Emergency department assessment of mild traumatic brain injury and prediction of post-concussion symptoms at one month post injury

Mild traumatic brain injury (mTBI) is a common injury and a significant proportion of those affected report chronic symptoms. This study investigated prediction of post-concussion symptoms using an Emergency Department (ED) assessment that examined neuropsychological and balance deficits and pain severity of 29 concussed individuals. Thirty participants with minor orthopedic injuries and 30 ED visitors were recruited as control subjects. Concussed and orthopedically injured participants were followed up by telephone at one month to assess symptom severity. In the ED, concussed subjects performed worse on some neuropsychological tests and had impaired balance compared to controls. They also reported significantly more post-concussive symptoms at follow-up. Neurocognitive impairment, pain and balance deficits were all significantly correlated with severity of post-concussion symptoms. The findings suggest that a combination of variables assessable in the ED may be useful in predicting which individuals will suffer persistent post-concussion problems.

Factor analysis of the self-report Dysexecutive (DEX-S) Questionnaire

The self-rating Dysexecutive Questionnaire (DEX-S) is a recently developed standardized self-report measure of behavioral difficulties associated with executive functioning such as impulsivity, inhibition, control, monitoring, and planning. Few studies have examined its construct validity, particularly for its potential wider use across a variety of clinical and nonclinical populations. This study examines the factor structure of the DEX-S questionnaire using a sample of nonclinical (N = 293) and clinical (N = 49) participants. A series of factor analyses were evaluated to determine the best factor solution for this scale. This was found to be a 4-factor solution with factors best described as inhibition, intention, social regulation, and abstract problem solving. The first 2 factors replicate factors from the 5-factor solutions found in previous studies that examined specific subpopulations. Although further research is needed to evaluate the factor structure within a range of subpopulations, this study supports the view that the DEX has the factor structure sufficient for its use in a wider context than only with neurological or head-injured patients. Overall, a 4-factor solution is recommended as the most stable and parsimonious solution in the wider context.

Factor structure and internal consistency of the Young Schema Questionnaire (Short Form) in Korean and Australian samples

We investigated cross-cultural differences in the factor structure and psychometric properties of the 75-item Young Schema Questionnaire-Short Form (YSQ-SF). Participants were 833 South Korean and 271 Australian undergraduate students. The South Korean sample was randomly divided into two sub-samples. Sample A was used for Exploratory Factor Analysis (EFA) and sample B was used for Confirmatory Factor Analysis (CFA). EFA for the South Korean sample revealed a 13-factor solution to be the best fit for the data, and CFA on the data from sample B confirmed this result. CFA on the data from the Australian sample also revealed a 13-factor solution. The overall scale of the YSQ-SF demonstrated a high level of internal consistency in the South Korean and Australian groups. Furthermore, adequate internal consistencies for all subscales in the South Korean and Australian samples were demonstrated. In conclusion, the results showed that YSQ-SF with 13 factors has good psychometric properties and reliability for South Korean and Australian University students. Korean samples had significantly higher YSD scores on most of the 13 subscales than the Australian sample. However, limitations of the current study preclude the generalisability of the findings to beyond undergraduate student populations. (c) 2006 Elsevier B.V. All rights reserved.

Seizure detection algorithm for neonates based on wave-sequence analysis

Objective: The description and evaluation of the performance of a new real-time seizure detection algorithm in the newborn infant. Methods: The algorithm includes parallel fragmentation of EEG signal into waves; wave-feature extraction and averaging; elementary, preliminary and final detection. The algorithm detects EEG waves with heightened regularity, using wave intervals, amplitudes and shapes. The performance of the algorithm was assessed with the use of event-based and liberal and conservative time-based approaches and compared with the performance of Gotman's and Liu's algorithms. Results: The algorithm was assessed on multi-channel EEG records of 55 neonates including 17 with seizures. The algorithm showed sensitivities ranging 83-95% with positive predictive values (PPV) 48-77%. There were 2.0 false positive detections per hour. In comparison, Gotman's algorithm (with 30 s gap-closing procedure) displayed sensitivities of 45-88% and PPV 29-56%; with 7.4 false positives per hour and Liu's algorithm displayed sensitivities of 96-99%, and PPV 10-25%; with 15.7 false positives per hour. Conclusions: The wave-sequence analysis based algorithm displayed higher sensitivity, higher PPV and a substantially lower level of false positives than two previously published algorithms. Significance: The proposed algorithm provides a basis for major improvements in neonatal seizure detection and monitoring. Published by Elsevier Ireland Ltd. on behalf of International Federation of Clinical Neurophysiology.

The regulatory challenges in engineering a safer tipple

David Nutt asks two very important questions. Can we make alcohol safer? Can we use pharmacology and neuroscience to engineer a safer alternative to alcohol? The answer to the first question is clearly ‘yes’. We can make alcohol safer by encouraging drinkers to consume less alcohol per occasion. That goal can be accomplished by imposing lower taxes on lower alcohol beverages or a volumetric tax on alcoholic beverages (Babor et al., 2003).

Belief in dealing with depression alone: Results from community surveys of adolescents and adults

Background: Community surveys have found that some people believe that it is better to deal with depression alone rather than seek help. However, there has been little research into the characteristics of this group. Methods: Data were drawn from three Australian surveys: (1) a national survey of 1001 adults aged 18+ years; (2) a school survey of 552 students aged 14-16 years from two regions; (3) a survey of 577 young people aged 12-17 years from the Melbourne region. In all three surveys, participants who believed it would be helpful to deal with depression alone were contrasted with those who believed it would be harmful in terms of sociodemographic characteristics, recognition of depression in a vignette, contact with people who experienced depression, beliefs about treatments, beliefs about using substances, beliefs about long-term outcomes, and beliefs about causes. Results: In both adolescents and adults, belief in dealing with depression alone was associated with male gender, less favourable views about mental health professionals, more favourable views about using substances to deal with depression, and a more positive expectation about the outcome if treatment is not sought. Adolescents believing in dealing with depression alone had more favourable views about some potential helpers, such as church workers and pharmacists. In adults, but not adolescents, there was an association with the belief that depression is caused by personal weakness. Limitations: The surveys did not directly ask about reasons for believing that dealing with depression alone would be helpful and did not assess actual help-seeking. Conclusions: Factors encouraging dealing with depression alone are a belief that it is a self-limiting disorder, that substances are an effective way to deal with it and, in adults, that depression is due to personal weakness. Consistent with previous research, males are an important target group for encouraging seeking help to deal with depression. (c) 2006 Elsevier B.V. All rights reserved.

Quantifying aphasic people's social lives in the context of non-aphasic peers

Background: Developing the knowledge base on the impact of aphasia on people's social lives has become increasingly important in recent times to further our understanding of the broad consequences of communication disability and thus provide appropriate services. Past research clearly indicates that relationships and social activities with family members and others undergo change with the onset of aphasia in an individual, however more evidence of a quantitative nature would be beneficial. Aims: The current research furthers our knowledge by quantifying chronically aphasic older people's regular social contacts and social activities, and places them in context by comparing them with healthy older people of similar age and education. Methods & Procedures: A total of 30 aphasic participants aged 57 to 88 years, and 71 non-aphasic controls aged 62 to 98 years were interviewed by a speech and language therapist using self-report measures of Social Network Analysis (Antonucci & Akiyama, 1987) and Social Activities Checklist (Cruice, 2001, in Worrall & Hickson, 2003). Demographic information was also collected. Descriptive statistics are presented and independent samples t tests were used to examine differences between the groups. Outcomes & Results: Participants with primarily mild to moderate aphasic impairment reported a considerable range of social contacts (5-51) and social activities (8-18). Many significant differences were evident between the two groups' social contacts and activities. On average, aphasic participants had nine fewer social contacts (mainly friend'' relationships) and three fewer social activities (mainly leisure'' activities) than their non-aphasic peers. The majority of controls were satisfied with their social activities, whereas the majority of aphasic participants were not and wanted to be doing more. There were some general similarities between the groups, in terms of range of social contacts, overall pattern of social relationships, and core social activities. Conclusions: Older people with chronic aphasia had significantly fewer social contacts and social activities than their peers. People with aphasia expressed a desire to increase the social activity of their lives. Given the importance of leisure activity and relationships with friends as well as family for positive well-being, speech and language therapists may direct their rehabilitation efforts towards two areas: (1) conversational partner programmes training friends to maintain these relationships; and (2) encouraging and supporting aphasic clients in leisure activities of their choice.

Rapid Atrophy of the Lumbar Multifidus Follows Experimental Disc or Nerve Root Injury.

Study Design. Experimental study of muscle changes after lumbar spinal injury. Objectives. To investigate effects of intervertebral disc and nerve root lesions on cross-sectional area, histology and chemistry of porcine lumbar multifidus. Summary of Background Data. The multifidus cross-sectional area is reduced in acute and chronic low back pain. Although chronic changes are widespread, acute changes at 1 segment are identified within days of injury. It is uncertain whether changes precede or follow injury, or what is the mechanism. Methods. The multifidus cross-sectional area was measured in 21 pigs from L1 to S1 with ultrasound before and 3 or 6 days after lesions: incision into L3 - L4 disc, medial branch transection of the L3 dorsal ramus, and a sham procedure. Samples from L3 to L5 were studied histologically and chemically. Results. The multifidus cross-sectional area was reduced at L4 ipsilateral to disc lesion but at L4 - L6 after nerve lesion. There was no change after sham or on the opposite side. Water and lactate were reduced bilaterally after disc lesion and ipsilateral to nerve lesion. Histology revealed enlargement of adipocytes and clustering of myofibers at multiple levels after disc and nerve lesions. Conclusions. These data resolve the controversy that the multifidus cross-sectional area reduces rapidly after lumbar injury. Changes after disc lesion affect 1 level with a different distribution to denervation. Such changes may be due to disuse following reflex inhibitory mechanisms.

Circadian blood pressure variation after acute stroke

We aimed to characterise the patterns of circadian blood pressure (BP) variation after acute stroke and determine whether any relationship exists between these patterns and stroke outcome. BP was recorded manually every 4 h for 48 h following acute stroke. Patients were classified according to the percentage fall in mean systolic BP (SBP) at night compared to during the day as: dippers (fall >= 10-= 20%); non-dippers (>= 0-

Automatic measurement of vertebral rotation in idiopathic scoliosis

Study Design. Development of an automatic measurement algorithm and comparison with manual measurement methods. Objectives. To develop a new computer-based method for automatic measurement of vertebral rotation in idiopathic scoliosis from computed tomography images and to compare the automatic method with two manual measurement techniques. Summary of Background Data. Techniques have been developed for vertebral rotation measurement in idiopathic scoliosis using plain radiographs, computed tomography, or magnetic resonance images. All of these techniques require manual selection of landmark points and are therefore subject to interobserver and intraobserver error. Methods. We developed a new method for automatic measurement of vertebral rotation in idiopathic scoliosis using a symmetry ratio algorithm. The automatic method provided values comparable with Aaro and Ho's manual measurement methods for a set of 19 transverse computed tomography slices through apical vertebrae, and with Aaro's method for a set of 204 reformatted computed tomography images through vertebral endplates. Results. Confidence intervals (95%) for intraobserver and interobserver variability using manual methods were in the range 5.5 to 7.2. The mean (+/- SD) difference between automatic and manual rotation measurements for the 19 apical images was -0.5 degrees +/- 3.3 degrees for Aaro's method and 0.7 degrees +/- 3.4 degrees for Ho's method. The mean (+/- SD) difference between automatic and manual rotation measurements for the 204 endplate images was 0.25 degrees +/- 3.8 degrees. Conclusions. The symmetry ratio algorithm allows automatic measurement of vertebral rotation in idiopathic scoliosis without intraobserver or interobserver error due to landmark point selection.

A naturalistic comparison of two right unilateral electroconvulsive therapy dosing protocols: 2-3X seizure threshold versus fixed high-dose

The aim of this study was to compare the outcomes associated with two differing right unilateral (RUL) electroconvulsive therapy (ECT) dosing protocols: 2-3X seizure threshold (2-3X ST) and fixed high dose (FHD) at 353 mC. A retrospective chart review was performed to compare patient outcomes during the implementation of two different dosing protocols: 2-3X ST from October 2000 to May 2001 and FHD from June 2001 to February 2002. A total of 56 patients received ECT under the 2-3X ST protocol, and 46 received ECT under the FHD protocol. In total, 13.6% of patients receiving ECT according to the 2-3X ST protocol received more than 12 ECT, whereas none of the FHD group received more than 12 ECT. The mean number of ECT per treatment course reduced significantly from 7.6 to 5.7 following the switch from the 2-3X ST protocol to the FHD protocol. There were no significant differences between the two groups in the incidence of adverse cognitive effects. ECT practitioners adhered to the 2-3X ST protocol for only 51.8% of ECT courses, with protocol adherence improving to 87% following introduction of the FHD protocol. Although this naturalistic retrospective chart survey had significant methodological limitations, it found that practitioners are more likely to correctly adhere to a fixed dose protocol, therefore, increasing its 'real world' effectiveness in comparison to titrated suprathreshold dosing techniques. The FHD protocol was associated with shorter courses of ECT than the 2-3X ST protocol, with no significant difference between the two protocols in clinically discernable adverse cognitive effects.

A prospective assessment of SRS-24 scores after endoscopic anterior instrumentation for scoliosis

Study Design. Prospective clinical case series. Objective. To evaluate the clinical outcome of anterior endoscopic instrumention for scoliosis using the SRS-24 questionnaire and to examine how these scores change over a 2-year follow-up period. Summary of Background Data. Anterior endoscopic instrumentation correction has several advantages compared with open procedures. However, the clinical results of this technique using a validated outcome measure have rarely been reported in the literature. Methods. A total of 83 consecutive patients underwent endoscopic anterior instrumentation performed at a single unit. Patients completed the SRS-24 questionnaire before surgery and at 3, 6, 12, and 24 months after surgery. The SRS-24 scores were compared between each of the follow-up intervals. Results. The pain, general self-image, and function from back condition domains improved after surgery (P < 0.05). Activity level significantly improved between 3 and 6 months, and both function domains improved between 6 and 12 months (P < 0.05). None of the domains increased significantly after 1 year. Conclusions. Endoscopic anterior instrumentation for scoliosis significantly improved pain, self-image, and function. The greatest improvement in function occurred between 6 and 12 months after surgery. The SRS-24 scores at 1 year from surgery may provide a good indicator of patient outcome in the long-term.