Left Ventricular Ejection Time Measured by Echocardiography Differentiates Neurobehavioral Resilience and Vulnerability to Sleep Loss and Stress

There are substantial individual differences (resilience and vulnerability) in performance resulting from sleep loss and psychosocial stress, but predictive potential biomarkers remain elusive. Similarly, marked changes in the cardiovascular system from sleep loss and stress include an increased risk for cardiovascular disease. It remains unknown whether key hemodynamic markers, including left ventricular ejection time (LVET), stroke volume (SV), heart rate (HR), cardiac index (CI), blood pressure (BP), and systemic vascular resistance index (SVRI), differ in resilient vs. vulnerable individuals and predict differential performance resilience with sleep loss and stress. We investigated for the first time whether the combination of total sleep deprivation (TSD) and psychological stress affected a comprehensive set of hemodynamic measures in healthy adults, and whether these measures differentiated neurobehavioral performance in resilient and vulnerable individuals. Thirty-two healthy adults (ages 27–53; 14 females) participated in a 5-day experiment in the Human Exploration Research Analog (HERA), a high-fidelity National Aeronautics and Space Administration (NASA) space analog isolation facility, consisting of two baseline nights, 39 h TSD, and two recovery nights. A modified Trier Social Stress Test induced psychological stress during TSD. Cardiovascular measure collection [SV, HR, CI, LVET, BP, and SVRI] and neurobehavioral performance testing (including a behavioral attention task and a rating of subjective sleepiness) occurred at six and 11 timepoints, respectively. Individuals with longer pre-study LVET (determined by a median split on pre-study LVET) tended to have poorer performance during TSD and stress. Resilient and vulnerable groups (determined by a median split on average TSD performance) showed significantly different profiles of SV, HR, CI, and LVET. Importantly, LVET at pre-study, but not other hemodynamic measures, reliably differentiated neurobehavioral performance during TSD and stress, and therefore may be a biomarker. Future studies should investigate whether the non-invasive marker, LVET, determines risk for adverse health outcomes.

Foot Mechanics Define Directional Changes in Curved-Path Walking: New Methods to Assess the Motor Skill of Walking

Although it is essential to navigating the world, curved path walking is a challenge to mediolateral balance control. The focus of previous curved-path walking research was in spatiotemporal characteristics. We quantified the foot-ground interaction, center of pressure (COP) characteristics during non-linear (eg curved-path) walking important to understand the functional mechanics of directional changes for curved paths. We hypothesized the foot mechanics differ between older adults with better versus poorer curved-path walking (Figure of 8 Walk Test, F8W). Twenty-five older adults (mean age 71.8 ± 8.9 years) completed the F8W on an instrumented walkway (Protokinetics, LLC.) The derived metrics of the foot mechanics included medial/lateral movement of the COP for inside and outside steps, maximum medial and lateral COP excursions, and total medial/lateral COP range. Pearson correlations were used to examine relations F8W (time and steps) and COP metrics; ANOVAs were used to examine differences in COP metrics between older adults grouped by median-split of F8W time. Longer F8W time and more steps were related to lesser total COP range and outside foot lateral maximum excursion (r range -0.415 to -0.706, p<0.04). Older adults with stronger F8W performance compared to poorer F8W performance had larger outside foot total COP ranges (3.61cm vs 4.39cm, p=0.016) and greater lateral excursion (1.60cm vs 2.12cm, p=0,003). Foot-ground interactions offer new insights into control of curved path walking and methods for evaluating efficacy of interventions focused on improving walking skill in older adults.

Cortisol and C-Reactive Protein Vary During Sleep Loss and Recovery but Are Not Markers of Neurobehavioral Resilience

Cortisol and C-reactive protein (CRP) typically change during total sleep deprivation (TSD) and psychological stress; however, it remains unknown whether these biological markers can differentiate robust individual differences in neurobehavioral performance and self-rated sleepiness resulting from these stressors. Additionally, little is known about cortisol and CRP recovery after TSD. In our study, 32 healthy adults (ages 27–53; mean ± SD, 35.1 ± 7.1 years; 14 females) participated in a highly controlled 5-day experiment in the Human Exploration Research Analog (HERA), a high-fidelity National Aeronautics and Space Administration (NASA) space analog isolation facility, consisting of two baseline nights, 39 h TSD, and two recovery nights. Psychological stress was induced by a modified Trier Social Stress Test (TSST) on the afternoon of TSD. Salivary cortisol and plasma CRP were obtained at six time points, before (pre-study), during [baseline, the morning of TSD (TSD AM), the afternoon of TSD (TSD PM), and recovery], and after (post-study) the experiment. A neurobehavioral test battery, including measures of behavioral attention and cognitive throughput, and a self-report measure of sleepiness, was administered 11 times. Resilient and vulnerable groups were defined by a median split on the average TSD performance or sleepiness score. Low and high pre-study cortisol and CRP were defined by a median split on respective values at pre-study. Cortisol and CRP both changed significantly across the study, with cortisol, but not CRP, increasing during TSD. During recovery, cortisol levels did not return to pre-TSD levels, whereas CRP levels did not differ from baseline. When sex was added as a between-subject factor, the time × sex interaction was significant for cortisol. Resilient and vulnerable groups did not differ in cortisol and CRP, and low and high pre-study cortisol/CRP groups did not differ on performance tasks or self-reported sleepiness. Thus, both cortisol and CRP reliably changed in a normal, healthy population as a result of sleep loss; however, cortisol and CRP were not markers of neurobehavioral resilience to TSD and stress in this study.

Predicting financial distress in the Indian textile sector

The purpose of this paper is to predict the financial distress of companies of the Indian textile sector using Altman Z score. The analysis conducted on 161 listed textile companies in India for a period of 10 years from 2009 to 2018. All the listed companies are categorized into large, medium, and small using the median split method based on the size of total assets. Kruskal Wallis test is applied to test whether the mean z-score is different for each category of companies. This research study shows that majority of the companies in the Indian textile sector are facing financial distress. Further, it shows that the z score of small, medium, and large-scale textile companies in India is significantly different.

Association of Performance in Strength and Plyometric Tests with Change of Direction Performance in Young Female Team-Sport Athletes

The change of direction (COD) ability is a task-specific skill dependent on different factors such as the degree of the turn, which has led to differentiating CODs as more force- (>90°) or velocity-oriented (<90°). Considering force and velocity requirements is of importance when designing sport-specific training programs for enhancing COD performance. Thus, 25 female handball and soccer players participated in this study, which investigated the association between three different strength and plyometric exercises and force- and velocity-oriented COD performance. By utilizing the median split analysis, the participants were further divided into a fast (n = 8) and a slow (n = 8) COD group, to investigate differences in step kinematics between fast and slow performers. The correlational analysis revealed that the bilateral back squat and unilateral quarter squat were significantly associated with several force- and velocity-oriented COD performance (r = −0.46 to −0.64), while the association between plyometric and COD performance was limited (r < 0.44). The fast COD group revealed higher levels of strength, jump height, peak velocities, higher step frequencies, shorter ground contact times, and greater acceleration and braking power (d > 1.29, p < 0.03). It was concluded that the observed correlation between strength and COD performance might be due to stronger athletes being able to produce more workload in a shorter time, which was supported by the step kinematics.

Slower adaptation of control strategies in individuals with high impulsive tendencies

Flexible use of reactive and proactive control according to environmental demands is the key to adaptive behavior. In this study, forty-eight adults performed ten blocks of an AX-CPT task to reveal the strength of proactive control by the calculation of the proactive behavioral index (PBI). They also filled out the UPPS questionnaire to assess their impulsiveness. The median-split method based on the global UPPS score distribution was used to categorize participants as having high (HI) or low (LI) impulsiveness traits. The analyses revealed that the PBI was negatively correlated with the UPPS scores, suggesting that the higher is the impulsiveness, the weaker the dominance of proactive control processes. We showed, at an individual level, that the PBI increased across blocks and suggested that this effect was due to a smaller decrease in reactive control processes. Notably, the PBI increase was slower in the HI group than in the LI group. Moreover, participants who did not adapt to task demands were all characterized as high impulsive. Overall, the current study demonstrates that (1) impulsiveness is associated with less dominant proactive control due to (2) slower adaptation to task demands (3) driven by a stronger reliance on reactive processes. These findings are discussed in regards to pathological populations.

Cigarette Smoking is Associated with Difficulties in the Use of Reappraisal for Emotion Regulation

Background: Negative emotions can promote smoking relapse during a quit attempt. The use of cognitive reappraisal to self-regulate these emotions may therefore aid smoking cessation. Determining whether smokers exhibit difficulties in the use of reappraisal, and which factors are associated with such difficulties, may aid smoking cessations.Methods: 50 smokers and 50 non-smokers completed an online reappraisal task in which they either reappraised or naturally experienced emotions induced by negatively- and neutrally-valenced images that presented situations in either the 1st-person or 3rd-person perspective. Participants also completed the Difficulties in Emotion Regulation Scale (DERS).Results: Compared to non-smokers, smokers were less successful in using reappraisal to self-regulate emotions elicited by negatively-valenced images (but not neutrally-valenced images). Importantly, this effect was only true for images that were presented in the 1st-person (but not 3rd-person) perspective. Contrary to predictions, there were no group differences in DERS scores. However, exploratory analyses showed that when smokers were split into those who exhibited low vs. high reappraisal success on the reappraisal task (via median split), the low success group exhibited an association between lower reappraisal success and a greater lack of emotional clarity on the DERS, whereas no such association was observed in the high success group.Conclusions: This study provides evidence that smokers may experience difficulties in the use of reappraisal to self-regulate negative emotions induced by situations that appear to be occurring to themselves, and that this deficit may be related to difficulties in understanding the nature and/or valence of the emotion experienced.

Knowledge, Attitude, and Behavior of Parents toward School Reopening Amidst Coronavirus Disease 2019 Pandemic in Indonesia

Objectives: Recently, the subject of reopening schools has raised several concerns, especially on the possibility of new COVID-19 cluster cases. The parent's role is essential in this matter. Therefore, this study aims to understand the parents' knowledge, attitude, and behavior toward COVID-19 in Indonesia. Methods: A cross-sectional study was conducted on 206 Indonesian parents. A 55-items questionnaire was used to assess the knowledge, attitude, and behavior of subjects. In this study, median split tests, Kruskal-Wallis, Cronbach's α, and Pearson correlation test were used. Results: Subjects were found to have high levels of knowledge, especially in the knowledge of COVID-19 as a contagious viral disease (98.5%), and the necessity for children to maintain personal hygiene to prevent COVID-19 (98.5%). Subjects' attitudes were highest at understanding how to prevent COVID-19 (95.1%) and teaching children how to avoid COVID-19 (98.1%). Subjects' attitude was lowest at hearing the news of the death of COVID-19 scares them (72.8%), and on how their child(ren) are getting bored at home because of COVID-19 (69.9%). Subjects' are shown to have high levels of behavior in every question. This study found a significant correlation between socioeconomic status and subjects' knowledge (p = 0.007). Conclusion: This study revealed a lack of understanding of prevention strategies among low-income households. Hence, there is a need for targeted messaging and health education in low-income settings that consider the challenges they may face when attempting their children to practice COVID-19 prevention if schools reopen. Keywords: COVID-19, Knowledge, Attitude, Behavior, Parents, Indonesia

Nonlinear Changes in Botulinum Toxin Treatment of Task-Specific Dystonia during Long-Term Treatment

Botulinum toxin (BoTX) is the standard treatment for task-specific dystonias (TSDs) such as musician’s dystonia (MD). Our aim was to assess the long-term changes in BoTX treatment in a highly homogeneous and, to our knowledge, largest group of MD patients with respect to the following parameters: (1) absolute and (2) relative BoTX dosage, (3) number of treated muscles, and (4) inter-injection interval. We retrospectively assessed a treatment period of 20 years in 233 patients, who had received a cumulative dose of 68,540 MU of BoTX in 1819 treatment sessions, performed by two neurologists. Nonlinear correlation was used to analyze changes in the parameters over the course of repeated treatments. Post-hoc we applied a median-split to classify two subgroups (high-BoTX, low-BoTX) depending on the total amount of BoTX needed during treatment. Across all patients, we found a decrease of dosage for the first approximately 25 treatments with an increase afterwards. The number of muscles and inter-injection intervals increased with time with a discrete decrease of inter-injection intervals after about 35 treatments. Subgroup differences were observed in the amount of BoTX and inter-injection intervals, with continuously increasing inter-injection intervals and decreasing BoTX dosage in the low-BTX group. Both groups showed a continuously increasing number of injected muscles. In summary, we found nonlinear changes of BoTX dosage and inter-injection intervals and a continuously increasing number of injected muscles with treatment duration in TSD-patients. Furthermore, we, for the first time, identified two subgroups with distinct differences. Increasing inter-injection intervals and decreasing BoTX dosages in the low-BoTX group indicated improvement of symptoms with continued treatment. Continually increasing BoTX dosages with unchanged inter-injection intervals in the high-BoTX group indicated deterioration.

Prognostic value of pre-infection routine laboratory parameters for COVID-19 mortality in tumor patients: Results of the ADHOK Coronavirus Tumor Registry.

10571 Background: Tumor patients (pts.) are considered susceptible to severe COVID-19 after SARS-CoV-2 infection. However, they represent a heterogeneous group of individuals with variable risk. Identification of vulnerable subgroups is important for prioritization of vaccination strategies and possible early therapeutic intervention after infection. Methods: Tumor pts. with PCR-confirmed SARS-CoV-2 infection were included in the multicentric ADHOK registry by 22 institutions. Detailed information about tumor disease and treatment, as well as routine laboratory parameters determined at least 10 days prior to SARS-CoV-2 infection, was collected retrospectively. The primary endpoint was defined as the outcome of the SARS-CoV-2 infection, graded according to the WHO: asymptomatic, mild, moderate, severe, critical, and COVID-19-related death. Results: Until Feb. 5, 2021, 215 pts. (67% with solid tumors, 33% with hematological neoplasms) were included in the registry. 74% of the pts. had an active malignancy. The course of SARS-CoV-2 infection was rather variable: 66% of the pts. remained asymptomatic or showed a mild-to-moderate course, while the rest developed severe or critical disease. The COVID-19-related mortality rate was 24%. Pre-infection routine laboratory values were available for 104 pts., obtained at a median of 21 days before SARS-CoV-2 infection. Compared to COVID-19 survivors, COVID-19 non-survivors showed significantly higher median levels of absolute neutrophil count (ANC: 3.6 vs. 6.4 /nL; p = 0.006, n = 91), neutrophil-to-lymphocyte ratio (NLR: 2.2 vs. 7.2; p = 0.005, n = 75), C-reactive protein (CRP: 9.9 vs. 42.0 mg/L; p = 0.001, n = 104), and lactate dehydrogenase (LDH: 213.0 vs. 267.0 U/L; p = 0.016, n = 78). When categorized by a median split, COVID-19 mortality was significantly higher in pts. with ANC > 4.4 /nL (4% vs. 55%, p < 0.001), NLR > 4.1 (5% vs. 58%, p < 0.001), CRP > 15.4 mg/L (18% vs. 46%, p = 0.003), LDH > 236 U/L (15% vs. 49%, p = 0.003) and lymphocytes < 1.3 /nL (41% vs. 11% p = 0.002). In multivariable analysis, ANC and CRP showed a strong and significant association with COVID-19-related death (OR 23.0 and 7.7, p = 0.007 and 0.029, respectively). To develop an easy-to-apply pre-infection score, we combined ANC and CRP and were able to separate three groups of pts. with significantly different COVID-19 outcomes (p < 0.001) (Table). Conclusions: Our results unveil subgroups of tumor pts. who may be at increased risk of severe COVID-19 and point to pre-infection routine laboratory parameters with potential prognostic power: ANC and CRP may help identify pts. at risk for severe COVID-19 before SARS-CoV-2 infection.[Table: see text]