Management of Return to School Following Brain Injury: An Evaluation Model.

Traumatic brain injury (TBI) affects children's ability to succeed at school. Few educators have the necessary training and knowledge needed to adequately monitor and treat students with a TBI, despite schools regularly serving as the long-term service provider. In this article, we describe a return to school model used in Oregon that implements best practices indicated by the extant literature, as well as our research protocol for evaluating this model. We discuss project aims and our planned procedures, including the measures used, our quasi-experimental design using matched controls, statistical power, and impact analyses. This project will provide the evidential base for implementation of a return to school model at scale.

A quasi-experimental study examining the effects of online traumatic brain injury professional development on educator knowledge, application, and efficacy in a practitioner setting.

Background: Each year ∼700 000 U.S. children ages 0-19 years sustain a traumatic brain injury. Children who experience brain injury are at risk for impairments in executive function, processing speed, cognition, memory, attention, and behavior which can lead to school failure. However, few teachers or other educational professionals receive training on effectively working with students who have traumatic brain injury (TBI). The purpose of this study was to examine the efficacy of an online traumatic brain injury professional development intervention, In the Classroom after Concussion: Best Practices for Student Success.Methods: This quasi-experimental study examined the effects of online traumatic brain injury professional development (In the Classroom after Concussion: Best Practices for Student Success) on educator knowledge, knowledge application, and self-efficacy in a practitioner setting with a sample of 81 educators from all professional backgrounds. Participants completed the pretest, accessed the In the Classroom training and posttest, and completed follow-up assessments 30 days after the posttest. Measures: (1) knowledge of effective strategies for working with students with TBI; (2) knowledge application; (3) self-efficacy in handling situations presented in text and video scenarios, and (4) a standardized measure of educator self-efficacy.Results: On the posttest assessment, educators showed significant gains in knowledge (p = 0.001, r = 0.62), knowledge application (p = 0.001, r = 0.63), and self-efficacy (p = 0.008, r = 0.29). At 30-day follow up, educators maintained significant gains in knowledge (p = 0.001, r = 0.62) and self-efficacy (p value = 0.008, r = 0.28), but not in knowledge application.Conclusion: Given the prevalence of traumatic brain injury, it is important to develop evidence-based, cost-effective approaches to knowledge transfer and exchange in traumatic brain injury professional development. In the Classroom is one such approach.Implications for rehabilitationWithout training in TBI, educators will be poorly prepared to monitor students' post-injury challenges and to address learning and behavioral challenges as they occur.Given the prevalence of TBI, it is important to develop evidence-based, cost-effective approaches to knowledge transfer and exchange in TBI professional development. In the Classroom is one such approach.

A survey of the training experiences and needs of paraprofessionals serving adults with brain injury.

Objective: To conduct a survey of the training experiences and needs of paraprofessionals (frontline staff) serving adults with moderate-severe TBI from the perspectives of four stakeholder groups: paraprofessionals, professionals, adults living with brain injury, and family members.Participants: Participants were (a) 28 paraprofessionals, (b) 45 professionals, (c) 41 adults living with brain injury, and (d) 22 family members, for a total of 136 participants.Design: We conducted an online, nationwide survey containing closed and open-ended questions. Four different versions of the survey were developed, one for each of the stakeholder groups, to capture their unique perspectives on the topic of paraprofessional training.Results: Descriptive statistics, non-parametric statistics, and qualitative, comment-based information across the four groups revealed that (a) paraprofessionals require comprehensive training to address the complex needs of persons with brain injury; (b) a range of training options and modalities is preferred; and (c) there are several challenges associated with providing paraprofessional training.Conclusions: This survey highlights the need for a comprehensive range of paraprofessional training options that address both knowledge and skill acquisition. These data have informed the development of an online, interactive training program for paraprofessionals serving this population.

Preliminary Efficacy of Online Traumatic Brain Injury Professional Development for Educators: An Exploratory Randomized Clinical Trial.

OBJECTIVE: To examine the efficacy of an online traumatic brain injury (TBI) professional development intervention, In the Classroom After Concussion: Best Practices for Student Success. DESIGN: A randomized controlled trial with a sample of 100 general educators, who were randomly assigned to the In the Classroom Web site (treatment group) or the LEARNet Web site (control group). Participants completed the pretest, accessed the In the Classroom or LEARNet site and the posttest and completed follow-up assessments 60 days after posttest. MEASURES: (1) Knowledge of effective strategies for working with students with TBI; (2) knowledge application; (3) self-efficacy in handling situations presented in text and video scenarios, and (4) a standardized self-efficacy measure. RESULTS: On the posttest assessment, In the Classroom educators showed significantly greater gains in knowledge (P < .0001, d = 1.36 [large effect]), TBI knowledge application (P = .0261, d = 0.46), and general self-efficacy (P = .0106, d = 0.39) than the LEARNet controls. In the Classroom educators maintained significant gains in knowledge (P = .001, d = 0.82) and general self-efficacy (P = .018, d = 0.38) but not in TBI knowledge application (P = .921, d = 0.02). CONCLUSION: Given the prevalence of TBI, it is important to develop evidence-based, cost-effective approaches to knowledge transfer and exchange in TBI professional development. In the Classroom is one such approach.

Extracorporeal Membrane Oxygenation in Adults - Variants, Complications during Therapy, and the Role of Radiological Imaging.

Background Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) as respiratory and circulatory assist therapies are gaining in importance in the treatment of critically ill patients. Depending on the place of cannulation - veno-venous for ECMO and veno-arterial for ECLS - distinct changes in hemodynamics will occur. In this review we describe the different types of ECMO and ECLS systems, the typical cannula placement and frequent complications under therapy. The most suitable imaging modalities will be presented and typical hemodynamic pitfalls in contrast-enhanced computed tomography or angiography will be elucidated. Methods The review is based on a literature search in PubMed with the terms "ECMO" and/or "ECLS" and/or "extracorporeal life support" and/or "imaging" and/or "complications". Statistical data was taken from the ECMO register of the "Extracorporeal Life Support Organization (ELSO)". Results Critical illness- and therapy-associated complications are common so that imaging, particularly computed tomography, becomes increasingly important. Following veno-venous cannulation in ECMO, the normal sequential blood flow is preserved, so that no contrast enhancement irregularities should be expected when the right timing and an adequate amount of contrast agent are selected. After veno-arterial cannulation in ECLS, different artifacts like pseudo-filling defects, pseudomembranes and irregular/low contrast enhancement of heart and pulmonary vessels can be found, depending on the site of cannulation and the residual cardiac function. Key points · Cannula placement is usually documented by radiography.. · Computed tomography is appropriate in the face of inconclusive cannula placement and probable complications.. · In veno-venous ECMO, no contrast enhancement artifacts are to be expected.. · Veno-arterial ECLS leads to pseudo-filling defects, pseudomembranes and irregular contrast enhancement of heart and pulmonary vessels.. Citation Format · Beck L, Burg MC, Heindel W et al. Extracorporeal Membrane Oxygenation in Adults - Variants, Complications during Therapy, and the Role of Radiological Imaging. Fortschr Röntgenstr 2017; 189: 119 - 127.

The role of 3DCT for the evaluation of chop injuries in clinical forensic medicine.

As hatchet blows to the human head frequently cause fatal injuries, the forensic examination of survivors with cranial chop injuries is a rare phenomenon in forensic casework. Besides evaluation of clinical records, photographs, and medico-legal physical examination, the analysis and 3-dimensional reconstruction of pre-treatment computed tomography data (3DCT) must be considered an important and indispensable tool for the assessment of those cases because the characteristics of chopping trauma often appear masked or changed by clinical treatment. In the present article, the role of 3DCT for the evaluation of chop wounds in clinical forensic medicine is demonstrated by an illustrative case report of a young man who was attacked with a hatchet. 3DCT provides additional possibilities for supplementing missing information, such as number and direction of blows as well as weapon identification. Furthermore, 3DCT facilitates demonstration in court and understanding of medical lay people. We conclude that 3DCT is of particular value for the evaluation of survivors of life-threatening head and face injury. An increasing significance of this technique may be expected.

Clinical characteristics and prognostic importance of mild-to-moderate noninfarct-related coronary artery disease in patients with first ST-elevation myocardial infarction.

BACKGROUND: Among patients hospitalized for an ST-elevation myocardial infarction, the presence of concomitant angiographically severe (≥70%) stenoses in noninfarct-related coronary arteries is associated with poorer in-hospital outcomes. However, there are limited data on patients with angiographically mild-to-moderate (< 70%) noninfarct-related artery (IRA) stenoses. METHODS: We studied 642 consecutive patients with a first STelevation myocardial infarction presenting to a tertiary medical center. We compared the clinical characteristics and outcomes of patients with isolated IRA disease versus patients with one or more mild-to-moderate non-IRA stenoses versus patients with one or more severe non-IRA stenoses. RESULTS: Of the 642 patients, 29.8% had isolated IRA disease, 22.6% had one or more mild-to-moderate non-IRA stenoses and 47.7% had one or more severe non-IRA stenoses. The age distribution was 54±12 versus 57±12 versus 58±11 years, with a P value of less than 0.001 and the diabetes prevalence was 27, 28, and 40%, respectively (P=0.003). Among the three groups, the in-hospital mortality was 3.1, 5.5, and 9.8% (P=0.013), the left ventricular ejection fraction was 48, 48, and 45% (P=0.013), and the rate of revascularization was 98, 95, and 88%, respectively (P<0.001). CONCLUSION: Patients with one or more mild-to-moderate non-IRA stenoses had favorable in-hospital outcomes that were comparable with the patients with isolated IRA disease, despite having adverse clinical characteristics that were similar to patients with severe non-IRA stenoses. These results highlight the incremental prognostic importance of angiographical data in patients with ST-elevation myocardial infarction. More research is needed to understand the influence of mild-to-moderate non-IRA stenoses on late outcomes.

Identification of dissociated non-steroidal glucocorticoid receptor agonists.

A new series of ligands for the glucocorticoid receptor (GR) is described. SAR development was guided by docking 3 into the GR active site and optimizing an unsubstituted phenyl ring for key interactions found in the steroid A-ring binding pocket. To identify compounds with an improved side effect profile over marketed steroids the functional activity of compounds was evaluated in cell based assays for transactivation (aromatase) and transrepression (IL-6). Through this effort, 36 has been identified as a partial agonist with a dissociated profile in these cell based assays.

Effects of feeding an infant formula containing Lactobacillus GG on the colonization of the intestine: a dose-response study in healthy infants.

OBJECTIVES: This study aimed to determine whether feeding Lactobacillus GG (LGG) at varying levels (10 to 10 cfu/day) would result in colonization, defined as > or =1,000 cfu of LGG per gram of stool in 3 of 5 samples collected during the feeding period. METHODS: Infants received unsupplemented formula during a 7-day baseline, 1 of 4 formulas containing 0 (control), 10 (low), 10 (medium), or 10 (high) cfu of LGG per day during a 2-week test, and unsupplemented formula during a 2-week follow-up. Baseline, test, and follow-up stool samples were evaluated for levels of viable LGG. RESULTS: During test, supplemented infants were colonized, compared with control (P < 0.05). Median stool counts of LGG (log10 cfu/g) in colonized infants were 5.24 (low), 6.05 (medium), and 5.97 (high). LGG persisted in the stools for 7 to 14 days after discontinuing LGG. No differences were observed among groups in stool consistency, flatulence, fussiness, or adverse events. CONCLUSION: A 2-week oral administration of 10 to 10 cfu/day LGG was well tolerated; all levels successfully colonized the intestinal tract of healthy, term infants.