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Abstract Background As the opioid epidemic continues to have a major negative impact across the US, community pharmacies have come under scrutiny from legal systems attempting to hold them accountable for their role in over dispensing and lack of patient intervention. While the most available tool for monitoring patients’ opioid use is Prescription Drug Monitoring Programs (PDMP), these do not provide pharmacists with actionable information and decision support. Our study addresses this gap through three objectives: [1] incorporate validated opioid risk metric thresholds into a PDMP platform to create the Opioid Risk Reduction Clinical Decision Support (ORRCDS) tool; [2] assess ORRCDS’ ability to reduce patient opioid risk; [3] assess ORRCDS’ sustainability and viability for broader dissemination in community pharmacy. Methods For objective 1, our team is partnering with leadership from the largest US PDMP organization and a top-five pharmacy chain to implement ORRCDS into the pharmacy chain’s workflow following the Guideline Implementation with Decision Support (GUIDES) framework. For objective 2, our team will conduct a type-1 implementation mixed methods study using a 2-arm parallel group clustered randomized design. We anticipate enrolling ~ 6,600 patients with moderate and high opioid use risk during the 6-month enrollment phase across 80 pharmacies. This sample size will provide 96.3% power to detect a 5% or greater difference in responder rate between the intervention and control arm. Responders are patients with moderate-risk at baseline who reduce to low-risk or those with high-risk at baseline who reduce to moderate or low-risk at 180 days post last intervention. To accomplish objective 3, we will use the Consolidated Framework for Implementation Research (CFIR) to develop and execute cross-sectional qualitative interviews with pharmacists (n = 15), pharmacy leaders (n = 15), and PDMP leaders (n = 15) regarding long term adoption and sustainability of the ORRCDS tool. Conclusions A PDMP tool that addresses moderate- and high-risk opioid use is not available in community pharmacy. This study will implement ORRCDS in a large retail pharmacy chain that will include additional screening and guidance to pharmacy staff to address risky opioid medication use. Our results will make critical advancements for protecting patient health and addressing the opioid epidemic.

Background: While most pregnant individuals with methamphetamine use disorder (MUD) achieve abstinence, the postpartum period remains a vulnerable time for return to methamphetamine use (MU). Promising data from human and animal models, including three randomized controlled trials, suggest that micronized progesterone may prevent postpartum return to cocaine and nicotine use by reducing cravings. The primary objective of this study is to assess feasibility of enrollment and randomization of postpartum individuals with MUD to micronized progesterone to prevent return to MU. The secondary objectives are to evaluate safety, establish a preliminary estimate of efficacy, and characterize the association between allopregnanolone levels and methamphetamine cravings. Methods: This is a pilot double-blind placebo randomized controlled trial. We plan to enroll 40 postpartum individuals with MUD over 24-months. Individuals, stratified by opioid use disorder (OUD), are randomized 1:1–400 mg oral micronized progesterone daily or placebo and attend weekly study sessions for 12 weeks. Feasibility is measured by achieving 80 % of enrollment goal. Safety is evaluated by side effect frequency, mental health status changes, lactation and medical complications. Efficacy is assessed by comparing proportion of participants with return to MU and time to return to MU based on self-report or urine testing between treatment and control groups. Salivary allopregnanolone levels and methamphetamine cravings are compared between the groups. Conclusion: Study results will provide a first critical step towards potential intervention for prevention of return to MU among postpartum individuals. Completion of this trial will set the stage for a large-scale efficacy trial.

Abstract Music provides a reward that can enhance learning and motivation in humans. While music is often combined with exercise to improve performance and upregulate mood, the relationship between music-induced reward and motor output is poorly understood. Here, we study music reward and motor output at the same time by capitalizing on music playing. Specifically, we investigate the effects of music improvisation and live accompaniment on motor, autonomic, and affective responses. Thirty adults performed a drumming task while (i) improvising or maintaining the beat and (ii) with live or recorded accompaniment. Motor response was characterized by acceleration of hand movements (accelerometry), wrist flexor and extensor muscle activation (electromyography), and the drum strike count (i.e., the number of drum strikes played). Autonomic arousal was measured by tonic response of electrodermal activity (EDA) and heart rate (HR). Affective responses were measured by a 12-item Likert scale. The combination of improvisation and live accompaniment, as compared to all other conditions, significantly increased acceleration of hand movements and muscle activation, as well as participant reports of reward during music playing. Improvisation, regardless of type of accompaniment, increased the drum strike count and autonomic arousal (including tonic EDA responses and several measures of HR), as well as participant reports of challenge. Importantly, increased motor response was associated with increased reward ratings during music improvisation, but not while participants were maintaining the beat. The increased motor responses achieved with improvisation and live accompaniment have important implications for enhancing dose of movement during exercise and physical rehabilitation.

Abstract Although FOXP3+ regulatory T cells (Treg) depend on IL-2 produced by other cells for their survival and function, the levels of IL-2 in inflamed tissue are low, making it unclear how Treg access this critical resource. Here, we show that Treg use heparanase (HPSE) to access IL-2 sequestered by heparan sulfate (HS) within the extracellular matrix (ECM) of inflamed central nervous system tissue. HPSE expression distinguishes human and murine Treg from conventional T cells and is regulated by the availability of IL-2. HPSE-/- Treg have impaired stability and function in vivo, including in the experimental autoimmune encephalomyelitis (EAE) mouse model of multiple sclerosis. Conversely, endowing monoclonal antibody-directed chimeric antigen receptor (mAbCAR) Treg with HPSE enhances their ability to access HS-sequestered IL-2 and their ability to suppress neuroinflammation in vivo. Together, these data identify a role for HPSE and the ECM in immune tolerance, providing new avenues for improving Treg-based therapy of autoimmunity.

Research examining the changes in muscle oxygen saturation across multiple sets of resistance exercise is limited. The purpose of this study was to describe the physiological response of muscle oxygenation parameters during upper-body resistance exercise and examine the differential effects of relevant participant characteristics on resistance training performance and muscle oxygen saturation dynamics. Sixty-one recreationally trained men (n = 44; 21.8 ± 2.6 years) and women (n = 17; 20.2 ± 1.8 years) completed five-repetition maximum sets of barbell bench presses at a load equal to 75% 1-RM with a 2 min rest interval. Muscle oxygen saturation (SmO2) dynamics within the anterior deltoid were monitored using a portable near-infrared spectroscopy sensor. The percent change in SmO2 (∆%SmO2), the muscle oxygen re-saturation rate (SmO2RecSlope), and the highest measured SmO2 value during recovery periods (SmO2Peak) were measured. Two-way (sex [men, women] x time [sets 1–5]) repeated measures analyses of variance (ANOVA) were performed on muscle saturation variables. To examine the effect of relevant controlling variables, separate analyses of covariance (ANCOVA) with repeated measures were also performed. No differences were seen with ∆%SmO2 across sets. The main effects for sets occurred for SmO2RecSlope, whereby a decline was noted on sets 4 and 5 (p = 0.001) compared to set 1. Additionally, SmO2Peak was the lowest on set 5 (p < 0.001) compared to all other sets. Moreover, body mass (p = 0.013), diastolic blood pressure (p = 0.044), and mean arterial pressure (p = 0.033) for ∆%SmO2 were the only significant covariates noted amongst the muscle oxygenation variables. In conclusion, no sex differences and only a few set differences in muscle oxygen saturation dynamics were seen without employing any covariates. Body mass, diastolic blood pressure, and mean arterial pressure were identified as factors that could influence observed responses.

To observe workout pacing strategies and determine which best predicted performance, this retrospective study analyzed recorded efforts from a random selection of 160 high-ranking (top 10,000) men and women (n = 80 each) in the 2020 CrossFit® Open (CFO). Video recordings submitted to the official competition leaderboard for all five tests were analyzed to quantify overall test completion rates (and tie-break time for test 5 only) and within-test repetition completion rate (repetitions × sec−1) for each exercise, as well as the quantity of failed repetitions, break strategy (count and duration), and transition times. Each variable was aggregated into first-half, last-half, and total-test averages, slopes, and coefficient of variation; except on test 5 (total-test only). Spearman's rank correlation coefficients were calculated between test completion rates, each test's respective pacing variables, competitor demographics (height and body mass) and CFO experience (i.e., past participation, consecutive competitions, and ranks). Stepwise regression using significantly (p

As spectral imaging techniques are becoming more prominent in science, advanced image segmentation algorithms are required to identify appropriate domains in these images. We present a version of image segmentation called manifold projection image segmentation (MPIS) that is generally applicable to a broad range of systems without the need for training because MPIS uses unsupervised machine learning with a few physically motivated hyperparameters. We apply MPIS to nanoscale x-ray absorption near edge structure (XANES) imaging, where XANES spectra are collected with nanometer spatial resolution. We show the superiority of manifold projection over linear transformations, such as the commonly used principal component analysis (PCA). Moreover, MPIS maintains accuracy while reducing computation time and sensitivity to noise compared to the standard nano-XANES imaging analysis procedure. Finally, we demonstrate how multimodal information, such as x-ray fluorescence data and spatial location of pixels, can be incorporated into the MPIS framework. We propose that MPIS is adaptable for any spectral imaging technique, including scanning transmission x-ray microscopy, where the length scale of domains is larger than the resolution of the experiment.

Variation in the preservation of β cell function in clinical trials in type 1 diabetes (T1D) has emphasized the need to define biomarkers to predict treatment response. The T1DAL trial targeted T cells with alefacept (LFA-3–Ig) and demonstrated C-peptide preservation in approximately 30% of new-onset T1D individuals. We analyzed islet antigen–reactive (IAR) CD4+ T cells in PBMC samples collected prior to treatment from alefacept- and placebo-treated individuals using flow cytometry and single-cell RNA sequencing. IAR CD4+ T cells at baseline had heterogeneous phenotypes. Transcript profiles formed phenotypic clusters of cells along a trajectory based on increasing maturation and activation, and T cell receptor (TCR) chains showed clonal expansion. Notably, the frequency of IAR CD4+ T cells with a memory phenotype and a unique transcript profile (cluster 3) were inversely correlated with C-peptide preservation in alefacept-treated, but not placebo-treated, individuals. Cluster 3 cells had a proinflammatory phenotype characterized by expression of the transcription factor BHLHE40 and the cytokines GM-CSF and TNF-α, and shared TCR chains with effector memory–like clusters. Our results suggest IAR CD4+ T cells as a potential baseline biomarker of response to therapies targeting the CD2 pathway and warrant investigation for other T cell–related therapies.

Measurement(s) transcripts • water chemistry Technology Type(s) RNAseq • GC/MS Factor Type(s) exposure Sample Characteristic - Organism Pimephales promelas Sample Characteristic - Environment estuary system Sample Characteristic - Location Milwaukee, WI, USA

This retrospective study collected video recordings of a random selection of eighty men and women (n = 160) completing all five tests of the 2020 CrossFit® Open. All competitors were ranked within the top 10,000 overall but were sub-divided based on whether they ranked within the top 10% of their respective divisions. To examine the effect of sex and rank on pacing strategy, video analysis quantified the overall repetition completion rate on each test, as well as per minute (or round) repetition completion rates for each test’s individual exercises, quantity of failed repetitions, break times, and transition times. All per minute (or round) data were aggregated into first- and last-half or total test average, slopes, and coefficient of variation. Sex and rank analyses of variance were performed on averages, slopes, and coefficients of variation for each variable calculated over the first and last halves of each test, except test 5 (total only). The top 10% of men were 17.5% faster (p < 0.001) than everyone else in tests 1, 3, and 5. The top 10% of women and remaining men were ~9.5% faster than remaining women in tests 1 and 3. In test 5, the remaining men were faster than top 10% of women (~11.2%, p < 0.001), and both were faster than the remaining women. In tests 2 and 4, the top 10% of athletes were 9.7% faster (p < 0.001) than remaining athletes, and at the same time, men were 7.7% faster (p < 0.001) than women. Analysis of each test’s components revealed the top 10% of competitors to be faster and more consistent in most areas, while men were generally faster than women in gymnastics components and more consistent with their pace for resistance training exercises. These data provide insight into the differential factors linked to success in the men’s and women’s CFO divisions.

Abstract Purpose To examine the relationships between past competition performances and 2020 CrossFit® Open (CFO) performance. Methods A random selection from the top one thousand athletes (n = 220, 28.5 ± 4.4 years, 178 ± 7 cm, 87.5 ± 10.2 kg) were selected for this study. Overall and weekly performances (including ranks and scores) of the 2020 CFO, as well as overall ranks from all previous CFO, regional, and Games™ competitions in which they competed, were recorded from their publicly available online profile. The highest, lowest, average, and standard deviation (SD) of past rankings, as well as participation statistics (i.e., years since first appearance, total and consecutive appearances, and participation rate), were calculated for each competition stage. Relationships were then assessed between 2020 CFO performance and all past competition experience variables by calculating Kendall’s tau (τ) correlation coefficients and Bayes factors (BF10). Results Overall and weekly ranking of the 2020 CFO was extremely favored (p 100) to be related to the athlete’s highest previous CFO rank (τ = 0.26–0.39) and individual regional appearances (τ = − 0.26 to − 0.34), as well as individual Games™ appearances (overall and for weeks 1, 3, and 4; τ = − 0.20 to − 0.22, p 100). Evidence for all other significant relationships ranged from moderate to very strong (p

Background Access to providers and programs that provide medications for opioid use disorder (MOUD) remains a systemic barrier for patients with opioid use disorder (OUD), particularly if they live in rural areas. The Rural Access to Medication Assisted Treatment (MAT) in Pennsylvania Project (Project RAMP) addressed this problem with a multisystem partnership that recruited, trained, and supported rural primary care providers to provide MOUD and implement an integrated care model (ICM) for patients with OUD. Given the demonstrated efficacy of Project RAMP, this article summarizes our recruitment strategies, including feasibility concerns for further expansion into other regions. Methods The approach for recruiting implementation sites included two phases: partner outreach and site identification. Once recruited, the Systems Transformation Framework guided planning and implementation activities. Recruitment and implementation activities were assessed with implementation trackers and evaluated by providers via key informant interviews (KIIs). Results Project RAMP recruited 26 primary care practices from 13 counties, including nine health systems and two private practice groups—exceeding the original target of 24 sites. There was a median of 49 days from first contact to project onboarding. A total of 108 primary care practices spanning 22 health systems declined participation. Findings from the KIIs highlighted the value of engaging PCPs by connecting to a shared vision (i.e., improving the quality of patient care) as well as addressing perceived participation barriers (e.g., offering concierge technical assistance to address lack of training or resources). Conclusion Findings highlight how successful recruitment activities should leverage the support of health system leadership. Findings also emphasize that aiding recruitment and engagement efforts successfully addressed prescribers’ perceived barriers to providing MOUD as well as facilitating better communication among administrators, PCPs, behavioral health professionals, care managers, and patients. Plain Language Summary: Opioid use disorder (OUD) is one of the leading causes of preventable illness and death. The standard of care for OUD is the provision of medications for opioid use disorder (MOUD) and the application of an integrative integrated care model (ICM) where behavioral health is blended with specialized medical services. Unfortunately, access to providers and healthcare facilities that provide MOUD or apply an ICM remains a systemic barrier for patients with OUD, particularly if they live in rural areas. Although there is no one-size-fits-all approach to implementing MOUD in primary care, findings from Project The Rural Access to Medication Assisted Treatment (MAT) in Pennsylvania Project (Project RAMP) highlight strategies that may improve future MOUD and ICM implementation efforts in similar rural contexts. Specifically, future efforts to increase MOUD capacity by recruiting new providers should be prepared to leverage health system leadership, address provider barriers via training and expert consultation, and facilitate connections to local behavioral health providers. This approach may be helpful to others recruiting health systems and primary care practices to implement new care models to use MOUD in treating patients with OUD.

IntroductionThe CrossFit® Open (CFO) acts a preliminary round that qualifies men and women for later stages of its annual Games competition. The CFO typically consists of 4-6 workouts that variably challenge an athlete's weightlifting strength, gymnastic skill, and endurance capacity. Except for differences in prescribed intensity loads, workouts are designed the same for men and women to elicit a similar challenge. While all workouts within a single year are unique to each other, one has been repeated from a previous CFO each year between 2012 and 2021. Because previous CFO workouts are often integrated into training, improvements are expected when a workout is officially repeated. However, besides documented record performances, it is unclear whether most athletes are improving, if these improvements affect ranking, or if differences exist between men and women.PurposeTo examine sex-division differences and performance changes across repeated CFO workouts, as well as their effect on CFO and workout ranking.MethodsEleven separate samples of 500 men and 500 women, who were representative of the same overall percent rank within each year involving one of the nine repeated CFO workouts (2011-2021) were drawn for this study. Each athlete's age (18-54 years), rank (overall and within each workout), and reported workout scores were collected from the competition's publicly-available leaderboard. Each sample had excluded any athlete who had not met minimum performance criteria (e.g., at least one completed round) for all prescribed (Rx) workouts within a given year (including those not analyzed). Since some workouts could be scored as repetitions completed or time-to-completion (TTC), and because programming was often scaled between men and women, all scores were converted to a repetition completion rate (repetitions divided by TTC [in minutes]).ResultsSeparate sex-division x time analyses of variance with repeated measures revealed significant (p < 0.05) interactions in all but one repeated workout comparison. Initially, men were faster in four workouts (~18.5%, range = 3.9-35.0%, p < 0.001), women in two (~7.1%, range = 5.2-9.0%, p < 0.001), and they tied in the remaining three workouts. When workouts were repeated in subsequent years, men were faster in three workouts (~5.4%, range = 0.9-7.8%, p < 0.05), while women were faster in two (~3.8%, range = 3.5-4.1%, p < 0.01). Though performance improved in seven of the nine workouts (~14.3%, p < 0.001) and percentile rank was controlled, athletes earned a lower rank (overall and within workout) on each repeated workout (p < 0.001).ConclusionsPerformance (measured as repetition completion rate) has improved in most repeated CFO workouts, particularly for women. However, improvements seen among all athletes, along with increased participation, have made it more difficult for athletes to improve their overall rank. To rank higher, individual athletes must improve their pace to a greater degree than the average improvements seen across the competitive field.

Background Systematic reviews and meta-analyses related to high-intensity functional training (HIFT) have been conducted. However, due to a restricted pool of available research, these investigations are often limited in scope. As such, a scoping review investigating the present literature surrounding the acute physiological response to HIFT-based exercise was chosen as a more appropriate structured review. Methodology A scoping review was conducted following Arksey and O’Malley’s framework. Three large scale databases were searched to reveal any article pertaining to HIFT and related exercise terminology. Results A total of 2,241 articles were found during the initial search. Following this, titles, then abstracts, and full-texts were reviewed to determine inclusion eligibility. A total of 60 articles which investigated a combined total of 35 unique HIFT workouts were included within this review. Conclusions A variety of physiological parameters and HIFT workouts have been examined. Markers of intensity (e.g., blood lactate concentrations, heart rate) have been most consistently assessed across all studies, and these support the idea that HIFT workouts are typically performed at high-intensity. In contrast, the inclusion of most other measures (e.g., hormonal, markers of inflammation and damage, energy expenditure, performance) has been inconsistent and has thus, limited the possibility for making generalized conclusions. Differences in study methodologies have further impacted conclusions, as different studies have varied in sample population characteristics, workouts assessed, and time points. Though it may be impossible to comprehensively research all possible HIFT workouts, consistent adoption of population definitions and workload quantification may overcome this challenge and assist with future comparisons.

Therapeutics that inhibit IL-6 at different points in its signaling pathway are in clinical use, yet whether the immunological effects of these interventions differ based on their molecular target is unknown. We performed short-term interventions in individuals with type 1 diabetes using anti–IL-6 (siltuximab) or anti–IL-6 receptor (IL-6R; tocilizumab) therapies and investigated the impact of this in vivo blockade on T cell fate and function. Immune outcomes were influenced by the target of the therapeutic intervention (IL-6 versus IL-6R) and by peak drug concentration. Tocilizumab reduced ICOS expression on T follicular helper cell populations and T cell receptor–driven (TCR-driven) STAT3 phosphorylation. Siltuximab reversed resistance to Treg-mediated suppression and increased TCR-driven phosphorylated STAT3 and production of IL-10, IL-21, and IL-27 by T effectors. Together, these findings indicate that the context of IL-6 blockade in vivo drives distinct T cell–intrinsic changes that may influence therapeutic outcomes.

RationalePrevious studies identified an interaction between HLA and oral peanut exposure. HLA-DQA1*01:02 had a protective role with the induction of Ara h 2 epitope-specific IgG4 associated with peanut consumption during the LEAP clinical trial for prevention of peanut allergy, while it was a risk allele for peanut allergy in the peanut avoidance group. We have now evaluated this gene-environment interaction in two subsequent peanut oral immunotherapy (OIT) trials - IMPACT and POISED - to better understand the potential for the HLA-DQA1*01:02 allele as an indicator of higher likelihood of desensitization, sustained unresponsiveness, and peanut allergy remission.MethodsWe determined HLA-DQA1*01:02 carrier status using genome sequencing from POISED (N=118, age: 7-55yr) and IMPACT (N=126, age: 12-

The design of high-intensity functional training (HIFT; e. g., CrossFit®) workouts and targeted physiological trait(s) vary on any given training day, week, or cycle. Daily workouts are typically comprised of different modality and exercise combinations that are prescribed across a wide range of intensities and durations. The only consistent aspect appears to be the common instruction to maximize effort and workout density by either completing “as many repetitions as possible” within a time limit (e.g., AMRAP, Tabata) or a list of exercises as quickly as possible. However, because effort can vary within and across workouts, the impact on an athlete's physiology may also vary daily. Programming that fails to account for this variation or consider how targeted physiological systems interrelate may lead to overuse, maladaptation, or injury. Athletes may proactively monitor for negative training responses, but any observed response must be tied to a quantifiable workload before meaningful changes (to programming) are possible. Though traditional methods exist for quantifying the resistance training loads, gymnastic movements, and cardiorespiratory modalities (e.g., cycling running) that might appear in a typical HIFT workout, those methods are not uniform, and their meaning will vary based on a specific exercise's placement within a HIFT workout. To objectively quantify HIFT workloads, the calculation must overcome differences in measurement standards used for each modality, be able to account for a component's placement within the workout and be useful regardless of how a workout is commonly scored (e.g., repetitions completed vs. time-to-completion) so that comparisons between workouts are possible. This review paper discusses necessary considerations for quantifying various HIFT workout components and structures, and then details the advantages and shortcomings of different methods used in practice and the scientific literature. Methods typically used in practice range from being excessively tedious and not conducive for making comparisons within or across workouts, to being overly simplistic, based on faulty assumptions, and inaccurate. Meanwhile, only a few HIFT-related studies have attempted to report relevant workloads and have predominantly relied on converting component and workout performance into a rate (i.e., repetitions per minute or second). Repetition completion rate may be easily and accurately tracked and allows for intra- and inter-workout comparisons. Athletes, coaches, and sports scientists are encouraged to adopt this method and potentially pair it with technology (e.g., linear position transducers) to quantify HIFT workloads. Consistent adoption of such methods would enable more precise programming alterations, and it would allow fair comparisons to be made between existing and future research.

Abstract Nutrient gradients in biofilms cause bacteria to organize into metabolically versatile communities capable of withstanding threats from external agents including bacteriophages, phagocytes, and antibiotics. We previously determined that oxygen availability spatially organizes respiration in uropathogenic Escherichia coli biofilms, and that the high-affinity respiratory quinol oxidase cytochrome bd is necessary for extracellular matrix production and biofilm development. In this study we investigate the physiologic consequences of cytochrome bd deficiency in biofilms and determine that loss of cytochrome bd induces a biofilm-specific increase in expression of general diffusion porins, leading to elevated outer membrane permeability. In addition, loss of cytochrome bd impedes the proton mediated efflux of noxious chemicals by diminishing respiratory flux. As a result, loss of cytochrome bd enhances cellular accumulation of noxious chemicals and increases biofilm susceptibility to antibiotics. These results identify an undescribed link between E. coli biofilm respiration and stress tolerance, while suggesting the possibility of inhibiting cytochrome bd as an antibiofilm therapeutic approach.

L-citrulline serves as a nitric oxide precursor with the potential to increase blood flow and improve resistance exercise performance, yet more research is needed to examine its ergogenic potential. To examine the effect of L-citrulline supplementation on resistance exercise performance, muscle oxygenation, and the subjective perception of effort, energy, focus, fatigue, and muscle pump, eighteen resistance-trained men (n = 11) and women (n = 7) (21.4 ± 1.8 years; 172.3 ± 7.5 cm; 76.9 ± 10.8 kg) were randomly assigned for supplementation with 8 g of L-citrulline (CIT) or a placebo (PL) in a cross-over fashion one hour prior to testing. Participants completed an isometric mid-thigh pull test (IMTP), a ballistic bench press protocol [two sets of two repetitions at 75% 1-repetition maximum (1 RM) with maximum ballistic intent], and a strength-endurance bench press protocol [five repetition-maximum sets at 75% 1RM]. Barbell velocity and power were measured via a linear position transducer during the ballistic protocol, while the repetitions completed, volume load and muscle oxygenation were quantified during the strength-endurance protocol. Subjective measures were assessed at the baseline and immediately pre- and post-exercise. Repeated measures of the analysis of variance and Bayesian equivalents revealed no significant interactions, providing evidence favoring the null hypothesis (BF10 < 1) for IMTP (PL 497.5 ± 133.6 vs. CIT 492.5 ± 129.4 N), barbell velocity, and power, and repetitions completed (PL 36.7 ± 7.2 vs. CIT 36.9 ± 8.1 repetitions). There were also no significant interactions for muscle oxygenation parameters or subjective measures except perceived fatigue. Women reported greater fatigue across all time points compared to men (~1.88 au, p = 0.045, BF10 = 0.2). The results indicate that a single 8 g dose of L-citrulline did not enhance isometric force production, muscle endurance, or muscle oxygenation parameters during the protocol implemented in this study.

Objective: Since concussion is the most common injury in ice hockey, the objective of the current study was to elucidate risk factors, specific mechanisms, and clinical presentations of concussion in men's and women's ice hockey. Methods: Ice hockey players from 5 institutions participating in the Concussion Assessment, Research, and Education Consortium were eligible for the current study. Participants who sustained a concussion outside of this sport were excluded. There were 332 (250 males, 82 females) athletes who participated in ice hockey, and 47 (36 males, 11 females) who sustained a concussion. Results: Previous concussion (odds ratio (OR) = 2.00; 95% confidence interval (95% CI): 1.02‒3.91) was associated with increased incident concussion odds, while wearing a mouthguard was protective against incident concussion (OR = 0.43; 95%CI: 0.22‒0.85). Overall, concussion mechanisms did not significantly differ between sexes. There were specific differences in how concussions presented clinically across male and female ice hockey players, however. Females (9.09%) were less likely than males (41.67%) to have a delayed symptom onset (p = 0.045). Additionally, females took significantly longer to reach asymptomatic (p = 0.015) and return-to-play clearance (p = 0.005). Within the first 2 weeks post-concussion, 86.11% of males reached asymptomatic, while only 45.50% of females reached the same phase of recovery. Most males (91.67%) were cleared for return to play within 3 weeks of their concussion, compared to less than half (45.50%) of females. Conclusion: The current study proposes possible risk factors, mechanisms, and clinical profiles to be validated in future concussions studies with larger female sample sizes. Understanding specific risk factors, concussion mechanisms, and clinical profiles of concussion in collegiate ice hockey may generate ideas for future concussion prevention or intervention studies.

Abstract Precisely targeted measurements of trace elements using laser ablation inductively coupled plasma mass spectrometry (LA-ICPMS) reveal inter-chamber heterogeneities in specimens of the planktic foraminifer Trilobatus (Globigerinoides) sacculifer. We find that Mg/Ca ratios in the final growth chamber are generally lower compared to previous growth chambers, but final chamber Mg/Ca is elevated in one of thirteen sample intervals. Differences in distributions of Mg/Ca values from separate growth chambers are observed, occurring most often at lower Mg/Ca values, suggesting that single-chamber measurements may not be reflective of the specimen’s integrated Mg/Ca. We compared LA-ICPMS Mg/Ca values to paired, same-individual Mg/Ca measured via inductively coupled plasma optical emission spectrometry (ICP-OES) to assess their correspondence. Paired LA-ICPMS and ICP-OES Mg/Ca show a maximum correlation coefficient of R = 0.92 (p

This study examined relationships between body composition and high-intensity functional training (HIFT) workout performance. Fifty-seven men (31.4 ± 6.9 years, 177.2 ± 7.5 cm, 84.7 ± 8.5 kg) and thirty-eight women (29.2 ± 6.4 years, 166.6 ± 6.1 cm, 66.5 ± 7.7 kg) with HIFT experience (≥6 months) reported completing “Fran” (21-15-9 repetitions of barbell thrusters and pull-ups) in 4.78 ± 2.22 min and 6.05 ± 2.84 min, respectively, and volunteered to complete dual-energy X-ray absorptiometry assessments. Participants were grouped by competition class (men, women, master’s men, master’s women) and percentile rank in “Fran” (≤25th percentile, 25–75th percentiles, ≥75th percentile). Two-way analyses of variance revealed expected differences (p < 0.001) between men and women in non-bone lean mass (NBLM), fat-free mass index, and fat mass, and more NBLM (10.6–10.8 kg) and less fat mass (2.7–5.2 kg) in >75th percentile compared to other percentiles. Most body composition measures were significantly (p < 0.05) related to performance in men and women but limited in master’s men; no relationships were seen in master’s women. “Fran” time was negatively correlated to NBLM and fat-free mass index in all percentile groups (ρ = -0.37 to -0.64) and bone mineral characteristics for >25th percentile (ρ = −0.41 to −0.63), and positively correlated to fat mass in 25–75th percentiles (ρ = 0.33–0.60). No other relationships were seen in ≤25th percentile. The influence of body composition on “Fran” time appears to vary by both competition class and percentile rank. Though training to increase lean mass always seems relevant, reducing body fat only appears relevant in mid-skilled trainees and when it is outside healthy parameters.

How the El Niño Southern Oscillation depends on the background conditions is not well known. Here, the authors present individual foraminifera distributions which show that central Pacific variability is related to the warmth and depth of the thermocline across varying climate background conditions over the past ~285,000 years.

Objective: To delineate health care disruption for individuals with acquired brain injury (ABI) during the peak of the pandemic and to understand the impact of health care disruption on health-related quality of life (HRQoL). Design: Cross-sectional survey. Setting: General community. Participants: Volunteer sample of adults with traumatic brain injury (TBI; n=33), adults with stroke (n=66), and adults without TBI or stroke (n=108) with access to the internet and personal technology (N=207). Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: Participants with TBI and stroke reported high rates of disruption in care specific to their diagnosis (53%-54.5%), while participants across all groups reported disruption for major medical care (range, 68.2%-80%), general health care (range, 60.3%-72.4%), and mental health care (range, 31.8%-83.3%). During the pandemic, participants with TBI and stroke used telehealth for care specific to their diagnosis (40.9%-42.4%), whereas all participants used telehealth for major medical care (range, 50%-86.7%), general health care (range, 31.2%-53.3%), and mental health care (range, 53.8%-72.7%). Disruption in TBI or stroke care and type of ABI explained 27.1% of the variance in HRQoL scores (F2,95=16.82, P

ObjectivesWe reviewed the current health service delivery for individuals with Autoimmune Encephalitis (AE) in the Philippines and to identify the gaps and challenges in its management.MethodologyWe conducted a scoping review of pertinent literature AE in the Philippines using the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines. We extracted data on epidemiology, legislation, health financing, information systems, pharmacotherapy, and healthcare services related to the management of AE in the local setting.DiscussionThe epidemiology of AE is still unknown. Out-of-pocket expenses contribute to most of the healthcare expenditure despite government-led programs to reduce the financial burden. The access to diagnostic examinations such as magnetic resonance imaging, electroencephalogram, and antibody testing is limited by the geographic distribution of the facilities and costs. The acute and long-term management of AE are cost-prohibitive and are not readily available. There are significant treatment gaps in the care of individuals with AE in the Philippines in terms of disease recognition, resource allocation, access to satisfactory diagnostic evaluation, and provision of prognosis-changing therapeutics. We proposed core strategies that can address these treatment gaps such as increasing awareness, improving access to health resources, adequate healthcare financing, and availability of support systems.

The primary purpose was to simplify external load data obtained during Division-I (DI) basketball competitions via principal component analysis (PCA). A secondary purpose was to determine if the PCA results were sensitive to load demands of different positional groups (POS). Data comprised 229 observations obtained from 10 men's basketball athletes participating in NCAA DI competitions. Each athlete donned an inertial measurement unit that was affixed to the same location on their shorts prior to competition. The PCA revealed two factors that possessed eigenvalues >1.0 and explained 81.42% of the total variance. The first factor comprised total decelerations (totDEC, 0.94), average speed (avgSPD, 0.90), total accelerations (totACC, 0.85), total mechanical load (totMECH, 0.84), and total jump load (totJUMP, 0.78). Maximum speed (maxSPD, 0.94) was the lone contributor to the second factor. Based on the PCA, external load variables were included in a multinomial logistic regression that predicted POS (Overall model, p < 0.0001; AUCcenters = 0.93, AUCguards = 0.88, AUCforwards = 0.80), but only maxSPD, totDEC, totJUMP, and totMECH were significant contributors to the model's success (p < 0.0001 for each). Even with the high significance, the model still had some issues differentiating between guards and forwards, as in-game demands often overlap between the two positions. Nevertheless, the PCA was effective at simplifying a large external load dataset collected on NCAA DI men's basketball athletes. These data revealed that maxSPD, totDEC, totJUMP, and totMECH were the most sensitive to positional differences during competitions. To best characterize competition demands, such variables may be used to individualize training and recovery regimens most effectively.

We investigated the interplay between genetics and oral peanut protein exposure in the determination of the immunological response to peanut using the targeted intervention in the LEAP clinical trial. We identified an association between peanut-specific IgG4 and HLA-DQA1*01:02 that was only observed in the presence of sustained oral peanut protein exposure. The association between IgG4 and HLA-DQA1*01:02 was driven by IgG4 specific for the Ara h 2 component. Once peanut consumption ceased, the association between IgG4-specific Ara h 2 and HLA-DQA1*01:02 was attenuated. The association was validated by observing expanded IgG4-specific epitopes in people who carried HLA-DQA1*01:02. Notably, we confirmed the previously reported associations with HLA-DQA1*01:02 and peanut allergy risk in the absence of oral peanut protein exposure. Interaction between HLA and presence or absence of exposure to peanut in an allergen- and epitope-specific manner implicates a mechanism of antigen recognition that is fundamental to driving immune responses related to allergy risk or protection.

To create normative scores for all CrossFit® Open (CFO) workouts and compare male and female performances, official scores were collected from the official competition leaderboard for all competitors of the 2011–2022 CFO competitions. Percentiles were calculated for athletes (18–54 years) who completed all workouts within a single year ‘as prescribed’ and met minimum scoring thresholds. Independent t-tests revealed significant (p < 0.05) sex differences for 56 of 60 workouts. In workouts scored by repetitions completed, men completed more repetitions in 18 workouts by small to large differences (d = 0.22–0.81), whereas women completed more repetitions in 6 workouts by small to medium differences (d = 0.36–0.77). When workouts were scored by time to completion, men were faster in 10 workouts by small to large differences (d = 0.23–1.12), while women were faster in 3 workouts by small differences (d = 0.46). In three workouts scored by load lifted, men lifted more weight by large differences (d = 2.00–2.98). All other differences were either trivial or not significant. Despite adjusted programming for men and women, the persistence of performance differences across all CFO workouts suggests that resultant challenges are not the same. These normative values may be useful for training and research in male and female CrossFit® athletes.

To examine relationships between Brazilian Jiu Jitsu (BJJ) descriptors (belt rank, experience, gi preference, and fighting style), resistance training (RT) experience, and measures of body composition, strength (maximal handgrip, 3-5-repetition maximum [RM] in barbell glute bridge [GB], prone bench row [PBR], and bench press [BP]), and velocity (GB, PBR, and BP at 7 kg and 30–60% 1-RM), 13 experienced (4.3 ± 3.4 years) BJJ athletes were recruited for this cross-sectional, pilot study. Significant (p < 0.05) Kendall’s tau and Bayesian relationships were seen between belt rank and body fat percentage (τ = −0.53, BF10 = 6.5), BJJ experience and body fat percentage (τ = −0.44 to −0.66, BF10 = 2.6–30.8) and GB velocity (τ = −0.45 to −0.46, BF10 = 2.8–3.1), RT experience and strength (τ = 0.44 to 0.73, BF10 = 2.6–75.1) and velocity (τ = −0.44 to 0.47, BF10 = 2.6–3.3), gi preference-training and relative PBR strength (τ = 0.70, BF10 = 51.9), gi preference-competition and height and lean mass (τ = −0.57 to 0.67, BF10 = 5.3–12.4) and BP velocity (τ = −0.52 to 0.67, BF10 = 3.5–14.0). The relevance of body composition and performance measures to sport-specific training and research interpretation are differentially affected by a BJJ athlete’s experience (BJJ, belt rank, RT), gi preferences, and fighting style.

Human islet antigen reactive CD4+ memory T cells (IAR T cells) play a key role in the pathogenesis of autoimmune type 1 diabetes (T1D). Using single-cell RNA sequencing (scRNA-Seq) to identify T cell receptors (TCRs) in IAR T cells, we have identified a class of TCRs that share TCRα chains between individuals (“public” chains). We isolated IAR T cells from blood of healthy, new-onset T1D and established T1D donors using multiplexed CD154 enrichment and identified paired TCRαβ sequences from 2767 individual cells. More than a quarter of cells shared TCR junctions between 2 or more cells (“expanded”), and 29/47 (~62%) of expanded TCRs tested showed specificity for islet antigen epitopes. Public TCRs sharing TCRα junctions were most prominent in new-onset T1D. Public TCR sequences were more germline like than expanded unique, or “private,” TCRs, and had shorter junction sequences, suggestive of fewer random nucleotide insertions. Public TCRα junctions were often paired with mismatched TCRβ junctions in TCRs; remarkably, a subset of these TCRs exhibited cross-reactivity toward distinct islet antigen peptides. Our findings demonstrate a prevalent population of IAR T cells with diverse specificities determined by TCRs with restricted TCRα junctions and germline-constrained antigen recognition properties. Since these “innate-like” TCRs differ from previously described immunodominant TCRβ chains in autoimmunity, they have implications for fundamental studies of disease mechanisms. Self-reactive restricted TCRα chains and their associated epitopes should be considered in fundamental and translational investigations of TCRs in T1D.

The development of rational approaches to restore immune tolerance requires an iterative approach that builds on past success and utilizes new mechanistic insights into immune-mediated pathologies. This article will review concepts that have evolved from the clinical trial experience of the Immune Tolerance Network, with an emphasis on lessons learned from the innovative mechanistic studies conducted for these trials and new strategies under development for induction of tolerance.

Despite the significant impact that concussion has on military service members, significant gaps remain in our understanding of the optimal diagnostic, management, and return to activity/duty criteria to mitigate the consequences of concussion. In response to these significant knowledge gaps, the US Department of Defense (DoD) and the National Collegiate Athletic Association (NCAA) partnered to form the NCAA-DoD Grand Alliance in 2014. The NCAA-DoD CARE Consortium was established with the aim of creating a national multisite research network to study the clinical and neurobiological natural history of concussion in NCAA athletes and military Service Academy cadets and midshipmen. In addition to the data collected for the larger CARE Consortium effort, the service academies have pursued military-specific lines of research relevant to operational and medical readiness associated with concussion. The purpose of this article is to describe the structure of the NCAA-DoD Grand Alliance efforts at the service academies, as well as discuss military-specific research objectives and provide an overview of progress to date. A secondary objective is to discuss the challenges associated with conducting large-scale studies in the Service Academy environment and highlight future directions for concussion research endeavors across the CARE Service Academy sites.

This article provides a reusable dataset describing detailed phenotypic and associated clinical parameters in n=303 clinical isolates of urinary Escherichia coli collected at Vanderbilt University Medical Center. De-identified clinical data collected with each isolate are detailed here and correlated to biofilm abundance and metabolomics data. Biofilm-abundance data were collected for each isolate under different in vitro conditions along with datasets quantifying biofilm abundance of each isolate under different conditions. Metabolomics data were collected from a subset of bacterial strains isolated from uncomplicated cases of cystitis or cases with no apparent symptoms accompanying colonization. For more insight, please see “Defining a Molecular Signature for Uropathogenic versus Urocolonizing Escherichia coli: The Status of the Field and New Clinical Opportunities” [1].

Background Muscular damage sustained while playing rugby may hinder performance across a season. β-Hydroxy β-Methylbutyrate (HMB) may help attenuate muscle damage and maintain lean mass and performance. This study sought to determine the effect of combining HMB with creatine monohydrate supplementation on measures of stress and muscle damage, body composition, strength and sprinting kinetics throughout a rugby season. Methods This double-blind, cross-over investigation recruited 16 male collegiate rugby players to provide resting blood samples and complete assessments of body composition, strength and sprinting performance prior to their fall season (PREFALL). After testing, the athletes were matched for fat-free mass and assigned to consume one of two supplementation regimens for 6 weeks: 5 g HMB + 5 g creatine per day (HMB-Cr: 20.9 ± 1.1 years; 177 ± 2 cm; 88.4 ± 4.9 kg) or 5 g creatine + 5 g placebo per day (Cr: 21.4 ± 2.1 years; 179 ± 2 cm; 88.3 ± 4.9 kg). After 6 weeks (POSTFALL), PREFALL testing was repeated in 13 of the original 16 athletes before a 10-wk wash-out period. Athletes who returned for the spring season (n = 8) repeated all fall-season procedures and testing prior to (PRESPRING) and following (POSTSPRING) their 6-wk spring season, except they were assigned to the opposite supplementation regimen. Results Linear mixed models with repeated measures revealed group x time interactions (p

This investigation examined anthropometric, hormonal, and physiological differences between advanced (ADV; n = 8, 27.8 ± 4.2 years, 170 ± 11 cm, 79.8 ± 13.3 kg) and recreational (REC; n = 8, 33.5 ± 8.1 years, 172 ± 14 cm, 76.3 ± 19.5 kg) CrossFit (CF) trained participants in comparison to physically-active controls (CON; n = 7, 27.5 ± 6.7 years, 171 ± 14 cm, 74.5 ± 14.3 kg). ADV and REC were distinguished by their past competitive success. REC and CON were resistance-trained (>2 years) and exercised on 3-5 days·wk-1 for the past year, but CON utilized traditional resistance and cardiovascular exercise. All participants provided a fasted, resting blood sample and completed assessments of resting metabolic rate, body composition, muscle morphology, isometric mid-thigh pull strength, peak aerobic capacity, and a 3-minute maximal cycle ergometer sprint across two separate occasions (separated by 3-7 days). Blood samples were analyzed for testosterone, cortisol, and insulin-like growth factor-1. Compared to both REC and CON, one-way analysis of variance revealed ADV to possess lower body fat percentage (6.7-8.3%, p = 0.007), greater bone and non-bone lean mass (12.5-26.8%, p ≤ 0.028), muscle morphology characteristics (14.2-59.9%, p < 0.05), isometric strength characteristics (15.4-41.8%, p < 0.05), peak aerobic capacity (18.8-19.1%, p = 0.002), and 3-minute cycling performance (15.4-51.1%, p ≤ 0.023). No differences were seen between REC and CON, or between all groups for resting metabolic rate or hormone concentrations. These data suggest ADV possess several physiological advantages over REC and CON, whereas similar physiological characteristics were present in individuals who have been regularly participating in either CF or resistance and cardiovascular training for the past year.

PurposeThe purpose of this study was to compare early and late rapid torque parameters of the plantar flexors (PFs) in middle-aged (MM) and older (OM) males, and determine the effect of normalization to peak torque (PT) and muscle cross-sectional area (CSA).MethodsTwenty-nine healthy, MM (n = 14; 45 ± 2 yrs) and OM (n = 15; 65 ± 3 yrs) performed rapid, maximal isometric contractions of the PFs. PT, as well as rate of torque development and impulse during the early (0-50 ms; RTD0-50, IMP0-50) and late (100-200 ms; RTD100-200, IMP100-200) contraction phases were calculated. Torque at 50 (TQ50), 100 (TQ100), and 200 (TQ200) ms was also obtained. CSA and echo-intensity (EI) of the gastrocnemii were acquired via ultrasonography. Torque variables were normalized to PT and CSA. Rate of EMG rise (RER) for the medial gastrocnemius was calculated at 30, 50 and 75 ms.ResultsTQ100 (MM = 69.71 ± 16.85 vs. OM = 55.99 ± 18.54 Nm; p = 0.046), TQ200 (MM = 114.76 ± 26.79 vs. OM = 91.56 ± 28.10 Nm; p = 0.031), and IMP100-200 (MM = 4.79 ± 1.11 vs. OM = 3.83 ± 1.17 Nm·s; p = 0.032) were lower in OM. PT, TQ50, RTD0-50, IMP0-50, RTD100-200, RER, CSA, and EI were similar between groups (p > 0.05). No differences were found for normalized torque variables (p > 0.05). EI was moderately associated with normalized torque parameters only (r = -0.38 --0.45). RER, at 75 ms, was moderately correlated with early, absolute torque measures and rapid torque variables made relative to PT and CSA (r = 0.41 --0.64).ConclusionLate rapid torque parameters of the PFs were preferentially impaired in OM compared to MM, and PT as well as CSA appeared to mediate this result.

Abstract Background CrossFit® practitioners commonly track progress by monitoring their ability to complete a variety of standardized benchmark workouts within a typical class setting. However, objective assessment of progress is challenging because normative data does not currently exist for any of these benchmark workouts. Therefore, the purpose of this study was to develop normative values for five common benchmark workouts (i.e., Fran, Grace, Helen, Filthy-50 [F50], and Fight-Gone-Bad [FGB]). Methods Performance data from 133,857 male (M) and female (F) profiles located on a publicly available website were collected and sorted by sex (i.e., male [M] and female [F]) and competitive age classification (i.e., teen [T], individual [I], or masters [M]) and screened for errors. Subsequently, 10,000 valid profiles were randomly selected for analysis. Results Means and standard deviations were calculated for each category for Fran (IM 250 ± 106 s; IF 331 ± 181 s; MM 311 ± 138 s; MF 368 ± 138 s; TM 316 ± 136 s; and TF 334 ± 120 s), Grace (IM 180 ± 90 s; IF 213 ± 96 s; MM 213 ± 93 s; MF 238 ± 100 s; TM 228 ± 63 s; and TF 223 ± 69 s), Helen (IM 9.5 ± 1.9 min; IF 11.1 ± 2.4 min; MM 10.2 ± 2.0 min; MF 11.5 ± 2.3 min; TM 9.4 ± 1.6 min; and TF 12.7 ± 1.9 min), F50 (IM 24.4 ± 5.9 min; IF 27.3 ± 6.9 min; MM 26.7 ± 6.1 min; MF 28.2 ± 6.0 min; TM 25.9 ± 7.9 min; and TF 28.3 ± 8.1 min), and FGB (IM 335 ± 65 repetitions; IF 292 ± 62 repetitions; MM 311 ± 59 repetitions; MF 280 ± 54 repetitions; TM 279 ± 44 repetitions; and TF 238 ± 35 repetitions). These values were then used to calculate normative percentile (in deciles) values for each category within each workout. Separate, one-way analyses of variance revealed significant (p

The 2018 CrossFit Open (CFO) was the initial stage of an annual competition that consisted of five weekly workouts. Current evidence suggests that a variety of fitness parameters are important for progressing beyond this stage, but little is known about which are the most important. To examine relationships between CFO performance, experience, and physiological fitness, sixteen experienced (>2 years) athletes (30.7 ± 6.9 years, 171 ± 12 cm, 78.0 ± 16.2 kg) volunteered to provide information about their training and competitive history, and then complete a battery of physiological assessments prior to competing in the 2018 CFO. Athletes’ resting energy expenditure, hormone concentrations, body composition, muscle morphology, cardiorespiratory fitness, and isometric strength were assessed on two separate occasions. Spearman correlations demonstrated significant (p < 0.05) relationships between most variables and performance on each workout. Stepwise regression revealed competition experience (R2 = 0.31–0.63), body composition (R2 = 0.55–0.80), vastus lateralis cross-sectional area (R2 = 0.29–0.89), respiratory compensation threshold (R2 = 0.54–0.75), and rate of force development (R2 = 0.30–0.76) to be the most common predictors. Of these, body composition was the most important. These fitness parameters are known targets with established training recommendations. Though preliminary, athletes may use these data to effectively train for CFO competition.

OBJECTIVES/GOALS: Access to pediatric subspecialty care varies by sociodemographic factors. Providers for gender diverse youth (GDY) are rare, and GDY face health disparities, stigma, and discrimination. We examined the association between GDY access to medical and mental health care and rurality, race, parental education, and other GDY-specific factors. METHODS/STUDY POPULATION: We surveyed parents of GDY (

This double-blind study examined effects of a protease enzyme blend (Prohydrolase®) added to whey protein on post-resistance exercise aminoacidemia and intramuscular anabolic signaling were investigated in ten resistance-trained males. Participants completed 4 sets of 8−10 repetitions in the leg press and leg extension exercises at 75% of 1-repetition maximum. Participants then consumed either 250 mg of Prohydrolase® + 26 g of whey protein (PW), 26 g whey alone (W), or non-nutritive control (CON) in counterbalanced order. Blood samples were obtained prior to exercise (baseline) and then immediately-post (IP), 30-, 60-, 90-, 120-, and 180-min post-exercise. Muscle biopsies were taken at baseline, 1-h (1H), and 3-h (3H) post-exercise. Phosphorylation of AKTSer437 was decreased (3H only: p < 0.001), mTORSer2448 was increased (1H: p = 0.025; 3H: p = 0.009), and p70S6KThr412 remained unchanged similarly for each condition. Plasma leucine, branch-chained amino acids, and essential amino acid concentrations for PW were significantly higher than CON (p < 0.05) at 30 min and similar to W. Compared to IP, PW was the only treatment with elevated plasma leucine levels at 30 min (p = 0.007; ∆ = 57.8 mmol/L, 95% Confidence Interval (CI): 20.0, 95.6) and EAA levels at 180 min (p = 0.003; ∆ = 179.1 mmol/L, 95% CI: 77.5, 280.7). Area under the curve amino acid analysis revealed no differences between PW and W. While no different than W, these data indicate that PW was the only group to produce elevated amino acid concentrations 30-min and 180-min post-ingestion.