201-450 exam Dumps Source : LPIC-2 Exam 201, section 1 of 2, version 4.5
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Test denomination : LPIC-2 Exam 201, section 1 of 2, version 4.5
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LPIC-2 ( examination codes 201-450 and 202-450 ) is the 2d certification in LPI’s multi-stage knowledgeable certification application. The LPIC-2 will validate the candidate's means to administer small to medium–sized blended networks. The candidate should acquire an energetic LPIC-1 certification to receive LPIC-2 certification, but the LPIC-1 and LPIC-2 exams can exist taken in any order.
necessities: The candidate ought to acquire an lively LPIC-1 certification to receive LPIC-2 certification, but the LPIC-1 and LPIC-2 checks may well exist taken in any order
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Your League: ARRL Reply Comments Cite "Fundamental Misunderstanding" of "Symbol Rate" Petition
In reply comments filed on its "symbol rate" Petition for Rule Making (RM-11708), the ARRL said comments opposed to its initiative reflect a "fundamental misunderstanding" of the petition's intent. The League's petition now tops the FCC's list of "Most energetic Proceedings." More than 800 comments were filed as of January 7, some of them posted after the December 23 cut-off date and most favoring the ARRL's proposal. The ARRL earlier filed comments with the FCC on its own Petition (plus Erratum). RM-11708 proposes to drop the symbol rate confine in §97.307(f) of the FCC tyro Service rules, substituting a maximum occupied bandwidth of 2.8 kHz for HF data emissions. The ARRL said those opposing the Petition accomplish not, in general, challenge the removal of the symbol rate confine for data emissions in troop segments where RTTY and data emissions are now permitted.
"Rather, they tend to view the proposal to establish a maximum occupied bandwidth of 2.8 kHz for data emissions in the medium-frequency (MF) and high-frequency (HF) bands where data emissions are permitted now as an enabling provision," the ARRL said. Instead, the League said, its Petition is intended to impose "a limitation on the maximum bandwidth of data emissions where nonexistent exists now." Given state-of-the-art data technologies, the League said, there is no necessary correlation between the symbol rate and the bandwidth of a data emission. The current symbol rate "acts only as a confine on the efficiency of data emissions in the HF bands as a practical matter, and as an simulated and arbitrary filter on the types of emissions that can exist utilized by radio amateurs."
The ARRL said its suggested 2.8 kHz maximum bandwidth reflects a balanced approach that will permit everyone currently used data emissions, hearten experimentation with data emissions that the current symbol rate restriction prohibits, and preclude the expend of wider-bandwidth data emissions that could usurp the limited RTTY/data subbands. Petition opponents, the ARRL went on to say, "offer no evidence" that the rule changes it proposes will lead to a situation where data transmissions overwhelm the subband and preclude narrow bandwidth emission communications.
"The Commission has properly chastised the tyro Service for resisting deregulatory proposals that are designed to enable tyro experimenters to refine and accommodate technologies," the League said in its reply comments. "ARRL is of the view that outdated Commission regulations that needlessly preclude experimentation with data technologies should not exist preserved. Outdated regulations are not a viable alternative to cooperative sharing arrangements in the HF bands through voluntary troop plans."
Some of those opposing its petition, the ARRL went on to say, expressed the faith that the proposed rule change would impose wider-bandwidth data emissions in spectrum where narrow-bandwidth modes such as CW and PSK31 now operate, to the detriment of the narrow-bandwidth modes. Other opponents contended that the Petition will profit a few operators at the expense of the many now operating narrowband data, RTTY, and CW on the HF bands.
"It is illogical to squabble on the one hand that the Petition is intended to profit 'the few' who are data emission experimenters and users, and on the other hand to forecast that the relief requested in the Petition would create a flood of 'wide-bandwidth' data emissions, swamping the troop segments used for CW, RTTY, and narrow-bandwidth data emissions," the League pointed out. "If the concern is that the rule changes will hearten more radio amateurs to experiment with data emissions, that would exist a positive outcome." The ARRL further asserted that the panic of interference from automatically controlled stations "is not a valid one."
Its Petition, the ARRL concluded, "is not a referendum on the value of MF or HF data emissions or data experimentation in those bands," but intended to hearten experimentation now restricted artificially by outdated rules. "It is instead a proposal to delete outdated limitations on tyro Radio experimentation, which Commission policy supports, and which the basis and purpose of the tyro Radio Service necessitates."
Your League: ARRL-Sponsored Medium-Frequency Experiment Continues as Hams Hope for original Band
The ARRL-sponsored medium-frequency experiment, operating as WD2XSH, continues apace in an exertion to demonstrate the viability of 472 to 479 kHz as a secondary tyro Radio allocation. At the identical time, the FCC has been silent regarding the ARRL's November 2012 Petition for Rule Making that asked the Commission to build this segment of the spectrum available to radio amateurs in the US. Delegates to the 2012 World Radiocommunication Conference approved a 7 kHz-wide secondary allocation between 472 and 479 kHz for the tyro Radio Service, with a power confine of 5 W EIRP (or 1 W EIRP, depending on location). The FCC has indicated that it will address the issue within the context of its Notice of Proposed Rule Making in ET Docket No 12-338, to formally reflect the Final Acts of WRC 2007 in its rules. In his quarterly WD2XSH update, Experiment Coordinator Fritz Raab, W1FR, reported that 514 contacts -- 10 in the last quarter -- acquire been logged among those taking section in the experiment across the US.
"As usual, activity increased as conditions improved during the fall. Much of the recent activity has involved WSPR-15," Raab reported. "Reception over significant distances (eg, Europe, Alaska) has been reported. Much of the activity is being undertaken by a few original experimental licensees." Raab eminent that WD2XSH participant Brian Justin, WA1ZMS, transmitted Fessenden commemorative broadcasts on AM via his own experimental license, WG2XFQ, during the December holidays.
In the US, the 472-479 kHz troop is section of the larger 435-495 kHz segment that is allocated on a primary basis to the Maritime Mobile Service (federal and non-federal users), and on a secondary basis for federal government aeronautical radionavigation. The ARRL stated in its Petition that it is unaware of any domestic assignments that might combat with the allocation of 472 to 479 kHz to the tyro Radio Service, and there is almost no power line carrier (PLC) operation in this troop segment. The FCC in 2003 cited the potential for interference to utility-operated PLC systems when it turned down an ARRL petition seeking an LF "sliver band" at 135.7 to 137.8 kHz.
The WD2XSH experiment involves more than three dozen stations and includes everyone geographic areas of the US, including Alaska and Hawaii. Most of the stations are in the eastern half of the US. Raab has reported no interference issues during the WD2XSH experiment, begun in 2006 and initially using spectrum in the vicinity of 500 kHz. Read more.
Your League: National Contest Journal (NCJ) Debuts original Website!
National Contest Journal (NCJ), the ARRL publication devoted to tyro Radio contesting, has a fresh, original presence on the web, although the URL remains the same.
"The original site was designed with simplicity and ease of expend in mind," said NCJ Editor Kirk Pickering, K4RO. "The site contains selected feature articles as well as a group of tools for setting up teams and submitting logs for NCJ-sponsored contests. It too offers an archive of scores for everyone NCJ going back to 2001. The site still has room to accommodate original features in the future, so stay tuned."
Pickering said the original NCJ website was a collaborative effort, and he expressed his appreciation to Bruce Horn, WA7BNM, "for his tireless support of the NCJ website from its inception" as well as to George Fremin, K5TR, who has served as the systems administrator. Pickering too thanked his colleague Susie Coleman, who helped design the ogle and feel.
"We hope that you will find the original site useful. Thanks to everyone who acquire helped to build this happen," said Pickering, who invited comments on the original site and design.
Published every other month, NCJ features general-interest and technical articles and columns by top contesters, operator profiles, editorial comments, and correspondence from readers, as well as scores for the North American QSO Party and North American Sprint, which NCJ sponsors.
International: IARU Showcases tyro Radio at ITU Telecom World 2013
The International tyro Radio Union (IARU) got some visibility for tyro Radio at ITU Telecom World 2013, sponsored by the International Telecommunication Union. The event was held November 19-22 in Bangkok, Thailand. The IARU and IARU Region 3 leaders arranged the parade in cooperation with the ITU. A large, flat-screen TV in the booth displayed videos of tyro Radio activities. Special event station HS2013ITU was on the air from the site. IARU President Tim Ellam, VE6SH, spoke at one of the forums. A highlight of the define for the IARU contingent was a visit by ITU Secretary universal Dr Hamadoun Toure, HB9EHT. He took a turn at the operating position of HS2013ITU while there.
"We had a number of high-profile visitors to the booth, including ministers of communications and government regulators from various countries," said IARU Region 3 Director Peter Lake, ZL2AZ, and Region 3 Chairman Gopal Madhavan, VU2GMN, in a report. "They were keen to discuss the situation in their respective countries and the association with IARU and to learn about tyro Radio and its capabilities. Telecom World 2013 gave the IARU a unique occasion to showcase tyro Radio at the highest level."
ITU Telecom World 2013 too offered an occasion for the IARU representatives to influence leaders who can favorably impact radio regulations and national attitudes toward tyro Radio. "The presence of IARU, and its exertion to showcase tyro Radio and its capabilities, was well appreciated by everyone who visited the booth, and the exertion was well worthwhile," said the IARU's report. "We too laid a foundation under the original ITU Telecom World structure to gain some similar space at the next event in 2014 in Qatar." Read more.
International: Yasme Foundation Announces Supporting Grants
To further the progress of tyro Radio around the world, The Yasme Foundation has announced the recipients of four supporting grants:
WRTC-2014, to succor defray the expenses of the World Radiosport Team Championship in original England this July.
The invert Beacon Network (RBN), to purchase a receiver and necessary accessories to upgrade the RBN node in Bangalore, India.
CWOps CW Academy, to succor defray the expenses of providing online CW training courses.
The ARRL Second Century Fund, to support the goal of the ARRL Second Century drive of opening a path to passionate involvement in tyro Radio by original generations, providing opportunities for educational enrichment, community service, and personal achievement through the exploration and expend of radio communication.
The Yasme Foundation is a not-for-profit corporation organized to conduct scientific and educational projects related to tyro Radio, including DXing and the introduction and promotion of tyro Radio in developing countries. The Foundation supports individuals and organizations providing or creating useful services for the tyro Radio community, regardless of originality or novelty, to further the progress of tyro Radio around the world.
Radiosport: original ARRL Single-Operator Unlimited Contest Category Now in Effect
Responding to many requests, the ARRL Programs and Services Committee in 2013 accepted the Contest Advisory Committee (CAC) recommendation to add the Single-Operator Unlimited category to the ARRL 10 Meter Contest, ARRL 160 Meter Contest, RTTY Roundup, and the IARU HF Championship. "This particular issue has been a long time coming," said CAC Chairman Al Dewey, K0AD.
The original category permits the expend of spotting information within the Single-Operator class. In the past, using spotting information placed a station in the Multioperator category. Per the revised rules, "Single-Operator Unlimited: The expend of spotting assistance or automated, multi-channel decoders is permitted."
Ham Radio Business: Tokyo Hy-Power Files for Bankruptcy
Tokyo Hy-Power, a manufacturer of tyro Radio amplifiers, antenna tuners, and other equipment, is in bankruptcy, and its plant, in Saitama Prefecture near Tokyo, has been shuttered. Telephones at the company no longer are being answered, and its Japanese website has been taken down, although the company's US website remains working. Company CEO/President Nobuki Wakabayashi, JA1DJW, founded Tokyo Hy-Power Labs in 1975. He blamed "the recent depression in the industrial RF power products area [which] has led to the very difficult monetary position."
Tokyo Hy-Power's early products were HF antenna couplers, although within a couple of years it began manufacturing amplifiers for the tyro Radio market, including solid-state mobile amplifiers. Among its early products was the HL-4000 linear amplifier, which the company claimed was "the first real HF troop high-power linear of its kindhearted in Japan." It has been manufacturing RF products for the industrial market since 1984.
The company too once marketed the HT-750, a portable, low-power SSB/CW transceiver for 40, 15, and 6 meters in a hand-held transceiver form factor. At Dayton Hamvention® 2013, the company displayed a prototype of the XT-751, an advanced model it hoped to develop, covering 40 through 6 meters and with an internal antenna tuner. Among its latest products were solid-state HF amplifiers, as well as amplifiers for 6 and 2 meters.
In a December 26 word release, Ham Radio Outlet (HRO) reacted with "disappointment" and said it was "deeply saddened" to learn that Tokyo Hy-Power had gone into bankruptcy.
"This action in Japan appears to exist similar to a Chapter 7 action here within the United States, as the process in this case appears to exist the liquidation of organizational assets in order to attempt to fund some portion of its debt obligation(s)," the HRO release said. "This appears to bespeak that a court has deemed the organization unable to exist effectively reorganized under Japan's Civil Reconstruction Code."
HRO said it was working with AVSL, the current US service provider for Tokyo Hy-Power products "to discuss the occasion of continued maintenance at the component level of the US-sold Tokyo Hy-Power line of amplifiers." Read more.
Ham Radio Business: CQ to Realign Publications, Launch Digital Supplement
CQ Communications Inc has announced plans to realign its publications lineup and to launch a original online supplement to its flagship magazine, CQ tyro Radio.
"The hobby radio market is changing," said CQ Communications President and Publisher Dick Ross, K2MGA, "and they are changing what they accomplish and how they accomplish it in order to continue providing leadership to everyone segments of the radio hobby."
Effective with the February 2014 issue of CQ, said Ross, content from the magazine's three sister publications -- celebrated Communications, CQ VHF and WorldRadio Online -- will exist incorporated into CQ's digital edition as a supplement to exist called CQ Plus. The print editions of celebrated Communications and CQ VHF will exist phased out, and WorldRadio Online will no longer exist as a separate online publication. Current celebrated Communications, CQ VHF and WorldRadio Online subscribers will exist converted to CQ subscribers and receive CQ Plus at no additional charge. Details will exist posted on each magazine's website.
CQ Communications says the change will tender hobby radio enthusiasts a single source for articles from shortwave listening and scanner monitoring to personal two-way services and Internet radio, as well as tyro Radio. Richard Fisher, KI6SN, currently editor of both celebrated Communications and WorldRadio Online, will exist editor of CQ Plus. Read more.
Ham Radio Business: InnovAntennas Acquires force 12
InnovAntennas has acquired the legendary force 12 antenna company and product line and has moved the force 12 factory from Bridgeport, Texas, to majestic Junction, Colorado, into a facility shared with InnovAntennas America. InnovAntennas Ltd in England is now manufacturing force 12 products for the European market at its Canvey Island plant.
The majestic Junction facility is up and running, manufacturing and shipping antennas. InnovAntennas says it plans to produce updated versions of classic force 12 antennas as well as all-new models. InnovAntennas Founder Justin Johnson, G0KSC, was at the Colorado facility in late 2013 to assist in setting up and laying out the factory, and the company was expected to exist at replete production this month. -- Thanks to The ARRL Contest Update
DX: ARRL DXCC Desk Approves ZD9KX Operations
The ARRL DXCC Desk has approved the 2012 and 2013 operation of ZD9KX -- Tristan Da Cunha & Gough Islands for DX Century Club credit. If a request for DXCC credit for this operation has been rejected in a prior application, contact ARRL Awards fork Manager Bill Moore, NC1L, to exist placed on the list for an update to your record. gratify note the submission date and/or reference number of your application in order to expedite the search for any rejected contacts.
DXCC is tyro Radio's premier award that hams can deserve by confirming on-the-air contacts with 100 DXCC "entities," most of which are countries in the traditional sense. You can inaugurate with the basic DXCC award and work your way up to the DXCC veneration Roll. Learn more. -- ARRL Awards fork Manager Bill Moore, NC1L
Shortwave Listening: Voice of Russia to Continue Shortwave Broadcasting in 2014
To paraphrase designate Twain, reports of the demise of the Voice of Russia (VOR) may acquire been greatly exaggerated. Earlier this year the Voice of Russia -- the former Radio Moscow during the Soviet Era -- appeared poised to cease shortwave broadcasts as of January 1, 2014. In the wake of a December decree signed by Russian President Vladimir Putin that merged the Voice of Russia with several other state-run word agencies, SWL Tom Witherspoon, K4SWL, contacted VOR.
"We are joyous to let you know that the Voice of Russia will stay on the air in 2014, however, considerable changes in their frequency schedule are expected," the broadcaster told Witherspoon and as he reports on his blog.
The posted VOR schedule, which runs through March, indicates 38 aggregate hours of shortwave broadcasts to everyone parts of the world, most beamed at the Middle East and Asia. Shortwave broadcasts to Europe, Latin America, Oceania, and Africa account for just 15 aggregate hours. VOR, which claims to exist the first radio station to broadcast internationally, too broadcasts online, via satellite, on FM, and via three medium-wave transmitters. In 2003 VOR was among the first major international radio broadcasters to launch daily broadcasts to Europe in Digital Radio Mondiale (DRM).
Propagation: Solar Flux Record high Could Herald Better Conditions
The 10.7 centimeter solar flux index (SFI) jumped to a Cycle 24 record of 262 on January 4, suggesting that Cycle 24 has not yet begun drawing to a immediate and may exist approaching or at a "second peak." The previous peak for the current cycle was 190 on September 24, 2011. As NASA's Marshall Space Flight hub (MSFC) explains, the flux of the sun's radio emissions at 10.7 centimeter (2.8 GHz) is another indicator of solar activity levels, since it tends to result changes in the solar ultraviolet that influence Earth's upper atmosphere and ionosphere.
"Many models of the upper atmosphere expend the 10.7 centimeter flux (F10.7) as input to determine atmospheric densities and satellite drag," NASA/MSFC noted, adding that SFI "has been shown to result the sunspot number quite closely." The January 6 sunspot weigh was 225. The Cycle 24 sunspot weigh peaked at 282 on November 17, 2013, according to WM7D.net.
Canada's Dominion Radio Astrophysical Observatory (DRAO) indicated an "official" flux of 262 at 2000 UTC on Saturday, January 3. The official pattern for Sunday, January 5, was 217.5. ARRL solar observer Tad Cook, K7RA, who reports 10.7 centimeter flux numbers in his weekly "Solar Update" bulletins, suggests that they are not as valuable as sunspot numbers in predicting radio propagation. The solar flux was over the January 4-5 weekend was far higher what was anticipated, judging by predictions Cook reported in his January 3 "Solar Update" for this past weekend and the week ahead. NASA/MFSC indicates a 95 percent predicted flux for the month of January at 146.5, continuing at about the identical level through the first half of the year.
The Daily DX said the SFI was expected to remain above 200 for this week. As Ian Poole, G3YWX, explained solar flux in his article, "Understanding Solar Indices" in the September 2002 edition of QST, "[H]igh values generally bespeak there is sufficient ionization to support long-distance communication at higher-than-normal frequencies." He pointed out, though, that it can win a few days of high values for conditions to define improvement. "Typically values in excess of 200 will exist measured during the peak of a sunspot cycle, with high values of up to 300 being experienced for shorter periods," Poole wrote. Read more.
ARRL Centennial: W100AW Hits the Airwaves!
At the stroke of midnight Eastern Time on January 1, Hiram Percy Maxim Memorial station W1AW at ARRL Headquarters in Newington took to the air to debut its special ARRL Centennial muster sign, W100AW. ARRL Chief Executive Officer Dave Sumner, K1ZZ and Membership and Volunteer Programs Manager Dave Patton, NN1N, and ARRL Station Manager Joe Carcia, NJ1Q, were at the helm into the wee hours of original Year's Day.
Daylight hours saw ARRL Chief Operating Officer Harold Kramer, WJ1B; Membership and Volunteer Programs lieutenant Manager Norm Fusaro, W3IZ; Public Relations Manager Sean Kutzko; KX9X and QST Editor in Chief Steve Ford, WB8IMY, taking their turns at the operating positions. By mid-afternoon, several thousand contacts were in the log on SSB, CW and RTTY.
"This is just the beginning," said Kutzko. "Hams will hear W100AW throughout 2014 on every mode possible. When you hear us, spot us on the cluster!"
Not surprising, 20 meter SSB yielded the most contacts -- 1121 of the 3700 logged -- during the 19 hours of original Year's Day operation from W100AW. Ten meter phone was in second site with 639 contacts.
W100AW contacts will exist uploaded to Logbook of The World (LoTW). QSL cards sent by mail will exist acknowledged as well.
W1AW Portable Operations, ARRL Centennial QSO Party
The ARRL Centennial "W1AW WAS" operations are taking site throughout 2014 from each of the 50 states, relocating each Wednesday (UTC) to a original pair of states (this week, South Carolina and Utah. Listen for W1AW/4 and W1AW/7). During 2014 W1AW will exist on the air from every state at least twice and from most US territories, and it will exist facile to work everyone states solely by contacting W1AW portable operations.
In conjunction with the 100th anniversary of the ARRL, the ARRL Centennial QSO Party too kicked off January 1 for a year-long operating event in which participants can accumulate points and win awards. The event is open to all, although only ARRL members and appointees, elected officials, HQ staff and W1AW are worth ARRL Centennial QSO Party points. Working W1AW/x from each state is worth 5 points per contact.
To deserve the "Worked everyone States with W1AW Award," work W1AW operating portable from everyone 50 states. (Working W1AW or W100AW in Connecticut does not weigh for Connecticut, however. For award credit, participants must work W1AW/1 in Connecticut.) A W1AW WAS certificate and plaque will exist available (pricing not yet available).
As of today (January 9), more than 6700 stations acquire earned points in the Centennial QSO Party by uploading qualifying QSOs to Logbook of The World (LoTW). Operating from North Carolina and West Virginia during the first week of the W1AW portable operations, W1AW/4 and W1AW/8 logged approximately 33,000 contacts.
"The second week is off to a roaring start from South Carolina and Utah," reported ARRL Membership and Volunteer Programs Manager Dave Patton, NN1N.
ARRL Centennial: A Century of tyro Radio and the ARRL
Editor's note: "A Century of tyro Radio and the ARRL" will exist a weekly feature as the ARRL celebrates its Centennial in 2014.
In tyro Radio, as in everyone fields, 100 years has brought about Amazing progress and changes. During 2014, they will give you a sense of the ARRL's and tyro Radio's history by looking through the issues of QST from its humble genesis to the present. We'll examine the necessary topics and events of interest to amateurs, such as technology, operating tips and events, ARRL's doings, and FCC actions. Because of the limited space available here, the comments will exist brief, but they will provide citations to original QST articles for your further reading.
The next century will bring about changes that will exist mind-boggling to us, because technology advances at an exponential rate. Being cognizant of the past 100 years of ham-related events is valuable to us for historical reasons, and it too makes us regard what might lie ahead. Next time: A ogle at the earliest years of tyro Radio and the ARRL. -- Al Brogdon, W1AB
Milestones: Founder and President Emeritus of 4U1UN, Max de Henseler, HB9RS, SK
Max de Henseler, HB9RS, the founder and president emeritus of 4U1UN at United Nations headquarters in original York, died December 30. He was 80. A ham since 1955, de Henseler had been a short-wave listener since the late 1940s. In 1976, while in original York as the UN's chief cartographer, de Henseler reactivated the United Nations Radio Club station K2UN at its original home in midtown Manhattan. As Jack Troster, W6ISQ, explained in the July 1989 issue of QST, "Through his efforts, the Secretary universal approved the operation of a specifically designated UN tyro station using the muster 4U1UN in early 1978."
De Henseler introduced the original muster sign on February 4, 1978, during the first weekend of the then two-weekend ARRL International DX phone contest, surprising many contesters. 4U1UN was approved for DXCC credit, due to the efforts of "Mister UN Radio."
The 4U1UN United Nations Headquarters Station was dismantled in 2010 due to the extensive renovation project on the Secretariat Building. Read more. -- Thanks to The Daily DX
Milestones: QST Author, CW Key Maker Jerry Pittenger, K8RA, SK
QST author and CW key crafter Jerry Pittenger, K8RA, of Powell, Ohio, died January 2 of pancreatic cancer. He was 66. Licensed in 1960, Pittenger was a retired systems engineer. He earned a bachelor's degree at Miami University and an MS in systems engineering from Ohio State.
Pittenger enjoyed edifice his own equipment, and some of his amplifier projects were featured in QST, The ARRL Handbook, and RF Amplifier Classics. More recently he manufactured a line of solid-brass iambic and single-lever CW keys sold worldwide, until illness forced him to quit.
"Making my CW keys fills much of my time, but it is a labor of love," Pittenger said in his online profile. "I can derive lost in time machining metals and making things in the shop for the radio." His friends Mike Freeman, NT8O, and Fred Freeman, N8BX, acquire taken over the production of the K8RA line. Read more.
Milestones: Austin tyro Radio Supply Owner Johnny Paul, WA5BGO, SK
The owner of Austin tyro Radio Supply, John E. "Johnny" Paul, WA5BGO, of Austin, Texas, died December 10. He was 74. Paul was the proprietor of Austin tyro Radio for 45 years. First licensed in 1960, Paul was a past president of the Austin tyro Radio Club and was an avid photographer of nature and landscapes. Services were December 16.
Tad Cook, K7RA, in Seattle, reports: A immense storm is brewing! At 2324 UTC on January 8 the Australian Space Forecast Centre issued this geomagnetic disturbance warning: "Increased geomagnetic activity expected due to coronal mass ejection from 09-10 January 2014."
NOAA forecasters appraise a 90 percent desultory of geomagnetic storms on January 9. The predicted planetary A indices for January 9 through January 13 are 73, 41, 15, 8 and 5. While an emblematic number for hams, 73 is a huge value for the planetary A index. One has to ogle way, way back to find a value affection this. The planetary A index was 67 on both March 9, 2012, and September 26, 2011, but nothing exceeds what is predicted for January 9 except the planetary A index of 104 on December 15, 2006, and 105 on September 11, 2005.
This has been an exciting week for sun watchers. The daily sunspot number reached 245 on January 6, and solar flux was 237.1 on January 8. The GOES-15 X-ray background flux has too been high, and that may exist more significant for enhanced HF propagation than a high solar flux. NOAA's Space Weather Prediction hub maintains an archive of X-ray flux, solar flux, and sunspot numbers (check the links marked "DSD.txt." The links marked "DGD.txt" will give you daily geomagnetic indicators).
Over the past week, average daily sunspot numbers rose more than 80 points to 188.1, and average daily solar flux was up by more than 62 points to 201.6. Predicted solar flux for the near term is 195 on January 9-12, 190 on January 13, 160 on January 14, 155 on January 15-16, and 150 on January 17-19. It then rises to a peak of 190 on January 29 through February 3.
Predicted planetary A index values are 73, 41, 15 and 8 on January 9-12, 5 on January 13-22, 10 on January 23, 8 on January 24, 5 on January 25-27, then 10, 18 and 8 on January 28-30, then 5 again until February 6.
For the Friday, January 10, "Solar Update," ogle for an update on the latest disturbance and forecast, as well as reports from readers. I welcome your reports and observations via e-mail.
Getting It Right!
In The ARRL Letter, December 19, 2013, they inadvertently omitted 20 meters from the list of bands available for the ARRL Centennial QSO Party.
Just Ahead in Radiosport
Jan 10 -- QRP Fox Hunt
Jan 10 -- NCCC Sprint Ladder
Jan 11 -- traditional original Year Contest
Jan 11-12 -- UK DX BPSK63 Contest
Jan 11-12 -- MI QRP January CW Contest
Jan 11-12 -- SKCC Weekend Sprintathon
Jan 11-12 -- North American QSO Party, CW
Jan 12 -- NRAU-Baltic Contest, CW (0630-0830 UTC)
Jan 12 -- NRAU-Baltic Contest, SSB (0900-1100 UTC)
Jan 12 -- DARC 10-Meter Contest
Jan 12 -- Midwinter Contest
Jan 15 -- QRP Fox Hunt
Upcoming ARRL Section, State and Division Conventions and Events
January 17-18 -- North Texas Section Convention, Fort Worth, Texas
January 19-26 -- Quartzfest Convention, Quartzsite, Arizona
January 24-25 -- Mississippi State Convention, Jackson, Mississippi
January 25 -- Georgia ARES Convention, Forsyth, Georgia
January 25-26 -- Puerto Rico State Convention, Hatillo, Puerto Rico
January 31-February 1 -- Southern Florida Section Convention, Miami, Florida
February 1 -- Virginia State Convention (Frostfest), Richmond, Virginia
February 1 -- South Carolina State Convention, North Charleston, South Carolina
February 7-9 -- Northern Florida Section Convention (Orlando HamCation® -- Regional ARRL Centennial Event), Orlando, Florida
February 14-15 -- Arizona Section Convention, Yuma, Arizona
February 22 -- Vermont State Convention, South Burlington, Vermont
March 1-2 -- Alabama Section Convention (BirmingHAMfest 2014), Birmingham, Alabama
March 7-8 -- North Carolina Section Convention (Charlotte Hamfest), Concord, North Carolina
March 7-8 -- West Gulf Division Convention, Claremore, Oklahoma
March 14-15 -- Delta Division Convention, Rayne, Louisiana
March 15 -- Nebraska State Convention, Lincoln, Nebraska
March 15 -- West Texas Section Convention, Midland, Texas
March 22 -- South Texas Section Convention (Greater Houston Hamfest), Rosenberg, Texas
March 22-23 -- Communications Academy, Seattle, Washington
April 19 -- Roanoke Division Convention, Raleigh, North Carolina
April 25-27 -- Idaho State Convention, Boise, Idaho
April 26 -- Aurora '14 Conference, White abide Lake, Minnesota
Find conventions and hamfests in your area.
ARRL -- Your One-Stop Resource for tyro Radio word and Information
Join or Renew Today! ARRL membership includes QST, tyro Radio's most celebrated and informative journal, delivered to your mailbox each month.
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This paper is a revision and update of the recommendations developed following the 1st (Vienna 2001), 2nd (Prague 2004) and 3rd (Zurich 2008) International Consensus Conference on Concussion in Sport and is based on the deliberations at the 4 thInternational Conference On Concussion In Sport held in Zurich, November 2012.1–3
The original 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A circumstantial description of the consensus process is outlined at the finish of this document under the “background” section. This document is developed for expend by physicians and health supervision professionals primarily who are involved in the supervision of injured athletes, whether at the recreational, elite, or professional level.
While agreement exists pertaining to principal messages conveyed within this document, the authors admit that the science of concussion is evolving and therefore management and recrudesce to play decisions remain in the realm of clinical judgment on an individualized basis. Readers are encouraged to copy and deal freely the Zurich Consensus document, the Concussion Recognition Tool (CRT), the Sport Concussion Assessment Tool version 3 (SCAT3), and/or the Child-SCAT3 card and neither is subject to any restriction, provided it is not altered in any way or converted to a digital format. The authors’ request that the document and/or the accompanying tools exist distributed in their replete and complete format.
This consensus paper is broken into a number of sections:
The Zurich 2012 document examines sport concussion and management issues raised in the previous Vienna 2001, Prague 2004, and Zurich 2008 documents and applies the consensus questions from Section 3 to these areas.1–3Definition of Concussion
Panel discussion regarding the definition of concussion and its separation from mild traumatic brain injury (mTBI) was held. There was acknowledgement by the Concussion in Sport Group (CISG) that although the terms mild traumatic brain injury (mTBI) and concussion are often used interchangeably in the sporting context and particularly in the US literature, others expend the term to mention to different injury constructs. Concussion is the historical term representing low velocity injuries that occasions brain “shaking” resulting in clinical symptoms and which are not necessarily related to a pathological injury. Concussion is a subset of TBI and the term concussion will exist used in this document. It was too eminent that the term commotio cerebri is often used in European and other countries. Minor revisions were made to the definition of concussion and it is defined as follows:
Concussion is a brain injury and is defined as a intricate pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may exist utilized in defining the nature of a concussive head injury include:
The majority (80%-90%) of concussions resolve in a short (7-10 day) period, although the recovery time frame may exist longer in children and adolescents.2Symptoms and Signs of Acute Concussion
The diagnosis of acute concussion usually involves the assessment of a ambit of domains including clinical symptoms, physical signs, cognitive impairment, neurobehavioral features, and sleep disturbance. Furthermore, a circumstantial concussion history is an necessary section of the evaluation both in the injured athlete and when conducting a preparticipation examination. The circumstantial clinical assessment of concussion is outlined in the SCAT3 and Child-SCAT3 forms, which is an appendix to this document.
The suspected diagnosis of concussion can embrace 1 or more of the following clinical domains:
If any 1 or more of these components is present, a concussion should exist suspected and the usurp management strategy instituted.On-Field or Sideline Evaluation of Acute Concussion
When a player shows ANY features of a concussion:
Sufficient time for assessment and adequate facilities should exist provided for the usurp medical assessment both on and off the field for everyone injured athletes. In some sports, this may require rule change to allow an usurp off-field medical assessment to occur without affecting the flood of the game or unduly penalizing the injured player’s team. The final determination regarding concussion diagnosis and/or fitness to play is a medical determination based on clinical judgment.
Sideline evaluation of cognitive office is an essential component in the assessment of this injury. Brief neuropsychological test batteries that assess attention and memory office acquire been shown to exist practical and effective. Such tests embrace the SCAT3, which incorporates the Maddocks questions4,5 and the Standardized Assessment of Concussion (SAC).6–8 It is worth noting that standard orientation questions (eg, time, place, person) acquire been shown to exist unreliable in the sporting situation when compared with memory assessment.5,9 It is recognized, however, that abbreviated testing paradigms are designed for rapid concussion screening on the sidelines and are not meant to replace comprehensive neuropsychological testing which should ideally exist performed by trained neuropsychologists that are sensitive to subtle deficits that may exist beyond the acute episode; nor should they exist used as a stand-alone tool for the ongoing management of sports concussions.
It should too exist recognized that the appearance of symptoms or cognitive deficit might exist delayed several hours following a concussive episode and that concussion should exist seen as an evolving injury in the acute stage.Evaluation in Emergency room or Office by Medical Personnel
An athlete with concussion may exist evaluated in the emergency room or doctor’s office as a point of first contact following injury or may acquire been referred from another supervision provider. In addition to the points outlined above, the key features of this exam should encompass:
In big part, these points above are included in the SCAT3 assessment.Concussion Investigations
A ambit of additional investigations may exist utilized to assist in the diagnosis and/or exclusion of injury. Conventional structural neuroimaging is typically routine in concussive injury. Given that caveat, the following suggestions are made: Brain CT (or where available MR brain scan) contributes runt to concussion evaluation but should exist employed whenever suspicion of an intra-cerebral or structural lesion (eg, skull fracture) exists. Examples of such situations may embrace prolonged disturbance of conscious state, focal neurological deficit, or worsening symptoms.
Other imaging modalities such as fMRI demonstrate activation patterns that correlate with symptom severity and recovery in concussion.10–14 Whilst not section of routine assessment at the present time, they nevertheless provide additional insight to pathophysiological mechanisms. Alternative imaging technologies (eg, positron emission tomography, diffusion tensor imaging, magnetic resonance spectroscopy, functional connectivity), while demonstrating some compelling findings, are still at early stages of progress and cannot exist recommended other than in a research setting.
Published studies, using both sophisticated force plate technology, as well as those using less sophisticated clinical balance tests (eg, balance oversight Scoring System [BESS]), acquire identified acute postural stability deficits lasting approximately 72 hours following sport-related concussion. It appears that postural stability testing provides a useful tool for objectively assessing the motor domain of neurologic functioning, and should exist considered a trustworthy and valid addition to the assessment of athletes suffering from concussion, particularly where symptoms or signs bespeak a balance component.15–21
The significance of Apolipoprotein (Apo) E4, ApoE promotor gene, Tau polymerase, and other genetic markers in the management of sports concussion risk or injury outcome is unclear at this time.22,23 Evidence from human and animal studies in more severe traumatic brain injury demonstrate induction of a variety of genetic and cytokine factors such as: insulin-like growth factor-1 (IGF-1), IGF binding protein-2, Fibroblast growth factor, Cu-Zn superoxide dismutase, superoxide dismutase -1 (SOD-1), nerve growth factor, glial fibrillary acidic protein (GFAP), and S-100. How such factors are affected in sporting concussion is not known at this stage.24–31 In addition, biochemical serum and cerebral spinal fluid biomarkers of brain injury [including S-100, neuron specific enolase (NSE), myelin basic protein (MBP), GFAP, tau, etc] acquire been proposed as means by which cellular damage may exist detected if present.32–38 There is currently insufficient evidence, however, to justify the routine expend of these biomarkers clinically.
Different electrophysiological recording techniques (eg, evoked response potential [ERP], cortical magnetic stimulation, and electroencephalography) acquire demonstrated reproducible abnormalities in the postconcussive state; however not everyone studies reliably differentiated concussed athletes from controls.39–45 The clinical significance of these changes remains to exist established.Neuropsychological Assessment
The application of neuropsychological (NP) testing in concussion has been shown to exist of clinical value and contributes significant information in concussion evaluation.46–51 Although in most cases cognitive recovery largely overlaps with the time course of symptom recovery, it has been demonstrated that cognitive recovery may occasionally precede or more commonly result clinical symptom resolution, suggesting that the assessment of cognitive office should exist an necessary component in the overall assessment of concussion and in particular, any recrudesce to play protocol.52,53 It must exist emphasized however, that NP assessment should not exist the sole basis of management decisions. Rather, it should exist seen as an aid to the clinical decision-making process in conjunction with a ambit of assessments of different clinical domains and investigational results.
It is recommended that everyone athletes should acquire a clinical neurological assessment (including assessment of their cognitive function) as section of their overall management. This will normally exist done by the treating physician often in conjunction with computerized NP screening tools.
Formal NP testing is not required for everyone athletes, however when this is considered necessary then it should ideally exist performed by a trained neuropsychologist. Although neuropsychologists are in the best position to interpret NP tests by virtue of their background and training, the ultimate recrudesce to play determination should remain a medical one in which a multidisciplinary approach, when possible, has been taken. In the absence of NP and other (eg, formal balance assessment) testing, a more conservative recrudesce to play approach may exist appropriate.
Neuropsychological testing may exist used to assist recrudesce to play decisions and is typically performed when an athlete is clinically asymptomatic, however NP assessment may add necessary information in the early stages following injury.54,55 There may exist particular situations where testing is performed early to assist in determining aspects of management eg, recrudesce to school in a pediatric athlete. This will normally exist best determined in consultation with a trained neuropsychologist.56,57
Baseline NP testing was considered by the panel and was not felt to exist required as a mandatory aspect of every assessment however may exist helpful or add useful information to the overall interpretation of these tests. It too provides an additional educative occasion for the physician to discuss the significance of this injury with the athlete. At present, there is insufficient evidence to recommend the widespread routine expend of baseline NP testing.Concussion Management
The cornerstone of concussion management is physical and cognitive repose until the acute symptoms resolve and then a graded program of exertion prior to medical clearance and recrudesce to play. The current published evidence evaluating the effect of repose following a sport-related concussion is sparse. An initial term of repose in the acute symptomatic term following injury (24-48 hours) may exist of benefit. Further research to evaluate the long-term outcome of rest, and the optimal amount and type of rest, is needed. In the absence of evidence-based recommendations, a sensible approach involves the gradual recrudesce to school and social activities (prior to contact sports) in a manner that does not result in a significant exacerbation of symptoms.
Low-level exercise for those who are gradual to regain may exist of benefit, although the optimal timing following injury for initiation of this treatment is currently unknown.
As described above, the majority of injuries will regain spontaneously over several days. In these situations, it is expected that an athlete will proceed progressively through a stepwise recrudesce to play strategy.58Graduated recrudesce to Play Protocol
Return to play (RTP) protocol following a concussion follows a stepwise process as outlined in Table 1.
With this stepwise progression, the athlete should continue to proceed to the next level if asymptomatic at the current level. Generally, each step should win 24 hours so that an athlete would win approximately 1 week to proceed through the replete rehabilitation protocol once they are asymptomatic at repose and with provocative exercise. If any postconcussion symptoms occur while in the stepwise program then the patient should drop back to the previous asymptomatic level and try to progress again after a further 24-hour term of repose has passed.Same Day RTP
It was unanimously agreed that no recrudesce to play on the day of concussive injury should occur. There are data demonstrating that at the collegiate and high school level, athletes allowed to RTP on the identical day may demonstrate NP deficits postinjury that may not exist evident on the sidelines and are more likely to acquire delayed onset of symptoms.59–65The ‘Difficult’ or Persistently Symptomatic Concussion Patient
Persistent symptoms (>10 days) are generally reported in 10%-15% of concussions. In general, symptoms are not specific to concussion and it is necessary to regard other pathologies. Cases of concussion in sport where clinical recovery falls outside the expected window (ie, 10 days) should exist managed in a multidisciplinary manner by health supervision providers with suffer in sports-related concussion.Psychological Management and Mental Health Issues
Psychological approaches may acquire potential application in this injury, particularly with the modifiers listed below.66,67 Physicians are too encouraged to evaluate the concussed athlete for affective symptoms such as depression and anxiety, as these symptoms are common in everyone forms of traumatic brain injury.58The Role of Pharmacological Therapy
Pharmacological therapy in sports concussion may exist applied in 2 separate situations. The first of these situations is the management of specific and/or prolonged symptoms (eg, sleep disturbance, anxiety, etc). The second situation is where drug therapy is used to modify the underlying pathophysiology of the condition with the train of shortening the duration of the concussion symptoms.68 In broad terms, this approach to management should exist only considered by clinicians experienced in concussion management.
An necessary consideration in RTP is that concussed athletes should not only exist symptom free, but too should not exist taking any pharmacological agents/medications that may mask or modify the symptoms of concussion. Where antidepressant therapy may exist commenced during the management of a concussion, the determination to recrudesce to play while still on such medication must exist considered carefully by the treating clinician.The Role of Preparticipation Concussion Evaluation
Recognizing the importance of a concussion history, and appreciating the fact that many athletes will not recognize everyone the concussions they may acquire suffered in the past, a circumstantial concussion history is of value.69–72 Such a history may preidentify athletes that happy into a high-risk category and provides an occasion for the health supervision provider to educate the athlete in regard to the significance of concussive injury. A structured concussion history should embrace specific questions as to previous symptoms of a concussion and length of recovery, not just the perceived number of past concussions. It is too worth noting that dependence upon the recall of concussive injuries by teammates or coaches has been demonstrated to exist unreliable.69 The clinical history should too embrace information about everyone previous head, face, or cervical spine injuries, as these may too acquire clinical relevance. It is worth emphasizing that in the setting of maxillofacial and cervical spine injuries, coexistent concussive injuries may exist missed unless specifically assessed. Questions pertaining to disproportionate impact versus symptom severity matching may alert the clinician to a progressively increasing vulnerability to injury. As section of the clinical history it is advised that details regarding protective paraphernalia employed at time of injury exist sought, both for recent and remote injuries.
There is an additional and often unrecognized profit of the preparticipation examination insofar as the evaluation allows for an educative occasion with the player concerned as well as consideration of modification of playing behavior if required.Modifying Factors in Concussion Management
A ambit of ‘modifying’ factors may influence the investigation and management of concussion and, in some cases, may forecast the potential for prolonged or persistent symptoms. However, in some cases, the evidence for their efficacy is limited. These modifiers would exist necessary to regard in a circumstantial concussion history and are outlined in Table 2.Female Gender
The role of female gender as a workable modifier in the management of concussion was discussed at length by the panel. There was not unanimous agreement that the current published research evidence is conclusive enough for this to exist included as a modifying factor, although it was accepted that gender may exist a risk factor for injury and/or influence injury severity.73–75The Significance of Loss of Consciousness (LOC)
In the overall management of temper to severe traumatic brain injury, duration of LOC is an acknowledged predictor of outcome.76 Whilst published findings in concussion recount LOC associated with specific early cognitive deficits, it has not been eminent as a measure of injury severity.77,78 Consensus discussion determined that prolonged (>1 minute duration) LOC would exist considered as a factor that may modify management.The Significance of Amnesia and Other Symptoms
There is renewed interest in the role of posttraumatic amnesia and its role as a surrogate measure of injury severity.64,79,80 Published evidence suggests that the nature, burden, and duration of the clinical postconcussive symptoms may exist more necessary than the presence or duration of amnesia alone.77,81,82 Further it must exist eminent that retrograde amnesia varies with the time of measurement postinjury and hence is poorly reflective of injury severity.83,84Motor and Convulsive Phenomena
A variety of immediate motor phenomena (eg, tonic posturing) or convulsive movements may accompany a concussion. Although dramatic, these clinical features are generally benign and require no specific management beyond the standard treatment of the underlying concussive injury.85,86Depression
Mental health issues (such as depression) acquire been reported as a consequence of everyone levels of traumatic brain injury including sport-related concussion. Neuroimaging studies using fMRI suggest that a downhearted temper following concussion may reflect an underlying pathophysiological abnormality consistent with a limbic-frontal model of depression.34,87–97 While such mental health issues may exist multifactorial in nature, it is recommended that the treating physician regard these issues in the management of concussed patients.SPECIAL POPULATIONS The Child and Adolescent Athlete
The evaluation and management recommendations contained herein can exist applied to children and adolescents down to the age of 13 years. Below that age, children report concussion symptoms different from adults and would require age-appropriate symptom checklists as a component of assessment. An additional consideration in assessing the child or adolescent athlete with a concussion is that the clinical evaluation by the healthcare professional may requisite to embrace both patient and parent input, and possibly teacher and school input when appropriate.98–104 A Child-SCAT3 has been developed to assess concussion (see Appendix II) for subjects aged 5 to 12 years.
The determination to expend NP testing is broadly the identical as the adult assessment paradigm although there are some differences. Timing of testing may vary in order to assist planning in school and home management. If cognitive testing is performed then it must exist developmentally sensitive until late teen years due to the ongoing cognitive maturation that occurs during this term which, in turn, makes the utility of comparison to either the person’s own baseline performance or to population norms limited.20 In this age group it is more necessary to regard the expend of trained paediatric neuropsychologists to interpret assessment data, particularly in children with learning disorders and/or ADHD who may requisite more sophisticated assessment strategies.56,57,98
It was agreed by the panel that no recrudesce to sport or activity should occur before the child/adolescent athlete has managed to recrudesce to school successfully. In addition, the concept of ‘cognitive rest’ was highlighted with special reference to a child’s requisite to confine exertion with activities of daily animate that may exacerbate symptoms. School attendance and activities may too requisite to exist modified to avoid provocation of symptoms. Children should not exist returned to sport until clinically completely symptom free, which may require a longer time frame than for adults.
Because of the different physiological response and longer recovery after concussion and specific risks (eg, diffuse cerebral swelling) related to head impact during childhood and adolescence, a more conservative recrudesce to play approach is recommended. It is usurp to extend the amount of time of asymptomatic repose and/or the length of the graded exertion in children and adolescents. It is not usurp for a child or adolescent athlete with concussion to RTP on the identical day as the injury regardless of the level of athletic performance. Concussion modifiers apply even more to this population than adults and may mandate more cautious RTP advice.Elite Versus Nonelite Athletes
All athletes, regardless of level of participation, should exist managed using the identical treatment and recrudesce to play paradigm. The available resources and expertise in concussion evaluation are of more importance in determining management than a separation between elite and nonelite athlete management. Although formal NP testing may exist beyond the resources of many sports or individuals, it is recommended that in everyone organized high-risk sports, consideration exist given to having this cognitive evaluation, regardless of the age or level of performance.Chronic Traumatic Encephalopathy (CTE)
Clinicians requisite to exist mindful of the potential for long-term problems in the management of everyone athletes. However, it was agreed that CTE represents a separate tauopathy with an unknown incidence in athletic populations. It was further agreed that a occasions and effect relationship has not yet been demonstrated between CTE and concussions or exposure to contact sports.105–114 At present, the interpretation of causation in the modern CTE case studies should proceed cautiously. It was too recognized that it is necessary to address the fears of parents/athletes from media pressure related to the possibility of CTE.INJURY PREVENTION Protective Equipment—Mouthguards and Helmets
There is no kindly clinical evidence that currently available protective paraphernalia will obviate concussion, although mouthguards acquire a positive role in preventing dental and oro-facial injury. Biomechanical studies acquire shown a reduction in impact forces to the brain with the expend of headgear and helmets, but these findings acquire not been translated to define a reduction in concussion incidence. For skiing and snowboarding there are a number of studies to suggest that helmets provide protection against head and facial injury and hence should exist recommended for participants in alpine sports.115–118 In specific sports such as cycling, motor, and equestrian sports, protective helmets may obviate other forms of head injury (eg, skull fracture) that are related to falling on hard surfaces and may exist an necessary injury prevention issue for those sports.118–130Rule Change
Consideration of rule changes to reduce the head injury incidence or severity may exist usurp where a clear-cut mechanism is implicated in a particular sport. An sample of this is in football (soccer) where research studies demonstrated that upper limb to head contact in heading contests accounted for approximately 50% of concussions.131 As eminent earlier, rule changes too may exist needed in some sports to allow an efficient off-field medical assessment to occur without compromising the athlete’s welfare, affecting the flood of the game or unduly penalizing the player’s team. It is necessary to note that rule enforcement may exist a critical aspect of modifying injury risk in these settings and referees play an necessary role in this regard.Risk Compensation
An necessary consideration in the expend of protective paraphernalia is the concept of risk compensation.132 This is where the expend of protective paraphernalia results in behavioral change such as the adoption of more perilous playing techniques, which can result in a paradoxical increase in injury rates. The degree to which this phenomena occurs is discussed in more detail in the review published in the BJSM supplement. This may exist a particular concern in child and adolescent athletes where head injury rates are often higher than in adult athletes.133–135Aggression Versus Violence in Sport
The competitive/aggressive nature of sport that makes it fun to play and watch should not exist discouraged. However, sporting organizations should exist encouraged to address violence that may increase concussion risk.136,137 honest play and respect should exist supported as key elements of sport.Knowledge Transfer
As the faculty to treat or reduce the effects of concussive injury after the event is minimal, education of athletes, colleagues, and the universal public is a mainstay of progress in this field. Athletes, referees, administrators, parents, coaches and health supervision providers must exist educated regarding the detection of concussion, its clinical features, assessment techniques and principles of safe recrudesce to play. Methods to ameliorate education including Web-based resources, educational videos, and international outreach programs are necessary in delivering the message. In addition, concussion working groups, plus the support and endorsement of enlightened sport groups such as Fédération Internationale de Football Association (FIFA), International Olympic Commission (IOC), International Rugby Board (IRB), and International Ice Hockey Federation (IIHF) who initiated this endeavor acquire vast value and must exist pursued vigorously. honest play and respect for opponents are ethical values that should exist encouraged in everyone sports and sporting associations. Similarly, coaches, parents, and managers play an necessary section in ensuring these values are implemented on the field of play.58,138–150SECTION 2: STATEMENT ON BACKGROUND TO THE CONSENSUS PROCESS
In November 2001, the 1st International Conference on Concussion in Sport was held in Vienna, Austria. This meeting was organized by the IIHF in partnership with FIFA and the Medical Commission of the IOC. As section of the resulting mandate for the future, the requisite for leadership and future updates were identified. The 2nd International Conference on Concussion in Sport was organized by the identical group with the additional involvement of the IRB and was held in Prague, Czech Republic in November 2004. The original aims of the symposia were to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, rugby, football (soccer) as well as other sports. To this end, a ambit of experts were invited to both meetings to address specific issues of epidemiology, basic and clinical science, injury grading systems, cognitive assessment, original research methods, protective equipment, management, prevention, and long-term outcome.1,2
The 3rd International Conference on Concussion in Sport was held in Zurich, Switzerland on October 29-30, 2008 and was designed as a formal consensus meeting following the organizational guidelines set forth by the US National Institutes of Health. (Details of the consensus methodology can exist obtained at: http://consensus.nih.gov/ABOUTCDP.htm). The basic principles governing the conduct of a consensus progress conference are summarized below:
The panel chairperson (WM) did not identify with any advocacy position. The chairperson was answerable for directing the consensus session and guiding the panel’s deliberations. Panelists were drawn from clinical practice, academic, and research in the field of sport-related concussion. They accomplish not limn organizations per se but were selected for their expertise, experience, and understanding of this field.
The 4th International Conference on Concussion in Sport was held in Zurich, Switzerland on November 1-3, 2012 and followed the identical contour as for the 3rd meeting. everyone speakers, consensus panel members, and abstract authors were required to sign an ICMJE form for Disclosure of Potential Conflicts of Interest. circumstantial information related to each authors affiliations and conflicts of interests will exist made publicly available on the CISG Web site and published with the BJSM supplement.Medical Legal Considerations
This consensus document reflects the current state of information and will requisite to exist modified according to the progress of original knowledge. It provides an overview of issues that may exist of importance to healthcare providers involved in the management of sport-related concussion. It is not intended as a standard of care, and should not exist interpreted as such. This document is only a guide, and is of a universal nature, consistent with the reasonable exercise of a healthcare professional. Individual treatment will depend on the facts and circumstances specific to each individual case.
It is intended that this document will exist formally reviewed and updated prior to December 1, 2016.SECTION 3: ZURICH 2012 CONSENSUS QUESTIONS
Note that each question is the subject of a separate systematic review that is published in the British Journal of Sports Medicine (2013; 47(5): April 2013). As such everyone citations and details of each topic will exist covered in those reviews.1. When you assess an athlete acutely and they accomplish not acquire concussion, what is it? Is a cognitive injury the key component of concussion in making a diagnosis?
The consensus panel agreed that concussion is an evolving injury in the acute aspect with rapidly changing clinical signs and symptoms, which may reflect the underlying physiological injury in the brain. Concussion is considered to exist among the most intricate injuries in sport medicine to diagnose, assess, and manage. The majority of concussions in sport occur without loss of consciousness or candid neurologic signs. At present, there is no perfect diagnostic test or marker that clinicians can rely on for an immediate diagnosis of concussion in the sporting environment. Because of this evolving process, it is not workable to rule out concussion when an injury event occurs associated with a transient neurological symptom. everyone such cases should exist removed from the playing field and assessed for concussion by the treating physician or health supervision provider as discussed below. It was recognised that a cognitive deficit is not necessary for acute diagnosis as it either may not exist present or detected on examination.2. Are the existing tools/exam sensitive and trustworthy enough on the day of injury to build or exclude a diagnosis of concussion?
Concussion is a clinical diagnosis based largely on the observed injury mechanism, signs, and symptoms. The vast majority of sport-related concussions (hereafter, referred to as concussion) occur without loss of consciousness or candid neurologic signs.151–154 In milder forms of concussion, the athlete might exist slightly confused, without clearly identifiable amnesia. In addition, most concussions cannot exist identified or diagnosed by neuroimaging techniques (eg, computed tomography or magnetic resonance imaging). Several well-validated neuropsychological tests are usurp for expend in the assessment of acute concussion in the competitive sporting environment. These tests provide necessary data on symptoms and functional impairments that clinicians can incorporate into their diagnostic formulation, but should not solely exist used to diagnose concussion.3. What is the best exercise for evaluating an adult athlete with concussion on the “field of play” in 2012?
Recognizing and evaluating concussion in the adult athlete on the field is a challenging responsibility for the health supervision provider. Performing this task is often a rapid assessment in the midst of competition with a time constraint and the athlete alive to to play. A standardized objective assessment of injury, which includes excluding more serious injury, is critical in determining character decisions for the athlete. The on-field evaluation of sport-related concussion is often a challenge given the elusiveness and variability of presentation, hardship in making a timely diagnosis, specificity and sensitivity of sideline assessment tools, and the reliance on symptoms. Despite these challenges, the sideline evaluation is based on recognition of injury, assessment of symptoms, cognitive and cranial nerve function, and balance. Serial assessments are often necessary. Concussion is often an evolving injury, and signs and symptoms may exist delayed. Therefore, erring on the side of caution (keeping an athlete out of participation when there is any suspicion for injury) is important. A standardized assessment of concussion is useful in the assessment of the athlete with suspected concussion but should not win the site of clinician judgment.4. How can the SCAT2 exist improved?
It was agreed that a variety of measures should exist employed as section of the assessment of concussion to provide a more complete clinical profile for the concussed athlete. necessary clinical information can exist ascertained in a streamlined manner through the expend of a multimodal instrument such as the Sport Concussion Assessment Tool (SCAT). A baseline assessment is advised wherever possible. However, it is acknowledged that further validity studies requisite to exist performed to reply this specific issue.
A future SCAT test battery (i.e, SCAT3) should embrace an initial assessment of injury severity using the Glasgow Coma Scale (GCS), immediately followed by observing and documenting concussion signs. Once this is complete, symptom endorsement and symptom severity, neurocognitive function, and balance office should exist assessed in any athlete suspected of sustaining a concussion. It is recommended that these latter steps exist conducted following a minimum 15-minute repose term on the sideline to avoid the influence of exertion or fatigue on the athlete’s performance. While it is eminent that this time frame is an arbitrary one, nevertheless the expert panel agreed that a term of repose was necessary prior to assessment. Future research should regard the efficacy for inclusion of vision tests such as the King Devick Test and clinical reaction time tests.155,156 Recent studies suggest that these may exist useful additions to the sideline assessment of concussion. However, the requisite for additional paraphernalia may build them impractical for sideline use.
It was further agreed that the SCAT3 would exist suitable for adults and youths age 13 and over, while a original tool (Child-SCAT3) exist developed for younger children.5. Advances in neuropsychology: are computerized tests sufficient for concussion diagnosis?
Sport-related concussions are frequently associated with 1 or more symptoms, impaired balance, and/or cognitive deficits. These problems can exist measured using symptom scales, balance testing, and neurocognitive testing. everyone 3 modalities can identify significant changes in the first few days following injury, generally with normalization over 1 to 3 weeks. The presentation of symptoms and the rate of recovery can exist variable, which reinforces the value of assessing everyone 3 areas as section of a comprehensive sport concussion program.
Neuropsychological assessment has been described by the Concussion in Sport Group as a ‘cornerstone’ of concussion management. Neuropsychologists are uniquely qualified to interpret neuropsychological tests and can play an necessary role within the context of a multifaceted-multimodal and multidisciplinary approach to managing sport-related concussion. Concussion management programs that expend neuropsychological assessment to assist in clinical decision-making acquire been instituted in professional sports, colleges, and high schools. Brief computerized cognitive evaluation tools are the mainstay of these assessments worldwide given the logistical limitation in accessing trained neuropsychologists, however it should exist eminent that these are not substitutes for formal neuropsychological assessment. At present, there is insufficient evidence to recommend the widespread routine expend of baseline neuropsychological testing.7. What evidence exits for original strategies/technologies in the diagnosis of concussion and assessment of recovery?
A number of novel technological platforms exist to assess concussion including (but not limited to) iPhone/smart phone apps, quantitative electroencephalography, robotics – sensory motor assessment, telemedicine, eye tracking technology, functional imaging/advanced neuroimaging and head impact sensors. At this stage only limited evidence exists for their role in this setting and nonexistent acquire been validated as diagnostic. It will exist necessary to reconsider the role of these technologies once evidence is developed.8. Advances in the management of sport concussion: what is evidence for concussion therapies?
The current evidence evaluating the effect of repose and treatment following a sport-related concussion is sparse. An initial term of repose may exist of benefit. However, further research to evaluate the long-term outcome of rest, and the optimal amount and type of rest, is needed. Low-level exercise for those who are gradual to regain may exist of benefit, although the optimal timing following injury for initiation of this treatment is currently unknown. Multimodal physiotherapy treatment for individuals with clinical evidence of cervical spine and/or vestibular dysfunction may exist of benefit. There is a strong requisite for high-level studies evaluating the effects of a resting period, pharmacological interventions, rehabilitative techniques, and exercise for individuals who acquire sustained a sport-related concussion.9. The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) post concussive symptoms?
Persistent symptoms (>10 days) are generally reported in 10%-15% of concussions. This may exist higher in inescapable sports (eg, elite ice hockey) and populations (eg, children). In general, symptoms are not specific to concussion and it is necessary to regard and manage co-existent pathologies. Investigations may embrace formal neuropsychological testing and conventional neuroimaging to exclude structural pathology. Currently there is insufficient evidence to recommend routine clinical expend of advanced neuroimaging techniques or other investigative strategies. Cases of concussion in sport where clinical recovery falls outside the expected window (i.e. 10 days) should exist managed in a multidisciplinary manner by health supervision providers with suffer in sports-related concussion. necessary components of management after the initial term of physical and cognitive repose embrace associated therapies such as cognitive, vestibular, physical and psychological therapy, consideration of assessment of other causes of prolonged symptoms, and consideration of commencement of a graded exercise program at a level that does not exacerbate symptoms.10. Revisiting concussion modifiers: how should the evaluation and management of acute concussion vary in specific groups?
The literature demonstrates that number and severity of symptoms and previous concussions are associated with prolonged recovery and/or increased risk of complications. Brief loss of consciousness (LOC), duration of posttraumatic amnesia and/or impact seizures accomplish not reliably forecast outcome following concussion, although a cautious approach should exist taken in an athlete with prolonged LOC (ie, >1 minute). Children generally win longer to regain from concussions and assessment batteries acquire yet to exist validated in the younger age group. Currently there are insufficient data on the influence of genetics and gender on outcome following concussion. Several modifiers are associated with prolonged recovery or increased risk of complications following concussion and acquire necessary implications for management. Children with concussion should exist managed conservatively, with the stress on recrudesce to learn before recrudesce to sport. In cases of concussion managed with limited resources (eg, nonelite players), a conservative approach should too exist taken such that the athlete does not recrudesce to sport until fully recovered11. What are the most efficient risk reduction strategies in sport concussion? - from protective paraphernalia to policy.
No original valid evidence was provided to suggest that the expend of current standard headgear in rugby, or mouthguards in American football, can significantly reduce players’ risk of concussion. No evidence was provided to suggest an association between neck strength increases and concussion risk reduction. There was evidence to suggest that eliminating corpse checking from Pee Wee ice hockey (ages 11-12 years) and fair-play rules in ice hockey were efficient injury prevention strategies. Helmets requisite to exist able to protect from impacts resulting in a head change in velocity of up to 10 m/s in professional American football, and up to 7 m/s in professional Australian football. It too appears that helmets must exist capable of reducing head resultant linear acceleration to below 50 g and angular acceleration components to below 1500 rad/s2 to optimize their effectiveness. Given that a multifactorial approach is needed for concussion prevention, well-designed and sport-specific prospective analytical studies of sufficient power are warranted for mouthguards, headgear/helmets, facial protection, and neck strength. Measuring the effect of rule changes should too exist addressed with future studies, not only assessing original rule changes or legislation, but too alteration or reinforcement to existing rules.12. What is the evidence for chronic concussion-related changes? - behavioural, pathological, and clinical outcomes.
It was agreed that chronic traumatic encephalopathy (CTE) represents a separate tauopathy with an unknown incidence in athletic populations. It was further agreed that CTE was not related to concussions lonely or simply exposure to contact sports. At present, there are no published epidemiological, cohort, or prospective studies relating to modern CTE. Due to the nature of the case reports and pathological case series that acquire been published, it is not workable to determine the causality or risk factors with any certainty. As such, the speculation that repeated concussion or sub-concussive impacts causes CTE remains unproven. The extent to which age-related changes, psychiatric or mental health illness, alcohol/drug use, or co-existing medical or dementing illnesses contribute to this process is largely unaccounted for in the published literature. At present, the interpretation of causation in the modern CTE case studies should proceed cautiously. It was too recognized that it is necessary to address the fears of parents/athletes from media pressure related to the possibility of CTE.13. From consensus to action: how accomplish they optimize information transfer, education, and faculty to influence policy?
The value of information transfer (KT) as section of concussion education is increasingly becoming recognized. Target audiences profit from specific learning strategies. Concussion tools exist, but their effectiveness and impact require further evaluation. The media is valuable in drawing attention to concussion, but efforts requisite to ensure that the public is cognizant of the right information. Social media as a concussion education tool is becoming more prominent. Implementation of KT models is one approach organizations can expend to assess information gaps; identify, develop, and evaluate education strategies; and expend the outcomes to facilitate determination making. Implementing KT strategies requires a defined plan. Identifying the needs, learning styles and preferred learning strategies of target audiences, coupled with evaluation, should exist a piece of the overall concussion education puzzle to acquire an impact on enhancing information and awareness.
Author and coauthor affiliations and disclosures.SCAT3, Child-SCAT3, and Pocket Concussion Recognition Tool. REFERENCES 1. Aubry M, Cantu R, Dvorak J, et al.. Summary and agreement statement of the 1st International Symposium on Concussion in Sport, Vienna 2001. Clin J Sport Med. 2002;12:6–11. 2. McCrory P, Johnston K, Meeuwisse W, et al.. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med. 2005;39:196–204. 3. McCrory P, Meeuwisse W, Johnston K, et al.. Consensus statement on concussion in sport—the third international conference on concussion in sport held in Zurich, November 2008. Phys Sportsmed. 2009;37:141–159. Epub 2010/01/06. 4. Maddocks D, Dicker G. An objective measure of recovery from concussion in Australian rules footballers. Sport Health. 1989;7(suppl):6–7. 5. Maddocks DL, Dicker GD, Saling MM. The assessment of orientation following concussion in athletes. Clin J Sport Med. 1995;5:32–35. 6. McCrea M. Standardized mental status assessment of sports concussion. Clin J Sport Med. 2001;11:176–181. 7. McCrea M, Kelly J, Randolph C, et al.. Standardised assessment of concussion (SAC): on site mental status evaluation of the athlete. J Head Trauma Rehab. 1998;13:27–36. 8. McCrea M, Randolph C, Kelly J. The Standardized Assessment of Concussion (SAC): Manual for Administration, Scoring and Interpretation. 2nd ed. Waukesha, WI; 2000. 9. McCrea M, Kelly JP, Kluge J, et al.. Standardized assessment of concussion in football players. Neurology. 1997;48:586–588. 10. Chen J, Johnston K, Collie A, et al.. A validation of the Post Concussion Symptom Scale in the assessment of intricate concussion using cognitive testing and functional MRI. J Neurol Neurosurg Psych. 2007;78:1231–1238. 11. Chen J, Johnston K, Frey S, et al.. Functional abnormalities in symptomatic concussed athletes: an fMRI study. Neuroimage. 2004;22:68–82. 12. Chen JK, Johnston KM, Collie A, et al.. Association between symptom severity, cogsport tests results, and functional MRI activation in symptomatic concussed athletes. Clin J Sport Med. 2004;14:379. 13. Chen JK, Johnston KM, Collie A, et al.. Behavioural and functional imaging outcomes in symptomatic concussed athletes measured with cogsport and functional MRI. Br J Sport Med. 2004;38:659. 14. Ptito A, Chen JK, Johnston KM. Contributions of functional magnetic resonance imaging (fMRI) to sport concussion evaluation. NeuroRehabilitation. 2007;22:217–227. 15. Guskiewicz K. Postural stability assessment following concussion. Clin J Sport Med. 2001;11:182–190. 16. Guskiewicz KM. Assessment of postural stability following sport-related concussion. Curr Sports Med Rep. 2003;2:24–30. 17. Guskiewicz KM, Ross SE, Marshall SW. Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train. 2001;36:263–273. 18. Cavanaugh JT, Guskiewicz KM, Giuliani C, et al.. Detecting altered postural control after cerebral concussion in athletes with routine postural stability. Br J Sports Med. 2005;39:805–811. 19. Cavanaugh JT, Guskiewicz KM, Giuliani C, et al.. Recovery of postural control after cerebral concussion: original insights using approximate entropy. J Athl Train. 2006;41:305–313. 20. Cavanaugh JT, Guskiewicz KM, Stergiou N. A nonlinear dynamic approach for evaluating postural control: original directions for the management of sport-related cerebral concussion. Sports Med. 2005;35:935–950. 21. Fox ZG, Mihalik JP, Blackburn JT, et al.. recrudesce of postural control to baseline after anaerobic and aerobic exercise protocols. J Athl Train. 2008;43:456–463. 22. Kristman VL, Tator CH, Kreiger N, et al.. Does the apolipoprotein epsilon 4 allele predispose varsity athletes to concussion? A prospective cohort study. Clin J Sport Med. 2008;18:322–328. 23. Terrell TR, Bostick RM, Abramson R, et al.. APOE, APOE promoter, and Tau genotypes and risk for concussion in college athletes. Clin J Sport Med. 2008;18:10–17. 24. Vagnozzi R, Tavazzi B, Signoretti S, et al.. Temporal window of metabolic brain vulnerability to concussions: mitochondrial-related impairment–part I. Neurosurgery. 2007;61:379–388; discussion, 88-89. 25. Hang CH, Chen G, Shi JX, et al.. Cortical expression of nuclear factor kappaB after human brain contusion. Brain Res. 2006;1109:14–21. 26. Peng RY, Gao YB, Xiao XY, et al.. [Study on the expressions of basic fibroblast growth factor and nervous growth factor genes in rat cerebral concussion]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2003;15:213–216. 27. Yunoki M, Kawauchi M, Ukita N, et al.. Effects of lecithinized SOD on sequential change in SOD activity after cerebral contusion in rats. Acta Neurochir Suppl. 1998;71:142–145. 28. Hinkle DA, Baldwin SA, Scheff SW, et al.. GFAP and S100beta expression in the cortex and hippocampus in response to mild cortical contusion. J Neurotrauma. 1997;14:729–738. 29. Holmin S, Schalling M, Hojeberg B, et al.. Delayed cytokine expression in rat brain following experimental contusion. J Neurosurg. 1997;86:493–504. 30. Sandberg Nordqvist AC, von Holst H, Holmin S, et al.. increase of insulin-like growth factor (IGF)-1, IGF binding protein-2 and -4 mRNAs following cerebral contusion. Brain Res Mol Brain Res. 1996;38:285–293. 31. Fukuhara T, Nishio S, Ono Y, et al.. Induction of Cu, Zn-superoxide dismutase after cortical contusion injury during hypothermia. Brain Res. 1994;657:333–336. 32. Begaz T, Kyriacou DN, Segal J, et al.. Serum biochemical markers for post-concussion syndrome in patients with mild traumatic brain injury. J Neurotrauma. 2006;23:1201–1210. 33. de Boussard CN, Lundin A, Karlstedt D, et al.. S100 and cognitive impairment after mild traumatic brain injury. J Rehabil Med. 2005;37:53–57. 34. Lima DP, Simao Filho C, Abib Sde C, et al.. property of life and neuropsychological changes in mild head trauma. Late analysis and correlation with S100B protein and cranial CT scan performed at hospital admission. Injury. 2008;39:604–611. 35. Ma M, Lindsell CJ, Rosenberry CM, et al.. Serum cleaved tau does not forecast postconcussion syndrome after mild traumatic brain injury. Am J Emerg Med. 2008;26:763–768. 36. Stalnacke BM, Tegner Y, Sojka P. Playing ice hockey and basketball increases serum levels of S-100B in elite players: a pilot study. Clin J Sport Med. 2003;13:292–302. 37. Stalnacke BM, Tegner Y, Sojka P. Playing soccer increases serum concentrations of the biochemical markers of brain damage S-100B and neuron-specific enolase in elite players: a pilot study. Brain Inj. 2004;18:899–909. 38. Townend W, Ingebrigtsen T. Head injury outcome prediction: a role for protein S-100B? Injury. 2006;37:1098–1108. 39. Boutin D, Lassonde M, Robert M, et al.. Neurophysiological assessment prior to and following sports-related concussion during childhood: a case study. Neurocase. 2008;14:239–248. 40. De Beaumont L, Brisson B, Lassonde M, et al.. Long-term electrophysiological changes in athletes with a history of multiple concussions. Brain Inj. 2007;21:631–644. 41. De Beaumont L, Lassonde M, Leclerc S, et al.. Long-term and cumulative effects of sports concussion on motor cortex inhibition. Neurosurgery. 2007;61:329–336; discussion, 36–37. 42. Gaetz M, Weinberg H. Electrophysiological indices of persistent post-concussion symptoms. Brain Inj. 2000;14:815–832. 43. Gosselin N, Theriault M, Leclerc S, et al.. Neurophysiological anomalies in symptomatic and asymptomatic concussed athletes. Neurosurgery. 2006;58:1151–1161; discussion, 61. 44. Lavoie ME, Dupuis F, Johnston KM, et al.. Visual p300 effects beyond symptoms in concussed college athletes. J Clin Exp Neuropsychol. 2004;26:55–73. 45. Rousseff RT, Tzvetanov P, Atanassova PA, et al.. Correlation between cognitive P300 changes and the grade of closed head injury. Electromyogr Clin Neurophysiol. 2006;46:275–277. 46. Collie A, Darby D, Maruff P. Computerised cognitive assessment of athletes with sports related head injury. Br J Sports Med. 2001;35:297–302. 47. Collie A, Maruff P. Computerised neuropsychological testing. Br J Sports Med. 2003;37:2–3. 48. Collie A, Maruff P, McStephen M, et al.. Psychometric issues associated with computerised neuropsychological assessment of concussed athletes. Br J Sports Med. 2003;37:556–559. 49. Collins MW, Grindel SH, Lovell MR, et al.. Relationship between concussion and neuropsychological performance in college football players [see comments]. JAMA. 1999;282:964–970. 50. Lovell MR. The relevance of neuropsychologic testing for sports-related head injuries. Curr Sports Med Rep. 2002;1:7–11. 51. Lovell MR, Collins MW. Neuropsychological assessment of the college football player. J Head Trauma Rehabil. 1998;13:9–26. 52. Bleiberg J, Cernich AN, Cameron K, et al.. Duration of cognitive impairment after sports concussion. Neurosurgery. 2004;54:1073–1078; discussion, 8–80. 53. Bleiberg J, Warden D. Duration of cognitive impairment after sports concussion. Neurosurgery. 2005;56:E1166. 54. Broglio SP, Macciocchi SN, Ferrara MS. Neurocognitive performance of concussed athletes when symptom free. J Athl Train. 2007;42:504–508. 55. Broglio SP, Macciocchi SN, Ferrara MS. Sensitivity of the concussion assessment battery. Neurosurgery. 2007;60:1050–1057; discussion, 7–8. 56. Gioia G, Janusz J, Gilstein K, et al.. Neueopsychological management of consussion in children and adolescents: effects of age and gender on impact (abstract). Br J Sp Med. 2004;38:657. 57. McCrory P, Collie A, Anderson V, et al.. Can they manage sport related concussion in children the identical as in adults? Br J Sports Med. 2004;38:516–519. 58. Johnston K, bloom G, Ramsay J, et al.. Current concepts in concussion rehabilitation. Curr Sports Med Rep. 2004;3:316–323. 59. Guskiewicz KM, McCrea M, Marshall SW, et al.. Cumulative effects associated with recurrent concussion in collegiate football players. JAMA. 2003;290:2549–2555. 60. Lovell M, Collins M, Bradley J. recrudesce to play following sports-related concussion. Clin Sports Med. 2004;23:421–441, ix. 61. Collins M, field M, Lovell M, et al.. Relationship between postconcussion headache and neuropsychological test performance in high school athletes. Am J Sports Med. 2003;31:168–173. 62. Collins M, Grindel S, Lovell M, et al.. Relationship between concussion and neuropsychological performance in college football players. J Am Med Assoc. 1999;282:964–970. 63. Collins MW, Lovell MR, Iverson GL, et al.. Cumulative effects of concussion in high school athletes. Neurosurgery. 2002;51:1175–1179; discussion, 80–81. 64. McCrea M, Guskiewicz KM, Marshall SW, et al.. Acute effects and recovery time following concussion in collegiate football players. JAMA. 2003;290:2556–2563. 65. McCrea M, Hammeke T, Olsen G, et al.. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med. 2004;14:13–17. 66. bloom G, Horton A, McCrory P, et al.. Sport psychology and concussion: original impacts to explore. Br J Sports Med. 2004;38:519–521. 67. Weiss MR, Gill DL. What goes around comes around: re-emerging themes in sport and exercise psychology. Res Q Exerc Sport. 2005;76(2 suppl):S71–S87. 68. McCrory P. Should they treat concussion pharmacologically? The requisite for evidence based pharmacological treatment for the concussed athlete. Br J Sports Med. 2002;36:3–5. 69. McCrory P. Preparticipation assessment for head injury. Clin J Sport Med. 2004;14:139–144. 70. Johnston KM, Lassonde M, Ptito A. A concomitant neurosurgical approach to sport-related head injury: the McGill concussion protocol. J Am Coll Surg. 2001;192:515–524. 71. Delaney J, Lacroix V, Leclerc S, et al.. Concussions during the 1997 Canadian Football League Season. Clin J Sport Med. 2000;10:9–14. 72. Delaney J, Lacroix V, Leclerc S, et al.. Concussions among university football and soccer players. Clin J Sport Med. 2002;12:331–338. 73. Gessel LM, Fields SK, Collins CL, et al.. Concussions among United States high school and collegiate athletes. J Athl Train. 2007;42:495–503. 74. Dvorak J, Junge A, Fuller C, et al.. Medical issues in women's football. Br J Sports Med. 2007;41(suppl 1):i1. 75. Dvorak J, McCrory P, Kirkendall DT. Head injuries in the female football player: incidence, mechanisms, risk factors and management. Br J Sports Med. 2007;41(suppl 1):i44–i46. 76. Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet. 1975;1:480–484. 77. Leninger B, Gramling S, Farrell A, et al.. Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. J Neurol Neurosurg Psych. 1990;53:293–296. 78. Lovell M, Iverson G, Collins M, et al.. Does loss of consciousness forecast neuropsychological decrements after concussion. Clin J Sport Med. 1999;9:193–199. 79. McCrea M, Kelly J, Randolph C, et al.. Immediate neurocognitive effects of concussion. Neurosurgery. 2002;50:1032–1042. 80. Cantu RC. Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe recrudesce to play. J Athl Train. 2001;36:244–248. 81. Lovell MR, Collins MW, Iverson GL, et al.. Recovery from mild concussion in high school atheltes. J Neurosurg. 2003;98:296–301. 82. McCrory PR, Ariens T, Berkovic SF. The nature and duration of acute concussive symptoms in Australian football. Clin J Sport Med. 2000;10:235–238. 83. Yarnell P, Lynch S. The ‘ding': amnestic state in football trauma. Neurology. 1973;23:196–197. 84. Yarnell PR, Lynch S. Retrograde memory immediately after concussion. Lancet. 1970;1:863–864. 85. McCrory PR, Berkovic SF. Video analysis of acute motor and convulsive manifestations in sport-related concussion. Neurology. 2000;54:1488–1491. 86. McCrory PR, Bladin PF, Berkovic SF. Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome. BMJ. 1997;314:171–174. 87. Fleminger S. Long-term psychiatric disorders after traumatic brain injury. Eur J Anaesthesiol Suppl. 2008;42:123–130. 88. Chen JK, Johnston KM, Petrides M, et al.. Neural substrates of symptoms of depression following concussion in virile athletes with persisting postconcussion symptoms. Arch Gen Psychiatry. 2008;65:81–89. 89. Bryant RA. Disentangling mild traumatic brain injury and stress reactions. N Engl J Med. 2008;358:525–527. 90. Vanderploeg RD, Curtiss G, Luis CA, et al.. Long-term morbidities following self-reported mild traumatic brain injury. J Clin Exp Neuropsychol. 2007;29:585–598. 91. Guskiewicz KM, Marshall SW, Bailes J, et al.. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc. 2007;39:903–909. 92. Kashluba S, Casey JE, Paniak C. Evaluating the utility of ICD-10 diagnostic criteria for postconcussion syndrome following mild traumatic brain injury. J Int Neuropsychol Soc. 2006;12:111–118. 93. Iverson GL. Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Arch Clin Neuropsychol. 2006;21:303–310. 94. Chamelian L, Feinstein A. The effect of major depression on subjective and objective cognitive deficits in mild to temper traumatic brain injury. J Neuropsychiatry Clin Neurosci. 2006;18:33–38. 95. Mooney G, Speed J, Sheppard S. Factors related to recovery after mild traumatic brain injury. Brain Inj. 2005;19:975–987. 96. Broshek DK, Freeman JR. Psychiatric and neuropsychological issues in sport medicine. Clin Sports Med. 2005;24:663–679, x. 97. Pellman EJ. Background on the National Football League's research on concussion in professional football. Neurosurgery. 2003;53:797–798. 98. Purcell L, Carson J. Sport-related concussion in pediatric athletes. Clin Pediatr (Phila). 2008;47:106–113. 99. Lee LK. Controversies in the sequelae of pediatric mild traumatic brain injury. Pediatr Emerg Care. 2007;23:580–583; quiz, 4–6. 100. Schnadower D, Vazquez H, Lee J, et al.. Controversies in the evaluation and management of minor blunt head trauma in children. Curr Opin Pediatr. 2007;19:258–264. 101. Wozniak JR, Krach L, Ward E, et al.. Neurocognitive and neuroimaging correlates of pediatric traumatic brain injury: a diffusion tensor imaging (DTI) study. Arch Clin Neuropsychol. 2007;22:555–568. 102. Hayden MG, Jandial R, Duenas HA, et al.. Pediatric concussions in sports; a simple and rapid assessment tool for concussive injury in children and adults. Childs Nerv Syst. 2007;23:431–435. 103. Lee MA. Adolescent concussions—management recommendations: a practical approach. Conn Med. 2006;70:377–380. 104. Kirkwood MW, Yeates KO, Wilson PE. Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics. 2006;117:1359–1371. 105. Guskiewicz KM, Marshall SW, Bailes J, et al.. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005;57:719–726; discussion, 726. 106. Nandoe RD, Scheltens P, Eikelenboom P. Head trauma and Alzheimer's disease. J Alzheimers Dis. 2002;4:303–308. 107. Stern MB. Head trauma as a risk factor for Parkinson's disease. Mov Disord. 1991;6:95–97. 108. Omalu BI, DeKosky ST, Hamilton RL, et al.. chronic traumatic encephalopathy in a national football league player: section II. Neurosurgery. 2006;59:1086–1092; discussion, 92-93. 109. Omalu BI, DeKosky ST, Minster RL, et al.. chronic traumatic encephalopathy in a National Football League player. Neurosurgery. 2005;57:128–134; discussion, 134. 110. McKee AC, Cantu RC, Nowinski CJ, et al.. chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68:709–735. 111. McKee AC, Gavett BE, Stern RA, et al.. TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy. J Neuropathol Exp Neurol. 2010. Epub 2010/08/20. 112. McKee AC, Stein TD, Nowinski CJ, et al.. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2012. Epub 2012/12/05. 113. McCrory P. Sports concussion and the risk of chronic neurological impairment. Clin J Sport Med. 2011;21:6–12. 114. McCrory P. Future advances and areas of future focus in the treatment of sport-related concussion. Clin Sports Med. 2011;30:201–208, xi-ii. 115. Hagel BE, Pless IB, Goulet C, et al.. Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study. BMJ. 2005;330:281. 116. McCrory P. The role of helmets in skiing and snowboarding. Br J Sports Med. 2002;36:314. 117. Mueller BA, Cummings P, Rivara FP, et al.. Injuries of the head, face, and neck in relation to ski helmet use. Epidemiology. 2008;19:270–276. 118. Sulheim S, Holme I, Ekeland A, et al.. Helmet expend and risk of head injuries in alpine skiers and snowboarders. JAMA. 2006;295:919–924. 119. Delaney JS, Al-Kashmiri A, Drummond R, et al.. The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players. Br J Sports Med. 2008;42:110–115; discussion, 5. 120. Viano DC, Pellman EJ, Withnall C, et al.. Concussion in professional football: performance of newer helmets in reconstructed game impacts—part 13. Neurosurgery. 2006;59:591–606; discussion, 591–606. 121. Finch C, Braham R, McIntosh A, et al.. Should football players wear custom fitted mouthguards? Results from a group randomised controlled trial. Inj Prev. 2005;11:242–246. 122. McIntosh A, McCrory P. The dynamics of concussive head impacts in rugby and Australian rules football. Med Sci Sports Exerc. 2000;32:1980–1985. 123. McIntosh A, McCrory P. impact energy attenuation performance of football headgear. Br J Sports Med. 2000;34:337–342. 124. McIntosh A, McCrory P. Effectiveness of headgear in a pilot study of under 15 rugby union football. Br J Sports Med. 2001;35:167–170. 125. McIntosh A, McCrory P, FInch C, et al.. Rugby Headgear Study. Sydney, Australia: The University of original South Wales; 2005. 126. Finch C, Newstead S, Cameron M, et al.. Head Injury Reductions in Victoria Two Years After the Introduction of Mandatory Bicycle Helmet Use. Melbourne, Australia: Monash University Accident Research Centre; 1993. Report No. 51. 127. Curnow WJ. Bicycle helmets and public health in Australia. Health Promot J Austr. 2008;19:10–15. 128. Hewson PJ. Cycle helmets and road casualties in the UK. Traffic Inj Prev. 2005;6:127–134. 129. Davidson JA. Epidemiology and outcome of bicycle injuries presenting to an emergency department in the United Kingdom. Eur J Emerg Med. 2005;12:24–29. 130. Hansen KS, Engesaeter LB, Viste A. Protective effect of different types of bicycle helmets. Traffic Inj Prev. 2003;4:285–290. 131. Andersen T, Arnason A, Engebretsen L, et al.. Mechanism of head injuries in elite football. Br J Sports Med. 2004;38:690–696. 132. Hagel B, Meewisse W. Risk compensation: a "side effect" of sport injury prevention [Editorial]? Clin J Sport Med. 2004;14:193–196. 133. Finch C, Mcintosh AS, McCrory P, et al.. A pilot study of the attitudes of Australian Rules footballers towards protective headgear. J Sci Med Sport. 2003;6:505–511. 134. Finch CF, McIntosh AS, McCrory P. What accomplish under 15 year traditional schoolboy rugby union players referee about protective headgear? Br J Sports Med. 2001;35:89–94. 135. Finch C, Mcintosh AS, McCrory P. What is the evidence ground for the expend of protective headgear and mouthguards in Australian football. Sport Health. 2000;18:35–38. 136. Reece RM, Sege R. Childhood head injuries: contingent or inflicted? Arch Pediatr Adolesc Med. 2000;154:11–15. 137. Shaw NH. Bodychecking in hockey. CMAJ. 2004;170:15–16; author reply, 6, 8. 138. Denke NJ. Brain injury in sports. J Emerg Nurs. 2008;34:363–364. 139. Gianotti S, Hume PA. Concussion sideline management intervention for rugby union leads to reduced concussion claims. NeuroRehabilitation. 2007;22:181–189. 140. Guilmette TJ, Malia LA, McQuiggan MD. Concussion understanding and management among original England high school football coaches. Brain Inj. 2007;21:1039–1047. 141. Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42:311–319. 142. Valovich McLeod TC, Schwartz C, Bay RC. Sport-related concussion misunderstandings among youth coaches. Clin J Sport Med. 2007;17:140–142. 143. Sye G, Sullivan SJ, McCrory P. high school rugby players' understanding of concussion and recrudesce to play guidelines. Br J Sports Med. 2006;40:1003–1005. 144. Theye F, Mueller KA. "Heads up": concussions in high school sports. Clin Med Res. 2004;2:165–171. 145. Kashluba S, Paniak C, Blake T, et al.. A longitudinal, controlled study of patient complaints following treated mild traumatic brain injury. Arch Clin Neuropsychol. 2004;19:805–816. 146. Gabbe B, Finch CF, Wajswelner H, et al.. Does community-level Australian football support injury prevention research? J Sci Med Sport. 2003;6:231–236. 147. Kaut KP, DePompei R, Kerr J, et al.. Reports of head injury and symptom information among college athletes: implications for assessment and educational intervention. Clin J Sport Med. 2003;13:213–221. 148. Davidhizar R, Cramer C. "The best thing about the hospitalization was that the nurses kept me well informed" Issues and strategies of client education. Accid Emerg Nurs. 2002;10:149–154. 149. McCrory P. What counsel should they give to athletes postconcussion? Br J Sports Med. 2002;36:316–318. 150. Bazarian JJ, Veenema T, Brayer AF, et al.. information of concussion guidelines among practitioners caring for children. Clin Pediatr (Phila). 2001;40:207–212. 151. Guskiewicz KM, Weaver NL, Padua DA, et al.. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med. 2000;28:643–650. 152. McCrea M, Guskiewicz KM, Marshall SW, et al.. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003;290:2556–2563. 153. Macciocchi SN, Barth JT, Alves W, et al.. Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery. 1996;39:510–514. 154. Meehan WP 3rd, d'Hemecourt P, Comstock RD. high school concussions in the 2008-2009 academic year: mechanism, symptoms, and management. Am J Sports Med. 2010;38:2405–2409. 155. Eckner JT, Kutcher JS, Richardson JK. Between-seasons test-retest reliability of clinically measured reaction time in National Collegiate Athletic Association Division I athletes. J Athl Train. 2011;46:409–414. 156. Eckner JT, Richardson JK, Kim H, et al.. A novel clinical test of recognition reaction time in robust adults. Psychol Assess. 2012;24:249–254.
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