Assessment of commercially available computerized neurocognitive testing in the adolescent concussed athlete: A retrospective analysis.

Background: Clinicians frequently use computer-based neurocognitive assessments to aid in the diagnosis and management of Sport Related Concussion (SRC). With practitioners using varied Neuro-Cognitive Assessment Tools (NCAT), questions arise concerning among NCAT and how these differences may affect patient care. The purpose of the current study is to offer a comparative analysis of two widely accepted, commercially available computer-based neurocognitive testing modalities in the adolescent concussed athlete. Hypothesis: There will be a difference between the C3 Logix® vs ImPACT® scoring in the IRPT and RTP Study Design: Retrospective chart review. Methods: In order to identify patients that were diagnosed with SRC, the records of patients reporting to a Sports Medicine practice were reviewed from a period of 18 months. All patients were assessed with either the ImPACT® or C3 Logix NCAT®. The date of the injury (DOI) as well as the patient’s symptom level (IVAL), time to initiation of the return to play protocol (IRTP), and time to the return to play (RTP) were recorded. Results: Two hundred and twenty-two records (222) were identified. There was no difference in the symptom score (P = 0.22) at the IEVAL between C3 Logix® (31.5±27.0) and ImPACT® (23.2±21.9), in the IRTP (P = 0.22) between the C3 Logix® (6.2±4.3 days) and ImPACT® (5.1±4.3 days) or RTP (P = 0.46) between C3 Logix (12.1±4.9 days) and ImPACT (15.6±19.8 days). Weak to moderate correlations were found between symptom scores, IRTP, and RTP. Conclusions: Clinicians made similar recommendations, independent of the NCAT used, as when to initiate the return to play protocol and when the patient could ultimately return to play. Clinical Relevance: The particular NCAT utilized by clinician was not a primary factor in the clinical judgement towards the management of the patient with SRC

ECG measurement parameters of athletes are reliable when made with a smartphone based ECG device

Pre-participation cardiac screening including electrocardiogram (ECG) is a subject of controversy among sports medicine practitioners. Opponents of pre-participation ECG screen site concerns regarding the cost and accuracy of the testing. Recently, a single lead ECG accessory has become available for use with smartphones. The purpose of this study was to evaluate the between and within rater validity and reliability of the Kardia device in recording the ECG parameters rate, rhythm, and PR, QRS, and QT intervals. The ECG parameter made with the smartphone were also compared to same measures made using a 12 lead electrocardiograph. This investigation used a repeated measures cross-sectional design. The investigation was conducted in 2 separate phases using separate participant samples. Phase 1 (N=10) was used to determine the within rater reliability with the Kardia device. Phase 2 (N=12) was used to determine the reliability between the Kardia device and the 12 lead electrocardiograph. The between rater and between device reliability for the rate, QT interval and QRS duration parameters ranged good to very good (ICC = 0.667 – 0.981). The current investigation showed that the reliability of the ECG parameters measured using the smartphone technology ranged from good to very good. This paper serves as support for a technological advancement that will help advance the debate on the utility of ECG testing as part of the athletic pre-participation physical

ECG measurement parameters of athletes are reliable when made with a smartphone based ECG device

Pre-participation cardiac screening including electrocardiogram (ECG) is a subject of controversy among sports medicine practitioners. Opponents of pre-participation ECG screen site concerns regarding the cost and accuracy of the testing. Recently, a single lead ECG accessory has become available for use with smartphones. The purpose of this study was to evaluate the between and within rater validity and reliability of the Kardia device in recording the ECG parameters rate, rhythm, and PR, QRS, and QT intervals. The ECG parameter made with the smartphone were also compared to same measures made using a 12 lead electrocardiograph. This investigation used a repeated measures cross-sectional design. The investigation was conducted in 2 separate phases using separate participant samples. Phase 1 (N=10) was used to determine the within rater reliability with the Kardia device. Phase 2 (N=12) was used to determine the reliability between the Kardia device and the 12 lead electrocardiograph. The between rater and between device reliability for the rate, QT interval and QRS duration parameters ranged good to very good (ICC = 0.667 – 0.981). The current investigation showed that the reliability of the ECG parameters measured using the smartphone technology ranged from good to very good. This paper serves as support for a technological advancement that will help advance the debate on the utility of ECG testing as part of the athletic pre-participation physical

Different paths to the modern state in Europe: the interaction between domestic political economy and interstate competition

Theoretical work on state formation and capacity has focused mostly on early modern Europe and on the experience of western European states during this period. While a number of European states monopolized domestic tax collection and achieved gains in state capacity during the early modern era, for others revenues stagnated or even declined, and these variations motivated alternative hypotheses for determinants of fiscal and state capacity. In this study we test the basic hypotheses in the existing literature making use of the large date set we have compiled for all of the leading states across the continent. We find strong empirical support for two prevailing threads in the literature, arguing respectively that interstate wars and changes in economic structure towards an urbanized economy had positive fiscal impact. Regarding the main point of contention in the theoretical literature, whether it was representative or authoritarian political regimes that facilitated the gains in fiscal capacity, we do not find conclusive evidence that one performed better than the other. Instead, the empirical evidence we have gathered lends supports to the hypothesis that when under pressure of war, the fiscal performance of representative regimes was better in the more urbanized-commercial economies and the fiscal performance of authoritarian regimes was better in rural-agrarian economie

Shocked monazite chronometry: integrating microstructural and in situ isotopic age data for determining precise impact ages

Monazite is a robust geochronometer and occurs in a wide range of rock types. Monazite also records shock deformation from meteorite impact but the effects of impact-related microstructures on the U–Th–Pb systematics remain poorly constrained. We have, therefore, analyzed shock-deformed monazite grains from the central uplift of the Vredefort impact structure, South Africa, and impact melt from the Araguainha impact structure, Brazil, using electron backscatter diffraction, electron microprobe elemental mapping, and secondary ion mass spectrometry (SIMS). Crystallographic orientation mapping of monazite grains from both impact structures reveals a similar combination of crystal-plastic deformation features, including shock twins, planar deformation bands and neoblasts. Shock twins were documented in up to four different orientations within individual monazite grains, occurring as compound and/or type one twins in (001), (100), (10 1 ¯) , {110}, { 212 } , and type two (irrational) twin planes with rational shear directions in [ 0 1 ¯ 1 ¯ ] and [ 1 ¯ 1 ¯ 0 ]. SIMS U–Th–Pb analyses of the plastically deformed parent domains reveal discordant age arrays, where discordance scales with increasing plastic strain. The correlation between discordance and strain is likely a result of the formation of fast diffusion pathways during the shock event. Neoblasts in granular monazite domains are strain-free, having grown during the impact events via consumption of strained parent grains. Neoblastic monazite from the Inlandsee leucogranofels at Vredefort records a 207Pb/206Pb age of 2010 ± 15 Ma (2σ, n = 9), consistent with previous impact age estimates of 2020 Ma. Neoblastic monazite from Araguainha impact melt yield a Concordia age of 259 ± 5 Ma (2σ, n = 7), which is consistent with previous impact age estimates of 255 ± 3 Ma. Our results demonstrate that targeting discrete microstructural domains in shocked monazite, as identified through orientation mapping, for in situ U–Th–Pb analysis can date impact-related deformation. Monazite is, therefore, one of the few high-temperature geochronometers that can be used for accurate and precise dating of meteorite impacts

Increased Mitochondrial Calcium Sensitivity and Abnormal Expression of Innate Immunity Genes Precede Dopaminergic Defects in Pink1-Deficient Mice

BACKGROUND: PTEN-induced kinase 1 (PINK1) is linked to recessive Parkinsonism (EOPD). Pink1 deletion results in impaired dopamine (DA) release and decreased mitochondrial respiration in the striatum of mice. To reveal additional mechanisms of Pink1-related dopaminergic dysfunction, we studied Ca²+ vulnerability of purified brain mitochondria, DA levels and metabolism and whether signaling pathways implicated in Parkinson\u27s disease (PD) display altered activity in the nigrostriatal system of Pink1⁻/⁻ mice. METHODS AND FINDINGS: Purified brain mitochondria of Pink1⁻/⁻ mice showed impaired Ca²+ storage capacity, resulting in increased Ca²+ induced mitochondrial permeability transition (mPT) that was rescued by cyclosporine A. A subpopulation of neurons in the substantia nigra of Pink1⁻/⁻ mice accumulated phospho-c-Jun, showing that Jun N-terminal kinase (JNK) activity is increased. Pink1⁻/⁻ mice 6 months and older displayed reduced DA levels associated with increased DA turnover. Moreover, Pink1⁻/⁻ mice had increased levels of IL-1β, IL-12 and IL-10 in the striatum after peripheral challenge with lipopolysaccharide (LPS), and Pink1⁻/⁻ embryonic fibroblasts showed decreased basal and inflammatory cytokine-induced nuclear factor kappa-β (NF-κB) activity. Quantitative transcriptional profiling in the striatum revealed that Pink1⁻/⁻ mice differentially express genes that (i) are upregulated in animals with experimentally induced dopaminergic lesions, (ii) regulate innate immune responses and/or apoptosis and (iii) promote axonal regeneration and sprouting. CONCLUSIONS: Increased mitochondrial Ca²+ sensitivity and JNK activity are early defects in Pink1⁻/⁻ mice that precede reduced DA levels and abnormal DA homeostasis and may contribute to neuronal dysfunction in familial PD. Differential gene expression in the nigrostriatal system of Pink1⁻/⁻ mice supports early dopaminergic dysfunction and shows that Pink1 deletion causes aberrant expression of genes that regulate innate immune responses. While some differentially expressed genes may mitigate neurodegeneration, increased LPS-induced brain cytokine expression and impaired cytokine-induced NF-κB activation may predispose neurons of Pink1⁻/⁻ mice to inflammation and injury-induced cell death

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury

Abstract: Background: Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods: The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. Results: The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions: In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction