Geriatric Bariatric Surgery: Outcomes at a Single Institution.

Obesity, especially in those over the age of 65, is associated with multiple comorbidities and decreased quality of life. Bariatric surgery is an effective method of weight loss and management of comorbidities and is increasingly utilized in younger and middle-aged populations. A retrospective review was performed of patients ≥65 years old who underwent bariatric surgery between 2018 and 2021 at a single institution to evaluate the safety and efficacy of bariatric surgery in older populations. A total of 11 patients were identified with a mean age of 67.5, ranging from 65 to 78. All patients had obesity-related comorbidities including hypertension (90.9%), obstructive sleep apnea (72.7%), diabetes mellitus (54.5%), hyperlipidemia (45.5%), and others. The mean %EWL at 12 months was 26.1% with improvement in comorbidities and no post-operative complications. Our results demonstrate that bariatric surgery can be safe for the geriatric population with improvement in weight loss and comorbidities.

Longitudinal changes in resting state fMRI brain self-similarity of asymptomatic high school American football athletes.

American football has become the focus of numerous studies highlighting a growing concern that cumulative exposure to repetitive, sports-related head acceleration events (HAEs) may have negative consequences for brain health, even in the absence of a diagnosed concussion. In this longitudinal study, brain functional connectivity was analyzed in a cohort of high school American football athletes over a single play season and compared against participants in non-collision high school sports. Football athletes underwent four resting-state functional magnetic resonance imaging sessions: once before (pre-season), twice during (in-season), and once 34-80 days after the contact activities play season ended (post-season). For each imaging session, functional connectomes (FCs) were computed for each athlete and compared across sessions using a metric reflecting the (self) similarity between two FCs. HAEs were monitored during all practices and games throughout the season using head-mounted sensors. Relative to the pre-season scan session, football athletes exhibited decreased FC self-similarity at the later in-season session, with apparent recovery of self-similarity by the time of the post-season session. In addition, both within and post-season self-similarity was correlated with cumulative exposure to head acceleration events. These results suggest that repetitive exposure to HAEs produces alterations in functional brain connectivity and highlight the necessity of collision-free recovery periods for football athletes.

Listening and attitude change.

We review research on the role of high-quality listening behavior in attitude change. We examine how listening behaviors can impact attitudes and the mechanisms underlying these effects. The article discusses research that explicitly examines high-quality listening, as well as research that examines behaviors that may indicate high-quality listening or that incorporates high-quality listening into larger interventions. The reviewed research suggests that receiving high-quality listening increases psychological safety and open-minded self-reflection, leading people to consider perspectives they otherwise would not. This in turn leads to less extreme, clearer, and more nuanced views on the topic of conversation. Finally, we highlight the need for further research to better understand the role of listening in attitude change, particularly in non-western cultures.

Association for Academic Surgery/Society of University Surgeons research awards are highly successful in fostering future surgeon-scientists.

BACKGROUND: The surgeon-scientist brings a unique perspective to surgical research. The Association of Academic Surgeons and Society of University Surgeons foster the development of surgeon-scientists through foundation awards to residents and junior faculty. We sought to evaluate the academic success of surgeons who received an Association for Academic Surgery/Society of University Surgeons award. METHODS: Information was collected for individuals who received a resident or junior faculty research award from the Association for Academic Surgery or Society of University Surgeons. Google Scholar, Scopus, and the National Institutes of Health Research Portfolio Online Reporting Tools: Expenditures and Results were used to assess scholarly achievements. RESULTS: Eighty-two resident awardees were included, 31 (38%) of whom were female. Thirteen (24%) are now professors, 12 (22%) are division chiefs, and 4 (7%) are department chairs. Resident awardees have a median of 886 citations (interquartile range 237-2,111) and an H-index of 14 (interquartile range 7-23). Seven (13%) went on to receive K08/K23 awards, and 7 (13%) received R01s, with a total of about $200 million in National Institutes of Health funding (79-fold return on investment). Thirty-four junior faculty awardees were included, 10 (29%) of whom were female. Thirteen (38%) are now professors, 12 (35%) are division chiefs, and 7 (21%) are department chairs. Faculty awardees have a median of 2,617 citations (interquartile range 1,343-7,857) and an H-index of 25 (interquartile range 18-49). Four (12%) received K08 or K23 awards, and 10 (29%) received R01s, with about $139 million in National Institutes of Health funding (98-fold return on investment). CONCLUSION: Association for Academic Surgery/Society of University Surgeons research awardees experience high degrees of success in academic surgery. Most resident awardees pursue fellowship training and remain in academic surgery. A high percentage of both faculty and resident awardees hold leadership positions and successfully achieve National Institutes of Health funding.

Ancillary documents for NIH grant applications: The pages beyond the science.

Preparing a grant proposal is no small feat, especially for research (R-series) grants from the National Institutes of Health. The National Institutes of Health is the largest public funder of biomedical research in the world, and as such, procuring a research grant from the National Institutes of Health is one of the ultimate benchmarks of success for a surgeon-scientist. Most investigators are familiar with the page limits for most R-series grants (12 pages for an R01 and 6 pages for an R21), with the addition of a single page allotted for the specific aims. Interestingly, despite the usual focus on the aforementioned research section, the rest of the application can routinely consist of an additional 100 to 150 pages, which means that pages allotted for the specific aims and research strategy represent only 10% of the complete application package. For busy surgeons, it is this abundance of ancillary documentation that can make preparing a research grant particularly onerous. Fortunately, for some, support exists within the department to help prepare much of this documentation by drawing from previous sources, templates, and boilerplate language that has been developed. Although these resources can significantly reduce the burden on individual investigators, there is a danger of leaning on generalized templates that can dilute the message of the overall grant proposal and introduce extraneous or incorrect information that can ultimately impact the cohesiveness and ultimately the competitiveness of the grant. The focus of this article is to educate surgeon-scientists regarding the purpose and importance of the ancillary information required for National Institutes of Health research grants and how to make the most of institutional resources while tailoring these materials to create a cohesive, competitive grant application.

A meta-analytic investigation of problem gambling and self-harm: A causal inference perspective.

OBJECTIVE: Problem gambling may be an underappreciated treatment target for reducing self-harm. Multivariate studies examining the relationship between problem gambling and self-harm have returned inconsistent results, perhaps due to insufficient power or differences in study quality. METHOD: We conducted a series of meta-analyses examining the effect of problem gambling on self-harm outcomes of varying severity. We assessed the sensitivity of results to study characteristics, publication bias, and influential cases. To highlight threats to causal inference, we evaluated each study for residual confounding bias. RESULTS: In total, two types of meta-analyses were adequately powered: those assessing (a) the effect of problem gambling (binary) on suicide ideation and (b) problem gambling (binary) on suicide attempt (k = 14 unique studies between the two meta-analyses). For both meta-analyses, we found a positive, statistically significant average effect of problem gambling on the respective self-harm outcome. We did not detect any influential studies among these two meta-analyses, nor residual confounding. However, these findings are limited by the overall quality of included literature. PET-PEESE analysis detected substantial potential publication bias in the main results, with both meta-analytic effects being reduced to statistical nonsignificance. All included studies also used a cross-sectional design for their analysis of interest, thus simultaneity bias cannot be ruled out. CONCLUSION: While these findings suggest there is an appreciable relationship between problem gambling and at least two forms of self-harm (suicide ideation and attempts), well-designed longitudinal research is needed to make more firm conclusions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

American Football Position-Specific Neurometabolic Changes in High School Athletes: A Magnetic Resonance Spectroscopic Study.

Reports estimate between 1.6-3.8 million sports-related concussions occur annually, with 30% occurring in youth male American football athletes. Many studies report neurophysiological changes in these athletes, but the exact reasons for these changes remain elusive. Investigation of injury mechanics highlights a need to address how player position might impact these changes. Here, 55 high school American football athletes (20 linemen; 35 non-linemen) underwent magnetic resonance spectroscopy four times over the course of a football season-once prior to the season (Pre), twice during (In1, In2), and once following (Post) to quantify metabolites (N-acetyl aspartate, choline, creatine, myo-inositol, and glutamate/glutamine) in the dorsolateral prefrontal cortex (DLPFC) and primary motor cortex (M1). Head acceleration events (HAEs) were monitored at each practice and game. Spectroscopic and HAE data were analyzed by imaging session and player position. Linear regression analyses were conducted between metabolite levels and HAEs, and metabolite levels in football athletes were compared with age-and gender-matched non-contact athletes. Across-season (i.e., between Pre and In1, In2, Post), different DLPFC and M1 metabolites decreased (p < 0.05) according to player position (i.e., linemen vs. non-linemen). The majority of regression results involved DLPFC metabolites in linemen, where metabolite levels were higher from Pre to Post, with increasing HAE load. Comparisons with control athletes revealed higher metabolite levels in football athletes both before and after the season. This study highlights the importance of player position when conducting analyses on American football athletes and demonstrates elevated DLPFC and M1 brain metabolites in football athletes compared with control athletes at both Pre and Post, suggesting potential HAE-related neurocompensatory mechanisms.

Normalized Brain Tissue-Level Evaluation of Volumetric Changes of Youth Athletes Participating in Collision Sports.

Observations of short-term changes in the neural health of youth athletes participating in collision sports (e.g., football and soccer) have highlighted a need to explore potential structural alterations in brain tissue volumes for these persons. Studies have shown biochemical, vascular, functional connectivity, and white matter diffusivity changes in the brain physiology of these athletes that are strongly correlated with repetitive head acceleration exposure. Here, research is presented that highlights regional anatomical volumetric measures that change longitudinally with accrued subconcussive trauma. A novel pipeline is introduced that provides simplified data analysis on standard-space template to quantify group-level longitudinal volumetric changes within these populations. For both sports, results highlight incremental relative regional volumetric changes in the subcortical cerebrospinal fluid that are strongly correlated with head exposure events greater than a 50-G threshold at the short-term post-season assessment. Moreover, longitudinal regional gray matter volumes are observed to decrease with time, only returning to baseline/pre-participation levels after sufficient (5-6 months) rest from collision-based exposure. These temporal structural volumetric alterations are significantly different from normal aging observed in sex- and age-matched controls participating in non-collision sports. Future work involves modeling repetitive head exposure thresholds with multi-modal image analysis and understanding the underlying physiological reason. A possible pathophysiological pathway is presented, highlighting the probable metabolic regulatory mechanisms. Continual participation in collision-based activities may represent a risk wherein recovery cannot occur. Even when present, the degree of the eventual recovery remains to be explored, but has strong implications for the well-being of collision-sport participants.

Estimation of Skin and Ocular Damage Avoided in the United States through Implementation of the Montreal Protocol on Substances that Deplete the Ozone Layer.

Overexposure to ultraviolet (UV) radiation is a threat to human health. It can cause skin cancer and cataracts. Human-made ozone-depleting substances (ODSs) reduce the ozone concentration in the Earth's stratosphere, which acts as a protective shield from UV radiation. To protect and restore the ozone layer, the Montreal Protocol on Substances that Deplete the Ozone Layer was enacted in 1987 to phase out the production and consumption of certain ODSs and was later amended and adjusted to significantly strengthen its requirements. The United States Environmental Protection Agency (EPA) uses its Atmospheric and Health Effects Framework (AHEF) model to assess the adverse human health effects associated with stratospheric ozone depletion and the U.S. health benefits from the global implementation of the Montreal Protocol. Comparing the Montreal Protocol as amended and adjusted with a scenario of no controls on ODSs showed the prevention of an estimated 443 million cases of skin cancer and 63 million cataract cases for people born in the United States between 1890 and 2100. In addition, 2.3 million skin cancer deaths are avoided. Compared with the original 1987 Montreal Protocol, strengthening the Montreal Protocol, through its subsequent amendments and adjustments, resulted in an estimated 230 million fewer skin cancer cases, 1.3 million fewer skin cancer deaths, and 33 million fewer cataract cases.

Distribution of Head Acceleration Events Varies by Position and Play Type in North American Football.

OBJECTIVE: The goal of this pilot study was to evaluate the number of head acceleration events (HAEs) based on position, play type, and starting stance. DESIGN: Prospective cohort study. SETTING: Postcollegiate skill development camp during practice sessions and 1 exhibition game. PARTICIPANTS: Seventy-eight male adult North American football athletes. INDEPENDENT VARIABLES: A position was assigned to each participant, and plays in the exhibition game were separated by play type for analysis. During the exhibition game, video data were used to determine the effects of the starting position ("up" in a 2-point stance or "down" in a 3- or 4-point stance) on the HAEs experienced by players on the offensive line. MAIN OUTCOME MEASURES: Peak linear acceleration and number of HAEs greater than 20 g (g = 9.81 m/s2) were measured using an xPatch (X2 Biosystems, Seattle, WA). RESULTS: Four hundred thirty-seven HAEs were recorded during practices and 272 recorded during the exhibition game; 98 and 52 HAEs, the greatest number of HAEs by position in the game, were experienced by the offensive and defensive linemen, respectively. Linebackers and tight ends experienced high percentages of HAEs above 60 g. Offensive line players in a down stance had a higher likelihood of sustaining a HAE than players in an up stance regardless of the type of play (run vs pass). CONCLUSIONS: Changing the stance of players on the offensive line and reducing the number of full-contact practices will lower HAEs.

Head acceleration event metrics in youth contact sports more dependent on sport than level of play.

The goal of the study was to evaluate how repetitive head traumas sustained by athletes in contact sports depend on sport and level of play. A total of 16 middle school football players, 107 high school football players, and 65 high school female soccer players participated. Players were separated into levels of play: middle school (MS), freshman (FR), junior varsity (JV), junior varsity-varsity (JV-V), and varsity (V). xPatch sensors were used to measure peak translational and angular accelerations (PTA and PAA, respectively) for each head acceleration event (HAE) during practice and game sessions. Data were analyzed using a custom MATLAB program to compare metrics that have been correlated with functional neurological changes: session metrics (median HAEs per contact session), season metrics (total HAEs, cumulative PTA/PAA), and regressions (cumulative PTA/PAA versus total HAEs, total HAEs versus median HAEs per contact session). Football players had greater session (p<.001) and season (p<.001) metrics than soccer players, but soccer players had a significantly greater player average PAA per HAE than football players (p<.001). Middle school football players had similar session and season metrics to high school level athletes. In conclusion, sport has a greater influence on HAE characteristics than level of play.

Characterizing near-infrared spectroscopy signal under hypercapnia.

Vasoactive stress tests (i.e. hypercapnia, elevated partial pressure of arterial CO2 [PaCO2 ]) are commonly used in functional MRI (fMRI), to induce cerebral blood flow changes and expose hidden perfusion deficits in the brain. Compared with fMRI, near-infrared spectroscopy (NIRS) is an alternative low-cost, real-time, and non-invasive tool, which can be applied in out-of-hospital settings. To develop and optimize vasoactive stress tests for NIRS, several hypercapnia-induced tasks were tested using concurrent-NIRS/fMRI on healthy subjects. The results indicated that the cerebral and extracerebral reactivity to elevated PaCO2 depended on the rate of the CO2 increase. A steep increase resulted in different cerebral and extracerebral reactivities, leading to unpredictable NIRS measurements compared with fMRI. However, a ramped increase, induced by ramped-CO2 inhalation or breath-holding tasks, induced synchronized cerebral, and extracerebral reactivities, resulting in consistent NIRS and fMRI measurements. These results demonstrate that only tasks that increase PaCO2 gradually can produce reliable NIRS results.

Evaluation of Impulse Attenuation by Football Helmets in the Frequency Domain.

Design of helmets used in contact sports has been driven by the necessity of preventing severe head injuries. Manufacturing standards and pass or fail grading systems ensure protective headgear built to withstand large impacts, but design standards do no account for impacts resulting in subconcussive episodes and the effects of cumulative impacts on its user. Thus, it is important to explore new design parameters, such as the frequency-domain measures of transmissibility and mechanical impedance that are based on energy absorption from a range of impact loads. Within the experimentally determined frequency range of interest (FROI), transmissibilities above unity were found in the 0-40 Hz range with the magnitude characteristics varying considerably with impact location. A similar variability with location was observed for the mechanical impedance, which ranged from 9 N/m to 50 N/m. Additional research is required to further understand how changes in the components or materials of the components will affect the performance of helmets, and how they may be used to reduce both transmissibility and dynamic impedance.

Time Flies When You're at RPE13: How Exercise Intensity Influences Perception of Time.

Hanson, NJ and Lee, TL. Time flies when you're at RPE13: How exercise intensity influences perception of time. J Strength Cond Res 34(12): 3546-3553, 2020-Previous studies have shown that there are some changes in our perception of time during exercise, but the relationship between intensity level and these perceptions is unclear. Therefore, the purpose of this study was to determine the effect of exercise intensity on prospective time estimations. Twenty-two trained runners (10 male, 12 female; age 25 ± 6 years) participated in three 30-minute treadmill runs that were perceptually regulated at rating of perceived exertion (RPE) levels of 13 ("somewhat hard"), 15 ("hard"), and 17 ("very hard"). Prospective time assessments, in which subjects estimated durations of 1, 3, 7, and 20 seconds, were obtained immediately before exercise, during (at 10 and 20 minutes), and after exercise. A 3 (RPE) × 4 (timepoint) × 4 (estimated duration) repeated-measures analysis of variance was completed. There was a significant main effect of RPE level (p = 0.013). Post hoc tests revealed that time estimations at RPE17 were significantly lower than those at RPE13 (p = 0.021). The main effects of timepoint and estimated duration were not significant (both p ≥ 0.05), and no interactions were present. However, there was a trend for time estimations to decrease in all conditions as exercise progressed, with a rebound after cessation of exercise. This study showed a clear effect of exercise intensity on time perception. Specifically, the subjects perceived time to pass by more slowly as intensity increased.

Every hit matters: White matter diffusivity changes in high school football athletes are correlated with repetitive head acceleration event exposure.

Recent evidence of short-term alterations in brain physiology associated with repeated exposure to moderate intensity subconcussive head acceleration events (HAEs), prompts the question whether these alterations represent an underlying neural injury. A retrospective analysis combining counts of experienced HAEs and longitudinal diffusion-weighted imaging explored whether greater exposure to incident mechanical forces was associated with traditional diffusion-based measures of neural injury-reduced fractional anisotropy (FA) and increased mean diffusivity (MD). Brains of high school athletes (N = 61) participating in American football exhibited greater spatial extents (or volumes) experiencing substantial changes (increases and decreases) in both FA and MD than brains of peers who do not participate in collision-based sports (N = 15). Further, the spatial extents of the football athlete brain exhibiting traditional diffusion-based markers of neural injury were found to be significantly correlated with the cumulative exposure to HAEs having peak translational acceleration exceeding 20 g. This finding demonstrates that subconcussive HAEs induce low-level neurotrauma, with prolonged exposure producing greater accumulation of neural damage. The duration and extent of recovery associated with periods in which athletes do not experience subconcussive HAEs now represents a priority for future study, such that appropriate participation and training schedules may be developed to minimize the risk of long-term neurological dysfunction.

MHC genotyping from rhesus macaque exome sequences.

Indian rhesus macaque major histocompatibility complex (MHC) variation can influence the outcomes of transplantation and infectious disease studies. Frequently, rhesus macaques are MHC genotyped to identify variants that could account for unexpected results. Since the MHC is only one region in the genome where variation could impact experimental outcomes, strategies for simultaneously profiling variation in the macaque MHC and the remainder of the protein coding genome would be useful. Here we determine MHC class I and class II genotypes using target-capture probes enriched for MHC sequences, a method we term macaque exome sequence (MES) genotyping. For a cohort of 27 Indian rhesus macaques, we describe two methods for obtaining MHC genotypes from MES data and demonstrate that the MHC class I and class II genotyping results obtained with these methods are 98.1% and 98.7% concordant, respectively, with expected MHC genotypes. In contrast, conventional MHC genotyping results obtained by deep sequencing of short multiplex PCR amplicons were only 92.6% concordant with expectations for this cohort.

Plant Identity Influences Foliar Fungal Symbionts More Than Elevation in the Colorado Rocky Mountains.

Despite colonizing nearly every plant on Earth, foliar fungal symbionts have received little attention in studies on the biogeography of host-associated microbes. Evidence from regional scale studies suggests that foliar fungal symbiont distributions are influenced both by plant hosts and environmental variation in climate and soil resources. However, previous surveys have focused on either one plant host across an environmental gradient or one gradient and multiple plant hosts, making it difficult to disentangle the influence of host identity from the influence of the environment on foliar endophyte communities. We used a culture-based approach to survey fungal symbiont composition in the leaves of nine C3 grass species along replicated elevation gradients in grasslands of the Colorado Rocky Mountains. In these ecosystems, the taxonomic richness and composition of foliar fungal symbionts were mostly structured by the taxonomic identity of the plant host rather than by variation in climate. Plant traits related to size (height and leaf length) were the best predictors of foliar fungal symbiont composition and diversity, and composition did not vary predictably with plant evolutionary history. The largest plants had the most diverse and distinctive fungal communities. These results suggest that across the ~ 300 m elevation range that we sampled, foliar fungal symbionts may indirectly experience climate change by tracking the shifting distributions of plant hosts rather than tracking climate directly.