The Uptake of Rare Trace Elements by Perennial Ryegrass (Lolium perenne L.).

Technological development has increased the use of chemical elements that have hitherto received scant scientific attention as environmental contaminants. Successful management of these rare trace elements (RTEs) requires elucidation of their mobility in the soil-plant system. We aimed to determine the capacity of Lolium perenne (a common pasture species) to tolerate and accumulate the RTEs Be, Ga, In, La, Ce, Nd, and Gd in a fluvial recent soil. Cadmium was used as a reference as a well-studied contaminant that is relatively mobile in the soil-plant system. Soil was spiked with 2.5-283 mg kg-1 of RTE or Cd salts, representing five, 10, 20, and 40 times their background concentrations in soil. For Be, Ce, In, and La, there was no growth reduction, even at the highest soil concentrations (76, 1132, 10.2, and 874 mg kg-1, respectively), which resulted in foliar concentrations of 7.1, 12, 0.11, and 50 mg kg-1, respectively. The maximum no-biomass reduction foliar concentrations for Cd, Gd, Nd, and Ga were 0.061, 0.1, 7.1, and 11 mg kg-1, respectively. Bioaccumulation coefficients ranged from 0.0030-0.95, and increased Ce < In < Nd ≅ Gd < La ≅ Be ≅ Ga < Cd. Beryllium and La were the RTEs most at risk of entering the food chain via L. perenne, as their toxicity thresholds were not reached in the ranges tested, and the bioaccumulation coefficient (plant/soil concentration quotient) trends indicated that uptake would continue to increase at higher soil concentrations. In contrast, In and Ce were the elements least likely to enter the food chain. Further research should repeat the experiments in different soil types or with different plant species to test the robustness of the findings.

Bioavailable iron concentrations regulate phytoplankton growth and bloom formation in low-nutrient lakes.

The growth of phytoplankton in lakes is thought to be primarily controlled by macronutrient concentrations, but the availability of trace metal micronutrients, such as iron (Fe), are increasingly recognised as important regulators of lake primary production. This study evaluates the role of Fe in regulating phytoplankton growth in lakes of different nutrient status in New Zealand. The results of this unique year-long study, combining highly sensitive trace metal concentration analysis of waters and particulates with advanced trace metal bioavailability and speciation modelling, constrains thresholds for bioavailable Fe and colloidal Fe of 0.8 nmol·L-1 and 30 nmol·L-1, respectively, below which phytoplankton growth-limitation occurs. These thresholds specifically control diatom bloom formation and termination in lakes, thereby exerting a strong influence on freshwater carbon sequestration, given the dominance of diatoms in lake bloom assemblages. Importantly, potentially toxic cyanobacteria thrived only after events of bottom water anoxia, when additional dissolved Fe in concentrations ≥4 nmol·L-1 was released into the water column. These new thresholds for bioavailable and colloidal Fe offer the potential to manage micronutrient levels in lakes for the purpose of regulating algal bloom formation and carbon sequestration, while at the same time, suppressing the formation of harmful cyanobacterial blooms.

Soil cadmium mobilisation by dissolved organic matter from soil amendments.

Dissolved organic matter (DOM) release from Cd contaminated soils been linked to mobilisation of the metal as Cd-DOM complexes and this may be exacerbated by organic matter-rich soil amendments. The quantity and quality of the DOM can determine the proportion of dissolved Cd that partitions to mobile complexes and their stability and, thus, the potential for Cd transport from contaminated soils. The aim of this work was to examine differences in Cd mobilisation from soils to which different types of soil amendments/conditioners have been applied and the importance of DOM characteristics in determining the extent to which this can happen. Three soils were spiked with Cd to 2 mg kg-1, allowed to equilibrate and then treated with compost and peat. These soils and an untreated subsample of each soil were then adjusted to three different pHs: 5.6, 6.4 and 7.4, using lime. The amount of Cd mobilised from each soil was tested using a column leaching experiment. Ultrafiltration and speciation modelling were used to determine amounts of Cd as DOM-complexed, "truly" dissolved (<5 kDa) and colloidal species, while DOM quality was assessed using UV-Vis and fluorescence spectroscopy. Most colloidal Cd was mobilised from the compost treated soils (50%-60%), followed by the peat treated soils (20-44%). The relationships between colloidal Cd, DOC concentration and soil pH, together with the spectroscopic and modelling results showed that structural properties of DOM are an important factor in mobilising Cd from contaminated soils.

ALLODUST augmented activated sludge single batch anaerobic reactor (AS-SBAnR) for high concentration nitrate removal from agricultural wastewater.

Nitrate is among the most widespread contaminants that threaten water bodies and waterways. Under favourable environmental conditions, high nitrate concentrations in water can contribute to eutrophication, thus presenting a high potential for risk to ecosystems and human health. Low-cost allophanic soil material and carbon-based bio-wastes have great potential to reduce nutrient concentrations from contaminated waters. This study investigated the mechanisms that underpin the reduction of nitrate concentrations and nitrous oxide (N2O) emission in the presence of novel developed media in an activated sludge process. A new operating approach, employing a newly developed media (ALLODUST), was evaluated for enhanced NO-3-N removal from agricultural wastewater. Two anaerobic-aerobic batch reactors were developed, where the coupled bottom aeration method was used for efficient agitation and aeration in the aerobic reactor. The reactor was run at high NO-3-N concentrations (110 mg L-1), under anoxic conditions at low- to long-term contact times (2, 12, and 22 h), while the aerobic period (clarification) was constant for all the experimental designs (2 h). ALLODUST retained its integrity and stability over the long-term operation. Low ALLODUST concentrations (5.95 g L-1) removed 87% of the NO-3-N from the wastewater within 12 h. Further exploration revealed that the same amount of the media was optimal for decreasing N2O emissions from the anaerobic activated sludge reactor by 80%.

Transport and speciation of uranium in groundwater-surface water systems impacted by legacy milling operations.

Growing worldwide concern over uranium contamination of groundwater resources has placed an emphasis on understanding uranium transport dynamics and potential toxicity in groundwater-surface water systems. In this study, we utilized novel in-situ sampling methods to establish the location and magnitude of contaminated groundwater entry into a receiving surface water environment, and to investigate the speciation and potential bioavailability of uranium in groundwater and surface water. Streambed temperature mapping successfully identified the location of groundwater entry to the Little Wind River, downgradient from the former Riverton uranium mill site, Wyoming, USA. Diffusive equilibrium in thin-film (DET) samplers further constrained the groundwater plume and established sediment pore water solute concentrations and patterns. In this system, evidence is presented for attenuation of uranium-rich groundwater in the shallow sediments where surface water and groundwater interaction occurs. Surface water grab and DET sampling successfully detected an increase in river uranium concentrations where the groundwater plume enters the Little Wind River; however, concentrations remained below environmental guideline levels. Uranium speciation was investigated using diffusive gradients in thin-film (DGT) samplers and geochemical speciation modelling. Together, these investigations indicate uranium may have limited bioavailability to organisms in the Little Wind River and, possibly, in other similar sites in the western U.S.A. This could be due to ion competition effects or the presence of non- or partially labile uranium complexes. Development of methods to establish the location of contaminated (uranium) groundwater entry to surface water environments, and the potential effects on ecosystems, is crucial to develop both site-specific and general conceptual models of uranium behavior and potential toxicity in affected ground and surface water environments.

Quality of life of ice hockey players after retirement due to concussions.

BACKGROUND: Sports-related concussion (SRC) is increasingly recognized as a potential health problem in ice hockey. Quality of life (QoL) in players retiring due to SRC has not been thoroughly addressed. MATERIALS & METHODS: QoL using the Sports Concussion Assessment Tool 5th Edition, Impact of Event Scale-Revised and Short Form Health Survey was measured in Swedish ice hockey players who retired due to persistence of postconcussion symptoms or fear of attaining additional SRC. RESULTS: A total of 76 players were assessed, on average of 5 years after their most recent SRC. Overall, retired players had a high burden of postconcussion symptoms and reduced QoL. CONCLUSION: Retired concussed ice hockey players have a reduced QoL, particularly those retiring due to postconcussion symptoms. Symptom burden should be continuously evaluated and guide the decision to retire.

Impacts of Phosphogypsum, Soluble Fertilizer and Lime Amendment of Acid Soils on the Bioavailability of Phosphorus and Sulphur Under Lucerne (Medicago sativa).

Legumes play critical dual roles in grazed grassland ecosystems; providing nitrogen inputs and high-quality feed for grazing livestock. However, many species fail to persist in acidic, low fertility soils. A glasshouse study was conducted to investigate the response of lucerne (Medicago sativa) to phosphogypsum (PG), lime and soluble P + S fertilizer (PS) application to two soils. Phosphorus and sulphur were applied through either PG (0, 1, 3 and 9 t ha-1) or P + S fertilizer at equivalent rates to PG. Both PG and PS were applied with or without lime, which was applied at 2 t ha-1. Yield and nutrient uptake of the lucerne was measured, while the soil was analyzed for pH, Olsen P and exchangeable aluminum. Yield responses were significantly different between the two soils. Maximum yields and P and S uptakes were obtained under PG 9 t ha-1 combined with lime. Exchangeable Al decreased in both soils under 1 ha-1 of PG compared with the control. At the highest rate, Olsen P increased by 8 and 6 mg kg-1 for PG and by 6 and 11 mg kg-1 for PS compared with the control for Glenmore and Molesworth soils respectively. Phosphogypsum showed positive effects on P and S bioavailability.

Losing the identity of a hockey player: the long-term effects of concussions.

AIM: To describe what suffering multiple concussions meant for former semi-professional or professional hockey players who were forced to end their career. RESULTS: Nine former Swedish hockey players, who once played on national or professional teams were interviewed. The interviews were analyzed with reference to hermeneutic phenomenology to interpret and explain their experiences. The theme of losing one's identity as a hockey player was constructed from five subthemes: being limited in everyday life, returning to the hockey stadium as soon as possible, forming a post career identity, lacking understanding and support, and preventing injuries by respecting other players. CONCLUSION: The former hockey players struggled with developing their off-the-ice identities and with finding other sources of meaning for their lives.

Environmental and edaphic factors affecting soil cadmium uptake by spinach, potatoes, onion and wheat.

The relative ease with which cadmium (Cd) in agricultural soils can transfer to crop plants can pose a potential health risk to consumers. However, efforts to predict and mitigate these risks are often confounded by the various factors that influence metal accumulation in the edible plant parts. The aim of this work was to identify key drivers that determine Cd concentrations in spinach leaves, potato tubers, onion bulbs and wheat grain grown in commercial horticultural operations across New Zealand (NZ). Paired soil and plant samples (n = 147) were collected from farms across different NZ growing regions. Cadmium concentrations in the edible parts were measured and four different tests were used to examine the potential bioavailability of soil Cd: pseudo-total and porewater concentrations, 0.05 M Ca(NO3)2-extraction and diffusive gradients in thin-films (DGT). Information on a range of soil and climatic variables was also collected. The methods' ability to represent Cd concentrations in the plant parts was assessed through single and multiple regression analysis that considered the different variables and the farm locations. Soil Cd concentrations determined by the different tests were positively related to plant concentrations and there were clear regional differences between these relationships. The Ca(NO3)2 extraction predicted over 76% of the variability in Cd concentrations in onion bulbs and spinach leaves, while DGT and porewater Cd provided the best estimates for potato tubers and wheat grains, respectively, once regional differences were considered, along with certain environmental and soil variables. The results show that certain soil and environmental factors can be a key influence for determining Cd accumulation in the edible parts of some plants and that regional differences are important for modulating the extent to which this occurs. These effects should be considered when trying to mitigate the potential risks arising from Cd in agricultural soils.

Environmental Parameters Affecting the Concentration of Iodine in New Zealand Pasture.

Iodine (I) is an essential trace element commonly deficient in agricultural systems. Whereas there is much information on I in food crops, there is a lacuna of knowledge on the environmental factors that affect pasture I concentrations. We aimed to identify the most important environmental factors affecting the concentration of I in New Zealand pastures, and the consequences to agricultural systems. Soil and pastoral samples were collected throughout the country and analyzed for I and other elements. The soils contained 1.1 to 86 mg I kg, with 0.005 to 1.4 mg kg in the pasture. In 26% of pastures, I concentrations were insufficient for sheep nutrition, whereas 87% contained insufficient I for cattle nutrition. Pasture I concentrations were negatively correlated with the distance from the sea, and the concentration of oxalate-extractable amorphous Al, Fe, and Si oxides, which immobilize soil I. Soil organic C and clay increased I retention in soil but did not significantly affect pasture I concentrations. Future work should investigate how soil properties affect pasture I uptake in inland areas.

Cadmium Concentrations in New Zealand Wheat: Effect of Cultivar Type, Soil Properties, and Crop Management.

Wheat ( L.) grain is a contributing source of dietary Cd in New Zealand, but despite this, there is a dearth of information on Cd concentrations in wheat and the factors that affect uptake. We measured Cd concentrations in 12 wheat cultivars grown in field sites across New Zealand and also assessed the soil, plant, and crop factors that have been reported to affect Cd uptake. We found there was a wide range in grain Cd concentrations (0.004 to 0.205 mg kg fresh weight [FW]). The overall mean concentration (0.066 mg kg FW) was below the maximum limit (ML) of 0.1 mg kg FW. Only 7% of grain samples across seven sites exceeded the ML. There were significant ( < 0.05) differences (2.5-fold) in Cd concentrations in wheat grain between cultivars. No strong significant relationships were found between soil properties and Cd concentrations in grain. Further, management factors affecting grain Cd concentrations were inconsistent. Given the lack of relationships between soils and management practices, the most effective way of limiting Cd uptake in wheat grain at sites where Cd exceeds MLs may be the use of low-Cd-accumulating cultivars. Further studies are required to explore specifically the influence of irrigation and effects of type and rate of fertilizer on Cd uptake in wheat, as well as to better understand the mechanisms of Cd uptake in wheat.

Simultaneous Quantification of Soil Phosphorus Labile Pool and Desorption Kinetics Using DGTs and 3D-DIFS.

The buffering of phosphorus concentrations in soil solution by the soil-solid phase is an important process for providing plant root access to nutrients. Accordingly, the size of labile solid phase-bound phosphorus pool and the rate at which it can resupply phosphorous into the dissolved phase can be important variables in determining when the plant availability of the nutrient may be limited. The phosphorus labile pool (Plabile) and its desorption kinetics were simultaneously evaluated in 10 agricultural UK soils using the diffusive gradients in thin-films (DGT) technique. The DGT-induced fluxes in the soil and sediments model (DIFS) was fitted to the time series of DGT deployments (1-240 h), which allowed the estimation of Plabile, and the system response time ( Tc). The Plabile concentration was then compared to that obtained by several soil P extracts including Olsen P, FeO-P, and water extractable P, in order to assess if the data from these analytical procedures can be used to represent the labile P across different soils. The Olsen P concentration, commonly used as a representation of the soil labile P pool, overestimated the desorbable P concentration by 6-fold. The use of this approach for the quantification of soil P desorption kinetic parameters found a wide range of equally valid solutions for Tc. Additionally, the performance of different DIFS model versions working in different dimensions (1D, 2D, and 3D) was compared. Although all models could provide a good fit to the experimental DGT time series data, the fitted parameters showed a poor agreement between different model versions. The limitations of the DIFS model family are associated with the assumptions taken in the modeling approach and the three-dimensional (3D) version is here considered to be the most precise among them.

Methotrexate treatment in rheumatoid arthritis and elevated liver enzymes: A long-term follow-up of predictors, surveillance, and outcome in clinical practice.

AIM: To assess predictors of alanine aminotransferase (ALT) elevation in methotrexate (MTX) treated rheumatoid arthritis (RA) patients, and to describe the monitoring of liver enzymes, including handling and outcome of elevated ALT. METHODS: All RA patients starting MTX in January, 2005 to April, 2013 at a rheumatology clinic, (Uppsala University Hospital, Sweden) were identified from electronic medical records. Clinical and laboratory data were obtained from medical records, supplemented by telephone interviews. Predictors for ALT >1.5× over the upper limit of normal (ULN) were identified by multiple regression analysis. RESULTS: The study comprised 213 RA patients starting MTX. During a mean follow-up of 4.3 years, 6288 ALT tests were performed; 7% of tests with ALT were >ULN. ALT >1.5× ULN was observed in 44 (21%) patients and the strongest predictor was a pre-treatment elevation of ALT (adjusted odds ratio = 6.8, 95% CI 2.2-20.5). Recurrent elevations occurred in 70% of patients who continued treatment, and the proportion was similar in those with and without interventions, for example MTX dose reduction (67% vs 73%, P = 0.43). Seven patients (3%) permanently stopped MTX due to ALT elevation, and two were eventually diagnosed with non-alcoholic fatty liver disease. No patient developed hepatic failure. CONCLUSION: Only a small number of ALT tests performed during MTX therapy in RA capture an elevation. A pre-treatment elevation of ALT was the strongest predictor for early and recurrent ALT elevations during therapy. This study supports a more individualized approach to monitoring and handling of ALT elevations during MTX therapy in RA than recommended in current guidelines.

Response of a Pioneering Species (Leptospermum scoparium J.R.Forst. & G.Forst.) to Heterogeneity in a Low-Fertility Soil.

Root foraging may increase plant nutrient acquisition at the cost of reducing the total volume of soil explored, thereby reducing the chance of the roots encountering additional patches. Patches in soil seldom contain just one nutrient: the patch may also have distinct textural, hydrological, and toxicological characteristics. We sought to determine the characteristics of root foraging by a pioneering species, Leptospermum scoparium, using pot trials and rhizobox experiments with patches of biosolids. The growth of L. scoparium was increased by <50 t/ha equiv. of biosolids but higher doses were inhibitory. Roots foraged patches of biosolids in a low-fertility soil. There was no evidence of chemotaxis, rather, the roots proliferated toward the patch of biosolids, following chemical gradients of nitrate. While the biosolids also contained high concentrations of other nutrients (P, K, and S), only significant chemical gradients of nitrate were found. Once the roots encountered a patch of biosolids, the growth of the plant increased to a level similar to plants growing in soil homogeneously mixed with biosolids or surface-applied biosolids. Our results indicate that roots forage nitrate, which is mobile in soil, and that gradients of nitrate may lead to patches containing other less mobile nutrients, such as phosphate or potassium.

The mobility and plant uptake of gallium and indium, two emerging contaminants associated with electronic waste and other sources.

Gallium (Ga) and indium (In) are increasingly susceptible to soil contamination via disposal of electronic equipment. Chemically similar to aluminium (Al), these elements may be mobile and bioavailable under acidic conditions. We sought to determine extent and nature of Ga and In mobility in the soil - plant system and thus their potential to enter the food chain. Batch sorption experiments on a high fertility silt loam (pH 5.95, CEC 22 meq 100 g-1) showed strong retention of both elements to the soil matrix, with mean distribution coefficient (KD) values of 408 and 2021 L kg-1 for Ga and In respectively. KD increased with concentration, which we attributed to precipitation of excess ions as insoluble hydroxides. KD decreased with increased pH as Ga/In(OH)2+ and Ga/In(OH)2+ transitioned to Ga/In(OH)4-. Movement into the aboveground portions of perennial ryegrass (Lolium perenne L.) was low, with bioaccumulation factors of 0.0037 for Ga and 0.0002 for In; foliar concentrations peaked at 11.6 mg kg-1 and 0.015 mg kg-1 respectively. The mobility of Ga and In in the soil - plant system is low compared to other common trace element contaminants such as cadmium, copper, and zinc. Therefore, Ga and In are likely to accumulate in soils and soil ingestion, either directly, via inhaled dust, or dust attached to food, will be the largest pathway into the food chain. Future work should focus on the effect of redox conditions on Ga and In, as well as uptake into acidophilic plants such as Camellia spp., which accumulate Al.

Trace metal mobilization by organic soil amendments: insights gained from analyses of solid and solution phase complexation of cadmium, nickel and zinc.

The accumulation of Cd in soils worldwide has increased the demand for methods to reduce the metal's plant bioavailability. Organic matter rich soil amendments have been shown to be effective in achieving this. However, it is not known how long these amendments can retain the Cd, and whether dissolved organic matter (DOM) released from them can enhance the metal's mobility in the environment. In this study we sought to test the Cd binding capacity of various organic soil amendments, and evaluate differences in characteristics of the DOM released to see if they can explain the lability of the Cd-DOM complexes. We collected ten organic soil amendments from around New Zealand: five different composts, biosolids from two sources, two types of peat and spent coffee grounds. We characterised the amendments' elemental composition and their ability to bind the Cd. We then selected two composts and two peats for further tests, where we measured the sorption of Ni or Zn by the amendments. We analysed the quality of the extracted DOM from the four amendments using 3D Excitation Emission Matrix analysis, and tested the lability of the metal-DOM complexes using an adapted diffusive gradients in thin-films (DGT) method. We found that composts bound the most Cd and that the emergent Cd-DOM complexes were less labile than those from the peats. Ni-DOM complexes were the least labile. The aromaticity of the extracted DOM appears to be an important factor in determining the lability of Ni complexes, but less so for Zn and Cd.

A mesocosm study of oxygen and trace metal dynamics in sediment microniches of reactive organic material.

Deposition of particulate organic matter (POM) induces diagenetic hot spots at the sediment-water interface (SWI). Here we explore the effects of intensive POM degradation for metal mobilization at the SWI. By using a combined planar optode-DGT (diffusive gradient in thin-films) sensor we obtained simultaneous measurements of dissolved O2 and trace metal dynamics around an aggregate of reactive organic matter placed on the SWI of a sediment mesocosm. The aggregate induced a rapid, highly localized, decrease in O2 concentration, resulting in an anoxic feature at the SWI. Co-located with this feature, we observed intense Fe and Mn mobilization, removal of Co, Ni and Zn and found evidence for the concurrent release and precipitation of Pb within a small confined volume. We also identified two small microniches in the anoxic sediment below the SWI, defined by elevated trace metal mobilization. Differences between the metal release rates in these two microniches indicate that they were formed by the mineralisation of different types of organic matter buried in the sediment. Our results provide direct empirical evidence for the potential importance of POM-induced reactive microniches when considering the fluxes of metals from and within aquatic sediments, and suggest that other elements' cycles may also be affected.

Effects of Lime and Organic Amendments Derived from Varied Source Materials on Cadmium Uptake by Potato.

Repeated applications of Cd-rich phosphate fertilizers have resulted in elevated concentrations of this toxic element in some New Zealand soils. Exceedance of the food safety standard for Cd (0.1 mg kg fresh weight) has been reported for potato ( L.). Composts may efficiently sorb Cd in soil and therefore reduce its phytoavailability, leading to reduced uptake by plants. We aimed to determine the potential of various composts, shredded corn stover, and lime at two different rates to reduce the transfer of Cd from a soil (containing 1.45 mg kg Cd) to potato (var. 'Nadine'). In the control, the peeled tubers, skins, leaves, and stems had Cd concentrations of 0.04, 0.09, 0.26, and 0.53 mg kg dry weight, respectively. There was a 71% reduction in tuber Cd concentrations in potatoes grown in soil amended with 5% (w/w) shredded corn stover, although it significantly decreased potato biomass. Potatoes grown in soil amended with pig manure compost, mushroom compost, sawdust-animal waste compost, and municipal compost at rates of either 2.5 or 5% (w/w) reduced tuber Cd concentrations by 58 to 66%, 46 to 63%, 52 to 53%, and 29 to 49%, respectively. Lime (1.3%) application in soil reduced tuber Cd concentrations by 50%. Composts significantly increased tuber biomass. Further work is warranted to identify the key components of composts that result in reduced Cd uptake by plants.

Neurochemical Aftermath of Repetitive Mild Traumatic Brain Injury.

IMPORTANCE: Evidence is accumulating that repeated mild traumatic brain injury (mTBI) incidents can lead to persistent, long-term debilitating symptoms and in some cases a progressive neurodegenerative condition referred to as chronic traumatic encephalopathy. However, to our knowledge, there are no objective tools to examine to which degree persistent symptoms after mTBI are caused by neuronal injury. OBJECTIVE: To determine whether persistent symptoms after mTBI are associated with brain injury as evaluated by cerebrospinal fluid biochemical markers for axonal damage and other aspects of central nervous system injury. DESIGN, SETTINGS, AND PARTICIPANTS: A multicenter cross-sectional study involving professional Swedish ice hockey players who have had repeated mTBI, had postconcussion symptoms for more than 3 months, and fulfilled the criteria for postconcussion syndrome (PCS) according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) matched with neurologically healthy control individuals. The participants were enrolled between January 2014 and February 2016. The players were also assessed with Rivermead Post Concussion Symptoms Questionnaire and magnetic resonance imaging. MAIN OUTCOMES AND MEASURES: Neurofilament light protein, total tau, glial fibrillary acidic protein, amyloid ß, phosphorylated tau, and neurogranin concentrations in cerebrospinal fluid. RESULTS: A total of 31 participants (16 men with PCS; median age, 31 years; range, 22-53 years; and 15 control individuals [11 men and 4 women]; median age, 25 years; range, 21-35 years) were assessed. Of 16 players with PCS, 9 had PCS symptoms for more than 1 year, while the remaining 7 returned to play within a year. Neurofilament light proteins were significantly increased in players with PCS for more than 1 year (median, 410 pg/mL; range, 230-1440 pg/mL) compared with players whose PCS resolved within 1 year (median, 210 pg/mL; range, 140-460 pg/mL) as well as control individuals (median 238 pg/mL, range 128-526 pg/mL; P = .04 and P = .02, respectively). Furthermore, neurofilament light protein concentrations correlated with Rivermead Post Concussion Symptoms Questionnaire scores and lifetime concussion events (ρ = 0.58, P = .02 and ρ = 0.52, P = .04, respectively). Overall, players with PCS had significantly lower cerebrospinal fluid amyloid-ß levels compared with control individuals (median, 1094 pg/mL; range, 845-1305 pg/mL; P = .05). CONCLUSIONS AND RELEVANCE: Increased cerebrospinal fluid neurofilament light proteins and reduced amyloid ß were observed in patients with PCS, suggestive of axonal white matter injury and amyloid deposition. Measurement of these biomarkers may be an objective tool to assess the degree of central nervous system injury in individuals with PCS and to distinguish individuals who are at risk of developing chronic traumatic encephalopathy.

Nursing students' perceptions of learning after high fidelity simulation: Effects of a Three-step Post-simulation Reflection Model.

BACKGROUND: High-fidelity simulation (HFS) has become a bridge between theoretical knowledge and practical skills. A safe and realistic environment is commonly used in nursing education to improve cognitive, affective and psychomotor abilities. Debriefing following a simulation experience provides opportunities for students to analyze and begin to reflect upon their decisions, actions and results. The nursing literature highlights the need to promote the concept of reflective practice and to assist students in reflection, and research indicates the need to refine and develop debriefing strategies, which is the focus of the current paper. PURPOSE: To explore the value of reflections after HFS by investigating nursing students' perceptions of their learning when a Three-step Post-simulation Reflection Model is used. DESIGN: A qualitative descriptive research approach was applied. METHOD: A Three-step Post-simulation Reflection Model that combined written and verbal reflections was used after an HFS experience in a second-year course in the Bachelor Program in Nursing at Luleå University of Technology, Sweden. Reflective texts written before and after a verbal group reflection were subjected to qualitative content analysis. FINDINGS: The main theme in the first written reflections was identified as "Starting to act as a nurse", with the following categories: feeling stressed, inadequate and inexperienced; developing an awareness of the importance of never compromising patient safety; planning the work and prioritizing; and beginning to understand and implement nursing knowledge. The main theme in the second written reflections was identified to be "Maturing in the profession", with the following categories: appreciating colleagues, good communication and thoughtfulness; gaining increased self-awareness and confidence; and beginning to understand the profession. CONCLUSION: The Three-step Post-simulation Reflection Model fostered an appreciation of clear and effective communication. Having time for thoughtfulness and reflection promotes self-awareness and a better understanding of both the nursing profession and patient safety. The progress demonstrated in the depth of the themes in the written reflections indicates that repeated reflections stimulate and enhance student learning. The findings point towards the potential effectiveness of alternate methods of reflections.