Minimal Clinically Important Difference for the Rasch Neuropsychiatric Inventory Irritability and Aggression Scale for Traumatic Brain Injury

Objective To determine the minimal clinically important difference (MCID) for a Rasch measure derived from the Irritability/Lability and Agitation/Aggression subscales of the Neuropsychiatric Inventory (NPI)—the Rasch NPI Irritability and Aggression Scale for Traumatic Brain Injury (NPI-TBI-IA). Design Distribution-based statistical methods were applied to retrospective data to determine candidates for the MCID. These candidates were evaluated by anchoring the NPI-TBI-IA to Global Impression of Change (GIC) ratings by participants, significant others, and a supervising physician. Setting Postacute rehabilitation outpatient clinic. Participants 274 cases with observer ratings; 232 cases with self-ratings by participants with moderate-severe TBI at least 6 months postinjury. Interventions Not applicable. Main Outcome Measure NPI-TBI-IA. Results For observer ratings on the NPI-TBI-IA, anchored comparisons found an improvement of 0.5 SD was associated with at least minimal general improvement on GIC by a significant majority (69%–80%); 0.5 SD improvement on participant NPI-TBI-IA self-ratings was also associated with at least minimal improvement on the GIC by a substantial majority (77%–83%). The percentage indicating significant global improvement did not increase markedly on most ratings at higher levels of improvement on the NPI-TBI-IA. Conclusions A 0.5 SD improvement on the NPI-TBI-IA indicates the MCID for both observer and participant ratings on this measure

The Relations of Self-Reported Aggression to Alexithymia, Depression, and Anxiety After Traumatic Brain Injury

Objectives: To compare self-reported aggression in people with and without traumatic brain injury (TBI) and examine the relations of aggression to alexithymia (poor emotional insight), depression, and anxiety. Setting: Rehabilitation hospital. Participants: Forty-six adults with moderate to severe TBI who were at least 3 months postinjury; 49 healthy controls (HCs); groups were frequency matched for age and gender. Design: Cross-sectional study using a quasi-experimental design. MainMeasures:Aggression (Buss-Perry Aggression Questionnaire); alexithymia (Toronto Alexithymia Scale-20); depression (Patient Health Questionnaire-9); and trait anxiety (State-Trait Anxiety Inventory). Results: Participants with TBI had significantly higher aggression scores than HCs. For participants with TBI, 34.2% of the adjusted variance of aggression was significantly explained by alexithymia, depression, and anxiety; alexithymia accounted for the largest unique portion of the variance in this model (16.2%). Alexithymia, depression, and anxiety explained 46% of the adjusted variance of aggression in HCs; in contrast to participants with TBI, depression was the largest unique contributor to aggression (15.9%). Conclusion: This was the first empirical study showing that poor emotional insight (alexithymia) significantly contributes to aggression after TBI. This relation, and the potential clinical implications it may have for the treatment of aggression, warrants further investigation

Negative Attribution Bias and Anger After Traumatic Brain Injury

Objectives: Negative attributions pertain to judgments of intent, hostility, and blame regarding others' behaviors. This study compared negative attributions made by people with and without traumatic brain injury (TBI) and examined the degree to which these negative attributions predicted angry ratings in response to situations. Setting: Outpatient rehabilitation hospital. Participants: Forty-six adults with moderate to severe TBI and 49 healthy controls. Design: Cross-sectional study using a quasi-experimental research design. Main Measures: In response to hypothetical scenarios, participants rated how irritated and angry they would be, and how intentional, hostile, and blameworthy they perceived characters' behaviors. There were 3 scenario types differentiated by the portrayal of characters' actions: benign, ambiguous, or hostile. All scenarios theoretically resulted in unpleasant outcomes for participants. Results: Participants with TBI had significantly higher ratings for feeling “irritated” and “angry” and attributions of “intent,” “hostility,” and “blame” compared with healthy controls for all scenario types. Negative attribution ratings accounted for 72.4% and 65.3% of the anger rating variance for participants with and without TBI, respectively. Conclusion: People with TBI may have negative attribution bias, in which they disproportionately judge the intent, hostility, and blameworthiness of others' behaviors. These attributions contributed to their ratings of feeling angry. This suggests that participants with TBI who have anger problems should be evaluated for this bias, and anger treatments should possibly aim to alter negative attributions. However, before implementing clinical practice changes, there is a need for replication with larger samples, and further investigation of the characteristics associated with negative attribution bias

Reductions in Alexithymia and Emotion Dysregulation After Training Emotional Self-Awareness Following Traumatic Brain Injury: A Phase I Trial

OBJECTIVES: To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI). SETTING: An outpatient rehabilitation hospital. PARTICIPANTS: Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years. DESIGN: Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up. INTERVENTION: Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations. MEASURES: Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS). RESULTS: Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high. CONCLUSION: This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention

Investigation of a New Couples Intervention for Individuals with Brain Injury: A Randomized Controlled Trial

d to (1) examine the efficacy of a treatment to enhance a couple’s relationship after brain injury (BI) particularly in relationship satisfaction and communication; and (2) determine couples’ satisfaction with this type of intervention. Design: Randomized Wait-list Controlled (WC) Trial. Setting: Midwestern outpatient BI rehabilitation center. Intervention: The Couples CARE intervention is a 16 week, 2-hour, manualized small group treatment utilizing psychoeducation, affect recognition and empathy training, cognitive and dialectical behavioral treatments (CBT, DBT), communication skills training, and Gottman’s theoretical framework for couples. Participants: Forty-four participants (22 persons with BI and their intimate partner) were randomized by couples to the intervention or WC group, with 11 couples in each group. Main Outcome Measures: Dyadic Adjustment Scale (DAS); Quality of Marriage Index (QMI); 4 Horsemen of the Apocalypse communication questionnaire. Measures were completed by the person with BI and their partner at 3 time points: baseline, immediate post-intervention, 3-month follow-up. Results The experimental group showed significant improvement at post-test and follow-up on the DAS and the Horsemen questionnaire compared to baseline and to the WC group which showed no significant changes on these measures. No significant effects were observed on the QMI for either group. Satisfaction scores were largely favorable. Conclusion suggest this intervention can improve couples’ dyadic adjustment and communication after BI. High satisfaction ratings suggest this small group intervention is feasible with couples following BI. Future directions for this intervention are discussed

Predictors of Individual-Level Innovation at Work: A Meta-Analysis

peer-reviewedNumerous narrative reviews related to innovation in work organizations have been published, yet very few quantitative reviews have been conducted. The present meta-analysis investigates the relationships between four predictor types (individual differences, motivation, job characteristics, and contextual influences) and individual-level workplace innovation. Results indicated that individual factors, characteristics of the job, and factors of the environment were moderately associated with phases of the innovation process. Implications for future research opportunities are discussed.ACCEPTEDpeer-reviewe

Social Competence Treatment after Traumatic Brain Injury: A Multicenter, Randomized, Controlled Trial of Interactive Group Treatment versus Non-Interactive Treatment

Objective To evaluate the effectiveness of a replicable group treatment program for improving social competence after traumatic brain injury (TBI). Design Multicenter randomized controlled trial comparing two methods of conducting a social competency skills program, an interactive group format versus a classroom lecture. Setting Community and Veteran rehabilitation centers. Participants 179 civilian, military, and veteran adults with TBI and social competence difficulties, at least 6 months post-injury. Experimental Intervention Thirteen weekly group interactive sessions (1.5 hours) with structured and facilitated group interactions to improve social competence. Alternative (Control) Intervention Thirteen traditional classroom sessions using the same curriculum with brief supplemental individual sessions but without structured group interaction. Primary Outcome Measure Profile of Pragmatic Impairment in Communication (PPIC), an objective behavioral rating of social communication impairments following TBI. Secondary Outcomes LaTrobe Communication Questionnaire (LCQ), Goal Attainment Scale (GAS), Satisfaction with Life Scale (SWLS), Post-Traumatic Stress Disorder Checklist – (PCL-C), Brief Symptom Inventory 18 (BSI-18), Scale of Perceived Social Self Efficacy (PSSE). Results Social competence goals (GAS) were achieved and maintained for most participants regardless of treatment method. Significant improvements in the primary outcome (PPIC) and two of the secondary outcomes (LCQ and BSI) were seen immediately post-treatment and at 3 months post-treatment in the AT arm only, however these improvements were not significantly different between the GIST and AT arms. Similar trends were observed for PSSE and PCL-C. Conclusions Social competence skills improved for persons with TBI in both treatment conditions. The group interactive format was not found to be a superior method of treatment delivery in this study

Preferential Association of Segment Blocks in Polyurethane Nanocomposites

Submitted to MacromoleculesControlling the level of dispersion of silicate layers in polymer matrices through intermolecular interactions and exploiting these interactions to enhance thermomechanical behavior are key challenges in the field of polymer nanocomposites. In this investigation, unmodified Laponite platelets are dispersed in a segmented polyurethane containing polar, hydrophilic soft segments and a hydrophobic hard segment using a novel solvent exchange method and compared to polyurethane nanocomposites containing more hydrophobic hard and soft domains. It was determined that the silicate layers were preferentially, but not exclusively, attracted to the hydrophilic, polar soft domains. An apparent micro-phase segregated morphology was observed in transmission electron microscopy for this system, revealing regions of exfoliation and intercalation. According to polarizing optical microscopy, strain-induced alignment is inhibited for this polyurethane nanocomposite, which is reflected in dramatic reductions in tensile strength and ultimate extensibility. In comparison, the Laponite discs appear to be preferentially, but not exclusively, embedded to the hard domains in the segmented polyurethanes containing more hydrophobic hard and soft domains. Exfoliation of the clay platelets leads to enhanced modulus and toughness without a reduction in extensibility. This study provides clues for exploiting silicate-polymer interactions to tune material properties without chemical modification.Institute for Soldier Nanotechnology (ISN) at MI

UV Observations of the Cool DBQA5 White Dwarf LDS 678A - Limits on the Atmospheric Composition, Pressure Shift, and Gravitational Redshift Derived from C I 2479

A high-resolution ultraviolet spectrum of the helium-rich degenerate LDS 678A, obtained with the International Ultraviolet Explorer (IUE) satellite, is presented. LDS 678A is the coolest metallic line degenerate (DQ or DZ) yet observed with the IUE echelle. These observations provide a detailed line profile of the strong C I 2479 absorption line and equivalent width W2479 = 2.35 + or - 0.06 A from which theoretical profile fits yield a carbon abundance of log C/He = (-6.7 + or- 0.2). The presence of carbon in a He-rich atmosphere lends credence to the notion that LDS 678A is a transitional case between the DB white dwarfs with nearly pure helium atmospheres and the helium-rich DQ white dwarfs which exhibit carbon bands. Corrected for an inferred pressure shift Vp = + 38 + or - 4 km/s for the C I 2479 line, a gravitational redshift of Vrs = + 26 + or - 13 km/s is deduced from which a most probable mass of 0.55 solar mass is derived