Balance Testing Following Concussion: Postural Sway versus Complexity Index.

BACKGROUND: Although postural control deficits are common following a concussion, the current clinical assessments for postural control tend to resolve within 3 to 10 days after injury. There is a lack of sensitive tools to examine subtle changes in postural control during the recovery phase following sports-related concussion. Only a limited number of studies have examined nonlinear dynamics of postural control; no study has examined this metric longitudinally during the recovery phase following a sports-related concussion. OBJECTIVE: To examine sway and complexity index of postural control in collegiate athletes during day 3, day 21, and day 90 following a concussion and compare them with noninjured controls. DESIGN: Prospective longitudinal case-control study. SETTING: University cerebrovascular research laboratory. PARTICIPANTS: Thirty-one male and female collegiate athletes on day 3 following a concussion. Twenty-eight athletes returned on day 21, and 21 completed assessments on day 90. Twenty-nine sports-matched noninjured controls. METHODS: Center of pressure (COP) measurements obtained during 60-second quiet standing on a force plate system with either eyes opened or closed. Postural sway was estimated as range and variability of COP in the anteroposterior (AP) and mediolateral planes. MAIN OUTCOME MEASUREMENTS: Complexity index of AP COP utilizing multiscale entropy analysis. RESULTS: Postural sway measured as AP range (P = .03) and variability (P = .04) during quiet standing with eyes closed were higher on day 3 compared to the controls. Postural sway in the concussed group was comparable to the noninjured controls by day 21 postinjury. However, postural control dynamics utilizing complexity index was lower on day 3 (P < .001) and persisted on day 21 (P < .006) and day 90 (P < .02), despite resolution of abnormal postural sway 21 days postinjury. CONCLUSION: Complexity index utilizing nonlinear dynamics might be a more sensitive objective biomarker for examining postural control following a concussion, with implications for return-to-play and interventions. Future studies with a larger sample size are needed to validate this finding. CLINICAL TRIAL NUMBER: NCT02754206. LEVEL OF EVIDENCE: III.

Attitude-Scenario-Emotion (ASE) sentiments are superficial.

Gervais & Fessler's (G&F's) Attitude-Scenario-Emotion (ASE) model reduces sentiments to superficial patterns of emotional responding that emerge when an underlying evaluative attitude interacts with appraisals of a range of specific scenarios. Thus construed, sentiments are epiphenomenal. We argue that G&F would do better to identify each sentiment (love, say) with the attitude that underlies and explains the patterns of emotional responding (in the case of love, this might be the attitude of valuing the good of a specific other).

Public health benefits of strategies to reduce greenhouse-gas emissions: household energy.

Energy used in dwellings is an important target for actions to avert climate change. Properly designed and implemented, such actions could have major co-benefits for public health. To investigate, we examined the effect of hypothetical strategies to improve energy efficiency in UK housing stock and to introduce 150 million low-emission household cookstoves in India. Methods similar to those of WHO's Comparative Risk Assessment exercise were applied to assess the effect on health that changes in the indoor environment could have. For UK housing, the magnitude and even direction of the changes in health depended on details of the intervention, but interventions were generally beneficial for health. For a strategy of combined fabric, ventilation, fuel switching, and behavioural changes, we estimated 850 fewer disability-adjusted life-years (DALYs), and a saving of 0.6 megatonnes of carbon dioxide (CO(2)), per million population in 1 year (on the basis of calculations comparing the health of the 2010 population with and without the specified outcome measures). The cookstove programme in India showed substantial benefits for acute lower respiratory infection in children, chronic obstructive pulmonary disease, and ischaemic heart disease. Calculated on a similar basis to the UK case study, the avoided burden of these outcomes was estimated to be 12 500 fewer DALYs and a saving of 0.1-0.2 megatonnes CO(2)-equivalent per million population in 1 year, mostly in short-lived greenhouse pollutants. Household energy interventions have potential for important co-benefits in pursuit of health and climate goals.