and appropriate attention from healthcare. The current study explored attitudes and preferences among 115 patients with ME/CFS who participated in the creation of a patient-driven instrument to …

Machine Learning Approaches For Fracture Risk Assessment: A Comparative Analysis Of Genomic And Phenotypic Data In 5130 Older Men, Qing Wu, Fatma Nasoz, Jongyun Jung, Bibek Bhattarai, Mira V. Han

Public Health Faculty Publications

The study aims were to develop fracture prediction models by using machine learning approaches and genomic data, as well as to identify the best modeling approach for fracture prediction. The genomic data of Osteoporotic Fractures in Men, cohort Study (n = 5130), were analyzed. After a comprehensive genotype imputation, genetic risk score (GRS) was calculated from 1103 associated Single Nucleotide Polymorphisms for each participant. Data were normalized and split into a training set (80%) and a validation set (20%) for analysis. Random forest, gradient boosting, neural network, and logistic regression were used to develop prediction models for major osteoporotic fractures …

Safety Of Endoscopic Retrograde Cholangiopancreatography (Ercp) In Pregnancy: A Systematic Review And Meta-Analysis, Mohamed Azab, Shishira Bharadwaj, Mahendran Jayaraj, Annie S. Hong, Pejman Solaimani, Mohamad Mubder, Hyeyoung Yeom, Ji Won Yoo, Michael L. Volk

School of Medicine Faculty Publications

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging procedure rarely associated with severe postprocedure complications. Hormonal changes during pregnancy promote cholelithiasis, but there are limited clinical data available on the outcomes of ERCP in pregnant women. ERCP techniques without irradiation were recently introduced as potential alternative. We performed a systematic review and meta-analysis to assess the safety of ERCP in pregnancy and to compare outcomes of radiation versus nonradiation ERCP. Materials and Methods: A systematic search of PubMed, Medline/Ovid, Web of Science, and Google Scholar through April 18th, 2018 using PRISMA and MOOSE guidelines identified 27 studies reporting the …

Rethinking Intravenous Catheter Size And Location For Computed Tomography Pulmonary Angiography, Travis Marshall, Nae Meng Chen, Eric Nguyen, David E. Slattery, Tony Zitek

School of Medicine Faculty Publications

Introduction: Computed tomography pulmonary angiography (CTPA) is the test of choice for diagnosis of pulmonary embolism (PE) in the emergency department (ED), but this test may be indeterminate for technical reasons such as inadequate contrast filling of the pulmonary arteries. Many hospitals have requirements for intravenous (IV) catheter size or location for CTPAs to reduce the chances of inadequate filling, but there is a lack of clinical data to support these requirements. The objective of this study was to determine if a certain size or location of IV catheter used for contrast for CTPA is associated with an increased chance …

Ultrasound Guided Placement Of Single-Lumen Peripheral Intravenous Catheters In The Internal Jugular Vein, Tony Zitek, Elizabeth Busby, Heather Hudson, John D. Mccourt, Jamie Baydoun, David E. Slattery

School of Medicine Faculty Publications

Introduction: The peripheral internal jugular (IJ), also called the “easy IJ,” is an alternative to peripheral venous access reserved for patients with difficult intravenous (IV) access. The procedure involves placing a single-lumen catheter in the IJ vein under ultrasound (US) guidance. As this technique is relatively new, the details regarding the ease of the procedure, how exactly it should be performed, and the safety of the procedure are uncertain. Our primary objective was to determine the success rate for peripheral IJ placement. Secondarily, we evaluated the time needed to complete the procedure and assessed for complications. Methods: This was a …

A Novel Deep Learning Framework For Internal Gross Target Volume Definition From 4d Computed Tomography Of Lung Cancer Patients, Xiadong Li, Ziheng Deng, Qinghua Deng, Lidan Zhang, Tianye Niu, Yu Kuang

Health Physics & Diagnostic Sciences Faculty Publications

In this paper, we study the reliability of a novel deep learning framework for internal gross target volume (IGTV) delineation from four-dimensional computed tomography (4DCT), which is applied to patients with lung cancer treated by Stereotactic Body Radiation Therapy (SBRT). 77 patients who underwent SBRT followed by 4DCT scans were incorporated in a retrospective study. The IGTV_DL was delineated using a novel deep machine learning algorithm with a linear exhaustive optimal combination framework, for the purpose of comparison, three other IGTVs base on common methods was also delineated, we compared the relative volume difference (RVI), matching index (MI) and encompassment …

Selective Use Of Pericardial Window And Drainage As Sole Treatment For Hemopericardium From Penetrating Chest Trauma, Paul J. Chestovich Md, Christopher F. Mcnicoll, Douglas R. Fraser, Purvi P. Patel, Deborah A. Kuhls, Esmeralda Clark, John J. Fildes

School of Medicine Faculty Publications

Background

Penetrating cardiac injuries (PCIs) are highly lethal, and a sternotomy is considered mandatory for suspected PCI. Recent literature suggests pericardial window (PCW) may be sufficient for superficial cardiac injuries to drain hemopericardium and assess for continued bleeding and instability. This study objective is to review patients with PCI managed with sternotomy and PCW and compare outcomes.

Methods

All patients with penetrating chest trauma from 2000 to 2016 requiring PCW or sternotomy were reviewed. Data were collected for patients who had PCW for hemopericardium managed with only pericardial drain, or underwent sternotomy for cardiac injuries grade 1–3 according to the …

E2f Transcription Factor 1 And Its Role In The Cell Cycle And Tumor Suppressor Proteins, Thea Hisuler, Yu Kuang

AANAPISI Poster Presentations

E2F Transcription Factor 1 (E2F1) E2F1 is a transcription factor, in which its expression is increased in human cancers. “Transcription factor E2F1 binds to and activates transcription,” in return leading to increased transcription at the G1 and S phase of the cell cycle (Slansky). The E2F transcription factor family “plays a crucial role in the control of cell cycle and action of tumor suppressor proteins and is also a target of the transforming proteins of small DNA tumor viruses” (NCBI).

Utilization Of Waist Circumference To Determine Type 2 Diabetes Risk Among Normal And Overweight Individuals, Mary Angela M. Terencio, Brian Schilling, Hayley Esdaile, Grace Mcdonald

AANAPISI Poster Presentations

The purpose of this study is to investigate whether noninvasive measurements such as waist circumference (WC) and waist-to-hip ratio (WHR) are effective for people who have a normal to overweight BMI in determining risk for type 2 diabetes. 29 million US adults have diabetes and 86 million have prediabetes. Numerous studies have indicated waist circumference as a strong predictor of type 2 diabetes in obese individuals. However there are few that research the effects of these anthropometric measurements with individuals who look lean but are potentially metabolically obese.

Regulation Of Cancer Stem Cells: Lysine Methylation Of P53, William Holliday, Yu Kuang

AANAPISI Poster Presentations

The highly studied p53 protein regulates multiple transitions through the cell cycle effectively halting the growth of tumorlike masses.[1] This gene was primitively identified an oncogene; however, it was later derived that p53 functions as a tumor suppressor.[1] Named due to its mass in kDa, p53 is a phosphoprotein comprised of 393 amino acids.[1] Normal cells contain controlled, small quantities of p53 in order to facilitate the regulation of normal cell activities such as growth arrest, senescence,DNArepair, and apoptosis.[1,2] These features are pivotal the continuation of healthy cell production. Constructively, the functions of p53 work together to pause the cell …

Induction Of Dusp9 In Xenografts From Human Breast Cancer Cell Lines Increases Mammary Cancer Stem Cells, Albert Barrios, Meher Parveen, Phd, Easter Thames, Melanie Baker, Shelha Pervin, Phd

Journal of Health Disparities Research and Practice

Breast cancer remains a complex disease that kills 40,000 women every year. Initiation and progression of breast cancer is influenced by heterogeneous groups of cells, including mammary cancer stem cells (MCSCs). Progression of this dreadful disease is driven by many signaling pathways among which MAPK pathway is highly prominent. Since targeting prominent kinases in MAPK pathway has been unsuccessful to control breast cancer, it is important to examine the phosphatases that regulate the activity of these kinases.

Using xenograft model from breast cancer cell lines, our lab has found that during the initial stages of xenograft development (week 1-4, 100-200mg …

Creating A Dynamic, Multi-Purpose Correction For Multiple Geometries And Field Sizes To Account For Off-Axis And Asymmetric Backscatter With Varian Portal Dosimetry, Remy Manigold

UNLV Theses, Dissertations, Professional Papers, and Capstones

Intensity modulated radiation therapy and volumetric modulated arc therapy are increasingly common in radiation therapy due to their benefits of target conformity and normal tissue sparing. Due to the complexities of plan delivery and the precision required, the dose delivered must be accurately measured for quality assurance (QA). One of the most efficient ways to perform patient-specific QA when using clinical linear accelerators (linac) is to use an electronic portal imaging device (EPID). Amorphous silicon (aSi) Electronic Portal Imaging Devices (EPIDs) are attached to the linac and can provide real-time feedback with spatial resolution on the order of sub-millimeter pixel …

A Study On Automated Process For Extracting White Blood Cellular Data From Microscopic Digital Injured Skeletal Muscle Images, Bibek Karki

UNLV Theses, Dissertations, Professional Papers, and Capstones

Skeletal muscle injury is one of the common injuries caused by high-intensity sports activities, military related works, and natural disasters. In order to discover better therapies, it is important to study muscle regeneration process. Muscle regeneration process tracking is the act of monitoring injured tissue section over time, noting white blood cell behavior and cell-fiber relations. A large number of microscopic images are taken for tracking muscle regeneration process over multiple time instances. Currently, manual approach is widely used to analyze a microscopic image of muscle cross section, which is time consuming, tedious and buggy.

Automation of this research methodology …

Factors Associated With Colorectal Cancer Screening Among Younger African American Men: A Systematic Review, Charles R. Rogers, Patricia Goodson, Margaret Foster

Journal of Health Disparities Research and Practice

Of cancers affecting both men and women, colorectal cancer (CRC) is the second leading cancer killer among African Americans in the U.S. Compared to White men, African American men have incidence and mortality rates 25% and 50% higher from CRC. Despite the benefits of early detection and the availability of effective screening, most adults over age 50 have not undergone testing, and disparities in colorectal cancer screening (CRCS) persist. Owing to CRC’s high incidence and younger age at presentation among African American men, CRCS is warranted at age 45 rather than 50. However, the factors influencing young adult (i.e., age < 50) African American men’s intention to screen and/or their CRCS behaviors has not been systematically assessed. To assess whether the factors influencing young adult African American men’s screening intentions and behaviors are changeable through structured health education interventions, we conducted a systematic review, with the two-fold purpose of: (1) synthesizing studies examining African American men's knowledge, beliefs, and behaviors regarding CRCS; and (2) assessing these studies’ methodological quality. Utilizing Garrard’s Matrix Method, a total of 28 manuscripts met our inclusion/exclusion criteria: 20 studies followed a non-experimental research design, 4 comprised a quasi-experimental design, and 4, an experimental design. Studies were published between 2002 and 2012; the majority, between 2007 and 2011. The factors most frequently assessed were behaviors (79%), beliefs (68%), and knowledge (61%) of CRC and CRCS. Six factors associated with CRC and CRCS emerged: previous CRCS, CRC test preference, perceived benefits, perceived barriers, CRC/CRCS knowledge, and physician support/recommendation. Studies were assigned a methodological quality score (MQS – ranging from 0 to 21). The mean MQS of 10.9 indicated these studies were, overall, of medium quality and suffered from specific flaws. Alongside a call for more rigorous research, this review provides important suggestions for practice and culturally relevant interventions.

Refining Best Practices For The Diagnosis Of Autism: A Comparison Between Individual Healthcare Practitioner Diagnosis And Transdisciplinary Assessment., Jessica Rae Stewart, Debra C. Vigil, Erika Ryst, Wei Yang

Nevada Journal of Public Health

The purpose of this study is to compare the diagnostic decision-making of individual healthcare practitioners against that of a transdisciplinary team. Despite national recognition of transdisciplinary assessment as the gold standard diagnostic approach, autism is most frequently diagnosed by individuals working independently in a variety of disciplines. The current study examined how closely these individual practitioners make diagnoses matching that of a transdisciplinary team. Twenty professionals from five different disciplines viewed videotape clips of fifteen children previously assessed by a transdisciplinary team. Results confirmed that individual healthcare practitioners matched the transdisciplinary team diagnosis on average only 65.6% of the time. …

Sex Determination Using Discriminant Function Analysis In Hispanic Children And Adolescents: A Lateral Cephalometric Study, Alyssa E. Sprowl

UNLV Theses, Dissertations, Professional Papers, and Capstones

Lateral cephalometric radiographs have been used for years to help diagnose skeletal and dental patterns in Orthodontics. Within the last decade, these radiographs have caught the interest of the department of Anthropology for the identification of gender within the adult and adolescent population. Numerous publications have been made but failed to identify sexual dimorphism in the pre-adolescent population. 303 lateral cephalograms of pre and post Latino adolescence age ranging from 6.5 to 17.9 years old were obtained from University of Nevada, Las Vegas (UNLV) digital database. 25 variables were identified and plotted with all linear and angular measurements transferred into …

Reliability And Validity Of The Ne1 Wound Assessment Tool (Wat), Stephanie Coon, Faustina Tran, Melinda Vicencio

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Current literature indicates a lack of reliability and validity of existing pressure ulcer (PrU) staging systems. This prompted the development of the N.E. One Can Stage (NEOCS). Recently this tool was modified and renamed, the NE1 Wound Assessment Tool (NE1 WAT). The purpose of this study is to test the reliability and validity of the NE1 WAT.

Subjects:

A sample of convenience of nine physical therapists (PTs) and 11 nurses (RNs) with PrU staging as part of their routine work duties were included in this study.

Methods:

A written exam was administered and consisted of assessment questions …

Timeliness Of Electronic Laboratory Reporting Vs. Traditional Laboratory Reporting In Southern Nevada From 1999-2012, Jennifer Lucas, Christopher Cochran

Interdisciplinary Research Scholarship Day

This project aims to compare timeliness between traditional laboratory reporting, ELR, and reporting after the implementation of TriSano, a modern electronic surveillance system, for common GI illnesses in Southern Nevada, with a prediction that ELR will be faster than traditional reports, and TriSano will be faster than the other two methods.

Racial Inequality In The Valuation Of Health Outcomes Expressed By The 1992 Acs Guidelines For Prostate Cancer Screening, C. A. Beam

Journal of Health Disparities Research and Practice

In 1992, the American Cancer Society (ACS) recommended annual screening for prostate cancer for men 50 and older using PSA. In this article, I introduce a method to use race and age-specific PSA accuracy data to evaluate differences in the valuation of outcomes by race and age that were expressed by the ACS guidelines. Using this new method, it can be concluded that the guidelines implied a 4-fold greater valuation was assigned to screening young white males with prostate cancer than the value that was assigned to young black males with cancer. Future implementation of guidelines for screening and testing …

Kinesio Taping On Short-Term Changes In Shoulder Strength In Healthy Adults: A Randomized Clinical Trial, Dario A. Callegari, Cristobal E. Cordova, Julia R. Dunievitz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Study Type: A Randomized Clinical Trial

Introduction:

Kinesio tape is an elastic tape used in various settings and it is purported to assist in strengthening weakened muscles. The mechanism behind this claim is neuromuscular facilitation. The purpose of this study was to determine if the claims of Kinesio tape would be supported in its role in strength enhancing properties.

Methods:

Twenty-nine healthy, untrained male and female college-aged individuals participated in this study. Two baseline measurements assessing shoulder external rotation (ER) strength were collected using isokinetic dynamometry. Subjects were then randomized into two groups, Kinesio tape with ER strengthening (KT-Ex) and …

T-Scores In African American Women, Catherine Meyer, Brooke L. Griffin, Kathy Komperda, Jill Borchert

Journal of Health Disparities Research and Practice

Many older bone densitometer (DXA) machines are programmed to calculate T-scores for African- American patients using peak African-American bone mass as reference standard.

This presents a problem because most data regarding fracture risk has been derived using Caucasian data (Binkley 2002). If the T-score for an African-American woman is calculated using a race-adjusted reference, the same absolute bone density will yield a lower T-score for an African- American than for a Caucasian woman. For this reason, the International Society for Clinical Densitometry has recommended that T-scores for all women, regardless of ethnicity, be calculated from Caucasian reference standards (ISCD 2007).

Assessing The Therapeutic Effect Of 630 Nm Light-Emitting Diodes Irradiation On The Recovery Of Exercise-Induced Hand Muscle Fatigue With Surface Electromyogram, Dandan Yang, Xiaoying Wu, Wensheng Hou, Xiaolin Zheng, Jun Zheng, Yingtao Jiang

Electrical & Computer Engineering Faculty Research

This paper aims to investigate the effect of light emitting diode therapy (LEDT) on exercise-induced hand muscle fatigue by measuring the surface electromyography (sEMG) of flexor digitorum superficialis. Ten healthy volunteers were randomly placed in the equal sized LEDT group and control group. All subjects performed a sustained fatiguing isometric contraction with the combination of four fingertips except thumb at 30% of maximal voluntary contraction (MVC) until exhaustion. The active LEDT or an identical passive rest therapy was then applied to flexor digitorum superficialis. Each subject was required to perform a re-fatigue task immediately after therapy which was the same …