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La Monica MB, Raub B, Malone K, Hartshorn S, Grdic J, Gustat A, Sandrock J. Methylliberine Ingestion Improves Various Indices of Affect but Not Cognitive Function in Healthy Men and Women. Nutrients 2023; 15:4509. [PMID: 37960163 PMCID: PMC10650428 DOI: 10.3390/nu15214509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
This study assessed the acute effects of oral methylliberine (DynamineTM) supplementation on cognitive function and indices of well-being. This was a double-blind, randomized, within-subject crossover trial. In total, 25 healthy men and women (33.5 ± 10.7 yr, 172.7 ± 8.6 cm, 73.3 ± 11.0 kg) underwent pretesting before ingesting methylliberine (100 mg) or a placebo (PLA) for 3 days. On the fourth day, the participants were tested before their fourth dose (baseline) and every hour post-ingestion for 3 h. After a one-week washout period, the participants repeated testing with the alternate investigational product. The testing battery consisted of vitals, Stroop test, Trail Making Test-B, and visual analog scales that assessed various indices of well-being. Mixed factorial ANOVAs with repeated measures were used to assess all variables. There were significant (p ≤ 0.050) interactions in terms of concentration, motivation, and mood. Methylliberine improved concentration at 1 and 3 h, motivation at 3 h, and mood at 1, 2, and 3 h (p ≤ 0.050). Methylliberine improved energy, sustained energy, and mood in all participants to a greater extent than PLA at 1 h and 3 h relative to baseline (p ≤ 0.050). PLA improved motivation at 1 and 2 h and mood at 2 h (p ≤ 0.050). Methylliberine improved concentration, well-being, and the ability to tolerate stress to a greater extent than PLA at 3 h relative to baseline (p ≤ 0.050). Women observed elevations in sustained energy at 1 and 3 h (p ≤ 0.050) with methylliberine vs. PLA. Methylliberine had a negligible influence on cognitive function and vitals (p > 0.050), and no adverse events were reported. Methylliberine significantly improved subjective feelings of energy, concentration, motivation, and mood, but not cognitive function. PLA improved motivation and mood at hours 1 and 2, while methylliberine sustained these benefits for longer. Methylliberine also improved concentration, well-being, and the ability to tolerate stress to a greater degree than PLA, while having no detrimental effects on vital signs. Methylliberine also seemed to have a positive impact on sustained energy in women.
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Evans C, Antonio J, Khan A, Vanderkley A, Berrocales M, Rojas J, Sakaria S, Petruzzelli J, Santana JC, Curtis J, Ricci T, Tartar JL. A Combination of Caffeine, TeaCrine, and Dynamine Improves the Neurophysiological and Performance Measures of Electronic (E)-Gamers. Cureus 2023; 15:e44254. [PMID: 37772230 PMCID: PMC10525932 DOI: 10.7759/cureus.44254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Video games require precise motor skills, quick reaction times, and cognitive engagement. The tremendous growth of the electronic (e)-gaming industry has increased the demands for cognitive supplements (e.g., nootropics) to help e-athletes gain a competitive edge. The primary aim of this study was to evaluate the effects of combined caffeine + TeaCrine + Dynamine measures of neurophysiological and first-person shooter game performance in e-gamers. METHODS Using a randomized double-blinded, crossover design, we assessed the effects of an acute, single-dose treatment of caffeine (200 mg) vs. caffeine (200 mg) + TeaCrine (10 mg) + Dynamine (50 mg) (CTD) vs. Ppacebo (maltodextrin). Each participant was tested under all three conditions one week apart. Baseline and post-dose measures were tested one hour apart. Participants [n = 49 male (24.4 ±, 4.5 yr)] were amateur e-gamers who play a first-person video game for at least 10 hours/week. Gaming performance was assessed through a series of first-person shooter training games through AIMLAB (State Space Labs, Inc., New York, USA). These included Reflex Shot (RS) standard, speed, and precision. The neurophysiological activity was captured while participants played three games through a single-channel EEG. RESULTS In the standard game, the caffeine and the CTD conditions shot significantly more targets relative to the placebo, and both caffeine and the CTD condition had significantly greater targets post-dose compared to pre-dose. However, both the placebo and caffeine conditions had significantly slower reaction times post-dose compared to pre-dose. In the speed game, both the caffeine and placebo conditions shot a significantly greater number of targets, while the placebo and caffeine conditions had significantly more shots post-dose compared to pre-dose. Only the CTD condition had a significant increase in total kills post-dose compared to pre-dose. In the precision game, only the CTD condition significantly improved the number of kills per second post-dose, while only the caffeine condition had more shots post-dose. EEG data collected concomitantly with game playing showed that the CTD condition resulted in significantly lower alpha power compared to the placebo condition. The CTD group also showed increased theta activity post-dose during game playing compared to both the placebo caffeine conditions. CONCLUSION CTD appears to improve overall shooting gaming performance and neurophysiological measures of cognitive activity compared to caffeine and placebo. Collectively, these findings suggest that CTD assists with speed-accuracy tradeoffs where caffeine-only can lead to erratic play; thus, CTD may be particularly beneficial for shooting precision. The EEG data support this notion since the CTD exhibited lower alpha power suggesting increased cognitive flexibility and arousal and higher theta power suggesting greater cognitive control and decision-making under pressure.
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Affiliation(s)
- Cassandra Evans
- Health Care Sciences, Nova Southeastern University, Fort Lauderdale, USA
- Human and Sport Performance, Rocky Mountain University of Health Professions, Provo, USA
| | - Jose Antonio
- Health Care Sciences, Nova Southeastern University, Fort Lauderdale, USA
| | - Amani Khan
- Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, USA
| | | | - Maria Berrocales
- Health Care Sciences, Nova Southeastern University, Fort Lauderdale, USA
| | - Jose Rojas
- Human and Sport Performance, Rocky Mountain University of Health Professions, Provo, USA
| | - Samir Sakaria
- Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, USA
| | | | | | - Jason Curtis
- Exercise Science, Keiser University, West Palm Beach, USA
| | - Tony Ricci
- Exercise and Sport Science, Nova Southeastern University, Fort Lauderdale, USA
| | - Jaime L Tartar
- Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, USA
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Cintineo HP, Bello ML, Chandler AJ, Cardaci TD, McFadden BA, Arent SM. Effects of caffeine, methylliberine, and theacrine on vigilance, marksmanship, and hemodynamic responses in tactical personnel: a double-blind, randomized, placebo-controlled trial. J Int Soc Sports Nutr 2022; 19:543-564. [PMID: 36016763 PMCID: PMC9397462 DOI: 10.1080/15502783.2022.2113339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Tactical athletes require fast reaction times (RT) along with high levels of vigilance and marksmanship performance. Caffeine has been shown to improve these measures but also results in increased blood pressure and jitteriness. Research on other purine alkaloids, such as methylliberine and theacrine, has suggested they do not increase blood pressure or jitteriness to the same extent, but their impact on tactical performance is unknown. Methods A between-subjects, randomized, placebo-controlled design was used to test the effects of placebo (PLA), 300 mg caffeine (CAF), and a combination of 150 mg caffeine, 100 mg methylliberine, and 50 mg theacrine (CMT) on RT and marksmanship along with hemodynamic and arousal measures following a sustained vigilance task in tactical personnel (n = 48). Following consumption of the supplement, participants underwent a 150-min protocol consisting of two rounds. Each round began with leisurely reading followed by a 30-min vigilance task before beginning two trials of movement and marksmanship tasks. Hemodynamics and felt arousal were assessed throughout the protocol. Composite Z-scores were calculated for overall performance measures at each timepoint, and mixed-effects models were used to assess differences in RT, accuracy, and composite Z-scores along with hemodynamics and felt arousal. An α-level of 0.05 was used to determine statistical significance, and Cohen’s d was used to quantify effect sizes. Results A Group-by-Time interaction for vigilance RT (P = 0.038) indicated improvements for both CAF and CMT from round 1 to round 2 (P < 0.01) while PLA did not change (P = 0.27). No Group main effects or Group-by-Time interactions were found for movement or marksmanship performance (P > 0.20). Group main effects for systolic (SBP; P = 0.001) and diastolic blood pressure (DBP; P = 0.028) indicated higher SBP in CAF (P = 0.003, d= 0.84) and CMT (P = 0.007, d= 0.79) compared to PLA but only higher DBP in CAF (P = 0.025, d= 0.74). No Group-by-Time interaction or Group main effect was found for felt arousal (P > 0.16). Conclusions These findings suggest similar benefits on RT during a vigilance task between CAF, containing 300 mg caffeine, and CMT above PLA, though CAF resulted in slightly less favorable hemodynamic changes. This study is the first to provide data showing similar efficacy of combined caffeine, methylliberine, and theacrine compared to double the caffeine dose consumed alone on vigilance RT but without a significant rise in DBP above PLA in tactical personnel.
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Affiliation(s)
- Harry P. Cintineo
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Marissa L. Bello
- Department of Kinesiology, Mississippi State University, Mississippi State, MS, USA
| | - Alexa J. Chandler
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Thomas D. Cardaci
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Bridget A. McFadden
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Shawn M. Arent
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
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Yin W, Zhang SQ, Pang WL, Chen XJ, Wen J, Hou J, Wang C, Song LY, Qiu ZM, Liang PT, Yuan JL, Yang ZS, Bian Y. Tang-Ping-San Decoction Remodel Intestinal Flora and Barrier to Ameliorate Type 2 Diabetes Mellitus in Rodent Model. Diabetes Metab Syndr Obes 2022; 15:2563-2581. [PMID: 36035516 PMCID: PMC9400815 DOI: 10.2147/dmso.s375572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/16/2022] [Indexed: 04/20/2023] Open
Abstract
PURPOSE Type 2 diabetes mellitus (T2DM) is a complex genetic disease associated with genetic and environmental factors. Previous studies have shown that changes in the gut microbiota may affect the development of host metabolic diseases and promote the progression of T2DM. Tang-ping-san (TPS) decoction can effectively treat T2DM. However, its specific mechanisms must be evaluated. PATIENTS AND METHODS In the present study, we established an animal model of T2DM using a high‑fat diet (HFD) with intraperitoneal injection streptozotocin injection. RESULTS The therapeutic effect of TPS decoction on T2DM in mice was initially evaluated. TPS decoction was found to improve hyperglycemia, hyperlipidemia, insulin resistance, and pathological liver, pancreatic, and colon changes. Moreover, it reduced the pro-inflammatory cytokine levels. Based on 16SrRNA sequencing, TPS decoction reduced the Firmicutes/Bacteroidetes ratio at the phylum level. At the genus level, it increased the relative abundances of Akkermansia, Muribaculaceae, and the Eubacterium coprostanoligenes group and decreased the relative abundance of Fusobacterium, Escherichia coli, Dubosiella, and Helicobacter. CONCLUSION TPS decoction improves T2DM and liver function and reduces the risk of hyperglycemia, hyperlipidemia, insulin resistance, pathological organ changes, and inflammatory reactions. The mechanism of TPS decoction in T2DM can be correlated with the reversal of gut microbiota dysfunction and repair of the intestinal mucosal barrier.
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Affiliation(s)
- Wen Yin
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Si-Qi Zhang
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Wen-Lin Pang
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Xiao-Jiao Chen
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Jing Wen
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Jiong Hou
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Cui Wang
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Li-Yun Song
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Zhen-Ming Qiu
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Peng-Tao Liang
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Jia-Li Yuan
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Zhong-Shan Yang
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
- Correspondence: Zhong-Shan Yang; Yao Bian, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China, Tel +86-871-65919932, Email ;
| | - Yao Bian
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
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Tartar JL, Banks JB, Marang M, Pizzo F, Antonio J. A Combination of Caffeine, TeaCrine® (Theacrine), and Dynamine® (Methylliberine) Increases Cognitive Performance and Reaction Time Without Interfering With Mood in Adult Male Egamers. Cureus 2021; 13:e20534. [PMID: 35103121 PMCID: PMC8768451 DOI: 10.7759/cureus.20534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Involvement in video game activities and competitive video gaming (esports) is a rapidly growing field. Moreover, there is a marked interest in identifying nutritional supplements to safely improve egamer performance. Methodology We conducted a repeated-measure, randomized crossover study to compare the effects of caffeine (125 mg), caffeine (125 mg) + Dynamine® (75 mg) + TeaCrine® (50 mg) (CDT), and matched placebo across three testing sessions (one week apart) among 50 young male egamers. We tested the effect of each product on multiple measures of cognition, self-reported mood (anxiety, alertness, and headache), and biomarkers of arousal (cortisol and salivary alpha-amylase). We also measured electroencephalogram power during the cognitive tasks. Finally, we tested whether individual differences in xenobiotic metabolism would affect the study outcome measures by genotyping each participant for cytochrome P450 1A2*1F (CYP1A2*1F) allele status. Results Compared to pre-dose, CDT improved performance on the Flanker Test of Inhibitory Control and improved reaction time on the Psychomotor Vigilance Task post-dose. Compared to the placebo, caffeine increased self-reported anxiety whereas the CDT combination increased self-reported alertness. Compared to the CDT combination, caffeine increased self-reported headaches. Physiological measures suggested that increases in delta EEG power and cortisol production are associated with the effects observed in the CDT condition to optimize certain aspects of egamer performance. CYP1A2*1F allele status did not moderate outcome variables between conditions in this study. Conclusions CDT is a safe and effective product for improving cognitive performance among egamers without increasing self-reported anxiety or headaches. EEG changes demonstrate that CDT increased attention to internal processing (i.e., increased cortical delta power) and potentially increased cognitive control (i.e., increased cortical theta frequency), while the increases in cortisol suggest increased energy mobilization. Future work should aim to clarify the physiological underpinnings of CDT-induced changes in performance and examine the effects of CDT under naturalistic egamer conditions.
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Auxtero MD, Chalante S, Abade MR, Jorge R, Fernandes AI. Potential Herb-Drug Interactions in the Management of Age-Related Cognitive Dysfunction. Pharmaceutics 2021; 13:124. [PMID: 33478035 PMCID: PMC7835864 DOI: 10.3390/pharmaceutics13010124] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/25/2022] Open
Abstract
Late-life mild cognitive impairment and dementia represent a significant burden on healthcare systems and a unique challenge to medicine due to the currently limited treatment options. Plant phytochemicals have been considered in alternative, or complementary, prevention and treatment strategies. Herbals are consumed as such, or as food supplements, whose consumption has recently increased. However, these products are not exempt from adverse effects and pharmacological interactions, presenting a special risk in aged, polymedicated individuals. Understanding pharmacokinetic and pharmacodynamic interactions is warranted to avoid undesirable adverse drug reactions, which may result in unwanted side-effects or therapeutic failure. The present study reviews the potential interactions between selected bioactive compounds (170) used by seniors for cognitive enhancement and representative drugs of 10 pharmacotherapeutic classes commonly prescribed to the middle-aged adults, often multimorbid and polymedicated, to anticipate and prevent risks arising from their co-administration. A literature review was conducted to identify mutual targets affected (inhibition/induction/substrate), the frequency of which was taken as a measure of potential interaction. Although a limited number of drugs were studied, from this work, interaction with other drugs affecting the same targets may be anticipated and prevented, constituting a valuable tool for healthcare professionals in clinical practice.
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Affiliation(s)
- Maria D. Auxtero
- CiiEM, Interdisciplinary Research Centre Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal; (M.D.A.); (S.C.); (M.R.A.); (R.J.)
| | - Susana Chalante
- CiiEM, Interdisciplinary Research Centre Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal; (M.D.A.); (S.C.); (M.R.A.); (R.J.)
| | - Mário R. Abade
- CiiEM, Interdisciplinary Research Centre Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal; (M.D.A.); (S.C.); (M.R.A.); (R.J.)
| | - Rui Jorge
- CiiEM, Interdisciplinary Research Centre Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal; (M.D.A.); (S.C.); (M.R.A.); (R.J.)
- Polytechnic Institute of Santarém, School of Agriculture, Quinta do Galinheiro, 2001-904 Santarém, Portugal
- CIEQV, Life Quality Research Centre, IPSantarém/IPLeiria, Avenida Dr. Mário Soares, 110, 2040-413 Rio Maior, Portugal
| | - Ana I. Fernandes
- CiiEM, Interdisciplinary Research Centre Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal; (M.D.A.); (S.C.); (M.R.A.); (R.J.)
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Sheng YY, Xiang J, Wang ZS, Jin J, Wang YQ, Li QS, Li D, Fang ZT, Lu JL, Ye JH, Liang YR, Zheng XQ. Theacrine From Camellia kucha and Its Health Beneficial Effects. Front Nutr 2020; 7:596823. [PMID: 33392238 PMCID: PMC7773691 DOI: 10.3389/fnut.2020.596823] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022] Open
Abstract
Theacrine, i.e., 1,3,7,9-tetramethyluric acid, is one of the major purine alkaloids found in leaf of a wild tea plant species Camellia kucha Hung T. Chang. Theacrine has been attracted great attentions academically owing to its diverse health benefits. Present review examines the advances in the research on the health beneficial effects of theacrine, including antioxidant effect, anti-inflammatory effect, locomotor activation and reducing fatigue effects, improving cognitive effect, hypnotic effect, ameliorating lipid metabolism and inhibiting breast cancer cell metastasis effect. The inconsistent results in this research field and further expectations were also discussed.
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Affiliation(s)
- Yue-Yue Sheng
- Tea Research Institute, Zhejiang University, Hangzhou, China
| | - Jing Xiang
- Tea Research Institute, Zhejiang University, Hangzhou, China
| | - Ze-Shi Wang
- Tea Research Institute, Zhejiang University, Hangzhou, China
| | - Jing Jin
- Zhejiang Agricultural Technology Extension Center, Hangzhou, China
| | - Ying-Qi Wang
- Tea Research Institute, Zhejiang University, Hangzhou, China
| | - Qing-Sheng Li
- Tea Research Institute, Zhejiang University, Hangzhou, China
| | - Da Li
- Tea Research Institute, Zhejiang University, Hangzhou, China
| | - Zhou-Tao Fang
- Tea Research Institute, Zhejiang University, Hangzhou, China
| | - Jian-Liang Lu
- Tea Research Institute, Zhejiang University, Hangzhou, China
| | - Jian-Hui Ye
- Tea Research Institute, Zhejiang University, Hangzhou, China
| | - Yue-Rong Liang
- Tea Research Institute, Zhejiang University, Hangzhou, China
| | - Xin-Qiang Zheng
- Tea Research Institute, Zhejiang University, Hangzhou, China
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Development of a liquid chromatography-tandem mass spectrometry (LC–MS/MS) method for characterizing caffeine, methylliberine, and theacrine pharmacokinetics in humans. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1155:122278. [DOI: 10.1016/j.jchromb.2020.122278] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 11/20/2022]
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