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Objective: To provide healthcare professionals guidance on youth at risk for prolonged recovery and post-traumatic headache (PTH), and on pharmacologic and non-pharmacologic management of PTH due to concussion and mild traumatic brain injury., Background: Headache is the most common persistent post-concussive symptom affecting 8% of youth for >3 months after concussion. Over the past decade, many studies have explored the treatment of PTH in youth, but there are no established guidelines., Methods: This white paper is based on a synthesis of an updated systematic review of the literature on treatment of PTH and a narrative review of the literature on risk factors for prolonged recovery and health disparities. Results were interpreted by a group of expert providers in PTH in children and adolescents through collaboration of the PTH and pediatric special interest groups of the American Headache Society., Results: Factors that consistently were associated with prolonged recovery from concussion and persistent PTH included female sex, a high number of acute symptoms, and adolescent age. Social determinants of health also likely play an important role in PTH and deserve consideration in the clinical and research settings. A total of 33 studies met the criteria for inclusion in the systematic review of PTH treatment in youth, although most were retrospective and of fair-to-poor quality. Treatment strategies included acute and preventive pharmacologic management, procedures, neuro-modulatory devices, physical therapy, physical activity, and behavioral health support. A collaborative care approach that includes a thoughtful combination of these management strategies is likely most effective., Conclusions: This white paper provides a roadmap for tailoring the treatment of PTH based on factors influencing prolonged headache, the timing of therapies, and therapies with the most evidence for treating PTH in youth. We also highlight research needed for developing more definitive guidelines on PTH management in youth., (© 2024 The Author(s). Headache: The Journal of Head and Face Pain published by Wiley Periodicals LLC on behalf of American Headache Society.)

Background: Magnetic resonance imaging (MRI)-guided biopsies are an accurate, but technically challenging, method for screening and diagnosis of breast lesions. This study assesses the safety and efficacy of an Image Guided Automated Robot (IGAR) in performing breast biopsies compared to manual procedures., Methods: Safety was determined from adverse events (AEs) and device deficiencies. Efficacy was assessed using targeting accuracy, number of successful biopsies, pain and scar scores, patient discomfort, and radiologist-determined ease-of-use., Results: All seven procedures in phase I were successfully and safely completed with no AEs and one device deficiency. The 23 IGAR biopsies in phase II outperformed the 18 manual biopsies in 1-week pain scores (p = 0.027), scarring at 1-week (p = 0.035), 1-month (p = 0.004), and components of comfort and ease-of-use. Phase II had seven and three AEs in the IGAR and manual groups, respectively (p = 0.317), with no serious AEs and nine device deficiencies., Conclusions: The IGAR system is safe and effective for breast biopsy procedures. The results from these trials indicate the IGAR system as a potentially viable alternative to manual breast biopsy procedures., (© 2022 John Wiley & Sons Ltd.)

Unnecessary accumulation of phosphorus (P) in agricultural soils continues to degrade water quality and linked ecosystem services. Managing both soil loss and soil P fertility status is therefore crucial for eutrophication control, but the relative environmental benefits of these two mitigation measures, and the timescales over which they occur, remain unclear. To support policies toward reduced P loadings from agricultural soils, we examined the impact of soil conservation and lowering of soil test P (STP) in different regions with intensive farming (Europe, the United States, and Australia). Relationships between STP and soluble reactive P concentrations in land runoff suggested that eutrophication control targets would be more achievable if STP concentrations were kept at or below the current recommended threshold values for fertilizer response. Simulations using the Annual P Loss Estimator (APLE) model in three contrasting catchments predicted total P losses ranging from 0.52 to 0.88 kg ha depending on soil P buffering and erosion vulnerability. Drawing down STP in all catchment soils to the threshold optimum for productivity reduced catchment P loss by between 18 and 40%, but this would take between 30 and 40+ years. In one catchment, STP drawdown was more effective in reducing P loss than erosion control, but combining both strategies was always the most effective and more rapid than erosion control alone. By accounting for both soil P buffering interactions and erosion vulnerability, the APLE model quickly provided reliable information on the magnitude and time frame of P loss reduction that can be realistically expected from soil and STP management. Greater precision in the sampling, analysis, and interpretation of STP, and more technical innovation to lower agronomic optimum STP concentrations on farms, is needed to foster long-term sustainable management of soil P fertility in the future., (© 2019 The Author(s).)