Predicting Length of Care Following Concussion

Concussions have become a prominent injury treated across medical care settings. Due to a complicated underlying pathophysiological process, concussions are subtle and produce a wide array of signs, including cognitive, somatic, and sensorimotor symptoms. The diverse symptomatology makes clinical assessment and management of concussions challenging for clinicians. Additionally, this complexity makes determining recovery trajectory after injury difficult for practitioners. Identifying individuals at risk for long durations of treatment early in their care would allow for early restorative interventions, reduced cost of care, and improved patient quality of life. This need lead to a series of studies attempting to add evidence to support the clinical assessment process of individuals following both suspected and diagnosed concussions. Our first study evaluated the rates and reasons for under-reporting of concussions and symptoms in female high school athletes, a neglected population of study in concussion research. We found female athletes often failed to report concussion symptoms to coaches and trainers. Additionally, only 2/3rds of athletes reported receiving concussion education that may explain the lack of reporting. Different clinical assessment techniques were also explored. Balance and reaction time assessment are commonly completed to help identify individuals with suspected concussion, but these assessments are subjective and often require equipment not available outside of clinical settings. We evaluated the validity and reliability of a mobile device application to assess balance and reaction time as part of a concussion screening. We found SwayTM to be comparable to force platform balance assessments and computerized reaction time measurement in healthy subjects, indicating these assessments have clinical utility. Additionally, the assessment only required a mobile device, allowing for assessment in clinics and sports settings without computers or force platform equipment. The last assessment method we evaluated involved neuroimaging techniques. Diffusion tensor imaging (DTI) has been used in the assessment of individuals with moderate to severe brain injury to objectively track recovery of function after trauma. We explored the similar use of DTI to objectively track recovery of function after concussion. We assessed 10 female participants experiencing slowed recovery of function after a concussion. We found no significant associations between DTI metrics for white matter pathway integrity and changes in symptoms over time, indicating that symptom improvement may occur in a non-congruent fashion with underlying neurological functioning. We did find improvements in pathway integrity were associated with improved reaction time and visual processing, adding to the clinical importance of assessing these skills. A lack of understanding as to which objective clinical features leads to increased risk of prolonged care adds to the complexity of determining a person’s recovery trajectory following concussion. This gap in evidence lead to an exploratory study evaluating differences in clinical presentation patterns between groups of individuals with typical treatment durations (≤ 28 days) and extended lengths of care ( 28 days). The exploratory factor analysis yielded different factor structures for each group. Notable differences included age, sex, history of psychiatric disorders, and neurocognitive abilities at the evaluation. These findings suggest clinical differences between individuals with longer and shorter lengths of care are observable at evaluation. After detecting differences between these groups, we sought to clarify the impact of each variable on length of care. A survival analysis was completed, evaluating the effects of clinical, demographic, and social factors on estimating length of care after concussion. We found males had shorter durations of care, while individuals with a history of concussion and better access to housing and transportation had longer durations of care. This study added evidence to support sex and concussion history as influential of longer durations of care. Additionally, while significant, housing and transportation access is likely not a protective feature for concussion recovery, but likely reflects the ability to attend follow-up treatments for concussion care. A final study was conducted to assess the predictive ability for each variable identified in the previous studies, with the primary outcome focused on determining which features best predict whether someone will have a typical duration of care (≤ 28 days) or an extended duration of care ( 28 days). A multivariable, logistic regression model was used to evaluate the significance of each variable. History of previous concussion and slowed reaction times at the evaluation had significant effects. Additionally, individuals from lower socioeconomic areas had lower odds of an extended length of care, although these findings should reflect ability to pursue care, rather than a reduction of recovery time. In summary, these studies add to the foundational knowledge of concussion assessment for diagnostic and recovery purposes. Additionally, these studies contribute to our understanding of factors that contribute to prolonged lengths of care for individuals after concussion. Clinicians should continue to complete thorough evaluation of individuals with suspected concussion, documenting concussion histories, sex, age, reaction times, and external social factors that may prevent or impede necessary follow-up care

Eye movements when looking at potential friends and romantic partners

Eye movements of 105 heterosexual undergraduate students (36 males) were monitored while viewing photographs of men and women identified as a potential mate or a potential friend. Results showed that people looked at the head and chest more when assessing potential mates and looked at the legs and feet more when assessing potential friends. Single people looked at the photographs longer and more frequently than coupled people, especially when evaluating potential mates. In addition, eye gaze was a valid indicator of relationship interest. For women, looking at the head corresponded to greater interest in friendship, whereas for men looking at the head corresponded to less interest in friendship. These findings show that relational goals and gender may affect the way people scan their environment and search for relevant information in line with their goals

Development of the cryogenic system of AEgIS at CERN

The AEgIS (Antimatter Experiment: Gravity, Interferometry, Spectroscopy) experiment is located at the antiproton decelerator complex of CERN. The main goal of the experiment is to perform the first direct measurement of the Earth’s gravitational acceleration on antihydrogen atoms within 1% precision. The antihydrogen is produced in a cylindrical Penning trap by combining antiprotons with positrons. To reach the precision of 1%, the antihydrogen has to be cooled to 100 mK to reduce its random velocity. A dilution refrigerator is selected to deliver the necessary cooling capacity of 100 μW at 50 mK. The AEgIS cryogenic system basically consists of cryostats for a 1-T and for a 5-T superconducting magnet, a central region cryostat, a dilution refrigerator cryostat and a measurement cryostat with a Moiré deflectometer to measure the gravitational acceleration. In autumn 2012, the 1-T cryostat, 5-T cryostat and central region cryostat were assembled and commissioned. The apparatus is cooled down in eight days using 2500 L of liquid helium and liquid nitrogen. During operation, the average consumption of liquid helium is 150 L∙day-1 and of liquid nitrogen 5 L·day-1. The temperature sensors at the Penning traps measured 12 K to 18 K, which is higher than expected. Simulations show that this is caused by a bad thermalization of the trap wiring. The implementation of the sub-kelvin region is foreseen for mid-2015. The antihydrogen will be cooled down to 100 mK in an ultra-cold trap consisting of multiple high-voltage electrodes made of sapphire with gold plated electrode sectors

Identifying predictors of suicide in severe mental illness : a feasibility study of a clinical prediction rule (Oxford Mental Illness and Suicide tool or OxMIS)

Background: Oxford Mental Illness and Suicide tool (OxMIS) is a brief, scalable, freely available, structured risk assessment tool to assess suicide risk in patients with severe mental illness (schizophrenia-spectrum disorders or bipolar disorder). OxMIS requires further external validation, but a lack of large-scale cohorts with relevant variables makes this challenging. Electronic health records provide possible data sources for external validation of risk prediction tools. However, they contain large amounts of information within free-text that is not readily extractable. In this study, we examined the feasibility of identifying suicide predictors needed to validate OxMIS in routinely collected electronic health records. Methods: In study 1, we manually reviewed electronic health records of 57 patients with severe mental illness to calculate OxMIS risk scores. In study 2, we examined the feasibility of using natural language processing to scale up this process. We used anonymized free-text documents from the Clinical Record Interactive Search database to train a named entity recognition model, a machine learning technique which recognizes concepts in free-text. The model identified eight concepts relevant for suicide risk assessment: medication (antidepressant/antipsychotic treatment), violence, education, self-harm, benefits receipt, drug/alcohol use disorder, suicide, and psychiatric admission. We assessed model performance in terms of precision (similar to positive predictive value), recall (similar to sensitivity) and F1 statistic (an overall performance measure). Results: In study 1, we estimated suicide risk for all patients using the OxMIS calculator, giving a range of 12 month risk estimates from 0.1-3.4%. For 13 out of 17 predictors, there was no missing information in electronic health records. For the remaining 4 predictors missingness ranged from 7-26%; to account for these missing variables, it was possible for OxMIS to estimate suicide risk using a range of scores. In study 2, the named entity recognition model had an overall precision of 0.77, recall of 0.90 and F1 score of 0.83. The concept with the best precision and recall was medication (precision 0.84, recall 0.96) and the weakest were suicide (precision 0.37), and drug/alcohol use disorder (recall 0.61). Conclusions: It is feasible to estimate suicide risk with the OxMIS tool using predictors identified in routine clinical records. Predictors could be extracted using natural language processing. However, electronic health records differ from other data sources, particularly for family history variables, which creates methodological challenges

The Hematopoietic System–specific Minor Histocompatibility Antigen HA-1 Shows Aberrant Expression in Epithelial Cancer Cells

Allogeneic stem cell transplantation (SCT) can induce curative graft-versus-tumor reactions in patients with hematological malignancies and solid tumors. The graft-versus-tumor reaction after human histocompatibility leukocyte antigen (HLA)-identical SCT is mediated by alloimmune donor T cells specific for polymorphic minor histocompatibility antigens (mHags). Among these, the mHag HA-1 was found to be restricted to the hematopoietic system. Here, we report on the HA-1 ribonucleic acid expression by microdissected carcinoma tissues and by single disseminated tumor cells isolated from patients with various epithelial tumors. The HA-1 peptide is molecularly defined, as it forms an immunogenic peptide ligand with HLA-A2 on the cell membrane of carcinoma cell lines. HA-1–specific cytotoxic T cells lyse epithelial tumor cell lines in vitro, whereas normal epithelial cells are not recognized. Thus, HA-1–specific immunotherapy combined with HLA-identical allogeneic SCT may now be feasible for patients with HA-1+ carcinomas

Interactions Between Zooplankton and Karenia brevis in the Gulf of Mexico.

Blooms of the toxic dinoflagellate K. brevis are common in the Gulf of Mexico, yet no in situ studies of the interactions between zooplankton and K. brevis in the Gulf of Mexico have been conducted. Zooplankton numerical abundance, biomass and taxonomic composition of nonbloom and K. brevis bloom stations within the ECOHAB study area were compared. At nonbloom stations, the most important determinant species were Parvolcalanus crassirostris, Oithona colcarva and Paracalanus quasimodo at the 5-m isobath and P. quasimodo, O. colcarva and Oikopleura dioka at the 25-m isobath. There was considerable overlap between the 5 and 25-m isobaths, with 9 species contributing to the top 90% of numerical abundance at both isobaths. Within K. brevis blooms Acartia tonsa, Centropages velificatus, Temora turbinata, Evadne tergestina, O. colcarva, O. dioika, and P. crassirostris were consistently dominant. Variations between non-bloom and bloom assemblages were evident, including variations in numerical abundance and biomass and the reduction in numerical abundance of 3 key species. Calculated grazing pressure proved insufficient to terminate K. brevis blooms, despite occasional grazing hot spots

Annihilation of low energy antiprotons in silicon

The goal of the AE$\mathrm{\bar{g}}$IS experiment at the Antiproton Decelerator (AD) at CERN, is to measure directly the Earth's gravitational acceleration on antimatter. To achieve this goal, the AE$\mathrm{\bar{g}}$IS collaboration will produce a pulsed, cold (100 mK) antihydrogen beam with a velocity of a few 100 m/s and measure the magnitude of the vertical deflection of the beam from a straight path. The final position of the falling antihydrogen will be detected by a position sensitive detector. This detector will consist of an active silicon part, where the annihilations take place, followed by an emulsion part. Together, they allow to achieve 1$$ precision on the measurement of $\bar{g}$ with about 600 reconstructed and time tagged annihilations. We present here, to the best of our knowledge, the first direct measurement of antiproton annihilation in a segmented silicon sensor, the first step towards designing a position sensitive silicon detector for the AE$\mathrm{\bar{g}}$IS experiment. We also present a first comparison with Monte Carlo simulations (GEANT4) for antiproton energies below 5 MeVComment: 21 pages in total, 29 figures, 3 table

Polar opposites? NGOs, left parties and the fight for social change in Nepal

In the early 1990s, when NGOs were rising to prominence as an ostensible force for social change in Nepal, the Maoists were also beginning to organise, and denounced NGOs as agents of imperialism. The Maoists came to prominence by fighting a People’s War launched in 1996, with the intention of improving life for the poor peasant and working-class majority. But after a decade-long struggle, the Maoists became incorporated into the parliamentary system. While Nepal’s first democratic revolution in 1990 met formal, popular political demands, which were consolidated in a subsequent revolution in 2006 overthrowing the monarchy and bringing the People’s War to an end, there was little socio-economic progress for the vast majority. The argument advanced in this article is that this lack of progress relied on the interplay of two phenomena: an anti-Maoist alliance consisting of the international community, the domestic ruling elite and NGOs, and a fundamental ambiguity at the heart of the Maoists’ political theory