Background/Objectives: Sleep is integral to cognitive functioning, yet many college students experience poor sleep, often influenced by dysfunctional beliefs about sleep. Dysfunctional beliefs can exacerbate sleep issues and negatively impact executive functioning (EF). Distinct EF facets, including inhibition, working memory, and cognitive flexibility, may differ in their sensitivity to sleep disruptions. While research suggests links between sleep and EF, less is known about how sleep-related beliefs may moderate this relationship and how sleep can affect the various EF facets. Utilizing an undergraduate population, this study examined how sleep quality/quantity affects the different EF facets, how this relationship differs between subjective and objective measurements, and whether dysfunctional beliefs about sleep moderate the relationship. Methods: Undergraduate students (N = 212, ages 18-23) completed self-report measures assessing dysfunctional beliefs about sleep (DBAS-16), sleep quality (ISI), and sleep quantity (self-reported sleep duration). Objective EF was measured using computerized CNS Vital Signs tasks targeting inhibition (Stroop Test), working memory (4-Part Continuous Performance Test), and cognitive flexibility (Shifting Attention). Subjective EF was measured using individual subscales on the Behavioral Rating Inventory of Executive Functioning-Adult Version (BRIEF-A). Results: Moderation analyses were conducted via linear regression. When measured objectively, neither sleep quantity nor insomnia severity (sleep quality) significantly affected any EF facets, and dysfunctional beliefs about sleep did not have any significant moderation effect. When measured subjectively, insomnia severity (sleep quality), but not sleep quantity, significantly predicted inhibition and cognitive flexibility; in contrast, neither predictor significantly predicted working memory. Regarding specific predictors, dysfunctional sleep beliefs were found to exert significant effect over all three facets; this effect was diminished when insomnia severity was included in the model. Regarding moderation, dysfunctional beliefs about sleep moderated the relationship between sleep quantity and all three EF facets. Conclusions: The impact of sleep quality, sleep quantity, and dysfunctional beliefs about sleep varies depending on whether the facets of EF are measured subjectively or objectively. Dysfunctional beliefs about sleep may exacerbate the perceived effect of short sleep duration on daytime cognitive functioning. In addition, insomnia severity may account for the effects of dysfunctional sleep beliefs on perceived inhibitory control and cognitive flexibility; however, working memory may be more resistant to the effects of sleep disturbances and dysfunctional sleep beliefs. Clinical implications of these results and future directions are discussed.

Introduction:Almost three million traumatic brain injuries (TBIs) are reported in the US annually. Concussions, also known as mild TBIs (mTBIs), are the most common and account for approximately 90% of TBIs annually. Research indicates confusion regarding the (1) symptoms, (2) mechanisms of injury, and (3) treatment and recovery associated with mTBI. This study sought to build upon previous research by investigating mTBI knowledge within these three domains. Materials and Methods:Responses from 529 participants were collected from two groups: college students (n = 333) and the general public (n = 196). Participants completed a self-report questionnaire that included true/false items spanning the three domains of mTBI knowledge. Results:Overall, mTBI knowledge accuracy was 67%, with highest accuracy on items related to mTBI symptoms (78.77%), followed by mechanisms of injury (71.6%) and treatment and recovery (53.9%). College students had significantly higher mTBI knowledge accuracy, as well as higher accuracy on the mTBI symptom and mechanism items. There were no significant differences in knowledge of mTBI treatment and recovery between groups. Discussion:This study highlights the importance of mTBI education following an mTBI diagnosis. Explanations for these findings considering demographic and individual differences are provided, and clinical implications are discussed.

ABSTRACT:The goal of this study was to examine the general public's level of accuracy and confidence in knowledge of chronic traumatic encephalopathy (CTE), as well as information sources. This study also explored how these factors affected comfort in allowing children to play a high-contact sport. This study utilized online surveys and included 529 participants. Overall, CTE knowledge accuracy was 48.02% (standard deviation = 0.23). Inaccuracies regarding the etiology and diagnosis of CTE were most common, whereas the symptoms and lack of treatments for CTE were more widely known. Despite overall low CTE knowledge accuracy, CTE knowledge confidence was positively correlated with comfort in allowing children to play a high-contact sport (r = 0.199, P ≤ 0.001). Participants identified television/movies followed by web sites and social media as the most utilized CTE information sources. These results further support the need for clinicians and researchers to address misconceptions about CTE.

Background Depression is associated with cardiac-related events and cognitive dysfunction contributing to poorer health outcomes and quality of life. Specifically, after cardiac surgery, broad cognitive domains are negatively affected. To address cognitive dysfunction following cardiac surgery, researchers have tested non-pharmacological interventions with varied success. Depression is associated with worse cardiac and cognitive health outcomes yet depression’s potential contribution to interventions mitigating cognitive dysfunction following cardiac surgery is poorly understood. Aims This review aims to examine the impact of depression on the effectiveness of non-pharmacological interventions designed to minimize cognitive dysfunction associated with cardiac surgery. Methods A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed articles between January 2011 to February 2022 obtained from PubMed, MEDLINE, EMBASE, Psych INFO, CINAHL, and the Web of Science databases were screened for inclusion based on predetermined criteria. Each article was screened, and data was abstracted by two authors. Results Of 8128 articles screened, 442 were assessed for eligibility and 4 met inclusion criteria. Three of the studies did not report associated depression scale scores. The other study reported depression symptoms as mild to severe. Conclusion These findings suggest limited information exists regarding the relationship between depression and cognitive function among cardiac surgery patients who undergo non-pharmacologic interventions. Future studies should carefully examine symptoms of depression in relation to cognitive impairment post-cardiac surgery; such studies may further guide clinical interventions.

Objective:Insomnia affects 30-45% of the world population, is related to mortality (i.e., auto accidents and job-related accidents), and is related to mood and affect disorders such as anxiety and depression. Better understanding of insomnia via increased research will decrease the burden on insomnia. The neurocognitive model of sleep proposes that conditioned somatic and cognitive hyperarousal develop in response to repeated pairings of sleep-related stimuli with insomnia-related wakefulness. The purpose of this study was to examine the neurocognitive model of sleep using a novel laboratory paradigm, the Sleep Approach Avoidance Task (SAAT). It was hypothesized that individuals who report symptoms of insomnia will display a bias for negative sleep-related images from the SAAT, which is presumably a reflection of cognitive, behavioral and physiological processes associated with hyperarousal. It was also hypothesized that participants who report poor sleep would provide different subjective ratings for negative images (i.e., stronger valence and arousal) than individuals who reported better sleep.Participants and Methods:An initial sample of 66 healthy college-aged participants completed the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI) the Dysfunctional Attitudes and Beliefs about Sleep (DBAS) scale and the Epworth Sleepiness Scale (ESS). Participants also completed the SAAT. The SAAT was developed to assess sleep-related bias in adults. The SAAT is a visual, joystick controlled reaction time task that measures implicit bias for positive and negative sleep-related images. At the end of the task the participants are also asked to rate each image along three dimensions included valence, arousal and dominance.Results:There was a positive correlation between the SAAT and the ISI [r(61) = .30, p = .01], indicating that symptoms of insomnia are related to negative approach-related bias for sleep-related images. No other correlations were observed between the SAAT and self-report sleep measures. With regard to rating of images, higher dominance ratings for negative images were correlated with the SAAT [r(62) = .24, p = .03], which indicates that the approach bias for negative images is associated with “being in control.” Multiple linear regression was used to test if ISI scores and dominance ratings for negative images significantly predicted SAAT bias scores. The overall regression was statistically significant [r2 = .13, F(2, 58) = 4.15, p = .02]. ISI scores significantly predicted SAAT scores (ß = .27, p = .04), whereas dominance ratings for negative images did not significantly predict SAAT scores (ß = .20, p = .11). Exploratory correlational analyses were also completed for ratings of images and other sleep self-report measures. Valence ratings for positive sleep-related images were positively correlated with the ESS [r(64) = .36, p = .01], whereas valence ratings for negative sleep-related images were negatively correlated with the ESS [r(64) = -.24, p = .03].Conclusions:Hypotheses were partially supported with the ISI being the only self-report measure associated with negative bias for sleep-related images. While ratings of dominance are associated with bias for negative sleep-related images, these ratings do not provide unique variance. These findings indicate a cognitive processing bias for sleep-related stimuli among young adult poor sleepers. Limitations, implications for assessment and intervention are discussed.

Objective:There are many common beliefs within the general public about Chronic Traumatic Encephalopathy (CTE) that contradict research findings and scientific evidence. Therefore, the goal of this study was to examine the accuracy of CTE knowledge across three diverse samples.Participants and Methods:The three groups included in the sample were 333 college students (54%), 196 individuals from the public (32%), and 90 psychology trainees/clinicians (54%) for a total of 619 participants. Online surveys were used to collect the CTE knowledge accuracy (i.e., the number correct divided by the total number of questions) of the sample. The questions about CTE were adapted from Merz et al. (2017) and from the Sports Neuropsychology Society’s “CTE: A Q and A Fact Sheet.”Results:Overall, CTE knowledge accuracy was 52% (M = 51%, SD = .24). Regarding inaccurate beliefs, two-thirds of the sample believed that CTE was related to sports participation alone even if a head injury did not occur, and most participants believed that CTE could be caused by a single injury. Additionally, confidence in CTE knowledge was positively correlated with willingness to allow their child to play a high contact sport despite overall low CTE knowledge accuracy. Last, many participants reported education (67%) and health care providers (61%) as their main sources of CTE information while only 18% of participants cited television/movies. However, when asked to provide additional details about their CTE information source, many participants cited ESPN specials and the movie “Concussion” as the main reason they learned of the condition and sought out additional information.Conclusions:The results of this study are consistent with previous research on CTE knowledge accuracy. This further supports the need for clinicians and researchers to address misconceptions by providing information and scientific facts.

Background Delirium-related biochemical derangements lead to electrical changes that can be detected in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. Studies using limited lead EEG show a large difference between patients with and without delirium while discriminating delirium from other causes. Handheld rapid EEG devices may be capable of detecting delirium before symptom onset, thus providing an objective physiological method to detect delirium when it is most amenable to interventions. Objective The aim of this study was to explore the potential for rapid EEG to detect waveform pattern changes consistent with delirium status. Methods This prospective exploratory pilot study used a correlational design and mixed models to explore the relationships between handheld portable EEG data and delirium status. Results While being under powered minimized opportunities to detect statistical differences in EEG-derived ratios using spectral density analysis, sleep-to-wake ratios tended to be higher in patients with delirium. Conclusions Limited lead EEG may be useful in predicting adverse outcomes and risk for delirium in older critically ill patients. Although this population is at the highest risk for mortality, delirium is not easily identified by current clinical assessments. Therefore, further investigation of limited lead EEG for delirium detection is warranted.

TOPIC Post-intensive care syndrome is a collection of symptoms that more than half of patients who survive a critical illness, and their family caregivers, experience after the illness. Those symptoms include weakness/fatigue, sleep disturbances/insomnia, cognitive dysfunction, posttraumatic stress disorder, other mental health conditions, and a lack of effective coping strategies. CLINICAL RELEVANCE To minimize the risk of a patient developing post-intensive care syndrome, intensive care unit nurses must adopt practices that reduce the severity of disability and optimize patient outcomes. They must also advocate for patients who need additional expert care. PURPOSE To describe interventions that critical care nurses can implement to minimize a patient's risk for post-intensive care syndrome. CONTENT COVERED This article describes patients who have a high risk of developing post-intensive care syndrome and interventions that are within nurses' purview.

Objective: Although the annual number of traumatic brain injuries (TBIs) reported in the US exceeds two million, data suggests that this is an underestimate. The goal of this study was to understand lifetime TBI incidence among a sample of college students. Additionally, this study examined whether a single yes/no question regarding TBI history was sufficient to gather accurate information about TBI incidence in college students.Design: Participants were asked a single TBI question and administered the BAT-LQ.Main Measures: The BAT-LQ is a screening tool designed to assess for probable lifetime TBIs.Results: Data from 121 participants were analyzed for this study. On the single-question, 24.8% of participants reported experiencing a TBI. However, upon further prompting, 76.8% of all participants reported experiencing a blow to the head accompanied by at least one diagnostic symptom of a TBI, suggesting a probable TBI based on best-practice diagnosis guidelines.Conclusion: The results of this study suggest that increased education about TBI is warranted to ensure that individuals receive care for probable TBIs, as many individuals likely lack knowledge about what constitutes a TBI diagnosis. Additionally, the results suggest that a single question may not be sufficient to capture true lifetime TBI incidence.

The majority of the population identifies as right-hand dominant, with a minority 10.6% identifying as left-hand dominant. Social factors may partially skew the distribution, but it remains that left-hand dominant individuals make up approximately 40 million people in the United States alone and yet, remain underrepresented in the motor control literature. Recent research has revealed behavioral and neurological differences between populations, therein overturning assumptions of a simple hemispheric flip in motor-related activations. The present work showed differentially adaptable motor programs between populations and found fundamental differences in methods of skill acquisition highlighting underlying neural strategies unique to each population. Difference maps and descriptive metrics of coherent activation patterns showed differences in how theta oscillations were utilized. The right-hand group relied on occipital parietal lobe connectivity for visual information integration necessary to inform the motor task, while the left-hand group relied on a more frontal lobe localized cognitive based approach. The findings provide insight into potential alternative methods of information integration and emphasize the importance for inclusion of the left-hand dominant population in the growing conceptualization of the brain promoting the generation of a more complete, stable, and accurate understanding of our complex biology.

Purpose The impact of sleep-related changes and disorders in the geriatric populations are of utmost concern due to health consequences and increased risk of injury as well as injuring others as a result of poor sleep. The purpose of this paper is to provide a brief review of the current state of the literature with regard to sleep, aging, common non-pharmacological interventions, and the potential use of exercise in combination with behavioral interventions. Methods Initially, this manuscript focuses on a brief (nonsystematic) review of sleep parameters and physiology that are associated with the aging process. Subsequently, information regarding sleep disorders in the elderly in general, and insomnia in particular are discussed. Last, a brief review of current recommended interventions is provided. Results The current major nonpharmacological interventions are described including Cognitive Behavioral Therapy for Insomnia (CBT-I). The potential use of exercise as a safe intervention for poor sleep is discussed. Finally, a call is made for increased research that examines the combination of traditional behavioral interventions with exercise.

ABSTRACT INTRODUCTION: Accurate communication of information regarding fluctuations in level of consciousness is critical. It is, important for nurses to understand terms related to consciousness to appropriately assess and implement plans of care. CONTENT: Although the neurobiology of consciousness is complex and multifaceted, consciousness can be conceptualized as having 2 distinct but interrelated dimensions: arousal and awareness. The different levels of consciousness are thought to fall on a continuum ranging from being fully awake to coma. CONCLUSION: This article focuses on the terms of consciousness, awareness, and arousal along with nursing implications where appropriate.

Objective: There is a need for examination of sleep across the entire adolescence to young adulthood developmental period (AYA; ages 12-25 years). The Adolescent Sleep Wake Scale (ASWS) is a 28-item measure of overall subjective sleep quality, including five sleep behavior domains (difficulty going to bed, falling asleep, maintaining sleep, reinitiating sleep, and returning to wakefulness), and has been validated to assess overall sleep quality and insomnia symptoms in adolescents (12-18 years). The current study aimed to examine whether the ASWS could be used to assess sleep across the AYA period by investigating the validity of the measure in a national sample of young adults (ages 19-25) using validated adult sleep measures. Materials and methods: A national sample recruited through Amazon's MTurk (N = 332; Mean age = 23.37 (SD = 1.55); 53.8% female; 51.4% Caucasian) completed an online survey including the ASWS, the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Bivariate correlational analyses were performed to explore convergent and discriminant validity. Results: The ASWS total score was strongly correlated with both the PSQI total score (r = -0.68) and ISI (r = -0.71) total score. The subscales of the PSQI, including Sleep Latency, Sleep Disturbance, and Daytime Dysfunction were correlated with corresponding ASWS domains. There were weak correlations with other subscales. Internal consistency was good (alpha = 0.88). Conclusions: Our results suggest that the ASWS measures areas of sleep problems in a manner consistent with the most frequently utilized self-report assessment in adults and supports the use of the ASWS across AYA. (C) 2020 Elsevier B.V. All rights reserved.

In 2018, the Society of Critical Care Medicine published the Pain Agitation Delirium Immobility and Sleep Disruption guidelines that recommend protocol assessment-based pain and sedation management. Since the publication of these guidelines, multiple studies and meta-analyses have been conducted comparing sedative options in the Intensive Care Unit (ICU) setting including dexmedetomidine and propofol. Sedatives are on a continuum when it comes to delirium risk. Propofol, like benzodiazepines, causes changes in sleep patterns by suppressing the rapid eye movement sleep stage not seen with dexmedetomidine, worsening the ICU patient's already poor sleep quality. This reduction in sleep quality increases the risk of delirium. As patient advocates, advanced practice nurses play a vital role in minimizing risk of patient harm. Sedative use and management are areas of opportunity for nurses to minimize this risk. When sedatives are needed, daily sedation vacations should be conducted to re-evaluate the minimum required dose. These practices can reduce sedation risks for delirium and allow for bedside screening and early detection.

Abstract Introduction Poor sleep quality has adverse effects ranging from decreased focus to increased work-related injuries. The Perceptual Vigilance Task (PVT), a measure of reaction time (RT) used to assess alertness is commonly used in sleep research. This study focuses on the relationship between dysfunctional sleep-related cognitions (Dysfunctional Beliefs and Attitudes About Sleep Scale [DBAS]), insomnia severity (Insomnia Severity Index [ISI]), and sleepiness (Epworth Sleepiness Scale [ESS]) and their association to PVT RT. Methods 162 participants were recruited from East Carolina University. Inclusion criteria: right-handed adults; exclusion criteria: history of brain injury, seizure disorder, or vision impairment. Age range 18–39 (M = 20.15; SD = 3.01); 81 (49.1%) females. Results ISI was correlated with PVT RT for inter-stimulus interval delay times of 1000ms r(162) = .155, p =.05, 2000ms r(162) = .204, p = .009, 5000ms r(162) =.164, p = .04, and 6000ms r(162) = .181, p = .02. DBAS was correlated with PVT RT for delay times of 2000ms r(162) = .204, p =.021, 3000ms r(162) = .160, p = .04, 4000ms r(162) = .170, p = .03, 6000ms r(162) = .171, p = .030, 7000ms r(162) = .219, p =.005, and 8000ms r(162) = .158 p = .045. ESS was not correlated with PVT. A regression was calculated to predict reaction time at 7000ms delay based on the DBAS (F(1,151) = 2.51, p = .01), with an R2 of .12. Conclusion There is a diminishing association found between insomnia severity and RT during inter-stimulus delay times (>6000ms). Dysfunctional beliefs about sleep correlate with RT through 8000ms delay, eventually predicting RT. Regardless of severity of sleep disturbance, sleep-related bias may affect subjective feelings of wakefulness and objective levels of alertness (e.g., one who believes they are not obtaining sufficient sleep may act accordingly). Support N/A

Survival following traumatic brain injury (TBI) has increased following advances in medical care. However, TBI survivors often experience significant deficits in cognitive function, psychological disturbance, and residual physical deficits. The caregivers for these survivors, who are often family members, may have limited capacity to provide the services and care that are required. Limitations in capacity may be attributable to poor preparation, increased burden, lack of appropriate resources, and lack of required support. Likewise, there are resultant consequences for the caregiver and the survivor. The purpose of this paper is to review issues associated with caregiver capacity including preparation, burden, burnout, and consequences. In the latter portion of the paper, assessment of caregiver readiness and understanding and intervention is described (as well as current limitations). The final portions of the paper describe future directions, the call for increased research, and medicolegal implications.

Background: Affective competencies, as demonstrated by behaviors acted upon by people, are essential components in providing optimal care and receiving trust from patients and clients of physical (PTs) and occupational therapists (OTs). These, along with knowledge and skills, have to be developed early on in the educational system. If these are generated, PT and OT schools will be guided on how to inculcate them in their respective outcomes-based education designs, from planning to assessment. Assessment of the manifestation of these affective competencies is a challenge to educators; thus, the need for behavioral indicators for each. This study developed a list of the necessary affective competencies and their behavioral indicators for PT and OT. Methodology: A sample of experts from different fields of practice in the PT and OT population groups underwent three rounds of generation and refinement to create a list of affective competencies and their consequent behavioral indicators. To come up with the final list, testing for group consistency was done using Cronbach’s alpha and mean ranks. Results: Forty-two PT and twenty-five OT experts generated the final list of affective competencies and their behavioral indicators. For the PTs, those competencies are accountability, adaptability/flexibility, altruism, compassion, creativity, diligence, effective communication, ethical reasoning, excellence, honesty, MA. LIEZEL V. BUMANGLAG,