Brain trauma exposure for American tackle football players 5 to 9 and 9 to 14 years of age.

American football helmets used by youth players are currently designed and tested to the same standards as professionals. The National Operating Committee on Standard and Safety requested research aiming at understanding the differences in brain trauma in youth American football for players aged five to nine and nine to fourteen years old to inform a youth specific American football standard. Video analysis and laboratory reconstructions of head impacts were undertaken to measure differences in head impact frequency, event types, and magnitudes of maximum principal strain (MPS) for the two age groups. Overall frequencies and frequencies for five categories of MPS representing different magnitudes of risk were tabulated. The MPS categories were very low (<0.08), low (0.08-0.169), medium (0.17-0.259), high (0.26-0.349) and very high (>0.35). Both cohorts experienced a majority of head impacts (>56%) at very low magnitude of MPS. Youth American football players aged 9-14 yrs. sustained a greater frequency of head impacts at MPS between 0.08 and 0.169 % associated with changes in brain structure and function. There were no differences in overall frequency, or in frequency of head impacts in other categories of MPS. The proportion of impacts considered injurious (MPS > 0.08) was greater in the 5-9 group (44%), than the 9-14 group (39%), and impacts above 0.35 % were only reported for the younger age group. The larger helmet-to-shoulder ratio in the younger age groups may have contributed to this finding suggesting that youth American football players under the age of nine would benefit from a child-specific football helmet.

Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes.

Previous research suggests that age of first exposure (AFE) to football before age 12 may have long-term clinical implications; however, this relationship has only been examined in small samples of former professional football players. We examined the association between AFE to football and behavior, mood and cognition in a large cohort of former amateur and professional football players. The sample included 214 former football players without other contact sport history. Participants completed the Brief Test of Adult Cognition by Telephone (BTACT), and self-reported measures of executive function and behavioral regulation (Behavior Rating Inventory of Executive Function-Adult Version Metacognition Index (MI), Behavioral Regulation Index (BRI)), depression (Center for Epidemiologic Studies Depression Scale (CES-D)) and apathy (Apathy Evaluation Scale (AES)). Outcomes were continuous and dichotomized as clinically impaired. AFE was dichotomized into <12 and ⩾12, and examined continuously. Multivariate mixed-effect regressions controlling for age, education and duration of play showed AFE to football before age 12 corresponded with >2 × increased odds for clinically impaired scores on all measures but BTACT: (odds ratio (OR), 95% confidence interval (CI): BRI, 2.16,1.19-3.91; MI, 2.10,1.17-3.76; CES-D, 3.08,1.65-5.76; AES, 2.39,1.32-4.32). Younger AFE predicted increased odds for clinical impairment on the AES (OR, 95% CI: 0.86, 0.76-0.97) and CES-D (OR, 95% CI: 0.85, 0.74-0.97). There was no interaction between AFE and highest level of play. Younger AFE to football, before age 12 in particular, was associated with increased odds for impairment in self-reported neuropsychiatric and executive function in 214 former American football players. Longitudinal studies will inform youth football policy and safety decisions.

Ingestion of swimming pool water by recreational swimmers.

The volume of water ingested by swimmers while swimming is of great interest to individuals who develop risk assessments using quantitative microbial risk assessment or epidemiological approaches. We have used chloroisocyanurate disinfected swimming pool waters to determine the amount of water swallowed by swimmers during swimming activity. The chloroisocyanurate, which is in equilibrium with chlorine and cyanuric acid in the pool water, provides a biomarker, cyanuric acid, that once swallowed passes through the body into the urine unchanged. The concentration of cyanuric acid in a 24 hour urine specimen and the concentration in pool water can be used to calculate the amount of water swallowed. Our study population of 549 participants, which was about evenly divided by gender, and young and adult swimmers, indicated that swimmers ingest about 32 mL per hour (arithmetic mean) and that children swallowed about four times as much water as adults during swimming activities. It was also observed that males had a tendency to swallow more water than females during swimming activity and that children spent about twice as much time in the water than adults.

Cerebral [18 F]T807/AV1451 retention pattern in clinically probable CTE resembles pathognomonic distribution of CTE tauopathy.

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder most commonly associated with repetitive traumatic brain injury (TBI) and characterized by the presence of neurofibrillary tangles of tau protein, known as a tauopathy. Currently, the diagnosis of CTE can only be definitively established postmortem. However, a new positron emission tomography (PET) ligand, [18F]T807/AV1451, may provide the antemortem detection of tau aggregates, and thus various tauopathies, including CTE. Our goal was to examine [18F]T807/AV1451 retention in athletes with neuropsychiatric symptoms associated with a history of multiple concussions. Here we report a 39-year-old retired National Football League player who suffered 22 concussions and manifested progressive neuropsychiatric symptoms. Emotional lability and irritability were the chief complaints. Serial neuropsychological exams revealed a decline in executive functioning, processing speed and fine motor skills. Naming was below average but other cognitive functions were preserved. Structural analysis of longitudinally acquired magenetic resonance imaging scans revealed cortical thinning in the left frontal and lateral temporal areas, as well as volume loss in the basal ganglia. PET with [18F]florbetapir was negative for amyloidosis. The [18F]T807/AV1451 PET showed multifocal areas of retention at the cortical gray matter-white matter junction, a distribution considered pathognomonic for CTE. [18F]T807/AV1451 standard uptake value (SUV) analysis showed increased uptake (SUVr⩾1.1) in bilateral cingulate, occipital, and orbitofrontal cortices, and several temporal areas. Although definitive identification of the neuropathological underpinnings basis for [18F]T807/AV1451 retention requires postmortem correlation, our data suggest that [18F]T807/AV1451 tauopathy imaging may be a promising tool to detect and diagnose CTE-related tauopathy in living subjects.

Second fractures among older adults in the year following hip, shoulder, or wrist fracture.

UNLABELLED: We report on second fracture occurrence in the year following a hip, shoulder or wrist fracture using insurance claims. Among 273,330 people, 4.3 % had a second fracture; risk did not differ by first fracture type. Estimated adjusted second fracture probabilities may facilitate population-based evaluation of secondary fracture prevention strategies. INTRODUCTION: The purpose of this study was estimate second fracture risk for the older US population in the year following a hip, shoulder, or wrist fracture. METHODS: Observational cohort study of Medicare fee-for-service beneficiaries with an index hip, shoulder, or wrist fragility fracture in 2009. Time-to-event analyses using Cox proportional hazards models to characterize the relationship between index fracture type (hip, shoulder, wrist) and patient factors (age, gender, and comorbidity) on second fracture risk in the year following the index fracture. RESULTS: Among 273,330 individuals with fracture, 11,885 (4.3 %) sustained a second hip, shoulder or wrist fracture within one year. Hip fracture was most common, regardless of the index fracture type. Comparing adjusted second fracture risks across index fracture types reveals that the magnitude of second fracture risk within each age-comorbidity group is similar regardless of the index fracture. Men and women face similar risks with frequently overlapping confidence intervals, except among women aged 85 years or older who are at greater risk. CONCLUSIONS: Regardless of index fracture type, second fractures are common in the year following hip, shoulder or wrist fracture. Secondary fracture prevention strategies that take a population perspective should be informed by these estimates which take competing mortality risks into account.

Dinâmica da população de coliformes durante a compostagem automatizada de dejetos líquidos de suínos / Population dynamics during composting of fecal automated pig slurry

Microrganismos presentes em dejetos de suínos podem contaminar o meio ambiente. Embora a compostagem seja preconizada como um método eficiente para reduzir este potencial poluidor dos dejetos, existem poucas informações de pesquisa sobre tal processo. O presente trabalho teve o objetivo de avaliar a eficiência da compostagem automatizada dos dejetos líquidos de suínos (DLS) na redução da população de coliformes, usados como indicadores de poluição fecal. Os DLS foram adicionados periodicamente, durante 106 dias, em substrato constituído pela mistura, em partes iguais, de maravalha e serragem. Foram efetuadas 14 adições de DLS, e em cada adição as leiras de compostagem eram revolvidas por meio de uma máquina especialmente desenvolvida para este fim. Foram avaliados dois tratamentos com três repetições, sendo um com e outro sem adição de ácido fosfórico aos dejetos, até pH 6,0. A adição de ácido visou reduzir as perdas de N por volatilização de amônia (NH3) durante a compostagem. A avaliação da população de coliformes foi feita pela técnica do número mais provável (NMP), com uso do caldo Fluorocult, incubado a 37ºC por 24h e posterior leitura em luz ultravioleta. A população de coliformes fecais não foi afetada pela adição de ácido fosfórico. O processo de compostagem automatizada foi eficiente na redução de coliformes fecais, cuja população original passou de 4,2x1010 para 1,2 x 105 ao final da compostagem (156 dias) sem adição de ácido e de 3,8x1010 para 2,3x104 na compostagem com adição de ácido. Essa remoção de coliformes fecais, promovida pela compostagem automatizada dos dejetos líquidos de suínos, corresponde a 99,99 por cento...

Microorganisms present in pig manure can contaminate the environment. Although composting is recommended as an efficient method to reduce the pollution potential of waste, there is little research information on this process. This study aimed to evaluate the efficiency of automated composting of pig slurry (PS) in reducing the population of coliforms, used as fecal pollution indicators. The PS was added periodically during 106 days in substrate, with a mixture, in equal parts, of wood shavings and sawdust. There were 14 additions of PS and at each addition the compost windrows were revolved through a machine especially developed for this purpose. Two treatments with three replications were evaluated, one with and one without the addition of phosphoric acid to the slurry up to pH 6.0. The acid addition aimed to reduce N losses through the volatilization of ammonia (NH3) during composting. Coliforms were evaluated by the technique of most probable number (MPN) using the Fluorocult broth, incubated at 37 ° C for 24 h and subsequent reading in ultra violet light. The population of fecal coliforms was not affected by the addition of phosphoric acid. The automated composting process was effective in reducing faecal coliforms, whose original population decreased from 4.2 x 1010 to 1.2 x 105 at the end of composting (156 days) without addition of acid and from 3.8 x1010 to 2,3 x104 in compost with added acid. This removal of faecal coliforms, promoted by automated composting of pig slurry, corresponds to 99.99 percent...

Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004.

In November 2001, the 1st International Symposium on Concussion in Sport was held in Vienna, Austria to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, football (soccer), and other sports. The 2nd International Symposium on Concussion in Sport was organised by the same group and held in Prague, Czech Republic in November 2004. It resulted in a revision and update of the Vienna consensus recommendations, which are presented here.

Magnetic field exposure during gestation: pineal and cerebral cortex serotonin in the rat.

Extremely low frequency (ELF) magnetic fields seem to have a reproducible influence on cells in transitional states, such as cells during the embryonic and early postnatal periods. Intense and continuous serotonergic synaptic growth is present during the first 2 weeks of postnatal development, paralleled by 5-HT content in the brain, so, the effect of ELF on 5-HT content in the cerebral cortex and pineal gland was determined in growing rats exposed during pregnancy, and in normal controls. The results showed a significant 5-HT increase at birth, 15 and 21 days, in the cerebral cortex. No differences were found in the pineal gland. These short MF exposures had a long term effect on cerebral cortex 5-HT, possibly starting since the fetal period. The relevance of the present findings are discussed as related to the serotonin trophic role on the brain cortex.

Stable association complex electrospray mass spectrometry for the determination of cyanuric acid.

Cyanuric acid, a suspected gastrointestinal or liver toxicant, has gained interest as a potential degradation product of triazine herbicides, such as simazine and atrazine. This paper investigates the determination of cyanuric acid by stable association complex electrospray mass spectrometry (cESI-MS). The cyanuric acid is extracted from the water through a microscale liquid-liquid extraction. The extract is evaporated to dryness, and an aqueous solution of quaternary ammonium cationic surfactant is added. When injected into the electrospray mass spectrometer, the surfactant and the cyanuric acid form a mass-selective stable association complex, which may be used for confident quantification of cyanuric acid. Several extraction solvents and surfactants were investigated. These studies provide insight into the mechanism of electrospray for the formation of these complexes, specifically with regard to the surface activity of the different surfactants and the chemistry of the surfactant-cyanuric acid complexes. From an analytical standpoint, the cESI-MS method detection limit for extraction of a 1 mL aqueous solution of cyanuric acid was 130 microg/L based on 3.14sigma(n-1) of seven replicate injections. Standard additions were used for quantification of eight aqueous samples. The cyanuric acid concentrations determined with cESI-MS were not significantly different at the 95% confidence level to those determined by conventional high-performance liquid chromatography (HPLC). A recovery of 100% from a fortified urine sample illustrates the robustness of the technique.

HPLC determination of cyanuric acid in swimming pool waters using phenyl and confirmatory porous graphitic carbon columns.

The chlorinated salts of cyanuric acid have found an important role in recreational swimming pool waters across the United States. Upon application to pool water, they can (1) release disinfectant chlorine or (2) stabilize the free available chlorine by acting as chlorine reservoirs in the form of cyanuric acid, preventing the photolytic destruction of residual chlorine by sunlight. Recommended levels of the cyanuric acid stabilizer are in the 10-100 mg/L concentration range according to the National Swimming Pool Foundation (San Antonio, TX). Two isocratic HPLC methods with UV detection (213 nm) employing phenyl and porous graphitic carbon (PGC) columns and phosphate buffer eluents (pH 6.7 and pH 9.1, respectively) were developed to accurately measure cyanuric acid in swimming pools. The two methods allowed fast separation and detection of the stabilizer in 4 (phenyl) and 8 (PGC) min. Both methods offered practical sensitivities with method detection limits of 0.07 (phenyl) and 0.02 mg/L (PGC). Neither one of the two methods required the use of sample cleanup cartridges. They exhibit chromatograms with excellent baseline stability enabling low-level quantitation. Most important, the PGC column had a useful lifetime of five months and 500 sample analyses/column. Eleven pool water samples were fortified with 4.8-50.0 mg/L stabilizer, and the average recovery was 99.8%. Finally, statistical analysis on the relative precisions of the two methods indicated equivalence at the 0.05 critical level.

Head injury in athletes.

HEAD INJURIES INCURRED during athletic endeavors have been recorded since games were first held. During the last century, our level of understanding of the types of cerebral insults, their causes, and their treatment has advanced significantly. Because of the extreme popularity of sports in the United States and worldwide, the implications of athletic head injury are enormous. This is especially true considering the current realization that mild traumatic brain injury (MTBI) or concussion represents a major health consideration with more long-ranging effects than previously thought. When considering athletic injuries, people who engage in organized sports, as well as the large number of people who engage in recreational activities, should be considered. There are 200 million international soccer players, a group increasingly recognized to be at risk for MTBI. The participation in contact sports of a large number of the population, especially youth, requires a careful and detailed analysis of injury trends and recommended treatment. There are numerous characteristics of this patient population that make management difficult, especially their implicit request to once again be subjected to potential MTBI by participating in contact sports. Recent research has better defined the epidemiological issues related to sports injuries involving the central nervous system and has also led to classification and management paradigms that help guide decisions regarding athletes' return to play. We currently have methods at our disposal that greatly assist us in managing this group of patients, including improved recognition of the clinical syndromes of MTBI, new testing such as neuropsychological assessment, radiographic evaluations, and a greater appreciation of the pathophysiology of concussive brain injury. The potential for long-term consequences of repetitive MTBI has been recognized, and we no longer consider the "dinged" states of athletic concussions to have the benign connotations they had in the past. We review the historical developments in the recognition and care of athletes with head injuries, the current theory of the pathophysiology and biomechanics of these insults, and the recommended management strategy, including return-to-play criteria.

An HPLC method with UV detection, pH control, and reductive ascorbic acid for cyanuric acid analysis in water.

Every year over 250 million pounds of cyanuric acid (CA) and chlorinated isocyanurates are produced industrially. These compounds are standard ingredients in formulations for household bleaches, industrial cleansers, dishwasher compounds, general sanitizers, and chlorine stabilizers. The method developed for CA using high-performance liquid chromatography (HPLC) with UV detection simplifies and optimizes certain parameters of previous methodologies by effective pH control of the eluent (95% phosphate buffer: 5% methanol, v/v) to the narrow pH range of 7.2-7.4. UV detection was set at the optimum wavelength of 213 nm where the cyanuric ion absorbs strongly. Analysis at the lower pH range of 6.8-7.1 proved inadequate due to CA keto-enol tautomerism, while at pHs of <6.8 there were substantial losses in analytical sensitivity. In contrast, pHs of >7.4 proved more sensitive but their use was rejected because of CA elution at the chromatographic void volume and due to chemical interferences. The complex equilibria of chlorinated isocyanurates and associated species were suppressed by using reductive ascorbic acid to restrict the products to CA. UV, HPLC-UV, and electrospray ionization mass spectrometry techniques were combined to monitor the reactive chlorinated isocyanurates and to support the use of ascorbic acid. The resulting method is reproducible and measures CA in the 0.5-125 mg/L linear concentration range with a method detection limit of 0.05 mg/L in water.

Same-session endoscopic retrograde cholangiopancreatography and cholecystectomy.

The objective was to determine the efficacy and safety of same-session endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy. Twenty-two patients who had ERCP and cholecystectomy performed in the same session under one general anesthetic were compared with 77 patients who had ERCP followed by surgery in the ensuing days. In the 93 patients who underwent attempted laparoscopic cholecystectomy, there was no difference in conversion to open rates between the same-session group and the delayed group. The length of stay after ERCP was longer in the delayed group. Same-session ERCP and cholecystectomy is safe and efficacious, and its routine use should be considered.