Panel of Towns: Morris County, NJ: The Morris County Park Commission White-Tailed Deer Management Program: A Multi-Faceted Approach

Symposium: The Increasing Conflicts of Deer and Human Populations in Suburban Area

Development of a decision support system framework for cultural heritage management

Decision support systems (DSSs) have been traditionally identified as useful information technology tools in a variety of fields, including the context of cultural heritage. However, to the best of our knowledge, no prior study has developed a DSS framework that incorporates all the main decision areas simultaneously in the context of cultural heritage. We fill this gap by focusing on design-science research and specifically by developing a DSS framework whose features support all the main decision areas for the sustainable management of cultural assets in a comprehensive manner. The main decision-making areas considered in our study encompass demand manage-ment, segmentation and communication, pricing, space management, and services management. For these areas, we select appropriate decision-making supporting techniques and data management solutions. The development of our framework, in the form of a web-based system, results in an architectural solution that is able to satisfy critical requirements such as ease of use and response time. We present an application of the innovative DSS framework to a museum and discuss the main managerial implications and future improvements

Duration of Posttraumatic Amnesia Predicts Neuropsychological and Global Outcome in Complicated Mild Traumatic Brain Injury.

OBJECTIVES: Examine the effects of posttraumatic amnesia (PTA) duration on neuropsychological and global recovery from 1 to 6 months after complicated mild traumatic brain injury (cmTBI). PARTICIPANTS: A total of 330 persons with cmTBI defined as Glasgow Coma Scale score of 13 to 15 in emergency department, with well-defined abnormalities on neuroimaging. METHODS: Enrollment within 24 hours of injury with follow-up at 1, 3, and 6 months. MEASURES: Glasgow Outcome Scale-Extended, California Verbal Learning Test II, and Controlled Oral Word Association Test. Duration of PTA was retrospectively measured with structured interview at 30 days postinjury. RESULTS: Despite all having a Glasgow Coma Scale Score of 13 to 15, a quarter of the sample had a PTA duration of greater than 7 days; half had PTA duration of 1 of 7 days. Both cognitive performance and Extended Glasgow Outcome Scale outcomes were strongly associated with time since injury and PTA duration, with those with PTA duration of greater than 1 week showing residual moderate disability at 6-month assessment. CONCLUSIONS: Findings reinforce importance of careful measurement of duration of PTA to refine outcome prediction and allocation of resources to those with cmTBI. Future research would benefit from standardization in computed tomographic criteria and use of severity indices beyond Glasgow Coma Scale to characterize cmTBI

P04.42. Use of complementary and alternative medicine among adults with neuro-psychiatric symptoms common to mild traumatic brain injury

Purpose: One in three adults uses complementary and alternative medicine (CAM) annually in the United States. However, the pattern of CAM use among adults with neuropsychiatric symptoms commonly reported by patients with mild traumatic brain injury (mTBI), a serious public health concern, is not well studied. Methods: We analyzed data from the 2007 National Health Interview Survey (n=23,393) to compare CAM use between adults with and without neuropsychiatric symptoms common to mTBI. Symptoms included self-reported anxiety, depression, insomnia, headaches, memory deficits, attentional deficits, and excessive sleepiness. CAM use was defined as use of mind-body (e.g., meditation), biological (e.g., herbs), manipulation (e.g., massage) therapies, and alternative medical systems (e.g., Ayurveda), within the past 12 months. We estimated prevalence and reasons for CAM use in patients with and without neuropsychiatric symptoms. We also explored variations in CAM use by the number of symptoms. Multivariable logistic regression was performed to examine the association between neuropsychiatric symptoms and CAM use after adjustment for sociodemographic characteristics, illness burden (e.g,. fibromyalgia, low back pain), access to care, and health habits. Results: Adults with neuropsychiatric symptoms had higher CAM use compared to adults without neuropsychiatric symptoms (44% vs. 30%, p<0.001); prevalence increased with increasing number of symptoms (p-value for trend <0.001, table below). Differences persisted after adjustment (table below). Twenty percent used CAM because standard treatments were either too expensive or ineffective; 25% used CAM because it was recommended by a provider. Conclusion: More than 40% of adults with neuropsychiatric symptoms observed in mTBI used CAM. An increasing number of symptoms was associated with increased use. Future research is needed to understand the use, efficacy, and safety of CAM in mTBI patients

Study adherence in a tDCS longitudinal clinical trial with people with spinal cord injury

Study design Secondary analysis of a clinical trial.Objectives To analyze adherence to 1-year transcranial Direct Current Stimulation (tDCS) clinical trial in people with chronic pain due to spinal cord injury (SCI). We also explore the association between dropout and several baseline variables such as age, depression levels, pain severity, number of days with pain in the last 7 days, walking ability, sleep, work, relationship with others, and enjoyment with life.Setting Boston, USA.Methods Forty-six participants were enrolled in this trial, and 33 participants were randomized to receive either active or sham tDCS.Results Using the full intention-to-treat (ITT) criteria, only 8 participants (24%) finished the study. The median time to dropout was seven (IQR:6,19) sessions (i.e., immediately after the first follow-up), regardless of the type of stimulation that participants received (active vs. sham tDCS) (chi(2) = 0.025, p = 0.875). An exploratory analysis suggested that only the number of days with pain in the last 7 days was moderately associated with dropout, with people experiencing less pain being more prone to dropout from the study.Conclusions Despite all the measures to improve study adherence (such as providing parking, flexibility to schedule sessions, follow-up with participants by phone), it seems that long follow-up periods may increase the likelihood of dropout. Given the need to understand long-term effects of interventions, longitudinal trials need to consider alternative designs or methods of treatment (for instance home treatment or home assessment) to decrease attrition rate.This project was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers H133N110010 and 90SI5021-01-00). SC and JL are supported by the Portuguese Foundation for Science and Technology PTDC/MHC-PCN/3950/2014; SC is also funded by the following FCT grant IF/00091/2015

Increased Gray Matter Diffusion Anisotropy in Patients with Persistent Post-Concussive Symptoms following Mild Traumatic Brain Injury

A significant percentage of individuals diagnosed with mild traumatic brain injury (mTBI) experience persistent post-concussive symptoms (PPCS). Little is known about the pathology of these symptoms and there is often no radiological evidence based on conventional clinical imaging. We aimed to utilize methods to evaluate microstructural tissue changes and to determine whether or not a link with PPCS was present. A novel analysis method was developed to identify abnormalities in high-resolution diffusion tensor imaging (DTI) when the location of brain injury is heterogeneous across subjects. A normative atlas with 145 brain regions of interest (ROI) was built from 47 normal controls. Comparing each subject’s diffusion measures to the atlas generated subject-specific profiles of injury. Abnormal ROIs were defined by absolute z-score values above a given threshold. The method was applied to 11 PPCS patients following mTBI and 11 matched controls. Z-score information for each individual was summarized with two location-independent measures: “load” (number of abnormal regions) and “severity” (largest absolute z-score). Group differences were then computed using Wilcoxon rank sum tests. Results showed statistically significantly higher load (p = 0.018) and severity (p = 0.006) for fractional anisotropy (FA) in patients compared with controls. Subject-specific profiles of injury evinced abnormally high FA regions in gray matter (30 occurrences over 11 patients), and abnormally low FA in white matter (3 occurrences over 11 subjects). Subject-specific profiles provide important information regarding the pathology associated with PPCS. Increased gray matter (GM) anisotropy is a novel in-vivo finding, which is consistent with an animal model of brain trauma that associates increased FA in GM with pathologies such as gliosis. In addition, the individualized analysis shows promise for enhancing the clinical care of PPCS patients as it could play a role in the diagnosis of brain injury not revealed using conventional imaging

Multiple prior concussions are associated with symptoms in high school athletes

Objectives: The purpose of this study was to evaluate the association of prior concussion on baseline computerized neurocognitive testing in a large cohort of high school athletes. Methods: This is a retrospective cohort study of student athletes from 49 Maine High Schools in 2010 who underwent baseline computerized neurocognitive evaluation with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®). As part of the ImPACT®, subjects reported a prior history of concussion as well as demographic information and a symptom questionnaire. We used linear regression to evaluate the association of prior concussion with baseline: (1) ImPACT® composite scores; and (2) symptom scores. Results: Six thousand seventy-five subjects were included in the study, of whom 57% were boys. The majority of student athletes (85.3%) reported no prior history of concussion while 4.6% reported having sustained two or more prior concussions. On simple linear regression, increasing number of concussions was related to worse performance in verbal memory (P = 0.039) and greater symptoms scores (P < 0.001). On multivariate modeling, only the association with baseline symptoms remained (P < 0.001). Other factors associated with baseline symptom reporting in the multivariate model included mental health history, headache/migraine history, gender, developmental and/or learning problems, and number of prior concussions. Interpretation In this large-scale, retrospective survey study, history of multiple prior concussions was associated with higher symptom burden but not baseline computerized neurocognitive testing. The association between baseline symptom reporting and clinical and demographic factors was greater than the association with a history of multiple concussions