King-Devick concussion test performs poorly as a screening tool in elite rugby union players: a prospective cohort study of two screening tests versus a clinical reference standard

BACKGROUND: The King-Devick (KD) test is an objective clinical test of eye movements that has been used to screen for concussion. We characterised the accuracy of the KD test and the World Rugby Head Injury Assessment (HIA-1) screening tools as methods of off-field evaluation for concussion after a suspicious head impact event. METHODS: A prospective cohort study was performed in elite English rugby union competitions between September 2016 and May 2017. The study population comprised consecutive players identified with a head impact event with the potential to result in concussion. The KD test was administered off-field, alongside the World Rugby HIA-1 screening tool, and the results were compared with the preseason baseline. Accuracy was measured against a reference standard of confirmed concussion, based on the clinical judgement of the team doctor after serial assessments. RESULTS: 145 head injury events requiring off-field medical room screening assessments were included in the primary analysis. The KD test demonstrated a sensitivity of 60% (95% CI 49.0 to 70) and a specificity of 39% (95% CI 26 to 54) in identifying players subsequently diagnosed with concussion. Area under the receiver operating characteristic curve for prolonged KD test times was 0.51 (95% CI 0.41 to 0.61). The World Rugby HIA-1 off-field screening tool sensitivity did not differ significantly from the KD test (sensitivity 75%, 95% CI 66 to 83, P=0.08), but specificity was significantly higher (91%, 95% CI 82 to 97, P<0.001). Although combining the KD test and the World Rugby HIA-1 multimodal screening assessment achieved a significantly higher sensitivity of 93% (95% CI 86% to 97%), there was a significantly lower specificity of 33% (95% CI 21% to 48%), compared with the HIA-1 test alone. CONCLUSIONS: The KD test demonstrated limited accuracy as a stand-alone remove-from-play sideline screening test for concussion. As expected with the addition of any parallel test, combination of the KD test with the HIA-1 off-field screening tool provided improved sensitivity in identifying concussion, but at the expense of markedly lower specificity. These results suggest that it is unlikely that the KD test will be incorporated into multimodal off-field screening assessments for concussion at the present time

A video analysis of head injuries satisfying the criteria for a head injury assessment in professional Rugby Union: a prospective cohort study

Objectives Concussion is the most common match injury in professional Rugby Union, accounting for 25% of match injuries. The primary prevention of head injuries requires that the injury mechanism be known so that interventions can be targeted to specifically overall incidence by focusing on characteristics with the greatest propensity to cause a head injury. Methods 611 head injury assessment (HIA) events in professional Rugby Union over a 3-year period were analysed, with specific reference to match events, position, time and nature of head contact. Results 464 (76%) of HIA events occur during tackles, with the tackler experiencing a significantly greater propensity for an HIA than the ball carrier (1.40 HIAs/1000 tackles for the tackler vs 0.54 HIAs/1000 tackles for the ball carrier, incidence rate ratio (IRR) 2.59). Propensity was significantly greater for backline players than forwards (IRR 1.54, 95%CI 1.28 to 1.84), but did not increase over the course of the match. Head to head contact accounted for the most tackler HIAs, with the greatest propensity. Conclusions By virtue of its high propensity and frequency, the tackle should be the focus for interventions that may include law change and technique education. A specific investigation of the characteristics of the tackle is warranted to refine the approach to preventative strategies

Revealing microhabitat requirements of an endangered specialist lizard with LiDAR

A central principle of threatened species management is the requirement for detailed understanding of species habitat requirements. Difficult terrain or cryptic behaviour can, however, make the study of habitat or microhabitat requirements difficult, calling for innovative data collection techniques. We used high-resolution terrestrial LiDAR imaging to develop three-dimensional models of log piles, quantifying the structural characteristics linked with occupancy of an endangered cryptic reptile, the western spiny-tailed skink (Egernia stokesii badia). Inhabited log piles were generally taller with smaller entrance hollows and a wider main log, had more high-hanging branches, fewer low-hanging branches, more mid- and understorey cover, and lower maximum canopy height. Significant characteristics linked with occupancy were longer log piles, an average of three logs, less canopy cover, and the presence of overhanging vegetation, likely relating to colony segregation, thermoregulatory requirements, and foraging opportunities. In addition to optimising translocation site selection, understanding microhabitat specificity of E. s. badia will help inform a range of management objectives, such as targeted monitoring and invasive predator control. There are also diverse opportunities for the application of this technology to a wide variety of future ecological studies and wildlife management initiatives pertaining to a range of cryptic, understudied taxa

A life-of-mine approach to fauna monitoring is critical for recovering functional ecosystems to restored landscapes

First published: 06 September 2021Mineral extraction activities are intensely disruptive to ecosystems and their associated fauna. Few countries globally have comprehensive legislation surrounding mine site restoration, but within Australia, restoration of discontinued mine sites is a legislative requirement. However, substantial ambiguity regarding the optimal techniques for restoring biodiverse and functional fauna assemblages remains, and monitoring activities typically focus on vegetation communities despite functioning ecosystems being reliant on key trophic interactions involving fauna. When fauna are considered, monitoring efforts typically yield baseline surveys of species richness and the presence or absence of conservation-significant taxa. Even where complete ecosystem recovery is not the goal of post-mining ecological recovery, we argue that there is a critical need for a life-of-mine approach to fauna monitoring underpinned by greater dialog between researchers, environmental regulators, and the mining industry. Environmental Impact Assessments should include requirements for the consideration of all potential impacts of mining on the structure, behavior, and ecological roles of fauna communities, restoration practices must facilitate the return of functional, resilient, and biodiverse fauna communities to restored post-mining landscapes, and the scope of monitoring practices should be broadened to a holistic examination of fauna communities. Recognizing, quantifying, and monitoring the impacts of mining activities and subsequent rehabilitation or restoration on fauna is vital to understanding how anthropogenic disturbances affect natural ecosystems, and in assisting in the successful recovery of ecosystem functionality to areas that have been damaged, degraded, or destroyed.Sophie L. Cross, Holly S. Bradley, Emily P. Tudor, Michael D. Craig, Sean Tomlinson, Michael J. Bamford, Philip W. Bateman, Adam T. Cros

Revealing microhabitat requirements of an endangered specialist lizard with LiDAR

A central principle of threatened species management is the requirement for detailed understanding of species habitat requirements. Difcult terrain or cryptic behaviour can, however, make the study of habitat or microhabitat requirements difcult, calling for innovative data collection techniques. We used high-resolution terrestrial LiDAR imaging to develop three-dimensional models of log piles, quantifying the structural characteristics linked with occupancy of an endangered cryptic reptile, the western spiny-tailed skink (Egernia stokesii badia). Inhabited log piles were generally taller with smaller entrance hollows and a wider main log, had more high-hanging branches, fewer low-hanging branches, more mid- and understorey cover, and lower maximum canopy height. Signifcant characteristics linked with occupancy were longer log piles, an average of three logs, less canopy cover, and the presence of overhanging vegetation, likely relating to colony segregation, thermoregulatory requirements, and foraging opportunities. In addition to optimising translocation site selection, understanding microhabitat specifcity of E. s. badia will help inform a range of management objectives, such as targeted monitoring and invasive predator control. There are also diverse opportunities for the application of this technology to a wide variety of future ecological studies and wildlife management initiatives pertaining to a range of cryptic, understudied taxa.Holly S. Bradley, Michael D. Craig, Adam T. Cross, SeanTomlinson, Michael J. Bamford, Philip W. Batema

Dimethyl fumarate selectively reduces memory T cells in multiple sclerosis patients

Background: Dimethyl fumarate (DMF) alters the phenotype of circulating immune cells and causes lymphopenia in a subpopulation of treated multiple sclerosis (MS) patients. Objective: To phenotypically characterize circulating leukocytes in DMF-treated MS patients. Methods: Cross-sectional observational comparisons of peripheral blood from DMF-treated MS patients (n = 17 lymphopenic and n = 24 non-lymphopenic), untreated MS patients (n = 17) and healthy controls (n = 23); immunophenotyped using flow cytometry. Longitudinal samples were analyzed for 13 DMF-treated patients. Results: Lymphopenic DMF-treated patients had significantly fewer circulating CD8+ and CD4+ T cells, CD56dim natural killer (NK) cells, CD19+ B cells and plasmacytoid dendritic cells when compared to controls. CXCR3+ and CCR6+ expression was disproportionately reduced among CD4+ T cells, while the proportion of T-regulatory (T-reg) cells was unchanged. DMF did not affect circulating CD56hi NKcells, monocytes or myeloid dendritic cells. Whether lymphopenic or not, DMF-treated patients had a lower proportion of circulating central and effector memory T cells and concomitant expansion of na\uefve T cells compared to the controls. Conclusions: DMF shifts the immunophenotypes of circulating T cells, causing a reduction of memory cells and a relative expansion of na\uefve cells, regardless of the absolute lymphocyte count. This may represent one mechanism of action of the drug. Lymphopenic patients had a disproportionate loss of CD8+ T-cells, which may affect their immunocompetence

Predators in a mining landscape: Threats to a behaviourally unique, endangered lizard

First published: 09 June 2022Patchy resource distribution can cluster predator activity around areas of the highest productivity in ecosystems. For the endangered Western Spiny-tailed Skink (Egernia stokesii badia) in Western Australia, the log piles that they permanently inhabit in an otherwise patchy, arid landscape, represent a potentially reliable, high abundance food source for predators. Not only are encounter rates by potential predators of E. s. badia likely to be influenced by vegetation structure at the micro habitat scale but also E. s. badia occurs in a region where minesites and associated infrastructure, such as landfill sites, likely concentrate generalist predators (e.g. Feral Cats and corvids). We assessed the influence of the presence of coarse woody debris (CWD) and distance to the land-fill on predator behaviour towards E. s. badia through plasticine model experiments, unbounded point count bird surveys and camera trapping. We found that CWD inhabited byE. s. badia attracted a greater relative activity of corvids compared with uninhabited CWD, or control sites without CWD. The relative activity of corvids and predatory birds combined increased with decreasing distance from the landfill. Preferential hunting by corvids at CWD inhabited byE. s. badia compared to both uninhabited CWD and open sites suggests that inhabited CWD may be targeted by generalist predators in the region, and that adaptive management may be required for species conservation around active mining areas.Holly S. Bradley, Michael D. Craig, Sean Tomlinson, Adam T. Cross, Michael J. Bamford, Philip W. Batema

NIN, a gene encoding a CEP110-like centrosomal protein, is fused to PDGFRB in a patient with a t(5;14)(q33;q24) and an imatinib-responsive myeloproliferative disorder

We describe a new PDGFRB fusion associated with a t(5;14)(q33;q24) in a patient with a longstanding chronic myeloproliferative disorder with eosinophilia. After confirmation of PDGFRB involvement and definition of the chromosome 14 breakpoint by fluorescence in situ hybridization, candidate partner genes were selected on the basis of the presence of predicted oligomerization domains believed to be an essential feature of tyrosine kinase fusion proteins. We demonstrate that the t(5;14) fuses PDGFRB to NIN, a gene encoding a centrosomal protein with CEP110-like function. After treatment with imatinib, the patient achieved hematological and cytogenetical remission, but NIN-PDGFRB mRNA remained detectable by reverse transcription-PCR