To evaluate neuropsychological assessments by telephone on patients with mild-severe TBI to facilitate follow-up evaluations and research studies when in person assessment is not feasible.

Objectives: To (1) identify informal caregivers to injured US service members following acute rehabilitation for polytraumatic injuries, principally traumatic brain injury (TBI), and (2) describe the prevalence and variation of care recipient and caregiver experiences. Design: Cross-sectional survey of caregivers. Participants: Caregivers (N = 564) of service members with TBI who received inpatient rehabilitation care in a Veterans Affairs' Polytrauma Rehabilitation Center between 2001 and 2009. Main Outcome Measures: Questions about caregiver and patient characteristics, type, and quantity of care currently being provided. Results: Caregiving responsibilities fall primarily on women (79%), typically a parent (62%) or spouse (32%). After a median 4 years since injury, 22% of patients still required assistance with activities of daily living and instrumental activities of daily living. An additional 48% required assistance with only instrumental activities of daily living. Nearly 25% of caregivers reported more than 40 h/wk of care and another 20% reported 5 to 40 h/wk of care. Of caregivers providing assistance with activities of daily living, 49% provided care ≥80 h/wk. Nearly 60% of caregivers were solely responsible for the caregiving. Most caregivers also reported providing other help, including managing emotions and navigating health and legal systems. Conclusions: Caregivers who provide assistance with either activities of daily living or instrumental activities of daily living may need additional resources to meet the long-term needs of their injured family member.

Increased length of the cavum septum pellucidum (CSP) and in utero infection are each associated with increased risk of schizophrenia. Hence, we examined whether prenatal infections are related to CSP length in schizophrenia patients. In a well-characterized birth cohort, in utero infection was assessed using serologic biomarkers or physician diagnoses. Magnetic resonance images were acquired, and CSP length was quantified by a standard protocol. In utero infection was associated with increased CSP length in exposed schizophrenia cases compared to unexposed cases, suggesting that prenatal infection plays a role in a neurodevelopmental morphologic anomaly that has been related previously to schizophrenia.

Objective: Executive dysfunction is one of the most prominent and functionally important cognitive deficits in schizophrenia. Although strong associations have been identified between executive impairments and structural and functional prefrontal cortical deficits, the etiological factors that contribute to disruption of this important cognitive domain remain unclear. Increasing evidence suggests that schizophrenia has a neurodevelopmental etiology, and several prenatal infections have been associated with risk of this disorder. The authors examined whether prenatal infection is associated with executive dysfunction in patients with schizophrenia. Method: The authors assessed the relationship between serologically documented prenatal exposure to influenza and toxoplasmosis and performance on the Wisconsin Card Sorting Test and the Trail Making Test, part B (Trails B), as well as other measures of executive function, in 26 patients with schizophrenia from a large and well-characterized birth cohort. Results: Patients who were exposed to infection in utero committed significantly more total errors on the Wisconsin Card Sorting Test and took significantly more time to complete the Trails B than unexposed patients. Exposed patients also exhibited deficits on figural fluency, letter-number sequencing, and backward digit span. Conclusions: Prenatal infections previously associated with schizophrenia are related to impaired performance on the Wisconsin Card Sorting Test and Trails B. The pattern of results suggests that cognitive set-shifting ability may be particularly vulnerable to this gestational exposure. Further work is needed to elucidate the specificity of prenatal infection to these executive function measures and to examine correlates with neuroanatomic and neurophysiologic anomalies.

Setting: Tertiary medical center. Program: Veterans Affairs (VA) polytrauma network sites. Program Description: As soldiers return from combat in Iraq and Afghanistan, the United States is seeing a large influx of patients into the VA Healthcare System. The growing population of new combat veterans prompted the VA to establish a polytrauma system of care with inpatient to outpatient programs. The polytrauma network sites (PNS) are designated to coordinate patient care on an outpatient basis. We report our local PNS experience, with the hope that lessons learned are shared among other PNS clinics across the country. An electronic screening process is automatically triggered at a veteran’s first point of contact within our regional network. A case worker reviews the referrals and determines who would need further assessment through phone interviews. Those who need and desire further evaluation and treatment are scheduled in-person evaluations. Assessment/Results: From its inception in July 2006 to January 2007, our PNS clinic received a total of 135 referrals, 86 of whom completed phone screening, and 51 of whom were scheduled for appointments. Each patient was systematically evaluated by members of the PNS team. Individualized treatment planning was provided via interdisciplinary team meetings. While 76% of the patients were exposed to blasts or explosions, 56% had transient alteration of consciousness. We found a high prevalence of post-traumatic stress disorder (70%) and cognitive impairment (50%). Moreover, 36% of patients failed the hearing screening, 50% reported tinnitus, and 15% reported vertigo. While 65% of patients reported vision-related complaints, only 29% had visual acuity impairments.Discussion: The local PNS clinic provided comprehensive screening, rehabilitation, and care coordination for veterans with physical and emotional traumas. Conclusions: Through the PNS, health care is being delivered to many of our wounded soldiers.

AAP Annual Meeting Abstracts: Abstracts of the Scientific Papers and Posters Presented at the Annual Meeting of the Association of Academic Physiatrists: Tucson, Arizona February 22–26, 2005: Poster Board Presentations

The LEP accelerator was installed in a circular tunne l 27 km in length with nine access points distributed around the circumference in the countryside and villages which surround CERN’s sites. The dismantling project involved the removal in less than 15 m onths of around 29000 tonnes of equipment from the accelerator itself and a furt her 10000 tonnes from the four experiments - all of which were located at an average depth of 100 m below ground level. There was no contamination risk in the project and less than 3% of the materials removed were classified as radioactive. However, the materials which were classified as radioactive have to be temporarily stored and they consume considerable resources. The major difficulties for the project were in the establishment of the theoretical radiological zoning, implementation of the traceability systems and making appropriate radiation measurements to confirm the zoning. The absence of detailed guidelines from the Fren ch authorities, having no threshold levels for release of radioactive materials and being the first dismantling project of a large accelerator made the task more difficult and more expensive. Further difficulties remain b ecause materials classified as having very weak radioactivity (tres faiblement actif -TFA) by the zoning study which have no induced activity have to be treated in the same way as radioactive waste. This paper describes the organisation of the project and its execution and examines some of the problems which arise from the INB system; the radiation protection aspects of the project are discussed in the paper entitled “Declassement du grand collisionneur d’electrons/positrons (LEP) du CERN”, also presented at this conference.