Evaluation Of The Vestibular And Ocular Motor Screening (Voms) As A Prognostic Tool For Protracted Recovery Following Paediatric Sportsrelated Concussion

Objective To understand the relationship between initial vestibular and ocular motor screening (VOMS) and recovery time, and the utility of VOMS to screen for protracted recovery in youth/adolescent patients with sport-related concussion (SRC). Methods Participants (8–18 years) who were diagnosed with an SRC within 7 days of the injury were administered the VOMS test by certified medical personnel. Recovery time (days) and protracted recovery (\u3e30 days) were the primary outcomes. Multivariable regression models were used to evaluate the association between VOMS symptom provocation and (1) recovery time (days) and (2) protracted recovery. Measures of VOMS validity, predictive ability and receiver operator curves were used to assess VOMS as a prognostic tool to accurately classify a normal/protracted recovery. Results After adjustment, any symptom provocation across all VOMS domains was associated (p\u3c0.05) with greater recovery time, except the convergence test (p=0.08) in females. All VOMS test thresholds (≥1 to ≥10) in males and (≥1 to ≥5) in females were associated (p\u3c0.05) with recovery time. However, the VOMS test performed poorly among males (receiver operating characteristic (ROC) area=0.66) and failed among females (ROC area=0.56) as a prognostic tool to identify those that will have a normal/protracted recovery. Conclusion In this sample, overall, the VOMS test was associated with recovery time (days); however, the VOMS was not a valid stand-alone prognostic tool to identify a delayed recovery, but may be useful in combination with other concussion symptomology assessments. Future studies should confirm these findings in larger samples while taking into consideration other comorbid factors that may influence recovery tim

USCID fourth international conference

Presented at the Role of irrigation and drainage in a sustainable future: USCID fourth international conference on irrigation and drainage on October 3-6, 2007 in Sacramento, California.In response to a range of internal and external drivers and the need to protect the district's pre-1914 water rights, Oakdale Irrigation District (OID) developed a long-term Water Resources Plan (WRP). The 100-year-old irrigation district provides irrigation and domestic water service to over 55,000 acres in California's San Joaquin Valley. The study effort created a strategic roadmap for the implementation of a $170 million capital program focused on protecting OID's water rights while meeting the changing needs of its constituency and serving the region. The second phase included programmatic environmental documentation, which is being followed by design and construction of facility improvements. This multi-disciplined effort included detailed land use modeling, water balance modeling, on-farm surveys, a comprehensive infrastructure assessment, and the development of a phased infrastructure plan to rehabilitate and modernize an out-of-date system. The approach also integrated water right evaluations, groundwater studies, development and evaluation of program alternatives, financial analyses, environmental compliance, and public outreach. Key benefits resulting from WRP implementation include protecting the district's water rights, increasing reliability during droughts, and modernizing a century-old system to meet the needs of its current and future customer base. Implementation includes a balanced effort of water transfers and expansion of service into OID's sphere of influence while keeping water rates affordable. OID's infrastructure will be rebuilt, modernized, and expanded, and customer service and water use efficiency will be enhanced

Management and Treatment of Concussions via Tele-Concussion in a Pediatric Setting: Methodological Approach and Descriptive Analysis

Background: Approximately 2 million children in the United States sustain a concussion annually, resulting in an economic impact as high as US $20 billion. Patients who receive treatment at concussion specialty clinics, versus primary care, experience faster recovery, thereby reducing patient burden and subsequent medical-related costs. Accessibility to specialty clinics is typically limited by the availability of in-office visits. This is particularly relevant in light of the severe acute respiratory syndrome coronavirus 2 pandemic and subsequent guidance to eliminate all non–medically necessary in-clinic visits. Telehealth has been used to effectively deliver in-clinic care across several disciplines including psychiatry, psychology, and neuropsychology. However, a model of telehealth delivered concussion assessment, treatment, and management has not been established. Objective: The purposes of this paper are to describe a pediatric concussion specialty clinic’s experiences in delivering telehealth concussion services and to provide preliminary descriptive data on a sample of pediatric telehealth patients with concussions. Methods: The specialty pediatric concussion clinic described here began providing telehealth services in 2019 and is part of the largest and fastest-growing telehealth hospital network in the United States. The clinical care process will be described, including accessing the telehealth platform, assessment during the initial appointment, injury management including communication with relevant patient stakeholders (eg, parent or guardians, athletic trainers), dissemination of rehabilitation exercises, and nature of follow-up visits. Descriptive data will include patient demographics, the radius of care, the time between the date of injury and initial visit, the average number of follow-up visits, and days until medically cleared for return-to-learn and return-to-play. Results: The analytic sample included 18 patients with concussions who were seen for all of their visits via telehealth between August 2019 and April 2020. The mean age of the sample was 14.5 (SD 2.5) years. The radius of care was a median of 17 (IQR 11.0-31.0) miles from the clinic with a median time between injury and the first visit of 21 (IQR 6.0-41.5) days. The mean number of visits was 2.2 (SD 0.8) with a median days between visits of 5.4 (IQR 3.0-9.3) to manage and treat the concussion. Of the 18 patients, 55.6% (n=10) were medically cleared for return-to-learn or -play in a median of 15.5 (IQR 11.0-29.0) days. Conclusions: Limited access to health care is a well-understood barrier for receiving quality care. Subsequently, there are increasing demands for flexibility in delivering concussion services remotely and in-clinic. This is the first paper to provide a clinically relevant framework for the assessment, management, and treatment of acute concussion via telehealth in a pediatric population

Exploring Vestibular/Ocular and Cognitive Dysfunction as Prognostic Factors for Protracted Recovery in Sports-Related Concussion Patients Aged 8 to 12 Years

Objective: To explore the prognostic ability of the vestibular/ocular motor screening (VOMS), King–Devick (K-D) Test, and C3 Logix Trails A and B to identify protracted recovery from sports-related concussion (SRC) in patients aged 8 to 12 years. Design: Retrospective cohort analysis. Setting: Specialty pediatric sports concussion clinic. Participants: A total of 114 youth athletes aged 8 to 12 years who were diagnosed with an SRC within 7 days of injury. Independent Variables: A positive screen on the VOMS, K-D, and C3 Logix Trails A and Trails B. Combined positive screens on multiple tests (ie, 2, 3, or all 4 positive screens of 4 possible). Main Outcome Measures: Recovery time in days and protracted recovery (recovery time $30-days) were the primary outcomes of interest. Results: A positive VOMS screen was associated with 1.31 greater days to SRC recovery (P 5 0.02) than a negative VOMS screen. The K-D and C3 Logix tests were not significantly associated with recovery time, nor were any combinations of tests (P . 0.05). The VOMS demonstrated moderate prognostic ability to predict normal recovery (negative predictive value 5 80.78% [95% CI 5 63.73-90.95]). Overall predictive accuracy of normal versus protracted recovery was strongest when a participant screened positive on all 4 tests (Accuracy 5 76.32% [95% CI 5 67.45-83.78]). Conclusions: The VOMS was associated with overall recovery time and proved to be a useful test to identify those who would experience a normal recovery time. Combining the 4 tests improved the prognostic accuracy of the protocol in predicting protracted versus normal recovery. These findings suggest that combining multiple, varied assessments of cognition and vestibular/ocular functions may better explain factors contributing to protracted recovery

Prospective Evaluation of 24-hour Movement Behaviors Among Adolescents Recovering From a Sport-related Concussion

This study aimed to describe the 24-hour composition of movement behaviors, including sleep, sedentary behavior, and physical activity (PA), among pediatric sports-related concussion (SRC) patients over their recovery period, assess the association between movement compositions and recovery time, and understand feasibility of 24-hour accelerometry in the study population. A cohort of 50 pediatric SRC patients were asked to wear a wrist-worn accelerometer continuously for the duration of their recovery. Among all enrolled participants, the sample was primarily 14 or 15 years of age (65%), female (55%), and recovered in under 28 days (88%). Accelerometer compliance was moderate; 35 participants (70%) were compliant with the protocol. Compositional analysis was used to address time-use objectives in 33 participants who provided adequate data for inclusion. Overall, participants spent an average of 50% of their 24-hour day sedentary, 33% sleeping, 11% in light intensity PA, and 6% in moderate or vigorous intensity PA. The 24-hour composition of movement behaviors was not associated with recovery time (p ¼ .09–.99). However, the limited sample size may have contributed to null findings. Given recent evidence supporting the effects of sedentary behavior and PA on concussion recovery, future studies should aim to further validate these findings in a larger sample

Machine learning to predict sports-related concussion recovery using clinical data

ObjectivesSport-related concussions (SRCs) are a concern for high school athletes. Understanding factors contributing to SRC recovery time may improve clinical management. However, the complexity of the many clinical measures of concussion data precludes many traditional methods. This study aimed to answer the question, what is the utility of modeling clinical concussion data using machine-learning algorithms for predicting SRC recovery time and protracted recovery? MethodsThis was a retrospective case series of participants aged 8 to 18 years with a diagnosis of SRC. A 6-part measure was administered to assess pre-injury risk factors, initial injury severity, and post-concussion symptoms, including the Vestibular Ocular Motor Screening (VOMS) measure, King-Devick Test and C3 Logix Trails Test data. These measures were used to predict recovery time (days from injury to full medical clearance) and binary protracted recovery (recovery time \u3e 21 days) according to several sex-stratified machine-learning models. The ability of the models to discriminate protracted recovery was compared to a human-driven model according to the area under the receiver operating characteristic curve (AUC). ResultsFor 293 males (mean age 14.0 years) and 362 females (mean age 13.7 years), the median (interquartile range) time to recover from an SRC was 26 (18–39) and 21 (14–31) days, respectively. Among 9 machine-learning models trained, the gradient boosting on decision-tree algorithms achieved the best performance to predict recovery time and protracted recovery in males and females. The models’ performance improved when VOMS data were used in conjunction with the King-Devick Test and C3 Logix Trails Test data. For males and females, the AUC was 0.84 and 0.78 versus 0.74 and 0.73, respectively, for statistical models for predicting protracted recovery. ConclusionsMachine-learning models were able to manage the complexity of the vestibular-ocular motor system data. These results demonstrate the clinical utility of machine-learning models to inform prognostic evaluation for SRC recovery time and protracted recovery

Association Between Concussion History and Factors Relating to Cognitive, Behavioral, and Emotional Health Among American High School Athletes: A Cross-sectional Analysis

Background: The cognitive, behavioral, and emotional deficits that may be associated with sports-related concussions among adolescents are unclear. Purpose: To examine the association between reported concussion history and factors relating to cognitive, behavioral, and emotional health among a population-based sample of US high school-aged adolescents. Study design: Cross-sectional study; Level of evidence, 3. Methods: Participants included a representative sample of US high school student-athletes who reported a concussion history (in the past 12 months) and relevant behaviors/outcomes within 3 domains: cognitive (academics, difficulty concentrating), behavioral (drinking and driving, carrying a weapon, physically fighting, tobacco use, marijuana use, binge drinking), and emotional (symptoms of depression, suicidal thoughts/actions). The adjusted relative odds of experiencing 0 and at least 1, 2, 3, or ≥4 concussions were modeled while mutually adjusting for the behaviors of interest in addition to age, race/ethnicity, and sleep problems. Data were reported in sex stratum. Results: A total of 13,268 participants were included in the unweighted data set. Overall, 14.5% (95% CI, 12.9%-16.2%) of female and 18.1% (95% CI, 16.4%-19.8%) of male student-athletes had at least 1 concussion in the past 12 months. As compared with those who reported not engaging in any of the behaviors deleterious to health or having had any of the negative health outcomes (composite score of 0), female athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 1.94 (95% CI, 1.55-2.43), 3.13 (95% CI, 2.30-4.33), and 6.05 (95% CI, 3.75-9.75) times more likely to have a recent history of concussions after accounting for relevant factors. As compared with those having a composite score of 0, male athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 2.03 (95% CI, 1.58-2.59), 3.80 (95% CI, 2.71-5.34), and 8.23 (95% CI, 4.91-13.77) times more likely to have a recent history of concussions after accounting for relevant factors. Conclusion: Self-reported concussions among US high school athletes is related to several deleterious health behaviors and outcomes. These associations should be confirmed in longitudinal analyses

Factors Related to Accelerometer-determined Patterns of Physical Activity in Adults: The Houston TRAIN Study

Meeting U.S. Physical Activity (PA) Guidelines has health benefits. Yet, little is known about the factors related to changes in PA over time, particularly among minority populations. PURPOSE: To examine sociodemographic, PA preferences, and health factors related to accelerometer-derived patterns of 1-year PA change in the Houston Travel Related Activity in Neighborhoods (TRAIN) Study, a majority-minority cohort. METHODS: Participants wore an ActiGraph wGT3X-BT monitor and completed self-report surveys at baseline and follow-up. Valid wear time was defined as ≥ 4 days, ≥ 10 hrs/day. PA was stratified by meeting Guidelines using total MVPA, defined by Freedson. Four PA patterns were defined: (i) ‘maintain high’ activity above Guidelines, (ii) ‘increased’ to meet Guidelines, (iii) ‘decreased’ from meet to not meet Guidelines, and (iv) ‘maintained low’ activity. Multinomial logistic regression was used to examine associations between studied factors and each PA pattern, with the ‘maintain high’ group as referent. RESULTS: Complete data were available for 153 adults (19% maintained high activity, 8.5% increased, 13% decreased, 59.5% maintained low activity). Controlling for all variables, males (OR = 0.3, 95% CI = 0.1, 0.9) had lower odds of being in the ‘maintain low’ group. Blacks (vs. whites, OR = 18.8, 95% CI = 2.6, 275.0), those liking biking (vs. strongly liking, OR = 4.6, 95% CI = 1.3, 15.6), and older participants (vs. younger, on continuous scale, OR = 1.1, 95% CI = 1.0, 1.1) had higher odds of being in the ‘maintain low’ group. Factors directly associated with being in the ‘increased’ group were being black (vs. white, OR = 17.9, 95% CI = 1.3, 120.9), strong dislike for biking (vs. strongly liking OR = 25.2, 95% CI = 1.6, 401.3), and having more chronic diseases (vs. less, on continuous scale, 95% CI = 1.5, 11.7). Having low educational attainment (vs. high, OR = 0.04, 95% CI = 0.0, 0.9) was inversely associated with being in the ‘increased’ group. No studied factors were significantly associated with being in the ‘decreased’ group. CONCLUSION: PA patterns are dynamic and suggest that sociodemographic, PA preferences, and health factors relate to change patterns over time. Future studies should examine the role of these factors over longer follow-up periods, and consider these factors when designing interventions

Reliability of an On-line System to Assess Physical Activity Behaviors in an Active Group of Kinesiology Undergraduate Students

Engaging in muscle strengthening activities (MSA) as part of a physical activity program offers health benefits. Although the merits of physical activity are well documented, many adults fail to meet appropriate levels as recommended in the 2008 Physical Activity Guidelines for Americans (PAGA). To get a more complete understanding on an individual's physical activity behaviors, the Tracking Resistance Exercise and Strength Training (TREST) internet based survey was developed. The purpose of the current study was to determine the test-retest reliability of TREST items. Additionally, the prevalence of participants meeting the 2008 PAGA was reported by gender. The survey was completed approximately two weeks apart by 224 (52% male) undergraduate kinesiology students. Analysis of the survey items presented TREST as a reliable instrument in assessing an individual's physical activity behavior with a focus on MSA. Among the convenience sample of 445 participants (56% male) that completed the survey in assessment #1, 73% met the 2008 PAGA minimum recommendations for MSA (>=2 days/week) and aerobic activity (>= 150 min MVPA). A more complete MSA and MVPA criteria was established (requiring MSA of all seven major muscle groups) and only 32% of participants met this guideline. In general, men engaged in aerobic exercise and MSA more than women. These results cannot be generalized due the age, activity level, and education of the study's participants. Future studies should investigate the validity of TREST items among a sample of varying fitness levels, races/ethnicities, ages, and educational levels

Examining the Associations and Cost-Effectiveness of Policy Level Changes to the Built and Transportation Environments Intended to Increase Physical Activity

Physical inactivity is a significant public health problem. Less than one-half of United States (US) adults report engaging in sufficient physical activity for health benefits and almost one-third report no leisure-time physical activity at all. Efforts to increase population levels of physical activity should focus on systematic interventions targeting the physical, social, and economic environments. Collectively, the three articles included in this dissertation aimed to assess relations in the physical (transportation and built), and economic environments related to physical activity. ^ The Houston Travel Related Activity in Neighborhoods (TRAIN) Study served as the parent study for this dissertation and data collected from 2013 to 2016 were used to address the specific aims. Briefly, the specific aims include: 1) to determine the association between baseline physical activity and transit use (Article 1), 2) to assess the changes in physical activity associated with living near improved sidewalks (Article 2), and 3) to determine if improving sidewalks sufficiently increases physical activity to be considered cost-effective (Article 3). The TRAIN Study is a natural experiment aimed at prospectively evaluating the impact of a light rail transit (LRT) system on transit use and physical activity over a four year period (2013–2017), in Houston, Texas. To be eligible, participants must, 1) be at least 18 years of age, 2) reside within a 3 mile Euclidean buffer around the LRT, and 3) be the only TRAIN participant in their household. A further eligibility criteria for this dissertation work included complete data on self-reported physical activity at baseline (Article 1) and first follow-up (Articles 2 \u26 3). ^ Article 1 utilized multiple logistic regressions to model the odds of transit users achieving sufficient physical activity for health benefits versus transit non-users. Articles 2 and 3 included a follow-up assessment a median 14.3 months post baseline assessment. Multivariable regressions (two-step probit \u26 OLS models in Article 2) were used to estimate the relation between living near sidewalk improvements and physical activity. Article 3 conducted a cost-effectiveness analysis of sidewalk improvements. Article 1 results indicated that transit users accumulated approximately 30 more weekly minutes of moderate intensity physical activity than transit non-users. Transit users had 2.46 (95% CI: 1.08–5.61) times the odds of health benefits from transit related physical activity than non-users. Article 2 found that reported leisure-time physical activity was 60% (expβ=0.46=1.58, p=0.009) higher among physically active participants living near two sidewalk improvements than not living near an improvement. Finally, Article 3 found that sidewalk improvements were cost-effective at a cost of $0.007–$0.07 per MET hour per year gained of self-reported physical activity. ^ These results highlight the importance of a multi-level or systems approach to increase physical activity. Future work should establish true baseline assessments of transit use and exposures to sidewalk improvements with longer follow-up periods to establish temporally sequenced and dose-response relations with physical activity.