Post-hoc Pairwise Comparisons Research Articles

Poster 217: Changes in Dynamic Hip Muscle Moment Arms During Activities of Daily Living

Objectives: Hip muscle function is affected by surgical intervention and is of particular concern when considering post-operative rehabilitation of the joint1. However, little is known about the dynamic, in vivo function of the hip muscles during activities of daily living. Marker-based motion capture studies have associated dysplastic hip anatomy with shorter abductor moment arm lengths during walking2, but these measurements are complicated by soft tissue artifact3. Biplane radiography is a highly accurate technique for measuring in vivo bone motion of the hip4 and has recently been utilized to estimate dynamic muscle moment arms, which are important factors influencing force and torque capabilities. Previous research studies utilizing biplane radiography have identified shorter muscle lengths and moment arms in the implanted hip compared to the contralateral hip of individuals with total hip arthroplasty during the double support phase of gait2, but normative in vivo moment arms of the hip musculature in asymptomatic individuals have yet to be established. Further, it remains unknown how moment arms change between activities of daily living, particularly during deep flexion activities that challenge hip stability. Developing a normative dataset of dynamic in vivo moment arm lengths would provide a valuable reference for clinicians and physical therapists developing rehabilitation protocols to strengthen the hip musculature and increase stability. The objective of this study was to determine in vivo moment arms of the hip abductors, adductors, and external rotators during gait and squatting in a cohort of asymptomatic adults. We hypothesized that the maximum moment arm length during squatting would be longer than during walking and static standing. Methods: Young adults with no history of hip surgery, chronic hip pathology, or severe lower extremity musculoskeletal injury were recruited to participate in this IRB-approved study. Participants performed bodyweight squats and treadmill walking within a biplane radiography system while ground reaction forces were collected at 1000 Hz from a dual-belt instrumented treadmill. The support phase of gait was defined by vertical ground reaction forces over 50 N. Synchronized biplane radiographs were collected at 50 images per second to image three trials of each hip for each activity. Subject-specific bone models of the pelvis and proximal femur were created from computed tomography (CT) scans (average 0.37x0.3 mm in-plane resolution, 0.625mm slice thickness). Coordinate systems5 and muscle origin and insertion points for the gluteus medius (hip abductor), gluteus minimus (hip abductor), pectineus (hip adductor), and grouped external rotators1 were identified based upon bony landmarks on the 3D bone models (Figure 1). In-vivo bone motion during each activity was determined by matching digitally reconstructed radiographs, created from the CT-based bone models, to the biplane radiographs using a registration process with a validated accuracy4 of 0.3mm. The line of action for each muscle segment was determined for each frame of the biplane radiographs as the vector from the muscle origin to the insertion. Moment arm length (MAL) was calculated for each frame of the dynamic biplane radiographs as the perpendicular distance between the hip joint center (acetabulum center) and the line of action of each muscle1 and interpolated to gait cycle for walking or percent maximum hip flexion during squatting. Differences between the maximum MAL during static standing, walking, and squatting were assessed within each muscle group using ANOVA with post-hoc pairwise comparisons performed as necessary. Results: Data from 186 trials of 43 hips from 22 individuals were included in the analysis (9M, 13F; mean age 22.0±2.2years; BMI 21.3±5.2kg/m2). Average walking velocity was 1.0±0.2m/s and the average maximum hip flexion during squatting was 101.6±16.1°. Average static standing MAL was greatest in the gluteus medius and smallest in the pectineus (Table 1). Maximum MAL was significantly different between all activities for all muscle groups (all p<0.001) (Table 1, Figure 2). Contrary to our hypothesis, moment arms of the abductors were smaller during squatting compared to other motions. Conclusions: This study demonstrates the in vivo torque generating capabilities of muscles surrounding the hip (reflected by their moment arm) change considerably from the standing position to positions encountered during active functional motions. Muscles involved in hip abduction and stabilization have less mechanical advantage at greater hip flexion, highlighting the importance of strengthening these muscle groups during rehabilitation. Specifically, moment arms of the hip abductors and external rotators are shorter during walking and squatting compared to standing, while moment arms of the adductors are shorter during walking and greater during squatting and standing. Knowledge of these postural changes in mechanical advantage can be useful when designing targeted rehabilitation protocols to strengthen the hip musculature and improve stability. Further research into relationships between dynamic in vivo hip muscle moment arms and lengths will yield additional insight into force and torque generating capacity of muscles during activities of daily living. These results are limited to treadmill walking and bodyweight squatting in asymptomatic young adults.

Functional near-infrared spectroscopy of medical students answering various item types.

Traditionally, the effect of assessment item types including true/false questions (TFQs), multiple-choice questions (MCQs), short answer questions (SAQs), and case scenario questions (CSQs) is examined through psychometric qualities or student interviews. However, brain activity while answering such questions or items remains unknown. Functional near-infrared spectroscopy (fNIRS) can be used to safely measure cerebral cortex hemodynamic response during various tasks. Hence, this fNIRS study aimed to determine differences in frontotemporal cortex activity as medical students answered TFQs, MCQs, SAQs, and CSQs. In total, 24 medical students (13 males and 11 females) were recruited in this study during their mid-psychiatry posting. Oxy-hemoglobin and deoxy-hemoglobin levels in the frontal and temporal regions were measured with a 52-channel fNIRS system. Participants answered 9-18 trials under each of the four types of tasks that were based on their psychiatry curriculum during fNIRS measurements. The area under the oxy-hemoglobin curve (AUC) for each participant and each item type was derived. Repeated measures ANOVA with post-hoc Bonferroni-corrected pairwise comparisons were used to determine differences in oxy-hemoglobin AUC between TFQs, MCQs, SAQs, and CSQs. Oxy-hemoglobin AUC was highest during the CSQs, followed by SAQs, MCQs, and TFQs in both the frontal and temporal regions. Statistically significant differences between different types of items were observed in oxy-hemoglobin AUC of the frontal region (p ≤ 0.001). Oxy-hemoglobin AUC in the frontal region was significantly higher during the CSQs than TFQ (p = 0.005) and during the SAQ than TFQ (p = 0.025). Although the percentage of correct responses was significantly lower in MCQ than in the other item types, there was no correlation between the percentage of correct response and oxy-hemoglobin AUC in both regions for all four item types (p > 0.05). CSQs and SAQs elicited greater hemodynamic response than MCQs and TFQs in the prefrontal cortex of medical students. This suggests that more cognitive skills may be required to answer CSQs and SAQs.

0420 Sleep onset misperception in youths with insomnia: Correlates and implications for treatment

Abstract Introduction Individuals with insomnia often show subjective-objective sleep discrepancy, especially an overestimation of their sleep onset latency (SOL) while the factors associated with such discrepancy remained unclear. Whilst cognitive behavioral therapy for insomnia (CBT-I) has been recommend as the first-line treatment for insomnia, there has been limited research to investigate the effects of CBT-I on sleep onset perception in youths with insomnia. The present study aimed to identify potential variables related to sleep onset misperception and explore the effects of CBT-I on sleep onset misperception among youths with insomnia. Methods Sixty treatment-seeking youths with insomnia (mean: 19.74 ±2.42, female: 55%) were recruited to assess for their sleep and clinical characteristics using self-report questionnaires and 7-days sleep diary and actigraphy (T1). A subset of the sample (N=19) further completed an 8-week CBT-I programme and assessed at one-week post-treatment (T2) and 6-month follow-up (T3). Sleep misperception index was computed by subtracting actigraphy-measured SOL from sleep diary reported SOL, where a higher value indicates a higher degree of SOL overestimation. Demographic, clinical and sleep-related variables were compared between high versus low sleep onset misperception groups as divided by the mean of the sample. Changes in sleep onset misperception after CBT-I were analyzed using repeated measures ANOVA. Results High sleep onset misperception group demonstrated a significantly higher degree of anxiety symptoms (t(28)=-3.92, p<.01) and pre-sleep cognitive arousal (t(28)=-0.49, p<.05) as compared to low sleep onset misperception group. Participants who completed CBT-I showed a significant decrease in subjective-objective SOL discrepancy (T1=19.52, T2=6.96, T3=-1.37). A post-hoc pairwise comparison using the Bonferroni correction suggested a significant decrease in subjective-objective SOL discrepancy from T1 to T3 (p<.05). Significant improvement in pre-sleep cognitive arousal was found from T1 to T3 (<.001) and such an improvement was found to be significantly correlated with the reduction in sleep onset misperception (r=0.16, p<.05). Conclusion Sleep onset misperception is associated with anxiety symptoms and pre-sleep cognitive arousal in youths with insomnia. Preliminary evidence supports that CBT-I is effective in improving sleep onset misperception in youths with insomnia. Future research should explore the neurophysiological mechanism underlying sleep onset misperception and the changes of such a discrepancy upon intervention. Support (if any)

0417 Pre-sleep wakefulness in patients with insomnia: heart rate variability during sleep onset

Abstract Introduction Pre-sleep stress or hyperarousal is a known key etiological component in insomnia disorder. However, physiological alterations during the sleep onset period are not well-understood. We aimed to characterize heart rate variability (HRV) in patients with insomnia during sleep onset. Methods Using data from the Sleep Heart Health Study at National Sleep Research Resource, we conducted a secondary analysis exploring HRV during the sleep onset period (defined as the time between lights-off and sleep onset) in patients with insomnia (IS group; n = 68) and comorbid obstructive sleep apnea (IS + OSA group; n = 135), compared with normal sleep controls (NSC group; n = 122). Overall group differences were tested using ANOVA. Post-hoc pairwise comparisons were conducted using the least significant difference (LSD) tests. Results During sleep onset, mean heart rates of the IS group (74.4±15.0 beats/min) and IS+OSA group (72.6±11.5 beats/min) were both significantly higher than the NSC group (69.7±9.4 beats/min, p=0.007 and p=0.044 respectively). Both the IS and IS+OSA groups showed lower heart rate variability compared to the NSC group, with significant differences in both time and frequency domains of HRV analysis including SDNN (p=0.002), RMSSD (p=0.035), pNN20 (p< 0.001), pNN50 (p=0.008), LnLF (p< 0.001), LnHF (p< 0.001). For all these measures, IS+OSA group had lower HRV compared to the IS group, although differences were not significant. When controlling for age, gender and BMI, and compared to the NSC group, IS group had significantly higher heart rates (β=4.8, p=0.008), and the IS+OSA group had significantly lower pNN20 (β=-0.039, p=0.002), pNN50 (β=-0.031, p=0.017) and LnHF (β=0.007, p=0.007). Conclusion Patients with insomnia had lower vagal activity during the sleep onset period, reflected in higher heart rates and lower heart rate variability. Such altered heart rate dynamics may serve as a physiological biomarker for insomnia during bedtime wakefulness, or as a potential tool to evaluate the efficacy of behavioral interventions which target bedtime stress. Support (if any) This research project was made possible by a grant from the American Academy of Sleep Medicine Foundation (PI: Yan Ma). We acknowledge the National Sleep Research Resource as the resource through which the Data/Datasets were obtained.

0684 Effects of Transcranial Magnetic Stimulation (TMS) on Treatment of Intrusive Thinking in Insomniac Populations

Abstract Introduction Patients with clinical insomnia commonly report intrusive thinking (IT) as a common contributor to delayed sleep onset. Evidence suggests that the default mode network (DMN) may contribute to this intrusive thinking. Therefore, we employed continuous theta burst (cTBS) repetitive transcranial magnetic stimulation (rTMS) to modulate DMN activation, and thus reduce IT before sleep. Methods In a counterbalanced cross-over design, active or sham cTBS was administered to 20 participants with clinical insomnia, 8 males (Mage=31.63, SD=6.74) and 12 females (Mage=23.75, SD=4.29), with sessions separated by at least 5 days. To assess intrusive thoughts prior to sleep, participants took the Glasgow Content of Thoughts Inventory (GCTI). We utilized the subscale of the GCTI measuring sleep and wakefulness. Higher scores indicate more persistent intrusive thoughts. We conducted a mixed ANOVA to examine effects of sham and active cTBS conditions on intrusive thoughts. Results There was a medium effect size (ηp2 =.087) but no significant variance (p>.05) in average IT scores between participants sham cTBS (M=19.100, SD=5.349) and active cTBS (M=18.200, SD=4.502) Post-TMS sessions. There was a significant interaction between sex, TMS, and administration (F(1,18)= 4.697; ηp2=.207; p=.044). We then conducted a simple effects analysis between males and females. There was no significant effect of cTBS condition on reported intrusive thinking post-TMS administration (F(1,7)= .628; ηp2=.082; p=.454). However, there was a significant interaction of cTBS condition on intrusive thoughts post-TMS administration for females (F(1,11)= 5.894; ηp2=.349; p=.034). Post-hoc pairwise comparison revealed that females reported significantly greater intrusive thinking post-TMS administration (M=20.167, SD=5.68) compared to pre-TMS administration (M=17.5, SD=5.73) during their sham cTBS session (p=.042). This was not present post-TMS administration during active cTBS (p>.05). Conclusion There was a decrease in intrusive thoughts relating to sleep and wakefulness in females, but not males, following active TMS. Interestingly, we also observed an increase in intrusive thoughts for the sham condition, suggesting that participants may have developed expectations of improvement and been sensitized to these cognitions when sleep was not improved. These findings are encouraging suggesting that cTBS may improve IT, although preliminary data suggest this may differ between males and females. Support (if any) W81XWH2010173

0066 Continuous Theta Burst Transcranial Magnetic Stimulation for Insomnia and its Effects on Verbal Recall Performance

Abstract Introduction In this project, we studied the efficacy of focused inhibitory stimulation using continuous theta burst stimulation (cTBS) repetitive transcranial magnetic stimulation (rTMS) on an easily accessible region of the default mode network (DMN). As reported elsewhere, we found that cTBS improved brain connectivity and objectively measured sleep. However, there is little known about the side effects of rTMS in the treatment of insomnia, so here we evaluated the effects on verbal memory recall. Methods Twenty adults with clinical insomnia completed this study (Mage=26.90, SD=6.56). Participants conducted two overnight visits during the study; one where they received active cTBS and one where they received a sham cTBS prior to sleep. Participants completed the California Verbal Learning Test (CVLT) before stimulation and again completed the recall portion following a night of laboratory monitored sleep. We analyzed CVLT recall performance with a repeated measures ANOVA with factors of condition (active cTBS vs. sham cTBS) and session (Short Recall, Long Recall, Cued Recall, and Recognition). Results Contrary to our hypothesis, our analyses indicate there was no significant effects on recall performance due to active cTBS. There was no main effect of condition on recall scores post-TMS administration (F(1, 18)=1.162, p=.220, ηp2 = 0.082). There was no interaction effect of active or sham cTBS on recall performance (F(4, 15)=.828, p=.528, ηp2=0.181). Posthoc pairwise comparisons demonstrated that there was no significant difference post-TMS administration between active cTBS and sham cTBS conditions on long recall, cued recall, or recognition (p>.05). There was no significant difference post-TMS administration on short-term recall performance. Participants scored lower on short term recall after receiving active cTBS (M=12.632; SD=2.910) than after sham cTBS administration (M=13.42 ;SD=2.545) (p=.048). Conclusion Compared to sham, active cTBS was not associated with any significant difference in long-term recall performance after TMS administration. While the results demonstrate there are short term effects to recall after administration, recall scores bounce back shortly after. While participants didn’t necessarily improve with active cTBS, it is beneficial to know there are no long-term harmful effects of active cTBS on recall as side effect of insomnia treatment. Support (if any) W81XWH2010173

0186 Continuous Theta Burst Transcranial Magnetic Stimulation and Signal Detection Performance on a Military Go/No-Go Task

Abstract Introduction Repetitive transcranial Magnetic Stimulation (rTMS) is an emerging non-pharmacological treatment method utilized to treat multiple clinical diagnoses to include anxiety, depression, and now insomnia. As part of a larger project, we showed that a single rTMS stimulation with continuous theta burst stimulation (cTBS) to the default mode network (DMN) was associated with improved sleep. However, there is little known about potential effects on attention and vigilance because of cTBS to the DMN. We hypothesized that active cTBS would have no significant impact on signal detection tasks post-TMS administration. Methods Twenty adults with clinical insomnia completed this study (Mage=26.90, SD=6.56). Participants completed two overnight visits in total; one where they received active cTBS and one where they received sham cTBS over an easily accessible node of the DMN (left angular gyrus). We analyzed signal detection performance utilizing a Go-No-Go (GNG) task. Three variables were calculated as a result: hit rate, correct rejection rate, and false alarm rate. Higher scores on hit rate and correct rejection rate indicate higher correct responses. Higher scores on false alarm rate indicates a higher number of incorrect responses. We conducted a repeated measures ANOVA with factors of condition, administration, and reversal. Results There was no main effect of condition on GNG hit rate (F(1,17)=1.365, p=.259, ηp2 =.074), GNG false alarm rate (F(1,17)=.210, p=.091, ηp2 =.244), or GNG correct rejection rate (F(1, 17)=1.677, p=.213, ηp2 =.090). We also found there were no significant interaction effects of TMS condition on performance on reversal conditions for GNG hit rate (F(1,17)=0.45, p=.834, ηp2 =.003), GNG false alarm rate (F(1,17)=1.572, p=.227, ηp2 =.085), or GNG correct rejection rate (F(1, 17)=1.510, p=.236, ηp2 =.082). Posthoc pairwise comparisons demonstrated that participants did not significantly differ on GNG hit rate, false alarm rate, or correct rejection rate between their active cTBS and sham cTBS session (p>.05). Conclusion Active cTBS was not significantly associated with any decline in response inhibition or signal detection. It is helpful for future recipients to know they are not adversely affected in attention or vigilance after receiving cTBS rTMS of the DMN for treatment of insomnia. Support (if any) W81XWH2010173

0649 Sex Differences in the Effects of TMS on Depression

Abstract Introduction As part of a larger study to examine the effects of repetitive transcranial magnetic stimulation (rTMS) over a single node of the default mode network (DMN) on sleep quality, we also examined secondary effects on depression. We hypothesized that rTMS would be more effective in females, rather than males, due to previously established higher rates of depression in the female population. Methods We administered continuous theta burst stimulation (cTBS) rTMS or sham stimulation, in a counterbalanced order separated by at least 5 days, over the left inferior parietal node of the DMN in 20 participants with clinical insomnia, 8 males (Mage=31.6, SD=6.7) and 12 females (Mage=23.8, SD=4.3). Beck Depression Inventory (BDI) scores obtained immediately before and after the stimulation sessions were compared using mixed (condition x time x sex) ANOVA to determine the effectiveness of rTMS in reducing symptoms of depression between the sexes. Results Overall, there was a large effect size (ηp2=0.207, p=0.077) in BDI scores between scores after the sham cTBS TMS session (M=12.47, SD=2.54) and scores after the active cTBS TMS session (M=10.00, SD=2.01). However, when separating for sex, males did not show a statistically significant reduction in depressive symptoms for the active session compared to the sham session (ηp2=0.08, F(1,6)=19.00, p=0.508). While the treatment did not significantly change depressive symptoms in females, large effect size was observed (ηp2=0.261, F(1,7)=18.06, p=0.16), suggesting potential efficacy of the treatment. Post-hoc pairwise comparisons reveal a greater change in depression symptom scores for active vs sham cTBS TMS in women (M=-4.00, SD=2.00), than men (M=-0.71, SD=1.43). Conclusion An intervention using cTBS rTMS to improve sleep also led to a trend toward reduced depression, that was more evident among women. As reported elsewhere, this treatment significantly improved polysomnographic sleep, and the present preliminary results suggest that it may also be useful for modestly improving depressive mood, but further research will be necessary due to the limited sample size. It is not clear whether the trends toward mood among women was due simply to higher baseline depression scores in that group, but the findings suggest that additional work is warranted. Support (if any) W81XWH2010173

(058) Acute Dorsal Genital Neuromodulation can Improve Subjective Arousal: A Pilot Study in Women With and Without Spinal Cord Injury

Abstract Introduction Female sexual dysfunction (FSD) is a potentially life altering condition that impacts an estimated 40% of women. Unfortunately, the few treatment options available have limited success due to adverse events and an inability to improve subjective arousal. One potential treatment option, neuromodulation, has improved female sexual function index (FSFI) scores in small studies. The underlying mechanisms of how neuromodulation may improve FSD are not understood. We hypothesize that neuromodulation provides benefits by increasing genital blood flow. Objective Our primary objective is to determine if a single period of dorsal genital nerve stimulation (DGNS) or tibial nerve stimulation (TNS) directly causes a change in vaginal blood flow (VBF). Our secondary objective is to assess if subjective arousal increases during a single period of DGNS or TNS. These interventions will be compared among three cohorts of women: women with C6–T10 spinal cord injury (SCI), women with FSD (FSFI lubrication sub-score < 4), and able-bodied women without FSD. Methods Participants attended two separate visits, one for each nerve target, randomly ordered and separated by 1–5 months. We are testing two experimental paradigms: without and with erotic audio-visual materials. The first experiments measured vaginal pulse amplitude (VPA) using a vaginal photoplethysmography transducer (VPP) before, during, and after 20 minutes of nerve stimulation. After data processing, we calculated average peak to peak (p2p) amplitudes for each time period and performed an ANOVA and post-hoc pairwise comparisons within each participant. For the second experiment we measured VPA during neutral and erotic videos both without stimulation and with stimulation. In both experiments we measured subjective arousal via a Likert-type scale at 4 timepoints and made comparisons across participants with a paired t-test. The first experiments are complete and data collection for the second experiments is ongoing. Results We recruited three participants in each cohort in the first experiments, with five participants completing both sessions. All participants saw significant changes in their p2p amplitude from before stimulation to after stimulation in DGNS trials (n = 3 increased, n = 4 decreased). Three of five participants had significant p2p increases in TNS trials and one participant had significant decreases. DGNS subject arousal scores increased significantly after stimulation, but TNS scores did not (Figure 1). Most participants reported genital sensations during DGNS (7 of 8) and TNS (3 of 6) sessions. Three participants have completed both visits in the second set of experiments, with similar trends. Conclusions Acute DGNS, but not TNS, increased subjective arousal across all participants. VPA responses to stimulation were heterogeneous and although most changes were significant, there may not be physiological or clinical relevance. It is possible that repeated stimulation sessions over time may enhance changes in VPA. Disclosure No

Electromyographic and mechanomyographic responses of the biceps brachii during concentric and eccentric muscle actions to failure at high and low relative loads.

This study examined neuromuscular responses of the biceps brachii (BB) for concentric and eccentric muscle actions during bilateral, dynamic constant external resistance (DCER), reciprocal forearm flexions and extensions to failure at high (80% 1 repetition maximum [1RM]) and low (30% 1RM) relative loads. Nine women completed 1RM testing and repetitions to failure (RTF) at 30 and 80% 1RM. Electromyographic (EMG) and mechanomyographic (MMG) amplitude (AMP) and mean power frequency (MPF) signals were measured from the BB. Analyses included repeated measures ANOVAs (p < 0.05) and post-hoc pairwise comparisons with Bonferroni corrected alpha of p < 0.008 and p < 0.01 for between and within factor pairwise comparisons, respectively. EMG AMP and MPF were significantly greater for concentric than eccentric muscle actions, regardless of load or time. However, time course of change analysis revealed parallel increases in EMG AMP for concentric and eccentric muscle actions during the RTF trials at 30% 1RM, but no change at 80% 1RM. There were significant increases in MMG AMP during concentric muscle actions, but decreases or no change during eccentric muscle actions. EMG and MMG MPF decreased over time, regardless of muscle action type and loading condition. The greater EMG AMP and MPF values during concentric compared to eccentric muscle actions may reflect the difference in the efficiency characteristic of these muscle actions. The neuromuscular responses suggested that fatigue may be mediated by recruitment of additional motor units with lower firing rates during concentric muscle actions, and changes in motor unit synchronization during eccentric muscle actions.

Neurocognitive effects of subanesthetic serial ketamine infusions in treatment resistant depression

IntroductionKetamine treatment prompts a rapid antidepressant response in treatment-resistant depression (TRD). We performed an exploratory investigation of how ketamine treatment in TRD affects different cognitive domains and relates to antidepressant response. MethodsPatients with TRD (N = 66; 30 M/35F; age = 39.5 ± 11.1 years) received four ketamine infusions (0.5 mg/kg). Neurocognitive function and depressive symptoms were assessed at baseline, 24 h after the first and fourth ketamine infusion, and 5 weeks following end of treatment. Mixed effect models tested for changes in seven neurocognitive domains and antidepressant response, with post-hoc pairwise comparisons between timepoints, including follow-up. Relationships between change in neurocognitive function and antidepressant response over the course of treatment were tested with Pearson's correlation and mediation analyses. Associations between baseline neurocognitive performance and antidepressant response were tested with Pearson's correlation. ResultsSignificant improvements in inhibition, working memory, processing speed, and overall fluid cognition were observed after the first and fourth ketamine infusion. Improvements in processing speed and overall fluid cognition persisted through follow-up. Significant improvements in depressive symptoms reverted towards baseline at follow-up. Baseline working memory and change in inhibition were moderately correlated with antidepressant response, however, improvements in neurocognitive performance were statistically independent from antidepressant response. ConclusionAntidepressant ketamine leads to improved neurocognitive function, which persist for at least 5 weeks. Neurocognitive improvements observed appear independent of antidepressant response, suggesting ketamine may target overlapping but distinct functional brain systems.LimitationsResearch investigating repeated serial ketamine treatments is important to determine cognitive safety. This study is a naturalistic design and does not include placebo.

Beyond Dimorphism: Body Size Variation Among Adult Orangutans Is Not Dichotomous by Sex.

Among extant great apes, orangutans are considered the most sexually dimorphic in body size. However, the expression of sexual dimorphism in orangutans is more complex than simply males being larger than females. At sexual maturity, some male orangutans develop cheek pads (flanges), while other males remain unflanged even after becoming reproductively capable. Sometimes flange development is delayed in otherwise sexually mature males for a few years. In other cases, flange development is delayed for many years or decades, with some males even spending their entire lifespan as unflanged adults. Thus, unflanged males of various chronological ages can be mistakenly identified as "subadults." Unflanged adult males are typically described as "female-sized," but this may simply reflect the fact that unflanged male body size has only ever been measured in peri-pubescent individuals. In this study, we measured the skeletons of 111 wild adult orangutans (Pongo spp.), including 20 unflanged males, 45 flanged males, and 46 females, resulting in the largest skeletal sample of unflanged males yet studied. We assessed long bone lengths (as a proxy for stature) for all 111 individuals and recorded weights-at-death, femoral head diameters, bi-iliac breadths, and long bone cross-sectional areas (CSA) (as proxies for mass) for 27 of these individuals, including seven flanged males, three adult confirmed-unflanged males, and three young adult likely-unflanged males. ANOVA and Kruskal-Wallis tests with Tukey and Dunn post-hoc pairwise comparisons, respectively, showed that body sizes for young adult unflanged males are similar to those of the adult females in the sample (all P≥0.09 except bi-iliac breadth), whereas body sizes for adult unflanged males ranged between those of adult flanged males and adult females for several measurements (all P<0.001). Thus, sexually mature male orangutans exhibit body sizes that range from the female end of the spectrum to the flanged male end of the spectrum. These results exemplify that the term "sexual dimorphism" fails to capture the full range of variation in adult orangutan body size. By including adult unflanged males in analyses of body size and other aspects of morphology, not as aberrations but as an expected part of orangutan variation, we may begin to shift the way that we think about features typically considered dichotomous according to biological sex.

Effect of translucency of CAD-CAM ceramic restorative materials and scanning aid conditions on the accuracy of intraoral scans

Background/purposeSubsurface scattering from translucent material would affect the digital scans. This study aimed to evaluate the effect of translucency of ceramic restorative materials and scanning aid conditions on the accuracy of intraoral scans. Materials and methodsIdentical anatomic contour crowns with ten ceramic restorative materials were fabricated: five zirconia, three lithium disilicate glass-ceramic, and two leucite reinforced glass-ceramic. The models with ceramic crowns were digitized with an intraoral scanner (IOS) and analyzed for accuracy (n = 10) with and without a scanning aid. Scan time efficiency was recorded. Square-shaped specimens with 1.0-mm thickness were fabricated with the same materials, and translucency parameter (TP) values were measured. One-way ANOVA, Welch ANOVA, and a post-hoc pairwise comparison or independent t-test were used for trueness and time analysis, and the F-test was used to examine the precision (α = 0.05). Pearson correlation test was conducted. ResultsSignificant differences were revealed for trueness with no scanning aid condition and for TP values (P < 0.05). In contrast, no statistically significant differences were observed for trueness with a scanning aid. A strong correlation (r = 0.854, P < 0.01) between TP value and trueness with no scanning aid was revealed. By applying a scanning aid, trueness was improved and scan time efficiency significantly increased (P < 0.05). ConclusionThe translucency of ceramic restorative materials negatively affects the accuracy of IOS scan without a scanning aid; however, the scan accuracy and time efficiency of IOS scanning for ceramic restorations can be improved by applying scanning aid, and prostheses with high quality without unnecessary labor can be produced.

Patient and parent perceptions of myopia modalities

Purpose This study compared quality of life (QoL) of myopic adults and children who were established spectacle, soft contact lens (SCL), or orthokeratology (OK) wearers as well as parent/child responses using Pediatric Refractive Error Profile 2 (PREP2). Methods Forty-eight adults (aged 18–26 years), 49 children (aged 9–17 years), and the children’s parent, completed PREP2, with 7 subscales (symptoms, vision, activities, appearance, peer perception, handling, and overall). Adults and children must have worn their correction for at least three years. Parents were asked to answer how they thought their child would answer. Scores were compared between age groups, among correction groups, and between children and their parents using non-parametric ANOVA, Mann-Whitney U and Wilcoxon Signed-Rank tests, as appropriate. Post-hoc pairwise comparisons among correction groups were conducted with Bonferroni adjustment. Results Average age of adults was 22 ± 2 and children was 14 ± 2 years, and duration of correction use was 8 ± 3 for adults and 5 ± 2 years for children (both p < 0.01). Adult OK wearers were more satisfied with vision (p = 0.04), activities (p < 0.001) and overall (p = 0.03) compared to spectacle wearers. Children OK wearers reported higher scores for activities than SCL (p = 0.048) and spectacle wearers (p < 0.001). Parents of contact lens wearers reported higher perceived QoL for activities (OK p < 0.001; SCL p = 0.02), handling (OK p = 0.02; SCL p < 0.001), appearance (SCL p = 0.001), and overall (OK p = 0.001; SCL p < 0.001) subscales than parents of child spectacle wearers. Conclusion Activity-driven children and adults perceive significant benefits from OK over spectacles. Parents’ perceptions did not align with their children’s perceptions of their correction.

Motion-Tracking Brillouin Microscopy Evaluation of Normal, Keratoconic, and Post–Laser Vision Correction Corneas

To characterize focal biomechanical differences between normal, keratoconic, and post-laser vision correction corneas using motion tracking Brillouin microscopy. Prospective cross-sectional study METHODS: Thirty eyes from 30 patients (10 normal controls (Controls), 10 post-laser vision correction (LVC), 10 stage I or II keratoconus (KC)) had Scheimpflug and motion tracking Brillouin microscopy imaging using a custom-built device. Mean, Maximum (Max), and Minimum (Min) Brillouin shift, Spatial standard deviation (SSD), and Max-Min values were compared. Min values were correlated with local Brillouin values at multiple Scheimpflug imaging locations. Mean (p<0.0003), Min (p<0.00001), SSD (p<0.01), and Max-Min (p<0.001) were significantly different between groups. In post-hoc pairwise comparisons, the best differentiators for group comparisons were Mean (p = 0.0004) and Min (0.000002) for Controls vs. KC, Min (p = 0.0022) and Max-Min (p = 0.002) for Controls vs. LVC, and Mean (p = 0.0037) and Min (p = 0.0043) for LVC vs. KC. Min (AUROC = 1.0) and Mean (AUROC = 0.96) performed well in differentiating Control and KC eyes. Min values correlated best with Brillouin shift values the thinnest point (r2 = 0.871, P=0.001) and K Max Tangential (r2 = 0.840, p = 0.002) locations. Motion tracking Brillouin microscopy effectively characterized focal corneal biomechanical alterations in LVC and keratoconus and clearly differentiated these groups from controls. Primary motion tracking Brillouin metrics performed well in differentiating groups as compared with basic Scheimpflug metrics, in contrast to previous Brillouin studies, and identified focal changes after LVC where prior Brillouin studies did not.

Analysing the physical output of international field hockey players through the lens of the phase of play

The purpose of this study was to describe the locomotor activity of men's hockey based on the phase of play and to identify if differences in locomotor activity exist between phases. Twenty-four players (age 26 ± 4) wore a 10 Hz Global Positioning System device to track locomotor activity during 10 international matches. The locomotor activity of players was allocated to five different phases: (1) established attack, (2) opposition counterattack, (3) established defence, (4) attacking counterattack and (5) offensive pressing, utilising a video analysis-based system. Linear mixed models and post-hoc pairwise comparisons, using estimated marginal means, were utilised to compare the locomotor activity in each phase of play within each position. Significant main effects were found for the phase of play on several locomotor activity metrics ( p ≤ 0.05). With respect to max speed and relative total distance across positions, counterattacks present a unique challenge compared to other phases. Established attack phases evoke lower max speed values than offensive pressing phases for all playing positions as well as compared to opposition counterattacks for defenders, midfielders, and forwards. Positional differences existed during attacking counterattack phases, with defenders producing lower values than both midfielders and forwards for high-speed running, high-speed running efforts, max speed and relative total distance. Depending on the metric, this approach captured 22%–70% of a player's locomotor activity providing valuable insight into the current dynamics of international hockey. This investigation demonstrated positional differences based on the phase of play, which may explain previous research findings regarding positional differences.

Randomised, prospective, blinded, clinical trial of opioid-free injectable anaesthesia with or without multimodal analgesia in kittens undergoing ovariohysterectomy.

This study compared an opioid-free injectable anaesthetic protocol with or without multimodal analgesia in kittens undergoing ovariohysterectomy. In this prospective, randomised, blinded, clinical trial, 29 healthy kittens (mean ± SD weight 1.55 ± 0.46 kg; aged 10 weeks to 6 months) were included. Anaesthesia was performed with an intramuscular injection of ketamine (4 mg/kg), dexmedetomidine (40 μg/kg) and midazolam (0.25 mg/kg). In the multimodal group (MMG), cats (n = 14) received meloxicam (0.1 mg/kg SC) and intraperitoneal bupivacaine 0.25% (2 mg/kg), whereas the same volume of saline was administered in the control group (CG; n = 15). Atipamezole (0.4 mg/kg IM) was given 15 mins after ovariohysterectomy. Postoperative pain was assessed using the UNESP-Botucatu multidimensional feline pain assessment scale - short form. Rescue analgesia (buprenorphine 0.02 mg/kg IM in MMG/CG and meloxicam 0.1 mg/kg SC in CG) was administered if pain scores were ⩾4/12. Soft food intake (after 2 and 60 mins) was evaluated at specific time points postoperatively. Statistical analyses were performed with linear models and post-hoc pairwise comparison with Benjamini-Hochberg corrections (P <0.05). The prevalence of rescue analgesia was higher in the CG (n = 15/15) than the MMG (n = 1/14; P <0.001). Pain scores at 1 h, 2 h and 4 h postoperatively were higher in the CG (4.1 ± 2.8, 4.8 ± 3.0 and 5.3 ± 1.2, respectively) than in the MMG (1.6 ± 1.0, 1.1 ± 1.0 and 0.9 ± 0.8, respectively; P <0.001). Food intake (%) at 1 h postoperatively was higher in the MMG after 2 and 60 mins (10.4 ± 9 and 71.9 ± 29, respectively) than in the CG (1.4 ± 2 and 13.9 ± 7, respectively; P <0.001). This opioid-free protocol using multimodal analgesia produced adequate postoperative pain relief, while almost eliminating the need for rescue analgesia in kittens undergoing ovariohysterectomy. Pain decreased food intake.

Excessive Erythrocytosis Is Not Associated With Altered Iron Homeostasis in Men From the World's Highest City.

Excessive Erythrocytosis Is Not Associated With Altered Iron Homeostasis in Men From the World's Highest City.

Lower Extremity Support Moment and Distribution of Joint Moments during Sloped Running

The existing literature often exhibits inconsistent findings regarding lower extremity kinetics during sloped running, likely due to high variability of typical individual joint moments between and within runners. A better understanding of the kinetic effects of sloped running may be achieved by comparing the support moment and joint contributions among level, upslope, and downslope running. Twenty recreational runners (10 females) ran on three different conditions (level, 6° upslope and 6° downslope). Total support moment and joint contributions of the hip, knee, and ankle joints were compared among the three slope conditions using a one-way ANOVA with repeated measures and post-hoc pairwise comparisons. Our results showed that peak total support moment was highest during upslope running and was lowest during downslope running. The joint contribution to total support moment was similar in upslope and level running where the ankle joint has highest contribution followed by the knee and hip joints. During downslope running, highest knee joint contribution but least ankle and hip joint contributions were found when compared to level and upslope running.

Comparison of external load indicators between official matches and sport-specific training in semi-professional soccer players: focus on intensity and strength.

The aim of this study was to investigate any differences in External Load indicators (ELi) between Official Matches (OM) and sport-specific tasks in semi-professional soccer players. 1932 observations among 28 semi-professional soccer players (FC Palermo, Italy, age: 25±6 years, height: 183±6 cm, weight: 75.2±7 kg) were collected through GPS devices (Qstarz BT-Q1000EX, 10 Hz) and the related software (LaGalaColli V: 8.6.4.3) during the season 2019-2020. Participants were monitored during OM, Friendly Matches (FM), Small Sided Games (SSG), and Match-Based Exercises (MBE), considering the percentage of intense accelerations (%int acc), percentage of intense decelerations (%int dec), and Passive Recovery time /min (PrT/m) as Eli. We detected the highest mean value for PrT/m in OM and the lowest in MBE and SSG (18.36±4.38 and 13.4±5.26 and 13.4±4.29 (s/min), respectively). The lowest mean values of %int acc and %int dec were found in OM and the highest in SSG (8.64±1.52 vs 13.02±3.14 and 9.25±1.56 vs 15.68±3.14, for %int acc and %int dec, respectively). Significant differences between the four tasks for all the ELi considered (p<0.001). The posthoc pairwise comparisons revealed significant differences for all the ELi between all tasks (p<0.001) except for the %int acc between MBE vs FM (p=0.003). No significant difference was found in PrT/m between MBE vs FM and SSG vs FM. ELi are in accordance with the performance model by achieving better values in training than OM, suggesting the fundamental role of GPS for monitoring external load in soccer.