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To determine if creatine (Cr) supplementation could influence cognitive performance and whether any changes were related to changes in prefrontal cortex (PFC) activation during such cognitive tasks, thirty (M = 11, F = 19) participants were evenly randomized to receive supplementation with Cr (CR10:10 g/day or CR20:20 g/day) or a placebo (PLA:10 g/day) for 6 weeks. Participants completed a cognitive test battery (processing speed, episodic memory, and attention) on two separate occasions prior to and following supplementation. Functional near-infrared spectroscopy (fNIRS) was used to measure PFC oxyhemoglobin (O 2 Hb) during the cognitive evaluation. A two-way repeated measures ANOVA was used to determine the differences between the groups and the timepoints for the cognitive performance scores and PFC O 2 Hb. In addition, a one-way ANOVA of % change was used to determine pre- and post-differences between the groups. Creatine (independent of dosage) had no significant effect on the measures of cognitive performance. There was a trend for decreased relative PFC O 2 Hb in the CR10 group versus the PLA group in the processing speed test ( p = 0.06). Overall, six weeks of Cr supplementation at a moderate or high dose does not improve cognitive performance or change PFC activation in young adults.

Histoplasmosis is a rare fungal infection caused by the dimorphic species Histoplasma (H.) capsulatum,  found in the Midwest and Central United States. Infection with H. capsulatum is observed in other regions beyond the Ohio and Mississippi River valley, including Mexico and Central and South America. There have been increasing reports of the disease occurring in Latin America in immunocompromised patients with human immunodeficiency virus (HIV). This case report details clinical findings of disseminated histoplasmosis in an immunocompromised patient, newly diagnosed with acquired immunodeficiency syndrome (AIDS) and initially presenting with sepsis of unclear source. The focus of this case report is the significance of detailed history-taking guiding for an appropriate investigation and recognition of the infectious source and giving insight into the management of disseminated histoplasmosis in the outpatient and inpatient settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghantarchyan et al.)

A multimodality approach has been proposed as an effective treatment for calciphylaxis in patients with end-stage kidney disease. In this retrospective study, we report the cases of 12 end-stage kidney disease patients from l'Hôtel-Dieu de Québec hospital (Canada) who were diagnosed with calciphylaxis between 2004 and 2012 and treated with a multimodality clinical approach including sodium thiosulfate (STS). Statistical analyses were performed to evaluate the impacts of patients characteristics, the different interventions as well as therapy regimen on the therapeutic response. The majority of patients ( n  = 9) were hemodialyzed. The patients-associated comorbidities were consistent with previously reported risk factors for calciphylaxis: Diabetes ( n  = 11), calcium-based phosphate binders use ( n  = 10), warfarin use ( n  = 9), obesity ( n  = 7), female gender ( n  = 8) and intravenous iron use ( n  = 8). STS was given for a median duration of 81 days. 75% of the patients had a response (total or partial) including a complete response in 42% of patients. One-year mortality rate was low (25%). STS was used during a mean duration of 83.33 ± 41.52 days and with a total cumulating dose of 1129.00 ± 490.58 g. The recorded mean time before a complete response was 102.20 days (51-143). Pain improvement occurred after a mean time of 8.67 ± 10.06 days. None of the studied factors was statistically associated with a complete or a partial response to the multimodality approach. Although our data have a limited statistical power, they support treating calciphylaxis with a multimodality approach including STS as its effects are independent from important clinical variables.

The COVID-19 pandemic prompted chaotic changes in the daily lives of K-12 teachers, resulting in increased stress and other mental health problems. Limited evidence regarding the relationship between physical activity, sleep, and perceived stress among teachers during the COVID-19 pandemic exists. Therefore, the purpose of this study was to investigate the association between physical activity, sleep quality, and perceived psychological stress among teachers during the COVID-19 pandemic. An online survey measuring physical activity, sleep quality, and perceived psychological stress was distributed across 47 US states between September and October of 2020. Data provided by 635 teachers (mean age: 42 ± 18 years, 74.6% female) were included in the present analysis. Results suggested a negative association between physical activity and perceived psychological stress. Mediation analyses indicated that teachers engaging in high levels of physical activity were more likely to have good quality sleep and, in turn, were less likely to report high levels of perceived stress. Physical activity and sleep-related interventions could help curtail the rising levels of psychological distress amongst K-12 teachers during stressful times such as the COVID-19 pandemic. Teachers, especially those that self-report as female and/or young, report high levels of stress. These high levels of stress are a serious challenge for school districts in terms of attracting and retaining qualified teachers in K-12 classrooms.

Acute aerobic exercise has been shown to improve fine motor skills and alter activation of the motor cortex (M1). The intensity of exercise may influence M1 activation, and further impact whole-body motor skill performance. The aims of the current study were to compare a whole-body motor skill via a piano task following moderate-intensity training (MIT) and high-intensity interval training (HIIT), and to determine if M1 activation is linked to any such changes in performance. Nine subjects (seven females and two males), aged 18 ± 1 years completed a control, MIT, and HIIT trial followed by administration of a piano performance task. M1 activation was evaluated by measuring oxyhemoglobin (O 2 Hb) and hemoglobin difference (Hbdiff) changes during post-exercise piano performance using functional near-infrared spectroscopy (fNIRS). The results indicate that piano performance scores were higher after the MIT trial, but not HIIT trial, compared to the control trial. A negative relationship was detected between heart rate during HIIT and post-HIIT piano scores. M1 activation (as measured by Hbdiff) was significantly increased after the HIIT trial. M1 activation was also positively associated with piano performance when exercise trials (HIIT + MIT) and all trials (HIIT + MIT + Control) were combined. We found that acute moderate-intensity exercise led to an improvement in complex motor skill performance while higher-intensity exercise increased M1 activation. These results demonstrate that moderate-intensity exercise can prime the nervous system for the acquisition of whole-body motor skills, suggesting that similar exercise protocols may be effective in improving the outcomes of other motor tasks performed during regular routines of daily life (e.g., sporting tasks, activities of daily living or rehabilitation). In addition, it appears that improvements in motor task performance may be driven by M1 activation. Our findings provide new mechanistic insight into the complex relationship between exercise intensity, M1 activation, and whole-body motor skill performance., 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 Moriarty, Johnson, Thomas, Evers, Auten, Cavey, Dorman and Bourbeau.)

The prevalence of overweight and obesity is increasing worldwide, which has been associated with poor cognitive outcomes. Participating in regular physical exercise may also improve cognition, and levels of brain-derived neurotrophic factor (BDNF), but the optimal exercise prescription remains to be elucidated. The purpose of the present study is to compare the effects of moderate intensity continuous training (MICT) and high intensity interval training (HIIT) on cognition, and serum BDNF levels in middle-aged and overweight men. Twenty-five sedentary, overweight men participated in the 8-week training intervention. Subjects were randomized into MICT (n = 12) or HIIT (n = 13) and performed exercise sessions 3x/week for 8-weeks. Cognitive function, and serum BDNF levels were assessed pre- and post-intervention. Statistical analysis was carried out using the Graph Pad Prism 7.0, and the level of significance was set at 5%. Significant improvements were observed in cognitive test scores, and BDNF levels in MICT and HIIT groups (p < 0.05). There were no significant differences in cognitive function between MICT and HIIT. The present study implicates that 8 weeks of MICT or HIIT may be a very useful non-pharmacological treatment option to improve cognitive function, and BDNF levels in middle-aged overweight men., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The gripping coronavirus disease (COVID-19) has imposed dramatic changes to many areas of daily living in all sectors of society across the world. We examined the relationship between perceived stress and health behaviors among college students during the COVID-19 pandemic. An online survey with measures of psychological stress, physical activity and exercise, and sleep and social connectedness was distributed in June and July of 2020. The survey was completed by 550 college students (mean age: 21.3 ± 3.8 years, 74.2% female, 94.4% Caucasian). Being female and unemployed and having a lower annual income were significantly associated with higher levels of stress. In addition, regression analysis found that reduced exercise and sleep during the COVID-19 pandemic significantly predicted the levels of stress of participants after controlling for gender, employment status, and annual income. University officials should aim to implement health-promotion strategies directed at preventing reductions in exercise and sleep duration, especially in those at greater risk of increased perceived stress such as females and economically disadvantaged students.

Purpose: To investigate the effects of cardiac rehabilitation (CR) exercise training on cognitive performance and whether the changes are associated with alterations in prefrontal cortex (PFC) oxygenation among patients with cardiovascular disease., Methods: Twenty (men: n = 15; women: n = 5) participants from an outpatient CR program were enrolled in the study. Each participant completed a cognitive performance test battery and a submaximal graded treadmill evaluation on separate occasions prior to and again upon completion of 18 individualized CR sessions. A functional near-infrared spectroscopy (fNIRS) device was used to measure left and right prefrontal cortex (LPFC and RPFC) oxygenation parameters (oxyhemoglobin [O2Hb], deoxyhemoglobin [HHb], total hemoglobin [tHb], and oxyhemoglobin difference [Hbdiff]) during the cognitive test battery., Results: Patients showed improvements in cardiorespiratory fitness (+1.4 metabolic equivalents [METs]) and various cognitive constructs. A significant increase in PFC oxygenation, primarily in the LPFC region, occurred at post-CR testing. Negative associations between changes in cognition (executive function [LPFC O2Hb: r = -0.45, P = .049; LPFC tHb: r = -0.49, P = .030] and fluid composite score [RPFC Hbdiff: r = -0.47, P = .038; LPFC Hbdiff: r = -0.45, P = .048]) and PFC changes were detected. The change in cardiorespiratory fitness was positively associated with the change in working memory score (r = 0.55, P = .016)., Conclusion: Cardiovascular disease patients enrolled in CR showed significant improvements in multiple cognitive domains along with increased cortical activation. The negative associations between cognitive functioning and PFC oxygenation suggest an improved neural efficiency.

Purpose: Impairment caused by stroke is a major cause of disablement in older adults. Physical activity has been shown to improve physical functioning; however, little research has been done to explore how physical activity of different intensities may affect physical function among stroke survivors. The purpose of this study was to examine the patterns of accelerometer-measured physical activity and the relationship between physical activity intensities and objective physical functioning and perceived functional limitations in stroke survivors., Methods: Stroke survivors (N = 30, mean age = 61.77 ± 11.17) completed the Short Physical Performance Battery and the Late-Life Function and Disability Instrument. Physical activity intensities were measured objectively using a 7-day actigraph accelerometer wear period and scored using the National Health and Nutrition Examination Survey cutoffs for sedentary (counts/minute ≤100), light (counts/minute 101-2019), and moderate to vigorous (moderate to vigorous physical activity counts/minute ≥2020) activity., Results: Multiple linear regressions controlling for age and time since stroke demonstrated that higher levels of moderate to vigorous physical activity predicted better Short Physical Performance Battery performance (β = .43, P = 0.04). For self-reported physical function, light physical activity predicted better basic lower limb function (β = .45, P = 0.009), better advanced lower limb function (β = .53, P = 0.003), better upper limb function (β = .37, P = 0.04), and higher total function score (β = .52, P = 0.002) on the Late-Life Function and Disability Instrument., Conclusions: These findings suggest that light activity as well as moderate to vigorous physical activity may contribute to better physical functioning in stroke survivors. Although moderate to vigorous physical activity significantly predicted the objective measure of physical function (Short Physical Performance Battery), light physical activity consistently predicted higher scores on all subscales of the Late-Life Function and Disability Instrument. Disabilities resulting from stroke may limit this population from engaging in moderate to vigorous physical activity, and these findings highlight the importance of light physical activity, which may offer similar perceived functional benefits. Future studies should focus on development of effective exercise interventions for stroke survivors by incorporating and comparing both moderate to vigorous physical activity and light-intensity physical activity.

Behavioral therapy (BT) and exercise are efficacious treatments for depression and anxiety when employed separately. The combination of BT and exercise (BT+Ex) may augment improvements but the combined effect of these therapies is not fully elucidated. The purpose of this meta-analysis was to determine if BT+Ex yielded a significant reduction in depression and anxiety symptoms compared to BT alone (BT). Randomized controlled studies published prior to September 2019 were searched among several databases (PUBMED, MEDLINE, PsychArticle, and Cochrane Central Register of Clinical Trials). Studies that measured depression and anxiety symptoms following BT+Ex vs. BT were extracted and analyzed. The effect of these therapies on depression and anxiety were analyzed. Subgroup analyses were performed to evaluate the effect of exercise intensity (moderate and high), exercise type (aerobic and combined exercise), and baseline levels of depression. The moderating effects of gender, age, and treatment duration were performed. Data were extracted from 18 studies (1686 participants, mean age = 47 years, 65% female). There was a significant effect of BT+Ex on symptoms of depression. The effect of BT+Ex was significant for moderate intensity exercise and elevated baseline levels of depression. Age moderated the effect for depression. There was a significant effect of BT+Ex on depressive symptoms in humans. Exercise intensity and elevated depressive symptoms may play a role in the effect of exercise.

Background Vaping is the use of e-cigarettes that contain inhalants such as nicotine, tetrahydrocannabinol, and cannabidiol. Vaping is associated with e-cigarette or vaping product use associated lung injury (EVALI) and is a recognized public health crisis. Despite rising numbers of hospitalizations due to EVALI, public knowledge and perceptions of the dangers of vaping require further investigation. Objectives This exploratory study assessed knowledge and perceptions of vaping in U.S. adults. Methods This study was approved by an ethical board, and informed consent was obtained from all participants. A cohort of U.S. adults was recruited by shared links on social media. Participants completed an anonymous online survey that contained vaping knowledge and perceptions items. An a priori power analysis was conducted at 95% power and alpha = 0.05. Statistics were calculated using IBM SPSS Statistics Version 26 (IBM Corp., Armonk, NY, USA). Results A sample of 413 (N = 413) U.S. adults participated in the survey. The majority of participants (79.18%) were females, and 65.62% were between 18 and 24 years of age. Over half (62.71%) of participants were never asked about vaping use by a clinician at any visit, and 56.51% agreed that vaping can reduce stress. Of all participants, 70.91% agreed that drinking alcohol makes someone more inclined to vape. Significant positive Spearman's rho correlations were found between vaping and the use of cannabis, cocaine, ecstasy, hallucinogens, and inhalants (p < 0.05). Conclusions We found a significant correlation between vaping and drug use. We also found that if the dangers of vaping are discussed by their health care providers, participants are more inclined to quit vaping. Unfortunately, many physicians report that they avoid discussing vaping with their patients due to lack of vaping knowledge. Our results illuminate the communication gap between patients and physicians. All clinicians need to counsel patients on the dangers of vaping, which might help prevent EVALI and related conditions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Bellisario et al.)

The purpose of this study was to investigate if prefrontal cortex (PFC) oxygenation during incremental exercise is altered among cardiovascular disease (CVD) patients who completed 6 weeks of exercise-based cardiac rehabilitation (CR). Nineteen (male = 14, female = 5; 65.5 ± 11.5 years) participants from an outpatient CR program were enrolled in the study. Each participant completed a submaximal graded treadmill evaluation at intake and again upon completion of 18 individualized CR sessions. Functional near-infrared spectroscopy (fNIRS) imaging was used to measure left- and right- PFC (LPFC and RPFC) oxygenation parameters during the submaximal exercise evaluations. Patients showed improvements in cardiorespiratory capacity (pre 5.5 ± 2.5 vs. post 6.9 ± 2.8 metabolic equivalents (METs)). A significant decrease in LPFC and RPFC oxygenation was observed during the post-CR exercise test compared to pre-CR. CVD patients enrolled in 6 weeks of CR showed significant improvements in functional capacity along with decreased cortical oxygenation during submaximal exercise. Exercise training may cause distribution of cortical resources to motor regions that support sustained exercise.

Context: Multiple forms of behavioral therapies have been developed to treat alcohol abuse disorders (AUDs). Despite positive outcomes during and immediately after behavioral treatment, 60% to 90% of patients relapse in the year after treatment. Combined approaches have also been developed, but similar high relapse rates have occurred. Aerobic exercise may be an appropriate complimentary treatment for behavioral therapy in AUDs. However, it is critical to identify the appropriate dose of exercise to gain maximal benefit., Objective: This literature review intended to explore the neural components of alcohol addiction, identify the mechanisms by which exercise might influence brain function, characterize the appropriate exercise intervention for AUDs, and ascertain strategies for implementing exercise into behavioral therapy treatment., Design: The research team searched the literature for systematic reviews, descriptive studies, case reports, cross-sectional, along with experimental design studies (both randomized controlled trials and nonrandomized single group). Mechanisms of AUD, neurophysiological adaptations to physical exercise, and exercise interventions in AUD treatment were the primary areas of interest. PubMed, ScienceDirect, Cochrane Library, and Google Scholar databases were searched between 1970 and 2019., Results: Neural mechanisms of AUD identified included abnormal neurotransmission, prefrontal cortex function, and neurogenic processes. Exercise may serve the underlying neurophysiological mechanisms of AUD, and this has been demonstrated in a handful of exercise therapies studied among alcohol abusers., Conclusions: Given the current reviews findings on the neural mechanisms of alcohol addiction, the neurophysiological basis of exercise treatment, and the results of exercise interventions during alcohol treatment the current research team has developed a novel approach to treatment of alcohol addiction by incorporating aerobic interval exercise into traditional, evidence-based, cognitive behavioral therapy. The benefits of exercise may promote and compliment CBT treatment and lead to reduced drinking outcomes.

Activation changes in the prefrontal cortex (PFC) regions have been linked to acute exercise-induced improvements in cognitive performance. The type of exercise performed may influence PFC activation, and further impact cognitive function. The present study aimed to compare PFC activation during cognitive testing after moderate-intensity, high intensity, and yoga exercises, and to determine if PFC activation is linked to cognitive performance. Eight subjects (four male and four female), aged 35 ± 5 completed a control, high intensity, moderate intensity, and yoga exercises followed by administration of a cognitive task (NIH Toolbox Fluid Cognition). Left and right PFC activation (LPFC and RPFC, respectively) were evaluated by measuring hemoglobin difference (Hbdiff) changes during post-exercise cognitive assessment using functional near infrared spectroscopy (fNIRS). Activation during the cognitive test was higher in the LPFC after moderate intensity exercise compared to control, high intensity, and yoga (5.30 ± 6.65 vs. 2.26 ± 2.40, 2.50 ± 1.48, 2.41 ± 2.36 μM, p < 0.05, respectively). A negative relationship was detected between LPFC and processing speed after exercise. PFC activation did not align with cognitive performance. However, acute exercise, regardless of type, appeared to alter neural processing. Specifically, less PFC activation was required for a given neural output after exercise.

Unlabelled: The purpose of this study is to measure the effects of carbohydrate ingestion during exercise in the heat by measuring markers of gastrointestinal damage and inflammation., Methods: Active subjects (n = 7) completed two 60-min running trials in a heated environment (70% VO2max, 30°C). At minute 20 of exercise, subjects consumed a carbohydrate gel (Cho) (27 g), or a non-carbohydrate placebo (nCho). Plasma endotoxin, I-FABP, TNF-α, IL-6, IL-1β, IL-10, and MCP-1 were measured pre-exercise, 20-min post-exercise, and again 2-h, and 4-h post-exercise., Results: Endotoxin increased 20-min post-exercise compared to pre in the Cho trial only (p = .03). I-FABP levels increased 20-min post-exercise in the Cho trial only compared to pre-exercise (p = .003). I-FABP levels were also increased in Cho trial 20-min post-exercise when compared to same time point in the nCho trial (p = .032). TNF-α increased 20-min post-exercise in the Cho trial only compared to pre (p = .03). Plasma IL-6 concentration increased 20-min post-exercise when compared to pre in both the Cho (p = .002) and nCho (p = .009), but remained elevated at the 2-h time point in the nCho trial (p = .03). I-FABP and several plasma cytokines (TNF-α, MCP-1, Il-6) returned to baseline sooner in the Cho trial., Conclusions: Ingestion of carbohydrate gel during exercise in the heat enhances markers of gastrointestinal wall damage.

Drug utilization review programs have been recognized as an effective way to control health care spending while maintaining quality services. This article describes the structure, mandate and activities of Quebec's Drug Utilization Review Network. This 112-member network, which represents 45% of health care facilities in the province, was established to promote the optimal utilization of drugs through the provision of support to pharmacology committees, therapeutic committees and pharmacy departments. The network's main role is to coordinate multi-centre drug utilization studies. Future challenges include maintaining member interest and evaluating the clinical and economic impact of the network's efforts.