Mild traumatic brain injury (mTBI) resulting from exposure to improvised explosive devices (IEDs) has fueled a requirement to develop animals models that mirror this condition using exposure to blast overpressure (BOP). En route to developing a model of repeated exposure to BOP we sought to initially characterize the effects of acute BOP exposure in rodents, focusing specifically on the levels of BOP exposure that produced clinical mTBI symptoms. We first measured BOP effects on gross motor function on a balance beam. Separate groups of unanesthetized rats were exposed (in different orientations) to 36.6, 74.5, and 116.7 kPa BOP exposure inside a pneumatically driven shock tube. Results demonstrated that rats exposed to 116.7 kPa demonstrated transient alterations or loss of consciousness indicated by a transient loss of righting and by increased latencies on the balance beam. The 116.7 kPa exposure was the threshold for overt pathology for acute BOP exposure with approximately 30% of rats presenting with evidence of subdural hemorrhage and cortical contusions. All animals exposed to 116.7 kPa BOP manifested evidence of significant pulmonary hemorrhage. Anterograde memory deficits were observed in rats exposed to 74.5 kPa facing the BOP wave and rats exposed to 116.7 kPa in the lateral (side) orientation. We next assessed repeated exposure to either lateral or frontal 36.6 kPa BOP in anesthetized rats, once per day for 12 days. Results showed that repeated exposure in the frontal, but not side, orientation to the BOP wave produced a transitory learning deficit on a Morris water maze task as shown by significantly longer latencies to reach the submerged platform in the second and third blocks of a four block session. Implications of these data are discussed in relation to the manifestation of mTBI in military personnel exposed to IEDs. Finally, we suggest that there are multiple types of long-term brain injury from blast exposure.
BackgroundIn response to the increasing complexity of the health care system, the field of health advocacy has emerged. However, little is known about factors that may influence a person’s likelihood of hiring a health advocate.PurposeThis study was designed to examine factors that influence a person’s likelihood of hiring a health advocate.MethodsThe participants were 889 randomly selected community members who were assigned to read one of six vignettes. Social support and confidence in the health care system were manipulated in the vignettes. Social support was either high or low and overall confidence was high, moderate, or low. The dependent variables were participants’ likelihood of hiring a health advocate and the hourly rate participants were willing to pay for a health advocate for six different services.ResultsThe results indicated that social support did not affect the likelihood of hiring a health advocate; however, confidence in the health care system did affect the likelihood of hiring a health advocate. Participants who read vignettes, in which the patient was described as having lower overall confidence levels, indicated a greater likelihood of hiring a health advocate than participants who read the vignettes in which the patient was described as having high confidence.ConclusionsMore research is needed to determine other factors that may influence the likelihood of hiring a health advocate and whether hiring a health advocate is a cost-effective way to improve the quality of health care by reducing the number of medical mistakes and improving patient-provider communication.
In this study, factors that influence a person's likelihood of hiring a pediatric health care advocate (HCA) for support and/or advisory services were examined. Participants were asked to read vignettes in which a child's symptom severity, probability of mortality, and age were manipulated. A significantly higher likelihood of hiring an HCA for advisory services than for support services was found. A significant interaction between level of mortality and type of service indicated that when mortality was depicted as high, participants reported a greater likelihood of hiring an HCA for support services than for advisory services.
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