Background: Few studies have examined psychiatric symptoms during the acute phase following a concussion in adolescents. Thus, this study compares anxiety and depression in acutely concussed and nonconcussed adolescents. Hypothesis: Acutely concussed adolescents will report greater anxiety and depressive symptoms compared with nonconcussed adolescents. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: Data were collected from 282 adolescents (111 concussed within 28 days of injury, 171 nonconcussed), 13 to 18 years of age, who completed Patient-Reported Outcome Measurement Information System (PROMIS) Anxiety and Depressive Symptoms measures. We calculated average T-scores for anxiety and depression across both groups and compared the proportion of those who scored above normal limits. Finally, we calculated risk ratios for anxiety and depression scores above normal limits. Results: Average T-scores for anxiety did not differ in concussed versus nonconcussed adolescents (mean: 45.9 [SD 10.84] vs 45.2 [8.1], respectively, P = 0.54), whereas average T-scores for depression were significantly higher in concussed versus nonconcussed adolescents (46.0 [10.88] vs 42.8 [8.48], respectively, P < 0.01). The proportion of concussed adolescents above normal limits for depression was greater than nonconcussed adolescents (32.4% vs 20.5%, respectively, P = 0.02). Post hoc sensitivity analyses excluding those with a history of anxiety or depression demonstrated a 1.45 (95% CI, 0.97, 2.01) and 1.56 (95% CI, 0.95, 2.56) increased risk of an above-normal anxiety and depression score for concussed compared with nonconcussed adolescents, respectively, although both were nonsignificant. Conclusion: Although we found few significant differences between the 2 groups, the results highlight that many concussed adolescents met the threshold for above-average symptoms on the depression and anxiety PROMIS measures. Clinical Relevance: In adolescents, there is increased risk for psychiatric sequalae in the acute period after a concussion. As such, we suggest that clinicians consider incorporating depression screening when caring for adolescents after a concussion.

Neurological disorders and traumatic brain injury (TBI) are among the leading causes of death and disability. The pupillary light reflex (PLR) is an emerging diagnostic tool for concussion in humans. We compared PLR obtained with a commercially available pupillometer in the 4 week old piglet model of the adolescent brain subject to rapid nonimpact head rotation (RNR), and in human adolescents with and without sports-related concussion (SRC). The 95% PLR reference ranges (RR, for maximum and minimum pupil diameter, latency, and average and peak constriction velocities) were established in healthy piglets (N = 13), and response reliability was validated in nine additional healthy piglets. PLR assessments were obtained in female piglets allocated to anesthetized sham (N = 10), single (sRNR, N = 13), and repeated (rRNR, N = 14) sagittal low-velocity RNR at pre-injury, as well as days 1, 4, and 7 post injury, and evaluated against RRs. In parallel, we established human PLR RRs in healthy adolescents (both sexes, N = 167) and compared healthy PLR to values obtained <28 days from a SRC (N = 177). In piglets, maximum and minimum diameter deficits were greater in rRNR than sRNR. Alterations peaked on day 1 post sRNR and rRNR, and remained altered at day 4 and 7. In SRC adolescents, the proportion of adolescents within the RR was significantly lower for maximum pupil diameter only (85.8%). We show that PLR deficits may persist in humans and piglets after low-velocity head rotations. Differences in timing of assessment after injury, developmental response to injury, and the number and magnitude of impacts may contribute to the differences observed between species. We conclude that PLR is a feasible, quantifiable involuntary physiological metric of neurological dysfunction in pigs, as well as humans. Healthy PLR porcine and human reference ranges established can be used for neurofunctional assessments after TBI or hypoxic exposures (e.g., stroke, apnea, or cardiac arrest).

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Objective(s): To examine the sociodemographic, behavioral, and clinical characteristics associated with 100% ART adherence and sustained viral suppression (SVS) among men who have sex with men (MSM) living with HIV and receiving HIV-related medical care in Texas. Design: A cross-sectional, three-stage design was used to sample jurisdictions, facilities, and HIV patients receiving medical care, using probability-proportional-to-size methods. Methods: Medical record abstraction and interview data (n = 1,426) from the 2009-2014 Medical Monitoring Project (MMP) cycles were used for this analysis. The associations between the sociodemographic, behavioral, and clinical characteristics with both 100% ART adherence and SVS were assessed using Rao-Scott chi-square tests. Multivariable logistic regression models were derived to estimate adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals (CI) for 100% ART adherence and SVS. Results: Of the MSM participants, 84% reported 100% ART adherence and 65% had SVS. Younger (age <55 years) and Black MSM who reported housing/food/income unmet needs were less likely to be 100% ART adherence or attain SVS (p<0.05 for all). Conversely, those who were 100% ART adherent were more likely to have SVS (p<0.05). Compared to MSM ≥55 years, those 18-34, 35-44, and 45-54 years were 34%, 23%, and 15% less likely to achieve SVS, respectively. Additionally, compared to White MSM, Black MSM were 13% less likely to achieve SVS and with adjustment of ART adherence, this association remained statistically significant (p<0.05). MSM who were 100% adherent to ART were 24% more likely to achieve SVS compared to those who were not completely adherent. Conclusions: Our study identified age, race/ethnicity, homelessness, and unmet needs for housing/food/income as major predictors of 100% ART adherence and SVS among MSM living with HIV and receiving medical care in Texas. Since MSM comprise the majority of people living with HIV in Texas, addressing these differences in SVS and ART adherence based on their sociodemographic, behavioral, and HIV-related characteristics is critical to meeting goals set to end the HIV epidemic in Texas.