bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective observational cohort of paediatricpediatric sport-related concussion
Authors: Dilworth Neil , Karam Siobhan , Eardley Ryan , Kraft Sari , Shukla Hemen , Leung Mark , Smith Ira
Published: November 2017

Objective

To determine the symptom duration, and time to return to school and sport after sport-related concussion in paediatric population aged 12–18 years. Symptom duration was hypothesised to be >7–10 days.

Design

Prospective observational cohort study.

Setting

Large urban community primary care sports medicine clinic.

Paticipants

30 participants age 12–18 years (Male: n=27;Female: n=3) presenting to clinic ≤14 days with sport-related concussion. 100% completed study. Exclusion criteria: age <12 and >18 years, presentation ≥15 days, non-sport related concussion.

Independent variable(s)/modifiers

Sport, SCAT3 score, past medical and concussion history, objective assessment variables (oculomotor, near-point convergence, vestibular, cognitive, cervical dysfunction).

Outcome measures

Symptom duration, return to sport, return to school (days)

Main results

Most concussions occurred playing ice-hockey (53%), followed by Canadian football and basketball. Mean intake SCAT3 symptom number was 10 and symptom score was 22. Patient characteristics included prior concussion (50%), prior neurological conditions (40%), and pre-existing psychological diagnosis (20%). The mean initial exam findings included near point convergence=6.5 cm and Balance Error Scoring System=26.1/30. Vestibular dysfunction (46.7%), cervical pain (53.3%), and abnormal coordination in (43.3%) were present. Mean duration of symptoms was 30.6 days; return to school was 23.9 days. 73.3% of patients would return to sport within 3 months (mean=34.6 days).

Conclusions

Sport-related concussion symptoms resolved ≥30 days after injury confirming prolonged symptoms in an adolescent population, affecting return to school and sport. Future larger similar prospective studies may identify associations between past medical history or clinical exam findings and symptom duration, return to school and sport.

Competing interests

None.
Symptom progression and relation to physical and cognitive activities based on ecologic momentary assessment of patients following concussion
Authors: Wiebe Douglas J , Grady Matthew F , Nance Michael , Houseknecht Eileen , Master Christina L
Published: November 2017

Objective

To use ecologic momentary assessment to measure and compare daily reports of physical/cognitive activity and symptoms among youth for 2 weeks after sustaining a concussion.

Design

Prospective cohort study, with patients reporting to random prompts on a handheld 3 times daily and wearing an accelerometer.

Setting

Specialty concussion program within a large regional paediatric healthcare network.

Participants

34 patients, ages 11–17 years with the diagnosis of concussion seen in the concussion program.

Independent variables

Measurements of daily physical activity (step count) and cognitive activity (composite score of texts sent, screen time minutes, reading minutes, school attendance).

Outcome measures

Daily symptoms on the Post Concussion Symptom Scale (PCSS).

Main results

Study subjects were enrolled a median of 6 days post-injury (range 5–13 days). Numerous profiles were observed, including being initially highly (PSCC≥20) or less symptomatic (PSCC ≤ 10), initially highly (steps>6000) or less physically active (steps<3000), and initially highly or less cognitively active. Levels of activity also varied greatly over follow-up. Symptoms declined in most subjects regardless of activity levels during follow-up. Regardless of activity levels, most patients were not symptomatic (PCSS ≤ 8) at the end of the follow-up period.

Conclusions

We found evidence that initial levels of physical and cognitive rest vary greatly in the days immediately following a first visit, and over subsequent weeks, but most patients were asymptomatic after 4 weeks from injury. This protocol can be used in larger studies designed to fully test whether and how physical and cognitive rest and their timing following injury affect recovery.

Competing interests

None.
55 the recognition of paediatric sports related concussion (5–16 year olds), initial management and advice among london based emergency medicine trainees
Authors: Hornby Catherine , England Mike , Medici Akbar de , Kipps Courtney
Published: November 2017

Objective

This study aimed to investigate knowledge of paediatric concussion amongst emergency medicine trainees, testing the hypothesis that emergency medicine trainees lack sufficient knowledge to competently assess, diagnose and manage sports-related paediatric concussion.

Design

cross-sectional questionnaire survey.

Setting

Secondary care emergency medicine departments.

Participants

All emergency medicine trainees in one geographical training region in the UK were invited to participate.

Outcome measures

occupational grade, years of experience, history of specific concussion training, awareness of head injury guidelines, perceived knowledge and confidence in concussion diagnosis and management.

Main results

Sixty questionnaires were returned. Across all training grades, the mean correct response score on questions of diagnosis, assessment and management of concussion was 73.4%. Nearly 70% of trainees were not aware of any concussion guidelines, and only 10% had attended a course or received training regarding concussion. There was a negative correlation between awareness of guidelines and perceived confidence (r=−0.50 p<0.001), and knowledge in diagnosis and management of concussion (r=−0.51, p<0.001). The majority (91.7%) of the participants would like further education on concussion management, with an online learning module being the preferred format (71.7%).

Conclusions

The study revealed insufficient level of knowledge and confidence in the assessment, diagnosis and management of paediatric concussion among emergency medicine trainees. None of the variables studied statistically predicted knowledge score. Additional concussion-specific education would be beneficial to optimise trainees’ knowledge of paediatric concussion.

Competing interests

None.
A history of multiple concussions does not alter the transcranial doppler-based assessment of the neurovascular coupling response
Authors: Smirl Jonathan D , Wright Alexander D , Bouilane Kevin , Bryk Kelsey , Donkelaar Paul van
Published: November 2017

Objective

To determine how a history of 3+ concussions alters elevations in cerebral blood velocity (CBV) in the posterior cerebral artery (PCA) during visual tasks.

Design

Retrospective Cohort.

Setting

Laboratory.

Participants

136 male contact-sport athletes (19.1±1.4 years, 66 football, 70 hockey) were recruited; 39 presented with 0 previous concussions, 16 with 3+ previous concussions; exclusion criteria included history of concussion within 6 months.

Intervention

Transcranial Doppler ultrasound indexed PCA-CBV during a series of visual tasks. Participants closed their eyes (20-seconds) and, when prompted, opened their eyes to complete a visual task (40-seconds). Testing occurred prior to the start of their athletic season. The visual trial raw traces were averaged together to enhance the signal-to-noise ratio of outcome measurements. The independent variable tested was concussion history.

Outcomes

Eyes-closed CBV (cm/s), peak elevation in CBV after eyes-open (cm/s), relative change in CBV (%), and total activation during the first 30 seconds of the task (indexed via area under the curve-AUC)

Main results

Independent samples T-Tests indicated there were no effects of concussion history on any outcome: Eyes-closed CBV (p=0.950), peak CBV (p=0.903), % CBV elevation (p=0.593), and AUC (p=0.718).

Conclusions

A history of multiple concussions does not alter the cerebrovasculature’s ability to maintain nutrient delivery required for visual challenges in cortical areas supplied by the PCA. This is an important finding; despite the long-term neurocognitive deficits associated with a history of concussions, the transcranial Doppler assessment of neurovascular coupling appears intact for this population of younger adult contact-sport athletes.

Competing interests

None.
Long-term impact of concussional head injury on cognitive functioning in retired australian rules footballers: a preliminary report of a 25-year follow-up
Authors: Maddocks David , Blaine Hannah , Inge Philipa , McCrory Paul , Saling Michael
Published: November 2017

Objective

the research involved a 25-year neuropsychological follow-up of an Australian Rules football (ARF) cohort studied originally by Maddocks and Saling (1996). The primary aim was to assess whether there is a long-term impact of concussional head injury on cognitive function.

Method

In addition to those tests originally administered (Digit Symbol Substitution Test; Paced Auditory Serial Addition Test; Four Choice Reaction Time), the California Verbal Learning Test, Trail Making Test, Controlled Oral Word Association Test, Victoria Stroop Test, and selected self-report functional health and well-being, and quality of life measures were used. Thirty former Australian Football League players, aged from 44-56 years (Mage=48.8 years), completed both the neuropsychological testing and psychosocial questionnaires.

Main results

Concussional history did not have an influence on cognitive or psychosocial functioning in this sample of retired ARF players. There was no evidence of deterioration in cognitive function across time. Irrespective of concussional history, age appeared to be an important contributor to subjective memory complaints, with older participants reporting greater memory concerns.

Conclusions

In this sample of retired ARF players no evidence of objective cognitive change was found over the time period in which CTE is said to evolve. This research shows, for the first time that long-term cognitive and psychosocial outcome in ARF players may be unrelated to career-long concussional history.

Competing interests

David Maddocks and Paul McCrory are members of the AFL Concussion Working Party.

None.
Wooden heads and glass jaws: the long-term effects of recurrent concussion and american football exposure on resting state networks
Authors: Clark Michael , Mihalik Jason , Guskiewicz Kevin
Published: November 2017

Objective

To elucidate the association between recurrent concussion and subconcussive head impacts andb the efficiency of resting state neural networks in retired American football athletes.

Design

Cross-sectional.

Subjects

32 former college football athletes and 32 former professional football athletes matched on age, position, and self-reported concussion history (age: 58.5±3.6 y). Of those, 61 subjects had quality imaging data (31 College, 30 Professional). Subjects were stratified by concussion history (High, 3+, N=31; Low, 0–1, N=30).

Outcome measures

IVs: Concussion history (Low/High) and football exposure (College/Professional). DVs: Mean local efficiency (LE) and clustering coefficients (CC) for seven anatomically defined neural subnetworks: frontal, temporal, occipital, medial temporal, subcortical, parietal, and cerebellar. Outcomes were analysed across several correlational thresholds (r=0–0.9).

Results

The high concussion group had lower frontal LE and CC than the low concussion group (Effect size range: 0.260 – 0.437, P<0.05). A crossover history-by-exposure interaction was observed in the cerebellar network (P=0.0063), such that former college athletes with high concussion history demonstrated lower LE and CC than college athletes with low concussion history. Interestingly, professional athletes with high concussion history demonstrated greater LE and CC than those with low concussion history. No other associations were observed across the five remaining neural networks.

Conclusions

These data challenge the notion that subconcussive head impact exposure is linked to long-term neurological dysfunction. Our data point to a potential heightened cerebellar network resiliency among retired professional athletes with a high number of concussions. Subconcussive head impact exposure alone does not appear to affect widespread cortical and cerebellar network function among retired American football athletes.

Competing interests

None.

Member of the Mackey-White committee of the NFL Players Association and member of the Head, Neck, and Spine Committee of the NFL.
Comparing performance on baseline computerized neurocognitive and balance
Authors: Weber Michelle L , Schmidt Julianne D , Hoffman Nicole L
Published: November 2017

Objective

To compare head impact severity between high and low performers on baseline neurocognitive and balance assessments in collegiate American football athletes.

Design

Prospective cohort.

Setting

On-field/Concussion Research Laboratory.

Participants

Thirty collegiate American football players (height: 187.0 cm, 95% CI: 184.6, 189.4; mass: 105.4 kg, 95% CI: 99.3, 111.6; age: 21.0 years, 95% CI: 20.5, 21.5).

Interventions

Participants completed a baseline neurocognitive assessment (Immediate Post-Concussion Assessment and Cognitive Test) and balance exam (Sensory Organization Test). Participants wore accelerometers (Head Impact Telemetry System) to capture measures of severity for 13,537 head impacts.

Outcome measures

Groups were divided into higher and lower performance groups using a median split for independent variables including composite neurocognitive (verbal memory, visual memory, processing speed, reaction time and impulse control) and balance performance. Random intercepts general linear models were used to compare linear acceleration (g), rotational acceleration (rad/s2), and Head Impact Technology severity profile (HITsp-unitless) between higher and lower performing groups (α=0.05). Position group was included in all models.

Main results

Athletes with slower reaction time had a trend towards higher linear acceleration (higher 26.4, 95% CI: 24.6, 28.3; lower 24.6, 95% CI: 23.7, 25.7;p=0.080) and significantly higher rotational acceleration (higher 1020.2, 95% CI: 990.1, 1051.2; lower 946.6, 95% CI: 910.0, 984.8;p=0.003).

Conclusions

Athletes with slower reaction time may be slower to prepare for collisions, resulting in higher magnitude head impacts. Clinicians should recognize athletes with slower reaction time on baseline neurocognitive assessments and understand the on-field implications. Research is needed to further identify a reaction time threshold between high and low performers, and risk of sustaining higher magnitude head impacts.

Competing interests

None.
Implications of attention deficit and hyperactivity disorders on neurocognitive performance and recovery in collegiate student–athletes
Authors: Ketcham Caroline , Patel Kirtida , Hall Eric
Published: November 2017

Background

Approximately 3–13% of college-aged students have a diagnosis of Attention Deficit/Hyperactivity Disorder (ADD/ADHD) which is characterised by impulsivity, inattention, and cognitive speed deficits which affects academic, athletic, and occupational performance even when treated.

Objective

The purpose of this study was to examine baseline neurocognitive differences in collegiate student-athletes with diagnosis of ADD/ADHD as well as recovery time from concussion.

Design

Cross-sectional.

Setting

Collegiate campus in North Carolina

Participants

Participants of this study included 1161 student-athletes (varsity, n=272 and club, n=889). 89 participants were followed post-concussion with 8 having diagnosis of ADD/ADHD.

Assessment of risk factors

Diagnosis of ADD/ADHD and days of recovery following concussion.

Outcome measures

Participants completed the Immediate Post-Concussion Assessment and Cognitive Testing which generated composite scores on Verbal Memory, Visual Memory, Visuomotor Speed, and Reaction Time as well as Total Symptom Scores.

Main results

There were no significant differences between groups for Visual Memory, Reaction Time and Total Symptom Scores (p>0.05). Those with diagnosis of ADD/ADHD (n=146) had lower verbal memory(mno=85.3, %95 CI: [84.6, 86] vs. madd=82.5, %95 CI:[80.7, 84.3], F(1, 1145)=8.6, p=0.003) and slower visuomotor speed (mno=41.7, %95 CI: [41.3, 42.7] vs. madd=40.5, %95: CI:[39.5,41.5],F(1,1145)=8.6,p=0.027) compared to those without a diagnosis. Those with ADD/ADHD took almost two times longer to recover than those without (mno=7.3 days, %95 CI: [6.2, 8.4] vs. madd=13.3 days, %95 CI:[9.4, 17.2], F(1, 89)=9.8, p=0.002).

Conclusions

Student-athletes with diagnosis of ADD/ADHD may benefit from targeted interventions as part of return to play/learn protocols. Previous research has shown that practice may help rehabilitate those with cognitive and visuomotor processing speed deficits following a concussion.

Competing interests

None.
Factors associated with post-concussion syndrome in high school student-athletes
Authors: Kerr Zachary, Y , Wasserman Erin, B , Zuckerman Scott, L , Yengo-Kahn Aaron, M , Dompier Thomas, P
Published: November 2017

Objective

This study examined factors predictive of post-concussion syndrome (PCS; i.e., concussion-related symptoms lasting ≥4 weeks) among high school (HS) student-athletes during the 2011/12-2013/14 academic years.

Design

Prospective cohort.

Setting

Concussion data originated from the National Athletic Trainers Injury and Outcomes Network (NATION), a nationwide surveillance program comprised of a convenience sample of 127 HS. All concussions were diagnosed and reported by athletic trainers and team physicians.

Subjects

Our sample included 1846 concussed HS student-athletes from 22 sports (73.7% male). For student-athletes with multiple concussions, only the most recent concussion was considered.

Intervention

Factors potentially related to PCS (i.e., sex, sport contact level, recurrent concussion, presence of symptoms) were examined.

Outcome measures

The 215 concussed student-athletes with PCS were compared to 1119 concussed student-athletes with symptoms lasting <2 weeks. Those with symptoms lasting 2-4 weeks were excluded (n=512). Logistic regression predicted the odds of PCS.

Results

In multivariate analysis, concussion symptoms associated with increased odds of PCS were somatic symptoms including: disorientation [odds ratio (OR)=1.86, 95% confidence interval (CI):1.04–3.33]; balance issues (OR=1.76, 95% CI: 1.00–3.10); visual impairments (OR=2.21, 95% CI: 1.23–3.97); noise sensitivity (OR=1.80, 95% CI: 1.02–3.17); and cognitive symptoms including: retrograde amnesia (OR=3.01, 95% CI: 1.31–6.91); and difficulty concentrating (OR=2.72, 95% CI:1.56–4.77). Sex, sport contact level, and recurrent concussion were not associated with PCS.

Conclusions

As in previous research, various somatic and cognitive symptoms were associated with PCS. The identification of risk factors potentially associated with PCS may assist clinicians in providing timely interventions to shorten symptom resolution and recovery time.

Competing interests

None
Gender differences in clinical presentation and recovery of sports related concussion
Authors: Bauman Shannon , Ray Mira , Joseph Paul P
Published: November 2017

Objective

To determine if gender plays a role in clinical presentation and recovery in concussion.

Design

Retrospective

Setting

one clinic

Participants

207 athletes (115 females, 92 males) presenting to clinic from September 2014 – January 2016. 79 athletes achieved clearance. Inclusion: sports or exercise, age 10–60 yrs.

Exclusion

non-sports

Outcome measures

Athletes completed computerised neurocognitive testing and physical assessments. A physician-led interdisciplinary team treated each athlete until resolution of signs and symptoms. Athletes were grouped by gender into recovery time groups (0–2 mo.; 3–5 mo.;≥ 6 mo.). An analysis by gender, age, symptoms, neurocognitive data, and concussion features was performed.

Main results

Females report higher post-concussion symptom scores than males (p<0.0002).Females had a higher total number of features 4.5 to 3.6(p<0.00003). With respect to recovery, 34% of all males in our study were discharged within 0–2 mo. of injury date, compared to 12% of females. Females continued to experience symptoms at ≥ 6 months. Overall, females had a longer recovery period than males (p<0.002). Among discharged females, those requiring longer treatment (≥3 mo) were of a more mature age (23.8±13.2), presented later to clinic (t=3.3±3.6 mo.)and reported moresymptoms (PCSS=40.83±19.53).

Conclusions

Female athletes present with higher post- concussion symptom scores and clinical features than their male counterparts. Mature females who later for treatment have a protracted recovery. Athletes of both genders who seek care earlier in the injury process have a shorter recovery.

Competing interests

None.
Retrospective analysis of the first year of an elite sports multidisciplinary complex concussion service in the uk
Authors: Richard Sylvester , Akbar de Medici , Ademola Adejewon
Published: November 2017

Objective

To define the characteristics, investigation, diagnosis and management of elite athletes attending a complex concussion service.

Design

Retrospective analysis of case notes.

Setting

Secondary care single centre.

Participants

All patients (n=38, aged 16-35, 79% male) seen between April 2015 and April 2016.

Outcomes

Patient characteristics (sport, position played in rugby, previous concussion history), referral reason, investigations, diagnosis, interventions.

Main results

Most referrals came from Rugby (74% Rugby, 16% soccer, 8% other). Back row (57%) and centre (25%) were the commonest rugby positions seen. The average number of previous concussions of this cohort was 2.5 (95% CI±0.85). Referral reasons included chronic symptoms following concussion (53%), delayed GRTP (21% of which 28% were due to reduced performance on computerised neuropsychological testing), multiple concussions (18%) and severe injury (8%). 95% of patients had brain MRI imaging (with SWI sequences) and 4 patients (10%) had abnormalities (cortical cavernoma, brainstem cavernoma, diffuse axonal injury, obstructive hydrocephalus). 30% of patients required additional vestibular and/or neuropsychological assessment in addition to screening. Post-traumatic migraine was the commonest single diagnosis (36%) followed by isolated vestibular dysfunction (16%). 30% had multiple diagnoses (usually migraine, vestibular dysfunction and mood disorder). 8% did not have concussion. Intervention with medical management for migraine was initiated in 40%, vestibular rehabilitation in 20% and psychological intervention in 15%.

Conclusions

A proportion of elite athletes with sports related concussion in the UK have complex needs. These require expert MDT assessment and management. The limited provision of such services needs to be addressed.

Competing interests

None.
Should our treatments be gender-specific? effect of gender on recovery from persistent post-concussion symptoms in children and adolescents participating in an active rehabilitation intervention
Authors: Gagnon Isabelle , Gauvin-Lepage Jérôme , Friedman Debbie , Grilli Lisa , Kocilowicz Helen
Published: November 2017

Objective

To estimate the extent to which gender contributes to severity of post-concussion symptoms (PCS) in youth with concussion, who are slow to recover and who receive an active rehabilitation intervention as part of their standard care.

Design

A retrospective analysis of a prospective cohort

Setting

Concussion Clinic of a Paediatric Trauma Centre in Canada.

Participants

355 youth with persistent PCS (188 girls; 167 boys). All Concussion patients’ information is entered prospectively in a clinical database and participants were selected for this study if they met the following criteria: 1) aged 6 to 17 years (mean=14.34, SD=2.22 years); 2) presenting with at least one PCS interfering with daily activities (mean total PCS score at initial assessment=24.50, SD=18.88), and 3) beginning an active rehabilitation intervention 4 weeks post injury (mean=30.46, SD=3.74 days).

Outcome measures

Severity of post-concussion symptoms, measured by the PCS scale included in the SCAT3, was the dependent variable. PCS were assessed 3 times over a 4-week follow-up period.

Main results

Boys presented with significantly less symptoms than girls 4 weeks post-injury, when starting the active rehabilitation intervention (PCSS total score mean; ♂=19.9, ♀=28.5, p<0.001, CI [−14.8, −6.4]). They continued to do so 2 and 4 weeks later, but the rate of recovery was slightly faster for girls over the follow-up period.

Conclusions

Although there are gender differences in the levels of PCS 4-weeks post-injury, and while boys may recover earlier from persistent PCS, both boys and girls benefit from participating in an active rehabilitation intervention.

Competing interests

None.
Sleep disorders after mild traumatic brain injuries in elements with professional athletic activity
Authors: Ch.Syrmos Nikolaos , Mylonas Argyios , Gavridakis Georgios , Giannouli Vaitsa
Published: November 2017

Indroduction

Sleep disturbances are common situations after traumatic brain injuries.

Aim

Aim of this study was to evaluate sleep disorders in elements professional athletic activity after mild traumatic brain injuries.

Material and methods

Evaluation of 10 professional athletes was performed, 7 men–70% and 3 women −30%(range 18–38 years and mean age 28) with sleep disturbances after mild traumatic brain injuries. The most common disturbances are insomnia in 6, 60% increased sleep need in 2–20%, and excessive daytime sleepiness in 2–20%. We suggest in all 10, 100%, cognitive-behavioural therapy and appropriate medication, under psychiatric surveillance. 8 of them 80% returned with safe results in the physical activity after 2 or 3 months.

Results

The most common disturbances were insomnia in 5, 50%, increased sleep need in 2–20%, and excessive daytime sleepiness in 3–30%. We suggest in all 10,100%, cognitive-behavioural therapy and appropriate medication, under psychiatric surveillance. 7 of them 70% returned with safe results in the physical activity after 2 or 3 months.

Conclusions

We need more investigation but seems that cognitive-behavioural therapy and medication could be helpful in these situation.

Competing interests

None.
What tests and measures should be added to the SCAT3 and related tests to improve their reliability, sensitivity and/or specificity in sideline concussion diagnosis? A systematic review
Authors: Echemendia Ruben J , Broglio Steven P , Davis Gavin A , Guskiewicz Kevin M , Hayden K. Alix , Leddy John J , Meehan William P , Putukian Margot , Sullivan S John , Schneider Kathryn J , McCrory Paul
Published: November 2017

Objectives

Several iterations of the Sport Concussion Assessment Tool (SCAT) have been published over the past 16 years. Our goal was to systematically review the literature related to the SCAT and provide recommendations for improving the tool. To achieve this goal, five separate but related searches were conducted and presented herein.

Design

Systematic literature review.

Data sources

Medline, Embase, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, SPORTDiscus and PubMed.

Eligibility criteria

Original, empirical, peer-reviewed findings published in English and included sports-related concussion (SRC). Review papers, case studies, editorials and conference proceedings/abstracts were excluded. The age range for the ChildSCAT was 5–12 years and for the Adult SCAT was 13 years and above.

Results

Out of 2961 articles screened, a total of 96 articles were included across the five searches. Searches were not mutually exclusive. The final number of articles included in the qualitative synthesis for each search was 21 on Adult SCAT, 32 on ChildSCAT, 21 on sideline, 8 on video/observation and 14 on oculomotor.

Summary/conclusions

The SCAT is the most widely accepted and deployable sport concussion assessment and screening tool currently available. There is some degree of support for using the SCAT2/SCAT3 and ChildSCAT3 in the evaluation of SRC, with and without baseline data. The addition of an oculomotor examination seems indicated, although the most valid method for assessing oculomotor function is not clear. Video-observable signs of concussion show promise, but there is insufficient evidence to warrant widespread use at this time.
Evaluation of a novel intervention providing insight into the tobacco industry to prevent the uptake of smoking in school-aged children: a mixed-methods study
Authors: Szatkowski Lisa , Taylor John , Taylor Amy , Lewis Sarah , Wu Qi , Parrott Steve , McNeill Ann , Britton John , Bauld Linda , Jones Laura L , Bains Manpreet
Published: November 2017

Objectives

Evidence from the USTruthcampaign suggests that interventions focusing on tobacco industry practices and ethics may be effective in preventing youth smoking uptake. We developed, piloted and evaluated a school-based intervention based on this premise.

Methods

Exploratory study students in years 7–8 (aged 11–13) in two UK schools receivedOperation Smoke Storm, comprising three 50 min classroom-based sessions in year 7, an accompanying family booklet and a 1-hour classroom-based booster session in year 8. We compared the risk and odds of ever smoking and susceptibility to smoking in year 8 students in study schools postintervention with students in control schools. Focus groups and interviews with students, teachers and parents evaluated the acceptability of the intervention.

Results

In intervention schools, the combined prevalence of ever smoking and susceptibility increased from 18.2% in year 7 to 33.8% in year 8. There was no significant difference in the odds of a year 8 student in an intervention school being an ever smoker or susceptible never smoker compared with controls (adjusted OR (aOR) 1.28, 95% CI 0.83 to 1.97, p=0.263) and no significant difference in the odds of ever smoking (aOR 0.82, 95% CI 0.42 to 1.58, p=0.549). Teachers highlighted differences by academic ability in how well the messages presented were understood. Use of the family component was low but was received positively by parents who engaged with it.

Conclusions

Operation Smoke Stormis an acceptable resource for delivering smoking-prevention education, but it does not appear to have reduced smoking and susceptibility.
Does risk and urgency of requested out-of-hours general practitioners care differ for people with intellectual disabilities in residential settings compared with the general population in the Netherlands? A cross-sectional routine data-based study
Authors: Heutmekers Marloes , Naaldenberg Jenneken , Verheggen Sabine A , Assendelft Willem J J , Lantman - de Valk Henny M J van Schrojenstein , Tobi Hilde , Leusink Geraline L
Published: November 2017

Objectives

To investigate whether people with intellectual disabilities (ID) in residential setting were more likely than people from the general population to request out-of-hours general practitioner (GP) care and whether these requests had a similar level of urgency.

Design

Cross-sectional routine data-based study.

Setting

Two GP cooperatives providing out-of-hours primary care in an area in the Netherlands.

Population

432 582 persons living in the out-of-hours service areas, of which 1448 could be identified as having an ID.

Main outcome measures

GP cooperative records of all contacts in 2014 for people with and without ID were used to calculate the relative risk of requesting care and the associated level of urgency.

Results

Of the people with ID (448/1448), 30.9% requested out-of-hours GP care, whereas for the general population this was 18.4% (79 206/431 134), resulting in a relative risk of 1.7 (95% CI 1.6 to 1.8). We found a different distribution of urgency level for people with and without ID. Generally, requests for people with ID were rated as less urgent.

Conclusion

People with ID in residential setting were more likely to request out-of-hours GP care than the general population. The distribution of the urgency level of requests differed between the two groups. The high percentage of demands relating to people with ID requesting counselling and advice suggests that some out-of-hours GP care may be avoidable. However, more insight is needed into the nature of out-of-hours primary care requests of people with ID to direct structural and reasonable adjustments towards the improvement of health information exchange in and around-the-clock access to primary care for people with ID.
Influencing organisational culture to improve hospital performance in care of patients with acute myocardial infarction: a mixed-methods intervention study
Authors: Curry Leslie A , Brault Marie A , Linnander Erika L , McNatt Zahirah , Brewster Amanda L , Cherlin Emily , Flieger Signe Peterson , Ting Henry H , Bradley Elizabeth H
Published: November 2017

Background

Hospital organisational culture affects patient outcomes including mortality rates for patients with acute myocardial infarction; however, little is known about whether and how culture can be positively influenced.

Methods

This is a 2-year, mixed-methods interventional study in 10 US hospitals to foster improvements in five domains of organisational culture: (1) learning environment, (2) senior management support, (3) psychological safety, (4) commitment to the organisation and (5) time for improvement. Outcomes were change in culture, uptake of five strategies associated with lower risk-standardised mortality rates (RSMR) and RSMR. Measures included a validated survey at baseline and at 12 and 24 months (n=223; average response rate 88%); in-depth interviews (n=393 interviews with 197 staff); and RSMR data from the Centers for Medicare and Medicaid Services.

Results

We observed significant changes (p<0.05) in culture between baseline and 24 months in the full sample, particularly in learning environment (p<0.001) and senior management support (p<0.001). Qualitative data indicated substantial shifts in these domains as well as psychological safety. Six of the 10 hospitals achieved substantial improvements in culture, and four made less progress. The use of evidence-based strategies also increased significantly (per hospital average of 2.4 strategies at baseline to 3.9 strategies at 24 months; p<0.05). The six hospitals that demonstrated substantial shifts in culture also experienced significantly greater reductions in RSMR than the four hospitals that did not shift culture (reduced RSMR by 1.07 percentage points vs 0.23 percentage points; p=0.03) between 2011–2014 and 2012–2015.

Conclusions

Investing in strategies to foster an organisational culture that supports high performance may help hospitals in their efforts to improve clinical outcomes.
Endobronchial valves for emphysema: an individual patient-level reanalysis of randomised controlled trials
Authors: Klooster Karin , Slebos Dirk-Jan , Zoumot Zaid , Davey Claire , Shah Pallav L , Hopkinson Nicholas S
Published: November 2017

Introduction

Endobronchial valve placement has potential as a treatment for patients with chronic obstructive pulmonary disease (COPD). However, a robust evidence base will be needed to convince commissioners of healthcare that it is a high-value treatment. We sought to develop the evidence base by performing an individual patient-level analysis of randomised controlled trials in people with heterogeneous emphysema and an absence of collateral ventilation.

Methods

A literature search (PROSPERO register CRD42016048127) identified two trials meeting these criteria, the BelieVeR-HIFi and STELVIO studies. Anonymised individual patient data were obtained from investigators and analysed. The primary outcome measure was a comparison of change in forced expiratory volume in 1 s (FEV1) from baseline between the treatment and control groups. Secondary end points were change from baseline in 6 min walk distance (6MWD), Medical Research Council dyspnoea score and St George’s Respiratory Questionnaire (SGRQ).

Results

114 individuals were treated with 3-month to 6-month follow-up data available for 101 individuals. FEV1improved by 23.1 (±28.3)% in patients treated with valves with a mean (95% CI) difference in response between groups of 17.8 (26.5, 9.2)% (p<0.0001). Relative to controls valve placement was associated with a fall in residual volume of 0.64 (0.43, 0.86) L (p<0.0001), a 9.5 (3.5, 15.6) unit fall in SGRQ (p=0.0022) and a 64.2 (94.0, 34.5) m increase in 6MWD. There were three deaths in the treatment arm and the pneumothorax rate was 15%.

Conclusions

These data strengthen the evidence that endobronchial valve treatment can produce clinically meaningful improvements in appropriately selected COPD patients.
Emerging role of thalidomide in the treatment of gastrointestinal bleeding
Authors: McFarlane Michael , O’Flynn Lauren , Ventre Rachel , Disney Benjamin R
Published: November 2017

Thalidomide was initially synthesised in 1954 and marketed as a sedative and antiemetic for morning sickness. It was withdrawn in 1961 due to the realisation that it was teratogenic with over 10 000 children born with congenital abnormalities. Since then it has been used for treatment of dermatological and oncological conditions, including myeloma. In 1994, it was found to have a potent antiangiogenic effect via downregulation of vascular endothelial growth factor (VEGF). This has led to its use in gastrointestinal bleeding, as vascular abnormalities such as angiodysplasia have been found to have elevated VEGF levels. This article will review the current evidence of the use of thalidomide in bleeding associated with gastrointestinal vascular malformations, including angiodysplasia, gastric cancer and radiation-induced proctitis.
Stopping antithrombotic therapy after acute upper gastrointestinal bleeding is associated with reduced survival
Authors: Siau Keith , Hannah Jack L , Hodson James , Widlak Monika , Bhala Neeraj , Iqbal Tariq H
Published: November 2017

Introduction

Antithrombotic drugs are often stopped following acute upper gastrointestinal bleeding (AUGIB) and frequently not restarted. The practice of antithrombotic discontinuation on discharge and its impact on outcomes are unclear.

Objective

To assess whether restarting antithrombotic therapy, prior to hospital discharge for AUGIB, affected clinical outcomes.

Design

Retrospective cohort study.

Setting

University hospital between May 2013 and November 2014, with median follow-up of 259 days.

Patients

Patients who underwent gastroscopy for AUGIB while on antithrombotic therapy.

Interventions

Continuation or cessation of antithrombotic(s) at discharge.

Main outcomes measures

Cause-specific mortality, thrombotic events, rebleeding and serious adverse events (any of the above).

Results

Of 118 patients analysed, antithrombotic treatment was stopped in 58 (49.2%). Older age, aspirin monotherapy and peptic ulcer disease were significant predictors of antithrombotic discontinuation, whereas dual antiplatelet use predicted antithrombotic maintenance. The 1-year postdischarge mortality rate was 11.3%, with deaths mainly due to thrombotic causes. Stopping antithrombotic therapy at the time of discharge was associated with increased mortality (HR 3.32; 95% CI 1.07 to 10.31, P=0.027), thrombotic events (HR 5.77; 95% CI 1.26 to 26.35, P=0.010) and overall adverse events (HR 2.98; 95% CI 1.32 to 6.74, P=0.006), with effects persisting after multivariable adjustment for age and peptic ulcer disease. On subgroup analysis, the thromboprotective benefit remained significant with continuation of non-aspirin regimens (P=0.016). There were no significant differences in postdischarge bleeding rates between groups (HR 3.43, 0.36 to 33.04, P=0.255).

Conclusion

In this hospital-based study, discontinuation of antithrombotic therapy is associated with increased thrombotic events and reduced survival.
Theoretical study of the CO, NO, and N2 adsorptions on Li-decorated graphene and boron-doped graphene
Authors: Song Yao-Dong , Wang Liang , Wu Li-Ming
Published: November 2017

The adsorption properties of common gas molecules (CO, NO, and N2) on the surface of Li-decorated pristine graphene and Li-decorated boron doped graphene are investigated using density functional theory. The adsorption energy, charge transfer, and density of states of gas molecules on three surfaces have been calculated and discussed, respectively. The results show that Li-decorated pristine graphene has strong interaction with CO and N2. Compared with Li-decorated pristine graphene, Li-decorated boron doped graphene exhibit a comparable adsorption ability of CO and N2. Moreover, Li-decorated boron doped graphene have a more significant adsorption energy to NO than that of Li-decorated pristine graphene because of the chemical interaction of the NO gas molecule. The strong interaction between the NO molecule and substrate (Li-decorated boron doped graphene) induces dramatic changes to the electrical conductivity of Li-decorated boron doped graphene. The results indicate that Li-decorated boron doped graphene would be an excellent candidate for sensing NO gas.
Noncommutative space–time and Hausdorff dimension
Authors: Anjana V. , Harikumar E. , Kapoor A. K.
Published: November 2017

We study the Hausdorff dimension of the path of a quantum particle in noncommutative space–time. We show that the Hausdorff dimension depends on the deformation parameter [Formula: see text] and the resolution [Formula: see text] for both nonrelativistic and relativistic quantum particle. For the nonrelativistic case, it is seen that Hausdorff dimension is always less than 2 in the noncommutative space–time. For relativistic quantum particle, we find the Hausdorff dimension increases with the noncommutative parameter, in contrast to the commutative space–time. We show that noncommutative correction to Dirac equation brings in the spinorial nature of the relativistic wave function into play, unlike in the commutative space–time. By imposing self-similarity condition on the path of nonrelativistic and relativistic quantum particle in noncommutative space–time, we derive the corresponding generalized uncertainty relation.
Measuring the Significance of Spatiotemporal Co-Occurrences
Authors: Aydin Berkay , Kucuk Ahmet , Angryk Rafal A. , Martens Petrus C.
Published: November 2017

Spatiotemporal co-occurrences are the appearances of spatial and temporal overlap relationships among trajectory-based spatiotemporal instances with region-based geometric representations. Assessing the significance of spatiotemporal co-occurrences plays an important role in the spatiotemporal frequent pattern mining applications of moving region objects. A spatiotemporal version of the popular Jaccard measure has been used for measuring the strength of spatiotemporal co-occurrences. We will demonstrate the shortcomings of the Jaccard (
J
) measure when it is used for assessing the significance of co-occurrences among spatiotemporal instances with highly different spatiotemporal evolution characteristics. We will present two extended novel measures (
J
+
and
J
*
) that address the problems linked to the
J
measure. Our work includes algorithms for the significance measure calculations, the proofs and explanations about the key properties of measures, and a detailed experimental evaluation section. Our experiments include in-depth relevancy and running time analyses demonstrating the suitability of our proposed measures for spatiotemporal frequent pattern mining algorithms.
Deregulation and Therapeutic Potential of the Hippo Pathway in Cancer
Authors: Lin Kimberly C. , Park Hyun Woo , Guan Kun-Liang
Published: November 2017

The Hippo pathway has drawn increasing interest in the past decade for its role in the regulation of cell growth, differentiation, organ size, and tissue homeostasis. Recent studies have expanded our knowledge of known upstream regulators of the Hippo pathway and have consistently demonstrated that the Hippo pathway is critical for translating cellular cues into transcriptional responses by receiving input from a wide range of upstream signals. Dramatic overgrowth phenotypes upon deregulation of the Hippo pathway have prompted investigation into its role in cancer. Here we provide an overview of the Hippo pathway, our current understanding of its role in tumorigenesis, and potential therapeutics targeting Hippo signaling.
Molecular and Genomic Determinants of Response to Immune Checkpoint Inhibition in Cancer
Authors: Jenkins Russell W. , Thummalapalli Rohit , Carter Jacob , Cañadas Israel , Barbie David A.
Published: November 2017

Molecularly targeted therapy and immunotherapy have dramatically changed the landscape of available treatment options for patients with advanced cancer. Improved understanding of the molecular and genomic features of cancers over the last decade has led to the development of successful targeted therapies and the field of precision cancer medicine. As a result of these advances, patients whose tumors harbor select molecular alterations are eligible for treatment with targeted therapies active against the unique molecular aberration. Concurrently, advances in tumor immunology have led to the development of immunomodulatory antibodies targeting T cell coinhibitory receptors CTLA-4 and PD-1 (programmed death–1) that have shown activity in several cancer histologies, reinvigorating antitumor immune responses in a subset of patients. These immunomodulatory antibodies offer the promise of durable disease control. However, discrete genomic determinants of response to cancer immunotherapy, unlike molecularly targeted therapies, have remained elusive, and robust biomarkers are lacking. Recent advances in tumor profiling have begun to identify novel genomic features that may influence response and resistance to cancer immunotherapy, including tumor mutational burden (e.g., microsatellite instability), copy-number alterations, and specific somatic alterations that influence immune recognition and response. Further investigation into the molecular and genomic features of response and resistance to cancer immunotherapy will be needed. We review the recent advances in understanding the molecular and genomic determinants of response to cancer immunotherapy, with an emphasis on immune checkpoint inhibitors.
Reentrant Phase Transitions and Triple Points of Topological AdS Black Holes in Born-Infeld-Massive Gravity
Authors: Zhang Ming , Zou De-Cheng , Yue Rui-Hong
Published: November 2017

Motivated by recent developments of black hole thermodynamics in de Rham, Gabadadze, and Tolley (dRGT) massive gravity, we study the critical behaviors of topological Anti-de Sitter (AdS) black holes in the presence of Born-Infeld nonlinear electrodynamics. Here the cosmological constant appears as a dynamical pressure of the system and its corresponding conjugate quantity is interpreted as thermodynamic volume. This shows that, besides the Van der Waals-like SBH/LBH phase transitions, the so-called reentrant phase transition (RPT) appears in four-dimensional space-time when the coupling coefficients cim2 of massive potential and Born-Infeld parameter b satisfy some certain conditions. In addition, we also find the triple critical points and the small/intermediate/large black hole phase transitions for d=5.