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Moderate-to-severe traumatic brain injury (M/S TBI) is a growing public health concern with significant impact on the cognitive functioning of survivors. Cognitive control and deficits in awareness have been linked to poor recovery and rehabilitation outcomes. One way to research cognitive control is through awareness of errors using electroencephalogram and event-related potentials (ERPs). Both the error-related negativity and the post-error positivity components of the ERP are linked to error awareness and cognitive control processes. Attentional capacity and levels of apathy influence error awareness in those with M/S TBI. There are strong links between awareness, attention, and apathy. However, limited research has examined the role of attention, awareness, and apathy using electrophysiological indices of error awareness to further understand cognitive control in a M/S TBI sample. The current study sought to elucidate the role of apathy in error awareness in those with M/S TBI. Participants included 75 neurologically-healthy controls (divided randomly into two control groups) and 24 individuals with M/S TBI. All participants completed self-report measures of mood, apathy, and executive functioning, as well as a brief neuropsychological battery to measure attention and cognitive ability. To measure awareness, participants completed the error awareness task (EAT), a modified Stroop go/no-go task. Participants signaled awareness of errors committed on the previous trial. The M/S TBI group decreased accuracy while improving or maintaining error awareness compared to controls over time. There were no significant between-group differences for ERN and Pe amplitudes. Levels of apathy in the M/S TBI group were included in three multiple regression analyses predicting proportion of unaware errors, ERN amplitude, and Pe amplitude. Apathy was predictive of error awareness, although not in the predicted direction. Major analyses were replicated using two distinct control groups to determine potential sample effects. Results showed consistent results comparing both control groups to a M/S TBI group. Findings show variable levels of awareness and accuracy over time for those with M/S TBI when compared to controls. Conclusions include varying levels of attention and awareness from the M/S TBI group over time, evidenced by improving awareness of errors when they are happening, but an inability to regulate performance sufficiently to improve accuracy. Levels of apathy are playing a role in error awareness, however, not in predicted directions. The study provides support for the role of attentional impairments in error awareness and encourages future studies to look for varying levels of performance within a given task when using populations linked to elevated levels of apathy and attentional deficits.

Background: Traumatic brain injury (TBI) still remains a difficult disorder to treat. TBI has been associated to chronic neuroinflammation and a high risk for neurodegenerative disorders. Since 2001 between ten to twenty percent of all deployed military members have suffered a combat-related TBI. Nearly twenty to thirty percent of those will experience chronic cognitive, behavioral and somatic symptoms after suffering a TBI. Methods: The objective of this review is to evaluate current literature examining vitamin D as a neurosteroid with protective properties and its clinical relevance after traumatic brain injury. Vitamin D is known to participate in neurobiological processes and genomic regulation in the brain. Clinical and laboratory findings support that vitamin D modulates the immune responses to trauma, diminishes oxidative and toxic damage, and inhibiting activation and progression of the neuroinflammation. Inadequate levels of vitamin D have been identified as a common risk factor for many neurological disorders and have been linked to poorer recovery. Results: This review found compelling evidence to support that the pathology of TBI is closely associated with neuroprotective mechanisms of vitamin D. Low vitamin D levels are common among US active duty military and veterans. The findings strongly suggest that optimizing vitamin D prior to injury could improve the recovery for military members after experiencing a TBI. Vitamin D ameliorates brain damage by modulating neuroinflammation, improving cell survival and down-regulating mechanisms involved in the progression of cell damage following a TBI. However, further studies are needed to evaluate the effects of vitamin D optimization in TBI outcomes.

This study presents mathematical surrogate models, derived from finite element kinematic response data, to predict car crash-induced occupant head and neck injury risk for a broad range of impact velocities (10 – 45 mph), impact locations, and angles of impact (-45° to 45°). The development of these models allowed for wide-scale injury prediction while significantly reducing the overall required number of impact test cases. From these, increases in both the impact velocity and the impact’s locational proximity to the occupant were determined to result in the greatest head and neck injury risks. Additionally, strong interactions between the impact orientation variables (location and angle) produced significant changes in the head injury risk, while the neck injury risk was relatively insensitive to these interactions; likely due to the uniaxiality of the current standard neck injury risk metrics. Overall, this methodology showed potential for future applications in wide-scale injury prediction or vehicular design optimization.

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This study aims to develop models for predicting rare events, specifically elevated intracranial pressure (ICP) in patients with traumatic brain injury (TBI). Using time-series data of ICP, we created and evaluated several machine learning models, including K-Nearest Neighbors, Random Forest, and logistic regression, in order to predict ICP levels exceeding 20 mmHg – acritical threshold for medical intervention. The time-series data was segmented and transformed into a tabular format, with feature engineering applied to extract meaningful statistical characteristics. We framed the problem as a binary classification task, focusing on whether ICP levels exceeded the 20 mmHg threshold. We focused on evaluating the optimal model by comparing the predictive performance of the algorithms. All models demonstrated good performance for predictions up to 30 minutes in advance, after which a significant decline in performance was observed. Within this timeframe, the models achieved Matthews Correlation Coefficient (MCC) scores ranging between 0.876 and 0.980, where the Random Forest models showed the highest performance. In contrast, logistic regression displayed a notable deviation at the 40-minute mark, recording an MCC score of 0.752. The results presented highlight potential to provide reliable, real-time predictions of dangerous ICP levels up to 30 minutes in advance, which is crucial for timely and effective medical interventions.

Acrolein is produced endogenously after traumatic brain injury (TBI) and is considered a primary mechanism for secondary damage occurring after TBI. We are using frontal cortex networks derived from mouse embryos and grown on microelectrode arrays in vitro to monitor the spontaneous activity of networks and the changes that occur after acrolein application. Networks exposed to acrolein exhibit a biphasic response profile. An initial increase in network activity, followed by a decrease to 100% activity loss in applications ≥ 50 µM. In applications below 50 µM, acrolein was not toxic but generated activity instability with coordinated but irregular population busts lasting for up to 6 days. The increase in activity preceding toxicity may be linked to a decrease in free spermine, a free radical scavenger that modulates Na+, K+, Ca+ channels as well as NMDA, Kainate, and AMPA receptors. Action potential wave shape analysis after 20 and 30 µM acrolein application revealed a concentration-dependent 15-33% increase in peak to peak amplitude within minutes after exposure. For the same concentrations of acrolein (50 µM), the time required to reach 100% activity loss (IT100) was longer in serum-free medium than in medium with 5% serum, in which IT100 values were reduced by a factor of 4. The greater toxicity in the presence of serum may be explained by acrolein adducts on serum proteins. These reaction products have been shown by other labs to be toxic in cell culture. This in vitro system could be used to expand biochemical analyses such as acrolein-induced spermine depletion and may provide an effective platform for investigating cell culture correlates of secondary TBI damage.

<p>Uppsatsen har en kvalitativ ansats och är beskrivande till sin form.Dess övergripande syfte var att öka förståelsen för traumatisk hjärnskada. Syftet var att förstå meningsaspekter av skadan och att ge ett bidrag till förståelsen av olika variationer av livsvärldsförändringen. Hur traumatisk hjärnskada kan förstås utifrån ett existentiellt perspektiv var särskilt fokuserat. Forskningsfrågan löd: Vad och hur berättar några vuxna personer som i vuxen ålder drabbats av en traumatisk hjärnskada om erfarenheter och konsekvenser av skadan och vilka slutsatser kan dras av en fenomenologisk hermeneutisk analys av detta.</p><p>Åtta personer som varit patienter inom hjärnskaderehabilitering intervjuades. Intervjuerna spelades in på band och skrevs ner ordagrant. Analys och tolkningsarbetet följde en fenomenologisk hermeneutisk metod utarbetad av Lindseth och Norberg(2004).</p><p>Huvudtema med huvudspår, teman och subteman utkristalliserades. Begreppet gränssituation bildar huvudtema. Därpå följer konsekvenser med identitetsförskjutning, relation och tid, samt ytterligare fyra teman. I berättelserna visade sig både gemensamma och unika drag. Ett innehållsperspektiv och ett stämningsperspektiv framträdde. En slutsats som dras är att skadan provocerar det som man tidigare tagit för givet. Dels vad det gäller synen på vem man själv är och dels hur man förhåller sig till en större kontext. Relationen till mening visar sig genom att den världsbild som man gjort till sin förloras, förändras och/eller fördjupas.</p> / <p>This thesis has a qualitative approach and is descriptive in form. The overaching aim was to increase the understanding of Traumatic Brain Injury (TBI). The purpose was to understand aspects of changing meaning as a consequence of the injury and unique variations in clients´changed life-worlds. Particular attention was devoted the issue of how TBI can be understood from an existential perspective. The research questions were: What and how do adults who suffered from TBI relate their experiences and the consequences of the injury, and what conclusions can be drawn from a phenomenological hermeneutical analysis of their stories?</p><p>Eight persons, all former patients in rehabilitation, were interviewed. Analysis and interpretations followed a phenomenological-hermeneutical method outlined by Lindseth and Norberg (2004). Main themes and subthemes were crystallised. The concept limitsituation constitutes a main theme. There follows consequences as for example to identity dislocation, relation and time. In the informant´s stories common as well as unique characteristics transpired. Emphasis was on the mood, and the context under which experiences arised. A conclusion was that the injury provokes one´s already esatblished world-view and the relation to meaning was exposed and challanged. The world-view was lost, reduced and/or challenged.</p>