Nurturing families: A feasibility randomised controlled trial of a whole-family intervention with vulnerable families in Jordan.

Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of intervention and study procedures to inform a fully-powered RCT. Eligible families were randomised to receive the Nurturing Families intervention or enhanced usual care (1:1). Masked assessors measured outcomes at baseline and endline; primary outcome measures were caregiver psychological distress, family functioning, and parenting practices. Families and implementing staff participated in qualitative interviews at endline. Of the 62 families screened, 60 (98%) were eligible, 97% completed the baseline and 90% completed the endline. Qualitative feedback indicated specific improvements in adolescent well-being, caregiver distress and parenting, and family relationships. Data highlighted high participant engagement and adequate facilitator fidelity and competence. Outcome measures had good psychometric properties (most α > 0.80) and sensitivity to change, with significant changes seen on most measures in the intervention but not control group. Findings indicate the acceptability and feasibility of intervention and study procedures. Subsequent full-scale evaluation is needed to determine effectiveness.

Exploring Indonesian Primary Schoolgirls' Experiences of School-based HPV Vaccination, Knowledge of HPV Risks and Prevention, and Preferences for Cervical Cancer Education.

OBJECTIVE: In 2016, Indonesia introduced its Human Papillomavirus (HPV) vaccination demonstration program for girls in grades 5 and 6 of primary school, to reduce cervical cancer (CC) burden in selected provinces and test the viability of nationwide vaccination. This study explored schoolgirls' experience of school-based HPV vaccination, their knowledge of HPV and HPV vaccination, and their preferences for cervical cancer (CC) education. METHODS: An online survey was conducted with schoolgirls who experienced HPV vaccination between 2019 and 2021 through the demonstration program. Using purposive sampling, respondents were recruited through partnerships with primary public health centres and primary schools in Jakarta and Yogyakarta. Data analysis was conducted using Chi-square test, Independent-samples t-test, and one-way ANOVA. RESULTS: One hundred and forty primary schoolgirls with a mean age of 12.2 years (SD = 0.70) completed the survey. Schools and mothers were identified as key actors in socialising children about important health information and as girls' preferred sources of information. The average summed score for girls' knowledge of HPV, the HPV vaccine, and CC after being vaccinated was 5.07 out of 10 (SD 0.23). Significant differences in the mean knowledge scores among participants with different preferences regarding CC education in school were observed. CONCLUSION: While schoolgirls' experiences of HPV vaccination were largely positive, their knowledge of critical health information regarding HPV vaccination and CC prevention needs improving. Thus, it is necessary to provide parents, and school-based educators with culturally appropriate strategies and comprehensive evidence-based information about HPV vaccination and CC prevention more effectively to children.

Metabolomics in archaeological science: A review of their advances and present requirements.

Metabolomics, the study of metabolites (small molecules of <1500 daltons), has been posited as a potential tool to explore the past in a comparable manner to other omics, e.g., genomics or proteomics. Archaeologists have used metabolomic approaches for a decade or so, mainly applied to organic residues adhering to archaeological materials. Because of advances in sensitivity, resolution, and the increased availability of different analytical platforms, combined with the low mass/volume required for analysis, metabolomics is now becoming a more feasible choice in the archaeological sector. Additional approaches, as presented by our group, show the versatility of metabolomics as a source of knowledge about the human past when using human osteoarchaeological remains. There is tremendous potential for metabolomics within archaeology, but further efforts are required to position it as a routine technique.

Examination of human osteoarchaeological remains as a feasible source of polar and apolar metabolites to study past conditions.

Metabolomics is a modern tool that aids in our understanding of the molecular changes in organisms. Archaeological science is a branch of archaeology that explores different archaeological materials using modern analytical tools. Human osteoarchaeological material are a frequent finding in archaeological contexts and have the potential to offer information about previous human populations, which can be illuminating about our current condition. Using a set of samples comprising different skeletal elements and bone structures, here we explore for the first time the possibility of extracting metabolites from osteoarchaeological material. Here, a protocol for extraction and measurement of extracted polar and less-polar/apolar metabolites by ultra-high performance liquid chromatography hyphenated to high resolution mass spectrometry is presented to measure the molecules separated after a reversed phase and hydrophilic interaction liquid chromatography column. Molecular information was obtained, showing that osteoarchaeological material is a viable source of molecular information for metabolomic studies.

Climate change, human health, and resilience in the Holocene.

Climate change is an indisputable threat to human health, especially for societies already confronted with rising social inequality, political and economic uncertainty, and a cascade of concurrent environmental challenges. Archaeological data about past climate and environment provide an important source of evidence about the potential challenges humans face and the long-term outcomes of alternative short-term adaptive strategies. Evidence from well-dated archaeological human skeletons and mummified remains speaks directly to patterns of human health over time through changing circumstances. Here, we describe variation in human epidemiological patterns in the context of past rapid climate change (RCC) events and other periods of past environmental change. Case studies confirm that human communities responded to environmental changes in diverse ways depending on historical, sociocultural, and biological contingencies. Certain factors, such as social inequality and disproportionate access to resources in large, complex societies may influence the probability of major sociopolitical disruptions and reorganizations-commonly known as "collapse." This survey of Holocene human-environmental relations demonstrates how flexibility, variation, and maintenance of Indigenous knowledge can be mitigating factors in the face of environmental challenges. Although contemporary climate change is more rapid and of greater magnitude than the RCC events and other environmental changes we discuss here, these lessons from the past provide clarity about potential priorities for equitable, sustainable development and the constraints of modernity we must address.

Accuracy of a Proactive Case Detection Tool for Internalizing and Externalizing Problems Among Children and Adolescents.

PURPOSE: Lack of identification and referral of children and adolescents with mental health problems contributes to the treatment gap in low- and middle-income countries, and especially in humanitarian settings. The Community Case Detection Tool (CCDT) is developed to improve community-based detection and increase help-seeking among children and adolescents in need of mental health care. The CCDT uses brief, easily understood pictorial vignettes that represent common symptoms of childhood internalizing and externalizing problems. The tool is developed for gatekeepers to support proactive detection of children in need of mental health care and to subsequently encourage help-seeking. This study evaluates the accuracy of the CCDT in detecting children and adolescents aged 6-18 years with significant mental health care needs in a conflict-affected setting: the occupied Palestinian territory. METHODS: Teachers and community workers were trained to use the CCDT. Children detected using the tool were invited for a structured clinical interview with a psychologist using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version, as well as the Strengths and Difficulties Questionnaire, to test the accuracy of CCDT-based detection. RESULTS: Our sample consists of 52 children positively detected as matching with one of the vignettes. Approximately three of four detected children were indicated for psychological treatment based on the clinical interview (positive predictive value = .769), and 64.6% returned 'borderline' or 'abnormal' total difficulty scores on the Strengths and Difficulties Questionnaire. CONCLUSIONS: The CCDT offers a promising low-cost solution to mitigate underdetection of mental health problems in challenging settings.

Hypoxaemia prevalence and management among children and adults presenting to primary care facilities in Uganda: A prospective cohort study.

Hypoxaemia (low blood oxygen) is common among hospitalised patients, increasing the odds of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. We conducted a cross sectional prevalence study and prospective cohort study of children with hypoxaemia in 30 primary care facilities in Uganda, Feb-Apr 2021. Clinical data collectors used handheld pulse oximeters to measure blood oxygen level (SpO2) of all acutely unwell children, adolescents, and adults. We followed up a cohort of children aged under 15 years with SpO2<93% by phone after 7 days to determine if the patient had attended another health facility, been admitted, or recovered. Primary outcome: proportion of children under 5 years of age with severe hypoxaemia (SpO2<90%). Secondary outcomes: severe (SpO2<90%) and moderate hypoxaemia (SpO2 90-93%) prevalence by age/sex/complaint; number of children with hypoxaemia referred, admitted and recovered. We included 1561 children U5, 935 children 5-14 years, and 3284 adolescents/adults 15+ years. Among children U5, the prevalence of severe hypoxaemia was 1.3% (95% CI 0.9 to 2.1); an additional 4.9% (3.9 to 6.1) had moderate hypoxaemia. Performing pulse oximetry according to World Health Organization guidelines exclusively on children with respiratory complaints would have missed 14% (3/21) of severe hypoxaemia and 11% (6/55) of moderate hypoxaemia. Hypoxaemia prevalence was low among children 5-14 years (0.3% severe, 1.1% moderate) and adolescents/adults 15+ years (0.1% severe, 0.5% moderate). A minority (12/27, 44%) of severely hypoxaemic patients were referred; 3 (12%) received oxygen. We followed 87 children aged under 15 years with SpO2<93%, with complete data for 61 (70%), finding low rates of referral (6/61, 10%), hospital attendance (10/61, 16%), and admission (6/61, 10%) with most (44/61, 72%) fully recovered at day 7. Barriers to referral included caregiver belief it was unnecessary (42/51, 82%), cost (8/51, 16%), and distance or lack of transport (3/51, 6%). Hypoxaemia is common among acutely unwell children under five years of age presenting to Ugandan primary care facilities. Routine pulse oximetry has potential to improve referral, management and clinical outcomes. Effectiveness, acceptability, and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in implementation trials, including economic analysis from health system and societal perspectives.

Time to be nosy: Evaluating the impact of environmental and sociocultural changes on maxillary sinusitis in the Middle Nile Valley (Neolithic to Medieval periods).

OBJECTIVE: To investigate the prevalence of maxillary sinusitis in people who lived in the Middle Nile Valley across different periods, cultures, and environmental conditions. MATERIALS: 481 skeletons from 13 sites, curated at the British Museum, London, were analysed. The sites ranged in date from the Neolithic to Medieval periods (c. 4900 BCE-CE 1500). METHODS: Bony changes within the maxillary sinuses, associated with sinusitis and oroantral fistulae were systematically recorded according to pre-established criteria. RESULTS: There were significant differences in the prevalence of maxillary sinusitis between time period/subsistence economy groups. The Neolithic hunter-gatherer/early agricultural group had the lowest prevalence, whilst the urban group demonstrated the highest frequency of the disease. CONCLUSIONS: Factors involved in the development of maxillary sinusitis are manifold and complex. However, the results indicate that increased aridity in Sudan in later periods and intensification of agricultural practices may have played a role in increasing prevalence of the disease. Urban environments, including crowding, poor sanitation, and industrial air pollution, could also have influenced susceptibility to maxillary sinusitis. SIGNIFICANCE: Prior to this paper, the impact of arid environments on respiratory health in the past had received little attention despite growing clinical research on the topic. Both arid and urban environments are predicted to expand in the future. This paper provides a deep-time perspective on an issue of increasing concern today. LIMITATIONS: Poor preservation of skeletons and a lack of archaeological settlement data for some sites. FUTURE RESEARCH: Investigation of a greater range of populations from different environments/climates.

Paleopathology of the Ychsma: Evidence of respiratory disease during the Late Intermediate Period (AD 1000-1476) at the Central Coastal site of Pachacamac, Peru.

OBJECTIVE: To investigate evidence for maxillary sinusitis and pulmonary inflammation in archaeological skeletons dating to the Late Intermediate Period (AD 1000-1476) at the site of Pachacamac, Peru. MATERIALS: Thirty-nine individuals (male, female, and unknown sex; 16+ years age-at-death) were analyzed for inflammatory periosteal reaction (IPR) on the visceral (inner) surfaces of the ribs, and 16 individuals were analyzed for evidence of maxillary sinusitis. METHODS: All individuals were macroscopically examined for bony changes in the maxillary sinuses and new bone formation on the ribs according to pre-established criteria. RESULTS: Some 33.3% (13/39) of individuals had IPR on the ribs and 93.8% (15/16) had bony changes in the maxillary sinuses. CONCLUSIONS: Respiratory disease was likely prevalent in people buried at Pachacamac during the Late Intermediate Period. A number of factors may have increased the risk of developing respiratory disease, including exposure to poor air quality and increased crowding and social mixing, resulting from pilgrimage to this important ritual center. SIGNIFICANCE: This paper represents one of the first systematic analyses of evidence for respiratory disease in Peruvian and South American human skeletal remains, demonstrating the suitability of the region for further study. LIMITATIONS: A limited sample was available for analysis. Additionally, the site's skeletal preservation was excellent, meaning the sample available for assessment of maxillary sinusitis was smaller, being limited to individuals with post-mortem breakage. FURTHER RESEARCH: The results of this study should stimulate further much needed systematic investigation of evidence for respiratory disease in other Peruvian and South American populations.

Can children predict psychological recovery after injury?

While children's voice is core to paediatric care, their own assessment of future psychological needs is underexplored. We conducted a prospective observational study among children hospitalised for injury in Melbourne, Australia. Their expectations of psychological recovery at baseline (in hospital) were significant and substantial predictors of their quality of life and post-traumatic stress 6 weeks later, suggesting potential diagnostic value.

Deconstructing Poststroke Delirium in a Prospective Cohort of Patients With Intracerebral Hemorrhage.

OBJECTIVES: Poststroke delirium may be underdiagnosed due to the challenges of disentangling delirium symptoms from underlying neurologic deficits. We aimed to determine the prevalence of individual delirium features and the frequency with which they could not be assessed in patients with intracerebral hemorrhage. DESIGN: Prospective observational cohort study. SETTING: Neurocritical Care and Stroke Units at a university hospital. PATIENTS: Consecutive patients with intracerebral hemorrhage from February 2018 to May 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: An attending neurointensivist performed 257 total daily assessments for delirium on 60 patients (mean age 68.0 [SD 18.4], 62% male, median intracerebral hemorrhage score 1.5 [interquartile range 1-2], delirium prevalence 57% [n = 34]). Each assessment included the Confusion Assessment Method for the ICU, Intensive Care Delirium Screening Checklist, a focused bedside cognitive examination, chart review, and nurse interview. We characterized individual symptom prevalence and established delirium diagnoses using Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, then compared performance of the Confusion Assessment Method for the ICU and Intensive Care Delirium Screening Checklist against reference-standard expert diagnosis. Symptom fluctuation (61% of all assessments), psychomotor changes (46%), sleep-wake disturbances (46%), and impaired arousal (37%) had the highest prevalence and were never rated "unable to assess," while inattention (36%), disorientation (27%), and disorganized thinking (18%) were also common but were often rated 'unable to assess' (32%, 43%, and 44% of assessments, respectively), most frequently due to aphasia (32% of patients). Including nonverbal assessments of attention decreased the frequency of 'unable to assess' ratings to 11%. Since the Intensive Care Delirium Screening Checklist may be positive without the presence of symptoms that require verbal assessment, it was more accurate (sensitivity = 77%, specificity = 97%, area under the receiver operating characteristic curve, 0.87) than the Confusion Assessment Method for the ICU (sensitivity = 41%, specificity = 88%, area under the receiver operating characteristic curve, 0.64). CONCLUSIONS: Delirium is common after intracerebral hemorrhage, but severe neurologic deficits may confound its assessment and lead to underdiagnosis. The Intensive Care Delirium Screening Checklist's inclusion of nonverbal features may make it more accurate than the Confusion Assessment Method for the ICU in patients with neurologic deficits, but novel tools designed for such patients may be warranted.

Clinical Instructors' Perceptions of Critical Knowledge, Critical Patient Care Skills, and Student Physical Therapist Preparedness in the Acute Care Setting.

PURPOSE: This study aimed to identify the acute care clinical instructors' perceptions of knowledge areas and patient care skills expected of a student physical therapist graduating from their academic program as well as their level of preparedness as they enter their terminal intern-ship. METHODS: Participants were 62 licensed physical therapists who were clinical instructors. This was a descriptive, cross-sectional study using a questionnaire. Descriptive analysis was used to identify the clinical instructors' perceptions. RESULTS: Clinical instructors perceived that it is important for the student physical therapists to be competent in knowledge and patient care skills in areas relating to patient safety, precautions and contraindications, physiologic responses to activity, the cardiovascular and pulmonary system, and intensive care unit conditions. Clinical instructors perceived that students needed to be more prepared to respond to adverse events, manage lines/devices, develop appropriate discharge plans, and communicate with family and other health care providers. CONCLUSIONS: The results of this study reveal gaps in preparedness that are important areas for academic and clinical emphasis to support student success in the acute care setting.

Inflammatory periosteal reaction on ribs associated with lower respiratory tract disease: A method for recording prevalence from sites with differing preservation.

OBJECTIVES: Inflammatory periosteal reaction (IPR) on the visceral surfaces of the ribs has been used in bioarchaeology as an indicator of lower respiratory tract disease. This article presents a detailed method for recording IPR on the ribs, even those in severely fragmented states, with the objectives of increasing the consistency of recording and producing true prevalence rates for skeletons so as to improve data comparability between future bioarchaeological studies of lower respiratory tract disease. MATERIALS AND METHODS: The presence and prevalence of respiratory-related IPR were recorded from three different Sudanese cemetery sites using a detailed method for identifying and recording IPR. Sites with variable preservation were chosen to test the applicability of the method. A flowchart to aid in identification of bony changes is presented. The method requires the recording of IPR on three separate sections of the rib (neck, angle, and shaft) and the allocation of ribs into rib cage regions of upper, upper-middle, middle, lower-middle, and lower. RESULTS: Results demonstrate differences in the distribution of IPR between sites and verify the method's applicability to archeological sites with various levels of skeletal preservation. DISCUSSION: While crude prevalence rates can indicate the number of individuals experiencing lower respiratory tract disease within a site, this method can provide information about the distribution of IPR within the rib cage. This should lead to new ways of distinguishing respiratory diseases within archeological populations. This method also allows for comparability between well-preserved and lesser-preserved sites by accommodating for rib fragmentation.

Injury talk: spontaneous parent-child conversations in the aftermath of a potentially traumatic event.

BACKGROUND: While talking about traumatic experiences is considered central to psychological recovery, little is known about how these conversations occur in daily life. OBJECTIVE: We investigated spontaneous injury talk among parents and children in the aftermath of a child's hospitalisation due to physical trauma, and its relationship with children's socioemotional functioning. METHODS: In a prospective naturalistic observation study, we audio-sampled the daily life of 71 families with the Electronically Activated Recorder after their child (3-16 years old) was discharged from hospital. We collected close to 20 000 snippets of audio information, which were double-coded for conversation characteristics, and measured children's socioemotional functioning with the Strengths and Difficulties Questionnaire (SDQ) at 6 weeks and 3 months postinjury. FINDINGS: The children were involved in injury talk for, on average, 46 min/day, 9 min of which referred to emotions. Children had significantly more injury conversations with their mothers than with their fathers. The tone of injury conversations was significantly more positive than that of non-injury conversations. More direct injury talk was associated with fewer problems on the emotion subscale of the SDQ at 3 months. Other associations between aspects of injury talk and children's socioemotional functioning were mostly non-significant, although they appeared to be stronger at 3 months than at 6 weeks. CONCLUSIONS: Families spontaneously talked about the injury and associated issues for about the same amount of time per day as a therapist might within a session (a 'therapy hour'). CLINICAL IMPLICATIONS: Making full use of naturally occurring injury talk may be a valuable direction for parent and family-focused postinjury interventions. However, the study design prevents causal inference, and further exploration is warranted.

Restoration of Vision After Brain Injury Using Magnet Glasses.

Visual impairments are common after traumatic brain injury (TBI) and negatively affect quality of life. We describe a 39-year-old woman with a severe TBI who was evaluated by the inpatient optometry and vision rehabilitation service with findings of complete right homonymous hemianopia and right cranial nerve III palsy with 30-degree right exotropia (eye turn out) and complete right ptosis (eyelid will not open). The 30-degree exotropia advantageously generated 30 degrees of right visual field expansion when the right ptosis was treated with a magnetic levator prosthesis, which restores eyelid opening. Once opened, the patient used visual field expansion derived from a right exotropia to overcome functional impairments caused by right hemianopia. Field expansion improved the patient's wheelchair mobility and reaching tasks during inpatient therapy. This is the first report of visual field expansion by strabismus facilitated by correction of ptosis. Strabismus should be considered for its potential field expansion benefits when homonymous visual deficits are present, before considering patching. A multidisciplinary vision rehabilitation team is well suited to make this determination.

Topical Review: Families Coping With Child Trauma: A Naturalistic Observation Methodology.

OBJECTIVE: To introduce a novel, naturalistic observational methodology (the Electronically Activated Recorder; EAR) as an opportunity to better understand the central role of the family environment in children's recovery from trauma. METHODS: Discussion of current research methods and a systematic literature review of EAR studies on health and well-being. RESULTS: Surveys, experience sampling, and the EAR method each provide different opportunities and challenges for studying family interactions. We identified 17 articles describing relevant EAR studies. These investigated questions of emotional well-being, communicative behaviors, and interpersonal relationships, predominantly in adults. 5 articles reported innovative research in children, triangulating EAR-observed behavioral data (e.g., on child conflict at home) with neuroendocrine assay, sociodemographic information, and parent report. Finally, we discussed psychometric, practical, and ethical considerations for conducting EAR research with children and families. CONCLUSIONS: Naturalistic observation methods such as the EAR have potential for pediatric psychology studies regarding trauma and the family environment.

Ear for recovery: protocol for a prospective study on parent-child communication and psychological recovery after paediatric injury.

INTRODUCTION: One in six children who have been admitted to hospital with an injury develop persistent stress symptoms that put their development at risk. Parents play a crucial role in children's psychological recovery, however, it is unknown how specific parenting behaviours can help or hinder. We aim to describe the nature and quantity of parent-child communication after a child has been injured, and to examine how these interactions are related to children's psychological recovery. METHODS AND ANALYSIS: We are conducting a prospective observational study among children aged 3-16 years, who have been admitted to a tertiary children's hospital with a serious injury. Data collection involves a naturalistic observation of spontaneous, everyday parent-child communication at home, shortly after discharge, and an assessment of children's psychological recovery at 6 weeks and 3 months post-injury. Main analyses comprise descriptive statistics, cluster analysis and analyses of variance. ETHICS AND DISSEMINATION: This study has been approved by the Human Research Ethics Committee of the Royal Children's Hospital Melbourne (33103) and Monash University Human Research Ethics Committee (CF13/2515-2013001322). We aim to disseminate the findings through international peer-reviewed journals, international conferences and social media. Participants will be sent a summary of the overall study findings.

Assessing limb apraxia in traumatic brain injury and spinal cord injury.

People with traumatic brain injury (TBI) may demonstrate action planning disorders and limb apraxia. Many patients, who sustain a spinal cord injury (SCI), sustain a co-occurring TBI (11-29 percent of people with SCI) and therefore are at risk for limb apraxia. People with SCI and TBI (SCI/TBI) rely on powered assistive devices which amplify movement. Their ability to learn complex motor compensatory strategies, that is, limb praxis, is critical to function. We wished to identify methods of screening for apraxia in patients with SCI/TBI. We reviewed instruments available for limb praxis assessment, presenting information on psychometric development, patient groups tested, commercial/clinical availability, and appropriateness for administration to people with motor weakness. Our review revealed that insufficient normative information exists for apraxia assessment in populations comparable to SCI/TBI patients who are typically young adults at the time of injury. There are few apraxia assessment instruments which do not require a motor response. Non-motoric apraxia assessments would be optimal for patients with an underlying motor weakness.

Left-sided brain injury associated with more hospital-acquired infections during inpatient rehabilitation.

OBJECTIVE: To test the hypothesis that a left-dominant brain immune network (LD-BIN) might affect the occurrence of infection during inpatient rehabilitation of stroke and traumatic brain injury (TBI). DESIGN: A retrospective analysis was performed on electronic medical records between January 2009 and December 2010. All patients with left- or right-sided stroke or TBI were included into the study. The LD-BIN hypothesis was tested by comparing HAI rates depending on whether patients had left- or right-sided brain lesions. SETTING: A large inpatient rehabilitation hospital. PARTICIPANTS: Among the patients (N=2236) with stroke or TBI who had either a left- or right-sided brain lesion, 163 patients were identified with HAIs. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Frequency of HAIs. RESULTS: In the 163 patients identified with HAIs with a diagnosis of stroke or TBI, chi-square analysis revealed a significantly higher proportion of HAIs among patients with left-sided (n=98; 60.1%) relative to right-sided (n=65; 39.9%) brain injuries (χ(2)=6.68, P<.01). These effects could not be attributed to either clinical or demographic factors. CONCLUSIONS: Our findings are consistent with the hypothesis that an LD-BIN may mediate vulnerability to infection during rehabilitation of patients with stroke or TBI. Further translational research investigating novel means of managing patients based on brain lesion location, and modulating the LD-BIN via behavioral and physiologic interventions, may result in neuroscience-based methods to improve infection resistance in brain-injured patients.

Functional assessment of spatial neglect: a review of the Catherine Bergego scale and an introduction of the Kessler foundation neglect assessment process.

Spatial neglect is a debilitating poststroke neurocognitive disorder associated with prolonged hospitalization and poor rehabilitation outcomes. The literature suggests a high prevalence of this disorder, but clinicians have difficulty reliably identifying affected survivors. This discrepancy may result from suboptimal use of validated neglect assessment procedures. In this article, we suggest use of a validated assessment tool that is sensitive to identification of neglect and its functional consequences - the Catherine Bergego Scale (CBS). We provide detailed item-by-item instructions for observation and scoring - the Kessler Foundation Neglect Assessment Process (KF-NAP). Rehabilitation researchers may be able to use the CBS via the KF-NAP to measure ecological outcomes and specific, separable perceptual-attentional and motor-exploratory spatial behaviors.