Cognitive Differences from Preseason to End of Season among Youth and College Football Players

Coronado et al. (2015) estimated that 329,290 children, aged 19 years and younger, were treated for sports and recreation injuries, including concussion, in emergency rooms during 2012. Further, they found that the number of concussions within this age group doubled since 2001. Many states now have laws regarding concussion education and testing for youth to high school level sports. While diagnosed concussions are important to evaluate, contact below the level necessary for concussion seems to accumulate over the course of a season (e.g., Abbas et al., 2015). This study examined sub-concussive hits and changes in neurocognitive assessment within a single season. The ImPACT test is a commonly used baseline and post-injury neurocognitive assessment for concussion. It includes composite scores for verbal memory, visual memory, visual motor speed, reaction time, and impulse control as well as an efficiency index score that compares speed of responding and accuracy. This test was given to college and youth football players during the preseason prior to the start of practices. One week after the season ended, players who did not receive a concussion during the season were asked to complete an end-of-season test. Approximately 33 and 52 percent of the DIII college and middle school football players, respectively, completed the end-of-season test. A series of 2x2 ANOVAs were conducted to look at differences on the ImPACT composite scores from preseason to end-of-season for youth and college football players. Overall, the results suggest that there are no meaningful differences in the cognitive domains examined by the ImPACT test over the course of a football season regardless of age. However, using rs-fMRI, Slobounov et al. (2017) found significant differences in the cingulate cortex and hippocampus among FBS football players within a single season. These differences were observed in the absence of clinical symptoms or a diagnosed concussion. Therefore, it appears that behavioral symptoms and neurocognitive assessments are not sensitive enough to detect the pathophysiological changes that take place in the brain due to sub-concussive hits absorbed over the course of a football season

Reliability and Test Differences for the Impact: Implications for Concussion Testing Programs

This study was conducted to determine the long-term relatability of ImPACT scores among young athletes. Youth sport participants (n=294) who completed ImPACT tests one year apart were included in the study. Ages ranged from nine to 14 with a mean of 11.42 (SD = .96). The majority (n = 215) were males. Test-retest reliabilities for verbal memory, visual memory, response time, and impulse control were statistically significant but weak, ranging between .33 and .49. The index score had poor test-retest reliabilities (r = .26). Visual-motor test-retest reliability was also significant but moderate (r=.68). Scores for the verbal memory subtest and the index score did not change over time. However, there was significant improvement for the visual memory (t(293) = 2.24, p \u3c .03, d = .13), visualmotor (t(293) = 9.23, p \u3c .001, d = .54), response time (t(293) = 3.78, p \u3c .001, d = .22), and impulse (t(293) = 3.27, p \u3c .001, d = .19) subtests. These results indicate that the long-term test-retest reliability of the ImPACT is inadequate and that several subtests change over time. Therefore, it is recommended that baseline ImPACT scores are obtained on an annual basis

Where do hands go? An audit of sequential hand-touch events on a hospital ward

Reservoirs of pathogens could establish themselves at forgotten sites on a ward, posing a continued risk for transmission to patients via unwashed hands. To track potential spread of organisms between surfaces and patients, and to gaina greater understanding into transmission pathways of pathogens during patient care. Hand-touch activities were audited covertly for 40 30 min sessions during summer and winter, and included hand hygiene on entry; contact with near-patient sites; patient contact; contact with clinical equipment; hand hygiene on exit; and contact with sites outside the room. There were 104 entries overall: 77 clinical staff (59 nurses; 18 doctors), 21 domestic staff, one pharmacist and five relatives. Hand-hygiene compliance among clinical staff before and after entry was 25% (38/154), with higher compliance during 20 summer periods [47%; 95% confidence interval (CI): 35.6e58.8] than during 20 winter periods (7%; 95% CI: 3.2e14.4; P < 0.0001). More than half of the staff (58%; 45/77) touched the patient. Staff were more likely to clean their hands prior to contact with a patient [odds ratio (OR): 3.44; 95% CI: 0.94e16.0); P ¼ 0.059] and sites beside the patient (OR: 6.76; 95% CI: 1.40e65.77; P ¼ 0.0067). Nearly half (48%; 37/77) handled patient notes and 25% touched the bed. Most frequently handled equipment inside the room were intravenous drip (30%) and blood pressure stand (13%), and computer (26%), notes trolley (23%) and telephone (21%) outside the room. Hand-hygiene compliance remains poor during covert observation; understanding the most frequent interactions between hands and surfaces could target sites for cleaning

The Tip of the Iceberg: A First Amendment Right To Promote Drugs Off-Label

Scholars, advocates, and courts have begun to recognize a First Amendment right for the makers of drugs and medical devices to promote their products “off-label,” without proving safety and efficacy of new intended uses. Yet, so far, this debate has occurred in a vacuum of peculiar cases, where convoluted commercial speech doctrine underdetermines the outcome. Juxtaposing these cases against other routine prosecutions of those who peddle unapproved drugs reveals the common legal regime at issue. Review of the seven arguments deployed in the off-label domain finds that, if they were valid, they would undermine the FDA’s entire premarket approval regime. Even more a companion paper shows that, if valid, this First Amendment logic would undermine a wide range of statutory regimes that have similar intent-based structures and that rely on speech as evidence of intent

The Ethics of Research That May Disadvantage Others

In prospective interventional research, a treatment may provide an advantage for the recipient over other humans not receiving it. If the intervention proves successful, the treated are better able to compete for a scarce ventilator, a class grade, or a litigation outcome, potentially risking the deaths, jobs, or incomes of non-treated persons. The concerns for “bystanders” have typically focused on direct harms (e.g., infecting them with a virus), unlike the mere competition for rivalrous goods at issue here.After broadly scoping this problem, analysis reveals several reasons that such research is typically permissible, notwithstanding the potential setbacks to the interests of non-participants. After considering the almost-dispositive concept of clinical equipoise, insights are gleaned from the harm principle, status quo bias, the levelling-down problem, and a potential bias against prospective interventional research versus program interventions with retrospective study. Consideration of institutional relationships also does not change the analysis that such research is permissible

The Split Benefit: The Painless Way to Put Skin Back in the Health Care Game

This Article proposes a solution to the growth of health care costs, focusing on the sector of expensive, and often unproven, treatments. Political, legal, and market limits prevent insurers or physicians from rationing care or putting downward pressure on prices. Since the insurer bears the cost, the patient is also not sensitive to price, and thus consumes even low-value treatments. The traditional cost-sharing solution is stymied by the patients’ limited wealth. When treatments can cost $25,000 or more, the median patient cannot be expected to pay a significant portion thereof. Instead, patients often enjoy supplemental insurance or exhaust their cost-sharing limits, and thus enjoy full insurance when making such a consumption decision. Raising the limits is a painful solution, since it would reduce access to care and cause medical bankruptcies. A new solution emerges from the recognition that insurance currently provides only an “in kind” benefit, paid to the provider rather than the beneficiary. Instead, under a “split benefit,” for expensive treatments (costing say$100,000), the insurer should consider satisfying its coverage obligation by paying a portion (say $10,000) directly to the patient. The patient decides whether to spend that portion on the treatment. If so, the insurer pays the balance ($90,000) to the provider, thereby insuring access. If the patient instead declines the care, she can save or spend the money on anything else. The insurer saves the balance ($90,000). Because it is fungible, the split benefit creates an opportunity cost, causing some patients to decline the expensive treatment in lieu of medical and non-medical alternatives that they value more highly. Strikingly, the split benefit is consistent with current insurance contracts and regulations, since it does not change coverage or the size of the benefit. That feature makes the split benefit practicable, unlike many other theoretical solutions. Moreover, the insurer can exercise the split benefit as a unilateral option, whenever it is most likely to save money. Unlike traditional cost-sharing policies or rationing, the split benefit does not reduce access to care. The proposal serves patients’ autonomy by giving them additional options, and reduces the distortion in the larger economy caused by non-fungible insurance. This Essay considers objections, including the possibility of stimulating false demand and the need to protect patients who are unable to decide for themselves - both of which the appropriate legal mechanisms can address

Will Courts Allow States to Regulate Drug Prices?

Pharmaceuticals are consuming increasingly large portions of U.S. state budgets, and high prices are preventing patients from getting, and adhering to, essential medicines. In mid-May 2018, President Donald Trump announced a heavily hyped but relatively modest federal plan to bring down drug prices. Meanwhile, several states are moving forward with their own solutions, and Maryland’s approach is particularly ambitious. In 2017, responding to notorious cases such as the 5000% increase in the cost of Daraprim (pyrimethamine) and the 10-fold increase in the cost of EpiPens (epinephrine auto-injectors), Maryland enacted a statute that prohibits manufacturers from “price gouging” on any “essential off-patent or generic drug.

Tailored codes for small quantum memories

We demonstrate that small quantum memories, realized via quantum error correction in multi-qubit devices, can benefit substantially by choosing a quantum code that is tailored to the relevant error model of the system. For a biased noise model, with independent bit and phase flips occurring at different rates, we show that a single code greatly outperforms the well-studied Steane code across the full range of parameters of the noise model, including for unbiased noise. In fact, this tailored code performs almost optimally when compared with 10,000 randomly selected stabilizer codes of comparable experimental complexity. Tailored codes can even outperform the Steane code with realistic experimental noise, and without any increase in the experimental complexity, as we demonstrate by comparison in the observed error model in a recent 7-qubit trapped ion experiment.Comment: 6 pages, 2 figures, supplementary material; v2 published versio