To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Introduction: Each year, 3/1000 Canadians sustain a mild traumatic brain injury (mTBI). Many of those mTBI are accompanied by various co-injuries such as dislocations, sprains, fractures or internal injuries. A number of those patients, with or without co-injuries will suffer from persistent post-concussive symptoms (PPCS) more than 90 days post injury. However, little is known about the impact of co-injuries on mTBI outcome. This study aims to describe the impact of co-injuries on PPCS and on patient return to normal activities. Methods: This multicenter prospective cohort study took place in seven large Canadian Emergency Departments (ED). Inclusion criteria: patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of ED visit, with a Glasgow Coma Scale score of 13-15. Patients who were admitted following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. A research nurse then conducted three follow-up phone interviews at 7, 30 and 90 days post-injury, in which they assessed symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to estimate the influence of co-injuries. Results: A total of 1674 patients were included, of which 1023 (61.1%) had at least one co-injury. At 90 days, patients with co-injuries seemed to be at higher risk of having 3 symptoms ≥2 points according to the RPQ (RR: 1.28 95% CI 1.02-1.61) and of experiencing the following symptoms: dizziness (RR: 1.50 95% CI 1.03-2.20), fatigue (RR: 1.35 95% CI 1.05-1.74), headaches (RR: 1.53 95% CI 1.10-2.13), taking longer to think (RR: 1.50 95% CI 1.07-2.11) and feeling frustrated (RR: 1.45 95% CI 1.01-2.07). We also observed that patients with co-injuries were at higher risk of non-return to their normal activities (RR: 2.31 95% CI 1.37-3.90). Conclusion: Patients with co-injuries could be at higher risk of suffering from specific symptoms at 90 days post-injury and to be unable to return to normal activities 90 days post-injury. A better understanding of the impact of co-injuries on mTBI could improve patient management. However, further research is needed to determine if the differences shown in this study are due to the impact of co-injuries on mTBI recovery or to the co-injuries themselves.
Introduction: Mild traumatic brain injury (mTBI) is a serious public health issue and as much as one third of mTBI patients could be affected by persistent post-concussion symptoms (PPCS) three months after their injury. Even though a significant proportion of all mTBIs are sports-related (SR), little is known on the recovery process of SR mTBI patients and the potential differences between SR mTBI and patients who suffered non-sports-related mTBI. The objective of this study was to describe the evolution of PPCS among patients who sustained a SR mTBI compared to those who sustained non sport-related mTBI. Methods: This Canadian multicenter prospective cohort study included patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of Emergency Department (ED) visit, with a Glasgow Coma Scale score of 13-15. Patients who were hospitalized following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. Three follow-up phone interviews were conducted by a research nurse at 7, 30 and 90 days post-injury to assess symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to demonstrate the impact of the mechanism of injury (sports vs non-sports) on the presence and severity of PPCS. Results: A total of 1676 mTBI patients were included, 358 (21.4%) of which sustained a SR mTBI. At 90 days post-injury, patients who suffered a SR mTBI seemed to be significantly less affected by fatigue (RR: 0.70 (95% CI: 0.50-0.97)) and irritability (RR: 0.60 (95% CI: 0.38-0.94)). However, no difference was observed between the two groups regarding each other symptom evaluated in the RPQ. Moreover, the proportion of patients with three symptoms or more, a score ≥21 on the RPQ and those who did return to their normal activities were also comparable. Conclusion: Although persistent post-concussion symptoms are slightly different depending on the mechanism of trauma, our results show that patients who sustained SR-mTBI could be at lower risk of experiencing some types of symptoms 90 days post-injury, in particular, fatigue and irritability.
Seasonal influenza can cause significant morbidity in pregnant women. Much of the existing epidemiological evidence on influenza during pregnancy has focused on the 2009 A/H1N1 pandemic. To measure the epidemiological characteristics of seasonal influenza infection among pregnant women and the impact on infant health, a cohort of 86 779 pregnancies during the influenza season (2012–2014) was established using probabilistic linkage of notifiable infectious disease, hospital admission, and birth information. A total of 192 laboratory-confirmed influenza infections were identified (2·2 per 1000 pregnancies), 14·6% of which were admitted to hospital. There was no difference in the proportion of infections admitted to hospital by trimester or subtype of infection. Influenza B infections were more likely to occur in second trimester compared with influenza A/H3N2 and influenza A/H1N1 infections (41·3%, 23·6%, and 33·3%, respectively), and on average, infants born to women with influenza B during pregnancy had 4·0% (95% CI 0·3–7·6%) lower birth weight relative to optimal compared with infants born to uninfected women (P = 0·03). Results from this linked population-based study suggest that there are differences in maternal infection by virus type and subtype and support the provision of seasonal influenza vaccine to pregnant women.
Introduction: Mild traumatic brain injury (mTBI) is a common problem and until now, ED physicians don’t have any tool to predict when the patient will return to work. The purpose of this study is to develop and validate a clinical decision rule to identify the ED patients who are at risk of non-return to work or to school three months after a mTBI. Methods: Patients were recruiting in five Level I and II Trauma Centers ED in the province of Québec. All patients were referred for a systematic telephone follow-up after three months. Information about their return to work/school, partial or complete, was collected. Log binomial regression was used to develop a predictive model and the validation of this model was performed on a different prospective cohort. Results: 13,7% of the patients did not return to work/school at three months. The final model was derived from a prospective cohort of 398 patients and included three risk factors: motor vehicle accident (2 points), loss of consciousness (1 point) and headache during the emergency department assessment (1 point). With a one-point threshold, this model has a sensitivity of 97% and a negative predictive value (NPV) of 98%. However, the specificity is only 23% and the positive predictive value (PPV) is 17%. The area under the curve is 0.786. Validation of the model was performed with a new prospective cohort of 517 patients, and demonstrated a sensitivity of 86% and a NPV of 91%. Conclusion: Although this model is not very specific, its high sensitivity and NPV indicate to the clinician that mTBI patients who don’t have any of the three criteria are at low risk of prolonged work stoppage after their trauma.
Introduction: Mild traumatic brain injury (mTBI) is a major cause of morbidity but there are no validated tools to help clinicians predict post-concussion symptoms. This systematic review and meta-analysis aimed to determine the prognostic value of S-100B protein to predict post-concussion symptoms following a mTBI in adults. Methods: The protocol of this systematic review was registered with the PROSPERO database (CRD42016032578). A search strategy was performed on seven databases (CINAHL, Cochrane CENTRAL, EMBASE, MEDLINE, Web of Knowledge, PyscBITE, PsycINFO) from their inception to October 2016. Studies evaluating the association between S-100B protein level and post-concussion symptoms assessed at least seven days after the mTBI were eligible. Individual patient data were requested. Studies eligibility assessment, data extraction and risk of bias assessment were performed independently by two researchers. Analyses were done following the meta-analysis using individual participant data or summary aggregate data guidelines from the Cochrane Methodology Review Group. Results: Outcomes were dichotomised as persistent (≥3 months) or early (≥7 days <3 months). Our search strategy yielded 23,298 citations of which 29 studies presenting between seven and 223 patients (n=2505) were included. Post-concussion syndrome (PCS) (16 studies), neuropsychological symptoms (9 studies) and health-related quality of life (4 studies) were the most frequently presented outcomes. The S-100B protein serum level of patients with no PCS was similar to that of patients experiencing persistent PCS (mean difference 0.00 [-0.05, 0.04]) or early PCS (mean difference 0.03 [-0.02, 0.08]). The odds of having persistent PCS (OR 0.56 (95% CI: 0.29-1.10) or early PCS (OR 1.67 (95% CI: 0.98-2.85) in patients with an elevated S-100B protein serum level was not significantly different from that of patients with normal values. No meta-analysis was performed for other outcomes than PCS due to heterogeneity and small samples. Studies’ overall risk of bias was considered moderate. Conclusion: Results suggest that the prognostic value of S-100B protein serum level to predict persistent and early post-concussion symptoms is limited. Variability in injury to S-100B protein sample time and outcomes assessed could potentially explain the lack of association and needs further evaluation.
Introduction: Mild traumatic brain injury (mTBI) is an understudied worldwide health problem and a socio-economic burden that remains a major cause of morbidity. However, there is no prognostication tool to help clinicians predict the occurrence of post-concussion symptoms. This systematic review aimed to determine the prognostic value of neuron-specific enolase (NSE) to predict post-concussion symptoms following a mTBI in adults. Methods: The protocol of this systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number CRD42016033683). Seven databases (CINAHL, Cochrane CENTRAL, EMBASE, MEDLINE, PsycBITE, PsycINFO, Web of Knowledge/Biosis) were searched for cohort studies evaluating the association between NSE levels and post-concussion symptoms assessed at least seven days after the mild TBI. Grey literature was also screened using databases on dissertations and theses as well as abstracts from relevant congresses. Two researchers independently screened studies for inclusion, extracted data, and appraised their quality using the Quality in Prognostic Studies (QUIPS) tool from the Cochrane Collaboration Group. Results: Our search strategy yielded a total of 23,298 citations from which eight cohorts presented in 10 studies were included. Studies included between 45 and 141 patients (total=608 patients). The most frequently assessed outcomes were post-concussion syndrome (PCS) (13 assessments), neuropsychological disorders (10 assessments), return to work or sick leave (2 assessments) and Glasgow Outcome Scale (GOS) (2 assessments). No association was found between an elevated NSE serum level and the occurrence of PCS. Of the 33 outcomes assessments performed, only three showed an association between a higher level of serum NSE and a post-concussion symptom (alteration of at least three cognitive domains at 2 weeks, standardised physician assessment at 6 weeks and headache at 6 months following a mild TBI). Included studies’ overall risk of bias was considered moderate. Conclusion: Results of this systematic review conclude that based on current levels of evidence, serum NSE levels alone do not provide prognostic information on persistent or early post-concussion symptoms after a mTBI.
We use the TGAS proper motions and parallaxes as well as published and new radial velocities to study the dynamics of nearby moving groups. In particular we try to determine their age using backtracing of the individual members to a common origin. We find that the current data, probably the radial velocities, do not allow to reach a successful conclusion.
The Universe is permeated by hot, turbulent, magnetized plasmas. Turbulent plasma is a major constituent of active galactic nuclei, supernova remnants, the intergalactic and interstellar medium, the solar corona, the solar wind and the Earth’s magnetosphere, just to mention a few examples. Energy dissipation of turbulent fluctuations plays a key role in plasma heating and energization, yet we still do not understand the underlying physical mechanisms involved. THOR is a mission designed to answer the questions of how turbulent plasma is heated and particles accelerated, how the dissipated energy is partitioned and how dissipation operates in different regimes of turbulence. THOR is a single-spacecraft mission with an orbit tuned to maximize data return from regions in near-Earth space – magnetosheath, shock, foreshock and pristine solar wind – featuring different kinds of turbulence. Here we summarize the THOR proposal submitted on 15 January 2015 to the ‘Call for a Medium-size mission opportunity in ESAs Science Programme for a launch in 2025 (M4)’. THOR has been selected by European Space Agency (ESA) for the study phase.
Background: Planning for neurology training necessitated a reflection on the experience of graduates. We explored practice characteristics, and training experience of recent graduates. Methods: Graduates from 2010-2014 completed a survey. Results: Response rate was 37% of 211. 56% were female. 91% were adult neurologists. 65% practiced in an outpatient setting. 63% worked in academics. 85% completed subspecialty training (median 1 year). 36% work 3 days a week or less. 82% took general call (median 1 night weekly). Role preparation was considered very good or excellent for most; however poor or fair ratings were 17% in advocacy and 8% in leadership. Training feedback was at least “good” for 87%. Burnout a few times a week or more was noted by 5% (6% during residency, particularly PGY1 and 5). 64% felt overly burdened by paperwork. Although most felt training was adequate, it was poor or fair at preparing for practice management (85%) and personal balance (55%). Most conditions were under-observed in training environment. Many noted a need for more independent practice development and community neurology. Conclusions: Although our training was found to be very good, some identified needs included advocacy training, and more training in general neurology in the longitudinal outpatient/community settings.
The Magellanic System represents one of the best places to study the formation and evolution of galaxies. Photometric surveys of various depths, areas and wavelengths have had a significant impact on our understanding of the system; however, a complete picture is still lacking. VMC (the VISTA near-infrared YJKs survey of the Magellanic System) will provide new data to derive the spatially resolved star formation history and to construct a three-dimensional map of the system. These data combined with those from other ongoing and planned surveys will give us an absolutely unique view of the system opening up the doors to truly new science!
Over the past 25 years, the Adult Netherlands Twin Register (ANTR) has collected a wealth of information on physical and mental health, lifestyle, and personality in adolescents and adults. This article provides an overview of the sources of information available, the main research findings, and an outlook for the future. Between 1991 and 2012, longitudinal surveys were completed by twins, their parents, siblings, spouses, and offspring. Data are available for 33,957 participants, with most individuals having completed two or more surveys. Smaller projects provided in-depth phenotyping, including measurements of the autonomic nervous system, neurocognitive function, and brain imaging. For 46% of the ANTR participants, DNA samples are available and whole genome scans have been obtained in more than 11,000 individuals. These data have resulted in numerous studies on heritability, gene x environment interactions, and causality, as well as gene finding studies. In the future, these studies will continue with collection of additional phenotypes, such as metabolomic and telomere length data, and detailed genetic information provided by DNA and RNA sequencing. Record linkage to national registers will allow the study of morbidity and mortality, thus providing insight into the development of health, lifestyle, and behavior across the lifespan.
Populations of many frogs have declined alarmingly in recent years, placing nearly one third of the > 6,000 species under threat of extinction. Declines have been attributed largely to habitat loss, environmental degradation and/or infectious diseases such as chytridiomycosis. Many frogs undergo dramatic natural population fluctuations such that long-term data are required to determine population trends without undue influence of stochastic factors. We present long-term quantitative data (individuals encountered per person hour of searching) for four monotypic frog genera endemic to an Afromontane region of exceptional importance but growing conservation concern: one endemic to the Ethiopian highlands (Spinophrynoides osgoodi) and three endemic to the Bale Mountains (Altiphrynoides malcolmi, Balebreviceps hillmani, Ericabatrachus baleensis), collected during 15 field trips to the Bale Mountains between 1971 and 2009. Only a single confirmed sighting of S. osgoodi has been made since 1995. The other three species have also declined, at least locally. E. baleensis appears to have been extirpated at its type locality and at the same site B. hillmani has declined. These declines are in association with substantial habitat degradation caused by a growing human population. Chytrid fungus has been found on several frog species in Bale, although no dead or moribund frogs have been encountered. These results expose an urgent need for more amphibian surveys in the Bale Mountains. Additionally, we argue that detrimental human exploitation must be halted immediately in at least some parts of the Harenna Forest if a conservation crisis is to be averted.
The next ESA spatial mission planned to study the Sun, Solar Orbiter (SO), necessitates very innovative EUV detectors. The commonly used silicon detectors suffer important limitations mainly in terms of UV robustness and dark current level. An alternative comes from diamond or III-nitride materials. In these materials, the radiation hardness, solar blindness and dark current are improved due to their wide bandgap. This paper presents the new developments on wide bandgap materials at the Royal Observatory of Belgium (ROB). We present also the LYRA instrument, the BOLD project, and the EUI instrument suite.
Bemisia tabaci, biotype B, commonly known as the silverleaf whitefly (SLW) is an alien species that invaded Australia in the mid-90s. This paper reports on the invasion ecology of SLW and the factors that are likely to have contributed to the first outbreak of this major pest in an Australian cotton cropping system. Population dynamics of SLW within whitefly-susceptible crop (cotton and cucurbit) and non-crop vegetation (sowthistle, Sonchus spp.) components of the cropping system were investigated over four consecutive growing seasons (September–June) 2001/02–2004/05 in the Emerald Irrigation Area (EIA) of Queensland, Australia. Based on fixed geo-referenced sampling sites, variation in spatial and temporal abundance of SLW within each system component was quantified to provide baseline data for the development of ecologically sustainable pest management strategies. Parasitism of large (3rd and 4th instars) SLW nymphs by native aphelinid wasps was quantified to determine the potential for natural control of SLW populations. Following the initial outbreak in 2001/02, SLW abundance declined and stabilised over the next three seasons. The population dynamics of SLW is characterised by inter-seasonal population cycling between the non-crop (weed) and cotton components of the EIA cropping system. Cotton was the largest sink for and source of SLW during the study period. Over-wintering populations dispersed from weed host plant sources to cotton in spring followed by a reverse dispersal in late summer and autumn to broad-leaved crops and weeds. A basic spatial source-sink analysis showed that SLW adult and nymph densities were higher in cotton fields that were closer to over-wintering weed sources throughout spring than in fields that were further away. Cucurbit fields were not significant sources of SLW and did not appear to contribute significantly to the regional population dynamics of the pest. Substantial parasitism of nymphal stages throughout the study period indicates that native parasitoid species and other natural enemies are important sources of SLW mortality in Australian cotton production systems. Weather conditions and use of broad-spectrum insecticides for pest control are implicated in the initial outbreak and on-going pest status of SLW in the region.
The National Institutes of Health (NIH) Magnetic Resonance Imaging
(MRI) Study of Normal Brain Development is a landmark study in which
structural and metabolic brain development and behavior are followed
longitudinally from birth to young adulthood in a population-based sample
of healthy children. The neuropsychological assessment protocol for
children aged 6 to 18 years is described and normative data are presented
for participants in that age range (N = 385). For many measures,
raw score performance improved steeply from 6 to 10 years, decelerating
during adolescence. Sex differences were documented for Block Design (male
advantage), CVLT, Pegboard and Coding (female advantage). Household income
predicted IQ and achievement, as well as externalizing problems and social
competence, but not the other cognitive or behavioral measures.
Performance of this healthy sample was generally better than published
norms. This linked imaging-clinical/behavioral database will be an
invaluable public resource for researchers for many years to come.
(JINS, 2007, 13, 729–746.)This project is supported by the National Institute of Child
Health and Human Development (Contract N01-HD02-3343), the National
Institute on Drug Abuse, the National Institute of Mental Health (Contract
N01-MH9-0002), and the National Institute of Neurological Disorders and
Stroke (Contracts N01-NS-9-2314, -2315, -2316, -2317, -2319 and -2320).
The views stated herein do not necessarily represent the official views of
the National Institutes of Health (National Institute of Child Health and
Human Development, National Institute on Drug Abuse, National Institute of
Mental Health, National Institute of Neurological Disorders and Stroke),
or the Department of Health and Human Services, nor any other agency of
the United States government.
IMEC is focusing its 3D-integration technology developments in 3 distinct directions: 3D-System-in-a-Package (3D-SiP), 3D-Wafer-Level-Packaging (3D-WLP) and 3D-Stacked-IC (3D-SiC). First, the background of these separate approaches will be given. Next the materials and technologies involved, the typical characteristics and the ongoing developments will be discussed. Finally, the roadmap for the 3D-integration in IMEC will be presented.