bluuebunny/crossref_metadata_2025 huggingface dataset:
A-08 Understanding the relationship between knowledge, beliefs, actions and confidence surrounding concussions among youth hockey coaches
Authors: Banovetz K , Rob J , Benert J , Custer A
Published: June 2023

Purpose

To investigate the effectiveness of mandatory concussion education among youth hockey coaches and to understand if increased knowledge correlates with confidence. Identification of facilitators and barriers to coaches’ beliefs and actions were also assessed.

Methods

Prospective, cross-sectional descriptive pilot study using an electronic survey via REDCap sent to youth coaches within the Minnesota Hockey organization. Quantitative questions were used to investigate knowledge and attitudes, while qualitative questions explored the facilitators and barriers to concussion management in youth hockey.

Results

98.8% of the 177 participants (M=150; F=22, NB=5), aged 18–65+ years completed the mandatory concussion training, with majority completing it in the last year (79%). 95% endorsed concussion education as beneficial with only 8 coaches reporting it was not helpful and 10 coaches requesting more educational materials. Over half of the participants (96; 54%) denied legislation impacting their attitude toward concussion. Confidence in concussion knowledge (3.07±1.09; 77%) and attitudes towards concussions (7.62±1.63; 85%) were positive. 39 (26%) coaches considered athlete and parent input most valuable for return to play. This may be related 72% of participants who reported no trained medical staff were present at games or practices. Concerningly, 20% of coaches may not encourage an athlete with loss of consciousness to seek emergent care.

Conclusions

Current mandatory concussion education produces increased knowledge, confidence, and appropriate action among majority of youth coaches. Coach reliance on athlete and parent report for clearance to play increases with no medical staff present for practices and games, which could have negative consequences.
A-09 Youth Athlete Concussion-Related Anxiety Perceptions
Authors: Beidler E , Bretzin A C , Schmitt A J
Published: June 2023

Purpose

To describe the prevalence of concussion-related anxiety in youth athletes, and determine what factors (e.g., sex, sport, concussion history, concussion education, parental concussion anxiety) were associated with greater anxiety.

Methods

Youth athletes participating in football, soccer, ice hockey, lacrosse (n=411; males=185, females=282; age=11.04±1.8 years) completed a cross-sectional survey. Participants completed demographic items and the Illness Perception Questionnaire, altered to be concussion-specific. We focused on the following four anxiety perception items scored on a Likert scale from 1 (strongly disagree) to 5 (strongly agree): “The thought of getting a concussion is upsetting to me.”, “I am afraid of getting a concussion.”, “The thought of me having a concussion makes me feel anxious.”, and “Concussions do not worry me [reverse].” The sum of items produced an overall anxiety composite score (20 possible points) with higher values indicating greater anxiety.

Results

Overall, 46.72% (n=192/411) of youth athletes were upset, 46.72% (n=196/411) afraid, or 29.0% (n=119/453) anxious at the thought of sustaining a concussion. Additionally, 49.9% (n=205/411) indicated concussions worry them. The sample mean anxiety perception composite score was 12.48±3.84. Participating in soccer (β: 1.49, 95% CI: 0.35, 2.62), being a girl (β: 1.40, 95% CI: 0.55, 2.26), and having a parent with higher concussion anxiety (β: 0.2, 95% CI: 0.82, 0.32) were associated with greater youth athlete concussion-related anxiety perceptions.

Conclusions

Concussion-related anxiety perceptions are fairly prevalent in youth athletes. More research is needed to determine how these beliefs may influence avoidance of risky sport behavior, intention to report a suspected concussion, and post-injury recovery outcomes.
A-11 Sex Differences in Performance Validity Testing in the Immediate Post-Concussion Assessment and Cognitive Test
Authors: Bouchard H C , Higgins K L
Published: June 2023

Purpose

Sex differences have frequently been investigated in concussion and poor effort is a known confound in baseline testing. However, research has yet to investigate if insufficient effort is different or has differential effects on baseline cognitive scores between male and female athletes.

Methods

Collegiate athletes (n=1,505; 43% female) completed ImPACT during their baseline concussion evaluation. Research has identified four embedded effort indicies in ImPACT which were used to estimate effort across a continuum. We evaluated the relationship between effort, sex, memory performance and speed performance using linear regression models.

Results

We found that athletes who failed one, two, or three+ effort indicators performed worse on all cognitive domains compared to athletes who failed zero effort indicators (p<0.05). More male athletes failed two or three+ effort indicators compared to female athletes (p<0.001). Female athletes performed faster overall on visual-motor speed tasks (p=0.001), but there was no interaction between sex and failed effort indicators. Female athletes also performed faster on reaction time and better verbal memory tasks compared to male athletes, but only when they failed three+ effort indicators (p<0.01).

Conclusions

These results suggest that as expected, athletes performed worse when they failed more effort indicators. Insufficient or poor effort appears to be different between male and female athletes, with male athletes demonstrating more indicators of poor effort than female athletes. Poor effort also appears to differentially effect cognitive scores with differences in reaction time and verbal memory only identified between groups when athletes failed three or more effort measures.
A-13 Concussion history is related to performance on executive functioning tasks in youth
Authors: Brower R
Published: June 2023

Purpose

Pediatric traumatic brain injuries (TBIs) are among the most common acquired disabilities in youth. They occur when the brain is rapidly developing and therefore many impact the child into adulthood and can impact executive functioning (EF) skills that are vital to everyday tasks, like maintaining attention, organizing, and inhibiting behaviors. It is important to understand the impact of childhood TBIs to learn how to best intervene.

Methods

11,224 children aged 9-10 years old (mean age=9.91, 49.4% male) at baseline completed an extensive battery of interviews and neuropsychological tasks through the Adolescent Brain Cognitive Development (ABCD) study. Based on parent reports on the Ohio State TBI screening measure, children were classified into No/Unlikely TBI, Possible Mild, Mild, Moderate, and Severe TBI. 153 children met criteria for possible mild TBI or higher. They also completed an array of neurocognitive measures, including Matrix Reasoning and several NIH Toolbox executive functioning tasks.

Results

There were small significant correlations between TBI status and a language task (Picture Vocab, r=.03, p=.002), attention task (Flanker, r=.02, p=.04), set shifting (Dimensional Change Card Sort, r=.02, p=.04), and with the crystallized cognition (r=.03, p=.005) and cognition composite (r=.03, p=.005) scores. Trend-level correlations were found for an oral reading task and fluid cognition composite score. However, when children with no TBI history were removed, no correlations held.

Conclusions

A history of even a mild TBI may be related to impaired functioning across several domains of executive functioning skills in youth.
A-14 Athletic Trainers' Perceptions of High School Athlete's Concussion Reporting Behaviors
Authors: Bunker N , Breitmeyer A , MacNeil B
Published: June 2023

Purpose

The purpose of this study was to evaluate athletic trainers’ (AT) perspectives of high school athletes overreporting concussion symptoms and evaluate their willingness to incorporate a neuropsychologist or licensed mental health professional on the sports medicine team.

Methods

This study was completed via electronic survey sent to 1,000 ATs employed in secondary schools across the United States. A total of 64 participants (17 male, 45 female, 2 non-binary) completed the survey. Participants were selected based on age greater than 21 years old employment in a secondary school. Frequencies and descriptive statistics were obtained for each variable, including AT experience level, AT confidence in diagnosis of SRC, school division, concern of overreporting, and willingness to add a mental health professional or neuropsychologist to the sports medicine team.

Results

Results of this study revealed 75% (n=64) of the participants endorsed concerns with athletes overreporting concussion symptoms, while 96.9% expressed interest in adding a neuropsychologist or mental health professional to the consultation team. Furthermore, 67.2% believe athletes view concussion as a way to discontinue playing their sport. Additionally, study results yielded a negative correlation between ATs’ school division and the rate of concern for overreporting concussion symptoms, r(62)=-.21, p=.047.

Conclusions

Overall, results indicated a growing concern regarding the validity of self-report symptoms associated with SRCs in high school athletes. Our findings highlight the need for valid and reliable screening measures and neuropsychological consultation. Future research is also needed to identify factors associated with concussion overreporting.
A-15 Predictive Utility of Risk Factors Associated with Vestibular and Oculomotor Outcomes Following Sport-Related Concussion
Authors: Burley C , Trbovich A , Patel S , French J , Collins M W , Kontos A P
Published: June 2023

Purpose

The purpose of the present study was to determine the ability of these risk factors to predict vestibular/oculomotor symptom provocation on the Vestibular/Oculomotor Screening (VOMS). It was hypothesized that both pre- and post-injury risk factors would predict symptom provocation on the VOMS.

Methods

This was a retrospective chart review of patients (n=78; 41 male) aged 15.2±1.7 years (range 12-18 years) seeking care at a concussion specialty clinic. Participants were seen 5.1±3.2 days (range 1-14 days) post-injury and completed a clinical interview, history questionnaire, symptom inventory, and VOMS as part of routine clinical care. Data analysis included chi-square tests with odds ratios to examine the association between identified risk factors and VOMS outcomes. An alpha value of .05 was used for all analyses.

Results

Personal history of motion sickness (χ2=7.6, p=.006, OR=11.4), personal history of oculomotor dysfunction (Fisher’s exact test, p=.01, OR=1.2), post-traumatic migraine (PTM) symptoms (χ2=11.7, p<.001, OR=5.4), and post-injury fogginess (χ2=10.1, p=.001, OR=4.8), were associated with presence of one or more post-injury VOMS individual item scores above clinical cutoff (i.e., symptom elevation >2). History of oculomotor dysfunction (Fisher’s exact test p=.013, OR=6.6) and PTM symptoms (χ2=5.0, p=.025, OR=3.3) were associated with obtaining a post-injury near-point convergence (NPC) distance >5 cm. Gender, loss of consciousness status, concussion history, history of migraine, and psychiatric history were not associated with VOMS symptom provocation or abnormal NPC.

Conclusions

Findings indicate that both pre-injury risk factors (i.e., personal history of motion sickness and history of oculomotor dysfunction) and post-injury risk factors (i.e., fogginess, PTM symptoms) were associated with clinically meaningful symptom provocation on the VOMS. In addition, history of oculomotor dysfunction and PTM symptoms were both associated with abnormal NPC distance. These results reinforce the importance of a comprehensive evaluation including a clinical history and vestibular and oculomotor screening following SRC. Consistent with prior research, loss of consciousness status and concussion history were not associated with increased risk for vestibular/oculomotor outcomes.
A-17 Predictors of Concussion Clinical Profiles and Prolonged Recovery
Authors: Choi D M , Kontos A P , Foster E , Goldberg K B
Published: June 2023

Purpose

This study examined relationships among concussion clinical profiles with patient demographic and clinical factors and the prognostic utility of the CP Screen tool at initial visit for prolonged recovery (>28 days).

Methods

297 participants with concussion were selected through convenience sampling for this retrospective cohort study (9-68 years old, 59.3% males, 71.7% sport-related concussion). At initial visit in UPMC clinics, participants of the original study completed the CP Screen along with the ImPACT, PCSS, VOMS, as part of standard care. Clinical profiles (anxiety/mood, cognitive/fatigue, posttraumatic migraine, vestibular, ocular) were endorsed via CP Screen criteria. Participants’ demographic (age, sex, mechanism of injury) and clinical (psychiatric, migraine, ADHD/LD, concussion histories) factors were examined.

Results

Females endorsed more clinical profiles (M=1.20, SD=1.54) than males (M=.60, SD=1.13) (p<.001). Psychiatric history predicted endorsement of anxiety/mood profile (OR=3.29, 95% CI [1.41, 7.69], p<.01), controlling for migraine, ADHD/LD, and concussion histories. Vestibular profile, controlling for other clinical profiles, predicted prolonged recovery (OR=3.93, 95% CI [1.52, 10.22], p<.01). Exploratory analysis for cognitive/fatigue profile as predictor of prolonged recovery revealed statistical significance (OR=2.16, 95% CI [1.01, 4.62], p<.05).

Conclusions

At initial visit, clinicians may anticipate females to present more symptomatic with clinical profiles than males and expect anxiety/mood profile endorsement by those with pre-existing psychiatric problems. Clinicians may also need to closely monitor patients initially endorsing vestibular or cognitive/fatigue profiles as they are more likely to experience an extensive recovery.
A-18 Indicators of Behavioral Symptom Management Strategy Adherence in Collegiate Athletes with Concussions
Authors: Clise E , Poskus J , LoGalbo A
Published: June 2023

Purpose

This study explores indicators of post-concussive behavioral symptom management strategy adherence in collegiate athletes.

Methods

Behavioral Symptom Management Strategy Recommendations were provided to 34 collegiate athletes (23 males, 11 females, ages: 18-22) at post-injury. At follow-up, athletes rated strategy adherence in overall frequency (never, rarely, sometimes, often, almost always). Athletes were administered the Sport Concussion Assessment Tool-5th Edition (SCAT-5) at post-injury and follow-up. Participant data was grouped by adherence frequency: Low (never-rarely, N=7), Moderate (sometimes, N=5), and High (often-almost always, N=22). Increases in SCAT-5 Total Symptom Score (TSS) and Symptom Severity Score (SSS) were calculated by subtracting baseline scores from post-injury scores. Score change outliers and instances in which baseline scores were higher than post-injury scores were removed.

Results

An overall significant mean difference in TSS and SSS changes from baseline to post-injury among adherence frequencies was found, F(2,31)=4.45, p=.02, F(2,31)=4.40, p=.021. Post-hoc tests (Tukey) demonstrated that increases in TSS from baseline to post-injury were significantly higher in athletes with High (M=8.73, SD=5.28, p=.03) and Moderate (M=10.40, SD=5.22, p=.039) adherence frequency compared to those with Low (M=3.00, SD=2.94). Similar effects were demonstrated for increases in SSS for High (M=21.77, SD=18.04, p=.043) and Moderate (M=29.80, SD=19.31, p=.029) compared to Low (M=3.71, SD=3.59). A significant correlation was found between adherence frequency and number of previous concussions, r=.39, p=.025.

Conclusions

Results suggest that greater increases in SCAT-5 TSS and SSS from baseline to post-injury and number of previous concussions are associated with a higher frequency of adherence to post-concussive behavioral symptom strategy recommendations in collegiate athletes.
A-22 Beyond Sports and Concussions: The Link between Shifting and Higher-Order Executive Functioning in Young Women
Authors: Doucette M M , Garcia-Barrera M A
Published: June 2023

Purpose

Our aim was to investigate the role of lifestyle factors, physical activity, sport, and concussion history, as well as Miyake and colleague’s (2000) three lower-order factors of executive function (shifting, updating, and inhibition) on higher-order decision making and self-reported executive functioning in young women.

Methods

180 Canadian female university students (ages 18–25) completed 9 computerized executive function tasks assessing shifting, updating, and inhibition, as well as decision making (Iowa Gambling Task). Participants also completed the Executive Function Index (subjective executive functioning) and reported their age, concussion history, weekly physical activity, and level of sports participation. Linear regression analysis was used to assess the effects of the predictor variables on the Executive Function Index scores and Iowa Gambling Task scores.

Results

Only shifting significantly predicted both subjective executive functioning scores (b=2.65, p<.05) and Iowa Gambling Task performance (b=269.02, p<.01). Weekly physical activity was significantly associated with subjective executive functioning (b=.10, p<.01), but not Iowa Gambling Task performance. Age, concussion history, sport participation, inhibition, and updating were not significant for either regression.

Conclusions

These findings suggest that shifting may be a critical component of both higher-order decision making and subjective executive functioning, while physical activity may be important for subjective executive functioning. The lack of predictive value for lifestyle factors such as concussion history and sports participation suggests that there are other factors influencing executive functioning performance in healthy young women. Future studies should explore other factors, such as hormonal variability, that may be impact subjective executive functioning and decision making in young women.
A-29 To report or not to report: A review of adolescent decision-making theories following sports-related concussion
Authors: Goodwin G J , Evangelista N D , Ozturk E D , Merrit V C
Published: June 2023

Purpose

Sports-related concussion (SRC) is a prevalent concern among adolescent athletes. If SRC is suspected, athletes are usually removed from play for assessment and symptom monitoring. Return-to-play decisions heavily rely on athlete self-report of SRC and associated symptoms. Social pressures and attitudes related to symptom reporting influence an athlete’s decision of whether to disclose symptoms; not reporting increases risk for subsequent injury and delayed recovery. Therefore, it is important to understand the adolescent decision-making process following SRC. In this review, prevailing theories that explain symptom reporting and decision-making following SRC will be evaluated from a clinical lens.

Data Selection

Literature was reviewed using Google Scholar, PubMed, and SCOPUS. Search terms included “concussion” AND “sport” AND “symptom reporting” OR “reporting” OR “self-report”. Other terms included “decision-making”, “disclosure”, “adolescent”, “high school”, and “college”. Articles from 2004-2023 were included.

Data Synthesis

Three prevailing theories have been proposed to explain symptom underreporting among adolescent athletes: the Theory of Reasoned Action and Planned Behavior, the Bandura Social Cognitive Theory, and the Disclosure Decision-Making Model. These theories will be critiqued and the lack of research on neurodevelopmental components of decision-making will be highlighted.

Conclusions

The decision-making process following SRC is complex, multi-factorial, and state-dependent. While these theories provide critical insights into symptom reporting following SRC, they do not consider important neurodevelopmental factors such as the imbalance between cognitive control and reward processing in adolescence. When educating parents and coaches about symptom reporting following SRC, it will be important for clinicians to consider socioemotional, cultural, environmental, and neurodevelopmental factors.
A-38 A Comparison Of Concussion History And Propensity For Risk-Taking In College-Aged Individuals
Authors: Loftin M C , Zynda A J , Pollard-McGrandy A M , Tracey A J , Covassin T
Published: June 2023

Purpose

The purpose of this study was to investigate differences in propensity for risk-taking between college-aged individuals with and without a history of concussion.

Methods

A cross-sectional study of individuals ages 18-30 years was conducted. Participants were administered a brief survey that included demographics, medical history, and the General Risk Propensity Scale (GRiPS). The GRiPS is an 8-item, self-report measure that assesses an individual’s general propensity to take risks (e.g., “I would take a risk even if it meant I might get hurt”). A score of 20 or higher indicates high propensity for risk taking while a score lower than 20 indicates low propensity for risk-taking. An independent samples t-test compared the mean scores of the GRiPS between individuals with and without a concussion history. Statistical significance was set at p<0.05.

Results

One hundred eighty-one participants (92 female; μ age=20.65 years; SD=2.56 years) were included in this study. Ninety-six (53.0%) participants had no concussion history, while 85 (47.0%) had a history of concussion. No significant differences in GRiPS mean scores was noted between groups (no concussion history: μ=23.97, SD=5.96; concussion history: μ=23.68, SD=6.72, p=.73).

Conclusions

These results suggest that an individual’s propensity for risk-taking is not influenced by concussion history, which conflicts with previous research. Future research may consider developing a survey to assess specific risk-taking behaviors that may be associated with a concussion (e.g., “I do not report symptoms of a concussion”) or if a propensity for risk-taking is higher in individuals currently with a concussion or a specific number of previous concussions.
A-40 Effort in ADHD/LD may be viewed on a continuum in baseline cognitive testing
Authors: Maietta J , Higgins K L , Bouchard H C , Liang J M , Schultz D H
Published: June 2023

Purpose

Baseline testing is commonplace for athletes at all levels. Poor effort complicates interpretation of baseline data. Previous research suggests that athletes with attention-deficit/hyperactivity disorder and/or learning disorder (ADHD/LD) perform worse on cognitive testing and are flagged invalid more often. It is unclear if this is due effort issues or cognitive difficulties from neurodevelopmental diagnoses. This study investigated the effect of self-reported ADHD/LD on performance validity testing (PVT).

Methods

231 NCAA athletes completed baseline ImPACT and one of two stand-alone PVTs (Medical Symptom Validity Test or Rey Dot Counting Test). Athletes (n=44; 19%) self-reported ADHD and/or LD. Effort was operationalized as a dichotomy (pass/fail 1+ indicator) and as a continuum (0, 1, 2, or 3+ failed indicators). Chi-square assessed the relationship between ADHD/LD and effort. Linear models assessed the relationship between ADHD/LD and clinical outcomes.

Results

Athletes with ADHD/LD reported more symptoms, less sleep, and performed worse on ImPACT’s Visual-Motor Speed composite (p<.05). When effort was dichotomized (pass/fail), athletes with ADHD/LD were more likely to “fail” PVTs (χ2=4.83; p<.05). When assessed on a continuum, athletes with ADHD/LD were more likely to fail 2+ indicators (45.5% versus 27.3%) but were not more likely to fail only 1 indicator than neurotypical athletes (18.2% versus 16.6%; χ2=6.55; p<.05).

Conclusions

Results suggest that ADHD/LD may increase the number of effort indicators failed; however, failure rates for one indicator may be similar to healthy controls. It is still unclear whether this performance is due to poor effort or diagnostic considerations. Future research is needed.
A-44 Piloting the Feasibility and Tolerability of a Post-Concussion Intervention
Authors: Morigney J , Squires R , Seagly K
Published: June 2023

Purpose

As yet, there is no gold standard treatment approach for persistent symptom experience following concussion, including sports-related concussion. As most methodologically sound studies indicate brain recovery following concussion is brief, it follows that other factors can maintain persistent symptom experience after the brain has healed. The literature indicates factors can include psychological status, avoidance of activity and emotion, poor sleep, and feeling isolated. As such, treatment should focus on these factors.

Methods

This pilot study examined the feasibility and tolerability of a virtual group intervention combining evidence-based concussion education with CBT- and ACT-based interventions to address the above factors. The goal of treatment was to redirect patients back to participation in values-based activities, with provision of coping strategies, thus decreasing focus on and experience of symptoms. Seventy-six patients who were at least three months post-injury and reporting continued post-concussion symptoms were clinically referred and sequentially enrolled in a virtual six-session concussion recovery group. The Concussion Symptom Checklist (CSC) was administered pre- and post-treatment to assess symptoms. Anonymous qualitative feedback about the group was also collected.

Results

Most patients remained enrolled in the group, missing no more than one session. Statistically significant decreases in both symptom severity and frequency were found from pre- to post-treatment. Qualitative patient feedback was predominantly positive.

Conclusions

The virtual concussion recovery group intervention was feasible, well-tolerated, and well-liked. Though no generalizations can be made from limited preliminary outcome data, there is indication that the severity and frequency of symptom experience, as measured by the CSC, decreased with this treatment.
A-45 Criteria for Determining Clinical Recovery from Concussion: A Survey of Sports Concussion Specialists
Authors: Moser R S , Choi D , Uhrig C , Broglio S , Mayer B , Boltz A , Master C , Schatz P
Published: June 2023

Purpose

To poll sports concussion specialists regarding most frequently used criteria for determination of concussion recovery.

Methods

Seventy-four participants responded to a survey including 17 items regarding clinical recovery from concussion in youth and adults. Overall, 69 reported treating patients with sports concussion, meeting criteria for inclusion (92.8% white, 53.6% male). Participants included neuropsychologists (n=35), certified athletic trainers (n=30), physicians (n=3), and one physical therapist who rated (1=Not Important; 5=Essential) clinical criteria for concussion recovery decisions.

Results

For youth, the majority of participants provided the highest “Essential” modal rating for all six criteria: Normal visual/ocular motor testing; non-contact physical exertion without symptoms; completion of graded return-to-play protocol; full day of school without symptoms; no concerns in physician exam; no fear/avoidance/anxiety in return to sport. For adults, highest model ratings included seven items: participation in non-contact exertion without symptoms; passed formal physical exertional testing; completion of graded return to play protocol; completion of full day of work/school without symptoms; physician exam with no concerns; no report of fear/avoidance/anxiety regarding return to sport; athlete reports feeling 100% back to normal. In adults, 79% indicated one week of no symptoms was sufficient to help indicate recovery and 75% indicated so for youth. For youth and adults, 56% of respondents endorsed use of neurocognitive testing as Essential/Very Important.

Conclusions

This study revealed similarity in concussion recovery decisions for adults and youth with minor differences. These results provide first steps toward documenting a template of current clinical practice for defining concussion recovery.
A-50 A Review of the Dangers of Misdiagnosing Concussions as Depression
Authors: Re S
Published: June 2023

Purpose

Underrepresentation of concussion diagnoses is of increasing concern for the health and wellbeing of young athletes. Similarly, there is increased attention on the mental health of student athletes. Less addressed, however, is potential for misdiagnosis between these concerns. This literature review explains the underpinnings of the potential misinterpretation of concussion symptoms under the guise of depression.

Methods

Peer reviewed studies published within the last 25 years were included in this review. Specific statistics referring to current high school and collegiate athletes included peer reviewed articles from 2020-2023.

Results

Depression and concussions are correlated, further, experiencing TBI and concussion puts an individual at increased risk for developing depression. Additionally, many symptoms of concussion overlap with diagnostic criteria for depression such as: fatigue, suicidal ideation, anhedonia, sleep difficulties, and low mood. The risk of misdiagnosis of depression in concussed athletes is apparent. However, no known study has demonstrated the rate of this misdiagnosis. Treatment for concussion recovery and depression management is fundamentally different, which calls for accurate differentiation between the occurrence of depressive symptoms and head trauma induced symptoms.

Conclusions

Future research regarding affordable and accessible methods to differentiate depression from concussion will help reduce the chances of misdiagnosis. Understanding the considerable overlap in symptomatology and importance of recognizing both concussion when it occurs as well as depression is essential for individuals working with student athletes. Improved education for high school and college coaches and athletes, along with clinicians and physicians is a key component in this change.
A-53 Co-Occurring Depression and Anxiety Increases Prospective Risk for Concussion
Authors: Riegler K E , Bradson M L , Sakamoto M S , Arnett P A
Published: June 2023

Purpose

There is limited research examining whether mental health concerns increase risk for future concussion, despite these difficulties being highly prevalent in college-age populations and student-athletes. This study investigates whether affective disturbance at baseline increases the risk for prospective concussion. We predict that athletes with co-occurring depression/ anxiety will incur the greatest risk for injury.

Methods

886 collegiate athletes completed baseline neuropsychological testing and were prospectively followed as part of a sports concussion management program. Athletes were separated into 4 groups (HCs, Depression Alone, Anxiety Alone, Co-Occurring Depression/Anxiety) based on self-reported anxiety and depression at baseline. Of the 886 athletes, 96 sustained future concussion. Logistic regression was conducted with prospective concussion (yes/no) as the outcome, and affective group as the predictor. Sex and sport were examined as covariates.

Results

After controlling for sport, athletes in the Co-Occurring Depression/Anxiety group were more than twice as likely to sustain prospective concussion compared to HCs, p=.03, OR=2.18, 95% CI [1.10,4.33]. Though not statistically significant, athletes in the Co-Occurring Depression/Anxiety showed a 59% and 56% increased risk for prospective concussion compared to the Depression Alone and Anxiety Alone groups, respectively. Athletes in the Depression Alone and Anxiety Alone groups both showed a 31% increased risk for prospective concussion compared to HCs.

Conclusions

Athletes with co-occurring depression/anxiety at baseline show a notably increased risk for sustaining future concussion, even after controlling for sport. These findings highlight the importance of screening for depression and anxiety at baseline to provide treatment for these athletes, improve well-being, and reduce concussion risk.
A-57 Resilience and School/Social/Home Life Disruption During Recovery in Concussed Adolescents
Authors: Shurtz L , Bunt S C , Chowdhury S K , Didehbani N , Stokes M , Miller S M , Bell K R , Cullum C M
Published: June 2023

Purpose

Resilience is an important factor in concussion recovery. Investigation of the relationship between resilience and level of perceived life disruption may prove beneficial in further understanding concussion recovery in adolescents.

Methods

Participants aged 12-18 who sustained a concussion (n=779) were evaluated within 30 days of injury at a North Texas Concussion Registry (ConTex) clinic. Participants completed the Brief Resilience Scale (BRS) at initial visit and were grouped as low, average, or high resilience. At 3-month follow-up, data were collected on perceived disruption in school/work, social life, and home responsibilities. ANCOVA with age as a covariate was used to determine differences between resilience groups.

Results

Significant differences in perceived disruption were found between participants with low versus high resilience: school/work [F(2, 775)=3.02, p=.049], social life [F(2, 775)=4.77, p=.009], and home responsibilities [F(2, 775)=5.18, p=.006] with the low resilience group endorsing higher levels of disruption and the high resilience group endorsing lower levels of disruption. There were no significant differences between the average resilience group and other groups in these areas, though these participants were descriptively intermediate. Age was found to be a covariate in disruption of school/work (p=.012) and social life (p=.019), but not in home responsibilities (p=.30).

Conclusions

Adolescents with lower resilience may perceive greater disruption in school/work, social life, and home responsibilities during concussion recovery, and age may modify aspects of this relationship. Adolescents with lower resilience may benefit from additional attention following concussion.
A-58 ImPACT remote administration? Can athletes take it at home?
Authors: Slicer K , Stafford C , Bennett R
Published: June 2023

Purpose

The current study aimed to evaluate environmental effects of neurocognitive baseline performance and overall symptom reports among student-athletes who took the ImPACT baseline assessment in a clinical setting or their home environment.

Methods

Participants were selected from an archival de-identified database. The sample consisted of 1,893 (37.3% male and 62.7% female) student-athletes with a mean age of 19.71 years. All student-athletes were administered ImPACT as a neurocognitive baseline screener prior to the beginning of their respective sport. Student-athletes were further divided into two groups: 1. At-home (n=405), and 2. In-clinic (n=405). Multiple independent samples t-tests were utilized to compare mean composite scores between the two groups.

Results

The independent samples t-test yielded a significant difference between groups on the ImPACT reaction time composite score, t(1891)=3.81, p<.001, and total symptom score, t(1891)=1.74, p=.024. Student-athletes who completed ImPACT at home demonstrated a significantly higher (slower) reaction time while also reporting significantly fewer symptoms.

Conclusions

When COVID-19 shut down our once-perceived “normal” societal function, university athletics were forced to change how they conducted concussion baseline screening for their student-athletes. The findings of the present study suggest the need for careful consideration regarding the environment of such neurocognitive baseline assessments as some factors including reaction time and total symptom report may be influenced by the test setting. Future studies should further explore possible confounding variables related to concussion assessment, such as test environment, that may be a unique precipitating factor of the COVID-19 pandemic.
A-68 The Relationship Between Brain Injury And Substance Use Patterns In University Students
Authors: Wilson A , Cherry J , Gicas K , Wojtowicz M
Published: June 2023

Purpose

Our prior research has suggested that athletes with history of traumatic brain injuries (TBIs) are at greater risk of single and polysubstance use. The present study further explored the factors associated with this relationship in a large undergraduate population.

Methods

894 university students (44% athletes) completed self-reported TBI history (blows to the head or whiplash causing loss of consciousness or memory, or feeling dazed), substance use (Alcohol and Cannabis Use Disorders Identification Tests (AUDIT; CUDIT)) and psychological measures. Relationships between these factors were examined using linear regression models.

Results

200 (22.4%) students reported a history of one or more TBIs (45.63% sport-related). TBI history predicted current cannabis and alcohol use, with those with a history of multiple TBIs reporting more problematic use of each substance (ps<.01) as well as greater polysubstance use (p<.001). Past history of depression predicted more problematic cannabis use (p=.007), while past history of anxiety and depression predicted more problematic alcohol use. When examining multiple factors associated with use, history of TBIs (p=.008) and higher current depression symptoms (p=.006) predicted more problematic cannabis use, whereas for alcohol users, history of TBI and female sex was related to more problematic use (p=.041).

Conclusions

History of TBI predicts higher levels of substance use and polysubstance use and increased number of TBIs and mental health problems may be related to greater risk of hazardous substance use. Consideration of TBI history is essential for identifying players at risk for engaging in problematic behaviours such as hazardous substance use.
A-70 Association of Resilience With Academic and Social Concerns in School Aged Children With Codncussion
Authors: Woods C , Hicks C , Bunt S , Tamez I , Stokes M , Hynan L , Cullum C M , Didehbani N , Miller S , Bell K
Published: June 2023

Purpose

Investigate the association between perceived resilience and academic and social concerns expressed by children and adolescents following concussion.

Methods

This prospective cohort study at North Texas Concussion Registry (CONTEX) clinics included 330 participants aged 5 to 17 diagnosed with concussion. At an initial clinical visit, patients completed the Brief Resilience Scale (BRS) to measure self-perceived pre-injury resilience. Patients were categorized into Low (BRS=1.00-2.99), Average (BRS=3.00 to 4.30), and High (BRS=4.31- 5.00) resilience groups. Participants completed the Concussion Learning Assessment and School Survey (CLASS) 3 months after enrollment. Specific academic/social concerns measured by the CLASS were categorized as either "no concern/stress" or "some level of concern/stress.” Chi-square analysis was used to investigate the association between initial pre-injury resilience and concern/stress.

Results

Higher resilience was associated with less concern about the injury affecting school learning and performance (χ2(2,329)= 11.65, p=.003), less stress regarding support at home from parents/siblings (χ2(2,330)= 8.60, p=.014), less stress from being overwhelmed by schoolwork piling up (χ2=9.46, p=.009) and grades dropping (χ2(2,330)= 13.29, p=.001). Lower resilience was associated with greater stress from missing time with friends and/or social activities (χ2(2,330)=8.37 p=.015) and not having enough support from teachers (χ2(2,330)=8.49, p=.014).

Conclusions

Resilience may be associated with academic and social concerns in children and adolescents with concussion. Children with a higher perceived resilience may have better outcomes in terms of their academic and social concerns following concussion. Further studies are necessary to confirm these findings and determine the potential clinical implications.
Production of recombinant His-tagged triple-FLAG peptide in Brevibacillus choshinensis and its utilization as an easy-to-remove affinity peptide
Authors: Sugihara Daiki , Ono Fuka , Sugino Motoki , Suzuki Hiromi , Endo Noriko , Shimada Atsuhiro , Ebihara Akio
Published: June 2023

Triple-FLAG (3 × FLAG)-tagged proteins can be affinity purified through binding to an anti-FLAG antibody and competitive elution with excess free 3 × FLAG peptide. To expand the availability of the 3 × FLAG purification system, we produced a recombinant His-tagged 3 × FLAG peptide in Brevibacillus choshinensis. The screening of connecting linkers between His-tag and the 3 × FLAG peptide, culture containers, and culture media showed that the His-tagged 3 × FLAG peptide with an LA linker was most expressed in 2SY medium using a baffled shake flask. The peptide was affinity-purified to give a yield of about 25 mg/L of culture. The peptide was effective for eluting 3 × FLAG-tagged α-amylase from anti-FLAG magnetic beads. Finally, the peptide remaining in the amylase fraction was removed by His-tag affinity purification. These results show that the recombinant His-tagged 3 × FLAG peptide can function as an easy-to-remove affinity peptide in the 3 × FLAG purification system.
MPCLCDA: predicting circRNA–disease associations by using automatically selected meta-path and contrastive learning
Authors: Liu Wei , Tang Ting , Lu Xu , Fu Xiangzheng , Yang Yu , Peng Li
Published: June 2023

Circular RNA (circRNA) is closely associated with human diseases. Accordingly, identifying the associations between human diseases and circRNA can help in disease prevention, diagnosis and treatment. Traditional methods are time consuming and laborious. Meanwhile, computational models can effectively predict potential circRNA–disease associations (CDAs), but are restricted by limited data, resulting in data with high dimension and imbalance. In this study, we propose a model based on automatically selected meta-path and contrastive learning, called the MPCLCDA model. First, the model constructs a new heterogeneous network based on circRNA similarity, disease similarity and known association, via automatically selected meta-path and obtains the low-dimensional fusion features of nodes via graph convolutional networks. Then, contrastive learning is used to optimize the fusion features further, and obtain the node features that make the distinction between positive and negative samples more evident. Finally, circRNA–disease scores are predicted through a multilayer perceptron. The proposed method is compared with advanced methods on four datasets. The average area under the receiver operating characteristic curve, area under the precision-recall curve and F1 score under 5-fold cross-validation reached 0.9752, 0.9831 and 0.9745, respectively. Simultaneously, case studies on human diseases further prove the predictive ability and application value of this method.
A feature extraction free approach for protein interactome inference from co-elution data
Authors: Chen Yu-Hsin , Chao Kuan-Hao , Wong Jin Yung , Liu Chien-Fu , Leu Jun-Yi , Tsai Huai-Kuang
Published: June 2023

Protein complexes are key functional units in cellular processes. High-throughput techniques, such as co-fractionation coupled with mass spectrometry (CF-MS), have advanced protein complex studies by enabling global interactome inference. However, dealing with complex fractionation characteristics to define true interactions is not a simple task, since CF-MS is prone to false positives due to the co-elution of non-interacting proteins by chance. Several computational methods have been designed to analyze CF-MS data and construct probabilistic protein–protein interaction (PPI) networks. Current methods usually first infer PPIs based on handcrafted CF-MS features, and then use clustering algorithms to form potential protein complexes. While powerful, these methods suffer from the potential bias of handcrafted features and severely imbalanced data distribution. However, the handcrafted features based on domain knowledge might introduce bias, and current methods also tend to overfit due to the severely imbalanced PPI data. To address these issues, we present a balanced end-to-end learning architecture, Software for Prediction of Interactome with Feature-extraction Free Elution Data (SPIFFED), to integrate feature representation from raw CF-MS data and interactome prediction by convolutional neural network. SPIFFED outperforms the state-of-the-art methods in predicting PPIs under the conventional imbalanced training. When trained with balanced data, SPIFFED had greatly improved sensitivity for true PPIs. Moreover, the ensemble SPIFFED model provides different voting schemes to integrate predicted PPIs from multiple CF-MS data. Using the clustering software (i.e. ClusterONE), SPIFFED allows users to infer high-confidence protein complexes depending on the CF-MS experimental designs. The source code of SPIFFED is freely available at: https://github.com/bio-it-station/SPIFFED.
DeepSTF: predicting transcription factor binding sites by interpretable deep neural networks combining sequence and shape
Authors: Ding Pengju , Wang Yifei , Zhang Xinyu , Gao Xin , Liu Guozhu , Yu Bin
Published: June 2023

Precise targeting of transcription factor binding sites (TFBSs) is essential to comprehending transcriptional regulatory processes and investigating cellular function. Although several deep learning algorithms have been created to predict TFBSs, the models’ intrinsic mechanisms and prediction results are difficult to explain. There is still room for improvement in prediction performance. We present DeepSTF, a unique deep-learning architecture for predicting TFBSs by integrating DNA sequence and shape profiles. We use the improved transformer encoder structure for the first time in the TFBSs prediction approach. DeepSTF extracts DNA higher-order sequence features using stacked convolutional neural networks (CNNs), whereas rich DNA shape profiles are extracted by combining improved transformer encoder structure and bidirectional long short-term memory (Bi-LSTM), and, finally, the derived higher-order sequence features and representative shape profiles are integrated into the channel dimension to achieve accurate TFBSs prediction. Experiments on 165 ENCODE chromatin immunoprecipitation sequencing (ChIP-seq) datasets show that DeepSTF considerably outperforms several state-of-the-art algorithms in predicting TFBSs, and we explain the usefulness of the transformer encoder structure and the combined strategy using sequence features and shape profiles in capturing multiple dependencies and learning essential features. In addition, this paper examines the significance of DNA shape features predicting TFBSs. The source code of DeepSTF is available at https://github.com/YuBinLab-QUST/DeepSTF/.
Erythema multiforme-like lesions in a patient with systemic lupus erythematosus progressing to toxic epidermal necrolysis-like lupus
Authors: Steele Lloyd , Pyne Dev , Jeetle Sharanpal , Cunningham Malvina , Goldsmith Portia , Dhoat Sasha , Kelly Stephen , Goiriz Rebeca
Published: June 2023

A 34-year-old woman of African ancestry had a diagnosis of systemic lupus erythematosus that was antinuclear antibodies (> 1 : 640, speckled), anti-U1-ribonucleoprotein, anti-Smith and anti-C1q positive. She presented to hospital with severely painful annular and polycyclic erosions, some with a targetoid-like appearance. After 6 weeks she developed slowly evolving dusky papules/plaques and flaccid bullae, suggestive of toxic epidermal necrolysis-like lupus, and was successfully treated with intravenous rituximab and intravenous immunoglobulin (2 g kg–1 over 3 days).