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To assess the recovery of the cardiac autonomic control system (CACS) response to the modified tilt-test during rehabilitation, in children post moderate-severe TBI at the subacute phase post-injury.Thirty-seven children aged 6-18 years, 14-162 days post moderate-severe TBI, participated in the study. The assessment included CACS values evaluation (heart rate (HR), heart rate variability (HRV) and blood pressure) during the modified tilt-test: five minutes lying supine and five minutes passive standing. Re-assessment was performed after eight weeks of rehabilitation.In both assessments, only four children reported symptoms associated with orthostatic intolerance during the modified tilt-test. No change was found over time in the HR and HRV values at rest. In response to the modified tilt-test, the systolic blood pressure showed change over time, with a significant interaction effect (p=0.04); while in the first assessment the SBP values showed a hypertension trend in the second assessment the SBP values showed a hypotension trend.Children post moderate-severe TBI at the sub-acute phase post-injury, have a better systolic blood pressure response during the modified tilt-test after eight weeks of individually tailored rehabilitation program, despite no change in the CACS values at rest.NCT03215082.

BACKGROUND: Increasing evidence suggests autonomic nervous system (ANS) dysfunction may occur following mild traumatic brain injury (mTBI). Measures of heart rate, heart rate variability, blood pressure and baroreceptor sensitivity can be used to evaluate ANS dysfunction following mTBI. OBJECTIVE: Summarize the evidence for ANS dysfunction in adults following mTBI. METHODS: A search of Embase, MEDLINE, Cochrane Central Register, PsycINFO, CINAHL and SPORTDiscus databases was conducted. Search topics included: mTBI and ANS. Identified abstracts were independently reviewed by 2 reviewers followed by full text screening. Risk of bias was assessed using a modified SIGN checklist. A structured synthesis was performed. RESULTS: Thirty-nine studies (combined 1,467 participants diagnosed with mTBI) evaluating ANS function were included. ANS function was evaluated under various conditions including: rest, during exertion, cold pressor test, Valsalva maneuver, using face cooling and eyeball pressure paradigms. Short-term or ultra-short-term recordings were most common. The majority of studies (28/39) were rated as “unacceptable” for quality of evidence. CONCLUSIONS: Altered parameters of ANS function have been reported in multiple conditions following mTBI, both acutely and in the post-acute/chronic stages of recovery. However, due to methodological limitations, conclusions regarding the severity and timing of ANS dysfunction following mTBI cannot be drawn.

One of the sequalae of severe traumatic brain injury (TBI) in children is impaired function of the cardiac autonomic control system (CACS) at rest. The CACS response to conventional autonomic tests is little known.To examine the CACS response to conventional autonomic tests in children after severe TBI during the rehabilitation period and to compare with typically developing (TD) children.This study combined a case-control and follow-up design. The severe TBI group (cases) consisted of 33 children aged 9-18 years, 14-142 days after severe TBI who were followed for 8 weeks during rehabilitation. The control group consisted of 19 TD children matched for age and sex. Heart rate (HR) and heart rate variability (HRV) were evaluated with the Polar RS800CX device at rest (sitting), during a handgrip test and during a paced breathing test.At the first assessment, we found lower HRV values at rest and a lower HRV response during the paced breathing and handgrip tests in the TBI group than the TD group (p0.01). After 8 weeks, HRV values did not change at rest in the TBI group, but the response to the autonomic tests improved significantly, with increased HRV values in response to the paced breathing test (p0.01) and the handgrip test (p = 0.01).After severe TBI, children exhibited an impaired CACS response to autonomic tests, with parasympathetic suppression and sympathetic arousal. After 8 weeks of rehabilitation, CACS function recovered partially and the response to the autonomic tests improved with no change in CACS function at rest.

Prescribed (or “planned”) burning is used by land managers to reduce fuel-loads in order to mitigate the spread of wildfire, thereby protecting life and property, and to promote environmental heterogeneity to enhance biodiversity. Globally, many fire management agencies focus on increasing extent and frequency of prescribed burning. There is a need to assess how high levels of prescribed burning may affect the long-term, landscape-level persistence of ecological communities. We forward projected management scenarios over 21 years to explore how the operationally realistic implementation of four different prescribed burn targets, covering 5, 3, 1.5 and 0% of a large reserve per annum (p.a.) might affect provision and removal of fire-mediated habitat of 11 rare and threatened bird species. Sustained implementation of high targets (5 and 3% p.a.) homogenised the landscape toward young vegetation, substantially reducing highly suitable habitat for species requiring intermediate (20–60 years post-fire) and older (60+ years) age classes. In contrast, no prescribed burning generated insufficient habitat for species with early (

Background Although intravenous immunoglobulin (IVIG) is effective therapy for Kawasaki disease (KD), the most common cause of acquired heart disease in children, 10–20% of patients are IVIG-resistant and require additional therapy. This group has an increased risk of coronary artery aneurysms (CAA) and there has been no adequately powered, randomized clinical trial in a multi-ethnic population to determine the optimal therapy for IVIG-resistant patients. Objectives The primary outcome is duration of fever in IVIG-resistant patients randomized to treatment with either infliximab or a second IVIG infusion. Secondary outcomes include comparison of inflammatory markers, duration of hospitalization, and coronary artery outcome. An exploratory aim records parent-reported outcomes including signs, symptoms and treatment experience. Methods The KIDCARE trial is a 30-site randomized Phase III comparative effectiveness trial in KD patients with fever ≥36 h after the completion of their first IVIG treatment. Eligible patients will be randomized to receive either a second dose of IVIG (2 g/kg) or infliximab (10 mg/kg). Subjects with persistent or recrudescent fever at 24 h following completion of the first study treatment will cross-over to the other treatment arm. Subjects will exit the study after their first outpatient visit (5–18 days following last study treatment). The parent-reported outcomes, collected daily during hospitalization and at home, will be compared by study arm. Conclusion This trial will contribute to the management of IVIG-resistant patients by establishing the relative efficacy of a second dose of IVIG compared to infliximab and will provide data regarding the patient/parent experience of these treatments.

In rugby union, a bracing mechanism of the neck and trunk is normally adopted in contact situations where high linear and angular forces are produced, which may contribute to the risk for sports-related concussion (SRC).To examine the feasibility of and test-retest reliability, both inter-rater and intra-rater reliability, of a novel neck strength test in schoolboy rugby players and to summarize neck strength values for this cohort, including rugby position-specific estimates.52 male schoolboy rugby union players completed the neck strength test protocol twice, eight days apart using a novel device.Intra-class correlation coefficients (ICCs) were good to excellent for test-retest reliability (range from 0.86 to 0.92) in all four directions. Intra-rater (ICCs range from 0.706 to 0.981) and inter-rater (ICCs range from 0.669 to 0.982) ranges were calculated. Significant differences were identified between forwards and backs for non-normalised force measures but no significant difference when normalised to bodyweight. The flexor:extensor ratio was 0.68 (SD 0.2) for forwards, 0.71 (SD 0.16) for backs and 0.67 (SD 0.16) for the cohort.While there is limited direct evidence to support a direct link between neck strength and SRC risk at present, investigating the relationship of neck strength, stiffness and impact anticipation might be a useful direction for further research. In conclusion, we describe a portable, user-friendly and safe neck strength test with good-to-excellent test-retest reliability, and intra-, inter-rater reliability. Test-retest ICC values compare favourably to gold standard fixed-frame dynamometry and are superior to hand-held dynamometry.

To describe injury and concussion rates and mechanisms in female high school rugby players.Two-year prospective cohort study.High school rugby.Participants included 214 female High school rugby players (year 1) and 207 female High school players (year 2) from the Calgary Senior High School Athletics Association 2018 and 2019 rugby competition.None.Match and training injury and concussion. Injury definition included any injury resulting in time loss, inability to complete a session, and/or requiring medical attention. Details of reported injuries were collected on injury report forms and validated by a certified athletic therapist on a validated online injury surveillance platform. Exposure hours for players were tracked using paper or virtual weekly exposure forms by team designates.A match incidence rate (IR) = 93.7 injuries/1000 match hours (95% confidence intervals (CI): 78.6-11.7) and training IR = 5.3 injuries/1000 training hours (95% CI: 4.0-6.9) were estimated. The tackle accounted for 109 (70%) match and 37 (44%) training injuries. Tackling was the most frequent mechanism of injury (IR = 37.5 injuries/1000 match hours, 95% CI: 27.5-51.8 and 1.2 injuries/1000 training hours, 95% CI: 0.7-2.4). Sixty-two match concussions (IR = 37.5 concussions/1000 match hours, 95% CI: 26.8-52.3) and 16 training concussions (IR = 1.0 concussions/1000 training hours, 95% CI: 0.7-1.4) occurred. Of 78 reported concussions, 78% for match and 56% for training were physician diagnosed. Tackling was the most frequent mechanism of concussion in matches (IR = 18.1 concussions/1000 match hours, 95% CI:11.4-28.6).Injury and concussion rates in female high school rugby are high. The tackle accounted for the highest proportion of injuries. Prevention strategies (eg, tackle policy change, tackle-training programs, and neuromuscular training) should be explored to increase sport safety.

Fire shapes ecosystems globally, including semi-arid ecosystems. In Australia, semi-arid ‘mallee’ ecosystems occur primarily across the southern part of the continent, forming an interface between the arid interior and temperate south. Mallee vegetation is characterized by short, multi-stemmed eucalypts that grow from a basal lignotuber. Fire shapes the structure and functioning of mallee ecosystems. Using the Murray Mallee region in south-eastern Australia as a case study, we examine the characteristics and role of fire, the consequences for biota, and the interaction of fire with other drivers. Wildfires in mallee ecosystems typically are large (1000s ha), burn with high severity, commonly cause top-kill of eucalypts, and create coarse-grained mosaics at a regional scale. Wildfires can occur in late spring and summer in both dry and wet years. Recovery of plant and animal communities is predictable and slow, with regeneration of eucalypts and many habitat components extending over decades. Time since the last fire strongly influences the distribution and abundance of many species and the structure of plant and animal communities. Animal species display a discrete set of generalized responses to time since fire. Systematic field studies and modeling are beginning to reveal how spatial variation in fire regimes (‘pyrodiversity’) at different scales shapes biodiversity. Pyrodiversity includes variation in the extent of post-fire habitats, the diversity of post-fire age-classes and their configuration. At regional scales, a desirable mix of fire histories for biodiversity conservation includes a combination of early, mid and late post-fire age-classes, weighted toward later seral stages that provide critical habitat for threatened species. Biodiversity is also influenced by interactions between fire and other drivers, including land clearing, rainfall, herbivory and predation. Extensive clearing for agriculture has altered the nature and impact of fire, and facilitated invasion by pest species that modify fuels, fire regimes and post-fire recovery. Given the natural and anthropogenic drivers of fire and the consequences of their interactions, we highlight opportunities for conserving mallee ecosystems. These include learning from and fostering Indigenous knowledge of fire, implementing actions that consider synergies between fire and other processes, and strategic monitoring of fire, biodiversity and other drivers to guide place-based, adaptive management under climate change.

BACKGROUND: Previous researchers have suggested that balance control deficits are detected more accurately with dual-task testing than single-task testing. However, it is necessary to examine the clinimetric properties of dual-task testing before employing it in clinical and research settings. OBJECTIVE: To examine and compare the relative and absolute reliability of the Balance Error Scoring System (BESS), Tandem Gait Test (TGT), and Clinical Reaction Time (CRT) under single and dual-task conditions in uninjured active youth and young adults. Study Design: Single-group, repeated-measures study. METHODS: Twenty-three individuals [9 female; median age 17 years] completed three trials of the BESS, TGT, and CRT under single and dual-task testing conditions during testing session one. Two raters assessed participants to assess inter-rater reliability. Either later on the same day or the following day, the protocol was repeated by one rater to assess intra-rater reliability. The average of three trials was used to calculate intra-rater (between-session) and inter-rater (within-session) intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Cohen's Kappa coefficient for tests as appropriate under both conditions. Bland-Altman plots (mean difference and 95% limits of agreement) were used to assess for a systematic error associated with a learning effect. RESULTS: Only one participant attended the second session on the following day, while 22 participants (95%) attended the second session within four hours after testing session one. Under single-task testing, estimated ICCs, SEMs, MDCs, and Kappa coefficients ranged from 0.24 to 0.99, 0.3 to 23, 0.8 to 64, and 0.03 to 0.64, respectively. Under dual-task testing, estimated ICCs, SEMs, MDCs, and Kappa coefficients ranged from 0.70 to 0.99, 0.4 to 17, 1.1 to 47, and 0.39 to 0.83, respectively. A learning effect was identified for all tests under all conditions. CONCLUSION: The BESS is the only clinical test that demonstrated acceptable reliability for clinical use under single-task testing conditions. The BESS, TGT, and CRT all demonstrated acceptable reliability for clinical use under dual-task testing conditions. A practice session should be used to reduce the possible learning effect seen. Further studies examining sources of the systematic error observed are needed. LEVEL OF EVIDENCE: 2b.

Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the clinical behaviours, thematic areas, and other issues raised by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2-4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to best implement a concussion clinical pathway. These overarching themes must be addressed to successfully implement a CP for pediatric concussion.

International audience; With ongoing introductions into Australia since the 1700s, the European rabbit (Oryctolagus cuniculus) has become one of the most widely distributed and abundant vertebrate pests, adversely impacting Australia's biodiversity and agroeconomy. To understand the population and range dynamics of the species and its impacts better, occurrence and abundance data have been collected by researchers and citizens from sites covering a broad spectrum of climatic and environmental conditions in Australia. The lack of a common and accessible repository for these data has, however, limited their use in determining important spatiotemporal drivers of the structure and dynamics of the geographical range of rabbits in Australia. To meet this need, we created the Australian National Rabbit Database, which combines more than 50 yr of historical and contemporary survey data collected from throughout the range of the species in Australia. The survey data, obtained from a suite of complementary monitoring methods, were combined with high‐resolution weather, climate, and environmental information, and an assessment of data quality. The database provides records of rabbit occurrence (689,265 records) and abundance (51,241 records, >120 distinct sites) suitable for identifying the spatiotemporal drivers of the rabbit's distribution and for determining spatial patterns of variation in its key life‐history traits, including maximum rates of population growth. Because all data are georeferenced and date stamped, they can be coupled with information from other databases and spatial layers to explore the potential effects of rabbit occurrence and abundance on Australia's native wildlife and agricultural production. The Australian National Rabbit Database is an important tool for understanding and managing the European rabbit in its invasive range and its effects on native biodiversity and agricultural production. It also provides a valuable resource for addressing questions related to the biology, success, and impacts of invasive species more generally. No copyright or proprietary restrictions are associated with the use of this data set other than citation of this Data Paper.

© 2018 Cambridge Philosophical Society Movement is a trait of fundamental importance in ecosystems subject to frequent disturbances, such as fire-prone ecosystems. Despite this, the role of movement in facilitating responses to fire has received little attention. Herein, we consider how animal movement interacts with fire history to shape species distributions. We consider how fire affects movement between habitat patches of differing fire histories that occur across a range of spatial and temporal scales, from daily foraging bouts to infrequent dispersal events, and annual migrations. We review animal movements in response to the immediate and abrupt impacts of fire, and the longer-term successional changes that fires set in train. We discuss how the novel threats of altered fire regimes, landscape fragmentation, and invasive species result in suboptimal movements that drive populations downwards. We then outline the types of data needed to study animal movements in relation to fire and novel threats, to hasten the integration of movement ecology and fire ecology. We conclude by outlining a research agenda for the integration of movement ecology and fire ecology by identifying key research questions that emerge from our synthesis of animal movements in fire-prone ecosystems.

This paper presents the Sport Concussion Assessment Tool 5th Edition (SCAT5), which is the most recent revision of a sport concussion evaluation tool for use by healthcare professionals in the acute evaluation of suspected concussion. The revision of the SCAT3 (first published in 2013) culminated in the SCAT5. The revision was based on a systematic review and synthesis of current research, public input and expert panel review as part of the 5th International Consensus Conference on Concussion in Sport held in Berlin in 2016. The SCAT5 is intended for use in those who are 13 years of age or older. The Child SCAT5 is a tool for those aged 5-12 years, which is discussed elsewhere.

It is now widely acknowledged that both content and process elements of psychotherapy play a part in client treatment outcomes. Despite this, there are pressures on Australian clinical psychology training programs to teach evidence-based approaches in a relatively short time frame. Producing clinical psychology graduates who have an adequate level of competence in evidence-based practice and meeting the demands of professional accreditation requirements can mean that less time is available to teach the process elements of psychotherapy. The aim of this study was to conduct a preliminary evaluation of a clinical psychology psychotherapy training program that combines an interpersonal process group with a cognitive behavioural therapy training model that incorporates self-reflection and self-practice. Eleven participants who participated in the training in 2008 completed the Counseling Self-Estimate Inventory at pre- and post-training. Significant improvements on the majority of the subscales of this inventory were found. A separate sample of nine trainees and clinical psychology registrars who also previously completed the program attended individual interviews in 2010 aimed at gaining their perspective regarding various aspects of the program. Self-practice of cognitive behavioural therapy techniques was found to be important in the identification and management of trainees’ own core beliefs, and to their appreciation of how challenging this process may be for clients. The interpersonal process group was described by participants as enhancing their competency as psychotherapists. Common themes included the experience of anxiety and a high level of emotion, and understanding how this experience might be similar for clients; increased self-awareness; and increased competence in process issues. Many participants believed the process and content components of training were equally important to their development as psychotherapists.

Flight control of micro aerial vehicles (MAVs) is challenging due to the size of small-scale robotics platforms, which places size, weight, and power limitations on onboard sensors, as well as restricts the data processing algorithms that can be implemented on the platforms. We focus on computing optic flow in order to control a MAV using small vision chips as opposed to a complex camera system in order to cut down on the size and weight of the sensors as well as the processing power needed. We propose using an externally produced vision sensor by Centeye, ArduEye, to develop an algorithm for computing optic flow, from existing algorithms tailored to the sensor, to be used to control a quadrotor. Such efforts will benefit the various MAV research thrusts by providing a successful optic flow sensor and data processing algorithm that can be applied to the flight control of other robotic platforms.

White—throated Sparrows (Zonotrichia albicollis) form winter flocks with linear dominance hierarchies. When birds of known dominance rank were presented with feeding sites that varied in distance from cover, individuals demonstrated a preference for the sites near cover over those in more open areas. This preference was reflected in the pattern of food depletion. Furthermore, dominant birds feed near shelter more often than subordinates, since high rank allowed access to preferred sites. Observations suggest that cover provides effective protection from predators. In an experiment to examine the trade—off between energy intake and predation risk, birds presented with food patches at various distances from cover did not feed optimally in terms of energy harvested per unit time. Food was depleted exponentially, and birds nearly exhausted an area before moving farther from cover. The data suggest that White—throated Sparrows reduce the risk of predation at the expense of foraging efficiency. See full-text ar...