Quality of Life in Youth Soccer Players After Mild Traumatic Brain Injury.

CONTEXT: Pediatric mild traumatic brain injuries (mTBIs) represent an evolving field of interest in youth athletics. Although most players recover within 4 weeks, some have symptoms that last longer. Little is known about youth health-related quality of life (HRQoL) after mTBI. OBJECTIVES: To characterize youth HRQoL after soccer-related mTBI and to identify predictors of individual differences in HRQoL recovery. DESIGN: Prospective cohort study. SETTING: Youth soccer. PARTICIPANTS: Soccer players, aged 8 to 17 years, who sustained an mTBI (n = 23) or orthopaedic injury (OI, n = 24) or remained uninjured (n = 23) during a single season. MAIN OUTCOME MEASURE(S): We assessed HRQoL via the Pediatric Quality of Life Inventory, version 4.0, and postconcussive symptoms via the Health and Behavior Index. Serial assessments occurred at 24 to 48 hours, 7 days, 30 days, and 90 days postinjury via telephone interview. RESULTS: At 7 days postinjury, the mTBI and OI groups had poorer total HRQoL (F2,67 = 11.35, P < .001) than the uninjured control group. At 7 days, the mTBI group had the poorest psychosocial HRQoL, whereas the OI group had the poorest physical HRQoL. Differences between the mTBI and uninjured control groups resolved by 30 days. Within the mTBI group, players with significant postconcussive symptoms at 7 days had poorer total (F1,21 = 23.071, P ≤ .001; F1,21 = 5.798, P = .028), psychosocial (F1,21 = 16.488, P = < .001; F1,21 = 5.050, P = .039), and physical (F1,21 = 21.671, P = < .001; F1,21 = 5.119, P = .038) HRQoL at 7 and 30 days, respectively, than players with minimal symptoms; these differences resolved by 90 days. CONCLUSIONS: As a group, youth soccer players who sustained mTBI had transient impairments in HRQoL that resolved by 30 days. A subset of players with significant postconcussive symptoms at 7 days postinjury had poorer HRQoL for at least 30 days postinjury than those whose postconcussive symptoms had resolved within a week of injury. This suggests ongoing recovery in this subset at 30 days and the potential utility of HRQoL as a measure of recovery.

Efficacy of IV Valproic Acid and Oral Valproic Acid Tapers for the Treatment of Pediatric Headaches in the Emergency Department.

Background and Objectives: Pediatric headaches, including migraine, are a common reason for emergency department (ED) presentation. IV valproic acid (VPA) followed by oral VPA tapers are often used to abort pediatric headache and reduce recurrence, though limited data exist regarding this approach. This study evaluated the effectiveness of IV VPA and oral VPA tapers for the treatment of acute pediatric headaches in the ED in preventing return encounters. Methods: This is a retrospective cohort study of patients aged 5-21 years presenting to a tertiary-care pediatric ED from 2010 to 2016 who received IV VPA for headache or migraine. Primary outcomes were ED disposition, percent pain reduction (initial vs 2-hour patient-reported pain score [10-point scale]), and return for acute headache treatment within 1 month. Results: A total of 486 ED encounters were included with a median patient age of 15 years; most of them were females (76%, 369/486). Of available pain scores within 2 hours of IV VPA administration, 41% (173/425) had ≥50% pain reduction. Fifty-two percent (254/486) were discharged without additional treatment, 14% (69/486) were discharged after additional treatment, and 33% (163/486) were admitted to the hospital. Initial pain score, number of preceding home treatments, and number of preceding ED treatments were not associated with ED disposition. Oral VPA tapers were prescribed in 39% (94/253) of encounters when the patient was discharged after IV VPA. Oral VPA tapers produced a transient decrease in recurrence at 72 hours, which was no longer present at 1 week nor 1 month. There was no difference in the time to recurrence or total number of return visits within 1 month. Discussion: IV VPA was efficacious in treating pediatric headaches evaluated in the ED, with nearly two-thirds of patients discharged home after administration. Oral VPA tapers did not reduce total headache recurrence nor time to recurrence. Given the limited benefit of oral VPA tapers, this practice should be re-examined. Classification of Evidence: This study provides Class IV evidence that for children with headache seen in the ED, IV VPA reduces head pain and Class III evidence that following this with an oral VPA taper is of no benefit.

Neuroimaging for Pediatric Non-First-Time Seizures in the Emergency Department.

Background and Objectives: Neuroimaging is often part of the workup for a pediatric patient presenting with a seizure to an emergency department (ED). We aim to evaluate when neuroimaging in the ED for children with a non-first-time seizure, or nonindex seizure (NIS), is associated with an acute change in management (ACM). Methods: This is a retrospective cohort study of all pediatric patients presenting to an ED from 2008 to 2018 with a NIS, excluding repeat febrile seizures, who underwent neuroimaging. Clinical characteristics were extracted from the electronic medical record. The primary outcome was new abnormal neuroimaging resulting in an ACM, defined as admission to the hospital, neurosurgical intervention, or new nonseizure medication administration. Results: We identified 492 encounters. Neuroimaging revealed new findings in 21% of encounters and led to ACMs in 5% of encounters. ACMs included admissions, neurosurgical interventions, and nonseizure medication changes. Factors associated with ACM included new seizure type (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.3-8.0), new focal examination finding (OR 3.0, 95% CI 1.3-7.1), altered mental status (OR 2.9, 95% CI 1.2-7.0), and a history of only provoked seizures (OR 2.8, 95% CI 1.0-7.5). Patients with 2 risk factors had an OR of 6.9 (95% CI 1.8-26.5) for an ACM, and those with 3-4 risk factors had an OR of 45.8 (95% CI 9.8-213.2). The negative predictive value for ACM in a patient with no risk factors was 98.6% (95% CI 95.9-99.5). Discussion: Patients with a NIS who have abnormal neuroimaging associated with an ACM present with unique risk factors. Prospectively validating these factors may allow for a prediction tool for NIS in EDs where reduced exposure to ionizing radiation, sedation, and resource utilization are critically important.

Hand-Arm Vibration Controls for Jackleg Rock Drills: A Pilot Study Assessing Ergonomic Hazards.

Jackleg drill operators are exposed to harmful levels of hand-arm vibration (HAV). Anti-vibration handles and gloves provide modest reductions in HAV exposures and forearm muscle exertion from the use of AV handles and gloves by jackleg drill operators. The goal of this pilot study was to investigate changes in HAV with the use of anti-vibration gloves and handles compared to forearm muscle exertion experienced by operators and measured with surface electromyography (EMG). Five subjects operated the drill under four different cases: no anti-vibration controls, anti-vibration gloves only, anti-vibration handle only, and simultaneous anti-vibration handle and glove use. Muscle exertion was expressed as a percent of maximum voluntary contraction (%MVC) and was compared using Welch's ANOVA with Games-Howell post-hoc comparisons. The case with both anti-vibration controls in use simultaneously (largest grip diameter) was associated with a mean %MVC of 36.13% during operation for all forearm muscles combined, which was significantly higher than the other cases (p < 0.05). There were no statistically significant differences in mean HAV exposures. The anti-vibration handle with anti-vibration glove case only increased the maximum allowable exposure time by eight minutes as compared to the control case without any anti-vibration controls. These results suggest that the modest HAV exposure reductions from the use of anti-vibration handles and gloves may pale in comparison to the increased muscle exertion resulting from their use, and this tradeoff among jackleg drill operators is a potential concern that warrants further investigation.

Safety Climate in MT Mining: A Case Study.

A safety climate case study was carried out at a surface metal mine where investigators administered the Liberty Mutual Short Scale Safety Climate Survey to 365-368 miners to measure safety climate in consecutive years. Following the baseline safety climate survey in 2019, Foundations for Safety Leadership (FSL) training was conducted with 81 middle to upper management employees at the mine site. Investigators found statistically significant differences in the pre vs. posttraining FSL assessment scores of the middle to upper management employees who attended the training. The follow-up safety climate evaluation was compared to baseline scores and revealed no significant improvement. The overall baseline company safety climate score of 76.38 increased minimally to 76.50 (p-value = 0.616). Investigators also evaluated differences in safety climate between the company's three major divisions (operations, maintenance, and administration). Both years administration had the highest mean score and operations had the lowest mean score. The authors attributed the statistically significant differences found among the three major divisions to various dissimilarities in their work environments.

Telemedicine in Pediatric Headache: A Review and Practical Implementation.

PURPOSE OF REVIEW: The purpose of this review was to summarize the current literature about telemedicine in pediatric headache and to provide practical guidance for its implementation. RECENT FINDINGS: There are few studies dedicated to telemedicine in pediatric headache, and existing studies are small. Patients and families report high levels of satisfaction with telemedicine, and most are willing to continue telemedicine visits in the future. Telemedicine demonstrated similar reductions in headache frequency, severity, and duration as patients treated in-person. Remotely delivered psychologic interventions have some utility in reducing headache severity acutely. Families feel telemedicine reduces geographic and financial barriers to care. Telemedicine in pediatric headache is a growing field. While there is limited research available, it appears safe, efficacious, and feasible. Headache-related outcomes, including frequency, severity, and duration, were similar amongst telemedicine and in-person visits. Future studies should include larger sample sizes and detailed analysis of adverse outcomes.

A comparison of respirable crystalline silica concentration measurements using a direct-on-filter Fourier transform infrared (FT-IR) transmission method vs. a traditional laboratory X-ray diffraction method.

Evaluation and control of respirable crystalline silica (RCS) exposures are critical components of an effective mine industrial hygiene program. To provide more timely exposure data in the field, an end-of-shift Fourier transform infrared (FT-IR) spectrometry method has been developed for evaluation of direct-on-filter RCS. The present study aimed to apply this FT-IR method using field samples collected in three Northwestern U.S. metal/nonmetal mines and compare the results to traditional laboratory X-ray diffraction analysis (XRD). Seventy-five dust samples were analyzed using both methods. Samples for each mine were split in half by random assignment, with half used to create a calibration factor for the FT-IR analysis and half used to apply the calibration. Nonparametric correlational and two-sample comparative tests were used to assess the strength of association and the level of agreement between the two methods. Strong, positive correlations were observed between FT-IR and XRD RCS concentrations, with Spearman rank correlation coefficients ranging between 0.84 and 0.97. The mean RCS concentrations determined through FT-IR analysis were lower than through XRD analysis, with mean differences ranging from -4 to -133 ug/m3 and mean percent errors ranging from 12% to 28%. There was a statistically significant improvement in the level of agreement between log FT-IR and log XRD RCS concentrations following calibration at two of the three mines, with mean differences of -0.03 (p = 0.002) and -0.02 (p = 0.044) in the log scale. The reduction in mean difference following calibration at the other mine was not statistically significant (mean log scale difference = -0.05, p = 0.215), but the differences between FT-IR and XRD were not significantly different without calibration (mean log scale difference = -0.07, p = 0.534). The results indicate that mine-specific calibration factors can improve the level of agreement between RCS concentrations determined via a field-based, end-of-shift FT-IR method in metal/non-metal mines as compared to traditional XRD analysis.

Functional MR Imaging: Blood Oxygen Level-Dependent and Resting State Techniques in Mild Traumatic Brain Injury.

This article discusses mild traumatic brain injury (mTBI)-associated effects on brain functional connectivity assessed via resting-state functional MR (fMR) imaging. Several studies have reported acute post-injury default mode network hyperconnectivity, followed by a period of decreased connectivity before later connectivity normalization in some patients. Other studies have reported mTBI associated effects on connectivity that remain evident for up to 5-years or more. Discordance in the published literature regarding the direction of network connectivity changes (eg, increased versus decreased connectivity) may reflect differences in timing of data collection post-injury, as well as the need to standardize MR imaging acquisition protocols and processing methods.

Assessing balance through the use of a low-cost head-mounted display in older adults: a pilot study.

INTRODUCTION: As the population ages, the prevention of falls is an increasingly important public health problem. Balance assessment forms an important component of fall-prevention programs for older adults. The recent development of cost-effective and highly responsive virtual reality (VR) systems means new methods of balance assessment are feasible in a clinical setting. This proof-of-concept study made use of the submillimeter tracking built into modern VR head-mounted displays (VRHMDs) to assess balance through the use of visual-vestibular conflict. The objective of this study was to evaluate the validity, acceptability, and reliability of using a VRHMD to assess balance in older adults. MATERIALS AND METHODS: Validity was assessed by comparing measurements from the VRHMD to measurements of postural sway from a force plate. Acceptability was assessed through the use of the Simulator Sickness Questionnaire pre- and postexposure to assess possible side effects of the visual-vestibular conflict. Reliability was assessed by measuring correlations between repeated measurements 1 week apart. Variables of possible importance that were found to be reliable (r≥0.9) between tests separated by a week were then tested for differences compared to a control group. Assessment was performed as a cross-sectional single-site community center-based study in 13 older adults (≥65 years old, 80.2±7.3 years old, 77% female, five at risk of falls, eight controls). The VR balance assessment consisted of four modules: a baseline module, a reaction module, a balance module, and a seated assessment. RESULTS: There was a significant difference in the rate at which participants with a risk of falls changed their tilt in the anteroposterior direction compared to the control group. Participants with a risk of falls changed their tilt in the anteroposterior direction at 0.7°/second vs 0.4°/second for those without a history of falls. No significant differences were found between pre/postassessment for oculomotor score or total Simulator Sickness Questionnaire score. Both the force plate and the head-mounted display balance-assessment system were able to detect differences between conditions meant to mask visual and proprioceptive information. CONCLUSION: This VRHMD is both affordable and portable, causes minimal simulator sickness, and produces repeatable results that can be used to assess balance in older adults.

Subconcussive Head Impact Exposure and White Matter Tract Changes over a Single Season of Youth Football.

Purpose To examine the effects of subconcussive impacts resulting from a single season of youth (age range, 8-13 years) football on changes in specific white matter (WM) tracts as detected with diffusion-tensor imaging in the absence of clinically diagnosed concussions. Materials and Methods Head impact data were recorded by using the Head Impact Telemetry system and quantified as the combined-probability risk-weighted cumulative exposure (RWECP). Twenty-five male participants were evaluated for seasonal fractional anisotropy (FA) changes in specific WM tracts: the inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus, and superior longitudinal fasciculus (SLF). Fiber tracts were segmented into a central core and two fiber terminals. The relationship between seasonal FA change in the whole fiber, central core, and the fiber terminals with RWECP was also investigated. Linear regression analysis was conducted to determine the association between RWECP and change in fiber tract FA during the season. Results There were statistically significant linear relationships between RWEcp and decreased FA in the whole (R2 = 0.433; P = .003), core (R2 = 0.3649; P = .007), and terminals (R2 = 0.5666; P < .001) of left IFOF. A trend toward statistical significance (P = .08) in right SLF was observed. A statistically significant correlation between decrease in FA of the right SLF terminal and RWECP was also observed (R2 = 0.2893; P = .028). Conclusion This study found a statistically significant relationship between head impact exposure and change of FA fractional anisotropy value of whole, core, and terminals of left IFOF and right SLF's terminals where WM and gray matter intersect, in the absence of a clinically diagnosed concussion. © RSNA, 2016.

Long-term survival with diaphanospondylodysostosis (DSD): survival to 5 years and further phenotypic characteristics.

We report on the natural history of diaphanospondylodysostosis (DSD) in the longest known survivor. DSD is a rare form of autosomal recessive vertebral dysotosis recently identified to be caused by a mutation in the BMPER gene. This condition is characterized by absent or severely delayed ossification of vertebral bodies, short broad thorax, short neck, protuberant abdomen, marked respiratory insufficiency, and normal appendicular skeleton. It is one of a number of spinal dysostoses, which are a heterogeneous group of axial skeletal malformations occurring during blastogenesis with continued evolution after birth. Significant medical intervention and at-home support contributed to the long-term survival of our patient. The patient had tracheomalacia, which resulted in respiratory insufficiency with thoracic insufficiency syndrome (TIS). Tracheostomy and vertical expandable prosthetic titanium rib (VEPTR) insertion operations ameliorated his symptoms. In addition, comprehensive physical and occupational therapy was performed due to chronic hypotonia. A consistent feature of all described DSD cases thus far are renal findings of dysplasia, nephrogenic rests or nephroblastomatosis, and/or cysts. The patient's renal cysts were monitored with serial ultrasounds at approximately 6-month intervals. The patient was diagnosed with bilateral renal cysts by ultrasound as a neonate, with eventual diagnosis at approximately 20 months of age with nephroblastoma suggesting this maybe an intrinsic part of DSD. The lack of other cases with nephroblastoma is likely related to the previously reported short period of survival.

Microdeletion of chromosome 15q24.3-25.2 and orofacial clefting.

We report a case of de novo microdeletion of 15q24.3-q25.2 in an infant with orofacial cleft and general hypotonia and suggest that this may be a critical region in orofacial development. In addition, this case highlights the usefulness of comparative genomic microarray in the evaluation of children with congenital anomalies with such defects.

Chromosome deletion of 14q32.33 detected by array comparative genomic hybridization in a patient with features of dubowitz syndrome.

We report a 4-year-old girl of Mexican origins with a clinical diagnosis of Dubowitz syndrome who carries a de novo terminal deletion at the 14q32.33 locus identified by array comparative genomic hybridization (aCGH). Dubowitz syndrome is a rare condition characterized by a constellation of features including growth retardation, short stature, microcephaly, micrognathia, eczema, telecanthus, blepharophimosis, ptosis, epicanthal folds, broad nasal bridge, round-tipped nose, mild to moderate developmental delay, and high-pitched hoarse voice. This syndrome is thought to be autosomal recessive; however, the etiology has not been determined. This is the first report of this deletion in association with this phenotype; it is possible that this deletion may be causal for a Dubowitz phenocopy.

Viral risk mitigation for Mammalian cell culture media.

Adventitious viral contamination in mammalian cell culture manufacturing facilities can lead to loss of product due to regulatory concerns regarding potential health risks. These events can also result in manufacturing shutdowns for extended periods of time. Numerous measures are currently taken to minimize these risks. Nonetheless, raw materials remain a high-risk entry point for viral contamination of mammalian cell cultures. Two virucidal technologies, ultraviolet radiation in the C band and high-temperature short-time pasteurization, were tested for the treatment of mammalian cell culture media. The results demonstrated no impact to the cell culture process or the quality of the products produced at the chosen dosage while providing robust viral protection.