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Structural inequality, the uneven distribution of resources and opportunities, influences health outcomes. However, the biological embedding of structural inequality in aging and dementia, especially among underrepresented populations, is unclear. We examined the association between structural inequality (country-level and state-level Gini indices) and brain volume and connectivity in 2,135 healthy controls, and individuals with Alzheimer's disease and frontotemporal lobe degeneration from Latin America and the United States. Greater structural inequality was linked to reduced brain volume and connectivity, with stronger effects in Latin America, especially in the temporo-cerebellar, fronto-thalamic and hippocampal regions. In the United States, milder effects were observed in the insular-cingular and temporal areas. Results were more pronounced in Alzheimer's disease and were independent of age, sex, education, cognition and other confounding factors. The findings highlight the critical role of structural inequality in aging and dementia, emphasizing the biological embedding of macrosocial factors and the need for targeted interventions in underserved populations., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Brain clocks, which quantify discrepancies between brain age and chronological age, hold promise for understanding brain health and disease. However, the impact of diversity (including geographical, socioeconomic, sociodemographic, sex and neurodegeneration) on the brain-age gap is unknown. We analyzed datasets from 5,306 participants across 15 countries (7 Latin American and Caribbean countries (LAC) and 8 non-LAC countries). Based on higher-order interactions, we developed a brain-age gap deep learning architecture for functional magnetic resonance imaging (2,953) and electroencephalography (2,353). The datasets comprised healthy controls and individuals with mild cognitive impairment, Alzheimer disease and behavioral variant frontotemporal dementia. LAC models evidenced older brain ages (functional magnetic resonance imaging: mean directional error = 5.60, root mean square error (r.m.s.e.) = 11.91; electroencephalography: mean directional error = 5.34, r.m.s.e. = 9.82) associated with frontoposterior networks compared with non-LAC models. Structural socioeconomic inequality, pollution and health disparities were influential predictors of increased brain-age gaps, especially in LAC (R² = 0.37, F² = 0.59, r.m.s.e. = 6.9). An ascending brain-age gap from healthy controls to mild cognitive impairment to Alzheimer disease was found. In LAC, we observed larger brain-age gaps in females in control and Alzheimer disease groups compared with the respective males. The results were not explained by variations in signal quality, demographics or acquisition methods. These findings provide a quantitative framework capturing the diversity of accelerated brain aging., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Context: Over 80% of patients anticipate fully returning to sport (RTS) within 1 year after anterior cruciate ligament reconstruction (ACLR), but only one quarter of patients succeed. Although several factors influence the RTS process, this study focused on how psychological responses to injury, such as injury-related fear and self-determined motivation, help to explain variation in rehabilitation experiences. There is limited information about how these meaningful psychological responses to injury are connected to responses such as athlete burnout or how patient perceptions of these responses relate to rehabilitation. The purpose of this qualitative study was to explore how patient perceptions of injury-related fear, self-determined motivation, and athlete burnout influence individual psychological and rehabilitation experiences at 4 to 6 months post-ACLR., Design: Qualitative study., Methods: Eight patients (female = 4, age = 16.3 ± 1.9) between 4 and 6 months post-ACLR who injured their knee playing or training for sports were included in the study. Patients completed the Sport Motivation Scale-6, Athlete Burnout Questionnaire, Perceived Stress Scale 4, and Tampa Scale of Kinesiophobia-11 to measure self-determined motivation, athlete burnout, stress, and injury fear. These questionnaires collected descriptive data used to guide audio- and video-recorded semistructured interviews. The interviews were transcribed and analyzed in a 6-stage process of thematic analysis., Results: Thematic analysis revealed 3 themes related to how participants perceived their rehabilitation experiences: (1) acknowledging recurring struggles during recovery, (2) finding motivation to RTS and normal life, and (3) successfully navigating the recovery process. In particular, participants described the impact of positive shifts in their psychological perceptions at 4 to 6 months post-ACLR., Conclusions: Patients 4 to 6 months post-ACLR described how struggles during their recovery and rehabilitation experiences were improved by positive shifts in their psychological perceptions. Increasing positive psychological awareness within a supportive rehabilitation environment may improve rehabilitation experiences and RTS rates after ACLR.

Objective: To synthesize the best available evidence regarding the perceptions and current clinical practices of athletic trainers (ATs) in integrating psychological skills into patient management., Data Sources: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost), PsycInfo (via EBSCOhost), SPORTDiscus (via EBSCOhost), and Scopus (via Elsevier)., Study Selection: Studies had to investigate the current clinical practices and perceptions of certified ATs in integrating psychologically informed practice for patient management. Studies that had level 4 evidence or higher were included. Studies were excluded if they were published before 1999, the primary language was not English, they involved athletic training students or other rehabilitation specialists, or they explored the athlete's and/or patient's perception of psychosocial techniques or strategies., Data Extraction: This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement in Exercise, Rehabilitation, Sport Medicine and Sports Science guidance., Data Synthesis: A total of 1857 articles were reviewed, and 8 met inclusion criteria. Two studies had level 2a evidence, 4 studies had level 4a evidence, and 2 studies had level 4b evidence. Six studies were rated as good quality, and 2 studies were rated as lesser quality. The included studies demonstrated a high-quality body of evidence with consistent results, which strengthens the review findings., Conclusions: Athletic trainers have the knowledge to identify when athletes are psychologically affected by injury and can identify common psychological responses. Although ATs acknowledge the value of implementing psychosocial strategies, a lack of confidence in implementing basic or advanced techniques, feeling underprepared by their educational program, and a lack of clinical training appear to affect the use of psychosocial techniques in clinical practice and the rate of mental health recognition and referral among ATs., (© by the National Athletic Trainers' Association, Inc.)

Background: Simultaneous interoceptive, emotional, and social cognition deficits are observed across neurodegenerative diseases. Indirect evidence suggests shared neurobiological bases underlying these impairments, termed the allostatic-interoceptive network (AIN). However, no study has yet explored the convergence of these deficits in neurodegenerative diseases or examined how structural and functional changes contribute to cross-domain impairments., Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) activated likelihood estimate meta-analysis encompassed studies that met the following inclusion criteria: interoception, emotion, or social cognition tasks; neurodegenerative diseases (behavioral variant frontotemporal dementia, primary progressive aphasias, Alzheimer's disease, Parkinson's disease, multiple sclerosis); and neuroimaging (structural: magnetic resonance imaging voxel-based morphometry; functional: magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography)., Results: Of 20,593 studies, 170 met inclusion criteria (58 interoception, 65 emotion, and 47 social cognition) involving 7032 participants (4963 patients and 2069 healthy control participants). In all participants combined, conjunction analyses revealed AIN involvement of the insula, amygdala, orbitofrontal cortex, anterior cingulate, striatum, thalamus, and hippocampus across domains. In behavioral variant frontotemporal dementia, this conjunction was replicated across domains, with further involvement of the temporal pole, temporal fusiform cortex, and angular gyrus. A convergence of interoception and emotion in the striatum, thalamus, and hippocampus in Parkinson's disease and the posterior insula in primary progressive aphasias was also observed. In Alzheimer's disease and multiple sclerosis, disruptions in the AIN were observed during interoception, but no convergence with emotion was identified., Conclusions: Neurodegeneration induces dysfunctional AIN across atrophy, connectivity, and metabolism, more accentuated in behavioral variant frontotemporal dementia. Findings bolster the predictive coding theories of large-scale AIN, calling for more synergistic approaches to understanding interoception, emotion, and social cognition impairments in neurodegeneration., (Copyright © 2024 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Structural income inequality - the uneven income distribution across regions or countries - could affect brain structure and function, beyond individual differences. However, the impact of structural income inequality on the brain dynamics and the roles of demographics and cognition in these associations remains unexplored., Methods: Here, we assessed the impact of structural income inequality, as measured by the Gini coefficient on multiple EEG metrics, while considering the subject-level effects of demographic (age, sex, education) and cognitive factors. Resting-state EEG signals were collected from a diverse sample (countries = 10; healthy individuals = 1394 from Argentina, Brazil, Colombia, Chile, Cuba, Greece, Ireland, Italy, Turkey and United Kingdom). Complexity (fractal dimension, permutation entropy, Wiener entropy, spectral structure variability), power spectral and aperiodic components (1/f slope, knee, offset), as well as graph-theoretic measures were analysed., Findings: Despite variability in samples, data collection methods, and EEG acquisition parameters, structural inequality systematically predicted electrophysiological brain dynamics, proving to be a more crucial determinant of brain dynamics than individual-level factors. Complexity and aperiodic activity metrics captured better the effects of structural inequality on brain function. Following inequality, age and cognition emerged as the most influential predictors. The overall results provided convergent multimodal metrics of biologic embedding of structural income inequality characterised by less complex signals, increased random asynchronous neural activity, and reduced alpha and beta power, particularly over temporoposterior regions., Conclusion: These findings might challenge conventional neuroscience approaches that tend to overemphasise the influence of individual-level factors, while neglecting structural factors. Results pave the way for neuroscience-informed public policies aimed at tackling structural inequalities in diverse populations., (© 2024 The Author(s). Clinical and Translational Medicine published by John Wiley & Sons Australia, Ltd on behalf of Shanghai Institute of Clinical Bioinformatics.)

Background: Education influences brain health and dementia. However, its impact across regions, specifically Latin America (LA) and the United States (US), is unknown., Methods: A total of 1412 participants comprising controls, patients with Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD) from LA and the US were included. We studied the association of education with brain volume and functional connectivity while controlling for imaging quality and variability, age, sex, total intracranial volume (TIV), and recording type., Results: Education influenced brain measures, explaining 24%-98% of the geographical differences. The educational disparities between LA and the US were associated with gray matter volume and connectivity variations, especially in LA and AD patients. Education emerged as a critical factor in classifying aging and dementia across regions., Discussion: The results underscore the impact of education on brain structure and function in LA, highlighting the importance of incorporating educational factors into diagnosing, care, and prevention, and emphasizing the need for global diversity in research., Highlights: Lower education was linked to reduced brain volume and connectivity in healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). Latin American cohorts have lower educational levels compared to the those in the United States. Educational disparities majorly drive brain health differences between regions. Educational differences were significant in both conditions, but more in AD than FTLD. Education stands as a critical factor in classifying aging and dementia across regions., (© 2024 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Models of healthy aging are typically based on the United States and Europe and may not apply to diverse and heterogeneous populations. In this study, our objectives were to conduct a meta-analysis to assess risk factors of cognition and functional ability across aging populations in Latin America and a scoping review focusing on methodological procedures. Our study design included randomized controlled trials and cohort, case-control and cross-sectional studies using multiple databases, including MEDLINE, the Virtual Health Library and Web of Science. From an initial pool of 455 studies, our meta-analysis included 38 final studies (28 assessing cognition and 10 assessing functional ability, n = 146,000 participants). Our results revealed significant but heterogeneous effects for cognition (odds ratio (OR) = 1.20, P = 0.03, confidence interval (CI) = (1.0127, 1.42); heterogeneity: I 2  = 92.1%, CI = (89.8%, 94%)) and functional ability (OR = 1.20, P = 0.01, CI = (1.04, 1.39); I 2  = 93.1%, CI = (89.3%, 95.5%)). Specific risk factors had limited effects, especially on functional ability, with moderate impacts for demographics and mental health and marginal effects for health status and social determinants of health. Methodological issues, such as outliers, inter-country differences and publication bias, influenced the results. Overall, we highlight the specific profile of risk factors associated with healthy aging in Latin America. The heterogeneity in results and methodological approaches in studying healthy aging call for greater harmonization and further regional research to understand healthy aging in Latin America., (© 2024. The Author(s).)

Diversity in brain health is influenced by individual differences in demographics and cognition. However, most studies on brain health and diseases have typically controlled for these factors rather than explored their potential to predict brain signals. Here, we assessed the role of individual differences in demographics (age, sex, and education; n = 1298) and cognition (n = 725) as predictors of different metrics usually used in case-control studies. These included power spectrum and aperiodic (1/f slope, knee, offset) metrics, as well as complexity (fractal dimension estimation, permutation entropy, Wiener entropy, spectral structure variability) and connectivity (graph-theoretic mutual information, conditional mutual information, organizational information) from the source space resting-state EEG activity in a diverse sample from the global south and north populations. Brain-phenotype models were computed using EEG metrics reflecting local activity (power spectrum and aperiodic components) and brain dynamics and interactions (complexity and graph-theoretic measures). Electrophysiological brain dynamics were modulated by individual differences despite the varied methods of data acquisition and assessments across multiple centers, indicating that results were unlikely to be accounted for by methodological discrepancies. Variations in brain signals were mainly influenced by age and cognition, while education and sex exhibited less importance. Power spectrum activity and graph-theoretic measures were the most sensitive in capturing individual differences. Older age, poorer cognition, and being male were associated with reduced alpha power, whereas older age and less education were associated with reduced network integration and segregation. Findings suggest that basic individual differences impact core metrics of brain function that are used in standard case-control studies. Considering individual variability and diversity in global settings would contribute to a more tailored understanding of brain function., Competing Interests: Declaration of competing interest none., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Injury surveillance data indicate that collegiate athletes are at greater risk for lower extremity (LE) injuries following sports-related concussion (SRC). While the association between SRC and LE injury appears to be clinically relevant up to 1-year post-SRC, little evidence has been provided to determine possible mechanistic rationales. Thus, we aimed to compare collegiate athletes with a history of SRC to matched controls on biomechanical and cognitive performance measures associated with LE injury risk. Athletes with a history of SRC (n = 20) and matched controls (n = 20) performed unanticipated bilateral land-and-cut tasks and cognitive assessments. Group-based analyses (ANOVA) and predictive modeling (C5.0 decision tree algorithm) were used to compare group differences on biomechanical and cognitive measures. Collegiate athletes with a history of SRC demonstrated approximately six degrees less peak knee flexion on both dominant (p = 0.03, d = 0.71) and nondominant (p = 0.02, d = 0.78) limbs during the land-and-cut tasks compared to controls. Verbal Memory, knee flexion, and Go/No Go total score (C5.0 decision tree algorithm) were identified as the strongest indicators of previous SRC injury history. Reduced knee flexion during sport-specific land-and-cut tasks may be a mechanism for increased LE injury risk in athletes with a history of SRC. There appears to be multiple biomechanical and cognitive predictors for identifying previous SRC in collegiate athletes, providing evidence to support a multifactorial SRC management strategy to reduce future injury risk., (© 2024 The Author(s). Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Objective: To evaluate the associations between psychological factors (pain self-efficacy, kinesiophobia, and pain catastrophizing), physical activity, and patient-reported hip function in patients presenting to physical therapy with chronic (>3 months) hip pain., Design: Observational, cross-sectional., Methods: Participants completed a survey including age, sex, height/weight, symptom duration, 11-item Tampa Scale for Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ), and 12-item International Hip Outcome Tool (iHOT-12). Participants wore an accelerometer (60 Hz) for 7 days. Predictors of iHOT-12 scores were assessed using a linear regression with forward variable selection., Results: Forty-one participants (29 females, 12 males; 40.5 ± 14.0 years; 26.7 ± 7.8 kg/m 2 ) with intra-articular nonarthritic hip condition (53.7%), hip osteoarthritis (19.5%), other/multiple diagnoses (17.1%), and extra-articular hip condition (9.8%) were evaluated. Diagnosis groups did not differ in sex, body mass index, physical activity, psychological measures, or patient-reported function ( P ≥.09). Participants with hip osteoarthritis (59.8 ± 8.3 years) were older than those with intra-articular nonarthritic hip conditions (33.0 ± 9.7 years) and other/multiple diagnoses (37.4 ± 10.6) ( P <.001). A model containing PSEQ scores, moderate-to-vigorous physical activity, and TSK-11 scores explained 38% of the variance in iHOT-12 scores ( P <.001), with PSEQ explaining 20% of the variance in iHOT-12 scores alone., Conclusion: Pain self-efficacy and kinesiophobia were associated with patient-reported function in people with chronic hip pain of multiple etiologies. Clinicians may consider screening for psychological factors in this patient population.

Brain clocks, which quantify discrepancies between brain age and chronological age, hold promise for understanding brain health and disease. However, the impact of multimodal diversity (geographical, socioeconomic, sociodemographic, sex, neurodegeneration) on the brain age gap (BAG) is unknown. Here, we analyzed datasets from 5,306 participants across 15 countries (7 Latin American countries -LAC, 8 non-LAC). Based on higher-order interactions in brain signals, we developed a BAG deep learning architecture for functional magnetic resonance imaging (fMRI=2,953) and electroencephalography (EEG=2,353). The datasets comprised healthy controls, and individuals with mild cognitive impairment, Alzheimer's disease, and behavioral variant frontotemporal dementia. LAC models evidenced older brain ages (fMRI: MDE=5.60, RMSE=11.91; EEG: MDE=5.34, RMSE=9.82) compared to non-LAC, associated with frontoposterior networks. Structural socioeconomic inequality and other disparity-related factors (pollution, health disparities) were influential predictors of increased brain age gaps, especially in LAC (R 2 =0.37, F 2 =0.59, RMSE=6.9). A gradient of increasing BAG from controls to mild cognitive impairment to Alzheimer's disease was found. In LAC, we observed larger BAGs in females in control and Alzheimer's disease groups compared to respective males. Results were not explained by variations in signal quality, demographics, or acquisition methods. Findings provide a quantitative framework capturing the multimodal diversity of accelerated brain aging., Competing Interests: Additional Declarations: There is NO Competing Interest. Competing Interest Statement None of the authors have competing financial or non-financial interests as defined by Nature Portfolio.

Growing up in neglectful households can impact multiple aspects of social cognition. However, research on neglect's effects on social cognition processes and their neuroanatomical correlates during adolescence is scarce. Here, we aimed to comprehensively assess social cognition processes (recognition of basic and contextual emotions, theory of mind, the experience of envy and Schadenfreude and empathy for pain) and their structural brain correlates in adolescents with legal neglect records within family-based care. First, we compared neglected adolescents ( n  = 27) with control participants ( n  = 25) on context-sensitive social cognition tasks while controlling for physical and emotional abuse and executive and intellectual functioning. Additionally, we explored the grey matter correlates of these domains through voxel-based morphometry. Compared to controls, neglected adolescents exhibited lower performance in contextual emotional recognition and theory of mind, higher levels of envy and Schadenfreude and diminished empathy. Physical and emotional abuse and executive or intellectual functioning did not explain these effects. Moreover, social cognition scores correlated with brain volumes in regions subserving social cognition and emotional processing. Our results underscore the potential impact of neglect on different aspects of social cognition during adolescence, emphasizing the necessity for preventive and intervention strategies to address these deficits in this population., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Context: Football sport participation has been linked to both positive and negative effects on overall health. Social support, a network that provides individuals with resources to cope effectively, may positively influence one's stress and mental health. However, little research has been conducted on adolescent football players., Objective: To examine the relationships among social support, psychological stress, and mental health in adolescent football athletes., Design: Cross-sectional study., Setting: High school athletes during the precompetitive and postcompetitive football season in rural Alabama., Patients or Other Participants: Black and African American adolescent athletes (N = 93) competing for a school-sponsored football team., Main Outcome Measure(s): After a competitive season, participants completed a battery of social support, psychological stress, and mental health symptom measures using the National Institutes of Health Toolbox Application and Patient-Reported Outcomes Measurement Information System. The T-score means, Pearson correlations, and multiple regression analyses were calculated., Results: Social support was negatively correlated with psychological stress (emotional support, r = -0.386; family relationships, r = -0.412; peer relationships, r = -0.265) and mental health (depression, r = -0.367 and r = -0.323 for emotional support and family relationships, respectively), whereas psychological stress and mental health (depression, r = 0.751; anxiety, r = 0.732) were positively correlated. In regression analyses, social support measures (ie, emotional support, family relationships, and peer relationships) were used to predict psychological stress (F = 7.094, P < .001, R2 = 0.191), depression symptoms (F = 5.323, P < .001, R2 = 0.151), and anxiety symptoms (F = 1.644, P = .190, R2 = 0.052)., Conclusions: In line with the stress-buffering hypothesis, social support in the form of family relationships and overall emotional support garnered through sport participation may reduce psychological stress and help to preserve the mental health of football athletes. These findings indicate that perceived social support may act as a positive resource for the coping of Black and African American adolescent athletes. Further research is warranted to understand the effects of stress and social support on the mental health of adolescents, particularly racial and ethnic minorities who are underrepresented in the athletic training literature., (© by the National Athletic Trainers’ Association, Inc.)

Context: Injury-related fear and quadriceps strength are independently associated with secondary anterior cruciate ligament (ACL) injury risk. It is not known whether injury-related fear and quadriceps strength are associated, despite their individual predictive capabilities of secondary ACL injury. The purpose of this study was to examine the association between injury-related fear and quadriceps strength in individuals at least 1 year after ACL reconstruction (ACLR)., Design: Cross-sectional study., Methods: Forty participants between the ages of 18 and 35 years at least 1 year post unilateral primary ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) and a standard isokinetic quadriceps strength assessment using the Biodex Isokinetic Dynamometer. Pearson Product-Moment correlations were used to examine the linear association between the TSK-11 scores and peak torque (in nanometers per kilogram) for each limb and between the TSK-11 scores and limb symmetry indices for each limb. Pearson Product-Moment correlation coefficients (r) were interpreted as very high (.90-1.00), high (.70-.90), moderate (.50-.70), low (.30-.50), and no correlation (.00-.30)., Results: The average TSK-11 score was 18.2 (5.3), average ACLR peak quadriceps torque was 1.9 (0.50) N·m/kg, average contralateral peak quadriceps torque was 2.3 (0.48) N·m/kg, and average limb symmetry index was 85.3% (12.6%). There was no statistically significant correlation between the TSK-11 and peak quadriceps torque on the ACLR limb (r = .12, P = .46), the TSK-11 and contralateral limb (r = .29, P = .07), or the TSK-11 and limb symmetry index (r = -.18, P = .27)., Conclusions: There was no association between kinesiophobia and peak isokinetic quadriceps strength in individuals at least 1 year post-ACLR. Both factors, independently, have been shown to influence risk of secondary injury in patients after ACLR.

Over the last decades, theoretical perspectives in the interdisciplinary field of the affective sciences have proliferated rather than converged due to differing assumptions about what human affective phenomena are and how they work. These metaphysical and mechanistic assumptions, shaped by academic context and values, have dictated affective constructs and operationalizations. However, an assumption about the purpose of affective phenomena can guide us to a common set of metaphysical and mechanistic assumptions. In this capstone paper, we home in on a nested teleological principle for human affective phenomena in order to synthesize metaphysical and mechanistic assumptions. Under this framework, human affective phenomena can collectively be considered algorithms that either adjust based on the human comfort zone (affective concerns) or monitor those adaptive processes (affective features). This teleologically-grounded framework offers a principled agenda and launchpad for both organizing existing perspectives and generating new ones. Ultimately, we hope the Human Affectome brings us a step closer to not only an integrated understanding of human affective phenomena, but an integrated field for affective research., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Context: Deficits in perceptual-motor function, like visuomotor reaction time (VMRT), are risk factors for primary and secondary anterior cruciate ligament (ACL) injury. Noncontact ACL injuries have been associated with slower reaction time, but whether this association exists for patients with contact ACL injuries is unknown. Exploring differences in VMRT among individuals with contact versus noncontact ACL injuries may provide a more comprehensive understanding of modifiable risk factors., Objective: To compare lower extremity VMRT (LEVMRT) in individuals with contact or noncontact ACL injuries after ACL reconstruction (ACLR)., Design: Cross-sectional study., Setting: Research laboratory., Patients or Other Participants: A total of 36 participants with primary, unilateral ACLR completed an LEVMRT assessment (contact ACL injury = 20 [56%], noncontact ACL injury = 16 [44%])., Main Outcome Measure(s): The LEVMRT was assessed bilaterally and collected using a series of wireless light discs deactivated by individuals with their feet. The ACLR-active LEVMRT (ie, ACLR limb is deactivating lights) and ACLR-stable LEVMRT were compared using separate analyses of covariance to determine the association with contact or noncontact injury using time since surgery as a covariate., Results: After controlling for time since surgery, a difference and large effect size between groups was found for the ACLR-stable LEVMRT (P = .010; η2 = 0.250) but not for the ACLR-active (P = .340; η2 = 0.065) condition. The contact group exhibited slower ACLR-stable LEVMRT (521.7 ± 59.3 milliseconds) than the noncontact group (483.4 ± 83.9 milliseconds)., Conclusions: Individuals with contact ACL injury demonstrated a slower LEVMRT while their ACLR limb was stabilizing. The group differences during the ACLR-stable LEVMRT task might indicate deficits in perceptual-motor function when the surgical limb maintains postural control during a reaction time task. After ACLR, individuals with contact injuries may need additional motor learning interventions to enhance perceptual-motor functioning., (© by the National Athletic Trainers’ Association, Inc.)

Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.

Context: Poor psychological responses after anterior cruciate ligament reconstruction (ACLR) have been associated with a failure to return to sport and increased secondary injury risk. However, we do not know whether poor psychological responses after ACLR influence patient-reported knee function and knee symptoms., Objective: To examine the association between psychological factors (ie, psychological readiness and injury-related fear) and the presence of persistent knee symptoms in individuals 6 to 12 months after ACLR., Design: Cross-sectional study., Setting: Research laboratory., Patients or Other Participants: In total, 101 participants, aged 13 to 25 years old, between 6 and 12 months after primary unilateral ACLR were enrolled in the study., Main Outcome Measure(s): Persistent knee symptoms were identified using an established criterion based on the subscales of the Knee injury and Osteoarthritis Outcome Score. Participants also completed the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) and the Tampa Scale of Kinesiophobia-11 (TSK-11) to assess psychological readiness and injury-related fear, respectively. Higher ACL-RSI scores indicate higher psychological readiness, and higher TSK-11 scores indicate higher injury-related fear., Results: Twenty-nine participants (29%) met the criteria for persistent knee symptoms. For every 1 SD lower in the ACL-RSI score, participants had 2.1 times greater odds of persistent knee symptoms after ACLR (95% CI = 1.3, 3.6). For every 1 SD higher in the TSK-11 score, participants had 1.9 times greater odds of persistent knee symptoms after ACLR (95% CI = 1.1, 3.3). Both the ACL-RSI and TSK-11 were considered good at classifying persistent knee symptoms, as the areas under the curve were 0.78 and 0.73, respectively., Conclusions: Individuals with a lower level of psychological readiness and more injury-related fear after ACLR had greater odds of persistent knee symptoms. Overall, these results highlight the potential clinical benefit of a comprehensive, biopsychosocial approach to managing health and wellness for individuals after ACLR., (© by the National Athletic Trainers’ Association, Inc.)

Context: Although 84% of patients expected to return to activity within 1 year of anterior cruciate ligament (ACL) reconstruction (ACLR), as few as 24% will return to their preinjury level of activity. By considering a patient's perceptions of reengagement in activity after ACLR, clinicians and researchers may be better equipped to implement interventions that are patient centered., Objective: To describe the validation of the ACL Reasons survey, a tool to aid clinicians and researchers in understanding patient perceptions of barriers to physical activity (PA) engagement after ACLR., Design: Cross-sectional study., Patients or Other Participants: The ACL Reasons survey was administered via Qualtrics to 78 patients 6 to 24 months after primary, unilateral ACLR. Patients were categorized as active, more challenging, or less active based on their responses to the ACL Reasons., Main Outcome Measure(s): Development of the ACL Reasons survey occurred via an iterative process of drafting and revising based on feedback from a team of external expert reviewers. Tegner activity level, Marx activity score, the Knee injury and Osteoarthritis Outcomes Score (KOOS), ACL Return to Sport after Injury score, and Tampa Scale of Kinesiophobia score were compared among groups using analysis-of-variance and Kruskal Wallis tests., Results: Groups differed based on Tegner activity level (P < .001), Marx activity score (P = .01), KOOS pain score (P = .02), KOOS symptom score (P = .04), KOOS sports and recreation score (P < .001), KOOS quality of life score (P < .001), ACL Return to Sport after Injury score (P < .001), and Tampa Scale of Kinesiophobia score (P < .001), with the less active group performing worse on each. Knee symptoms, fear of knee symptoms or movement, and fear of injury were the most common reasons for the change in PA engagement., Conclusions: These results support the validity of the ACL Reasons survey as a tool for identifying barriers to PA engagement after ACLR. This tool may help facilitate communication between patients with ACLR and their health care providers to enhance patient-centered care., (© by the National Athletic Trainers’ Association, Inc.)

Athletic identity is a psychological factor of concern for athletes after sport-related concussion (SRC). The integrated model of response to sport injury includes athletic identity as a psychological factor within its model, but it has often been overlooked as a consideration affecting outcomes of SRC. In this review, we applied the integrated model of response to sport injury to the current available evidence about the negative consequences of a stronger athletic identity on health outcomes after SRC. Theory-based research recommendations will be provided to facilitate research in this area. Recommendations for athletic training clinical practice to assess and consider athletic identity as part of routine clinical care for those after SRC will also be discussed., (© by the National Athletic Trainers’ Association, Inc.)

Background: The triggering receptor expressed on myeloid cell 2 (TREM2) is a major regulator of neuroinflammatory processes in neurodegeneration. To date, the p.H157Y variant of TREM2 has been reported only in patients with Alzheimer's disease. Here, we report three patients with frontotemporal dementia (FTD) from three unrelated families with heterozygous p.H157Y variant of TREM2 : two patients from Colombian families (study 1) and a third Mexican origin case from the USA (study 2)., Methods: To determine if the p.H157Y variant might be associated with a specific FTD presentation, we compared in each study the cases with age-matched, sex-matched and education-matched groups-a healthy control group (HC) and a group with FTD with neither TREM2 mutations nor family antecedents (Ng-FTD and Ng-FTD-MND)., Results: The two Colombian cases presented with early behavioural changes, greater impairments in general cognition and executive function compared with both HC and Ng-FTD groups. These patients also exhibited brain atrophy in areas characteristic of FTD. Furthermore, TREM2 cases showed increased atrophy compared with Ng-FTD in frontal, temporal, parietal, precuneus, basal ganglia, parahippocampal/hippocampal and cerebellar regions. The Mexican case presented with FTD and motor neuron disease (MND), showing grey matter reduction in basal ganglia and thalamus, and extensive TDP-43 type B pathology., Conclusion: In all TREM2 cases, multiple atrophy peaks overlapped with the maximum peaks of TREM2 gene expression in crucial brain regions including frontal, temporal, thalamic and basal ganglia areas. These results provide the first report of an FTD presentation potentially associated with the p.H157Y variant with exacerbated neurocognitive impairments., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Psychologically informed practice is an approach to patient management that encourages clinicians to treat patients from a biopsychosocial perspective and can be adopted by athletic trainers to manage sport-related injuries. As described in the domains of athletic training clinical practice, athletic trainers are expected to identify, address, and make appropriate referrals regarding psychosocial responses to injuries and mental health symptoms. Psychologically informed practice suggests addressing physical impairments in addition to screening and intervening for psychosocial responses with patients. In this Current Clinical Concepts paper, we discuss appropriate patient-reported outcome measures used to screen for mental health symptoms and psychosocial responses, provide recommendations on psychological interventions that can be integrated to enhance patient outcomes, and describe how to effectively refer a patient to an appropriate mental health professional., (© by the National Athletic Trainers' Association, Inc.)

Women's contributions to science have been consistently underrepresented throughout history. Despite many efforts and some progresses being made to reduce gender inequity in science, pursuing an academic career across disciplines, including Alzheimer's disease (AD) and other dementias, remains challenging for women. Idiosyncratic difficulties of Latin American countries likely accentuate the gender gap. In this Perspective, we celebrate outstanding contributions from Argentinian, Chilean, and Colombian colleagues in dementia research and discuss barriers and opportunities identified by them. We aim to acknowledge Latin American women's work and bring visibility to the challenges they face throughout their careers in order to inform potential solutions. Also, we highlight the need to perform a systematic assessment of the gender gap in the Latin American dementia community of researchers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Fittipaldi, Baez, Gonzalez-Silva and Duran-Aniotz.)

Introduction: Research has identified significant racial differences in cigarette smoking behavior, associated disease risk, likelihood of cessation, and mortality from smoking-related diseases. The current study assessed, via qualitative narrative analysis, racial differences in participants' motivations for smoking, perceived consequences of smoking, and how participants deal with cravings/withdrawal, as well as thoughts and feelings about quitting, seeking assistance with quitting, and the importance of social support in quitting., Methods: Semistructured interviews were conducted with 11 Black and 11 White cigarette smokers. Data were analyzed using the Thematic Networks Analysis process, which entailed coding the data and constructing thematic networks by identifying basic and organizing themes., Results: While there were no descriptive racial differences identified in participants' motivation for smoking or perceived consequences of smoking, differences existed between Blacks and Whites in terms of approaches in dealing with smoking cravings and withdrawal, perceived self-efficacy in controlling cravings, preferred methods of learning about and receiving smoking cessation assistance, and overall preference for receiving cessation-related support., Conclusions: Further investigation is needed into racial differences in methods to deal with cigarette cravings and withdrawal, preferences for receiving cessation information, and social support for cessation. This research will further develop our understanding of and ability to address factors underlying racial disparities in smoking behavior and cessation, as well as inform the development of future smoking cessation interventions., Competing Interests: The authors have no conflicts of interests to declare., (Copyright © 2023 Alina Shevorykin et al.)

Social cognition impairments may be associated with poor functional outcomes, symptoms, and disability in social anxiety disorder (SAD) and generalized anxiety disorder (GAD). This meta-analysis aims to determine if emotion recognition and theory of mind (ToM) are impaired in SAD or GAD compared to healthy controls. A systematic review was conducted in electronic databases (PubMed, PsycNet, and Web of Science) to retrieve studies assessing emotion recognition and/or ToM in patients with SAD or GAD, compared to healthy controls, up to March 2022. Meta-analyses using random-effects models were conducted. We identified 21 eligible studies: 13 reported emotion recognition and 10 ToM outcomes, with 585 SAD patients, 178 GAD patients, and 753 controls. Compared to controls, patients with SAD exhibited impairments in emotion recognition (SMD = -0.32, CI = -0.47 - -0.16, z = -3.97, p < 0.0001) and ToM (SMD = -0.44, CI = -0.83 -0.04, z = -2.18, p < 0.01). Results for GAD were inconclusive due to the limited number of studies meeting the inclusion criteria (two for each domain). Relevant demographic and clinical variables (age, sex, education level, and anxiety scores) were not significantly correlated with emotion recognition or ToM impairments in SAD and GAD. Further studies employing ecological measures with larger and homogenous samples are needed to better delineate the factors influencing social cognition outcomes in both SAD and GAD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Baez, Tangarife, Davila-Mejia, Trujillo-Güiza and Forero.)

Objective: This study explored the burgeoning youth practice of possessing a fake, secondary Instagram account known as a "Finsta" in relation to exposure to alcohol-related content and college drinking., Participants: First-year university students with at least a primary Instagram account ( N  = 296) completed online surveys., Method: Surveys assessed whether participants did or did not have a Finsta pre-matriculation (T1), Instagram alcohol content exposure one month into college (T2), and alcohol use at T1 and near the end of the first year (T3)., Results: Moderated mediation analysis revealed that having a Finsta at T1 was associated with greater exposure to alcohol-related posts at T2 and, for male but not female students, predicted heavier drinking at T3., Conclusion: Findings are consistent with previous results suggesting that males may be more behaviorally impacted by peers' depictions of alcohol use on social media. This carries implications for social media-based intervention efforts targeting first-year students.

After an anterior cruciate ligament (ACL) injury, people need secondary prevention strategies to identify osteoarthritis at its earliest stages so that interventions can be implemented to halt or slow the progression toward its long-term burden. The Osteoarthritis Action Alliance formed an interdisciplinary Secondary Prevention Task Group to develop a consensus on recommendations to provide clinicians with secondary prevention strategies that are intended to reduce the risk of osteoarthritis after a person has an ACL injury. The group achieved consensus on 15 out of 16 recommendations that address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. We hope this statement raises awareness among clinicians and researchers on the importance of taking steps to mitigate the risk of osteoarthritis after an ACL injury., (© by the National Athletic Trainers' Association, Inc.)

Context: The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury., Objective: Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps., Design: Consensus process., Setting: Virtual video conference calls and online voting., Patients or Other Participants: The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds., Main Outcome Measure(s): The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation., Results: The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models., Conclusions: This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury., (© by the National Athletic Trainers' Association, Inc.)

Introduction: This study aimed to investigate the associations between kinesiophobia, knee abduction angle (KAA) during the first 100 ms of landing, and knee flexion excursion (KFE) in individuals 5-12 months after anterior cruciate ligament reconstruction (ACLR). We hypothesized that greater kinesiophobia would be associated with greater peak KAA and lesser KFE during landing on the ACLR limb, but not on the contralateral limb., Methods: Thirty-six participants between 14 and 35 yr old (females = 19, age = 19.9 ± 5.1 yr, height = 172.5 ± 9.4 cm, weight = 76.7 ± 20.0 kg, time since surgery =7.2 ± 1.7 months) were recruited from a sports medicine clinic at 5-12 months after primary unilateral ACLR. Participants completed the Tampa Scale of Kinesiophobia-11 (TSK-11) to measure kinesiophobia and three successful trials of a standard drop vertical jump task. A 10-camera three-dimensional motion capture system synchronized with two embedded force plate platforms was used to capture jump-landing kinematics. Separate stepwise linear regression models were used to examine the associations between kinesiophobia, peak KAA, and KFE on the ACLR and contralateral limbs after accounting for time since surgery and biological sex., Results: When accounting for time since surgery and biological sex, every 1-point increase on the TSK-11 (i.e., increase in kinesiophobia) associated with a 0.37° increase (i.e., a 7.1% increase) in ACLR limb KAA ( P = 0.02). Kinesiophobia was not associated with contralateral limb KAA, ACLR limb KFE, or contralateral limb KFE., Conclusions: Higher kinesiophobia was related to greater amounts of peak KAA during landing in individuals 5-12 months post-ACLR. Modifying kinesiophobia may help to decrease KAA and lead to reduced secondary ACL injury risk. Future research should investigate feasible psychological interventions to reduce kinesiophobia and improve KAA in patients post-ACLR., (Copyright © 2022 by the American College of Sports Medicine.)

Context: Many individuals who sustain a lateral ankle sprain (LAS) fail to return to prior activity due to residual symptoms; and report elevated levels of injury-related fear, decreased function, and decreased health-related quality of life (HRQOL). Additionally, individuals with history of LAS exhibit deficits in neurocognitive functional measures like visuomotor reaction time (VMRT), which contributes to worse patient-reported outcome scores. The aim of this study was to examine the relationship between HRQOL and lower-extremity (LE) VMRT in individuals with LAS history., Design: Cross-sectional., Methods: Young adult female volunteers with history of LAS (n = 22; age = 24 [3.5] y; height = 163.1 [9.8] cm; mass = 65.1 [11.5] kg; and time since last LAS = 67.8 [50.5] mo) completed HRQOL outcomes including the following: (1) Tampa Scale of Kinesiophobia-11, (2) Fear-Avoidance Beliefs Questionnaire, (3) Penn State Worry Questionnaire, (4) modified Disablement in the Physically Active Scale, and (5) Foot and Ankle Disability Index (FADI). Additionally, participants completed a LE-VMRT task by responding to a visual stimulus using their foot to deactivate light sensors. Participants completed trials bilaterally. Separate Spearman rho correlations were performed to assess the relationship between patient-reported outcomes assessing constructs of HRQOL and LE-VRMT bilaterally. Significance was set at P < .05., Results: There was a strong, significant negative correlation between FADI-Activities of Daily Living (ρ = -.68; P = .002) and FADI-Sport (ρ = -.76; P = .001) scores and injured limb LE-VMRT; moderate, significant negative correlations between the uninjured limb LE-VMRT and FADI-Activities of Daily Living (ρ = -.60; P = .01) and FADI-Sport (ρ = -.60; P = .01) scores; and moderate, significant positive correlations between the injured limb LE-VMRT and modified Disablement in the Physically Active Scale-Physical Summary Component (ρ = .52; P = .01) and modified Disablement in the Physically Active Scale-Total (ρ = .54; P = .02) scores. All other correlations were not statistically significant., Conclusions: Young adult women with history of LAS demonstrated an association between self-reported constructs of HRQOL and LE-VMRT. As LE-VMRT is a modifiable injury risk factor, future studies should examine the effectiveness of interventions designed to improve LE-VMRT and the impact on self-reported HRQOL.

Social emotions are critical to successfully navigate in a complex social world because they promote self-regulation of behaviour. Difficulties in social behaviour are at the core of autism spectrum disorder (ASD). However, social emotions and their neural correlates have been scarcely investigated in this population. In particular, the experience of envy has not been addressed in ASD despite involving neurocognitive processes crucially compromised in this condition. Here, we used an fMRI adapted version of a well-validated task to investigate the subjective experience of envy and its neural correlates in adults with ASD (n = 30) in comparison with neurotypical controls (n = 28). Results revealed that both groups reported similarly intense experience of envy in association with canonical activation in the anterior cingulate cortex and the anterior insula, among other regions. However, in participants with ASD, the experience of envy was accompanied by overactivation of the posterior insula, the postcentral gyrus and the posterior superior temporal gyrus, regions subserving the processing of painful experiences and mentalizing. This pattern of results suggests that individuals with ASD may use compensatory strategies based on the embodied amplification of pain and additional mentalizing efforts to shape their subjective experience of envy. Results have relevant implications to better understand the heterogeneity of this condition and to develop new intervention targets., (© 2023 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Individuals with autism spectrum disorder (ASD) present difficulties in integrating mental state information in complex moral tasks. Yet, ASD research has not examined whether this process is influenced by emotions, let alone while capturing its neural bases. We investigated how language-induced emotions modulate intent-based moral judgment in ASD. In a fMRI task, 30 adults with ASD and 27 neurotypical controls read vignettes whose protagonists commit harm either accidentally or intentionally, and then decided how much punishment the protagonist deserved. Emotional content was manipulated across scenarios through the use of graphic language (designed to trigger arousing negative responses) vs. plain (just-the-facts, emotionless) language. Off-line functional connectivity correlates of task performance were also analyzed. In ASD, emotional (graphic) descriptions amplified punishment ratings of accidental harms, associated with increased activity in fronto-temporo-limbic, precentral, and postcentral/supramarginal regions (critical for emotional and empathic processes), and reduced connectivity among the orbitofrontal cortex and the angular gyrus (involved in mentalizing). Language manipulation did not influence intentional harm processing in ASD. In conclusion, in arousing and ambiguous social situations that lack intentionality clues (i.e. graphic accidental harm scenarios), individuals with ASD would misuse their emotional responses as the main source of information to guide their moral decisions. Conversely, in face of explicit harmful intentions, they would be able to compensate their socioemotional alterations and assign punishment through non-emotional pathways. Despite limitations, such as the small sample size and low ecological validity of the task, results of the present study proved reliable and have relevant theoretical and translational implications., (© 2023. The Author(s).)

Purpose: Following a case-control design, as a primary objective, this study aimed to explore the relationship between quality of life (QoL) scores and gray matter (GM) volumes in patients with Huntington's disease (HD). As a secondary objective, we assessed the relationship between QoL scores and other important behavioral, clinical and demographical variables in patients with HD and HD patients' caregivers., Methods: We recruited 75 participants (25 HD patients, 25 caregivers, and 25 controls) and assessed their QoL using the World Health Organization Quality of Life scale-Brief Version (WHOQOL-BREF). Participants were also assessed with general cognitive functioning tests and clinical scales. In addition, we acquired MRI scans from all participants., Results: Our results showed that patients exhibited significantly lower scores in all four QoL domains (physical health, psychological wellbeing, social relationships, and relationship with the environment) compared to caregivers and controls. Caregivers showed lower scores than controls in the physical health and the environmental domains. In HD patients, lower scores in QoL domains were associated with lower GM volumes, mainly in the precuneus and the cerebellum. Moreover, in HD patients, physical disability and GM volume reduction were significant predictors of QoL decrease in all domains. For caregivers, years of formal education was the most important predictor of QoL., Conclusions: HD patients exhibit greater GM volume loss as well as lower QoL scores compared to caregivers and controls. However, caregivers displayed lower scores in QoL scores than controls, with years of education being a significant predictor. Our results reflect a first attempt to investigate the relationships among QoL, GM volumes, and other important factors in an HD and HD caregiver sample., (© 2022. The Author(s).)

Background: Although social cognition is compromised in patients with neurodegenerative disorders such as behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD), research on moral emotions and their neural correlates in these populations is scarce. No previous study has explored the utility of moral emotions, compared to and in combination with classical general cognitive state tools, to discriminate bvFTD from AD patients., Objective: To examine self-conscious (guilt and embarrassment) and other-oriented (pity and indignation) moral emotions, their subjective experience, and their structural brain underpinnings in bvFTD (n = 31) and AD (n = 30) patients, compared to healthy controls (n = 37). We also explored the potential utility of moral emotions measures to discriminate bvFTD from AD., Methods: We used a modified version of the Moral Sentiment Task measuring the participants' accuracy scores and their emotional subjective experiences., Results: bvFTD patients exhibited greater impairments in self-conscious and other-oriented moral emotions as compared with AD patients and healthy controls. Moral emotions combined with general cognitive state tools emerged as useful measures to discriminate bvFTD from AD patients. In bvFTD patients, lower moral emotions scores were associated with lower gray matter volumes in caudate nucleus and inferior and middle temporal gyri. In AD, these scores were associated with lower gray matter volumes in superior and middle frontal gyri, middle temporal gyrus, inferior parietal lobule and supramarginal gyrus., Conclusion: These findings contribute to a better understanding of moral emotion deficits across neurodegenerative disorders, highlighting the potential benefits of integrating this domain into the clinical assessment.

Background: Behavioral variant frontotemporal dementia (bvFTD) has been related to different genetic factors. Identifying multimodal phenotypic heterogeneity triggered by various genetic influences is critical for improving diagnosis, prognosis, and treatments. However, the specific impact of different genetic levels (mutations vs. risk variants vs. sporadic presentations) on clinical and neurocognitive phenotypes is not entirely understood, specially in patites from underrepresented regions such as Colombia., Methods: Here, in a multiple single cases study, we provide systematic comparisons regarding cognitive, neuropsychiatric, brain atrophy, and gene expression-atrophy overlap in a novel cohort of FTD patients (n = 42) from Colombia with different genetic levels, including patients with known genetic influences (G-FTD) such as those with genetic mutations (GR1) in particular genes (MAPT, TARDBP, and TREM2); patients with risk variants (GR2) in genes associated with FTD (tau Haplotypes H1 and H2 and APOE variants including ε2, ε3, ε4); and sporadic FTD patients (S-FTD (GR3))., Results: We found that patients from GR1 and GR2 exhibited earlier disease onset, pervasive cognitive impairments (cognitive screening, executive functioning, ToM), and increased brain atrophy (prefrontal areas, cingulated cortices, basal ganglia, and inferior temporal gyrus) than S-FTD patients (GR3). No differences in disease duration were observed across groups. Additionally, significant neuropsychiatric symptoms were observed in the GR1. The GR1 also presented more clinical and neurocognitive compromise than GR2 patients; these groups, however, did not display differences in disease onset or duration. APOE and tau patients showed more neuropsychiatric symptoms and primary atrophy in parietal and temporal cortices than GR1 patients. The gene-atrophy overlap analysis revealed atrophy in regions with specific genetic overexpression in all G-FTD patients. A differential family presentation did not explain the results., Conclusions: Our results support the existence of genetic levels affecting the clinical, neurocognitive, and, to a lesser extent, neuropsychiatric presentation of bvFTD in the present underrepresented sample. These results support tailored assessments characterization based on the parallels of genetic levels and neurocognitive profiles in bvFTD., (© 2022. The Author(s).)

Measures of social cognition have now become central in neuropsychology, being essential for early and differential diagnoses, follow-up, and rehabilitation in a wide range of conditions. With the scientific world becoming increasingly interconnected, international neuropsychological and medical collaborations are burgeoning to tackle the global challenges that are mental health conditions. These initiatives commonly merge data across a diversity of populations and countries, while ignoring their specificity., Objective: In this context, we aimed to estimate the influence of participants' nationality on social cognition evaluation. This issue is of particular importance as most cognitive tasks are developed in highly specific contexts, not representative of that encountered by the world's population., Method: Through a large international study across 18 sites, neuropsychologists assessed core aspects of social cognition in 587 participants from 12 countries using traditional and widely used tasks., Results: Age, gender, and education were found to impact measures of mentalizing and emotion recognition. After controlling for these factors, differences between countries accounted for more than 20% of the variance on both measures. Importantly, it was possible to isolate participants' nationality from potential translation issues, which classically constitute a major limitation., Conclusions: Overall, these findings highlight the need for important methodological shifts to better represent social cognition in both fundamental research and clinical practice, especially within emerging international networks and consortia. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Public health researchers are increasingly interested in the potential relationships between social media (SM) use, well-being, and health behavior among adolescents. However, most research has assessed daily SM time via self-report survey questions, despite a lack of clarity around the accuracy of such reports given the current tendency of youth to access SM on multiple electronic devices and cycle between multiple SM platforms on a daily basis (i.e., platform swinging). The current study investigates the potential for systematic reporting biases to skew findings. Three hundred and twenty incoming college students downloaded software on their computers, tablets, and smartphones to track their active use of Facebook, Twitter, Instagram, and Snapchat over a 2-week surveillance period and then self-reported their average daily minutes on each platform immediately after. Larger proportions of students over-estimated than under-estimated their use, with the largest overestimations found on the most heavily used platforms. Females logged significantly more SM time and were less accurate in reporting than were males and, independently, the likelihood of substantial inaccuracies in reporting total SM time and time on most individual platforms increased with each additional SM platform participants reported using. Findings demonstrate that self-reported estimates of SM time among adolescents in the age of SM platform swinging are prone to substantial error and may lead to biased conclusions about relationships between variables. Alternative measurement approaches are suggested to improve the validity of future research in this area.

Strong group identities arise in intergroup conflict scenarios and perpetuate sectarian violence even in post-conflict scenarios. In particular, out-group negative implicit associations are predictors of decreased intergroup forgiveness, as well as increased distrust and aggression against the out-group. Thus, the presence of implicit intergroup (i.e., ex-combatants and victims) biases seems to be a relevant factor in post-conflict scenarios. Here, we aimed to explore whether negative biases toward the out-group are boosted by (a) previous exposure to conflict violence or (b) identification with an armed violent group. One hundred and twenty-eight participants, 65 ex-combatants from Colombian guerrillas and 63 victims of the armed conflict, were assessed with a modified version of the implicit association test (IAT). Our results revealed that the victim group showed a significant negative bias against ex-combatants. However, no bias toward the out-group (i.e., victims) or in-group favoritism was observed in the ex-combatant group. Similarly, we found that IAT scores were not associated with sociodemographical variables (i.e., sex, years of education, or type of dwelling), the levels of combat exposure, victimization armed-conflict-related experiences, or child abuse antecedents. Our results showed an unexpected lack of in-group bias in ex-combatants, potentially triggered by the effect of current demobilization and reintegration processes. Thus, negative associations with the out-group will persist in the framework of societal condemnation of the out-group. In contrast, these negative biases will tend to be abolished when entering in conflict with larger societal reintegration processes. The results reinforce the idea that reintegration may benefit from interventions at the societal level, including all actors of the conflict. In addition, our findings highlight the importance of implementing victim interventions aimed at reducing stigma and revengeful actions in spaces of collective disarmament.

Objective: To compare the prevalence of participants meeting different patient-reported criteria for early osteoarthritis (OA) illness after anterior cruciate ligament reconstruction (ACLR)., Methods: Participants completed the Knee Injury and Osteoarthritis Outcomes Score (KOOS) at a single time point 5.0-7.9 months post-ACLR. We used established KOOS subscale criteria (i.e., Luyten original and Englund original) to define patient-reported early OA illness. A two-by-two contingency table and McNemar's test were used to compare the prevalence of participants who met the Luyten original versus Englund original KOOS criteria for early OA illness. These analyses were repeated using KOOS subscale thresholds based on established population-specific patient acceptable symptom state (PASS) within the Luyten and Englund KOOS criteria (i.e., Luyten PASS and Englund PASS)., Results: A greater prevalence of participants with ACLR met the Luyten original criteria (n = 165 [54%]) compared to those who met the Englund original criteria (n = 128 [42%]; χ 2  = 19.3, P < 0.001). When using the KOOS subscale PASS as thresholds, a significantly greater prevalence of participants with ACLR met the Luyten PASS criteria (n = 133 [43%]) compared to those who met the Englund PASS criteria (n = 85 [28%]; χ 2  = 48.0, P < 0.001). When combining the Luyten and Englund KOOS criteria and using the original/PASS subscale thresholds, respectively, 40%/57% of participants met neither, 24%/15% met only 1, and 36%/28% met both KOOS criteria., Conclusion: Regardless of the classification criteria used to define early OA illness, it is concerning that 28-54% of patients report considerable symptoms ~6 months post-ACLR. Our findings will improve the classification criteria to define early OA illness, which may raise awareness for the need of population-specific criteria., (© 2021 American College of Rheumatology.)

Background: Sources of physical activity (PA) and motivation for return to sport after anterior cruciate ligament reconstruction (ACLR) differ between adolescents and adults. It is unclear whether these differences influence participation in PA during the first year after ACLR when individuals are transitioning from rehabilitative care to unrestricted activity., Purpose: To compare device-assessed measures of PA between adolescents and adults at 6 to 12 months after ACLR., Study Design: Cross-sectional study; Level of evidence, 3., Methods: Included were 22 adolescents (age, 15.9 ± 1.2 years; time since surgery = 8.0 ± 2.1 months) and 23 adults (age, 22.5 ± 5.0 years; time since surgery = 8.2 ± 2.1 months) who were cleared for unrestricted PA after primary unilateral ACLR. Participants were considered physically active if they met their age-specific United States Department of Health and Human Services PA guidelines. Participants wore an accelerometer-based PA monitor for at least 7 days. Daily minutes of moderate to vigorous-PA (MVPA) and daily step counts were reported and compared between age groups using analysis of covariance, with monitor wear time and sex included as covariates. The association between age group and meeting age-specific PA guidelines was assessed using binary logistic regression and reported as an odds ratio., Results: Adults with ACLR participated in 16 minutes more MVPA per day (49 ± 22 vs 33 ± 16 minutes per day; P < .001) and took 2212 more steps per day (8365 ± 2294 vs 6153 ± 1765 steps per day; P < .001) when compared with adolescent participants. In addition, 83% of adults were physically active, compared with 9% of adolescents (odds ratio = 60.2; 95% CI, 7.6-493.4)., Conclusion: Adolescents with ACLR were less physically active than adults with ACLR, and only 9% of adolescents met aerobic PA guidelines. This is concerning because PA patterns adopted early in life are predictive of PA patterns in adulthood. Our findings indicate a need to better understand underlying causes of reduced PA among adolescents with ACLR and to develop intervention strategies that promote engagement in adequate PA after rehabilitation., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This work was partially funded by a grant from the National Athletic Trainers’ Association Research and Education Foundation (award 1718NIP01). L.W. has received education payments from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Frontotemporal dementia (FTD) is the third most common form of dementia across all age groups and is a leading cause of early-onset dementia. The Frontotemporal dementia (FTD) includes a spectrum of diseases that are classified according to their clinical presentation and patterns of neurodegeneration. There are two main types of FTD: behavioral FTD variant (bvFTD), characterized by a deterioration in social function, behavior, and personality; and primary progressive aphasias (PPA), characterized by a deficit in language skills. There are other types of FTD-related disorders that present motor impairment and/or parkinsonism, including FTD with motor neuron disease (FTD-MND), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). The FTD and its associated disorders present great clinical heterogeneity. The diagnosis of FTD is based on the identification through clinical assessments of a specific clinical phenotype of impairments in different domains, complemented by an evaluation through instruments, i.e., tests and questionnaires, validated for the population under study, thus, achieving timely detection and treatment. While the prevalence of dementia in Latin America and the Caribbean (LAC) is increasing rapidly, there is still a lack of standardized instruments and consensus for FTD diagnosis. In this context, it is important to review the published tests and questionnaires adapted and/or validated in LAC for the assessment of cognition, behavior, functionality, and gait in FTD and its spectrum. Therefore, our paper has three main goals. First, to present a narrative review of the main tests and questionnaires published in LAC for the assessment of FTD and its spectrum in six dimensions: (i) Cognitive screening; (ii) Neuropsychological assessment divided by cognitive domain; (iii) Gait assessment; (iv) Behavioral and neuropsychiatric symptoms; (v) Functional assessment; and (vi) Global Rating Scale. Second, to propose a multidimensional clinical assessment of FTD in LAC identifying the main gaps. Lastly, it is proposed to create a LAC consortium that will discuss strategies to address the current challenges in the field., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Henríquez, Cabello, Baez, Souza, Lillo, Martínez-Pernía, Olavarría, Torralva and Slachevsky.)

An outbreak of over 1,000 COVID-19 cases in Provincetown, Massachusetts (MA), in July 2021-the first large outbreak mostly in vaccinated individuals in the US-prompted a comprehensive public health response, motivating changes to national masking recommendations and raising questions about infection and transmission among vaccinated individuals. To address these questions, we combined viral genomic and epidemiological data from 467 individuals, including 40% of outbreak-associated cases. The Delta variant accounted for 99% of cases in this dataset; it was introduced from at least 40 sources, but 83% of cases derived from a single source, likely through transmission across multiple settings over a short time rather than a single event. Genomic and epidemiological data supported multiple transmissions of Delta from and between fully vaccinated individuals. However, despite its magnitude, the outbreak had limited onward impact in MA and the US overall, likely due to high vaccination rates and a robust public health response., Competing Interests: Declaration of interests P.C.S. is a co-founder of, shareholder in, and scientific advisor to Sherlock Biosciences, as well as a board member of and shareholder in Danaher Corporation. J.E.L. has received consulting fees from Sherlock Biosciences. A.P. is a venture partner at Google Ventures. W.P.H. is a member of the scientific advisory board of Biobot. Other authors report no competing interests., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Biotic and abiotic factors interact with dominant plants-the locally most frequent or with the largest coverage-and nondominant plants differently, partially because dominant plants modify the environment where nondominant plants grow. For instance, if dominant plants compete strongly, they will deplete most resources, forcing nondominant plants into a narrower niche space. Conversely, if dominant plants are constrained by the environment, they might not exhaust available resources but instead may ameliorate environmental stressors that usually limit nondominants. Hence, the nature of interactions among nondominant species could be modified by dominant species. Furthermore, these differences could translate into a disparity in the phylogenetic relatedness among dominants compared to the relatedness among nondominants. By estimating phylogenetic dispersion in 78 grasslands across five continents, we found that dominant species were clustered (e.g., co-dominant grasses), suggesting dominant species are likely organized by environmental filtering, and that nondominant species were either randomly assembled or overdispersed. Traits showed similar trends for those sites (<50%) with sufficient trait data. Furthermore, several lineages scattered in the phylogeny had more nondominant species than expected at random, suggesting that traits common in nondominants are phylogenetically conserved and have evolved multiple times. We also explored environmental drivers of the dominant/nondominant disparity. We found different assembly patterns for dominants and nondominants, consistent with asymmetries in assembly mechanisms. Among the different postulated mechanisms, our results suggest two complementary hypotheses seldom explored: (1) Nondominant species include lineages adapted to thrive in the environment generated by dominant species. (2) Even when dominant species reduce resources to nondominant ones, dominant species could have a stronger positive effect on some nondominants by ameliorating environmental stressors affecting them, than by depleting resources and increasing the environmental stress to those nondominants. These results show that the dominant/nondominant asymmetry has ecological and evolutionary consequences fundamental to understand plant communities., Competing Interests: None declared., (© 2021 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Backround: Research suggests that the social media platforms popular on college campuses may reflect, reinforce, and even exacerbate heavy drinking practices among students. The present study was designed to directly examine: (1) whether exposure to alcohol-related content on social media diminishes the efficacy of a traditional web-based personalized normative feedback (PNF) alcohol intervention among first-year drinkers; and (2) if social media inspired features and digital game mechanics can be integrated into a PNF intervention to combat social media-based alcohol influence and increase efficacy., Method: Alcohol experienced first-year college students (N = 223) completed a pre-survey that assessed exposure to alcohol-related content and social media and were randomized to 1 of 3 web-based alcohol PNF conditions (traditional, gamified only, or social media inspired gamified). One month later, participants' alcohol consumption was reassessed., Results: Among participants who received traditional PNF, social media-based alcohol exposure interacted with pre-intervention drinking such that traditional PNF was less effective in reducing drinking among heavier drinkers reporting greater exposure to alcohol-related social media content. Further, when regression models compared the efficacy of all three conditions, the social media inspired gamified PNF condition was significantly more effective in reducing drinking than was traditional PNF among moderate and heavy drinkers reporting greater exposure to alcohol on social media., Conclusion: Although additional research is needed, these findings suggest that representing the population of students on whom normative statistics are based with social media-like user avatars and profiles may enhance the degree to which alcohol PNF is relatable and believable among high-risk students., (Copyright © 2021. Published by Elsevier B.V.)

Objective: The objective of this pilot study was to examine the preliminary feasibility and efficacy of in vivo exposure therapy (IVET) to decrease injury-related fear in females with history of ACLR., Design: Pilot Study., Setting: Sports Medicine Research Laboratory., Participants: 12 female participants with history of ACLR (≥ 1 year post-operative) were randomized into a 5-week IVET group (n = 6) or 5-week sham physical activity (PA) monitoring group (n = 6)., Main Outcome Measures: The independent variables were Group and Time. The dependent variables were the Photographic Series of Sports Activities for ACLR (PHOSA-ACLR) and the Tampa Scale of Kinesiophobia-11 (TSK-11) scores. A Group x Time repeated measures two-way analysis of variance was completed for the PHOSA-ACLR and the TSK-11. Partial η 2 effect sizes were used to examine clinically meaningful differences., Results: High retention and adherence rates were observed in the intervention group. The PHOSA-ACLR exhibited a significant main effect for Time (F 1,10  = 9.92, p = 0.01, partial η 2  = 0.50), but not for Group. No statistically significant or clinically meaningful differences were observed for the TSK-11., Conclusion: Both groups exhibited decreased injury-related fear for specific functional tasks. Future research should further examine the efficacy of IVET and PA monitoring to decrease injury-related fear in patients after ACLR., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Multiple summer events, including large indoor gatherings, in Provincetown, Massachusetts (MA), in July 2021 contributed to an outbreak of over one thousand COVID-19 cases among residents and visitors. Most cases were fully vaccinated, many of whom were also symptomatic, prompting a comprehensive public health response, motivating changes to national masking recommendations, and raising questions about infection and transmission among vaccinated individuals. To characterize the outbreak and the viral population underlying it, we combined genomic and epidemiological data from 467 individuals, including 40% of known outbreak-associated cases. The Delta variant accounted for 99% of sequenced outbreak-associated cases. Phylogenetic analysis suggests over 40 sources of Delta in the dataset, with one responsible for a single cluster containing 83% of outbreak-associated genomes. This cluster was likely not the result of extensive spread at a single site, but rather transmission from a common source across multiple settings over a short time. Genomic and epidemiological data combined provide strong support for 25 transmission events from, including many between, fully vaccinated individuals; genomic data alone provides evidence for an additional 64. Together, genomic epidemiology provides a high-resolution picture of the Provincetown outbreak, revealing multiple cases of transmission of Delta from fully vaccinated individuals. However, despite its magnitude, the outbreak was restricted in its onward impact in MA and the US, likely due to high vaccination rates and a robust public health response.