bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute intraprocedural thrombosis during an arterial ductal stenting successfully managed by eptifibatide
Authors: Mumtaz Zeeshan Ahmed , Sivakumar Kothandam
Published: August 2021

Acute stent thrombosis may complicate neonatal arterial duct stenting for reduced pulmonary blood flow. Thrombolytic agents recanalise the clot but may cause bleeding around the vascular sheaths and other sites. Since early thrombus is platelet mediated, intravenous platelet glycoprotein inhibitor like eptifibatide is likely to be effective, but rarely utilised in neonates. Ductal stent thrombosis treated with eptifibatide is reported.
Acute rheumatic fever: 10-year single-center experience: clinical and laboratory findings, with subclinical carditis and treatment complications
Authors: Bulbul Lida , Akyol Mehmet Bedir , Civan Hasret Ayyıldız , Elitok Gizem Kara , Hatipoglu Sami , Akkus Canan Hasbal , Bulbul Ali
Published: August 2021

Background:

Acute rheumatic fever in childhood continues to cause serious morbidity despite all developments. The objective of this study was to evaluate the clinical and laboratory characteristics of patients with acute rheumatic fever and to determine the frequency of subclinical carditis and the side effects of the drugs used in the treatment.

Methods:

The data of patients hospitalised between 2008 and 2018 with the diagnosis of acute rheumatic fever were included in the study. The relationship of gender and age with the frequency of major symptoms and the distribution of the drugs used in the treatment and their side effects were evaluated.

Results:

Medical records of 102 patients with complete data were reviewed. 56.9% of the patients were male and the mean age was 10.7 ± 1.9 years. The most common distribution of complaints found were arthritis (51%), arthralgia (25.5%) and fever (16.7%). 10.8% of all patients (n = 11) were diagnosed subclinical carditis via echocardiographic evaluation. The frequency of carditis was higher in female patients with a borderline statistical significance (p = 0.05). However, there was no statistically significant difference between gender and arthritis (p = 0.22) and carditis (p > 0.05). Anti-congestive therapy was required in 22% and inotropic treatment was needed in 6.1% cases. Toxic hepatitis developed in four cases during the acetylsalicylic acid treatment.

Conclusions:

In a 10-year period, detection of subclinical carditis in 10.8% cases supported that echocardiography should be performed as a standard method for the diagnosis of acute rheumatic fever. Patients should be followed closely in terms of hepatic toxicity due to acetylsalicylic acid used in the treatment.
Glide paths for a retirement plan with deferred annuities
Authors: Jang Chul , Clare Andrew , Owadally Iqbal
Published: August 2021

We construct investment glide paths for a retirement plan using both traditional asset classes and deferred annuities (DAs). The glide paths are approximated by averaging the asset proportions of stochastic optimal investment solutions. The objective function consists of power utility in terms of secured retirement income from purchased DAs, as well as a bequest that can be withdrawn before retirement. Compared with conventional glide paths and investment strategies, our DA-enhanced glide paths provide the investor with higher welfare gains, more efficient investment portfolios and more responsive retirement income patterns and bequest levels to different fee structures and personal preferences.
Sequence variants in malignant hyperthermia genes in Iceland: classification and actionable findings in a population database
Authors: Fridriksdottir Run , Jonsson Arnar J. , Jensson Brynjar O. , Sverrisson Kristinn O. , Arnadottir Gudny A. , Skarphedinsdottir Sigurbjorg J. , Katrinardottir Hildigunnur , Snaebjornsdottir Steinunn , Jonsson Hakon , Eiriksson Ogmundur , Oskarsson Gudjon R. , Oddsson Asmundur , Jonasdottir Adalbjorg , Jonasdottir Aslaug , Sigurdsson Gisli H. , Indridason Einar P. , Sigurdsson Stefan B. , Bjornsdottir Gyda , Saemundsdottir Jona , Magnusson Olafur T. , Bjornsson Hans T. , Thorsteinsdottir Unnur , Sigurdsson Theodor S. , Sulem Patrick , Sigurdsson Martin I. , Stefansson Kari
Published: August 2021

Malignant hyperthermia (MH) susceptibility is a rare life-threatening disorder that occurs upon exposure to a triggering agent. MH is commonly due to protein-altering variants in RYR1 and CACNA1S. The American College of Medical Genetics and Genomics recommends that when pathogenic and likely pathogenic variants in RYR1 and CACNA1S are incidentally found, they should be reported to the carriers. The detection of actionable variants allows the avoidance of exposure to triggering agents during anesthesia. First, we report a 10-year-old Icelandic proband with a suspected MH event, harboring a heterozygous missense variant NM_000540.2:c.6710G>A r.(6710g>a) p.(Cys2237Tyr) in the RYR1 gene that is likely pathogenic. The variant is private to four individuals within a three-generation family and absent from 62,240 whole-genome sequenced (WGS) Icelanders. Haplotype sharing and WGS revealed that the variant occurred as a somatic mosaicism also present in germline of the proband’s paternal grandmother. Second, using a set of 62,240 Icelanders with WGS, we assessed the carrier frequency of actionable pathogenic and likely pathogenic variants in RYR1 and CACNA1S. We observed 13 actionable variants in RYR1, based on ClinVar classifications, carried by 43 Icelanders, and no actionable variant in CACNA1S. One in 1450 Icelanders carries an actionable variant for MH. Extensive sequencing allows for better classification and precise dating of variants, and WGS of a large fraction of the population has led to incidental findings of actionable MH genotypes.
A contorted nanographene shelter
Authors: Wu Huang , Wang Yu , Song Bo , Wang Hui-Juan , Zhou Jiawang , Sun Yixun , Jones Leighton O. , Liu Wenqi , Zhang Long , Zhang Xuan , Cai Kang , Chen Xiao-Yang , Stern Charlotte L. , Wei Junfa , Farha Omar K. , Anna Jessica M. , Schatz George C. , Liu Yu , Fraser Stoddart J.
Published: August 2021

Nanographenes have kindled considerable interest in the fields of materials science and supramolecular chemistry as a result of their unique self-assembling and optoelectronic properties. Encapsulating the contorted nanographenes inside artificial receptors, however, remains challenging. Herein, we report the design and synthesis of a trigonal prismatic hexacationic cage, which has a large cavity and adopts a relatively flexible conformation. It serves as a receptor, not only for planar coronene, but also for contorted nanographene derivatives with diameters of approximately 15 Å and thicknesses of 7 Å. A comprehensive investigation of the host-guest interactions in the solid, solution and gaseous states by experimentation and theoretical calculations reveals collectively an induced-fit binding mechanism with high binding affinities between the cage and the nanographenes. Notably, the photostability of the nanographenes is improved significantly by the ultrafast deactivation of their excited states within the cage. Encapsulating the contorted nanographenes inside the cage provides a noncovalent strategy for regulating their photoreactivity.
A comprehensive risk score for effective risk stratification and screening of nasopharyngeal carcinoma
Authors: Zhou Xiang , Cao Su-Mei , Cai Yong-Lin , Zhang Xiao , Zhang Shanshan , Feng Guo-Fei , Chen Yufeng , Feng Qi-Sheng , Chen Yijun , Chang Ellen T. , Liu Zhonghua , Adami Hans-Olov , Liu Jianjun , Ye Weimin , Zhang Zhe , Zeng Yi-Xin , Xu Miao
Published: August 2021

Using Epstein-Barr virus (EBV)-based markers to screen populations at high risk for nasopharyngeal carcinoma (NPC) is an attractive preventive approach. Here, we develop a comprehensive risk score (CRS) that combines risk effects of EBV and human genetics for NPC risk stratification and validate this CRS within an independent, population-based dataset. Comparing the top decile with the bottom quintile of CRSs, the odds ratio of developing NPC is 21 (95% confidence interval: 12–37) in the validation dataset. When combining the top quintile of CRS with EBV serology tests currently used for NPC screening in southern China, the positive prediction value of screening increases from 4.70% (serology test alone) to 43.24% (CRS plus serology test). By identifying individuals at a monogenic level of NPC risk, this CRS approach provides opportunities for personalized risk prediction and population screening in endemic areas for the early diagnosis and secondary prevention of NPC.
A modular self-adjuvanting cancer vaccine combined with an oncolytic vaccine induces potent antitumor immunity
Authors: Das Krishna , Belnoue Elodie , Rossi Matteo , Hofer Tamara , Danklmaier Sarah , Nolden Tobias , Schreiber Liesa-Marie , Angerer Katharina , Kimpel Janine , Hoegler Sandra , Spiesschaert Bart , Kenner Lukas , von Laer Dorothee , Elbers Knut , Derouazi Madiha , Wollmann Guido
Published: August 2021

Functional tumor-specific cytotoxic T cells elicited by therapeutic cancer vaccination in combination with oncolytic viruses offer opportunities to address resistance to checkpoint blockade therapy. Two cancer vaccines, the self-adjuvanting protein vaccine KISIMA, and the recombinant oncolytic vesicular stomatitis virus pseudotyped with LCMV-GP expressing tumor-associated antigens, termed VSV-GP-TAA, both show promise as a single agent. Here we find that, when given in a heterologous prime-boost regimen with an optimized schedule and route of administration, combining KISIMA and VSV-GP-TAA vaccinations induces better cancer immunity than individually. Using several mouse tumor models with varying degrees of susceptibility for viral replication, we find that priming with KISIMA-TAA followed by VSV-GP-TAA boost causes profound changes in the tumor microenvironment, and induces a large pool of poly-functional and persistent antigen-specific cytotoxic T cells in the periphery. Combining this heterologous vaccination with checkpoint blockade further improves therapeutic efficacy with long-term survival in the spectrum. Overall, heterologous vaccination with KISIMA and VSV-GP-TAA could sensitize non-inflamed tumors to checkpoint blockade therapy.
Paleocene/Eocene carbon feedbacks triggered by volcanic activity
Authors: Kender Sev , Bogus Kara , Pedersen Gunver K. , Dybkjær Karen , Mather Tamsin A. , Mariani Erica , Ridgwell Andy , Riding James B. , Wagner Thomas , Hesselbo Stephen P. , Leng Melanie J.
Published: August 2021

The Paleocene–Eocene Thermal Maximum (PETM) was a period of geologically-rapid carbon release and global warming ~56 million years ago. Although modelling, outcrop and proxy records suggest volcanic carbon release occurred, it has not yet been possible to identify the PETM trigger, or if multiple reservoirs of carbon were involved. Here we report elevated levels of mercury relative to organic carbon—a proxy for volcanism—directly preceding and within the early PETM from two North Sea sedimentary cores, signifying pulsed volcanism from the North Atlantic Igneous Province likely provided the trigger and subsequently sustained elevated CO2. However, the PETM onset coincides with a mercury low, suggesting at least one other carbon reservoir released significant greenhouse gases in response to initial warming. Our results support the existence of ‘tipping points’ in the Earth system, which can trigger release of additional carbon reservoirs and drive Earth’s climate into a hotter state.
Vortex-assisted natural deep eutectic solvent dispersive liquid–liquid microextraction based on the solidification of a floating organic drop for the determination of benzoic acid and sorbic acid in condiments
Authors: Zhu Xiaoming , Geng Shuwen , Wen Tao , Qin Feng , Zhao Longshan
Published: August 2021

Schematic diagram of VA-DLLME-SFO procedure.
Endothelial cell membrane-based biosurface for targeted delivery to acute injury: analysis of leukocyte-mediated nanoparticle transportation
Authors: Wang Fang , Hou Wenda , Xiao Chenglu , Hao Yaoyao , Su Ni , Deng Yu , Wang Jieting , Yu Luying , Xie Jing-Ming , Xiong Jing-Wei , Luo Ying
Published: August 2021

The endothelial cell membranes behave as biosurfaces of nanoparticles to bind immune cellsin situfor leukocyte-mediated delivery to injured area which were demonstrated both in mice and zebrafish models.
HCOOH disproportionation to MeOH promoted by molybdenum PNP complexes
Authors: Alberico Elisabetta , Leischner Thomas , Junge Henrik , Kammer Anja , Sang Rui , Seifert Jenny , Baumann Wolfgang , Spannenberg Anke , Junge Kathrin , Beller Matthias
Published: August 2021

Mo(0) complexes with aliphatic PNP-pincer ligands enable the first example of non-noble metal catalyzed formic acid disproportionation leading to methanol with a selectivity of up to 37% and a turnover number up to 69.
Informational Masking Effects of Speech Versus Nonspeech Noise on Cortical Auditory Evoked Potentials
Authors: Vander Werff Kathy R. , Niemczak Christopher E. , Morse Kenneth
Published: August 2021

Purpose

Background noise has been categorized as energetic masking due to spectrotemporal overlap of the target and masker on the auditory periphery or informational masking due to cognitive-level interference from relevant content such as speech. The effects of masking on cortical and sensory auditory processing can be objectively studied with the cortical auditory evoked potential (CAEP). However, whether effects on neural response morphology are due to energetic spectrotemporal differences or informational content is not fully understood. The current multi-experiment series was designed to assess the effects of speech versus nonspeech maskers on the neural encoding of speech information in the central auditory system, specifically in terms of the effects of speech babble noise maskers varying by talker number.

Method

CAEPs were recorded from normal-hearing young adults in response to speech syllables in the presence of energetic maskers (white or speech-shaped noise) and varying amounts of informational maskers (speech babble maskers). The primary manipulation of informational masking was the number of talkers in speech babble, and results on CAEPs were compared to those of nonspeech maskers with different temporal and spectral characteristics.

Results

Even when nonspeech noise maskers were spectrally shaped and temporally modulated to speech babble maskers, notable changes in the typical morphology of the CAEP in response to speech stimuli were identified in the presence of primarily energetic maskers and speech babble maskers with varying numbers of talkers.

Conclusions

While differences in CAEP outcomes did not reach significance by number of talkers, neural components were significantly affected by speech babble maskers compared to nonspeech maskers. These results suggest an informational masking influence on neural encoding of speech information at the sensory cortical level of auditory processing, even without active participation on the part of the listener.
Patientensicherheit durch Risiko- und Qualitätsmanagement im Gesundheitswesen
Authors: Netzer-Nawrocki Juliane
Published: August 2021

Die Patientensicherheit ist ein wesentlicher Bestandteil des Gesundheitsrechts und sie ist ein Kernelement der Qualitätssicherung und des Qualitätsmanagements.1 Im Folgenden sollen ein Überblick über die Entwicklung der Patientensicherheit gegeben werden und die Elemente des Qualitätsmanagements sowie die Konkretisierung durch die Qualitätsmanagementrichtlinie des Gemeinsamen Bundesausschusses dargestellt werden.
Non compliance des Patienten als Behandlungsfehler?
Authors: Maus Christian , Makoski Kyrill
Published: August 2021

Die Nichtbefolgung ärztlicher Ratschläge kann dem Patienten nur dann vorgeworfen werden, wenn der Arzt den Patienten vorher darüber aufgeklärt hat, welche Folgen dieses Handeln haben kann. Liegt ein Behandlungsfehler vor und verhält sich der Patient zusätzlich weiter schädigend, dann kann das eigene Verhalten des Patienten den Arzt entlasten – aber nur dann, wenn der Patient entsprechend informiert wurde.
Umbau einer Schilddrüsenpraxis
Authors: Knoop Anja
Published: August 2021

Nuklearmedizinische Praxen bestehen oft über Jahrzehnte in der gleichen Praxisfläche. In diesen großen Zeiträumen kommt es unweigerlichen zu gesetzlichen Änderungen. Das reicht von Anforderungen im nuklearmedizinischen Sinne bis hin zu bauordnungsrelevanten Änderungen wie beispielsweise Barrierefreiheit und Arbeitsschutz. Sind Modernisierungsmaßnahmen geplant und notwendig, ist der Umfang im Vorfeld zu untersuchen.
An Extraordinary Reconstruction of a Postoperative Defect after Metatarsophalangeal Joint Arthrodesis of the Big Toe Using the “Chinese Forearm Flap”
Authors: Ring Andrej
Published: August 2021

Background We present an unusual technique for reconstruction of a postoperative tissue defect following hallux rigidus surgery.

Methods A complicated course after left big toe arthrodesis resulted in a soft tissue defect with bone exposure of the first ray. Amputation of the big toe was categorically rejected by the patient. There was advanced arteriosclerosis with single-vessel supply to the foot via the posterior tibial artery.

Outcome To preserve the big toe, the defect was covered by a fasciocutaneous radial free flap with a 15 cm long vascular pedicle which was microanastomosed to the posterior tibial artery and its accompanying vein at the level of the medial malleolus.

Conclusion In certain extreme situations, the free “Chinese” radial flap can be quite effective in covering forefoot defects and allowing satisfactory and aesthetically pleasing soft tissue reconstruction.
Versorgungsbedarf in einer psychosomatischen Spezialambulanz für Geflüchtete an einem Universitätsklinikum
Authors: Beyer Thomas , Morawa Eva , Graemer Katrin , Erim Yesim
Published: August 2021

Hintergrund Nach der Fluchtbewegung von 2015 wurde vielfach festgestellt, dass die psychotherapeutischen Angebote nicht für den anzunehmenden Bedarf ausreichen können.

Fragestellung Ziel dieser Studie war es, anhand eines Fragebogens, die in einer Spezialambulanz an einer Regelversorgungseinrichtung durchgeführten Behandlungen zu untersuchen und deren spezifischen Aspekte festzustellen.

Material und Methoden Ablauf und Inhalte der psychotherapeutischen Behandlungen mit Geflüchteten wurden im Forscherteam diskutiert. Auf dieser Grundlage wurden die zu erwartenden Rahmenbedingungen und Interventionen in einem Fragebogen zusammengefasst. Dieser diente der retrospektiven Untersuchung der Behandlungen. Die Auswertung der Daten erfolgte rein deskriptiv.

Ergebnisse 60 Behandlungen von Geflüchteten konnten ausgewertet werden. Die Inhalte der untersuchten Behandlungen können in Interventionen, besondere Rahmenbedingungen, ärztlich-psychotherapeutische Maßnahmen und Beachtung kultureller sowie religiöser Aspekte gegliedert werden. Unsere Ergebnisse geben einen differenzierten Überblick über die Inhalte der Behandlungen bei einer psychisch hochbelasteten Patientengruppe. Das Festlegen der Sitzordnung in einem gedolmetschten Gespräch erfolgte bei 56, Psychoedukation bei 43, Affekt- und Stressregulation bei 32, die Thematisierung religiöser Aspekte bei 28 und die Behandlung mit Psychopharmaka bei 24 Geflüchteten.

Diskussion Unsere Ergebnisse zeigen, dass in den untersuchten Behandlungen stabilisierende Interventionen erfolgten, aber auch interkulturelle und religiöse Aspekte thematisiert wurden. Das Herstellen einer stabilen Beziehung zu den Geflüchteten wird vor allem beeinflusst durch interkulturelle sowie religiöse Aspekte und die Besonderheiten der Anwesenheit eines Dolmetschers und des Übersetzungsprozesses.
Gemeindepsychiatrische Krisenhilfen
Authors: Greve Nils
Published: August 2021

Der Beitrag beschreibt die Grundprinzipien und die praktische Funktionsweise regionaler, in das gemeindepsychiatrische Versorgungssystem eingegliederter Krisendienste. In Deutschland gab es lange Zeit nur einzelne Pilotprojekte, die anhand eines Beispiels kurz beschrieben werden. Selektivverträge mit einigen Krankenkassen und zuletzt die Verankerung regionaler Krisendienste in den Psychisch-Kranken-Gesetzen von Berlin und Bayern eröffnen zukünftig die Perspektive einer flächendeckenden ambulant-aufsuchenden Krisenintervention in Deutschland.
Synthesis of Nitrile-Functionalized Polydentate N-Heterocycles as Building Blocks for Covalent Triazine Frameworks
Authors: Stevens Christian V. , Everaert Jonas , Debruyne Maarten , Vanden Bussche Flore , Van Hecke Kristof , Heugebaert Thomas S. A. , Van Der Voort Pascal , Van Speybroeck Veronique
Published: August 2021

Covalent triazine frameworks (CTFs) based on polydentate ligands are highly promising supports to anchor catalytic metal complexes. The modular nature of CTFs allows to tailor the composition, structure, and function to its specific application. Access to a broad range of chelating building blocks is therefore essential. In this respect, we extended the current available set of CTF building blocks with new nitrile-functionalized N-heterocyclic ligands. This paper presents the synthesis of the six ligands which vary in the extent of the aromatic system and the denticity. The new building blocks may help in a rational design of enhanced support materials in catalysis.
Applying the Euclidean-signature semi-classical method to the quantum Taub models with a cosmological constant and aligned electromagnetic field
Authors: Berkowitz Daniel
Published: August 2021

We prove the existence of a countably infinite number of “excited” states for the Lorentzian-signature Taub–Wheeler–DeWitt (WDW) equation when a cosmological constant is present using the Euclidean-signature semi-classical method. We also find a “ground” state solution when both an aligned electromagnetic field and cosmological constant are present; as a result, conjecture that the Euclidean-signature semi-classical method can be used to prove the existence of a countably “infinite” number of “excited” states when the two aforementioned matter sources are present. Afterward, we prove the existence of asymptotic solutions to the vacuum Taub–WDW equation using the “no boundary” and “wormhole” solutions of the Taub Euclidean-signature Hamilton–Jacobi equation and compare their mathematical properties. We then discuss the fascinating qualitative properties of the wave functions we have computed. By utilizing the Euclidean-signature semi-classical method in the above manner, we further show its ability to prove the existence of solutions to Lorentzian-signature equations without having to invoke a Wick rotation. This feature of not needing to apply a Wick rotation makes this method potentially very useful for tackling a variety of problems in bosonic relativistic field theory and quantum gravity.
A physical realization of porpoise biosonar concerning sound reception
Authors: Song Zhongchang , Zhang Chuang , Zhang Jinhu , Ou Wenzhan , Zhang Yu
Published: August 2021

Finless porpoises have evolved to equip a unique sound reception system composed of acoustic structures with gradient sound speed and density to achieve sound reception. Through numerical simulations and experiments, we demonstrated that this reception feat can be accomplished through physical implementation. Using the effective medium theory, we built respective composites to form an artificial bioinspired receptor to mimic the sound reception system of porpoise. This paper introduces an alternate aspect to bridge the gap between natural biosonar and artificial construction, shedding lights on inspiring additional advanced sound reception designs and systems.
Semiempirical method for examining asynchronicity in metal–oxido-mediated C–H bond activation
Authors: Barman Suman K. , Yang Meng-Yin , Parsell Trenton H. , Green Michael T. , Borovik A. S.
Published: August 2021

Significance

There is considerable interest in understanding the role that asynchronicity plays in metal–oxido-mediated C–H bond activation. A semiempirical method is presented for gauging the relative importance of the free energies for proton transfer (PT) and electron transfer (ET) in determining the rate constants for C–H bond cleavage. The method deviates from traditional Bell–Evans–Polanyi analyses by examining the behavior of log (
k
) vs. a linear combination of PT and ET terms, rather than bond strengths. The appropriate combination of free energy terms is determined by the linearity of plots vs. log (
k
). We developed the approach by examining substrate oxidations by a Mn
IV
–oxido complex and applied it to data for other M–O(H) systems, indicating it has general applicability to other proton-coupled electron transfer (PCET) processes.
Zoo and exhibit design.
Authors: Rees Paul A.
Published: August 2021

This chapter contains questions on the methods used to contain animals, zoo design and the design of individual animal exhibits.
A-9 Representing the Underrepresented: An Examination of Racial/Ethnic Differences in TBI-Related Outcomes in U.S. Veterans Enrolled in the Million Veteran Program
Authors: Sakamoto McKenna S , Chanfreau-Coffinier Catherine , Delano-Wood Lisa , Program V A Million Veteran , Merritt Victoria C
Published: August 2021

Objective

Traumatic brain injury (TBI) research in Veterans is based primarily on non-Hispanic White samples, which does not reflect the diversity of the current military population. We examined the relationship between race/ethnicity and clinical outcomes in a large sample of Iraq/Afghanistan-era Veterans within the Million Veteran Program.

Method

Primary outcomes included injury characteristics, neurobehavioral-related symptoms, and employment status gleaned from the Comprehensive TBI Evaluation (CTBIE) for 7006 Veterans with a clinician-confirmed history of TBI. Logistic regressions adjusting for age, sex, and education examined the effect of race/ethnicity on CTBIE outcomes.

Results

Racial/ethnic groups included non-Hispanic White (n = 4203), Hispanic (¬n = 1302), non-Hispanic Black (n = 951), Asian (¬n = 205), Multiracial (¬n = 157), Native Hawaiian/Pacific Islander (−n = 91), and American Indian/Alaska Native (¬n = 79). Race/ethnicity was significantly associated with 5/10 CTBIE variables after applying Bonferroni-correction: blast exposure, loss of consciousness, post-traumatic amnesia (PTA), affective neurobehavioral symptoms, and unemployment (p’s < 0.0001). Relative to non-Hispanic Whites, Veterans self-identifying as Asian, non-Hispanic Black, and Hispanic were less likely to experience certain injury-related characteristics (e.g., blast exposure, PTA). Additionally, Asian and Native Hawaiian/Pacific Islander groups were less likely to endorse severe affective symptoms compared to White Veterans, whereas Black Veterans were more likely to endorse severe affective symptoms.

Conclusions

Results highlight that certain TBI outcomes—particularly those related to injury characteristics and affective symptoms—vary by race/ethnicity. An enhanced understanding of how outcomes are modified by race/ethnicity is vital so that clinical care can be appropriately tailored to the unique needs of racially and ethnically diverse Veterans. Future studies should further elucidate the relationship between race/ethnicity and TBI outcomes.
A-94 Characterization of Million Veteran Program (MVP) Enrollees with Comprehensive TBI Evaluation (CTBIE) Data: An Analysis of Neurobehavioral Symptoms
Authors: Ozturk Erin , Chanfreau-Coffinier Catherine , Sakamoto McKenna S , Merritt Victoria C , Delano-Wood Lisa
Published: August 2021

Objective

Using a large sample of U.S. Veterans enrolled in the Million Veteran Program (MVP), we sought to evaluate neurobehavioral symptoms obtained from the Veterans Health Administration’s Comprehensive Traumatic Brain Injury Evaluation (CTBIE).

Method

Eligible participants (N = 12,144) included MVP-enrolled Veterans who completed the CTBIE, a clinician-administered interview that assesses for historical, deployment-related TBIs and evaluates current symptoms using the Neurobehavioral Symptom Inventory (NSI). Clinicians completing the CTBIE made clinical determinations about each participant’s TBI diagnostic status (n = 7631 CTBIE+, n = 4513 CTBIE-) as well as likely symptom etiology (TBI: n = 612, Behavioral Health: n = 4965, Combination TBI and Behavioral Health [Comorbid]: n = 2773, Symptom Resolution; n = 750; and Other: n = 1282). We evaluated the association of TBI diagnostic group and symptom etiology group with neurobehavioral symptoms using ANCOVAs adjusted for sociodemographic characteristics.

Results

Results showed a significant effect of TBI on the NSI total score (p < 0.001, ηp2 = 0.02), with CTBIE+ Veterans endorsing greater symptoms than CTBIE- Veterans. There was also a significant association of symptom etiology group with the NSI total score (p < 0.001, ηp2 = 0.07). Post-hoc analyses showed that the Behavioral Health and Comorbid groups endorsed significantly greater symptoms compared to the TBI, Symptom Resolution, and Other groups. A similar pattern of results was found for all NSI symptom domain scores (vestibular, somatic, cognitive, and affective) and symptom breadth scores.

Conclusions

Findings from this large epidemiologic MVP study bolster prior work suggesting that behavioral health (e.g., depression, PTSD) greatly contributes to post-concussive symptom endorsement in chronic TBI. Results further highlight the importance of prioritizing mental health treatment in this vulnerable population.
A-95 The Relationship between Attention Deficit Hyperactivity Disorder (ADHD) and Vestibular Impairments Following Adolescent Sports-Related Concussion (SRC)
Authors: Gilliland Taylor , Reynolds Erin , Covert Kayla , Bennett Monica , Driver Simon
Published: August 2021

Objective

Athletes with ADHD may experience longer and/or more complicated recoveries following SRC; however, previous research has focused on neurocognitive outcomes. The objective of this study was to investigate the relationship between a history of ADHD among adolescent athletes and vestibular impairments following SRC.

Method

Participants included 166 athletes aged 15.9 +/− 1.5 who sustained an SRC, including 25 with a documented history of ADHD. Appropriate summary statistics were used to describe the data. ADHD and non-ADHD groups were compared using t-tests and Mann–Whitney U tests for continuous variables and Chi-square tests for categorical variables. A linear regression model analyzed the relationship between a history of ADHD and vestibular outcomes including horizontal and vertical vestibulo-ocular reflex (hVOR; vVOR), visual motion sensitivity (VMS), and Dizziness Handicap Index (DHI), while referral to vestibular therapy (VT) was analyzed using logistic regression.

Results

Athletes with ADHD experienced significantly higher rates of on-field dizziness, (p = 0.039) and dizziness following vVOR testing on the Vestibular/Ocular Motor Screening (VOMS; p = 0.041). Athletes with ADHD were more likely to be referred to vestibular therapy (VT) (p = 0.033) and displayed abnormal vVOR test during the initial VT visit (p = 0.040).

Conclusions

Adolescent athletes with a history of ADHD are more likely to report on-field dizziness following SRC and increased dizziness with vVOR testing on VOMS, thus resulting in more frequent referrals to VT, where they also display abnormal vVOR results. Additional research is needed to improve treatment strategies and recovery outcomes in athletes after SRC.
A-96 Stability of ImPACT’s Latent Structure from Baseline to Post Concussion Assessment
Authors: Goodwin Grace J , Maietta Julia E , Ahmed Anthony O , Hopkins Nia A , Moore Sara A , Rodrigues Jessica , Pascual Melanie S , Kuwabara Hana C , Kinsora Thomas F , Ross Staci R , Allen Daniel N
Published: August 2021

Objective

ImPACT is commonly used for sport-concussion management. Baseline and post-concussion tests serve as within-athlete comparisons for return-to-play decision-making. Previous literature has questioned whether ImPACT’s five composites accurately represent the internal structure of its cognitive scores. A recent alternative four-factor structure has strong confirmatory evidence for baseline scores (Maietta et al., doi:10.1037/pas0001014). The present study examined the stability of these constructs post-concussion.

Method

The current study utilized a case-matched design (age, sex, sport category) to select a sample of 3560 high school athletes’ baseline (n = 1780) and post-concussion (n = 1780) assessments. Multi-group CFA of first-order, hierarchical, and bifactor models was conducted to assess measurement invariance (configural, metric, scalar, and residual invariance) between baseline and post-concussion samples. Change in comparative fit indices was interpreted as the primary indicator of model invariance.

Results

ImPACT’s five composite structure, as well as the hierarchical and bifactor models, exhibited inadequate fit to the baseline and post-concussion data. The four-factor model demonstrated superior fit in the baseline sample and good fit in the post-concussion sample. The four-factor structure demonstrated invariance across injury status (baseline to post-concussion).

Conclusion

Given that ImPACT’s scores are used for return-to-play decision-making, it is important that they are psychometrically sound. Recent literature suggests that ImPACT’s five composites are not an adequate representation of the cognitive constructs. Findings support validity of the four-factor structure despite injury status, suggesting these cognitive constructs are assessable at both pre- and post-concussion. Additional research is needed to determine implications of these findings for tracking cognitive change following sport-related concussion and making return-to-play decisions.
A-100 Examining Spanish-English Bilingual Boston Naming Test Norms in Traumatic Brain Injury Survivors
Authors: Baez Abril , Lopez-Hernandez Daniel W , Olmos Winter , Rough-Fraser Rachel A , Smith Kristina E , Bueno Alexis , Munoz Isabel C , Saravia Sarah , Budding Deborah , Vespa Paul , Hovda David A , Litvin Pavel Y , Graub Nick , McArthur David l , Plurad David , Fatoorechi Sarah , Woo Ellen , Hardy David J , Wright Matthew J
Published: August 2021

Objective

We examined two established Spanish-English bilingual norms to assess if traumatic brain injury (TBI) deficits were still found if language was no longer a variable influencing Boston Naming Test (BNT) performance.

Method

The sample consisted of 47 healthy comparison (HC; 24 English-Monolinguals; 23 Spanish-English Bilinguals), 33 acute TBI (ATBI; 20 English-Monolinguals; 13 Spanish-English Bilinguals), and 25 Chronic TBI (CTBI: 13 English-Monolinguals; 12 Spanish-English Bilinguals) participants. Raw scores and adjusted demographic T-scores (Roberts et al., 2002; Rosselli et al., 1997) were used to evaluate BNT performance.

Results

An ANCOVA controlling for age, revealed the HC group outperformed the TBI group on the BNT (raw score), p = 0.003, ηp2 = 0.11. We also found monolinguals outperformed bilinguals on the BNT, p = 0.000, ηp2 = 0.24. Using the Roberts et al., (2002) norms, we found the HC group outperformed the TBI group, p = 0.003, ηp2 = 0.11, but no language differences were found. Next, using Rosselli et al., (1997) norms, we found the HC group outperformed the TBI group on the BNT, p = 0.003, ηp2 = 0.11, and monolingual speakers outperformed bilingual speakers, p = 0.014, ηp2 = 0.06. No interactions were found.

Conclusions

As expected, the TBI group demonstrated worse BNT performance compared to HC group on both language norms. However, when using Roberts et al., (2002) Spanish-English bilingual norms, no language group differences were found. Our data indicates that when examining BNT performance in a Spanish-English bilingual and English-monolingual TBI sample, Roberts et al., (2002) normative data may be better suited to evaluate BNT deficits in a TBI while taking language into account.
A-101 Reaction Time and Reaction Time Variability with the Brain Gauge Somatosensory Device in Service Members with and without Acute Concussion
Authors: Cole Wesley , Ivins Brian J , Arrieux Jacques P , Crawford Haley R , Tommerdahl Mark , Jorgensen-Wagers Kendra
Published: August 2021

Objective

Research has demonstrated reaction time variability (RTV) as a potentially sensitive metric for post-concussion assessments. The Brain Gauge Clinical Metrics battery (BG) device uses tactile sensory stimulation to elicit a response, increasing accuracy to <1 msec versus 30–100 msec in visually-based reaction time (RT) measures. We sought to determine if BG RTV could adequately identify individuals with acute concussion.

Methods

We administered BG to 98 healthy control service members (SMs) and 64 SMs within 7 days of a medically diagnosed concussion. The battery includes simple RT and repeated simple RT subtests with RT variability (RTV) for each test calculated as the sd of mean RT for each participant. We used t-tests and gamma regression to compare group RT and RTV means. “Cutoffs” based on percentiles of the control group RTV distribution were calculated and the proportion of each group falling below these cutoffs was determined.

Results

There were statistically significant differences with large effect sizes between groups across all four metrics. The proportion of participants in the concussion group falling below the cutoffs was higher than among controls, with large effect sizes. T-tests and gamma regression showed that group mean RT and RTV differed significantly under multiple distributional assumptions.

Conclusions

Both RT and RTV using the BG somatosensory device demonstrated the ability to discriminate between healthy control SMs and SMs with acute concussion. This is further evidence that RTV is a sensitive measure for acute concussion and the use of a tactile sensory stimulus may represent an improvement over a visual stimulus.
A-103 Examining Self-Awareness in Acute Stroke and Traumatic Brain Injury Populations
Authors: Watorek Vanessa , Shwartz Susan , Day Chelsea
Published: August 2021

Objective

Following acquired brain injury (ABI), self-awareness of deficits is frequently diminished. A review of the literature suggests most investigations of self-awareness following ABI have been in traumatic brain injury (TBI) populations, with emerging research in those with stroke (e.g., Al Banna et al., 2016). Therefore, this study examined self-awareness across diagnoses, neuroanatomical correlates, and demographics.

Method

Participants included 82 patients (TBI n = 59 and stroke n = 23) from an inpatient ABI unit. Patients, neuropsychologists, and family members completed the Awareness Questionnaire (AQ). The difference between patient-clinician or patient-family total score was examined, with scores >20 suggestive of impaired self-awareness.

Results

Participants with left-hemisphere (LH) injury endorsed higher functioning (Patient Total) compared to those with right or bilateral injury, p 0.05. However, there was greater difference scores between those with TBI compared to stroke on patient-clinician total cognitive scores t(80) = 2.125, p = 0.037 and patient-family behavioral/affective total scores t(15.86) = 4.045, p < 0.001 such that those with TBI’s were more aware of their deficits. Regarding demographics, level of education predicted level of patient awareness, but no demographic factors predicted the overall difference score.

Conclusions

Individuals with LH injury may be more prone to reduced awareness than expected. Additionally, specific domains of functioning may be more useful in examining awareness deficits across diagnostic groups than overall scores.
A-108 Psychological and Sociodemographic Challenges, but Not History of Mild Traumatic Brain Injury, Is Associated with Criminal Justice Involvement among Veterans and Service Members
Authors: Gius Becky , Fournier Lauren F , Reljic Tea , Pogoda Terri , Corrigan John , Garcia Amanda , Troyanskaya Maya , Miles Shannon
Published: August 2021

Objective

Examine factors associated with history of arrests and felony incarceration among Veterans and Service Members (V/SM) with combat exposure.

Method

Participants were V/SM who completed a baseline assessment for the multicenter Chronic Effects of Neurotrauma Consortium study (N = 1555). Most were male (87%), white (72%), with a mean age of 40 years (SD = 9.71). The majority (83%) reported a history of ≥1 mild traumatic brain injury (mTBI), with thirty-five present of those experiencing 3+ mTBIs.

Results

Three groups were composed based on self-reported level of involvement with the criminal justice system: 1.) No history of arrests or incarcerations (65%), 2.) A lifetime history of arrest but no felony incarceration (32%), and 3.) A lifetime history of felony incarceration (3%). Chi-square and Kruskal-Wallis H tests revealed statistically significant differences between the groups in demographic factors including the incarcerated group having younger age, greater percentage of men, lower education, and greater percentage of never being married, followed by the arrest group and then the no arrest group (all p < 0.05). The incarcerated group also had the highest level of posttraumatic stress disorder (PTSD) symptoms, lowest social support, and greatest percentage of hazardous alcohol consumption, followed by the arrest and then the no arrest groups (all p < 0.05). No differences were found between groups for mTBI history or neuropsychological testing results.

Conclusions

Correlates of legal involvement among V/SM span demographic and psychological dimensions. Some correlates are modifiable, including social support, PTSD symptoms, and alcohol consumption. Addressing these modifiable risk factors is critical to lower the risk of future criminal justice involvement.
A-118 Efficacy of Computerized Cognitive Rehabilitation Programs in Treating Warfighters with a History of Mild Traumatic Brain Injury
Authors: Bailie Jason , Westphal Alia , Basham Angela , Lopez Juan , Caswell Melissa , Babakhanyan Ida
Published: August 2021

Background

Computerized cognitive rehabilitation programs (CCRP) have gained popularity in recent years. The objective of this study was to investigate the efficacy of CCRP in military personnel with a prior mTBI.

Methods

21 active-duty service members with a history of mTBI were enrolled in the randomized clinical trial. Participants completed one of two CCRPs (Lumosity or the University of California Riverside Brain Game Center). Primary dependent variable was the Key Behavioral Change Inventory (KBCI) with eight scales: Inattention, Impulsivity, Unawareness of problems, Apathy, Interpersonal difficulty, Communication problems, Somatic difficulties, and Emotional adjustment. Other variables included age, education, number of mTBIs, years since last mTBI, total lifetime years of repetitive head injury (RHI).

Results

There was a significant reduction in Somatic Difficulties post-treatment (p = 0.029) with trends towards reductions on Inattention (p = 0.077) and Apathy (p = 0.064). 19/21 (90%) of participants had improvement in at least one KBCI scale (i.e., at least one point change), 14/21 (66%) had 3 or more scales improved, and 7/21 (67%) had 5 or more scales improved. Total number of scales improved was correlated with years since TBI (rho = 0.38, p = 0.044) and years of RHI (rho = 0.459, p = 0.018).

Conclusions

CCRP had modest efficacy in improving persistent symptoms following a mTBI. Fewer years since mTBI and fewer number of years of RHI were associated with better treatment response.
A-124 Sleep Quality and Quantity in Individuals Aging with Traumatic Brain Injury: Associations with Psychosocial Outcomes and Health Conditions
Authors: Riccitello Rachael M , Rabinowitz Amanda R , Venkatesan Umesh M , Dell Kristine C , Vervoordts Samantha M , Hillary Frank G
Published: August 2021

Objective

To examine the association of sleep quality/duration with chronic health conditions, psychological distress, and quality of life (QOL) in older adults with chronic traumatic brain injury (TBI).

Methods

120 older adults (x-age = 64.2 ± 8.3) 1 or more years (med = 9.8, range = 1.1–45.6) post moderate–severe TBI reported on history of chronic health conditions and current sleep duration and quality. Participants were categorized by sleep duration (< 6, 6–8, >8 hours) and whether or not they felt well-rested. Outcome measures were QOL (Quality of Life after Brain Injury questionnaire) and psychological distress (Brief Symptom Inventory-18).

Results

65% of individuals reported receiving 6–8 hours of sleep; 78% reported feeling well-rested. 17.5% reported no health conditions, 47.5% one condition, and 35% reported two or more. High blood pressure, high cholesterol, and diabetes were the most common. Number of health conditions was not related to sleep quality χ2(2,N = 120) =0.83, p = 0.66, or quantity, χ2(4,N = 120) =7.4, p = 0.12. MANCOVA controlling for age, chronicity, and injury severity revealed a significant association between poor sleep quality and decreased QOL across multiple life domains, V = 0.30, F(6,105) = 4.6, p < 0.001, ηp2 = 0.21. Sleep duration was also associated with QOL, Λ = 0.80, F(12,208) = 2.1, p < 0.05, ηp2 = 0.108. In ANCOVAs, poor sleep quality was related to increased psychological distress, F(1,110) = 18.3, p < 0.001, ηp2 = 0.142, but sleep duration was not, F(2,109) = 2.2, p = 0.12, ηp2 = 0.038.

Conclusion

Although most participants received the recommended amount of sleep, poor sleep quality/quantity were associated with poorer QOL and sleep quality was additionally associated with psychological distress. Chronic health conditions were prevalent in the sample, but not related to self-reported sleep quality/duration.
A-131 Treating Parkinson’s Disease with Mindfulness: A Systematic Review
Authors: Lemke Jillian , Corbin Christopher
Published: August 2021

Objective

Mindfulness has been recognized as an evidence-based treatment in a range of psychological and medical (i.e., chronic pain, dementia, diabetes) conditions. Despite several randomized and non-randomized control trials, there continues to be a lack of consensus regarding mindfulness as an effective treatment for individuals with Parkinson’s disease (PD).

Methods

PsychINFO, Medline, ProQuest, and Embase, were searched using a combination of terms such as “Parkinson’s” and “Mindfulness” or “Meditation.” Studies were included if they reported method, participants, interventions used, and outcomes. Results were extracted and assessed for quality and relevance.

Data Synthesis

The systematic analysis revealed that mindfulness was primarily effective in reducing non-motor symptoms of PD, except for one survey study of PD patients, which indicated that mindfulness was associated with improved motor symptoms. Otherwise, mindfulness resulted in decreased anxiety and distress while also improving social support. Of the two studies that included caregivers in treatment, mindfulness was associated with reduced caregiver burden.

Conclusion

The results supported the use of mindfulness as an effective adjunct to PD treatment, with the strongest effects on non-motor symptoms and caregiver distress. Notably, the studies included were limited by small sample sizes and patients with mild to moderate symptoms of PD. Further random controlled trials with larger sample sizes and differing degrees of PD severity are needed to conclusively determine the effects of mindfulness in treating PD.