Beliefs affecting concussion reporting among military cadets: advanced observations through machine learning.

BACKGROUND: Untreated concussions are an important health concern. The number of concussions sustained each year is difficult to pinpoint due to diverse reporting routes and many people not reporting. A growing body of literature investigates the motivations for concussion under-reporting, proposing ties with knowledge of concussion outcomes and concussion culture. The present work employs machine learning to identify trends in knowledge and willingness to self-report concussions. METHODS: 2,204 cadets completed a survey addressing athletic and pilot status, concussion symptoms and outcome beliefs, ethical beliefs, demographics, and reporting willingness. RESULTS: Clustering and non-negative matrix analysis identified connections to self-report willingness within: knowledge of symptoms, ethical beliefs, reporting requirements, and belief of long-term concussion outcomes. Support vector machine classification of cadet reporting likelihood reveals symptom and outcome knowledge may be inversely related to reporting among those rating ethics considerations as low, while heightened ethics may predict higher reporting likeliness overall. CONCLUSIONS: Machine-learning analysis bolsters prior theories on the importance of concussion culture in reporting and indicate more symptom knowledge may decrease willingness to report. Uniquely, our analysis indicated importance of ethical behavior may be associated with general concussion reporting willingness, inviting further consideration from healthcare practitioners seeking increased reporting.

Concussion reporting intentions for incoming military athletes and cadets.

Cultures of concussion reporting exist outside athletics; however, athlete-only studies dominate the literature. Comparing athletes and similar high-risk populations broadens our understanding of concussion reporting acculturation. We aimed to (1) describe and compare concussion self-report willingness as measured by anticipated concussion reporting (ACR), perceived costs, perceived rewards, brain health knowledge, and correct symptom identification for incoming cadets at the United States Air Force Academy (USAFA) (n = 1,136; female = 276, 24.43%) and (2) determine whether those variables predict ACR. Univariate analyses were performed to compare intercollegiate status, sex, and parental income for perceived costs and rewards, and brain health knowledge (α = 0.05) and multinomial logistic regressions to determine if those variables predicted ACR. A $40,000 parental increase in income resulted in one additional symptom identified (ß = 0.80, p = 0.026). Athletes demonstrated greater brain health knowledge by nearly one symptom correctly identified (ß = 0.98, p = 0.002); non-athletes reported significantly greater ACR (ß = 5.92; p < 0.001). Our model accounted for 37% of the variance in ACR (χ2 = 393.86, p < 0.001, Nagelkerke R2 = 0.37). Before military acculturation, athletes had less intention to seek medical care for concussion, likely from prior athletic experiences.

Number of prior concussions predict poorer concussion care seeking in military cadets.

PRIMARY OBJECTIVE: To determine whether concussion history predicts concussion care seeking, self-management practices, or confidence to recognize/report. RESEARCH DESIGN: Cross-sectional. METHODS & PROCEDURES: 706 United States Air Force Academy (USAFA) cadets completed survey items regarding concussion history (0,1,2,3+), likelihood of reporting a concussion, self-management, and confidence to recognize/report. We used multivariate ordinal and binary logistic regression models to predict responses using concussion history, sex, and race.Main outcomes & results: cadets with 1 (OR = 0.59, 95%CI:0.43-0.82), 2 (OR = 0.55, 95%CI:0.31-0.98), or 3+ (OR = 0.36, 95%CI:0.17-0.78) concussions while at USAFA had respective 41%, 45%, and 64% lower likelihood to report the concussion scenario (ref = no history, p < .001). USAFA cadets with more extensive concussion histories had higher prevalence of not seeking care for a concussion (p < .001); more strongly endorsed self-management (p = .001-0.010); and had greater confidence in their ability to recognize a concussion (p = .005), but not to report (p = .198-0.413). CONCLUSIONS: Prior concussion experiences may deter cadets from seeking medical care for future concussions. Interventions should address concussion history and clinicians should consider how the post-concussion management process might deter care seeking.

Large-scale coding sequence change underlies the evolution of postdevelopmental novelty in honey bees.

Whether coding or regulatory sequence change is more important to the evolution of phenotypic novelty is one of biology's major unresolved questions. The field of evo-devo has shown that in early development changes to regulatory regions are the dominant mode of genetic change, but whether this extends to the evolution of novel phenotypes in the adult organism is unclear. Here, we conduct ten RNA-Seq experiments across both novel and conserved tissues in the honey bee to determine to what extent postdevelopmental novelty is based on changes to the coding regions of genes. We make several discoveries. First, we show that with respect to novel physiological functions in the adult animal, positively selected tissue-specific genes of high expression underlie novelty by conferring specialized cellular functions. Such genes are often, but not always taxonomically restricted genes (TRGs). We further show that positively selected genes, whether TRGs or conserved genes, are the least connected genes within gene expression networks. Overall, this work suggests that the evo-devo paradigm is limited, and that the evolution of novelty, postdevelopment, follows additional rules. Specifically, evo-devo stresses that high network connectedness (repeated use of the same gene in many contexts) constrains coding sequence change as it would lead to negative pleiotropic effects. Here, we show that in the adult animal, the converse is true: Genes with low network connectedness (TRGs and tissue-specific conserved genes) underlie novel phenotypes by rapidly changing coding sequence to perform new-specialized functions.

Effects of aripiprazole once-monthly on symptoms of schizophrenia in patients switched from oral antipsychotics.

OBJECTIVE: To assess the effects of aripiprazole once-monthly 400 mg (AOM 400) on clinical symptoms and global improvement in schizophrenia after switching from an oral antipsychotic. METHODS: In a multicenter, open-label, mirror-image, naturalistic study in patients with schizophrenia (>1 year, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision [DSM-IV-TR] criteria), changes in efficacy measures were assessed during prospective treatment (6 months) with AOM 400 after switching from standard-of-care oral antipsychotics. During prospective treatment, patients were cross-titrated to oral aripiprazole monotherapy (1-4) weeks followed by open-label AOM 400 (24 weeks). Mean change from baseline of the open-label AOM 400 phase in Positive and Negative Syndrome Scale (PANSS) scores (total, positive and negative subscales) and Clinical Global Impression-Severity (CGI-S) scores; mean CGI-Improvement (CGI-I) score; and proportion of responders (≥30% decrease from baseline in PANSS total score or CGI-I score of 1 [very much improved] or 2 [much improved]) were assessed. RESULTS: PANSS and CGI-S scores improved from baseline (P<0.0001) and CGI-I demonstrated improvement at all time points. By the end of the study, 49.0% of patients were PANSS or CGI-I responders. CONCLUSIONS: In a community setting, patients with schizophrenia who were stabilized at baseline and switched to AOM 400 from oral antipsychotics showed clear improvements in clinical symptoms.

Differential expression of endogenous plant cell wall degrading enzyme genes in the stick insect (Phasmatodea) midgut.

BACKGROUND: Stick and leaf insects (Phasmatodea) are an exclusively leaf-feeding order of insects with no record of omnivory, unlike other "herbivorous" Polyneoptera. They represent an ideal system for investigating the adaptations necessary for obligate folivory, including plant cell wall degrading enzymes (PCWDEs). However, their physiology and internal anatomy is poorly understood, with limited genomic resources available. RESULTS: We de novo assembled transcriptomes for the anterior and posterior midguts of six diverse Phasmatodea species, with RNA-Seq on one exemplar species, Peruphasma schultei. The latter's assembly yielded >100,000 transcripts, with over 4000 transcripts uniquely or more highly expressed in specific midgut sections. Two to three dozen PCWDE encoding gene families, including cellulases and pectinases, were differentially expressed in the anterior midgut. These genes were also found in genomic DNA from phasmid brain tissue, suggesting endogenous production. Sequence alignments revealed catalytic sites on most PCWDE transcripts. While most phasmid PCWDE genes showed homology with those of other insects, the pectinases were homologous to bacterial genes. CONCLUSIONS: We identified a large and diverse PCWDE repertoire endogenous to the phasmids. If these expressed genes are translated into active enzymes, then phasmids can theoretically break plant cell walls into their monomer components independently of microbial symbionts. The differential gene expression between the two midgut sections provides the first molecular hints as to their function in living phasmids. Our work expands the resources available for industrial applications of animal-derived PCWDEs, and facilitates evolutionary analysis of lower Polyneopteran digestive enzymes, including the pectinases whose origin in Phasmatodea may have been a horizontal transfer event from bacteria.

Aripiprazole once-monthly for treatment of schizophrenia: double-blind, randomised, non-inferiority study.

BACKGROUND: Long-acting injectable formulations of antipsychotics are treatment alternatives to oral agents. AIMS: To assess the efficacy of aripiprazole once-monthly compared with oral aripiprazole for maintenance treatment of schizophrenia. METHOD: A 38-week, double-blind, active-controlled, non-inferiority study; randomisation (2:2:1) to aripiprazole once-monthly 400 mg, oral aripiprazole (10-30 mg/day) or aripiprazole once-monthly 50 mg (a dose below the therapeutic threshold for assay sensitivity). ( TRIAL REGISTRATION: clinicaltrials.gov, NCT00706654.) RESULTS: A total of 1118 patients were screened, and 662 responders to oral aripiprazole were randomised. Kaplan-Meier estimated impending relapse rates at week 26 were 7.12% for aripiprazole once-monthly 400 mg and 7.76% for oral aripiprazole. This difference (-0.64%, 95% CI -5.26 to 3.99) excluded the predefined non-inferiority margin of 11.5%. Treatments were superior to aripiprazole once-monthly 50 mg (21.80%, P < or = 0.001). CONCLUSIONS: Aripiprazole once-monthly 400 mg was non-inferior to oral aripiprazole, and the reduction in Kaplan-Meier estimated impending relapse rate at week 26 was statistically significant v. aripiprazole once-monthly 50 mg.

The genome sequence of the leaf-cutter ant Atta cephalotes reveals insights into its obligate symbiotic lifestyle.

Leaf-cutter ants are one of the most important herbivorous insects in the Neotropics, harvesting vast quantities of fresh leaf material. The ants use leaves to cultivate a fungus that serves as the colony's primary food source. This obligate ant-fungus mutualism is one of the few occurrences of farming by non-humans and likely facilitated the formation of their massive colonies. Mature leaf-cutter ant colonies contain millions of workers ranging in size from small garden tenders to large soldiers, resulting in one of the most complex polymorphic caste systems within ants. To begin uncovering the genomic underpinnings of this system, we sequenced the genome of Atta cephalotes using 454 pyrosequencing. One prediction from this ant's lifestyle is that it has undergone genetic modifications that reflect its obligate dependence on the fungus for nutrients. Analysis of this genome sequence is consistent with this hypothesis, as we find evidence for reductions in genes related to nutrient acquisition. These include extensive reductions in serine proteases (which are likely unnecessary because proteolysis is not a primary mechanism used to process nutrients obtained from the fungus), a loss of genes involved in arginine biosynthesis (suggesting that this amino acid is obtained from the fungus), and the absence of a hexamerin (which sequesters amino acids during larval development in other insects). Following recent reports of genome sequences from other insects that engage in symbioses with beneficial microbes, the A. cephalotes genome provides new insights into the symbiotic lifestyle of this ant and advances our understanding of host-microbe symbioses.

Draft genome of the globally widespread and invasive Argentine ant (Linepithema humile).

Ants are some of the most abundant and familiar animals on Earth, and they play vital roles in most terrestrial ecosystems. Although all ants are eusocial, and display a variety of complex and fascinating behaviors, few genomic resources exist for them. Here, we report the draft genome sequence of a particularly widespread and well-studied species, the invasive Argentine ant (Linepithema humile), which was accomplished using a combination of 454 (Roche) and Illumina sequencing and community-based funding rather than federal grant support. Manual annotation of >1,000 genes from a variety of different gene families and functional classes reveals unique features of the Argentine ant's biology, as well as similarities to Apis mellifera and Nasonia vitripennis. Distinctive features of the Argentine ant genome include remarkable expansions of gustatory (116 genes) and odorant receptors (367 genes), an abundance of cytochrome P450 genes (>110), lineage-specific expansions of yellow/major royal jelly proteins and desaturases, and complete CpG DNA methylation and RNAi toolkits. The Argentine ant genome contains fewer immune genes than Drosophila and Tribolium, which may reflect the prominent role played by behavioral and chemical suppression of pathogens. Analysis of the ratio of observed to expected CpG nucleotides for genes in the reproductive development and apoptosis pathways suggests higher levels of methylation than in the genome overall. The resources provided by this genome sequence will offer an abundance of tools for researchers seeking to illuminate the fascinating biology of this emerging model organism.

Draft genome of the red harvester ant Pogonomyrmex barbatus.

We report the draft genome sequence of the red harvester ant, Pogonomyrmex barbatus. The genome was sequenced using 454 pyrosequencing, and the current assembly and annotation were completed in less than 1 y. Analyses of conserved gene groups (more than 1,200 manually annotated genes to date) suggest a high-quality assembly and annotation comparable to recently sequenced insect genomes using Sanger sequencing. The red harvester ant is a model for studying reproductive division of labor, phenotypic plasticity, and sociogenomics. Although the genome of P. barbatus is similar to other sequenced hymenopterans (Apis mellifera and Nasonia vitripennis) in GC content and compositional organization, and possesses a complete CpG methylation toolkit, its predicted genomic CpG content differs markedly from the other hymenopterans. Gene networks involved in generating key differences between the queen and worker castes (e.g., wings and ovaries) show signatures of increased methylation and suggest that ants and bees may have independently co-opted the same gene regulatory mechanisms for reproductive division of labor. Gene family expansions (e.g., 344 functional odorant receptors) and pseudogene accumulation in chemoreception and P450 genes compared with A. mellifera and N. vitripennis are consistent with major life-history changes during the adaptive radiation of Pogonomyrmex spp., perhaps in parallel with the development of the North American deserts.

The importance of tissue specificity for RNA-seq: highlighting the errors of composite structure extractions.

BACKGROUND: A composite biological structure, such as an insect head or abdomen, contains many internal structures with distinct functions. Composite structures are often used in RNA-seq studies, though it is unclear how expression of the same gene in different tissues and structures within the same structure affects the measurement (or even utility) of the resulting patterns of gene expression. Here we determine how complex composite tissue structure affects measures of gene expression using RNA-seq. RESULTS: We focus on two structures in the honey bee (the sting gland and digestive tract) both contained within one larger structure, the whole abdomen. For each of the three structures, we used RNA-seq to identify differentially expressed genes between two developmental stages, nurse bees and foragers. Based on RNA-seq for each structure-specific extraction, we found that RNA-seq with composite structures leads to many false negatives (genes strongly differentially expressed in particular structures which are not found to be differentially expressed within the composite structure). We also found a significant number of genes with one pattern of differential expression in the tissue-specific extraction, and the opposite in the composite extraction, suggesting multiple signals from such genes within the composite structure. We found these patterns for different classes of genes including transcription factors. CONCLUSIONS: Many RNA-seq studies currently use composite extractions, and even whole insect extractions, when tissue and structure specific extractions are possible. This is due to the logistical difficultly of micro-dissection and unawareness of the potential errors associated with composite extractions. The present study suggests that RNA-seq studies of composite structures are prone to false negatives and difficult to interpret positive signals for genes with variable patterns of local expression. In general, our results suggest that RNA-seq on large composite structures should be avoided unless it is possible to demonstrate that the effects shown here do not exist for the genes of interest.

The golden goose in the crosshairs: the transition to defined contribution pension plans in the public sector: unintended consequences.

State, county, and local governments are currently facing a myriad of economic issues, based on shrinking tax revenues combined with increased expenditures. Of these, the costs related to defined benefit pension plans are one of the most serious issues facing many public employers. Through a comprehensive review of the existing literature, this article examines how the shift from the defined benefit (DB) to defined contribution (DC) pension plan has the potential to enhance levels of labor unrest due to changes in union militancy, bargaining skills deficits, intra-organizational conflict, and issues related to economic trade-offs. Besides the capacity for immediate and deleterious ramifications in the collective bargaining process, the transition to the DC pension also presents some potentially negative consequences related to human resource management, including changes in the psychological contract, recruitment strategies, employee turnover, and changes in retirement patterns. Recommendations to improve labor relations and human resource management practices in the DC pension environment are also explored.

Pluralistic Ignorance as a Contributing Factor to Concussion Underreporting.

BACKGROUND: Concussion underreporting is endemic, and social norms are an established predictor of concussion reporting behavior. However, pluralistic ignorance-a situation in which most individuals in a group hold the belief that their peers' views differ from their own, despite views actually being similar-has not been studied in this context. AIM: To assess whether pluralistic ignorance contributes to concussion underreporting. METHOD: We surveyed 2,504 military service academy cadets. Each cadet was presented with a survey asking about their willingness to self-report a concussion, their perception of other cadets' willingness to report a concussion, and personal and demographic factors. RESULTS: Most cadets viewed themselves as more willing to report a concussion than others (mean difference = 1.12, 95% CI [1.02, 1.21]), a belief consistent with pluralistic ignorance. Demographic characteristics were associated with holding this belief. For example, female cadets and upper-class cadets were more likely to show this disparity than male or under-class cadets, respectively. Collegiate athletes not only showed similar willingness to report concussion as nonathletes but also perceived other cadets as less likely to report concussions. Meanwhile, future pilots showed less self-report willingness and perceived that others were similarly unwilling to report concussions. DISCUSSION: A majority of this economically and geographically diverse population displays characteristics of pluralistic ignorance: They largely share proconcussion reporting sentiments but incorrectly perceive that others do not. This belief is not held uniformly in all subpopulations, which may inform how these beliefs are developed and maintained. CONCLUSIONS: Pluralistic ignorance is an important consideration in concussion education efforts.

United States Air Force Academy Cadets' Unprompted Knowledge of Concussions and "Bell Ringers" or "Dings": Perceived Differences and Similarities.

CONTEXT: After a possible concussion mechanism, cadets are unlikely to have a list of concussion signs and symptoms at their disposal. As such, unprompted concussion knowledge may be an essential factor in personal recognition of injury. OBJECTIVE: To explore determinants that contributed to United States Air Force Academy (USAFA) cadets' disclosure of a concussion. This research focused on 1 of 8 overall discovered themes of unprompted concussion knowledge. DESIGN: Qualitative study. SETTING: Military academy. PATIENTS OR OTHER PARTICIPANTS: Cadets at the USAFA (males = 23, females = 11, age = 19.91 ± 1.14 years). MAIN OUTCOME MEASURE(S): We conducted 34 semistructured interviews. The transcribed text was analyzed in a 5-cycle process. From this process, 8 overall themes emerged, including unprompted concussion knowledge. Subthemes were concussion definition, concussion symptoms, "bell-ringer" or "ding" definition, "bell-ringer" or "ding" symptoms, and concussion versus "bell ringer" or "ding." RESULTS: Many participants were able to describe a concussion fairly accurately. The most commonly listed concussion signs and symptoms were dizziness (n = 22/34, 64.7%); "can't remember"/"memory loss"/"forgetful" (n = 19/34, 55.9%); and headache (n = 16/34, 47.1%). The cadet participants characterized the most common bell-ringer or ding signs and symptoms as dizziness (n = 2/34, 5.9%) and headache (n = 2/34, 5.9%). Cadets also described how a bell ringer or ding differs from a concussion, often commenting that concussions were more severe than bell ringers or dings. CONCLUSIONS: Overall, USAFA cadet participants listed common concussion signs and symptoms. However, they perceived differences between a concussion and a bell ringer or ding. Although decreasing the use of colloquial terms for concussion is recommended, use of these terms when examining a concussion history may be helpful. Concussion-education interventions should continue to focus on describing concussion signs and symptoms using cadets' own words to describe the injury (eg, "forgetful") but differentiating between what may and may not be a concussion and encouraging individuals to consult health care providers regarding possible concussion symptoms.

The Role of Social Support in Concussion Disclosure in United States Air Force Academy Cadets: A Mixed Methods Approach.

INTRODUCTION: United States Air Force Academy (USAFA) cadets are at risk for sustaining concussions; however, several factors inhibit disclosure. We aimed to better understand the role of social support in concussion disclosure. METHODS AND MATERIALS: We used a mixed methods approach with an electronic survey and interviews. The survey used a 9-point Likert scale (1 = strongly disagree and 9 = strongly agree) to assess concussion disclosure. Survey items asked cadets whom they felt most comfortable disclosing a concussion or bell-ringer/ding to, how quickly they would seek medical attention for a suspected concussion or bell-ringer/ding, whether cadets would be generally supportive/unsupportive of another cadet disclosing a concussion to medical staff, and whether other cadets important to them would be generally supportive/unsupportive if they reported a concussion to medical staff. Two multivariate linear regressions, one for concussion and one for bell-ringers/dings, were calculated to determine whether cadet choice of the person they felt most comfortable disclosing a concussion or bell-ringer/ding to predicted whether they would immediately seek medical attention for either condition. Choice of person included Air Officer Commanding (AOC)/Academy Military Trainer (AMT), upper classmen, cadet who had recovered from a concussion, cadet, closest friend, teammate, and squadmate. Descriptive analyses assessed whether cadets felt supported or unsupported by other cadets and by those who were important to them concerning concussion reporting. Thirty-four semi-structured interviews were conducted with cadets to explore their views on concussion disclosure. RESULTS: Increased comfort with disclosing a suspected concussion to an AOC/AMT had higher agreement seeking medical attention (ß = 0.28, P < .001). For every 1-point increase in being comfortable disclosing a potential bell-ringer/ding to an AOC/AMT (ß = 0.272, P < .001), squadmate (ß = 0.241, P = .002), and teammate (ß = -0.182, P = .035), agreement for seeking medical attention immediately increased 0.27, increased 0.24, and decreased 0.18, respectively. Interviews indicated cadets would often speak to a peer before seeking medical attention. CONCLUSIONS: Our results suggested that cadets felt comfortable reporting a suspected concussion or bell-ringer/ding to various peers and that those peers would be supportive of that choice, indicating social support. Future interventions should include educating cadets that peers may come to them, especially if they are AOCs/AMTs or squadmates.

Taxonomically restricted genes are associated with the evolution of sociality in the honey bee.

BACKGROUND: Studies have shown that taxonomically restricted genes are significant in number and important for the evolution of lineage specific traits. Social insects have gained many novel morphological and behavioral traits relative to their solitary ancestors. The task repertoire of an advanced social insect, for example, can be 40-50 tasks, about twice that of a solitary wasp or bee. The genetic basis of this expansion in behavioral repertoire is still poorly understood, and a role for taxonomically restricted genes has not been explored at the whole genome level. RESULTS: Here we present comparative genomics results suggesting that taxonomically restricted genes may have played an important role in generating the expansion of behavioral repertoire associated with the evolution of eusociality. First, we show that the current honey bee official gene set contains about 700 taxonomically restricted genes. These are split between orphans, genes found only in the Hymenoptera, and genes found only in insects. Few of the orphans or genes restricted to the Hymenoptera have been the focus of experimental work, but several of those that have are associated with novel eusocial traits or traits thought to have changed radically as a consequence of eusociality. Second, we predicted that if taxonomically restricted genes are important for generating novel eusocial traits, then they should be expressed with greater frequency in workers relative to the queen, as the workers exhibit most of the novel behavior of the honey bee relative to their solitary ancestors. We found support for this prediction. Twice as many taxonomically restricted genes were found amongst the genes with higher expression in workers compared to those with higher expression in queens. Finally, we compiled an extensive list of candidate taxonomically restricted genes involved in eusocial evolution by analyzing several caste specific gene expression data sets. CONCLUSIONS: This work identifies a large number of candidate taxonomically restricted genes that may have played a role in eusocial evolution. This work thus lays the foundation for future functional genomics work on the evolution of novelty in the context of social behavior. We also present preliminary evidence, based on biased patterns of gene expression, that taxonomically restricted genes may have played a role in the evolution of caste systems, a characteristic lineage specific social trait.

Detection of deformed wing virus (DWV) in the Vietnamese walking stick Medauroidea extradentata (Phasmatodea).

Deformed wing virus (DWV) is a single-stranded positive sense RNA virus that mainly infects honey bees (Apis mellifera) and can have devastating impacts on the colony. Recent studies have shown the presence of this virus in several species of Apis spp. and some other Hymenoptera, but our knowledge of their host range is very limited. We screened previously sequenced RNAseq libraries from different tissues of Vietnamese Walking Stick, Medauroidea extradentata (Phasmatodea) for DWV. We only found this virus in six libraries from anterior and posterior midgut tissue. From the midgut libraries we were able to construct a complete DWV genome sequence, which consisted of 10,140 nucleotides and included one open reading frame. Pairwise genome comparison confirmed strong similarity (98.89 %) of these assembled sequences with only 113 SNPs to the original DWV genome. We hypothesize the M. extradentata acquired this virus via a foodborne transmission by consuming DWV-infected material such as pollen or leaves contaminated with virus infected bee faeces.

United States Air Force Academy Cadets' Perceived Costs of Concussion Disclosure.

INTRODUCTION: Concussion is unique among sport-related injuries as effective clinical diagnosis and treatment often rely on symptom-report for clinician diagnosis and treatment. However, at-risk populations such as collegiate athletes and military academy cadets often have been shown to under-report concussions and symptoms, complicating diagnosis, treatment, and policy-based interventions. The purpose of this study was to explore factors influencing concussion reporting in United States Air Force Academy (USAFA) cadets. MATERIALS AND METHODS: Semi-structured interviews were conducted on 34 cadets (18 with concussion history; 16 without concussion history). This study was approved by the USAFA Institutional Review Board. Analysis included a five-cycle process of clarifying the topic at hand through an introduction, conducting a literature review, data collection and summarization, relating current findings to current literature, and making final interpretations. Data were summarized by creation of a codebook after reading five transcripts and identifying meaningful units. A four-person research team read and identified meaningful units individually, then met to discuss common meaningful units and codebook creation. Once the codebook was created, the lead researcher used the codebook to code all transcripts. RESULTS: Eight themes were generated from interview transcripts. This manuscript focuses on the perceived costs following a concussion theme and the following subthemes: perceived costs to physical fitness, military career aspirations, pilot qualifications, sport, reputation, academics, and lack of time. CONCLUSIONS: Cadet interviews described a complex environment where concussions were often viewed as costly to future career ambitions and provided potential reasons for non-disclosure largely including disruption in daily life. Reduction in perceived and actual harms due to concussion disclosure will require not only improving clinical care, but also addressing barriers to self-disclosure. Additionally, research suggests the sooner one reports a concussion, the sooner they return to physical or military activity. Educational interventions should be designed to address the perceived costs identified from our study and educate cadets that while some costs may be reality, others may not. Secondly, it should also be stressed to cadets that the sooner one seeks medical attention following a concussion, the sooner they may return to activity. Messaging around these themes may decrease the costs associated with time removed from academics, athletics, or military activities therefore minimizing attempts at concussion self-management. Lastly, if efforts are made to improve the overall concussion disclosure stigma, cadets may increase seeking care after injury because their reputation may not be as impacted.

Hearing Loss and Irritability Reporting Without Vestibular Differences in Explosive Breaching Professionals.

Background: Blast exposure is a potential hazard in modern military operations and training, especially for some military occupations. Helmets, peripheral armor, hearing protection, and eye protection worn by military personnel provide some acute protection from blast effects but may not fully protect personnel against cumulative effects of repeated blast overpressure waves experienced over a career. The current study aimed to characterize the long-term outcomes of repeated exposure to primary blast overpressure in experienced career operators with an emphasis on the assessment of hearing and vestibular outcomes. Methods: Participants included experienced "breachers" (military and law enforcement explosives professionals who gain entry into structures through controlled detonation of charges) and similarly aged and experienced "non-breachers" (non-breaching military and law enforcement personnel). Responses to a clinical interview and performance on audiological and vestibular testing were compared. Results: Hearing loss, ringing in the ears, irritability, and sensitivity to light or noise were more common among breachers than non-breachers. Breachers reported more combat exposure than non-breachers, and subsequently, memory loss and difficulty concentrating were associated with both breaching and combat exposure. Vestibular and ocular motor outcomes were not different between breachers and non-breachers. Conclusion: Hearing-related, irritability, and sensitivity outcomes are associated with a career in breaching. Future studies examining long-term effects of blast exposure should take measures to control for combat exposure.