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Objective: Traumatic brain injury (TBI) sustained in childhood is associated with poor social outcomes. This study investigated the role of theory of mind (ToM) as a mediator of the relation between TBI and peer rejection/victimization and reciprocated friendships, as well as the moderating effect of parental nurturance on those relationships. Method: Participants were children of 8–13 years old (M = 10.45, SD = 1.47), including 13 with severe TBI, 39 with complicated mild/moderate TBI, and 32 children with orthopedic injuries. Data on peer rejection/victimization and friendship were collected in school classrooms using the Extended Class Play and friendship nominations. Parents rated parental nurturance using the Child-Rearing Practices Report. Finally, ToM was measured based on children’s average performance across three tasks measuring different aspects of ToM. Results: Severe TBI was associated with poorer ToM, greater peer rejection/victimization, and fewer reciprocated friendships. ToM mediated the relation between severe TBI and peer rejection/victimization (i.e., severe TBI predicted poorer ToM, which in turn predicted greater rejection/victimization). Parental nurturance significantly moderated this relation, such that the mediating effect of ToM was significant only at low and average levels of parental nurturance, for both severe and complicated mild/moderate TBI groups. Neither the mediating effect of ToM nor the moderating effect of parental nurturance was significant for reciprocated friendships. Conclusion: High parental nurturance may mitigate the negative effects of ToM deficits on risk of peer rejection/victimization among children with TBI. Interventions designed to increase parental nurturance or ToM may promote better social outcomes among children with TBI.
Objectives: This study examined the relationship of the home environment to long-term executive functioning (EF) following early childhood traumatic brain injury (TBI). Methods: Participants (N=134) were drawn from a larger parent study of 3- to 6-year-old children hospitalized for severe TBI (n=16), complicated mild/moderate TBI (n=44), or orthopedic injury (OI; n=74), recruited prospectively at four tertiary care hospitals in the United States and followed for an average of 6.8 years post-injury. Quality of the home environment, caregiver psychological distress, and general family functioning were assessed shortly after injury (i.e., early home) and again at follow-up (i.e., late home). Participants completed several performance-based measures of EF at follow-up. Hierarchical regression analyses examined the early and late home environment measures as predictors of EF, both as main effects and as moderators of group differences. Results: The early and late home environment were inconsistent predictors of long-term EF across groups. Group differences in EF were significant for only the TEA-Ch Walk/Don’t Walk subtest, with poorer performance in the severe TBI group. However, several significant interactions suggested that the home environment moderated group differences in EF, particularly after complicated mild/moderate TBI. Conclusions: The home environment is not a consistent predictor of long-term EF in children with early TBI and OI, but may moderate the effects of TBI on EF. The findings suggest that interventions designed to improve the quality of stimulation in children’s home environments might reduce the long-term effects of early childhood TBI on EF. (JINS, 2018, 24, 11–21)
Objectives: The current study examines whether psychosocial outcomes following pediatric traumatic brain injury (TBI) vary as a function of children’s rejection sensitivity (RS), defined as their disposition to be hypersensitive to cues of rejection from peers. Methods: Children ages 8–13 with a history of severe TBI (STBI, n=16), complicated mild/moderate TBI (n=35), or orthopedic injury (OI, n=49) completed measures assessing self-esteem and RS on average 3.28 years post-injury (SD=1.33, range=1.25–6.34). Parents reported on their child’s emotional and behavioral functioning and social participation. Results: Regression analyses found moderation of group differences by RS for three outcomes: social participation, self-perceptions of social acceptance, and externalizing behavior problems. Conditional effects at varying levels of RS indicated that externalizing problems and social participation were significantly worse for children with STBI at high levels of RS, compared to children with OI. Social participation for the STBI group remained significantly lower than the OI group at mean levels of RS, but not at low levels of RS. At high levels of RS, self-perceptions of social acceptance were lower for children with moderate TBI compared to OI, but group differences were not significant at mean or low levels of RS. No evidence of moderation was found for global self-worth, self-perceptions of physical appearance or athletic ability, or internalizing problems. Conclusions: The findings highlight the salient nature of social outcomes in the context of varying levels of RS. These findings may have implications for the design of interventions to improve social outcomes following TBI. (JINS, 2017, 23, 451–459)
The Bovine Respiratory Disease Coordinated Agricultural Project (BRD CAP) is a 5-year project funded by the United States Department of Agriculture (USDA), with an overriding objective to use the tools of modern genomics to identify cattle that are less susceptible to BRD. To do this, two large genome wide association studies (GWAS) were conducted using a case:control design on preweaned Holstein dairy heifers and beef feedlot cattle. A health scoring system was used to identify BRD cases and controls. Heritability estimates for BRD susceptibility ranged from 19 to 21% in dairy calves to 29.2% in beef cattle when using numerical scores as a semi-quantitative definition of BRD. A GWAS analysis conducted on the dairy calf data showed that single nucleotide polymorphism (SNP) effects explained 20% of the variation in BRD incidence and 17–20% of the variation in clinical signs. These results represent a preliminary analysis of ongoing work to identify loci associated with BRD. Future work includes validation of the chromosomal regions and SNPs that have been identified as important for BRD susceptibility, fine mapping of chromosomes to identify causal SNPs, and integration of predictive markers for BRD susceptibility into genetic tests and national cattle genetic evaluations.
Evaluation of the headache patient begins with the historical exam. Physical findings of concern associated with the headache include: unequal weakness; generalized malaise and inability to ambulate; fevers; neck stiffness; and unequal pupils. Primary causes for the headache include tension headache, migraine, cluster and caffeine withdrawal, and the secondary causes include infection, subarachnoid hemorrhage (SAH), eye complaints, and tumors. Secondary headache is tending to improve as underlying cause of the headache is treated. This chapter presents a review of the common treatment options for the management of headache in the EMS environment. These include inhaled oxygen, anti-emetics, opioids, nonsteroidal anti-inflammatory drugs (NSAIDS), and analgesics. EMS providers must have a heightened level of concern for the causes of headache requiring emergent treatment. The area of headache evaluation and management in the EMS environment needs further study.
This study examined differences in friendship quality between children with traumatic brain injury (TBI) and orthopedic injury (OI) and behavioral outcomes for children from both groups. Participants were 41 children with TBI and 43 children with OI (M age=10.4). Data were collected using peer- and teacher-reported measures of participants’ social adjustment and parent-reported measures of children’s post-injury behaviors. Participants and their mutually nominated best friends also completed a measure of the quality of their friendships. Children with TBI reported significantly more support and satisfaction in their friendships than children with OI. Children with TBI and their mutual best friend were more similar in their reports of friendship quality compared to children with OI and their mutual best friends. Additionally, for children with TBI who were rejected by peers, friendship support buffered against maladaptive psychosocial outcomes, and predicted skills related to social competence. Friendship satisfaction was related to higher teacher ratings of social skills for the TBI group only. Positive and supportive friendships play an important role for children with TBI, especially for those not accepted by peers. Such friendships may protect children with TBI who are rejected against maladaptive psychosocial outcomes, and promote skills related to social competence. (JINS, 2014, 21, 1–10)
Research reveals mixed results regarding the utility of standardized cognitive and academic tests to predict educational outcomes in youth following a traumatic brain injury (TBI). Yet, deficits in everyday school-based outcomes are prevalent after pediatric TBI. The current study used path modeling to test the hypothesis that parent ratings of adolescents’ daily behaviors associated with executive functioning (EF) would predict long-term functional educational outcomes following pediatric TBI, even when injury severity and patient demographics were included in the model. Furthermore, we contrasted the predictive strength of the EF behavioral ratings with that of a common measure of verbal memory. A total of 132 adolescents who were hospitalized for moderate to severe TBI were recruited to participate in a randomized clinical intervention trial. EF ratings and verbal memory were measured within 6 months of the injury; functional educational outcomes were measured 12 months later. EF ratings and verbal memory added to injury severity in predicting educational competence post injury but did not predict post-injury initiation of special education. The results demonstrated that measurement of EF behaviors is an important research and clinical tool for prediction of functional outcomes in pediatric TBI. (JINS, 2013, 19, 1–9)
Social communication involves influencing what other people think and feel about themselves. We use the term conative theory of mind (ToM) to refer to communicative interactions involving one person trying to influence the mental and emotional state of another, paradigmatic examples of which are irony and empathy. This study reports how children with traumatic brain injury (TBI) understand ironic criticism and empathic praise, on a task requiring them to identify speaker belief and intention for direct conative speech acts involving literal truth, and indirect speech acts involving either ironic criticism or empathic praise. Participants were 71 children in the chronic state of a single TBI and 57 age- and gender-matched children with orthopedic injuries (OI). Group differences emerged on indirect speech acts involving conation (i.e., irony and empathy), but not on structurally and linguistically identical direct speech acts, suggesting specific deficits in this aspect of social cognition in school-age children with TBI. Deficits in children with mild-moderate TBI were less widespread and more selective than those of children with more severe injuries. Deficits in understanding the social, conative function of indirect speech acts like irony and empathy have widespread and deep implications for social function in children with TBI. (JINS, 2013, 19, 1–11)
This study examined peer relationships in children with traumatic brain injury (TBI) relative to children with orthopedic injuries (OI), and explored whether differences in peer relationships correlated with white matter volumes. Classroom procedures were used to elicit peer perceptions of social behavior, acceptance, and friendships for eighty-seven 8- to 13-year-old children, 15 with severe TBI, 40 with complicated mild/moderate TBI, and 32 with OI. Magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) were used to investigate volumetric correlates of peer relationship measures. Children with severe TBI were rated higher in rejection-victimization than children with OI, and were less likely than children with OI to have a mutual friendship in their classroom (47% vs. 88%). Children with TBI without a mutual friend were rated lower than those with a mutual friend on sociability-popularity and prosocial behavior and higher on rejection-victimization, and had lower peer acceptance ratings. Mutual friendship ratings were related to white matter volumes in several posterior brain regions, but not to overall brain atrophy. Severe TBI in children is associated with detrimental peer relationships that are related to focal volumetric reductions in white matter within regions of the brain involved in social information-processing. (JINS, 2013, 19, 1–10)
Facial emotion expresses feelings, but is also a vehicle for social communication. Using five basic emotions (happiness, sadness, fear, disgust, and anger) in a comprehension paradigm, we studied how facial expression reflects inner feelings (emotional expression) but may be socially modulated to communicate a different emotion from the inner feeling (emotive communication, a form of affective theory of mind). Participants were 8- to 12-year-old children with TBI (n = 78) and peers with orthopedic injuries (n = 56). Children with mild–moderate or severe TBI performed more poorly than the OI group, and chose less cognitively sophisticated strategies for emotive communication. Compared to the OI and mild–moderate TBI groups, children with severe TBI had more deficits in anger, fear, and sadness; neutralized emotions less often; produced socially inappropriate responses; and failed to differentiate the core emotional dimension of arousal. Children with TBI have difficulty understanding the dual role of facial emotions in expressing feelings and communicating socially relevant but deceptive emotions, and these difficulties likely contribute to their social problems. (JINS, 2013, 18, 1–10)
Theory of mind (ToM) involves thinking about mental states and intentions to understand what other people know and to predict how they will act. We studied ToM in children with traumatic brain injury (TBI) and age- and gender-matched children with orthopedic injuries (OI), using a new three-frame Jack and Jill cartoon task that measures intentional thinking separate from contingent task demands. In the key ToM trials, which required intentional thinking, Jack switched a black ball from one hat to another of a different color, but Jill did not witness the switch; in the otherwise identical non-ToM trials, the switch was witnessed. Overall accuracy was higher in children with OI than in those with TBI. Children with severe TBI showed a larger decline in accuracy on ToM trials, suggesting a specific deficit in ToM among children with severe TBI. Accuracy was significantly higher on trials following errors than on trials following correct responses, suggesting that all groups monitored performance and responded to errors with increased vigilance. TBI is associated with poorer intentional processing in school-age children and adolescents relative to peers with OI; furthermore, children with TBI are challenged specifically by intentional demands, especially when their injury is severe. (JINS, 2012, 19, 1–9)
While information for the medical aspects of disaster surge is increasingly available, there is little guidance for health care facilities on how to manage the psychological aspects of large-scale disasters that might involve a surge of psychological casualties. In addition, no models are available to guide the development of training curricula to address these needs. This article describes 2 conceptual frameworks to guide hospitals and clinics in managing such consequences. One framework was developed to understand the antecedents of psychological effects or “psychological triggers” (restricted movement, limited resources, limited information, trauma exposure, and perceived personal or family risk) that cause the emotional, behavioral, and cognitive reactions following large-scale disasters. Another framework, adapted from the Donabedian quality of care model, was developed to guide appropriate disaster response by health care facilities in addressing the consequences of reactions to psychological triggers. This framework specifies structural components (internal organizational structure and chain of command, resources and infrastructure, and knowledge and skills) that should be in place before an event to minimize consequences. The framework also specifies process components (coordination with external organizations, risk assessment and monitoring, psychological support, and communication and information sharing) to support evidence-informed interventions.
(Disaster Med Public Health Preparedness. 2011;5:73-80)
The primary aims of this study were to examine post-injury cognitive development in young children with traumatic brain injury (TBI) and to investigate the role of the proximal family environment in predicting cognitive outcomes. Age at injury was 3–6 years, and TBI was classified as severe (n = 23), moderate (n = 21), and complicated mild (n = 43). A comparison group of children who sustained orthopedic injuries (OI, n = 117) was also recruited. Child cognitive assessments were administered at a post-acute baseline evaluation and repeated at 6, 12, and 18 months post-injury. Assessment of the family environment consisted of baseline measures of learning support and stimulation in the home and of parenting characteristics observed during videotaped parent–child interactions. Relative to the OI group, children with severe TBI group had generalized cognitive deficiencies and those with less severe TBI had weaknesses in visual memory and executive function. Although deficits persisted or emerged across follow-up, more optimal family environments were associated with higher scores for all injury groups. The findings confirm other reports of poor recovery of cognitive skills following early childhood TBI and suggest environmental influences on outcomes. (JINS, 2010, 16, 157–168.)
Previous studies have documented weaknesses in cognitive ability and early academic readiness in young children with traumatic brain injury (TBI). However, few of these studies have rigorously controlled for demographic characteristics, examined the effects of TBI severity on a wide range of skills, or explored moderating influences of environmental factors on outcomes. To meet these objectives, each of three groups of children with TBI (20 with severe, 64 with moderate, and 15 with mild) were compared with a group of 117 children with orthopedic injuries (OI group). The children were hospitalized for their injuries between 3 and 6 years of age and were assessed an average of 1½ months post injury. Analysis revealed generalized weaknesses in cognitive and school readiness skills in the severe TBI group and less pervasive effects of moderate TBI. Indices of TBI severity predicted outcomes within the TBI sample and environmental factors moderated the effects of TBI on some measures. The findings document adverse effects of TBI in early childhood on postacute cognitive and school readiness skills and indicate that these effects are related to both injury severity and the family environment. (JINS, 2008, 14, 734–745.)
We describe 2 pediatric patients with Ralstonia pickettii bacteremia associated with extracorporeal membrane oxygenation (ECMO) therapy. Investigation revealed a common environmental source—the ECMO temperature-control units. We created guidelines for disinfecting these units that do not void the manufacturer's warranty and have prevented additional cases of bacteremia due to this organism.
Monte-Carlo simulation was used to examine the effects of fire return rates on the equilibrium age structure of a one-million-hectare lodgepole pine forest (Pinus contorta var. latifolia Engelm. ex S. Wats.; Pinaceae) and yielded a mosaic of ages over the one million hectares for each fire regime modelled. These mosaics were used to generate mosaics of susceptibility to mountain pine beetle (MPB) (Dendroctonus ponderosae Hopkins, 1902) attack. This susceptibility was related to the age distribution to calculate the mean susceptibility of the forest. Susceptibility maps were produced for two timber supply areas in British Columbia, as well as for the whole of B.C. In addition, we defined a quality, called traversability, that describes the ability of a beetle population to disperse across a landscape according to defined rules of susceptibility and maximum distance for dispersal through unsuitable habitat. Using each of 40 combinations of susceptibility classifications and dispersal limits, the landscape was categorized as traversable or non-traversable. This represents the suitability of a landscape to the unimpeded spread of an incipient beetle population. It was found that (i) long fire cycles yield an age structure highly susceptible to beetle attack; (ii) fire suppression reduces the frequency of fires and yields an age structure highly susceptible to beetle attack; and (iii) harvesting one age class reduces the mean susceptibility to MPB attack, and this reduction decreases with increasing harvest age and increasing fire cycle length. When fires were limited in size to less than 100 ha, the area was always traversable. For larger fires, traversability declined, and for the largest fires (up to one million hectares), the area was often not traversable. Harvesting reduced the mean susceptibility and traversability, often substantially. Traversability was calculated for the whole of B.C. in blocks of about one million hectares using B.C. Ministry of Forests and Range inventory data for the year 2000. The area most traversable was the area around Tweedsmuir Park and the Lakes Timber Supply Area, where most of the present outbreak of MPB is centred. FRAGSTATS patch metrics were calculated for each of the simulations and were related to traversability using discriminant analysis. This analysis was then applied to the B.C. inventory; the concordance was high, with 93.3% of conditions being correctly classified.
Maltreatment places children at risk for psychiatric morbidity,
especially conduct problems. However, not all maltreated children develop
conduct problems. We tested whether the effect of physical maltreatment on
risk for conduct problems was strongest among those who were at high
genetic risk for these problems using data from the E-risk Study, a
representative cohort of 1,116 5-year-old British twin pairs and their
families. Children's conduct problems were ascertained via parent and
teacher interviews. Physical maltreatment was ascertained via parent
report. Children's genetic risk for conduct problems was estimated as
a function of their co-twin's conduct disorder status and the
pair's zygosity. The effect of maltreatment on risk for conduct
problems was strongest among those at high genetic risk. The experience of
maltreatment was associated with an increase of 2% in the probability of a
conduct disorder diagnosis among children at low genetic risk for conduct
disorder but an increase of 24% among children at high genetic risk.
Prediction of behavioral pathology can attain greater accuracy if both
pathogenic environments and genetic risk are ascertained. Certain
genotypes may promote resistance to trauma. Physically maltreated children
whose first-degree relatives engage in antisocial behavior warrant
priority for therapeutic intervention.We
are grateful to the Study mothers and fathers, the twins, and the
twins' teachers for their participation. Our thanks to Robert Plomin
for his contributions; to Thomas Achenbach for generous permission to
adapt the CBCL; to Tom Price for comments on earlier drafts of this
manuscript; to Hallmark Cards for their support; and to members of the
E-Risk team for their dedication, hard work, and insights. The E-Risk
Study is funded by Medical Research Council Grant G9806489. Terrie Moffitt
is a Royal Society–Wolfson Research Merit Award holder.
Simple process models are applied to predict microstructural changes due to
the thermal cycle imposed in friction stir welding. A softening model
developed for heat-treatable aluminium alloys of the 6000 series is applied
to the aerospace alloy 2014 in the peak-aged (T6) condition. It is found
that the model is not readily applicable to alloy 2024 in the naturally aged
(T3) temper, but the softening behaviour can still be described
semi-empirically. Both analytical and numerical (finite element) thermal
models are used to predict the thermal histories in trial welds. These are
coupled to the microstructural model to investigate: (a) the hardness
profile across the welded plate; (b) alloy softening ahead of the
approaching welding tool. By incorporating the softening model applied to
6082-T6 alloy, the hardness profile of friction stir welds in dissimilar
alloys is also predicted.