Concussion Management in Children and Adolescents

Concussion is a controversial topic right now in the world of sports and emergency medicine. Concussions are a common injury in children and adolescents that are involved in sports. It is important for everyone involved with adolescents and sports know and understand the signs and symptoms of concussions in order to prevent -further complications of concussions. The systems of grading concussions are no longer used, and concussion management has moved towards return to play guidelines. In this case report, a sixteen-year-old female presented to the clinic for a pre-sports physical examination prior to starting volleyball and track, however, she had sustained a concussion six weeks prior. In having a previous concussion, it is prudent to ensure that this patient has no cun-ent post-concussion symptoms. It is also important to evaluate her risk of second impact syndrome. Second impact syndrome does not need to be a severe second injury to the brain. The first injury is believed to have sensitized the brain, and the second injury is devastating. The literature review conducted has shown that the return to play guidelines for concussion and head injury patients are highly individualized. Every practitioner, including those in rural settings, should have an expanded knowledge base regarding concussions and how to manage the

Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial

Objective To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies

Practice development plans to improve the primary care management of acute asthma: randomised controlled trial

Background: Our professional development plan aimed to improve the primary care management of acute asthma, which is known to be suboptimal. Methods: We invited 59 general practices in Grampian, Scotland to participate. Consenting practices were randomised to early and delayed intervention groups. Practices undertook audits of their management of all acute attacks (excluding children under 5 years) occurring in the 3 months preceding baseline, 6-months and 12-months study time-points. The educational programme [including feedback of audit results, attendance at a multidisciplinary interactive workshop, and formulation of development plan by practice teams] was delivered to the early group at baseline and to the delayed group at 6 months. Primary outcome measure was recording of peak flow compared to best/predicted at 6 months. Analyses are presented both with, and without adjustment for clustering. Results: 23 consenting practices were randomised: 11 to early intervention. Baseline practice demography was similar. Six early intervention practices withdraw before completing the baseline audit. There was no significant improvement in our primary outcome measure (the proportion with peak flow compared to best/predicted) at either the 6 or 12 month time points after adjustment for baseline and practice effects. However, the between group difference in the adjusted combined assessment score, whilst non-significant at 6 months (Early: 2.48 (SE 0.43) vs. Delayed 2.26 (SE 0.33) p = 0.69) reached significance at 12 m (Early:3.60 (SE 0.35) vs. Delayed 2.30 (SE 0.28) p = 0.02). Conclusion: We demonstrated no significant benefit at the a priori 6-month assessment point, though improvement in the objective assessment of attacks was shown after 12 months. Our practice development programme, incorporating audit, feedback and a workshop, successfully engaged the healthcare team of participating practices, though future randomised trials of educational interventions need to recognise that effecting change in primary care practices takes time. Monitoring of the assessment of acute attacks proved to be a feasible and responsive indicator of quality care

Use of Homogeneously-Sized Carbon Steel Ball Bearings to Study Microbially-Influenced Corrosion in Oil Field Samples

Microbially-influenced corrosion (MIC) contributes to the general corrosion rate (CR), which is typically measured with carbon steel coupons. Here we explore the use of carbon steel ball bearings, referred to as beads (55.0 ± 0.3 mg; Ø = 0.238 cm), for determining CRs. CRs for samples from an oil field in Oceania incubated with beads were determined by the weight loss method, using acid treatment to remove corrosion products. The release of ferrous and ferric iron was also measured and CRs based on weight loss and iron determination were in good agreement. Average CRs were 0.022 mm/yr for 8 produced waters with high numbers (105/ml) of acid-producing bacteria (APB), but no sulfate-reducing bacteria (SRB). Average CRs were 0.009 mm/yr for 5 central processing facility (CPF) waters, which had no APB or SRB due to weekly biocide treatment and 0.036 mm/yr for 2 CPF tank bottom sludges, which had high numbers of APB (106/ml) and SRB (108/ml). Hence, corrosion monitoring with carbon steel beads indicated that biocide treatment of CPF waters decreased the CR, except where biocide did not penetrate. The CR for incubations with 20 ml of a produced water decreased from 0.061 to 0.007 mm/yr when increasing the number of beads from 1 to 40. CRs determined with beads were higher than those with coupons, possibly also due to a higher weight of iron per unit volume used in incubations with coupons. Use of 1 ml syringe columns, containing carbon steel beads and injected with 10 ml/day of SRB-containing medium for 256 days gave a CR of 0.11 mm/yr under flow conditions. The standard deviation of the distribution of residual bead weights, a measure for the unevenness of the corrosion, increased with increasing CR. The most heavily corroded beads showed significant pitting. Hence the use of uniformly sized carbon steel beads offers new opportunities for screening and monitoring of corrosion including determination of the distribution of corrosion rates, which allows estimation of the probability of high rate events that may lead to failure

Supplemental Material – Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery

Supplemental Material for Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery by Siân Williams, Amanda Barnard, Phil Collis, Jaime Correia de Sousa, Suraj Ghimire, Monsur Habib, Tessa Jelen, Frank Kanniess, Vince Mak, Sonia Martins, Ema Paulino, Hilary Pinnock, Miguel Roman, Hanna Sandelowsky, Ioanna Tsiligianni, Laurine van der Steen and Fabio Weber Donatelli in the Journal of Health Services Research & Policy.</p