scholarly journals A Kinetic Model for Blood Biomarker Levels After Mild Traumatic Brain Injury

2021 ◽  
Vol 12 ◽  
Author(s):  
Sima Azizi ◽  
Daniel B. Hier ◽  
Blaine Allen ◽  
Tayo Obafemi-Ajayi ◽  
Gayla R. Olbricht ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Kinetic Model ◽  
Sensitivity Analyses ◽  
Oral Drug ◽  
Parameter Estimates ◽  
Model Parameters ◽  
Mild Tbi ◽  
Social Burden ◽  
Blood Biomarker

Traumatic brain injury (TBI) imposes a significant economic and social burden. The diagnosis and prognosis of mild TBI, also called concussion, is challenging. Concussions are common among contact sport athletes. After a blow to the head, it is often difficult to determine who has had a concussion, who should be withheld from play, if a concussed athlete is ready to return to the field, and which concussed athlete will develop a post-concussion syndrome. Biomarkers can be detected in the cerebrospinal fluid and blood after traumatic brain injury and their levels may have prognostic value. Despite significant investigation, questions remain as to the trajectories of blood biomarker levels over time after mild TBI. Modeling the kinetic behavior of these biomarkers could be informative. We propose a one-compartment kinetic model for S100B, UCH-L1, NF-L, GFAP, and tau biomarker levels after mild TBI based on accepted pharmacokinetic models for oral drug absorption. We approximated model parameters using previously published studies. Since parameter estimates were approximate, we did uncertainty and sensitivity analyses. Using estimated kinetic parameters for each biomarker, we applied the model to an available post-concussion biomarker dataset of UCH-L1, GFAP, tau, and NF-L biomarkers levels. We have demonstrated the feasibility of modeling blood biomarker levels after mild TBI with a one compartment kinetic model. More work is needed to better establish model parameters and to understand the implications of the model for diagnostic use of these blood biomarkers for mild TBI.

scholarly journals Development of prognostic models for Health-Related Quality of Life following traumatic brain injury

2021 ◽  
Author(s):  
Isabel R. A. Retel Helmrich ◽  
David van Klaveren ◽  
Simone A. Dijkland ◽  
Hester F. Lingsma ◽  
Suzanne Polinder ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Model Performance ◽  
Prognostic Models ◽  
Health Related Quality ◽  
Mild Tbi ◽  
Related Quality ◽  
Health Related

Abstract Background Traumatic brain injury (TBI) is a leading cause of impairments affecting Health-Related Quality of Life (HRQoL). We aimed to identify predictors of and develop prognostic models for HRQoL following TBI. Methods We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Core study, including patients with a clinical diagnosis of TBI and an indication for computed tomography presenting within 24 h of injury. The primary outcome measures were the SF-36v2 physical (PCS) and mental (MCS) health component summary scores and the Quality of Life after Traumatic Brain Injury (QOLIBRI) total score 6 months post injury. We considered 16 patient and injury characteristics in linear regression analyses. Model performance was expressed as proportion of variance explained (R2) and corrected for optimism with bootstrap procedures. Results 2666 Adult patients completed the HRQoL questionnaires. Most were mild TBI patients (74%). The strongest predictors for PCS were Glasgow Coma Scale, major extracranial injury, and pre-injury health status, while MCS and QOLIBRI were mainly related to pre-injury mental health problems, level of education, and type of employment. R2 of the full models was 19% for PCS, 9% for MCS, and 13% for the QOLIBRI. In a subset of patients following predominantly mild TBI (N = 436), including 2 week HRQoL assessment improved model performance substantially (R2 PCS 15% to 37%, MCS 12% to 36%, and QOLIBRI 10% to 48%). Conclusion Medical and injury-related characteristics are of greatest importance for the prediction of PCS, whereas patient-related characteristics are more important for the prediction of MCS and the QOLIBRI following TBI.

scholarly journals Emergency Department Referral Profile of Traumatic Brain Injury Records at a Tertiary Care Hospital of Pakistan

2021 ◽  
Author(s):  
Maria Khan ◽  
Uzair Yaqoob ◽  
Zair Hassan ◽  
Muhammad Muizz Uddin
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Road Traffic ◽  
Tertiary Care ◽  
Initial Assessment ◽  
Care Hospital ◽  
Mild Tbi ◽  
Epidemiological Characteristics ◽  
The Impact

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This was a cross-sectional study conducted at the Lady Reading Hospital, Peshawar, Pakistan. Data were extracted from the medical records from January 1st to December 31st, 2019. Patient age, sex, type of trauma, and immediate outcome of the referral to the Emergency Department were recorded. The severity of TBI was categorized based on Glasgow Coma Scale (GCS) in mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS <8) classes. The Emergency Department referral profile was classified as admissions, disposed, detained and disposed, referred.Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively commonplace picture of epidemiological data on the burden of TBI in Pakistan. As a large proportion of patients had a mild TBI, and there is a high risk of mild TBI being under-diagnosed, we warrant further investigation of mild TBI in population-based studies.

Association of Military Employment With Late-Life Cognitive Decline and Dementia: A Population-Based Prospective Cohort Study

2021 ◽  
Author(s):  
Melinda C Power ◽  
Alia E Murphy ◽  
Kan Z Gianattasio ◽  
Y i Zhang ◽  
Rod L Walker ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Cognitive Decline ◽  
Late Life ◽  
Cognitive Change ◽  
Effect Modification ◽  
Sensitivity Analyses ◽  
Loss Of Consciousness ◽  
Increased Risk

ABSTRACT Introduction As the number of U.S. veterans over age 65 has increased, interest in whether military service affects late-life health outcomes has grown. Whether military employment is associated with increased risk of cognitive decline and dementia remains unclear. Materials and Methods We used data from 4,370 participants of the longitudinal Adult Changes in Thought (ACT) cohort study, enrolled at age 65 or older, to examine whether military employment was associated with greater cognitive decline or higher risk of incident dementia in late life. We classified persons as having military employment if their first or second-longest occupation was with the military. Cognitive status was assessed at each biennial Adult Changes in Thought study visit using the Cognitive Abilities Screening Instrument, scored using item response theory (CASI-IRT). Participants meeting screening criteria were referred for dementia ascertainment involving clinical examination and additional cognitive testing. Primary analyses were adjusted for sociodemographic characteristics and APOE genotype. Secondary analyses additionally adjusted for indicators of early-life socioeconomic status and considered effect modification by age, gender, and prior traumatic brain injury with loss of consciousness TBI with LOC. Results Overall, 6% of participants had military employment; of these, 76% were males. Military employment was not significantly associated with cognitive change (difference in modeled 10-year cognitive change in CASI-IRT scores in SD units (95% confidence interval [CI]): −0.042 (−0.19, 0.11), risk of dementia (hazard ratio [HR] [95% CI]: 0.92 [0.71, 1.18]), or risk of Alzheimer’s disease dementia (HR [95% CI]: 0.93 [0.70, 1.23]). These results were robust to additional adjustment and sensitivity analyses. There was no evidence of effect modification by age, gender, or traumatic brain injury with loss of consciousness. Conclusions Among members of the Adult Changes in Thought cohort, military employment was not associated with increased risk of cognitive decline or dementia. Nevertheless, military veterans face the same high risks for cognitive decline and dementia as other aging adults.

Neutrophil to lymphocyte ratio as a predictive biomarker for computed tomography scan use in mild traumatic brain injury

2020 ◽  
Vol 14 (12) ◽  
pp. 1085-1090
Author(s):  
George A Alexiou ◽  
Georgios D Lianos ◽  
Aggeliki Tzima ◽  
Athanasios Sotiropoulos ◽  
Anastasios Nasios ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Characteristic Curve ◽  
Predictive Biomarker ◽  
Health Concern ◽  
Mild Tbi ◽  
Ct Findings ◽  
The Mean

Aim: Traumatic brain injury (TBI) is a serious health concern. We set out to investigate the role of neutrophil-to-lymphocytes ratio (NLR) at admission for predicting the need for computed tomography (CT) in mild-TBI. Materials & methods: A retrospective study of adult patients who presented with mild-TBI Results: One hundred and thirty patients met the inclusion criteria. Seventy-four patients had positive CT-findings. The mean NLR-levels at presentations were 5.6 ± 4.8. Patients with positive CT-findings had significant higher NLR-levels. Receiver operating characteristic curve analysis was conducted and the threshold of NLR-levels for detecting the cases with positive CT-findings was 2.5, with 78.1% sensitivity and 63% specificity Conclusion: To the best of our knowledge no previous study has assessed the value of NLR-levels for predicting the need for CT in mild-TBI.

scholarly journals How to estimate mild Traumatic Brain Injury Incidence? The interest of Emergency Departments data

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
V Bourdin ◽  
L Manitchoko ◽  
P Azouvi ◽  
R Hellmann ◽  
L Josseran
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Incidence Rate ◽  
Emergency Departments ◽  
Mild Tbi ◽  
Health Measures ◽  
High Incidence ◽  
High Incidence Rate ◽  
Screening Procedures

Abstract Background Traumatic brain injury (TBI) is a major public health issue, with a significant socio-economic burden. In France, very little is known about TBI epidemiology, and the TBI population is mainly described via studies carried out on the most severe patients. A large number of studies showed that a significant proportion of patients suffer from long-term disability after mild TBI (mTBI). This Post-Concussive Syndrome (PCS) remains poorly known by health professionals. Identifying early prognostic factors for the development of PCS is therefore essential, since it can ensure widespread clinical and economic benefits. This work aims at providing an updated description of the incidence of mild TBI (mTBI) based on data from Emergency Departments (ED) in the Ile-de-France (IDF) region (Paris area). Methods We estimated the mTBI incidence, using mainly data from the OSCOUR (Organisation de la Surveillance Coordonnée des Urgences) database from 01/01/2011 to 31/12/2015. The OSCOUR Network data collection methodology is based on the registration of all patients visiting the emergency services (ED) of participating hospitals. An extrapolation of the proportion of TBI patients visiting an OSCOUR ED to all ED of the IDF allowed us to compute a mTBI Annual Incidence Rate (AIR) in IDF. Results Between 2011 and 2015, 95,910 mTBI patients visited the OSCOUR ED in IDF, and the AIR was estimated at 292.4/100,000 inhabitants (when reported to the French population scale: a total of 196,000 mTBI are supposed to happen each year). Conclusions The surprisingly high incidence rate of mTBI observed in this study requires an evaluation of public health measures to prevent these injuries and reduce their consequences. New screening procedures should be implemented to point out the patients at risk for complications and PCS. Alongside the care aspect, prevention should be developed to reduce the incidence of TBIs, and prevention policies should be assessed by reiterating our evaluation. Key messages Between 2011 and 2015, 95,910 mTBI patients visited the OSCOUR Emergency Departments in Ile de France, and the annual incident rate was estimated at 292.4/100,000 inhabitants. The mTBI high incidence rate requires an evaluation of public health measures to prevent these injuries and reduce their consequences, but also the implementation of new screening procedures.

Preinjury Psychological Factors and Case Formulation in Mild Traumatic Brain Injury Rehabilitation: A Case Report

2019 ◽  
Vol 63 (3) ◽  
pp. 156-167 ◽  
Author(s):  
Joanne E. Taylor ◽  
Renée F. Seebeck
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Psychological Factors ◽  
Illustrative Case ◽  
Case Formulation ◽  
Treatment Team ◽  
Mild Tbi ◽  
Case Examples ◽  
Rehabilitation Professionals

Mild traumatic brain injury (TBI) accounts for the majority of TBIs. Most cases recover within 3 months and usual medical advice covers physical and cognitive rest, activity and fatigue management, and education. However, in some cases, symptoms can persist and there may be ongoing postconcussion difficulties. It is well established that pre- and postinjury psychological factors can contribute to cases of persistent postconcussion symptoms. However, there are few illustrative case examples in the published literature on mild TBI. This case example demonstrates the pivotal role that preinjury psychological factors can play in recovery from mild TBI, using an example of a 35-year-old woman with persistent mild TBI symptoms who had a limited response to previous brief treatment through a Concussion Clinic. Through the process of assessment and development of a psychological case formulation, preinjury psychological factors that had been barriers to recovery and prior rehabilitation efforts were identified. Rehabilitation counselors are equipped to (1) identify and address such barriers, (2) communicate this information to other rehabilitation professionals in the treatment team to facilitate a shared understanding of how factors might affect the client’s functioning and (3) contribute to team case formulation.

scholarly journals Coping Strategies as a Predictor of Post-concussive Symptoms in Children with Mild Traumatic Brain Injury versus Mild Orthopedic Injury

2011 ◽  
Vol 17 (2) ◽  
pp. 317-326 ◽  
Author(s):  
Stacey E. Woodrome ◽  
Keith Owen Yeates ◽  
H. Gerry Taylor ◽  
Jerome Rusin ◽  
Barbara Bangert ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Coping Strategies ◽  
Mild Traumatic Brain Injury ◽  
Group Differences ◽  
Post Injury ◽  
Mild Tbi ◽  
Orthopedic Injury ◽  
Children's Coping ◽  
Over Time

AbstractThis study examined whether children's coping strategies are related to post-concussive symptoms following mild traumatic brain injury (TBI) versus orthopedic injury (OI). Participants were 8- to 15-year-old children with mild TBI (n = 167) or OI (n = 84). They rated their current preferred coping strategies and post-injury symptoms at 2 weeks (baseline) and 1, 3, and 12 months post-injury. Children's reported use of coping strategies did not vary significantly over time, so their baseline coping ratings were examined as predictors of post-concussive symptoms across time. Self-ratings of symptoms were positively related to emotion-focused strategies and negatively related to problem-focused engagement after both mild TBI and OI. Higher problem-focused disengagement predicted larger group differences in children's ratings of symptoms, suggesting that problem-focused disengagement moderates the effects of mild TBI. Coping strategies collectively accounted for approximately 10–15% of the variance in children's post-concussive symptoms over time. The findings suggest that coping may play an important role in accounting for children's perceptions of post-concussive symptoms after mild TBI. (JINS, 2011, 17, 317–326)

scholarly journals The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kelly M. Naugle ◽  
Christopher Carey ◽  
Eric Evans ◽  
Jonathan Saxe ◽  
Ryan Overman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Pain Catastrophizing ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Mild Tbi ◽  
Inhibitory Capacity ◽  
Pressure Pain Thresholds ◽  
Post Traumatic

Abstract Background Post-traumatic headache (PTH) is one of the most common and long-lasting symptoms following mild traumatic brain injury (TBI). However, the pathological mechanisms underlying the development of persistent PTH remain poorly understood. The primary purpose of this prospective pilot study was to evaluate whether early pain modulatory profiles (sensitization and endogenous pain inhibitory capacity) and psychological factors after mild TBI predict the development of persistent PTH in mild TBI patients. Methods Adult mild TBI patients recruited from Level I Emergency Department Trauma Centers completed study sessions at 1–2 weeks, 1-month, and 4-months post mild TBI. Participants completed the following outcome measures during each session: conditioned pain modulation to measure endogenous pain inhibitory capacity, temporal summation of pain and pressure pain thresholds of the head to measure sensitization of the head, Pain Catastrophizing Scale, Center for Epidemiological Studies – Depression Scale, and a standardized headache survey. Participants were classified into persistent PTH (PPTH) and no-PPTH groups based on the 4-month data. Results The results revealed that mild TBI patients developing persistent PTH exhibited significantly diminished pain inhibitory capacity, and greater depression and pain catastrophizing following injury compared to those who do not develop persistent PTH. Furthermore, logistic regression indicated that headache pain intensity at 1–2 weeks and pain inhibitory capacity on the conditioned pain modulation test at 1–2 weeks predicted persistent PTH classification at 4 months post injury. Conclusions Overall, the results suggested that persistent PTH is characterized by dysfunctional alterations in endogenous pain modulatory function and psychological processes in the early stages following mild TBI, which likely exacerbate risk for the maintenance of PTH.

Modeling Biodegradation of Subsurface Oil in Sand Beaches Polluted with Oil

2014 ◽  
Vol 2014 (1) ◽  
pp. 1113-1125
Author(s):  
Xiaolong Geng ◽  
Michel C. Boufadel
Keyword(s):  
Microbial Biomass ◽  
Galvanized Steel ◽  
Sensitivity Analyses ◽  
Parameter Estimates ◽  
Model Parameters ◽  
Zone Model ◽  
Residual Oil ◽  
Monod Kinetics ◽  
Microbial Biomass Nitrogen ◽  
Total N

ABSTRACT In April 2010, the explosion of the Deepwater Horizon (DWH) drilling platform led to the release of nearly 4.9 million barrels of crude oil into the Gulf of Mexico. The oil was brought to the supratidal zone of beaches (landward of the high tide line) by waves during storms, and was buried during subsequent storms. The objective of this paper is to investigate the biodegradation of subsurface oil in a tidally influenced sand beach located at Bon Secour National Wildlife Refuge and polluted by the DWH oil spill. Two transects were installed perpendicular to the shoreline within the supratidal zone of the beach. One transect had four galvanized steel piezometer wells to measure the water level. The other transect had four stainless steel multiport sampling wells that were used to collect pore water samples below the beach surface. The samples were analyzed for dissolved oxygen (DO), nitrogen, and redox conditions. Sediment samples were also collected at different depths to measure residual oil concentrations and microbial biomass. As the biodegradation of hydrocarbons was of interest, a biological model based on Monod kinetics was developed and coupled to the transport model MARUN, which is a two dimensional (vertical slice) finite element model for water flow and solute transport in tidally influenced beaches. The resulting coupled model, BIOMARUN, was used to simulate the biodegradation of total n-alkanes and polycyclic aromatic hydrocarbons (PAHs) trapped as residual oil in the unsaturated zone. Model parameter estimates were constrained by published Monod kinetics parameters. The field measurements, such as the concentrations of the oil, microbial biomass, nitrogen, and DO, were used as inputs for the simulations. The biodegradation of alkanes and PAHs was predicted in the simulation, and sensitivity analyses were conducted to assess the effect of the model parameters on the modeling results. Simulation results indicated that n-alkanes and PAHs would be biodegraded by 80% after 2 ± 0.5 years and 3.5 ± 0.5 years, respectively.

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