An examination of the Effectiveness of a Cognitive Group Intervention for People with Acquired Brain Injury

Neuropsychological rehabilitation is concerned with enabling people with brain injury to achieve their maximum potential in various domains such as psychological, social, leisure, vocational or everyday functioning. This study investigated, in a sample of people with Acquired Brain Injury (ABI), whether participating in a twelve-week group intervention brings about significant change in areas of cognition, community integration, satisfaction with life, distress, cognitive self-evaluation and knowledge of brain injury. Thirty-two participants (n = 32) with an ABI took part in this matched control study. Participants completed a series of neuropsychological tests (California Verbal Learning Test-Second Edition (CVLT-II); Trail Making Test; Sustained Attention Response Task (SART); and Digit-Span Task) and questionnaires (Community Integration Questionnaire; Satisfaction With Life Scale; Hospital Anxiety and Depression Scale; Cognitive Group Self-Evaluation; and Knowledge of Brain Injury Questionnaire) at three timepoints over a nine month period. Results showed a significant overall effect across the three timepoints in the intervention group on elements of the CVLT-II test and a significant overall effect across the three timepoints in both groups on elements of the Trail Making Test. A significant effect was seen between T1 and T2 in the intervention group on elements of the SART and Digit Span tests, and for the control group, significant effects between these two timepoints were seen on elements of the Trail Making Test, SART (target reaction time subscale) and the Digit Span test (disimprovment in performance between T1 and T2). Significant effects were seen between T2 and T3 for the intervention group on elements of the Trail Making Test and for the control group on elements of the CVLT-II test. Significant effects were seen between T1 and T3 for the intervention group on elements of the Trail Making and SART tests and for the control group, on elements of the CVLT-II test and Cognitive Self Evaluation questionnaire. There was a significant difference in Knowledge of Brain Injury scores for the main effect of time. This study provides some support for the effectiveness of a group-based intervention combining psychoeducation, basic strategy training and stress management techniques for individuals with ABI and has important implications for neurorehabilitation service providers, individuals with an ABI and their families

Exposure Assessment for Endocrine Disruptors: Some Considerations in the Design of Studies

Reproduced with permission from Environmental Health Perspectives. doi:10.1289/ehp.5798In studies designed to evaluate exposure-response relationships in children's development from conception through puberty, multiple factors that affect the generation of meaningful exposure metrics must be considered. These factors include multiple routes of exposure; the timing, frequency, and duration of exposure; need for qualitative and quantitative data; sample collection and storage protocols; and the selection and documentation of analytic methods. The methods for exposure data collection and analysis must be sufficiently robust to accommodate the a priori hypotheses to be tested, as well as hypotheses generated from the data. A number of issues that must be considered in study design are summarized here

The Interpersonal Style and Complementarity Between Crisis Negotiators and Forensic Inpatients

Previous negotiation research has explored the interaction and communication between crisis negotiators and perpetrators. A crisis negotiator attempts to resolve a critical incident through negotiation with an individual, or group of persons in crisis. The purpose of this study was to establish the interpersonal style of crisis negotiators and complementarity of the interpersonal interaction between them and forensic inpatients. Crisis negotiators, clinical workers and students (n = 90) used the Check List of Interpersonal Transactions-Revised (CLOIT-R) to identify interpersonal style, along with eight vignettes detailing interpersonal styles. Crisis negotiators were most likely to have a friendly interpersonal style compared to the other non-trained groups. Complementarity theory was not exclusively supported as submissive individuals did not show optimistic judgments in working with dominant forensic inpatients and vice versa. Exploratory analysis revealed that dominant crisis negotiators were optimistic in working with forensic inpatients with a dominant interpersonal style. This study provides insight into the area of interpersonal complementarity of crisis negotiators and forensic inpatients. Whilst further research is required, a potential new finding was established, with significant ‘similarity’ found when dominant crisis negotiators are asked to work with dominant forensic inpatients

Changes and interruptions during COVID-19: caregivers of people with brain health challenges—A qualitative analysis

BackgroundThe social and economic challenges of the COVID-19 pandemic greatly impacted people's physical and mental health. The majority of care for individuals with brain health challenges, including dementia and mental illness, is provided by informal family caregivers. The “Coping with Loneliness, Isolation and COVID-19” (CLIC) Global Caregiver Survey 2020 received responses from over 5,000 caregivers across 50 countries of people living with enduring brain and/or physical health conditions.AimThis study examined English-speaking caregivers of people with brain health challenges (dementia and mental health conditions) descriptions of changes and interruptions in their ability to provide care in the context of the COVID-19 pandemic.Materials and methodsQuantitative and qualitative data were collected as part of the large-scale CLIC Global Caregiver Survey. Data from over 900 English language respondents were analyzed using descriptive statistics and thematic content analysis. A multidisciplinary team of clinicians and health policy practitioners participated in team-based qualitative analyses.ResultsThe majority of respondents were from the United States (71% USA), female (83%) and care providers to people living with dementia (81%). Respondents reported concerns about their loved one's physical and mental health, the limited access to other caregiving sources and the limited opportunities to maintain personal wellbeing. Practical, social, psychological and emotional impacts affected their ability to offer care. There was clear evidence that the disruption to health and social care services—institutions, day care and home services impacted the ability to offer care.DiscussionThe pandemic may be seen as a catastrophic “event” that negatively impacted lives and livelihoods. A number of the social determinants of health were negatively impacted for the caregivers surveyed during this prolonged period. Caring for caregivers and supportive health and social care interventions are required to maintain the wellbeing of this informal workforce. This study represents the largest, cross-country survey on the impact of the COVID-19 pandemic on caregivers of people with brain health challenges to date; serving as an important resource for support agencies and to inform policy

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes

Background The first epidemic wave of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over one-third of care homes reported an outbreak, while there was limited testing of hospital patients discharged to care homes. Aim To investigate patients discharged from hospitals as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. Methods A clinical review was performed for all patients discharges from hospitals to care homes from 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease 2019 (COVID-19) test history, clinical assessment at discharge, whole-genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis using Cluster Investigation and Virus Epidemiological Tool software. Patient timelines were obtained using electronic hospital records. Findings In total, 787 patients discharged from hospitals to care homes were identified. Of these, 776 (99%) were ruled out for subsequent introduction of SARS-CoV-2 into care homes. However, for 10 episodes, the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data were available. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission, leading to 10 positive cases in their care home. Conclusion The majority of patients discharged from hospitals were ruled out for introduction of SARS-CoV-2 into care homes, highlighting the importance of screening all new admissions when faced with a novel emerging virus and no available vaccine

SARS-CoV-2 Omicron is an immune escape variant with an altered cell entry pathway

Vaccines based on the spike protein of SARS-CoV-2 are a cornerstone of the public health response to COVID-19. The emergence of hypermutated, increasingly transmissible variants of concern (VOCs) threaten this strategy. Omicron (B.1.1.529), the fifth VOC to be described, harbours multiple amino acid mutations in spike, half of which lie within the receptor-binding domain. Here we demonstrate substantial evasion of neutralization by Omicron BA.1 and BA.2 variants in vitro using sera from individuals vaccinated with ChAdOx1, BNT162b2 and mRNA-1273. These data were mirrored by a substantial reduction in real-world vaccine effectiveness that was partially restored by booster vaccination. The Omicron variants BA.1 and BA.2 did not induce cell syncytia in vitro and favoured a TMPRSS2-independent endosomal entry pathway, these phenotypes mapping to distinct regions of the spike protein. Impaired cell fusion was determined by the receptor-binding domain, while endosomal entry mapped to the S2 domain. Such marked changes in antigenicity and replicative biology may underlie the rapid global spread and altered pathogenicity of the Omicron variant

An examination of the Effectiveness of a Cognitive Group Intervention for People with Acquired Brain Injury

Neuropsychological rehabilitation is concerned with enabling people with brain injury to achieve their maximum potential in various domains such as psychological, social, leisure, vocational or everyday functioning. This study investigated, in a sample of people with Acquired Brain Injury (ABI), whether participating in a twelve-week group intervention brings about significant change in areas of cognition, community integration, satisfaction with life, distress, cognitive self-evaluation and knowledge of brain injury. Thirty-two participants (n = 32) with an ABI took part in this matched control study. Participants completed a series of neuropsychological tests (California Verbal Learning Test-Second Edition (CVLT-II); Trail Making Test; Sustained Attention Response Task (SART); and Digit-Span Task) and questionnaires (Community Integration Questionnaire; Satisfaction With Life Scale; Hospital Anxiety and Depression Scale; Cognitive Group Self-Evaluation; and Knowledge of Brain Injury Questionnaire) at three timepoints over a nine month period. Results showed a significant overall effect across the three timepoints in the intervention group on elements of the CVLT-II test and a significant overall effect across the three timepoints in both groups on elements of the Trail Making Test. A significant effect was seen between T1 and T2 in the intervention group on elements of the SART and Digit Span tests, and for the control group, significant effects between these two timepoints were seen on elements of the Trail Making Test, SART (target reaction time subscale) and the Digit Span test (disimprovment in performance between T1 and T2). Significant effects were seen between T2 and T3 for the intervention group on elements of the Trail Making Test and for the control group on elements of the CVLT-II test. Significant effects were seen between T1 and T3 for the intervention group on elements of the Trail Making and SART tests and for the control group, on elements of the CVLT-II test and Cognitive Self Evaluation questionnaire. There was a significant difference in Knowledge of Brain Injury scores for the main effect of time. This study provides some support for the effectiveness of a group-based intervention combining psychoeducation, basic strategy training and stress management techniques for individuals with ABI and has important implications for neurorehabilitation service providers, individuals with an ABI and their families

An examination of the Effectiveness of a Cognitive Group Intervention for People with Acquired Brain Injury

Neuropsychological rehabilitation is concerned with enabling people with brain injury to achieve their maximum potential in various domains such as psychological, social, leisure, vocational or everyday functioning. This study investigated, in a sample of people with Acquired Brain Injury (ABI), whether participating in a twelve-week group intervention brings about significant change in areas of cognition, community integration, satisfaction with life, distress, cognitive self-evaluation and knowledge of brain injury. Thirty-two participants (n = 32) with an ABI took part in this matched control study. Participants completed a series of neuropsychological tests (California Verbal Learning Test-Second Edition (CVLT-II); Trail Making Test; Sustained Attention Response Task (SART); and Digit-Span Task) and questionnaires (Community Integration Questionnaire; Satisfaction With Life Scale; Hospital Anxiety and Depression Scale; Cognitive Group Self-Evaluation; and Knowledge of Brain Injury Questionnaire) at three timepoints over a nine month period. Results showed a significant overall effect across the three timepoints in the intervention group on elements of the CVLT-II test and a significant overall effect across the three timepoints in both groups on elements of the Trail Making Test. A significant effect was seen between T1 and T2 in the intervention group on elements of the SART and Digit Span tests, and for the control group, significant effects between these two timepoints were seen on elements of the Trail Making Test, SART (target reaction time subscale) and the Digit Span test (disimprovment in performance between T1 and T2). Significant effects were seen between T2 and T3 for the intervention group on elements of the Trail Making Test and for the control group on elements of the CVLT-II test. Significant effects were seen between T1 and T3 for the intervention group on elements of the Trail Making and SART tests and for the control group, on elements of the CVLT-II test and Cognitive Self Evaluation questionnaire. There was a significant difference in Knowledge of Brain Injury scores for the main effect of time. This study provides some support for the effectiveness of a group-based intervention combining psychoeducation, basic strategy training and stress management techniques for individuals with ABI and has important implications for neurorehabilitation service providers, individuals with an ABI and their families