Treatment consent capacity in patients with traumatic brain injury across a range of injury severity.

OBJECTIVE: To investigate medical decision-making capacity (MDC) in patients with acute traumatic brain injury (TBI) across a range of injury severity. METHODS: We evaluated MDC cross-sectionally 1 month after injury in 40 healthy controls and 86 patients with TBI stratified by injury severity (28 mild [mTBI], 15 complicated mild [cmTBI], 43 moderate/severe [msevTBI]). We compared group performance on the Capacity to Consent to Treatment Instrument and its 5 consent standards (expressing choice, reasonable choice, appreciation, reasoning, understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, severe impairment) on the consent standards were also assigned to each participant with TBI using cut scores referenced to control performance. RESULTS: One month after injury, the mTBI group performed equivalently to controls on all consent standards. In contrast, the cmTBI group was impaired relative to controls on the understanding standard. No differences emerged between the mTBI and cmTBI groups. The msevTBI group was impaired on almost all standards relative to both control and mTBI groups, and on the understanding standard relative to the cmTBI group. Capacity compromise (mild/moderate or severe impairment ratings) on the 3 clinically complex standards (understanding, reasoning, appreciation) occurred in 10%-30% of patients with mTBI, 50% of patients with cmTBI, and 50%-80% of patients with msevTBI. CONCLUSIONS: One month following injury, MDC is largely intact in patients with mTBI, but is impaired in patients with cmTBI and msevTBI. Impaired MDC is prevalent in acute TBI and is strongly related to injury severity.

Development of an electrochemical assay for 2,6-dinitrotoluene, based on a screen-printed carbon electrode, and its potential application in bioanalysis, occupational and public health.

Screen-printed carbon electrodes (SPCEs) have been successfully exploited as disposable sensors for the measurement of 2,6-dinitrotoluene (2,6-DNT) using a stripping voltammetric method. Initial investigations were undertaken using cyclic voltammetry (CV) to characterise the redox behaviour at the SPCEs. Further studies were then performed to deduce the optimum applied potential and accumulation time for the stripping voltammetric procedure. In addition, a study was carried out to ascertain whether small volumes of samples could be reliably used for analysis. From these studies it was shown that a 100 microl aliquot of sample could be analysed and the calibration plot was linear from 161 ng ml(-1) to 137 microg ml(-1) (R(2)=0.9991), the former concentration being the detection limit. The effects of the major components of human saliva at concentrations normally present were investigated. Of the individual components tested, only Cl(-) and albumen were found to interfere. The presence of the latter could be easily overcome by the addition of (NH(4))(2)SO(4). An interference study was also carried out on some inorganic and organic species that may be present in water samples. The sensors were evaluated by carrying out 2,6-DNT determinations on spiked and unspiked human saliva, dust wipe and potable water samples. Mean recoveries of 47.5, 73.4 and 102.4% were obtained; coefficients of variation of 7.88, 6.63 and 6.42% were calculated for a concentration of 9.1 microg ml(-1) in water, 10.6 microg ml(-1) saliva samples, and 141.1 ng cm(-2) for dust wipe samples, respectively. The performance characteristics show that the method holds promise and reliable data may be obtained for 2,6-DNT in bioanalysis and public health.