Validity of the CES-D for depression screening in military service members with a history of mild traumatic brain injury.

Primary Objective: To advance knowledge about the value of the Center for Epidemiologic Studies - Depression scale (CES-D) for depression screening in military service members with a history of mild traumatic brain injury (mTBI). Research Design: Retrospective data from 336 military service members with a history of mTBI were extracted from a TBI Repository at a large military medical center. Participants included in this study screened positive for mTBI in a primary care clinic or soldier readiness processing center and were enrolled in the TBI repository from November 6, 2014 to May 31, 2017. At the time of enrollment, participants completed the CES-D and their electronic medical records (EMR) were searched for diagnoses of depressive disorders. Methods and Procedures: Receiver-operating characteristic (ROC) analysis of the CES-D was used to discriminate cases with and without depression diagnoses. Main Outcomes and Results: Area under the ROC curve (AUC) was .897. Sensitivity (.824) and specificity (.826) were maximized at a cut score of 18 or greater, slightly higher than the standard cut of 16 established for civilian samples. Conclusions: Results suggest that the CES-D is a valid screening instrument for depressive disorders in military samples with a history of mTBI.

Preliminary findings of cortical thickness abnormalities in blast injured service members and their relationship to clinical findings.

Though cortical abnormalities have been demonstrated in moderate and severe traumatic brain injured (TBI) patients, there have been no studies examining cortical changes following blast related mild TBI (mTBI). The purpose of this study was to determine the effects and functional relevance of blast mTBI on cortical thickness in a small cohort of carefully screened blast injured US Service Members (SM). Twelve SM with mTBI acquired through blast injury were compared to 11 demographically matched control SM without TBI. Both mTBI and control participants were active duty and had completed a combat deployment. Subjects underwent MRI examination and the T1 weighted anatomic images were processed using the FreeSurfer suite of tools. Cortical thickness maps were compared between groups and examined for relationships with time since injury (TSI). Utilizing a large database of functional imaging results (BrainMap), significant regions of interest (ROI) were used to determine the behavioral profiles most consistently associated with the specific ROI. In addition, clinical variables were examined as part of post-hoc analysis of functional relevance. Group comparisons controlling for age demonstrated several significant clusters of cortical thinning for the blast injured SM. After multiple comparisons correction (False Discovery Rate (FDR)), two left hemisphere clusters remained significant (left superior temporal (STG) and frontal (SFG) gyri). No clusters were significantly correlated with TSI after FDR correction. Behavioral analysis for the STG and SFG clusters demonstrated three significant behavioral/cognitive sub-domains, each associated with audition and language. Blast injured SMs demonstrated distinct areas of cortical thinning in the STG and SFG. These areas have been previously shown to be associated with audition and language. Post-hoc analyses of clinical records demonstrated significant abnormal audiology reports for the blast injured SM suggesting that the thinning in these ROIs might be related to injury to the external auditory system rather than direct injury to the brain from the blast. It is clear that additional replication is needed in much larger cohorts. Importantly, the combination of imaging tools and methods in this study successfully demonstrated the potential to define unique ROIs and functional correlates that can be used to design future studies.

Category fluency in mild cognitive impairment: reduced effect of practice in test-retest conditions.

Verbal fluency tests are commonly used in neurocognitive and mental status examinations in patients with suspected dementia. Inflation of test scores as a result of practice effects may yield false-negative results in test-retest and multidisciplinary settings, particularly among patients with mild cognitive deficits. To address this issue, animal naming was administered twice within a 1-week period to a group of individuals referred for suspected dementia who were ultimately diagnosed with mild cognitive impairment (MCI; amnestic form), probable Alzheimer disease (AD), or no dementia. A 2 x 3 repeated-measures analysis of variance revealed a statistically significant interaction between administration time and group. Post hoc analyses indicated that nondemented controls were the only group to demonstrate a significant practice effect, producing an average of approximately three more animal names at time two. Like patients with a diagnosis of AD, subjects with amnestic MCI failed to benefit from repeated exposure to the animal naming test, and only controls showed an average improvement upon retest. This underscores the cognitive similarity between individuals diagnosed with amnestic MCI and AD and suggests that improvement upon retest may be a diagnostically useful finding.

Retrospective identification of chemical warfare agents by high-temperature automatic thermal desorption-gas chromatography-mass spectrometry.

An automated thermal desorption (ATD)-gas chromatography-mass spectrometry method was developed for the analysis of selected chemical warfare (CW) agents. Suitable methods were developed for analytes of high volatility to low volatility. The less volatile CW agents required the purchase and installation of a high-temperature valve upgrade kit allowing valve temperatures of up to 260 degrees C to be reached. The limit of detection was 50 ng on the tube for most CW agents in full scan. Chloropicrin exhibited some temperature dependence, with detection limits improving as ATD temperatures were decreased below 150 degrees C. A sample storage trial was undertaken to establish the most suitable storage environment for CW agents adsorbed onto Tenax TA. Temperature and time of storage were found to influence recovery of analytes with best recoveries being observed after 1 day storage in a freezer (-12 degrees C). This method was evaluated during a trial of procedures for sampling and identification of chemical agents at Porton Down, UK. Sulfur mustard was detected downwind of a simulated exploded munition.

Extraction of thiodiglycol from soil using pressurised liquid extraction.

Thiodiglycol (TDG) is the predominant hydrolysis product of the chemical warfare agent sulfur mustard. The extraction of TDG was investigated using pressurised liquid extraction and the results compared for a variety of different solvents and soils. TDG was analysed underivatised by gas chromatography with flame photometric detection. A mixture of methanol-water (9:1), proved to be the most efficient extracting solvent for TDG at a temperature of 150 degrees C and 10 MPa.

Helping people with alcohol problems.

Many nurses may feel reluctant to include questions on alcohol use in their general patient assessments but studies have shown that brief interventions on this subject can help people cut down on their drinking and improve their health.

Effects of practice on category fluency in Alzheimer's disease.

Evaluation of patients with suspected Alzheimer's disease (AD) often involves clinicians of multiple disciplines working in collaboration to maximize diagnostic accuracy. Accordingly, repeated administrations of some common tests of mental status may occur within a relatively brief time period. The effect of such retesting on subsequent results is largely unknown for many cognitive tasks, despite the possibility that repeated administrations may artificially inflate scores. To assess the potential impact of practice effects on a commonly administered verbal fluency task, animal naming was administered twice within a 1-week period to 111 patients with probable AD and 12 persons without dementia. Non-demended subjects were the only group to demonstrate a small (3 point), but statistically significant practice effect. Regardless of level of cognitive impairment, patients with AD did not show significant practice effects over repeated administrations of animal naming after a relatively brief test-retest interval, suggesting the robust nature of this task in AD.

Improving the stability of algebraic curves for applications.

An algebraic curve is defined as the zero set of a polynomial in two variables. Algebraic curves are practical for modeling shapes much more complicated than conics or superquadrics. The main drawback in representing shapes by algebraic curves has been the lack of repeatability in fitting algebraic curves to data. Usually, arguments against using algebraic curves involve references to mathematicians Wilkinson (and Runge). The first goal of this article is to understand the stability issue of algebraic curve fitting. Then a fitting method based on ridge regression and restricting the representation to well behaved subsets of polynomials is proposed, and its properties are investigated. The fitting algorithm is of sufficient stability for very fast position-invariant shape recognition, position estimation, and shape tracking, based on invariants and new representations. Among appropriate applications are shape-based indexing into image databases.

Alcohol home detoxification: a way forward.

Alcohol detoxification within the home environment is a safe, cost-effective alternative to inpatient care and the problem drinker is more likely to complete the treatment. Yet health trusts continue to ignore this community approach for those individuals with alcohol-related problems.

Assessment and monitoring of alcohol-related problems.

Employers are increasingly requesting employees to submit to screening for alcohol-related problems (ARPs). Holistic assessment, leading to problem identification and treatment, can lead to a reduction in the number of accidents occurring in the workplace. This article argues against the practice of assessment based solely on blood levels of liver enzymes and mean corpuscular volume of erythrocytes and introduces a new diagnostic test which, if used with a full and systematic assessment, may lead to more accuracy in diagnostic interpretation.

Alcohol home detoxification.

Traditional inpatient treatments for alcohol-related problems often prevent the problem drinker from seeking early intervention. Inpatient treatment may be particularly difficult for women because of stigma, labelling and family commitments. An alternative, home-based program initiated in the United Kingdom (U.K.) in the late 1980s and currently being trialed by many health districts, may be of interest to Canadian nurses. In addition to improved client outcomes and cost-effectiveness, the program offers nurses a higher public and medical profile. Clinical nurse specialists in particular may want to consider whether the expanded role of their British colleagues might be appropriate for Canadian adaptation.

Simple parallel hierarchical and relaxation algorithms for segmenting noncausal markovian random fields.

The modeling and segmentation of images by MRF's (Markov random fields) is treated. These are two-dimensional noncausal Markovian stochastic processes. Two conceptually new algorithms are presented for segmenting textured images into regions in each of which the data are modeled as one of C MRF's. The algorithms are designed to operate in real time when implemented on new parallel computer architectures that can be built with present technology. A doubly stochastic representation is used in image modeling. Here, a Gaussian MRF is used to model textures in visible light and infrared images, and an autobinary (or autoternary, etc.) MRF to model a priori information about the local geometry of textured image regions. For image segmentation, the true texture class regions are treated either as a priori completely unknown or as a realization of a binary (or ternary, etc.) MRF. In the former case, image segmentation is realized as true maximum likelihood estimation. In the latter case, it is realized as true maximum a posteriori likelihood segmentation. In addition to providing a mathematically correct means for introducing geometric structure, the autobinary (or ternary, etc.) MRF can be used in a generative mode to generate image geometries and artificial images, and such simulations constitute a very powerful tool for studying the effects of these models and the appropriate choice of model parameters. The first segmentation algorithm is hierarchical and uses a pyramid-like structure in new ways that exploit the mutual dependencies among disjoint pieces of a textured region.

On optimally combining pieces of information, with application to estimating 3-d complex-object position from range data.

New asymptotic methods are introduced that permit computationally simple Bayesian recognition and parameter estimation for many large data sets described by a combination of algebraic, geometric, and probabilistic models. The techniques introduced permit controlled decomposition of a large problem into small problems for separate parallel processing where maximum likelihood estimation or Bayesian estimation or recognition can be realized locally. These results can be combined to arrive at globally optimum estimation or recognition. The approach is applied to the maximum likelihood estimation of 3-D complex-object position. To this end, the surface of an object is modeled as a collection of patches of primitive quadrics, i.e., planar, cylindrical, and spherical patches, possibly augmented by boundary segments. The primitive surface-patch models are specified by geometric parameters, reflecting location, orientation, and dimension information. The object-position estimation is based on sets of range data points, each set associated with an object primitive. Probability density functions are introduced that model the generation of range measurement points. This entails the formulation of a noise mechanism in three-space accounting for inaccuracies in the 3-D measurements and possibly for inaccuracies in the 3-D modeling. We develop the necessary techniques for optimal local parameter estimation and primitive boundary or surface type recognition for each small patch of data, and then optimal combining of these inaccurate locally derived parameter estimates in order to arrive at roughly globally optimum object-position estimation.

Heritable somaclonal variation in gliadin proteins of wheat plants derived from immature embryo callus culture.

Fertile r0 plants of the winter wheat line ND7532 (Triticum aestivum L.) were regenerated from callus tissue after 60-190 days in culture. Seeds produced from these self-pollinated plants were planted in the field. Of the 5586 R1 plants, 32 differed for one or more agronomic traits from plants not passed through tissue culture process. Gliadin electrophoregrams were prepared from bulk samples of R2 seed from these 32 plants. Four of the 32 produced gliadin patterns different from controls, so 12 seeds of each of these four lines were examined individually. Three of the four mutant lines were fixed for the presence of a mutant protein of 50 relative mobility units (RMU) and the corresponding loss of a parental protein of 26 RMU. The remaining line segregated for the presence/absence of band 50 and the corresponding loss/retention of band 26. The mutant protein of 50 RMU was never seen in control plants. This indicated that either band 50 was coded for by a mutant gene allelic to the gene that coded for band 26 or that bands 26 and 50 were coded for by two different structural alleles under the control of a common regulatory locus. Each of the 12 seeds from the four mutant lines contained a prominent protein band at 30 (RMU), which was only observed as a faint band in one control seed. The types of variation in gliadin patterns observed in somaclones of ND7532 were similar to those reported for the line 'Yaqui 50E', except that, gliadin changes occurred less frequently in ND7532.

Bayesian recognition of local 3-d shape by approximating image intensity functions with quadric polynomials.

The recognition in image data of viewed patches of spheres, cylinders, and planes in the 3-D world is discussed as a first step to complex object recognition or complex object location and orientation estimation. Accordingly, an image is partitioned into small square windows, each of which is a view of a piece of a sphere, or of a cylinder, or of a plane. Windows are processed in parallel for recognition of content. New concepts and techniques include approximations of the image within a window by 2-D quadric polynomials where each approximation is constrained by one of the hypotheses that the 3-D surface shape seen is either planar, cylindrical, or spherical; a recognizer based upon these approximations to determine whether the object patch viewed is a piece of a sphere, or a piece of a cylinder, or a piece of a plane; lowpass filtering of the image by the approximation. The shape recognition is computationally simple, and for large windows is approximately Bayesian minimum-probability-of-error recognition. These classifications are useful for many purposes. One such purpose is to enable a following processor to use an appropriate estimator to estimate shape, and orientation and location parameters for the 3-D surface seen within a window.