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Tegeler CL, Haight TJ, Cole WR, Shaltout HA, Choi YS, Harris TE, Rachels N, Bellini PG, Roy MJ, Tegeler CH. Acoustic neuromodulation with or without micro-voltage tACS reduces post-concussive symptoms. Brain Inj 2025; 39:496-508. [PMID: 39913294 DOI: 10.1080/02699052.2024.2445709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 11/25/2024] [Accepted: 12/17/2024] [Indexed: 04/19/2025]
Abstract
OBJECTIVE Persistent post-concussive symptoms (PPCS) are common and disruptive, particularly in military service members (SM), yet there are no approved therapies targeting underlying physiological processes. This study was designed to compare acoustic neuromodulation using Cereset Research™ Standard Operating Procedures (CR-SOP), with Cereset Research Cranial Electrical Stimulation (CR-CES), on PPCS. METHODS SM, veterans, or dependents with PPCS (Neurobehavioral Symptom Inventory [NSI] Score ≥23) were randomized to receive 10 sessions of engineered tones linked to brainwaves (CR-SOP) or 5 sessions of CR-CES, which adds intermittent low voltage transcranial alternating current stimulation (tACS) to CR-SOP. Designed to assess non-inferiority between varied doses of CR-SOP and CR-CES, the primary outcome was a change in post-concussive symptoms on the NSI, with secondary outcomes of heart rate variability (HRV) and self-report measures of PTSD, sleep, headaches, and depression. RESULTS Among study participants (n = 80, 21.3% female, mean age 40.2 [SD 13.2], 4.8 deployments, 3.2 TBIs), mean NSI declined from 45.6 to 29.5 after intervention (p < 0.0001), with gains sustained at 3 months (29.7). No significant between group differences for NSI (CR-SOP: baseline 43.9, post-intervention 26.0, 3-month 27.2, and CR-CES 46.4, 30.7, and 31.1, respectively), and no evidence of inferiority between the groups with respect to NSI. Similar improvements were seen on PCL-5, ISI, HIT-6, and PHQ-9, with no HRV differences between groups. CONCLUSION Both acoustic neuromodulation alone (CR-SOP) and a lower dose of CR-SOP, with tACS added (CR-CES), significantly improved PPCS out to 3 months. REGISTRATION ClinicalTrials.gov - NCT03649958.
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Affiliation(s)
- Catherine L Tegeler
- Department of Neurology, Wake Forest University School of Medicine (WFUSM), Winston-Salem, North Carolina, USA
| | - Thaddeus J Haight
- Department of Medicine, Uniformed Services University (USU), Bethesda, Maryland, USA
- Military Traumatic Brain Injury Initiative, USU, Bethesda, Maryland, USA
- Henry M. Jackson Foundation, Bethesda, Maryland, USA
| | - Wesley R Cole
- Department of Exercise and Sports Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hossam A Shaltout
- Department of Surgery, Hypertension and Vascular Research Center, WFUSM, Winston-Salem, North Carolina, USA
| | - Y Sammy Choi
- Womack Army Medical Center (WAMC), Fort Liberty, North Carolina, USA
| | - Tyler E Harris
- Womack Army Medical Center (WAMC), Fort Liberty, North Carolina, USA
| | - Nora Rachels
- Womack Army Medical Center (WAMC), Fort Liberty, North Carolina, USA
| | - Paula G Bellini
- Department of Medicine, Uniformed Services University (USU), Bethesda, Maryland, USA
- Military Traumatic Brain Injury Initiative, USU, Bethesda, Maryland, USA
- Henry M. Jackson Foundation, Bethesda, Maryland, USA
| | - Michael J Roy
- Department of Medicine, Uniformed Services University (USU), Bethesda, Maryland, USA
- Military Traumatic Brain Injury Initiative, USU, Bethesda, Maryland, USA
- Walter Reed National Military Medical Center (WRNMMC), Bethesda, Maryland, USA
| | - Charles H Tegeler
- Department of Neurology, Wake Forest University School of Medicine (WFUSM), Winston-Salem, North Carolina, USA
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Goldstein KM, Pace R, Dancu C, Raman SR, Bridges-Curry Z, Klimek-Johnson P, Jeevanathan A, Gallion AH, Der T, Tabriz AA, Sprague S, Rushton S, Hammer AJ, Sims CA, Coleman JN, Martino J, Cantrell S, Gordon AM, Jacobs M, Alexopoulos AS, Chen D, Gierisch JM. An Evidence Map of the Women Veterans' Health Literature, 2016 to 2023: A Systematic Review. JAMA Netw Open 2025; 8:e256372. [PMID: 40261651 PMCID: PMC12015682 DOI: 10.1001/jamanetworkopen.2025.6372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 02/18/2025] [Indexed: 04/24/2025] Open
Abstract
Importance Women veterans are the fastest-growing veteran subpopulation in the US. Women veterans often experience military service-related health issues in addition to conditions common to all women. Because women veterans are more likely to receive care in the civilian setting than through the Department of Veterans Affairs (VA), all women's health clinicians should be equipped to provide patient-centered care for women veterans. The health care of women veterans requires evidence-based care informed by population-specific scientific literature. An updated evidence map evaluating women veteran-focused health literature is needed. Objective To map the scope and breadth of women veterans' health literature published from 2016 to 2023. Evidence Review In this systematic review, MEDLINE, Embase, and CINAHL Complete were searched for eligible articles published from 2016 to 2023. Articles reporting about US women veterans' health outcomes or on the experience of providing care to women veterans were included. Included articles were required to report patient-level outcomes that included either data for only women veterans or reported results separately for women veterans. Articles were grouped by primary focus area based on categories previously established by the VA Women's Health research agendas and prior evidence maps. Findings The volume of women veterans' health literature published between 2016 and 2023 of 932 articles was double that of the prior 8 years. The largest portion of this literature was focused on chronic medical conditions (137 articles [15%]), general mental health (203 articles [22%]), and interpersonal violence (121 articles 3[13%]). Areas of greatest growth included reproductive health (physical and mental), pain, suicide, and nonsuicidal self-injury. Additionally, emerging areas of inquiry were found, including military-related toxic exposures and harassment within the health care setting. Conclusions and Relevance In this systematic review of literature focused on the health of women veterans, the volume of literature was found to have doubled and expanded in important areas that aligned with VA research priorities. However, despite the growth in research related to women veterans, several important research gaps remain within this field of study. Research addressing health issues pertinent to a growing and aging women veterans' population will require rigorous research and program evaluations.
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Affiliation(s)
- Karen M. Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (VA) Health Care System, Durham, North Carolina
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, North Carolina
| | - Rachel Pace
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (VA) Health Care System, Durham, North Carolina
| | - Caroline Dancu
- San Francisco VA Health Care System, San Francisco, California
- University of California, San Francisco
| | - Sudha R. Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Zoe Bridges-Curry
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (VA) Health Care System, Durham, North Carolina
| | - Patrycja Klimek-Johnson
- San Francisco VA Health Care System, San Francisco, California
- University of California, San Francisco
| | | | - Anna H. Gallion
- VA Tennessee Valley Healthcare System, Nashville
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Tatyana Der
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, North Carolina
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Syketha Sprague
- Department of Medicine—Renal Section, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | | | - A. Jean Hammer
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill
| | - Catherine A. Sims
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (VA) Health Care System, Durham, North Carolina
- Division of Rheumatology, Duke University, Durham, North Carolina
| | - Jessica N. Coleman
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (VA) Health Care System, Durham, North Carolina
| | | | - Sarah Cantrell
- Duke University Medical Center Library and Archives, Duke University School of Medicine, Durham, North Carolina
| | - Adelaide M. Gordon
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (VA) Health Care System, Durham, North Carolina
| | - Morgan Jacobs
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (VA) Health Care System, Durham, North Carolina
| | - Anastasia-Stefania Alexopoulos
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (VA) Health Care System, Durham, North Carolina
- Duke University Medical Center, Durham, North Carolina
| | - Dazhe Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Jennifer M. Gierisch
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (VA) Health Care System, Durham, North Carolina
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
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Gatto NM, Renz A, Tom SE, Lyons M, Macuiba JA, Dodd TS, Lind BK, Gray SL, Meyers K, Larson EB, Nelson JC, McEvoy LK, Sankaran S, Key D, Litondo JA, Crane PK. The Adult Changes in Thought (ACT) Medical Records Abstraction Project: A Resource for Research on Biological, Psychosocial and Behavioral Factors on the Aging Brain and Alzheimer's Disease and Related Dementias. Brain Sci 2024; 14:1075. [PMID: 39595838 PMCID: PMC11592130 DOI: 10.3390/brainsci14111075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 10/23/2024] [Accepted: 10/25/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Adult Changes in Thought (ACT), a prospective cohort study, enrolls older adult members of Kaiser Permanente Washington. We describe an ambitious project to abstract medical records facilitating epidemiological investigation. METHODS Abstracted data include medications; laboratory results; women's health; blood pressure; physical injuries; cardiovascular, neurological, psychiatric and other medical conditions. RESULTS Of 1419 of 5763 participants with completed abstractions, 1387 (97.7%) were deceased; 602 (42.4%) were diagnosed with Alzheimer's Disease and Related Dementias; 985 (69.4%) had a brain autopsy. Each participant had an average of 34.3 (SD = 13.4) years of data abstracted. Over 64% had pharmacy data preceding 1977; 87.5% had laboratory data preceding 1988. Stroke, anxiety, depression and confusion during hospitalization were common among participants diagnosed with dementia. CONCLUSIONS Medical records are transformed into data for analyses with outcomes derived from other ACT data. We provide detailed, unparalleled longitudinal clinical data to support a variety of epidemiological research on clinical-pathological correlations.
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Affiliation(s)
- Nicole M. Gatto
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Anne Renz
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Sarah E. Tom
- Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Mary Lyons
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Jennifer A. Macuiba
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Tammy S. Dodd
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Bonnie K. Lind
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Shelly L. Gray
- School of Pharmacy, University of Washington, Seattle, WA 98102, USA;
| | - Kelly Meyers
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Jennifer C. Nelson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Linda K. McEvoy
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Sundary Sankaran
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Dustin Key
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Jeremiah A. Litondo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; (A.R.); (M.L.); (J.A.M.); (T.S.D.); (B.K.L.); (K.M.); (E.B.L.); (J.C.N.); (L.K.M.); (S.S.); (D.K.); (J.A.L.)
| | - Paul K. Crane
- School of Medicine, University of Washington, Seattle, WA 98195, USA;
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de Oliveira DV, Vieira RDCA, Pipek LZ, de Sousa RMC, de Souza CPE, Santana-Santos E, Paiva WS. Long-Term Outcomes in Severe Traumatic Brain Injury and Associated Factors: A Prospective Cohort Study. J Clin Med 2022; 11:6466. [PMID: 36362693 PMCID: PMC9655294 DOI: 10.3390/jcm11216466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 04/03/2024] Open
Abstract
OBJECTIVE The presence of focal lesion (FL) after a severe traumatic brain injury is an important factor in determining morbidity and mortality. Despite this relevance, few studies show the pattern of recovery of patients with severe traumatic brain injury (TBI) with FL within one year. The objective of this study was to identify the pattern of recovery, independence to perform activities of daily living (ADL), and factors associated with mortality and unfavorable outcome at six and twelve months after severe TBI with FL. METHODOLOGY This is a prospective cohort, with data collected at admission, hospital discharge, three, six, and twelve months after TBI. RESULTS The study included 131 adults with a mean age of 34.08 years. At twelve months, 39% of the participants died, 80% were functionally independent by the Glasgow Outcome Scale Extended, 79% by the Disability Rating Scale, 79% were independent for performing ADLs by the Katz Index, and 53.9% by the Lawton Scale. Report of alcohol intake, sedation time, length of stay in intensive care (ICU LOS), Glasgow Coma Scale, trauma severity indices, hyperglycemia, blood glucose, and infection were associated with death. At six and twelve months, tachypnea, age, ICU LOS, trauma severity indices, respiratory rate, multiple radiographic injuries, and cardiac rate were associated with dependence. CONCLUSIONS Patients have satisfactory functional recovery up to twelve months after trauma, with an accentuated improvement in the first three months. Clinical and sociodemographic variables were associated with post-trauma outcomes. Almost all victims of severe TBI with focal lesions evolved to death or independence.
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Affiliation(s)
- Daniel Vieira de Oliveira
- Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-010, SP, Brazil
| | | | - Leonardo Zumerkorn Pipek
- Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-010, SP, Brazil
| | | | | | | | - Wellingson Silva Paiva
- Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-010, SP, Brazil
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