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Tracking falls among elders is challenging. In this reliability study, which took place between October 2007 and February 2008, the authors compared participants’ daily recordings of falls on calendars with a telephone survey of recall of falls over the previous 3 months within the population-based MOBILIZE Boston Study cohort, a cohort of 765 elders. From the cohort, 218 participants were randomly selected. Falls were tracked prospectively on daily calendars (mailed back monthly). Telephone recalls of falls over the previous 3 months were conducted in January and February 2008. Agreement, sensitivity, and specificity were calculated to compare the occurrence of falls as determined by 3-month recall with falls recorded by daily calendar (gold standard) during the same 3-month period. Results showed good agreement between recall and calendars: 27 persons reported a fall by both methods. However, while the 3-month recall correctly classified persons who did not fall (164 persons by both methods), it missed 25% of participants who fell (of 36 participants with a calendar-reported fall, 9 did not report a fall by telephone recall). Kappa was 0.74 (95% confidence interval: 0.68, 0.80), sensitivity was 75%, and specificity was 96%. Retrospective 3-month recall of falls resulted in underreporting of falls by as much as 25% compared with daily calendars. Calendars should be considered the preferred method of ascertaining falls in longitudinal studies. [ABSTRACT FROM PUBLISHER]

Few studies have evaluated the validity of adolescent diet recall after many decades. Between 1943 and 1970, yearly diet records were completed by parents of adolescents participating in an ongoing US study. In 2005–2006, study participants who had been 13–18 years of age when the diet records were collected were asked to complete a food frequency questionnaire regarding their adolescent diet. Food frequency questionnaires and diet records were available for 72 participants. The authors calculated Spearman correlation coefficients between food, food group, and nutrient intakes from the diet records and food frequency questionnaire and deattenuated them to account for the effects of within-person variation measured in the diet records on the association. The median deattenuated correlation for foods was 0.30, ranging from −0.53 for a beef, pork, or lamb sandwich to 0.99 for diet soda. The median deattenuated correlation for food groups was 0.31 (range: −0.48 for breads to 0.70 for hot beverages); for nutrient intakes, it was 0.25 (range: −0.08 for iron to 0.82 for vitamin B12). Some dietary factors were reasonably recalled 3–6 decades later. However, this food frequency questionnaire did not validly measure overall adolescent diet when completed by middle-aged and older adults on average 48 years after adolescence. [ABSTRACT FROM PUBLISHER]

Life-course epidemiologic studies frequently obtain data on perinatal and childhood factors through adult self-report. Data from a prospective US birth cohort of 262 women, born between 1959 and 1963 (average age at adult follow-up, 41.8 years), were used to assess the validity of self-reported birth weight category by sociodemographic characteristics. The effect of reporting error on the associations of birth weight with childhood and adult body mass index was evaluated by comparing the estimates of associations from linear regression analyses. The level of agreement between the birth weight category reported by 85% of the participants and the birth weight recorded at the time of birth was moderate to good (sensitivity = 73%, weighted kappa = 0.67). The validity varied by birth weight category (sensitivity range = 58%–81% for the lowest and highest birth weight category, respectively) and was highest for participants who were white, of lower childhood family income, and born to older mothers. Despite this moderate to good validity, the associations of birth weight with childhood and adult body mass index were attenuated and no longer statistically significant when self-reported birth weight was used. In conclusion, birth weight reported in middle adult life is measured with error, limiting its utility for detecting modest associations with health in later life periods. [ABSTRACT FROM PUBLISHER]

Purpose: Twenty-four–hour diet recall interviews (24HRs) are used to assess diet and to validate other diet assessment instruments. Therefore it is important to know how many 24HRs are required to describe an individual''s intake. Method: Seventy-nine middle-aged white women completed seven 24HRs over a 14-day period, during which energy expenditure (EE) was determined by the doubly labeled water method (DLW). Mean daily intakes were compared to DLW-derived EE using paired t tests. Linear mixed models were used to evaluate the effect of call sequence and day of the week on 24HR-derived energy intake while adjusting for education, relative body weight, social desirability, and an interaction between call sequence and social desirability. Results: Mean EE from DLW was 2115kcal/day. Adjusted 24HR-derived energy intake was lowest at call 1 (1501kcal/day); significantly higher energy intake was observed at calls 2 and 3 (2246 and 2315kcal/day, respectively). Energy intake on Friday was significantly lower than on Sunday. Averaging energy intake from the first two calls better approximated true energy expenditure than did the first call, and averaging the first three calls further improved the estimate (p =0.02 for both comparisons). Additional calls did not improve estimation. Conclusions: Energy intake is underreported on the first 24HR. Three 24HRs appear optimal for estimating energy intake. [Copyright &y& Elsevier]

Epidemiologic research shows that pets influence human health, demonstrating both protective and deleterious health risks; therefore, valid definitions of pet exposure would enhance research. The authors determined how well young adults aged 18 years report their early childhood pets. Subjects in an established birth cohort from Detroit, Michigan, born in 1987–1989 (n = 820) were asked a series of questions about pets in the home during their first 6 years of life. Pet recall was compared with annual prospectively collected parental report from 12–18 years prior. Exposure to cats was correctly reported on average 86.3% of the time (95% confidence interval: 85.0, 87.5) and dogs 79.2% (95% confidence interval: 77.7, 80.6) of the time (P < 0.01). Cats and dogs were more likely to be underreported than overreported, from as few as 1.8-fold to as many as 8.3-fold (P < 0.05). Reporting differed by sex of the respondent and current pet ownership. No differences were found in reporting by those who experienced allergy symptoms near dogs or cats. Findings suggest good reliability of young adult pet reporting for ages 0–6 years but that childhood pet exposure may need to be assessed separately depending on the participant's sex and the outcome of interest. [ABSTRACT FROM PUBLISHER]

Childhood family atmosphere is a frequent topic in psychotherapy. Our aim was to assess the stability of affect associated with autobiographical memories. In a 7-year follow-up study of depression, 414 primary care patients and psychiatric outpatients both at baseline and at follow-up completed the self-inquiry Depression Scale (DEPS) and answered simple questions about the mental atmosphere in their childhood families. The prevalence and the distribution of changes in affect were calculated by cross-tabulation. Logistic regression analyses were used to assess associations between depressiveness and changes in affect. Nearly 50% of the sample had at least one change in the responses. Young age and male gender were significant predictors for changes. Depressiveness was associated with changes in miserable affect of the childhood home. Affect associated with autobiographical memories seems to change over a longer period. The association between depressiveness and changes in recollections is convoluted. The large number of changes of affects concerning autobiographical memories should be taken into account both in psychotherapy and in studies of life-long experiences. Future long follow-up studies with more specific multi-item measures on family atmosphere are needed. [ABSTRACT FROM AUTHOR]

Objective: This randomized controlled trial aimed to determine whether an interactive CD-ROM improved cancer patients’ recall of chemotherapy treatment information over standard written information, and whether demographic, cognitive, and psychological factors better predicted recall than this format of delivery. Methods: One-hundred-and-one new patients about to commence chemotherapy were randomized to receive written information or a CD-ROM containing treatment information before giving informed consent. Patients’ recall, concentration, short-term memory, reading comprehension, anxiety, depression, and coping styles were assessed with standardized measures pre-treatment. Seventy-seven patients completed tests for recall of treatment information before their second chemotherapy session. Results: Intention-to-treat analyses indicated no significant differences between the written information and CD-ROM groups across recall questions about number of drugs received (p =.43), treatment length (p =.23), and treatment goal (p =.69). Binary logistic regressions indicated that for groups combined different variables predicted each of the recall questions. Conclusion: An interactive CD-ROM did not improve cancer patients’ recall of treatment information enough to warrant changes in consent procedures. Practice implications: Different variables predicted recall of different treatment aspects highlighting the complex nature of attempting to improve patient recall. Attending to the effect of depression on patient knowledge and understanding appears paramount. [Copyright &y& Elsevier]

This study attempted to replicate negative bias and depressive explanatory style in depression using life narratives. The two central aspects of narrative, temporal succession and evaluation, were also explored. These aspects were tested for the first time using entire life narratives of 17 depressed inpatients and non-depressed controls matched for sex and educational level. Negative bias and depressive explanatory style were replicated as typical for the depressed group. Life narratives of depressed patients also deviated more from a linear temporal order and compared less frequently the past with the present. Contrary to expectations, the depressed did not differ in the overall frequency of evaluations. However, they used more past than present evaluations and more experience-near evaluations than cognitive evaluations, suggesting that they are more immersed in past experiences. It is concluded that negative bias and depressive explanatory style can be found also in a naturalistic narrative measure, and that depression affects the two major aspects of narrative. It is argued that life narratives, as measures close to everyday clinical practice and as the most encompassing form of self-representation, should complement more experimental procedures in the study of cognitive and communicative processes in psychopathology. Depression and Anxiety, 2008. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Abstract: In dietary recall for a specified target period, an intrusion denotes an item reported eaten that was not consumed during that period. Intrusions may denote items available during the specified period, items consumed during other periods, or items from general knowledge of dietary intake. To investigate a cognitive basis of intrusions, we analyzed data from a dietary-reporting validation study in which 69 fourth-grade children were observed eating 2 school meals (breakfast and lunch) and interviewed that evening about that day''s intake in person or by telephone. Of 450 items reported eaten for school meals, 82 were intrusions. Observations and school food service production records were used to determine whether items denoted by intrusions were available in school food service environments on the interview day, as many as 3 school days prior to the interview day, and the day following the interview. Availability of items denoted by intrusions decreased backward over days from the interview day, and decreased from the interview day to the following day. Among 40 children who reported at least 1 intrusion, mean number of intrusions (controlling for number of items reported) increased as interviews occurred later in the week. These results are consistent with the idea that some intrusions are based on specific memories of items encountered but not eaten during the target period, or encountered before the target period. Other intrusions are likely based on general dietary knowledge. It may be possible to design interview techniques to reduce the occurrence of intrusions that are incorrectly based on specific memories. [Copyright &y& Elsevier]

Abstract: While the adverse medical complications and consequences of delirium has been well studied, the same is not true of the psychological morbidity associated with the condition. A better understanding of what it is like to be delirious has the potential to improve recognition, management and treatment of delirium. This article examines the literature relating to the experience of delirium from the perspective of patients, families, and staff. Finally, suggestions for further work that might advance might advance our understanding of these issues are outlined. [Copyright &y& Elsevier]

Context Most studies on medical expertise research have focused on diagnostic performance, whereas patient management has been largely ignored. According to knowledge encapsulation theory, applying encapsulated knowledge is a characteristic of expert doctors’ diagnostic reasoning, but it is unclear whether or not encapsulated knowledge also plays a prominent role when processing a clinical case with a management focus. Methods The participants were 40 medical students (20 in Year 4 and 20 in Year 6) and 20 expert doctors (internists). Participants were asked to study the cases with either a diagnostic (Dx) or a management (Mx) focus. Subsequently, participants were asked to write down what they remembered from the case. Results In both conditions, experts recalled fewer propositions and used more high-level inferences than medical students. Furthermore, they processed the cases faster and more accurately than medical students, but no significant difference between Mx and Dx conditions was found. Year 4 students also showed no significant differences in recall and processing speed between conditions. By contrast, Year 6 students recalled more in a Dx than in an Mx condition, but there was no significant difference in processing speed between conditions. Conclusions In both conditions, findings indicate that the experts’ and Year 4 students’ performance was not affected by processing focus. The fact that only Year 6 students were affected by processing focus might be explained by the assumption that their diagnostic knowledge and management knowledge are not fully integrated yet, a process that has already taken place in the expert’s knowledge structure. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate patients'' ability to recall their preoperative self-reported quality of life, function, and general health 2 weeks postoperatively. Study Design and Setting: We randomized consecutive patients undergoing arthroscopic knee surgery to group I (assessments at 4 weeks preoperatively, on the day of surgery, and 2 weeks and 12 months postoperatively) or group II (assessments at 2 weeks and 12 months postoperatively). At each visit patients completed disease-specific, knee-specific, and generic health rating scales. At a median of 2 weeks postoperative (range, 0.6 to 14 weeks), patients completed questionnaires according to their recollection of their health 2 weeks before surgery. Results: Agreement between actual and recalled data was excellent for disease-specific (ICCWOMET =0.88 (95% CI 0.82–0.91), ICCACL-QOL =0.86 (95% CI 0.75–0.91)), knee-specific (ICCIKDC =0.92 (95% CI 0.90–0.94), ICCKOOS =0.93 (95% CI 0.91 to 0.95), and general physical health (ICCSF-36(PCS) =0.81 (95% CI 0.75–0.86)) instruments. Agreement for general mental health was moderate (ICCSF-36(MCS) =0.67 (95% CI 0.58–0.75). Greater error associated with recalled ratings contributed to small increases in sample size requirements or small decreases in power to detect differences between groups. Conclusion: Patients recalled their preoperative quality of life, function, and general health at 2 weeks postoperative with sufficiently high accuracy to warrant substituting prospectively collected baseline data with recalled ratings. [Copyright &y& Elsevier]

Self-reported perinatal exposures to chemicals or pollutant sources in case–control studies of birth defects may be inaccurate due to misreporting among mothers. In a case–control study of neural tube defects delivered in California in 1987–1988, mothers of case and control infants were asked whether they lived within 0.25 mile (400 m) of agricultural crops. Responses were compared against a gold standard derived from historical agricultural land-use survey maps. The odds ratio for self-reported proximity to any crops (1.62, 95% confidence interval: 1.08, 2.43) appeared to be positively biased compared with the estimate for map-based proximity (1.17, 95% confidence interval: 0.79, 1.71). This pattern was also observed for proximity to specific crops such as nonpermanent and orchard crops. For vineyards, however, we observed an increased risk associated with map-based proximity (odds ratio=2.45, 95% confidence interval: 1.08, 5.58) but not with self-reported proximity (1.09, 95% confidence interval: 0.51, 2.34). The sensitivity of self-reported proximity to any crops was greater for case (65.7%) than control mothers (50.0%) while specificity was about the same for case and control mothers (87.5 vs. 89.3%), suggesting that control mothers under-reported proximity to crops. Differential reporting was also observed between geographic regions, urban and rural residents, and across levels of maternal employment and education. These results suggest differential reporting between case and control mothers as well as an influence from maternal demographic characteristics on reporting accuracy.Journal of Exposure Science and Environmental Epidemiology (2006) 16, 147–155. doi:10.1038/sj.jea.7500444; published online 27 July 2005 [ABSTRACT FROM AUTHOR]

Objectives: To determine whether the interval over which patients are asked to remember their falls affects fall reporting. Design: Systematic literature review. Setting: Community. Participants: Individuals being monitored for falls in prospective studies that asked participants to recall falls over varying intervals. Measurements: Sensitivity and specificity of retrospective recall compared with a criterion-standard prospective assessment using some form of ongoing fall monitoring. Results: Six studies met the inclusion criteria. Recall of falls in the previous year was specific (specificity 91–95%) but less sensitive (sensitivity 80–89%) than the criterion standard of ongoing prospective collection of fall data using fall calendars or postcards. Patients with injurious falls were more likely to recall their falls. Lower Mini-Mental State Examination score was associated with poorer recall of falls in the one study addressing this issue. Conclusion: Whenever accurate data on all falls are critical, such as with interventions to decrease the rate of falls, researchers should gather information on falls every week or every month from study participants. The optimal method of fall monitoring—postcard, calendar, diary, telephone, or some combination of these—remains unknown. [ABSTRACT FROM AUTHOR]

Estimates of the level of unmet need for mental health treatment often rely on self-reported use of mental health services. However, depressed persons may over-report their use in relation to administrative records if they are highly distressed. This study seeks to repIicate and explicate the finding that persons at a high level of distress report more mental health service use than recorded in their healthcare records. The study sample, N = 36,892, 12 years and older, was drawn from the 1996/97 Ontario portion of the Canadian National Population Health Survey. Respondents were individually linked to their administrative mental healthcare records 12 months backward in time. Of these, 96.5% agreed to the link and 23,063 (62.5%) were linked. Almost two-thirds of those who were depressed in the past year were currently at a high level of distress. Differential reporting of use for highly distressed persons in excess of 100% remained in the use of different types of physician providers after adjustments for other potential determinants of use. Telescoping was also not an explanation. The patterns of differential reporting between groups expected to diverge and converge in their recall ability were consistent with a recall bias. As this study was not able to rule out a recall bias, it further accentuates concerns about the impact of bias in the measurement of mental health-service use and inferences made concerning the determinants of use. [ABSTRACT FROM AUTHOR]

Thompson R, Bogner HR, Coyne JC, Gallo JJ, Eaton WW. Personal characteristics associated with consistency of recall of depressed or anhedonic mood in the 13-year follow-up of the Baltimore Epidemiologic Catchment Area Survey. Acta Psychiatr Scand 2004: 109: 345–354. © Blackwell Munksgaard 2004. Our study addressed two primary questions: (1) How reliable is long-term recall of lifetime history of episodes of depressed mood? (2) What characteristics are associated with consistent recall of this history? Psychiatric symptoms were assessed in a population-based longitudinal survey of 1498 persons twice, in 1981 and 1994. Respondents whose reports of history of depressed affect were discordant after a 13-year follow-up interval were compared with those whose reports were concordant. Absence of a reported history of episode of depressed mood was more consistently recalled than presence of such an episode. The kappa of reported lifetime history of episode of depressed mood was 0.32. Several personal characteristics predicted consistency of recall. If assessment of past episodes of depressed mood is used as guide for identifying cases at risk for depression, account must be taken of the personal factors that might influence recall. [ABSTRACT FROM AUTHOR]

Background Q fever is a zoonotic disease caused by Coxiella burnetii. Primary infection can progress to persistent infection irrespective of initial symptomatology. Our aim is to describe the clinical features, treatment, risk of progression, use of prophylaxis, and outcomes of Coxiella burnetii infection at our institution. Methods We did a retrospective review of all adult patients with positive Coxiella burnetii serology at Mayo Clinic, Rochester from 1st January 2012 to 31st December 2018. Centers for Disease Control and Prevention (CDC) case definition and classification were used to group the patients into confirmed and probable acute Q fever, and confirmed and probable chronic/persistent Q fever. Data on demographics, clinical presentation, comorbid conditions, exposure history, risk factors associated with progression, serology, treatment and outcomes were collected. Results We found 266 patients with positive titres of Coxiella IgG or IgM greater than 1:16, of which 49 patients met the CDC case definition for Q fever. Median age at presentation was 62 years. 45/49 (91. 8%) were men, while 4/49 (8%) were women. 20/49 (40. 8%) patients presented with acute Q fever of which 5 (25%) patients progressed to persistent infection. 29/49 (59%) patients presented with persistent Q fever of which 4 patients could recall symptoms suggestive of acute Q fever. The most common presentation of acute Q fever was acute febrile illness (65%). Endocarditis (11/29) was the most common presentation of chronic/persistent Q fever. Of the 5 patients with acute Q fever that progressed to persistent infection, 3/5(60%) progressed despite being on doxycycline and hydroxychloroquine. 8/29 patients with persistent Q fever had serological resolution at last follow-up. 2/4(50%) deaths were attributable to Q fever. Conclusion Minority of the patients tested met the case definition. 25% of patients with acute disease progressed to chronic Q fever out of which 60%(3/5) progressed despite prophylaxis. Endocarditis and vascular infections were the most common chronic cases. Interestingly we found 4 cases of MPGN in association with Q fever. Prosthetic valves are the most important risk factors for progression (P = 0.02). Serological cure often lags behind clinical cure (27% vs. 68% in persistent infection)(Table 4). Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Measles, rubella, and maternal and neonatal tetanus have been verified to be eliminated in Haiti, but a diphtheria outbreak has been ongoing since 2014. To evaluate progress toward maintaining vaccine preventable disease (VPD) elimination and control, we conducted the first survey to estimate immunity to these VPDs among children in Haiti. Methods We conducted a nationally representative, two-stage cluster survey in 2017, stratifying Haiti into 2 regions: (1) West Region, the highly urban West department that includes one-third of Haiti's population; (2) Non-West Region (all other departments). We sampled 4,286 households to recruit at least 910 children aged 5–7 years. We obtained vaccination history and dried blood spots from one eligible child per household. Antibody concentrations to VPDs were measured on a multiplex bead assay. We compared seroprotection and vaccination coverage estimates. Results Among 1146 enrolled children, tetanus (83%, 95% CI: 80%–86%) and diphtheria (83%, 95% CI: 81%–85%) seroprotection were higher than coverage with ≥3 doses of tetanus and diphtheria containing vaccine (DTP3) (68%, 95% CI: 61%–74%). No participants had antibody concentrations consistent with long-term immunity to tetanus or diphtheria. Measles (87%, 95% CI: 85%–89%) and rubella (84%, 95% CI: 81%–87%) seroprotection were higher than or similar to coverage with at least one dose of measles-rubella (MR) vaccine (84%, 95% CI: 80%–87%) (Figure 1). MR second-dose coverage was 20% (95% CI: 16%–24%). Seroprotection in the West Region was lower than in the non-West region for all VPDs. Conclusion Discordance between DTP3 coverage and seroprotection might be due to underestimating vaccination coverage by recall. Lack of long-term protection against tetanus or diphtheria is consistent with declining antibody concentrations by school-age after the primary DTP series, indicating the need for a booster dose. Seroprotection against measles and rubella viruses was lower than levels needed to prevent transmission, particularly in the West region; re-introduction of either virus could lead to an epidemic. Haiti should reach ≥95% DTP3 and two-dose MR coverage and add tetanus and diphtheria vaccine booster doses per global recommendations. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background The ACIP recommends influenza and Tdap vaccination during pregnancy to reduce the risk of influenza and pertussis in the mother and her infant. We assessed influenza and Tdap vaccination coverage and associated factors among pregnant women enrolled in PREVAIL, a prospective birth cohort study in Cincinnati, OH. We assessed sensitivity and specificity of self report for both vaccines against state registry, maternal healthcare provider, and work-place records. Methods We enrolled and interviewed 265 pregnant women regarding self-reported receipt of influenza and Tdap vaccines, and obtained vaccine records from registry, electronic medical record, provider, employer, or pharmacy. We grouped subjects by documented vaccination status and analyzed demographic variables and vaccine attitudes regarding efficacy, safety, and hesitancy using unadjusted Fisher exact tests. We analyzed sensitivity and specificity of maternal recall. Results We identified documentation of influenza and Tdap vaccine receipt during pregnancy in 172/265 (64.9%) and 238/265 (89.8%) of women, respectively (Figure 1); by self report, 177/265 (66.8%) reported receiving influenza and 221/265 (83.4%) Tdap vaccine. The two most common primary reasons cited for receiving influenza vaccine were "to protect my baby" (36.7%) and "to protect myself" (26%; Figure 2). Pregnant women were more likely to get Tdap vaccine if a healthcare worker recommended it (OR 5.4). Subjects were more likely to get influenza vaccine if they believed it was effective in preventing influenza in themselves (OR 9.0) or their babies (OR 8.1). While positive recall had a high concordance (95.2% and 93.4% for influenza and Tdap, respectively), 12.5% and 32.1% of mothers incorrectly recalled not receiving an influenza or Tdap vaccine, respectively, that was documented as received in the records (Figure 3). Conclusion We found high concordance between maternal recall and verification for both influenza and Tdap vaccines. In this single-site cohort of 265 women, self report was a reliable measure of vaccination status among pregnant women. Provider communication to pregnant women regarding effectiveness of influenza and Tdap vaccinations for themselves and their infants may lead to higher maternal vaccination rates. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Annually in the US alone , Clostridioides difficile infection (CDI) afflicts nearly 500,000 patients causing 29,000 deaths. Since early and aggressive interventions could save lives but are not optimally deployed in all patients, numerous studies have published predictive models for adverse outcomes. These models are usually developed at a single institution, and largely are not externally validated. This aim of this study was to validate the predictability for severe CDI with previously published risk scores in a multicenter cohort of patients with CDI. Methods We conducted a retrospective study on four separate inpatient cohorts with CDI from three distinct sites: the Universities of Michigan (2010–2012 and 2016), Chicago (2012), and Wisconsin (2012). The primary composite outcome was admission to an intensive care unit, colectomy, and/or death attributed to CDI within 30 days of positive test. Structured query and manual chart review abstracted data from the medical record at each site. Published CDI severity scores were assessed and compared with each other and the IDSA guideline definition of severe CDI. Sensitivity, specificity, area under the receiver operator characteristic curve (AuROC), precision-recall curves, and net reclassification index (NRI) were calculated to compare models. Results We included 3,775 patients from the four cohorts (Table 1) and evaluated eight severity scores (Table 2). The IDSA (baseline comparator) model showed poor performance across cohorts(Table 3). Of the binary classification models, including those that were most predictive of the primary composite outcome, Jardin, performed poorly with minimal to no NRI improvement compared with IDSA. The continuous score models, Toro and ATLAS, performed better, but the AuROC varied by site by up to 17% (Table 3). The Gujja model varied the most: from most predictive in the University of Michigan 2010–2012 cohort to having no predictive value in the 2016 cohort (Table 3). Conclusion No published CDI severity score showed stable, acceptable predictive ability across multiple cohorts/institutions. To maximize performance and clinical utility, future efforts should focus on a multicenter-derived and validated scoring system, and/or incorporate novel biomarkers. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

The European Food Consumption Survey Method (EFCO- Henauw S, Becker W. A European food consumption survey method- Intake assessment - an ILSI Europe dietary intake and exposure task. [Extracted from the article]

Objective In right hemisphere cerebrovascular accident (CVA), expected deficits might include inattention syndromes, visuospatial impairment, or neglect. This case study adds to the literature by presenting neuropsychological data from a patient with a complex medical history who experienced two right hemisphere CVAs. The aim is to demonstrate that neuropsychological deficits following CVA may not be as expected in patients with comorbidities, and to highlight the importance of neuropsychological assessment in such cases. Method The patient is a 69-year-old, right-handed, African American man who presented with reading and memory difficulties, problems recognizing faces, and vision impairment following right occipital and temporoparietal ischemic CVAs. Comprehensive neuropsychological evaluation was conducted. Formal measures were utilized, but the examiners were also required to devise appropriate bedside measures. Results The patient had difficulty recognizing his caregiver's face. He could not identify facial expressions made by examiners, but commented on individual facial features. Design copies were distorted/fragmented, and he evidenced difficulty integrating visual components into a whole. He also demonstrated spelling and verbal memory impairment (BDAE Oral Spelling raw = 0; HVLT-R recall and recognition < 1st percentile). Full results are included in a supplemental data table. Conclusions Results were strongly suggestive of simultanagnosia, though this disorder typically results from bilateral parietal-occipital lesions. Additionally, the neuropsychological impairments noted extended beyond those typical of right hemisphere CVA, likely related to the patient's history of multiple comorbidities (e.g. infectious disease, polysubstance abuse). This case highlights the importance of neuropsychological assessment in the care of medically complex patients, and the unique ability of neuropsychologists to conduct such evaluations. [ABSTRACT FROM AUTHOR]

In recent years, it has been noticed that adolescent and adult patients with autism spectrum disorder (ASD) sometimes visit psychiatric medical institutions. In some cases, these patients commit an act of violence and are dealt with by psychiatric emergency and forensic psychiatric services. In this report, we present two cases with ASD who visited a psychiatric emergency service because of the 'time slip' phenomenon, and discuss the clinical significance of this phenomenon. [ABSTRACT FROM AUTHOR]

Health departments routinely investigate cases of gastroenteritis through interviews to determine the source of infection. However, validation studies of dietary questionnaires typically focus on quantities consumed and don't assess questions designed to identify sources of foodborne illness. We aimed to assess the accuracy and reliability of information collected by surveys of food history recall for gastroenteritis investigations. A questionnaire was developed to investigate the sources of foodborne gastroenteritis in Australia, with questions on food exposures selected for validation. Fifty-five participants photographed all foods consumed and food receipts obtained during a seven-day observation period. These photographs were uploaded to an online survey or emailed to the researcher. Participants were contacted 14 days later for a telephone interview about foods consumed in the seven-day period. Questionnaire responses were compared to uploaded photographs. Kappa statistics (κ) and 95% confidence intervals were calculated. Sixty-two questions were assessed, including those targeting foods considered high-risk for foodborne gastroenteritis. Potential risk factors covered by these questions included: meats (poultry, beef, pork, and deli meats), the state of poultry purchased (raw versus precooked), and the number of meals eaten outside of the home. Several questions targeting high-risk foods were found to have substantial-to-almost perfect agreement (κ ≥ 0.610) between what was eaten and what was reported by participants, with most questions showing at least a moderate level of agreement (κ = 0.410–0.600). Questions regarding exposure to different types of meat showed a high level of consistency. The only question with poor participant recall (κ < 0.000) was that relating to consumption of undercooked beef or veal. Several questions designed for investigation of gastroenteritis were found to provide at least a moderate level of accurate and reliable recall, even after a delay until interview. These questions are suitable for investigating sources of foodborne gastroenteritis. • Recall of exposure to high-risk foods was assessed. • Most questions showed at least a moderate level of agreement. • Dining locations were assessed as having consistently high recall. • Questions that quantified consumption in number of days had poorer validity. • Questions and results can inform surveys for investigation of gastroenteritis. [ABSTRACT FROM AUTHOR]

Ethics, aircraft, aviation, death, government, guilt, love, marriage, life event, metals, military personnel, mothers, mental recall, schools, medical, shame, spouse, strikes, employee, terminally ill, memory, skin, clinical practice guideline, protective helmet, depressed mood, intern, self esteem, pilots, play behavior, filters, emotional vulnerability, primary care provider, army, navy, air force, tincture, daughter, script, united states department of defense, courage, psychologists. [Extracted from the article]

Objective With over 37 million Spanish-speakers, the US is the second country in the world with the largest number of Spanish-speakers. Identification of neurological dysfunction via neuropsychological testing for this language group requires knowledgeable application of available tests and normative data. Accordingly, we investigated whether rates of neurocognitive impairment (NCI) varied based on the Spanish language normative method used. Method Participants included 254 healthy native Spanish-speakers (Age: M = 37.3, SD = 10.4; Education: M = 10.7, SD = 4.3; 59% Female; 78.7% of known Mexican origin/descent) living in the US-Mexico border region. Participants completed the Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test (TMT) A&B, and Animal Naming in Spanish. Raw test scores were converted to demographically-adjusted T-scores based on normative adjustments developed for this population (Neuropsychological Norms for the US-Mexico Border Region in Spanish [NP-NUMBRS]) and norms developed based on samples in Mexico (Latin American Norms from Mexico [LAN-M] and NEUROPSI). Rates of NCI (T < 40) based on the different normative methods were compared via McNemar's tests. Results Rates of NCI for NP-NUMBRS and NEUROPSI fell between the expected 15-17%. Compared to NP-NUMBRS, significantly lower rates were found when applying LAN-M for HVLT-R Total (4%) and Delayed Recall (8%), TMT-A (1%), and Animal Naming (10%; all ps <.0002). No significant differences were found for TMT-B (p >.05). Conclusions Present findings revealed that while the NP-NUMBRS and NEUROPSI norms yielded similar NCI rates, and LAN-M norms underestimated NCI on three tests. This highlights the importance of carefully considering available normative adjustments for Spanish-speakers when applying them to specific populations. [ABSTRACT FROM AUTHOR]

Objective Mayo's Older Adult Normative Studies (MOANS) have served as an important resource for clinicians for three decades. Data collection was completed prior to the development and widespread use of Mild Cognitive Impairment (MCI) as a construct. Therefore, a portion of individuals included in the MOANS normative studies likely had undetected cognitive impairment. Method The Mayo Clinic Study of Aging (MCSA) is a population-based study of cognitive aging among Olmsted County, Minnesota, residents that began in October 2004. We applied age-adjusted MOANS norms (Ivnik et al. 1992) for the Auditory Verbal Learning Test (AVLT) long delay recall to cognitively unimpaired participants age 56 or older in the MCSA (N = 3,603). We used 1-sample tests of proportions comparing observed impairment rates to impairment rates expected based on a normal distribution of performance. Results Results showed that a significantly lower than expected number of participants demonstrated impaired delayed recall based on MOANS norms (all p's <.001). Using a lenient cut-off (< -1 SD), only 7.3% of participants demonstrated impaired performance (vs. 15.9% expected), and this was more pronounced for females (3.5% impaired) relative to males (11.1% impaired). Further, only 0.6% of participants demonstrated impaired performance at a cut-off of < -2 SD, and no participants aged 80-91 reached this cut-off (2.3% expected). Conclusions Results suggest that the sensitivity of the original MOANS norms is lowered by likely inclusion of individuals with MCI, particularly in females. Updated normative data for the AVLT that exclude individuals with MCI and adjust for sex are needed. [ABSTRACT FROM AUTHOR]

Objective To validate a fully automated scoring algorithm for the Rey-Osterrieth Complex Figure Test (ROCFT) by comparing the scoring results of the algorithm to the results of human raters. Method The algorithm consisted of a cascade of deep neural networks which were trained on human rater scores to extract the 18 segments of the figure, and to quantify the patient's performance. Algorithm results were compared to six expert raters for 303 drawings. We tested whether the average correlation between algorithm scores and scores by all human raters was equivalent to the average inter-rater correlation (with equality bound Δr <.05). The immediate and delayed recall trial were used; the copy trial showed a strong ceiling effect. Results The mean Pearson correlation between raters was.94 (SD = 0.01). The correlation between to algorithm and the raters was.88 (SD = 0.02). A two-one-sided t-tests (TOST) equivalence test showed that these correlations were not strictly equivalent, t(5) = 4.02, p =.995, 95% CI [0.35, 0.52]. Conclusions Although not strictly equivalent to human ratings, the algorithm's performance is high, approaching a level of reliability found among human raters. We expect that improved individual segment detection will bring the algorithm scoring accuracy on par with that of human raters. Algorithmic scoring of the ROCFT will likely save valuable time and lead to higher levels of standardization in clinical practice. [ABSTRACT FROM AUTHOR]

Objective Fergenbaum et al. 2009 found that obesity was linked to increased cognitive issues in otherwise healthy individuals, while another study found obesity to be neuroprotective in a sample of dementia patients (Fitzpatrick et al. 2009). The present study explores whether obesity is associated with worse cognitive dysfunction in those with Multiple Sclerosis (MS). Method This study examined archival neuropsychological test data of 40 patients diagnosed with MS. Participants were separated into two groups based on their BMI: healthy/overweight individuals and obese/morbidly obese. ANOVA was performed to compare performances between groups on tasks measuring learning and memory, processing speed, and executive functioning; areas commonly affected in MS. Results Significant differences between groups were noted on only portions of two different tests; unstructured verbal learning (p =.003) and mental sequencing (p =.048), but no differences were found in other tasks. Particularly, performance was statistically equal between groups on measures of response inhibition (p =.887), visual processing speed (p =.182), visuospatial learning (p =.118), visuospatial free recall (p =.205), simple auditory attention (p =.630), working memory (p =.223), psychomotor speed (p =.969), and complex divided attention (p =.202). Conclusion Obese patients with MS scored significantly better on the majority of tasks that we reviewed. These results seem to contradict a study that examined healthy subjects but seems to replicate findings in at least one clinical population; those with dementia. It is possible that increased BMI in clinical populations may indicate better overall health leading to better cognition, though if it is actually neuroprotective and only limited to MS and dementia is uncertain. Future research endeavors are discussed. [ABSTRACT FROM AUTHOR]

Objective Explore neuropsychological and quality of life outcomes of epilepsy surgery in an underserved, primarily immigrant, Spanish-speaking cohort of people with epilepsy (PWE). Methods Pre- and postsurgical Neuropsychological Screening Battery for Hispanics (NeSBHIS) and Quality of Life in Epilepsy-31 (QOLIE-31; Spanish Version) results were compared for 22 adult Latinos (females = 50%), from Mexico (81.8%), El Salvador (9.1%) and Guatemala (9.1%). All participants were part of a comprehensive epilepsy center in Los Angeles. Mean surgical age was 33.5 years (SD = 8.5), while mean education was 8.7 years (SD = 3.1). Seizures were exclusively lateralized to right (59.1%) and left hemispheres (40.9%). Results One-tailed, paired t-tests demonstrated statistically significant differences between pre- and postsurgical raw scores for Digit Span, t(21) = -2.52, p = 0.02 (presurgical M = 8.05, SD = 1.70; postsurgical M = 7.32, SD = 1.43), and the Auditory Verbal Learning Test (AVLT) Delayed Recall, t(21) = -2.99, p < 0.01 (presurgical M=10.00, SD=2.51; postsurgical M = 8.55 SD = 2.61). Respective effect sizes were moderate (d =.54; d =.64). QOLIE-31 scores improved on all subscales, as expected. Significant changes |p < 0.05| were found on most QOLIE-31 subscales, i.e. Seizure Worry, Emotional Well-Being, Social Function and Overall Quality of Life. Remaining subscales did not significantly improve, i.e. Energy/Fatigue, Cognitive and Medication Effects. Conclusions Attention and verbal memory declines after epilepsy surgery were associated with limited improvements on QOLIE-31 subscales of Cognitive, Energy/Fatigue and Medication Effects in Latino PWE. Previous studies have not simultaneously examined neuropsychological and QOLIE-31 outcomes after epilepsy surgery in this unique, underserved, Spanish-speaking population. Further investigation is warranted. [ABSTRACT FROM AUTHOR]

Objective Despite potential for dependence and adverse neurological effects, long-term benzodiazepine (BDZ) use is common among persons living with HIV (PLWH). As PLWH are at risk for CNS dysfunction, we retrospectively examined the association between BDZ use and HIV-associated neurocognitive disorders (HAND). Methods 306 PLWH (mean age = 45.1 years) underwent comprehensive neurobehavioral evaluations. Current BDZ use (BDZ+) was determined via self-report. Using propensity scores, 153 BDZ- individuals were matched to 153 BDZ+ participants on demographics, HIV disease characteristics, and comorbidities. Multiple regression models examined HAND and demographically-adjusted neurocognitive T-scores as a function of BDZ group, adjusting for estimated premorbid ability, current affective symptoms, and nadir CD4 count. Secondary analyses explored neurocognitive correlates of positive BDZ urine toxicology screens (TOX+). Results Median BDZ use was 24 months. Compared to BDZ-, BDZ+ had higher likelihood of HAND (OR = 2.14; p =.003) and poorer global (d = -0.33, p =.005), processing speed (d = -0.29, p =.013), and motor T-scores (d = -0.35, p = 0.003). Compared to BDZ+/TOX-, BDZ+/TOX+ users exhibited additional decrements in global (p =.033), executive function (p =.019), and delayed recall T-scores (p =.006). Conclusions BDZ use may elevate risk for HAND, potentially through diffuse neurocognitive slowing and acute compromise of recall and higher-order capacities. These effects are robust to psychosocial and HIV-specific factors and occur in comparison to a tightly-matched BDZ- group. Indications for BDZs (e.g. insomnia) may also impact neurocognition and/or manifest from latent neuropathology. Longitudinal studies should evaluate potential causal associations between HAND and BDZs. Given the extent of BDZ use and possibility of neurocognitive recovery post-abstinence, interventional studies should explore treatment alternatives to BDZs in PLWH. [ABSTRACT FROM AUTHOR]

Objective Examine whether performance on spoken language assessment measures may be associated with performance at different phases of verbal learning and recall tasks. Method The assessment records of 222 American Veterans with diverse neuropsychiatric conditions were analyzed using Exploratory Factor Analyses. There were no exclusion criteria. All participants completed the Visual Naming (VisNam), Sentence Repetition (SenRep), Controlled Word Association (COWA), and Token Tests of the Multilingual Aphasia Examination (MAE), and Benton Serial Digit Learning Test – 8 Digits (SDL8). Individual assessment instruments were factored using Principal Component Analyses (PCA). A three-factor solution of the SDL-8 was co-factored with the spoken language components of the MAE to identify common sources of variance. Results A three-factor solution of the SDL8 separated trials into three overlapping factors consisting of early (SDL8_Early), middle (SDL8_Middle), and late (SDL8_Late) trials. Co-factoring the three new scales with the verbal components of the MAE produced a five-factor model explaining 84.563% of the shared variance: 1) SDL8_Early loaded with SenRep, 2) SDL8_Middle loaded with SenRep, 3) SDL8_Late loaded with Token, 4) SDL8_Late loaded with COWA, and 5) VisNam alone formed the fifth factor. Conclusions The results suggest that rote repetition is largely associated with early trials and slightly associated with middle trials, while late trials are largely associated with auditory comprehension and slightly associated with verbal fluency. This may be indicative of a shift in use of spoken language abilities to accommodate increasing levels of complexity in presented verbal short-term memory tasks and thus reflective of a change on learning strategy to optimize performance. [ABSTRACT FROM AUTHOR]

Objective Lesions to the retrosplenial cortex secondary to acute stroke or tumor have been shown to disrupt Papez's circuit due to disconnection between the anterior thalamus and hippocampus, via the posterior cingulate, producing an amnestic syndrome. This case demonstrates how small but strategic lacunes in this region may produce memory deficits. Method The patient is a 52-year-old, right-handed, African-American woman with 18 years of education who reported memory changes over the last 8 years (e.g. misplacing items, forgetting details of conversations). Her medical history was notable for BMI of 31 and borderline diabetes. She completed structural magnetic resonance imaging 6 years prior to, and concordant with, her neuropsychological evaluation. Both scans showed two small (2-3 mm) right-sided retrosplenial lacunes, without evidence of hippocampal or global volume loss over the 6-year span. Results Her neurocognitive profile was characterized by impairments in both verbal (stories, word-list) and figural memory, with relative strengths in attention, processing speed, and executive functioning. Across memory measures, she performed in the low average-to-mildly impaired range on immediate recall, mildly-to-severely impaired range on delayed recall, and did not benefit from yes-no recognition format. She demonstrated additional features of an amnestic profile, including flat learning slope, recency effect, elevated cued recall intrusion errors, and very elevated false positive errors on recognition. Conclusions Findings expand upon the existing literature to show that chronic, small retrosplenial lacunes can disrupt the connection between the anterior thalamus and hippocampus, resulting in a clinical presentation of circumscribed memory impairment that persists years beyond acute vascular changes. [ABSTRACT FROM AUTHOR]

Objective Atypical language laterality, secondary to refractory epilepsy, presents complications to surgical planning/cognitive outcomes. Extant research shows the non-dominant hemisphere reallocates neural resources for language compensation in response to left-sided lesions (resulting in decreased visuoperceptual/visual memory). The present study examined relationships between 1) lesion location and atypical language organization and 2) lesion location/language laterality on performance on memory (California Verbal Memory Test 2nd-edition (CVLT; Delayed Recall), and visuoperceptual (Rey-Osterrieth Complex Figure Test, ROCFT; Copy) tests in relation to lesion location in a sample of patients with intractable epilepsy. Method Retrospective data was compiled on patients with refractory epilepsy undergoing interdisciplinary pre-surgical workup (N = 101), mean age of 37.2 (SD = 11.9) and mean education of 12.3 (SD = 3.7). The sample was then stratified by non-lesional (n = 48), left (n = 26), right (n = 21) or bilateral (n = 6) mesial temporal sclerosis (MTL); and, language laterality was confirmed by neuroradiologists via functional Magnetic Resonance Imaging (fMRI) scans. Results Analyses showed patients with left MTS were more likely to have atypical language organization, X2 (1, N = 47) = 6.6, p =.01. Moreover, significant differences on T-scores for CVLT, F (3,15) = 3.81, p =.04, 95% Cl [-1.73, -.08] and ROCFT, F(4,28) = 2.85, p =.046 95% Cl [31.62, 46.17] were found between groups stratified by lesion location/language laterality, respectively. Conclusions Organization of language in epileptic populations presents atypically in conjunction with left-sided lesions. Additionally, cognitive processes such as verbal memory and visuoperceptual abilities suffer based on lesion presence/location and language laterality in this fMRI confirmed sample. [ABSTRACT FROM AUTHOR]

Objective Poorer sleep quality is related to worse cognitive functioning in the general population and people living with HIV; however, many studies use self-report sleep questionnaires that rely on retrospective recall. This study aimed to examine the relationship between objective (wrist actigraphy) and subjective sleep quality with neurocognitive functioning. Method Eighty-five adults aged 50-74 years with and without HIV (HIV+ n = 53, HIV- n = 32) were recruited from the community and ongoing studies at UC San Diego. Participants completed comprehensive neuropsychological testing assessing global and domain-specific cognition. Participants wore actigraphy watches for 14 nights after neuropsychological testing to objectively assess sleep quality (i.e. total sleep time (TST), efficiency, wake after sleep onset, and sleep fragmentation). The Pittsburgh Sleep Quality Index assessed subjective sleep quality. Results After adjusting for demographic variables and use of sleep medications, there were no differences in any sleep quality measures by HIV status (p's>0.05). In separate adjusted linear regression models, lower sleep efficiency (p = 0.02; 95% CI: -9.5, -1.1) and greater sleep fragmentation (p = 0.02; 95% CI: -0.82, -0.09) were associated with worse learning. Less TST was associated with worse working memory (p = 0.02; 95% CI: -9.2, -0.8). In contrast, worse subjective sleep quality was associated with worse executive function (p < 0.01; 95% CI: -1.18, -0.23) and working memory (p = 0.03; 95% CI: -1.22, -0.07). Conclusion Both objective and subjective sleep quality were associated with cognition in both persons with and without HIV; however, subjective and objective sleep quality were associated with different cognitive domains. Therefore, both objective and subjective sleep quality are important health behaviors to assess. [ABSTRACT FROM AUTHOR]

Objective An investigation into memory and intellectual functioning of 18 individuals with neurofibromatosis type 1 (NF-1) was undertaken. Method Ten children [mean age=8.9 (SD = 3.4; range = 5-16), 54.5% male, 81.9% Caucasian, 9.1% African American, 9.1% mixed race] and 9 adults [mean age = 55.7 (SD = 23.9; range = 19-88), 63.6% male, 90.9% Caucasian, 9.1% African American] completed neuropsychological assessments. One individual completed initial assessment as a child and underwent re-evaluation as an adult, and 1 child and 2 adults completed re-evaluations. Results For adults, the Wechsler Adult Intelligence Scale (WAIS-4/3) was administered. For children, Wechsler Intelligence Scale for Children (WISC-5/4), Wechsler Preschool and Primary Scale of Intelligence (WPPSI-3), Stanford-Binet Intelligence Scales (SB-5), and WAIS-3 were utilized. Mean Full Scale IQ (FSIQ) in adults was 83.4 (SD = 12.8; range 69-98) and in children was 83.8 (SD = 11.6; range 65-102). Visual and verbal memory was assessed with a variety of instruments, and performance ranged from impaired to high normal across immediate recall (percentile range < 1-98), delayed recall (percentile range < 1-91), and delayed recognition (percentile range < 1-91). Conclusions Mean intelligence among persons in this NF-1 clinical sample was found to be in low average range. Many persons with NF-1 showed mean immediate and delayed verbal recall in normal range, though a subset of individuals demonstrated impaired range verbal memory. Overall, children with NF-1 tend to show memory performance at levels above their own IQ level. Adults with NF-1 frequently perform at levels equivalent to or above their IQ level, albeit with exceptions evidenced among a subset of adults. [ABSTRACT FROM AUTHOR]

There is a high rate of medical and psychiatric comorbidities in the HIV population (Kilbourne et al, 2001), many of which complicate the clinical picture, especially with respect to cognitive functioning (Milanini & Valcour, 2017). It is important to be aware of the impact multiple disorders can have on formulating impressions and treatment planning. We reviewed the records of 35 consecutive patients with HIV seen in our neuropsychology clinic in a county hospital. The 30 men and 5 women had a mean age of 49 (SD = 13.7), with mean education of 13.5 years (SD = 2.0). Average age of HIV diagnosis was 33 (SD = 9.3). Patients had an average of eight major comorbid medical and psychiatric diagnoses, including ADHD (45%), mood disorders (62%), developmental disorders (11%), substance abuse or dependence (45%), sleep apnea (11%), TBI (31%), stroke (14%), cardiovascular disease (51%), and hepatitis (20%). Neuropsychological data were available for 33 patients. Performance on CVLT Trial 5 and Delayed Recall, Rey-Ostereith Copy, WAIS-IV Information and Digit Span, as well as Trail Making A and B were used to measure memory and executive functioning. 21% of the sample obtained one score that was >2 SD below the normative means, and 45% obtained 2 or more scores >2 SD below the mean.In this clinical sample referred for evaluation of cognitive functioning, there was a high rate of comorbid diagnoses. This review highlights the point that comorbid diagnoses are a common presentation and must be considered when discussing etiology of cognitive impairment and treatment planning. [ABSTRACT FROM AUTHOR]

Purpose Early versions of the Sports Concussion Assessment Tool utilized a summary score, but it was removed in the third edition due to lack of empirical support (Guskiewicz et al. 2013). Echemendia et al. (2017) note that the SCAT-5's changes, such as an expansion from a 5-word to 10-word list, improved utility over previous additions. Therefore, empirical support for a summary score on the SCAT-5 should be reassessed. Methods Collegiate athletes (N=532, 64% male) completed the SCAT-5 and ImPACT during their baseline evaluation. Various SCAT-5 summary score formulas were created to determine a concurrently valid summary score that remained comprehensive of all three SCAT-5 domains (cognitive, symptom, vestibular). The summary score was calculated by: [Immediate Memory Total + Delayed Recall + Orientation + Concentration + (30 – BESS Total Errors) - Total Symptom Score]. Results Pearson correlations determined that the summary score was significantly correlated with ImPACT Verbal Memory (r=.27, p<.001), Visual Memory (r=.24, p<.001), Visual-Motor Speed (r=.30, p<.001), Reaction Time (r=-.25, p<.001) and Total Symptoms (r=-.18, p<.001). Conclusion Our results support the validity of a SCAT-5 summary score. Clinically, the summary score is intended to measure changes in global functioning across baseline, post-trauma and follow-up concussion evaluation. Additionally, it should serve as a measure of global progression during the acute post-trauma window of sideline to post-trauma evaluation. Future research should examine the SCAT-5 summary score with outcome measures such as recovery time. [ABSTRACT FROM AUTHOR]

Purpose The dual-task (DT) paradigm consists of concurrent administration of motor and cognitive tasks which may demonstrate improved measurement properties of the included tasks as compared to independent administration. Our study examined the test-retest reliability of a clinically-relevant DT assessment. Methods Our prospective cohort study included 60 (53.3% female) healthy, recreationally active college students (Age=20.5–1.34 years; Height=171.7–9.33 cm). Participants completed the Standardized Assessment of Concussion (SAC) and timed tandem gait (TTG) test concurrently for the DT assessment at two time points separated by a two-week test-retest interval. The SAC composite score (45 points) was calculated by summing the domain scores of immediate memory (30 points) which consisted of a 10-word list, concentration (5 points), and delayed recall (10 points). The TTG composite score was calculated by summing the mean time to complete the TTG during each SAC task (3 trials for immediate memory, up to 5 trials for the digits-backwards task, and one trial for the months in reverse order and delayed recall tasks). Mixed-model intraclass correlation coefficients (ICC[3,1]) with 95% confidence intervals were calculated to evaluate test-retest reliability between time points for the SAC and TTG composite scores. Results Mean SAC (39.4–3.80 vs. 39.6–3.49 points) and TTG (52.1–9.44 vs. 48.2–8.33 sec) composite scores were observed at time points 1 and 2, respectively. Moderate (ICC[3,1]=0.56 [0.26, 0.74]) and good (ICC[3,1]=0.88 [0.80, 0.93]) test-retest reliability were observed for the SAC and TTG composite scores, respectively. Conclusion Test-retest reliability for our DT assessment aligns with previously established values for independent administration of the SAC and TTG. [ABSTRACT FROM AUTHOR]

Purpose Traditional "paper and pencil" neuropsychological tests and computerized test batteries have been employed in the assessment of sports-related concussion (SRC). Each type of test has inherent strengths and weaknesses. The NHL has constructed a "hybrid" battery of tests that uses both traditional and computerized measures in the evaluation of its players suspected of SRC. The purpose of this paper is to use factor analytic techniques to examine the relationships among the measures that comprise this battery. Methods Post-injury neuropsychological test data using the hybrid battery were obtained from 343 NHL players following their first concussion while playing in the league. ImPACT was used as the computer test battery. The traditional battery included: Hopkins Verbal Learning Test, Brief Visuospatial Memory Test, Color Trails, PSU Cancellation, Symbol Digits Modalities Test (including incidental memory), and Verbal Fluency. Results Five factors were extracted explaining 64.55% of the variance. The factor labels and the measures principally loading on each factor were as follows: Factor 1, Verbal Learning and Memory (HVLT Total and Delayed Recall); Factor 2, Processing Speed (Color Trails A/B, PSU Cancellation, and SDMT-Total); Factor 3, Visual Memory (BVMT- Total and Delayed); Factor 4, Cued Memory (ImPACT-Visual and Verbal Memory Composites); and Factor 5, Reaction Time (ImPACT Reaction Time and Visual Motor Speed composites). Conclusion These data underscore the unique contributions of traditional and ImPACT neuropsychological measures to the evaluation SRC in a sample of professional hockey players. It appears that both approaches measure different aspects of cognitive functioning. The next logical step is to use these data in evaluating the diagnostic utility of these measures as part of a combined battery. [ABSTRACT FROM AUTHOR]

Purpose The assessment of concussed athletes uses standardized tools like the Sport Concussion Assessment Tool (SCAT). The purpose of this study was to evaluate whether concussed athletes accurately recalled baseline functioning. Methods A retrospective cohort analysis of University football student-athletes from 2014-16 seasons was conducted. Forty-six student-athletes (M=19.7, SD=1.8) who suffered a concussion during the competitive season underwent a post-concussion assessment with a sports medicine physician within 24 hours of injury. Assessments included use of the symptom report from The SCAT3. Athletes were asked to recall their pre-injury baseline functioning. Results Of the 46 athletes who underwent assessments, 22 reported having at least 1 symptom (M=1.4, SD=2.0) at baseline evaluations. Yet at the initial medical evaluation, only 10 of these athletes correctly recalled having symptoms prior to injury, and none of them accurately reported their total symptom report. Paired t-tests revealed significant differences between an athletes predicted recall of the number of symptoms (M=0.7, SD=1.2) and total symptom scores (M=2.1, SD=3.4) conditions; t(45)=-3.28, p=.002, d=0.48. Conclusion Having accurate information for diagnosing concussions is important during concussion medical evaluations. Many clinicians depend on an athlete's subjective reporting of symptom change. Our results indicate that an athlete's accuracy of pre-injury functioning is poor, consistent with what has been termed "the good old days bias." The findings suggest having baseline assessments can be helpful and clinicians may need to carefully understand an athletes pre-morbid functioning. [ABSTRACT FROM AUTHOR]

Bowel perforation due to inadvertent ingestion of foreign objects is, fortunately, a rare event. However, it can lead to deadly complications when it occurs. Thin, sharp and pointed objects like toothpicks are more likely to pierce the bowel wall. Diagnosing toothpick ingestion and perforation is difficult since most patients do not recall swallowing the toothpick, symptoms and physical examinations are nonspecific, the symptoms can resemble many abdominal pathologies, and since a toothpick has a radiolucent nature that makes it difficult to detect through X-ray imaging. Due to this, most of the cases are identified during the transoperative period. We present the case of a 27-year-old male who presented with symptoms clinically indistinguishable from acute appendicitis. During surgery, two toothpicks were discovered that compromised the cecum and the appendix. After successful removal of the foreign objects, the patient underwent a full recovery. [ABSTRACT FROM AUTHOR]

Inadvertent ingestion of foreign bodies is a common condition within clinical practice. It rarely produces any symptoms. The diagnosis is difficult since most patients do not recall having swallowed any object. Needles, pins, keys, nails and bones are among the most commonly ingested foreign bodies. Severe complications are uncommon, but if present they can put patients' lives at risk. Although extremely rare, the ingested foreign body may end lodging in the appendix, posing a challenge for the clinical team. Once the exact location of the object is confirmed, the extraction of the foreign object must be performed to avoid complications. The present report describes a case of a young adult patient, who presented to the emergency room after a routine medical examination. A 30 mm metallic nail was discovered in the tip of the appendix. After a failed endoscopic approach an appendectomy was performed, and the patient underwent a complete recovery. [ABSTRACT FROM AUTHOR]

Introduction: This study assesses the relationship between tobacco/e-cigarette marketing exposure and single, dual, and polytobacco product use, among adolescents. Given the increased use of noncigarette tobacco products (eg, cigars, e-cigarettes, hookah) among youth, it is imperative to understand if marketing exposure is associated with dual and polytobacco product use.Methods: Data were obtained from the 2014 National Youth Tobacco Survey and weighted to be representative of US middle and high school students. Multivariable multinomial logistic regression models were used to assess the relationships between product marketing (via internet, print, retail, and TV/movies) and past 30-day single, dual, and poly (three or more) tobacco product use. Three analyses were conducted using different categories as referent groups to allow for comprehensive examination of the relationships between all groups.Results: Marketing exposure was significantly correlated with a greater risk of single, dual, and polytobacco product use relative to nonusers. Relative to single product users, product marketing exposure was significantly correlated with a greater relative risk of dual and polytobacco use. There was no statistical difference in the association of marketing exposure between dual and polytobacco use, in any model.Conclusion: A positive relationship between tobacco product marketing exposure and number of tobacco products used was observed. The magnitude of the relationship grew from single product to dual/poly use. Restrictions of marketing of all tobacco products, similar to cigarettes, particularly in the retail setting, should be considered.Implications: This study has two primary public health implications. First, self-reported exposure to tobacco/e-cigarette marketing is widespread among adolescents of all tobacco product categories. Second, this widespread exposure to tobacco/e-cigarette marketing appears to not only be correlated with use of a single tobacco product (eg, cigarettes, e-cigarettes), but also multiple tobacco products. While longitudinal studies are needed to further investigate the relationships observed in this study, findings justify further study given the known relationship between tobacco marketing exposure and subsequent cigarette use. [ABSTRACT FROM AUTHOR]

Purpose: Data about maternal recall accuracy for classifying early pregnancy medication exposure are meager. Nonetheless, studies often rely on recall to evaluate potential impact of pharmaceuticals on the developing fetus.Methods: Right from the Start is a community-based pregnancy cohort that enrolled women from North Carolina, Tennessee, and Texas. A subset of 318 women participated in daily medication diaries initiated before conception (2006-2012). We examined nonsteroidal anti-inflammatory drugs (NSAIDs) as an example of a drug type that is difficult to study due to its intermittent and primarily over-the-counter use as well as its incomplete documentation in medical and pharmaceutical records. Selective serotonin reuptake inhibitors (SSRI) were assessed as a prescription medication comparator. Maternal recall of NSAID and SSRI use in early pregnancy was examined by comparing diary data (gold standard) to first-trimester interview.Results: Sensitivity and specificity for recall of NSAID exposure were 78.6% and 62.3%, respectively (kappa statistic: 0.41), with 72.3% agreement for exposure classification. Sensitivity and specificity for recall of SSRI exposure were 77.8% and 99.0%, respectively (kappa statistic: 0.79), with 97.8% agreement.Conclusions: Our findings suggest the validity of maternal recall varies with medication type and prospective data collection should be prioritized when studying early pregnancy drug exposures. [ABSTRACT FROM AUTHOR]