Concussion Management, Education, and Return-to-Play Policies in High Schools: A Survey of Athletic Directors, Athletic Trainers, and Coaches

Background: Concussions represent 8.9% to 13.2% of all high school athletic injuries. How these injuries are managed is currently unknown. Hypothesis: There are differences in concussion management and awareness between boys football, boys ice hockey, and boys and girls soccer. Study Design: Descriptive epidemiologic study. Methods: High school athletic directors were contacted via email and asked to complete an online survey with four separate sections for athletic directors, head coaches, team physicians, or certified athletic trainers. Results: According to coaches, concussion awareness education was provided for football (97%), hockey (65%), and boys and girls soccer (57% and 47%, respectively) (P \u3c 0.01). Use of sideline screening tools was significantly greater for football (P = 0.03). All participants agreed that a player who has suffered a concussion cannot return to play the same day. Conclusion: There is a difference in concussion management and awareness between the four sports. Concussion education is well promoted in football but should be expanded in soccer and hockey. Players are not allowed to return to play the same day, and the majority are referred to a physician. Clinical Relevance: Study results highlight the differences in concussion education between sports. Healthcare providers should address these gaps

Shoulder muscle activation pattern recognition based on sEMG and machine learning algorithms

BACKGROUND AND OBJECTIVE: Surface electromyography (sEMG) has been used for robotic rehabilitation engineering for volitional control of hand prostheses or elbow exoskeleton, however, using sEMG for volitional control of an upper limb exoskeleton has not been perfectly developed. The long-term goal of our study is to process shoulder muscle bio-electrical signals for rehabilitative robotic assistive device motion control. The purposes of this study included: 1) to test the feasibility of machine learning algorithms in shoulder motion pattern recognition using sEMG signals from shoulder and upper limb muscles, 2) to investigate the influence of motion speed, individual variability, EMG recording device, and the amount of EMG datasets on the shoulder motion pattern recognition accuracy. METHODS: A novel convolutional neural network (CNN) structure was constructed to process EMG signals from 12 muscles for the pattern recognition of upper arm motions including resting, drinking, backward-forward motion, and abduction motion. The accuracy of the CNN models for pattern recognition under different motion speeds, among individuals, and by EMG recording devices was statistically analyzed using ANOVA, GLM Univariate analysis, and Chi-square tests. The influence of EMG dataset number used for CNN model training on recognition accuracy was studied by gradually increasing dataset number until the highest accuracy was obtained. RESULTS: Results showed that the accuracy of the normal speed CNN model in motion pattern recognition was 97.57% for normal speed motions and 97.07% for fast speed motions. The accuracy of the cross-subjects CNN model in motion pattern recognition was 79.64%. The accuracy of the cross-device CNN model in motion pattern recognition was 88.93% for normal speed motion and 80.87% for mixed speed. There was a statistical difference in pattern recognition accuracy between different CNN models. CONCLUSION: The EMG signals of shoulder and upper arm muscles from the upper limb motions can be processed using CNN algorithms to recognize the identical motions of the upper limb including drinking, forward/backward, abduction, and resting. A simple CNN model trained by EMG datasets of a designated motion speed accurately detected the motion patterns of the same motion speed, yielding the highest accuracy compared with other mixed CNN models for various speeds of motion pattern recognition. Increase of the number of EMG datasets for CNN model training improved the pattern recognition accuracy

Evaluation of solar exposure in Brachiaria decumbens poisoning in sheep

Foram utilizados 26 ovinos, entre 3 e 4 meses de idade, divididos em 3 grupos, provenientes de rebanhos que nunca tiveram contato com pastos de Brachiaria spp.. Dois grupos receberam Brachiaria decumbens no cocho diariamente ad libitum, sendo que um deles permaneceu em área com exposição solar (GS) e o outro foi mantido em baias cobertas protegidos do sol (GSB). O grupo controle (GC) foi também mantido em local com exposição solar e alimentado com feno de Cynodon dactylon e capim Pennisetum purpureum triturado. Todos os grupos receberam alimentação em cochos e foram suplementados com 200g/ dia/animal de ração comercial para ovinos. Foi realizada a avaliação clínica diária dos ovinos e colhidas amostras duas vezes por semana para dosagem sérica de AST e GGT. Os animais que morreram foram submetidos a necropsia e em todos os ovinos sobreviventes foi realizada biópsia hepática no final do experimento. Três animais do grupo GS adoeceram e dois morreram. Um ovino do grupo GSB adoeceu e morreu. Não houve alterações clínicas nos ovinos controles. Os principais sinais clínicos observados nos animais que adoeceram foram apatia, emagrecimento, fotofobia, hiperemia e secreção ocular e icterícia. Nenhum animal apresentou lesões cutâneas de fotossensibilização. O grupo que permaneceu no sol apresentou atividades séricas médias de AST e GGT significativamente maiores que a dos demais grupos (p≤0,05) e os animais que permaneceram na sombra apresentaram níveis maiores de GGT (p≤0,05) em comparação ao grupo controle. A histopatologia das amostras de fígados dos ovinos com sinais clínicos demonstrou tumefação e vacuolização de hepatócitos, necrose individual de hepatócitos, macrófagos espumosos com cristais birrefringentes intracitoplasmáticos e dentro de ductos biliares e infiltrado mononuclear periportal. Amostras do capim fornecidas aos cordeiros evidenciaram níveis médios de 0,94±0,80% da saponina protodioscina. As observações do presente experimento sugerem que a não exposição ao sol não evita a presença de sinais clínicos da intoxicação, mas que a exposição solar exacerba os sinais clínicos.Twenty-six five-month-old lambs originated from flocks with no previous contact with Brachiaria spp. pastures were divided into three groups. Two groups (GS and GSB) were fed daily with fresh harvested Brachiaria decumbens ad libitum. GS was kept in an area with solar exposure and GSB was kept in stalls sheltered from solar exposure. Control group (GC) was also kept under solar exposure, but fed with Cynodon dactylon grass hay and Pennisetum pur¬pureum fresh grass. All sheep from the three groups were supplemented with 200g daily of a commercial concentrated food. Evaluation of clinical signs was carried out daily and blood samples were collected twice a week to determine AST and GGT serum activities. Three out of nine lambs of GS presented clinical signs of Brachiaria spp. poisoning, and two died. One animal showed clinical signs and died in GSB. The main clinical signs observed were apathy, weight loss, photophobia, conjunctivitis, ocular mucous discharge and jaundice. Dermatitis due to photosensitization was not observed. Mean serum AST and GGT activities were significantly higher (p≤0,05) in the group exposed to sun, than in the other two groups, and the GGT activities were significantly higher in the group sheltered than in the control group (p≤0,05). All animals at the end of the experiment were submitted to liver biopsy and died lambs were necropsied. Histopathological evaluation of liver samples from sheep with clinical signs evidenced swelling and vacuolization of hepatocytes, individual hepatocytes necrosis, presence of foamy macrophages, crystal negative images within bile ducts and foamy macrophages, biliary duct hyperplasia and periportal mononuclear infiltration. These results suggest that sun exposure does not define intoxication, but exacerbates the toxicity of the grass

Comprehensive Analysis of Tissue Preservation and Recording Quality from Chronic Multielectrode Implants

Multielectrodes have been used with great success to simultaneously record the activity of neuronal populations in awake, behaving animals. In particular, there is great promise in the use of this technique to allow the control of neuroprosthetic devices by human patients. However, it is crucial to fully characterize the tissue response to the chronic implants in animal models ahead of the initiation of human clinical trials. Here we evaluated the effects of unilateral multielectrode implants on the motor cortex of rats weekly recorded for 1–6 months using several histological methods to assess metabolic markers, inflammatory response, immediate-early gene (IEG) expression, cytoskeletal integrity and apoptotic profiles. We also investigated the correlations between each of these features and firing rates, to estimate the impact of post-implant time on neuronal recordings. Overall, limited neuronal loss and glial activation were observed on the implanted sites. Reactivity to enzymatic metabolic markers and IEG expression were not significantly different between implanted and non-implanted hemispheres. Multielectrode recordings remained viable for up to 6 months after implantation, and firing rates correlated well to the histochemical and immunohistochemical markers. Altogether, our results indicate that chronic tungsten multielectrode implants do not substantially alter the histological and functional integrity of target sites in the cerebral cortex

Dihydropyridine receptors and type 1 ryanodine receptors constitute the molecular machinery for voltage-induced Ca2+ release in nerve terminals

Ca2+ stores were studied in a preparation of freshly dissociated terminals from hypothalamic magnocellular neurons. Depolarization from a holding level of -80 mV in the absence of extracellular Ca2+ elicited Ca2+ release from intraterminal stores, a ryanodine-sensitive process designated as voltage-induced Ca2+ release (VICaR). The release took one of two forms: an increase in the frequency but not the quantal size of Ca2+ syntillas, which are brief, focal Ca2+ transients, or an increase in global [Ca2+]. The present study provides evidence that the sensors of membrane potential for VICaR are dihydropyridine receptors (DHPRs). First, over the range of -80 to -60 mV, in which there was no detectable voltage-gated inward Ca2+ current, syntilla frequency was increased e-fold per 8.4 mV of depolarization, a value consistent with the voltage sensitivity of DHPR-mediated VICaR in skeletal muscle. Second, VICaR was blocked by the dihydropyridine antagonist nifedipine, which immobilizes the gating charge of DHPRs but not by Cd2+ or FPL 64176 (methyl 2,5 dimethyl-4[2-(phenylmethyl)benzoyl]-1H-pyrrole-3-carboxylate), a non-dihydropyridine agonist specific for L-type Ca2+ channels, having no effect on gating charge movement. At 0 mV, the IC50 for nifedipine blockade of VICaR in the form of syntillas was 214 nM in the absence of extracellular Ca2+. Third, type 1 ryanodine receptors, the type to which DHPRs are coupled in skeletal muscle, were detected immunohistochemically at the plasma membrane of the terminals. VICaR may constitute a new link between neuronal activity, as signaled by depolarization, and a rise in intraterminal Ca2+

Natriuretic peptides and integrated risk assessment for cardiovascular disease. an individual-participant-data meta-analysis

BACKGROUND: Guidelines for primary prevention of cardiovascular diseases focus on prediction of coronary heart disease and stroke. We assessed whether or not measurement of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration could enable a more integrated approach than at present by predicting heart failure and enhancing coronary heart disease and stroke risk assessment. METHODS: In this individual-participant-data meta-analysis, we generated and harmonised individual-participant data from relevant prospective studies via both de-novo NT-proBNP concentration measurement of stored samples and collection of data from studies identified through a systematic search of the literature (PubMed, Scientific Citation Index Expanded, and Embase) for articles published up to Sept 4, 2014, using search terms related to natriuretic peptide family members and the primary outcomes, with no language restrictions. We calculated risk ratios and measures of risk discrimination and reclassification across predicted 10 year risk categories (ie, <5%, 5% to <7·5%, and ≥7·5%), adding assessment of NT-proBNP concentration to that of conventional risk factors (ie, age, sex, smoking status, systolic blood pressure, history of diabetes, and total and HDL cholesterol concentrations). Primary outcomes were the combination of coronary heart disease and stroke, and the combination of coronary heart disease, stroke, and heart failure. FINDINGS: We recorded 5500 coronary heart disease, 4002 stroke, and 2212 heart failure outcomes among 95 617 participants without a history of cardiovascular disease in 40 prospective studies. Risk ratios (for a comparison of the top third vs bottom third of NT-proBNP concentrations, adjusted for conventional risk factors) were 1·76 (95% CI 1·56-1·98) for the combination of coronary heart disease and stroke and 2·00 (1·77-2·26) for the combination of coronary heart disease, stroke, and heart failure. Addition of information about NT-proBNP concentration to a model containing conventional risk factors was associated with a C-index increase of 0·012 (0·010-0·014) and a net reclassification improvement of 0·027 (0·019-0·036) for the combination of coronary heart disease and stroke and a C-index increase of 0·019 (0·016-0·022) and a net reclassification improvement of 0·028 (0·019-0·038) for the combination of coronary heart disease, stroke, and heart failure. INTERPRETATION: In people without baseline cardiovascular disease, NT-proBNP concentration assessment strongly predicted first-onset heart failure and augmented coronary heart disease and stroke prediction, suggesting that NT-proBNP concentration assessment could be used to integrate heart failure into cardiovascular disease primary prevention

Beyond Building Back Better: Imagining a Future for Human and Planetary Health

COVID-19 is disrupting and transforming our world. We argue that transformations catalyzed by this pandemic should be harnessed to improve human and planetary health and well-being. This paradigm shift requires us to go ‘Beyond Building Back Better’ by nesting the economic domain of sustainable development within social and environmental domains. Drawing on the E4As approach (Engage, Assess, Align, Accelerate, Account) to implementing the 2030 Agenda for Sustainable Development, we explore the implications of this kind of radical transformative change, focusing particularly on the role of the health sector. We conclude that recovery and transition from COVID-19 that delivers the future we want, and need, requires more than a technical understanding of the transformation at hand. It also requires commitment and courage from leaders and policymakers to challenge dominant constructs and to imagine a truly thriving, equitable and sustainable future in order to create a world where the economy is not an end in itself, but a means to secure the health and wellbeing of people and the planet

Growth differentiation factor 15 and cardiovascular risk: individual patient meta-analysis

AIMS: Levels of growth differentiation factor 15 (GDF-15), a cytokine secreted in response to cellular stress and inflammation, have been associated with multiple types of cardiovascular (CV) events. However, its comparative prognostic performance across different presentations of atherosclerotic cardiovascular disease (ASCVD) remains unknown. METHODS AND RESULTS: An individual patient meta-analysis was performed using data pooled from eight trials including 53 486 patients. Baseline GDF-15 concentration was analyzed as a continuous variable and using established cutpoints ( 1800 ng/L) to evaluate its prognostic performance for CV death/hospitalization for heart failure (HHF), major adverse cardiovascular events (MACE), and their components using Cox models adjusted for clinical variables and established CV biomarkers. Analyses were further stratified on ASCVD status: acute coronary syndrome (ACS), stabilized after recent ACS, and stable ASCVD. Overall, higher GDF-15 concentration was significantly and independently associated with an increased rate of CV death/HHF and MACE (P < 0.001 for each). However, while GDF-15 showed a robust and consistent independent association with CV death and HHF across all presentations of ASCVD, its prognostic association with future myocardial infarction (MI) and stroke only remained significant in patients stabilized after recent ACS or with stable ASCVD [hazard ratio (HR): 1.24, 95% confidence interval (CI): 1.17-1.31 and HR: 1.16, 95% CI: 1.05-1.28 for MI and stroke, respectively] and not in ACS (HR: 0.98, 95% CI: 0.90-1.06 and HR: 0.87, 95% CI: 0.39-1.92, respectively). CONCLUSION: Growth differentiation factor 15 consistently adds prognostic information for CV death and HHF across the spectrum of ASCVD. GDF-15 also adds prognostic information for MI and stroke beyond clinical risk factors and cardiac biomarkers but not in the setting of ACS

Reserva estratégica do medicamento – uma ferramenta (in)vulgar

Como têm respondido as Forças Armadas à emergência COVID-19? Que impactos tem esta crise na organização e nas missões militares? Em que medida afetará os recursos que lhes são alocados, ou o peso relativo de diferentes serviços ou áreas internamente? Que lições para a articulação com outras forças de segurança e organizações civis? Estas são algumas das questões que colocámos aos especialistas convidados neste IDN Brief. Para além de participantes nacionais desafiámos também analistas de França, Reino Unido, Holanda, Canadá e África do Sul que nos trazem reflexões a partir da experiência dos seus países. Os desafios que enfrentamos exigem cada vez mais partilha de informação, aprendizagem cruzada e respostas cooperativas.info:eu-repo/semantics/publishedVersio