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Abstract NAD is an essential co-factor for cellular energy metabolism and multiple other processes. Systemic NAD+ deficiency has been implicated in skeletal deformities during development in both humans and mice. NAD levels are maintained by multiple synthetic pathways but which ones are important in bone forming cells is unknown. Here, we generate mice with deletion of Nicotinamide Phosphoribosyltransferase (Nampt), a critical enzyme in the NAD salvage pathway, in all mesenchymal lineage cells of the limbs. At birth, Nampt ΔPrx1 exhibit dramatic limb shortening due to death of growth plate chondrocytes. Administration of the NAD precursor nicotinamide riboside during pregnancy prevents the majority of in utero defects. Depletion of NAD post-birth also promotes chondrocyte death, preventing further endochondral ossification and joint development. In contrast, osteoblast formation still occurs in knockout mice, in line with distinctly different microenvironments and reliance on redox reactions between chondrocytes and osteoblasts. These findings define a critical role for cell-autonomous NAD homeostasis during endochondral bone formation.

BackgroundRacial and ethnic differences in emergency department (ED) visits have been reported among adolescent patients but are unsubstantiated among adults. Therefore, our purpose in this study was to examine the relationship between race/ethnicity and adult ED visits for concussions, their injury mechanisms, and computed tomography (CT) scan use among a nationally representative sample.MethodsWe used the National Hospital Ambulatory Medical Care Survey database from 2010–2015 to examine 63,725 adult (20–45 years old) patient visits, representing an estimated 310.6 million visits presented to EDs. Of these visits, 884 (4.5 million national estimate) were diagnosed with a concussion. Visit records detailed patient information (age, sex, race/ethnicity, geographic region, primary payment type), ED visit diagnoses, injury mechanism (sport, motor vehicle, fall, struck by or against, “other”), and head CT scan use. The primary independent variable was race/ethnicity (non-Hispanic Asian, non-Hispanic Black or African American, Hispanic/Latinx, non-Hispanic multiracial or another, and non-Hispanic White). We used multivariable logistic and multinomial regression models with complex survey sampling design weighting to examine the relationship between concussion ED visits, injury mechanisms, and CT scan use separately by race/ethnicity while accounting for covariates.ResultsThere were no associations between race/ethnicity and concussion diagnosis among adult ED visits after accounting for covariates. Relative to sports-related injuries, non-Hispanic Black or African American patient visits were associated with a motor vehicle (OR = 2.69, 95% CI: 1.06–6.86) and “other” injury mechanism (OR = 4.58, 95% CI: 1.34–15.69) compared to non-Hispanic White patients. Relative to sports-related injuries, non-Hispanic Asian, multiracial, or patients of another race had decreased odds of falls (OR = 0.20, 95% CI: 0.04–0.91) and “other” injuries (OR = 0.09, 95% CI: 0.01–0.55) compared to non-Hispanic White patients. The odds of a CT scan being performed were significantly lower among Hispanic/Latinx patient visits relative to non-Hispanic White patients (OR = 0.52, 95% CI: 0.30–0.91), while no other race/ethnicity comparisons differed.ConclusionOur findings indicate that the overarching concussion ED visit likelihood may not differ by race/ethnicity in adults, but the underlying mechanism causing the concussion and receiving a CT scan demonstrates considerable differences. Prospective future research is warranted to comprehensively understand and intervene in the complex, multi-level race/ethnicity relationships related to concussion health care to ensure equitable patient treatment.

Background: Concussed patients have impaired reaction time (RT) and cognition following injury that may linger and impair driving performance. Limited research has used direct methods to assess driving-RT post-concussion. Our study compared driving RT during simulated scenarios between concussed and control individuals and examined driving-RT's relationship with traditional computerized neurocognitive testing (CNT) domains. Methods: We employed a cross-sectional study among 14 concussed (15.9 ± 9.8 days post-concussion, mean ± SD) individuals and 14 healthy controls matched for age, sex, and driving experience. Participants completed a driving simulator and CNT (CNS Vital Signs) assessment within 48 h of symptom resolution. A driving-RT composite (ms) was derived from 3 simulated driving scenarios: stoplight (green to yellow), evasion (avoiding approaching vehicle), and pedestrian (person running in front of vehicle). The CNT domains included verbal and visual memory; CNT-RT (simple-, complex-, Stroop-RT individually); simple and complex attention; motor, psychomotor, and processing speed; executive function; and cognitive flexibility. Independent t tests and Hedge d effect sizes assessed driving-RT differences between groups, Pearson correlations (r) examined driving RT and CNT domain relationships among cohorts separately, and p values were controlled for false discovery rate via Benjamini-Hochberg procedures (α = 0.05). Results: Concussed participants demonstrated slower driving-RT composite scores than controls (mean difference = 292.86 ms; 95% confidence interval (95%CI): 70.18–515.54; p = 0.023; d = 0.992). Evasion-RT (p = 0.054; d = 0.806), pedestrian-RT (p = 0.258; d = 0.312), and stoplight-RT (p = 0.292; d = 0.585) outcomes were not statistically significant after false-discovery rate corrections but demonstrated medium to large effect sizes for concussed deficits. Among concussed individuals, driving-RT outcomes did not significantly correlate with CNT domains (r-range: –0.51 to 0.55; p > 0.05). No correlations existed between driving-RT outcomes and CNT domains among control participants either (r-range: –0.52 to 0.72; p > 0.05). Conclusion: Slowed driving-RT composite scores and large effect sizes among concussed individuals when asymptomatic signify lingering impairment and raise driving-safety concerns. Driving-RT and CNT-RT measures correlated moderately but not statistically, which indicates that CNT-RT is not an optimal surrogate for driving RT.

Flue-gas desulfurization (FGD) gypsum, a byproduct of coal-fired electrical utility plants, has been shown to effectively reduce phosphorus (P) leaching in many agricultural systems. However, its applications in horticultural production systems have been insufficiently researched resulting in limited industry adoption. To evaluate the efficacy of FGD gypsum to reduce P leaching in horticultural media, pine bark substrates were amended with FGD gypsum at 2.5, 5, and 10% (v/v). In accordance with industry practice, controlled release fertilizer (19N-3P-10K) was amply incorporated into all potting media treatments to support primary nutrient sufficiency of transplanted stock. The greatest P leaching occurred in the control substrates containing only pine bark and fertilizer. The standard pine bark substrate treatment, containing lime and micronutrients, reduced total P leaching by 35% and should be considered a best management practice. The addition of FGD gypsum at 2.5, 5, and 10% (v/v) reduced the total P collected in leachate by 47, 59, and 70%, respectively. Gypsum amendments increased potassium leachate concentrations but elevated potassium levels normalized after ~20 days. With little to no effect on substrate physical properties or pH, pine bark substrates can be amended with FGD gypsum to effectively reduce P leaching in short-term crops.

Context: Dual-task (simultaneous cognitive–motor activities) assessments have been adapted into reliable and valid clinical concussion measures. However, abundant motor and cognitive variations leave researchers and clinicians uncertain about which combinations elicit the intended dual-task effect. Our objective was to examine differences between commonly employed dual-task motor and cognitive combinations among healthy, college-aged individuals. Design: Cross-sectional laboratory study. Methods: Twenty participants (age: 21.3 [2.4] y; height: 176.0 [9.1] cm; mass: 76.0 [16.4] kg; 20% with concussion history) completed 4 motor tasks (gait, tandem gait, single-leg balance, and tandem balance) under 5 cognitive conditions (single task, subtraction, month reversal, spelling backward, and visual Stroop) in a research laboratory. The motor performance outcomes were spatiotemporal variables for gait and tandem gait and center of pressure path length (in centimeters) for single-leg and tandem balance. Cognitive outcomes were response rate (responses/second) and cognitive accuracy. We used separate repeated-measures analyses of variance for each motor and cognitive outcome with post hoc Tukey t tests. Results: Gait velocity, gait stride length, and tandem gait velocity demonstrated significant cognitive–motor interactions (P's <.001) such that all dual-task conditions resulted in varyingly slower or shorter movement than single task. Conversely, single-leg balance (P =.627) and tandem balance (P =.434) center of pressure path length did not significantly differ among the dual-task cognitive conditions or relative to single task. Statistically significant cognitive–motor interactions were observed only for spelling backward accuracy (P =.004) and response rates for spelling backward, month reversal, and visual Stroop (P's <.001) such that worse accuracy, but faster response rates, occurred during motor tasks. Conclusions: Gait and tandem gait motor tasks accompanied with spelling backward or subtraction cognitive tasks demonstrated consistently strong dual-task effects and, therefore, may be the best suited for clinical and research use following concussion. [ABSTRACT FROM AUTHOR]

Context: Single- and dual-task walking gait assessments have been used to identify persistent movement and cognitive dysfunction among athletes with concussions. However, it is unclear whether previous ankle sprain injuries confound these outcomes during baseline testing. The purpose of this study was to determine the effects of (1) ankle sprain history and (2) time since prior ankle sprain injury on single- and dual-task spatiotemporal gait outcomes and cognitive measures. Design: Cross- sectional study. Methods: We assessed 60 college Division-I athletes (31 with ankle sprain history; 13 females and 18 males, 19.3 [0.8] y; 29 with no ankle sprain history, 14 females and 15 males, 19.7 [0.9] y) who completed injury history forms and underwent concussion baseline testing. Athletes completed single- and dual-task gait assessments by walking back and forth along an 8-m walkway for 40 seconds. Athletes wore a smartphone with an associated mobile application on their lumbar spine to record spatiotemporal gait parameters and dual-task cognitive performance. Separate multivariate analyses of variance were used to assess the effects of ankle sprain injury history on spatiotemporal measures, gait variability, and cognitive performance. We performed a multivariate regression subanalysis on athletes who reported time since injury (n = 23) to assess temporal effects on gait and cognitive performance. Results: Athletes with and without a histoiy of ankle sprains had comparable spatiotemporal and gait variability outcomes during single- (P = .42; P = .13) and dual-task (P = .75; P = .55) conditions. Additionally, ankle sprain injury history did not significantly influence cognitive performance (P = .35). Finally, time since ankle sprain did not significantly affect single- (P = .75) and dual-task gait (P = .69), nor cognitive performance (P = 19). Conclusions: Ankle sprain injury history did not significantly alter spatiotemporal gait outcomes nor cognitive performance during this common clinical assessment. Future studies may consider including athletes with ankle sprain injury history during concussion assessments. [ABSTRACT FROM AUTHOR]

Context: Aberrant movement patterns among individuals with concussion history have been reported during sport-related movement. However, the acute postconcussion kinematic and kinetic biomechanical movement patterns during a rapid acceleration–deceleration task have not been profiled and leaves their progressive trajectory unknown. Our study aimed to examine single-leg hop stabilization kinematics and kinetics between concussed and healthy-matched controls acutely (≤7 d) and when asymptomatic (≤72 h of symptom resolution). Design: Prospective, cohort laboratory study. Methods: Ten concussed (60% male; 19.2 [0.9] y; 178.7 [14.0] cm; 71.3 [18.0] kg) and 10 matched controls (60% male; 19.5 [1.2] y; 176.1 [12.6] cm; 71.0 [17.0] kg) completed the single-leg hop stabilization task under single and dual task (subtracting by 6's or 7's) at both time points. Participants stood on a 30-cm tall box set 50% of their height behind force plates while in an athletic stance. A synchronized light was illuminated randomly, queuing participants to initiate the movement as rapidly as possible. Participants then jumped forward, landed on their nondominant leg, and were instructed to reach and maintain stabilization as fast as possible upon ground contact. We used 2 (group) × 2 (time) mixed-model analyses of variance to compare single-leg hop stabilization outcomes separately during single and dual task. Results: We observed a significant main group effect for single-task ankle plantarflexion moment, with greater normalized torque (mean difference = 0.03 N·m/body weight; P =.048, g = 1.18) for concussed individuals across time points. A significant interaction effect for single-task reaction time indicated that concussed individuals had slower performance acutely relative to asymptomatic (mean difference = 0.09 s; P =.015, g = 0.64), while control group performance was stable. No other main or interaction effects for single-leg hop stabilization task metrics were present during single and dual task (P ≥.051). Conclusions: Greater ankle plantarflexion torque coupled with slower reaction time may indicate stiff, conservative single-leg hop stabilization performance acutely following concussion. Our findings shed preliminary light on the recovery trajectories of biomechanical alterations following concussion and provide specific kinematic and kinetic focal points for future research. [ABSTRACT FROM AUTHOR]

This review evaluates the strength of evidence for school-based mental health and suicide prevention programs that meet the legal eligibility criteria of the Suicide Training and Awareness Nationally Delivered for Universal Prevention Act of 2021 (STANDUP Act). Included studies were aggregated by program and a program's overall body of evidence was evaluated using the LEGEND system. Requirements for implementation were also documented. We identified 29 studies, which, when aggregated, encompassed 12 unique programs that meet the statute's evidence-based criteria. All four outcomes described in the statute were measured, with help-seeking being the most commonly measured. Two programs were assigned a high level of evidence in decreasing suicidal thoughts and behaviors. The findings serve as a resource for school officials in identifying evidence-based mental health and suicide prevention programs and understanding the resources needed for implementation. [ABSTRACT FROM AUTHOR]

Objective: Concussion evaluations use a multidimensional assessment to evaluate unique patient function dimensions (e.g., subjective symptoms differ from balance assessments), but the overarching latent factor structure has not been empirically substantiated. Our objective was to determine the cumulative latent factor structure of pre-injury baseline and acute (<48-h) post-concussion assessment battery outcomes, and determine measurement equivalence among common factors in collegiate student-athletes. Methods: Collegiate student-athletes at baseline (n = 21,865) and post-concussion (n = 1,537) across 25-institutions completed standardized assessments. Individual items were used from the baseline and post-concussion assessments and consisted of: Sport Concussion Assessment Tool, Brief Symptom Inventory-18, Standardized Assessment of Concussion, Balance Error Scoring System, Immediate Post-Concussion Assessment and Cognitive Test, and vestibular-ocular motor screening. Exploratory factor analysis was used on half the baseline data, and confirmatory factor analysis on the remaining baseline data and post-concussion data separately. Measurement equivalence was assessed between sex, sport contact classification, concussion history, and time. Results: A 10-factor exploratory model was established and comprised of: depression, somatic, vestibulo-ocular, headache, postural stability, neurocognition, emotional, fatigue, cognitive, consciousness clouding. The 10-factor model was confirmed at baseline and post-concussion with strong measurement equivalence between timepoints. Strong to strict measurement equivalence was observed for sex, sport contact classification, and concussion history at both timepoints separately. Conclusion: Our findings established a robust 10-factor latent factor model equivalent across timepoints and common factors among healthy and concussed collegiate athletes. Clinicians can use these findings to target specific factors while reducing redundant elements to provide efficient, comprehensive post-concussion assessments. [ABSTRACT FROM AUTHOR]

Context: Neuromuscular function is altered acutely following concussion and theoretically linked to the subsequent postconcussion musculoskeletal injury risk. Existing research has only examined voluntary muscle activation, limiting mechanistic understanding. Therefore, our study aimed to examine voluntary and involuntary muscle activation between college-aged, concussed individuals when symptom-free and healthy matched controls. Design: Prospective, cross-sectional cohort laboratory study. Methods: Concussed and healthy participants (n = 24; 58% male, age: 19.3 [1.1] y, mass: 70.3 [16.4] kg, height: 177.3 [12.7] cm) completed the superimposed burst (SB) neuromuscular assessment on their dominant limb within 72 hours after self-reporting asymptomatic (22.4 [20.2] d postinjury). Unnormalized and bodyweight-normalized quadriceps maximal voluntary isometric contraction torque (in newton meters), unnormalized and bodyweight-normalized electrically stimulated SB torque, pain (numeric 1–10) during SB, and the central activation ratio (in percentage) were assessed via the SB. Parametric and nonparametric analyses, 95% confidence intervals (95% CIs), and Hedges g (parametric) and Spearman ρ (nonparametric) effect sizes were used to examine group differences (α =.05). Results: The maximal voluntary isometric contraction torque (concussed: 635.60 N·m [300.93] vs control: 556.27 N·m [182.46]; 95% CI, −131.36 to 290.02; P =.443; d = 0.33), SB torque (concussed: 203.22 N·m [97.17], control: 262.85 N·m [159.07]; 95% CI, −171.22 to 51.97; P =.280; d = −0.47), and central activation ratio (concussed: 72.16% [17.16], control: 70.09% [12.63]; 95% CI, −10.68 to 14.83; P =.740; d = 0.14) did not differ between the concussed and control groups regardless of bodyweight normalization (P ≥.344). Pain during the SB was significantly higher with a medium effect for participants with a concussion versus healthy controls (concussed: median = 7, control: median = 5; P =.046; ρ = −0.42). Discussion: These findings suggest concussed participants do not have statistically altered voluntary or involuntary quadricep neuromuscular function once asymptomatic compared with controls. Therefore, the elevated postconcussion musculoskeletal injury risk may not be attributed to lower-extremity muscle activation. Concussed participants displayed greater pain perception during the SB, which suggests somatosensory or perception changes requiring further examination. [ABSTRACT FROM AUTHOR]

The Shared Witness of C.S. Lewis and Austin Farrer: Friendship, Influence and an Anglican Worldview. Philip Irving Mitchell. Kent State University Press, 2021. CS. Lewis, as is often noted, was [...]

Objective Investigate the relationships between concussion history and years of football participation (repetitive head impact proxy) with alcohol use across multiple decades in former professional football players. Methods Participants (n  = 348; mean age = 49.0 ± 9.4) completed health questionnaires in 2001 and 2019, which included self-reported concussion history and years of participation. Alcohol use frequency and amount per occasion were reported for three timepoints: during professional career, 2001, and 2019. Ordinal logistic regression models were fit to test associations of concussion history and years of participation with alcohol use at each timepoint. Results There were no significant associations between either concussion history or years of football participation with alcohol use (frequency and amount per occasion) at any timepoint. Effect estimates for concussion history and years of football participation with alcohol use were generally comparable across timepoints. Conclusions Later life alcohol use by former American football players is not associated with concussion history or years of exposure to football. [ABSTRACT FROM AUTHOR]

Context: Reaction time is commonly assessed postconcussion through a computerized neurocognitive battery. Although this measure is sensitive to postconcussion deficits, it is not clear if computerized reaction time reflects the dynamic reaction time necessary to compete effectively and safely during sporting activities. Functional reaction time assessments may be useful postconcussion, but reliability must be determined before clinical implementation. Objective: To determine the test–retest reliability of a functional reaction time assessment battery and to determine if reaction time improved between sessions. Design: Cohort. Setting: Laboratory. Participants: Forty-one participants (21 men and 20 women) completed 2 time points. Participants, on average, were 22.5 (2.1) years old, 72.5 (11.9) cm tall, had a mass of 71.0 (13.7) kg, and were mostly right leg and hand dominant (92.7%). Interventions: Participants completed 2 clinical reaction time tests (computerized Stroop and drop stick) and 5 functional reaction time tests (gait, jump landing, single-leg hop, anticipated cut, and unanticipated cut) across 2 sessions. Drop stick and functional reaction time assessments were performed in single (motor task only) and dual task (motor task with cognitive task). Main Outcome Measures: Reaction time (in seconds) was calculated during all assessments. Test–retest reliability was determined using 2-way mixed-effects intraclass correlation coefficients (3, k). Paired samples t tests compared mean reaction time between sessions. Results: Test–retest reliability was moderate to excellent for all reaction time outcomes (intraclass correlation coefficients [3, k] range =.766–.925). Several statistically significant between-session mean differences were observed, but effect sizes were negligible to small (d range = 0.05–0.44). Conclusions: The functional reaction time assessment battery displayed similar reliability to the standard computerized reaction time assessment battery and may provide important postinjury information, but more research is needed to determine clinical utility. [ABSTRACT FROM AUTHOR]

Context: Laboratory-based movement assessments are commonly performed without cognitive stimuli (ie, single-task) despite the simultaneous cognitive processing and movement (ie, dual task) demands required during sport. Cognitive loading may critically alter human movement and be an important consideration for truly assessing functional movement and understanding injury risk in the laboratory, but limited investigations exist. Objective: To comprehensively examine and compare kinematics and kinetics between single- and dual-task functional movement among healthy participants while controlling for sex. Design: Cross-sectional study. Setting: Laboratory. Patients (or Other Participants): Forty-one healthy, physically active participants (49% female; 22.5 ± 2.1 y; 172.5 ± 11.9 cm; 71.0 ± 13.7 kg) enrolled in and completed the study. Intervention(s): All participants completed the functional movement protocol under single- and dual-task (subtracting by 6s or 7s) conditions in a randomized order. Participants jumped forward from a 30-cm tall box and performed (1) maximum vertical jump landings and (2) dominant and (3) nondominant leg, single-leg 45° cuts after landing. Main Outcome Measures: The authors used mixed-model analysis of variances (α =.05) to compare peak hip, knee, and ankle joint angles (degrees) and moments (N·m/BW) in the sagittal and frontal planes, and peak vertical ground reaction force (N/BW) and vertical impulse (Ns/BW) between cognitive conditions and sex. Results: Dual-task resulted in greater peak vertical ground reaction force compared with single-task during jump landing (mean difference = 0.06 N/BW; 95% confidence interval [CI], 0.01 to 0.12; P =.025) but less force during dominant leg cutting (mean difference = −0.08 N/BW; 95% CI, −0.14 to −0.02; P =.015). Less hip-flexion torque occurred during dual task than single task (mean difference = −0.09 N/BW; 95% CI, −0.17 to −0.02). No other outcomes were different between single and dual task (P ≥.053). Conclusions: Slight, but potentially important, kinematic and kinetic differences were observed between single- and dual-task that may have implications for functional movement assessments and injury risk research. More research examining how various cognitive and movement tasks interact to alter functional movement among pathological populations is warranted before clinical implementation. [ABSTRACT FROM AUTHOR]

Wearable accelerometry devices quantify on-field frequency and severity of head impacts to further improve sport safety. Commonly employed post-data collection cleaning techniques may affect these outcomes. Our purpose was to compare game impact rates and magnitudes between three different cleaning levels (Level-1: impacts recorded within start and end times, Level-2: impacts during pauses/breaks removed, Level-3: video verified) for male youth tackle football. Participants (n = 23, age = 10.9 ± 0.3 yrs, height = 150.0 ± 8.3 cm, mass = 41.6 ± 8.4 kg) wore Triax SIM-G sensors throughout Fall 2019. Impact rates, ratios (IRRs), and 95% confidence intervals (95%CI) were used to compare levels. Random-effects general linear models were used to compare peak linear acceleration (PLA;g) and angular velocity (PAV;rads/s). Level-1 resulted in higher impact rates (4.57; 95%CI = 4.14–5.05) compared to Level-2 (3.09; 95%CI = 2.80–3.42; IRR = 1.48; 95%CI = 1.34–1.63) and Level-3 datasets (2.56; 95%CI = 2.30–2.85; IRR = 1.78; 95%CI = 1.60–1.98). Level-2 had higher impact rates compared to Level-3 (1.21; 95%CI = 1.08–1.35). Level-1 resulted in higher PAV than Level-2 and Level-3 (p < 0.001) datasets. PLA did not differ across datasets (p = 0.296). Head impact data should be filtered of pauses/breaks, and does not substantially differ outcome estimates compared to time-intensive video verification. [ABSTRACT FROM AUTHOR]

Background: Current medical practices and recommendations largely ignore the safety of postconcussion driving, even though commonly used measures of neurocognition, balance, and vestibulo-ocular function show impairment. Purpose: To compare simulated driving between patients with concussion and controls throughout concussion recovery using a case-control design. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 26 concussed and 23 control Division I collegiate athletes completed a driving simulation assessment at 3 time points (within 72 hours, asymptomatic, and return to sport). Cumulative driving simulation outcome variables included total number of collisions, speed exceedances, stop signs missed, lane excursions, total drive time, percentage of time over the speed limit, and percentage of time out of the lane. The mean speed, standard deviation of speed (SDS), lateral lane position, and standard deviation of lateral lane position (SDLP) were examined for each of the 11 drive segments. Outcomes were compared using generalized linear mixed models with random intercepts by participant with Poisson or normal distributions. Results: Within 72 hours of injury, the concussion group committed more lane excursions (median difference, 2; P =.003), exhibited greater SDS while avoiding a child pedestrian crossing the road (Cohen d = 0.73; P =.011), drove ~7 inches (~18 cm) closer to the centerline during a residential left curve (d = 0.90; P =.015), and had greater SDLP while navigating around a car crash compared with controls (d = 0.72; P =.016). When asymptomatic, the concussion group committed fewer speed exceedances (median difference, 2; P =.002) and had lower SDLP while navigating through a traffic light compared with controls (d = 0.60; P =.045). No differences were evident at return to sport. Groups did not differ in total collisions at any time point. Conclusion: The concussion group showed more impaired driving patterns within 72 hours of injury, drove more conservatively once asymptomatic, and had similar driving performance at the time they returned fully to sport. Clinicians should consider these findings when discussing driving with patients acutely after concussion. Further research is needed to determine whether on-road collision risk is elevated after concussion. [ABSTRACT FROM AUTHOR]

NAD is an essential co-factor for cellular energy metabolism and multiple other processes. Systemic NAD+ deficiency has been implicated in skeletal deformities during development in both humans and mice. NAD levels are maintained by multiple synthetic pathways but which ones are important in bone forming cells is unknown. Here, we generate mice with deletion of Nicotinamide Phosphoribosyltransferase (Nampt), a critical enzyme in the NAD salvage pathway, in all mesenchymal lineage cells of the limbs. At birth, NamptΔPrx1 exhibit dramatic limb shortening due to death of growth plate chondrocytes. Administration of the NAD precursor nicotinamide riboside during pregnancy prevents the majority of in utero defects. Depletion of NAD post-birth also promotes chondrocyte death, preventing further endochondral ossification and joint development. In contrast, osteoblast formation still occurs in knockout mice, in line with distinctly different microenvironments and reliance on redox reactions between chondrocytes and osteoblasts. These findings define a critical role for cell-autonomous NAD homeostasis during endochondral bone formation. Deficiency in NAD+ has been implicated in skeletal deformities during development in both humans and mice. Here, the authors use mice that lack the critical enzyme of the NAD+ salvage pathway Nampt in mesenchymal lineage cells to show that the NAD salvage pathway is indispensable for endochondral but not intramembranous bone development. [ABSTRACT FROM AUTHOR]

Postconcussion reaction time deficits are common, but existing assessments lack sport-related applicability. We developed the Standardized Assessment of Reaction Time (StART) tool to emulate the simultaneous cognitive and motor function demands in sport, but its reliability is unestablished. To determine the intrarater, interrater, and test-retest reliability of StART and to examine the dual-task effect, time effect, and relationships between StART and computerized and laboratory-based functional reaction time assessments. Prospective cohort study. Clinical laboratory. Twenty healthy, physically active individuals (age = 20.3 ± 1.8 years, females = 12, no concussion history = 75%). Participants completed the StART, computerized reaction time (Stroop task via CNS Vital Signs), and laboratory-based jump landing and cutting reaction time under single-task and dual-task (subtracting by 6s or 7s) cognitive conditions at 2 testing sessions a median of 7 days apart. We used intraclass correlation coefficients (ICCs), repeated-measure analysis of variance, and Pearson r correlations to address our aims. Overall, good to strong interrater (ICC [2,k] range = 0.83–0.97), intrarater (ICC [3,k] range = 0.91–0.98), and test-retest (ICC [3,k] range = 0.69–0.89) reliability were observed. A significant reaction time assessment-by-cognitive condition interaction was present (P =.018, ηp2 = 0.14), with StART having the largest dual-task effect. Main time effects for dual-task conditions were seen across all reaction time assessments (mean difference = −25 milliseconds, P =.026, ηp2 = 0.08) with improved performance at the second testing session. No StART outcomes correlated with computerized reaction time (P >.05), although some correlated with single-task (r range = 0.42–0.65) and dual-task (r range = 0.19–0.50) laboratory cutting reaction time. The StART demonstrated overall reliable performance relative to other reaction time measures. Reliability coupled with a strong dual-task effect indicates that StART is a valid measure for examining functional reaction time and may have future utility for sport-related concussion return-to-play decision-making. [ABSTRACT FROM AUTHOR]

Shumski, EJ, Lempke, LB, Johnson, RS, Oh, J, Schmidt, JD, and Lynall, RC. Jump height and hip power decrease during cognitive loading regardless of sex: implications for sport performance metrics. J Strength Cond Res 37(4): 793–798, 2023—Sex and cognitive loading separately influence jumping performance. However, it is unknown how cognitive loading influences jump performance and how sex and cognitive loading interact. The purpose of our study was to determine if an interaction existed between sex and cognitive loading for the dependent variables jump height, ground contact time, reactive strength index, vertical stiffness, impulse, and lower extremity joint power during a double limb drop vertical jump. Twenty-one male (23.2 ± 2.5 years, 180.8 ± 8.4 cm, 80.4 ± 10.2 kg) and 20 female (21.7 ± 1.0 years, 163.7 ± 8.2 cm, 61.2 ± 9.4 kg) physically active individuals participated. Subjects jumped from a 30 cm box placed 50% of their height away from 2 force plates under single-task and dual-task (serial 6s or 7s) conditions. Separate 2 × 2 analyses of variance were used for all dependent variables (α = 0.05) with Bonferroni post hoc mean differences and 95% confidence intervals (CIs). There were no significant interactions for any outcomes (p ≥ 0.190). Condition main effects demonstrated subjects jumped significantly higher (1.84 cm, 95% CI = 0.68–3.01, d = 0.26, p = 0.003) and with greater hip power (0.29 Watts·BW−1·HT−1, 95% CI = 0.04–0.54, d = 0.21, p = 0.025) during single task compared with dual task. Sex main effects revealed males jumped higher (9.88 cm, 95% CI = 7.00–12.77, d = 2.17, p < 0.001), with greater reactive strength index (0.29, 95% CI = 0.17–0.41, d = 1.52, p < 0.001), greater ankle power (3.70 Watts·BW−1·HT−1, 95% CI = 2.26–5.13, d = 1.64, p < 0.001), and greater knee power (5.00 Watts·BW−1·HT−1, 95% CI = 3.25–6.75, d = 1.82, p < 0.001) compared with females. Jump performance is influenced by sex and dual-task conditions but not their interaction. To optimize jumping performance, testing should be completed without distractions (single task) to decrease cognitive loading. [ABSTRACT FROM AUTHOR]

Certified athletic therapists in Ireland and Canada serve essential concussion assessment and management roles, but their health care practices and concussion knowledge have not been established. To examine Irish and Canadian athletic therapist cohorts' (1) concussion knowledge, (2) current concussion assessment and management techniques across all job settings, and (3) the association of concussion assessment and management practices with years of clinical experience and highest degree attained. Cross-sectional cohort study. Online survey. Licensed Irish (49.7%, n = 91/183) and Canadian (10.1%, n = 211/2090) athletic therapists. Athletic therapists completed an online survey assessing their demographics, concussion knowledge (symptom recognition, patient–clinician scenarios), frequency of concussions assessed annually, and assessment and return-to-play (RTP) measures using a modified, previously validated survey. Symptom recognition consisted of 20 (8 true, 12 false) items on recognition of signs and symptoms that were scored as total correct. Descriptive statistics and odds ratios were used to examine survey responses where appropriate. Irish (86.8%, n = 46/53) and Canadian (93.4%, n = 155/166) athletic therapists indicated RTP guidelines were the most common method for determining RTP. Symptom recognition scores were 72.8% ± 17.0% among Irish and 76.6% ± 17.0% among Canadian athletic therapists. Irish (91.2%, n = 52/57) and Canadian (90.4%, n = 161/178) athletic therapists reported standardized sideline assessments as the most used concussion assessment method. Irish and Canadian athletic therapists' use of 2-domain (Irish: 38.6% [n = 22/57]; Canadian: 73.6% [n = 131/178]) and 3-domain (Irish: 3.5% [n = 2/57]; Canadian: 19.7% [n = 35/178]) minimum assessments (ie, symptoms, balance, or neurocognitive) was not associated with education or clinical experience (P ≥.07), except for Canadian athletic therapists with master's degrees having greater odds of completing 2-domain assessments at initial evaluation than those with bachelor's degrees (odds ratio = 1.80; 95% CI = 1.41, 1.95). Irish and Canadian athletic therapists demonstrated similar concussion knowledge; however, most did not fully adhere to international consensus guidelines for concussion assessment as evidenced by low 2- and 3-domain assessment use. Athletic therapists should aim to implement multidimensional concussion assessments to ensure optimal health care practices and patient safety. [ABSTRACT FROM AUTHOR]

With growing concerns surrounding exposure to head impacts in youth tackle football, players and parents must understand the exposure level when assenting and consenting to participate. To determine whether youth football players and parents could estimate on-field head-impact frequency, severity, and location. Prospective cohort study. Football field. We administered a 10-question head-impact estimation tool to parents (n = 23; mean age = 36.5 years [95% CI = 31.7, 37.3 years]) and players (n = 16 boys; mean age = 11.1 years [95% CI = 10.3, 11.8 years]). Player on-field head-impact exposure was captured using the Triax SIM-G system. We determined the accuracy between player and parent estimates relative to on-field head-impact exposures using κ and weighted κ values. Youth tackle football players and parents did not accurately estimate on-field head-impact frequency (κ range = −0.09 to 0.40), severity (κ range = −0.05 to 0.34), or location (κ range = −0.30 to 0.13). Players and parents overestimated head-impact frequency in practices but underestimated the frequency in games. Both groups overestimated head-impact severity, particularly in games. Most players and parents underestimated the number of head impacts to the top of the head, particularly during practices. Underestimations of head-impact frequency in games and to the top of the head suggest that informed consent processes aimed at educating players and parents should be improved. Overestimations of head-impact frequency in practices and severity may explain declining rates of youth tackle football participation. [ABSTRACT FROM AUTHOR]

Objective: Balance impairments may suggest somatosensory disruption beyond concussion clinical recovery, but somatosensory subsystems have never been directly assessed. Our objective was to examine somatosensory function between individuals with a concussion and healthy matched-controls at acute (<7 days) and asymptomatic (<72 hours of being symptom-free) time points. Setting: Laboratory. Participants: Participants with a concussion and matched controls (n = 24; 58% male, age: 19.3 ± 1.1 years, mass: 70.3 ± 16.4 kg, height: 177.3 ± 12.7 cm). Design: Prospective cohort. Main Measures: Somatosensory assessments on the dominant limb at both time points included: (1) plantar touch sensation threshold via Semmes-Weinstein monofilaments, (2) plantar pressure pain threshold via algometry, and (3) knee absolute passive joint repositioning (PJR) error via Biodex across 3 arcs (105°-75°, 30°-60°, 90°-45° knee-flexion). We used mixed-model analyses of variance, post hoc Tukey honestly significant difference t tests with mean difference, 95% CI, and Hedges' g effect sizes to examine outcomes. Results: Touch sensation had a group effect with the concussion cohort needing 0.95 grams of force (gf) more relative to controls (95% CI: 0.03 to 1.87; P =.043). No touch sensation interaction was present, but medium and large effects were observed for greater gf needed among the concussed cohort at the acute (1.11 gf; 95% CI: 0.17 to 2.05; g = 0.96) and asymptomatic time points (0.79 gf; 95% CI: −0.15 to 1.73; g = 0.73). No plantar pressure pain threshold effects were observed (P ≥.311), with negligible pressure difference magnitudes at the acute (0.26 pound force [lbf]/cm2; 95% CI: −1.54 to 2.06; g = 0.13) and medium magnitudes at the asymptomatic time points (0.99 lbf/cm2; 95% CI: −0.81 to 2.80; g = 0.42) for the concussed cohort needing more pressure to detect pain. The 30° to 60° PJR had a time effect, with asymptomatic time point having 3.12° better accuracy (95% CI: 1.23° to 5.02; P =.002). The concussed cohort had small-to-medium magnitude differences relative to controls at the acute time point for PJR during 105° to 75° (0.89°; g = 0.30) and 90° to 45° (0.62°; g = 0.17), but not 30° to 60° (−1.75°; g = −0.40). Conclusions: Individuals with a concussion exhibited large effects for diminished plantar touch sensation and small to medium effects for inhibited plantar pressure pain sensation compared with controls, which may indicate altered somatosensory function. Negligible PJR differences suggest knee joint position sense is not altered post-concussion. Pre- and postconcussion examination is warranted to understand causal somatosensory mechanisms. [ABSTRACT FROM AUTHOR]

Clinical reaction-time (RT) measures are frequently used when examining patients with concussion but do not correlate with functional movement RT. We developed the Standardized Assessment of RT (StART) to emulate the rapid cognitive demands and whole-body movement needed in sport. To assess StART differences across 6 cognitive-motor combinations, examine potential demographic and health history confounders, and provide preliminary reference data for healthy collegiate student-athletes. Prospective, cross-sectional study. Clinical medicine facilities. A total of 89 student-athletes (56 [62.9%] men, 33 [37.1%] women; age = 19.5 ± 0.9 years, height = 178.2 ± 21.7 cm, mass = 80.4 ± 24 kg; no concussion history = 64 [71.9%]). Student-athletes completed health history questionnaires and StART during preseason testing. The StART consisted of 3 movements (standing, single-legged balance, and cutting) under 2 cognitive states (single task and dual task [subtracting by 6's or 7's]) for 3 trials under each condition. The StART trials were calculated as milliseconds between penlight illumination and initial movement. We used a 3 × 2 repeated-measures analysis of variance with post hoc t tests and 95% CIs to assess StART cognitive and movement differences, conducted univariable linear regressions to examine StART performance associations, and reported StART performance as percentiles. All StART conditions differed (P ≤.03), except single-task standing versus single-task single-legged balance (P =.36). Every 1-year age increase was associated with an 18-millisecond (95% CI = 8, 27 milliseconds) slower single-task cutting RT (P <.001). Female athletes had slower single-task (15 milliseconds; 95% CI = 2, 28 milliseconds; P =.02) and dual-task (28 milliseconds; 95% CI = 2, 55 milliseconds; P =.03) standing RT than male athletes. No other demographic or health history factors were associated with any StART condition (P ≥.056). The StART outcomes were unique across each cognitive-motor combination, suggesting minimal subtest redundancy. Only age and sex were associated with select outcomes. The StART composite scores may minimize confounding factors, but future researchers should consider age and sex when providing normative data. [ABSTRACT FROM AUTHOR]

Flue-gas desulfurization (FGD) gypsum, a byproduct of coal-fired electrical utility plants, has been shown to effectively reduce phosphorus (P) leaching in many agricultural systems. However, its applications in horticultural production systems have been insufficiently researched resulting in limited industry adoption. To evaluate the efficacy of FGD gypsum to reduce P leaching in horticultural media, pine bark substrates were amended with FGD gypsum at 2.5, 5, and 10% (v/v). In accordance with industry practice, controlled release fertilizer (19N-3P-10K) was amply incorporated into all potting media treatments to support primary nutrient sufficiency of transplanted stock. The greatest P leaching occurred in the control substrates containing only pine bark and fertilizer. The standard pine bark substrate treatment, containing lime and micronutrients, reduced total P leaching by 35% and should be considered a best management practice. The addition of FGD gypsum at 2.5, 5, and 10% (v/v) reduced the total P collected in leachate by 47, 59, and 70%, respectively. Gypsum amendments increased potassium leachate concentrations but elevated potassium levels normalized after ~20 days. With little to no effect on substrate physical properties or pH, pine bark substrates can be amended with FGD gypsum to effectively reduce P leaching in short-term crops. [ABSTRACT FROM AUTHOR]

Therapeutic Area: ASCVD/CVD Risk Assessment Background: B-natriuretic peptide (BNP) is used as a screening biomarker for patients in cardio-obstetric programs. In nonpregnant females, obesity falsely lowers BNP, but its accuracy in the obese pregnant population is less known. We studied the diagnostic and prognostic utility of BNP in a predominantly obese, high-risk obstetric population in Arkansas. Methods: We established a retrospective registry of pregnant patients who had undergone a BNP and echocardiographic assessment (within 30 days of each other) at the University of Arkansas Medical Center between January 1, 1995, to October 30, 2022. We assessed the relationship between BNP levels and left ventricular ejection fraction (LVEF) using Pearson correlation coefficients. We used receiver operating curves to identify an optimal BNP cutoff for predicting a reduced LVEF (