A Combined sEMG and Accelerometer System for Monitoring Functional Activity in Stroke

Remote monitoring of physical activity using bodyworn sensors provides an alternative to assessment of functional independence by subjective, paper-based questionnaires. This study investigated the classification accuracy of a combined surface electromyographic (sEMG) and accelerometer (ACC) sensor system for monitoring activities of daily living in patients with stroke. sEMG and ACC data were recorded from 10 hemi paretic patients while they carried out a sequence of 11 activities of daily living (Identification tasks), and 10 activities used to evaluate misclassification errors (non-Identification tasks). The sEMG and ACC sensor data were analyzed using a multilayered neural network and an adaptive neuro-fuzzy inference system to identify the minimal sensor configuration needed to accurately classify the identification tasks, with a minimal number of misclassifications from the non-Identification tasks. The results demonstrated that the highest sensitivity and specificity for the identification tasks was achieved using a subset of 4 ACC sensors and adjacent sEMG sensors located on both upper arms, one forearm, and one thigh, respectively. This configuration resulted in a mean sensitivity of 95.0 %, and a mean specificity of 99.7 % for the identification tasks, and a mean misclassification error of < 10% for the non-Identification tasks. The findings support the feasibility of a hybrid sEMG and ACC wearable sensor system for automatic recognition of motor tasks used to assess functional independence in patients with stroke.

A service evaluation of an occupational health Covid-19 referral pathway

Background

A rapid management referral pathway was established by a private UK occupational health (OH) provider to offer assessments and advice on managing individual risk relating to Covid-19 in the workplace.

Aims

The aim of this service evaluation was to assess the utilization and effectiveness of the pathway in supporting referrers during a pandemic.

Methods

Referrals between March–August 2020 were analysed by date and industry to assess service utilization. A survey was sent to a convenience sample of referrers throughout this period, requesting feedback on whether the report led to a change in how the worker was managed, and whether it increased referrer confidence in managing the worker.

Results

Five hundred and seventy referrals were made, predominantly from wholesale and retail; professional, scientific and technical; and food and drink production. There was a small peak of referrals from manufacturing in April and a larger peak in July–August from wholesale and retail, and food and drink production. Of 166 surveys sent, 58 were completed (35% response rate). In 71% of cases, referrers indicated that the report led to change in how the worker was managed, and in 86% of cases, referrers reported being more confident in managing the worker.

Conclusions

The pathway was well-utilized. OH assessments and advice have an important role to play in a pandemic, with useful impact on how workers are managed and how confident managers feel in managing workers.

Behavioral and neuroanatomical outcomes following altered serotonin expression in a hypoxic-ischemic injury neonate rodent model

BACKGROUND

Children born prematurely (<37 gestational weeks) are at risk for a variety of adverse medical events. They may experience ischemic and/or hemorrhagic events leading to negative neural sequelae. They are also exposed to repeated stressful experiences as part of life-saving care within the neonatal intensive care unit (NICU). These experiences have been associated with methylation of SLC6A4, a gene which codes for serotonin transport proteins, and is associated with anxiety, depression, and increased incidence of autism spectrum disorders.The purpose of this study was to examine the effects of altered serotonin levels on behavioral and neuroanatomical outcomes in a neonatal rodent model with or without exposure to hypoxic-ischemic (HI) injury.

METHODS

Wistar rat pups were randomly assigned to either HI injury or sham groups. Pups within each group were treated with a chronic SSRI (Citalopram HBr) to simulate the effects of SLC6A4 methylation, or saline (NS). Subjects were assessed on behavioral tasks and neuropathologic indices.

RESULTS

HI injured subjects performed poorly on behavioral tasks. SSRI subjects did not display significantly greater anxiety. HI + SSRI subjects learned faster than HI+NS. Histologically, SSRI subjects had predominantly larger brain volumes than NS.

CONCLUSION

SSRI treated subjects without injury showed patterns of increased anxiety, consistent with theories of SLC6A4 methylation. The paradoxical trend to improved cognition in HI+SSRI subjects relative to HI alone, may reflect an unexpected SSRI neuroprotective effect in the presence of injury, and may be related to serotonin-induced neurogenesis.

Clostridium difficile toxins or infection induce upregulation of adenosine receptors and IL-6 with early pro-inflammatory and late anti-inflammatory pattern

Clostridium difficile causes intestinal inflammation, which increases adenosine. We compared the expression of adenosine receptors (AR) subtypes A1, A2A, A2B, and A3 in HCT-8, IEC-6 cells, and isolated intestinal epithelial cells, challenged or not with Clostridium difficile toxin A and B (TcdA and TcdB) or infection (CDI). In HCT-8, TcdB induced an early A2BR expression at 6 h and a late A2AR expression at 6 and 24 h. In addition, both TcdA and TcdB increased IL-6 expression at all time-points (peak at 6 h) and PSB603, an A2BR antagonist, decreased IL-6 expression and production. In isolated cecum epithelial cells, TcdA induced an early expression of A2BR at 2s and 6 h, followed by a late expression of A2AR at 6 and 24 h and of A1R at 24 h. In CDI, A2AR and A2BR expressions were increased at day 3, but not at day 7. ARs play a role in regulating inflammation during CDI by inducing an early pro-inflammatory and a late anti-inflammatory response. The timing of interventions with AR antagonist or agonists may be of relevance in treatment of CDI.

The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery

Objective:

To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons.

Methods:

Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups.

Results:

More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures.

Conclusion:

Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology.

Level of evidence:

Level IV

1212 A Systematic Assessment Of Engagement, Functionality, Aesthetics, Information, And Recommendation Features In Sleep Mobile Applications

Introduction

Initial download and use of sleep tracking is very high, but prolonged use is very low. Poor prolonged use may be attributable to several factors such as engagement, functionality, aesthetics, information, and recommendation. We appraised these five factors in 16 consumer- and research/medical- grade digital sleep devices.

Methods

Three reviewers independently assessed 16 consumer- and medical-grade sleep digital devices using the Mobile Application Rating Scale (MARS) App quality ratings, which measures engagement (engagement, entertainment, interest, customization, interactivity, target group), functionality (functionality, performance, ease of use, navigation, gestural design), aesthetics (layout, graphics, visual appeal), information (Accuracy. Goals, Quality of information, Quantity of information, Visual information, Credibility, and Evidence base) and recommended on a Likert scale, with 1- Inadequate to 5 Excellent. Each subcategory is rated on a 1-5 Likert scale which is summed for each category: engagement (30), functionality (25), aesthetics (15), information (35) and recommended (yes or no).

Results

Devices that had the highest engagement score were Fitbit (27), Apple Watch (27), Garmin (27), and Dreem 2 headband (25.5). Apple Watch (30) had highest score; while Fitbit (13), Apple Watch (13), Garmin (13), Samsung Gear (13) had highest aesthetic score. While for information, ActiGraph (35), SOMNOwatch plus (35), CleveMed SleepView Monitor (35), CleveMed Sapphire PSG (35), SOMNOscreen plus (35), Nox T3 Sleep Monitor (35) and Nox A1 PSG System (35) had the highest ratings. The Dreem 2 headband has the potential induce prolong use among users with and without sleep disorders, based on high scores on engagement (25.5), Functionality (20.5), and Information (26.5).

Conclusion

Consumer- and research-grade digital devices that measure sleep have varying levels of engagement, functionality, aesthetics, information and recommendations to facilitate prolong use. Consumer grade devices had higher engagement, functionality and aesthetics scores, while research grade devices had higher information and recommendation scores. If consumer- and research-grade devices are to have prolonged use, standardization is needed across the five MARS components.

Support

K01HL135452, R01MD007716, R01HL142066, and K07AG052685

1102 Relationship Between Emotional Distress And Sleep Duration Among Hispanics Using The 2018 National Health Interview Survey Dataset

Introduction

Although Hispanics experience a high level of shorter sleep duration (&lt; 7 hrs./24 period), a clear mechanism or cause is lacking. Previous research indicate that emotional distress may explain the burden of shorter sleep among blacks. Applying these findings to Hispanics, we investigated whether emotional distress explains the burden of short sleep duration (&lt; 7 hrs.) among Hispanics and if this relationship varies by sex

Methods

We used data from the 2018 National Health Interview Survey (NHIS) dataset, a nationally representative sample, in which only Hispanic ethnicity participants (N=3,091) were analyzed. Average sleep duration was self-reported and measured in hours. Emotional distress was measured using Kessler 6, which measures how an individual felt over the past 30 days: nervous, hopeless, restless/fidgety, depressed, effortful and worthless. To assess the association between short sleep duration and emotional distress, we performed Pearson correlation, hierarchical regression analyses, and stratified this relationship by sex to determine if this relationship differed between males and females, adjusting for covariates.

Results

Of the total sample of 3,091 Hispanics, 1,762 were female, and 1,329 were male. Sleep duration and emotional distress were negatively correlated among females (r = -.27, p &lt;.001) and males (r=-.18, p &lt;.001). Among Hispanic females, sleep duration significantly predicted emotional distress, β = -.27, t = -11.60, p &lt;.001, and explained a significant portion of variance in emotional distress, R2 = .07, F= 134.63, p &lt;.001. While, among Hispanic males, sleep significantly predicted emotional distress (β = -.18, t =-6.5, p &lt;.001) and explained a significant portion of the variance in emotional distress (R2 = .03, F= 42.37, p &lt;.001).

Conclusion

Our findings indicate that a negative sleep-ED relationship, suggesting that shorter sleep was predictive of higher levels of emotional distress among Hispanics and that this relationship is greater among Hispanic females, compared males.

Support

K01HL135452, R01MD007716, R01HL142066, and K07AG052685

1113 Physical Activity Moderates The Sleep-emotional Distress Relationship, But Less So Among Blacks Vs. Whites

Introduction

Emotional distress (ED) is associated with poor sleep. Research shows that minority populations experience greater vulnerabilities to both ED and poor sleep. Interventions such as relaxation training and behavioral therapy address this relationship but are not always successful. Research shows that physical activity (PA) is negatively associated with ED and positively associated with sleep duration. However, it is unclear whether PA attenuates the relationship between ED and sleep, and if this relationship differs by race/ethnicity.

Methods

We analyzed data from the 2005-2015 National Health Interview Survey (NHIS), a nationally representative dataset of 416,152 participants. ED, hours of PA per day, and average sleep duration were collected. Regression models with covariates (age, sex, employment status, BMI) were used to analyze the moderation effect of PA within sleep and ED. Regression models were stratified by race/ethnicity.

Results

261,686 participants (45,926 blacks, 17.55%, and 215,760 whites, 82.45%) responded with the required variables for analysis. 63% of participants reported at least some physical activity. The results of the regression showed that a significant amount of variance in ED stemmed from sleep duration; F (7, 121088) = 1,619.72, p &lt; 0.001. PA was found to have a significant main effect, t(121,088) = 9.01, p= &lt;0.001. There was a significant moderation effect of PA, t(121088) =7.26, p &lt; 0.001. Stratification showed that the moderation effect of PA was not significant among blacks t(121,088) = -1.45, p=0.149 and significant among whites b = -.08, t(101,754) = -7.82, p &lt; 0.001.

Conclusion

The present study found support for moderation of PA in the sleep-ED relationship. However, it found that blacks do not experience the same benefits of PA in this relationship as whites. Further research should be performed to understand the connection of PA to sleep duration and ED.

Support

This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, K01HL135452, and K07AG052685

1189 Recruiting, Training, And Implementing Sleep Health Educators In Community-based Research To Improve Sleep Health

Introduction

Adherence to OSA assessment and treatment is low among racial/ethnic minorities, particularly among blacks. Navigating patients along the continuum of care from assessment to treatment adherence requires motivation, social support, and self-efficacy. Previous studies indicate that community health educators can provide motivation, social support, and skills to patients to better navigate the complex OSA care continuum. However, recruiting, training, and implementing sleep health educators in clinical or research settings is complex. For the current study, we describe how we recruit, train, and implement sleep health educators in research and clinical settings and assess what makes a sleep health educator successful.

Methods

We recruited and trained twenty-five self-identified black sleep health educators for a randomized clinical trial (R01MD007716) focused on increasing OSA assessment and treatment adherence among blacks. During recruitment, we assessed key personality attributes that translate to being an effective sleep health educator, via behavioral and personality surveys, focused groups, and process forms filled out by educators. Sleep health educators underwent an 8-week training program on sleep health and motivational interviewing. In order to be certified, sleep health educators had to pass a written and scenario-based assessment. During the implementation phase of the trial, we assessed how many interviews each health educator conducted and whether individual characteristics were related to how many interviews.

Results

Of the trained educators, 80% were female, ranging from 25 to 58 years old. They all completed at least high school. All educators rated the program highly and were very satisfied with dispensing tailored sleep health education. Educators who displayed the highest knowledge about sleep health, provided frequent emotional and strategic support, committed to helping their assigned participants, and who rated their rapport highly with their assigned participants were most effective in getting their participant to adhere to OSA assessment and treatment.

Conclusion

Sleep health educators can be vital to increasing OSA assessment and treatment adherence among blacks. In order to ensure success, sleep health educators must undergo a thorough recruitment, training, and implementation and dissemination process.

Support

K01HL135452, R01MD007716, R01HL142066, K01HL135452,and K07AG052685

0621 Utilization of the Ares to Predict OSA Among Blacks Using Home-Based Watchpat Recording

Introduction

In two waves of data we collected in Brooklyn New York, we observed blacks were at high risk for obstructive sleep apnea (OSA). In the NIH-funded study ‘Metabolic Syndrome Outcome Study (MetSO), blacks enrolled from primary-care settings had a 59% risk of OSA. Similarly, blacks surveyed in churches and barbershops had a 43% risk of OSA. While these studies showed higher than expected risk as noted in the general population (29%), it remains uncertain how many of those blacks would be diagnosed with OSA in that population. The purpose of this study was to explore the rate of OSA using the WatchPat device in a community-based setting.

Methods

Data were collected from an NIH-funded study ‘Peer-Enhanced Education to Reduce Sleep Ethnic Disparities, designed to navigate blacks at risk of OSA to receive timely diagnosis and treatment using peer-delivered linguistically and culturally tailored sleep health education. Blacks were screened for OSA using the Apnea Risk Evaluation System (ARES) Questionnaire; a score ≥6 denoted moderate-high OSA risk. Individuals were asked to wear the WatchPAT 200 for one night during a week-long sleep assessment. WatchPat 200 measures SaO2 to determine respiratory-related arousals, defined as an Apnea-Hypopnea Index (AHI) ≥5, which is used to identify and diagnose OSA. We used SPSS 25.0 to perform logical regression analysis to assess associations between ARES and WatchPat AHI.

Results

A sample of 111 blacks provided valid ARES and WatchPat data for the present analyses. Of the sample, the mean age was 62.26 (SD=13.52 years; female = 55%); 49% reported annual income &gt;20K and 79.5% reported a high school education. Moreover, 27% reported high blood pressure, 13%, diabetes, and 65% were overweight/obese. Multivariate-adjusted logical regression analyses indicated that blacks at risk for OSA were 66% more likely to receive an OSA diagnosis based on WatchPat AHI data (OR = 1.662, p &lt; 0.01). The model adjusted for age, sex, income, and education.

Conclusion

The present study demonstrated that blacks at risk for OSA at the community level have a significant likelihood of receiving an OSA diagnosis using home-based recordings.

Support

NIH Support (T32HL129953, RO1MD007716, K01HL135452 and K07AG052685).

1114 Urbanicity And The Sleep-mental Health Relationship

Introduction

Inadequate sleep has been found to be associated with poor mental health. This is especially true in low-income and minority populations, who are concentrated in cities. It is not understood to what degree living in a city vs. a rural environment affects sleep and resulting mental health outcomes. This study seeks to understand how living in an urban environment affects the relationship between inadequate sleep and mental health.

Methods

The study used data from the 2018 US Behavioral Risk Factor Surveillance System (BRFSS,) a nationwide health dataset collected by telephone. Respondents were classified as living in either an urban or rural environment based on their zip code. Respondents reported hours of sleep per night and mental health status. This study classified mental health status based on whether the respondent reported one or more incidences of poor mental health in the previous 30 days.

Results

After filtration, 348,540 respondents were split into urban and rural groups. Binary logistic regression was run in each group to compare how much living in an urban environment contributed to the relationship between sleep duration and mental health. Sleep in the analysis was found to significantly contribute to both models; urban X2(15, N=295,796) = 11,485.70, p &lt;0.001 rural X2(15, N=52,744) = 2,465.64, p &lt;0.001. The estimated odds ratio resulted in a decrease of 13.9% [Exp(B) = 0.861] in reported poor mental health for every unit increase of sleep in the urban population, and decrease of 14.9% [Exp(B) = 0.851] in the rural population.

Conclusion

In urban and rural dwellers, sleep duration predicted poor mental health. Contrary to expectations, sleep was more strongly tied to mental health in rural than urban populations. This was true even after controlling for sex, income, and education level. Further research should seek to understand how environment affects sleep and mental health.

Support

This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, K01HL135452, and K07AG052685.

Nutritional geometry of mitochondrial genetic effects on male fertility

Organismal fitness is partly determined by how well the nutritional intake matches sex-specific metabolic requirements. Metabolism itself is underpinned by complex genomic interactions involving products from both nuclear and mitochondrial genomes. Products from these two genomes must coordinate how nutrients are extracted, used and recycled, processes vital for fuelling reproduction. Given the complicated nature of metabolism, it is not well understood how the functioning of these two genomes is modulated by nutrients. Here we use nutritional geometry techniques on Drosophila lines that only differ in their mtDNA, with the aim to understand if there is nutrient-dependent mitochondrial genetic variance for male reproduction. We first find genetic variance for diet consumption, indicating that flies are consuming different amounts of food to meet new physiological requirements. We then find an interaction between mtDNA and diet for fitness, suggesting that the mtDNA plays a role in modulating diet-dependent fitness. Our results enhance our basic understanding of nutritional health and our chimeric genomes.

Dry Rehydratable Film Method for Enumerating Confirmed Escherichia coli in Poultry, Meats, and Seafood: Collaborative Study

A rehydratable dry-film plating method for Escherichia coli, the Petrifilm E. coli/Coliform (EC) Count Plate in foods, has been compared with the AOAC INTERNATIONAL most probable number (MPN) method. Eleven laboratories participated in the collaborative study. Three E. coli levels in 8 samples each of frozen raw ground turkey, frozen raw ground beef, and frozen cooked fish were tested in duplicate. Mean log counts for the Petri film plate procedure were not significantly different from those for the MPN procedure for cooked fish samples inoculated with low or high inocula levels, for samples of raw turkey inoculated at medium level, and for beef inoculated at low, medium, and high levels. Repeatability and reproducibility vari ances of the Petrifilm EC Plate method recorded at 24 h were as good as or better than those of the MPN method. The dry rehydratable film method for enumerating confirmed E. coli in poultry, meats, and seafood has been adopted first action by AOAC INTERNATIONAL.

Country Report: The Report of Transplant Activity and Outcome During the First 12 Months at the First National Hematopoietic Stem Cell Transplant Center in Sri Lanka

Sri Lanka is a developing country with a population of 21 million. Nation Cancer Institute (NCI) is the largest tertiary cancer centre with universal health coverage. Absence of hematopoietic stem cell transplant (HSCT) was a major deficiency as most patients cannot afford transplant abroad. In 2013-14, NCI decided to establish the first National HSCT center in collaboration with St. Vincent's Hospital Sydney. Eventually, the first Autologous HSCT was established at NCI in December 2016. Patients with multiple myeloma (MM) in very good partial remission or better remission, and patients with relapsed Non-Hodgkin's lymphoma (NHL) and Hodgkin lymphoma (HL), who were less than 65 years with good performance status were selected. Stem cells were mobilized with cyclophosphamide and G-CSF and the products were cryopreserved. Melphalan was the conditioning regime for MM while BEAM was used for HL and NHL. Twenty autologous transplants were performed in the first year. Mean age was 47 years (range: 17-62) and male to female ratio was 3: 2. There were 17 MM and one each of NHL, HL and POEMS syndrome patients. Median CD34＋ stem cells collected was 12.72×106/kg (range: 3-31) and median infused cell dose was 4.07×106/kg (range: 2-7.4). Median engraftment day was 13 (range: 11-19) and median hospitalization was 16 days (range: 14-20). All developed febrile neutropenia and GradeⅢ thrombocytopenia. Zero transplant-related mortality was observed with acceptable morbidity. At the median follow-up of 47 weeks, the overall survival was 100% with all the patients still in remission.

A-21 Inhibition of Overlearned Verbal Responses and Quantity of Speech Among Age Cohorts

Objective

Off-topic speech (OTS) has been linked with deficits in executive functioning, and specifically inhibition. OTS research has focused primarily on tangentiality, whereas in this study we focused on quantity of speech. The purpose of this study was to investigate the relationship between inhibition of overlearned responses using a Stroop task and quantity of speech.

Method

A college sample of young adults (n = 63; age 18-28) and healthy, community-dwelling older adults (n = 76; age 60-99) completed the Delis-Kaplan Executive Function Systems (D-KEFS) Color-Word Interference Test and provided a verbal sample in which they recounted a procedural memory and an episodic memory. These samples were transcribed and rated for quantity of speech by three independent judges.

Results

Among all participants, longer time to complete color naming (r = -.21, p = .02) and inhibition (r = -.21, p = .01) was associated with lower quantity of speech on procedural memory. Among young adults, longer time to complete inhibition was associated with lower quantity of speech (r = -.26, p = .04). Among older adults, longer time to complete color naming (r = -.32, p = .005), word reading (r = -.27, p = .02), and inhibition (r = -.35, p = .002) was associated with lower quantity of speech. No relationships were found between performance on Stroop conditions and quantity of speech for episodic memory.

Conclusions

Results suggest that among both age cohorts, difficulty inhibiting overlearned verbal responses is associated with lower quantity of speech regarding a procedural memory but not an episodic memory.

A-13 Sustained Attention, Impulsivity, and Tangentiality of Speech Among Young Adults and Older Adults

Objective

Previous research has linked off-topic verbosity (OTV) among older adults with lower performance on neuropsychological tests tapping attention and executive functioning. However, most of this research has utilized relatively brief neurocognitive measures. Continuous performance tests (CPTs) measure sustained attention and impulsivity. The purpose of this study was to investigate relationships between sustained attention, impulsivity, and tangentiality of speech among young adults and older adults.

Method

Young adult college students (age 18-29; n= 61) and healthy, community-dwelling older adults (age 60-99; n = 81) were administered the Conners’ Continuous Performance Test – 3 and provided a sample of speech (one episodic memory and one procedural memory). These speech samples were transcribed and rated for tangentiality by three independent reviewers.

Results

Among all participants, greater tangentiality of speech was associated with omission errors (r = .22, p = .01) but not with commission errors. This same pattern was found among older adults: omission errors (r = .23, p = .04) were associated with greater tangentiality but commission errors were not. Among young adults, these relationships were not statistically significant.

Conclusions

Results suggest that tangentiality of speech is associated with inattentiveness but not impulsivity, and this relationship may be more marked among older adults than young adults. OTV among older adults may stem from difficulty sustaining attention over time rather than diminished capacity for inhibiting impulses.

A Mechanical Brain Damage Framework Used to Model Abnormal Brain Tau Protein Accumulations of National Football League Players

A mechanics-based brain damage framework is used to model the abnormal accumulation of hyperphosphorylated p-tau associated with chronic traumatic encephalopathy within the brains of deceased National Football League (NFL) players studied at Boston University and to provide a framework for understanding the damage mechanisms. p-tau damage is formulated as the multiplicative decomposition of three independently evolving damage internal state variables (ISVs): nucleation related to number density, growth related to the average area, and coalescence related to the nearest neighbor distance. The ISVs evolve under different rates for three well known mechanical boundary conditions, which in themselves introduce three different rates making a total of nine scenarios, that we postulate are related to brain damage progression: (1) monotonic overloads, (2) cyclic fatigue which corresponds to repetitive impacts, and (3) creep which is correlated to damage accumulation over time. Different NFL player positions are described to capture the different types of damage progression. Skill position players, such as quarterbacks, are expected to exhibit a greater p-tau protein accumulation during low cycle fatigue (higher amplitude impacts with a lesser number), and linemen who exhibit a greater p-tau protein accumulation during high cycle fatigue (lower amplitude impacts with a greater number of impacts). This mechanics-based damage framework presents a foundation for developing a multiscale model for traumatic brain injury that combines mechanics with biology.