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The authors interviewed more than one hundred high school students in three regions of China about their knowledge and perceptions of the United States and China. The authors' findings suggest the following: (1) students possess extensive knowledge about the United States in terms of its history, geography, socioeconomic system, and education, and they obtain the knowledge from multiple media sources besides social studies curriculum; (2) students obtain knowledge about China mainly from news media, social studies class, and their personal experience; (3) students admire American socioeconomic and educational systems but resent America's interference with China's domestic issues and its hegemony in world affairs; (4) students take pride in China's economic development but resent the education system and are concerned about economic inequity existing in China today; and (5) students believe that mutual understanding and learning from each other will benefit the United States, China, and the whole world. (Contains 2 notes.)

Objectives: Studies that evaluate the effectiveness of concussion laws often use only a single variable (ie, presence of the law), failing to account for law complexity. We examined the association between multiple design elements of state concussion laws and rates of sports-related concussion reporting among US high school athletes. Methods: We derived 3 design elements of concussion laws from the 2009-2017 LawAtlas database: (1) strength of law, (2) number of law revisions, and (3) speed of law adoption. We examined the association between these design elements and rates of new and recurrent sports-related concussion reporting from the 2009-2010 through 2016-2017 academic years in a nationally representative sample of high school athletes participating in High School Report Information Online, an online data collection tool. Results: A total of 7064 sports-related concussions (6332 [89.6%] new and 732 [10.4%] recurrent concussions) were reported during the study period, with an overall rate of 39.7 sports-related concussions per 100 000 athletic exposures (eg, game or practice). Rates of new concussion reporting were higher among high schools in states with medium- or high-strength concussion laws than in states with low-strength concussion laws and in states with at least 1 concussion law revision than in states with no concussion law revisions. Rates of recurrent concussion reporting were lower among high schools in states with ≥2 concussion law revisions than in states with <2 concussion law revisions. Early law adoption was associated with higher rates of new and recurrent concussion reporting, and late law adoption was associated with lower rates of new and recurrent concussion reporting. Conclusion: Our findings may help inform legislators of the public health effect of concussion laws. [ABSTRACT FROM AUTHOR]

The authors interviewed more than one hundred high school students in three regions of China about their knowledge and perceptions of the United States and China. The authors' findings suggest the following: (1) students possess extensive knowledge about the United States in terms of its history, geography, socioeconomic system, and education, and they obtain the knowledge from multiple media sources besides social studies curriculum; (2) students obtain knowledge about China mainly from news media, social studies class, and their personal experience; (3) students admire American socioeconomic and educational systems but resent America's interference with China's domestic issues and its hegemony in world affairs; (4) students take pride in China's economic development but resent the education system and are concerned about economic inequity existing in China today; and (5) students believe that mutual understanding and learning from each other will benefit the United States, China, and the whole world. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the central tendency and dispersion for incubation period of COVID-19 and, in turn, assess the effect of a certain length of quarantine for close contacts in active monitoring., Methods: Literature related to SARS-CoV-2 and COVID-19 was searched through April 26, 2020. Quality was assessed according to Agency for Healthcare Research and Quality guidelines. Log-normal distribution for the incubation period was assumed to estimate the parameters for each study. Incubation period median and dispersion were estimated, and distribution was simulated., Results: Fifty-six studies encompassing 4095 cases were included in this meta-analysis. The estimated median incubation period for general transmissions was 5.8 days [95% confidence interval (95% CI): 5.3, 6.2]. Incubation period was significantly longer for asymptomatic transmissions (median: 7.7 days; 95% CI 6.3, 9.4) than for general transmissions (P = 0.0408). Median and dispersion were higher for SARS-CoV-2 incubation compared to other viral respiratory infections. Furthermore, about 12 in 10,000 contacts in active monitoring would develop symptoms after 14 days, or below 1 in 10,000 for asymptomatic transmissions. Meta-regression suggested that each 10-year increase in age resulted in an average 16% increment in length of median incubation (incubation period ratio, 1.16, 95% CI 1.01, 1.32; P = 0.0250)., Conclusion: This study estimated the median and dispersion of the SARS-CoV-2 incubation period more precisely. A 14-day quarantine period is sufficient to trace and identify symptomatic infections., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Retrospective estimates of head impact burden in contact sports are often used in studies assessing for correlation of head impact exposure with neurocognitive outcomes later in life. These estimations assume a consistent impact burden from year to year. We monitored head impacts in youth tackle football players in the 6th-8th grades and high school varsity players using helmet-based sensors during two consecutive seasons. Helmet-based pressure sensors were used to measure head impacts, and estimates of peak linear acceleration (g's) were then grouped and summed for cumulative impact. After each season, players estimated whether they experienced an average, below average, or above average head impact burden in relation to their teammates. Of the 98 players who participated, 54 played in both seasons and sustained a median of 102.5 impacts (2206 cumulative g's) in season 1 and 161 impacts (3682 cumulative g's) in season 2. Using pairwise comparisons, number of impacts and cumulative g's increased in the youth players from season 1 to season 2 (p = 0.0021 and p = 0.0018, respectively), but there was a trend towards a decrease in number of impacts and g's at the high school level. In an exploratory analysis, perceived cumulative head impact and measured cumulative g's weakly correlated (Pearson's correlation coefficient = 0.26 for season 1 and 0.02 for season 2). In conclusion, cumulative head impacts differ significantly from one season to the next, and players have difficulty estimating their cumulative head impacts in relation to their team mates, especially at the youth level. Retrospective estimations of head impact burden should account for this variability.

Background: Existing studies analyzing the impact of state concussion laws have found an increase in concussion-related medical encounters post-law, in some instances, such increases were observed during the pre-law period due to a potential "spillover" effect. This study assessed the effects of Ohio's concussion law, while accounting for such a "spillover" effect, on the trends in monthly rates of concussion-related medical encounters in Medicaid insured children using autoregressive integrated moving average (ARIMA) analysis., Methods: We analyzed claim data obtained from the Partners For Kids database, a pediatric accountable care organization in Ohio. Concussion-related medical encounters for Medicaid-insured children (ages 0-18 years) treated between April 1, 2008 to December 31, 2016 were selected and analyzed. We assessed pre- and post-law trends in concussion-related medical encounters using an ARIMA intervention model. We also used traditional regression methods to validate the study results., Results: A total of 16,943 concussion-related medical encounters sustained by 15,545 unique patients were included. Monthly rates of concussion-related medical encounters significantly increased from 4.64 per 10,000 member months during the pre-law period to 6.69 per 10,000 member months in the post-law period (P < 0.0001). Three upward breaks in the monthly rates of concussion-related medical encounters were observed between 2009 and 2016, with two breaks observed during the pre-law period. Specifically, the increased breakpoint observed in July 2011 (P = 0.0186) was significantly associated with an estimated 7.3% increase (95% CI: 1.1-13.7) in the rate of concussion-related medical encounters. This finding was confirmed in the Poisson regression and curve fitting models. Furthermore, a seasonal trend in concussion-related medical encounters was observed with the highest rates in September and October of each year., Conclusions: Two of the three upward breaks identified in the monthly rate of concussion-related medical encounters occurred before the enactment of Ohio's concussion law, suggesting a potential "spillover" effect. Further research is needed to confirm such an effect in children with other types of medical insurance.

Objective: To describe the rates and patterns of initial emergency department (ED) encounters and follow-up care for concussions among Medicaid-insured children before and after the 2013 enactment of Ohio concussion law., Study Design: Using a time-series design, this study analyzed concussion claim data obtained from Partners for Kids, a pediatric accountable-care organization in Ohio. A total of 12 512 concussions and 48 238 associated claims for services between January 1, 2008, and June 30, 2017, with an initial ED encounter among Medicaid-insured children (ages 0-18 years) were analyzed. The effect of the law on the odds of follow-up care were assessed using generalized estimating equations models, adjusted for sex, age group, and residence location., Results: Of the total 12 512 concussions, 63.9% occurred in male patients, 70.1% in patients ages 10-18 years, and 65.2% in patients from urban areas. The rate of initial ED encounters for concussions increased from 2008 to 2014 (2.8 to 4.9 per 10 000 members), followed by a decrease in 2016 (4.2 per 10 000 members). A significant increase in follow-up care after the initial ED encounter was observed from pre-law to post-law (OR 1.73, 95% CI 1.61, 1.86). A shift in follow-up care was observed from radiology and ambulance services in pre-law to primary care providers in post-law., Conclusions: The Ohio concussion law may have influenced the patterns of initial ED visit and follow-up care for concussions among Medicaid-insured children. Future studies evaluating the impact of the law should analyze the utilization patterns among children with various insurance/payment types., (Copyright © 2018 Elsevier Inc. All rights reserved.)