bluuebunny/crossref_metadata_2025 huggingface dataset:
Imaging Features of Intramedullary Spinal Cord Lesions with Histopathological Correlation
Authors: Singh Bhanupriya , Chauhan Abhishek , Raj Gaurav
Published: July 2022

Purpose Most of the intramedullary spinal cord lesions have a component of insidious myelopathic changes at the time of diagnosis. Among the spinal cord lesions, intramedullary neoplasms are rare (25%). They represent 4 to 10% of all central nervous system tumors. But due to involvement of tracts, they are associated with significant neurological symptoms. Their imaging features can help early diagnosis and predict prognosis. We aim to narrow down differential diagnoses of intramedullary lesions based on imaging findings.

Materials and Methods This retrospective study included 40 patients as a sample that underwent magnetic resonance imaging spine at our institution (on 3T machine). Patient population had varied clinical complaints, ranging from headache, nausea, vomiting, motor weakness, bladder and bowel involvement, progressive paraparesis to paraplegia. Lesions were evaluated site, size, margin, associated cysts, signal intensity, enhancement, and associated syringohydromyelia.

Results This study obtained majority of the lesions to be ependymoma (15) and astrocytoma (11), followed by infection (4), hemangioblastoma (3), and metastasis (2). Five patients were either lost to follow-up or not operated on.

Conclusion Most of the intramedullary lesions were malignant and were showing postcontrast enhancement. Ependymomas were more frequently present in cervical region, central in location with well-defined margins and focal postcontrast enhancement. Among the total of 15 ependymomas, three cases were associated with neurofibromatosis-2. Ependymomas were more frequently associated with syringohydromyelia and peripheral hemorrhage (cap sign). Astrocytoma was more frequently seen in children, thoracic and eccentric in location with ill-defined margins. Enhancement in astrocytoma was dependent on the grade of tumor. Metastasis was a differential, with imaging characteristics dependent on type of primary. Intramedullary granuloma due to infection can also be confusing mimics of neoplasm. High-velocity signal loss due to flow voids is seen in the hemangioblastomas.
Step-by-Step Guide to Surface Mold Applicator-Based Brachytherapy in a Case of Early Carcinoma Penis: An Organ-Preserving Approach
Authors: Thakur Purnima , Gupta Manish , Gupta Ranjan , Singh Tarunjot , Parihar Neeraj , Ranjan Asha
Published: July 2022

Purpose In this report we discuss an individually customized surface mold applicator technique to treat a case of early carcinoma penis. This case report is one of its kind which describes the brachytherapy treatment planning based on orthogonal X-ray technique.

Material and methods T1N0 disease with squamous cell carcinoma histology involving the foreskin of penis and abutting the glans penis was treated by surface mold applicator technique. Impression of the organ was taken using alginate. Cast was prepared from the impression using Type 4 gypsum. The acrylic mold-based applicator was fabricated on the cast. The catheters were positioned and fixed on the acrylic mold. The organ is placed in the mold-based applicator and the catheters are reconstructed on two-dimensional imaging. The brachytherapy is delivered by the 18-channel high-dose rate Oncentra brachytherapy using Ir192 source. The dose given was 45 Gy in 15 fractions, twice daily more than 6 hours apart.

Results Patient was reviewed after 6 weeks for follow-up and there was complete regression of the ulcer. At present, patient is on follow-up for the last 10 months and is now disease-free.

Conclusion With judicious patient selection, surface mold brachytherapy is an attractive alternative to the interstitial brachytherapy. It is comfortable for the patient, is easily repeatable, and is time saving in high work load and limited resource settings. Early results with this technique are promising.
Treatment Outcomes with Reduced-Dose Bortezomib in Adult Patients with Multiple Myeloma: A Single-Center Experience
Authors: Vallente Jeremiah R. , Cortez Carlo Francisco N. , Mirasol Ma Angelina L.
Published: July 2022

Objectives Bortezomib vial-sharing is commonly employed to maximize the treatment of patients with multiple myeloma (MM) in resource-limited setting. This strategy minimizes delays in treatment but reduces the dose of bortezomib received by the patient. Herein, we aimed to determine the treatment patterns and outcomes in Filipino patients with MM who received reduced-dose bortezomib.

Methods The records of 47 adult patients with MM, seen at our institution from 2016 to 2019 and treated with reduced-dose bortezomib, were retrospectively reviewed.

Results The median age of the patients at diagnosis was 55 years; 59.6% were male. VCD (bortezomib, cyclophosphamide, dexamethasone) regimen was the most commonly used (70.7%) bortezomib-based treatment. Among the newly diagnosed patients, bortezomib-based treatment afforded an overall response rate of 79.3%. The median overall survival was not reached. Univariate analysis showed that the hemoglobin level affected response while age, hemoglobin and calcium levels, the choice of induction regimen, and the depth of response all had an impact on survival.

Conclusion This study is the first to investigate the real-world outcomes of reduced-dose bortezomib in MM treatment and may provide initial evidence that bortezomib vial-sharing is an acceptable strategy in the treatment of MM in resource-limited setting.
An approximate inertial manifold (AIM) based closure for turbulent flows
Authors: Akram Maryam , Hassanaly Malik , Raman Venkat
Published: July 2022

A closure model for turbulent flows is developed based on a dynamical system theory. An appropriately discretized formulation of the governing equations is considered for this process. The key ingredient is an approximation of the system’s attractor, where all the trajectories in phase space are confined. This approximate inertial manifold based approach provides a path to track trajectories of the system in a lower-dimensional subspace. Unlike conventional coarse-graining approaches, the turbulent field is decomposed into resolved and unresolved dynamics using the properties of the governing equations. The novelty of the approach relies on the reconstruction of the unresolved field constrained by the governing equations. A posteriori tests for homogeneous isotropic turbulence and the Kuramoto–Sivashinsky equation show promising results for considerable dimension reduction with strong convergence properties. The proposed model outperforms the dynamic Smagorinsky model, and the computational overhead is competitive with similar approaches.
A scoping review to inform the use of continuous quality improvement in Australian Aboriginal oral health care
Authors: Patel Jilen , Durey Angela , Naoum Steven , Kruger Estie , Slack-Smith Linda
Published: July 2022

Objective The need to improve existing services to Aboriginal communities is prioritised by Australia’s National Oral Health Plan. Although only an emerging area in dentistry, continuous quality improvement (CQI) approaches have positively impacted the delivery of primary health services to Aboriginal communities. This scoping review maps the applicability of CQI strategies to Aboriginal Australian oral healthcare services. Methods A scoping review was conducted and studies that reported using CQI approaches to improve existing oral health services or quality of care deemed relevant to Aboriginal Australian communities were included. Results A total of 73 articles were retrieved and eight articles were included in the final synthesis. Several CQI tools were identified, including: plan–do–study–act cycles, dental quality alliance measures, prioritisation matrices, causal mapping and the use of collective impact methodology. Conclusion Data exploring CQI in the context of Aboriginal oral health is scarce. The plan–do–study–act cycle and its variations show potential applicability to Aboriginal oral health care. However, for CQI approaches to be adequately implemented, the prevailing model of dental care requires a paradigm shift from quality assurance to quality improvement, acknowledging the impact of structural and process elements on care.
Evaluation of climate variability and change in ACCESS historical simulations for CMIP6
Authors: Rashid Harun A. , Sullivan Arnold , Dix Martin , Bi Daohua , Mackallah Chloe , Ziehn Tilo , Dobrohotoff Peter , O’Farrell Siobhan , Harman Ian N. , Bodman Roger , Marsland Simon
Published: July 2022

We analyse and document the historical simulations performed by two versions of the Australian Community Climate and Earth System Simulator (ACCESS-CM2 and ACCESS-ESM1.5) for the Coupled Model Intercomparison Project Phase 6 (CMIP6). Three ensemble members from each model are used to compare the simulated seasonal-mean climate, climate variability and climate change with observations over the historical period. Where appropriate, we also compare the ACCESS model results with the results from 36 other CMIP6 models. We find that the simulations of the winter and summer mean climates (over the global domain) by the two ACCESS models are similar to or better than most of the other CMIP6 models for surface temperature, precipitation and surface specific humidity. For sea-level pressure, both ACCESS models perform worse than most other models. The spatial structures of the prominent climate variability modes (ENSO, IOD, IPO and AMO) also compare favourably with the corresponding observed structures. However, the results for the simulation of the models’ temporal variability are mixed. In particular, whereas ACCESS-ESM1.5 simulates ENSO events with ~3-year periods (that are closer to the observed periods of 3–7 years), the ACCESS-CM2 simulates ENSO events having quasi-biennial periods. However, ACCESS-CM2 has a much smaller bias (−0.1 W m−2) in present-day top-of-the-atmosphere energy balance than ACCESS-ESM1.5 (−0.6 W m−2). The ACCESS models simulate the anthropogenic climate change signal in historical global-mean surface temperature reasonably well, although the simulated signal variances are ~10% weaker than the observed signal variance (a common bias in most CMIP6 models). Both models also well simulate the major features of observed surface temperature changes, as isolated using a multiple regression model. Despite some identified biases, the two ACCESS models provide high-quality climate simulations that may be used in further analyses of climate variability and change.
Three new tribes in Myrtaceae and reassessment of Kanieae
Authors: Wilson Peter G. , Heslewood Margaret M. , Tarran Myall A.
Published: July 2022

The current tribal classification of Myrtaceae was based on analysis of the plastid matK coding region within the trnK intron. The phylogenetic position of the genera Cloezia and Xanthomyrtus was poorly supported, and the original sequence for Kania, the type genus of the tribe Kanieae, was rather poor. To clarify relationships, we sequenced plastid psbA–trnH and an extended portion of the trnK intron, including the spacer regions flanking matK, and nuclear ribosomal ITS and ETS regions for representative species across the tribes, including denser sampling of the three genera of interest. Analyses of these extended datasets show a strong relationship between Kania and the tribe Metrosidereae but not with other genera presently assigned to the Kanieae. The relationship between Kania and the tribe Metrosidereae is strongly correlated with morphological features recently documented in Metrosideros fossils. Consequently, a new tribe, Tristaniopsideae PeterG.Wilson, is described to accommodate most genera presently assigned to Kanieae. Furthermore, the morphological divergence and genetic distance shown by Cloezia and Xanthomyrtus are here considered as justifying their recognition as the tribes Cloezieae Peter G.Wilson and Xanthomyrteae Peter G.Wilson. Recognition of these tribes brings to four the number of tribes absent from present-day mainland Australia. Prior to this study, Metrosidereae was the only tribe in subfamily Myrtoideae that was absent from mainland Australia.
Road orientation affects the impact of roads on wildlife
Authors: Mulero-Pázmány Margarita , Rollán Laura , D’Amico Marcello , González-Suárez Manuela
Published: July 2022

Context Understanding the factors determining the impacts of roads and how they fragment landscapes limiting the movement of animals, is key to implement efficient mitigation measures. Aims Here we investigate if road orientation in relation to limiting resources, a largely overlooked factor on road impact assessments, can influence the movement of animals within a landscape where water resources are spatially clustered. Methods We evaluated movement by monitoring animal tracks on unpaved roads: two with a North–South orientation and two with an East–West orientation. Key results Animals were more likely to follow roads leading to limiting resources (i.e. East–West orientation), confirming human linear structures can facilitate wildlife movements. Carnivores were more likely to follow roads with any orientation and for longer compared to ungulates, whereas ungulates followed roads mainly in the orientation of limiting resources. Conclusions Road orientation affects how roads influence the movement of animals in landscapes where resources are distributed along a spatial gradient with different effects for ungulates and carnivores. Implications The key implications of this work affect the planning and implementation of mitigation strategies and safety measures. Our results suggest road-crossing infrastructure and fences will be most important in roads traversing a gradient to allow wildlife movement while preventing collisions. For roads along a gradient, crossing structures may be less important, but fences or appropriate signage could be useful to prevent or warn drivers of animals travelling on the road.
A dry ancient plume mantle from noble gas isotopes
Authors: Parai Rita
Published: July 2022

Primordial volatiles were delivered to terrestrial reservoirs during Earth’s accretion, and the mantle plume source is thought to have retained a greater proportion of primordial volatiles compared with the upper mantle. This study shows that mantle He, Ne, and Xe isotopes require that the plume mantle had low concentrations of volatiles like Xe and H
2
O at the end of accretion compared with the upper mantle. A lower extent of mantle processing alone is not sufficient to explain plume noble gas signatures. Ratios of primordial isotopes are used to determine proportions of solar, chondritic, and regassed atmospheric volatiles in the plume mantle and upper mantle. The regassed Ne flux exceeds the regassed Xe flux but has a small impact on the mantle Ne budget. Pairing primordial isotopes with radiogenic systems gives an absolute concentration of
130
Xe in the plume source of ∼1.5 × 10
7
atoms
130
Xe/g at the end of accretion, ∼4 times less than that determined for the ancient upper mantle. A record of limited accretion of volatile-rich solids thus survives in the He-Ne-Xe signatures of mantle rocks today. A primordial viscosity contrast originating from a factor of ∼4 to ∼250 times lower H
2
O concentration in the plume mantle compared with the upper mantle may explain (a) why giant impacts that triggered whole mantle magma oceans did not homogenize the growing planet, (b) why the plume mantle has experienced less processing by partial melting over Earth’s history, and (c) how early-formed isotopic heterogeneities may have survived ∼4.5 Gy of solid-state mantle convection.
Insulin regulates neurovascular coupling through astrocytes
Authors: Fernandez Ana M. , Martinez-Rachadell Laura , Navarrete Marta , Pose-Utrilla Julia , Davila Jose Carlos , Pignatelli Jaime , Diaz-Pacheco Sonia , Guerra-Cantera Santiago , Viedma-Moreno Emilia , Palenzuela Rocio , Ruiz de Martin Esteban Samuel , Mostany Ricardo , Garcia-Caceres Cristina , Tschöp Matthias , Iglesias Teresa , de Ceballos Maria L. , Gutierrez Antonia , Torres Aleman Ignacio
Published: July 2022

Mice with insulin receptor (IR)–deficient astrocytes (GFAP-IR knockout [KO] mice) show blunted responses to insulin and reduced brain glucose uptake, whereas IR-deficient astrocytes show disturbed mitochondrial responses to glucose. While exploring the functional impact of disturbed mitochondrial function in astrocytes, we observed that GFAP-IR KO mice show uncoupling of brain blood flow with glucose uptake. Since IR-deficient astrocytes show higher levels of reactive oxidant species (ROS), this leads to stimulation of hypoxia-inducible factor-1α and, consequently, of the vascular endothelial growth factor angiogenic pathway. Indeed, GFAP-IR KO mice show disturbed brain vascularity and blood flow that is normalized by treatment with the antioxidant
N
-acetylcysteine (NAC). NAC ameliorated high ROS levels, normalized angiogenic signaling and mitochondrial function in IR-deficient astrocytes, and normalized neurovascular coupling in GFAP-IR KO mice. Our results indicate that by modulating glucose uptake and angiogenesis, insulin receptors in astrocytes participate in neurovascular coupling.
Pluricentric legal Chinese
Authors: Chan Clara Ho-yan , Galdia Marcus
Published: July 2022

Chinese is the language of legislation and of court and administrative procedures in several jurisdictions as well
as in numerous international organizations. Its legal status differs from jurisdiction to jurisdiction and displays its
pluricentric character. Legal acts that are issued in these jurisdictions demonstrate therefore different levels of terminological
formation and other legal-linguistically relevant varieties. It is the task of legal lexicography to register lexical varieties of
legal Chinese in the relevant jurisdictions. However, in addition to all lexicological and lexicographical efforts, the question
could be asked whether terminological harmonization constitutes the appropriate answer to problems caused by pluricentric Chinese
legal terminology. It could be claimed that the task of legal linguists is not only to research but also to shape the Chinese
legal language. There exist, in fact, examples of such activities that will be closely scrutinized in this article.
Interpreter-mediated communication in cognitive assessments and psychotherapy
Authors: Scarvaglieri Claudio , Muntigl Peter
Published: July 2022

Our paper investigates interpreter-mediated communication as intercultural dialogue in psychotherapy and assessments of cognitive functioning. We rely on previously published data to demonstrate the characteristics of communication in this setting and point to challenges relating to the validity of the assessments and to the efficacy of therapy. Using analytic tools from Conversation Analysis and Discourse Analysis, we specifically investigate how interpretation affects the interactional trajectory of communication, how interpreters manage both cultural and epistemic differences between the primary participants, how they deal with potential threats to the patient’s face and how they overall facilitate intercultural dialogue. We discuss concerns about the outcome of tests achieved in these circumstances and the challenges and potentials of interpretation in therapy.
Effect of fibre arrangement on temperature field of CFRP induction heating
Authors: Fu Tianyu , Zhao Hui , Yang Ning , Zhu Jun , Zhou Shaodong
Published: July 2022

Because the characteristics of carbon fibre composites (CFRP) are directly related to the arrangement of fibre bundles, changing the orientation of fibres generates a shift in temperature field distribution during material heating. As a result, a finite element meso analysis model of CFRP induction heating is developed based on the actual laying mode and equivalent electro-magnetic thermal characteristics, and the variation laws of vortex current, calorific value, and temperature field distribution in CFRP with various fibre arrangements are simulated to investigate the role of fibre laying mode in the induction heating process. Simultaneously, the induction heating experiment shows that the finite element model developed in this paper can accurately calculate the distribution of temperature field of various types of CFRP.
Evidence for superionic H2O and diffusive He–H2O at high temperature and high pressure
Authors: Kim Minseob , Oka Kenta , Ahmed Sohan , Somayazulu Maddury S , Meng Yue , Yoo Choong-Shik
Published: July 2022

We present the evidence of superionic phase formed in H2O and, for the first time, diffusive H2O–He phase, based on time-resolved x-ray diffraction experiments performed on ramp-laser-heated samples in diamond anvil cells. The diffraction results signify a similar bcc-like structure of superionic H2O and diffusive He–H2O, while following different transition dynamics. Based on time and temperature evolution of the lattice parameter, the superionic H2O phase forms gradually in pure H2O over the temperature range of 1350–1400 K at 23 GPa, but the diffusive He–H2O phase forms abruptly at 1300 K at 26 GPa. We suggest that the faster dynamics and lower transition temperature in He–H2O are due to a larger diffusion coefficient of interstitial-filled He than that of more strongly bound H atoms. This conjecture is then consistent with He disordered diffusive phase predicted at lower temperatures, rather than H-disordered superionic phase in He–H2O.
Direct CP violation of three body decay processes from the resonance effect*
Authors: Lü Gang , Zhao Yan-Lin , Liu Liang-Chen , Guo Xin-Heng
Published: July 2022

The physical state of

mesons can be mixed using the unitary matrix. The decay processes

and

originate from isospin symmetry breaking. The

,

, and

interferences lead to a resonance contribution to produce strong phases.

violation is considered from isospin symmetry breaking due to the new strong phase of the first order.

violation can be enhanced greatly for the decay process

when the invariant masses of

pairs are in the area around the

resonance range and

resonance range in perturbative QCD. We also discuss the possibility of searching for the predicted

violation at the LHC.
Realization of broadband polarization-insensitive negative refraction using water-based metamaterial
Authors: Wang Danqi , Wang Yuxiang , Li Xuewen , Yan Haokui , Huang Xiaojun
Published: July 2022

We propose a water-based metamaterial to realize the broadband polarization insensitive negative refraction. The designed metamaterial exhibits the multiple resonances in broadband region and displays negative permittivity and permeability simultaneously with a broadband negative refractive index. Simulated result shows that two separated wide bandwidths of negative refractive index are formed at 12.5–22.7 GHz, and 26.2–28.0 GHz, and the relative bandwidths of which are 58.0%, and 6.7%, respectively. In addition, beam shifting simulation is carried out to verify the retrieved effective refractive index from the scatter parameters, and the calculated results based on beam shifting simulation are agreed well with the retrieved effective refractive indices. Finally, the microwave measurement is performed to exam the simulated and calculated results, and three results of simulation, calculation, and measurement are consistent with each other. The design using water-based metamaterial provides an alternative approach to realize a broadband negative refraction.
Synthesis of novel 1–dimensional structure from Mo6S8 Chevrel phase of electrode for Mg batteries
Authors: Kang Gil–Seon , Hu Qicheng , Li Siying , Bhoraskar Sudha V , Yoo Ji–Beom
Published: July 2022

The Chevrel phase (CP) (Mo6S8), which is used as an electrode material in Mg rechargeable batteries, has a capacity limit owing to ion insertion and trapping. To address this problem, we modify the wire structure of the CP. Mo6S3I6 nanowires, in which iodiene is substituted for Mo6S9 nanowires as infinite CP structures, can be synthesized in various ways. When synthesizing stoichiometrically, an unwanted secondary phase may appear. We solved these problems by reducing the synthesis time. Electrochemical analysis was performed using these nanowires as an active material in Mg batteries.
Screen-printed capacitive pressure sensors with high sensitivity and accuracy on flexible substrates
Authors: Albrecht Andreas , Salmerón José F , Moreno-Cruz Fernando , Becherer Markus , Lugli Paolo , Cheng Gordon , Rivadeneyra Almudena
Published: July 2022

Printable elastic conductors promise large-area stretchable sensor/actuator networks for healthcare, wearables and robotics, among other areas. Force pressure sensors are one of their most attractive applications, although their large-area integration has been limited by difficulties in their processability or bendability and their use by their insufficient sensitivity or stability. In this work, we present a flexible screen-printed capacitive pressure sensor, able to be modularly integrated in large-area systems thanks to the substrate flexibility, bending within itself capability and not only at its intersections, and cuttability, allowing a range of modifications in size and shape for complex structures. We built the sensors with a microstructured dielectric, whose hill radii were tuned (between 125 and 375 µm) until obtaining a measurement range of five orders of magnitude, with a logarithm sensitivity above 20% dB−1 at the maximum pressure peak of 750 kPa and of 80% kPa−1 at the lowest test value of 0.5 kPa. These results went along completely with the theoretical model that we also developed. Besides, while smaller pillars showed a significant hysteresis for decreasing pressures, we observed how large hills performed with a small hysteresis of down to 3%, way ahead of the published sensors to the best of our knowledge.
Drain-extended MOS design using High-k dielectric to control off-state BTBT with enhanced switching performance
Authors: Pali Shraddha , Kaushik Pragyey Kumar , Gupta Ankur
Published: July 2022

This work explores the application of high-k dielectric to suppress off-state band-to-band tunneling (BTBT) and enhance the switching performance of conventional Drain-extended NMOS (C_DeNMOS). C_DeNMOS switching performance is limited by extended gate over the drift region, while the high field effects near the gate edge are responsible for BTBT below the gate-to-drain overlap region. We investigate two improved configurations of DeNMOS (1) Planar and (2) Trench structures incorporating a floating plate (FP). In comparison to C_DeNMOS, it is demonstrated that employing high-k dielectric HfO2 with appropriately doped FP in the Planar and Trench structures can efficiently modulate the surface field while also reducing surface charge accumulation. As a result, BTBT is suppressed in Planar and Trench structures when HfO2 is used as dielectric, in addition to improvement in switching delay, reverse recovery behavior, and switching energy performance at higher operating frequencies.
A-04 Acute Sports-Related Concussion Associations Between Cognitive Symptoms, Memory Performance, and Default Mode Network Hub Connectivity
Authors: Bouchard H C , Schultz D H , Higgins K , Laing J M , Rodriguez A I , Carlson E , Tuttle J , Mayer M , Albers L , Maerlender A , Neta M , Savage C R
Published: July 2022

Purpose: Disruptions in cognitive performance are commonly reported after a sports-related concussion (SRC) and may be related to brain network changes, particularly within the default mode network (DMN). Since well-connected brain regions across networks (hubs) play an important role in network organization, we hypothesize that DMN hubs will be disrupted after a SRC and associated with cognitive symptoms and cognitive performance. Methods: We collected resting-state fMRI, symptoms, and cognitive performance data from 44 student-athletes at baseline, after a SRC, and at recovery. Participation coefficient defined hubs for each athlete. We compared changes in functional connectivity between hubs and non-hubs within the DMN and between DMN hubs and non-hubs in the remaining networks. We used linear regression to examine the relationship between functional connectivity, cognitive symptoms, and cognitive performance while controlling for concussion history. Results: Functional connectivity between hubs and non-hubs within the DMN increased from baseline to post-injury and decreased from post-injury to recovery, but not to baseline connectivity levels. Post-injury functional connectivity was related to increased cognitive symptoms and decreased visual memory performance. Functional connectivity decreased between hubs in the DMN and non-hubs in the cingulo-opercular, salience, somatomotor, and visual networks from baseline to post-injury. Cognitive symptoms and visual memory performance were related to functional connectivity between DMN hubs and visual network non-hubs. Conclusions: Self-reported cognitive symptoms and cognitive performance were associated with changes in DMN hub connectivity. This relationship may suggest a decrease in efficiency between brain networks after a SRC and may provide insight into post-injury compensation during task performance.
A-05 Retrospective Comparison of Concussion Recovery Between School and All Star Cheerleaders
Authors: Boucher S J , Jones C A , Price A M , Ellis C , Abt J , Burkhart S O
Published: July 2022

Purpose: Though often categorized together, All Star and school cheerleading are vastly different in concussion risk due to competitiveness and skill difficulty. The purpose of the current study was to compare concussion rate and recovery in school and All Star cheerleaders diagnosed with sports-related concussions (SRC). Methods: This study was a retrospective comparison of cheerleaders (aged 8–18 years) who were evaluated in a specialty concussion clinic and diagnosed with SRC from 2020–2022. A total of 64 female cheerleaders were included (33 school and 31 All Star). We compared days to clinic, prior history of concussion, Post-Concussion Symptom Scale (PCSS) total score, symptom provocation on the Vestibular Ocular Motor Screen, and recovery time in days for each group. Results: Reports of at least one prior concussion were higher in All Star cheerleaders (61%) compared to school cheerleaders (39%). Initial evaluation occurred an average of 4.0 ± 5.8 days post injury for All Star cheerleaders, with recovery occurring in 23.6 ± 17.4 days compared to school cheerleaders who were evaluated for initial evaluation an average of 4.2 ± 4.3 days post injury and recovered in 27.6 ± 19.7 days (P > 0.05). All Star cheerleaders experienced greater symptom provocation (P = 0.05) on horizontal vestibular-ocular reflex compared to school cheerleaders. There was no difference in symptom reporting on the PCSS (P = 0.23). Conclusions: Higher rates of prior concussion were reported in All Star cheerleaders. This may be a function of the more difficult skills being performed. Future research should investigate the impact of skill level and mechanism of injury on SRCs in All Star Cheerleading.
A-06 Exploring The Current State Of Resilience Interventions In Athletes: A Review
Authors: Brower R B , Mosch S C
Published: July 2022

Purpose: It is becoming increasingly well known that higher levels of premorbid psychological resiliency in athletes predict better recovery outcomes from sports-related concussion and other types of injuries. This review addresses the current state of interventions designed to increase resilience in athletes. Methods: A thorough search of the literature was conducted using the keywords “increasing resilience in athletes” and “resilience, interventions, athletes” via Google Scholar, PubMed, and PsycINFO. Papers published in peer-reviewed journals between 2017–2022 that focused on an intervention or set of skills that increased resilience in an athlete population were included. 33 studies were initially identified and 18 fit the criteria for this review. Results: There are many promising interventions for increasing resilience in athletes. Treatments fell into three general categories, including increasing positive thoughts and feelings, increasing interoceptive awareness/connection, and increasing quality of social support. All studies implemented pre- and post- intervention assessments to measure change over time, and some included randomization to treatment or control groups. Importantly, many resilience interventions encouraged athletes to reframe help-seeking behaviors as a resilient act rather than one of weakness and focused on increasing the quality of social support from teammates, athletic trainers, friends, and family. Conclusions: Interventions covering a variety of strategies show promise in increasing athletes’ resilience across many sports. Successful treatments ranged from one 30-minute workshop to season-long training sessions. Future directions for resilience interventions should examine the use of technology to administer and/or monitor resilience change, as well as novel approaches including gamifying interventions to make them more palatable.
A-07 Initial Symptoms, Pre-Existing Emotional Factors, and Symptoms of Stress During Recovery from Concussion
Authors: Bunt S , Didehbani N , Stokes M , Miller S , Bell K , Cullum C M
Published: July 2022

Purpose: Investigate the association of initial symptoms, mechanism of concussion, and emotional state with symptoms of stress reported during recovery from concussion in high school students. Methods: Concussed High School students (n = 183) aged 13–18 were evaluated within 30 days of injury at a North Texas Concussion Registry (ConTex) clinic with 71% (n = 130) sport-related. Subjects completed a medical history, the Sport Concussion Assessment Tool-5 Symptom Evaluation (PCSS), General Anxiety Disorder (GAD-7), and Patient Health Questionnaire-8 (PHQ-8) at initial visit. At three-month follow-up subjects completed the PTSD Checklist for DSM-5 (PCL-5). A linear regression was conducted predicting total scores on the follow up PCL-5. Predictors included initial Total PCSS Symptom Score, GAD-7, PHQ-8, sex, mechanism of injury (sport vs non-sport) and history of treatment for anxiety/depression. Results: A multiple regression model predicting participant’s total PCL-5 score at three month follow-up (R2 = 0.40, p < 0.001) included PHQ-8 (β = 0.34, p < 0.001), GAD-7 (β = 0.20, p = 0.016), history of treatment for depression (β = 0.17, p = 0.015), severity of initial symptoms (β = 0.15, p = 0.045) and mechanism of injury (β = −0.14, p = 0.018). There was no significant difference in PCL-5 scores between sport vs non-sport injury groups. Conclusions: Pre-existing depression and higher levels of self-reported anxiety and/or depression at time of injury may be associated with increased symptoms of stress during concussion recovery. Severity of initial symptoms and mechanism of injury may also be related to feelings of stress during recovery. Further investigations should include baseline measure of stress prior to injury.
A-08 Differences in Long-term Stability of Baseline ImPACT Scores in High School Football Players
Authors: Burley C , Datoc A , Lashley L
Published: July 2022

Purpose: To explore the long-term stability of ImPACT baseline composite scores at a one-year interval across multiple age groups within a sample of high school football players. Methods: A total of 660 high school football players completed two ImPACT baseline assessments approximately 1 year apart (average days between = 337.8, SD = 68.0). Subjects were separated into three groups based on age at first baseline: Age 14: n = 249; Age 15: n = 246; Age 16: n = 165. Subjects reporting concussion history and/or history of Learning Disability or Attention-Deficit/Hyperactivity Disorder at either timepoint were excluded. Results: Repeated measures t-tests for subjects who completed initial baseline at 14 indicated significant differences in Verbal Memory (t(248) = −2.99, p = 0.003; Cohen’s d = 19), Visual Memory (t(248) = −4.47, p < 0.001; d = 0.28), and Visual Motor Speed (t(248) = −8.18, p < 0.001; d = 0.52). Repeated measures t-tests for subjects who completed initial baseline at 15 indicated significant differences in Visual Memory (t(245) = −4.82, p < 0.001; d = 0.31) and Visual Motor Speed (t(245) = −7.89, p < 0.001; d = 0.50). Repeated measures t-tests for subjects who completed initial baseline at 16 indicated significant differences in Visual Motor Speed (t(164) = −5.32, p < 0.001; d = 0.41). Conclusions: Overall, ImPACT composite scores appear more variable for younger athletes with stability increasing as athletes develop. Clinicians should consider differing degrees of variability when planning pre-season baselines (i.e., whether to assess annually or bi-annually) as well as recency of baselines when interpreting change following injury.
A-16 Gender Differences and Composite Scores Performance at Baseline
Authors: Gilmore M , Lashley L , Golden C
Published: July 2022

Purpose: To examine whether there are gender differences in symptomatology reported at baseline testing in individuals who did not report a prior concussion history, diagnosis of ADHD, dyslexia, autism, headaches, psychiatric conditions, substance abuse, and epilepsy at baseline using ImPACT. Methods: Participants were selected from an archival de-identified sports medicine ImPACT baseline database. The sample (n = 1898) consisted of adolescent high school athletes, primarily male (60.8%) in South Florida (mean age = 15.35 years, SD = 1.09). An independent samples t-test was conducted to determine the relationship between gender and composite score performance at baseline. All analyses were conducted at p < 0.05. Results: The independent samples t-test revealed significant differences (p < 0.001) between genders on verbal memory and impulse control composite scores, but not visual memory, visual motor speed, and reaction time. Conclusions: Females performed significantly better on the overall measure of verbal memory which is consistent with previous studies (Cottle et al., 2017; Covassin et al., 2006). This may be due to female athletes exerting more effort or taking baseline testing more seriously (Cottle et al., 2017). Female athletes exhibited more control on impulse control, a task where quick and accurate decision making is required. Significant differences were not found in reaction time, visual memory, and visual motor speed which is not in line with previous studies. This may be due to the version of ImPACT used. Previous studies were conducted using version 2.0 or 2.1, while this study was conducted with versions 4.1 and 4.2. As ImPACT was updated, the new versions may have become less sensitive to differences in gender.
A-19 Distress Predicts Poorer Cognitive Performance At Post-Injury In Concussed Athletes
Authors: Hansen J , Mrazik M , Wagner R , Ree-Fedun Q , David C , Arends P , Varkovestski M , Naidu D
Published: July 2022

Purpose: This study evaluated the consistency between athletes’ self-reported cognitive symptoms and cognitive test performance. Methods: The sample included 784 Canadian Football League athletes who underwent standardized cognitive testing with cognitive testing (ImPACT) and the Brief Symptom Inventory (BSI-18) at baseline. Over 2 consecutive seasons, 46 players were diagnosed with concussions following assessment with team physicians within 48 hours; 10 were eliminated due to missing data. Five cognitive symptoms (feeling slowed down, feeling in a fog, not feeling right, difficulties concentration, difficulties with memory) were used to create a composite score (Cog). The Cog index, the depression, anxiety, total index scores from the BSI, and the 5 ImPACT cognitive domains were correlated at baseline and post-injury. History of learning disabilities, ADHD, psychiatric diagnosis, and history of concussion were co-variates. Results: There were no significant correlations between Cog, depression, anxiety or total BSI scores and the ImPACT cognitive domains at baseline. At post injury there were no significant correlations between Cog or ImPACT index scores. In contrast, significant negative correlations were found between BSI Anxiety and verbal memory (r = 0.67, p < 0.01), visual memory (r = 0.68, p < 0.01), and visual-motor processing speed (r = 0.48, p < 0.05). In addition, there were significant negative correlations between the BSI total score and visual memory (r = 0.51, p < 0.05) and reaction time (r = 0.55, p < 0.05). Conclusions: Self-reported cognitive difficulties do not correlate with poorer cognitive outcomes in our sample of professional football players. However, distress at post-injury was significantly correlated to performance, suggesting psychological variables may play a role in cognitive functioning.
A-22 Neurorehabilitation Improves Emotional Domain Symptoms in Active and Retired NHL Players
Authors: Kalambaheti E , Kornfeld S
Published: July 2022

Purpose: The prevalence of concussions in the National Hockey League (NHL) has been identified as approximately 1 concussion per 16.67 games, and the long-term effects of traumatic brain injuries are being highlighted in recent research. These long-term consequences may be due to chronic symptoms, especially neuropsychological symptoms, from unaddressed neurological dysfunction. Methods: A neuro-rehabilitation clinic treated 14 active or retired NHL players with symptoms relating to head injury an average of 2.47 years after their most recent head injury. A 5-day, multi-modal neurorehabilitation program was administered in 10 one-hour treatment sessions. Each session consisted of a combination of photobiomodulation, repetitive peripheral somatosensory stimuli, neuromuscular reeducation, vestibular rehabilitation, orthoptic exercises, cognitive exercises, and/or off-vertical axis rotation utilizing a multi-axis rotational chair. Results: On intake, the average overall symptom severity score of the SCAT5 graded symptom checklist was 31.42, and the average severity of emotional domain symptoms (Nervousness/Anxiety, Irritability, Sadness, More Emotional) was 5.86. Of the 14 players, 12 players reported symptoms in the emotional domain on intake while only 6 players reported emotional domain symptoms on exit. On average, emotional domain symptom severity score decreased by 81.71% compared to the 72.27% decrease in total symptom severity.: Conclusions: This neurorehabilitation program has shown to be beneficial at decreasing overall symptom severity in NHL players with symptoms post-head injury, especially symptoms that may be described as neuropsychological. The authors suggest further research be performed with a larger sample size and a follow-up study be performed to assess progression/regression.
A-26 The Prevalence of Invalid Baseline ImPACT® Test Scores in Adolescent Student Athletes
Authors: Liu B C , Gaudet C E , Schatz P , Berkner P , Iverson G L
Published: July 2022

Purpose: Immediate Post-Concussion and Cognitive Testing (ImPACT®) is among the most commonly used neuropsychological measures to establish a baseline estimate of neuropsychological functioning for concussion management. We sought to identify correlates of invalid performance on ImPACT® baseline testing in adolescents. Methods: The sample included 67,009 English-speaking adolescents (ages 14–18, mean: 15.51, SD: 1.22) who completed ImPACT® baseline tests in English between 2009 and 2019. The association between invalid performance (as determined by the embedded invalidity indicators) and demographic and health variables was assessed using chi-square tests and with odds ratios (OR). Results: Overall, 7.2% of adolescents produced invalid baseline tests. Boys (7.9%) produced more invalid baselines than girls (6.2%; χ2 = 70.35, p < 0.001, OR = 1.29, 95% CI = 1.22, 1.37). Adolescents with learning disabilities (16.4%), attention-deficit/hyperactivity disorder (11.1%), and those who have received special education services (16.0%) or repeated more than 1 year of school (11.0%), all obtained invalid baselines at higher frequencies than those who did not endorse these variables (i.e., 6.5%–6.8%; p < 0.001). Adolescents who reported receiving treatment for headaches (9.5%), migraines (9.4%), epilepsy/seizures (11.1%), substance/alcohol use (17.0%), or a psychiatric condition (10.0%) obtained invalid baselines at higher frequencies than those who did not (i.e., 6.6%–6.9%; p < 0.001). Conclusions: Consistent with prior research, approximately 7% of adolescents produced invalid baselines. However, the frequencies of invalid performances were substantially greater for subgroups such as those with learning disabilities, those who have received special education services, and youth who have received past substance abuse treatment.
A-28 Systematic Review And Meta-Analysis Of Factors Influencing Sport Concussion For Athletes with ADHD and/or LD
Authors: Maietta J E , Renn B N , Goodwin G J , Salva C , Maietta L N , Moore S A , Hopkins N A , Donohue B , Allen D N
Published: July 2022

Purpose: Purpose: Athletes with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or Learning Disorder (LD) are at increased risk for sport concussion and require specialized attention. Although systematic reviews of ADHD/LD and concussion are reported, no meta-analyses have been conducted. Additionally, no reviews focused on the most common concussion assessment, ImPACT. Methods: Data Selection: The current review used PRISMA guidelines. Searches utilized PubMed, Web of Science, and PsycINFO. Articles selected for this meta-analysis examined ADHD and/or LD (high school and collegiate athletes) using ImPACT from 2000–2021. Topics included: 1) baseline and 2) post-concussion performance on ImPACT, 3) symptom reporting using the Post-Concussion Symptom Scale, 4) invalid baseline classification on ImPACT, 5) concussion rates, and 6) concussion recovery. 10,163 articles were identified. 39 were included in review and 19 were included in random-effects meta-analyses on topics 1, 3, 4, and 5. Results: Data Synthesis: Meta-analysis results found decreased baseline performance on ImPACT for athletes with ADHD (trivial to small effects), LD (small to medium effects), and ADHD/LD (small to medium effects). Increased symptom reporting was found for athletes with ADHD (small effect). Increased odds of invalid ImPACT baseline performance (trivial effect) and concussion (small effect) were found in ADHD. Conclusions: Athletes with ADHD and/or LD demonstrate differences on ImPACT in cognitive performance, symptom reporting, and concussion risk (particularly for ADHD). Most research focused on ADHD. Future work should further examine athletes with LD and co-occurring ADHD/LD as well as the effects that these conditions can have on concussion recovery, given the mixed literature in that regard.