Post-traumatic growth in adult survivors of brain injury: a qualitative study of participants completing a pilot trial of brief positive psychotherapy

Purpose: Post-traumatic growth (PTG) can occur following acquired brain injury (ABI). It has been proposed that people experiencing psychological distress following ABI may benefit from a positive psychotherapy intervention (PPT) aimed at increasing well-being; PPT may also influence PTG. We aimed to investigate PTG experiences in participants of a positive psychotherapy pilot trial. Methods: ABI survivors who had received PPT or treatment as usual (TAU) were interviewed individually after the end of the trial. Thematic analysis was conducted, to code transcripts for known themes from PTG literature as well as newly emerging themes. Results: Four participants (age = 46–62; n = 3 male; months since injury = 11–20) from the PPT group and three (age = 58–74; n = 2 male; months since injury = 9–22) from the TAU group were interviewed. Six themes were shared across both groups: personal strength, appreciation of life, relating to others, optimism/positive attitude, feeling fortunate compared to others, and positive emotional/behavioral changes. Two themes were expressed by PPT participants only: lifestyle improvements and new possibilities. One TAU participant reported spiritual change. Conclusions: A greater understanding of the development of PTG following ABI may help rehabilitation clinicians to promote better adjustment by focusing on clients’ potential for positive change and enhancing their capacity for growth

Balancing the demands of two tasks: an investigation of cognitive–motor dual-tasking in relapsing remitting multiple sclerosis

Background: People with relapsing remitting multiple sclerosis (PwRRMS) suffer disproportionate decrements in gait under dual-task conditions, when walking and a cognitive task are combined. There has been much less investigation of the impact of cognitive demands on balance. Objectives: This study investigated whether: (1) PwRRMS show disproportionate decrements in postural stability under dual-task conditions compared to healthy controls, and (2) dual-task decrements are associated with everyday dual-tasking difficulties. The impact of mood, fatigue, and disease severity on dual-tasking was also examined. Methods: A total of 34 PwRRMS and 34 matched controls completed cognitive (digit span) and balance (movement of center of pressure on Biosway on stable and unstable surfaces) tasks under single- and dual-task conditions. Everyday dual-tasking was measured using the Dual-Tasking Questionnaire. Mood was measured by the Hospital Anxiety & Depression Scale. Fatigue was measured via the Modified Fatigue Index Scale. Results: No differences in age, gender, years of education, estimated pre-morbid IQ, or baseline digit span between groups. Compared with controls, PwRRMS showed significantly greater decrement in postural stability under dual-task conditions on an unstable surface (p=.007), but not a stable surface (p=.679). Balance decrement scores were not correlated with everyday dual-tasking difficulties or fatigue. Stable surface balance decrement scores were significantly associated with levels of anxiety (rho=0.527; p=.001) and depression (rho=0.451; p=.007). Conclusions: RRMS causes dual-tasking difficulties, impacting balance under challenging conditions, which may contribute to increased risk of gait difficulties and falls. The relationship between anxiety/depression and dual-task decrement suggests that emotional factors may be contributing to dual-task difficulties

Informant single screening questions for delirium and dementia in acute care – a cross-sectional test accuracy pilot study

Background Cognitive impairment often goes undetected in older people in hospital. Efficient screening tools are required to improve detection.<p></p> To determine diagnostic properties of two separate informant-based single screening questions for cognitive impairment (dementia and delirium) in hospitalised older people.<p></p> Methods Patients over 65 years non-electively admitted to medical or geriatric wards within a teaching hospital. Our index tests were single screening questions (SSQ), one for dementia (“How has your relative/friend’s memory changed over the past 5 years (up to just before their current illness)?”) and one for delirium (“How has your relative/friend’s memory changed with his/her current illness?”), which were assessed with informant response given on a five point Likert scale.<p></p> Any deterioration on our index tests of SSQ-dementia and SSQ-delirium was accepted as a positive screen for cognitive impairment. Scores were compared to the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) >3.38 accepted as dementia, and Confusion Assessment Method (CAM) diagnosis of delirium. We also collected direct cognitive screening data using Mini Mental Status Examination (MMSE).<p></p> Results Informant responses were obtained in 70/161 (43.5%) patients, median age 80.8 (range:67–97) years; mean MMSE score 18.5 (SD: 8.1). The SSQ-dementia when compared to the IQCODE had a sensitivity of 83.3% and specificity of 93.1%. The SSQ-delirium when compared to CAM diagnosis had sensitivity of 76.9% and a specificity of 56.1%.<p></p> Conclusions These findings show promise for use of an informant single screening question tool as the first step in detection of dementia in older people in acute hospital care, although this approach appears to be less accurate in screening for delirium.<p></p&gt

Towards validation of a new computerised test of goal neglect: preliminary evidence from clinical and neuroimaging pilot studies

Objective: Goal neglect is a significant problem following brain injury, and is a target for rehabilitation. It is not yet known how neural activation might change to reflect rehabilitation gains. We developed a computerised multiple elements test (CMET), suitable for use in neuroimaging paradigms. Design: Pilot correlational study and event-related fMRI study. Methods: In Study 1, 18 adults with acquired brain injury were assessed using the CMET, other tests of goal neglect (Hotel Test; Modified Six Elements Test) and tests of reasoning. In Study 2, 12 healthy adults underwent fMRI, during which the CMET was administered under two conditions: self-generated switching and experimenter-prompted switching. Results: Among the clinical sample, CMET performance was positively correlated with both the Hotel Test (r = 0.675, p = 0.003) and the Modified Six Elements Test (r = 0.568, p = 0.014), but not with other clinical or demographic measures. In the healthy sample, fMRI demonstrated significant activation in rostro-lateral prefrontal cortex in the self-generated condition compared with the prompted condition (peak 40, 44, 4; ZE = 4.25, p(FWEcorr) = 0.026). Conclusions: These pilot studies provide preliminary evidence towards the validation of the CMET as a measure of goal neglect. Future studies will aim to further establish its psychometric properties, and determine optimum pre- and post-rehabilitation fMRI paradigms

Spacetime Supersymmetry in a nontrivial NS-NS Superstring Background

In this paper we consider superstring propagation in a nontrivial NS-NS background. We deform the world sheet stress tensor and supercurrent with an infinitesimal B_{\mu\nu} field. We construct the gauge-covariant super-Poincare generators in this background and show that the B_{\mu\nu} field spontaneously breaks spacetime supersymmetry. We find that the gauge-covariant spacetime momenta cease to commute with each other and with the spacetime supercharges. We construct a set of "magnetic" super-Poincare generators that are conserved for constant field strength H_{\mu\nu\lambda}, and show that these generators obey a "magnetic" extension of the ordinary supersymmetry algebra.Comment: 13 pages, Latex. Published versio

Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study

Introduction: screening all unscheduled older adults for delirium is recommended in national guidelines, but there is no consensus on how to perform initial assessment. Aim: to evaluate the test accuracy of five brief cognitive assessment tools for delirium diagnosis in routine clinical practice. Methods: a consecutive cohort of non-elective, elderly care (older than 65 years) hospital inpatients admitted to a geriatric medical assessment unit of an urban teaching hospital. Reference assessments were clinical diagnosis of delirium performed by elderly care physicians. Routine screening tests were: Abbreviated Mental Test (AMT-10, AMT-4), 4 A's Test (4AT), brief Confusion Assessment Method (bCAM), months of the year backwards (MOTYB) and informant Single Question in Delirium (SQiD). Results: we assessed 500 patients, mean age 83 years (range = 66−101). Clinical diagnoses were: 93 of 500 (18.6%) definite delirium, 104 of 500 (20.8%) possible delirium and 277 of 500 (55.4%) no delirium; 266 of 500 (53.2%) were identified as definite or possible dementia. For diagnosis of definite delirium, AMT-4 (cut-point < 3/4) had a sensitivity of 92.7% (95% confidence interval (CI): 84.8–97.3), with a specificity of 53.7% (95% CI: 48.1–59.2); AMT-10 (<4/10), MOTYB (<4/12) and SQiD showed similar performance. bCAM had a sensitivity of 70.3% (95% CI: 58.5–80.3) with a specificity of 91.4% (95% CI: 87.7–94.3). 4AT (>4/12) had a sensitivity of 86.7% (95% CI: 77.5–93.2) and specificity of 69.5% (95% CI: 64.4–74.3). Conclusions: short screening tools such as AMT-4 or MOTYB have good sensitivity for definite delirium, but poor specificity; these tools may be reasonable as a first stage in assessment for delirium. The 4AT is feasible and appears to perform well with good sensitivity and reasonable specificity

Effort testing in dementia assessment: a systematic review

Objective: Interpretation of neuropsychological test data is only valid when appropriate effort has been exerted. Research, however, suggests that neuropsychologists do not always formally test for effort and that this may especially be the case in the context of dementia assessment. This review systematically examined the literature that has investigated the use of both purpose-built and embedded effort-sensitive indices in dementia, mild cognitive impairment (MCI), and healthy control samples. The aim was to determine which tests of effort are most sensitive to suboptimal effort and least sensitive to the type of cognitive impairment seen in dementia. Methods: A systematic search of databases was conducted to October 2017. There was no start date. Results: Twenty-five studies were included for review. The studies were divided into two categories according to methodology. One category of studies (n = 5) was reviewed using a tailored methodological quality rating checklist whilst the remaining studies (n = 20) were reviewed using the Crowe Critical Appraisal Tool (CCAT). Conclusions: The results of this review suggest that PVTs which take a hierarchical approach to effort testing such as the WMT, MSVT, and NV-MSVT are preferable for use with older adults who are under investigation for possible dementia. These tests go above and beyond the traditional pass/fail approach of more traditional tests of effort because they allow the examiner to analyze the examinee’s profile of scores. The methodological limitations and challenges involved in this field of research are discussed

Nature Of Transition Circumstellar Disks. I. The Ophiuchus Molecular Cloud

We have obtained millimeter-wavelength photometry, high-resolution optical spectroscopy, and adaptive optics near-infrared imaging for a sample of 26 Spitzer-selected transition circumstellar disks. All of our targets are located in the Ophiuchus molecular cloud (d similar to 125 pc) and have spectral energy distributions (SEDs) suggesting the presence of inner opacity holes. We use these ground-based data to estimate the disk mass, multiplicity, and accretion rate for each object in our sample in order to investigate the mechanisms potentially responsible for their inner holes. We find that transition disks are a heterogeneous group of objects, with disk masses ranging from <0.6 to 40 M(JUP) and accretion rates ranging from <10(-11) to 10(-7) M(circle dot) yr(-1), but most tend to have much lower masses and accretion rates than "full disks" (i.e., disks without opacity holes). Eight of our targets have stellar companions: six of them are binaries and the other two are triple systems. In four cases, the stellar companions are close enough to suspect they are responsible for the inferred inner holes. We find that nine of our 26 targets have low disk mass (<2.5 M(JUP)) and negligible accretion (<10(-11) M(circle dot) yr(-1)), and are thus consistent with photoevaporating (or photoevaporated) disks. Four of these nine non-accreting objects have fractional disk luminosities <10(-3) and could already be in a debris disk stage. Seventeen of our transition disks are accreting. Thirteen of these accreting objects are consistent with grain growth. The remaining four accreting objects have SEDs suggesting the presence of sharp inner holes, and thus are excellent candidates for harboring giant planets.NASA 1224608, 1230782, 1230779, 1407FONDECYT 1061199Basal CATA PFB 06/09ALMA FUND 31070021ALMA-Conicyt FUND 31060010National Science Foundation AST0-808144Spitzer Space Telescope Legacy Science ProgramAstronom

Differential regulation of the SMN2 gene by individual HDAC proteins

Spinal muscular atrophy (SMA) is an autosomal recessive neurodegenerative disorder that is the leading genetic cause of infantile death. SMA is caused by homozygous deletion or mutation of the survival of motor neuron 1 gene (SMN1). The SMN2 gene is nearly identical to SMN1, however is alternatively spliced. The close relationship to SMN1 results in SMN2 being a very power genetic modifier of SMA disease severity and a target for therapies. We sought to identify the regulatory role individual HDAC proteins use to control expression of full length protein from the SMN2 genes. We used quantitative PCR to determine the effects shRNA silencing of individual HDACs on the steady state levels of a SMN2-luciferase reporter transcripts. We determined that reduction of individual HDAC proteins was sufficient to increase SMN protein levels in a transgenic reporter system. Knockdown of class I HDAC proteins preferentially activated the reporter by increased promoter transcription. Silencing of class II HDAC proteins maintained transcriptional activity; however silencing of HDAC 5 and 6 also appeared to enhance inclusion of an alternatively spliced exon. This work highlights HDAC proteins 2 and 6 as excellent investigative targets. These data are important to the basic understanding of SMN expression regulation and the refinements of current therapeutic compounds as well as the development of novel SMA therapeutics

Non-disabled secondary school children’s lived experiences of a wheelchair basketball programme delivered in the East of England

Frequently an unquestioned belief is held in UK schools in the value of ‘normalised’ ability in physical education. Consequently inclusion of disabled students can be problematical. Negative perceptions of disability are rarely challenged. This study investigated the embodied experiences of 50 non-disabled secondary school pupils during a programme designed to introduce disability sport to non-disabled schoolchildren entitled ‘The Wheelchair Sports Project.’ Wheelchair Basketball sessions were delivered by coaches during physical education for a 12 week period. 50 pupils aged between 10 and 12 years took part. Non-participant observations were completed during the intervention and guided group interviews were completed with 40 participants pre and post project. Bourdieu’s theoretical framework was utilized during data analysis. The impact of the project on pupils’ perceptions of physical disability was investigated. Prior to the project, pupils emphasized the ‘otherness’ of disabled bodies and described disability sport as inferior and not ‘real.’ Observations highlighted how pupils’ experienced physical challenges adapting to wheelchair basketball. Pupils struggled to control wheelchairs and frequently diverged from acceptable behaviour by using their lower limbs to ‘cheat.’ Post-programme interviews demonstrated pupils’ perceptions of physical disability altered due to their embodied experiences. Pupils described high physical demands of wheelchair basketball and began to focus upon similarities between themselves and physically disabled individuals. However, no reference was made to mental or psychological disability, emphasizing the specificity of the effects of pupils’ embodied experiences on their habitus’