Factorial validity and comparability of the six translations of the Rivermead Post-Concussion Symptoms Questionnaire translations: results from the CENTER-TBI study.

BACKGROUND: Comparison of patient-reported outcomes in multilingual studies requires evidence of the equivalence of translated versions of the questionnaires. The present study examines the factorial validity and comparability of six language versions of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) administered to individuals following traumatic brain injury (TBI) in the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) study. METHODS: Six competing RPQ models were estimated using data from Dutch (n = 597), English (n = 223), Finnish (n = 213), Italian (n = 268), Norwegian (n = 263), and Spanish (n = 254) language samples recruited six months after injury. To determine whether the same latent construct was measured by the best-fitting model across languages and TBI severity groups (mild/moderate vs. severe), measurement invariance (MI) was tested using a confirmatory factor analysis framework. RESULTS: The results did not indicate a violation of the MI assumption. The six RPQ translations were largely comparable across languages and were able to capture the same construct across TBI severity groups. The three-factor solution comprising emotional, cognitive, and somatic factors provided the best fit with the following indices for the total sample: χ2 (101) = 647.04, [Formula: see text]= 6.41, p < 0.001, CFI = 0.995, TLI = 0.994, RMSEA = 0.055, CI90%[0.051, 0.059], SRMR = 0.051. CONCLUSION: The RPQ can be used in international research and clinical settings, allowing direct comparisons of scores across languages analyzed within the full spectrum of TBI severity. To strengthen the aggregated applicability across languages, further analyses of the utility of the response scale and comparisons between different translations of the RPQ at the item level are recommended.

Longitudinal Internal Validity of the Quality of Life after Brain Injury: Response Shift and Responsiveness.

The Quality of Life after Brain Injury (QoLIBRI) questionnaire was developed and validated to assess disease-specific health-related quality of life (HRQoL) in individuals after TBI. The present study aims to determine its longitudinal validity by assessing its responsiveness and response shift from 3 to 6 months post-injury. Analyses were based on data from the European longitudinal observational cohort Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. A total of 1659 individuals recovering from TBI were included in the analyses. Response shift was assessed using longitudinal measurement invariance testing within the confirmatory factor analyses framework. Responsiveness was analyzed using linear regression models that compared changes in functional recovery as measured by the Glasgow Outcome Scale-Extended (GOSE) with changes in the QoLIBRI scales from 3 to 6 months post-injury. Longitudinal tests of measurement invariance and analyses of discrepancies in practical significance indicated the absence of response shift. Changes in functional recovery status from three to six months were significantly associated with the responsiveness of the QoLIBRI scales over the same time period. The QoLIBRI can be used in longitudinal studies and is responsive to changes in an individual's functional recovery during the first 6 months after TBI.

Sensitivity of outcome instruments in a priori selected patient groups after traumatic brain injury: Results from the CENTER-TBI study.

Traumatic brain injury (TBI) can negatively impact patients' lives on many dimensions. Multiple instruments are available for evaluating TBI outcomes, but it is still unclear which instruments are the most sensitive for that purpose. This study examines the sensitivity of nine outcome instruments in terms of their ability to discriminate within and between specific patient groups, selected a priori as identified from the literature, at three different time points within a year after TBI (i.e., 3, 6, and 12 months post injury). The sensitivity of the instruments to sociodemographic (sex, age, education), premorbid (psychological health status), and injury-related (clinical care pathways, TBI and extracranial injury severity) factors was assessed by means of cross-sectional multivariate Wei-Lachin analyses. The Glasgow Outcome Scale Extended (GOSE)-the standard in the field of TBI for measuring functional recovery-demonstrated the highest sensitivity in most group comparisons. However, as single functional scale, it may not be able to reflect the multidimensional nature of the outcome. Therefore, the GOSE was used as a reference for further sensitivity analyses on more specific outcome scales, addressing further potential deficits following TBI. The physical component summary score (PCS) of the generic health-related quality of life (HRQOL) instruments (SF-36v2/-12v2) and the TBI-specific HRQOL instruments (QOLIBRI/-OS) were most sensitive in distinguishing recovery after TBI across all time points and patient groups, followed by the RPQ assessing post-concussion symptoms and the PHQ-9 measuring depression. The SF-36v2/-12v2 mental component summary score and the GAD-7 measuring anxiety were less sensitive in several group comparisons. The assessment of the functional recovery status combined with generic HRQOL (the PCS of the SF-12v2), disease-specific HRQOL (QOLIBRI-OS), and post-concussion symptoms (RPQ) can provide a sensitive, comprehensive, yet time-efficient evaluation of the health status of individuals after TBI in different patient groups.

Acute Maternal Stress Disrupts Infant Regulation of the Autonomic Nervous System and Behavior: A CASP Study.

Exposure to maternal stress is assumed to influence infant health and development across the lifespan. The autonomic nervous system (ANS) is especially sensitive to the effects of the early caregiving environment and linked to predictors of later mental health. Understanding how exposure to maternal stress adversely affects the developing ANS could inform prevention. However, there is no agreed upon definition of maternal stress making its study difficult. Here we use the Caretaker Acute Stress Paradigm (CASP) to study the effects of maternal stress in an experimentally controlled laboratory setting. The CASP has 5 episodes, a natural play, followed by a caretaker stressor (or control) condition, another play, a classic still face episode, followed by another play. A total of 104 4-months-old infants and their mothers were randomly assigned to either the caretaker-stress or caretaker-control condition. Changes in behavior, heart rate (HR), and respiratory sinus arrhythmia (RSA) before and after the introduction of the stressor (or control condition) were recorded and compared. Infants in the maternal stress condition showed significantly more behavioral distress [X 2 = (1, N = 104) = 4.662, p = 0.031]. Moreover, infants whose mothers were in the stress condition showed an significant increase in heart rate after the caretaker condition [F (1, 102) = 9.81, p = 0.002]. Finally we observed a trend to faster RSA recovery in infants of the control condition [F (1, 75) = 3.539, p = 0.064]. Results indicate that exposure to acute maternal stress affects infant regulation of the autonomic nervous system and behavior.

Translation and Linguistic Validation of Outcome Instruments for Traumatic Brain Injury Research and Clinical Practice: A Step-by-Step Approach within the Observational CENTER-TBI Study.

Assessing outcomes in multinational studies on traumatic brain injury (TBI) poses major challenges and requires relevant instruments in languages other than English. Of the 19 outcome instruments selected for use in the observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study, 17 measures lacked translations in at least one target language. To fill this gap, we aimed to develop well-translated linguistically and psychometrically validated instruments. We performed translations and linguistic validations of patient-reported measures (PROMs), clinician-reported (ClinRO), and performance-based (PerfO) outcome instruments, using forward and backward translations, reconciliations, cognitive debriefings with up to 10 participants, iterative revisions, and international harmonization with input from over 150 international collaborators. In total, 237 translations and 211 linguistic validations were carried out in up to 20 languages. Translations were evaluated at the linguistic and cultural level by coding changes when the original versions are compared with subsequent translation steps, using the output of cognitive debriefings, and using comprehension rates. The average comprehension rate per instrument varied from 88% to 98%, indicating a good quality of the translations. These outcome instruments provide a solid basis for future TBI research and clinical practice and allow the aggregation and analysis of data across different countries and languages.

The Association of Post-Concussion and Post-Traumatic Stress Disorder Symptoms with Health-Related Quality of Life, Health Care Use and Return-to-Work after Mild Traumatic Brain Injury.

Patients with mild traumatic brain injury (mTBI) are at risk for post-concussion (PC) symptoms and post-traumatic stress disorder (PTSD). The co-occurrence of PC and PTSD symptoms after mTBI in relation to health-related quality of life (HRQoL), health care utilization, and return to work has not yet been investigated. PC and PTSD symptoms were measured six months post-TBI by respectively the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). Of the 1566 individuals after mTBI who met the inclusion criteria, 26.1% experienced PC symptoms (RPQ ≥16). Additionally, 9.8% experienced PTSD symptoms (PCL-5 ≥ 33), of which the vast majority (81%) also reported experiencing PC symptoms. Differences between patients with no/mild symptoms, with only PC, only PTSD, and both PC and PTSD symptoms in HRQoL, return to work, and rehabilitation were analyzed using logistic and linear regression analyses. Patients with PC and/or PTSD symptoms reported lower HRQoL, higher rates of rehabilitation, and lower return to work rates compared to patients with no/mild symptoms. Patients with both PC and PTSD symptoms reported significantly lower HRQoL (B = -2.73, CI = -4.65; -0.83, p < 0.001) compared to those with only PC symptoms, while there were no significant differences in their ongoing rehabilitation care (OR = 1.39, CI = 0.77-2.49, p = 0.272) and return to work rates (OR = 0.49, CI = 0.15-1.63, p = 0.246) at six months. These results underline the importance of the diagnosis and appropriate treatment of patients with mTBI, experiencing PC and/or PTSD symptoms.

A Caretaker Acute Stress Paradigm: Effects on behavior and physiology of caretaker and infant.

While experimental stress paradigms of infants (arm restraint; the Still-Face) are powerful tools for infant research, no study has experimentally stressed mothers to observe its independent effects on infant stress regulation. Extant caretaker/maternal stress studies essentially are correlational and confounded by other conditions (e.g., depression). Here, we present a standard procedure, the Caregiver Acute Stress Paradigm (CASP), for stressing mothers during en face interactions with their infants. We hypothesized that infants of the stressed mothers would be more distressed than infants of non-stressed mothers. A total of 106 four-month-old infants and their mothers were randomly assigned to the experimental stress or non-stress manipulation. Confirming our hypothesis, infants of the stressed mothers were significantly more likely to become distressed and require terminating the procedure. While objective ratings of maternal behavior showed no difference between groups, mother in the stress condition self-rated the episode following the caretaker stress significantly lower than mothers in the non-stress group. The self-ratings in the maternal stress-group were reflected in infant cortisol. The findings indicate that CASP is an effective experimental paradigm for exploring the independent effects of an acute stress on caretakers, including effects of conditions, such as poverty or mental illness.

Limited bedding and nesting material changes indices of cellular metabolism and behavioral thermal regulation in Long-Evans rats during the first two weeks of life.

A quality nest can buffer pups from the cold climate in typical laboratory housing by insulating them from cool ambient air and facilitating pup huddling during early life when many thermal regulation strategies are not yet developed. The limited nesting material (LBN) manipulation prevents the dam from constructing a quality nest. In the present study, we investigate whether LBN presents a thermal challenge to pups across the first two postnatal weeks. Behavioral thermal regulation (huddling), physiological thermogenesis (activation of brown adipose tissue; BAT), changes in cellular metabolism (mitochondrial biogenesis) in peripheral and central tissues, and maternal behavior were measured in environments with LBN or abundant bedding on postnatal day (P) 2, P6, P10, and P14. The huddle of LBN litters had greater area, greater perimeter, and reduced circularity, and more pups visible. Control male pups were visible longer than control female pups during home cage recordings and LBN pups were visible longer than control pups. Heart weight relative to body weight was higher in LBN pups after P2. LBN affected BAT, but not white adipose tissue (WAT), activation in a sex and age-specific manner, with reductions in UCP1 expression after P2. Pups appear especially affected by LBN on P6, when mitochondrial DNA copy number was reduced in WAT. Mitochondrial DNA copy number was reduced in LBN pups in the hippocampus but not the brainstem. Our data provide evidence of changes in indices of thermal regulation and cellular metabolism in LBN pups which may be indicative of changes in energy allocation during development.

A Novel Next-Generation Sequencing and Analysis Platform to Assess the Identity of Recombinant Adeno-Associated Viral Preparations from Viral DNA Extracts.

Recombinant adeno-associated virus (rAAV) vectors are increasingly popular gene delivery tools in biological systems. They are safe and lead to high-level, long-term transgene expression. rAAV are available in multiple serotypes, natural or engineered, which enable targeting to a wide array of tissues and cell types. In addition, rAAVs are relatively easily produced in a well-equipped lab or obtained from a viral vector core facility. Unfortunately, there is no standardization of quality control assays beyond titering and purity assessments. Next-generation sequencing (NGS) can be used to identify rAAV preparations. Because the rAAV genome is single stranded, previous studies have assumed that rAAV genomes must be converted to double strands before NGS. We demonstrate that rAAV DNA extracts exist primarily as double-stranded species. We hypothesize that these molecules form from the natural base pairing of complementary [+] and [-] strands after DNA extraction and show that rAAV DNA extracts are sufficient templates for downstream NGS without the labor-intensive double-stranding step. Here, we provide a detailed protocol for the simple and rapid NGS of rAAV genomes from DNA extracts. With this protocol, users can quickly confirm the identity of an rAAV preparation and detect the presence of contaminating rAAV DNA. In addition, we share custom Python scripts that allow users to accurately determine the serotype and detect Cre-independent DNA recombination events in rAAV containing Lox sites within minutes. We have used these scripts to analyze more than 100 rAAV preparations. Although we focused on the detection of cross-contaminating rAAV DNA and recombination events, our Python scripts can be customized to detect other sequences or events, such as reverse packaging of plasmid backbone or DNA from the packaging cell line. We find that the NGS of rAAV DNA extracts, termed viral genome sequencing, is a simple and powerful method for rAAV validation.

Early Life Exposure to Violence: Developmental Consequences on Brain and Behavior.

Exposure to intimate partner violence (IPV) can have long-lasting effects on a child's socio-emotional and neurological development. Research has focused on the effects of IPV on women or older children, while the developmental consequences of exposure to domestic violence during early childhood are less well documented. However, one would expect significant developmental effects since the infant's brain and stress-related systems are especially susceptible to environmental stimuli. The goal of this mini-review is to examine how findings on infant exposure to IPV can be related to risk and resilience of development in infancy. We describe the known effects of witnessing violence during the perinatal period on socio-emotional development and the possible pathways by which IPV affects brain and stress-regulating systems. Exposure to IPV during infancy disrupts the infant's emotional and cognitive development, the development of the Hypothalamus-Pituitary-Adrenal (HPA) axis and brain structures related to witnessing itself (auditory and visual cortex). The findings are embedded in the context of the resource depletion hypothesis. A central problem is the dearth of research on exposure to IPV during infancy, its effect on caregiving, and infant development. Nonetheless, the available evidence makes it clear that policies for prevention of IPV are critically needed.

Conscious sedation with dexmedetomidine compared with asleep-awake-asleep craniotomies in glioma surgery: an analysis of 180 patients.

OBJECTIVEAwake craniotomies have become a feasible tool over time to treat brain tumors located in eloquent regions. Different techniques have been applied in neurooncology centers. Both "asleep-awake-asleep" (asleep) and "conscious sedation" were used subsequently at the authors' neurosurgical department. Since 2013, the authors have only performed conscious sedation surgeries, predominantly using the α2-receptor agonist dexmedetomidine as the anesthetic drug. The aim of this study was to compare both mentioned techniques and evaluate the clinical use of dexmedetomidine in the setting of awake craniotomies for glioma surgery.METHODSThe authors retrospectively analyzed patients who underwent operations either under the asleep condition using propofol-remifentanil or under conscious sedation conditions using dexmedetomidine infusions. In the asleep group patients were intubated with a laryngeal mask and extubated for the assessment period. Adverse events, as well as applied drugs with doses and frequency of usage, were recorded.RESULTSFrom 224 awake surgeries between 2009 and 2015, 180 were performed for the resection of gliomas and included in the study. In the conscious sedation group (n = 75) significantly fewer opiates (p < 0.001) and vasoactive (p < 0.001) and antihypertensive (p < 0.001) drugs were used in comparison with the asleep group (n = 105). Furthermore, the postoperative length of stay (p < 0.001) and the surgical duration (p < 0.001) were significantly lower in the conscious sedation group.CONCLUSIONSUse of dexmedetomidine creates excellent conditions for awake surgeries. It sedates moderately and acts as an anxiolytic. Thus, after ceasing infusion it enables quick and reliable clinical neurological assessment of patients. This might lead to reducing the amount of administered antihypertensive and vasoactive drugs as well as the length of hospitalization, while likely ensuring more rapid surgery.