Friday, November 13, 2020

Soccer players' head injury risk could be reduced with simple adjustments to the ball

PURDUE UNIVERSITY

Research News

WEST LAFAYETTE, Ind. -- Up to 22% of soccer injuries are concussions that can result from players using their heads to direct the ball during a game.

To reduce risk of injury, a new study recommends preventing how hard a ball hits the head by inflating balls to lower pressures and subbing them out when they get wet.

The study, conducted by Purdue University engineers, found that inflating balls to pressures on the lower end of ranges enforced by soccer governing bodies such as the NCAA and FIFA could reduce forces associated with potential head injury by about 20%.

But if the ball gets too wet, it can quickly surpass the NCAA weight limit for game play and still produce a nasty impact, the researchers said.

"If the ball has too high of a pressure, gets too waterlogged, or both, it actually turns into a weapon. Heading that ball is like heading a brick," said Eric Nauman, a Purdue professor of mechanical engineering and basic medical sciences with a courtesy appointment in biomedical engineering.

Soccer governing bodies already regulate ball pressure, size, mass and water absorption at the start of a game, but Nauman's lab is the first to conduct a study evaluating the effects of each of these ball parameters on producing an impact associated with potential neurophysiological changes.

The results are published in the journal PLOS One. The researchers discuss the work in a video on YouTube at https://youtu.be/3b_19wW7K6A.

The study also evaluated ball velocity, finding that this variable actually contributes the most to how hard a ball hits. But ball pressure and water absorption would be more realistic to control.

"You can't control how hard a player kicks a ball. There are other ways to decrease those forces and still have a playable game," Nauman said.

A professional soccer player heads the ball about 12 times over the course of a single game and 800 times in games over an entire season, past studies have shown.

The lower end of NCAA and FIFA pressure ranges, which the researchers discovered could help reduce the ball's peak impact force, already aligns with pressures specified by the manufacturer on the ball. These specifications would provide an easy way to know if a pressure is low enough to reduce risk of head injury.

"The study really sheds light on the issue of how the weight and impact of the ball can change under different conditions. Sports governing bodies and manufacturers can use this research to further reduce the risk of lasting brain functional or structural injury as a result of head impacts accrued through soccer game play," said Francis Shen, a professor of law at the University of Minnesota whose research focuses on the intersection of sports concussions and the legal system.

Nauman and Shen met through the Big Ten-Ivy League Traumatic Brain Injury Collaboration, a multi-institutional research effort to better understand the causes and effects of sport-related concussion and head injuries.

In this study, Nauman's lab tested three soccer ball sizes - a 4, 4.5 and a 5 - by kicking them against a force plate in a lab. Even though only size 5 balls are played by professional adults, the researchers also observed the smaller 4 and 4.5 sizes played by kids under the age of 12 to evaluate how much the size of a ball contributes to peak impact force.

The study included 50 trials for each ball size at four different pressures, ranging from 4 psi to 16 psi. This range includes pressures below standard manufacturing specifications and near the limit of soccer governing body regulations.

Purdue graduate student Nicolas Leiva-Molano did 200 kicks per ball size for a total of 600 kicks.

To test water absorption, the researchers submerged each ball size for 90 minutes - the duration of a game regulated by soccer governing bodies. They weighed and rotated each ball every 15 minutes.

Within the first 15 minutes, a size 5 soccer ball had already exceeded the allowable weight gain cited in NCAA soccer rules.

Based on this study's findings, a size 4.5 soccer ball is the safest to play in terms of forces contributed by pressure, mass and water absorption. But reducing pressure and limiting water absorption made a difference for all three ball sizes.

"This was a very simple experiment. But there just hasn't been much data out there on these issues, and that's a huge problem," Nauman said.

The next step would be to replicate this experiment outside of the lab, ideally in partnership with a high school or college athletic conference, which would allow the researchers to study the effects of ball hits at different parameters before and after a season.

"There are lots of examples in sports where organizations have changed the rules to make the game safer. This new study suggests a simple way to further those efforts for safer equipment and game play," Shen said.

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ABSTRACT

Factors affecting peak impact force during soccer headers and implications for the mitigation of head injuries

Joshua Auger, Justin Markel, Dimitri D. Pecoski, Nicolas Leiva-Molano, Thomas M. Talavage, Larry Leverenz, Francis Shen, Eric A. Nauman

DOI: 10.1371/journal.pone.0240162

It has been documented that up to 22% of all soccer injuries are concussions. This is in part due to players purposely using their head to direct the ball during play. To provide a more complete understanding of head trauma in soccer athletes, this study characterized the effects of four soccer ball characteristics (size, inflation pressure, mass, velocity) on the resulting peak impact force as it relates to the potential for incurring neurophysiological changes. A total of six hundred trials were performed on size 4 and 5 soccer balls as well as a novel lightweight soccer ball. Impact force was measured with a force plate and ball velocity was determined using motion capture. These data were used, in conjunction with dimensional analysis to relate impact force to ball size, mass, velocity, and pressure. Reasonable reductions in allowable ball parameters resulted in a 19.7% decrease in peak impact force. Adjustments to ball parameters could reduce a high cumulative peak translational acceleration soccer athlete down into a previously defined safer low loading range. In addition, it was noted that water absorption by soccer balls can result in masses that substantially increase impact force and quickly surpass the NCAA weight limit for game play. Additional research is required to determine whether varying soccer ball characteristics will enable soccer players to avoid persistent neurophysiological deficits or what additional interventions may be necessary and the legal implications of these data are discussed.

Repeated small blasts put military, law enforcement at risk for brain injury

UVA-led study examined specialists who use explosives to enter buildings

UNIVERSITY OF VIRGINIA HEALTH SYSTEM

Research News

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IMAGE: UVA SCHOOL OF MEDICINE RESEARCHER JAMES STONE, MD, PHD, IS HELPING DEVELOP A MODEL PREDICTING HOW REGULAR EXPOSURE TO ARTILLERY BLASTS AFFECTS THE BRAINS OF MILITARY PERSONNEL. view more 

CREDIT: UVA HEALTH

Military and law-enforcement personnel repeatedly exposed to low-level blasts have significant brain changes - including an increased level of brain injury and inflammation - compared with a control group, a new study has found.

Led by University of Virginia School of Medicine researcher James Stone, MD, PhD, the study compared the brains of 20 "breachers" - specialists who use explosives to enter buildings and other structures - with a 14-person, age-matched control group. The breachers had been exposed to an average of 4,628 blasts, while the control group had been exposed to an average of three.

Blood measurements and neuropsychological assessments suggest that the breachers have increased levels of brain injury and inflammation, which the researchers wrote is "consistent with the theory that exposure to breaching-related blasts leads to system-wide effects in the brain."

The study also found that the breachers had statistically significant differences in blood flow, brain structure and brain activity.

"This study is the first to comprehensively assess military and law enforcement personnel to better understand whether repetitive blast exposure over a career can lead to changes within the brain," Stone said. "This is an area of high importance to military and law enforcement communities, as it is becoming increasingly clear there may be occupational health considerations related to repetitive low-level blast exposure in training and operations over the career of an exposed individual."

Investigating Brain Injury

The researchers wrote that further studies will be needed to determine more precisely what level and frequency of blast exposure may result in the observed brain changes.

Stone and his colleagues have two additional studies underway to further examine the effects of blasts on the brains of military personnel. The first - backed by a three-year, $2.1 million grant from the U.S. Department of Defense - is researching the effects of regular exposure to artillery blasts. The second is examining whether special operations forces are at risk for brain injury over their career.

"These additional studies will allow us to better understand whether the observations made in breachers are also seen in other blast-exposed populations, such as those that operate heavy weapons," Stone said. "We also hope to be able to shed light on how the brain responds to repetitive blasts on a molecular level."

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Findings Published

The researchers published their findings in the Journal of Neurotrauma. The UVA research team included Stone, Brian B. Avants, Nicholas J. Tustison, Meghan O'Brien and Natalie Domeisen. They were joined by colleagues from the National Institute of Neurological Disorders and Stroke, National Institute of Nursing Research, University of Florida, Pennsylvania State University, Oak Ridge Institute for Science and Education, Uniformed Services University, Walter Reed Army Institute of Research, the Department of Defense Joint Artificial Intelligence Center, University of Glasgow and the Naval Medical Research Center.

The work was supported by Joint Program Committee-5 Development of Exposure Standards to Repeated Blast Exposure program, work unit 603115HP-3730-001-A1118; Office of Naval Research (ONR) award N00014-18-1-2440, with supplemental funding to the ONR award provided by Cohen Veterans Bioscience; imaging resources from the Center for Neuroscience and Re-generative Medicine; the Clinical Neurosciences Program of the National Institute of Neurological Disorders and Stroke, project 1ZIANS002977-21; and the Research Participation Program at the Walter Reed Army Institute of Research.

 

On the way to lifelike robots

PAI: Physical Artificial Intelligence

SWISS FEDERAL LABORATORIES FOR MATERIALS SCIENCE AND TECHNOLOGY (EMPA)

Research News

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IMAGE: ROBOTICS RESEARCHER MIRKO KOVAC WANTS TO MERGE MACHINES WITH THE INTELLIGENCE OF LIFE. view more 

CREDIT: IMAGE: ROBERT STÃœRMER / EMPA

Artificial intelligence is supposed to make machines perform at ever more amazing levels. A robot that can do little more than a remote-controlled model car has a limited range of applications. But from an automatic machine to an autonomous robot, it is a big, almost revolutionary step. Robotics researchers Mirko Kovac and Aslan Miriyev, who both work at Empa's "Materials and Technology Center of Robotics" in Dübendorf and at the "Aerial Robotics Lab" of Imperial College London, are convinced that one decisive component can make this evolutionary step possible: Physical artificial intelligence, PAI for short. Only when the artificial intelligence of a digital "brain" is merged with an intelligent body could new types of robots be created that have properties comparable to those of intelligent living organisms. They have now published their concept in the latest issue of the renowned scientific journal Nature Machine Intelligence.

Thinking outside the box

In order to develop fully autonomous, intelligent robot systems, researchers must recognize and utilize the synergies of different disciplines, such as materials science, biology, mechanical engineering, chemistry and computer science, according to the Empa scientists. "We imagine that PAI robots will only become reality through the use of a variety of unconventional materials and by combining research methods from various disciplines," says Mirko Kovac. To do this, researchers would need a much broader range of skills than is usually seen in conventional robotics. Interdisciplinary cooperation, partnerships and an adaptation of the curriculum for young researchers are therefore called for. "Working in a multidisciplinary environment requires courage and constant learning. Researchers must leave their comfort zones and think beyond the boundaries of their own field".

Symbiosis of man and machine

The Empa researchers want to promote the vision of a society in which people are "living" together seamlessly with machines. "This symbiosis can only be achieved if safe interaction is possible and if the machines have true, Physical AI, allowing them to live like benevolent animals together with nature and people," says Kovac. The researchers now hope that their work will encourage active discussion of the topic.

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Exoskeleton-assisted walking improves mobility in individuals with spinal cord injury


Multi-center U.S. trial shows exoskeleton training is safe, feasible, and effective across wide spectrum of individuals with mobility deficits caused by traumatic spinal cord injury

KESSLER FOUNDATION

Research News

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IMAGE: FOR THIS STUDY, TWO TYPES OF EXOSKELETONS WERE USED BY PARTICIPANTS WITH SPINAL CORD INJURY - EKSO GT, SHOWN HERE, AND REWALK. view more 

CREDIT: KESSLER FOUNDATION

East Hanover, NJ. November 12, 2020.
Exoskeletal-assisted walking is safe, feasible, and effective in individuals disabled by spinal cord injury, according to the results of a federally funded multi-site randomized clinical trial. The article, "Mobility skills with exoskeletal-assisted walking in persons with SCI: Results from a three-center randomized clinical trial" (doi: 10.3389/frobt.2020.00093), was published August 4, 2020 in Frontiers in Robotics and AI. It is available open access at https://www.frontiersin.org/articles/10.3389/frobt.2020.00093/full

The authors are Eun-Kyoung Hong, Pierre Asselin, MS, Steven Knezevic, Stephen Kornfeld, DO, and Ann M. Spungen, EdD, of the James J. Peters VA Medical Center, Gail Forrest, PhD, of Kessler Foundation, Peter Gorman, MD, and William Scott, PhD, of the University of Maryland School of Medicine, and Sandra Wojciehowski, PT, of Craig Hospital and Kessler Foundation. The study was conducted at three sites: James J. Peters VA Medical Center, Bronx, NY; Kessler Foundation, West Orange, NJ; and the University of Maryland.

Study investigators sought to establish guidelines for clinical exoskeletal-assisted walking programs for individuals with spinal cord injury. Their goal was to determine the number of exoskeleton training sessions needed by individuals with varied mobility deficits to gain adequate exoskeletal assisted walking skills and attain velocity milestones. Two powered exoskeletons were used in the study: the Ekso GT (Ekso Bionics), and ReWalk (ReWalk Robotics).

The 50 participants included individuals with tetraplegia and paraplegia, both motor complete and incomplete. In this randomized control trial, their performance was measured over a total of 36 sessions. Participants were randomized to Group 1 (exo-assisted walking) or Group 2 (usual activity) for 12 weeks; each group crossed over to the other study arm. After 12, 24, and 36 sessions, their progress was measured by the 10-meter walk test seconds (s) (10MWT), 6-min walk test meters (m) (6MWT), and the Timed-Up-and-Go (s) (TUG).

The majority of participants mastered the ability to ambulate effectively with the assistance of the exoskeleton, according to Dr. Forrest, director of the Tim and Caroline Reynolds Center for Spinal Stimulation, and associate director of the Center for Mobility and Rehabilitation Engineering Research at Kessler Foundation. After 12 sessions, 31 (62%), 35 (70%), and 36 (72%) participants achieved the milestones established for the 10MWT, 6MWT, and TUG, respectively. After 36 sessions, the results improved, with 40 (80%), 41 (82%), and 42 (84%) of participants meeting the criteria for the 10MWT, 6MWT, and TUG, respectively.

"Participants showed improvement regardless of level of injury, completeness, or duration of injury," noted Dr. Forrest, "indicating that exoskeletons can be used to improve mobility across a broad spectrum of individuals with neurological deficits caused by spinal cord injury. Our results can be used to guide the application of exoskeletons to spinal cord injury rehabilitation, and the timely acquisition of skills for the safe use of these devices for rehabilitation and community use."

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Funding sources:
US Department of Defense CDMRP SCI Award 30234 (W81XWH-14-2-0170); National Center for the Medical Consequences of SCI (B9212-C, B2020-C); James Lawrence Kernan Endowment Fund; Bronx Veterans Medical Research Foundation

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit KesslerFoundation.org.

 

Racial disparities in pediatric diabetes treatment

UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING

Research News

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IMAGE: TERRI H. LIPMAN, PHD, CRNP, FAAN, MIRIAM STIRL ENDOWED TERM PROFESSOR OF NUTRITION, PROFESSOR OF NURSING OF CHILDREN AND ASSISTANT DEAN FOR COMMUNITY ENGAGEMENT AT PENN NURSING. view more 

CREDIT: PENN NURSING

PHILADELPHIA (November 12, 2020) - Type 1 diabetes (T1D) is the third most common pediatric chronic disease in the United States, and the risk of the disease has risen sharply in non-Hispanic Black (NHB) children in the last 20 years, data show. Ironically, the significant advances in T1D therapeutics over recent years, especially new technologies, may have exacerbated racial disparities in diabetes treatment and outcomes.

In an article in the journal Pediatric Diabetes, researchers from the University of Pennsylvania School of Nursing (Penn Nursing) and the Children's Hospital of Philadelphia detail their retrospective study of more than 2,800 children with T1D. Their findings have helped quantify racial and ethnic disparities in health care use, technology application, and outcomes in pediatric diabetes treatment.

"Disparities in these treatments are of clinical significance, as both intensive insulin therapy and the incorporation of technology have been associated with improved glycemic control and, consequently, reduced long-term complications," writes Terri H. Lipman, PhD, CRNP, FAAN, Miriam Stirl Endowed Term Professor of Nutrition, Professor of Nursing of Children and Assistant Dean for Community Engagement at Penn Nursing.

The article, "Racial Disparities in Treatment and Outcomes of Children With Type 1 Diabetes," details how treatment modalities, clinical outcomes, and appointment attendance in NHB versus non-Hispanic white and Hispanic children with T1D were examined while including the contribution of insurance status (as a proxy for socioeconomic status) to these disparities. Despite similar outpatient appointment attendance rates, significant disparities in continuous glucose monitoring and insulin pump use were observed.

"Disparities in health care cannot be eliminated without a societal effort to address structural racism. The underlying etiologies of health care disparities, including the impact of patient and provider bias, should be fully investigated and strategies developed to mitigate these contributing factors," concludes Lipman.

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The article is available online. Co-authors of the article include Jennifer A. Smith, Oona Patil, Steven M. Willi, and Colin P. Hawkins, all of the Children's Hospital of Philadelphia.

About the University of Pennsylvania School of Nursing

The University of Pennsylvania School of Nursing is one of the world's leading schools of nursing. For the fifth year in a row, it is ranked the #1 nursing school in the world by QS University and is consistently ranked highly in the U.S. News & World Report annual list of best graduate schools. Penn Nursing is currently ranked # 1 in funding from the National Institutes of Health, among other schools of nursing, for the third consecutive year. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through innovation in research, education, and practice. Follow Penn Nursing on: Facebook, Twitter, LinkedIn, & Instagram.

 

Combined intimate partner violence that includes sexual violence is common & more damaging

UNIVERSITY OF BRISTOL

Research News

Women who experience sexual violence combined with other forms of intimate partner violence suffer greater damage to their health and are much more likely to attempt suicide, according to a study led by researchers at the University of Bristol's Centre for Academic Primary Care published today [12 November] in the International Journal of Epidemiology .

Intimate partner violence - psychological, physical or sexual violence perpetrated by a current or former partner - is the most common form of violence experienced by women worldwide.

The study, conducted in collaboration with the World Health Organization (WHO) and University of Melbourne, found that all types of intimate partner violence were associated with long-lasting damage to health but combinations that included sexual violence were more common and markedly more damaging to women's physical and mental health.

Researchers analysed data from the WHO multi-country study on women's health, which has information from 16 different sites in 11 different countries on over 21,000 women who have ever had a partner. This new analysis assessed different combinations of psychological, physical and sexual intimate partner violence and their impacts on health.

They found that over 15 per cent of ever-partnered women had experienced a combination of intimate partner violence that included sexual violence. Those who had experienced this in the last year were ten times more likely to attempt suicide than those who had not. Women who had experienced multiple forms of abuse were also more likely to experience difficulty walking, difficulty with daily activities, pain or discomfort, poor memory or concentration, dizziness, and vaginal discharge, and to be taking sleeping pills or painkillers.

Study lead, Dr Lucy Potter a GP and NIHR In-Practice Clinical Research Fellow at the University of Bristol's Centre for Academic Primary Care, said: "We know intimate partner violence is damaging to health. What this study adds is the recognition of the profound harm caused by multiple forms of abuse, particularly when it includes sexual violence, and how we do not see this when all forms of abuse are lumped together as one experience. Practitioners and policy makers must appreciate the diversity of experience of intimate partner violence to tailor support appropriately.

"We also found that these health impacts persist over a year after the abuse ends. So, effective prevention and early intervention are vital to the health of individuals and families and health systems."

Senior author, Professor Gene Feder from the University of Bristol's Centre for Academic Primary Care, said: "Violence against women is a violation of human rights that damages their and their children's physical and mental health, with substantial health care and societal costs. It is an important cause of ill health among women globally and an indicator for Goal 5 - Gender Equality and Women and Girls' Empowerment - of the United Nations' Sustainable Development Goals.

"This study, analysing the impact of different types and combinations of intimate partner violence, shows the severe health impact when these include sexual or psychological abuse. These types of abuse are often not recognised by health care providers."

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Paper

'Categories and health impacts of intimate partner violence in the World Health Organization (WHO) multi-country study on women's health and domestic violence' by Lucy Potter et al. in International Journal of Epidemiology

#COVIDIOTS

Survey: Americans likely to attend large holiday gatherings despite COVID-19

Nearly two in five report they will likely attend a gathering with more than 10 people and a third will not ask guests to wear masks

THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER

Research News

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IMAGE: THE WEST FAMILY SHARES A HOLIDAY MEAL WITH FAMILY MEMBERS THROUGH VIDEO CHAT. EXPERTS SAY THAT ALTHOUGH CELEBRATIONS WILL LOOK DIFFERENT THIS YEAR, THERE ARE STILL OPPORTUNITIES TO MAKE TREASURED... view more 

CREDIT: ALL MULTIMEDIA IS AVAILABLE FOR FREE AND UNRESTRICTED MEDIA USE WITH COURTESY TO THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER

COLUMBUS, Ohio - A new national survey by The Ohio State University Wexner Medical Center finds that although a majority of Americans plan to take precautions at holiday gatherings, such as social distancing and asking those with COVID symptoms not to attend, many will also put themselves at risk. Nearly two in five report they will likely attend a gathering with more than 10 people and a third will not ask guests to wear masks.

This holiday season comes with a lot of worry and stress as families try to find ways to balance their desire to celebrate together with the risk of spreading COVID-19. While cases of the virus remain high, colder weather across the country is forcing gatherings indoors, where the virus can more easily spread.

"We're going to look back at what happened during this holiday season and ask ourselves, 'Were we part of the solution or were we part of the problem?'" said Dr. Iahn Gonsenhauser, chief quality and patient safety officer at The Ohio State University Wexner Medical Center. "When you're gathered together around the table, engaged in conversation, sitting less than six feet apart with your masks down, even in a small group, that's when the spread of this virus can really happen."

Gonsenhauser says the safest solution is the one that people don't want to hear: find ways to communicate virtually and cancel in-person plans. However, if you do decide to have guests, it's important to have a plan in place and to communicate that plan to everyone attending. Consider wearing masks at all times, separating seating arrangements by household and assigning one or two people to serve the food. If you're moving your holiday plans outdoors, make sure to follow the same precautions you would indoors. And if you plan to travel or welcome out-of-town guests, stay informed about the COVID-19 rates and restrictions in both locations.

"If you have someone in your household who's high risk and you're in a low incidence area, you're going to want to think twice about having a celebration where people are coming from an area where there's a lot of virus in the community," Gonsenhauser said.

While celebrations will certainly look different this year, Gonsenhauser says it can also be an opportunity to make treasured memories with loved ones and experiment with new traditions. Try a virtual dinner or gift exchange or drop off surprise treats on friends' and family members' door steps.

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