Web-based Visual and Cognitive Screening Battery for Rural OEF/OIF/OND Veterans

这项提议旨在开发一种新型的基于网络的筛查电池，以测试视觉和认知功能。 包括测试对比敏感度、视觉处理速度、注意力、执行功能、 和记忆，建议的电池将1)解决几个重要的知识空白，关于视觉和 OEF/OIF/OND退伍军人的认知功能，包括视觉和视觉缺陷的协变性 认知域和潜在的地理差异；2)提供成本效益高的筛查方法 美国农村地区的退伍军人，改善了这些服务不足的人群的医疗服务。 这项建议的培训部分也将有助于申请者成为 退伍军人事务部一名全职、全额资助的独立调查员，利用视觉领域的基础科学研究 并将这些发现转化为新的筛查方法，可以 在远程医疗中实施，以改善所有退伍军人在农村和城市地区获得医疗保健的机会。 培训目标包括：1)培训最先进的视觉功能和认知心理测量评估； 以及服务和实施研究2)神经心理学培训，以了解视觉和 认知缺陷与退伍军人的心理和身体健康问题有关，3)增加 应聘者精通最先进的基于网络的编程技术，以及4)允许应聘者 通过成功地通过以下途径竞争优秀人才资助，从而获得独立调查员的地位 退伍军人事务部或其他非退伍军人事务部资助机会(即，美国国立卫生研究院)。 设计和方法：提案的第一阶段(目标1)涉及开发和主办放映 基于网络的认知测试平台TestMyBrain上的电池，标准数据将从该平台收集 超过15,000名美国志愿者(全球约50,000名)以及WHODAS调查一起评估功能性残疾 涉及六个领域和人口统计问题，评估当前的军事或退伍军人状况和访问 医疗保健服务。在提案的第二阶段(目标2)，我们将招募并测试120个OEF/OIF/OND 来自退伍军人协会波士顿社区的退伍军人将组成三个组：有视力障碍的退伍军人，退伍军人 有认知缺陷的人，还有一组退伍军人。这些参与者将完成四次电池 两个多月，两次在我们的实验室，两次在他们自己的家里。来自拟议的测试和其他 将使用神经心理学测量来评估筛查措施的可靠性和有效性。 最后，城乡参与者和退伍军人与平民之间的地理差异分析 参与者将完成这一数据集的初步需求评估(目标3)。 目标1：开发基于网络的视觉和认知测试软件程序并确定 基于年龄的标准价值观。假设1a：网络用户的寿命趋势和高峰期表现 这些措施将与相应临床评估中公布的值相匹配。假设1b：年龄调整 视觉和认知评估的表现将与所测量的功能结果相关 在WHODAS调查问卷上。假设1c：将视觉和视觉的性能测量结合起来 认知领域将比单独在这两个领域中的表现测量更好地预测功能结果。 目标2：将基于网络的测试与基于实验室的测试进行比较，以评估基于网络的 措施。假设2a：测量将在时间和环境中具有高可靠性(可靠性：0.7)。 假设2b：与标准筛查工具类似，测量将具有诊断准确性&gt；0.6英寸 老兵组(对照组、视觉缺陷组、认知缺陷组)的分类。目标3：确定区域特征 绩效差异以及与功能结果和医疗保健获取的关系。假设3： 年龄调整后的绩效衡量标准将显示出与平民和 生活在农村地区的退伍军人。这种关联将通过自我报告的获得医疗保健的机会来调节。

This proposal aims to develop a novel web-based screening battery to test visual and cognitive functioning. Incorporating five tasks that test contrast sensitivity, visual processing speed, attention, executive functioning, and memory, the proposed battery will 1) address several important knowledge gaps regarding visual and cognitive functioning in OEF/OIF/OND Veterans, including covariation in deficits across the visual and cognitive domains and potential geographical disparities and 2) provide a cost-effective approach to screen Veterans in rural regions of the United States, improving healthcare services for this under-served population. The training portion of this proposal will also facilitate the applicant’s long-term career goal of becoming a full-time fully funded independent investigator at the VA, utilizing basic science research in the fields of vision science and neuropsychology and translating these findings into novel screening methods that can be implemented within telemedicine to improve healthcare access for all Veterans, both in rural and urban regions. The training aims include: 1) training in state of the art visual function and cognitive psychometric assessments, and services and implementation research 2) training in neuropsychology to understand how visual and cognitive deficits relate to OEF/OIF/OND Veteran’s mental and physical health issues , 3) Increasing the candidate’s proficiency in state-of-the-art web-based programming techniques, and 4) allowing the candidate to progress to an independent investigator status through successfully competing for merit funding through the VA or other non-VA funding opportunities (i.e., NIH). DESIGN & METHOD: The first phase of the proposal (Aim 1) involves developing and hosting the screening battery on the web-based cognitive testing platform TestMyBrain where normative data will be collected from over 15,000 U.S. volunteers (~50,000 worldwide) along with the WHODAS survey to asses functional disability across six domains and demographic questions assessing current military or veteran status and access to healthcare services. In the second phase of the proposal (Aim 2) we will recruit and test 120 OEF/OIF/OND Veterans from the VA Boston community who will make up three groups: Veterans with visual deficit, Veterans with cognitive deficits, and a control group of Veterans. These participants will complete the battery four times over two months, twice in our laboratory and twice in their own homes. Data from the proposed tests and other neuropsychological measures will be used to assess the reliability and validity of the screening measures. Finally, geographical disparities analyses between rural and urban participants and Veteran vs. civilian participants will be completed on this dataset for preliminary needs assessment (Aim 3). OBJECTIVES: Aim 1: Develop a web-based visual and cognitive testing software program and determine normative age-based values. Hypothesis 1a: Lifespan trends and age-of-peak performance on our web-based measures will match published values from corresponding clinical assessments. Hypothesis 1b: Age-adjusted performance on the visual and cognitive assessments will be correlated with functional outcomes as measured on the WHODAS questionnaire. Hypothesis 1c: Combining performance measures across the visual and cognitive domains will predict functional outcomes better than performance measures in either domain alone. Aim 2: Compare web-based to lab-based testing to assess the reliability and validity of the web-based measures. Hypothesis 2a: Measurements will have high reliability across time and setting (reliability > 0.7). Hypothesis 2b: Similar to standard screening tools, measurements will have diagnostic accuracy > 0.6 in classifying the Veteran group (Control, Visual Deficit, Cognitive Deficit). Aim 3: Characterize regional differences in performance and relationship to functional outcomes and healthcare access. Hypothesis 3: Age-adjusted performance measures will show stronger correlations with functional outcomes in civilians and Veterans living in rural regions. This correlation will be mediated by self-reported access to healthcare.