Norm-Based Cutoffs as Predictors of Prolonged Recovery After Adolescent Sport-Related Concussion.

OBJECTIVES: To identify predictors of prolonged recovery (ie, >28 days) using patient demographic factors and healthy, norm-based cutoffs on a multimodal test battery in adolescents after sport-related concussions (SRCs). DESIGN: Retrospective cohort. Patients were deemed recovered after successful completion of return-to-play/school protocols and received medical clearance. SETTING: Community concussion clinic. PATIENTS: Male and female adolescent student athletes diagnosed with a SRC and evaluated within 1 week of injury. INDEPENDENT VARIABLES: Patient demographics, medical history, injury description, computerized neurocognitive testing, vestibular/ocular testing, and symptoms at initial clinical visit. MAIN OUTCOME MEASURES: Performance on clinical testing to predict recovery duration, classified as normal (<28 days) or prolonged (>28 days). RESULTS: A total of 201 adolescent student athletes (age = 15.3 ± 1.4 years) were included (female 35%). Average recovery duration for the entire cohort was 22.3 ± 13.3 days, with 22% (n = 45) of adolescent student athletes taking >28 days to recover. The final model was 88.3% accurate in classifying normal and prolonged recovery. Predictor variables included sex, loss of consciousness, history of ocular disorder, history of concussion, performance on visual motor speed composite, visual motion sensitivity symptom provocation and near point of convergence distance, number-naming total time, and symptom count. CONCLUSIONS: These findings suggest that using norm-based cutoffs from cognitive, oculomotor, and vestibulo-ocular testing and symptom reporting, clinicians can accurately predict a prolonged recovery (sensitivity = 81%) and normal recovery (specificity = 83%) in an adolescent, SRC cohort.

Arterial Stiffness and Cardiorespiratory Fitness Are Associated With Cognitive Function in Older Adults.

Age-related cognitive impairment has been associated with arterial stiffening and decreased cardiorespiratory fitness. The aims of this cross-sectional study were to compare cognitive function domains and cardiovascular parameters in older adults (≥ 65 years old) with high and normal aortic stiffness (via carotid-femoral pulse wave velocity, cfPWV) and to explore relationships among cfPWV, carotid intima-media thickness, cardiorespiratory fitness, and cognitive function. Vascular and cognitive function were measured in older adults with either normal or high cfPWV. Cognitive function was measured via an intensive one-time neuropsychological battery, while cfPWV by applanation tonometry, carotid intima-media thickness and function (i.e., distensibility) by ultrasonography, and cardiorespiratory fitness (i.e., VO2peak) by a submaximal exercise test. Correlations among age, VO2peak, carotid intima-media thickness, cfPWV, and cognitive function were performed along with a series of multivariate analyses of variance. Compared with NAS, participants with HAS had greater aortic, carotid, and brachial blood pressures but similar cardiorespiratory fitness and carotid intima-media thickness and distensibility. Participants with NAS exhibited better neuropsychological performance in executive function and attention and overall cognitive function than those with HAS. When controlling for age, visual scanning and perception scores were correlated with cfPWV and VO2peak. Our findings suggest that certain cognitive domains for older adults are associated with their cardiorespiratory fitness and aortic stiffness.

Predicting Autonomous Shuttle Acceptance in Older Drivers Based on Technology Readiness/Use/Barriers, Life Space, Driving Habits, and Cognition.

Shared autonomous vehicle services (i. e., automated shuttles, AS) are being deployed globally and may improve older adults (>65 years old) mobility, independence, and participation in the community. However, AS must be user friendly and provide safety benefits if older drivers are to accept and adopt this technology. Current potential barriers to their acceptance of AS include a lack of trust in the systems and hesitation to adopt emerging technology. Technology readiness, perceived ease of use, perceived barriers, and intention to use the technology, are particularly important constructs to consider in older adults' acceptance and adoption practices of AS. Likewise, person factors, i.e., age, life space mobility, driving habits, and cognition predict driving safety among older drivers. However, we are not sure if and how these factors may also predict older adults' intention to use the AS. In the current study, we examined responses from 104 older drivers (M age = 74.3, SD age = 5.9) who completed the Automated Vehicle User Perception Survey (AVUPS) before and after riding in an on-road automated shuttle (EasyMile EZ10). The study participants also provided information through the Technology Readiness Index, Technology Acceptance Measure, Life Space Questionnaire, Driving Habits Questionnaire, Trail-making Test Part A and Part B (TMT A and TMT B). Older drivers' age, cognitive scores (i.e., TMT B), driving habits (i.e., crashes and/or citations, exposure, and difficulty of driving) and life space (i.e., how far older adults venture from their primary dwelling) were entered into four models to predict their acceptance of AVs-operationalized according to the subscales (i.e., intention to use, perceived barriers, and well-being) and the total acceptance score of the AVUPS. Next, a partial least squares structural equation model (PLS-SEM) elucidated the relationships between, technology readiness, perceived ease of use, barriers to AV acceptance, life space, crashes and/or citations, driving exposure, driving difficulty, cognition, and intention to use AS. The regression models indicated that neither age nor cognition (TMT B) significantly predicted older drivers' perceptions of AVs; but their self-reported driving difficulty (p = 0.019) predicted their intention to use AVs: R 2 = 6.18%, F (2,101) = 4.554, p = 0.040. Therefore, intention to use was the dependent variable in the subsequent PLS-SEM. Findings from the PLS-SEM (R 2 = 0.467) indicated the only statistically significant predictors of intention to use were technology readiness (ß = 0.247, CI = 0.087-0.411) and barriers to AV acceptance (ß = -0.504, CI = 0.285-0.692). These novel findings provide evidence suggesting that technology readiness and barriers must be better understood if older drivers are to accept and adopt AS.

Monogenic Diabetes and Integrated Stress Response Genes Display Altered Gene Expression in Type 1 Diabetes.

Type 1 diabetes (T1D) has a multifactorial autoimmune etiology, involving environmental prompts and polygenic predisposition. We hypothesized that pancreata from individuals with and at risk for T1D would exhibit dysregulated expression of genes associated with monogenic forms of diabetes caused by nonredundant single-gene mutations. Using a "monogenetic transcriptomic strategy," we measured the expression of these genes in human T1D, autoantibody-positive (autoantibody+), and control pancreas tissues with real-time quantitative PCR in accordance with the Minimum Information for Publication of Quantitative Real-Time PCR Experiments (MIQE) guidelines. Gene and protein expression was visualized in situ with use of immunofluorescence, RNAscope, and confocal microscopy. Two dozen monogenic diabetes genes showed altered expression in human pancreata from individuals with T1D versus unaffected control subjects. Six of these genes also saw dysregulation in pancreata from autoantibody+ individuals at increased risk for T1D. As a subset of these genes are related to cellular stress responses, we measured integrated stress response (ISR) genes and identified 20 with altered expression in T1D pancreata, including three of the four eIF2α-dependent kinases. Equally intriguing, we observed significant repression of the three arms of the ISR in autoantibody+ pancreata. Collectively, these efforts suggest monogenic diabetes and ISR genes are dysregulated early in the T1D disease process and likely contribute to the disorder's pathogenesis.

The effects of a caffeine-like supplement, TeaCrine®, on muscular strength, endurance and power performance in resistance-trained men.

BACKGROUND: TeaCrine® is the synthetic version to naturally occurring theacrine (1, 3, 7, 9-tetramethyluric acid) found in the leaves of Camellia kucha tea plants. A few studies have examined the effects of TeaCrine® on cognitive perception, but no research exists examining its effects on resistance exercise performance. The purpose of this study was to determine the efficacy of TeaCrine®, a caffeine-like compound, on maximal muscular strength, endurance, and power performance in resistance-trained men. METHODS: Twelve resistance-trained men participated in a randomized, double-blind, cross-over designed study. Each participant performed one-repetition maximum (1RM) bench press, 1RM squat, bench press repetitions to failure (RTF) at 70% 1RM, squat RTF at 70% 1RM, and 2-km rowing time trial 90 min after consumption of: (1) Caffeine 300 mg (CAFF300); (2) TeaCrine® 300 mg (TEA300); (3) TeaCrine® + Caffeine (COMBO; 150 mg/150 mg); (4) Placebo 300 mg (PLA). Power and velocity were measured using a TENDO Power Analyzer. Visual analogue scales for energy, focus, motivation to exercise, and fatigue were administered at baseline and 90 min post-treatment ingestion (pre-workout). Rating of perceived exertion was assessed after bench press RTF and squat RTF. RESULTS: There were no differences between groups for 1RM, RTF, and power in the bench press and squat exercises. Only CAFF300 resulted in significant increases in perceived energy and motivation to exercise vs. TEA300 and PLA (Energy: + 9.8%, 95% confidence interval [3.3-16.4%], p < 0.01; + 15.3%, 95% CI [2.2-28.5%], p < 0.02; Motivation to exercise: + 8.9%, 95% CI [0.2-17.6%], p = 0.04, + 14.8%, 95% CI [4.7-24.8%], p < 0.01, respectively) and increased focus (+ 9.6%, 95% CI [2.1-17.1%], p = 0.01) vs. TEA300, but there were no significant differences between CAFF300 and COMBO (Energy + 3.9% [- 6.9-14.7%], Focus + 2.5% [- 6.3-11.3%], Motivation to exercise + 0.5% [- 11.6-12.6%]; p > 0.05). CONCLUSION: Neither TEA300, CAFF300, COMBO, or PLA (when consumed 90 min pre-exercise) improved muscular strength, power, or endurance performance in resistance-trained men. Only CAFF300 improved measures of focus, energy, and motivation to exercise.