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93 Acceptability and Usability of Tablet-Based Neuropsychological Tests among South African and Ugandan Adolescents With and Without HIV
- Christopher M Ferraris, Rebecca Dunayev, Nour Kanaan, Courtney E Kirsch, Corey Morrison, Nana Asiedu, Daphne Tsapalas, Anthony F Santoro, Nicole J Phillips, Jacqueline Hoare, Angel Nanteza, Joy L Gumikiriza-Onoria, Victor Musiime, Sahera Dirajlal-Fargo, Reuben N Robbins
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 495-496
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Objective:
Neuropsychological (NP) tests are increasingly computerized, which automates testing, scoring, and administration. These innovations are well-suited for use in resource-limited settings, such as low- to middle- income countries (LMICs), which often lack specialized testing resources (e.g., trained staff, forms, norms, equipment). Despite this, there is a dearth of research on their acceptability and usability which could affect performance, particularly in LMICs with varying levels of access to computer technology. NeuroScreen is a tablet-based battery of tests assessing learning, memory, working memory, processing speed, executive functions, and motor speed. This study evaluated the acceptability and usability of NeuroScreen among two groups of LMIC adolescents with and without HIV from Cape Town, South Africa and Kampala, Uganda.
Participants and Methods:Adolescents in Cape Town (n=131) and Kampala (n=80) completed NeuroScreen and questions about their use and ownership of, as well as comfort with computer technology and their experiences completing NeuroScreen. Participants rated their technology use -comfort with and ease-of-use of computers, tablets, smartphones, and NeuroScreen on a Likert-type scale: (1) Very Easy/Very Comfortable to (6) Very Difficult/Very Uncomfortable. For analyses, responses of Somewhat Easy/Comfortable to Very Easy/Comfortable were collapsed to codify comfort and ease. Descriptive statistics assessed technology use and experiences of using the NeuroScreen tool. A qualitative question asked how participants would feel receiving NeuroScreen routinely in the future; responses were coded as positive, negative, or neutral (e.g., “I would enjoy it”). Chi-squares assessed for group differences.
Results:South African adolescents were 15.42 years on average, 50.3% male, and 49% were HIV-positive. Ugandan adolescents were 15.64 years on average, 50.6% male, and 54% HIVpositive. South African participants were more likely than Ugandan participants to have ever used a computer (71% vs. 49%; p<.005), or tablet (58% vs. 40%; p<.05), whereas smartphone use was similar (94% vs 87%). South African participants reported higher rates of comfort using a computer (86% vs. 46%; p<.001) and smartphone (96% vs. 88%; p<.05) compared to Ugandan participants. Ugandan adolescents rated using NeuroScreen as easier than South African adolescents (96% vs. 87%; p<.05).). Regarding within-sample differences by HIV status, Ugandan participants with HIV were less likely to have used a computer than participants without HIV (70% vs. 57%; p<.05, respectively).The Finger Tapping test was rated as the easiest by both South African (73%) and Ugandan (64%) participants. Trail Making was rated as the most difficult test among Ugandan participants (37%); 75% of South African participants reported no tasks as difficult followed by Finger Tapping as most difficult (8%). When asked about completing NeuroScreen at routine doctor’s visits, most South Africans (85%) and Ugandans (72%) responded positively.
Conclusions:This study found that even with low prior tablet use and varying levels of comfort in using technology, South African and Ugandan adolescents rated NeuroScreen with high acceptability and usability. These data suggest that scaling up NeuroScreen in LMICs, where technology use might be limited, may be appropriate for adolescent populations. Further research should examine prior experience and comfort with tablets as predictors NeuroScreen test performance.
71 Examining the Psychometric Validity of NeuroScreen to Assess Neurocognition in Hospitalized Psychosis Patients in Uganda
- Nana Asiedu, Corey Morrison, Courtney Kirsch, Rebecca Dunayev, Nour Kanaan, Christopher Ferraris, Anthony Santoro, Daphne Tsapalas, Reuben Robbins, Dan Stein, Dickens H. Akena, Noeline Nakasujja, Nastassja Koen, Emmanuel Mwesiga
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 855-856
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Objective:
People with psychotic disorders often experience neurocognitive deficits, such as neurocognitive impairment (NCI), which can negatively affect their daily activities (e.g., performing independent tasks) and recovery. Because of this, the American Psychology Association advocates integrating neurocognitive testing into routine care for people living with psychotic disorders, especially those in their first episode, to inform treatment and improve clinical outcomes. However, in low-and-middle income countries (LMICs), such as Uganda where the current study took place, administering neurocognitive tests in healthcare settings presents numerous challenges. In Uganda there are few resources (e.g., trained clinical staff, and culturally relevant and normed tests) to routinely offer testing in healthcare settings. NeuroScreen is a brief, highly automated, tablet-based neurocognitive testing tool that can be administered by all levels of healthcare staff and has been translated into indigenous Ugandan languages. To examine the psychometric properties of NeuroScreen, we measured convergent and criterion validity of the NeuroScreen tests by comparing performance on them to performance on a traditional battery of neurocognitive tests widely used to assess neurocognition in people with psychotic disorders, the Matric Consensus Cognitive Battery (MCCB).
Participants and Methods:Sixty-five patients admitted into Butabika Mental Referral Hospital in Uganda after experiencing a psychotic episode and forty-seven demographically similar control participants completed two neurocognitive test batteries: the MCCB and NeuroScreen. Both batteries include tests measuring the neurocognitive domains of executive functioning, working memory, verbal learning, and processing speed. Prior to completing each battery, patients were medically stabilized and could not exhibit any positive symptoms on the day of testing. On the day of testing, medication dosages were scheduled so that patients would not experience sedative effects while testing. To examine convergent validity, we examined correlations between overall performance on NeuroScreen and the MCCB, as well as tests that measured the same neurocognitive domains. To examine criterion validity, an ROC curve was computed to examine the sensitivity and specificity of NeuroScreen to detect NCI as defined by the MCCB.
Results:There was a large correlation between overall performance on NeuroScreen and the MCCB battery of tests, r(110) = .65, p < .001. Correlations of various strengths were found among tests measuring the same neurocognitive domains in each battery: executive functioning [r(110) = .56 p <.001], processing speed [r(110) = .44, p <.001)], working memory [r(110) = .29, p<.01], and verbal learning [r(110) = .22, p < .01]. ROC analysis of the ability of NeuroScreen to detect MCCB defined NCI showed an area under curve of .798 and optimal sensitivity and specificity of 83% and 60%, respectively.
Conclusions:Overall test performance between the NeuroScreen and MCCB test batteries was similar in this sample of Ugandans with and without a psychotic disorder, with the strongest correlations in tests of executive functioning and processing speed. ROC analysis provided criterion validity evidence of NeuroScreen to detect MCCB defined NCI. These results provide support for use of NeuroScreen to assess neurocognitive functioning among patients with psychotic disorders in Uganda, however more work needs to be to determine how well it can be implemented in this setting. Future directions include assessing cultural acceptability of NeuroScreen and generating normative data from a larger population of Ugandan test-takers.
Advances in conditioning of low- and intermediate-level nuclear waste
- Michael I. Ojovan, Rebecca A. Robbins, Miklos Garamszeghy
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- Journal:
- MRS Advances / Volume 3 / Issue 19 / 2018
- Published online by Cambridge University Press:
- 10 December 2017, pp. 983-990
- Print publication:
- 2018
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Radioactive waste with widely varying characteristics is generated from the operation and maintenance of nuclear reactors, nuclear fuel cycle facilities, research facilities and medical facilities and the through the use of radioisotopes in industrial applications. The waste needs to be treated and conditioned appropriately to provide wasteforms acceptable for safe storage and disposal. Conditioning of radioactive waste is an important step to prepare waste for long-term storage or disposal and includes the following processes:
▪ Immobilization which may or may not also provide volume reduction, including
a) Low temperature processes and
b) Thermal processes;
▪ Containerization for
a) Transport,
b) Storage, and
c) Disposal;
▪ Overpacking of primary containers
a) Prior to disposal and
b) In a disposal facility as part of disposal process.
Conditioning consists of operations that produce a waste package suitable for handling, transportation, storage and/or disposal and may be performed for a variety of reasons including standardization of practices and/or wasteforms, technical requirements for waste stability in relation to a repository design or safety case, technical requirements related to waste transportation, societal preferences, regulatory preferences, etc. This paper gives an overview of recent advances in conditioning of low- and intermediate-level radioactive waste.
The paper is based on the new IAEA Handbook “Conditioning of Low- and Intermediate-Level Liquid, Solidified and Solid Waste” which is one of eight IAEA handbooks intended to provide guidance for evaluating and implementing various characterisation and radioactive waste processing and storage technologies before final disposal
Vitreous Materials for Nuclear Waste Immobilisation and IAEA Support Activities
- Rebecca A. Robbins, Michael I. Ojovan
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- Journal:
- MRS Advances / Volume 1 / Issue 63-64 / 2016
- Published online by Cambridge University Press:
- 20 February 2017, pp. 4201-4206
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- 2016
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Vitreous materials are the overwhelming world-wide choice for the immobilisation of HLW resulting from nuclear fuel reprocessing due to glass tolerance for the chemical elements found in the waste as well as its inherent stability and durability. Vitrification is a mature technology and has been used for high-level nuclear waste immobilization for more than 50 years. Borosilicate glass is the formulation of choice in most applications although other formulations are also used e.g. phosphate glasses are used to immobilize high level wastes in Russia. The excellent durability of vitrified radioactive waste ensures a high degree of environment protection. Waste vitrification gives high waste volume reduction along with simple and cheap disposal facilities. Although vitrification requires a high initial investment and then operational costs, the overall cost of vitrified radioactive waste is usually lower than alternative options when account is taken of transportation and disposal expenses. Glass has proven to be also a suitable matrix for intermediate and low-level radioactive wastes and is currently used to treat legacy waste in USA, and NPP operational waste in Russia and South Korea. This report is also outlining IAEA activities aiming to support utilisation of vitreous materials for nuclear waste immobilisation.