The Effect of TITAN Evo (TE) Chair on Muscle Stiffness, Player Perceptions and Performance

PURPOSE: To examine the difference of an Aeron chair and a TITAN Evo (TE) chair on muscle stiffness, gaming performance, and gamers perceptions during a 2-hour League of Legends gaming session. METHODS: All subjects signed written consent to participate in this mixed-method randomized cross-over design trial. Each subject performed 2 testing days. Prior to each gaming session, subjects were fitted to each chair according to manufacturer guidelines and shown all the adjustable features of each chair. Instructions were “please adjust the chair to your preference”. Prior to gaming, subjects sat for 15 minutes in the chair. Dynamic muscle stiffness [N/m] was tested using oscillation frequency [Hz]. Measurements were taken bilaterally on the upper trapezius, mid trapezius, lower trapezius and erector spinae muscles pre and post 2 hours of game play. Surveys were administered following each day on chair preference. Total Wins and Kills were recorded. A paired t-test was used to compare the difference in muscle stiffness pre- and post-game play between chairs and for wins and kills, as well as descriptive statistics. RESULTS: Thirty-three subjects (men 85%, age 23 ± 4.9) were analyzed. No significant differences were found in muscle stiffness measures except upper trapezius. After 2 hours of gameplay, the left erector spinae in the TE was 4.8% less than the Aeron chair (p=0.1), and 3.8% less on the right (p=0.29). In the TE chair, the left lower trapezius was 1.7% less (p=0.64), and 4.4% less on the right (p=0.44). The left mid trapezius was 15.6% lower (p=0.94), and 13.7% less on the right (p=0.36). The left upper trapezius was 7.7% higher (p=0.03), and 2.8% higher on the right. No significant difference was found in the left upper trapezius between groups (p= 0.71). Although not significant, subjects showed 25% more wins in the TE chair(p=0.27) and 15% more kills in the TE chair (p=0.32). Chair preference showed 58% of subjects preferred the TE chair over 42% who preferred the Aeron chair. CONCLUSION: This study found minimal differences in muscle stiffness between the TE chair and the Aeron chair. However, the data suggests that the TE chair is the preferred choice among this group of gamers and is associated with enhanced performance

Examining the Influence of Behavioral Factors on Compliance and Persistence with Glatiramer Acetate Injection for Relapsing-Remitting Multiple Sclerosis

Objective: To evaluate the relationship between compliance and persistence with glatiramer acetate (GA) and the behavioral variables in the transtheoretical model of change. Methods: Patients diagnosed with relapsing-remitting multiple sclerosis and being treated with GA for the first time, whether treatment-naïve (TN) or treatment-experienced (TE), were eligible for this prospective, observational, 12-week study. Institutional Review Board approval was obtained for each of 32 US study sites, and written informed consent was obtained for all patients prior to study procedures. Four office visits were required. Study procedures included baseline self-injection training and patient-reported behavioral variable surveys. Injection competence and medication compliance and persistence were assessed at weeks 4 and 12. Results: A total of 257 patients were enrolled; 80.9% were female, 81.6% white, and 60.0% TN. The evaluable population included 146 TN patients and 88 TE patients having discontinued beta-interferons. TE patients were at a significantly higher readiness stage, were less concerned about the negative aspects of self-injection, but had lower levels of MS self-efficacy than TN patients. While compliance and persistence rates did not differ between TN and TE groups, there were differences in outcome predictors. For the TN patients both higher self-injection competence at baseline and improvement in self-injection competence over the first month of therapy were predictive of better compliance and persistence with GA. Separate from injection competence, higher levels of functional self-efficacy were directly associated with better persistence in TN patients. None of the behavioral variables appeared to predict compliance or persistence for the TE patients. Conclusion: Among the TN, injection competency at baseline and improvement over the first month of use were significant predictors of compliance and persistence to GA at 12 weeks.Improving self-injection competence should be a priority when planning interventions for TN patients. Behavioral factors predicting compliance and persistence among TE patients require further study. ClinicalTrials.gov (number NCT00238654

Therapy optimization in multiple sclerosis: a prospective observational study of therapy compliance and outcomes.

BACKGROUND: Data sources for MS research are numerous but rarely provide an objective measure of drug therapy compliance coupled with patient-reported health outcomes. The objective of this paper is to describe the methods and baseline characteristics of the Therapy Optimization in MS (TOP MS) study designed to investigate the relationship between disease-modifying therapy compliance and health outcomes. METHODS: TOP MS was designed as a prospective, observational, nationwide patient-focused study using an internet portal for data entry. The protocol was reviewed and approved by Sterling IRB. The study was registered with ClinicalTrials.gov. It captured structured survey data monthly from MS patients recruited by specialty pharmacies. Data collection included the clinical characteristics of MS such as MS relapses. Disability, quality of life and work productivity and activity impairment were assessed quarterly with well-validated scales. When events like severe fatigue or new or worsening depression were reported, feedback was provided to treating physicians. The therapy compliance measure was derived from pharmacy drug shipment records uploaded to the study database. The data presented in this paper use descriptive statistics. RESULTS: The TOP MS Study enrolled 2966 participants receiving their disease-modifying therapy (DMT) from specialty pharmacies. The mean age of the sample was 49 years, 80.4% were female, 89.9% were Caucasian and 55.7% were employed full or part time. Mean time since first symptoms was 11.5 years; mean duration since diagnosis was 9.5 years. Patient-reported EDSS was 3.5; 72.2% had a relapsing-remitting disease course. The most commonly reported symptoms at the time of enrollment were fatigue (74.7%), impaired coordination or balance (61.8%) and numbness and tingling (61.2%). Half of the sample was using glatiramer acetate and half was using beta-interferons. CONCLUSION: Demographic and clinical characteristics of the TOP MS sample at enrollment are consistent with other community-based MS samples, and the sample appears to be representative of DMT users in the US. TOP MS data can be used to explore the associations between disease-modifying therapy compliance and health outcomes. TRIAL REGISTRATION: ClinicalTrials.gov (NCT00819000)

Saliva microRNA Biomarkers of Cumulative Concussion

Recurrent concussions increase risk for persistent post-concussion symptoms, and may lead to chronic neurocognitive deficits. Little is known about the molecular pathways that contribute to persistent concussion symptoms. We hypothesized that salivary measurement of microribonucleic acids (miRNAs), a class of epitranscriptional molecules implicated in concussion pathophysiology, would provide insights about the molecular cascade resulting from recurrent concussions. This hypothesis was tested in a case-control study involving 13 former professional football athletes with a history of recurrent concussion, and 18 age/sex-matched peers. Molecules of interest were further validated in a cross-sectional study of 310 younger individuals with a history of no concussion (n = 230), a single concussion (n = 56), or recurrent concussions (n = 24). There was no difference in neurocognitive performance between the former professional athletes and their peers, or among younger individuals with varying concussion exposures. However, younger individuals without prior concussion outperformed peers with prior concussion on three balance assessments. Twenty salivary miRNAs differed (adj. p \u3c 0.05) between former professional athletes and their peers. Two of these (miR-28-3p and miR-339-3p) demonstrated relationships (p \u3c 0.05) with the number of prior concussions reported by younger individuals. miR-28-3p and miR-339-5p may play a role in the pathophysiologic mechanism involved in cumulative concussion effects

Diagnosing Mild Traumatic Brain Injury Using Saliva RNA Compared to Cognitive and Balance Testing

BACKGROUND: Early, accurate diagnosis of mild traumatic brain injury (mTBI) can improve clinical outcomes for patients, but mTBI remains difficult to diagnose because of reliance on subjective symptom reports. An objective biomarker could increase diagnostic accuracy and improve clinical outcomes. The aim of this study was to assess the ability of salivary noncoding RNA (ncRNA) to serve as a diagnostic adjunct to current clinical tools. We hypothesized that saliva ncRNA levels would demonstrate comparable accuracy for identifying mTBI as measures of symptom burden, neurocognition, and balance. METHODS: This case‐control study involved 538 individuals. Participants included 251 individuals with mTBI, enrolled ≤14 days postinjury, from 11 clinical sites. Saliva samples (n = 679) were collected at five time points (≤3, 4‐7, 8‐14, 15‐30, and 31‐60 days post‐mTBI). Levels of ncRNAs (microRNAs, small nucleolar RNAs, and piwi‐interacting RNAs) were quantified within each sample using RNA sequencing. The first sample from each mTBI participant was compared to saliva samples from 287 controls. Samples were divided into testing (n = 430; mTBI = 201 and control = 239) and training sets (n = 108; mTBI = 50 and control = 58). The test set was used to identify ncRNA diagnostic candidates and create a diagnostic model. Model accuracy was assessed in the naïve test set. RESULTS: A model utilizing seven ncRNA ratios, along with participant age and chronic headache status, differentiated mTBI and control participants with a cross‐validated area under the curve (AUC) of .857 in the training set (95% CI, .816‐.903) and .823 in the naïve test set. In a subset of participants (n = 321; mTBI = 176 and control = 145) assessed for symptom burden (Post‐Concussion Symptom Scale), as well as neurocognition and balance (ClearEdge System), these clinical measures yielded cross‐validated AUC of .835 (95% CI, .782‐.880) and .853 (95% CI, .803‐.899), respectively. A model employing symptom burden and four neurocognitive measures identified mTBI participants with similar AUC (.888; CI, .845‐.925) as symptom burden and four ncRNAs (.932; 95% CI, .890‐.965). CONCLUSION: Salivary ncRNA levels represent a noninvasive, biologic measure that can aid objective, accurate diagnosis of mTBI

Management of breakthrough disease in patients with multiple sclerosis: when an increasing of Interferon beta dose should be effective?

<p>Abstract</p> <p>Background</p> <p>In daily clinical setting, some patients affected by relapsing-remitting Multiple Sclerosis (RRMS) are switched from the low-dose to the high-dose Interferon beta (IFNB) in order to achieve a better control of the disease.</p> <p>Purpose</p> <p>In this observational, post-marketing study we reported the 2-year clinical outcomes of patients switched to the high-dose IFNB; we also evaluated whether different criteria adopted to switch patients had an influence on the clinical outcomes.</p> <p>Methods</p> <p>Patients affected by RRMS and switched from the low-dose to the high-dose IFNB due to the occurrence of relapses, or contrast-enhancing lesions (CELs) as detected by yearly scheduled MRI scans, were followed for two years. Expanded Disability Status Scale (EDSS) scores, as well as clinical relapses, were evaluated during the follow-up period.</p> <p>Results</p> <p>We identified 121 patients switched to the high-dose IFNB. One hundred patients increased the IFNB dose because of the occurrence of one or more relapses, and 21 because of the presence of one or more CELs, even in absence of clinical relapses. At the end of the 2-year follow-up, 72 (59.5%) patients had a relapse, and 51 (42.1%) reached a sustained progression on EDSS score. Overall, 85 (70.3%) patients showed some clinical disease activity (i.e. relapses or disability progression) after the switch.</p> <p>Relapse risk after increasing the IFNB dose was greater in patients who switched because of relapses than those switched only for MRI activity (HR: 5.55, p = 0.001). A high EDSS score (HR: 1.77, p < 0.001) and the combination of clinical and MRI activity at switch raised the risk of sustained disability progression after increasing the IFNB dose (HR: 2.14, p = 0.01).</p> <p>Conclusion</p> <p>In the majority of MS patients, switching from the low-dose to the high-dose IFNB did not reduce the risk of further relapses or increased disability in the 2-year follow period.</p> <p>Although we observed that patients who switched only on the basis on MRI activity (even in absence of clinical attacks) had a lower risk of further relapses, larger studies are warranted before to recommend a switch algorithm based on MRI findings.</p