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Background: Sport-related concussions (SRCs) affect millions of adolescents and young adults annually in the USA; however, current SRC consensus statements provide limited guidance on academic support for students within higher education. Objective: To generate consensus on appropriate academic recommendations for clinicians, students, and academic stakeholders to support university students during their recovery. Methods: Panelists participated in three stages of a modified Delphi procedure: the first stage included a series of open-ended questions after reviewing a literature review on post-SRC return-to-learn (RTL) in higher education; the second stage asked panelists to anonymously rate the recommendations developed through the first Delphi stage using a 9-point scale; and the final stage offered panelists the opportunity to change their responses and/or provide feedback based on the group's overall ratings. Results: Twenty-two panelists including clinicians, concussion researchers, and academic stakeholders (54.5% female) from 15 institutions and/or healthcare systems participated in a modified Delphi procedure. A total of 42 statements were developed after round one. Following the next two rounds, 27 statements achieved consensus amongst the panel resulting in the four-stage Post-Concussion Collegiate RTL Protocol. Conclusion: There are several unique challenges when assisting university students back to the classroom after SRC. Explicit guidelines on when to seek additional medical care (e.g., if they are experiencing worsening or persistent symptoms) and how to approach their instructor(s) regarding academic support may help the student self-advocate. Findings from the present study address barriers and provide a framework for universities to facilitate a multidisciplinary approach amongst medical and academic stakeholders. [ABSTRACT FROM AUTHOR]

Background: To optimally care for concussed individuals, a multi-dimensional approach is critical and a key component of this assessment in the athletic environment is computer-based neurocognitive testing. However, there continues to be concerns about the reliability and validity of these testing tools. The purpose of this study was to determine the sensitivity and specificity of three common computer-based neurocognitive tests (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT], CNS Vital Signs, and CogState Computerized Assessment Tool [CCAT]), to provide guidance on their clinical utility. Methods: This study analyzed assessments from a cohort of collegiate athletes and non-varsity cadets from the NCAA-DoD CARE Consortium. The data were collected from 2014–2018. Study participants were divided into two testing groups [concussed, n = 1414 (baseline/24–48 h) and healthy, n = 8305 (baseline/baseline)]. For each test type, change scores were calculated for the components of interest. Then, the Normative Change method, which used normative data published in a similar cohort, and the Reliable Change Index (RCI) method were used to determine if the change scores were significant. Results: Using the Normative Change method, ImPACT performed best with an 87.5%-confidence interval and 1 number of components failed (NCF; sensitivity = 0.583, specificity = 0.625, F1 = 0.308). CNS Vital Signs performed best with a 90%-confidence interval and 1 NCF (sensitivity = 0.587, specificity = 0.532, F1 = 0.314). CCAT performed best when using a 75%-confidence interval and 2 NCF (sensitivity = 0.513, specificity = 0.715, F1 = 0.290). When using the RCI method, ImPACT performed best with an 87.5%-confidence interval and 1 NCF (sensitivity = 0.626, specificity = 0.559, F1 = 0.297). Conclusion: When considering all three computer-based neurocognitive tests, the overall low sensitivity and specificity results provide additional evidence for the use of a multi-dimensional assessment for concussion diagnosis, including symptom evaluation, postural control assessment, neuropsychological status, and other functional assessments. [ABSTRACT FROM AUTHOR]

Alcohol use disorder is widespread in the United States and research suggests that significant neuropsychological damage can result from prolonged and/or excessive alcohol use. Neuropsychological and affective effects of prolonged and/or excessive alcohol use include memory deficits, limited emotional expression and recognition, and impairments in executive functioning. Research has yielded mixed results on the improvement of these deficits once alcohol use is discontinued. The aim of this study was to assess psychological changes during an approximately 28-day residential substance use treatment program among adults diagnosed with an alcohol use disorder (N = 122). Patients were predominantly White (91.8%) and male (77.9%). Cognitive, psychological and affective functioning were measured utilizing WebNeuro, a computer-based assessment of four specific domains (Feeling, Self-Regulation, Emotion, and Thinking). Time 1 assessments were completed following alcohol detoxification and Time 2 assessments were conducted upon discharge from the treatment facility, approximately 28-days after Time 1. Results revealed significant increases across all four domains at Time 2, suggesting that there were significant improvements in cognitive and psychological functioning over time. The effect of Time was qualified by a significant Time × AUDIT score interaction in predicting the Feeling and Self-Regulation domains, indicating the more severe the alcohol use, the greater the psychological improvement. Continued research is needed to determine whether functioning continues to improve following treatment for an alcohol use disorder. [ABSTRACT FROM PUBLISHER]

Background: Adenotonsillectomy is the most commonly performed operation for pediatric snoring/sleep disordered breathing (S/SDB). However, 20-40% of patients will fail to improve. Drug-induced sleep endoscopy (DISE) may provide a more individualized surgical plan and limit unsuccessful surgeries. The aim of this study was to assess the impact of DISE on surgical decision-making in surgically naïve children with S/SDB. Methods: A retrospective observational cohort study was undertaken at the Stollery Children's Hospital. Patients 3-17 years of age who underwent DISE-directed surgery for S/SDB between January 2009 and December 2015 were eligible. We excluded other indications for tonsillectomy and syndromic children. The primary outcome was the level of agreement between a DISE-based surgical decision and the reference standard based on the American Academy of Pediatrics (AAP) guidelines via un-weighted Cohen's kappa. Secondary outcomes included the frequency and type of alternate surgical targets identified by DISE. The agreement on tonsil size between in-office physical assessment and DISE was also calculated. The effectiveness of DISE-directed surgery on postoperative S/SDB was not investigated. Results: Five hundred fifty-eight patients were included. DISE changed the surgical plan in 35% of patients. Agreement between DISE-based and AAP clinical practice guidelines-based management was low (κ = 0.354 +/- 0.021 [95% CI 0.312-0.395]). An alternate diagnosis or surgical target was identified by DISE in 54% of patients. There was moderate agreement on tonsil size (κ = 0.44 [0.33-0.55]) between DISE and in-office clinical assessment. Conclusions: This is a first phase diagnostic study, which demonstrates that DISE affects decision-making in surgically naïve children with S/SDB in up to 35% of patients. It has utility in individualizing first stage surgical treatments as well as identifying alternate targets for further surgical or medical therapy, while potentially limiting unsuccessful surgeries. Further studies to examine the effect of DISE on surgical outcomes are required. [ABSTRACT FROM AUTHOR]

The comorbidity between eating disorders (EDs) and substance use disorders (SUDs) is of particular concern given the high rates of mortality, relapse and poor treatment outcomes associated with both disorders. As a result, there has been a growing impetus within the field to elucidate factors that might influence and aid treatment for this comorbidity. One such factor is dispositional mindfulness, as past literature has demonstrated a significant relationship between mindfulness and both EDs and SUDs. However, we are unaware of any research that has examined the relationship between dispositional mindfulness and ED symptoms in a sample of men in residential treatment for SUDs. Medical records from 152 men were included in the current study. Alcohol and drug use and problems, ED symptoms and dispositional mindfulness were assessed with self-report measures. Hierarchical regression analysis indicated that dispositional mindfulness was inversely related to ED symptoms after controlling for alcohol use, drug use and age. Although results are preliminary and continued research in this area is needed, our findings suggest that there may be potential usefulness in targeting and enhancing mindfulness among patients in residential treatment for SUDs with cooccurring psychiatric symptoms (e.g., EDs). [ABSTRACT FROM PUBLISHER]

Sprint interval training (SIT) can elicit improvements in aerobic and anaerobic capacity. While variations in SIT protocols have been investigated, the influence of social processes cannot be overlooked. As research supports the use of groups to influence individual cognitions and behaviours, the current project assessed the effectiveness of a group-based intervention with participants conducting SIT. Specifically, 53 amateur athletes (age, 21.9 ± 2.9 years; 53% females) took part in a 4-week training program (3 sessions per week, 30-s 'all-out' efforts with 4 min active recovery, repeated 4-6 times per session), and were assigned to 'true group', aggregate, or individual conditions. Results indicated no significant differences between groups for the physiological measures. With regards to training improvements from baseline for all participants- regardless of condition - significant main effects for time were identified for maximal oxygen uptake (2.5-2.8 mL·kg−1·min−1, p < 0.001, η2 = 0.03), time-trial performance (14-32 s, p < 0.001, η2 = 0.37), and anaerobic power (1.1-1.7 k·h−1, p < 0.001, η2 = 0.66). With regards to the psychological measures, significant main effects between groups were found for motivation ( p = 0.033, η2 = 0.13), task self-efficacy ( p = 0.018, η2 = 0.15), and scheduling self-efficacy ( p = 0.003, η2 = 0.22). The true group experienced greater improvements in motivation than the individual condition, but the aggregate and individual conditions demonstrated greater increases in task and scheduling self-efficacy. Though the SIT paradigm employed induced training improvements similar to previous work, the group intervention was not able to further these improvements. [ABSTRACT FROM AUTHOR]

Past research has consistently demonstrated high co-occurrence between substance use disorders (SUDs) and compulsive sexual behaviors (CSBs). Numerous studies have also indicated that maladaptive core beliefs and early maladaptive schemas (EMS) are prevalent among individuals with SUDs and CSBs. However, research has yet to examine the relationship between EMS and CSBs among substance-dependent populations. Thus, the purpose of the current study was to examine this relationship in a sample of 198 men and 62 women in residential treatment for SUDs. Findings demonstrated that the five EMS domains were positively associated with CSBs. Results further demonstrated that patients meeting the cutoff score for CSBs scored significantly higher than patients not meeting the cutoff score for CSBs on the EMS domains ofdisconnection/rejection, impaired autonomy, and impaired limit. These findings suggest that there is an important and significant relationship between EMS and CSBs among adults in substance use treatment. Results from the current study indicate that EMS may provide a potentially important focus for treatment, particularly among individuals with co-morbid CSBs and SUDs. Given the preliminary nature of this study, continued research is needed to replicate and extend the findings from the current study. [ABSTRACT FROM AUTHOR]

Background: Generalized anxiety disorder (GAD) co-occurs with substance use disorders (SUDs) at an alarmingly high rate, and the presence of anxiety is associated with an increased risk for relapse to substance use following treatment. Furthermore, comorbid SUDs and other forms of psychopathology are associated with an increased risk for leaving treatment against medical advice (AMA). Objective and Method: Research has yet to examine whether the presence of GAD symptoms is associated with leaving treatment AMA in SUDs populations. Thus, the current study sought to address this important gap in the literature by examining this relationship among a sample of 122 women in residential treatment for SUDs. Results: Results demonstrated that GAD symptoms were significantly associated with the decision to leave treatment AMA after controlling for age, education, problematic alcohol and drug use, and depression symptoms. Conclusions/Importance: Our finding indicates the potential importance of assessing and targeting GAD in treatment for SUDs, which may increase treatment compliance. [ABSTRACT FROM AUTHOR]

There is a large literature documenting that adult men in treatment for substance use disorders perpetrate more aggression than men without substance use disorders. Unfortunately, there is minimal research on aggression among young adult men (i.e., 18–25 years of age) in treatment for substance use. Moreover, although aggression is more likely to occur when individuals are acutely intoxicated by alcohol or drugs, research also suggests that antisocial (ASPD) and borderline (BPD) personality features increase the chances an individual will use aggression. The current study therefore examined the associations between ASPD and BPD features, including specific features that are reflective of impulsivity, and aggression in young adult men in treatment for substance use disorders (N = 79). Controlling for age, education, alcohol and drug use, ASPD features were positively associated with various indicators of aggression (e.g., physical, verbal, attitudinal), whereas BPD features were only associated with physical aggression. However, ASPD and BPD features that were specific to impulsivity were robustly related to indicators of aggression. Findings suggest that substance use treatment should attempt to target ASPD and BPD features in young adult men, which may help reduce aggression after treatment. [ABSTRACT FROM PUBLISHER]

There is a large literature on substance misuse and interpersonal aggression, including aggression perpetrated by women in treatment for substance misuse. There is also a growing body of literature on mindfulness and substance use, as well as mindfulness and aggression. However, to date, there has been little research on whether dispositional mindfulness is associated with increased aggression among women in treatment for substance misuse. The current study, therefore, examined whether dispositional mindfulness was associated with aggression, above and beyond substance use and demographic characteristics, in women in residential substance misuse treatment (N = 137). Results showed that lower dispositional mindfulness was associated with increased aggression (physical, verbal, and aggressive attitude). Moreover, this relationship between dispositional mindfulness and aggression remained even after controlling for alcohol problems, drug problems, and age, all known predictors of aggression. Our results provide the first empirical evidence that dispositional mindfulness is negatively associated with aggression in women in treatment for substance misuse. Pending replication, this could have important implications for treatment. Specifically, mindfulness-based interventions may prove helpful for the concurrent treatment of substance misuse and aggression. [ABSTRACT FROM AUTHOR]

Background: Mental health and/or substance use issues are associated with significant disparities in morbidity and mortality. The aim of this study was to identify the mechanisms underlying poor primary care access for this population. Method: This was a community-based participatory action qualitative study, in which 85 adults who self-identified as having a serious mental health and/or substance use issue and 17 service providers from various disciplines who worked with this population participated in a semi-structured interview. Results: Client, service provider and health system barriers to access were identified. Client factors, including socioeconomic and psychological barriers, make it difficult for clients to access primary care, keep appointments, and/or prioritize their own health care. Provider factors, including knowledge and personal values related to mental health and substance use, determine the extent to which clients report their specific needs are met in the primary care setting. Health system factors, such as models of primary care delivery, determine the context within which both client and service provider factors operate. Conclusions: This study helps elucidate the mechanisms behind poor primary health care access among people with substance use and/or mental health issues. The results suggest that interdisciplinary, collaborative models of primary healthcare may improve accessibility and quality of care for this population, and that more education about mental health and substance use issues may be needed to support service providers in providing adequate care for their clients. [ABSTRACT FROM AUTHOR]

Mindfulness has received an abundance of research attention in recent years, largely due to mindfulness-based interventions demonstrating positive mental and physical health outcomes. However, less research has examined individual’s trait levels of mindfulness and how it is related to mental health, particularly among individuals seeking substance use treatment. Therefore, in the current study, we examined the relation between trait mindfulness and early maladaptive schemas (EMS), which are dysfunctional cognitive and behavioural patterns that theoretically underlie the development of mental health problems, among women seeking residential substance use treatment. Pre-existing, adult female, patient records from a residential substance abuse treatment facility were reviewed (N = 67). Results demonstrated that higher trait mindfulness was negatively associated with 12 of the 18 EMS. Moreover, patients who endorsed multiple EMS reported lower trait mindfulness than patients who endorsed zero (or one) EMS. These findings are the first to examine the relation between trait mindfulness and EMS among women seeking substance use treatment. Findings suggest that EMS and trait mindfulness are robustly related and future research should examine whether mindfulness-based interventions reduce EMS. [ABSTRACT FROM PUBLISHER]

Mindfulness is a growing area of investigation among individuals manifesting substance use disorders, as mindfulness meditation may help to prevent relapse to substance use. The current study examined levels of trait mindfulness in substance users seeking treatment from May 2012 to August 2012 in a Tennessee residential center and whether patients with probable (i.e., diagnoses based on a self-report screening instrument) comorbid depression or PTSD reported lower mindfulness than patients without a probable comorbid diagnosis. Data were collected from a convenience sample of archival patient records ( N = 125) and four instruments. The majority of patients were male ( n = 84) and non-Hispanic Caucasian (92%); the mean age of the sample was 37.36 ( SD = 12.47). Results showed that lower trait mindfulness was associated with increased levels of substance use, depression, and PTSD. Patients with a probable depression or PTSD diagnosis reported lower mindfulness than patients without these disorders. Patients with probable comorbid depression and PTSD reported the lowest levels of mindfulness. These findings suggest that altering levels of mindfulness may be important for individuals manifesting dual-diagnoses in substance user treatment. The study's limitations are noted. [ABSTRACT FROM AUTHOR]

Mindfulness is increasingly being recognized as an important correlate of mental health, and is inversely corelated with substance use. To date, preliminary research suggests that mindfulness-based interventions may be effective for the treatment of substance use disorders. However, there is a notable lack of research on deficits in mindfulness among individuals who seek residential substance abuse treatment, including whether they report lower levels of mindfulness relative to healthy controls. Thus, the current study examined differences in mindfulness between a sample of adult substance abusers who sought residential treatment ( N = 107) and normative data on mindfulness from healthy adults. Results demonstrated that the substance abusers reported less mindfulness relative to the normative data, including lower levels of mindful curiosity and decentering, with effect sizes differences between groups falling into the large range. No differences were evident in mindfulness between men and women patients or between individuals with an alcohol or drug diagnosis. These results provide evidence that substance abusers seeking treatment may have lower levels of mindfulness relative to healthy adults, supporting the use of mindfulness-based interventions with this population. [ABSTRACT FROM AUTHOR]

Recent research has begun to examine the early maladaptive schemas of substance abusers, as it is believed that targeting these core beliefs in treatment may result in improved substance use outcomes. One special population that has received scant attention in the research literature, despite high levels of substance use, is airline pilots. The current study examined the early maladaptive schemas of a sample of airline pilots (n= 64) who were seeking residential treatment for alcohol dependence and whether they differed in early maladaptive schemas from non-pilot substance abusers who were also seeking residential treatment for alcohol dependence (n= 45). Pre-existing medical records from patients of a residential substance abuse treatment facility were reviewed for the current study. Of the 18 early maladaptive schemas, results demonstrated that pilots scored higher than non-pilots on the early maladaptive schema of unrelenting standards (high internalized standards of behavior), whereas non-pilots scored higher on insufficient self-control (low frustration tolerance and self-control). Early maladaptive schemas may be a relevant treatment target for substance abuse treatment seeking pilots and non-pilots. [ABSTRACT FROM PUBLISHER]

Early maladaptive schemas, defined as cognitive and behavioural patterns of viewing oneself and the world that cause considerable distress, are increasingly being recognized as an important underlying correlate of mental health problems. Recent research has begun to examine early maladaptive schemas among individuals seeking treatment for substance abuse. Unfortunately, there is limited research on whether substance abusers score higher on early maladaptive schemas than non-clinical controls. Thus, the current study examined whether a sample of young adult female substance abuse treatment seekers ( n = 180) scored higher than a non-clinical group of female college students ( n = 284) on early maladaptive schemas. Results demonstrated that the substance abuse group scored higher than the non-clinical group on 16 of the 18 early maladaptive schemas. In addition, a number of differences in early maladaptive schemas were large in effect size. Implications of these findings for future research and substance abuse treatment programmes are discussed. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Young adult female substance users have a number of early maladaptive schemas that may be contributing to the onset and maintenance of substance use., Findings from the current study suggest that early maladaptive schemas are more prevalent among young adult female substance abusers than a non-clinical control group, even after controlling for demographic differences between groups., The treatment of substance abuse among young adults should consider targeting early maladaptive schemas. [ABSTRACT FROM AUTHOR]

The abuse of opioids is a serious and prevalent problem and research is needed on factors that may place individuals at risk for misusing opioids. Depression is a common co-morbid mental health problem among opioid users. Theory and research suggest that early maladaptive schemas may underlie mental health problems including depression and substance abuse. The current study sought to determine whether early maladaptive schemas were associated with depression among a treatment seeking sample of male and female opioid users ( n = 194). We also examined whether depression, as assessed by the Minnesota Multiphasic Personality Inventory, Second Edition, varied by gender and whether gender differences in depression remained after controlling for early maladaptive schemas. Results showed that women scored significantly higher than men on three of the five early maladaptive schema domains and that gender did not predict depression after controlling for schema domains. Early maladaptive schemas were also more strongly associated with depression for men than women. Implications of these findings for interventions and future research are discussed. Copyright © 2012 John Wiley & Sons, Ltd. Key Practicioner Message Individuals with opioid dependence have a number of early maladaptive schemas that may be contributing to the onset and maintenance of substance use., Although there are generally broad gender differences in major depression, findings from the current study suggest that early maladaptive schemas are a better predictor of depressive symptoms than gender among opioid dependent adults., The treatment of opioid dependence, with or without co-morbid depressive symptoms, should target early maladaptive schemas. [ABSTRACT FROM AUTHOR]

Early maladaptive schemas, which are cognitive and behavioral patterns of viewing oneself and the world that result in substantial distress, are gradually being documented as important vulnerabilities for substance abuse. Unfortunately, there is limited research on early maladaptive schemas among substance abusers and their family members. Research on this topic may carry important implications for family-focused substance use interventions. The current study examined similarities and differences in early maladaptive schemas among a sample of substance abuse treatment seeking adults ( n = 47) and at least one parent ( n = 58). Results demonstrated that the substance abusers scored higher than their parents on 17 of 18 early maladaptive schemas, with most differences falling into the large effect size range. There were some similarities in the specific early maladaptive schemas endorsed by both groups despite substance abusers scoring higher on all schemas. Implications of these findings for future research and family-focused substance use treatment programs are discussed. [ABSTRACT FROM AUTHOR]

Objective. To investigate whether cartilage degeneration is prevented or minimized in a rat model of anterior cruciate ligament (ACL) injury following a single dose-escalated intraarticular injection of lubricin derived from human synoviocytes in culture. Methods. Unilateral ACL transection (ACLT) of the right hind limb was performed in Lewis rats (n = 56). Control animals underwent a capsulotomy alone, leaving the ACL intact (n = 11). Intraarticular injections (50 μl/injection) of phosphate buffered saline (PBS; n = 14 rats) and human synoviocyte lubricin (1,600 μg/ml; n = 14 rats) were performed on day 7 postsurgery. Animals were killed on day 70 postsurgery. Histologic specimens were immunoprobed for lubricin and sulfated glycosaminoglycans. Urinary C-telopeptide of type II collagen (CTX-II) levels were measured on days 35 and 70 postsurgery. Hind limb maximum applied force was determined using a variable resistor walkway to monitor quadruped gait asymmetries. Results. Increased immunostaining for lubricin in the superficial zone and on the surface of cartilage was observed in lubricin-treated and control animals but not in PBS-treated or untreated animals with ACLT. On days 35 and 70 after surgery, urinary CTX-II levels in human synoviocyte lubricin-treated animals were lower than in untreated and PBS-treated animals (P < 0.005 and P < 0.001, respectively). Animals with ACLT treated with human synoviocyte lubricin and control animals distributed their weight equally between hind limbs compared to PBS-treated or untreated animals (P < 0.01). Conclusion. Our findings indicate that a single intraarticular injection of concentrated lubricin following ACLT reduces type II collagen degradation and improves weight bearing in the affected rat joint. These findings support the practice of tribosupplementation with lubricin for retarding cartilage degeneration and possibly the development of posttraumatic osteoarthritis. [ABSTRACT FROM AUTHOR]

A study is presented which compares the measures of head impact frequency, location of head impact, and the kinematic responses to the impact before cases of immediate and delayed concussions were diagnosed in collegiate and high school football players. The study concludes the highest kinematic measurements are associated with the immediate diagnosis of concussion and the higher frequency of impact measurement is associated with delayed diagnosis. Topics include the Gadd severity index, players' history of head impact exposure (HIE), and Head Impact Telemetry (HIT) System helmets.

Research is presented which compares the severity and frequency of head impacts in football players with a focus on identifying the specificity, sensitivity, and accuracy of single-impact severity measures used for diagnosing head injury or concussion. The article notes the study's 1,208 subjects were from college and high school football teams and 95 were diagnosed with concussion. The study concludes the players sustained more severe impacts and more frequent impacts on days they played with diagnosed concussions.