201-450 exam Dumps Source : LPIC-2 Exam 201, fraction 1 of 2, version 4.5
Test Code : 201-450
Test designation : LPIC-2 Exam 201, fraction 1 of 2, version 4.5
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: 161 existent Questions
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LPIC-2 ( examination codes 201-450 and 202-450 ) is the 2d certification in LPI’s multi-stage knowledgeable certification application. The LPIC-2 will validate the candidate's means to administer minute to medium–sized blended networks. The candidate should gain an vigorous LPIC-1 certification to receive LPIC-2 certification, but the LPIC-1 and LPIC-2 exams can subsist taken in any order.
necessities: The candidate ought to gain an lively LPIC-1 certification to receive LPIC-2 certification, but the LPIC-1 and LPIC-2 checks may well subsist taken in any order
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Your League: ARRL Reply Comments Cite "Fundamental Misunderstanding" of "Symbol Rate" Petition
In reply comments filed on its "symbol rate" Petition for Rule Making (RM-11708), the ARRL said comments opposed to its initiative reflect a "fundamental misunderstanding" of the petition's intent. The League's petition now tops the FCC's list of "Most vigorous Proceedings." More than 800 comments were filed as of January 7, some of them posted after the December 23 cut-off date and most favoring the ARRL's proposal. The ARRL earlier filed comments with the FCC on its own Petition (plus Erratum). RM-11708 proposes to drop the attribute rate restrict in §97.307(f) of the FCC amateur Service rules, substituting a maximum occupied bandwidth of 2.8 kHz for HF data emissions. The ARRL said those opposing the Petition accomplish not, in general, challenge the removal of the attribute rate restrict for data emissions in band segments where RTTY and data emissions are now permitted.
"Rather, they minister to view the proposal to establish a maximum occupied bandwidth of 2.8 kHz for data emissions in the medium-frequency (MF) and high-frequency (HF) bands where data emissions are permitted now as an enabling provision," the ARRL said. Instead, the League said, its Petition is intended to impose "a limitation on the maximum bandwidth of data emissions where None exists now." Given state-of-the-art data technologies, the League said, there is no necessary correlation between the attribute rate and the bandwidth of a data emission. The current attribute rate "acts only as a restrict on the efficiency of data emissions in the HF bands as a practical matter, and as an ersatz and whimsical filter on the types of emissions that can subsist utilized by radio amateurs."
The ARRL said its suggested 2.8 kHz maximum bandwidth reflects a balanced approach that will permit bar None currently used data emissions, hearten experimentation with data emissions that the current attribute rate restriction prohibits, and preclude the exhaust of wider-bandwidth data emissions that could usurp the limited RTTY/data subbands. Petition opponents, the ARRL went on to say, "offer no evidence" that the rule changes it proposes will lead to a situation where data transmissions overwhelm the subband and preclude narrow bandwidth emission communications.
"The Commission has properly chastised the amateur Service for resisting deregulatory proposals that are designed to enable amateur experimenters to refine and reconcile technologies," the League said in its reply comments. "ARRL is of the view that outdated Commission regulations that needlessly preclude experimentation with data technologies should not subsist preserved. Outdated regulations are not a viable alternative to cooperative sharing arrangements in the HF bands through voluntary band plans."
Some of those opposing its petition, the ARRL went on to say, expressed the faith that the proposed rule change would impose wider-bandwidth data emissions in spectrum where narrow-bandwidth modes such as CW and PSK31 now operate, to the detriment of the narrow-bandwidth modes. Other opponents contended that the Petition will capitalize a few operators at the expense of the many now operating narrowband data, RTTY, and CW on the HF bands.
"It is illogical to argue on the one hand that the Petition is intended to capitalize 'the few' who are data emission experimenters and users, and on the other hand to forecast that the relief requested in the Petition would create a flood of 'wide-bandwidth' data emissions, swamping the band segments used for CW, RTTY, and narrow-bandwidth data emissions," the League pointed out. "If the concern is that the rule changes will hearten more radio amateurs to experiment with data emissions, that would subsist a positive outcome." The ARRL further asserted that the apprehension of interference from automatically controlled stations "is not a telling one."
Its Petition, the ARRL concluded, "is not a referendum on the value of MF or HF data emissions or data experimentation in those bands," but intended to hearten experimentation now restricted artificially by outdated rules. "It is instead a proposal to delete outdated limitations on amateur Radio experimentation, which Commission policy supports, and which the basis and purpose of the amateur Radio Service necessitates."
Your League: ARRL-Sponsored Medium-Frequency Experiment Continues as Hams Hope for unusual Band
The ARRL-sponsored medium-frequency experiment, operating as WD2XSH, continues apace in an trouble to demonstrate the viability of 472 to 479 kHz as a secondary amateur Radio allocation. At the identical time, the FCC has been taciturn regarding the ARRL's November 2012 Petition for Rule Making that asked the Commission to fabricate this segment of the spectrum available to radio amateurs in the US. Delegates to the 2012 World Radiocommunication Conference approved a 7 kHz-wide secondary allocation between 472 and 479 kHz for the amateur Radio Service, with a power restrict of 5 W EIRP (or 1 W EIRP, depending on location). The FCC has indicated that it will address the issue within the context of its Notice of Proposed Rule Making in ET Docket No 12-338, to formally reflect the Final Acts of WRC 2007 in its rules. In his quarterly WD2XSH update, Experiment Coordinator Fritz Raab, W1FR, reported that 514 contacts -- 10 in the final quarter -- gain been logged among those taking fraction in the experiment across the US.
"As usual, activity increased as conditions improved during the fall. Much of the recent activity has involved WSPR-15," Raab reported. "Reception over significant distances (eg, Europe, Alaska) has been reported. Much of the activity is being undertaken by a few unusual experimental licensees." Raab famed that WD2XSH participant Brian Justin, WA1ZMS, transmitted Fessenden commemorative broadcasts on AM via his own experimental license, WG2XFQ, during the December holidays.
In the US, the 472-479 kHz band is fraction of the larger 435-495 kHz segment that is allocated on a primary basis to the Maritime Mobile Service (federal and non-federal users), and on a secondary basis for federal government aeronautical radionavigation. The ARRL stated in its Petition that it is unaware of any domestic assignments that might combat with the allocation of 472 to 479 kHz to the amateur Radio Service, and there is almost no power line carrier (PLC) operation in this band segment. The FCC in 2003 cited the potential for interference to utility-operated PLC systems when it turned down an ARRL petition seeking an LF "sliver band" at 135.7 to 137.8 kHz.
The WD2XSH experiment involves more than three dozen stations and includes bar None geographic areas of the US, including Alaska and Hawaii. Most of the stations are in the eastern half of the US. Raab has reported no interference issues during the WD2XSH experiment, begun in 2006 and initially using spectrum in the vicinity of 500 kHz. Read more.
Your League: National Contest Journal (NCJ) Debuts unusual Website!
National Contest Journal (NCJ), the ARRL publication devoted to amateur Radio contesting, has a fresh, unusual presence on the web, although the URL remains the same.
"The unusual site was designed with simplicity and ease of exhaust in mind," said NCJ Editor Kirk Pickering, K4RO. "The site contains selected feature articles as well as a group of tools for setting up teams and submitting logs for NCJ-sponsored contests. It furthermore offers an archive of scores for bar None NCJ going back to 2001. The site still has room to accommodate unusual features in the future, so remain tuned."
Pickering said the unusual NCJ website was a collaborative effort, and he expressed his appreciation to Bruce Horn, WA7BNM, "for his unwearied support of the NCJ website from its inception" as well as to George Fremin, K5TR, who has served as the systems administrator. Pickering furthermore thanked his colleague Susie Coleman, who helped design the spy and feel.
"We hope that you will find the unusual site useful. Thanks to bar None who gain helped to fabricate this happen," said Pickering, who invited comments on the unusual site and design.
Published every other month, NCJ features general-interest and technical articles and columns by top contesters, operator profiles, editorial comments, and correspondence from readers, as well as scores for the North American QSO Party and North American Sprint, which NCJ sponsors.
International: IARU Showcases amateur Radio at ITU Telecom World 2013
The International amateur Radio Union (IARU) got some visibility for amateur Radio at ITU Telecom World 2013, sponsored by the International Telecommunication Union. The event was held November 19-22 in Bangkok, Thailand. The IARU and IARU Region 3 leaders arranged the panoply in cooperation with the ITU. A large, flat-screen TV in the booth displayed videos of amateur Radio activities. Special event station HS2013ITU was on the air from the site. IARU President Tim Ellam, VE6SH, spoke at one of the forums. A highlight of the point to for the IARU contingent was a visit by ITU Secretary universal Dr Hamadoun Toure, HB9EHT. He took a turn at the operating position of HS2013ITU while there.
"We had a number of high-profile visitors to the booth, including ministers of communications and government regulators from various countries," said IARU Region 3 Director Peter Lake, ZL2AZ, and Region 3 Chairman Gopal Madhavan, VU2GMN, in a report. "They were keen to contend the situation in their respective countries and the association with IARU and to learn about amateur Radio and its capabilities. Telecom World 2013 gave the IARU a unique opportunity to showcase amateur Radio at the highest level."
ITU Telecom World 2013 furthermore offered an opportunity for the IARU representatives to influence leaders who can favorably impact radio regulations and national attitudes toward amateur Radio. "The presence of IARU, and its trouble to showcase amateur Radio and its capabilities, was well appreciated by bar None who visited the booth, and the trouble was well worthwhile," said the IARU's report. "We furthermore laid a foundation under the unusual ITU Telecom World structure to gain some similar space at the next event in 2014 in Qatar." Read more.
International: Yasme Foundation Announces Supporting Grants
To further the development of amateur Radio around the world, The Yasme Foundation has announced the recipients of four supporting grants:
WRTC-2014, to wait on defray the expenses of the World Radiosport Team Championship in unusual England this July.
The reverse Beacon Network (RBN), to purchase a receiver and necessary accessories to upgrade the RBN node in Bangalore, India.
CWOps CW Academy, to wait on defray the expenses of providing online CW training courses.
The ARRL Second Century Fund, to support the goal of the ARRL Second Century crusade of opening a path to passionate involvement in amateur Radio by unusual generations, providing opportunities for educational enrichment, community service, and personal achievement through the exploration and exhaust of radio communication.
The Yasme Foundation is a not-for-profit corporation organized to conduct scientific and educational projects related to amateur Radio, including DXing and the introduction and promotion of amateur Radio in developing countries. The Foundation supports individuals and organizations providing or creating useful services for the amateur Radio community, regardless of originality or novelty, to further the development of amateur Radio around the world.
Radiosport: unusual ARRL Single-Operator Unlimited Contest Category Now in Effect
Responding to many requests, the ARRL Programs and Services Committee in 2013 accepted the Contest Advisory Committee (CAC) recommendation to add the Single-Operator Unlimited category to the ARRL 10 Meter Contest, ARRL 160 Meter Contest, RTTY Roundup, and the IARU HF Championship. "This particular issue has been a long time coming," said CAC Chairman Al Dewey, K0AD.
The unusual category permits the exhaust of spotting information within the Single-Operator class. In the past, using spotting information placed a station in the Multioperator category. Per the revised rules, "Single-Operator Unlimited: The exhaust of spotting assistance or automated, multi-channel decoders is permitted."
Ham Radio Business: Tokyo Hy-Power Files for Bankruptcy
Tokyo Hy-Power, a manufacturer of amateur Radio amplifiers, antenna tuners, and other equipment, is in bankruptcy, and its plant, in Saitama Prefecture near Tokyo, has been shuttered. Telephones at the company no longer are being answered, and its Japanese website has been taken down, although the company's US website remains working. Company CEO/President Nobuki Wakabayashi, JA1DJW, founded Tokyo Hy-Power Labs in 1975. He blamed "the recent depression in the industrial RF power products locality [which] has led to the very difficult monetary position."
Tokyo Hy-Power's early products were HF antenna couplers, although within a yoke of years it began manufacturing amplifiers for the amateur Radio market, including solid-state mobile amplifiers. Among its early products was the HL-4000 linear amplifier, which the company claimed was "the first existent HF band high-power linear of its kindly in Japan." It has been manufacturing RF products for the industrial market since 1984.
The company furthermore once marketed the HT-750, a portable, low-power SSB/CW transceiver for 40, 15, and 6 meters in a hand-held transceiver form factor. At Dayton Hamvention® 2013, the company displayed a prototype of the XT-751, an advanced model it hoped to develop, covering 40 through 6 meters and with an internal antenna tuner. Among its latest products were solid-state HF amplifiers, as well as amplifiers for 6 and 2 meters.
In a December 26 advice release, Ham Radio Outlet (HRO) reacted with "disappointment" and said it was "deeply saddened" to learn that Tokyo Hy-Power had gone into bankruptcy.
"This action in Japan appears to subsist similar to a Chapter 7 action here within the United States, as the process in this case appears to subsist the liquidation of organizational assets in order to attempt to fund some portion of its debt obligation(s)," the HRO release said. "This appears to testify that a court has deemed the organization unable to subsist effectively reorganized under Japan's Civil Reconstruction Code."
HRO said it was working with AVSL, the current US service provider for Tokyo Hy-Power products "to contend the opportunity of continued maintenance at the component flat of the US-sold Tokyo Hy-Power line of amplifiers." Read more.
Ham Radio Business: CQ to Realign Publications, Launch Digital Supplement
CQ Communications Inc has announced plans to realign its publications lineup and to launch a unusual online supplement to its flagship magazine, CQ amateur Radio.
"The hobby radio market is changing," said CQ Communications President and Publisher Dick Ross, K2MGA, "and they are changing what they accomplish and how they accomplish it in order to continue providing leadership to bar None segments of the radio hobby."
Effective with the February 2014 issue of CQ, said Ross, content from the magazine's three sister publications -- Popular Communications, CQ VHF and WorldRadio Online -- will subsist incorporated into CQ's digital edition as a supplement to subsist called CQ Plus. The print editions of Popular Communications and CQ VHF will subsist phased out, and WorldRadio Online will no longer exist as a part online publication. Current Popular Communications, CQ VHF and WorldRadio Online subscribers will subsist converted to CQ subscribers and receive CQ Plus at no additional charge. Details will subsist posted on each magazine's website.
CQ Communications says the change will tender hobby radio enthusiasts a lone source for articles from shortwave listening and scanner monitoring to personal two-way services and Internet radio, as well as amateur Radio. Richard Fisher, KI6SN, currently editor of both Popular Communications and WorldRadio Online, will subsist editor of CQ Plus. Read more.
Ham Radio Business: InnovAntennas Acquires accommodate 12
InnovAntennas has acquired the legendary accommodate 12 antenna company and product line and has moved the accommodate 12 factory from Bridgeport, Texas, to magnificient Junction, Colorado, into a facility shared with InnovAntennas America. InnovAntennas Ltd in England is now manufacturing accommodate 12 products for the European market at its Canvey Island plant.
The magnificient Junction facility is up and running, manufacturing and shipping antennas. InnovAntennas says it plans to relent updated versions of classic accommodate 12 antennas as well as all-new models. InnovAntennas Founder Justin Johnson, G0KSC, was at the Colorado facility in late 2013 to assist in setting up and laying out the factory, and the company was expected to subsist at complete production this month. -- Thanks to The ARRL Contest Update
DX: ARRL DXCC Desk Approves ZD9KX Operations
The ARRL DXCC Desk has approved the 2012 and 2013 operation of ZD9KX -- Tristan Da Cunha & Gough Islands for DX Century Club credit. If a request for DXCC credit for this operation has been rejected in a prior application, contact ARRL Awards fork Manager Bill Moore, NC1L, to subsist placed on the list for an update to your record. gladden note the submission date and/or reference number of your application in order to expedite the search for any rejected contacts.
DXCC is amateur Radio's premier award that hams can earn by confirming on-the-air contacts with 100 DXCC "entities," most of which are countries in the traditional sense. You can initiate with the basic DXCC award and work your way up to the DXCC homage Roll. Learn more. -- ARRL Awards fork Manager Bill Moore, NC1L
Shortwave Listening: Voice of Russia to Continue Shortwave Broadcasting in 2014
To paraphrase note Twain, reports of the demise of the Voice of Russia (VOR) may gain been greatly exaggerated. Earlier this year the Voice of Russia -- the former Radio Moscow during the Soviet Era -- appeared poised to cease shortwave broadcasts as of January 1, 2014. In the wake of a December decree signed by Russian President Vladimir Putin that merged the Voice of Russia with several other state-run advice agencies, SWL Tom Witherspoon, K4SWL, contacted VOR.
"We are joyous to let you know that the Voice of Russia will remain on the air in 2014, however, considerable changes in their frequency schedule are expected," the broadcaster told Witherspoon and as he reports on his blog.
The posted VOR schedule, which runs through March, indicates 38 aggregate hours of shortwave broadcasts to bar None parts of the world, most beamed at the Middle East and Asia. Shortwave broadcasts to Europe, Latin America, Oceania, and Africa account for just 15 aggregate hours. VOR, which claims to subsist the first radio station to broadcast internationally, furthermore broadcasts online, via satellite, on FM, and via three medium-wave transmitters. In 2003 VOR was among the first major international radio broadcasters to launch daily broadcasts to Europe in Digital Radio Mondiale (DRM).
Propagation: Solar Flux Record tall Could Herald Better Conditions
The 10.7 centimeter solar flux index (SFI) jumped to a Cycle 24 record of 262 on January 4, suggesting that Cycle 24 has not yet begun drawing to a near and may subsist approaching or at a "second peak." The previous peak for the current cycle was 190 on September 24, 2011. As NASA's Marshall Space Flight heart (MSFC) explains, the flux of the sun's radio emissions at 10.7 centimeter (2.8 GHz) is another indicator of solar activity levels, since it tends to supervene changes in the solar ultraviolet that influence Earth's upper atmosphere and ionosphere.
"Many models of the upper atmosphere exhaust the 10.7 centimeter flux (F10.7) as input to determine atmospheric densities and satellite drag," NASA/MSFC noted, adding that SFI "has been shown to supervene the sunspot number quite closely." The January 6 sunspot matter was 225. The Cycle 24 sunspot matter peaked at 282 on November 17, 2013, according to WM7D.net.
Canada's Dominion Radio Astrophysical Observatory (DRAO) indicated an "official" flux of 262 at 2000 UTC on Saturday, January 3. The official pattern for Sunday, January 5, was 217.5. ARRL solar observer Tad Cook, K7RA, who reports 10.7 centimeter flux numbers in his weekly "Solar Update" bulletins, suggests that they are not as valuable as sunspot numbers in predicting radio propagation. The solar flux was over the January 4-5 weekend was far higher what was anticipated, judging by predictions Cook reported in his January 3 "Solar Update" for this past weekend and the week ahead. NASA/MFSC indicates a 95 percent predicted flux for the month of January at 146.5, continuing at about the identical flat through the first half of the year.
The Daily DX said the SFI was expected to remain above 200 for this week. As Ian Poole, G3YWX, explained solar flux in his article, "Understanding Solar Indices" in the September 2002 edition of QST, "[H]igh values generally testify there is enough ionization to support long-distance communication at higher-than-normal frequencies." He pointed out, though, that it can seize a few days of tall values for conditions to point to improvement. "Typically values in excess of 200 will subsist measured during the peak of a sunspot cycle, with tall values of up to 300 being experienced for shorter periods," Poole wrote. Read more.
ARRL Centennial: W100AW Hits the Airwaves!
At the stroke of midnight Eastern Time on January 1, Hiram Percy Maxim Memorial station W1AW at ARRL Headquarters in Newington took to the air to debut its special ARRL Centennial summon sign, W100AW. ARRL Chief Executive Officer Dave Sumner, K1ZZ and Membership and Volunteer Programs Manager Dave Patton, NN1N, and ARRL Station Manager Joe Carcia, NJ1Q, were at the helm into the wee hours of unusual Year's Day.
Daylight hours saw ARRL Chief Operating Officer Harold Kramer, WJ1B; Membership and Volunteer Programs assistant Manager Norm Fusaro, W3IZ; Public Relations Manager Sean Kutzko; KX9X and QST Editor in Chief Steve Ford, WB8IMY, taking their turns at the operating positions. By mid-afternoon, several thousand contacts were in the log on SSB, CW and RTTY.
"This is just the beginning," said Kutzko. "Hams will hear W100AW throughout 2014 on every mode possible. When you hear us, spot us on the cluster!"
Not surprising, 20 meter SSB yielded the most contacts -- 1121 of the 3700 logged -- during the 19 hours of unusual Year's Day operation from W100AW. Ten meter phone was in second set with 639 contacts.
W100AW contacts will subsist uploaded to Logbook of The World (LoTW). QSL cards sent by mail will subsist acknowledged as well.
W1AW Portable Operations, ARRL Centennial QSO Party
The ARRL Centennial "W1AW WAS" operations are taking set throughout 2014 from each of the 50 states, relocating each Wednesday (UTC) to a unusual pair of states (this week, South Carolina and Utah. Listen for W1AW/4 and W1AW/7). During 2014 W1AW will subsist on the air from every state at least twice and from most US territories, and it will subsist facile to work bar None states solely by contacting W1AW portable operations.
In conjunction with the 100th anniversary of the ARRL, the ARRL Centennial QSO Party furthermore kicked off January 1 for a year-long operating event in which participants can accumulate points and win awards. The event is open to all, although only ARRL members and appointees, elected officials, HQ staff and W1AW are worth ARRL Centennial QSO Party points. Working W1AW/x from each state is worth 5 points per contact.
To earn the "Worked bar None States with W1AW Award," work W1AW operating portable from bar None 50 states. (Working W1AW or W100AW in Connecticut does not matter for Connecticut, however. For award credit, participants must work W1AW/1 in Connecticut.) A W1AW WAS certificate and plaque will subsist available (pricing not yet available).
As of today (January 9), more than 6700 stations gain earned points in the Centennial QSO Party by uploading qualifying QSOs to Logbook of The World (LoTW). Operating from North Carolina and West Virginia during the first week of the W1AW portable operations, W1AW/4 and W1AW/8 logged approximately 33,000 contacts.
"The second week is off to a roaring start from South Carolina and Utah," reported ARRL Membership and Volunteer Programs Manager Dave Patton, NN1N.
ARRL Centennial: A Century of amateur Radio and the ARRL
Editor's note: "A Century of amateur Radio and the ARRL" will subsist a weekly feature as the ARRL celebrates its Centennial in 2014.
In amateur Radio, as in bar None fields, 100 years has brought about improbable progress and changes. During 2014, they will give you a sense of the ARRL's and amateur Radio's history by looking through the issues of QST from its humble birth to the present. We'll examine the valuable topics and events of interest to amateurs, such as technology, operating tips and events, ARRL's doings, and FCC actions. Because of the limited space available here, the comments will subsist brief, but they will provide citations to original QST articles for your further reading.
The next century will bring about changes that will subsist mind-boggling to us, because technology advances at an exponential rate. Being alert of the past 100 years of ham-related events is valuable to us for historical reasons, and it furthermore makes us reckon what might lie ahead. Next time: A spy at the earliest years of amateur Radio and the ARRL. -- Al Brogdon, W1AB
Milestones: Founder and President Emeritus of 4U1UN, Max de Henseler, HB9RS, SK
Max de Henseler, HB9RS, the founder and president emeritus of 4U1UN at United Nations headquarters in unusual York, died December 30. He was 80. A ham since 1955, de Henseler had been a short-wave listener since the late 1940s. In 1976, while in unusual York as the UN's chief cartographer, de Henseler reactivated the United Nations Radio Club station K2UN at its unusual home in midtown Manhattan. As Jack Troster, W6ISQ, explained in the July 1989 issue of QST, "Through his efforts, the Secretary universal approved the operation of a specifically designated UN amateur station using the summon 4U1UN in early 1978."
De Henseler introduced the unusual summon token on February 4, 1978, during the first weekend of the then two-weekend ARRL International DX phone contest, surprising many contesters. 4U1UN was approved for DXCC credit, due to the efforts of "Mister UN Radio."
The 4U1UN United Nations Headquarters Station was dismantled in 2010 due to the extensive renovation project on the Secretariat Building. Read more. -- Thanks to The Daily DX
Milestones: QST Author, CW Key Maker Jerry Pittenger, K8RA, SK
QST author and CW key crafter Jerry Pittenger, K8RA, of Powell, Ohio, died January 2 of pancreatic cancer. He was 66. Licensed in 1960, Pittenger was a retired systems engineer. He earned a bachelor's degree at Miami University and an MS in systems engineering from Ohio State.
Pittenger enjoyed edifice his own equipment, and some of his amplifier projects were featured in QST, The ARRL Handbook, and RF Amplifier Classics. More recently he manufactured a line of solid-brass iambic and single-lever CW keys sold worldwide, until illness forced him to quit.
"Making my CW keys fills much of my time, but it is a labor of love," Pittenger said in his online profile. "I can net lost in time machining metals and making things in the shop for the radio." His friends Mike Freeman, NT8O, and Fred Freeman, N8BX, gain taken over the production of the K8RA line. Read more.
Milestones: Austin amateur Radio Supply Owner Johnny Paul, WA5BGO, SK
The owner of Austin amateur Radio Supply, John E. "Johnny" Paul, WA5BGO, of Austin, Texas, died December 10. He was 74. Paul was the proprietor of Austin amateur Radio for 45 years. First licensed in 1960, Paul was a past president of the Austin amateur Radio Club and was an avid photographer of nature and landscapes. Services were December 16.
Tad Cook, K7RA, in Seattle, reports: A magnificient storm is brewing! At 2324 UTC on January 8 the Australian Space Forecast Centre issued this geomagnetic disturbance warning: "Increased geomagnetic activity expected due to coronal mass ejection from 09-10 January 2014."
NOAA forecasters assess a 90 percent chance of geomagnetic storms on January 9. The predicted planetary A indices for January 9 through January 13 are 73, 41, 15, 8 and 5. While an emblematic number for hams, 73 is a huge value for the planetary A index. One has to spy way, way back to find a value like this. The planetary A index was 67 on both March 9, 2012, and September 26, 2011, but nothing exceeds what is predicted for January 9 except the planetary A index of 104 on December 15, 2006, and 105 on September 11, 2005.
This has been an exciting week for sun watchers. The daily sunspot number reached 245 on January 6, and solar flux was 237.1 on January 8. The GOES-15 X-ray background flux has furthermore been high, and that may subsist more significant for enhanced HF propagation than a tall solar flux. NOAA's Space Weather Prediction heart maintains an archive of X-ray flux, solar flux, and sunspot numbers (check the links marked "DSD.txt." The links marked "DGD.txt" will give you daily geomagnetic indicators).
Over the past week, mediocre daily sunspot numbers rose more than 80 points to 188.1, and mediocre daily solar flux was up by more than 62 points to 201.6. Predicted solar flux for the near term is 195 on January 9-12, 190 on January 13, 160 on January 14, 155 on January 15-16, and 150 on January 17-19. It then rises to a peak of 190 on January 29 through February 3.
Predicted planetary A index values are 73, 41, 15 and 8 on January 9-12, 5 on January 13-22, 10 on January 23, 8 on January 24, 5 on January 25-27, then 10, 18 and 8 on January 28-30, then 5 again until February 6.
For the Friday, January 10, "Solar Update," spy for an update on the latest disturbance and forecast, as well as reports from readers. I welcome your reports and observations via e-mail.
Getting It Right!
In The ARRL Letter, December 19, 2013, they inadvertently omitted 20 meters from the list of bands available for the ARRL Centennial QSO Party.
Just Ahead in Radiosport
Jan 10 -- QRP Fox Hunt
Jan 10 -- NCCC Sprint Ladder
Jan 11 -- faded unusual Year Contest
Jan 11-12 -- UK DX BPSK63 Contest
Jan 11-12 -- MI QRP January CW Contest
Jan 11-12 -- SKCC Weekend Sprintathon
Jan 11-12 -- North American QSO Party, CW
Jan 12 -- NRAU-Baltic Contest, CW (0630-0830 UTC)
Jan 12 -- NRAU-Baltic Contest, SSB (0900-1100 UTC)
Jan 12 -- DARC 10-Meter Contest
Jan 12 -- Midwinter Contest
Jan 15 -- QRP Fox Hunt
Upcoming ARRL Section, state and Division Conventions and Events
January 17-18 -- North Texas Section Convention, Fort Worth, Texas
January 19-26 -- Quartzfest Convention, Quartzsite, Arizona
January 24-25 -- Mississippi state Convention, Jackson, Mississippi
January 25 -- Georgia ARES Convention, Forsyth, Georgia
January 25-26 -- Puerto Rico state Convention, Hatillo, Puerto Rico
January 31-February 1 -- Southern Florida Section Convention, Miami, Florida
February 1 -- Virginia state Convention (Frostfest), Richmond, Virginia
February 1 -- South Carolina state Convention, North Charleston, South Carolina
February 7-9 -- Northern Florida Section Convention (Orlando HamCation® -- Regional ARRL Centennial Event), Orlando, Florida
February 14-15 -- Arizona Section Convention, Yuma, Arizona
February 22 -- Vermont state Convention, South Burlington, Vermont
March 1-2 -- Alabama Section Convention (BirmingHAMfest 2014), Birmingham, Alabama
March 7-8 -- North Carolina Section Convention (Charlotte Hamfest), Concord, North Carolina
March 7-8 -- West Gulf Division Convention, Claremore, Oklahoma
March 14-15 -- Delta Division Convention, Rayne, Louisiana
March 15 -- Nebraska state Convention, Lincoln, Nebraska
March 15 -- West Texas Section Convention, Midland, Texas
March 22 -- South Texas Section Convention (Greater Houston Hamfest), Rosenberg, Texas
March 22-23 -- Communications Academy, Seattle, Washington
April 19 -- Roanoke Division Convention, Raleigh, North Carolina
April 25-27 -- Idaho state Convention, Boise, Idaho
April 26 -- Aurora '14 Conference, White endure Lake, Minnesota
Find conventions and hamfests in your area.
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This paper is a revision and update of the recommendations developed following the 1st (Vienna 2001), 2nd (Prague 2004) and 3rd (Zurich 2008) International Consensus Conference on Concussion in Sport and is based on the deliberations at the 4 thInternational Conference On Concussion In Sport held in Zurich, November 2012.1–3
The unusual 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A minute description of the consensus process is outlined at the remain of this document under the “background” section. This document is developed for exhaust by physicians and health supervision professionals primarily who are involved in the supervision of injured athletes, whether at the recreational, elite, or professional level.
While agreement exists pertaining to principal messages conveyed within this document, the authors admit that the science of concussion is evolving and therefore management and recrudesce to play decisions remain in the realm of clinical judgment on an individualized basis. Readers are encouraged to copy and dole freely the Zurich Consensus document, the Concussion Recognition implement (CRT), the Sport Concussion Assessment implement version 3 (SCAT3), and/or the Child-SCAT3 card and neither is topic to any restriction, provided it is not altered in any way or converted to a digital format. The authors’ request that the document and/or the accompanying tools subsist distributed in their complete and complete format.
This consensus paper is broken into a number of sections:
The Zurich 2012 document examines sport concussion and management issues raised in the previous Vienna 2001, Prague 2004, and Zurich 2008 documents and applies the consensus questions from Section 3 to these areas.1–3Definition of Concussion
Panel discussion regarding the definition of concussion and its separation from mild traumatic brain injury (mTBI) was held. There was acknowledgement by the Concussion in Sport Group (CISG) that although the terms mild traumatic brain injury (mTBI) and concussion are often used interchangeably in the sporting context and particularly in the US literature, others exhaust the term to mention to different injury constructs. Concussion is the historical term representing low velocity injuries that antecedent brain “shaking” resulting in clinical symptoms and which are not necessarily related to a pathological injury. Concussion is a subset of TBI and the term concussion will subsist used in this document. It was furthermore famed that the term commotio cerebri is often used in European and other countries. Minor revisions were made to the definition of concussion and it is defined as follows:
Concussion is a brain injury and is defined as a intricate pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may subsist utilized in defining the nature of a concussive head injury include:
The majority (80%-90%) of concussions resolve in a short (7-10 day) period, although the recovery time frame may subsist longer in children and adolescents.2Symptoms and Signs of Acute Concussion
The diagnosis of acute concussion usually involves the assessment of a purview of domains including clinical symptoms, physical signs, cognitive impairment, neurobehavioral features, and sleep disturbance. Furthermore, a minute concussion history is an valuable fraction of the evaluation both in the injured athlete and when conducting a preparticipation examination. The minute clinical assessment of concussion is outlined in the SCAT3 and Child-SCAT3 forms, which is an appendix to this document.
The suspected diagnosis of concussion can embrace 1 or more of the following clinical domains:
If any 1 or more of these components is present, a concussion should subsist suspected and the commandeer management strategy instituted.On-Field or Sideline Evaluation of Acute Concussion
When a player shows ANY features of a concussion:
Sufficient time for assessment and adequate facilities should subsist provided for the commandeer medical assessment both on and off the field for bar None injured athletes. In some sports, this may require rule change to allow an commandeer off-field medical assessment to occur without affecting the flood of the game or unduly penalizing the injured player’s team. The final determination regarding concussion diagnosis and/or fitness to play is a medical conclusion based on clinical judgment.
Sideline evaluation of cognitive office is an essential component in the assessment of this injury. Brief neuropsychological test batteries that assess attention and remembrance office gain been shown to subsist practical and effective. Such tests embrace the SCAT3, which incorporates the Maddocks questions4,5 and the Standardized Assessment of Concussion (SAC).6–8 It is worth noting that measure orientation questions (eg, time, place, person) gain been shown to subsist unreliable in the sporting situation when compared with remembrance assessment.5,9 It is recognized, however, that abbreviated testing paradigms are designed for rapid concussion screening on the sidelines and are not meant to replace comprehensive neuropsychological testing which should ideally subsist performed by trained neuropsychologists that are sensitive to subtle deficits that may exist beyond the acute episode; nor should they subsist used as a stand-alone implement for the ongoing management of sports concussions.
It should furthermore subsist recognized that the appearance of symptoms or cognitive deficit might subsist delayed several hours following a concussive episode and that concussion should subsist seen as an evolving injury in the acute stage.Evaluation in Emergency room or Office by Medical Personnel
An athlete with concussion may subsist evaluated in the emergency room or doctor’s office as a point of first contact following injury or may gain been referred from another supervision provider. In addition to the points outlined above, the key features of this exam should encompass:
In great part, these points above are included in the SCAT3 assessment.Concussion Investigations
A purview of additional investigations may subsist utilized to assist in the diagnosis and/or exclusion of injury. Conventional structural neuroimaging is typically typical in concussive injury. Given that caveat, the following suggestions are made: Brain CT (or where available MR brain scan) contributes microscopic to concussion evaluation but should subsist employed whenever suspicion of an intra-cerebral or structural lesion (eg, skull fracture) exists. Examples of such situations may embrace prolonged disturbance of conscious state, focal neurological deficit, or worsening symptoms.
Other imaging modalities such as fMRI demonstrate activation patterns that correlate with symptom severity and recovery in concussion.10–14 Whilst not fraction of routine assessment at the present time, they nevertheless provide additional insight to pathophysiological mechanisms. Alternative imaging technologies (eg, positron emission tomography, diffusion tensor imaging, magnetic resonance spectroscopy, functional connectivity), while demonstrating some compelling findings, are still at early stages of development and cannot subsist recommended other than in a research setting.
Published studies, using both sophisticated accommodate plate technology, as well as those using less sophisticated clinical equipoise tests (eg, equipoise oversight Scoring System [BESS]), gain identified acute postural stability deficits lasting approximately 72 hours following sport-related concussion. It appears that postural stability testing provides a useful implement for objectively assessing the motor domain of neurologic functioning, and should subsist considered a dependable and telling addition to the assessment of athletes suffering from concussion, particularly where symptoms or signs testify a equipoise component.15–21
The significance of Apolipoprotein (Apo) E4, ApoE promotor gene, Tau polymerase, and other genetic markers in the management of sports concussion risk or injury outcome is unclear at this time.22,23 Evidence from human and animal studies in more severe traumatic brain injury demonstrate induction of a variety of genetic and cytokine factors such as: insulin-like growth factor-1 (IGF-1), IGF binding protein-2, Fibroblast growth factor, Cu-Zn superoxide dismutase, superoxide dismutase -1 (SOD-1), nerve growth factor, glial fibrillary acidic protein (GFAP), and S-100. How such factors are affected in sporting concussion is not known at this stage.24–31 In addition, biochemical serum and cerebral spinal fluid biomarkers of brain injury [including S-100, neuron specific enolase (NSE), myelin basic protein (MBP), GFAP, tau, etc] gain been proposed as means by which cellular damage may subsist detected if present.32–38 There is currently insufficient evidence, however, to justify the routine exhaust of these biomarkers clinically.
Different electrophysiological recording techniques (eg, evoked response potential [ERP], cortical magnetic stimulation, and electroencephalography) gain demonstrated reproducible abnormalities in the postconcussive state; however not bar None studies reliably differentiated concussed athletes from controls.39–45 The clinical significance of these changes remains to subsist established.Neuropsychological Assessment
The application of neuropsychological (NP) testing in concussion has been shown to subsist of clinical value and contributes significant information in concussion evaluation.46–51 Although in most cases cognitive recovery largely overlaps with the time course of symptom recovery, it has been demonstrated that cognitive recovery may occasionally precede or more commonly supervene clinical symptom resolution, suggesting that the assessment of cognitive office should subsist an valuable component in the overall assessment of concussion and in particular, any recrudesce to play protocol.52,53 It must subsist emphasized however, that NP assessment should not subsist the sole basis of management decisions. Rather, it should subsist seen as an aid to the clinical decision-making process in conjunction with a purview of assessments of different clinical domains and investigational results.
It is recommended that bar None athletes should gain a clinical neurological assessment (including assessment of their cognitive function) as fraction of their overall management. This will normally subsist done by the treating physician often in conjunction with computerized NP screening tools.
Formal NP testing is not required for bar None athletes, however when this is considered necessary then it should ideally subsist performed by a trained neuropsychologist. Although neuropsychologists are in the best position to interpret NP tests by virtue of their background and training, the ultimate recrudesce to play conclusion should remain a medical one in which a multidisciplinary approach, when possible, has been taken. In the absence of NP and other (eg, formal equipoise assessment) testing, a more conservative recrudesce to play approach may subsist appropriate.
Neuropsychological testing may subsist used to assist recrudesce to play decisions and is typically performed when an athlete is clinically asymptomatic, however NP assessment may add valuable information in the early stages following injury.54,55 There may subsist particular situations where testing is performed early to assist in determining aspects of management eg, recrudesce to school in a pediatric athlete. This will normally subsist best determined in consultation with a trained neuropsychologist.56,57
Baseline NP testing was considered by the panel and was not felt to subsist required as a mandatory aspect of every assessment however may subsist helpful or add useful information to the overall interpretation of these tests. It furthermore provides an additional educative opportunity for the physician to contend the significance of this injury with the athlete. At present, there is insufficient evidence to recommend the widespread routine exhaust of baseline NP testing.Concussion Management
The cornerstone of concussion management is physical and cognitive relaxation until the acute symptoms resolve and then a graded program of exertion prior to medical clearance and recrudesce to play. The current published evidence evaluating the consequence of relaxation following a sport-related concussion is sparse. An initial era of relaxation in the acute symptomatic era following injury (24-48 hours) may subsist of benefit. Further research to evaluate the long-term outcome of rest, and the optimal amount and type of rest, is needed. In the absence of evidence-based recommendations, a sensible approach involves the gradual recrudesce to school and companionable activities (prior to contact sports) in a manner that does not result in a significant exacerbation of symptoms.
Low-level exercise for those who are deliberate to recover may subsist of benefit, although the optimal timing following injury for initiation of this treatment is currently unknown.
As described above, the majority of injuries will recover spontaneously over several days. In these situations, it is expected that an athlete will proceed progressively through a stepwise recrudesce to play strategy.58Graduated recrudesce to Play Protocol
Return to play (RTP) protocol following a concussion follows a stepwise process as outlined in Table 1.
With this stepwise progression, the athlete should continue to proceed to the next flat if asymptomatic at the current level. Generally, each step should seize 24 hours so that an athlete would seize approximately 1 week to proceed through the complete rehabilitation protocol once they are asymptomatic at relaxation and with provocative exercise. If any postconcussion symptoms occur while in the stepwise program then the patient should drop back to the previous asymptomatic flat and try to progress again after a further 24-hour era of relaxation has passed.Same Day RTP
It was unanimously agreed that no recrudesce to play on the day of concussive injury should occur. There are data demonstrating that at the collegiate and tall school level, athletes allowed to RTP on the identical day may demonstrate NP deficits postinjury that may not subsist evident on the sidelines and are more likely to gain delayed onset of symptoms.59–65The ‘Difficult’ or Persistently Symptomatic Concussion Patient
Persistent symptoms (>10 days) are generally reported in 10%-15% of concussions. In general, symptoms are not specific to concussion and it is valuable to reckon other pathologies. Cases of concussion in sport where clinical recovery falls outside the expected window (ie, 10 days) should subsist managed in a multidisciplinary manner by health supervision providers with experience in sports-related concussion.Psychological Management and Mental Health Issues
Psychological approaches may gain potential application in this injury, particularly with the modifiers listed below.66,67 Physicians are furthermore encouraged to evaluate the concussed athlete for affective symptoms such as depression and anxiety, as these symptoms are common in bar None forms of traumatic brain injury.58The Role of Pharmacological Therapy
Pharmacological therapy in sports concussion may subsist applied in 2 distinct situations. The first of these situations is the management of specific and/or prolonged symptoms (eg, sleep disturbance, anxiety, etc). The second situation is where drug therapy is used to modify the underlying pathophysiology of the condition with the point of shortening the duration of the concussion symptoms.68 In broad terms, this approach to management should subsist only considered by clinicians experienced in concussion management.
An valuable consideration in RTP is that concussed athletes should not only subsist symptom free, but furthermore should not subsist taking any pharmacological agents/medications that may mask or modify the symptoms of concussion. Where antidepressant therapy may subsist commenced during the management of a concussion, the conclusion to recrudesce to play while still on such medication must subsist considered carefully by the treating clinician.The Role of Preparticipation Concussion Evaluation
Recognizing the weight of a concussion history, and appreciating the fact that many athletes will not recognize bar None the concussions they may gain suffered in the past, a minute concussion history is of value.69–72 Such a history may preidentify athletes that suitable into a high-risk category and provides an opportunity for the health supervision provider to educate the athlete in regard to the significance of concussive injury. A structured concussion history should embrace specific questions as to previous symptoms of a concussion and length of recovery, not just the perceived number of past concussions. It is furthermore worth noting that dependence upon the recall of concussive injuries by teammates or coaches has been demonstrated to subsist unreliable.69 The clinical history should furthermore embrace information about bar None previous head, face, or cervical spine injuries, as these may furthermore gain clinical relevance. It is worth emphasizing that in the setting of maxillofacial and cervical spine injuries, coexistent concussive injuries may subsist missed unless specifically assessed. Questions pertaining to disproportionate impact versus symptom severity matching may alert the clinician to a progressively increasing vulnerability to injury. As fraction of the clinical history it is advised that details regarding protective materiel employed at time of injury subsist sought, both for recent and remote injuries.
There is an additional and often unrecognized capitalize of the preparticipation examination insofar as the evaluation allows for an educative opportunity with the player concerned as well as consideration of modification of playing deportment if required.Modifying Factors in Concussion Management
A purview of ‘modifying’ factors may influence the investigation and management of concussion and, in some cases, may forecast the potential for prolonged or persistent symptoms. However, in some cases, the evidence for their efficacy is limited. These modifiers would subsist valuable to reckon in a minute concussion history and are outlined in Table 2.Female Gender
The role of female gender as a viable modifier in the management of concussion was discussed at length by the panel. There was not unanimous agreement that the current published research evidence is conclusive enough for this to subsist included as a modifying factor, although it was accepted that gender may subsist a risk factor for injury and/or influence injury severity.73–75The Significance of Loss of Consciousness (LOC)
In the overall management of moderate to severe traumatic brain injury, duration of LOC is an acknowledged predictor of outcome.76 Whilst published findings in concussion characterize LOC associated with specific early cognitive deficits, it has not been famed as a measure of injury severity.77,78 Consensus discussion determined that prolonged (>1 minute duration) LOC would subsist considered as a factor that may modify management.The Significance of Amnesia and Other Symptoms
There is renewed interest in the role of posttraumatic amnesia and its role as a surrogate measure of injury severity.64,79,80 Published evidence suggests that the nature, burden, and duration of the clinical postconcussive symptoms may subsist more valuable than the presence or duration of amnesia alone.77,81,82 Further it must subsist famed that retrograde amnesia varies with the time of measurement postinjury and hence is poorly reflective of injury severity.83,84Motor and Convulsive Phenomena
A variety of immediate motor phenomena (eg, tonic posturing) or convulsive movements may escort a concussion. Although dramatic, these clinical features are generally benign and require no specific management beyond the measure treatment of the underlying concussive injury.85,86Depression
Mental health issues (such as depression) gain been reported as a consequence of bar None levels of traumatic brain injury including sport-related concussion. Neuroimaging studies using fMRI intimate that a dejected mood following concussion may reflect an underlying pathophysiological abnormality consistent with a limbic-frontal model of depression.34,87–97 While such mental health issues may subsist multifactorial in nature, it is recommended that the treating physician reckon these issues in the management of concussed patients.SPECIAL POPULATIONS The Child and Adolescent Athlete
The evaluation and management recommendations contained herein can subsist applied to children and adolescents down to the age of 13 years. Below that age, children report concussion symptoms different from adults and would require age-appropriate symptom checklists as a component of assessment. An additional consideration in assessing the child or adolescent athlete with a concussion is that the clinical evaluation by the healthcare professional may requisite to embrace both patient and parent input, and possibly teacher and school input when appropriate.98–104 A Child-SCAT3 has been developed to assess concussion (see Appendix II) for subjects aged 5 to 12 years.
The conclusion to exhaust NP testing is broadly the identical as the adult assessment paradigm although there are some differences. Timing of testing may differ in order to assist planning in school and home management. If cognitive testing is performed then it must subsist developmentally sensitive until late teen years due to the ongoing cognitive maturation that occurs during this era which, in turn, makes the utility of comparison to either the person’s own baseline performance or to population norms limited.20 In this age group it is more valuable to reckon the exhaust of trained paediatric neuropsychologists to interpret assessment data, particularly in children with learning disorders and/or ADHD who may requisite more sophisticated assessment strategies.56,57,98
It was agreed by the panel that no recrudesce to sport or activity should occur before the child/adolescent athlete has managed to recrudesce to school successfully. In addition, the concept of ‘cognitive rest’ was highlighted with special reference to a child’s requisite to restrict exertion with activities of daily animate that may exacerbate symptoms. School attendance and activities may furthermore requisite to subsist modified to avoid provocation of symptoms. Children should not subsist returned to sport until clinically completely symptom free, which may require a longer time frame than for adults.
Because of the different physiological response and longer recovery after concussion and specific risks (eg, diffuse cerebral swelling) related to head impact during childhood and adolescence, a more conservative recrudesce to play approach is recommended. It is commandeer to extend the amount of time of asymptomatic relaxation and/or the length of the graded exertion in children and adolescents. It is not commandeer for a child or adolescent athlete with concussion to RTP on the identical day as the injury regardless of the flat of athletic performance. Concussion modifiers apply even more to this population than adults and may mandate more cautious RTP advice.Elite Versus Nonelite Athletes
All athletes, regardless of flat of participation, should subsist managed using the identical treatment and recrudesce to play paradigm. The available resources and expertise in concussion evaluation are of more weight in determining management than a separation between elite and nonelite athlete management. Although formal NP testing may subsist beyond the resources of many sports or individuals, it is recommended that in bar None organized high-risk sports, consideration subsist given to having this cognitive evaluation, regardless of the age or flat of performance.Chronic Traumatic Encephalopathy (CTE)
Clinicians requisite to subsist mindful of the potential for long-term problems in the management of bar None athletes. However, it was agreed that CTE represents a distinct tauopathy with an unknown incidence in athletic populations. It was further agreed that a antecedent and consequence relationship has not yet been demonstrated between CTE and concussions or exposure to contact sports.105–114 At present, the interpretation of causation in the modern CTE case studies should proceed cautiously. It was furthermore recognized that it is valuable to address the fears of parents/athletes from media pressure related to the possibility of CTE.INJURY PREVENTION Protective Equipment—Mouthguards and Helmets
There is no sterling clinical evidence that currently available protective materiel will forestall concussion, although mouthguards gain a transparent role in preventing dental and oro-facial injury. Biomechanical studies gain shown a reduction in impact forces to the brain with the exhaust of headgear and helmets, but these findings gain not been translated to point to a reduction in concussion incidence. For skiing and snowboarding there are a number of studies to intimate that helmets provide protection against head and facial injury and hence should subsist recommended for participants in alpine sports.115–118 In specific sports such as cycling, motor, and equestrian sports, protective helmets may forestall other forms of head injury (eg, skull fracture) that are related to falling on difficult surfaces and may subsist an valuable injury prevention issue for those sports.118–130Rule Change
Consideration of rule changes to reduce the head injury incidence or severity may subsist commandeer where a clear-cut mechanism is implicated in a particular sport. An illustration of this is in football (soccer) where research studies demonstrated that upper limb to head contact in heading contests accounted for approximately 50% of concussions.131 As famed earlier, rule changes furthermore may subsist needed in some sports to allow an efficacious off-field medical assessment to occur without compromising the athlete’s welfare, affecting the flood of the game or unduly penalizing the player’s team. It is valuable to note that rule enforcement may subsist a faultfinding aspect of modifying injury risk in these settings and referees play an valuable role in this regard.Risk Compensation
An valuable consideration in the exhaust of protective materiel is the concept of risk compensation.132 This is where the exhaust of protective materiel results in behavioral change such as the adoption of more uncertain playing techniques, which can result in a paradoxical increase in injury rates. The degree to which this phenomena occurs is discussed in more detail in the review published in the BJSM supplement. This may subsist a particular concern in child and adolescent athletes where head injury rates are often higher than in adult athletes.133–135Aggression Versus Violence in Sport
The competitive/aggressive nature of sport that makes it fun to play and watch should not subsist discouraged. However, sporting organizations should subsist encouraged to address violence that may increase concussion risk.136,137 unbiased play and respect should subsist supported as key elements of sport.Knowledge Transfer
As the ability to treat or reduce the effects of concussive injury after the event is minimal, education of athletes, colleagues, and the universal public is a mainstay of progress in this field. Athletes, referees, administrators, parents, coaches and health supervision providers must subsist educated regarding the detection of concussion, its clinical features, assessment techniques and principles of safe recrudesce to play. Methods to better education including Web-based resources, educational videos, and international outreach programs are valuable in delivering the message. In addition, concussion working groups, plus the support and endorsement of enlightened sport groups such as Fédération Internationale de Football Association (FIFA), International Olympic Commission (IOC), International Rugby Board (IRB), and International Ice Hockey Federation (IIHF) who initiated this endeavor gain immense value and must subsist pursued vigorously. unbiased play and respect for opponents are ethical values that should subsist encouraged in bar None sports and sporting associations. Similarly, coaches, parents, and managers play an valuable fraction in ensuring these values are implemented on the field of play.58,138–150SECTION 2: STATEMENT ON BACKGROUND TO THE CONSENSUS PROCESS
In November 2001, the 1st International Conference on Concussion in Sport was held in Vienna, Austria. This meeting was organized by the IIHF in partnership with FIFA and the Medical Commission of the IOC. As fraction of the resulting mandate for the future, the requisite for leadership and future updates were identified. The 2nd International Conference on Concussion in Sport was organized by the identical group with the additional involvement of the IRB and was held in Prague, Czech Republic in November 2004. The original aims of the symposia were to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, rugby, football (soccer) as well as other sports. To this end, a purview of experts were invited to both meetings to address specific issues of epidemiology, basic and clinical science, injury grading systems, cognitive assessment, unusual research methods, protective equipment, management, prevention, and long-term outcome.1,2
The 3rd International Conference on Concussion in Sport was held in Zurich, Switzerland on October 29-30, 2008 and was designed as a formal consensus meeting following the organizational guidelines set forth by the US National Institutes of Health. (Details of the consensus methodology can subsist obtained at: http://consensus.nih.gov/ABOUTCDP.htm). The basic principles governing the conduct of a consensus development conference are summarized below:
The panel chairperson (WM) did not identify with any advocacy position. The chairperson was liable for directing the consensus session and guiding the panel’s deliberations. Panelists were drawn from clinical practice, academic, and research in the field of sport-related concussion. They accomplish not portray organizations per se but were selected for their expertise, experience, and understanding of this field.
The 4th International Conference on Concussion in Sport was held in Zurich, Switzerland on November 1-3, 2012 and followed the identical silhouette as for the 3rd meeting. bar None speakers, consensus panel members, and abstract authors were required to token an ICMJE form for Disclosure of Potential Conflicts of Interest. minute information related to each authors affiliations and conflicts of interests will subsist made publicly available on the CISG Web site and published with the BJSM supplement.Medical Legal Considerations
This consensus document reflects the current state of learning and will requisite to subsist modified according to the development of unusual knowledge. It provides an overview of issues that may subsist of weight to healthcare providers involved in the management of sport-related concussion. It is not intended as a measure of care, and should not subsist interpreted as such. This document is only a guide, and is of a universal nature, consistent with the reasonable practice of a healthcare professional. Individual treatment will depend on the facts and circumstances specific to each individual case.
It is intended that this document will subsist formally reviewed and updated prior to December 1, 2016.SECTION 3: ZURICH 2012 CONSENSUS QUESTIONS
Note that each question is the topic of a part systematic review that is published in the British Journal of Sports Medicine (2013; 47(5): April 2013). As such bar None citations and details of each topic will subsist covered in those reviews.1. When you assess an athlete acutely and they accomplish not gain concussion, what is it? Is a cognitive injury the key component of concussion in making a diagnosis?
The consensus panel agreed that concussion is an evolving injury in the acute side with rapidly changing clinical signs and symptoms, which may reflect the underlying physiological injury in the brain. Concussion is considered to subsist among the most intricate injuries in sport medicine to diagnose, assess, and manage. The majority of concussions in sport occur without loss of consciousness or open neurologic signs. At present, there is no faultless diagnostic test or marker that clinicians can depend on for an immediate diagnosis of concussion in the sporting environment. Because of this evolving process, it is not viable to rule out concussion when an injury event occurs associated with a momentary neurological symptom. bar None such cases should subsist removed from the playing field and assessed for concussion by the treating physician or health supervision provider as discussed below. It was recognised that a cognitive deficit is not necessary for acute diagnosis as it either may not subsist present or detected on examination.2. Are the existing tools/exam sensitive and dependable enough on the day of injury to fabricate or exclude a diagnosis of concussion?
Concussion is a clinical diagnosis based largely on the observed injury mechanism, signs, and symptoms. The vast majority of sport-related concussions (hereafter, referred to as concussion) occur without loss of consciousness or open neurologic signs.151–154 In milder forms of concussion, the athlete might subsist slightly confused, without clearly identifiable amnesia. In addition, most concussions cannot subsist identified or diagnosed by neuroimaging techniques (eg, computed tomography or magnetic resonance imaging). Several well-validated neuropsychological tests are commandeer for exhaust in the assessment of acute concussion in the competitive sporting environment. These tests provide valuable data on symptoms and functional impairments that clinicians can incorporate into their diagnostic formulation, but should not solely subsist used to diagnose concussion.3. What is the best practice for evaluating an adult athlete with concussion on the “field of play” in 2012?
Recognizing and evaluating concussion in the adult athlete on the field is a challenging responsibility for the health supervision provider. Performing this assignment is often a rapid assessment in the midst of competition with a time constraint and the athlete involved to play. A standardized objective assessment of injury, which includes excluding more serious injury, is faultfinding in determining character decisions for the athlete. The on-field evaluation of sport-related concussion is often a challenge given the elusiveness and variability of presentation, hardship in making a timely diagnosis, specificity and sensitivity of sideline assessment tools, and the reliance on symptoms. Despite these challenges, the sideline evaluation is based on recognition of injury, assessment of symptoms, cognitive and cranial nerve function, and balance. Serial assessments are often necessary. Concussion is often an evolving injury, and signs and symptoms may subsist delayed. Therefore, erring on the side of caution (keeping an athlete out of participation when there is any suspicion for injury) is important. A standardized assessment of concussion is useful in the assessment of the athlete with suspected concussion but should not seize the set of clinician judgment.4. How can the SCAT2 subsist improved?
It was agreed that a variety of measures should subsist employed as fraction of the assessment of concussion to provide a more complete clinical profile for the concussed athlete. valuable clinical information can subsist ascertained in a streamlined manner through the exhaust of a multimodal instrument such as the Sport Concussion Assessment implement (SCAT). A baseline assessment is advised wherever possible. However, it is acknowledged that further validity studies requisite to subsist performed to reply this specific issue.
A future SCAT test battery (i.e, SCAT3) should embrace an initial assessment of injury severity using the Glasgow Coma Scale (GCS), immediately followed by observing and documenting concussion signs. Once this is complete, symptom endorsement and symptom severity, neurocognitive function, and equipoise office should subsist assessed in any athlete suspected of sustaining a concussion. It is recommended that these latter steps subsist conducted following a minimum 15-minute relaxation era on the sideline to avoid the influence of exertion or fatigue on the athlete’s performance. While it is famed that this time frame is an whimsical one, nevertheless the expert panel agreed that a era of relaxation was valuable prior to assessment. Future research should reckon the efficacy for inclusion of vision tests such as the King Devick Test and clinical reaction time tests.155,156 Recent studies intimate that these may subsist useful additions to the sideline assessment of concussion. However, the requisite for additional materiel may fabricate them impractical for sideline use.
It was further agreed that the SCAT3 would subsist suitable for adults and youths age 13 and over, while a unusual implement (Child-SCAT3) subsist developed for younger children.5. Advances in neuropsychology: are computerized tests enough for concussion diagnosis?
Sport-related concussions are frequently associated with 1 or more symptoms, impaired balance, and/or cognitive deficits. These problems can subsist measured using symptom scales, equipoise testing, and neurocognitive testing. bar None 3 modalities can identify significant changes in the first few days following injury, generally with normalization over 1 to 3 weeks. The presentation of symptoms and the rate of recovery can subsist variable, which reinforces the value of assessing bar None 3 areas as fraction of a comprehensive sport concussion program.
Neuropsychological assessment has been described by the Concussion in Sport Group as a ‘cornerstone’ of concussion management. Neuropsychologists are uniquely qualified to interpret neuropsychological tests and can play an valuable role within the context of a multifaceted-multimodal and multidisciplinary approach to managing sport-related concussion. Concussion management programs that exhaust neuropsychological assessment to assist in clinical decision-making gain been instituted in professional sports, colleges, and tall schools. Brief computerized cognitive evaluation tools are the mainstay of these assessments worldwide given the logistical limitation in accessing trained neuropsychologists, however it should subsist famed that these are not substitutes for formal neuropsychological assessment. At present, there is insufficient evidence to recommend the widespread routine exhaust of baseline neuropsychological testing.7. What evidence exits for unusual strategies/technologies in the diagnosis of concussion and assessment of recovery?
A number of novel technological platforms exist to assess concussion including (but not limited to) iPhone/smart phone apps, quantitative electroencephalography, robotics – sensory motor assessment, telemedicine, eye tracking technology, functional imaging/advanced neuroimaging and head impact sensors. At this stage only limited evidence exists for their role in this setting and None gain been validated as diagnostic. It will subsist valuable to reconsider the role of these technologies once evidence is developed.8. Advances in the management of sport concussion: what is evidence for concussion therapies?
The current evidence evaluating the consequence of relaxation and treatment following a sport-related concussion is sparse. An initial era of relaxation may subsist of benefit. However, further research to evaluate the long-term outcome of rest, and the optimal amount and type of rest, is needed. Low-level exercise for those who are deliberate to recover may subsist of benefit, although the optimal timing following injury for initiation of this treatment is currently unknown. Multimodal physiotherapy treatment for individuals with clinical evidence of cervical spine and/or vestibular dysfunction may subsist of benefit. There is a sturdy requisite for high-level studies evaluating the effects of a resting period, pharmacological interventions, rehabilitative techniques, and exercise for individuals who gain sustained a sport-related concussion.9. The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) post concussive symptoms?
Persistent symptoms (>10 days) are generally reported in 10%-15% of concussions. This may subsist higher in certain sports (eg, elite ice hockey) and populations (eg, children). In general, symptoms are not specific to concussion and it is valuable to reckon and manage co-existent pathologies. Investigations may embrace formal neuropsychological testing and conventional neuroimaging to exclude structural pathology. Currently there is insufficient evidence to recommend routine clinical exhaust of advanced neuroimaging techniques or other investigative strategies. Cases of concussion in sport where clinical recovery falls outside the expected window (i.e. 10 days) should subsist managed in a multidisciplinary manner by health supervision providers with experience in sports-related concussion. valuable components of management after the initial era of physical and cognitive relaxation embrace associated therapies such as cognitive, vestibular, physical and psychological therapy, consideration of assessment of other causes of prolonged symptoms, and consideration of commencement of a graded exercise program at a flat that does not exacerbate symptoms.10. Revisiting concussion modifiers: how should the evaluation and management of acute concussion differ in specific groups?
The literature demonstrates that number and severity of symptoms and previous concussions are associated with prolonged recovery and/or increased risk of complications. Brief loss of consciousness (LOC), duration of posttraumatic amnesia and/or impact seizures accomplish not reliably forecast outcome following concussion, although a cautious approach should subsist taken in an athlete with prolonged LOC (ie, >1 minute). Children generally seize longer to recover from concussions and assessment batteries gain yet to subsist validated in the younger age group. Currently there are insufficient data on the influence of genetics and gender on outcome following concussion. Several modifiers are associated with prolonged recovery or increased risk of complications following concussion and gain valuable implications for management. Children with concussion should subsist managed conservatively, with the stress on recrudesce to learn before recrudesce to sport. In cases of concussion managed with limited resources (eg, nonelite players), a conservative approach should furthermore subsist taken such that the athlete does not recrudesce to sport until fully recovered11. What are the most efficacious risk reduction strategies in sport concussion? - from protective materiel to policy.
No unusual telling evidence was provided to intimate that the exhaust of current measure headgear in rugby, or mouthguards in American football, can significantly reduce players’ risk of concussion. No evidence was provided to intimate an association between neck strength increases and concussion risk reduction. There was evidence to intimate that eliminating cadaver checking from Pee Wee ice hockey (ages 11-12 years) and fair-play rules in ice hockey were efficacious injury prevention strategies. Helmets requisite to subsist able to protect from impacts resulting in a head change in velocity of up to 10 m/s in professional American football, and up to 7 m/s in professional Australian football. It furthermore appears that helmets must subsist capable of reducing head resultant linear acceleration to below 50 g and angular acceleration components to below 1500 rad/s2 to optimize their effectiveness. Given that a multifactorial approach is needed for concussion prevention, well-designed and sport-specific prospective analytical studies of enough power are warranted for mouthguards, headgear/helmets, facial protection, and neck strength. Measuring the consequence of rule changes should furthermore subsist addressed with future studies, not only assessing unusual rule changes or legislation, but furthermore alteration or reinforcement to existing rules.12. What is the evidence for habitual concussion-related changes? - behavioural, pathological, and clinical outcomes.
It was agreed that habitual traumatic encephalopathy (CTE) represents a distinct tauopathy with an unknown incidence in athletic populations. It was further agreed that CTE was not related to concussions alone or simply exposure to contact sports. At present, there are no published epidemiological, cohort, or prospective studies relating to modern CTE. Due to the nature of the case reports and pathological case series that gain been published, it is not viable to determine the causality or risk factors with any certainty. As such, the speculation that repeated concussion or sub-concussive impacts causes CTE remains unproven. The extent to which age-related changes, psychiatric or mental health illness, alcohol/drug use, or co-existing medical or dementing illnesses contribute to this process is largely unaccounted for in the published literature. At present, the interpretation of causation in the modern CTE case studies should proceed cautiously. It was furthermore recognized that it is valuable to address the fears of parents/athletes from media pressure related to the possibility of CTE.13. From consensus to action: how accomplish they optimize learning transfer, education, and ability to influence policy?
The value of learning transfer (KT) as fraction of concussion education is increasingly becoming recognized. Target audiences capitalize from specific learning strategies. Concussion tools exist, but their effectiveness and impact require further evaluation. The media is valuable in drawing attention to concussion, but efforts requisite to ensure that the public is alert of the prerogative information. companionable media as a concussion education implement is becoming more prominent. Implementation of KT models is one approach organizations can exhaust to assess learning gaps; identify, develop, and evaluate education strategies; and exhaust the outcomes to facilitate conclusion making. Implementing KT strategies requires a defined plan. Identifying the needs, learning styles and preferred learning strategies of target audiences, coupled with evaluation, should subsist a piece of the overall concussion education confound to gain an impact on enhancing learning and awareness.
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