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BackgroundIdentifying separate dimensions of concussion symptoms may inform a precision medicine approach to treatment. It was previously reported that a bifactor model identified distinct acute postconcussion symptom dimensions.PurposeTo replicate previous findings of a bifactor structure of concussion symptoms in the Concussion Assessment Research and Education (CARE) Consortium sample, examine measurement invariance from pre- to postinjury, and evaluate whether factors are associated with other clinical and biomarker measures.Study designCohort study (Diagnosis); Level of evidence, 2.MethodsCollegiate athletes were prospectively evaluated using the Sport Concussion Assessment Tool-3 (SCAT-3) during preseason (N = 31,557); 2789 were followed at <6 hours and 24 to 48 hours after concussion. Item-level SCAT-3 ratings were analyzed using exploratory and confirmatory factor analyses. Bifactor and higher-order models were compared for their fit and interpretability. Measurement invariance tested the stability of the identified factor structure across time. The association between factors and criterion measures (clinical and blood-based markers of concussion severity, symptom duration) was evaluated.ResultsThe optimal structure for each time point was a 7-factor bifactor model: a General factor, on which all items loaded, and 6 specific factors-Vestibulo-ocular, Headache, Sensory, Fatigue, Cognitive, and Emotional. The model manifested strict invariance across the 2 postinjury time points but only configural invariance from baseline to postinjury. From <6 to 24-48 hours, some dimensions increased in severity (Sensory, Fatigue, Emotional), while others decreased (General, Headache, Vestibulo-ocular). The factors correlated with differing clinical and biomarker criterion measures and showed differing patterns of association with symptom duration at different time points.ConclusionBifactor modeling supported the predominant unidimensionality of concussion symptoms wh

ObjectiveTo examine the association between estimated age at first exposure (eAFE) to American football and clinical measures throughout recovery following concussion.MethodsParticipants were recruited across 30 colleges and universities as part of the National Collegiate Athletic Association (NCAA)-Department of Defense Concussion Assessment, Research and Education Consortium. There were 294 NCAA American football players (age 19 ± 1 years) evaluated 24-48 hours following concussion with valid baseline data and 327 (age 19 ± 1 years) evaluated at the time they were asymptomatic with valid baseline data. Participants sustained a medically diagnosed concussion between baseline testing and postconcussion assessments. Outcome measures included the number of days until asymptomatic, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) composite scores, Balance Error Scoring System (BESS) total score, and Brief Symptom Inventory 18 (BSI-18) subscores. The eAFE was defined as participant's age at the time of assessment minus self-reported number of years playing football.ResultsIn unadjusted regression models, younger eAFE was associated with lower (worse) ImPACT Visual Motor Speed (R 2 = 0.031, p = 0.012) at 24-48 hours following injury and lower (better) BSI-18 Somatization subscores (R 2 = 0.014, p = 0.038) when the athletes were asymptomatic. The effect sizes were very small. The eAFE was not associated with the number of days until asymptomatic, other ImPACT composite scores, BESS total score, or other BSI-18 subscores.ConclusionEarlier eAFE to American football was not associated with longer symptom recovery, worse balance, worse cognitive performance, or greater psychological distress following concussion. In these NCAA football players, longer duration of exposure to football during childhood and adolescence appears to be unrelated to clinical recovery following concussion.

INTRODUCTION: Acquired Brain Injury, whether resulting from Traumatic brain injury (TBI) or Cerebral Vascular Accident (CVA), represent major health concerns for the Department of Defense and the nation. TBI has been referred to as the "signature" injury of recent U.S. military conflicts in Iraq and Afghanistan - affecting approximately 380,000 service members from 2000 to 2017; whereas CVA has been estimated to effect 795,000 individuals each year in the United States. TBI and CVA often present with similar motor, cognitive, and emotional deficits; therefore the treatment interventions for both often overlap. The Defense Health Agency and Veterans Health Administration would benefit from enhanced rehabilitation solutions to treat deficits resulting from acquired brain injuries (ABI), including both TBI and CVA. The purpose of this study was to evaluate the feasibility of implementing a novel, integrative, and intensive virtual rehabilitation system for treating symptoms of ABI in an outpatient clinic. The secondary aim was to evaluate the system's clinical effectiveness. MATERIALS AND METHODS: Military healthcare beneficiaries with ABI diagnoses completed a 6-week randomized feasibility study of the BrightBrainer Virtual Rehabilitation (BBVR) system in an outpatient military hospital clinic. Twenty-six candidates were screened, consented and randomized, 21 of whom completed the study. The BBVR system is an experimental adjunct ABI therapy program which utilizes virtual reality and repetitive bilateral upper extremity training. Four self-report questionnaires measured participant and provider acceptance of the system. Seven clinical outcomes included the Fugl-Meyer Assessment of Upper Extremity, Box and Blocks Test, Jebsen-Taylor Hand Function Test, Automated Neuropsychological Assessment Metrics, Neurobehavioral Symptom Inventory, Quick Inventory of Depressive Symptomatology-Self-Report, and Post Traumatic Stress Disorder Checklist- Civilian Version. The statistica

Brad M Isaacson,1,2 Thomas M Swanson,1,2,4 Benjamin K Potter,4 Paul F Pasquina2,3 1The Henry M Jackson Foundation for the Advancement of Military Medicine, 2The Center for Rehabilitation Sciences Research, Department of Physical Medicine and Rehabilitation, Uniformed Services University of Health Sciences, 3Department of Rehabilitation, Walter Reed National Military Medical Center, 4Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA Abstract: Tourniquet use during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) has contributed to the high survival rate of combat-injured service members. While preservation of a life – even at the potential expense of a limb – should always take precedence, delayed perfusion in traumatized residual limbs may alter the proliferation, differentiation, and function of endothelial and osteoprogenitor cells. Given the synergistic relationship between angiogenesis and osteogenesis, and the influence of environmental conditions on bone formation, hypoxic conditions from tourniquets may in part explain the higher frequency of heterotopic ossification (HO) present during OIF/OEF. Determining a correlation between tourniquet usage/duration on subsequent HO formation remains challenging. Long-term retrospective investigations have been limited, since the United States Army's Institute of Surgical Research did not standardized tourniquet issuance until July 2004. Thus, associating tourniquet-induced HO in previous military conflicts is not feasible, since poor medical documentation and inadequate application of these medical devices prevent large-scale meta-analyses. Therefore, this article focuses on the basics of bone biology and how tourniquet usage following combat trauma may impact osteogenesis, and subsequently, ectopic bone formation. Keywords: heterotopic ossification, osteogenesis, combat, trauma, ectopic bone, osteoprogenitor cells, Operation I

In Year 1 of this grant the team established the necessary infrastructure and received full IRB approval. The investigators recruited 40% of their intended study population and demonstrated the ability to flurochrome label ectopic bone samples. Histological data is still being analyzed however; the first four patients of our study have mineral apposition rates (MAR) that are approximately 2x as rapid as non-pathological human bone (1.92 +/- 0.09 microns per day vs. 1.0 micron per day). Additionally, localized regions of bone demonstrated high metabolic growth, with MAR approaching 3.5 microns per day. Scanning electron microscopy has provided images of the varying stages of bone mineralization and highly vascular channels in HO. Salary support for the investigators has resulted in 2 peer-reviewed publications (1 accepted, 1 submitted) and grant W81XWH-12-2-0017 was acknowledged., The original document contains color images.

Since the beginning of the conflicts in Iraq and Afghanistan more than a decade ago, much has been learned with regard to combat casualty care. Although progress has been significant, knowledge gaps still exist. The seventh Extremity War Injuries symposium held in January 2012, reviewed the current state of knowledge and defined knowledge gaps in acute care, reconstructive care, and rehabilitative care in order to provide policymakers information on the areas in which research funding would be the most beneficial., Pub. in Journal of American Academy Orthopaedic Surgeons, v20 n1, pS99-S102, 2012.

Soldiers and their Families are the Army's principal asset. They are at the core of the Army, and as an organization we have the sacred responsibility to care for our wounded, injured, and ill Soldiers. Every wounded, injured, or ill Soldier deserves indeed has earned the right to be provided with excellent medical care and a broad range of opportunities to allow him or her to succeed either through continuation on active duty or through becoming a successful Veteran. As an all-volunteer force, many Soldiers view the Army as their professional home or at least as an important step along the way toward another career path. Their selfless service and commitment to defending freedom are to be respected and admired. America is well represented by this generation of Soldiers. Future historians will surely designate them as a Great Generation, having faced adversity with great courage, humility, patriotism, and honor. Leaders of Warriors in Transition must help wounded, injured, and ill Soldiers to regain their bearings, to set their azimuth, and then aim high for success. This occurs from the early stages of healing through reintegration into the force or to the civilian community. Leaders of Warriors in Transition need to be involved with their Soldiers, to invigorate them, to inform them and be informed by them, and to inspire them to ultimately achieve their fullest potential. The Comprehensive Transition Plan is an essential tool for leaders and Soldiers to navigate the terrain and set a course for achieving their goals. The Comprehensive Transition Plan is a process, a framework for communication, and a living document to record outcomes for leaders, healthcare providers, and Soldiers and their Families. We encourage all Army leaders to read this book, to study it and take notes, and to implement their knowledge for the benefit of their Soldiers.

Since its national debut in 1987, Fresh Air with Terry Gross has been a highly acclaimed and much adored weekday magazine among public radio listeners. Each week, nearly 4.8 million people turn to Peabody Award-winning host Terry Gross for insightful conversations with the leading voices in contemporary arts and issues. The renowned program reaches a global audience, with over 620 public radio stations broadcasting Fresh Air, and 3 million podcast downloads each week. Fresh Air has broken the mold of 'talk show' by weaving together superior journalism and intimate storytelling from modern-day intellectuals, politicians and artists alike. Through probing questions and careful research, Gross's interviews are lauded for revealing a fresh perspective on cultural icons and trends. Her thorough conversations are often complemented by commentary from well-known contributors. Fresh Air is produced at WHYY-FM in Philadelphia and broadcast nationally by NPR., (1.) Prosthetics engineer JONATHAN KUNIHOLM (KUNNY-home). The graduate student and Iraq war vet returned home from his tour of duty missing part of his right arm. He both uses and designs prosthetic devices. Kuniholm is at the Center for Biologically Inspired Materials & Material Systems at Duke University. He started the Open Prosthetics Project, an open source collaboration effort. More info at http://www.openprosthetics.org, and he's a partner at Tackle Design, an industrical design, research and development firm. (DAVE DAVIES INTERVIEW) (THIS INTERVIEW CONTINUES INTO THE SECOND HALF OF THE SHOW). (2.) COLONEL PAUL PASQUINA, MD (pass-QUEEN-ah). He's the medical director of the amputee program at the Walter Reed Army Medical Center in Washington DC. He is also the Chief of the Integrated Department of Orthpaedics and Rehabilitation at Walter Reed. With advances in military medicine, more soldiers are surviving war wounds, but returning home missing limbs. He'll talk about the latest advances in prosthetics for amputees. (DAVE DAVIES INTERVIEW) (3.) Actor WOODY HARRELSON. He stars in the new film The Messenger about soldiers who visit family members to tell them a loved one has died in combat. His other films include No Country for Old Men, The Thin Red Line, The People vs. Larry Flynt, Natural Born Killers, and White Men Can't Jump. (INTERVIEW BY DAVE DAVIES). (THIS IS PART ONE OF THE INTERVIEW. PART TWO WILL BE BROADCAST LATER). (4.) Rock critic KEN TUCKER reviews Shadow on the Ground, the third album by Texas country singer James Hand.