Background:Return to play(RTP)in elite rugby is managed using a 6-stage graduated RTP protocol,which can result in clearance to play within 1 week of injury.We aimed to explore how symptom,cognitive,and balance presen...Background:Return to play(RTP)in elite rugby is managed using a 6-stage graduated RTP protocol,which can result in clearance to play within 1 week of injury.We aimed to explore how symptom,cognitive,and balance presentation and evolution during concussion screens 2 h(head injury assessment(HIA2)and 48 h(HIA3)after injury were associated with time to RTP)to identify whether a more conservative graduated RTP may be appropriate.Methods:A retrospective cohort study was conducted in 380 concussed rugby players from elite men’s rugby over 3 consecutive seasons.Players were classified as shorter or longer returns,depending on whether RTP occurred within 7 days(allowing them to be considered to play the match 1 week after injury)or longer than 8 days,respectively.Symptom,cognitive,and balance performance during screens was assessed relative to baseline(normal or abnormal)and to the preceding screen(improving or worsening).Associations between sub-test abnormalities and RTP time were explored using odds ratios(OR,longer vs.shorter).Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving.Results:Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time(HIA2:OR=2.21,95%confidence interval(95%CI):1.39-3.50;HIA3:OR=3.30,95%CI:1.89-5.75).Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return(HIA2:OR=2.49,95%CI:1.36-4.58;HIA3:OR=3.34,95%CI:1.10-10.15).Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3.Cognitive and balance performance were not associated with longer return and did not affect median days absence.Conclusion:Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times.This may guide a more conservative approach to RTP,while still adhering to individualized concussion management principles.展开更多
The St. Johns River is one of the premiere waterways in the southeastern United States, but it is increasingly affected by anthropogenic disturbances and influences such as excessive loading of nutrients. In the curre...The St. Johns River is one of the premiere waterways in the southeastern United States, but it is increasingly affected by anthropogenic disturbances and influences such as excessive loading of nutrients. In the current pilot project, small native plant communities (“garden sites”) were established along sections of riparian corridors of five first-order tributaries in residential-commercial areas that drain into the lower St. Johns River in north Florida. In addition, four “non-garden” (control) tributaries were monitored for comparison. Garden sites included five species native to the area;20 plants of each species on both banks (200 total plants). These sites were used to assess the ability of partially restored riparian areas to ameliorate nutrient loading and water quality and determine their impact on local biodiversity in disturbed suburban drainage systems. Partially restored sites showed a significant reduction in both NO3- and P concentrations in both soil and water samples compared to control sites. For instance, soil NO3- levels were reduced by 14% in garden sites, while water samples were 30% lower. Moreover, both plant species richness and Shannon diversity (H’) were significantly higher at partially restored sites, 33 and 19% respectively, compared to control streams after two years. Garden sites also had significantly higher terrestrial and invertebrate diversity than non-restored tributaries. Intermittent patches of partially restored habitat along suburban riparian corridors may provide a practical cost-effective technique for improving ecosystem function, water quality and increasing biodiversity along these frequently disturbed lotic habitats. Trends detected in the current study may have general implications for riparian restoration and reduction of nutrient loading in these small tributaries and, ultimately, effect water quality of the lower St. Johns River basin.展开更多
文摘Background:Return to play(RTP)in elite rugby is managed using a 6-stage graduated RTP protocol,which can result in clearance to play within 1 week of injury.We aimed to explore how symptom,cognitive,and balance presentation and evolution during concussion screens 2 h(head injury assessment(HIA2)and 48 h(HIA3)after injury were associated with time to RTP)to identify whether a more conservative graduated RTP may be appropriate.Methods:A retrospective cohort study was conducted in 380 concussed rugby players from elite men’s rugby over 3 consecutive seasons.Players were classified as shorter or longer returns,depending on whether RTP occurred within 7 days(allowing them to be considered to play the match 1 week after injury)or longer than 8 days,respectively.Symptom,cognitive,and balance performance during screens was assessed relative to baseline(normal or abnormal)and to the preceding screen(improving or worsening).Associations between sub-test abnormalities and RTP time were explored using odds ratios(OR,longer vs.shorter).Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving.Results:Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time(HIA2:OR=2.21,95%confidence interval(95%CI):1.39-3.50;HIA3:OR=3.30,95%CI:1.89-5.75).Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return(HIA2:OR=2.49,95%CI:1.36-4.58;HIA3:OR=3.34,95%CI:1.10-10.15).Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3.Cognitive and balance performance were not associated with longer return and did not affect median days absence.Conclusion:Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times.This may guide a more conservative approach to RTP,while still adhering to individualized concussion management principles.
文摘The St. Johns River is one of the premiere waterways in the southeastern United States, but it is increasingly affected by anthropogenic disturbances and influences such as excessive loading of nutrients. In the current pilot project, small native plant communities (“garden sites”) were established along sections of riparian corridors of five first-order tributaries in residential-commercial areas that drain into the lower St. Johns River in north Florida. In addition, four “non-garden” (control) tributaries were monitored for comparison. Garden sites included five species native to the area;20 plants of each species on both banks (200 total plants). These sites were used to assess the ability of partially restored riparian areas to ameliorate nutrient loading and water quality and determine their impact on local biodiversity in disturbed suburban drainage systems. Partially restored sites showed a significant reduction in both NO3- and P concentrations in both soil and water samples compared to control sites. For instance, soil NO3- levels were reduced by 14% in garden sites, while water samples were 30% lower. Moreover, both plant species richness and Shannon diversity (H’) were significantly higher at partially restored sites, 33 and 19% respectively, compared to control streams after two years. Garden sites also had significantly higher terrestrial and invertebrate diversity than non-restored tributaries. Intermittent patches of partially restored habitat along suburban riparian corridors may provide a practical cost-effective technique for improving ecosystem function, water quality and increasing biodiversity along these frequently disturbed lotic habitats. Trends detected in the current study may have general implications for riparian restoration and reduction of nutrient loading in these small tributaries and, ultimately, effect water quality of the lower St. Johns River basin.
