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Traumatic brain injury (TBI) effects a large number of individuals, both civilians and military personnel, every year. The neuroinflammatory response mounted in the brain following a head injury continues long after the effects of initial subside. While it was initially thought to only occur in moderate or severe TBI, the deleterious effects of this cascade have recently been identified in patients with mild TBI (mTBI). Hypopituitarism is an often underreported condition and can result from TBI of all severity. The long-term sequelae of TBI can manifest in or exacerbate many other comorbidities of brain injury, such as neuroendocrine dysfunction or mental health conditions. Both TBI and hypopituitarism can present with symptoms similar to some psychiatric disorders, or exacerbation comorbid conditions. Veteran patients presenting to their primary care providers with symptoms of irritability, depression, anxiety, or cognitive and behavioral changes may meet criteria to receive diagnoses of psychiatric illnesses prevalent in the military population, while not being evaluated for pituitary dysfunction, and thus receive inadequate treatment. The proposed study aims to identify the prevalence of patients that are receiving psychiatric treatment that have both a history of mTBI and reduced levels of pituitary hormones on serum assays. By identifying a significant portion of this population, future studies can assess the impact that hormonal replacement has on success of psychotherapy, resolution of symptoms, and impact on functional status, among other factors.

An Unbearable Illumination of Truth is a series of sculptures created to explore the connection between trauma and healing. The sculptural exhibition addresses economic, occupational, childhood, sexual, and gender-based trauma. These sculptures incorporate familiar motifs and visual metaphors to express narratives of varying types of traumas. A broad range of sculptural materials (such as wood, fabric, and found objects) and methods are used to create these symbolic, objective forms. The juxtaposition of shelters with other forms and materials visually enacts the themes of vulnerability and intrigue that characterizes traumatic incidents. Shelters are referenced throughout this entire body of work as an allegory for identity. Ultimately, this work is intended to induce empathy and raise awareness of important, underlying social issues that revolve around trauma. This message is especially important today due to a dramatic increase of trauma related issues as a result of the COVID-19 pandemic.

This quantitative research is on the efficacy of Minnesota Statute 144.574 enacted in 2005 in response to the growing awareness of behavior leading to inflicted Traumatic Brain Injuries (iTBI) in infants and children. The model for this research is grounded in the Theory of Reasoned Action wherein the education of new parents which graphically explains the physiologic changes to the structural architecture of the brain post-trauma, paired with their signature on a social contract (SC), demonstrated a reduction in incidence. Because the enacted statute does not include the signing of a SC, nor does it require face-to-face education as in the model, Statute 144.574 cannot claim to be completely grounded in medical science. The result is that neither legislators nor the medical and public health community know whether the statute is effective in lowering incidence. This research was designed to explore the difference in the incidence pre-and post-enactment, in rural vs. urban communities, the proportion of incidence and ethnicity, and an ordinal shift in the distribution of severity. All births in Minnesota from 1998 through 2017 were included. Cases defined using International Classification of Disease were extracted from secondary data from the brain and spinal cord injury, hospital discharge, and vital statistics databases. A Z-test was employed to compare the incidence in a control cohort of infants and children born prior to enactment to the incidence of same in an interventional cohort born post-enactment. Results suggest the statute has not resulted in lowering incidence, have uncovered an unanticipated statistically significant increase in rural vs. urban incidence, yet point to a trend in favor of less severe iTBI. These results represent a positive social change which is grounded in the society's imperative and social justice of protecting children by informing public health officials, caregivers, and legislators of the need for meaningful reform and strengthening of programs leading to lowering the incidence of iTBI in children in Minnesota.

Most law enforcement officers experience a traumatic event within the first 3 years of duty but may not receive proper mental health training in the police academy to prepare them for a career in law enforcement, and little is understood about police academy training regarding mental health. Using secondary traumatic stress (STS) as a conceptual framework, the purpose of this qualitative study was to understand the perspective of law officers on the usefulness of academy training to prevent or manage mental health issues that may arise from law enforcement duty. Data were collected from 35 law enforcement officers in a Southern state through an online, qualitative survey. These data were inductively coded and subjected to a thematic analysis procedure. Findings indicate that both STS and post-traumatic stress disorder (PTSD) are shunned topics in the law enforcement community. Additionally, respondents perceived that reconstructing police academy training manuals to include personal stress management and increasing awareness of STS may better protect law enforcement officers and enhance community relations while providing a more sustainable police force. The positive social change implications of this study include recommendations to police academies to include mental health training and preparation as part of early academy training to promote better mental health among police officers and reduce the negative effects of STS and PTSD.

One of the primary reasons many college students with disabilities, and more specifically college student veterans with disabilities, do not seek support services is due to the stigma associated with disability, especially cognitive and mental health disabilities. The purpose of the present study was to explore how public university faculty in the state of Illinois perceive a college student veteran with the concurrent disabilities of post traumatic stress disorder (PTSD) and traumatic brain injury (TBI). This information was gleaned by means of a mixed-method, online survey. Through iterative, comparative, qualitative analysis, characteristics used to describe college student veterans with the PTSD and TBI were classified into six emergent prototypes. These prototypes included (1) the mature independent student; (2) the American hero; (3) the special needs student; (4) the isolated student; (5) the volatile student; and (6) the wounded warrior. Secondary analyses quantitatively examined the relationship between contact with a student veteran and the proportion of positive responses given for each participant as well as the relationship between contact with a student veteran and the proportion of negative responses given for each participant. Pearson correlation analysis indicated no significant relationship between prior contact factor scores and the proportion of positive responses given by faculty r(269) = .032, p = .597 nor was there a significant relationship detected between prior contact factor scores and the proportion of negative responses given by faculty r(269) = -.020, p= .745. Tertiary analysis examined the proportion of positive to negative perceptions by faculty. Overall, faculty responses were more negative than positive. Implications for best practices at the administration level as well as for faculty and students were discussed. Limitations to the study were also discussed.

Purpose: Interdisciplinary research in epidemiology, neurology, neuroscience, and sports medicine commonly highlight the dangerous short- and long-term sequelae of sport-related concussions (SRC). Despite advancements in clinical evaluation and recognition, many SRCs are not properly diagnosed and managed, leaving many athletes in danger of acute and chronic neurological deficits. Epidemiological studies suggest the prevalence of chronic traumatic encephalopathy (CTE) is three times, and Alzheimer's disease is four times greater in former athletes with a history of SRC than non-athletes. The underlying mechanisms linking SRC and contact-sport participation to neurodegeneration are not fully understood. Herein, I hypothesized that transient insufficiency of the lymphatic and glymphatic clearance systems in the central nervous system (CNS) could play a crucial role in the SRC-mediated neurological conditions. Therefore, this study aimed to examine the differences in plasma levels of extracellular vesicles (EV) that are associated with the lymphatic and glymphatic clearance systems of the CNS among athletes following sport-related head impacts. Participants: Plasma EV concentrations were analyzed in collegiate athletes (controls n=29, SRC n=19) with and without SRC. In a parallel study, fourteen college-aged soccer players participated in a laboratory-based, repetitive subconcussion paradigm. All participants provided written informed consent, and the study was approved by institutional review board at Temple University. Methods: We evaluated EVs containing markers associated with the CNS lymphatic and glymphatic systems, including lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1), astrocyte-specific glial fibrillary acidic protein (GFAP), aquaporin 4 (AQP4), and the platelet and endothelial cell adhesion molecule 1(PECAM-1 or CD31). Tetraspanin-28 (CD81) was used as an EV-specific marker. Blood samples from athlete controls were collected once during preseason baseline assessments. Samples from athletes with SRC were collected within 72 hours of injury. Whole blood was double-centrifuged to obtain platelet-poor plasma, snap-frozen in liquid nitrogen, and stored at -80°C until analyzed. Quantification of plasma EVs was performed using spectral flow cytometry. Mann-Whitney U tests were used for group comparisons of single and double-positive EV concentrations, and receiver-operating characteristic curve (ROC) and area under the curve (AUC) analyses assessed diagnostic efficacy. Within-group changes in plasma EVs following repetitive, subconcussive head impacts were assessed with Friedman's test using Dunn's correction for multiple comparisons. Results: Among athletes with SRC, plasma concentrations of LYVE1+EVs and CD31+EVs were significantly elevated within 72 hours of injury compared to controls (LYVE1+EVs, p < 0.0001; CD31+EVs, p = 0.005). ROC analysis revealed plasma concentrations of LYVE1+EVs demonstrated significant diagnostic accuracy to differentiate athletes with SRC from athlete controls (AUC: 0.971, 95% C.I. = 0.933-1.000, p < 0.0001). Notably, concentrations of LYVE1+/CD81+ double-positive EVs, CD31+/CD81+ double-positive EVs, and GFAP+/CD81+ double-positive EVs were significantly higher among athletes with SRC within 72 hours of injury compared to control athletes (p < 0.0001; p = 0.0002; p < 0.0001, respectively). Plasma AQP4+/GFAP+ double-positive EVs and AQP4+/CD81+ double-positive EVs were not. However, plasma concentrations of GFAP+/CD81+ double-positive EVs and AQP4+/GFAP+ double-positive EVs were significantly elevated after repetitive, subconcussive head impacts (p < 0.0001 and p = 0.004, respectively). Conclusion: Plasma concentrations of double-positive EVs, including LYVE1+/CD81+EVs, CD31+/CD81+EVs, and GFAP+/CD81+EVs, may be promising biomarkers for acute SRC. EVs associated with the glymphatic system, GFAP+/CD81+EVs and AQP4+/GFAP+EVs, were significantly elevated after repetitive subconcussive head impacts. The differences observed in EV responses to SRC and subconcussion may provide novel mechanistic insights about sport-associated neurodegeneration for current and future athletes. / Kinesiology

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In an average year more than 1.7 million people will experience a traumatic brain injury (TBI) in the United States. It is known that atrophy occurs across a spectrum for TBI patients, ranging from mild to severe. Current conventional magnetic resonance imaging (MRI) methods are inconsistent in detecting this atrophy on the milder end of the spectrum. Also more contemporary imaging tools, although efficient, are too time consuming for clinical applicability. It is for these reasons that a quick and efficient measurement for detecting this atrophy is needed by clinicians. The measuring of third ventricle width had the potential to be this measurement, since it is known that ventricular dilation is an indirect measure of brain atrophy. This study used two different data sets acquired at multiple sites. A total of 152 TBI patients' MRI scans were analyzed with diagnosis ranging from mild to severe. They have been age matched with 97 orthopedic injury controls. All scans were analyzed using Freesurfer® auto-segmentation software to acquire cortical, subcortical, and ventricular volumes. These metrics were then used as a standard of efficacy which we tested the new third ventricle width protocol against. There was no statistically significant difference between the overall TBI group and OI group (Welch's F(1,238.435) = 1.091, p= .267). The complicated mild injury subgroup was significantly increased from the mild subgroup (p= .001, d= .87). The grand average third ventricle width measurement was the best prognosticator of all measures analyzed despite only predicting 35.1% of cases correctly. The findings suggest that the third ventricle width measurement is insensitive to atrophy between all groups as hypothesized.

Youth football players ages 8-12 may incur hundreds of repeated head impacts (RHI) each season. Evidence suggests concussive brain injury during childhood may disrupt normal developmental processes resulting in long-term impairments. However, little research has investigated the long-term effects of incurring RHI during critical periods of neurodevelopment. Rapid myelination and cerebral blood flow rates, peaks in regional cortical thickness and volumes of specific structures, refinement of regional connectivity, and other neurodevelopmental changes occurring in the brain from ages 10-12 could create a window of vulnerability to RHI. The objective of this research was to determine the relationship between exposure to RHI prior to age 12, during a critical period of neurodevelopment, and later-life brain structure and function. Former National Football League (NFL) players ages 40-65 were divided into two groups based on their age of first exposure (AFE) to RHI through tackle football: AFE <12 and AFE ≥12. In the first study, we observed significantly lower scores on objective tests of executive functioning, memory, and estimated verbal IQ in those who began playing football prior to age 12 compared to those who began playing at age 12 or older. Next, we used diffusion tensor imaging (DTI) to examine the structural integrity of the corpus callosum (CC) and observed that the AFE <12 group had significantly lower fractional anisotropy (FA) as well as a greater decline in FA with age in anterior CC regions than the AFE ≥12 group. Lastly, we used advanced DTI tractography techniques to examine seven CC regions. Significant differences between AFE groups in associations between CC diffusion measures and cognition, mood, and behavior were found. The results of this research suggest that incurring RHI through tackle football during a critical neurodevelopmental period prior to age 12 may result in later-life structural and functional consequences, including cognitive, mood, and behavioral impairments; alterations in white matter structure; and greater vulnerability of white matter to the normal aging process. If replicated with longitudinal designs, larger samples, and athletes whose highest level of play was youth, high school, or college, these findings may have implications for safety recommendations for youth sports.