Validation of a Multimodal EEG-Based Index to Aid in Diagnosing and Tracking Concussion Among Athletes

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S20.3-S21
Author(s):  
Jeffrey J. Bazarian ◽  
Leslie S. Prichep
Keyword(s):  
Brain Function ◽  
Injury Severity ◽  
Symptom Burden ◽  
Self Report ◽  
Return To Play ◽  
Neurocognitive Performance ◽  
Convenience Sample ◽  
Standard Assessment ◽  
Prolonged Recovery ◽  
Objective Marker

ObjectiveThe goal of this study was to validate an EEG based multimodal index to aid in the assessment of concussion at time of injury, severity of concussion, and aid in evaluating readiness to return to play/activity.BackgroundThe absence of a gold standard for diagnosis of concussion results in reliance on subjective self-report of symptoms. EEG has been demonstrated to be sensitive to changes in brain function following head injury, especially in connectivity. Using machine learning with inputs primarily from EEG measures, and including multimodal inputs, an objective marker of the likelihood of concussion (Concussion Index, CI) was derived.Design/MethodsMale and female concussed athletes and controls ages of 13–25 years, represented a convenience sample (n = 580), enrolled from US High School, Colleges, and Concussion Clinics. Concussed subjects had a witnessed head impact and were removed from play by site guidelines. Assessments were performed within 72 hours of injury, at clinically determined return to play (RTP), 45 days following RTP, and included EEG (frontal and frontotemporal regions), neurocognitive performance, and standard concussion assessments.ResultsSensitivity = 85.99%, Specificity = 70.78%, NPV = 90.10% and PPV = 62.02, were obtained. Results demonstrated significance: (1) between CI at injury compared to RTP (p < 0.0001); (2) between CI in patients with rapid (<14 days) compared with those with prolonged recovery (=14 days), (p = 0.0038); (3) stability over time in controls (p < 0.0001); and (4) between CI and total symptom burden (correlation coefficient 0.8031, p < 0.0001).ConclusionsThis study independently validated a multimodal, EEG-based, objective index of concussion (CI). The neurotechnology platform incorporating this capability is handheld, rapid to use, and lends itself to incorporation into the standard assessment of concussion to aid in clinical diagnosis and assessment of readiness to RTP. This data supported the FDA clearance for the Concussion Index (embedded in the BrainScope medical device).

Differences in Reward and Persistency characterise Behavior in Chronic Pain for the Iowa Gambling Task in a Web-based Lab-in-the-field study (Preprint)

2020 ◽  
Author(s):  
Lili Zhang ◽  
Himanshu Vashisht ◽  
Alekhya Nethra ◽  
Brian Slattery ◽  
Tomas Ward
Keyword(s):  
Decision Making ◽  
Social Media ◽  
Chronic Pain ◽  
Iowa Gambling Task ◽  
Learning Curves ◽  
Self Report ◽  
Healthy Controls ◽  
Gambling Task ◽  
Convenience Sample ◽  
Pain Experiences

BACKGROUND Chronic pain is a significant world-wide health problem. It has been reported that people with chronic pain experience decision-making impairments, but these findings have been based on conventional lab experiments to date. In such experiments researchers have extensive control of conditions and can more precisely eliminate potential confounds. In contrast, there is much less known regarding how chronic pain impacts decision-making captured via lab-in-the-field experiments. Although such settings can introduce more experimental uncertainty, it is believed that collecting data in more ecologically valid contexts can better characterize the real-world impact of chronic pain. OBJECTIVE We aim to quantify decision-making differences between chronic pain individuals and healthy controls in a lab-in-the-field environment through taking advantage of internet technologies and social media. METHODS A cross-sectional design with independent groups was employed. A convenience sample of 45 participants were recruited through social media - 20 participants who self-reported living with chronic pain, and 25 people with no pain or who were living with pain for less than 6 months acting as controls. All participants completed a self-report questionnaire assessing their pain experiences and a neuropsychological task measuring their decision-making, i.e. the Iowa Gambling Task (IGT) in their web browser at a time and location of their choice without supervision. RESULTS Standard behavioral analysis revealed no differences in learning strategies between the two groups although qualitative differences could be observed in learning curves. However, computational modelling revealed that individuals with chronic pain were quicker to update their behavior relative to healthy controls, which reflected their increased learning rate (95% HDI from 0.66 to 0.99) when fitted with the VPP model. This result was further validated and extended on the ORL model because higher differences (95% HDI from 0.16 to 0.47) between the reward and punishment learning rates were observed when fitted on this model, indicating that chronic pain individuals were more sensitive to rewards. It was also found that they were less persistent in their choices during the IGT compared to controls, a fact reflected by their decreased outcome perseverance (95% HDI from -4.38 to -0.21) when fitted using the ORL model. Moreover, correlation analysis revealed that the estimated parameters had predictive value for the self-reported pain experiences, suggesting that the altered cognitive parameters could be potential candidates for inclusion in chronic pain assessments. CONCLUSIONS We found that individuals with chronic pain were more driven by rewards and less consistent when making decisions in our lab-in-the-field experiment. In this case study, it was demonstrated that compared to standard statistical summaries of behavioral performance, computational approaches offered superior ability to resolve, understand and explain the differences in decision- making behavior in the context of chronic pain outside the lab.

Relationship between medication adherence and psychosocial adjustment in patients with type 2 diabetes: A cross-sectional study

2020 ◽  
Vol 40 (3) ◽  
pp. 116-122
Author(s):  
Duygu Kes ◽  
Feray Gökdoğan
Keyword(s):  
Type 2 Diabetes ◽  
Psychosocial Adjustment ◽  
Large City ◽  
Psychosocial Care ◽  
Self Report ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Adherence To Medication ◽  
The Relationship

Adherence to drug treatment is a multidimensional concept. It is affected by many factors, such as physiological, psychological, family, environmental and social conditions. However, relatively little is known about the relationship between adherence to medication and psychosocial adjustment. The aim was to explore the relationship between adherence to antidiabetic drugs and the psychosocial adjustment of patients with type 2 diabetes mellitus. This cross-sectional descriptive correlational study was conducted between March and June 2018. A convenience sample of participants was recruited from seven internal disease outpatient clinics at a public tertiary hospital, located in a large city that serves as a gateway to nearby rural and urban areas in the north-west region of Turkey. Data were collected using the Adherence to Refills and Medications Scale (ARMS-7), and the Psychosocial Adjustment to Illness Scale–Self Report (PAIS–SR). This study is reported in accordance with STROBE. Pearson’s correlation analysis found a significant weak positive correlation between all domains of the PAIS–SR and the total scores on the ARMS‐7. The participants’ scores on medication refill were found to be significantly and positively correlated with all of the PAIS–SR domain scores except the sexual relationships domain. Psychosocial care could play a crucial role in improving drug regimen adherence among patients with diabetes. Therefore, nurses should integrate psychosocial care into daily practice.

Comparing Traumatic Brain Injury Symptoms Reported via Questionnaires Versus a Novel Structured Interview

2021 ◽  
pp. 1-11
Author(s):  
Natalie A. Emmert ◽  
Georgia Ristow ◽  
Michael A. McCrea ◽  
Terri A. deRoon-Cassini ◽  
Lindsay D. Nelson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Response Bias ◽  
Minnesota Multiphasic Personality Inventory ◽  
Assessment Tool ◽  
Symptom Burden ◽  
Structured Interview ◽  
Self Report ◽  
Symptom Reporting ◽  
Clinical Interviews

Abstract Objective: Mild traumatic brain injury (mTBI) symptoms are typically assessed via questionnaires in research, yet questionnaires may be more prone to biases than direct clinical interviews. We compared mTBI symptoms reported on two widely used self-report inventories and the novel Structured Interview of TBI Symptoms (SITS). Second, we explored the association between acquiescence response bias and symptom reporting across modes of assessment. Method: Level 1 trauma center patients with mTBI (N = 73) were recruited within 2 weeks of injury, assessed at 3 months post-TBI, and produced nonacquiescent profiles. Assessments collected included the SITS (comprising open-ended and closed-ended questions), Rivermead Post Concussion Symptoms Questionnaire (RPQ), Sport Concussion Assessment Tool-3 (SCAT-3) symptom checklist, and Minnesota Multiphasic Personality Inventory-2 Restructured Form True Response Inconsistency (TRIN-r) scale. Results: Current mTBI symptom burden and individual symptom endorsement were highly concordant between SITS closed-ended questions, the RPQ, and the SCAT-3. Within the SITS, participants reported significantly fewer mTBI symptoms to open-ended as compared to later closed-ended questions, and this difference was weakly correlated with TRIN-r. Symptom scales were weakly associated with TRIN-r. Conclusions: mTBI symptom reporting varies primarily by whether questioning is open- vs. closed-ended but not by mode of assessment (interview, questionnaire). Acquiescence response bias appears to play a measurable but small role in mTBI symptom reporting overall and the degree to which participants report more symptoms to closed- than open-ended questioning. These findings have important implications for mTBI research and support the validity of widely used TBI symptom inventories.

Androgen deprivation therapy and radiation for prostate cancer—cognitive impairment, sleep, symptom burden: a prospective study

2021 ◽  
pp. bmjspcare-2021-003098
Author(s):  
Joshua Tulk ◽  
Joshua A Rash ◽  
John Thoms ◽  
Richard Wassersug ◽  
Brian Gonzalez ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cognitive Impairment ◽  
Androgen Deprivation Therapy ◽  
Sleep Onset ◽  
Symptom Burden ◽  
Physical Symptoms ◽  
Androgen Deprivation ◽  
Self Report ◽  
Subjective Cognitive Decline ◽  
Subjective Time

ObjectivesThis paper (1) sought to compare sleep, mood and physical symptom profiles of men with prostate cancer (PCa) who experienced subjective and objective cancer-related cognitive impairment (CRCI) during the first year of treatment and (2) examine if fluctuations in mood and physical symptoms are associated with change in subjective or objective CRCI.MethodsThis prospective observational cohort study examined 24 new patients with PCa receiving androgen deprivation therapy (ADT) and radiation therapy (RT) during the first 12 months of treatment. Participants completed subjective and objective assessments of cognition, sleep continuity and self-report measures of insomnia, fatigue, depression and anxiety. Independent sample t-tests, correlations and hierarchical regressions were used to compare groups, explore associations, and assess change over time. Effects are reported as corrected Cohen’s d (dc).ResultsMen with objective CRCI reported worse subjective time asleep (dc=0.47) and more depression (dc=0.55). Men with subjective CRCI reported worse insomnia (dc=0.99), hot flashes (dc=0.76), sleep quality (dc=0.54), subjective total sleep time (dc=0.41), wake after sleep onset (dc=0.71), sleep efficiency (dc=0.49), fatigue (dc=0.67) and objectively estimated sleep latency (dc=0.72) than men without subjective CRCI. Declines in perceived cognition was associated with higher anxiety (p=0.05), fatigue (p≤0.01) and symptoms of insomnia (p=0.01). Finally, subjective time awake during the night (p=0.03) and fatigue (p=0.02) were associated with subjective cognitive decline, controlling for objective change.ConclusionsSubjective concerns of CRCI appear more critical to patient experience than objective measurements in men with PCa who have received RT and ADT. Interventions to improve sleep may result in an improved perception of cognition.

The Role of Maternal Self-efficacy in the Link Between Childhood Maltreatment and Maternal Stress During Transition to Motherhood

2021 ◽  
pp. 088626052110428
Author(s):  
Gabriella Bentley ◽  
Osnat Zamir
Keyword(s):  
Childhood Abuse ◽  
Childhood Maltreatment ◽  
Parental Stress ◽  
Self Efficacy ◽  
Self Report ◽  
Convenience Sample ◽  
History Of Childhood ◽  
Transition To Motherhood ◽  
History Of

The transition to motherhood is a significant developmental milestone in many women’s lives. This transitional period may be more stressful for women with a history of childhood maltreatment (CM) than for women without such a history. This study tested whether parental self-efficacy (PSE) accounts for the link between CM and parental stress in mothers transitioning to motherhood. The study used a convenience sample of 1,306 first-time mothers of children aged two years or younger. Mothers filled out online self-report questionnaires assessing history of CM, PSE, and prenatal stress. Consistent with the hypotheses, exposure to CM was directly associated with greater parental stress. Also, PSE partially mediated the associations between CM and parental stress, such that mothers with a history of childhood abuse reported a lower level of PSE, which in turn was associated with greater parental stress. In conclusion, the study highlights the important role of negative cognitions related to parenting for maternal dysfunction following exposure to childhood abuse. These findings suggest a need to incorporate preventive interventions designed to promote PSE for mothers exposed to CM. Such programs may alleviate parental stress and further support the healthy development of the child.

The development and internal consistency of the comprehensive lower limb amputee socket survey in active lower limb amputees

2018 ◽  
Vol 43 (1) ◽  
pp. 80-87 ◽  
Author(s):  
Robert Gailey ◽  
Anat Kristal ◽  
Jennifer Lucarevic ◽  
Shane Harris ◽  
Brooks Applegate ◽  
...  
Keyword(s):  
Internal Consistency ◽  
Lower Limb ◽  
Self Report ◽  
Cronbach’S Alpha ◽  
Convenience Sample ◽  
Cronbach's Alpha ◽  
Prosthetic Socket ◽  
Lower Limb Amputee ◽  
Report Measure ◽  
Lower Limb Amputees

Background: Prosthetic socket fit is an important element associated with successful ambulation and use of a prosthesis. Prosthetists and rehabilitation clinicians would benefit from an assessment tool that discriminates between and quantifies the multiple determinants that influence the lower limb amputee’s performance and satisfaction of a prosthetic socket. Objectives: To determine the internal consistency of the comprehensive lower limb amputee socket survey, a new self-report measure of prosthetic socket satisfaction that quantifies suspension, stability, comfort, and appearance. Study design: Cross-sectional sample of active amputees. Methods: Interviews were conducted with prosthetists, physical therapists, and lower limb amputees to identify clinical concerns and common activities influencing socket fit. An expert panel of five clinicians reviewed the items and constructed the original version of the comprehensive lower limb amputee socket survey which was then administered to a convenience sample of 47 active lower limb amputees. Item analysis and Cronbach’s alpha were used to determine the final version of the comprehensive lower limb amputee socket survey. Results: Following item raw score-to-total score correlation with Cronbach’s alpha for comprehensive lower limb amputee socket survey determinants, internal consistency improved when nine questions were eliminated. Conclusion: The comprehensive lower limb amputee socket survey is a self-report measure of prosthetic socket satisfaction with very good internal consistency. Clinical relevance When socket problems occur, the ability to determine the specific cause can reduce modification time, enhance socket fit, and promote patient satisfaction. A standardized multi-dimensional assessment measure of socket satisfaction enables prosthetists to quantify the multiple determinants of socket satisfaction, improve patient communication, and demonstrate the value of socket interventions.

Extended Breastfeeding in Poland: Knowledge of Health Care Providers and Attitudes on Breastfeeding Beyond Infancy

2018 ◽  
Vol 35 (2) ◽  
pp. 371-380 ◽  
Author(s):  
Barbara Baranowska ◽  
Marta Malinowska ◽  
Ewelina Stanaszek ◽  
Dorota Sys ◽  
Grażyna Bączek ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Health Professionals ◽  
Further Education ◽  
Self Report ◽  
Care Providers ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Level Of Knowledge ◽  
The Relationship

Background: Extended breastfeeding is rare in Poland, and lack of acceptance and understanding is often evident in public opinion. The ability to provide reliable information about breastfeeding beyond infancy depends on health professionals’ levels of knowledge and attitudes. They are considered by most parents in Poland to be authorities in the field of child nutrition. Research aims: To determine (1) the level of knowledge and the attitudes of Polish health professionals towards extended breastfeeding; (2) the relationship between personal breastfeeding experience and attitudes towards extended breastfeeding; and (3) the relationship between knowledge about breastfeeding beyond twelve months and attitudes towards breastfeeding beyond infancy. Methods: A one-group prospective, cross-sectional, self-report style survey was used. The convenience sample ( N = 495) comprised gynaecologists, neonatologists and midwives. Data were collected via an online questionnaire and the results were analyzed with the use of descriptive statistics, a chi-square independence test, Fisher’s exact test, post-hoc testing, and two-part tables using SPSS. Results: Most of the respondents (76.7%; n = 384) had a low level of knowledge about the benefits of breastfeeding beyond twelve months and even emphasized that this nutritional choice could have negative impacts. There was a positive correlation ( F = 105.847; p = < .01) between levels of knowledge and respondents’ attitudes towards breastfeeding beyond infancy. Attitudes were also influenced by the length of time respondents had breastfed. Conclusion: Healthcare providers have an insufficient level of knowledge about extended breastfeeding and need further education in this area.

scholarly journals Evaluation of a short version of the Experiences in Close Relationships-Revised questionnaire (ECR-RD8): results from a representative German sample

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Johannes C. Ehrenthal ◽  
Johannes Zimmermann ◽  
Katja Brenk-Franz ◽  
Ulrike Dinger ◽  
Henning Schauenburg ◽  
...  
Keyword(s):  
Close Relationships ◽  
Full Scale ◽  
Self Report ◽  
Future Research ◽  
Short Version ◽  
German Population ◽  
Attachment Insecurity ◽  
Convenience Sample ◽  
Norm Values ◽  
Experiences In Close Relationships

Abstract Background Attachment insecurity is a prominent risk factor for the development and course of psychiatric and psychosomatic disorders. The Experiences in Close Relationships - Revised (ECR-R) questionnaire is a widely used self-report to assess attachment related anxiety and avoidance. However, its length has the potential to restrict its use in large, multi-instrument studies. The aim of this study was to develop and evaluate a brief version of the ECR-R, and provide norm values for the German population. Methods A screening version of the original ECR-R was developed through principal components analysis of datasets from several previous studies. In a representative sample of 2428 randomly selected individuals from the German population, we compared fit indices of different models by means of confirmatory factor analyses (CFA). We investigated the convergent validity of the screening version in an independent convenience sample of 557 participants. Correlations between the short and the full scale were investigated in a re-analysis of the original German ECR-R evaluation sample. Results CFA indicated a satisfactory model fit for an eight-item version (ECR-RD8). The ECR-RD8 demonstrated adequate reliability. The subscales correlated as expected with another self-report measure of attachment in an independent sample. Individuals with higher levels of attachment anxiety, but especially higher levels of attachment avoidance were significantly more likely to not be in a relationship, across all age groups. Correlations between the short and the full scale were high. Conclusions The ECR-RD8 appears to be a reliable, valid, and economic questionnaire for assessing attachment insecurity. In addition, the reported population-based norm values will help to contextualize future research findings.

scholarly journals Self-reported hearing status and audiometric thresholds among college students using headphones

2021 ◽  
Vol 13 (3) ◽  
pp. 60-68
Author(s):  
Yash Shrimal ◽  
Aparna Nandurkar
Keyword(s):  
Management Strategies ◽  
Self Report ◽  
Convenience Sample ◽  
Hearing Sensitivity ◽  
Hearing Status ◽  
College Going ◽  
Hearing Thresholds ◽  
Hearing Difficulty ◽  
Listening Habits ◽  
Insert Earphones

Purpose: The study aims to investigate headphone listening habits of college-going students and for those using headphones, correlate self-reported hearing status with average audiometric hearing thresholds. Method: Headphone listening habits and awareness of adverse effects of the same was profiled in college-going students using a questionnaire distributed through online platform. Hearing thresholds were then compared for those with and without self-report of hearing difficulty. 341 responses were obtained from students between 17 and 23 years of age. For the second part of the study, a convenience sample of 30 willing students from among these 341 was selected. Pure tone thresholds were obtained for various frequencies with a high frequency audiometer. PTA (average of 500, 1000, 2000 Hz) and HFPTA (average of 4000, 6000, 8000, 10000 Hz) were calculated for both the ears and compared for those with and without reported hearing difficulty. Results: 78% students reported headphone usage for less than 3 hours per day, while 22% reported usage for more than 3 hours per day. 77% respondents were aware that listening to loud sounds can alter hearing sensitivity, but many (54.83%) did not have awareness about the minimum safe hours of listening. There was a weak positive correlation between self-reported hearing difficulty and poor ear HFPTA (r = 0.2304). Conclusion: Majority of students used insert earphones even after knowing the adverse effect of the same. There was a weak correlation found between the self-reported hearing problems and audiometric hearing thresholds. Implication: More awareness is needed about the ill effects of headphone usage amongst the young teenage population. Proper counseling and management strategies are required for people who report difficulty in hearing.

scholarly journals Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime and In-Theater Department of Defense Medical Records

2021 ◽  
Author(s):  
Sahra Kim ◽  
Alyssa Currao ◽  
Jennifer R. Fonda ◽  
Brigitta Beck ◽  
Alexandra Kenna ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Department Of Defense ◽  
Medical Records ◽  
Brain Injuries ◽  
Injury Severity ◽  
Assessment Tools ◽  
System Level ◽  
Chi Square ◽  
Convenience Sample

Abstract Background: Since 2006, efforts have been made to increase the identification of traumatic brain injuries (TBIs) in post-9/11 military personnel. The BAT-L is the first validated instrument to diagnose TBIs throughout the lifespan in post-9/11 Veterans. The objective is to investigate the correspondence of the Boston Assessment of TBI-Lifetime (BAT-L) diagnostic prevalence and injury severity of traumatic brain injury with in-theater medical records from Department of Defense (DoD). Methods: A convenience sample of 153 Veterans deployed in 2011 enrolled in the TRACTS longitudinal cohort study was examined. Retrospective review of DoD online medical records to determine diagnostic prevalence and injury severity for all head injury cases during deployment were compared with diagnostic prevalence and injury severity from the BAT-L clinical interview using Chi-square analyses.Results: There was moderate correspondence for TBI diagnosis between the BAT-L and DoD records (κ = 0.42). Sensitivity was 72.7% and specificity was 82.8%. Comparison of injury severity also had moderate correspondence (κ = 0.41). Missing TBI diagnostic data from DoD records was frequent; 43% percent of TBIs reported on the BAT-L did not have any documentation of mTBI assessment or diagnosis in DoD records while 83% did not have in-theater documentation.Conclusions: Diagnosis of TBI via the BAT-L retrospective interview was both sensitive and specific when compared to DoD medical records. However, diagnostic correspondence was only moderate. This lack of diagnostic agreement was related to multiple factors including lack of documentation of injury, differences in assessment tools and goals, and other combat-related motivational factors associated with failure to report injuries while deployed. Several policies were implemented to address underreporting and under-documentation of TBI, yet challenges remain. Findings suggest changes at both individual-level (e.g. service members) and system-level (e.g. DoD/military branches) are needed to adequately diagnose and document all TBI during deployment.

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