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Objective: To examine the association between social Internet use and real-world societal participation in survivors of moderate-severe traumatic brain injury. Design: Prospective cross-sectional observational study. Setting: Ten Traumatic Brain Injury Model Systems Centers. Participants: A total of 331 participants in the Traumatic Brain Injury Model Systems, interviewed at any follow-up year between April 2014 and March 2015. Main Measures: Survey on Internet use, including social media and other online socialization; Participation Assessment with Recombined Tools-Objective with separate analyses of Productivity, Social Relations, Out and About subscales; covariates included demographics, injury variables, and functional and emotional status at follow-up. Results: Participants were classified as social Internet users (N = 232) or nonusers (N = 99). Users had significantly higher Participation Assessment with Recombined Tools-Objective Social Relations scores than nonusers. A similar finding pertained to Out and About scores, with the between-group difference significantly greater for those with greater depressive symptoms severity. Users and nonusers did not differ significantly on Productivity subscale. Conclusions: The positive association between social Internet use and real-world social participation suggests that people with traumatic brain injury do not use social media as an alternative to real-world socialization. Rather, it is likely that similar barriers and facilitators affect both online and real-world social participation following traumatic brain injury. Emotional function should be considered as a moderating factor in further studies. [ABSTRACT FROM AUTHOR]

Objective: Return to work and school following traumatic brain injury (TBI) is an outcome of central importance both to TBI survivors and to society. The current study estimates the probability of returning to productivity over 5 years following moderate to severe brain injury. Design: A secondary longitudinal analysis using random effects modeling, that is, individual growth curve analysis based on a sample of 2542 population-weighted individuals from a multicenter cohort study. Setting: Acute inpatient rehabilitation facilities. Participants: Individuals 16 years and older with a primary diagnosis of TBI who were engaged in school or work at the time of injury. Main Outcome Measures: Participation in productive activity, defined as employment or school, as reported during follow-up telephone interviews at 1, 2, and 5 years postinjury. Results: Baseline variables, age of injury, race, level of education and occupational category at the time of injury, disability rating at hospital discharge, substance abuse status, and rehabilitation length of stay, are significantly associated with probability of return to productivity. Individual-level productivity trajectories generally indicate that the probability of returning to productivity increases over time. Conclusions: Results of this study highlight the importance of preinjury occupational status and level of education in returning to productive activity following moderate to severe TBI. [ABSTRACT FROM AUTHOR]

Objective: To explore associations of specific physical and neuropsychiatric medical conditions to motor and cognitive functioning and life satisfaction over the first 10 years following traumatic brain injury (TBI). Setting: Telephone follow-up through 6 TBI Model System centers. Participants: In total, 404 individuals or proxies with TBI enrolled in the TBI Model System longitudinal study participating in 10-year follow-up. Design: Individual growth curve analysis. Main Measures: FIM Motor and Cognitive subscales, Satisfaction With Life Scales, and Medical and Mental Health Comorbidities Interview. Results: Hypertension, diabetes, cancers, rheumatoid arthritis, and anxiety negatively affected the trajectory of motor functioning over time. Diabetes, cancers, chronic bronchitis, anxiety, and depression negatively impacted cognitive functioning. Numerous neuropsychiatric conditions (sleep disorder, alcoholism, drug addiction, anxiety, panic attacks, posttraumatic stress disorder, depression, and bipolar disorder), as well as hypertension, liver disease, and cancers, diminished life satisfaction. Other medical conditions had a negative effect on functioning and satisfaction at specific follow-up periods. Conclusion: Natural recovery after TBI may include delayed onset of functional decline or early recovery, followed by progressive deterioration, and is negatively affected by medical comorbidities. Results contribute to the growing evidence that TBI is most appropriately treated as a chronic medical condition complicated by a variety of comorbid conditions. [ABSTRACT FROM AUTHOR]

Objective: To determine whether rehospitalization during the first 2 years after moderate to severe traumatic brain injury (TBI) is associated with poor participation at 5 years post-TBI, after controlling for demographic and severity factors. Setting: TBI Model Systems Program. Participants: Community-dwelling individuals with TBI, 16 years or older (n = 1940). Design: Retrospective data analysis of a multicenter prospective study. Main Measures: Participation Assessment with Recombined Tools-Objective (PART-O). Results: After controlling for demographic and severity factors, a general linear model indicated that rehospitalization status (ie, never rehospitalized during years 1 and 2, rehospitalized either during year 1 or 2, or rehospitalized during both years 1 and 2) predicted less participation at 5 years post-TBI (P = .0353). The PART-O scores were in the hypothesized direction, with the lowest covariate-adjusted mean participation score found for the group with rehospitalizations during both years and the highest covariate-adjusted mean participation score found in the group with no rehospitalizations. Examining total number of rehospitalizations during years 1 and 2, rather than rehospitalization status, yielded analogous results (P = .0148). Conclusions: This study suggests that rehospitalization in the first 2 years after TBI is negatively associated with participation at 5 years after injury. Since participation is considered a key indicator of successful TBI rehabilitation, minimizing the need for rehospitalizations and promoting health in the community setting should be a priority of postacute care for individuals with TBI. [ABSTRACT FROM AUTHOR]

Objective: To identify factors that predict trajectories of participation over the first 5 years after moderate to severe traumatic brain injury (TBI). Setting: TBI Model System Programs. Participants: Community-dwelling individuals with TBI, 16 years of age or older (n = 1947). Design: Secondary analysis of a prospective, nonrandomly sampled, longitudinal data registry. Main Measures: Participation Assessment with Recombined Tools--Objective (PART-O). Results: Age at injury and FIM Motor score predicted trajectory of participation over the first 5 years after moderate to severe TBI. Older age predicted generally worse participation overall as well as progressively worsening participation over time. Higher FIM Motor raised the predicted participation values, although it reduced the rate of improvement in participation scores over time. FIM Cognitive scores, race, depression, years of education, and living setting did not predict trajectory but did significantly influence participation consistently at all time points. Conclusion: The trajectories of participation over the first 5 years after TBI can be predicted by age at injury and FIM Motor scores. These findings may enhance the ability of rehabilitation professionals to identify individuals at risk for poor participation after TBI and develop targeted interventions for optimizing involvement in life activities. [ABSTRACT FROM AUTHOR]

Objectives: To characterize Internet and social media use among adults with moderate to severe traumatic brain injury (TBI) and to compare demographic and socioeconomic factors associated with Internet use between those with and without TBI. Setting: Ten Traumatic Brain Injury Model Systems centers. Participants: Persons with moderate to severe TBI (N = 337) enrolled in the TBI Model Systems National Database and eligible for follow-up from April 1, 2014, to March 31, 2015. Design: Prospective cross-sectional observational cohort study. Main Measures: Internet usage survey. Results: The proportion of Internet users with TBI was high (74%) but significantly lower than those in the general population (84%). Smartphones were the most prevalent means of Internet access for persons with TBI. The majority of Internet users with TBI had a profile account on a social networking site (79%), with more than half of the sample reporting multiplatform use of 2 or more social networking sites. Conclusion: Despite the prevalence of Internet use among persons with TBI, technological disparities remain in comparison with the general population. The extent of social media use among persons with TBI demonstrates the potential of these platforms for social engagement and other purposes. However, further research examining the quality of online activities and identifying potential risk factors of problematic use is recommended. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the test-retest reliability of measures that comprise the Traumatic Brain Injury Model Systems follow-up data set. Participants: A total of 224 persons with a moderate-severe traumatic brain injury (TBI) enrolled in the Traumatic Brain Injury Model Systems National Database. Design: Following standard administration of the follow-up interview, a second interview was administered 14 to 28 days later using the same interviewer and the same mode of administration. Main Measures: Traumatic Brain Injury Model Systems follow-up interview that includes 66 variables comprised (a) single item measures of demographics; employment; general health as well as specific health conditions; rehospitalization; tobacco, alcohol, and other drug use; transportation; and mental health and (b) multi-item instruments: FIM; Participation Assessment With Recombined Tools-Objective; Disability Rating Scale; Glasgow Outcome Scale--Extended; Supervision Rating Scale; Satisfaction With Life Scale; TBI Quality of Life Anxiety and Depression items; and The Ohio State University TBI Identification Method. Results: Intraclass correlation coefficient values ranged from 0.65 to 0.99, weighted kappa values ranged from 0.54 to 0.99, and kappa values ranged from 0.43 to 1.00. Four kappa/weighted kappa estimates fell below 0.60: arrested, psychiatric hospitalization, number of days not in good physical health, and rating of general emotional health. Conclusions: With few exceptions, good to excellent test-retest reliability estimates were obtained. The findings support the use of these measures in prior and future studies and indicate that persons with moderate-severe TBI can provide reliable self-report. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of all severities of traumatic brain injury (TBI), regardless of treatment setting, and their associated negative outcomes. Participants: A total of 2701 adult Coloradoans. Design: A statewide, population-based, random digit–dialed telephone survey. Main Measures: The lifetime history of TBI was assessed by a modification of the Ohio State University TBI Identification Method; activity limitation and life satisfaction were also assessed. Results: The distribution of self-reported lifetime injury was as follows: 19.8%, no injury; 37.7%, injury but no TBI; 36.4%, mild TBI; and 6.0%, moderate-severe TBI. Of those reporting a TBI, 23.1% were hospitalized, 38.5% were treated in an emergency department, 9.8% were treated in a physician’s office, and 27.5% did not seek medical care. A clear gradient of activity limitations and low life satisfaction was seen, with the highest proportions of these negative outcomes occurring in people reporting more severe TBI and the lowest proportions in those not reporting a TBI. Approximately twice as many people reported activity limitations and low life satisfaction after nonhospitalized TBI compared with hospitalized TBI. Conclusions: This investigation highlights the seriousness of TBI as a public health problem and the importance of including all severities of TBI, no matter where, or if treated, in estimating the prevalence of disability co-occurring with TBI. [ABSTRACT FROM AUTHOR]

Objective: To investigate the rates of negative outcomes associated with all severities of traumatic brain injury (TBI), treated in all settings or not treated at all, in comparison to the general population. Participants: Coloradoans without injury, with injury but no TBI, with mild TBI but no loss of consciousness (LOC), mild TBI with LOC,moderate TBI, or severe TBI. Design: Statewide population-based survey. Main measures: Computer-assisted,modified Ohio State University TBI Identification Method; Behavioral Risk Factor Surveillance System and National Health Interview Survey questions; Satisfaction with Life Scale; and postconcussive symptoms. Results: Up to 42.5% of participants reported a lifetime history of at least 1 TBI. Multiple negative outcomes were found to increase in prevalence in a stepwise fashion in association with greater TBI severity, with the clearest patterns observed for disability, poor life satisfaction, and impaired memory. Conclusions: Traumatic brain injury was found to be associated with disability and other negative outcomes in a general population survey. This study does not allow us to examine the proximate causes of disability, but it suggests that TBI may serve to both cause disability directly and exacerbate the influence of other etiologies. These relations should be examined in subsequent studies. [ABSTRACT FROM AUTHOR]

Objectives: Provide test-retest reliability (>5 months) of the Ohio State University Traumatic Brain Injury Identification Method modified for use as a computer-assisted telephone interview (CATI) to capture traumatic brain injury (TBI) and other substantial bodily injuries among a representative sample of noninstitutionalized adults living in Colorado. Design: Four subsamples of 50 individuals, including people with no major lifetime injury, a major lifetime injury but no TBI, TBI with no loss of consciousness, and TBI with loss of consciousness, were interviewed using the CATI Ohio State University Traumatic Brain Injury Identification Method between 6 and 18 months after an initial interview. Participants: Stratified random sample of Coloradans (n = 200) selected from a larger study of TBI. Primary Measures: Cumulative, Severity and Age-related indices were assessed for long-term reliability. Cumulative indices were those that summed the total number of specific TBI severities across the lifetime; Severity indices included measures of the most severe type of injury incurred throughout the lifetime; and Age-related indices assessed the timing of specific injury types across the lifespan. Results: Test-retest reliabilities ranged from poor to excellent. The indices demonstrating the greatest reliability were Severity measures, with intraclass correlations for ordinal indices ranging from 0.62 to 0.78 and Cohen κ ranging from 0.50 to 0.62. One Cumulative outcome demonstrated high reliability (0.70 for number of TBIs with loss of consciousness ≥30 minutes), while the remaining Cumulative outcomes demonstrated low reliability, ranging from 0.06 to 0.21. Age-related test-retest reliabilities were fair to poor, with intraclass correlations of 0.38 to 0.49 and Cohen κ of 0.32 and 0.34. Conclusion: The CATI-modified Ohio State University Traumatic Brain Injury Identification Method used in this study is an effective measure for evaluating the maximum TBI severity incurred throughout the lifetime within a general population survey. The CATI measure is not recommended for use in determining cumulative counts of lifetime incidence of TBI. [ABSTRACT FROM AUTHOR]

Objective: To estimate the overall and by age-group characteristics at admission and discharge from rehabilitation between 2001 and 2010 of all late-teens and adults undergoing inpatient rehabilitation for a primary diagnosis o f traumatic brain injury (TBI) in the United States. Design: Secondary data analysis. Setting: Acute inpatient rehabilitation facilities. Participants: Patients aged 16 years and older receiving inpatient rehabilitation for a primary diagnosis of TBI between 2001 and 2010. Main Outcome Measures: Functional independence, level of disability, and living situation. Results: The incidence o f TBI by age group found the largest proportion of cases to be aged 80 years and older, with a gradual decline in incidence in the age group of 30 years, at which point there was a slight increase. Injuries resulted predominantly from falls (49.8%) and motor vehicle crashes (40.8%); however, injuries to the youngest individuals were largely from motor vehicle crashes with decreasing rates as age increased, while injuries due to falls rose as age increased, with the oldest age groups most likely to incur a TBI. Preinjury alcohol misuse and substance use were found to occur in 22.9% and 12.2% of the total population, respectively; however, age distributions demonstrated high preinjury use among individuals younger than 50 years (eg, 46.4% and 30.6% for those aged 20 and 29 years, respectively) with decreasing misuse as age increased. Of the total population, 49.2% were retired, 31.1% employed, 14.1% not working, and 5.6% students. Trends by age showed that younger individuals were more likely to be students or employed (eg, 14.5% and 62.0% for those aged 20 and 29 years, respectively), with employment status peaking for those aged 30 to 39 years, and declining to 3.2% for the oldest age group (80 years and older). The trend of person(s) living alone between pre- and postrehabilitation showed the least amount of change for those aged 16 to 19 years with steadily increasing changes as age increased. Similar trends were seen for residence changes pre- and postrehabilitation, with the youngest most likely to return to living at a private residence, and a gradual decrease in return to living at a private residence as age increased. FIM instrument (“FIM”) Motor and Cognitive subscale scores demonstrated that younger individuals had lower scores at admission to rehabilitation and higher scores at rehabilitation discharge. Conclusion: This study provides population estimates for all patients 16 years of age and older receiving inpatient rehabilitation for a primary diagnosis o f TBI in the United States between 2001 and 2010. A recent trend shows the aging of the inpatient TBI rehabilitation population. Many characteristics important to rehabilitation outcomes are influenced by age, with older individuals trending toward being female, having less severe TBIs, incurring TBIs as a result of falls, but showing less improvement during rehabilitation, greater resulting disability, and more changes in their living situation postrehabilitation. These findings are of particular interest, as the oldest age groups considered in these analyses did not include the baby boom population. [ABSTRACT FROM AUTHOR]

The article discusses a study on patients with a primary rehabilitation diagnosis of Traumatic Brain Injury (TBI) to determine the representativeness of the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB). It considers demographic characteristics, functional status, and hospital stays as outcome measures and compares the U.S. TBI rehabilitation population data and TBIMS-NDB. It concludes that TBIMS-NDB is a representative of patients receiving rehabilitation TBI in the U.S.

Objectives: To determine the types of environmental barriers reported by persons with traumatic brain injury (TBI) and to identify the relations between environmental barriers and such components of societal participation as employment, community mobility, social integration, and life satisfaction. Design: Seventy-three persons with TBI who were participating in the TBI Model Systems program at Craig Hospital were surveyed at 1 year, using a new measure of the environment, the Craig Hospital Inventory of Environmental Factors (CHIEF), which rates frequency and impact of 25 barriers. Results: Transportation, the surroundings, government policies, attitudes, and the natural environment were the environmental barriers with the greatest reported impact. Those who were married, older, and unemployed or not in school reported the most barriers overall. Additionally, those reporting a greater impact from environmental barriers also reported lower levels of participation and life satisfaction. Conclusions: Although environmental barriers affect TBI survivors and play a role in their outcomes, their interplay with other, perhaps as yet unidentified, factors requires continued research. CHIEF may be a valuable tool for understanding the environment's role in the lives of people with TBI, and identifying the general environmental domains where interventions are needed to reduce their negative impact. [ABSTRACT FROM AUTHOR]

Background: Immune-suppressed solid-organ transplant recipients (SOTRs) display impaired humoral responses to COVID-19 vaccination, but T cell responses are incompletely understood. SARS-CoV-2 variants Omicron BA.4/5 (BA.4/5) and XBB.1.5 escape neutralization by antibodies induced by vaccination or infection with earlier strains, but T cell recognition of these lineages in SOTRs is unclear., Methods: We characterized Spike-specific T cell responses to ancestral SARS-CoV-2 and BA.4/5 peptides in 42 kidney, liver, and lung transplant recipients throughout a 3- or 4-dose ancestral Spike mRNA vaccination schedule. As the XBB.1.5 variant emerged during the study, we tested vaccine-induced T cell responses in 10 additional participants using recombinant XBB.1.5 Spike protein. Using an optimized activation-induced marker assay, we quantified circulating Spike-specific CD4 + and CD8 +  T cells based on antigen-stimulated expression of CD134, CD69, CD25, CD137, and/or CD107a., Results: Vaccination strongly induced SARS-CoV-2-specific T cells, including BA.4/5- and XBB.1.5-reactive T cells, which remained detectable over time and further increased following a fourth dose. However, responses to BA.4/5 (1.34- to 1.67-fold lower) XBB.1.5 (2.0- to 18-fold lower) were significantly reduced in magnitude compared with ancestral strain responses. CD4 + responses correlated with anti-receptor-binding domain antibodies and predicted subsequent antibody responses in seronegative individuals. Lung transplant recipients receiving prednisone and older adults displayed weaker responses., Conclusions: Ancestral strain vaccination stimulates BA.4/5 and XBB.1.5-cross-reactive T cells in SOTRs, but at lower magnitudes. Antigen-specific T cells can predict future antibody responses. Our data support monitoring both humoral and cellular immunity in SOTRs to track COVID-19 vaccine immunogenicity against emerging variants., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Seminal advances in virtual human (VH) technology have introduced highly interactive, computer-animated VH interviewers. Their utility for aiding in chronic pain care is unknown. We developed three interactive telehealth VH interviews-a standard pain-focused, a psychosocial risk factor, and a pain psychology and neuroscience educational interview. We then conducted a preliminary investigation of their feasibility, acceptability, and efficacy. We also experimentally compared a human and a computer-generated VH voice., Methods: Patients ( N = 94, age = 22-78 years) with chronic musculoskeletal pain were randomly assigned to the standard ( n = 31), psychosocial ( n = 34), or educational ( n = 29) VH interview and one of the two VH voices. Acceptability ratings included patient satisfaction and expectations/evaluations of the VH interview. Outcomes assessed at baseline and about 1-month postinterview were pain intensity, interference, emotional distress, pain catastrophizing, and readiness for pain self-management. Linear mixed-effects models were used to test between- and within-condition effects., Results: Acceptability ratings showed that satisfaction with the VH and telehealth format was generally high, with no condition differences. Study attrition was low ( n = 5). Intent-to-treat-analyses showed that, compared with the standard interview, the psychosocial interview yielded a significantly greater reduction in pain interference ( p = .049, d = 0.43) and a marginally greater reduction in pain intensity ( p = .054, d = 0.36), whereas the educational interview led to a marginally greater yet nonsignificant increase in readiness for change ( p = .095, d = 0.24), as well as several significant improvements within-condition. Results did not differ by VH voice., Conclusions: Interactive VH interviewers hold promise for improving chronic pain care, including probing for psychosocial risk factors and providing pain-related education., (Copyright © 2023 by the American Psychosomatic Society.)

Objective: The aim of this study was to understand registered nurses' (RNs') perceptions of attending a live streaming versus in-person continuing education event., Background: During the COVID-19 global pandemic, in-person continuing education events for healthcare providers required conversion to digital platforms. Literature is sparse regarding healthcare providers' perceptions on attending a live streaming continuing education event., Methods: Registered nurses completed a survey after a live streaming research conference from a large US healthcare system. Likert-scale survey items were analyzed using descriptive statistics and open-ended questions with content analysis and thematic coding., Results: A total of 219 RNs participated. The RNs reported an overall positive experience with the live streaming event and indicated a preference for this platform for the future. Three benefits emerged: savings, self-care and safety, and user-friendly. Perceived drawbacks were coded with 3 themes: technical issues, impaired focus, and social/networking challenges., Conclusions: Despite challenges, live streaming conferences may be satisfying and preferable for nurses., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To understand impacts of social, behavioral and physical factors on well-being of office workstation users during COVID-19 work from home (WFH)., Methods: A questionnaire was deployed from April 24 to June 11, 2020 and 988 responses were valid. Linear regression, multinomial logistic regression and chi-square tests were used to understand factors associated with overall physical and mental health statuses and number of new physical and mental health issues., Results: Decreased overall physical and mental well-being after WFH were associated with physical exercise, food intake, communication with coworkers, children at home, distractions while working, adjusted work hours, workstation set-up and satisfaction with workspace indoor environmental factors., Conclusion: This study highlights factors that impact workers' physical and mental health well-being while WFH and provides a foundation for considering how to best support a positive WFH experience., Competing Interests: Becerik-Gerber, Xiao, Lucas, and Roll have no relationships/conditions/circumstances that present potential conflict of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Context: The United States is in the midst of an opioid overdose epidemic. Opioids killed more than 28 000 people in 2014, more than any year on record. One approach to addressing this growing epidemic is Opioid Overdose Education and Naloxone Distribution (OEND) training. Little is known about these programs' participants and their effectiveness across different demographic groups., Objectives: To examine (1) whether knowledge and attitudes improved over the course of the training programs; (2) whether training outcomes differ by demographics; and (3) what overdose experiences do attendees have, and whether those experiences influence their knowledge and attitudes., Design: A pre- and posttest survey was used to collect data on participants' demographics, overdose experiences, and opioid overdose knowledge and attitudes., Setting: Surveys that took place at community-wide OEND programs were offered throughout Erie County, New York, during October and November 2015., Participants: Community members who elected to attend the training programs, were at least 18 years of age, spoke English, and were willing and able to participate were included in the sample (N = 198)., Intervention: N/A., Main Outcome Measure: The Opioid Overdose Knowledge and Attitudes Scale., Results: Knowledge and attitude scores significantly improved from pre- to posttest assessments, increasing by 23.1% and 15.4%, respectively (Ps < .001). There were significant demographic differences in knowledge and attitudes at the pretest assessment, but these differences were ameliorated by the OEND program and did not persist at posttest assessment. In addition, 62.9% of participants had never experienced, witnessed, or known someone who had overdosed., Conclusion: Results indicate that OEND programs are effective at improving knowledge and attitudes toward opioid overdose. These results indicate that OEND programs are not reaching the highest risk individuals but are instead attracting concerned family and significant others. Future programs should focus on reaching current opioid users, overdose victims, and their families to ensure OEND programs are reaching the target audiences.

Background: Giant papillae tongue disorder (GPTD) is a newly discovered, long-lasting clinical disorder that may develop in organ-transplanted pediatric recipients. The key feature of this disorder is the unique tongue lesion, which comprises swollen fungiform papillae. The aim of this study was to characterize the immunohistopathology of this novel inflammatory condition., Methods: Six organ transplanted children with GPTD were included in the study. Routine histopathology and immunohistochemical stainings for CD3, CD4, CD8, CD25, FOXP3, CD20, CD138, CD68, CD1a, CD15, CD23, and mast cell tryptase were performed., Results: Immunohistochemical analyses of the oral lesions revealed a subepithelial infiltrate that was primarily composed of CD3- and CD4-positive T cells, CD20-expressing B cells, macrophages, and CD138-positive plasma cells. The CD20-positive cells did not display the typical B cell morphology, having in general a more dendritic cell-like appearance. The CD138-expressing plasma cells were distinctly localized as a dense infiltrate beneath the accumulation of T cells and B cells. Increased numbers of CD1a-expressing Langerhans cells were detected both in the epithelium and connective tissue. Because no granulomas were observed and only single lesional eosinophils were detected, GPTD does not resemble a granulomatous or eosinophilic condition., Conclusions: We describe for the first time the immunopathological characteristics of a novel inflammatory disorder of the oral cavity, which may develop after solid organ transplantation in children.

This study explored Magnet Chief Nursing Officers' cues-to-action initiating lesbian, gay, bisexual, or transgender (LGBT)-specific policies. Homonegativity has a negative effect on employee recruitment and retention and patient satisfaction. Little has been known about what cues-to-action might initiate LGBT inclusive training. Surveys were mailed to 343 Chief Nursing Officers. Cues-to-action survey was used to assess what inspires initiation of LGBT training. Demographic surveys were used to assess what impact variables might have on cues-to-action. Age, sex, religiosity, location, and region had significant effect on cues-to-action. Developing demographically informed training and policies for LGBT equality in health care is suggestive of greater employee and patient satisfaction.

Purpose: This study investigated the relationship between uncorrected astigmatism and early academic readiness in at-risk preschool-aged children., Methods: A vision screening and academic records review were performed on 122 three- to five-year-old children enrolled in the Philadelphia Head Start program. Vision screening results were related to two measures of early academic readiness, the teacher-reported Work Sampling System (WSS) and the parent-reported Ages and Stages Questionnaire (ASQ). Both measures assess multiple developmental and skill domains thought to be related to academic readiness. Children with astigmatism (defined as >|-0.25| in either eye) were compared with children who had no astigmatism. Associations between astigmatism and specific subscales of the WSS and ASQ were examined using parametric and nonparametric bivariate statistics and regression analyses controlling for age and spherical refractive error., Results: Presence of astigmatism was negatively associated with multiple domains of academic readiness. Children with astigmatism had significantly lower mean scores on Personal and Social Development, Language and Literacy, and Physical Development domains of the WSS, and on Personal/Social, Communication, and Fine Motor domains of the ASQ. These differences between children with astigmatism and children with no astigmatism persisted after statistically adjusting for age and magnitude of spherical refractive error. Nonparametric tests corroborated these findings for the Language and Literacy and Physical Health and Development domains of the WSS and the Communication domain of the ASQ., Conclusions: The presence of astigmatism detected in a screening setting was associated with a pattern of reduced academic readiness in multiple developmental and educational domains among at-risk preschool-aged children. This study may help to establish the role of early vision screenings, comprehensive vision examinations, and the need for refractive correction to improve academic success in preschool children.

Objective: This study explored Magnet® hospital chief nursing officers' (CNOs') attitudes toward gays and lesbians and the impact that these attitudes have on providing advocacy for lesbian, gay, bisexual, or transgender (LGBT) patients and staff., Background: Homonegativity encompasses both heterosexism and homophobia and has profound effects on the health of LGBT populations. Little has been reported about the attitudes of CNOs toward LGBT populations and how these might impact advocacy for LGBT healthcare., Methods: Surveys were electronically mailed to 343 Magnet CNOs. The Modern Homonegativity Scale was used to assess attitudes, and additional statements were developed to assess the comfort level of the respondent in advocating for LGBT populations., Results: Attitudes among CNOs toward LGBT populations and comfort with advocating for LGBT populations were positively correlated. Those demonstrating less homonegative attitudes were more likely to feel comfortable advocating for LGBT patients and staff., Conclusions: Recognizing and addressing bias among nurse leaders through education are important to ensure equitable healthcare for patients and employees.

Purpose: This study evaluated the effect of intravenous (IV) catheter gauge size on catheter placement, contrast infusion, and image quality for patients undergoing IV contrast-enhanced multidetector computed tomography (MDCT)., Materials and Methods: One thousand consecutive adult outpatients undergoing IV contrast-enhanced MDCT and 10 IV insertion CT nurses were observed from IV catheter selection through IV removal. Patients' demographics, number of sticks required, catheter gauge during each attempt, time for catheter placement, IV nurses' assessment of vein quality and contrast infusion parameters were recorded. Scan quality was assessed subjectively., Results: Subjects included 547 men and 453 women, with a mean age 59.2 years (range, 19-92 years). Median number of catheter attempts was 1 per patient (range, 1-9). Catheters were successfully placed in 98%. First and final catheters were most commonly 20 gauge (59% and 56%, respectively), followed by 22 gauge (34% for both), 18 gauge (6% for both), and 24 gauge (2% and 3%, respectively). Mean infusion rate correlated with catheter gauge: 5.3 mL/s for 18 gauge; 3.5 mL/s for 20 gauge; 2.3 mL/s for 22 gauge; and 1.7 mL/s for 24 gauge (P < 0.0001). Target infusion rate of ≥ 3 mL/s was related to catheter gauge (100% of 18 gauge, 71% of 20 gauge, 11% of 22 gauge, and 0% of 24 gauge; P < 0.0001). Nine hundred sixty-eight subjects underwent imaging. Most of the CT examinations (935/968 [97%]) were of acceptable quality., Conclusion: Experienced IV starters usually achieve IV access in one attempt by tailoring IV catheter gauge to vein quality; however, target infusion rates are not likely to be achieved with 22- and 24-gauge catheters, used in nearly 1/3 of the patients in this study.

Objectives: To provide an updated version of the Paediatric Index of Mortality 2 for assessing the risk of mortality among children admitted to an ICU., Design: International, multicenter, prospective cohort study., Setting: Sixty ICUs that accept pediatric admissions in Australia, New Zealand, Ireland, and the United Kingdom., Patients: All children admitted in 2010 and 2011 younger than 18 years old at the time of admission and either died in ICU or were discharged. Patients who were transferred to another ICU were not included. Fifty-three thousand one hundred twelve patient admissions were included in the analysis., Interventions: None., Measurement and Main Results: A revised prediction model was built using logistic regression. Variable selection was based on significance at the 95% level and overall improvement of the model's discriminatory performance and goodness of fit. The final model discriminated well (area under the curve, 0.88, 0.88-0.89); however, the model performed better in Australia and New Zealand than in the United Kingdom and Ireland (area under the curve was 0.91, 0.90-0.93 and 0.85, 0.84-0.86, respectively)., Conclusions: Paediatric Index of Mortality 3 provides an international standard based on a large contemporary dataset for the comparison of risk-adjusted mortality among children admitted to intensive care.

Purpose: This study evaluated the repeatability of the Developmental Eye Movement Test (DEM) with three consecutive administrations on two separate visits to 181 children between the ages of 6 years and 11 years 11 months., Methods: Children with visual acuity of ≥ 20/25, normal binocularity, and accommodation were administered three different versions of the DEM test. One to 4 weeks after the first administration of the DEM, the children were tested again using the same order for the three versions of the DEM. Measures of within- and between-session repeatability for the vertical-adjusted time, horizontal-adjusted time, ratio, and error scores were determined., Results: The within-session repeatability for vertical- and horizontal-adjusted time were good to excellent but were poor to good for ratio, and poor to fair for errors. The between-session intraclass correlation coefficients were fair to good for both the vertical and horizontal scores but poor for the ratio and error scores. The repeatability of the pass-fail diagnostic classification within a single session for each subject on test and retest was compared. The percentage of patients who remained in the same classification ranged from 71 to 100% for both vertical and horizontal scores. Wider variability was seen with the ratio and error scores showing between 47 and 100% of the children remaining classified as pass or fail with repeated administrations of the DEM. Such findings would suggest that children in this age range may show improvements in all four test scores without any intervention., Conclusions: Although the DEM is widely used in optometric practice, the results of this study suggest that clinicians should be cautious about using the DEM test in isolation for reaching a diagnosis or monitoring the effectiveness of treatment for saccadic dysfunction.

Objective: To examine behavioral observations of affiliation (ie, warmth versus hostility) and control (ie, dominance versus submissiveness) and prior divorce as predictors of coronary artery calcification (CAC) in older couples. In some but not all studies, marital disruption and low marital quality have been shown to confer risk of coronary artery disease (CAD). Inconsistencies might reflect limitations of self-reports of marital quality compared with behavioral observations. Also, aspects of marital quality related to CAD might differ for men and women., Methods: Couples underwent computed tomography scans for CAC and marital assessments, including observations of laboratory-based disagreement. Participants were 154 couples (mean age, 63.5 years; mean length of marriage, 36.4 years) free of prior diagnosis of CAD., Results: Controlling traditional risk factors, we found behavioral measures of affiliation (low warmth) accounted for 6.2% of variance in CAC for women, p < .01, but not for men. Controlling behavior (dominance) accounted for 6.0% of variance in CAC for men, p < .02, but not for women. Behavioral measures were related to self-reports of marital quality, but the latter were unrelated to CAC. History of divorce predicted CAC for men and women., Conclusions: History of divorce and behavioral--but not self-report--measures of marital quality were related to CAD, such that low warmth and high dominance conferred risk for women and men, respectively. Prior research might underestimate the role of marital quality in CAD by relying on global self-reports of this risk factor.

The objective of the present research was to develop a single measure of the major symptoms of both neuropathic and non-neuropathic pain that can be used in studies of epidemiology, natural history, pathophysiologic mechanisms, and treatment response. We expanded and revised the Short-form McGill Pain Questionnaire (SF-MPQ) pain descriptors by adding symptoms relevant to neuropathic pain and by modifying the response format to a 0-10 numerical rating scale to provide increased responsiveness in longitudinal studies and clinical trials. The reliability, validity, and subscale structure of the revised SF-MPQ (SF-MPQ-2) were examined in responses from 882 individuals with diverse chronic pain syndromes and in 226 patients with painful diabetic peripheral neuropathy who participated in a randomized clinical trial. The data suggest that the SF-MPQ-2 has excellent reliability and validity, and the results of both exploratory and confirmatory factor analyses provided support for four readily interpretable subscales-continuous pain, intermittent pain, predominantly neuropathic pain, and affective descriptors. These results provide a basis for use of the SF-MPQ-2 in future clinical research, including clinical trials of treatments for neuropathic and non-neuropathic pain conditions.

This two-phase study was conducted to identify relevant domains of patient-reported outcomes from the perspective of people who experience chronic pain. In Phase 1, focus groups were conducted to generate a pool of patient outcome-related domains and their components. The results of the focus groups identified 19 aspects of their lives that were significantly impacted by the presence of their symptoms and for which improvements were important criteria they would use in evaluating the effectiveness of any treatment. Phase 2 was conducted to examine the importance and relevance of domains identified from a much larger and diverse sample of people with chronic pain. A survey was developed and posted on the American Chronic Pain Association website. Participants were asked to rate the importance of each item or domain identified by the focus groups on a scale of 0 to10 (i.e., 0="not at all important" and 10="extremely important"). The survey was completed by 959 individuals. The results indicate that all 19 aspects of daily life derived from the focus groups were considered important with a majority of respondents indicating a score of 8 or greater. In addition to pain reduction, the most important aspects were enjoyment of life, emotional well-being, fatigue, weakness, and sleep-related problems. Chronic pain clearly impacts health-related quality of life. The results of the two phases of the study indicate that people with chronic pain consider functioning and well-being as important areas affected by the presence of symptoms and as appropriate targets of treatment. These multiple outcomes should be considered when evaluating the efficacy and effectiveness of chronic pain treatments.

Objective: To examine the association between hostile personality traits and coronary artery disease (CAD) and the role of aspects of hostility, method of assessment, and age as influences on its magnitude, as prior studies of hostility and coronary artery calcification (CAC) have produced conflicting findings., Methods: Participants included 300 married couples (mean age = 54.4 years) free from diagnosed CAD. Participants completed four measures of hostility-self-reports and spouse ratings of angry hostility (i.e., tendency to experience anger) and antagonism (i.e., argumentative, mistrusting, and cold interpersonal behavior)., Results: In hierarchical random regression models accounting for dependency between husbands' and wives' observations, analyses of log-transformed Agatston scores indicated that self-reports of angry hostility and antagonism were not related to CAC. However, spouse ratings of both anger and antagonism were significantly associated with CAC severity. Interactions with age indicated that these associations occurred only among older participants. Control of behavioral and biomedical risk factors did not eliminate these effects. Antagonism but not anger was an independent predictor of CAC when considered simultaneously., Conclusions: Hostility is associated with concurrent asymptomatic CAD as assessed through CAC, but this effect is likely to be underestimated when hostility is assessed through self-reports rather than ratings by others and in samples with lower prevalence and severity of CAC.

The purpose of this study was to describe strategies used by clinical nurse specialists when caring for patients involved in "difficult" clinician-patient situations. Clinical nurse specialist members of the National Association of Clinical Nurse Specialists were surveyed to identify frequently used and high-priority strategies. Subjects (N = 234) identified strategies from a wide spectrum of activities, with agreement found between highest and lowest frequently used and priority approaches. Respect for the patient and ability to focus on the issue at hand emerged in the highest reported strategies.

Objective: To assess the efficacy, across a range of disability groups, of the Craig Handicap Assessment and Reporting Technique (CHART), a measure of societal participation., Design: Cross-sectional analysis survey methodology. A total of 1110 community-based, nonhospitalized Coloradans with spinal cord injury, traumatic brain injury, multiple sclerosis, stroke, burn, or amputation were interviewed twice, 2 wks apart, using the CHART and a single administration of the FIM., Results: Across all impairment groups, the intraclass correlation for the total score and the subscales of CHART-R were high. In addition, the CHART-R discriminated among the impairment categories in a direction that parallels increasing disability., Conclusions: CHART may be an appropriate measure of handicap for a range of physical or cognitive impairments.

Objective: To describe the effects of inhaled nitric oxide on oxygenation and ventilation in patients with acute, hypoxic respiratory failure and to characterize those who respond to low doses with a significant improvement in PaO2., Design: Prospective dose response trial of inhaled nitric oxide. Patients who demonstrated a > or =15% improvement in PaO2 were randomized to receive conventional mechanical ventilation with or without prolonged inhaled nitric oxide., Setting: Pediatric intensive care unit of a tertiary care children's hospital serving as a regional referral center for respiratory failure., Patients: Pediatric patients with an acute parenchymal lung disease requiring mechanical ventilation, an F(IO2) of > or =0.5, a positive end-expiratory pressure of > or =7 cm H2O, and whose PaO2/FIO2 ratio was < or =160., Interventions: PaO2, PaCO2, pH, heart rate, blood pressure, and methemoglobin were recorded at baseline and after inhaling 1, 5, 10, and 20 ppm of nitric oxide. Peak expiratory flow rate and mean airway resistance were measured while subjects received 0 and 20 ppm of inhaled nitric oxide. Patients were followed up until extubation or death., Measurements and Main Results: Twenty-six patients (median age, 2.6 yrs [range, 1 mo-18.2 yrs]) were enrolled in the study. PaO2 increased (p< .001) and Pa(CO2) fell (p< .0001) from baseline with the administration of inhaled nitric oxide. There was no statistical difference among 1, 5, 10, and 20 ppm with regard to effects on oxygenation. Sixteen patients (62%) responded to inhaled nitric oxide with a > or =15% improvement in PaO2; 14 of these responses occurred at a dose of 1 or 5 ppm. Response to inhaled nitric oxide was not associated with age, length of intubation, presence of primary lung disease, chest radiograph, or illness severity. Among patients weighing < or =20 kg, responders showed a greater fall in mean airway resistance (p < .05) than nonresponders. Mortality was not influenced by prolonged inhaled nitric oxide when analyzed by intention to treat. Patients receiving prolonged inhaled nitric oxide at doses of < or =20 ppm maintained methemoglobin levels of <3.0% and circuit concentrations of NO2 of <1 ppm., Conclusions: Inhaled nitric oxide at doses of < or =5 ppm improves the oxygenation and (to a lesser extent) ventilation of most children with acute, hypoxic respiratory failure. The unpredictable response of patients necessitates individualized dosing of inhaled nitric oxide, starting at concentrations of < or =1 ppm. Inhaled nitric oxide at < or =20 ppm may exert a small salutary effect on bronchial tone. The benefits of prolonged inhaled nitric oxide remain unknown.

Purpose: We describe the spontaneous resolution of a myelodysplastic cytogenetic abnormality developing during the treatment of acute lymphocytic leukemia., Patients and Methods: A 6-year-old girl with acute lymphocytic leukemia had a clinical picture of myelodysplasia 18 months after diagnosis. The clonal cytogenetic abnormality, 46,XX,del(5)(q12q12), resolved spontaneously 4 months after the discontinuation of chemotherapy. Maintenance chemotherapy was resumed 1 month later and continued for an additional 9 months. Currently, she has been off therapy for 10 months., Conclusion: A myelodysplastic clonal cytogenetic abnormality developing during treatment may cause some confusion for management. This study demonstrates that spontaneous resolution is possible and that bone marrow transplantation or other intensive treatment may not be necessary.

When mice are given a 30% scald burn, the growth of subsequently inoculated Ehrlich ascites tumor is markedly accelerated. This effect, which parallels the well documented suppression of cell-mediated immunity occurring postburn, disappears 10 days postinjury. Possible clinical implications are discussed and an illustrative case report is presented.