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Introduction: Modifiable risk factors account for a substantial proportion of Alzheimer's disease (AD) cases and we currently have a discrete AT(N) biomarker profile for AD biomarkers: amyloid (A), p-tau (T), and neurodegeneration (N). Here, we investigated how modifiable risk factors relate to the three hallmark AT(N) biomarkers of AD., Methods: Participants from the European Prevention of Alzheimer's Dementia (EPAD) study underwent clinical assessments, brain magnetic resonance imaging, and cerebrospinal fluid collection and analysis. Generalized additive models (GAMs) with penalized regression splines were modeled in the AD Workbench on the NTKApp., Results: A total of 1,434 participants were included (56% women, 39% APOE ε4+) with an average age of 65.5 (± 7.2) years. We found that modifiable risk factors of less education ( t = 3.9, p < 0.001), less exercise ( t = 2.1, p = 0.034), traumatic brain injury ( t = -2.1, p = 0.036), and higher body mass index ( t = -4.5, p < 0.001) were all significantly associated with higher AD biomarker burden., Discussion: This cross-sectional study provides further support for modifiable risk factors displaying neuroprotective associations with the characteristic AT(N) biomarkers of AD., Competing Interests: MC is a full-time employee of Roche Diagnostics International Ltd, Rotkreuz, Switzerland and holds shares in F. Hoffman-La Roche. CL is a full-time employee of Roche Diagnostics GmbH, Penzberg, Germany. ELECSYS is a trademark of Roche. The remaining 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. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Roccati, Bindoff, Collins, Eastgate, Borchard, Alty, King, Vickers, Carboni and Logan.)

Objectives: Guided by the social ecological model, this study aimed to examine the relations of built environments (i.e., walking/cycling infrastructure, recreation facilities, neighborhood safety/crime), youth's transition abilities, and changes of youth's physical activity (PA) and play behaviors due to COVID-19-based restrictions. Ethnic and socioeconomic status (SES) disparities were also examined on studies variables during the COVID-19 restrictions., Method: A cross-sectional research design was used to assess an anonymous online survey completed by US parents/guardians. The final sample had 1324 children and adolescents (Mean age  = 9.75; SD = 3.95; 51.3% girls), and 35.5% the families were of upper socioeconomic class (income > $150,000). Parents reported the perceived built environment and neighborhood safety, child's PA and play behaviors during COVID-19 pandemic shelter-in-place restrictions., Results: Youths who had access to safe built environment were more active and played more outdoor/indoor (p < .01). It was found playing behavior in yard and neighborhood were significantly increased, but community-based play behavior was significantly reduced during COVID-19 restrictions. The SEM analysis (χ 2 /df = 236.04/54; CFI = .966) supported indirect and direct effects of neighborhood safety on PA changes during COVID-19 restrictions, and the youth's ability to respond to COVID-19 restrictions served as a full mediator. Low-SES and Hispanic minority youth reported significantly less safety to walking or playing in their neighborhoods than their middle-/high-SES non-Hispanic peers (p < .001). Regardless of ethnicity, the magnitude of the reduction of MVPA was significantly higher among low-SES groups than that of the high- and middle-SES groups (p < .001)., Conclusions: These findings demonstrate a need to tailor programs and policies to help high-risk groups (e.g., low SES) stay active, healthy, and resilient during and after the COVID-19 pandemic., (© 2022. W. Montague Cobb-NMA Health Institute.)

Introduction: The Gait Profile Score (GPS) requires a comparative dataset, to identify altered mechanics in persons with a gait abnormality. This gait index has been shown to be useful for identifying gait pathology prior to the assessment of treatment outcomes. Though studies have shown differences in kinematic normative datasets between different testing sites, there is limited information available on the changes in GPS score based on normative dataset selection. The aim of this study was to quantify the influence of normative reference data from two institutions, on the GPS and Gait Variable Scores (GVS), calculated on the same group of patients with Cerebral Palsy., Methods: Seventy patients (Avg. age: 12.1 ± 2.9) diagnosed with CP underwent gait analysis during walking at a self-selected speed at Scottish Rite for Children (SRC). GPS and GVS scores were determined using normative kinematic data at a self-selected speed from, 83 typically developing children ages 4-17 from Gillette, and the same age range of children from SRC's normative dataset. Average normalized speed was compared between institutions. Signed rank tests were performed on the GPS and GVS scores using each institution's dataset. Spearman's correlations between scores using SRC and Gillette were determined within GMFCS level., Results: Normalized speed was comparable between each institution's datasets. Within each GMFCS level, significant differences when using SRC vs. Gillette were found in most scores (p < 0.05). Scores were moderately to strongly correlated within each GMFCS level (range ρ = 0.448-0.998)., Conclusions: Significant statistical differences were found in GPS and GVS scores but were within the range of previously reported variation across multiple sites. Caution and consideration may need to be taken when reporting GPS and GVS scores that are calculated utilizing different normative datasets as these scores may not be equivalent., Competing Interests: Declaration of Competing Interest All authors have no conflicts of interests to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objectives: This study compared discussion board involvement between family carers and non-carers in the Understanding Dementia Massive Open Online Course (UD-MOOC)., Methods: A mixed methods observational cohort study of family carers and non-carers was undertaken over the February-April 2020 UD-MOOC. Discussion board engagement was measured as number of posts and replies and examined longitudinally using mixed models. Discussion topics were explored through structural topic models (STM). Subsequently, thematic analysis of STM derived-topic exemplars was conducted to contextualise these discussions., Results: Family carers were ( n  = 2320) found to post ( p  < 0.001) and reply ( p  = 0.029) significantly more often than non-carers ( n  = 2392). Of the 32-STM derived-topics, meaningful activities (mean Δ = 0.007, 95% CrI [0.005-0.100]), personal stories of diagnosis (mean Δ = 0.007, 95% CrI [0.005-0.009]), and family history of dementia (mean Δ = 0.006, 95% CrI [0.004-0.008]) were discussed significantly more frequently by family carers compared to non-carers., Conclusion: These results may reflect underlying motivational differences and circumstantial relevance. Perhaps the greater engagement by family carers is related to a sense of having inadequate relevant offline social resources, where engagement in the UD-MOOC discussion boards may serve as means to share experiences with others.

Background: Though flatness of the talar dome (TD) is a potential consequence of operative and nonoperative clubfoot management, the functional impact of this deformity is not well understood. This study analyzes the relationship between TD morphology and ankle function at skeletal maturity in patients treated for idiopathic clubfoot during infancy., Methods: 33 skeletally mature patients (average age 17.9 years) with 48 idiopathic clubfeet were identified. Weightbearing radiographs, gait analysis, and patient-reported outcomes using the Pediatric Orthopaedic Data Collection Instrument (PODCI) were obtained. Radius of curvature (ROC) of the TD and tibial plafond were measured along with other parameters of talar and calcaneal morphology. All measurements were correlated to PODCI scores and gait analysis data., Results: Patients demonstrated marked variability in ROC of the TD (mean 30.8 mm, SD 13.6 mm), TD radius to talar length (R/L) ratio (mean 0.56, SD 0.28), opening angle of the TD (alpha angle) (mean 89.6°, SD 28.4°), and tibiotalar incongruity index (mean 0.18, SD 0.16). Increased tibiotalar incongruity index correlated with decreased maximum plantar flexion ( r = ‒0.325, P = .02). A less acute alpha angle of the talar dome correlated with increased maximum ankle power generation ( r = 0.321, P = .03) as did increased length of the talar neck ( r = 0.358, P = .013). Increased tibiotalar incongruity index correlated negatively with PODCI global function domain scores ( r = ‒0.490, P = .04; r = ‒0.381, P = .03, respectively), whereas length of the talar body correlated with higher global function scores ( r = 0.376, P = .03) and lower pain scores ( r = 0.350, P = .046)., Conclusion: At skeletal maturity, flattening of the talar dome and tibiotalar incongruity on plain radiographs correlate modestly with gait changes, whereas tibiotalar incongruity and length of the talar body, not flatness of the talar dome, correlate with decreased patient-reported outcome scores., Level of Evidence: Level III, prognostic.

Background: Daily moderate-to-vigorous physical activity (MVPA) is vital to the physical, mental, and social well-being of children. Early restrictions during the coronavirus disease 2019 (COVID-19) pandemic included the closure of schools and physical activity (PA) amenities across the US. This study aimed to examine the impact of the pandemic on the PA and play behavior of U.S. children and to provide evidence-based recommendations to improve their PA., Methods: A cross-sectional, online, parent-reported survey was conducted of children aged 3-18 years between April and June 2020 to assess light PA and MVPA using a modified Godin Leisure-Time Exercise Questionnaire. Additional items included family/child socioeconomic demographics, child adaptability to the pandemic, and community access. The survey was shared through social media and snowball sampling distribution., Results: Analysis of 1310 surveys indicated child PA scores declined significantly during the pandemic (from 56.6 to 44.6, max 119, p < 0.001). Specifically, MVPA score decreased (from 46.7 to 34.7, max 98, p < 0.001) while light PA remained the same. Age-based changes were seen in the quantity, variety, and intensity of PA, with the lowest pandemic-related impact seen in preschoolers and the highest in high schoolers (-4.7 vs. -17.2, p < 0.001). Community-based peer PA decreased across all age groups., Conclusion: This study shows decreased PA levels in U.S. children, according to parent reporting, during the COVID-19 pandemic. Recommendations for community leaders, educators, and parents to improve PA in children are provided. With continued spread of COVID-19, these results and recommendations may be imperative to the physical well-being of U.S. children., (Copyright © 2021. Production and hosting by Elsevier B.V.)

Objectives: The objective of the current study was to examine the pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) within an Australian inpatient psychiatric setting., Method: A retrospective audit of 300 random hospital files of those admitted as inpatients between Nov 2014 and Nov 2015 was undertaken. Data was quantitatively analysed and described., Results: The number of inpatients who had a vitamin D determination during their admission was 37/300 (12.33%). The mean vitamin D level of those tested was 51.63 nmol/l. Of those that were tested, 18/37 (48.6%) were mildly to moderately deficient. There was a statistically significant difference in age and length of stay between those that were and were not tested for vitamin D levels, p-value <0.001 and 0.017, respectively. In addition, a simple linear regression indicated a weak association between length of stay and vitamin D levels., Conclusion: This audit highlights vitamin D screening inadequacy. More research is recommended to establish tangible benefits of supplementation, while local practice provides valuable data for education and policy purposes.

The term food addiction (FA) denotes a concept among researchers and lay consumers as a behavioural phenotype related to excessive food consumption. In this study we examined the prevalence of FA using the validated Yale Food Addiction Scale (YFAS) as well as the dimensional symptom count. In addition, we explored associations between participant characteristics and FA diagnosis. Outpatients attending a clozapine clinic and possessing a diagnosis of schizophrenia were invited to complete an anonymous survey using the YFAS. Ninety three surveys were used to calculate the diagnostic YFAS criteria for FA. The prevalence of FA found in this sample was 26.9%. Among individuals who did not meet "diagnostic" criteria FA, 77.4% endorsed 3 or more symptoms but did not report distress or impairment. The most common food addiction symptom was a persistent desire or repeated unsuccessful attempts to cut down consumption (97.9%). The significant finding in association between individual's characteristics and diagnosis of FA was employment. Several factors related to reported results are postulated and discussed. The current study has found the prevalence of FA amongst people living with schizophrenia to be higher than the general populations but not as high as populations with disordered eating., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: Early metastasis in node-negative breast cancer indicates that breast cancer cells obviously can bypass the lymph nodes and disseminate directly hematogenous to distant organs. For this purpose, we evaluated the prognostic value of blood-borne, HER2-positive circulating tumor cells (CTC) in the peripheral blood from 42 breast cancer patients with a median follow-up of 95 months., Experimental Design: Cells were isolated by the patented combined buoyant density gradient and immunomagnetic separation procedure and analyzed by immunocytochemistry., Results: We detected one to eight CTCs in the peripheral blood of 17 of 35 patients (48.6%) presenting no overt metastasis. As a positive control, 7 of 7 (100%) patients with metastatic disease presented positive. Healthy persons and patients (n = 32) operated for nonmalignant diseases presented negative for CTCs. The presence and frequency of HER2-positive CTCs correlated with a significantly decreased disease-free survival (P < 0.005) and overall survival (P < 0.05). Interestingly, in 12 patients with HER2-positive CTCs, the primary tumor was negative for HER2 as assessed by immunohistochemical score and fluorescence in situ hybridization., Conclusions: This study provides some evidence of a prognostic effect of HER2-positive CTCs in stage I to III breast cancer. Future studies have to determine the outcome of patients treated with HER2-targeting therapies with respect to HER2-positive CTC levels because it is not unlikely that high levels of HER2-positive CTCs reflect the activity of the tumor and may predict response to trastuzumab.