Let crying babes lie: Study supports notion of leaving infants to cry themselves back to sleep
Thursday, January 3, 2013
Today, mothers of newborns find themselves confronting a common dilemma: Should they let their babies "cry it out" when they wake up at night? Or should they rush to comfort their crying little one?
In fact, waking up in the middle of the night is the most common concern that parents of infants report to pediatricians. Now, a new study from Temple psychology professor Marsha Weinraub gives parents some scientific facts to help with that decision.
The study, published in Developmental Psychology, supports the idea that a majority of infants are best left to self-soothe and fall back to sleep on their own.
"By six months of age, most babies sleep through the night, awakening their mothers only about once per week. However, not all children follow this pattern of development," said Weinraub, an expert on child development and parent-child relationships.
For the study, Weinraub and her colleagues measured patterns of nighttime sleep awakenings in infants ages six to 36 months. Her findings revealed two groups: sleepers and transitional sleepers.
"If you measure them while they are sleeping, all babies ? like all adults ? move through a sleep cycle every 1 1/2 to 2 hours where they wake up and then return to sleep," said Weinraub. "Some of them do cry and call out when they awaken, and that is called 'not sleeping through the night.'"
For the study, Weinraub's team asked parents of more than 1,200 infants to report on their child's awakenings at 6, 15, 24 and 36 months. They found that by six months of age, 66 percent of babies ? the sleepers ? did not awaken, or awoke just once per week, following a flat trajectory as they grew. But a full 33 percent woke up seven nights per week at six months, dropping to two nights by 15 months and to one night per week by 24 months.
Of the babies that awoke, the majority were boys. These transitional sleepers also tended to score higher on an assessment of difficult temperament which identified traits such as irritability and distractibility. And, these babies were more likely to be breastfed. Mothers of these babies were more likely to be depressed and have greater maternal sensitivity.
The findings suggest a couple of things, said Weinraub. One is that genetic or constitutional factors such as those that might be reflected in difficult temperaments appear implicated in early sleep problems. "Families who are seeing sleep problems persist past 18 months should seek advice," Weinraub said.
Another takeaway is that it is important for babies to learn how to fall asleep on their own. "When mothers tune in to these night time awakenings and/or if a baby is in the habit of falling asleep during breastfeeding, then he or she may not be learning to how to self-soothe, something that is critical for regular sleep," she said.
According to Weinraub, the mechanism by which maternal depression is connected to infant awakenings is an area that would benefit from further research. On the one hand, Weinraub said, it's possible that mothers who are depressed at six and 36 months may have been depressed during pregnancy and that this prenatal depression could have affected neural development and sleep awakenings. At the same time, it's important to recognize that sleep deprivation can, of course, exacerbate maternal depression, she said.
"Because the mothers in our study described infants with many awakenings per week as creating problems for themselves and other family members, parents might be encouraged to establish more nuanced and carefully targeted routines to help babies with self-soothing and to seek occasional respite," said Weinraub.
"The best advice is to put infants to bed at a regular time every night, allow them to fall asleep on their own and resist the urge to respond right away to awakenings."
###
Temple University: http://www.temple.edu
Thanks to Temple University for this article.
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Tech giants Google and Yahoo are among the worst offending ad networks that help financially fund major film and music pirating sites around the world, according to a new report by USC's Annenberg Innovation Lab.
Using Google's own Transparency Report as a guide, USC named the 10 ad networks that place the most ads on pirate sites, based on the most DMCA Takedown requests?for copyright infringement.
Intentional or not, the worst offenders are:
Openx
Google (including Double Click)
Exoclick
Sumotorrent
Propellerads
Yahoo (including Right Media)
Quantcast
Media Shakers
Yesads
Infolinks
Google, however, is not taking the accusation at face value. A spokesperson told Marketing Land:
?We have not seen a copy of this report and don?t know the methodology, but to the extent it suggests that Google ads are a major source of funds for major pirate sites, we believe it is mistaken. Over the past several years, we?ve taken a leadership role in this fight, partnering with industry organizations to cut off the flow of money to piracy sites, as well as investing significant time and money to keep copyright-infringing content out of our network. The complexity of online advertising has led some to conclude, incorrectly, that the mere presence of any Google code on a site means financial support from Google.?
Yahoo has been silent, thus far.
USC is deeply ingrained in Hollywood culture and the report, which will be updated monthly, is helmed by Jonathan Taplin.?The former film exec became a particularly vocal anti-piracy advocate when SOPA ? which he noted was a "fatally flawed piece of legislation" ? was brought in front of Congress.
When talking to the LA Times, Taplin implied that this monthly list will be a service to ad networks.
"Whenever we talk to a brand about the fact that their ads are all over the pirate sites, they're like, 'Oh, how did that happen?'" Taplin said. "We thought it would be easier if they knew what ad networks were putting ads on pirate sites ? so they could avoid them."
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Bisexual men on the 'down low' run risk for poor mental healthPublic release date: 2-Jan-2013 [ | E-mail | Share ]
Contact: Stephanie Berger sb2247@columbia.edu 212-305-4372 Columbia University's Mailman School of Public Health
First study to look at the mental health of closeted bisexuals finds that concealment takes a toll
January 2, 2013 -- Bisexual men are less likely to disclose and more likely to conceal their sexual orientation than gay men. In the first study to look at the mental health of this population, researchers at Columbia University's Mailman School of Public Health found that greater concealment of homosexual behavior was associated with more symptoms of depression and anxiety.
The study published in the American Psychological Association's Journal of Consulting and Clinical Psychology, examined bisexual men "on the down low," a subgroup of bisexual men who live predominantly heterosexual lives and do not disclose their same-sex behavior, a group that has not been studied to date. The researchers studied 203 nongay-identified men in New York City, who self-reported being behaviorally bisexual and had not disclosed their same-sex behavior to their female partners.
According to findings, men who live with a wife or girlfriend, who think of themselves as heterosexual, and who have a lower frequency of sex with men were more likely to conceal their same-sex behavior. Greater frequency of sex with women also correlated with greater concealment. Men with a household income of $30,000 or more per year reported greater concealment about their same-sex behavior than men with lower incomes.
"Our research provides information on the factors that might contribute to greater concealment among this group of behaviorally bisexual men," said Eric Schrimshaw, PhD, assistant professor of Sociomedical Sciences and lead author. "Such information is critical to understanding which of these bisexual men may be at greatest risk for mental health problems."
Nearly 38% of the men reported that they have not shared with anyone that they have sex with men. Only 41% reported that they had confided in a best friend or parent.
Dr. Schrimshaw and colleagues found that greater concealment correlated with more symptoms of depression and anxiety and lower positive emotions. However, disclosure to a few close friends or family did not seem to help; disclosure to confidants was not associated with good mental health.
"The fact that concealment, but not disclosure, was associated with the mental health of these bisexual men is critically important for the way therapeutic interventions are conducted in this population," said Karolynn Siegel, PhD, professor of Sociomedical Sciences and co-author. "Although disclosure may result in acceptance from family and friends, in other cases -- particularly with female partners -- disclosure may also result in rejecting reactions, which are adversely associated with mental health."
The research also suggests reasons why concealment was negatively associated with mental health. Bisexual men who were more concerned than others about concealing their same-sex behavior also tended to report lower levels of social support and more internalized homophobia that is, negative attitudes toward their same-sex behavior.
The findings indicate that publically disclosing their same-sex behavior may not be necessary to their mental health, as long as bisexual men have adequate emotional support to cope with other stressors in their lives. Professionals who do therapeutic work with bisexual men may wish to focus instead on helping such men reduce their perceived need to conceal their same-sex behavior and accept their sexual orientation.
###
Funding for the study was provided by the National Institute of Mental Health (R01-MH076680) and National Institute on Drug Abuse (T32-DA007233).
About Columbia University's Mailman School of Public Health
Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including the International Center for AIDS Care and Treatment Programs (ICAP), the National Center for Disaster Preparedness, and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Bisexual men on the 'down low' run risk for poor mental healthPublic release date: 2-Jan-2013 [ | E-mail | Share ]
Contact: Stephanie Berger sb2247@columbia.edu 212-305-4372 Columbia University's Mailman School of Public Health
First study to look at the mental health of closeted bisexuals finds that concealment takes a toll
January 2, 2013 -- Bisexual men are less likely to disclose and more likely to conceal their sexual orientation than gay men. In the first study to look at the mental health of this population, researchers at Columbia University's Mailman School of Public Health found that greater concealment of homosexual behavior was associated with more symptoms of depression and anxiety.
The study published in the American Psychological Association's Journal of Consulting and Clinical Psychology, examined bisexual men "on the down low," a subgroup of bisexual men who live predominantly heterosexual lives and do not disclose their same-sex behavior, a group that has not been studied to date. The researchers studied 203 nongay-identified men in New York City, who self-reported being behaviorally bisexual and had not disclosed their same-sex behavior to their female partners.
According to findings, men who live with a wife or girlfriend, who think of themselves as heterosexual, and who have a lower frequency of sex with men were more likely to conceal their same-sex behavior. Greater frequency of sex with women also correlated with greater concealment. Men with a household income of $30,000 or more per year reported greater concealment about their same-sex behavior than men with lower incomes.
"Our research provides information on the factors that might contribute to greater concealment among this group of behaviorally bisexual men," said Eric Schrimshaw, PhD, assistant professor of Sociomedical Sciences and lead author. "Such information is critical to understanding which of these bisexual men may be at greatest risk for mental health problems."
Nearly 38% of the men reported that they have not shared with anyone that they have sex with men. Only 41% reported that they had confided in a best friend or parent.
Dr. Schrimshaw and colleagues found that greater concealment correlated with more symptoms of depression and anxiety and lower positive emotions. However, disclosure to a few close friends or family did not seem to help; disclosure to confidants was not associated with good mental health.
"The fact that concealment, but not disclosure, was associated with the mental health of these bisexual men is critically important for the way therapeutic interventions are conducted in this population," said Karolynn Siegel, PhD, professor of Sociomedical Sciences and co-author. "Although disclosure may result in acceptance from family and friends, in other cases -- particularly with female partners -- disclosure may also result in rejecting reactions, which are adversely associated with mental health."
The research also suggests reasons why concealment was negatively associated with mental health. Bisexual men who were more concerned than others about concealing their same-sex behavior also tended to report lower levels of social support and more internalized homophobia that is, negative attitudes toward their same-sex behavior.
The findings indicate that publically disclosing their same-sex behavior may not be necessary to their mental health, as long as bisexual men have adequate emotional support to cope with other stressors in their lives. Professionals who do therapeutic work with bisexual men may wish to focus instead on helping such men reduce their perceived need to conceal their same-sex behavior and accept their sexual orientation.
###
Funding for the study was provided by the National Institute of Mental Health (R01-MH076680) and National Institute on Drug Abuse (T32-DA007233).
About Columbia University's Mailman School of Public Health
Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including the International Center for AIDS Care and Treatment Programs (ICAP), the National Center for Disaster Preparedness, and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Mid-market company size is somewhat of an amorphous term, usually defined by revenue or employee size. Although there is no hard and fast rule, mid-market companies generally are between $25m-$250m in annual revenues and between 50?500 employees.
In terms of Health Insurance, 50 employees is somewhat of a magic number as it is the point when insurance carriers look at the company-specific claim history and have less regulatory pricing and disclosure restrictions to deal with. Companies with less than 50 employees are typically put in a ?community pool? and have less control over rate increases.
?WTIA Health Trust and the Mid -Market
The WTIA?Health Trust?is a bona fide association health plan (AHP) that gives small companies (<50 employees) some of the same pricing benefits as large companies. The WTIA?Health Trust has 13 plan options that range from very rich to basic. All 13 plan options are considered ?fully insured? plan types. The WTIA?Health Trust?is extremely valuable to our small company members, literally saving them thousands of dollars per year while enabling them to be more competitive from a recruitment standpoint.
Unfortunately, the WTIA?Health Trust?is not the ideal solution for ?mid-market? companies, especially as company headcount approaches more than 100 employees.
Health Insurance ? How the ?System? works & Rules of Thumb
Most insurance carriers shoot for a claims loss ratio between 80%-85%. Said another way, they are targeting a 15%-20% profit on the premiums they take in. This profit goes directly to the insurance carriers and a portion of the proceeds are used to compensate insurance brokers and other service providers. Consider the following example:
This is a very simple example to illustrate how the system works. It also provides some nice ?material? rules of thumbs:
? 600 per month per employee is a reasonable starting point when forecasting health care costs for mid-market companies. This is blended cost between single employees and those with families or dependents. This concept is referred to as PEPM (per employee premium monthly).
? 100 employee company yields around ~$60k cost per month in health insurance. Again, this is a starting point for developing a general cost estimate.
? Insurance/service provider companies make ~$12k per month of a 100 person company
Why ?Self-insurance? mathematically makes sense for the Mid Market
Although the WTIA Health Trust has thirteen (13) plan options, it only has 1 real plan type-fully insured. Fully insured is the most traditional plan type with the carrier being responsible for almost of the claims and the employer being responsible for paying monthly premiums. There are; however, other plan types that are available with the ?self-insured? plan type being the next most common for mid-market companies. Using the same example above you can see why the self-insured plan type is attractive:
It is clear from the above example why self-insurance is so popular but also risky. Rather than paying premium costs the employer bears the ?claim risk?. Over time and with a large enough employee base this should theoretically result in massive savings as the employer will effectively eliminate the 15%-20% profit paid to outside parties. Much like gambling where the house should win over a large sample size, self -insurance should result in cheaper health insurance costs for employers over time.
The theoretical concept explained above is why the ?self-insurance? plan type is highly popular with mid-market companies. The key exercise that mid-market companies must go through in evaluating self?insurance is the underlying health of its employee base. If there are known medical conditions and/or a significant non-recurring claims expected, self?insurance is probably not the right solution.
Health Savings Accounts and why they are so popular
Health Savings Accounts (HSA?s) is a fully insured plan type; however, the deductible is much higher than in a traditional plan option. This factor keeps monthly premium costs down as there is less incentive for employees to use the health care system when they have a high deductible to cover. HSA?s usually allow for a free annual preventive visit (physical) and also have properties of a traditional IRA making it another investment vehicle for employees.
More employers have been selecting Health Savings plan options than ever before because it offers the risk protection of a fully insured plan with the cheaper costs associated with a self-insured plan. It also moves the responsibility to the employee and gets them active in the management of their health. Using the same example above, I have constructed a comparison for a generic 100 person tech company:
As you can see from the example above, the ?HSA offers a nice ?intermediate? option as it allows the employer to manage risk while realizing sizable savings.
WTIA health insurance options for large groups (Including Mid-Market)
The WTIA has traditionally focused on small group health insurance offerings (<50 employees) for its members. Recently, however, the WTIA?has been exploring health insurance offerings targeted at large groups (>50 employees) which certainly include mid-market companies. Specifically, the WTIA?has been working with its insurance carrier partner, Regence Blue Shield, to accomplish the following:
1) Develop a suite of insurance products (plan types) and services specifically tailored to member companies with 50 or more employees. This would include fully insured and self-insured (ASO) plan types.
2) Leverage the healthcare purchasing power of the technology industry in Washington State to deliver significant savings to member companies.
3) Offer competitively priced insurance products that are bundled with a WTIA?membership to provide access to our community and resource base.
We expect to have a large group offering in place by the summer of FY 2013.
Why should all this matter to you?
Washington law provides a way for small businesses to pool their purchasing power to buy health insurance through trade associations and member-governed groups, like the WTIA. These plans, called Association Health Plans or Affinity Group Plans, allow small employers the advantage of large group rates for health insurance. The WTIA?Health Trust?is just one of the many ways your membership can help you curb business costs while providing more value to your employees. But what happens when a small employer moves along in the business life cycle and becomes a mid-market employer? What happens when they become large? WTIA?is working hard to make sure there are scalable options in place that serve our member base in all stages of the business life-cycle.
With nationalized healthcare implementing in the near future, it?s important to understand not only what?s available, but what the very best option is for your unique business situation. What may be great for some, might not be the most cost effective for others.
For more information on what your options are, contact your WTIA?member representative.
Mike Monroe Vice President of Operations & Finance Washington Technology Industry Association
Second impact syndrome: A devastating injury to the young brainPublic release date: 1-Jan-2013 [ | E-mail | Share ]
Contact: Jo Ann M Eliason jaeliason@thejns.org 434-982-1209 Journal of Neurosurgery Publishing Group
New imaging findings
Charlottesville, VA (January 1, 2013). Physicians at Indiana University School of Medicine and the Northwest Radiology Network (Indianapolis, Indiana) report the case of a 17-year-old high school football player with second impact syndrome (SIS). A rare and devastating traumatic brain injury, SIS occurs when a person, most often a teenager, sustains a second head injury before recovery from an earlier head injury is complete. To the best of the authors' knowledge, this is the first reported case in which imaging studies were performed after both injuries, adding new knowledge of the event. Findings in this case are reported and discussed in "Second impact syndrome in football: new imaging and insights into a rare and devastating condition. Case report," by Elizabeth Weinstein, M.D., and colleagues, published today online, ahead of print, in the Journal of Neurosurgery: Pediatrics.
The patient sustained the first injury when he received a helmet-to-helmet hit from an opposing player during a punt return. Despite immediate symptoms of dizziness and visual disturbance, he continued to play in the game. For the next few days he experienced severe headaches and fatigue. Four days after the game, he consulted a doctor about the headaches. Computerized tomography (CT) scans of the patient's head appeared normal, but he was advised not to return to play until all of his symptoms were gone. The young man chose instead to return to practice immediately.
The following day, despite complaints of headache and difficulty with concentration, the young man participated in hitting drills. After a few hits he was slow standing up, and after several more hits he collapsed, became unresponsive, and suffered a seizure. He was transferred initially to a local emergency department, where a CT examination revealed small, thin subdural hematomas on each side of the brain. The patient received intubation and was treated medically. Shortly thereafter he was airlifted to a tertiary trauma and neurosurgical center at Indiana University Health Methodist Hospital in Indianapolis.
At the tertiary center, the patient was found to be minimally responsive and to have increased intracranial pressure (25-30 mm Hg; normal 5-15 mm Hg). Additional CT scans obtained there confirmed the presence of the subdural hematomas and mild cerebral swelling. Magnetic resonance images of the brain and upper spinal cord showed downward herniation of the brain, subdural hematomas on both sides of the brain, and abnormal diffusion in the medial left thalamus. Structures in the vicinity of the brain's midline, including the thalamus and hypothalamus, had shifted downward. There did not seem to be any blood vessel damage or spinal cord injury. The MR images did not detect cerebral edema.
The patient's injury involved other serious consequences identified during the hospital stay, including prolonged elevated intracranial pressure, areas of brain softening (in both thalami, the medial frontal lobes, and elsewhere), hypotension, renal failure, sepsis, pneumonia, and temporary cardiac arrest. Even with optimal care, the patient remained in the hospital for 98 days and was unable to walk or talk when he was discharged. Three years later, he has regained much of his speech but is very impulsive and is confined to a wheel chair.
In SIS, the brain injury produces a loss of cerebral autoregulation. Cerebral arteries widen, allowing more blood to flow throughout the brain, and massive cerebral swelling can occur. These lead to increased intracranial pressure, causing the brain to enlarge. Because the skull is a limited container, the brain can become herniated as it seeks a space to expand. The authors note that some investigators previously postulated that the loss of cerebral autoregulation is caused by a "space-occupying injury" from the initial injury. Findings in this case do not substantiate that claim because the CT scan was normal. Weinstein and colleagues point out that several types of injury do not necessarily register on an imaging study, and " a normal head CT scan does not obviate the need for close clinical follow-up and for the athlete to be cognitively normal and asymptomatic before return to play."
In this case, the patient experienced severe headaches throughout the interval between injuries. The authors state that evidence of persistent, long-lasting, severe headaches, which have repeatedly been identified in patients with SIS, indicate an ongoing and significant pathological neurophysiological condition in the absence of evidence on the CT scan. The authors suggest that this symptom may be a specific predictor for the possibility of SIS if a second injury occurs before the first has resolved.
The take-away message in this study, according to coauthor Dr. Michael Turner, "is that there must not be a return to play if the athlete is at all symptomatic. A normal CT scan will not identify a patient who can be released to play. The mechanism of SIS is probably hyperemia [increased blood in the brain], not occult hematoma."
SIS rarely occurs, but when it does the effect is usually devastating. Often the patient dies. The authors stress the importance of educating coaches, athletes, family members, and treating physicians about the risks and possible consequences of sports-related head injuries.
###
Weinstein E, Turner M, Kuzma BB, Feuer H. Second impact syndrome in football: new imaging and insights into a rare and devastating condition. Case report. Journal of Neurosurgery: Pediatrics, published online, ahead of print, January 1, 2013; DOI: 10.3171/2012.11.PEDS12343.
Disclosure: Dr. Henry Feuer is the neurosurgical consultant for the Indianapolis Colts and is a member of the Return to Play Subcommittee of the National Football League Head, Neck, and Spine Medical Committee. He is also the neurosurgical consultant for the Indiana High School Athletic Association. Dr. Elizabeth Weinstein provides emergency medical support along with Indiana University Health for NFL players at Indianapolis Colts home games.
For additional information, please contact:
Ms. Jo Ann M. Eliason, MA, ELS
Communications Manager
Journal of Neurosurgery Publishing Group
One Morton Drive, Suite 200
Charlottesville, VA 22903
Email: jaeliason@thejns.org
Telephone 434-982-1209
Fax 434-924-2702
The Journal of Neurosurgery: Pediatrics is a monthly peer-reviewed journal focused on diseases and disorders of the central nervous system and spine in children. This journal contains a variety of articles, including descriptions of preclinical and clinical research as well as case reports and technical notes. The Journal of Neurosurgery: Pediatrics is one of four monthly journals published by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons, an association dedicated to advancing the specialty of neurological surgery in order to promote the highest quality of patient care. The Journal of Neurosurgery: Pediatrics appears in print and on the Internet.
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Second impact syndrome: A devastating injury to the young brainPublic release date: 1-Jan-2013 [ | E-mail | Share ]
Contact: Jo Ann M Eliason jaeliason@thejns.org 434-982-1209 Journal of Neurosurgery Publishing Group
New imaging findings
Charlottesville, VA (January 1, 2013). Physicians at Indiana University School of Medicine and the Northwest Radiology Network (Indianapolis, Indiana) report the case of a 17-year-old high school football player with second impact syndrome (SIS). A rare and devastating traumatic brain injury, SIS occurs when a person, most often a teenager, sustains a second head injury before recovery from an earlier head injury is complete. To the best of the authors' knowledge, this is the first reported case in which imaging studies were performed after both injuries, adding new knowledge of the event. Findings in this case are reported and discussed in "Second impact syndrome in football: new imaging and insights into a rare and devastating condition. Case report," by Elizabeth Weinstein, M.D., and colleagues, published today online, ahead of print, in the Journal of Neurosurgery: Pediatrics.
The patient sustained the first injury when he received a helmet-to-helmet hit from an opposing player during a punt return. Despite immediate symptoms of dizziness and visual disturbance, he continued to play in the game. For the next few days he experienced severe headaches and fatigue. Four days after the game, he consulted a doctor about the headaches. Computerized tomography (CT) scans of the patient's head appeared normal, but he was advised not to return to play until all of his symptoms were gone. The young man chose instead to return to practice immediately.
The following day, despite complaints of headache and difficulty with concentration, the young man participated in hitting drills. After a few hits he was slow standing up, and after several more hits he collapsed, became unresponsive, and suffered a seizure. He was transferred initially to a local emergency department, where a CT examination revealed small, thin subdural hematomas on each side of the brain. The patient received intubation and was treated medically. Shortly thereafter he was airlifted to a tertiary trauma and neurosurgical center at Indiana University Health Methodist Hospital in Indianapolis.
At the tertiary center, the patient was found to be minimally responsive and to have increased intracranial pressure (25-30 mm Hg; normal 5-15 mm Hg). Additional CT scans obtained there confirmed the presence of the subdural hematomas and mild cerebral swelling. Magnetic resonance images of the brain and upper spinal cord showed downward herniation of the brain, subdural hematomas on both sides of the brain, and abnormal diffusion in the medial left thalamus. Structures in the vicinity of the brain's midline, including the thalamus and hypothalamus, had shifted downward. There did not seem to be any blood vessel damage or spinal cord injury. The MR images did not detect cerebral edema.
The patient's injury involved other serious consequences identified during the hospital stay, including prolonged elevated intracranial pressure, areas of brain softening (in both thalami, the medial frontal lobes, and elsewhere), hypotension, renal failure, sepsis, pneumonia, and temporary cardiac arrest. Even with optimal care, the patient remained in the hospital for 98 days and was unable to walk or talk when he was discharged. Three years later, he has regained much of his speech but is very impulsive and is confined to a wheel chair.
In SIS, the brain injury produces a loss of cerebral autoregulation. Cerebral arteries widen, allowing more blood to flow throughout the brain, and massive cerebral swelling can occur. These lead to increased intracranial pressure, causing the brain to enlarge. Because the skull is a limited container, the brain can become herniated as it seeks a space to expand. The authors note that some investigators previously postulated that the loss of cerebral autoregulation is caused by a "space-occupying injury" from the initial injury. Findings in this case do not substantiate that claim because the CT scan was normal. Weinstein and colleagues point out that several types of injury do not necessarily register on an imaging study, and " a normal head CT scan does not obviate the need for close clinical follow-up and for the athlete to be cognitively normal and asymptomatic before return to play."
In this case, the patient experienced severe headaches throughout the interval between injuries. The authors state that evidence of persistent, long-lasting, severe headaches, which have repeatedly been identified in patients with SIS, indicate an ongoing and significant pathological neurophysiological condition in the absence of evidence on the CT scan. The authors suggest that this symptom may be a specific predictor for the possibility of SIS if a second injury occurs before the first has resolved.
The take-away message in this study, according to coauthor Dr. Michael Turner, "is that there must not be a return to play if the athlete is at all symptomatic. A normal CT scan will not identify a patient who can be released to play. The mechanism of SIS is probably hyperemia [increased blood in the brain], not occult hematoma."
SIS rarely occurs, but when it does the effect is usually devastating. Often the patient dies. The authors stress the importance of educating coaches, athletes, family members, and treating physicians about the risks and possible consequences of sports-related head injuries.
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Weinstein E, Turner M, Kuzma BB, Feuer H. Second impact syndrome in football: new imaging and insights into a rare and devastating condition. Case report. Journal of Neurosurgery: Pediatrics, published online, ahead of print, January 1, 2013; DOI: 10.3171/2012.11.PEDS12343.
Disclosure: Dr. Henry Feuer is the neurosurgical consultant for the Indianapolis Colts and is a member of the Return to Play Subcommittee of the National Football League Head, Neck, and Spine Medical Committee. He is also the neurosurgical consultant for the Indiana High School Athletic Association. Dr. Elizabeth Weinstein provides emergency medical support along with Indiana University Health for NFL players at Indianapolis Colts home games.
For additional information, please contact:
Ms. Jo Ann M. Eliason, MA, ELS
Communications Manager
Journal of Neurosurgery Publishing Group
One Morton Drive, Suite 200
Charlottesville, VA 22903
Email: jaeliason@thejns.org
Telephone 434-982-1209
Fax 434-924-2702
The Journal of Neurosurgery: Pediatrics is a monthly peer-reviewed journal focused on diseases and disorders of the central nervous system and spine in children. This journal contains a variety of articles, including descriptions of preclinical and clinical research as well as case reports and technical notes. The Journal of Neurosurgery: Pediatrics is one of four monthly journals published by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons, an association dedicated to advancing the specialty of neurological surgery in order to promote the highest quality of patient care. The Journal of Neurosurgery: Pediatrics appears in print and on the Internet.
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Jan. 2, 2013 ? A little-known meteor shower named after an extinct constellation, the Quadrantids will present an excellent chance for hardy souls to start the year off with some late-night meteor watching. Peaking in the wee morning hours of Jan. 3, the Quadrantids have a maximum rate of about 80 per hour, varying between 60-200. Unfortunately, light from a waning gibbous moon will wash out many Quadrantids, cutting down on the number of meteors seen by skywatchers.
Unlike the more famous Perseid and Geminid meteor showers, the Quadrantids only last a few hours, so it's the morning of Jan. 3 or nothing. Given the location of the radiant -- northern tip of Bootes the Herdsman -- only observers at latitudes north of 51 degrees south will be able to see Quadrantids.
Watch the Quadrantids! Live Ustream Feed
A live Ustream feed of the Quadrantid shower will be embedded below on the nights of Jan. 2-4 (http://www.ustream.tv/channel/nasa-msfc). The camera is mounted at NASA's Marshall Space Flight Center in Huntsville, Ala. During the day you will see either pre-recorded footage or a blank box -- the camera is light-activated and turns on at dusk (approx. 6 p.m. EST). ? Convert to your local time: http://ssd.jpl.nasa.gov/tc.cgi
Do You Have Some Great Quadrantid Images?
If you have some great images of the Quadrantid meteor shower, please consider adding them to the Quadrantid Meteors photo group in Flickr (http://www.flickr.com/groups/quadrantids/). Who knows -- your images may attract interest from the media and receive international exposure.
More About the Quadrantids
The Quadrantids derive their name from the constellation of Quadrans Muralis (mural quadrant), which was created by the French astronomer Jerome Lalande in 1795. Located between the constellations of Bootes and Draco, Quadrans represents an early astronomical instrument used to observe and plot stars. Even though the constellation is no longer recognized by astronomers, it was around long enough to give the meteor shower -- first seen in 1825 -- its name.
Like the Geminids, the Quadrantids originate from an asteroid, called 2003 EH1. Dynamical studies suggest that this body could very well be a piece of a comet which broke apart several centuries ago, and that the meteors you will see before dawn on Jan. 3 are the small debris from this fragmentation. After hundreds of years orbiting the sun, they will enter our atmosphere at 90,000 mph, burning up 50 miles above Earth's surface -- a fiery end to a long journey!
Editor's note, Jan. 2, 10:45 a.m. EST: Tonight is the peak of the 2013 Quadrantid meteor shower. Best viewing will be in the northern hemisphere, but the shower can be seen at latitudes north of 51 degrees south. Meteor rates increase after midnight and peak between 3 a.m. and dawn, your local time. To view Quadrantids, go outside and allow your eyes 30-45 minutes to adjust to the dark. Look straight up, allowing your eyes to take in as much of the sky as possible. You will need cloudless, dark skies away from city lights to see the shower. The maximum rate will be about 120/hour. However, light from the waning gibbous moon will wash out fainter meteors, so don't expect to see this many. The peak rate of the Quadrantids has varied between 60-200, so its peak is not as consistent as other showers.
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WASHINGTON (AP) ? Democrats and Republicans say signs of progress are emerging in urgent negotiations to avert the looming 'fiscal cliff' ahead of a midnight deadline.
A person familiar with the negotiations says Democrats have offered to extend tax cuts for families making up to $450,000 a year and individuals making up to $400,000. President Barack Obama originally wanted the tax cuts to be extended only for families making up to $250,000 a year.
Unless an agreement is reached and approved by Congress by the start of New Year's Day, more than $500 billion in 2013 tax increases will begin to take effect and $109 billion will be carved from defense and domestic programs
The person familiar with the talks requested anonymity in order to discuss the internal negotiations.
Yippee! Let's poison ourselves with beverages that will make us violently ill! It was your battle cry last night, and today you're paying the price. But what is that hangover you're experiencing, exactly? More »
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Public release date: 2-Jan-2013
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