IMPORTANCE: Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency ...department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States. OBJECTIVE: To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI. EVIDENCE REVIEW: The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were deemed by the workgroup to be relevant to the recommendations. The dates of the initial literature search were January 1, 1990, to November 30, 2012, and the dates of the updated literature search were December 1, 2012, to July 31, 2015. FINDINGS: The CDC guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence. Recommendations address imaging, symptom scales, cognitive testing, and standardized assessment for diagnosis; history and risk factor assessment, monitoring, and counseling for prognosis; and patient/family education, rest, support, return to school, and symptom management for treatment. CONCLUSIONS AND RELEVANCE: This guideline identifies the best practices for mTBI based on the current evidence; updates should be made as the body of evidence grows. In addition to the development of the guideline, CDC has created user-friendly guideline implementation materials that are concise and actionable. Evaluation of the guideline and implementation materials is crucial in understanding the influence of the recommendations.
IMPORTANCE: In recent years, there has been an exponential increase in the research guiding pediatric mild traumatic brain injury (mTBI) clinical management, in large part because of heightened ...concerns about the consequences of mTBI, also known as concussion, in children. The CDC National Center for Injury Prevention and Control’s (NCIPC) Board of Scientific Counselors (BSC), a federal advisory committee, established the Pediatric Mild TBI Guideline workgroup to complete this systematic review summarizing the first 25 years of literature in this field of study. OBJECTIVE: To conduct a systematic review of the pediatric mTBI literature to serve as the foundation for an evidence-based guideline with clinical recommendations associated with the diagnosis and management of pediatric mTBI. EVIDENCE REVIEW: Using a modified Delphi process, the authors selected 6 clinical questions on diagnosis, prognosis, and management or treatment of pediatric mTBI. Two consecutive searches were conducted on PubMed, Embase, ERIC, CINAHL, and SportDiscus. The first included the dates January 1, 1990, to November 30, 2012, and an updated search included December 1, 2012, to July 31, 2015. The initial search was completed from December 2012 to January 2013; the updated search, from July 2015 to August 2015. Two authors worked in pairs to abstract study characteristics independently for each article selected for inclusion. A third author adjudicated disagreements. The risk of bias in each study was determined using the American Academy of Neurology Classification of Evidence Scheme. Conclusion statements were developed regarding the evidence within each clinical question, and a level of confidence in the evidence was assigned to each conclusion using a modified GRADE methodology. Data analysis was completed from October 2014 to May 2015 for the initial search and from November 2015 to April 2016 for the updated search. FINDINGS: Validated tools are available to assist clinicians in the diagnosis and management of pediatric mTBI. A significant body of research exists to identify features that are associated with more serious TBI-associated intracranial injury, delayed recovery from mTBI, and long-term sequelae. However, high-quality studies of treatments meant to improve mTBI outcomes are currently lacking. CONCLUSIONS AND RELEVANCE: This systematic review was used to develop an evidence-based clinical guideline for the diagnosis and management of pediatric mTBI. While an increasing amount of research provides clinically useful information, this systematic review identified key gaps in diagnosis, prognosis, and management.
An online learning approach for trend recognition Paulk, David
Proceedings of the 8th ACM International Conference on PErvasive Technologies Related to Assistive Environments,
07/2015
Conference Proceeding
This work assesses the performance of the Gradient Descent and Exponentiated Gradient online learning algorithms on the Wikipedia Page Traffic Statistics Dataset. The two algorithms are trained to ...predict future Wikipedia page traffic during a 7-month period. Predictions are a weighted combination of feature attributes, which are various measurements of page traffic change. The algorithms improve their predictions as they learn patterns from the data sequence by updating a weight distribution over the features. Cumulative loss for predictions during the 7-month sequence is used as an evaluation metric. The cumulative loss measurements demonstrate that the Exponentiated Gradient algorithm predicts future Wikipedia page traffic more accurately Gradient Descent does with the computed features. The cumulative loss measurements also suggest that the Exponentiated Gradient algorithm becomes less confused than the Gradient Descent algorithm becomes when irrelevant features are present among relevant features.
Assistive technologies to track ocean forests Paulk, David
Proceedings of the 6th International Conference on PErvasive Technologies Related to Assistive Environments,
05/2013
Conference Proceeding
P. oceanica is a species of seagrass indigenous to the shallow water seabeds in Mediterranean Sea. The large underwater meadows it forms span the shallower waters around the islands and are vital to ...the sustainability of its encompassing marine ecosystem. Recently, environmental impacts have resulted in an irreversible degradation of the species. Stronger evidence of degradation is needed to provide reason for changing policy on activities that are potential sources of environmental impact. By running a classification algorithm on aerial imagery containing visible P. oceanica, data points that circumscribe the species in polygons can be created. By projecting this data on the original images, information about the species' environmental presence is visualized. Accuracy of the data can be verified by collecting ground truthing data. When repeated over multiple years, a history of the environment and the species' coverage can be built, providing evidence of environmental trends.
Each day in the United States, more than 8,500 children suffer abuse at the hands of those they trust. Every day, an estimated 14 to 22 or more children die because of abuse. Recognition of this ...problem began in the United States in 1962 after C. Henry Kempe and colleagues published 'The Battered Child Syndrome' in the Journal of the American Medical Association (JAMA) first identifying abuse as a problem. Many successful child abuse prevention programs do exist. However, there is a lack of research regarding if graduates of these programs utilize the skills and knowledge obtained and if so, how these skills and knowledge are utilized. These were the questions that guided this study. This was a grounded theory study that involved interviewing successful graduates of a child abuse prevention program in a North Carolina city. Recruitment of participants occurred via letters mailed to clients who met the criteria for being selected for the study. The letter explained the purpose of the study, assured confidentiality and further offered that participants would be paid $35.00 for participating in the study. Twenty-six graduates were interviewed at length in an open-ended fashion. Each interview took place on an individual basis. Following the tenets of grounded theory analysis, three types of coding were used: open coding, axial coding and selective coding. The question as to did the graduates utilize the skills and knowledge they obtained was answered through one of two ways: through parents' self-reports of whether they did or did not use the skills they learned and through changes in parenting behavior parents attributed to specific skills learned in the parent education program. All but one, or 96%, of the participants said they did use skills learned in the parenting program. Through the interviews, positive changes in parenting behavior were demonstrated to have occurred thus confirming that graduates did utilize the skills and knowledge they obtained. The data demonstrated research subjects' change from being parent-centered in their parenting to being child-centered. In respect to how the parents changed, the data showed a transformation from parent-centered parenting to relationship-centered parenting. Copies of dissertations may be obtained by addressing your request to ProQuest, 789 E. Eisenhower Parkway, P.O. Box 1346, Ann Arbor, MI 48106-1346. Telephone 1-800-521-3042; email: disspub@umi.com
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