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Objective To examine headache and depression over time in individuals who sustained mild traumatic brain injury (mTBI). Prevalence of headache and depression early after mTBI and at 1 year postinjury as well as the relationship between the two are evaluated. Background Headache is the most common physical symptom and depression is among the most common psychiatric diagnosis after traumatic brain injury regardless of severity. Headache and depression have been found to be two independent factors related to poor outcome after mTBI, yet there appears to be a paucity of research exploring the comorbidity of these two conditions after injury. Method/Design Longitudinal survey design over 1 year of 212 participants with mTBI who were admitted to a Level 1 trauma center for observation or other system injuries. Depression was based on a score ≥10 on the Patient Health Questionnaire-9. Headache was based on participant report of new or worse-than-preinjury headache since hospitalization (baseline) or within the previous 3 months at 1 year postinjury. Results The prevalence of headache and depression at baseline was 64% (135/212) and 15% (31/212), respectively. The prevalence of headache and depression at 1 year was 68% (127/187) and 27% (50/187), respectively. The co-occurrence of headache and depression increased from 11% (23/212) at baseline to 25% (46/187) at 1 year. At 1 year, the risk ratio of individuals who had headache to be depressed was 5.43 (95% CI 2.05-14.40) compared to those without headache ( P < .001). The corresponding risk ratio at baseline was 1.64 (95% CI .77-3.49; P = .23). Conclusions While prevalence of headache is consistently high over the first year after injury, rate of depression increased over the first year for those who were followed. Given the high rate of comorbidity, those with headache may develop depression over time. Evaluation for possible depression in those with headache after mTBI should be conducted to address both conditions over the year following injury. [ABSTRACT FROM AUTHOR]

Dietary patterns with cardiovascular benefits have been recommended, but the relative contributions of individual foods and food components, alone or in combination, remain undefined. Male ApoE−/− mice were fed either a purified AIN-93G control diet, a Western diet (WD), or a WD with 10% tomato powder (TP), 2% soy germ (SG), or the combination, for 4 wk ( n = 10 per group). Plasma total cholesterol and triglycerides were measured with enzymatic colorimetric kits, and serum amyloid A (SAA) was measured by ELISA. Liver lipids were extracted with chloroform:methanol, and triglycerides, free and esterified cholesterol measured with enzymatic colorimetric kits. Expression of Cyp27a1, Cyp7a1, Abcg5, and Abcg8 in the liver was determined by quantitative polymerase chain reaction. Sections of the aortic root and aorta were cut and stained with hematoxylin and eosin (H&E) to assess extent of atherosclerotic lesions. WD-fed animals had greater liver and adipose weights, plasma cholesterol and SAA, hepatic lipids, and atherosclerosis than AIN-93G animals. TP and SG did not decrease atherosclerosis as measured by H&E-stained sections of the aortic root, aortic arch, and descending aorta. The TP diets further increased plasma cholesterol, but also led to increased expression of the Abcg5/8 transporters involved in cholesterol efflux. Addition of SG alone to the WD attenuated WD-induced increases in plasma cholesterol, liver lipids, and gonadal adipose weight. The results of this study do not support the use of either TP or SG for reduction of atherosclerosis, but suggest some beneficial effects of SG on lipid metabolism in this model of cardiovascular disease. [ABSTRACT FROM AUTHOR]

von Willebrand Factor (vWF) is a multimeric plasma protein important for platelet plug formation. As part of its haemostatic role, it is released from endothelial cells during vascular stress or injury and is considered an excellent biomarker of endothelial function. Currently, there are no validated kits available to measure vWF in rabbits. We developed a sensitive and reproducible sandwich enzyme- linked immunosorbent assay (ELISA) for detection of vWF in rabbit plasma using commercially available antibodies and reagents. Purified human vWF was used as a calibrator standard with a dynamic range of 1.56-100 ng/mL. The Minimum Required Dilution for rabbit plasma was 1:100. When plasma was spiked with 3.76 or 10 ng/mL vWF, recovery was 108 ± 2% and 93 ± 2%, respectively. Intra- and inter-assay precision for 8 rabbit plasma samples were 3% and 4%, respectively. The Minimum Detectable Concentration was 254 pg/mL for purified human vWF and 1:10,700 dilution of cholesterol-fed rabbit plasma, and the Reliable Detection Limits were 457 pg/mL and 1:5940. Three freeze-thaw cycles significantly decreased vWF concentrations for purified human vWF and 2 of 3 plasma samples assayed. This ELISA provides sensitive and reproducible measurements of rabbit plasma vWF, which is an important biomarker for cardiovascular research. [ABSTRACT FROM AUTHOR]

Presents a letters to the editor about emergency medicine.

An emergency department provides care for a full spectrum of undifferentiated disorders and its size may influence how well it can do so. Outcomes research in emergency medicine is limited, although outcomes in severe trauma and acute coronary syndromes have been shown to be influenced by available facilities and expertise. A department can be too small to provide the full spectrum of emergency care, as has been documented with General Practice Casualty Units. Some research suggests that a critical mass is required to ensure acceptable outcomes. Small departments may operate in a hierarchical system, led by teaching hospitals setting practice standards. However, these may be opinion as much as evidence based and not broadly applicable as a universal practice standard. Small departments can be overwhelmed by trauma and other major cases or when the teaching hospital is unable to accept emergency patients or transfers because they are operating at capacity. Further outcomes research and audit of individual hospitals is required to determine a minimum optimum size for emergency departments. [ABSTRACT FROM AUTHOR]

Objective: To document the management of young children with fever without source presenting to emergency departments in Australia and New Zealand, and to document to what extent published guidelines are followed. Method: A questionnaire survey was mailed to Directors of emergency departments. Results: Variation in practice, by a number of measures including age ranges used, threshold temperature, investigations performed, antibiotic use and admission criteria was found. Half the departments did not have written management protocols which correlated with greater variation in practice within a department, compared with those that did have written management protocols. For children 3 to 36 months of age, in three of 23 departments (13%) antibiotics were routinely prescribed for fever without source. Conclusions: Among emergency departments, there is variation in practice in the management of fever without source in infants and young children. Variation within departments is correlated with lack of written management guidelines. Antibiotic use is markedly less than recommended in published guidelines and clinical assessment is emphasized. It is proposed that published guidelines have not been incorporated into routine practice because evidence from clinical trials does not support the guidelines. [ABSTRACT FROM AUTHOR]

Background: Achieving optimal tumour coverage during craniospinal irradiation (CSI) is a challenge. Whilst several critical organs are at risk of radiation-induced toxicity, if target volume structures like the cribriform plate receive less than 95% of the prescribed dose, tumours could recur. Aim: This single-institution study seeks to establish the most effective craniospinal radiotherapy amongst 3D conformal radiation therapy (CRT), intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) by comparing dosimetry across target volumes, organs at risk (OARs) and total irradiated volume. Time taken for contouring, generation and evaluation of treatment plans, quality assurance and treatment beam delivery is assessed. Setting: The demographics of patients comprised of six children and one adult who underwent 3D CRT craniospinal radiotherapy at a Western Cape hospital. Methods: Approval from the Human Research Ethics Committee was obtained. The 3D CRT plan consisted of two parallel opposing lateral fields at the cranial isocentre and a single posterior field at the spinal isocentre. Both the IMRT and VMAT plans comprised three isocentres, one cranial and two spinal, with a total of 15 fields. Results: Volumetric modulated arc therapy was the most conformal (CI = 0.48) and IMRT the most homogeneous (HI = 0.06). Although the VMAT low-dose bath (58.1%) was highest at 2 Gy, OARs were least exposed with VMAT. The total time taken for VMAT was the shortest. Conclusion: Volumetric modulated arc therapy was recommended as the most effective CSI technique owing to its superior conformality, least OARs exposure and fastest planning times. Clinical investigation into possible late adverse effects arising from the VMAT low-dose bath should be conducted. Contribution: This study will establish which of the three radiation therapy (RT) techniques is most effective in the treatment of craniospinal tumours, as well as, which technique offers the fastest turn around time. [ABSTRACT FROM AUTHOR]

The article describes the case of a vehicular accident patient who died because he did not undergo neurosurgeon based on the advise of the physician. Topics include the lack of trauma infrastructure of the doctors on duty, the reluctance of physicians to accept advice over the telephone, and the need for the speedy facilitation of urgent transfer of major trauma by consultants.

A letter to the editor about Hoffman's views on the use of thrombolysis in acute strokemanagement is presented.

A letter to the editor is presented in response to the article "Thrombolysis in Acute Ischaemic Stroke: Example of a Health Divide?," by H. Choi in the January 6, 2010 issue.

Discrete particle dynamics is one of the least understood aspects of river bedload transport, but in situ measurement of stone movement during floods poses a significant technical challenge. A promising approach to address this knowledge gap is to use sensors embedded within stones. Sensors must be waterproof and recoverable after being transported downstream and potentially buried by other sediment. To address this challenge rugged sensors (Kinematic Loggers) were developed for deployment inside stones (ranging in size from cobbles to boulders) during floods. The sensors feature a 9-axis inertial measurement unit, 3-axis high-g accelerometer, 128 MB flash memory, and a 433 MHz LoRa radio transmission module for sensor recovery. The sensors are enclosed in rugged waterproof housings for deployment in extreme conditions (i.e., bedload transport during floods). Novel relay units and drone-based recovery systems were also developed for finding the sensors after field deployments. Firmware to control the sensors and relay units was developed, as well as software for configuring the sensors and an android application for communicating with the sensors via the LoRa radio transmission module. This paper covers the technical development of the sensors, mounting them inside stones, and field recovery tests. Although designed for measurement of coarse bedload transport and particle dynamics during floods, the sensors are equally applicable for deployment in other harsh environments, such as to study landslide and rockfall dynamics. [ABSTRACT FROM AUTHOR]

Several letters to the editor in response to the article "Update on the third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited," by Peter Sandercock, Joanna Wardlaw, Martin Dennis in the previous issue of the periodical and a response by the authors to same, are presented.