bluuebunny/crossref_metadata_2025 huggingface dataset:
The association between future time perspective and sexual behaviours in individuals attending HIV testing centres
Authors: Guillon Marlène , Fouéré Sébastien , Segouin Christophe , Simon Anne
Published: March 2019

Background

Most European countries are still facing a high burden of sexually transmitted infections (STIs) cases each year. Available literature has found associations between time preference, i.e. the relative weight given by individuals to future outcomes compared to present ones, and various health behaviours such as tobacco or alcohol consumption, vaccination or participation in cancer screening programmes. Our objective is to investigate the role of future preference in risky sexual behaviours.

Methods

We conducted a cross-sectional study using self-administered questionnaires in three HIV testing centres in Paris. We collected data on sexual behaviours, risk perceptions, risk attitude, future preference (Considerations of Future Consequences scale) and socioeconomic and demographic variables. Full data for variables used in regression analyses were available for 1090 respondents. We study factors associated with condom use at the first sexual encounter, with the frequency of condom use and with the number of sexual partners.

Results

In the full sample, future preference is positively correlated with both measures of condom use while it is negatively correlated with the number of sexual partners. Decomposing the analysis by risk group, our results indicate that future preference has more impact on sexual behaviours, especially condom use, among men who have sex with men compared to heterosexual men and, to a lesser extent, compared to heterosexual women.

Conclusion

If future time perspective is confirmed as a determinant of safer sexual behaviours, prevention campaigns could be shifted towards greater information on short-term consequences of STIs.
A Multi-study Coordinated Meta-analysis of Pulmonary Function and Cognition in Aging
Authors: Duggan Emily C , Piccinin Andrea M , Clouston Sean , Koval Andriy V , Robitaille Annie , Zammit Andrea R , Wu Chenkai , Brown Cassandra L , Lee Lewina O , Finkel Deborah , Beasley William H , Kaye Jeffrey , Terrera Graciela Muniz , Katz Mindy , Lipton Richard B , Deeg Dorly , Bennett David A , Praetorius Björk Marcus , Johansson Boo , Spiro Avron , Weuve Jennifer , Hofer Scott M
Published: March 2019

Background

Substantial research is dedicated to understanding the aging-related dynamics among individual differences in level, change, and variation across physical and cognitive abilities. Evaluating replicability and synthesizing these findings has been limited by differences in measurements and samples, and by study design and statistical analyses confounding between-person differences with within-person changes. In this article, we conducted a coordinated analysis and summary meta-analysis of new results on the aging-related dynamics linking pulmonary function and cognitive performance.

Methods

We performed coordinated analysis of bivariate growth models in data from 20,586 participants across eight longitudinal studies to examine individual differences in baseline level, rate of change, and occasion-specific variability in pulmonary and cognitive functioning. Results were summarized using meta-analysis.

Results

We found consistent but weak baseline and longitudinal associations in levels of pulmonary and cognitive functioning, but no associations in occasion-specific variability.

Conclusions

Results provide limited evidence for a consistent link between simultaneous changes in pulmonary and cognitive function in a normal aging population. Further research is required to understand patterns of onset of decline and differences in rates of change within and across physical and cognitive functioning domains, both within-individuals and across countries and birth cohorts. Coordinated analysis provides an efficient and rigorous approach for replicating and comparing results across independent longitudinal studies.
Nanopore sequencing of long ribosomal DNA amplicons enables portable and simple biodiversity assessments with high phylogenetic resolution across broad taxonomic scale
Authors: Krehenwinkel Henrik , Pomerantz Aaron , Henderson James B , Kennedy Susan R , Lim Jun Ying , Swamy Varun , Shoobridge Juan Diego , Graham Natalie , Patel Nipam H , Gillespie Rosemary G , Prost Stefan
Published: March 2019

Background

In light of the current biodiversity crisis, DNA barcoding is developing into an essential tool to quantify state shifts in global ecosystems. Current barcoding protocols often rely on short amplicon sequences, which yield accurate identification of biological entities in a community but provide limited phylogenetic resolution across broad taxonomic scales. However, the phylogenetic structure of communities is an essential component of biodiversity. Consequently, a barcoding approach is required that unites robust taxonomic assignment power and high phylogenetic utility. A possible solution is offered by sequencing long ribosomal DNA (rDNA) amplicons on the MinION platform (Oxford Nanopore Technologies).

Findings

Using a dataset of various animal and plant species, with a focus on arthropods, we assemble a pipeline for long rDNA barcode analysis and introduce a new software (MiniBar) to demultiplex dual indexed Nanopore reads. We find excellent phylogenetic and taxonomic resolution offered by long rDNA sequences across broad taxonomic scales. We highlight the simplicity of our approach by field barcoding with a miniaturized, mobile laboratory in a remote rainforest. We also test the utility of long rDNA amplicons for analysis of community diversity through metabarcoding and find that they recover highly skewed diversity estimates.

Conclusions

Sequencing dual indexed, long rDNA amplicons on the MinION platform is a straightforward, cost-effective, portable, and universal approach for eukaryote DNA barcoding. Although bulk community analyses using long-amplicon approaches may introduce biases, the long rDNA amplicons approach signifies a powerful tool for enabling the accurate recovery of taxonomic and phylogenetic diversity across biological communities.
Health workers’ knowledge of safer conception and attitudes toward reproductive rights of HIV-infected couples in Kano, Nigeria
Authors: Iliyasu Zubairu , Galadanci Hadiza S , Zubairu Ahmad A , Amole Taiwo G , Sam-Agudu Nadia A , Aliyu Muktar H
Published: March 2019

Background

The restriction of reproductive rights of HIV-positive couples in low-resource settings could be related to the attitudes and skills of health workers. We assessed health workers’ knowledge of safer conception and their attitudes toward the reproductive rights of HIV-positive couples in a tertiary hospital in Nigeria.

Methods

A cross-section of health workers (n=294) was interviewed using structured questionnaires. Knowledge and attitude scores were analyzed. Logistic regression was employed to generate adjusted odds ratios (AORs) for predictors of attitude.

Results

Safer conception methods mentioned by respondents included timed unprotected intercourse with (27.9%) and without antiretroviral pre-exposure prophylaxis (37.4%), in vitro fertilization plus intracytoplasmic sperm injection (26.5%), and sperm washing and intrauterine insemination (24.8%). The majority (94.2%) of health workers acknowledged the reproductive rights of HIV-infected persons, although (64.6%) strongly felt that HIV-infected couples should have fewer children. Health workers reported always/nearly always counseling their patients on HIV transmission risks (64.1%) and safer conception (59.2% and 48.3% for females and males, respectively) (p<0.05). Among health workers, being older (30–39 vs <30 y) (AOR=1.33, 95% CI=1.13–2.47), married (AOR=2.15, 95% CI=1.17–5.58) and having a larger HIV-positive daily caseload (20–49 vs <20) (AOR=1.98, 95% CI=1.07–3.64) predicted positive attitude towards reproductive rights of HIV-affected couples.

Conclusions

Health workers had limited knowledge of safer conception methods, but were supportive of the reproductive rights of HIV-positive couples. Health workers in Nigeria require training to effectively counsel couples on their reproductive rights, risks and options.
Exact Adaptive Confidence Intervals for Small Areas
Authors: Burris Kyle C , Hoff Peter D
Published: March 2019

In the analysis of survey data, it is of interest to estimate and quantify uncertainty about means or totals for each of several nonoverlapping subpopulations or areas. When the sample size for a given area is small, standard confidence intervals based on data only from that area can be unacceptably wide. In order to reduce interval width, practitioners often utilize multilevel models in order to borrow information across areas, resulting in intervals centered around shrinkage estimators. However, such intervals only have the nominal coverage rate on average across areas under the assumed model for across-area heterogeneity. The coverage rate for a given area depends on the actual value of the area mean and can be nearly zero for areas with means that are far from the across-group average. As such, the use of uncertainty intervals centered around shrinkage estimators are inappropriate when area-specific coverage rates are desired. In this article, we propose an alternative confidence interval procedure for area means and totals under normally distributed sampling errors. This procedure not only has constant 1−α frequentist coverage for all values of the target quantity but also uses auxiliary information to borrow information across areas. Because of this, the corresponding intervals have shorter expected lengths than standard confidence intervals centered on the unbiased direct estimator. Importantly, the coverage of the procedure does not depend on the assumed model for across-area heterogeneity. Rather, improvements to the model for across-area heterogeneity result in reduced expected interval width.
A new method to trace three-dimensional magnetic field structure within molecular clouds using dust polarization
Authors: Chen Che-Yu , King Patrick K , Li Zhi-Yun , Fissel Laura M , Mazzei Renato R
Published: March 2019

The complete three-dimensional structure of the magnetic field within molecular clouds has eluded determination despite its high value in determining controlling factors in the star formation process, as it cannot be directly probed observationally. Considering that inclination of the magnetic field relative to the plane of sky is one of the major sources of depolarization of thermal emission from dust in molecular clouds, we propose here a new method to estimate the inclination angle of the cloud-scale magnetic field based on the statistical properties of the observed polarization fraction. We test this method using a series of Monte Carlo experiments and find that the method works well, provided that deviations of magnetic field direction from the averaged values are small. When applied to synthetic observations of numerical simulations of star-forming clouds, our method gives fairly accurate measurements of the mean magnetic field inclination angle (within 10°–25°), which can further be improved if we restrict our technique to regions of low dispersion in polarization angles ${\cal S}$. We tested our method on the BLASTPol polarimetric observations of the Vela C molecular cloud complex, which suggests that the magnetic field of Vela C has a high inclination angle (∼60°), consistent with previous analyses.
A search for red giant solar-like oscillations in all Kepler data
Authors: Hon Marc , Stello Dennis , García Rafael A , Mathur Savita , Sharma Sanjib , Colman Isabel L , Bugnet Lisa
Published: March 2019

The recently published Kepler mission Data Release 25 (DR25) reported on ∼197 000 targets observed during the mission. Despite this, no wide search for red giants showing solar-like oscillations have been made across all stars observed in Kepler’s long-cadence mode. In this work, we perform this task using custom apertures on the Kepler pixel files and detect oscillations in 21 914 stars, representing the largest sample of solar-like oscillating stars to date. We measure their frequency at maximum power, νmax, down to $\nu _{\mathrm{max}}\simeq 4\, \mu$Hz and obtain log (g) estimates with a typical uncertainty below 0.05 dex, which is superior to typical measurements from spectroscopy. Additionally, the νmax distribution of our detections show good agreement with results from a simulated model of the Milky Way, with a ratio of observed to predicted stars of 0.992 for stars with $10 \lt \nu _{\mathrm{max}}\lt 270\, \mu$Hz. Among our red giant detections, we find 909 to be dwarf/subgiant stars whose flux signal is polluted by a neighbouring giant as a result of using larger photometric apertures than those used by the NASA Kepler science processing pipeline. We further find that only 293 of the polluting giants are known Kepler targets. The remainder comprises over 600 newly identified oscillating red giants, with many expected to belong to the Galactic halo, serendipitously falling within the Kepler pixel files of targeted stars.
Health Literacy, Opioid Misuse, and Pain Experience Among Adults with Chronic Pain
Authors: Rogers Andrew H , Bakhshaie Jafar , Orr Michael F , Ditre Joseph W , Zvolensky Michael J
Published: March 2019

Background

Chronic pain is a significant public health problem that is associated with several negative health outcomes, including increased health care cost, decreased productivity, and prescription opioid misuse. Although efforts have been made to curb the growing opioid epidemic in the United States, further research is needed to better understand individual difference factors that may be associated with greater pain and opioid misuse. Lower levels of health literacy, defined as the ability to obtain, understand, and use health information to make important decisions regarding health and medical care, has been associated with several chronic illnesses. Yet little work has examined the relationship between health literacy, pain, and opioid misuse among individuals with chronic pain.

Methods

The current study examined health literacy in relation to current opioid misuse, severity of opioid dependence, pain severity, and pain disability among 445 adults with chronic pain (74.6% female, Mage [SD] = 38.45 [11.06] years).

Results

Results indicated that health literacy was significantly negatively associated with each of the criterion variables.

Conclusions

These results suggest that health literacy may contribute to opioid misuse and pain experience among individuals with chronic pain. Interventions targeting health literacy among individuals with chronic illness may help to address the opioid public health crisis.
Reduced DNA Methylation of the Oxytocin Receptor Gene Is Associated With Anhedonia-Asociality in Women With Recent-Onset Schizophrenia and Ultra-high Risk for Psychosis
Authors: Bang Minji , Kang Jee In , Kim Se Joo , Park Jin Young , Kim Kyung Ran , Lee Su Young , Park Kyungmee , Lee Eun , Lee Seung-Koo , An Suk Kyoon
Published: March 2019

Negative symptoms are recognized as a fundamental feature of schizophrenia throughout the disease course. Epigenetic alterations in the oxytocin receptor gene (OXTR) may be a key mechanism involved in social-emotional disturbances of schizophrenia. Here, we investigated OXTR methylation and its association with clinical and brain network connectivity phenotypes of negative symptoms, particularly anhedonia-asociality, in individuals with recent-onset schizophrenia (ROS) and at ultrahigh risk (UHR) for psychosis. Sixty-four ROS (39 women), 46 UHR (19 women), and 98 healthy individuals (52 women) participated in this study. OXTR methylation was quantified using the pyrosequencing method. A subset of participants (16 ROS, 23 UHR, and 33 healthy controls [HCs]) underwent a 5.5-minute resting-state functional magnetic resonance imaging to determine the relationship between OXTR methylation and the striatal-amygdala network functional connectivity (FC) underlying anhedonia-asociality. Both men and women with ROS and UHR showed significantly decreased OXTR methylation compared to HCs. In women with ROS and UHR, decreased OXTR methylation showed a significant correlation with increased anhedonia-asociality. FC of the striatal-amygdala network, positively associated with the severity of anhedonia-asociality, showed an inverse correlation with OXTR methylation. This study suggests that epigenetic alterations of OXTR, which can be detected before the development of full-blown psychosis, confer susceptibility to schizophrenia and play a crucial role in the manifestation of anhedonia-asociality, particularly in women.
An NP's guide to diagnosing and treating alpha-1 antitrypsin deficiency
Authors: Newell Judith A. , Donahue Christine , Hogarth D. Kyle
Published: March 2019

As NPs play an increasingly vital role in primary care, they must be well versed in a variety of conditions. Alpha-1 antitrypsin (AAT) deficiency is a respiratory disease for which there is particularly low awareness in both the nursing profession and the wider medical community. This article provides an overview of AAT deficiency and includes guidance for diagnosing the disease.
Socially Assistive Robots for Helping Pediatric Distress and Pain
Authors: Trost Margaret J. , Ford Adam R. , Kysh Lynn , Gold Jeffrey I. , Matarić Maja
Published: March 2019

Objectives:

Interacting with socially assistive robots (SAR) has been shown to influence human behaviors and emotions. This study sought to review the literature on SAR intervention for reducing pediatric distress and pain in medical settings.

Methods:

Databases (PubMed, Cochrane Library, CINAHL, PsycINFO, ERIC, Web of Science, Engineering Village, Scopus, Google Scholar, IEEE Xplore) were searched from database inception to January 2018 with the aid of a medical librarian. Included studies examined any SAR intervention for reducing pain or improving emotional well-being in children related to physical or psychiatric care, with outcomes assessed by some quantitative measure. Study quality was assessed using the modified Downs and Black checklist (max. score, 28). The review is registered in PROSPERO (CRD42016043018).

Results:

Eight studies met the eligibility criteria and represented 206 children. Of the 2 studies using Wong-Baker’s FACES scale, 1 study claimed to be effective at reducing pain (Cohen d=0.49 to 0.62), while the other appeared effective only when parents and child interacted with SAR together. Distress was evaluated using validated measures in 4 studies, 3 of which showed reduction in distress while one showed no difference. Satisfaction surveys from 4 studies showed that children were interested in using SAR again. Quality scores ranged from 8 to 26.

Conclusions:

There is limited evidence suggesting that SAR interventions may reduce distress and no clear evidence showing reduction in pain for children in medical settings. Engineers are conducting interventions using SAR in pediatric populations. Health care providers should be engaged in technology research related to children to facilitate testing and improve the effectiveness of these systems.
Sleep and Pain
Authors: Whibley Daniel , AlKandari Nourah , Kristensen Kaja , Barnish Max , Rzewuska Magdalena , Druce Katie L. , Tang Nicole K.Y.
Published: March 2019

Objectives:

A relationship between sleep and pain is well established. A better understanding of the mechanisms that link sleep and pain intensity is urgently needed to optimize pain management interventions. The objective of this systematic review was to identify, synthesize, and critically appraise studies that have investigated putative mediators on the path between sleep and pain intensity.

Methods:

A systematic search of 5 electronic bibliographic databases (EMBASE, MEDLINE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials) was conducted. Eligible studies had to apply a formal test of mediation to variables on the path between a sleep variable and pain intensity or vice versa. All searches, data extraction and quality assessment were conducted by at least 2 independent reviewers.

Results:

The search yielded 2839 unique articles, 9 of which were eligible. Of 13 mediation analyses, 11 investigated pathways from a sleep variable to pain intensity. Putative mediators included affect/mood, depression and/or anxiety, attention to pain, pain helplessness, stress, fatigue, and physical activity. Two analyses investigated pathways from pain intensity to a sleep variable, examining the potentially mediating role of depressive symptoms and mood. Although evidence supported a mediating role for psychological and physiological aspects of emotional experiences and attentional processes, methodological limitations were common, including use of cross-sectional data and minimal adjustment for potential confounders.

Discussion:

A growing body of research is applying mediation analysis to elucidate mechanistic pathways between sleep and pain intensity. Currently sparse evidence would be illuminated by more intensively collected longitudinal data and improvements in analysis.
Nursing Students’ Technological Equipment Usage and Individual Innovation Levels
Authors: Turan Nuray , Kaya Hatice , Durgun Hanife , Aşti Türkinaz
Published: March 2019

Technological equipment is an indispensable part of many people's lives. In parallel with this development, the role of innovation is critical to nurses' ability to provide patient care. Today, nursing students have grown up with technology. Therefore, the field is expected to be more open to innovation in nursing care. It is thought that the use of technological equipment influences the level of innovation. The purpose of this study was to determine nursing students' technological equipment usage, individual innovation levels, and the relationship between them. This descriptive study employed a correlational design during the 2015–2016 academic year at a Nursing Department in the Faculty of Health Sciences in Istanbul. The study population comprised 199 nursing students. The study sample included 165 students who volunteered to participate and were chosen at random. Most (93.3%) of the students were women, and the mean age was 20.92 ± 1.63 years. Data were collected using a devised structured-question form, the Technological Device Use Habits Scale, and the Individual Innovation Scale. Participants' mean scores on the Technological Equipment Usage (a subscale of the Technological Device Use Habits Scale) and on the Individual Innovation Scale were 135.15 ± 27.09 and 61.02 ± 8.89, respectively. Students' technological equipment usage subscale was higher than the other subscales; furthermore, their individual innovation levels revealed that they were “questioners.” Several factors affected students' technological equipment usage and individual innovation levels including their age, income, work status, usage of social networking sites, Internet connection type, and if they considered themselves as innovative. The role of technological innovation is critical to nurses' ability to provide patient care.
Hands-on Tutorial on a Modeling Framework for Projections of Climate Change Impacts on Health
Authors: Vicedo-Cabrera Ana M. , Sera Francesco , Gasparrini Antonio
Published: March 2019

Reliable estimates of future health impacts due to climate change are needed to inform and contribute to the design of efficient adaptation and mitigation strategies. However, projecting health burdens associated to specific environmental stressors is a challenging task because of the complex risk patterns and inherent uncertainty of future climate scenarios. These assessments involve multidisciplinary knowledge, requiring expertise in epidemiology, statistics, and climate science, among other subjects. Here, we present a methodologic framework to estimate future health impacts under climate change scenarios based on a defined set of assumptions and advanced statistical techniques developed in time-series analysis in environmental epidemiology. The proposed methodology is illustrated through a step-by-step hands-on tutorial structured in well-defined sections that cover the main methodological steps and essential elements. Each section provides a thorough description of each step, along with a discussion on available analytical options and the rationale on the choices made in the proposed framework. The illustration is complemented with a practical example of study using real-world data and a series of R scripts included as Supplementary Digital Content; http://links.lww.com/EDE/B504, which facilitates its replication and extension on other environmental stressors, outcomes, study settings, and projection scenarios. Users should critically assess the potential modeling alternatives and modify the framework and R code to adapt them to their research on health impact projections.
Validation of an Algorithm for Claims-based Incidence of Prostate Cancer
Authors: Parlett Lauren E. , Beachler Daniel C. , Lanes Stephan , Hoover Robert N. , Cook Michael B.
Published: March 2019

Background:

Prostate cancer is a commonly studied outcome in administrative claims studies, but there is a dearth of validated case identifying algorithms. The long-term development of the disease increases the difficulty in separating prevalent from incident prostate cancer. The purpose of this validation study was to assess the accuracy of a claims algorithm to identify incident prostate cancer among men in commercial and Medicare Advantage US health plans.

Methods:

We identified prostate cancer in claims as a prostate cancer diagnosis within 28 days after a prostate biopsy and compared case ascertainment in the claims with the gold standard results from the Georgia Comprehensive Cancer Registry (GCCR).

Results:

We identified 74,008 men from a large health plan claims database for possible linkage with GCCR. Among the 382 prostate cancer cases identified in claims, 312 were also identified in the GCCR (positive predictive value [PPV] = 82%). Of the registry cases, 91% (95% confidence interval = 88, 94) were correctly identified in claims. Claims and registry diagnosis dates of prostate cancer matched exactly in 254/312 (81%) cases. Nearly half of the false-positive cases also had claims for prostate cancer treatment. Thirteen (43%) false-negative cases were classified as noncases by virtue of having a biopsy and diagnosis >28 days apart as required by the algorithm. Compared to matches, false-negative cases were older men with less aggressive prostate cancer.

Conclusions:

Our algorithm demonstrated a PPV of 82% with 92% sensitivity in ascertaining incident PC. Administrative health plan claims can be a valuable and accurate source to identify incident prostate cancer cases.
Measuring Workload with Paired Detectors
Authors: Corns Robert , Schroeder Charles , Sandhu Gurpreet , Henderson Keith , McKay Ian
Published: March 2019

Linear accelerator workloads for each available photon energy are important quantities to know for radiation safety considerations, and presented is a technique to measure the workload using paired detectors. The signals from the two detectors can give sufficient information to separate the signal contributions from 6 and 18 MV photon fields and, combined with a signal-per-monitor-unit calibration factor, yields the number of monitor units delivered for each energy. CR-39 NTD is a neutron detector chosen for its ability to discriminate between 6 MV and 18 MV radiation fields. TLD-100 is a detector responsive to both 6 MV and 18 MV fields. These appeared to be a good choice for a detector pair. This experiment had both failures and successes to report. The CR-39 NTD and TLD-100 were not a successful pairing. The CR-39 NTD signals saturated under this experiment’s exposure conditions. The TLD-100 had a combination of detector noise and detector sensitivity that made extracting the 6 MV signal from the total signal impractical, unless the total exposure was overwhelmingly 6 MV. Nevertheless, the TLD-100 proved to be excellent for determining workloads when it was exposed to a single energy with 1% accuracy and 3% precision. The theory and data analysis showed the importance of understanding the noise contributions for the more general problem of pairing any two detector types. This experiment indicated the TLD-100 could be an excellent detector choice if paired with a suitable second detector.
Model of Steady-state Temperature Rise in Multilayer Tissues Due to Narrow-beam Millimeter-wave Radiofrequency Field Exposure
Authors: Gajda Gregory B. , Lemay Eric , Paradis Jonathan
Published: March 2019

The assessment of health effects due to localized exposures from radiofrequency fields is facilitated by characterizing the steady-state, surface temperature rise in tissue. A closed-form analytical model was developed that relates the steady-state, surface temperature rise in multilayer planar tissues as a function of the spatial-peak power density and beam dimensions of an incident millimeter wave. Model data was derived from finite-difference solutions of the Pennes bioheat transfer equation for both normal-incidence plane waves and for narrow, circularly symmetric beams with Gaussian intensity distribution on the surface. Monte Carlo techniques were employed by representing tissue layer thicknesses at different body sites as statistical distributions compiled from human data found in the literature. The finite-difference solutions were validated against analytical solutions of the bioheat equation for the plane wave case and against a narrow-beam solution performed using a commercial multiphysics simulation package. In both cases, agreement was within 1–2%. For a given frequency, the resulting analytical model has four input parameters, two of which are deterministic, describing the level of exposure (i.e., the spatial-peak power density and beam width). The remaining two are stochastic quantities, extracted from the Monte Carlo analyses. The analytical model is composed of relatively simple functions that can be programmed in a spreadsheet. Demonstration of the analytical model is provided in two examples: the calculation of spatial-peak power density vs. beam width that produces a predefined maximum steady-state surface temperature, and the performance evaluation of various proposed spatial-averaging areas for the incident power density.
Strengthening the Evidence Base: Recommendations for Future Research Identified Through the Development of CDC's Pediatric Mild TBI Guideline
Authors: Suskauer Stacy J. , Yeates Keith Owen , Sarmiento Kelly , Benzel Edward C. , Breiding Matthew J. , Broomand Catherine , Haarbauer-Krupa Juliet , Turner Michael , Weissman Barbara , Lumba-Brown Angela
Published: March 2019

Objective:

The recently published Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury (mTBI) was developed following an extensive review of the scientific literature. Through this review, experts identified limitations in existing pediatric mTBI research related to study setting and generalizability, mechanism of injury and age of cohorts studied, choice of control groups, confounding, measurement issues, reporting of results, and specific study design considerations. This report summarizes those limitations and provides a framework for optimizing the future quality of research conduct and reporting.

Results:

Specific recommendations are provided related to diagnostic accuracy, population screening, prognostic accuracy, and therapeutic interventions.

Conclusion:

Incorporation of the recommended approaches will increase the yield of eligible research for inclusion in future systematic reviews and guidelines for pediatric mTBI.
Healthcare Utilization and Missed Workdays for Parents of Children With Traumatic Brain Injury
Authors: Nelson Richard E. , Ma Junjie , Cheng Yan , Ewing-Cobbs Linda , Clark Amy , Keenan Heather
Published: March 2019

Background:

We enrolled patients in a prospective study in which we obtained estimates of the direct and indirect burden for families of children with traumatic brain injury (TBI) relative to a control group of families of children with orthopedic injury (OI).

Methods:

Parents were surveyed at 3 time points following injury: 3, 6, and 12 months. At each follow-up contact, we asked parents to list the number of workdays missed, number of miles traveled, amount of travel-related costs, and whether their child had an emergency department (ED) visit, hospital admission, any over-the-counter (OTC) medications, and any prescription medications during that time period. We assessed the difference in these outcomes between the TBI and OI groups using multivariable logistic and 2-part regression models to account for high concentrations of zero values.

Results:

Children with TBI had significantly greater odds of having an ED visit (3.04; 95% CI, 1.12-8.24), OTC medications (1.98; 95% CI, 1.34-2.94), and prescription medications (2.34; 95% CI, 1.19-4.59) than those with OI. In addition, parents of children with TBI missed significantly more days of work (19.91 days; 95% CI, 11.64-28.17) overall during the 12 months following injury than their OI counterparts.

Conclusion:

Extrapolating our results to the entire country, we estimate that pediatric TBI is associated with more than 670 000 lost workdays annually over the 12 months following injury, which translates into more than $150 million in lost productivity. These missed workdays and lost productivity may be prevented through safety efforts to reduce pediatric TBI.
Protocol for a Randomized Controlled Trial of CI Therapy for Rehabilitation of Upper Extremity Motor Deficit: The Bringing Rehabilitation to American Veterans Everywhere Project
Authors: Morris David M. , Taub Edward , Mark Victor W. , Liu Wei , Brenner Lisa , Pickett Treven , Stearns-Yoder Kelly , Bishop-McKay Staci , Taylor Andrea , Reder Laura , Adams Terrie , Rimmer James , Dew Dustin , Szaflarski Jerzy , Womble Brent , Stevens Lillian , Rothman David , Uswatte Gitendra
Published: March 2019

Constraint-induced movement therapy (CI therapy) has been shown to reduce disability for individuals with upper extremity (UE) hemiparesis following different neurologic injuries. This article describes the study design and methodological considerations of the Bringing Rehabilitation to American Veterans Everywhere (BRAVE) Project, a randomized controlled trial of CI therapy to improve the motor deficit of participants with chronic and subacute traumatic brain injury. Our CI therapy protocol comprises 4 major components: (1) intensive training of the more-affected UE for target of 3 hour/day for 10 consecutive weekdays, (2) a behavioral technique termed shaping during training, (3) a “transfer package,” 0.5 hour/day, of behavioral techniques to transfer therapeutic gains from the treatment setting to the life situation, and (4) prolonged restraint of use of the UE not being trained. The primary endpoint is posttreatment change on the Motor Activity Log, which assesses the use of the more-affected arm outside the laboratory in everyday life situations. Data from a number of secondary outcome measures are also being collected and can be categorized as physical, genomic, biologic, fitness, cognitive/behavioral, quality of life, and neuroimaging measures.
Improvement and Prediction of Memory and Executive Functions in Patients Admitted to a Neurosurgery Service With Complicated and Uncomplicated Mild Traumatic Brain Injury
Authors: Holthe Oyvor Oistensen , Hellstrom Torgeir , Andelic Nada , Server Andres , Sigurdardottir Solrun
Published: March 2019

Objectives:

To compare neuropsychological performances between patients with and without intracranial abnormalities after mild traumatic brain injury (mTBI) and assess the relationship between demographics, injury severity, and self-reported symptom characteristics with improvements in memory and executive functions (8 weeks to 1 year postinjury).

Setting:

Inpatient/outpatient followed up at the Department of Physical Medicine and Rehabilitation, Oslo, Norway.

Participants:

Patients were divided into groups of complicated (n = 73) or uncomplicated mTBIs (n = 77) based on intracranial findings on computed tomographic or magnetic resonance imaging brain scans.

Design:

Prospective, longitudinal cohort study.

Main Measures:

Neuropsychological assessments of memory and executive functions, self-reports of postconcussion, depression, posttraumatic stress symptoms, and general functioning at 8 weeks and 1 year postinjury.

Results:

Longitudinal data showed that patients with complicated and uncomplicated mTBIs had similar cognitive performance and improvements. Hierarchical linear modeling revealed that individuals with early posttraumatic stress disorder and/or depressive symptoms performed worse on measures of Memory functions, and those with younger age (<40 years) and lower education (<12 years) performed worse on measures of Executive functions.

Conclusion:

Findings are suggestive of a good cognitive outcome following complicated and uncomplicated mTBIs. Early assessments of posttraumatic stress disorder and depression seem useful in identifying those most vulnerable having poorer cognitive outcomes, providing further interventions that may affect emotional and cognitive recovery.
Decreased Risk of Dementia Among Patients With Traumatic Brain Injury Receiving Acupuncture Treatment: A Population-Based Retrospective Cohort Study
Authors: Juan Ying-Hsu , Livneh Hanoch , Huang Hui-Jun , Lu Ming-Chi , Yeh Chia-Chou , Tsai Tzung-Yi
Published: March 2019

Objective:

We conducted a longitudinal cohort study comparing the effect of acupuncture on the risk of dementia in Taiwanese individuals with traumatic brain injury (TBI).

Design and Participants:

A national health insurance database was used to identify 15 440 newly diagnosed TBI patients 20 to 70 years old between 1998 and 2007. Of the identified patients, 6308 received acupuncture following the onset of TBI (acupuncture users) and 9132 patients did not receive acupuncture (nonacupuncture users).

Measures:

All enrollees were followed until the end of 2012 to record incident cases of dementia. A Cox proportional hazards regression model was used to compute adjusted hazard ratios for the relationship of acupuncture use with dementia.

Results:

During the follow-up period, 249 acupuncture users and 810 nonacupuncture users developed dementia, corresponding to incidence rates of 6.11 and 9.64 per 1000 person-years, respectively. Use of acupuncture was significantly associated with a lower risk of dementia. Those who received more than 5 sessions of acupuncture benefited most from it.

Conclusions:

Adding acupuncture to the clinical management of patients with TBI may benefit these patients by decreasing their risk of developing dementia.
Prevalence of Medical and Psychiatric Comorbidities Following Traumatic Brain Injury
Authors: Hammond Flora M. , Corrigan John D. , Ketchum Jessica M. , Malec James F. , Dams-O'Connor Kristen , Hart Tessa , Novack Thomas A. , Bogner Jennifer , Dahdah Marie N. , Whiteneck Gale G.
Published: March 2019

Objective:

To examine the prevalence of selected medical and psychiatric comorbidities that existed prior to or up to 10 years following traumatic brain injury (TBI) requiring acute rehabilitation.

Design:

Retrospective cohort.

Setting:

Six TBI Model Systems (TBIMS) centers.

Participants:

In total, 404 participants in the TBIMS National Database who experienced TBI 10 years prior.

Interventions:

Not applicable.

Main Outcome Measure:

Self-reported medical and psychiatric comorbidities and the onset time of each endorsed comorbidity.

Results:

At 10 years postinjury, the most common comorbidities developing postinjury, in order, were back pain, depression, hypertension, anxiety, fractures, high blood cholesterol, sleep disorders, panic attacks, osteoarthritis, and diabetes. Comparing those 50 years and older to those younger than 50 years, diabetes (odds ratio [OR] = 3.54; P = .0016), high blood cholesterol (OR = 2.04; P = .0092), osteoarthritis (OR = 2.02; P = .0454), and hypertension (OR = 1.84; P = .0175) were significantly more prevalent in the older cohort while panic attacks (OR = 0.33; P = .0022) were significantly more prevalent in the younger cohort. No significant differences in prevalence rates between the older and younger cohorts were found for back pain, depression, anxiety, fractures, or sleep disorders.

Conclusions:

People with moderate-severe TBI experience other medical and mental health comorbidities during the long-term course of recovery and life after injury. The findings can inform further investigation into comorbidities associated with TBI and the role of medical care, surveillance, prevention, lifestyle, and healthy behaviors in potentially modifying their presence and/or prevalence over the life span.
The Natural History of Postconcussion Recovery Among High School Athletes
Authors: Dise-Lewis Jeanne E. , Forster Jeri E. , McAvoy Karen , Stearns-Yoder Kelly A. , Bahraini Nazanin H. , Laker Scott R. , Brenner Lisa A.
Published: March 2019

Objective:

Evaluate postconcussive symptom reporting and recovery.

Setting:

Public high school.

Participants:

Unmatched controls (n = 760); students who sustained a sports-related concussion (n = 77); matched controls (gender, grade, sport) (n = 77).

Design:

Prospective longitudinal cohort study.

Outcome measure:

Immediate Postconcussion Assessment and Cognitive Testing.

Results:

At baseline, athletes who went on to sustain concussions were more likely than unmatched controls to be younger (P = .02), male (P = .001), and participate in different sports (P < .0001) such as football (concussed = 52%, unmatched controls = 20%). Differences were also noted regarding a previous history of concussion (P = .045; concussed athletes = 26%; unmatched control athletes = 16%) and lifetime number of concussions (P = .05). At baseline, those whose sustained concussions during the study period were more likely than matched controls to report numbness (P = .01) and concentration problems (P = .01) and more likely than unmatched controls to report dizziness (P = .02), sensitivity to light (P = .01), sensitivity to noise (P = .002), and numbness (P = .02). However, when data were reanalyzed and those with a previous history of concussion were removed, differences between those who sustained concussions during the study period and matched controls were no longer significant; when compared to unmatched controls, sensitivity to light (P = .01) and vision problems (P = .04) remained significant. Among those who sustained concussions, median time to recovery was 6 days (95% confidence interval: 4-9), and 71 out of 77 (92%) recovered by the fourth postinjury evaluation (median: 20 days postinjury).

Conclusions:

Course and time frame of recovery were variable. Data also suggest that a previous history of concussion may be contributing to baseline symptom reporting and highlight the potential enduring impact of history of concussion on sensorimotor function. However, further research as to whether preinjury measures of sensorimotor function may increase understanding regarding concussion risk is warranted.
Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury: Examining Associations With Demographics, Healthcare Utilization, Institutionalization, and 1-Year Outcomes
Authors: Kumar Raj G. , Olsen Jennifer , Juengst Shannon B. , Dams-O'Connor Kristen , O'Neil-Pirozzi Therese M. , Hammond Flora M. , Wagner Amy K.
Published: March 2019

Objectives:

To assess the relationship of acute complications, preexisting chronic diseases, and substance abuse with clinical and functional outcomes among adults 50 years and older with moderate-to-severe traumatic brain injury (TBI).

Design:

Prospective cohort study.

Participants:

Adults 50 years and older with moderate-to-severe TBI (n = 2134).

Measures:

Clusters of comorbid health conditions empirically derived from non-injury International Classification of Diseases, Ninth Revision codes, demographic/injury variables, and outcome (acute and rehabilitation length of stay [LOS], Functional Independence Measure efficiency, posttraumatic amnesia [PTA] duration, institutionalization, rehospitalization, and Glasgow Outcome Scale–Extended (GOS-E) at 1 year).

Results:

Individuals with greater acute hospital complication burden were more often middle-aged men, injured in motor vehicle accidents, and had longer LOS and PTA. These same individuals experienced higher rates of 1-year rehospitalization and greater odds of unfavorable GOS-E scores at 1 year. Those with greater chronic disease burden were more likely to be rehospitalized at 1 year. Individuals with more substance abuse burden were most often younger (eg, middle adulthood), black race, less educated, injured via motor vehicle accidents, and had an increased risk for institutionalization.

Conclusion:

Preexisting health conditions and acute complications contribute to TBI outcomes. This work provides a foundation to explore effects of comorbidity prevention and management on TBI recovery in older adults.
The Contribution of Social Support, Professional Support, and Financial Hardship to Family Caregiver Life Satisfaction After Traumatic Brain Injury
Authors: Sabella Scott A. , Suchan Christopher S.
Published: March 2019

Objectives:

(a) To assess whether 3 changeable environmental variables (social support, professional support, and financial hardship) contribute to explaining differences in well-being of family caregivers after traumatic brain injury (TBI), above and beyond the influence of neurobehavioral functioning. (b) To assess the unique and relative contribution of social support, professional support, and financial hardship to life satisfaction of family caregivers.

Participants:

Adult family caregivers (n = 136) of individuals who received inpatient rehabilitation following a TBI.

Measures:

The Social Provisions Scale; Brief Scale of Financial Hardship after Brain Injury; Satisfaction with Life Scale; and adapted scales measuring professional support and neurobehavioral functioning.

Design:

Cross-sectional study using survey methodology.

Results:

Social support, professional support, and financial hardship explained a significant amount of variance in life satisfaction after controlling for neurobehavioral functioning (R
2 change = 0.34, considered a large effect size). Social support and financial hardship were significant unique predictors within the model, but professional support was not.

Conclusion:

Social support and financial hardship are prominent environmental variables that may hold promise for targeted intervention development and testing designed to support family adaptation after TBI.