Portable decision support for diagnosis of traumatic brain injury

Early detection and diagnosis of Traumatic Brain Injury (TBI) could reduce significantly the death rate and improve the quality of life of the people affected if emergency services are equipped with tools for TBI diagnosis at the place of the accident. This problem is addressed here by proposing a portable decision support system called EmerEEG, which is based on Quantitative Electroencephalography (qEEG). The contributions of the paper are the proposed system concept, architecture and decision support for TBI diagnosis. By the virtue of its easily operable mobile system, the proposed solution for emergency TBI diagnosis provides valuable decision support at a very early stage after an accident, thereby enabling a short response time in critical situations and better prospects for the people affected

Automatic EEG processing for the early diagnosis of traumatic brain injury

Traumatic Brain Injury (TBI) is recognized as an important cause of death and disabilities after an accident. The availability a tool for the early diagnosis of brain dysfunctions could greatly improve the quality of life of people affected by TBI and even prevent deaths. The contribution of the paper is a process including several methods for the automatic processing of electroencephalography (EEG) data, in order to provide a fast and reliable diagnosis of TBI. Integrated in a portable decision support system called EmerEEG, the TBI diagnosis is obtained using discriminant analysis based on quantitative EEG (qEEG) features extracted from data recordings after the automatic removal of artifacts. The proposed algorithm computes the TBI diagnosis on the basis of a model extracted from clinically-labelled EEG records. The system evaluations have confirmed the speed and reliability of the processing algorithms as well as the system's ability to deliver accurate diagnosis. The developed algorithms have achieved 79.1% accuracy in removing artifacts, and 87.85% accuracy in TBI diagnosis. Therefore, the developed system enables a short response time in emergency situations and provides a tool the emergency services could base their decision upon, thus preventing possibly miss-diagnosed injuries

Investigation of Machine Learning Approaches for Traumatic Brain Injury Classification via EEG Assessment in Mice.

Due to the difficulties and complications in the quantitative assessment of traumatic brain injury (TBI) and its increasing relevance in today's world, robust detection of TBI has become more significant than ever. In this work, we investigate several machine learning approaches to assess their performance in classifying electroencephalogram (EEG) data of TBI in a mouse model. Algorithms such as decision trees (DT), random forest (RF), neural network (NN), support vector machine (SVM), K-nearest neighbors (KNN) and convolutional neural network (CNN) were analyzed based on their performance to classify mild TBI (mTBI) data from those of the control group in wake stages for different epoch lengths. Average power in different frequency sub-bands and alpha:theta power ratio in EEG were used as input features for machine learning approaches. Results in this mouse model were promising, suggesting similar approaches may be applicable to detect TBI in humans in practical scenarios

Jefferson Digital Commons quarterly report: January-March 2020

This quarterly report includes: New Look for the Jefferson Digital Commons Articles COVID-19 Working Papers Educational Materials From the Archives Grand Rounds and Lectures JeffMD Scholarly Inquiry Abstracts Journals and Newsletters Master of Public Health Capstones Oral Histories Posters and Conference Presentations What People are Saying About the Jefferson the Digital Common

Research Evaluating Sports ConcUssion Events-Rapid Assessment of Concussion and Evidence for Return (RESCUE-RACER): a two-year longitudinal observational study of concussion in motorsport.

INTRODUCTION: Concussion is a clinical diagnosis, based on self-reported patient symptoms supported by clinical assessments across many domains including postural control, ocular/vestibular dysfunction, and neurocognition. Concussion incidence may be rising in motorsport which, combined with unresolved challenges to accurate diagnosis and lack of guidance on the optimal return-to-race timeframe, creates a difficult environment for healthcare practitioners. METHODS AND ANALYSIS: Research Evaluating Sports ConcUssion Events-Rapid Assessment of Concussion and Evidence for Return (RESCUE-RACER) evaluates motorsports competitors at baseline (Competitor Assessment at Baseline; Ocular, Neuroscientific (CArBON) study) and post-injury (Concussion Assessment and Return to motorSport (CARS) study), including longitudinal data. CArBON collects pre-injury neuroscientific data; CARS repeats the CArBON battery sequentially during recovery for competitors involved in a potentially concussive event. As its primary outcome, RESCUE-RACER will develop the evidence base for an accurate trackside diagnostic tool. Baseline objective clinical scoring (Sport Concussion Assessment Tool-5th edition (SCAT5)) and neurocognitive data (Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)) will be assessed for specificity to motorsport and relationship to existing examinations. Changes to SCAT5 and ocular, vestibular, and reaction time function (Dx 100) will be estimated by the reliability change index as a practical tool for trackside diagnosis. Neuropsychological (Cambridge Neuropsychological Test Automated Battery (CANTAB)) assessments, brain MRI (7 Tesla) and salivary biomarkers will be compared with the new tool to establish utility in diagnosing and monitoring concussive injuries. ETHICS AND DISSEMINATION: Ethical approval was received from East of England-Cambridge Central Research Ethics Committee (18/EE/0141). Participants will be notified of study outcomes via publications (to administrators) and summary reports (funder communications). Ideally, all publications will be open access. TRIAL REGISTRATION NUMBER: February 2019 nationally (Central Portfolio Management System 38259) and internationally (ClinicalTrials.gov NCT03844282)

Combat Veterans, Mental Health Issues, and the Death Penalty: Addressing the Impact of Post-Traumatic Stress Disorder and Traumatic Brain Injury

More than 1.5 million Americans have participated in combat operations in Iraq and Afghanistan over the past seven years. Some of these veterans have subsequently committed capital crimes and found themselves in our nation’s criminal justice system. This Essay argues that combat veterans suffering from post-traumatic stress disorder or traumatic brain injury at the time of their offenses should not be subject to the death penalty. Offering mitigating evidence regarding military training, post-traumatic stress disorder, and traumatic brain injury presents one means that combat veterans may use to argue for their lives during the sentencing phase of their trials. Alternatively, Atkins v. Virginia and Roper v. Simmons offer a framework for establishing a legislatively or judicially created categorical exclusion for these offenders, exempting them from the death penalty as a matter of law. By understanding how combat service and service-related injuries affect the personal culpability of these offenders, the legal system can avoid the consequences of sentencing to death America’s mentally wounded warriors, ensuring that only the worst offenders are subject to the ultimate punishment

Analysis of Sideline Concussion Screening Tools in an Athletic Setting

This paper serves as a primer to healthcare professionals of the now and future of sideline screening for concussion. In the past decade, significant research into sports-related concussions has expanded understanding of what is as a very complex injury. As the definition of concussion has evolved, the impact they have is put into perspective. As more research into the short- and long-term effects of concussions brings to light the effects of continuing to participate after suffering a concussion, the importance of keeping concussed athletes off the field is now understood as a potential life or death situation. With the dangers of continuing to play after concussion becoming apparent there has been a renewed emphasis on tools and/or techniques that screen for symptoms of concussion. Some of the most widespread include, but are not limited to, the Standardized Assessment for Concussion (SAC), the Balance Error Scoring System (BESS), the Sideline Concussion Assessment Tool 3rd Edition (SCAT3) and King-Devick Test (KDT). This paper will explore the benefits, limitations, and implementation of each of these assessment tools. A crucial part of improving rates of concussion recognition is to look at what has been developed based on the most current understanding of concussions. As more attention has been drawn to the potential dangers of concussions and repeated sub-concussive blows there has been a surge in funding and studies regarding current and developing technique’s and tools. This paper examines tools recently implemented or under development and explores their potential benefits, limitations and availability. These include Vestibular-Ocular Motor Screening (VOMS), force plate balance testing and blood tests for proteins associated with injury to the brain. The paper concludes with a discussion of the benefits, limitations and reliability of each test. Recommendations are made for developing a sideline concussion screening protocol

Window into the mind:Advanced handheld spectroscopic eye-safe technology for point-of-care neurodiagnostic

Traumatic brain injury (TBI), a major cause of morbidity and mortality worldwide, is hard to diagnose at the point of care with patients often exhibiting no clinical symptoms. There is an urgent need for rapid point-of-care diagnostics to enable timely intervention. We have developed a technology for rapid acquisition of molecular fingerprints of TBI biochemistry to safely measure proxies for cerebral injury through the eye, providing a path toward noninvasive point-of-care neurodiagnostics using simultaneous Raman spectroscopy and fundus imaging of the neuroretina. Detection of endogenous neuromarkers in porcine eyes' posterior revealed enhancement of high-wave number bands, clearly distinguishing TBI and healthy cohorts, classified via artificial neural network algorithm for automated data interpretation. Clinically, translating into reduced specialist support, this markedly improves the speed of diagnosis. Designed as a hand-held cost-effective technology, it can allow clinicians to rapidly assess TBI at the point of care and identify long-term changes in brain biochemistry in acute or chronic neurodiseases.</p

Assessment of Anti-Saccades Within 24 to 48 Hours Post-Concussion

INTRODUCTION: Oculomotor control dysfunction is present in about 90% of concussed athletes, with anti-saccades being the most prominent. PURPOSE: To investigate anti-saccades, reflexive gaze deviations from a fixed point or area of interest, between NCAA Division I athletes 24 to 48 hours post-concussion (PC) and healthy, matched controls (MC). METHODS: 10 PC (4 female, 6 male; age: 18.9 ± 0.9 years) and 10 MC (4 female, 6 male; age: 18.3 ± 0.6 years) wore a monocular eye tracker (240Hz) while performing 2 trials of the 60-second WiiFit Soccer Heading game. During play, participants were instructed to not deviate their gaze away from the center area of interest. Ocular raw point of gaze coordinates were tracked during play for specific areas of interest (left, right, and center) to determine gaze deviations away from the center area of interest. RESULTS: One-way ANOVAs revealed significantly greater anti-saccades (p = 0.031) in PC (15.2 ± 7.1) when compared to MC (5.4 ± 5.2), significantly greater anti-saccade durations (p = 0.023) in PC (11.2 ± 8.8s) when compared to MC (1.2 ± 1.3 s), and significantly greater average anti-saccade durations (p \u3c .0001) in PC (0.671 ± 0.205s) when compared to MC (0.133 ± 0.042s). CONCLUSIONS: These results suggest that anti-saccades are significantly more prevalent in PC compared to MC. The great number and duration of anti-saccades could suggest a major deficiency in oculomotor control and could be a candidate marker for concussion