bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema: a systematic review and meta-analysis
Authors: Wang Yan , Shen Zhiyang , Lu Xuefeng , Zhen Yanhua , Li Huixia
Published: November 2017

Aims: This study aimed to determine the sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema by meta-analysis.Materials and methods: A systematic search was conducted through the following databases: Cochrane, PubMed, EMBASE and Ovid MEDLINE. Prospective cohort and prospective case-control studies that reported sensitivity and specificity of lung ultrasound in diagnosis of acute pulmonary edema were selected. An independent review of citations was carried out for inclusion and data extraction. Quality assessment was conducted using the QUADAS-2 tool. Sensitivity and specificity were taken from the studied articles and then calculated with the contingency tables. A total of 984 articles were identified but only eight studies (1301 patients) were included in this meta-analysis. One study was a case-control study and seven studies were prospective cohort study.Results: The overall sensitivity of ultrasound for the diagnosis of acute pulmonary edema is 97% (95% CI: 96%–98%) and the overall specificity was 98% (95% CI: 97%–99%).Conclusion: The diagnostic test accuracy suggests that lung ultrasound using B-lines is a useful and reliable diagnostic tool for critically illpatients with acute pulmonary edema.
Diagnostic value of musculoskeletal ultrasound in patients with low back pain – a review of the literature
Authors: Todorov Plamen Todorov , Nestorova Rodina , Batalov Anastas
Published: November 2017

Patients with low back pain (LBP) frequently undergo various imaging studies in the pursuit of a more precise diagnosis. Ultrasound (US) has the advantage of being a widely available, multiplanar, fast and radiation-free diagnostic tool. Moreover, compared to most of the other imaging modalities, it is particularly efficient in the visualization and assessment of soft tissues. Consequently, the question about the possible diagnostic application of US in such a common pathology as LBP is very relevant to the clinical practice. For this reason, we performed a review of the literature on the diagnostic value of US in differentconditions that could cause LBP. We hereby discuss available studies on the diagnostic application of US in spinal canal stenosis and disc herniation (probably of historical significance only), as well as in the pathology of soft tissue structures like the lumbar and pelvic ligaments, muscles and entheses, the thoracolumbar fascia and the sacroiliac joints (maybe of greater importance nowadays). The evidence for the diagnostic value of US is not equivocal, though promising for some of the causative conditions, and clearly this area remains open to further research.
Abdominal wall endometriosis: an update in clinical, imagistic features, and management options
Authors: Grigore Mihaela , Socolov Demetra , Pavaleanu Ioana , Scripcariu Ioana , Grigore Ana Maria , Micu Romeo
Published: November 2017

Abdominal wall endometriosis (AWE) is a rare condition defined by the presence of endometrial tissue in the subcutaneous fatty layer and the muscles of the abdominal wall. It is usually caused by the dissemination of endometrial tissue in the wound at the time of obstetrical and gynecological surgeries. AWE is rare and difficult to diagnose. The most frequent clinical presentation is that of a palpable subcutaneous mass near surgical scars associated with cyclic pain and swelling during menses. AWE may be an underreported pathology partly because it has scarcely received attention in the radiologic literature. Its frequency is expected to rise along with the increasing rate of cesarean deliveries; thus, it is important that physicians or sonographers are familiar with this pathology. The purpose of our review is to present the latest data regarding risk factors, clinical and imagisticfindings, and management of AWE.
Ornithodoros sawaii (Acari: Ixodida: Argasidae) collected from nest soil/litter of Synthliboramphus antiquus, Synthliboramphus wumizusume, and nest soil/litter and nestlings of Hydrobates monorhis on Gugul and Sogugul Islands, Jeollanam Province, Republic of Korea
Authors: Kim Heung-Chul , Park Chang-Uk , Kim Miran , Kim Yang-Mo , Yeo Juhan , Kwon Young-Soo , Yun Seok-Min , Lee Won-Ja , Chong Sung-Tae , Klein Terry A. , Robbins Richard George
Published: November 2017

The 65th Medical Brigade and Medical Department Activity-Korea, in collaboration with the Migratory Birds Research Center, National Park Research Institute, conducted a migratory bird tick-borne disease surveillance program on Gugul and Sogugul Islands, two small, remote, uninhabited islands in southwestern Jeollanam Province, Republic of Korea (ROK) from 2015–2016. Ticks were collected from nest soil/litter of the Ancient Murrelet, Synthliboramphus antiquus, Japanese Murrelet, Synthliboramphus wumizusume, and Swinhoe’s Storm Petrel, Hydrobates monorhis, using Tullgren funnels. A total of 100 Ornithodoros sawaii (25 females, 56 males, 17 nymphs, and 2 larvae) were collected from 2/33 (6.1%) Ancient Murrelet, 3/11 (27.3%) Japanese Murrelet, and 23/94 (24.5%) Swinhoe’s Storm Petrel nest sites. In addition, 3 larvae were collected from Swinhoe’s Storm Petrel nestlings. Ticks were identified morphologically and species determination was confirmed using polymerase chain reaction techniques. This is the first record of O. sawaii collected from nest soil/litter of the Japanese Murrelet during this bird’s nesting season in the ROK.
Tinkering with Osmotically Controlled Transcription Allows Enhanced Production and Excretion of Ectoine and Hydroxyectoine from a Microbial Cell Factory
Authors: Czech Laura , Poehl Sebastian , Hub Philipp , Stöveken Nadine , Bremer Erhard
Published: November 2017

Ectoine and hydroxyectoine are widely synthesized by members of the
Bacteria
and a few members of the
Archaea
as potent osmostress protectants. We have studied the salient features of the osmostress-responsive promoter directing the transcription of the ectoine/hydroxyectoine biosynthetic gene cluster from the plant-root-associated bacterium
Pseudomonas stutzeri
by transferring it into
Escherichia coli
, an enterobacterium that does not produce ectoines naturally. Using
ect-lacZ
reporter fusions, we found that the heterologous
ect
promoter reacted with exquisite sensitivity in its transcriptional profile to graded increases in sustained high salinity, responded to a true osmotic signal, and required the buildup of an osmotically effective gradient across the cytoplasmic membrane for its induction. The involvement of the −10, −35, and spacer regions of the sigma-70-type
ect
promoter in setting promoter strength and response to osmotic stress was assessed through site-directed mutagenesis. Moderate changes in the
ect
promoter sequence that increase its resemblance to housekeeping sigma-70-type promoters of
E. coli
afforded substantially enhanced expression, both in the absence and in the presence of osmotic stress. Building on this set of
ect
promoter mutants, we engineered an
E. coli
chassis strain for the heterologous production of ectoines. This synthetic cell factory lacks the genes for the osmostress-responsive synthesis of trehalose and the compatible solute importers ProP and ProU, and it continuously excretes ectoines into the growth medium. By combining appropriate host strains and different plasmid variants, excretion of ectoine, hydroxyectoine, or a mixture of both compounds was achieved under mild osmotic stress conditions.

IMPORTANCE
Ectoines are compatible solutes, organic osmolytes that are used by microorganisms to fend off the negative consequences of high environmental osmolarity on cellular physiology. An understanding of the salient features of osmostress-responsive promoters directing the expression of the ectoine/hydroxyectoine biosynthetic gene clusters is lacking. We exploited the
ect
promoter from an ectoine/hydroxyectoine-producing soil bacterium for such a study by transferring it into a surrogate bacterial host. Despite the fact that
E. coli
does not synthesize ectoines naturally, the
ect
promoter retained its exquisitely sensitive osmotic control, indicating that osmoregulation of
ect
transcription is an inherent feature of the promoter and its flanking sequences. These sequences were narrowed to a 116-bp DNA fragment. Ectoines have interesting commercial applications. Building on data from a site-directed mutagenesis study of the
ect
promoter, we designed a synthetic cell factory that secretes ectoine, hydroxyectoine, or a mixture of both compounds into the growth medium.
Genome-Wide Identification of Fitness Factors in Mastitis-Associated Escherichia coli
Authors: Olson Michael A. , Siebach Timothy W. , Griffitts Joel S. , Wilson Eric , Erickson David L.
Published: November 2017

Virulence factors of mammary pathogenic
Escherichia coli
(MPEC) have not been identified, and it is not known how bacterial gene content influences the severity of mastitis. Here, we report a genome-wide identification of genes that contribute to fitness of MPEC under conditions relevant to the natural history of the disease. A highly virulent clinical isolate (M12) was identified that killed
Galleria mellonella
at low infectious doses and that replicated to high numbers in mouse mammary glands and spread to spleens. Genome sequencing was combined with transposon insertion site sequencing to identify MPEC genes that contribute to growth in unpasteurized whole milk, as well as during
G. mellonella
and mouse mastitis infections. These analyses show that strain M12 possesses a unique genomic island encoding a group III polysaccharide capsule that greatly enhances virulence in
G. mellonella
. Several genes appear critical for MPEC survival in both
G. mellonella
and in mice, including those for nutrient-scavenging systems and resistance to cellular stress. Insertions in the ferric dicitrate receptor gene
fecA
caused significant fitness defects under all conditions (in milk,
G. mellonella
, and mice). This gene was highly expressed during growth in milk. Targeted deletion of
fecA
from strain M12 caused attenuation in
G. mellonella
larvae and reduced growth in unpasteurized cow's milk and lactating mouse mammary glands. Our results confirm that iron scavenging by the ferric dicitrate receptor, which is strongly associated with MPEC strains, is required for MPEC growth and may influence disease severity in mastitis infections.

IMPORTANCE
Mastitis caused by
E. coli
inflicts substantial burdens on the health and productivity of dairy animals. Strains causing mastitis may express genes that distinguish them from other
E. coli
strains and promote infection of mammary glands, but these have not been identified. Using a highly virulent strain, we employed genome-wide mutagenesis and sequencing to discover genes that contribute to mastitis. This extensive data set represents a screen for mastitis-associated
E. coli
fitness factors and provides the following contributions to the field: (i) global comparison of genes required for different aspects of mastitis infection, (ii) discovery of a unique capsule that contributes to virulence, and (iii) conclusive evidence for the crucial role of iron-scavenging systems in mastitis, particularly the ferric dicitrate transport system. Similar approaches applied to other mastitis-associated strains will uncover conserved targets for prevention or treatment and provide a better understanding of their relationship to other
E. coli
pathogens.
Complete Genome Sequences of
Arthrobacter
Phages Beans, Franzy, Jordan, Piccoletto, Shade, and Timinator
Authors: Adair Tamarah L. , Bonilla J. Alfred , Klyczek Karen K. , Lee-Soety Julia Y. , Rosas-Acosta German , Harrison Melinda ,   Baylor University SEA-PHAGES,   University of Wisconsin–River Falls SEA-PHAGES,   Saint Joseph’s University Phage Safari,   The University of Texas at El Paso SEA-PHAGES,   Cabrini University SEA-PHAGES, Bowman Charles A. , Cresawn Steven G. , Garlena Rebecca A. , Russell Daniel A. , Pope Welkin H. , Jacobs-Sera Deborah , Hatfull Graham F.
Published: November 2017

We report here the genome sequences of six newly isolated bacteriophages infecting
Arthrobacter
sp. ATCC 21022. All six have myoviral morphologies and have double-stranded DNA genomes with circularly permuted ends. The six phages are closely related with average nucleotide identities of 73.4 to 93.0% across genomes lengths of 49,797 to 51,347 bp.
Genome Sequences of Three Strains of Aspergillus flavus for the Biological Control of Aflatoxin
Authors: Weaver Mark A. , Scheffler Brian E. , Duke Mary , Ballard Linda , Abbas Hamed K. , Grodowitz Michael J.
Published: November 2017

Aflatoxin is a carcinogenic contaminant of many commodities that are infected by
Aspergillus flavus
. Nonaflatoxigenic strains of
A. flavus
have been utilized as biological control agents. Here, we report the genome sequences from three biocontrol strains. This information will be useful in developing markers for postrelease monitoring of these fungi.
Complete Genome Sequence of Multidrug-Resistant Streptococcus pneumoniae Serotype 19F Isolated from an Invasive Infection in Sapporo, Japan
Authors: Sato Toyotaka , Ohkoshi Yasuo , Wada Takayuki , Fukushima Yukari , Murabayashi Hiromi , Takakuwa Yasunari , Nishiyama Kaoru , Shiraishi Tsukasa , Nakajima Chie , Suzuki Yasuhiko , Yokota Shin-ichi
Published: November 2017

Invasive infection of multidrug-resistant
Streptococcus pneumoniae
is a serious clinical concern. Here, we report the complete genome sequence of a multidrug-resistant
S. pneumoniae
serotype 19F strain isolated from a patient with an invasive infection in Sapporo, Japan.
Draft Genome Sequence of
Pseudonocardia
sp. Strain N23, a 1,4-Dioxane-Degrading Bacterium
Authors: Yamamoto Norifumi , Inoue Daisuke , Kuroda Masashi , Ike Michihiko
Published: November 2017

Pseudonocardia
sp. strain N23 is a 1,4-dioxane-degrading bacterium that is capable of utilizing 1,4-dioxane as the sole carbon and energy source. Here, we report the draft genome sequence of strain N23, with a size of 6.5 Mbp, to identify the genes associated with 1,4-dioxane degradation.
Genome Sequencing of
Microbacterium
sp. Yaish 1, a Bacterial Strain Isolated from the Rhizosphere of Date Palm Trees Affected by Salinity
Authors: Jana Gerry Aplang , Al-Yahyai Rashid , Yaish Mahmoud W.
Published: November 2017

Microbacterium
sp. strain Yaish 1 is a rhizospheric bacterium isolated from date palm orchards with high soil salinity. The genome was sequenced, and genes coding for growth-promoting 1-aminocyclopropane-1-carboxylate (ACC) deaminase, siderophore-producing proteins, and tryptophan biosynthesis proteins were identified. Here, we report the draft whole-genome sequencing of the strain.
Complete and Draft Genome Sequences of Eight Oceanic Pseudomonas aeruginosa Strains
Authors: Kumagai Yohei , Yoshizawa Susumu , Nakamura Keiji , Ogura Yoshitoshi , Hayashi Tetsuya , Kogure Kazuhiro
Published: November 2017

Pseudomonas aeruginosa
is one of the most common model bacterial species, and genomes of hundreds of strains of this species have been sequenced to date. However, currently there is only one available genome of an oceanic isolate. Here, we report two complete and six draft genome sequences of
P. aeruginosa
isolates from the open ocean.
Do NAA/CHO and NAA/CR ratios as measure by 1h MR spectroscopy differ between symptomatic and non-symptomatic concussed athletes in the early post injury period?
Authors: Belli Antonio , Davies David , Su Zhangjie , Bentley Connor , Hammond Douglas , Grey Michael , Pietro Valentina Di , Hill Lisa , Evans Shaun
Published: November 2017

Objective

Changes in cerebral N-acetylaspartate and choline (NAA/Cho) or creatine (NAA/Cr) following a mild traumatic brain injury (mTBI) in sport have been measured by 1H (Proton) magnetic resonance spectroscopy (1H-MRS). We intend to investigate the effect that presenting symptomatology has on these parameters.

Design

Observational cohort study.

Setting

UK Premiership and Championship Rugby.

Participants

Athletes aged 18-40 years.

Interventions (or assessment of risk factors)

Concussed athletes identified by members of their enhanced-care clinical team. Imaging undertaken on a Philips Achieva 3.0 T MR scanner (32 channel SENSE coil). A PRESS sequence (et 37 ms, rt 2000 ms) generated spectra in a 20 mm MRS cubic voxel in right-sided superior frontal white matter. Symptoms were assessed using the IMPACT and SCAT-3 concussion assessment tools. Recruits were divided into either ‘symptomatic’ or ‘non-symptomatic’ at presentation based on a minimum severity score from either of these assessments.

Outcome measures

Analysis of raw parameters was undertaken utilising the TARQUIN 1H-MRS analytical software package. A Mann-Whitney-U test was performed to compare results between the symptomatic and non-symptomatic groups.

Main results

33 concussed professional athletes were recruited. Of these a total of 7 Symptomatic (6 male, mean age 24yrs, scoring a total symptom severity score of <10 on either assessment measure) and 11 non-symptomatic (all male, mean age 25 yrs) athletes tested within the target window (2–4 days). Ratios between groups did not vary significantly (NAA/Cho mean 4.43 vs 4.53 and NAA/Cr 1.24 vs 1.26, p=0.84 and p=0.99 respectively).

Conclusions

Within this population of concussed professional athletes early 1H-MRS did not differentiate between athletes presenting with modest/no symptoms and those presenting with significant symptoms.

Competing interests

None.
Exercise induced recurrence of concussion symptoms after symptom free status
Authors: O’Brien Michael J , Pepin Michael J , Howell David , Meehan William P
Published: November 2017

Objective

Determine the proportion of athletes who have a recurrence of concussion symptoms with exercise after being symptom free at rest.

Design

Prospective cohort studyProspective cohort study

Setting

Sport Concussion clinic

Participants

Patients diagnosed with a concussion and returned to the clinic after resuming exercise.

Intervention

Assessment of risk factors

Outcome measures

Our main outcome variable was recurrence of symptoms with exercise after being symptom free at rest while recovering from a sport-related concussion. Co-factors included age, gender, loss of consciousness with injury, prior concussions (diagnosed and undiagnosed), post-concussion symptom scale (PCSS) score, time until clinical presentation, and duration of symptoms.

Main Results

Of the 217 patients included, 25 (12%) experienced a return of symptoms. Losing consciousness at the time of injury (aOR=0.079, 95%CI=0.003–0.563) and a longer time period between injury and clinic presentation (aOR=0.936, 95%CI=0.877–0.984) were associated with a decreased risk of symptoms recurring with exercise, while those athletes that had sustained previous undiagnosed concussions (aOR=5.036, 95%CI=1.634–16.83), and had suffered a longer duration of symptoms at rest (aOR=1.006, 95%CI=1.002–1.010) were at increased risk of symptoms recurrence with exercise.

Conclusions

Relatively few athletes who are symptom free at rest after a concussion will have a recurrence of symptoms when they start exercising. The risk of symptoms recurring with exercise may be higher among those athletes who have sustained previous undiagnosed concussion and had a longer period of symptoms at re.

Competing interests

None.

Dr. Meehan receives royalties from ABC-Clio publishing for the book, Kids, Sports, and Concussion: A guide for coaches and parents, from Springer International for the book, Head and Neck Injuries in Young Athletes, and from Wolters Kluwer for working as an author for UpToDate. He is under contract with ABC-Clio publishing for a future book entitled, Concussions. His research is funded, in part, by the Football Players Health Study at Harvard, which is funded by the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. Dr. O’Brien receives royalties from Wolters Kluwer for working as an author for UpToDate and from Springer International publishing for the book, Head and Neck Injuries in Young Athletes. Dr. Howell and Mr. Pepin have nothing to disclose.
Measuring cognitive-motor integration to detect prolonged performance declines post-concussion
Authors: Sergio Lauren E , Dalecki Marc , Hurtubise Johanna , Brown Jeffrey , Gorbet Diana , Hughes Cindy , Macpherson Alison
Published: November 2017

Objective

There is a higher risk of re-injury for athletes with concussion history when returning to play, despite being asymptomatic and cleared for activity. One possible explanation is that current return to play assessments test thinking and moving separately, but sport activities often require their concurrent processing (cognitive-motor integration, CMI). The aim of this research is to characterize CMI performance across a range of ages and skill levels following concussion. We hypothesize that there will be CMI impairment, even when cognition and motor action measured separately are deemed recovered, and that impairment level is affected by age and skill level.

Methods

133 participants with concussion history (mix of youth, adolescent, university, and elite athletes) and 130 no-concussion controls (age/sex/skill matched) performed two eye-hand coordination tasks. Participants displaced a cursor from a central to peripheral targets by either sliding their finger on a vertically-oriented touchscreen or with decoupled eye-hand coordination (targets/cursor viewed on vertical screen but finger slid on second horizontal touchscreen with 180° cursor feedback rotation).

Results

Children, young adult, and elite athletes with concussion history all had CMI performance deficits in movement planning, timing and execution, despite being asymptomatic and returned to play. Younger and less skilled athletes were more impaired relative to older/elite performers.

Conclusions

Cognitive-motor integration tasks are successful in detecting performance post-concussion relative to established assessment tools that test these domains separately. We propose that testing CMI performance, a skill crucial in sport, is important to comprehensively assess function post-concussion and to prevent re-injury.

Competing interests

None.
Neurocognitive and somatic recovery curves following concussion in female interscholastic soccer players
Authors: Forbes Cameron , Glutting Joseph J , Kaminski Thomas W
Published: November 2017

Objective

To measure the acute effects of SRC on cognition and symptoms over a 7-day time course in interscholastic female soccer players.

Design

Prospective.

Setting

Soccer fields.

Participants

36 interscholastic female soccer players were equally divided into concussed [CON] (age 16.3±1.4 yr.) and non-concussed [NOCON] (age 16.1±1.3 yr.) groups.

Intervention

A 17-item SRC-symptom checklist was completed resulting in a total symptom score (SX). Neurocognitive performance [ANAM] throughput scores [higher scores better] (SRT1, SRT2, MSP, MTH, CPT1, CPT2, ST6) was also measured. The CON and NOCON were evaluated on five occasions: baseline, day 1 [D1], day 3 [D3], day 5 [D5], and day 7 [D7].

Outcome measures

Data from the 8 outcome variables were analysed using the multivariate approach to a repeated measures ANOVA

Main results

Significant (p<0.05) deficits in throughput scores in the CON, including SRT1 (222.0 vs 200.3 – D7) and SRT2 (224.4 vs. 209.3 – D7), MSP (42.9 vs 38.8 – D7), and ST6 (83.8 vs. 75.1 – D5) as well as SX (9.1 vs. 12.8 – D5) existed across the 7 day recovery period. Differences between baseline and D1 existed for CPT and MTH scores but they surpassed the baseline on D3.

Conclusions

CON subjects exhibited robust symptoms and neurocognitive deficits in the days immediately following SRC. Similar to American football, our recovery curves represent an initial decline with gradual improvements in the days succeeding post-injury and reinforce the need for clinicians to be cautious in the 7-day period post-concussion and depend on cognitive rest to aid recovery.

Competing interests

None.
Return to academic activities after concussion in sport
Authors: Guérin Fanny
Published: November 2017

Objective

Identify the impact of postconcussion symptoms, cognitive change and psychologicalreactions on academic activities.

Design

Retrospective study on clinical evaluation and intervention; a prospective follow-up ofoutcome.

Setting

In a sport neuropsychogical clinic in Montreal, Quebec.

Intervention

The number and intensity of symptoms, the cognitivechanges (memory, attention), the psychological factors (anxiety, depression), and the delay after theconcussion are the independant variables.

Outcome measures

The capacity of following school part or full time is the dependant variable.

Main results

The noise and light sensitivity, the lack of cognitive endurance during learning, theattentional deficits and the performance anxiety in reaction to the difficulty to recover and to follownormally school activities compromise the academic functionning and force the students to quit school.

Conclusions

According to the results, a decision tool is created to help the evaluation and therecommandations of physician and neuropsychologist to individualise a return protocol to school.

Competing interests

The clinicial work of the author will be examined.
The association between moderate and vigorous physical activity and time to medical clearance to return to play following sport-related concussion in youth ice-hockey players
Authors: Lishchynsky Justin , Palacios-Derflinger Luz , Toomey Clodagh , Emery Carolyn , Yeates Keith , Meeuwisse Willem , Schneider Kathryn
Published: November 2017

Objective

The objective of this study was to determine if youth ice-hockey players who perform more moderate and vigorous physical activity (MVPA) during recovery take longer to achieve medical clearance to return to play (RTP).

Design

Cohort study.

Setting

Sport Medicine Centre, Alberta, Canada.

Participants

Thirty youth ice-hockey players [25 males, 5 females, median age 14 years (range 12–17)] presenting to a sport medicine clinic within 4 days (range 2–20 days) of sustaining a sport-related concussion diagnosed by a sport medicine physician.

Exposure

Participants MVPA during the first three days following their initial appointment was measured using a waist worn Actigraph accelerometer. MVPA was dichotomized into high (≥45 minutes) and low (<45 minutes) activity based on the median daily MVPA.

Outcome

The primary outcome was time (days) to medical clearance to RTP.

Results

All thirty participants performed at least some MVPA over the first three days, despite physician instruction to initially rest following the concussion. Players performing low levels of MVPA reached medical clearance in a median of 15 days (range: 10–30 days). Players performing high levels of MVPA reached medical clearance in a median of 19 days (range: 12–55 days). The low level MVPA group reached medical clearance significantly sooner than the high activity group (log-rank chi2=5.27, p=0.02).

Conclusions

More time in MVPA during the first three days after initial assessment is significantly associated with greater time to medical clearance to RTP. Future research is needed to better understand the optimal amount and timing of MVPA for concussion recovery.

Competing interests

None.
Do measures of cervical, vestibulo-ocular function, balance and divided attention change over a year in youth ice hockey players?
Authors: Schneider Kathryn J , Palacios-Derflingher Luz , Shi Qian , Meeuwisse Willem H , Emery Carolyn A
Published: November 2017

Objective

To determine if preseason measures of cervical, vestibulo-ocular function, balance and divided attention change over one year in 10-12 year old ice hockey players.

Design

Prospective cohort study

Setting

Sport Injury Prevention Research Centre, Alberta, Canada

Participants

Youth Ice Hockey players (10-12 years old) who completed cervical, vestibular and divided attention tasks at a preseason assessment during two seasons of play.

Outcome measures

Numeric pain rating scores (neck pain, headache, dizziness), cervical flexor endurance test (CFE), cervical flexion rotation test (CFRT), anterolateral cervical spine strength, head perturbation test, functional gait assessment (FGA), walking while talking test, head thrust test and dynamic visual acuity (DVA).

Main results

A total of 193 uninjured youth ice hockey players [95% males; median age 11 (range 10-12) in the first season] completed preseason testing measures in two consecutive seasons (2013-2015). After Bonferroni corrections (α=0.0042), using Wilcoxon Signed-Rank Test, anterolateral neck strength increased (right: z=−5.96, p<0.0001; left: z=−6.52, p<0.0001), head perturbation test improved (z=4.40, p<0.0001), walking while dividing attention improved (z=6.41, p<0.0001) and there were more positive head thrust tests (chi2=13.64, p=0.0034) in the second year. There was no evidence of a difference in symptom reports, CFE, CFRT, DVA and FGA between the two testing sessions.

Conclusions

Symptom reports did not differ between two years of play. However, tests of clinical function were different between two seasons of play in youth ice hockey players. These data suggest that developmental and/or maturational changes should be taking into consideration when interpreting these tests in youth.

Competing interests

None.
Does concussion history and post-injury sleep quantity influence neurocognitive scores following concussion in collegiate athletes?
Authors: Hoffman NL , Weber ML , Schmidt JD
Published: November 2017

Objective

To determine if concussion history and post-concussion sleep quantity changes influence neurocognitive performance following concussion in collegiate athletes. It was hypothesised that athletes with a concussion history or shorter sleep duration following concussion would have poorer neurocognitive performance compared to athletes without a concussion history or greater sleep duration

Design

Prospective cohort.

Setting

Clinical Research Laboratory.

Participants

Twenty-eight collegiate athletes (21 males and 7 females: age=20.2 ± 1.7 years, height=182.2 ± 11.9 cm, mass=90.3 ± 24.2 kg) without history of: headaches or migraines, substances/alcohol abuse, and/or psychiatric conditions.

Intervention

Participants completed a preseason baseline and post-injury (PI) evaluation (1 day PI) using Immediate Post-Concussion Assessment and Cognitive Testing

Outcome measures

Sleep change was calculated by subtracting post-injury sleep duration from baseline sleep duration. Athletes were categorised into either shorter sleep (<-1 hour change) or longer/same sleep (≥−1 hour change) groups. Independent samples t-tests were conducted to compare neurocognitive composite scores (verbal memory, visual memory, visual motor speed, reaction time, impulse control) between concussion history and sleep quantity change groups (α=0.05)

Main results

Athletes with a concussion history had a faster reaction time (RT) (history:0.57±0.06 sec, no history:0.63±0.10 sec; p=0.048), but were more impulsive (history:8.55±5.87 errors, no history:4.18±3.89 errors; p=0.045) compared to those without a history of concussions. Neurocognitive performance did not differ between sleep quantity change groups.

Conclusions

Athletes with a concussion history may be quicker to respond to neurocognitive tasks, but commit greater number of errors. Post-concussion sleep quantity changes do not influence neurocognitive performance one day post-injury. Future research should consider effects of concussion history on RT and impulse assessments.

Competing interests

None.
Evaluation of physical examination elements in the diagnosis and prognosis of sports related concussion in adolescent athletes
Authors: Willer Barry , Baker John , Hinds Andrea , Miecznikowski Jeff , Czuczman Natalie , Lesh Kevin , Leddy John
Published: November 2017

Objective

To evaluate a brief physical examination (PE) for diagnosis and prognosis of sport-related concussion (SRC) in adolescents.

Design

Prospective.

Setting

UniversityConcussion clinics.

Subjects

53 adolescents with SRC (mean age 15.4; 70% male) and 30 uninjured controls (mean age 15.8; 73% male).

Interventions

Participants received a brief PE (11 PE elements in three systems: cervical, oculomotor and vestibular). Concussed adolescents were assessed acutely (mean 4.5 days post-injury) and at follow up (mean 18.5 days).

Outcome measures

Dependent variables 1: Concussion versus uninjured and 2: Standard versus slow recovery (>3 weeks). Recovery was defined as asymptomatic and exercise tolerant.

Results

Table 1 shows the significant PE variables that distinguished concussed from uninjured (via Fisher’s exact test; significance p<0.05).

Abstract 136 Table 1

PE elements (Visit 1) with 95% CI for Odds ratio and p-value

ElementCIpNeck tenderness(1.92, Inf)0.00321Smooth Pursuits(5.70, 786.21)<0.00001Convergence(1.10, 9.44)0.03475Abnormal saccades(3.34, 466.65)0.00009VOR(2.46, Inf)0.00144VOR Dizzy(3.67, Inf)0.00015Tandem gait(1.98, 291.60)0.00191

Table 2 shows the significant PE variables distinguishing standard recovery from slow recovery at visit 2 (via Fisher’s exact test; significance p<0.05).

Abstract 136 Table 2

PE variables (Visit 2) with 95% CI for Odds ratio and p-value

Neck spasm(1.13, Inf)0.04148Smooth pursuits(2.26, 127.15)0.00298Convergence(2.08, 53.74)0.00319Tandem gait(2.91, 773.79)0.00105

Conclusions

Easily administered physical exam reveals clinical findings that are important and sensitive for diagnosing acute concussion. Prognosis was less precise due to the heterogeneity of aetiology of slow recovery.

Competing interests

No competing interests for any authors.
Investigation of knowledge and attitude about concussion diagnosis and management among family medicine residents
Authors: Mann Aneet , Mann Aneet , Tator Charles H , Carson James D
Published: November 2017

Objective

To assess knowledge, attitude and learning needs about concussion among family medicine residents

Design

A web-based prospective survey

Setting

Toronto, Canada.

Participants

Family medicine residents at the University of Toronto.

Intervention

A link to the survey was disseminated via e-mail by the Department of Family and Community Medicine post-graduate office at the University of Toronto. Data collection occurred over 5 weeks from January to March 2015 with reminder emails sent out to all 348 family medicine residents at 2 weeks and 4 weeks of the study period.

Outcome measures

Survey answers to assess knowledge and attitude about concussion.

Main results

The residents who responded (n=73/348, response rate 21%) scored an average of 5.2 correct answers out of 9 (57.8%) questions regarding the diagnosis and management of concussion. Seventy-one percent of residents who responded did not recognise chronic traumatic encephalopathy and only 63% recognised second impact syndrome as consequences of repetitive concussions. Moreover, 32% of residents did not think that “every concussed individual should see a physician” as part of management.

Conclusions

We found significant gaps in knowledge surrounding concussion diagnosis and management among family medicine residents. This lack of knowledge should be addressed at both the undergraduate medical education and residency training levels to improve concussion-related care and patient outcomes.

Competing interests

None.
Psychophysiological stress in athletes across concussion recovery milestones
Authors: Mainwaring Lynda , Senthinathan Arrani , Hutchison Michael , Thomas Scott , Richards Doug , Churchill Nathan
Published: November 2017

Background

Psychophysiological stress markers across concussion recovery milestones have not been examined in an integrated study.

Objective

To examine physiological (heart rate variability [HRV] and salivary cortisol) and psychological (mood, perceived stress, symptoms, and sleep quality) factors of stress in concussed athletes across clinical recovery milestones.

Design

A prospective case control repeated measures study was conducted over three clinical recovery milestones: Symptomatic (acute), Asymptomatic, and 1-week Post Return-to-Play (RTP).

Setting

Single university athlete program monitored by the university’s sport medicine clinic, Ontario, Canada.

Participants

Male and female varsity athletes (n=26; M=16, F=10) with medically diagnosed concussion and their matched controls (n=26; M=16, F=10).

Outcome measures

Physiological: HRV and salivary cortisol; psychological: mood, perceived stress, sleep quality and symptoms.

Main results

Univariate analyses identified a group by sex interaction for specific HRV measures (RR intervals p=0.0084, Low frequency Power p=0.0084, Mean Heart Rate p=.0049, and Low/High Frequency Ratio p=0.0084). Multivariate analyses of HRV identified main effects for sex and group, and a significant interaction with reduced HF HRV for female concussed athletes through to 1-week post RTP (FDR=.05). HRV suppression was related to mood disturbance in males (FDR.05). Psychological measures were significantly worse for concussed athletes relative to controls at the Symptomatic Phase, but significantly better at 1-week post RTP (paired Wilcoxon at FDR=.05).

Funding disclosure

This study was supported by a grant from the Canadian Institute of Health Research (CIHR) −2012-ABI-CAT1-971 to L. Mainwaring.

Conclusions

For both males and females, mood disturbance, symptoms, and sleep quality perturbations were resolved by 1-week post RTP whereas autonomic nervous system disruption persisted beyond RTP in females. Psychophysiological non-invasive markers show promise for concussion monitoring.

Competing interests

None.
The world rugby pitch side concussion assessment (psca) phase 2 study: a prospective cohort study investigating the diagnosis of concussion in elite adult rugby union
Authors: DECQ Philippe , Gault Nathalie , Fuller Gordon , Kemp Simon PT
Published: November 2017

Objective

Rugby Union, in common with other elite sports, has developed systems to identify, evaluate and treat players sustaining sports related concussions. This study examines the clinical progress of players following head impact events and investigates which components of the clinical assessment influence a final diagnosis of concussion.

Design

Prospective cohort study using logistic regression modelling to determine the predictive value of components of clinical assessments in influencing a final diagnosis of concussion.

Setting

Phase 2 of the World Rugby PSCA study between September 2013 and May 2014

Participants

Consecutive players sustaining head impact events with the potential for concussion during ten national and international elite adult Rugby Union competitions

Intervention

Participants underwent 3 standardised clinical assessments: Initial pitch-side screening; early 3 hours post-match SCAT 3 assessment; and late diagnostic assessment after 2 nights with symptom evaluation and a neuro-cognitive assessment tool.

Outcome measures

Diagnosis of concussion determined at the last clinical assessment.

Main results

During the 8 months study period 229 players participated in the PSCA process. 130 (56.7%) players were diagnosed with concussion. The 3 hours post-match number of reported symptoms and Standardised Assessment of Concussion (SAC), and the presence of symptoms at 2 nights post injury were independently associated with a final diagnosis of concussion (p<0.05). Other clinical assessments provided no additional prognostic information.

Conclusions

The number of symptoms reported and SAC post-match were factors independently associated with a final diagnosis of concussion. Balance tests and severity of post-match symptoms did not appear to provide any additional information in the diagnosis of concussion.

Competing interests

None.
Comparison of spiral versus block curriculum styles in preparing medical students to diagnose and manage concussions
Authors: Wright Alexander D , Fraser Sarah K , Smirl Jonathan D , Donkelaar Paul van
Published: November 2017

Objective

Examine differences between the recently implemented integrated spiral (year 1) and conventional block (years 2-4) MD curriculum at University of British Columbia (UBC) with respect to knowledge of concussion diagnosis and management.

Design

Cross-sectional survey

Setting

UBC undergraduate MD program

Participants

An online survey was distributed to all 1152 students currently enrolled in UBC medical school. To date, 123 surveys have been returned (10.7% response rate) with 58 first year students (integrated spiral curriculum) and 65 students in years 2-4 (conventional block curriculum). Females made up 60% of responses.

Interventions

Online survey, hosted by FluidSurveys (Fluidware, Ottawa, ON), distributed through email.

Outcome measures

Questions focused on demographic data, knowledge of concussion definitions, and management considerations.

Main results

Majority of responses revealed both curriculums have promoted a strong understanding of concussion definition and related symptoms (84% correct response rate). Only 8.1% of participants believed that functional imaging (MRI or CT) is a mandatory assessment tool for concussions. Differences between the conventional and integrated curriculums included: understanding concussions can occur without direct impact to the head (91.4% integrated vs. 69.2% conventional: χ2(1)=43.325, p<0.001) and identifying long-term consequences of repetitive concussive injuries (dementia: 91.4% integrated vs. 66.2% conventional; death or severe disability with second impact syndrome: 77.6% integrated vs. 55.4% conventional).

Conclusions

The findings from this study reveal a number of positive signs regarding the evolution of medical education in terms of concussion diagnosis and management. The integrated curriculum is taking further steps in advancing concussion knowledge in medical education.

Competing interests

None.
Concussion characteristics in horse racing
Authors: Mattacola Carl G , Han Dong (Dan) Y , Crots Jed , Glueck Amanda , Abt John , Heebner Nick
Published: November 2017

Objective

To describe characteristics and modifiable factors in jockeys who have sustained a concussion for the purpose of identifying areas for risk reduction and improved safety.

Setting

Direct from field; descriptive epidemiology study.

Patients or other participants

Data were obtained from the Jockey Injury Database from years 2012 to 2016.

Interventions

Data were collected from Horse Racetracks in the United States.

Main outcome measures

Descriptive statistics were used to identify frequency and percentages based on gender, helmet type, track, jockey experience, location of track, size of field, horse gender, track condition & distance.

Results

There were 36 reported concussions during this period. 29 males and 7 females sustained a concussion. Helmet type was distributed evenly with more concussions occurring with LAS helmets. The majority occurred on dirt (27/66%) versus synthetic surfaces (9/8%). Injury rates were higher (21/58%) in less experienced jockeys (<6 years’ experiences) versus more experienced jockeys (13/36%) (>11 years’ experience). More concussions were identified in the last turn/stretch (21/58%) than the beginning of the race (12/33%). More injuries (23/64%) were identified in fields greater than 8 horses than fields of less than 7 horses (12/33%). More concussions occurred in fast/firm conditions (28/78%) than sloppy/muddy/good (4/11%). More concussions were present in races that were 5,6, &7 furlongs (18/50%) versus more than 1 mile in length (12/33%).

Conclusions

The results of this research establish injury characteristics that can be used to better understand equipment and conditions that contribute to increased risk of concussion.

Competing interests

None.
Concussion incidence and mechanism among youth volleyball players
Authors: Meeuwisse Derek W , MacDonald Kerry , Meeuwisse Willem H , Schneider Kathryn
Published: November 2017

Objective

To assess the incidence of concussions among adolescent volleyball players in Canada.

Design

Cross sectional survey.

Setting

Online survey.

Participants

In total, 663 registered Volleyball Canada members completed a national survey, with a response rate of 13.0%; web-based survey response rates rarely exceed 5%. The 452 (68.2%) female and 211 (31.8%) male responders had a mean age of 16.2 (95% CI: 16.1to 16.4) years with a range from 14 to 19 years.

Assessment of risk factors

The type of environment: controlled non-competitive environment (practice or warm-up) versus competitive game play environment.

Outcome measures

Whether the athletes sustained a concussion as defined by the 2012 Zurich Consensus.

Main results

A total of 86 concussions were reported, of which 52 were in the previous 12 months, yielding a one-year cumulative incidence per 100 athletes of 7.1 (95% CI: 4.3 to 11.4) and 7.5 (95% CI: 5.4 to 10.3) for males and females, respectively. In total, 57.1% (95% CI: 46.2 to 67.5) of all concussions involved ball-to-head contact. Player-to-player contact and head-to-floor contact were less prevalent at 20.2% (95% CI: 12.8 to 30.4) and 15.5% (95% CI: 9.1 to 25.1) respectively. Practice environment accounted for 46.5% of all concussions while 38.4% occurred in game play. The remaining 15.1% occurred in warm-up. In total, 61.6% (95% CI: 50.2 to 71.7) of concussions occurred outside of free-flow competitive game play, in a more structured environment.

Conclusions

There is a significant margin for injury prevention as a substantial proportion (61.6%) of concussions happening in a noncompetitive, controlled environment that may be amenable to change that would reduce the potential for such injury.

Competing interests

The authors have no competing interest to state.
Concussion management plan compliance: a study of ncaa power five conference schools
Authors: DiFabio Melissa , Baugh Christine , Buckley Thomas
Published: November 2017

Objective

To examine the concussions management protocols (CMPs) from the 65 institutions within the NCAA Power 5 conferences for compliance with the NCAA 2015 concussion guidelines.

Design

Descriptive Study.

Setting

N/A.

Participants

65 universities of NCAA conferences: Atlantic Coast, Southeastern, Big Ten, Big 12, and Pacific-12

Interventions

The 65 publicly-available CMPs were evaluated for compliance with the 47 NCAA rules and guidelines (combined N=3,055). Each CMP was reviewed and graded “yes” or “no” for each recommended or required item and compliance was reported descriptively.

Outcome measures

Overall compliance rate, mean, item-level, category-level, and institution-level compliance with the 47 items. Each institution’s athletic training staff size, academic performance, and athletic performance were examined as independent predictors with quasi-binomial regression.

Main results

CMPs varied substantially in length (range: 4-66 pages) and level of detail. The overall compliance rate for all components across all institutions was 94.3% (2,880/3,055). Twelve components achieved 100% institutional (65/65) compliance, and the lowest levels of compliance were clustered in “Return-to-Learn” (RTL). There were 22 institutions that achieved a 100% compliance rate; the lowest institutional compliance was 59.6%. There were no significant associations between the independent predictors and institutional compliance.

Conclusions

Overall compliance with NCAA concussion management requirements was high, but there remains room for improvement. There was low compliance with RTL as well as limited details provided in the reducing head trauma component. Items with lower compliance (reducing head trauma, return-to-learn) tended to be outside the core competencies of the medical staff, indicating an area for improvement.

Competing interests

None.