Neurocognitive correlates of probable posttraumatic stress disorder following traumatic brain injury

Introduction

Neurocognitive problems associated with posttraumatic stress disorder (PTSD) can interact with impairment resulting from traumatic brain injury (TBI).

Research question

We aimed to identify neurocognitive problems associated with probable PTSD following TBI in a civilian sample.

Material and methods

The study is part of the CENTER-TBI project (Collaborative European Neurotrauma Effectiveness Research) that aims to better characterize TBI. For this cross-sectional study, we included patients of all severities aged over 15, and a Glasgow Outcome Score Extended (GOSE) above 3. Participants were assessed at six months post-injury on the PTSD Checklist-5 (PCL-5), the Trail Making Test (TMT), the Rey Auditory Verbal Learning Test (RAVLT) and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Primary analysis was a complete case analysis. Regression analyses were performed to investigate the association between the PCL-5 and cognition.

Results

Of the 1134 participants included in the complete case analysis, 13.5% screened positive for PTSD. Probable PTSD was significantly associated with higher TMT-(B-A) (OR ​= ​1.35, 95% CI: 1.14–1.60, p ​< ​.001) and lower RAVLT-delayed recall scores (OR ​= ​0.74, 95% CI: 0.61–0.91, p ​= ​.004) after controlling for age, sex, psychiatric history, baseline Glasgow Coma Scale and education.

Discussion and conclusion

Poorer performance on cognitive tests assessing task switching and, to a lesser extent, delayed verbal recall is associated with probable PTSD in civilians who have suffered TBI.

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Six months after traumatic brain injury 13.5% of people screen positive for PTSD.

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Task switching performance and verbal memory are related to probable PTSD.

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PTSD severity is related to processing speed and task switching performance.

Bigdata Oriented Multimedia Mobile Health Applications

In this paper, two mHealth applications are introduced, which can be employed as the terminals of bigdata based health service to collect information for electronic medical records (EMRs). The first one is a hybrid system for improving the user experience in the hyperbaric oxygen chamber by 3D stereoscopic virtual reality glasses and immersive perception. Several HMDs have been tested and compared. The second application is a voice interactive serious game as a likely solution for providing assistive rehabilitation tool for therapists. The recorder of the voice of patients could be analysed to evaluate the long-time rehabilitation results and further to predict the rehabilitation process.

Virtual reality and cognitive rehabilitation: a review of current outcome research

BACKGROUND

Recent advancement in the technology of virtual reality (VR) has allowed improved applications for cognitive rehabilitation.

OBJECTIVES

The aim of this review is to facilitate comparisons of therapeutic efficacy of different VR interventions.

METHODS

A systematic approach for the review of VR cognitive rehabilitation outcome research addressed the nature of each sample, treatment apparatus, experimental treatment protocol, control treatment protocol, statistical analysis and results. Using this approach, studies that provide valid evidence of efficacy of VR applications are summarized. Applications that have not yet undergone controlled outcome study but which have promise are introduced.

RESULTS

Seventeen studies conducted over the past eight years are reviewed. The few randomized controlled trials that have been completed show that some applications are effective in treating cognitive deficits in people with neurological diagnoses although further study is needed.

CONCLUSION

Innovations requiring further study include the use of enriched virtual environments that provide haptic sensory input in addition to visual and auditory inputs and the use of commercially available gaming systems to provide tele-rehabilitation services. Recommendations are offered to improve efficacy of rehabilitation, to improve scientific rigor of rehabilitation research and to broaden access to the evidence-based treatments that this research has identified.

[Incidence of hospitalization for traumatic brain injury in children and adolescents (Valencia Community, Spain, 2002-2009)]

INTRODUCTION. Traumatic brain injuries (TBI) are a major cause of morbidity and mortality in children and adolescents but there are hardly any studies on the incidence and temporal evolution. AIM. To describe recent trends (2002-2009) in the incidence of hospitalization for TBI in children and adolescents in the region of Valencia. PATIENTS AND METHODS. Emergency admissions were identified in hospitals in the Valencian Health Agency from patients aged 0-19 years with a diagnosis of TBI (codes of the International Classification of Diseases 800, 801, 803, 804 and 850 to 854) during 2002 to 2009. The severity was classified using the fifth digit of these codes and the crude and standardized rates per 100,000 children were estimated stratified by age, sex and severity. RESULTS. From 2002 to 2009 a total of 5,504 TBI in children up to age of 19 years were hospitalized (mild: 92.9%; moderate to severe: 7.1%). In-hospital mortality was 0.6% for mild TBI and 15.7% for moderate-severe. Crude rates of mild head injury per 100,000 children fell from 85.9 to 55.4 in 2002-2009 (boys: 114.1 to 68.3, girls: 56.1 to 41.8), especially in the 15-19 years. For moderate-severe TBI, rates decreased from 5.73 to 2.78 per 100,000 in 2002-2009 (boys: 8.69 to 3.67; girls: 2.59 to 1.84). CONCLUSIONS. The incidence of pediatric TBI in the Valencia region has decreased significantly in the period 2002-2009, but their medical, legal, societal and family consequences still represents a substantial burden.

Feasibility of the membrane bioreactor process for water reclamation

The feasibility of the membrane bioreactor (MBR) process for water reclamation was studied. Process evaluation was based on the following: literature review of MBRs, worldwide survey of MBRs, and preliminary costs estimates. The literature review and the survey have shown that the MBR process offers several benefits over the conventional activated sludge process, including: smaller space and reactor requirements, better effluent water quality, disinfection, increased volumetric loading, and less sludge production. The MBR process can exist in two different configurations, one with the low-pressure membrane modules replacing the clarifier downstream the bioreactor (in series), and the second with the membranes submerged within the bioreactor. Four major companies are currently marketing MBRs while many other companies are also in the process of developing new MBRs. The MBR process operates in a considerably different range of parameters than the conventional activated sludge process. The preliminary cost evaluation has shown that the MBR process is cost competitive with other conventional wastewater treatment processes.

Evaluation of an integrated membrane system for water repurification

An integrated membrane system was evaluated for water repurification. Performance evaluation of the membrane system was based on three criteria: flux and fouling, disinfection capability, and rejection of pollutants. Minimal membrane fouling was observed for all of the membranes employed in the study. Significant contaminant rejection was also achieved by the membrane system purifying the reclaimed water to meet and exceed drinking water standards. Wide range of virus rejection was observed for the membranes, which was dependent on the membrane type, manufacturer, and the fouling status. Overall, the results of this study demonstrated that the integrated membrane system is a very effective and reliable process for water repurification.