Test Performance Research Articles

Intra- and Post-procedural Patient-reported Experience Measures and their Correlation with post-ERCP Adverse Events and Unplanned Healthcare Utilization

Background and Study Aims Post-endoscopic retrograde cholangiopancreatography (ERCP) adverse events (AEs) are common, as is unplanned healthcare utilization (UHU). We aimed to elucidate potential associations between intra- and post-procedural patient-reported experience measures (PREMs) and post-ERCP AEs and UHU. Patients and Methods Prospective data from a multi-center collaborative were used. A validated 0-10 Likert-based PREM assessing intra- and post-procedural symptoms was applied to patients following ERCP and protocolized follow-up was performed at 30 days to identify AEs and UHU for reasons not meeting the definitions of any AE. Multivariable logistic regression was conducted using PREM domains as exposures and individual AEs and UHU as outcomes, with a priori selected patient- and procedure-related covariates. Test performance characteristics and odds ratios (ORs) and 95% confidence intervals (95% CIs) for each PREM domain were reported. Results From September 2018 through October 2023, 3,434 ERCPs were included. Post-procedural abdominal pain of >3 was predictive of pancreatitis (OR 3.71, 2.37-5.73), while a score >6 was strongly predictive of perforation (OR 9.54, 1.10-59.37). Post-procedural pain was also predictive of UHU within 30 days when used as a continuous predictor (OR 1.08 per point, 1.01-1.16). Post-procedural pain of >6 demonstrated high negative predictive values and specificities for post-ERCP AEs. Conclusions Patient-reported symptom scores from a simple Likert-based PREM at the time of discharge from ERCP are associated with presentations for pancreatitis, perforation, and UHU within 30 days. Applying PREMs post-ERCP could potentially prevent UHU and/or facilitate earlier management and improved outcomes for patients with post-ERCP AEs.

EXPRESS: Pure-tone audiometry and dichotic listening in primary progressive aphasia and Alzheimer's disease

Hearing is multifaceted and the relative contributions of peripheral and central hearing loss are rarely considered together in the context of dementia. Here, we assessed peripheral (as measured with pure-tone audiometry) and central (as measured with dichotic listening) hearing in 19 patients with typical amnestic Alzheimer’s disease (tAD), 10 patients with logopenic variant primary progressive aphasia (lvPPA), 11 patients with nonfluent/agrammatic variant PPA (nfvPPA), 15 patients with semantic variant PPA (svPPA), and 28 healthy age-matched individuals. Participants also underwent neuropsychological assessment and magnetic resonance image scanning, allowing us to use voxel-based morphometry to assess associations between hearing scores and grey matter volume. Dichotic listening was impaired in all patient groups relative to healthy controls. In the combined patient (but not healthy control) cohort, dichotic listening scores were significantly correlated with measures of global cognitive functioning and speech-based neuropsychological tasks. Pure-tone audiometry scores were not significantly elevated in any patient group relative to the healthy control group, and no significant correlations were observed between peripheral hearing and neuropsychological task performance in either the combined patient or healthy control cohorts. Neuroanatomically, dichotic listening performance was associated with grey matter volume in a bilateral fronto-temporo-parietal network over the combined patient cohort, but no correlates were identified for pure-tone audiometry. Our findings highlight the importance of speech parsing mechanisms beyond elementary sound detection in driving cognitive test performance, underline the importance of assessing central hearing alongside peripheral hearing in people with dementia, and further delineate the complex auditory profiles of neurodegenerative dementias.

Repeat Faecal Immunochemical Testing for Colorectal Cancer Detection in Symptomatic and Screening Patients: A Systematic Review and Meta-Analysis.

Faecal immunochemical testing (FIT) is widely used in bowel screening programmes and assessing symptomatic patients for suspected colorectal cancer (CRC). The evidence for single test performance of FIT in both settings is considerable; however, the use of a repeat test to increase sensitivity remains uncertain. We aimed to review what increase in test positivity would be generated by additional FITs, whether a repeated FIT detects previously missed CRC and advanced colorectal neoplasia (ACRN), and to estimate the sensitivity of double-FIT strategies to diagnose CRC and ACRN. A systematic search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) was performed using key search terms. Studies reporting the use of more than one FIT in the same screening round or planned assessment of a single symptomatic patient episode were included. Studies were categorised by the reported study population into asymptomatic, mixed (cohorts of combined asymptomatic, symptomatic, or high-risk surveillance), or symptomatic cohorts. A total of 68 studies were included for analysis (39 asymptomatic, 21 mixed, 7 symptomatic, and 1 study with discrete asymptomatic and symptomatic data). At a threshold of 10 µg Hb/g, the two-test positivity ranged between 8.1 and 34.5%, with an increase from the second test of 3-9.2 percentage points. Four out of five studies comparing one versus two tests for diagnosing CRC at 10 µg Hb/g identified additional cases with the second test, with a minimum of 50% reduction in missed CRC. At a threshold of 20 µg Hb/g, the second test increased the positivity by 1.3-6.7 percentage points, with a two-test positivity of between 5.1 and 25.0%. Using a threshold of 20 µg Hb/g, five out of seven studies had a 25% reduction in missed CRC. A meta-analysis estimated the double-FIT sensitivity at 10 µg Hb/g for CRC in mixed-risk and symptomatic cohorts to be 94% and 98%, respectively. Repeated use of FIT helps to diagnose more cases of CRC with a moderate increase in positivity. A double-FIT strategy at 10 µg Hb/g in mixed and symptomatic cohorts has a very high sensitivity for CRC.

Diagnostic Accuracy of Circulating Tumor HPV DNA Testing in Patients With a Lateral Neck Mass

The most frequent presenting symptom for patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a lateral neck mass. Circulating tumor tissue-modified viral (TTMV)-HPV DNA is a unique biomarker produced by the fragmentation of HPV DNA during the degradation of HPV-associated tumors, and its detection and quantitation are currently being used as an adjunct to imaging in monitoring for disease recurrence and may have utility for diagnosis. To measure the diagnostic characteristics of TTMV-HPV DNA compared with gold standard tissue biopsy for diagnosing HPV-OPSCC in patients presenting with an indeterminate lateral neck mass. This prospective diagnostic test study enrolled patients 18 years or older who presented with a lateral neck mass to a large urban tertiary health care system from December 2021 to June 2023. Participants underwent standard-of-care testing to obtain a tissue diagnosis and a single TTMV-HPV DNA measurement. The primary outcome of interest was sensitivity, while specificity, positive predictive value, and negative predictive value were secondary end points. A subset analysis was performed comparing test performance metrics between TTMV-HPV DNA testing and fine-needle aspiration. A total of 138 patients were included, of whom 80 (58.0%) were men, with median age of 57.5 years (IQR, 43.3-67.0 years). Of 138 patients, 87 (63.0%) had neck masses in level 2 and 47 (34.1%) had HPV-OPSCC. TTMV-HPV DNA testing exhibited a sensitivity of 95.7% (95% CI, 85.5%-99.5% [45 of 47 patients]), specificity of 97.8% (95% CI, 92.3%-99.7% [89 of 91 patients]), positive predictive value of 95.7% (95% CI, 85.5%-99.5% [45 of 47 patients]), and negative predictive value of 97.8% (95% CI, 92.3%-99.7% [89 of 91 patients]). In this diagnostic study of patients presenting with a lateral neck mass, circulating TTMV-HPV DNA demonstrated excellent diagnostic test characteristics for the detection of HPV-OPSCC. Such testing may have particular utility for patients in whom obtaining adequate tissue is problematic, as is often the case with cystic neck masses and unknown primary tumors.

Facial emotion recognition in children with attention deficit hyperactivity disorder

Objective Attention Deficit Hyperactivity Disorder (ADHD) is defined as a persistent pattern of inattention and hyperactivity-impulsivity that interferes with functioning anofd development. Increased emotional reactivity and impaired emotion regulation are established findings in children with ADHD. Impairments in executive functions such as impulse control and working memory, in turn, have also been suggested to have a negative effect on emotion recognition. However, studies exploring suspected deficits in the ability to recognise facial emotions in ADHD have to date yielded controversial results. We sought to clarify the mechanism of possible emotion recognition dysfunction in children with ADHD. Methods Sixty-one children diagnosed with ADHD (aged 10.36 ± 1.89 years) and a control group (N = 78; aged 9.6 ± 1.8 years) were evaluated with questionnaires and computerized tests for cognitive and facial emotion recognition capacity. Results The ADHD group displayed more behavioural issues and performed worse in cognitive tests compared to the control group. Group status (i.e. ADHD vs. control group) did not predict facial emotion recognition when controlled for age, IQ and sex in linear regression models. Performance in Divided Attention predicted facial emotion recognition in linear regression in the ADHD group. Conclusions Individuals with ADHD showed facial emotion recognition capacity similar to a typically developing control group. Good performance in a cognitive test assessing divided attention predicted capacity for facial emotion recognition, but only in the ADHD group.

Effects of Caffeinated Chewing Gum on Ice Hockey Performance after Jet Lag Intervention: Double-Blind Crossover Trial.

The purpose of this study was to examine the impact of caffeinated chewing gum on the physical performance of elite ice hockey players after a jet lag intervention. Fourteen national-level (age: 25.2 ± 5.4; height: 176.5 ± 5.3; weight: 78.1 ± 13.4) ice hockey players were tested late at night after a full day awake schedule with jet lag. A randomised, double-blind experimental design was employed in which participants either chewed caffeinated gum (CAF) containing 3 mg/kg caffeine or a caffeine-free placebo gum (PLA) for 10 min prior to undertaking a series of on-ice and off-ice tests. The off-ice tests included grip force, the counter-movement jump (CMJ), and the squat jump (SJ). The on-ice tests included a 35 m sprint, the S-Shape agility test, and the Yo-Yo intermittent recovery test (Yo-Yo IR1 test). The CMJ height (CAF: 47.2 ± 4.4; PL: 45.9 ± 3.5; p = 0.035; Cohen's d = 0.32) and SJ height (CAF: 46.7 ± 4.1; PL: 44.9 ± 3.8; p = 0.047; Cohen's d = 0.44) were found to be significantly higher in the CAF than in the PL trial. However, there were no significant differences (p > 0.05) in grip force, as well as in the 35 m sprint, the S-Shape agility test, and the Yo-Yo IR1 test. The present study found that, following a jet lag intervention, although the consumption of caffeinated gum resulted in an increase in vertical jump height, it had no impact on performance in the ice tests. The results of this study may help coaches and athletes consider the need for caffeine supplementation when experiencing jet lag.

Internalizing and somatic symptoms influence the discrepancy between subjective and objective cognitive difficulties in adults with ADHD who have valid and invalid test scores.

This study investigated the relationship between various intrapersonal factors and the discrepancy between subjective and objective cognitive difficulties in adults with attention-deficit hyperactivity disorder (ADHD). The first aim was to examine these associations in patients with valid cognitive symptom reporting. The next aim was to investigate the same associations in patients with invalid scores on tests of cognitive symptom overreporting. The sample comprised 154 adults who underwent a neuropsychological evaluation for ADHD. Patients were divided into groups based on whether they had valid cognitive symptom reporting and valid test performance (n = 117) or invalid cognitive symptom overreporting but valid test performance (n = 37). Scores from multiple symptom and performance validity tests were used to group patients. Using patients' scores from a cognitive concerns self-report measure and composite index of objective performance tests, we created a subjective-objective discrepancy index to quantify the extent of cognitive concerns that exceeded difficulties on objective testing. Various measures were used to assess intrapersonal factors thought to influence the subjective-objective cognitive discrepancy, including demographics, estimated premorbid intellectual ability, internalizing symptoms, somatic symptoms, and perceived social support. Patients reported greater cognitive difficulties on subjective measures than observed on objective testing. The discrepancy between subjective and objective scores was most strongly associated with internalizing and somatic symptoms. These associations were observed in both validity groups. Subjective cognitive concerns may be more indicative of the extent of internalizing and somatic symptoms than actual cognitive impairment in adults with ADHD, regardless if they have valid scores on cognitive symptom overreporting tests.

The S in STEM: gender differences in science anxiety and its relations with science test performance-related variables

BackgroundSTEM education has experienced significant growth due to its pivotal role in innovation and economic development. While cognitive factors like prior knowledge are known predictors of STEM success, non-cognitive factors, including attitudes and demographics, also play vital roles. However, there is a notable scarcity of research focusing on the "S" in STEM—science—compared to extensive studies in fields like mathematics. This study aims to address this gap by exploring gender differences in science test performance and related attitudes, providing insights into this under-researched aspect of STEM education.ResultsThe effective sample comprised 1839 Estonian 12th-grade students who took a computer-assisted science test. The test consisted of tasks combining chemistry, physics, biology, and geography, and a post-test survey was also administered. Across the total sample, the results showed that test performance positively correlated with test-taking duration, effort, and test importance. Test performance was negatively correlated with perceived test difficulty. Interestingly, while general science anxiety was not associated with test performance, subject-specific anxiety, especially chemistry anxiety had a negative association with test performance. While there were no gender differences in test performance, female students scored consistently higher on all science anxiety measures, compared to male students. Furthermore, female students assessed the science test to be more difficult, and they also took more time to complete the test. The correlations in gender subsamples mirrored those observed in the total sample.ConclusionsThe association between science test performance and test-related variables is nuanced: students might not necessarily have a “general” STEM anxiety but it may be associated with a specific subject. Moreover, the findings imply that although there are no gender differences in test performance, girls have a greater anxiety when it comes to natural sciences subjects. These findings indicate the need for investigating the origin of such anxieties, which do not seem to stem from aptitude.

Testosterone and resistance training improved physical performance and reduced fatigue in frail older men: 1 year follow-up of a randomized clinicaltrial.

To improve health conditions among hypogonadal men ≥70 years of age using testosterone undecanoate (TU) injections, progressive strength training, and oral supplements of vitamin D, calcium, and protein. This study is a 1-year follow-up of a double-blind RCT lasting 20 weeks, including 148 older men ≥70 years old with low testosterone levels and mobility problems. During 52 weeks, 4 groups received either testosterone therapy (TU) or progressive resistance training (Training), both (Combo), or no intervention (Controls). Physiotherapists supported the training groups until week 20, while these participants continued trained on their own during weeks 21 to 52. The main outcome measure was the 30-s chair stand test. The following numbers of participants completed the trial: 20 (Combo), 20 (Controls), 24 (TU), and 14 (Training). When examining 30-s chair stand test performance within each group at baseline, and at weeks 4, 20 and 52, only the Combo group improved (p = 0.001, Friedman Test). Compared to controls, only the Combo group experienced reduced fatigue and tiredness (p < 0.05). Fifty-two weeks of testosterone supplementation combined with progressive resistance training may enhance physical performance, alleviate fatigue, and had no notable detrimental impacts among males aged ≥70 suffering from mobility issues and testosterone insufficiency.Trial registration - Clinical Trials NCT02873559.

Mayo Normative Studies: regression-based normative data for remote self-administration of the Stricker Learning Span, Symbols Test and Mayo Test Drive Screening Battery Composite and validation in individuals with Mild Cognitive Impairment and dementia.

Few normative data for unsupervised, remotely-administered computerized cognitive measures are available. We examined variables to include in normative models for Mayo Test Drive (a multi-device remote cognitive assessment platform) measures, developed normative data, and validated the norms. 1240 Cognitively Unimpaired (CU) adults ages 32-100-years (96% white) from the Mayo Clinic Study of Aging and Mayo Alzheimer's Disease Research Center with Clinical Dementia Rating® of 0 were included. We converted raw scores to normalized scaled scores and derived regression-based normative data adjusting for age, age2, sex and education (base model); alternative norms are also provided (age+age2+sex; age+age2). We assessed additional terms using an a priori cut-off of 1% variance improvement above the base model. We examined low test performance rates (<-1 standard deviation) in independent validation samples (n=167 CU, n=64 mild cognitive impairment (MCI), n=14 dementia). Rates were significantly different when 95% confidence intervals (CI) did not include the expected 14.7% base rate. No model terms met the a priori cut-off beyond the base model, including device type, response input source (e.g., mouse, etc.) or session interference. Norms showed expected low performance rates in CU and greater rates of low performance in MCI and dementia in independent validation samples. Typical normative models appear appropriate for remote self-administered MTD measures and are sensitive to cognitive impairment. Device type and response input source did not explain enough variance for inclusion in normative models but are important for individual-level interpretation. Future work will increase inclusion of individuals from under-represented groups.

Sleep restriction and age effects on distinct aspects of cognition in adolescents.

Insufficient sleep negatively impacts scholastic performance in children and adolescents. Here we use a dose response time in bed (TIB) restriction study to evaluate associations between sleep loss and multiple aspects of cognition. We evaluated changes in cognitive measures across ages 10 to 23 years and determined whether the effects of sleep loss changed across this age range. A younger cohort (n=77, age range 9.9 to 16.2 years) was studied annually for 3 years. An older cohort study (n=82, age range 15 to 22.8 years) was interrupted by the COVID pandemic with 25 participants completing multiple years. Annually participants completed each of three TIB conditions: four consecutive nights with 7, 8.5, or 10h in bed. A day of cognitive testing followed the fourth night. Restricting TIB to 7h was associated with impaired top-down attentional control and cognitive flexibility, but performance did not differ between the 8.5 and 10h TIB conditions. Psychomotor vigilance test performance decreased as TIB was restricted from 10 to 8.5h and decreased further with restriction to 7h. Sternberg test measures of working memory were not significantly affected by TIB restriction. The effects of sleep loss on these cognitive measures did not change significantly with age, but age-related improvement in many of the measures may compensate for some sleep loss effects. The findings here do not indicate an adolescent decrease in sleep need; however, the minimal duration of sleep needed for optimal performance appears to differ depending on the cognitive measure.

A - 79 Comparison of Neuropsychological Test Performance between Monolingual Older Adults with Varying Cognitive Profiles

Abstract Objective With the rapid aging and cultural differences of the Latinx population, psychologists have expressed concerns regarding neuropsychological evaluations used for Alzheimer’s disease (ad), including the appropriateness of normative data and misinterpretation of test scores. This study explores various facets of neuropsychological performance between Spanish and English-speaking older adults with ad or normal cognition (NC). Method Participants (N = 17,716) from a de-identified database from the National Alzheimer’s’ Coordinating Center were administered Boston Naming Test-30 items (BNT-30), Animal &amp; Vegetable Verbal Fluency, Digit Symbol, Mini-Mental Status Examination (MMSE), Logical Memory I &amp; II (LM-I &amp; II), and Trail Making Test A &amp; B (TMT-A &amp; B). Correlations, multiple linear hierarchical regressions, and two-factor Analyses of Variance (ANOVAs) were used. Results Significant associations between interest areas (e.g., sex, ethnicity, race, age, education level, and/or age of cognitive onset) and test performances were found in each diagnosis group. Primary language, education level, and diagnosis were found to be significant predictors of LM-I (f2 = 0.19), LM-II (f2 = 0.22), and TMT-B (f2 = 0.15) performance. Significant interactions of primary language and diagnosis group were found among test performances for the MMSE, LM-II, Animals Verbal Fluency, TMT-A, and TMT-B (p &amp;lt; 0.05). Conclusions Further research is warranted to understand the complexity of using neuropsychological assessments to detect ad-related deficits among Spanish-speaking Latinx individuals. Evidence-based neuropsychological practice guidelines must acknowledge the importance of education level and primary language on test performance.

Smile stimuli induce better performance in tests performed by children and adolescents practicing jiu-jitsu

Aims: This study compared the performance of children and adolescents practicing jiu-jitsu when stimulated or not stimulated to smile before specific and non-specific physical tests. Methods: 268 children and adolescents (male=168) were measured in 5 tests (30” by 3’ interval) of which 3 were specific (4-Leg Exercise, Gyaku-tsuki test and O-soto-otoshi nage-komi test) and 2 non-specific (Side jumps and Burpees). These tests were carried out under two conditions: a) without prior stimuli; b) after joy stimuli. Results: There was an isolated effect of the pre-test intervention for non-specific tests, with better performance after joy stimuli (Side jumps: 35.8±13.3 vs. 30.1±11.1; Burpees: 16.1±5 .3 vs. 13.8±4.8 repetitions; p≤0.001 for both comparisons). There were also isolated effects of the pre-test intervention for the specific O-soto-otoshi nage-komi test and 4-Leg Exercise, where happiness stimuli resulted in better performance (O-soto-otoshi nage-komi test: 15.2±3.5 vs. 12.5 ± 3.7 repetitions; 4-Leg Exercise: 3.5±1.2 vs. 2.8±1.2 repetitions p≤0.001 for both comparisons). For the Gyaku-tsuki test, there was an interaction effect between intervention and age (p=0.02), where older children performed better. Conclusion: Stimulating emotions of happiness brings better performance in children and adolescents practicing jiu-jitsu regardless of gender and age, except for the Gyaku-tsuki test where older people tend to perform better. Keywords: martial arts, emotion, children, adolescent, performance.

A - 70 Contextualizing Racial/Ethnic Differences in Baseline Assessment among Collegiate Athletes

Abstract Objective Compared to other factors that influence neuropsychological test performance, few studies have examined the relationship between racial/ethnic identity and baseline assessment performance in collegiate athletes, and even fewer have contextualized results using structural factors linked to test performance (e.g., premorbid cognitive ability). This study examined racial/ethnic differences in baseline assessment performance before and after controlling for premorbid functioning. We hypothesized that there would be racial/ethnic differences in performance but that controlling for premorbid functioning would reduce these differences. Method Participants included 875 collegiate athletes who were grouped based on racial/ethnic identity (White = 661, Black = 165, Another Race = 49) and underwent a comprehensive neuropsychological battery. Cognitive composite scores and intraindividual variability (IIV) were calculated for two neurocognitive domains: attention/processing speed and memory. Premorbid functioning was assessed with the Wechsler Test of Adult Reading (WTAR). ANCOVAs were used to examine racial/ethnic differences in these four cognitive domains before and after controlling for WTAR scores. Results Before controlling for WTAR scores, there were significant racial/ethnic differences in the attention/processing speed and memory composite scores and in attention/processing speed IIV, p’s &amp;lt; 0.001, ηp2 = 0.02–0.03. However, there were no significant racial/ethnic differences in memory IIV, p = 0.97. After controlling for WTAR scores, there were no significant racial/ethnic differences in the attention/processing (p = 0.530, ηp2 = 0.001) or memory (p = 0.183, ηp2 = 0.004) composite scores, and the relationship between racial/ethnic identity and attention/processing speed IIV became less significant (p = 0.014, ηp2 = 0.01). Conclusions Results suggest that racial/ethnic differences at baseline assessment can be largely accounted for by premorbid functioning, which underscores the importance of considering sociocultural context when assessing racially/ethnically diverse athletes.

A combination of case-based learning with flipped classroom improved performance of medical students in nephrology bedside teaching

BackgroundBedside teaching remains a challenging endeavor for clinical doctors and medical students, as the students often encounter difficulties in applying their knowledge to clinical situations. This study aims to evaluate the efficacy of combining case-based learning (CBL) with a flipped classroom (FC) approach in nephrology bedside teaching.MethodsA total of 92 medical students were enrolled in this study, including clerks and interns. The students were assigned into two groups. The CBL/FC group students received the combined teaching approach of CBL and FC (CBL/FC). Students who received the traditional lecture-based teaching (LBT) approach were treated as the control group. General knowledge tests, clinical case scenarios, and questionnaires were used to evaluate the teaching efficacy.ResultsNinety-two students were included in this study. Overall, 46 students were assigned to the CBL/FC group, while the other 46 students were assigned to the LBT group. The students in both groups showed comparable performance in the knowledge test. However, in clinical case scenarios, students in the CBL/FC group demonstrated superior performance compared to those in the LBT group. Additionally, the analysis of questionnaires revealed that the CBL/FC group students expressed more positive attitudes toward their proficiency in medical history taking, physical examination, medical record documentation, clinical reasoning, and consideration for patients’ welfare. Moreover, the students from the CBL/FC group regarded the CBL/FC teaching approach as an effective and satisfying method without increasing the learning burden.ConclusionThis study reveals that the CBL/FC combined teaching approach shows promise in nephrology education and provides an effective and alternative format for medical teaching.

Articulated ankle-foot orthoses associated with home-based task-specific training improve functional mobility in patients with stroke: a randomized clinical trial

ABSTRACT Introduction We compared fixed and articulated ankle-foot orthoses (AFOs) in home-based mobility tasks to assess short-term mobility, dynamic balance, quality of life, anxiety/depression, disability level, stroke severity, autonomy, human functioning, and patient satisfaction. Methods This was a two-arm, parallel-group, randomized controlled trial with concealed allocation, assessor blinding, and a complete case analysis involving patients with chronic stroke. The participants were randomized into two groups: fixed (n = 24) and articulated (n = 23) AFOs. The AFOs were custom-fabricated, and both groups performed four-week home-based mobility tasks five days weekly. Primary outcome measures included changes in balance and mobility assessed using the Tinetti Performance-Oriented Mobility Assessment (POMA), Timed Up and Go (TUG) test, and Functional Ambulation Category (FAC). Secondary outcomes included quality of life, anxiety/depression, disability, stroke severity, autonomy, human functioning, and patient satisfaction. Results In a between-group comparison, after adjusting for age, sex, stroke severity, and thrombolysis, the articulated AFO group showed better performance in the TUG test (p = 0.020; d = 0.93), POMA-Gait (p = 0.001; d = 0.53), POMA-Total (p = 0.048; d = 0.98), and FAC (p = 0.003; d = 1.03) than the fixed AFO group. Moreover, significant difference was noted in human functioning (moving around using equipment)between the groups (p = 0.047; d = 92). Conclusion A program involving home-based mobility tasks and articulated AFOs improved functional mobility after stroke.

Experimental investigation on the mechanical characteristics of ultra-high-molecular-weight polyethylene (UHMWPE) based fiber-reinforced concrete

This study investigates the static and dynamic mechanical properties of ultra-high-molecular-weight polyethylene (UHMWPE) fiber-reinforced concrete (FRC). The properties were assessed by conducting compressive strength, flexural strength, split tensile strength, and impact resistance. The pneumatic dispersion method was used for the UHMWPE fiber pretreatment. The concrete mix was prepared with a water-to-cement ratio of 0.6 and an aggregate fineness modulus of 5.39. UHMWPE fibers, measuring 6 mm and 12 mm in length and incorporated at addition rates of 5 wt‰, 10 wt‰, 15 wt‰, and 20 wt‰ of the fiber-to-cement weight ratio, were added to the concrete specimens for testing. The results showed that the FRC with 12 mm UHMWPE fiber and 15 wt‰ fiber-to-cement weight ratio achieved the best performance in the compressive strength test, and it increase 51.92 % compared with benchmark specimen. For the flexural test results, the 6 mm UHMWPR fiber performed best at a 15 wt‰ addition ratio, and it increase 18.77 % compared with benchmark specimen. Moreover, the FRC with 12 mm UHMWPR fiber excelled at a 20 wt‰ addition ratio in split tensile strength test, and it increase 92.14 % compared with benchmark specimen. The drop weight test indicated that a 15 wt‰ addition ratio with 12 mm UHMWPE fiber significantly enhanced performance, with an average impact number improvement of 5527 % under a 50 Joule impact energy, compared to the benchmark specimens. The study concludes that incorporating UHMWPE fiber into concrete significantly boosts its static and dynamic performance.

BIN1 deficiency enhances ULK3-dependent autophagic flux and reduces dendritic size in mouse hippocampal neurons

ABSTRACT Genome-wide association studies identified variants around the BIN1 (bridging integrator 1) gene locus as prominent risk factors for late-onset Alzheimer disease. In the present study, we decreased the expression of BIN1 in mouse hippocampal neurons to investigate its neuronal function. Bin1 knockdown via RNAi reduced the dendritic arbor size in primary cultured hippocampal neurons as well as in mature Cornu Ammonis 1 excitatory neurons. The AAV-mediated Bin1 RNAi knockdown also generated a significant regional volume loss around the injection sites at the organ level, as revealed by 7-Tesla structural magnetic resonance imaging, and an impaired spatial reference memory performance in the Barnes maze test. Unexpectedly, Bin1 knockdown led to concurrent activation of both macroautophagy/autophagy and MTOR (mechanistic target of rapamycin kinase) complex 1 (MTORC1). Autophagy inhibition with the lysosome inhibitor chloroquine effectively mitigated the Bin1 knockdown-induced dendritic regression. The subsequent molecular studydemonstrated that increased expression of ULK3 (unc-51 like kinase 3), which is MTOR-insensitive, supported autophagosome formation in BIN1 deficiency. Reducing ULK3 activity with SU6668, a receptor tyrosine kinase inhibitor, or decreasing neuronal ULK3 expression through AAV-mediated RNAi, significantly attenuated Bin1 knockdown-induced hippocampal volume loss and spatial memory decline. In Alzheimer disease patients, the major neuronal isoform of BIN1 is specifically reduced. Our work suggests this reduction is probably an important molecular event that increases the autophagy level, which might subsequently promote brain atrophy and cognitive impairment through reducing dendritic structures, and ULK3 is a potential interventional target for relieving these detrimental effects.Abbreviations: AV: adeno-associated virus; Aβ: amyloid-β; ACTB: actin, beta; AD: Alzheimer disease; Aduk: Another Drosophila Unc-51-like kinase; AKT1: thymoma viral proto-oncogene 1; AMPK: AMP-activated protein kinase; AP: autophagosome; BafA1: bafilomycin A1; BDNF: brain derived neurotrophic factor; BIN1: bridging integrator 1; BIN1-iso1: BIN1, isoform 1; CA1: cornu Ammonis 1; CA3: cornu Ammonis 3; CLAP: clathrin and adapter binding; CQ: chloroquine; DMEM: Dulbecco’s modified Eagle medium; EGFP: enhanced green fluorescent protein; GWAS: genome-wide association study; MAP1LC3B/LC3B: microtubule-associated protein 1 light chain 3 beta; MRI: magnetic resonance imaging; MTOR; mechanistic target of rapamycin kinase; MTORC1: MTOR complex 1; PET: positron emission tomography; qRT-PCR: real-time quantitative reverse transcription PCR; ROS: reactive oxygen species; RPS6KB1: ribosomal protein S6 kinase B1; TFEB: transcription factor EB; ULK1: unc-51 like kinase 1; ULK3: unc-51 like kinase 3.

Quantifying the Training Loads and Corresponding Changes in Physical Qualities among Adolescent, Schoolboy Rugby League Players.

The adolescent development period is critical for rugby league athletes, given the physical growth, neuromuscular adaptation, and skill acquisition that occurs. Secondary schools play an important role in the development of adolescent rugby league players; however, players may be selected into rugby league academies and development programs outside of school, as well as participating in additional sports. In turn, the training loads these young athletes accrue and the implications of these loads are currently unknown. Our aim was to quantify the training loads and concomitant changes in physical qualities of schoolboy and adolescent rugby league players during mesocycles within the pre-season and in-season phases. This is a prospective experimental study. Twenty-one schoolboy rugby league players (16.2 ± 1.3 years) were monitored across separate 4-week mesocycles in the pre-season and in-season. Session frequency, duration, and the session rating of perceived exertion (sRPE) load were reported for all examples of training and match participation in the school rugby league program, as well as club and representative teams for any sport and personal strength and conditioning. Various physical qualities were assessed before and after each 4-week mesocycle. The sRPE load that accumulated across the 4-week mesocycles was higher in the pre-season than the in-season (8260 ± 2021 arbitrary units [AU] vs. 6148 ± 980 AU, p < 0.001), with non-significant differences in accumulated session frequency and duration between phases. Session frequency, duration, and sRPE load differed (p < 0.05) between some weeks in an inconsistent manner during the pre-season and in-season mesocycles. Regarding physical qualities, improvements (p < 0.05) in the 10 m sprint test, Multistage Fitness Test, medicine ball throw, and 1-repetition maximum back squat and bench press performances were evident across the pre-season mesocycle, with declines (p < 0.05) in the 505-Agility Test, L-run Test, and 1-repetition maximum back squat performances across the in-season mesocycle. Conclusions: These novel training load data show schoolboy rugby league players experience considerable demands that may be suitable in developing several physical qualities during the pre-season but detrimental to maintaining such qualities across the in-season.

A - 115 Cognitive Predictors of Phosphorylated Skin Nerve α-Synuclein Deposition in Patients with Suspected Synucleinopathy

Abstract Objective Synucleinopathies are a group of neurodegenerative diseases caused by abnormal α-Synuclein aggregates and characterized by motor, autonomic, and cognitive changes, including Parkinson’s disease, Lewy Body disease, and Multiple System Atrophy. Due to variability in presentation, clinical phenotyping is challenging for diagnosis and treatment planning. Phosphorylated α-Synuclein (P-syn) detected in nerve fibers using skin biopsy shows promise in clinical phenotyping of synucleinopathies. However, cognitive predictors of P-syn deposition in synucleinopathies have not been fully explored. This study aimed to examine the utility of cognitive testing in predicting P-syn deposition in a clinical sample. Method A chart review of 52 older adults (Mean age = 72.8 years) referred to an outpatient neurology clinic for a diagnostic dementia workup was conducted. Clinical variables were collected, including skin biopsy (Syn-One) and cognitive test scores (Short Test of Mental Status [STMS]). P-syn was detected in 22 patients (42%) and at 68%, 41%, and 55% of central (neck) and distal (thigh and calf) biopsy sites, respectively. Results Overall cognition (STMS Total) did not significantly differ between patients with (Mean = 30.5) and without (Mean = 29.6) P-syn (p = 0.51). Within the P-syn positive group, STMS Registration-Trials and Calculation scores significantly predicted distally deposited P-syn (F(1,18) = 7.54, p = 0.01). This relationship was more pronounced in the thigh compared to the calf biopsy sites. Conclusion STMS Registration-Trials (immediate recall) and Calculation scores were significantly related to distally deposited P-syn. These findings highlight the importance of how cognitive test performance can potentially impact clinical phenotyping in synucleinopathies. Future research will examine the relationship between cognition, clinical features, and other neurodegenerative disease biomarkers.