Concussion Management in Older People: A Scoping Review.

OBJECTIVE: To map existing literature about concussion management in older people, identifying and analyzing gaps in our understanding. CONTEXT: Concussion injuries affect older people, yet little guidance is available about how to approach concussion management with older people. Research does not always include older populations, and it is unclear to what extent standard concussion management is appropriate for older people. DESIGN: Scoping review. METHOD: A structured literature search was conducted using 4 databases to identify existing literature relating to concussion management in older people. Studies that assessed outcomes relating to the management of concussion/mild traumatic brain injury in those 65 years or older were included and mapped according to the main themes addressed. RESULTS: The search yielded a total of 18 articles. Three themes related to early management (use of anticoagulants n = 6, intracranial lesions n = 3, and service delivery for older people n = 5), and 1 theme related to general management (cognitive issues n = 4). A lack of articles exploring general management in older people was observed. CONCLUSION: Existing literature indicates that specific management strategies are needed for older people with concussion, especially in early management. This review highlights that good evidence is available about early management and this is reflected in some guidelines, yet little evidence about general management is available and this gap is not acknowledged in guidelines. Distinct approaches to early management in older people are clearly recommended to mitigate the risk of poor outcomes. In contrast, general concussion management for older people is poorly understood, with older people poorly represented in research. A better understanding is needed because-as observed in early management-older people have distinct characteristics that may render standard management approaches unsuitable.

Do beluga whales truly migrate? Testing a key trait of the classical migration syndrome.

BACKGROUND: Migration enables organisms to access resources in separate regions that have predictable but asynchronous spatiotemporal variability in habitat quality. The classical migration syndrome is defined by key traits including directionally persistent long-distance movements during which maintenance activities are suppressed. But recently, seasonal round-trip movements have frequently been considered to constitute migration irrespective of the traits required to meet this movement type, conflating common outcomes with common traits required for a mechanistic understanding of long-distance movements. We aimed to test whether a cetacean ceases foraging during so-called migratory movements, conforming to a trait that defines classical migration. METHODS: We used location and dive data collected by satellite tags deployed on beluga whales (Delphinapterus leucas) from the Eastern Beaufort Sea population, which undertake long-distance directed movements between summer and winter areas. To identify phases of directionally persistent travel, behavioural states (area-restricted search, ARS; or Transit) were decoded using a hidden-Markov model, based on step length and turning angle. Established dive profiles were then used as a proxy for foraging, to test the hypothesis that belugas cease foraging during these long-distance transiting movements, i.e., they suppress maintenance activities. RESULTS: Belugas principally made directed horizontal movements when moving between summer and winter residency areas, remaining in a Transit state for an average of 75.4% (range = 58.5-87.2%) of the time. All individuals, however, exhibited persistent foraging during Transit movements (75.8% of hours decoded as the Transit state had ≥ 1 foraging dive). These data indicate that belugas actively search for and/or respond to resources during these long-distance movements that are typically called a migration. CONCLUSIONS: The long-distance movements of belugas do not conform to the traits defining the classical migration syndrome, but instead have characteristics of both migratory and nomadic behaviour, which may prove adaptive in the face of unpredictable environmental change. Such patterns are likely present in other cetaceans that have been labeled as migratory. Examination of not only horizontal movement state, but also the vertical behaviour of aquatic animals during directed movements is essential for identifying whether a species exhibits traits of the classical migration syndrome or another long-distance movement strategy, enabling improved ecological inference.

A cell-free bioassay for the detection of androgens.

Androgens remain abused performance-enhancing drugs in sports. Technologies based on mass spectrometry can detect all forms of androgens but fail if the androgen represents a novel structure. A bioassay detects androgens based on function rather than structure. To date, there has been limited adoption of cell-based in vitro bioassays as a screening tool for nontargeted androgen detection because they require expert personnel and specialized equipment to perform. We now describe the development of a cell-free version of an androgen in vitro bioassay. Stage 1 involved in vitro transcription/translation reactions (IVTT) using a DNA template encoding an enhancer/androgen response element (ARE) regulatory region upstream of a minimal promoter that drives expression of a reporter protein. The assay detected testosterone across the concentration range of 106.7 to 0.0144 ng/ml (3.7 × 10-7 to 5 × 10-11 M), with an EC50 of 6.63 ng/ml (23 nM). To reduce complexity, Stages 2-4 of development included just in vitro transcription (IVT) reactions, whereby the output was an RNA molecule. Stage 2 involved directly labelling the RNA molecule with fluorophore-labelled nucleotide triphosphates, Stage 3 involved reverse transcription-polymerase chain reaction (PCR) of the RNA molecule, and Stage 4 utilized an RNA aptamer, Mango II, as its RNA output. The Stage 4 product detected testosterone across the range of 106.7-0.0001 ng/ml (3.7 × 10-7 to 5 × 10-13 M), with an EC50 of 0.04 ng/ml (0.155 nM). Further to this, we show that the Stage 4 product can detect other androgenic molecules. Relative to cell-based bioassays, the Stage 4 product is easy to perform and could be developed into a routine, high-throughput, nontargeted androgen screen.

The association of adolescents' television viewing with Body Mass Index percentile, food addiction, and addictive phone use.

Television (TV) viewing remain a popular forms of screen time for adolescents. Greater TV viewing is associated with a number of negative consequences for adolescent health. In a changing media landscape, it is important to understand adolescents' overall and commercial TV exposure, and how TV viewing is linked to health risks (e.g., obesity, food addiction, and phone addiction). The purpose of this study was to: 1) examine differences by age, gender, race/ethnicity, and parental education in overall TV and commercial TV viewing and 2) investigate whether adolescents who watch more overall TV and commercial TV programming were more likely to have a higher BMI percentile, more addictive eating, and more addictive phone use. A sample of 190 adolescents (13-16 years of age) completed Time-Use Diaries (TUDs) in 2015-2017. We found that girls had more overall weekday TV time than males. No other gender differences were detected for weekend TV time or commercial TV time. Higher BMI percentile was not correlated with greater overall or commercial TV viewing. However, we did identify a positive association between overall TV viewing and commercial TV viewing with addictive-eating and addictive phone use. This effect was mainly driven by boys. To our knowledge, this is the first study to investigate patterns of television viewing and addictive-like eating and addictive phone use. We conclude that adolescents, particularly boys, with higher TV viewing may be more likely to present with problems with addictive eating behavior and phone use. Our findings add to the research on the behavioral health correlates of TV viewing among adolescents.

Adolescents' Addictive Phone Use: Associations with Eating Behaviors and Adiposity.

Concerns have been raised about excessive or "addictive" phone use among adolescents, and the impact that addictive phone use (APU) can have on adolescent development and health. Most research on the physical health correlates of smartphone use has been limited to sleep health, whereas other outcomes, such as eating behaviors and obesity risk have not received as much attention. To address this gap in the literature, we examined the association between APU and emotion regulation difficulties, impulsivity, maladaptive eating behaviors, and adiposity in a sample of 111 adolescents. We found that APU is associated with greater emotion regulation difficulties, dysregulated eating, restrained eating, food addiction, and higher percent body fat. Further, we found that emotion regulation difficulties mediated the association between APU and dysregulated eating, restrained eating, and food addiction. Findings suggest that addictive phone use may confer increased risk for obesogenic eating behaviors and food addiction via challenges in regulating emotions.

In vivo metabolism of the designer anabolic steroid hemapolin in the thoroughbred horse.

Hemapolin (2α,3α-epithio-17α-methyl-5α-androstan-17ß-ol) is a designer steroid that is an ingredient in several "dietary" and "nutritional" supplements available online. As an unusual chemical modification to the steroid A-ring could allow this compound to pass through antidoping screens undetected, the metabolism of hemapolin was investigated by an in vivo equine drug administration study coupled with GC-MS analysis. Following administration of synthetically prepared hemapolin to a thoroughbred horse, madol (17α-methyl-5α-androst-2-en-17ß-ol), reduced and dihydroxylated madol (17α-methyl-5α-androstane-2ß,3α,17ß-triol), and the isomeric enone metabolites 17ß-hydroxy-17α-methyl-5α-androst-3-en-2-one and 17ß-hydroxy-17α-methyl-5α-androst-2-en-4-one, were detected and confirmed in equine urine extracts by comparison with a library of synthetically derived reference materials. A number of additional madol derivatives derived from hydroxylation, dihydroxylation, and trihydroxylation were also detected but not fully identified by this approach. A yeast cell-based androgen receptor bioassay of available reference materials showed that hemapolin and many of the metabolites identified by this study were potent activators of the equine androgen receptor. This study reveals the metabolites resulting from the equine administration of the androgen hemapolin that can be incorporated into routine GC-MS antidoping screening and confirmation protocols to detect the illicit use of this agent in equine sports.

Zinc-dependent effects of small molecules on the insulin-sensitive transcription factor FOXO1a and gluconeogenic genes.

Metal-binding compounds have recently been reported to have anti-hyperglycaemic properties in vivo. In the current study, we have investigated the ability of these compounds and related structures to induce insulin-like signal transduction to downstream effectors such as the transcription factor FOXO1a and the key gluconeogenic regulatory enzymes phosphoenolpyruvate carboxykinase (PEPCK) and glucose 6-phosphatase (G6Pase). Our results indicate that ß-thujaplicin, diethyldithiocarbamate (DEDTC) and its clinically-used dimer disulfiram, induce insulin-like dose-dependent effects on signalling to FOXO1a in a manner that is strictly dependent on the presence of zinc ions, as other ions including aluminium, cobalt, copper, lithium and manganese cannot substitute. The most potent compound tested on gluconeogenesis is disulfiram, which in the presence of 10 µM zinc, inhibited both PEPCK and G6Pase with an IC50 of 4 µM. Our results demonstrate that metal-binding compounds with diverse structures can induce zinc-dependent insulin-like effects on signal transduction and gene expression.

Healthy by Design: an innovative planning tool for the development of safe, accessible and attractive environments.

The Healthy by Design guidelines were developed by the National Heart Foundation of Australia in 2004 to assist planners to deliver plans for residential developments that support active living. This article provides an overview of the contents of this resource. It also provides examples of its application and influence in the planning sector.