Service Animals in Health Care Settings.

This JAMA Insights article reviews Americans with Disabilities Act (ADA) rules for patients, visitors, and other members of the public bringing service animals into health care settings.

Exploring the relationship between contraceptive medication use and concussion recovery in female collegiate athletes: a LIMBIC MATARS consortium investigation.

OBJECTIVE: While recovery from concussion is variable, women are more likely to report symptoms, experience worse outcomes, and have longer recovery trajectories following concussion than men. Preliminary data suggest that hormonal fluctuations, specifically progesterone, may be associated with this variability. This study aimed to understand the effect of contraceptive medication on concussion recovery. METHODS: A retrospective chart review using consensus-based common data elements was conducted at 11 NCAA institutions as part of the LIMBIC MATARS consortium. Participants included female collegiate athletes diagnosed with a concussion who did (n = 117) or did not report (n = 339) contraceptive medication use. Number of days between diagnosis and symptom resolution were compared using Mann-Whitney U tests. Self-reported diagnosis of attention deficit hyperactivity disorder, concussion history, anxiety, and depression was compared using Chi-squared tests. RESULTS: The proportions of participants who did or did not take contraceptive medication were similar across covariates. Female athletes regardless of contraceptive medication use recovered similarly following a concussion. CONCLUSIONS: Our findings suggest that contraceptive medication use did not significantly impact concussion recovery. Future prospective investigations should examine documentation practices and operationalize terminology for hormonal contraceptive medication to better understand their role on recovery from sport-related concussion in female collegiate athletes.

The influence of ADHD on recovery from sport concussion among collegiate athletes in the United States: LIMBIC MATARS consortium investigation.

OBJECTIVE: The present study aimed to assess the potential influence of a diagnosis of ADHD on concussion recovery among collegiate athletes. DESIGN: Retrospective and cross-sectional. METHODS: Data were extracted retrospectively from medical records across LIMBIC MATARS member institutions (n = 11), representing 1,044 concussion cases among collegiate athletes. After exclusions, 406 concussions were included in our analysis (ADHD: n = 38, age = 20.2 ± 1.67 years, 18.4% female; No ADHD: n = 368, age = 19.8 ± 1.39 years, 40.1% female). Mann-Whitney U tests were used to compare days from injury to diagnosis, symptom resolution, and return to sport among athletes with and without ADHD. RESULTS: No differences were observed for days from concussion until diagnosis (z = -0.33, p = 0.74), until days to symptom resolution (z = -1.30, p = 0.19), or days until return to sport (z = -0.68, p = 0.49); among concussion cases with or without a previously reported diagnosis of ADHD. CONCLUSION: Our findings further expand the literature that suggests ADHD is not strongly associated with recovery trajectory following sport concussion in collegiate athletes. Future research should extend these findings to be inclusive of additional preexisting health conditions and moderating effects related to medication usage among diverse athlete levels.

Concussion-Related Disruptions to Hub Connectivity in the Default Mode Network Are Related to Symptoms and Cognition.

Concussions present with a myriad of symptomatic and cognitive concerns; however, the relationship between these functional disruptions and the underlying changes in the brain are not yet well understood. Hubs, or brain regions that are connected to many different functional networks, may be specifically disrupted after concussion. Given the implications in concussion research, we quantified hub disruption within the default mode network (DMN) and between the DMN and other brain networks. We collected resting-state functional magnetic resonance imaging data from collegiate student-athletes (n = 44) at three time points: baseline (before beginning their athletic season), acute post-injury (approximately 48h after a diagnosed concussion), and recovery (after starting return-to-play progression, but before returning to contact). We used self-reported symptoms and computerized cognitive assessments collected across similar time points to link these functional connectivity changes to clinical outcomes. Concussion resulted in increased connectivity between regions within the DMN compared with baseline and recovery, and this post-injury connectivity was more positively related to symptoms and more negatively related to visual memory performance compared with baseline and recovery. Further, concussion led to decreased connectivity between DMN hubs and visual network non-hubs relative to baseline and recovery, and this post-injury connectivity was more negatively related to somatic symptoms and more positively related to visual memory performance compared with baseline and recovery. Relationships between functional connectivity, symptoms, and cognition were not significantly different at baseline versus recovery. These results highlight a unique relationship between self-reported symptoms, visual memory performance, and acute functional connectivity changes involving DMN hubs after concussion in athletes. This may provide evidence for a disrupted balance of within- and between-network communication highlighting possible network inefficiencies after concussion. These results aid in our understanding of the pathophysiological disruptions after concussion and inform our understanding of the associations between disruptions in brain connectivity and specific clinical presentations acutely post-injury.

Utility of the Counseling Center Assessment of Psychological Symptoms Screen in a Collegiate Athlete Population.

CONTEXT: Mental health screening as a part of collegiate athletic preparticipation evaluations is becoming increasingly common, but effective and efficient screening depends on a screening tool that can accurately identify mental health symptoms and the need for mental health intervention. DESIGN: Case-control study. SETTING: Archival clinical records review. PATIENTS OR OTHER PARTICIPANTS: Two cohorts of incoming National Collegiate Athletics Association Division I collegiate athletes (N = 353). MAIN OUTCOME MEASURE(S): Athletes completed the Counseling Center Assessment of Psychological Symptoms (CCAPS) Screen as a part of their preparticipation evaluation. These data were then matched with basic demographic data and mental health treatment history from clinical records, and the utility of the CCAPS Screen in determining a future or ongoing need for mental health services was analyzed. RESULTS: Score differences for each of the 8 CCAPS Screen scales (Depression, Generalized Anxiety, Social Anxiety, Academic Distress, Eating Concerns, Frustration, Family Distress, and Alcohol Use) were found based on several demographic variables. Logistic regression analysis demonstrated that female sex, team sport participation, and the Generalized Anxiety scale score predicted future participation in mental health treatment. Decision tree testing of the CCAPS scales showed low utility in classifying those who received mental health treatment versus those who did not. CONCLUSIONS: The CCAPS Screen did not appear to differentiate well between those who eventually received mental health services and those who did not. This should not be taken to mean that mental health screening is not useful but rather that a 1-time, state-based screening is not sufficient for athletes who experience intermittent but recurring stressors in a dynamic environment. A proposed model for improving the current standard of practice for mental health screening is provided as a focus of future research.

Survey of depressive symptomatology in brain injury resulting from intimate partner violence.

OBJECTIVE: A high prevalence of depression exists in specific sub-samples of survivors of brain injury (BI) sustained from intimate partner violence (IPV). However, the experience of depression by survivors of IPV-related BI from general civilian populations remains unclear. This study documents the symptom profile of depression reported by individuals who screened positive for sustaining an IPV-related BI. METHODS: 36 individuals who screened positive for possible IPV-related BI completed the Beck Depression Inventory-2nd Edition (BDI-II). Subscales characterizing the nature of the symptoms were created. Frequency and descriptive statistics were calculated for item responses on the BDI-II. Participants were also assigned to high or low symptom severity groups to examine between-group differences. RESULTS: Participants endorsed experiencing somatic symptoms more severely than self-evaluative and affective symptoms. Additionally, self-evaluative and cognitive symptoms correlated with total BDI-II scores for the high symptom severity group but not for the low symptom severity group. CONCLUSIONS: The findings highlight somatic symptoms of depression, in particular as a common experience among survivors of IPV-related BI. Further, self-evaluative and cognitive symptoms may be more sensitive in detecting depression after IPV-related BI. These results may aid in the development of guidelines to better diagnose and treat depression in IPV-related BI.

Lithium Chloride-Substituted Methylammonium Lead Tribromide Perovskites for Dual γ/Neutron Sensing.

Dual γ/neutron radiation sensors are a critical component of the nuclear security mission to prevent the proliferation of a special nuclear material (SNM). While high-performing semiconductors such as high purity germanium (HPGe) and CdZnTe (CZT) already exist in the nuclear security enterprise, their high cost and/or logistical burdens make widespread deployment difficult to achieve. Metal lead halide perovskites (MHPs) have attracted interest in recent years to address this challenge. In particular, methylammonium lead tribromide (CH3NH3PbBr3, MAPbBr3, or MAPB) has been widely evaluated for its radiation sensing capabilities. While previous studies have demonstrated low-energy X-ray and α particle sensing of MAPB-based detectors and several studies discuss the potential for γ ray sensing, neutron sensing of this material has been rarely explored. Here, we explore the incorporation of lithium in the form of LiCl into the MAPB structure to add thermal neutron sensitivity. Characterizations of the lithium-doped MAPB crystals demonstrate that quality growths are achievable with single crystals that exhibit high crystallinity, no phase change, and high macroscopic bulk quality. Finally, we report on the first demonstrated γ ray and thermal neutron sensing based on lithium-doped MAPB single crystals, which is a significant milestone in the development of 3D dual γ/neutron MHP sensors.

High-Throughput Study of Antisolvents on the Stability of Multicomponent Metal Halide Perovskites through Robotics-Based Synthesis and Machine Learning Approaches.

Antisolvent crystallization methods are frequently used to fabricate high-quality metal halide perovskite (MHP) thin films, to produce sizable single crystals, and to synthesize nanoparticles at room temperature. However, a systematic exploration of the effect of specific antisolvents on the intrinsic stability of multicomponent MHPs has yet to be demonstrated. Here, we develop a high-throughput experimental workflow that incorporates chemical robotic synthesis, automated characterization, and machine learning techniques to explore how the choice of antisolvent affects the intrinsic stability of binary MHP systems in ambient conditions over time. Different combinations of the end-members, MAPbI3, MAPbBr3, FAPbI3, FAPbBr3, CsPbI3, and CsPbBr3 (MA, methylammonium; FA+, formamidinium), are used to synthesize 15 combinatorial libraries, each with 96 unique combinations. In total, roughly 1100 different compositions are synthesized. Each library is fabricated twice by using two different antisolvents: toluene and chloroform. Once synthesized, photoluminescence spectroscopy is automatically performed every 5 min for approximately 6 h. Nonnegative matrix factorization (NMF) is then utilized to map the time- and compositional-dependent optoelectronic properties. Through the utilization of this workflow for each library, we demonstrate that the selection of antisolvent is critical to the intrinsic stability of MHPs in ambient conditions. We explore possible dynamical processes, such as halide segregation, responsible for either the stability or eventual degradation as caused by the choice of antisolvent. Overall, this high-throughput study demonstrates the vital role that antisolvents play in the synthesis of high-quality multicomponent MHP systems.

Intimate Partner Violence and Brain Injury Screening.

The study examined rates of possible brain injury among survivors of intimate partner violence. Of the 171 women screened, 91% indicated they had been hit in the head or strangled, and 31% reported it happened more than six times in their life. Only 35% of women who were hit in the head or strangled received medical treatment, and 64% reported losing consciousness or experienced a period of being dazed and confused. Organizations serving intimate partner violence survivors should routinely screen survivors for brain injury so they can obtain timely referrals for neurorehabilitation services to improve their quality of life.

Psoriatic arthritis treatment patterns and costs among pharmacologic treatment-naïve patients.

OBJECTIVES: Pharmacologic treatment for psoriatic arthritis (PsA) includes traditional oral small molecules (OSMs), tumor necrosis factor inhibitors (TNFis), and newer oral therapies such as a phosphodiesterase-4 (PDE4) inhibitor and a Janus kinase inhibitor. We aimed to describe treatment patterns and health care costs for treatment-naïve patients with active PsA initiating pharmacologic treatment. STUDY DESIGN: This was an observational, retrospective study. METHODS: We assessed treatment patterns and health care costs from the IBM MarketScan Research databases. We calculated costs during the 12-month follow-up period for inpatient and outpatient medical health care, including outpatient prescription costs. RESULTS: A total of 3491 patients were identified for the study. Incident therapies included OSMs methotrexate (58.3%), sulfasalazine (9.8%), hydroxychloroquine (2.3%), and other OSMs (1.9%); TNFis adalimumab (12.3%), etanercept (8.6%), infliximab (1.9%), and other TNFis (1.4%); and the PDE4 inhibitor apremilast (2.6%). Persistence ranged from 15.2% to 34.6% with OSM monotherapy and from 42.9% to 58.2% with TNFi monotherapy. Percentage of patients with a gap of at least 60 days in therapy ranged from 42.9% to 48.5% with OSMs and from 17.9% to 29.9% with TNFis. Mean first-line unadjusted per-patient per-month total health care costs for OSMs ranged from $1029 to $1456 and mean total health care costs ranged from $19,173 to $25,013. Mean unadjusted per-patient per-month total health care costs for TNFis ranged from $4203 to $7063 and mean total health care costs ranged from $45,635 to $60,933. CONCLUSIONS: Although patients using OSMs had generally lower total health care costs, they also had the highest rates of treatment modifications such as low persistence and medication gaps of at least 60 days.

Outcomes and change processes of an established family education program for carers of adults diagnosed with a serious mental health condition.

BACKGROUND: Family education programs (FEPs) target caregiving-related psychological distress for carers of relatives/friends diagnosed with serious mental health conditions. While FEPs are efficacious in reducing distress, the mechanisms are not fully known. Peer group support and greater mental health knowledge are proposed to reduce carers' psychological distress by reducing stigmatising attitudes and self-blame, and strengthening carers' relationship with their relative. METHODS: Adult carers (n = 1016) who participated in Wellways Australia's FEP from 2009 to 2016 completed self-report questionnaires at the core program's start and end, during the consolidation period, and at a 6-month follow-up. Those who enrolled early completed questionnaires prior to a wait-list period. We used linear mixed-effects modelling to assess the program's effectiveness using a naturalistic wait-list control longitudinal design, and multivariate latent growth modelling to test a theory-based process change model. RESULTS: While there was no significant change over the wait-list period, psychological distress, self-blame and stigmatising attitudes significantly decreased, and communication and relationship quality/feelings increased from the core program's start to its end. Changes were maintained throughout the consolidation period and follow-up. Peer group support significantly predicted the declining trajectory of distress. Peer group support and greater knowledge significantly predicted declining levels of self-blame and stigmatising attitudes, and increasing levels of communication. CONCLUSIONS: This is the first study to quantitatively validate the mechanisms underlying the effect of FEPs on carers' psychological distress. Peer group support is key in modifying carers' appraisals of their friend/relatives' condition. Continued implementation of FEPs within mental health service systems is warranted.

Spatially Resolved Carrier Dynamics at MAPbBr3 Single Crystal-Electrode Interface.

Despite the rapid progress in organic-inorganic halide perovskites (OIHPs) for applications such as solar cells and detectors, knowledge of coupling between electronic and ionic charge carrier dynamics is so far limited. While the presence of dual-conduction channels is widely accepted, the precise physical mechanisms governing the impact of electronic (e.g. electrons and holes) and ionic conduction, especially interface phenomena, remain uncertain. The lack of understanding stems largely from the lack of appropriate tools to capture the electrochemical dynamics on the length scales of the local inhomogeneities present (e.g., interfaces, grain boundaries, space charge regions) and time scales over which the coupled dynamics take place. Here, we implement Kelvin probe force microscopy (KPFM) to explore the charge carrier dynamics at the methylammonium lead tribromide (MAPbBr3) single crystal-gold electrode interface. In this work, the temporal dynamics of the electric field and charge carrier distribution at the electrode interface is spatially visualized by time-resolved KPFM mapping. The results demonstrate an interplay of several phenomena, including charge injection, recombination, and ion migration, leading to an unbalanced charge dynamic at MAPbBr3 single crystal-electrode interface under forward and reverse bias conditions explaining the origin of the current-voltage hysteresis in these devices. We contrast the bias-assisted charge dynamics under both illuminated and dark conditions, providing a comprehensive picture of overall carrier dynamics and interface properties in a MAPbBr3 single crystal with lateral symmetric Au electrodes. Remarkably, illumination leads to the formation of a wider space charge region due to accumulation of negative charges (both electrons and halide ions) at the positive electrode, which can effectively screen the external electric field leading to lower charge extraction efficiency. The results suggest that the choice of contact or interfacial engineering can control the performance of OIHP devices without requiring modification of the material's bulk properties.

Concussion competencies: a training model for school-based concussion management.

This study reports on the use of ten knowledge competencies related to the behavioral management of concussion in schools. Trainings using these competencies as learning objectives were delivered to school personnel. This aims of the use of competencies in this way are to streamline the education of key stakeholders, to establish clear roles and responsibilities for constituents and equip individuals working with students following a concussion with the relevant knowledge to optimize outcomes. The majority of participants, primarily speech language pathologists working as related service providers in the schools where the trainings occurred, judged the use of the competencies to be informative and useful to their practice both immediately following the training and at a 5-month follow-up. The greatest gains in knowledge were noted by those participants self-reporting the least amount of knowledge pre-training. Participants also ranked the perceived value and relative importance of each of the ten competencies.

Patient Eligibility for Transoral Endocrine Surgery Procedures in the United States.

Importance: Transoral endocrine surgery (TES) allows thyroid and parathyroid operations to be performed without leaving any visible scar on the body. Controversy regarding the value of TES remains, in part owing to the common belief that TES is only applicable to a small, select group of patients. Knowledge of the overall applicability of these procedures is essential to understand the operation, as well as to decide the amount of effort and resources that should be allocated to further study the safety, efficacy, and value of these operations. Objective: To determine what percentage of US patients undergoing thyroid and parathyroid surgery are eligible for TES using currently accepted exclusion criteria. Design, Setting, and Participants: Cross-sectional study of 1000 consecutive thyroid and parathyroid operations (with or without neck dissection) performed between July 1, 2015, and July 1, 2018, at 3 high-volume academic US thyroid- and parathyroid-focused surgical practices (2 general surgery, 1 otolaryngology-head and neck endocrine surgery). Eligibility for TES was determined by retrospectively applying previously published exclusion criteria to the cases. Main Outcomes and Measures: The primary outcome was the percentage of thyroid and parathyroid cases eligible for TES. Secondary outcomes were a subgroup analysis of the percentage of specific types of cases eligible and the reasons for ineligibility. Results: The mean (SD) age of the 1000 surgical patients was 53 (15) years, mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 29 (7), and 747 (75.0%) of the patients were women. Five hundred fifty-eight (55.8%) of the patients were eligible for TES. Most patients with thyroid nodules with cytologically indeterminate behavior (165 of 217 [76.0%]), benign thyroid conditions (166 of 240 [69.2%]), and primary hyperparathyroidism (158 of 273 [57.9%]) were eligible for TES, but only 67 of 231 (29.0%) of patients with thyroid cancer were eligible. Among all 1000 cases reviewed, previous neck operation (97 of 441 [22.0%]), nonlocalized primary hyperparathyroidism (78 of 441 [17.7%]), and need for neck dissection (66 of 441 [15.0%]) were the most common reasons for ineligibility. Conclusions and Relevance: More than half of all patients undergoing thyroid and parathyroid surgery in this study were eligible for TES. This broad applicability suggests that a prospective multicenter trial is reasonable to definitively study the safety, outcomes, and cost of TES.

Persistence and adherence of biologics in US patients with psoriatic arthritis: analyses from a claims database.

Aim: To evaluate the persistence and adherence of subcutaneous biologics in patients with psoriatic arthritis (PsA). Patients & methods: Psoriatic arthritis patients who initiated adalimumab, certolizumab pegol, etanercept, golimumab or secukinumab between 15 January 2016 and 31 July 2017 were identified in the Truven Databases. Outcomes included discontinuation rate, persistence and adherence over 12 months. Results: Of 1558 patients included, the 12-month discontinuation rate was lowest with secukinumab (36.5%), followed by adalimumab, golimumab, etanercept and certolizumab pegol (42.6-51.6%). Mean persistence ranged from 240.7 (certolizumab pegol) to 282.8 days (secukinumab). The mean proportion of days covered was highest with secukinumab (0.67) and lowest with certolizumab pegol (0.49). Conclusion: Patients who initiated secukinumab had the lowest discontinuation rate and highest persistence and adherence over 12 months.

Vocational support in mental health service delivery in Australia.

BACKGROUND: Individuals experiencing severe and persistent mental illness report a desire to gain and sustain work. Individual Placement and Support (IPS) is an evidence-based approach to vocational rehabilitation to support competitive employment outcomes. AIM/OBJECTIVE: This study aimed to evaluate whether a joint-governance management partnership, between a clinical adult mental health and an employment service, could deliver a sustained IPS program in Australia. MATERIALS AND METHOD: The methodology entailed a Clinical Data Mining approach, to examine records from seven years of implementation of IPS in one setting within an Australian public mental health service context. RESULTS/FINDINGS: Despite the prevalence of schizophrenia spectrum diagnoses and an older mean age (39 years), indicating that a large proportion of the cohort had experienced serious mental illness for over twenty years, findings were that 46.3% of participants achieved employment. CONCLUSIONS: This is an excellent result and is comparable to the only randomised control trial, with adult services, in the Australian context, which found a 42.5% employment rate possible under IPS compared with just 23.5% with referral to external employment services. SIGNIFICANCE: More extensive trialling of IPS across clinical services is required, in Australia and internationally, including fidelity protocols, for knowledge translation to be achieved.

Trends of genetic screening in patients with pheochromocytoma and paraganglioma: 15-year experience in a high-volume tertiary referral center.

BACKGROUND AND OBJECTIVES: Genetic testing for pheochromocytoma and paraganglioma allows for early detection of hereditary syndromes and enables close follow-up of high-risk patient. We investigated the trends in genetic testing among patients at a high-volume referral center and evaluated the prevalence of pheochromocytomas and paragangliomas. METHODS: We reviewed the charts of 129 patients who underwent adrenalectomy for pheochromocytoma and paraganglioma between January 2000 and July 2015. To evaluate for trends in genetic testing, patients were divided by year of diagnosis: 2000-2005 (group 1, n = 35), 2006-2010 (group 2, n = 44), and 2011-2015 (group 3, n = 50). RESULTS: Among 129 patients the mean age was 47 years and 56% were women. Groups 2 and 3 were more frequently referred for genetic consultation than group 1, 73%, and 94% versus 26% (P < 0.001). A total of 67% followed up on the referral. The prevalence of genetic mutation was 50% (21/42 tested). The percentage with a genetic syndrome was 23%, 28%, and 22% respectively for groups 1, 2, and 3. CONCLUSIONS: Referral for genetic counseling significantly increased in the past 15 years. However, only two-thirds of patients followed up with genetic counselors and, therefore, clinicians can do more to improve the adherence rate for genetic counseling.

Challenges in implementing individual placement and support in the Australian mental health service and policy context.

Objective Although Australia's service and policy context differs from that of the US, studies have highlighted potential for individual placement and support (IPS) to support competitive employment outcomes for people with severe and persistent mental illness. The aim of the present study was to explore why the model is not yet widely available. Methods A document analysis was conducted to discern reasons for challenges in implementation of IPS practice principles within the Australian service context. Results The document analysis illustrated that although policy acknowledges the importance of increasing employment rates for people with severe and persistent mental illness, consistent measures, change indicators, direction and time frames are lacking in policy and strategy documentation. Further, IPS principles are not consistently evident in guiding operational documentation that government-funded Disability Employment Services (DES) programs are mandated to adhere to. Conclusions For IPS to be readily implemented, it is necessary for government to offer support to agencies to partner and formal endorsement of the model as a preferred approach in tendering processes. Obligations and processes must be reviewed to ensure that model fidelity is achievable within the Australian Commonwealth policy and service context for programs to achieve competitive employment rates comparable to the most successful international programs. What is known about the topic? The IPS model has been established as the most efficacious approach to support people with severe and persistent mental ill health to gain and sustain employment internationally, yet little is known as to why this model has had very limited uptake in the Australian adult mental health service and policy context. What does this paper add? This paper provides an investigation into the achievability of IPS within DES philosophical and contractual arrangements. What are the implications for practitioners? Mental health practitioners are typically skilled in their understanding of individual or micro-level challenges faced by consumers in achieving vocational goals: working with symptoms, medication side effects, motivation and anxiety. The present study was designed to offer practitioners an increased understanding of service-level factors, because these present considerable challenges to achieving sustained employment. This paper is a call for greater advocacy towards better integration of employment and mental health service delivery in the Australian policy and practice context.

Utility of repeated assessment after invalid baseline neurocognitive test performance.

CONTEXT: Although the prevalence of invalid baseline neurocognitive testing has been documented, and repeated administration after obtaining invalid results is recommended, no empirical data are available on the utility of repeated assessment after obtaining invalid baseline results. OBJECTIVE: To document the utility of readministering neurocognitive testing after an invalid baseline test. DESIGN: Case series. SETTING: Schools, colleges, and universities. PATIENTS OR OTHER PARTICIPANTS: A total of 156 athletes who obtained invalid results on ImPACT baseline neurocognitive testing and were readministered the ImPACT baseline test within a 2-week period (mean = 4 days). MAIN OUTCOME MEASURE(S): Overall prevalence of invalid results on reassessment, specific invalidity indicators at initial and follow-up baseline, dependent-samples analysis of variance, with Bonferroni correction for multiple comparisons. RESULTS: Reassessment resulted in valid test results for 87.2% of the sample. Poor performance on the design memory and three-letter subscales were the most common reasons for athletes obtaining an invalid baseline result, on both the initial assessment and the reassessment. Significant improvements were noted on all ImPACT composite scores except for reaction time on reassessment. Of note, 40% of athletes showed slower reaction time scores on reassessment, perhaps reflecting a more cautious approach taken the second time. Invalid results were more likely to be obtained by athletes with a self-reported history of attention-deficit disorder or learning disability on reassessments (35%) than on initial baseline assessments (10%). CONCLUSIONS: Repeat assessment after the initial invalid baseline performance yielded valid results in nearly 90% of cases. Invalid results on a follow-up assessment may be influenced by a history of attention-deficit disorder or learning disability, the skills and abilities of the individual, or a particular test-taking approach; in these cases, a third assessment may not be useful.

Highly selective synthesis of tetra-substituted furans and cyclopropenes: copper(I)-catalyzed formal cycloadditions of internal aryl alkynes and diazoacetates.

A convenient Cu(I)-catalyzed cycloaddition of electron rich internal aryl alkynes and diazoacetates was discovered for the chemoselective and regioselective synthesis of tetra-substituted furans and cyclopropenes in moderate isolated yields (18-67%), and alkyne conversion (29-73%).