English-speaking Adults Research Articles

TECHNICAL BEHAVIOURS OF CHILD SEXUAL EXPLOITATION MATERIAL OFFENDERS

An exploration of the technological behaviours of previously convicted child sexual exploitation material (CSEM) offenders provides a foundation for future applied research into deterrence, investigation, and treatment efforts. This study evaluates the technology choices and transitions of individuals previously convicted of CSEM offenses. Based on their inclusion in two sex offender registries, anonymous survey results (n=78) were collected from English-speaking adults within the United States. CSEM offenders chose technologies based on both utility and perceived risk; peer-to-peer and web-browsers were the most common gateway technologies and showed substantial sustained usage; a substantial minority of users never stored CSEM and only viewed it; most respondents used more than one technology to view CSEM; CSEM offenders used more countermeasures than the public but did not use encryption at higher rates; almost all CSEM consumers started viewing adult SEM first; and countermeasures were used primarily to reduce psychological strain (anxiety).

Social Well-Being, Psychological Factors, and Chronic Conditions Among Older Adults.

Aging is characterized by the decline in physical health, functional status, and loss of social roles and relationships that can challenge the quality of life. Social well-being may help explain how aging individuals experience declining physical health and social relationships. Despite the high prevalence of chronic conditions among older adults, research exploring the relationship between social well-being and chronic disease is sparse. The study aims were to investigate the relationship between social well-being and psychological factors (e.g., perceived control, life satisfaction, self-esteem, active coping, optimism, and religious coping) by chronic condition in older adults. Cross-sectional study. The current study comprises older adults (N = 1,251, aged ≥ 65 y) who participated in the third wave of the National Survey of Midlife in the United States (i.e., MIDUS). MIDUS was conducted on a random-digit-dial sample of community-dwelling, English-speaking adults. Six instruments representing psychological resources (life satisfaction, perceived control, self-esteem, optimism, active coping, and religious coping) and five dimensions of social well-being (social actualization, social coherence, social acceptance, social contribution, social integration) were measured. An index of chronic disease comprised of self-reported data whether they had received a physician's diagnosis for any chronic conditions over the past year. The findings indicated that the individuals without chronic conditions had significantly higher social integration, social acceptance, and social contribution scores than the individuals with chronic conditions (t = 2.26, p < 0.05, t = 2.85, p < 0.01, and t = 2.23, p < 0.05, respectively). For individuals diagnosed with more than one chronic condition, perceived control, self-esteem, and optimism were positively related to their social well-being (β = .33, p < .001, β = .17, p < .001, and β = .33, p < .001, respectively). Findings suggested that older adults with multiple chronic conditions have a decrease in social well-being. Chronic disease management programs may help increase social well-being among individuals with multiple chronic conditions.

Does Adjusting for Social Desirability Reduce Ceiling Effects and Increase Variation of Patient-Reported Experience Measures?

Social desirability bias (a tendency to underreport undesirable attitudes and behaviors) may account, in part, for the notable ceiling effects and limited variability of patient-reported experience measures (PREMs) such as satisfaction, communication effectiveness, and perceived empathy. Given that there is always room for improvement for both clinicians and the care environment, ceiling effects can hinder improvement efforts. This study tested whether weighting of satisfaction scales according to the extent of social desirability can create a more normal distribution of scores and less ceiling effect. In a cross-sectional study 118 English-speaking adults seeking musculoskeletal specialty care completed 2 measures of satisfaction with care (one iterative scale and one 11-point ordinal scale), a measure of social desirability, and basic demographics. Normality of satisfaction scores was assessed using Shapiro-Wilk tests. After weighting for social desirability, scores on the iterative satisfaction scale had a more normal distribution while scores on the 11-point ordinal satisfaction scale did not. The ceiling effects in satisfaction decreased from 47% (n = 56) to 2.5% (n = 3) for the iterative scale, and from 81% (n = 95) to 2.5% (n = 3) for the ordinal scale. There were no differences in mean satisfaction when the social desirability was measured prior to completion of the satisfaction surveys compared to after. The observation that adjustment for levels of social desirability bias can reduce ceiling effects suggests that accounting for personal factors could help us develop PREMs with greater variability in scores, which may prove useful for quality improvement efforts.

Functional Near-Infrared Spectroscopy of English-Speaking Adults with Attention-Deficit/Hyperactivity Disorder During a Verbal Fluency Task

Functional Near-Infrared Spectroscopy of English-Speaking Adults with Attention-Deficit/Hyperactivity Disorder During a Verbal Fluency Task

The Reproducibility of Bio-Acoustic Features is Associated With Sample Duration, Speech Task, and Gender.

Bio-acoustic properties of speech show evolving value in analyzing psychiatric illnesses. Obtaining a sufficient speech sample length to quantify these properties is essential, but the impact of sample duration on the stability of bio-acoustic features has not been systematically explored. We aimed to evaluate bio-acoustic features' reproducibility against changes in speech durations and tasks. We extracted source, spectral, formant, and prosodic features in 185 English-speaking adults (98 w, 87 m) for reading-a-story and counting tasks. We compared features at 25% of the total sample duration of the reading task to those obtained from non-overlapping randomly selected sub-samples shortened to 75%, 50%, and 25% of total duration using intraclass correlation coefficients. We also compared the features extracted from entire recordings to those measured at 25% of the duration and features obtained from 50% of the duration. Further, we compared features extracted from reading-a-story to counting tasks. Our results show that the number of reproducible features (out of 125) decreased stepwise with duration reduction. Spectral shape, pitch, and formants reached excellent reproducibility. Mel-frequency cepstral coefficients (MFCCs), loudness, and zero-crossing rate achieved excellent reproducibility only at a longer duration. Reproducibility of source, MFCC derivatives, and voicing probability (VP) was poor. Significant gender differences existed in jitter, MFCC first-derivative, spectral skewness, pitch, VP, and formants. Around 97% of features in both genders were not reproducible across speech tasks, in part due to the short counting task duration. In conclusion, bio-acoustic features are less reproducible in shorter samples and are affected by gender.

Feeling Listened To: A Parsesciencing Inquiry.

Feeling listened to as a universal humanuniverse living experience was investigated with the Parsesciencing mode of inquiry. Historians were 10 English-speaking adults between 18 and 65 years old who had been hospitalized, willing to share their experiences of feeling listened to. The inquiry stance was "What is the discerning extant moment of the universal humanuniverse living experience of feeling listened to?" The major discovery of this investigation revealed the discerning extant moment as: Feeling listened to is uplifting recognition amid disconcerting rebuff, as treasured affiliations surfaces with joyful gratification.

Firearm Purchasing During the COVID-19 Pandemic: Results From the 2021 National Firearms Survey.

The surge in background checks beginning in March 2020 suggested an acceleration in firearm purchases. Little was known about the people who bought these guns. To estimate the number and describe characteristics of firearm purchasers over a period spanning prepandemic and pandemic time, characterize new gun owners, and estimate the number of persons newly exposed to household firearms. Probability-based online survey conducted in April 2021. Survey weights generated nationally representative estimates. United States, 1 January 2019 to 26 April 2021. 19049 of 29985 (64%) English-speaking adults responded to the survey invitation; 5932 owned firearms, including 1933 who had purchased firearms since 2019, of whom 447 had become new gun owners. The estimated number and characteristics of adults who, since 2019, have purchased firearms, distinguishing those who became new gun owners from those who did not, and the estimated number of household members newly exposed to firearms. An estimated 2.9% of U.S. adults (7.5 million) became new gun owners from 1 January 2019 to 26 April 2021. Most (5.4 million) had lived in homes without guns, collectively exposing, in addition to themselves, over 11 million persons to household firearms, including more than 5 million children. Approximately half of all new gun owners were female (50% in 2019 and 47% in 2020 to 2021), 20% were Black (21% in 2019 and in 2020-2021), and 20% were Hispanic (20% in 2019 and 19% in 2020-2021). By contrast, other recent purchasers who were not new gun owners were predominantly male (70%) and White (74%), as were gun owners overall (63% male, 73% White). Retrospective assessment of when respondents purchased firearms. National estimates about new gun owners were based on 447 respondents. Efforts to reduce firearm injury should consider the recent acceleration in firearm purchasing and the characteristics of new gun owners. The Joyce Foundation.

Attitudes towards code-switching among young and middle-aged Kannada–English-speaking adults

Code-switching (CS) is a natural sociolinguistic phenomenon in bilingualism. This study investigated the attitudes of young and middle-aged Kannada–English-speaking adults towards CS. A total of 254 participants (143 young and 111 middle-aged) participated in this online survey. The survey included four components: demographic characteristics, proficiency, attitude and sentence acceptability task. Further, the study examined the relationship between age, proficiency, acceptability judgments and attitudes toward code-switching. Frequency analyses estimated the number and percentage of occurrences of the categorical variables. Chi-square test of association assessed the relationship between sociolinguistic variables such as age and language proficiency. Results revealed that participants generally had a positive attitude towards code-switching. The effects of age on attitudes towards CS are discussed. Overall, the study intended to draw insights regarding attitudes towards CS in India.

Smartphone ownership and usage in Chinese- and English-speaking older adults.

Data collection by smartphone is becoming more widespread in healthcare research. Previous studies reported racial/ethnical differences in the use of digital health technology. However, cross-language group comparison (Chinese- and English-speaking older adults) were not performed in these studies. This project will expand to smartphone technology use in diverse older populations with a focus on Chinese American older adults who are monolingual Chinese-speakers. The Alzheimer's Disease Research Center (ADRC) at Icahn School of Medicine at Mount Sinai (ISMMS) evaluates diverse older populations using National Alzheimer's Coordinating Center's Uniform Data Set (NACC UDS). The UDS has different language versions, including English and Chinese. The evaluation includes a medical examination, cognitive assessments, and a research blood draw. Smartphone ownership and usage were captured using a local questionnaire developed by our ADRC. The questionnaire, available in English and Chinese, was administered by our ADRC coordinators during the COVID-19 pandemic. Multivariate analysis of variance (MANOVA) was used to examine differences in technology ownership and usages between the two language groups, while controlling for age, gender, education, and cognitive status (measured by Clinical Dementia Rating). 33 Chinese- and 117 English-speaking older adults who received a diagnosis of normal cognition or mild cognitive impairment at consensus were included in the data analysis. Results reveal a high prevalence of smartphone ownership in our Chinese- (100%) and English-speaking older participants (86.3%). Participants in both language groups use mobile technology for a wide range of purposes, such as getting news and other information (Chinese=90.9%; English=87.2%), sending/receiving text (Chinese=97.0%; English=96.6%), watching videos/TV shows (Chinese=78.8%; English=69.2%), and taking classes (Chinese=57.5%; English=57.3%). However, Chinese-speaking older adults were less likely than English-speaking older adults to use mobile technology to post their own reviews or comments online (Chinese=9.1%; English=39.3%, p=0.001), download or purchase an app (Chinese=21.2%; English=70.9%, p<0.001), track health/ fitness via apps/website (Chinese=12.1%; English=47.9%, p<0.001) and manage/receive medical care (Chinese=15.2%; English=67.5%, p<0.001). Our findings highlight potential barriers to smartphone usage in Chinese American older adults with limited English proficiency. The results have implications for how smartphone technology can be used in clinical practice and aging research.

Psychometric evaluation of the 8-item Altarum Consumer Engagement (ACE) Measure\u2122 in community-dwelling adults in Singapore

BackgroundA valid and reliable measure is essential to assess patient engagement and its impact on health outcomes. This study aimed to examine the psychometric properties of the 8-item Altarum Consumer Engagement Measure™ (ACE Measure) among English-speaking community-dwelling adults in Singapore.MethodsThis cross-sectional study involved 400 randomly selected community-dwelling adults (mean age: 49.7 years, 50.0% were female, 72.3% were Chinese) who completed the English version of the 8-item ACE Measure independently. The item-level statistics were described. The internal consistency of the measure was measured by Cronbach alpha and item-rest correlations. Validity of the tool was assessed by 1) factorial validity using confirmatory factor analysis (CFA), 2) hypothesis-testing validity by correlating ACE subscales (Commitment and Navigation) with health-related outcomes, and 3) criterion validity against the Patient Activation Measure and Health Confidence Measure.ResultsThere was no floor or ceiling effect for Commitment and Navigation subscales, and the Cronbach alpha for each subscale was 0.76 and 0.54, respectively. The two-factor structure was confirmed by CFA. In general, Commitment and Navigation subscales were positively correlated with frequency of activity participation (rho = 0.30 - 0.33) and EQ-5D visual analog scale (rho = 0.15 - 0.30). Individuals who perceived better health than peers had higher subscale scores (p < 0.01). Each subscale score had moderate and positive correlations with activation score (rho = 0.48 - 0.55) and health confidence score (rho = 0.35 - 0.47).ConclusionsThe two-subscale ACE Measure demonstrated good construct validity in English-speaking Singapore community-dwelling adults. Evidence in internal consistency was mixed, indicating further investigation.

Pick the smaller number: No influence of linguistic markedness on three-digit number processing

The symbolic number comparison task has been widely used to investigate the cognitive representation and underlying processes of multi-digit number processing. The standard procedure to establish numerical distance and compatibility effects in such number comparison paradigms usually entails asking participants to indicate the larger of two presented multi-digit Arabic numbers rather than to indicate the smaller number. In terms of linguistic markedness, this procedure includes the unmarked/base form in the task instruction (i.e., large). Here we evaluate distance and compatibility effects in a three-digit number comparison task observed in Bahnmueller et al. (2015, https://doi.org/10.3389/fpsyg.2015.01216) using a marked task instruction (i.e., ‘pick the smaller number’). Moreover, we aimed at clarifying whether the markedness of task instruction influences common numerical effects and especially componential processing as indexed by compatibility effects. We instructed German- and English-speaking adults (N = 52) to indicate the smaller number in a three-digit number comparison task as opposed to indicating the larger number in Bahnmueller et al. (2015). We replicated standard effects of distance and compatibility in the new pick the smaller number experiment. Moreover, when comparing our findings to Bahnmueller et al. (2015), numerical effects did not differ significantly between the two studies as indicated by both frequentist and Bayesian analysis. Taken together our data suggest that distance and compatibility effects alongside componential processing of multi-digit numbers are rather robust against variations of linguistic markedness of task instructions.

Consonantal Landmarks as Predictors of Dysarthria among English-Speaking Adults with Cerebral Palsy.

The current study explored the possibility that the consonantal landmarks served as predictors of dysarthric speech produced by English-speaking adults with cerebral palsy (CP). Additionally, the relationship between the perceptual severity of dysarthric speech and the consonantal landmarks was explored. The analyses included 210 sentences from the TORGO database produced by seven English-speaking CP speakers with dysarthria and seven typically developing controls matched in age and gender. The results indicated that the clinical group produced more total landmark features than did the control group. A binominal regression analysis revealed that the improper control of laryngeal vibration and the inability to tactically control the energy in a voiced segment would lead to the higher likelihood of dysarthric speech. A multinominal regression analysis revealed that producing too many +v and −v landmark features would lead to higher perceptual severity levels among the CP speakers. Together with literature, the current study proposed that the landmark-based acoustic analysis could quantify the differences in consonantal productions between dysarthric and non-dysarthric speech and reflect the underlying speech motor deficits of the population in concern.

Improving social cognition and skills in adult ASD: a tDCS pilot study

Abstract Introduction: Social cognition and social skills deficits are core to Autism Spectrum Disorder (ASD). Challenges include establishing shared and meaningful relationships with others, a socioemotional process often facilitated by the ability to accurately categorize facial expressions. Existing therapies are extremely time- and labor-intensive. We hypothesized that combining transcranial direct current stimulation (tDCS) with computer-based social skill and cognition interventions would improve measures of empathy and facial expression in high-functioning adults with ASD. Participants & Stimulation: Seven right-handed, English-speaking adults with normal or higher cognitive function and a score of 32 or higher on the Autism Quotient (AQ) participated in two experimental (verum/sham) sessions in a randomized, within-subjects, double-blinded design. The anodal electrode was over right temporoparietal (rTPJ: CP6), a region known to play an important role in social cognition. Stimulation was at 2.0 mA (verum 30 minutes, sham 30 seconds) with a cathodal electrode on the ipsilateral deltoid. During stimulation, participants viewed photos of human and dog faces followed by training videos on facial emotion detection, emotion and empathy identification, and social skills and interactions. Results: Participants were tested before (baseline) and after each stimulation session on the Empathy Quotient (EQ), a global trait/state measure that includes cognitive empathy, empathetic concern and perspective taking. Changes in facial emotion recognition was assessed from responses to multiple-choice questionnaires of emotional facial expressions in static images. Participants scored significantly higher on the EQ, Z = -2.366, p < 0.02, r = 0.68, and had significantly less inaccurate identifications of threatening facial emotion expressions, Z= -1.90, p < 0.02, r = 0.55, after receiving verum compared to sham tDCS. Conclusion: Anodal tDCS applied over rTPJ and paired with computer-based training on social skills and cognition shows promise as a potential treatment method for improving social skills and social cognition in high-functioning adults with ASD. Keywords: Autism Spectrum Disorder (ASD), tDCS, social skills, social cognition

Increased rates of social defeat and schizotypy in racial minorities

This study examines the extent to which a measure of multidimensional schizotypy is associated with experiences of social defeat. Based on the social defeat hypothesis of psychosis, which suggests that chronic stressful experiences leading to social defeat increase risk for psychotic-like experiences, we expect that individual differences on a schizotypy measure would be explained by differences in social defeat. We hypothesized that racial and ethnic minorities would report higher rates of schizotypy relative to non-minorities and that social defeat would explain those differences. Participants included a community sample of English-speaking adults ages 18 and older, recruited from online social media platforms (N = 501; M age = 28.06). Demographic information was collected, as well as the Multidimensional Schizotypy Scale–Brief (Kwapil et al., 2018) and the Defeat Scale (Gilbert & Allan, 1998). Analyses revealed that social defeat and schizotypy scores are highly correlated. Examination of group differences revealed that racial and ethnic minorities reported higher rates of schizotypy and higher rates of social defeat than non-minorities. ANCOVA analyses revealed that, after controlling for social defeat scores, racial and ethnic status was no longer significantly associated with schizotypy scores.

Functional near-infrared spectroscopy during the verbal fluency task of English-Speaking adults with mood disorders: A preliminary study

Functional near-infrared spectroscopy (fNIRS) provides a direct and objective assessment of cerebral cortex function. It may be used to determine neurophysiological differences between psychiatric disorders with overlapping symptoms, such as major depressive disorder (MDD) and bipolar disorder (BD). Therefore, this preliminary study aimed to compare fNIRS signals during the verbal fluency task (VFT) of English-speaking healthy controls (HC), patients with MDD and patients with BD. Fifteen HCs, 15 patients with MDD and 15 patients with BD were recruited. Groups were matched for age, gender, ethnicity and education. Relative oxy-haemoglobin and deoxy-haemoglobin changes in the frontotemporal cortex was monitored with a 52-channel fNIRS system. Integral values of the frontal and temporal regions were derived as a measure cortical haemodynamic response magnitude. Both patient groups had lower frontal and temporal region integral values than HCs, and patients with MDD had lower frontal region integral value than patients with BD. Moreover, patients could be differentiated from HCs using the frontal and temporal integral values, and patient groups could be differentiated using the frontal region integral values. VFT performance, clinical history and symptom severity were not associated with integral values. These results suggest that prefrontal cortex haemodynamic dysfunction occurs in mood disorders, and it is more extensive in MDD than BD. The fNIRS-VFT paradigm may be a potential tool for differentiating MDD from BD in clinical settings, and these findings need to be verified in a larger sample of English-speaking patients with mood disorders.

Effects of 12-Week Supervised Early Resistance Training (SEcReT) Versus Aerobic-Based Rehabilitation on Cognitive Recovery Following Cardiac Surgery via Median Sternotomy: A Pilot Randomised Controlled Trial

To investigate the effects of a 12-week early moderate-intensity resistance training program compared to aerobic-based rehabilitation on postoperative cognitive recovery following cardiac surgery via median sternotomy. This was a multicentre, prospective, pragmatic, non-blinded, pilot randomised controlled trial (1:1 randomisation) of two parallel groups that compared a 12-week early moderate-intensity resistance training group to a control group, receiving aerobic-based rehabilitation. English-speaking adults (≥18 years) undergoing elective cardiac surgery via median sternotomy were randomised using sealed envelopes, with allocation revealed before surgery. The primary outcome was cognitive function, assessed using the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), at baseline, 14 weeks and 6 months postoperatively. The ADAS-cog score at 14 weeks was significantly better for the resistance training group (n=14, 7.2±1.4; 95% CI 4.3, 10.2, vs n=17, 9.2±1.3; 95% CI 6.6, 11.9, p=0.010). At 14 weeks postoperatively, 53% of the aerobic-based rehabilitation group (n=9/17) experienced cognitive decline by two points or more from baseline ADAS-cog score, compared to 0% of the resistance training group (n=0/14; p=0.001). Early resistance training appears to be safe and may improve cognitive recovery compared to standard, aerobic-based rehabilitation following cardiac surgery via median sternotomy, however as this was a pilot study, the sample size was small and further research is needed to determine a causal relationship.

CONTINUUM: A single-arm pilot care transition intervention for hospitalized patients with advanced cancer.

33 Background: Patients with advanced cancer are frequently hospitalized and experience burdensome transitions of care after discharge. Interventions to address patients’ symptoms, support medication management, and ensure continuity of care after discharge are lacking. We sought to demonstrate the feasibility and acceptability of CONTINUUM (CONTINUity of care Under Management by video visits) for this population. Methods: We conducted a single-arm pilot trial (n = 50) of CONTINUUM at Massachusetts General Hospital (MGH). The intervention consisted of a video visit with an oncology nurse practitioner (NP) within 3 business days of hospital discharge to address symptoms, medication management, hospitalization-related issues, and care coordination. Prior to discharge, we enrolled English-speaking adults with advanced breast, gastrointestinal, genitourinary, or thoracic cancers experiencing an unplanned hospitalization who were receiving ongoing oncology care at MGH and being discharged home without hospice services. We defined the intervention as feasible if ≥70% of approached and eligible patients enrolled and if ≥70% of enrolled patients completed the intervention within 3 business days of discharge. At 2 weeks after discharge, patients rated the ease of use of the video technology and stated whether they would recommend the intervention. NPs completed post-intervention surveys to assess fidelity to the intervention protocol. Results: From 01/07/21 to 05/28/21, we enrolled 50 patients (75% of patients approached). Of the enrolled patients (median age = 65 years; 62% and 22% had advanced gastrointestinal or thoracic cancers, respectively), 78% of enrolled patients received the intervention within 3 business days of discharge. Patient rating of the ease of use of video technology was a mean of 7.6 out of 10, with 72% stating they “agreed” or “strongly agreed” that they would recommend the intervention. NP post-intervention surveys revealed that visits primarily focused on symptom management (56%), followed by addressing post-hospital care issues (21%). Of the 30 patients with 30-day follow-up, 43% were readmitted within 30 days of discharge, and 17% died within 30 days of discharge. Conclusions: We found that CONTINUUM, which consists of an NP-delivered video visit soon after hospital discharge addressing patients’ symptoms, medications, and care coordination, represents a feasible and acceptable approach to provide post-discharge care for hospitalized patients with advanced cancer. Future studies will test the efficacy of the intervention for reducing hospital readmissions. Clinical trial information: NCT04640714.

Effect of cumulative distance in motor space on segment-sized slips in 3-word phrases

Slips, or speech errors (e.g., “teep a cape” for “keep a tape”), have been described as the disordered arrangement of discrete elements, giving rise to the hypothesis that these arise from misordering during phonological encoding. An alternative hypothesis is that slips are articulatory timing errors, conditioned by the same motor factors that underlie coarticulation. This hypothesis motivates the present study, which used a modified slip procedure to elicit errors from 40 native English-speaking adults. Participants spoke 3-word phrases that were constructed as mini tongue twisters, with alternating word onsets and repeating rhymes. These phrases were designed to condition slips to a greater or less extent according to coarticulatory-adjacent processes (e.g., palatalization). A metric of cumulative distance-traveled in motor space during phrase production was also calculated: the degree of change in vocal tract shapes across the phrase, estimated using data generated within the tubesounds model in ArtiSynth. Phrases designed to more strongly condition slips were expected to cover less cumulative distance in motor space than phrases designed to less strongly condition slips. The distance-traveled metric did not always align with this expectation, but was nonetheless a better predictor of presence/absence of slips than phrase condition in analyses on preliminary data.

Firearm access and dementia: A qualitative study of reported behavioral disturbances and responses.

Cognitive impairment and behavioral changes associated with Alzheimer's disease and related dementias (ADRDs) can impair safe firearm handling ability, an issue that can be challenging for ADRD caregivers to address. In this qualitative analysis, we sought to explore behavioral disruptions that raise concerns about firearm access in dementia and how caregivers react and respond. Secondary qualitative analysis using data from semi-structured, one-on-one interviews originally conducted as part of a study to develop firearm safety educational materials for ADRD caregivers. Interviewees were English-speaking adults (≥18 years) from three stakeholder groups: ADRD caregivers (professional or informal), medical professionals (geriatricians, neurologists), and firearm professionals (retailers, range employees, instructors). For secondary analysis, transcripts of interviews were recoded and analyzed after an inductive-deductive thematic analysis process. Among 24 participants, 17 (70%) were female and 20 (83%) white; 13 (54%) had personal or professional experience with ADRD caregiving; and 5 (21%) had a firearm affiliation. Major themes were: (1) behavioral disturbances that make caregivers concerned about firearm access; (2) caregiver emotional responses to and difficulties associated with these disturbances; and (3) caregiver actions (planned or actual) to limit firearms access. Various behavioral disturbances and emotional burdens can trigger ADRD caregiver concern about firearms access, but strategies exist for restricting or safeguarding firearms in the home. Study findings suggest a need for caregiver support on this topic, including counseling by healthcare providers, advance planning for older firearm owners, and development of community resources.

Incidence and Referral for Management of Communication Complaints in Mild Traumatic Brain Injury

Research Objectives To identify commonly reported cognitive-communication problems after mild traumatic brain injury (mTBI), and to describe the relationship between cognitive-communication complaints and referral for speech-language pathology (SLP) services. Design Pre-post design. Setting Outpatient specialty clinic. Participants Participants were 41 English-speaking adults and adolescents between the ages of 14 and 65 (M=29.17, SD=13.66) with uncomplicated mTBI; 23 participants repeated measures at discharge. Interventions Survey completion at first visit and discharge. Main Outcome Measures LaTrobe Communication Questionnaire (LCQ), Post Concussion Symptom Scale (PCSS), and SLP referral were the main outcome measures. Demographic information and injury characteristics were also extracted from participants’ medical records. Results Participants reported more problems with speaking too slowly (M=1.68), participating in group conversations (M=2.20), and three other issues at their first visits than published norms. According to Wilcoxon Signed-Rank test results, communication complaints decreased significantly by discharge (V=165, p=.005). Regression analyses showed that LCQ scores were related to PCSS scores (b=0.25, p < .001). Although the total LCQ score was not related to SLP referral, seven LCQ items (e.g., “Leave out important details,” "Go over and over the same ground," "Need a long time to think") were found to be significant predictors (OR=2.42-4.87, p < .04). Besides LCQ items, PCSS scores were also predictive of SLP referral (OR=1.04, 95% CI=1.01-1.08, p < .01). Demographics variables and injury characteristics were not significantly associated with LCQ scores or SLP referral in the current sample. Conclusions A subset of individuals experiences communication problems post concussion. Those who reported communication problems were more likely to be referred to SLP rehabilitation. Future research should examine the usefulness of communication items in directing rehabilitation pathways. Author(s) Disclosures We have no conflict of interest to disclose. To identify commonly reported cognitive-communication problems after mild traumatic brain injury (mTBI), and to describe the relationship between cognitive-communication complaints and referral for speech-language pathology (SLP) services. Pre-post design. Outpatient specialty clinic. Participants were 41 English-speaking adults and adolescents between the ages of 14 and 65 (M=29.17, SD=13.66) with uncomplicated mTBI; 23 participants repeated measures at discharge. Survey completion at first visit and discharge. LaTrobe Communication Questionnaire (LCQ), Post Concussion Symptom Scale (PCSS), and SLP referral were the main outcome measures. Demographic information and injury characteristics were also extracted from participants’ medical records. Participants reported more problems with speaking too slowly (M=1.68), participating in group conversations (M=2.20), and three other issues at their first visits than published norms. According to Wilcoxon Signed-Rank test results, communication complaints decreased significantly by discharge (V=165, p=.005). Regression analyses showed that LCQ scores were related to PCSS scores (b=0.25, p < .001). Although the total LCQ score was not related to SLP referral, seven LCQ items (e.g., “Leave out important details,” "Go over and over the same ground," "Need a long time to think") were found to be significant predictors (OR=2.42-4.87, p < .04). Besides LCQ items, PCSS scores were also predictive of SLP referral (OR=1.04, 95% CI=1.01-1.08, p < .01). Demographics variables and injury characteristics were not significantly associated with LCQ scores or SLP referral in the current sample. A subset of individuals experiences communication problems post concussion. Those who reported communication problems were more likely to be referred to SLP rehabilitation. Future research should examine the usefulness of communication items in directing rehabilitation pathways.