Gamified Closed-Loop Intervention Enhances Tic Suppression in Children: A Randomized Trial.

BACKGROUND: Gamification of behavioral intervention for tic disorders (TDs) potentially enhances compliance and offers key clinical advantages. By delivering immediate positive feedback upon tic-suppression, games may counteract negative reinforcement, which presumably contribute to tic consolidation by relieving uncomfortable premonitory urges. OBJECTIVES: We developed a gamified protocol (XTics), which leverages this potential by combining gamified tic-triggering with immediate feedback, and evaluated its clinical value in enhancing tic suppression. METHODS: XTics encompasses two conditions: Immediate and Contingent Reward (ICR), where game progression is contingent upon successful tic suppression, and Delayed Reward (DR), where game events' outcomes are random. Employing a randomized crossover design, 35 participants (aged 7-15 years) underwent daily gaming sessions over a week per condition. Improvements in our primary measures, including the inter-tic interval (ITI) and tic severity assessment by blinded evaluators (Yale Global Tic Severity-Total Tic Score [YGTSS-TTS], Rush), and parents (Parent Tic Questionnaire [PTQ]), were compared between ICR and DR, and assessed across conditions for the 4-week protocol. RESULTS: No participant voluntarily left the study before completing its two-phase protocol. As expected, ITI showed significantly larger improvement (Z = 4.19, P = 2.85 × 10-5) after ICR (1442 ± 2250%) versus DR (242 ± 493%) training, increasing at a higher pace (t(67) = 3.15, P = 0.0025). Similarly, Rush tic severity scores reduced more post-ICR versus DR (t(47) = 3.47, P = 0.002). We observed a clinically significant reduction of 25.69 ± 23.39% in YGTSS-TTS following a f4-week protocol including both conditions. Parent-reported tic severity decreased by 42.99 ± 31.69% from baseline to 3 months post-treatment. CONCLUSIONS: The combination of gamified tic-triggering with immediate and contingent rewards demonstrates a promising approach for enhancing treatment efficacy in TDs, boosting traditional therapeutic methods. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Impact of movie and video game elements on tic manifestation in children.

BACKGROUND AND PURPOSE: Children in developed countries spend a significant portion of their waking hours engaging with audiovisual content and video games. The impact of media consumption on children's health and well-being has been widely studied, including its effects on tic disorders. Previous studies have shown that tic frequency can both increase and decrease during activities like gaming and television watching, resulting in mixed findings. METHODS: To better understand the impact of audiovisual media on tics, we conducted a fine-grained tic manifestation analysis. We focused on the effects of the impact of a movie scene with suspensful elements and a video game designed to heighten anticipation, thought to stimulate phasic and striatal dopamine release. We closely monitored tic frequency throuhghout these experiences based on moment-to-moment tic annotation. The study included 20 participants (19 males aged 7-16) diagnosed with tic disorders (Yale Global Tic Severity Scale≥8), and we tested the replicability of our findings with an independent group of 36 children (15 females, aged 7-15) with tic disorders. RESULTS: During film viewing, we observed significant synchronization in the temporal tic patterns of various individuals despite diversity in their tic profiles. Furthermore, employing a video game developed for our study, we found that tic frequency increases during anticipation of a pending reward. This finding was replicated in a second experiment with an independent cohort. CONCLUSIONS: Our results indicate that tic frequency is affected by media elements in the short-term, and call for further investigation of the long-term impacts of exposure to such tic triggers.

Characteristics of Second-Line Investigations of Middle-Aged Athletes Who Failed Preparticipation Examinations.

OBJECTIVE: The role of exercise testing during preparticipation examinations (PPEs) of middle-aged athletes is uncertain. This study examined the characteristics of disqualifications after an initial PPE that includes an exercise test in competitive athletes older than 30 years. We investigated disqualification rates and reasons, second-line investigations performed, and final decisions regarding competitive sports participation. DESIGN: Chart review. SETTING: Sports medicine clinic. PARTICIPANTS: Athletes aged >30 years that performed an exercise test as part of their annual PPE at our sports medicine clinic (n = 866). INDEPENDENT VARIABLES: Age, sex, height, weight, sport type, cardiovascular risk factors, and abnormal PPE findings. MAIN OUTCOME MEASURES: Additional investigations performed, approval/disqualification regarding competitive sports participation. RESULTS: The initial disqualification rate of athletes was 9.8%. Three (3.6%) athletes were disqualified following questionnaire and physical examination, 19 (22.4%) because of resting electrocardiogram findings, and 65 (76.5%) following the exercise test. After additional work-up, only 5 athletes (0.4%) were ultimately found ineligible for competitive sports. From those, only 2 athletes (0.2%) were disqualified because of exercise test findings, which were episodes of supraventricular tachycardia and not ischemia-related. CONCLUSIONS: The addition of an exercise test to the PPE of middle-aged athletes is of limited value. If exercise testing of older athletes is performed, arrhythmias are probably of higher significance than ST-T changes.

Pediatric obesity and body weight following the COVID-19 pandemic.

BACKGROUND: The SARS-CoV-19 pandemic and its associated lockdowns affected children's lifestyle dramatically. The effect of such changes on children's weight and obesity status is unknown. The aim of this study was to compare body weight and obesity rates in children from before the pandemic to 6 months after the major periods of lockdowns in Israel. METHODS: We used data from medical records of pediatric emergency department visits, where weight is routinely measured, to compare weight and obesity prevalence in the fourth quartile of 2020 (n = 2468) as compared with the fourth quartiles of 2018-2019 (n = 5300). Weight was transformed to age- and sex-specific standard-deviation-scores (SDS) for analysis. RESULTS: Weight-SDS increased by a mean of 0.07 during the first 6 months of the pandemic, yet this was only significant in preschoolers. Obesity rates also increased in this age group only, by 37%, from 8.1% to 11.1% (p = 0.01). CONCLUSIONS: Weight-SDS and obesity prevalence increased during the SARS-CoV-19 pandemic, yet only in younger children. Additional studies from other populations are needed.

Mutations in PPCS, Encoding Phosphopantothenoylcysteine Synthetase, Cause Autosomal-Recessive Dilated Cardiomyopathy.

Coenzyme A (CoA) is an essential metabolic cofactor used by around 4% of cellular enzymes. Its role is to carry and transfer acetyl and acyl groups to other molecules. Cells can synthesize CoA de novo from vitamin B5 (pantothenate) through five consecutive enzymatic steps. Phosphopantothenoylcysteine synthetase (PPCS) catalyzes the second step of the pathway during which phosphopantothenate reacts with ATP and cysteine to form phosphopantothenoylcysteine. Inborn errors of CoA biosynthesis have been implicated in neurodegeneration with brain iron accumulation (NBIA), a group of rare neurological disorders characterized by accumulation of iron in the basal ganglia and progressive neurodegeneration. Exome sequencing in five individuals from two unrelated families presenting with dilated cardiomyopathy revealed biallelic mutations in PPCS, linking CoA synthesis with a cardiac phenotype. Studies in yeast and fruit flies confirmed the pathogenicity of identified mutations. Biochemical analysis revealed a decrease in CoA levels in fibroblasts of all affected individuals. CoA biosynthesis can occur with pantethine as a source independent from PPCS, suggesting pantethine as targeted treatment for the affected individuals still alive.

Somatic engagement alters subsequent neurobehavioral correlates of affective mentalizing.

Socio-emotional encounters involve a resonance of others' affective states, known as affect sharing (AS); and attribution of mental states to others, known as theory-of-mind (ToM). Empathy necessitates the integration of both processes, yet their interaction during emotional episodes and subsequent generation of inferences on others' affective states has rarely been tested. To address this, we developed a novel experimental design, wherein we manipulated AS by presenting nonverbal emotionally negative movies twice-each time accompanied by one of two soundtracks that accentuated either somatic cues or externally generated sounds. Movies were followed by questions addressing affective-ToM (emotional inferences), cognitive-ToM (inferences on beliefs and knowledge), and non-ToM aspects. Results revealed a neural differentiation between AS, affective-ToM, and cognitive-ToM. AS movies activated regions that have been implicated in emotional (e.g., amygdala) and somatosensory processing, and synchronized brain activity between participants in the latter. Affective-ToM activated the middle insula, limbic regions, and both ventral and dorsal portions of the medial prefrontal cortex (ventral medial prefrontal cortex [VMPFC] and dorsal medial prefrontal cortex [DMPFC], respectively), whereas cognitive-ToM activated posteromedial and lateral-prefrontal and temporal cortices. Critically, AS movies specifically altered neural activation in AS and ToM-related regions during subsequent affective-ToM inferences, most notably in the DMPFC. Moreover, DMPFC-VMPFC connectivity correlated with affective-ToM accuracy, when such questions followed AS movies. Our results associate empathic processes with designated neural activations and shed light on how neuro-behavioral indices of affective ToM are shaped by preceding somatic engagement.

Neuraminidase Inhibitors and Hospital Length of Stay: A Meta-analysis of Individual Participant Data to Determine Treatment Effectiveness Among Patients Hospitalized With Nonfatal 2009 Pandemic Influenza A(H1N1) Virus Infection.

BACKGROUND: The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear. METHODS: We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded. RESULTS: We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78-.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS. CONCLUSIONS: When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.

Electroencephalographic evidence for the involvement of mirror-neuron and error-monitoring related processes in virtual body ownership.

The illusion that an artificial or virtual object becomes part of one's body has been demonstrated and productively investigated in the past two decades. Empirical and theoretical accounts of this phenomenon suggest that the body ownership illusion relies not on a single process, but rather on the alignment of the biological and the alternative bodies across multiple aspects. However, the portrayal of these aspects and the demarcation of their neurophysiological correlates has yet to be established. Our study examines electroencephalographic (EEG) markers of two extensively studied systems in the context of virtual body ownership illusion: the mirror-neuron system (MNS) and the error-monitoring system (EMS). We designed an experimental manipulation of brief involuntary and unexpected virtual hand bounces, which triggers both systems, and examined how the response of EEG markers of these systems to this manipulation is modulated by three aspects of body ownership: agency, visuotactile synchronicity, and semantic congruence between the participant's hands and its virtual representation. We found evidence for enhanced MNS-related power suppression at the Mu band in the synchronous and semantic congruence conditions. On the other hand, the EMS-related Pe/P300 wave was reduced by semantic congruence. This Pe/P300 effect was stronger among participants who exhibited higher acceptance of the spatial illusion and an increased tendency for affective empathy. Mu power and Pe/P300 were not correlated, suggesting a dissociation between the distinct aspects of body ownership they probe. The findings suggest that synchronicity and semantic congruence induce sensorimotor sensitivity to the alternative body, whereas the latter parameter also buffers minor erroneous virtual motions. These neurophysiological markers may be added to the arsenal of body ownership probes and incorporated into VR rehabilitation protocols.

High prevalence of attention-deficit/hyperactivity disorder in adolescents with severe obesity seeking bariatric surgery.

AIM: To examine the prevalence of attention-deficit/hyperactivity disorder (ADHD) and related post-surgical weight loss in adolescents with severe obesity seeking bariatric surgery. METHODS: The study population included 84 adolescents (age 13-19 years; 44 males, 40 females) with severe obesity who sought bariatric surgery at the Sheba Medical Centre in Israel during the years 2011-2017. Anthropometric and clinical data were collected from medical records. A subgroup of 20 participants filled questionnaires that evaluated ADHD-like symptoms, eating behaviours and quality of life. Data on adolescents that ultimately underwent surgery (n = 45) were also obtained. RESULTS: The prevalence of ADHD was 28.6% in adolescents seeking bariatric surgery, much higher than that of the general adolescent population of Israel (17.1%, P < .001). There were no significant differences in reductions of weight, body mass index, body mass index standard deviation scores and body fat percent between participants with or without ADHD. In the subgroup that filled questionnaires, higher scores on ADHD-Rating Scale at baseline were associated with greater excess weight loss. CONCLUSION: The prevalence of ADHD in adolescents seeking bariatric surgery was very high. Diagnosed ADHD was not related to post-surgical weight loss, whereas baseline ADHD-related behaviour was associated with higher post-surgical weight loss.

Ergogenic Effects of 8 Days of Sceletium Tortuosum Supplementation on Mood, Visual Tracking, and Reaction in Recreationally Trained Men and Women.

Hoffman, JR, Marcus, I, Dubnov-Raz, G, and Gepner, Y. Ergogenic effects of 8 days of Sceletium tortuosum supplementation on mood, visual tracking, and reaction in recreationally trained men and women. J Strength Cond Res 34(9): 2476-2481, 2020-Sceletium tortuosum (ST) is a South African plant that has been reported to promote a sense of well-being in healthy individuals and used in treating people with anxiety, stress, or depression. These studies have been conducted in middle-aged and older adults, but no investigations have been performed in a healthy, young adult population. Thus, the purpose of this study was to examine the effect of 8 days of ST extract (25-mg) supplementation on changes in reactive agility, visual tracking, and mood. Sixty recreationally trained men (n = 48) and women (n = 12), between 20 and 35 years, were randomly assigned to 1 of 2 groups: ST or placebo (PL). Subjects were tested on 2 occasions: before supplementation and 2-hours after supplementation on day 8. Subjects completed a subjective questionnaire to assess alertness and energy using a visual analog scale (VAS). In addition, subjects completed the Profile of Mood States questionnaire and performed reactive agility and visual tracking assessments. Significant improvements were noted for ST in complex reactive performance that required subjects to respond to repeated visual stimuli with a cognitive load compared with PL. However, no significant changes were noted between the groups in either VAS or total mood score. In addition, no differences were observed in simple reaction assessments. The results of this study demonstrate an ergogenic benefit in complex reactive tasks that include a cognitive load. However, in this subject population studied, no benefits in mood were observed.

Preferred weight-related terminology by parents of children with obesity.

AIM: In order to improve weight-related discussion with patients and minimise their discomfort, the terminology used by medical staff should be carefully chosen. The aim of the study was to identify the most motivating weight-related terminology to use with children with obesity. METHODS: Focus groups were used to generate a list of 12 weight-related terms in Hebrew, sent by a questionnaire to parents of children and adolescents with obesity. Terms were graded according to how desirable, stigmatising, blaming or motivating they were perceived. We identified the most positive and negative weight-based terms and conducted linear regressions to predict child motivation to lose weight when positive terms are used. RESULTS: The least stigmatising and most motivating and desirable terms were 'unhealthy body weight' and 'unhealthy lifestyle'. Medical staff mostly used 'overweight', which was relatively inoffensive yet not very motivating. 'Fat/obese' ('Shamen') was the most stigmatising and blaming term and the least desired. Only 20% of parents endorsed a nonverbal graphical tool to describe body size. CONCLUSION: Our findings encourage using health-based terminology over weight-based terminology to promote treatment and lifestyle changes in children with obesity. Healthcare professionals should adopt patient-centred care and improve the weight-related terms they use with children with obesity.

Obsessive-compulsive symptomatology in female adolescent inpatients with restrictive compared with binge-purge eating disorders.

OBJECTIVE: Strong relationships exist between obsessive-compulsive (OC) disorder and eating disorders (EDs). The aim of the study was to investigate whether OC symptoms would be expressed differently in different ED types. METHOD: Ninety-four female adolescent inpatients with restricting anorexia nervosa (AN-R), 67 with binge/purge AN (AN-B/P), and 48 with bulimia nervosa (BN) were assessed on admission and discharge using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS), Eating Attitude Test-26 (EAT-26), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). RESULTS: On admission, patients with AN-B/P exhibited higher scores on the Y-BOCS, YBC-EDS, EAT-26, and BDI in comparison with patients with AN-R or BN. A significant improvement on all psychometric variables from admission to discharge was found for all participants taken together. Nonetheless, patients with AN-B/P and/or BN showed a greater improvement on Y-BOCS, BDI, and STAI than patients with AN-R, whereas no between-group difference was found for YBC-EDS and EAT-26. CONCLUSIONS: Obsessionality is more severe in acutely ill AN-B/P patients than in patients with AN-R and BN, whereas a greater improvement in obsessionality from the acutely ill to the stabilized ED condition is found in patients with binge/purge in comparison with restrictive pathology.

[EXERCISE IS MEDICINE, INCLUDING STRENGTH TRAINING!]

INTRODUCTION: This editorial focuses on strength training, an integral part of the exercise prescription for children, adolescents and adults. While filling the complete exercise prescription of aerobic and strength components provides maximal health benefits, it is noteworthy that even performing only aerobic activities or strength training is still better than no activity. The exercise prescription should be individually tailored to every person, according to her/his preferences, physical or technical limitations, medical conditions, etc. Some prefer, or are limited to, strength training only. Such activities improve muscle strength and athletic capabilities, in children mostly via improved neuromuscular control, and in youth and adults through muscle hypertrophy as well. From a health perspective, strength training had only been associated with better cardiovascular risk profiles in youth and with reduced mortality risks in adults. Interventional studies demonstrated that such training improves cardiovascular risk and physical functioning in youth and in adults, in healthy individuals and in those with chronic health conditions. Undoubtedly, strength training is medicine.

Dynamic Shifts in Large-Scale Brain Network Balance As a Function of Arousal.

The ability to temporarily prioritize rapid and vigilant reactions over slower higher-order cognitive functions is essential for adaptive responding to threat. This reprioritization is believed to reflect shifts in resource allocation between large-scale brain networks that support these cognitive functions, including the salience and executive control networks. However, how changes in communication within and between such networks dynamically unfold as a function of threat-related arousal remains unknown. To address this issue, we collected functional MRI data and continuously assessed the heart rate from 120 healthy human adults as they viewed emotionally arousing and ecologically valid cinematographic material. We then developed an analysis method that tracks dynamic changes in large-scale network cohesion by quantifying the level of within-network and between-network interaction. We found a monotonically increasing relationship between heart rate, a physiological index of arousal, and within-network cohesion in the salience network, indicating that coordination of activity within the salience network dynamically tracks arousal. Strikingly, salience-executive control between-network cohesion peaked at moderate arousal. These findings indicate that at moderate arousal, which has been associated with optimal noradrenergic signaling, the salience network is optimally able to engage the executive control network to coordinate cognitive activity, but is unable to do so at tonically elevated noradrenergic levels associated with acute stress. Our findings extend neurophysiological models of the effects of stress-related neuromodulatory signaling at the cellular level to large-scale neural systems, and thereby explain shifts in cognitive functioning during acute stress, which may play an important role in the development and maintenance of stress-related mental disorders. SIGNIFICANCE STATEMENT: How does brain functioning change in arousing or stressful situations? Extant literature suggests that through global projections, arousal-related neuromodulatory changes can rapidly alter coordination of neural activity across brain-wide neural systems or large-scale networks. Since it is unknown how such processes unfold, we developed a method to dynamically track levels of within-network and between-network interaction. We applied this technique to human neuroimaging data acquired while participants watched realistic and emotionally arousing cinematographic material. Results demonstrate that cohesion within the salience network monotonically increases with arousal, while cohesion of this network with the executive control network peaks at moderate arousal. Our findings explain how cognitive performance shifts as a function of arousal, and provide new insights into vulnerability for stress-related psychopathology.

Recovery of upper-body muscle power after short intensive exercise: comparing boys and men.

PURPOSE: Boys' lower-body muscle power generation (PO) recovers faster than men's following intensive exercise. The purpose of this study was to examine whether boys differ from adult men in recovering from upper-body muscle power generation following intensive exercise. METHODS: Fifteen prepubertal boys (M ± SD age 10.6 ± 1.0 years) and 13 men (31.1 ± 5.0 years) performed two upper-body Wingate Anaerobic Tests (WAnT), separated by either 2-min or 10-min recovery intervals. WAnT parameters, pre-and post-WAnT heart rates (HR), and blood lactate ([La]) were measured during recovery from the WAnTs. RESULTS: Boys' mean power (MP) of the repeated WAnT (WAnT2) following 2- and 10-min recoveries was 97.3 ± 7.2% and 99.4 ± 3.9%, respectively, compared to MP of the first test (WAnT1) (p > 0.05 for both tests). In contrast, in men's MP of the WAnT2 following the 2-min recovery, was significantly lower than that of the WAnT1 (84.4 ± 6.7%, p = 0.0001). While boys' and men's HR recovery after 2 min differed significantly (p = 0.046), no between-group differences were found following the 10-min recovery. Peak [La] in boys was 37-44% lower than that in men (p = 0.002). CONCLUSIONS: The faster recovery of PO in boys after supra-maximal upper-body exercise is partially explained by the lower power generated by boys, attributed in part to a lower anaerobic capacity and to the greater relative contribution of aerobic processes to performance and recovery from anaerobic-type tasks. Further research is needed to determine the physiologic, neurologic and biochemical basis of the rapid muscle power recovery in children.

Different attention bias patterns in anorexia nervosa restricting and binge/purge types.

Patients with anorexia nervosa (AN) have been shown to display both elevated anxiety and attentional biases in threat processing. In this study, we compared threat-related attention patterns of patients with AN restricting type (AN-R; n = 32), AN binge/purge type (AN-B/P; n = 23), and healthy controls (n = 19). A dot-probe task with either eating disorder-related or general and social anxiety-related words was used to measure attention patterns. Severity of eating disorder symptoms, depression, anxiety, and stress were also assessed. Patients with AN-R showed vigilance to both types of threat words, whereas patients with AN-B/P showed avoidance of both threat types. Healthy control participants did not show any attention bias. Attention bias was not associated with any of the demographic, clinical, and psychometric parameters introduced. These findings suggest that there are differential patterns of attention allocation in patients with AN-R and AN-B/P. More research is needed to identify what causes/underlies these differential patterns.

[PRINCIPLES FOR THE INTERPRETATION OF CARDIOPULMONARY EXERCISE TESTS (CPET)].

INTRODUCTION: The cardiopulmonary exercise test (CPET) permits the most accurate and reproducible quantification of cardiopulmonary fitness, a grading of the etiology and severity of cardiopulmonary impairments, and an objective assessment of the response to an intervention. Moreover, over the last three decades, a large volume of research has been directed toward the utility of CPET as a diagnostic and prognostic tool; these studies have established CPET as a scientifically sound and, therefore, clinically valuable method for accurately assessing exercise limitation and prognosis in various disease states. The CPET is relatively easy to perform, yet complex in the interpretation of the results. The current review presents the principles of the analytic process of the test results, in order to obtain possible diagnoses.

Impact of Outpatient Neuraminidase Inhibitor Treatment in Patients Infected With Influenza A(H1N1)pdm09 at High Risk of Hospitalization: An Individual Participant Data Metaanalysis.

BACKGROUND: While evidence exists to support the effectiveness of neuraminidase inhibitors (NAIs) in reducing mortality when given to hospitalized patients with A(H1N1)pdm09 virus infection, the impact of outpatient treatment on hospitalization has not been clearly established. We investigated the impact of outpatient NAI treatment on subsequent hospitalization in patients with A(H1N1)pdm09 virus infection. METHODS: We assembled general community and outpatient data from 9 clinical centers in different countries collected between January 2009 and December 2010. We standardized data from each study center to create a pooled dataset and then used mixed-effects logistic regression modeling to determine the effect of NAI treatment on hospitalization. We adjusted for NAI treatment propensity and preadmission antibiotic use, including "study center" as a random intercept to account for differences in baseline hospitalization rate between centers. RESULTS: We included 3376 patients with influenza A(H1N1)pdm09, of whom 3085 (91.4%) had laboratory-confirmed infection. Eight hundred seventy-three patients (25.8%) received outpatient or community-based NAI treatment, 928 of 2395 (38.8%) with available data had dyspnea or respiratory distress, and hospitalizations occurred in 1705 (50.5%). After adjustment for preadmission antibiotics and NAI treatment propensity, preadmission NAI treatment was associated with decreased odds of hospital admission compared to no NAI treatment (adjusted odds ratio, 0.24; 95% confidence interval, 0.20-0.30). CONCLUSIONS: In a population with confirmed or suspected A(H1N1)pdm09 and at high risk of hospitalization, outpatient or community-based NAI treatment significantly reduced the likelihood of requiring hospital admission. These data suggest that community patients with severe influenza should receive NAI treatment.

Robust inter-subject audiovisual decoding in functional magnetic resonance imaging using high-dimensional regression.

Major methodological advancements have been recently made in the field of neural decoding, which is concerned with the reconstruction of mental content from neuroimaging measures. However, in the absence of a large-scale examination of the validity of the decoding models across subjects and content, the extent to which these models can be generalized is not clear. This study addresses the challenge of producing generalizable decoding models, which allow the reconstruction of perceived audiovisual features from human magnetic resonance imaging (fMRI) data without prior training of the algorithm on the decoded content. We applied an adapted version of kernel ridge regression combined with temporal optimization on data acquired during film viewing (234 runs) to generate standardized brain models for sound loudness, speech presence, perceived motion, face-to-frame ratio, lightness, and color brightness. The prediction accuracies were tested on data collected from different subjects watching other movies mainly in another scanner. Substantial and significant (QFDR<0.05) correlations between the reconstructed and the original descriptors were found for the first three features (loudness, speech, and motion) in all of the 9 test movies (R¯=0.62, R¯ = 0.60, R¯ = 0.60, respectively) with high reproducibility of the predictors across subjects. The face ratio model produced significant correlations in 7 out of 8 movies (R¯=0.56). The lightness and brightness models did not show robustness (R¯=0.23, R¯ = 0). Further analysis of additional data (95 runs) indicated that loudness reconstruction veridicality can consistently reveal relevant group differences in musical experience. The findings point to the validity and generalizability of our loudness, speech, motion, and face ratio models for complex cinematic stimuli (as well as for music in the case of loudness). While future research should further validate these models using controlled stimuli and explore the feasibility of extracting more complex models via this method, the reliability of our results indicates the potential usefulness of the approach and the resulting models in basic scientific and diagnostic contexts.

Prediction of Maximal Heart Rate in Children and Adolescents.

OBJECTIVE: To identify a method to predict the maximal heart rate (MHR) in children and adolescents, as available prediction equations developed for adults have a low accuracy in children. We hypothesized that MHR may be influenced by resting heart rate, anthropometric factors, or fitness level. DESIGN: Cross-sectional study. SETTING: Sports medicine center in primary care. PARTICIPANTS: Data from 627 treadmill maximal exercise tests performed by 433 pediatric athletes (age 13.7 ± 2.1 years, 70% males) were analyzed. INDEPENDENT VARIABLES: Age, sex, sport type, stature, body mass, BMI, body fat, fitness level, resting, and MHR were recorded. MAIN OUTCOME MEASURES: To develop a prediction equation for MHR in youth, using stepwise multivariate linear regression and linear mixed model. To determine correlations between existing prediction equations and pediatric MHR. RESULTS: Observed MHR was 197 ± 8.6 b·min. Regression analysis revealed that resting heart rate, fitness, body mass, and fat percent were predictors of MHR (R = 0.25, P < 0.001), whereas age was not. Resting heart rate explained 15.6% of MHR variance, body mass added 5.7%, fat percent added 2.4%, and fitness added 1.2%. Existing adult equations had low correlations with observed MHR in children and adolescents (r = -0.03-0.34). CONCLUSIONS: A new equation to predict MHR in children and adolescents was developed, but was found to have low predictive ability, a finding similar to adult equations applied to children. CLINICAL RELEVANCE: Considering the narrow range of MHR in youth, we propose using 197 b·min as the mean MHR in children and adolescents, with 180 b·min the minimal threshold value (-2 standard deviations).