Geotechnical Analysis of Contaminated Sand by Light Non-Aquous Phase Liquids

Contaminated soil reuse was investigated, with higher profusion, throughout the early 90’s, coinciding with the 1991 Gulf War, when efforts to amend large crude oil releases began in geotechnical assessment of contaminated soils. Isolated works referring to geotechnical testing with hydrocarbon ground contaminants are described in the state-of-the-art, which have been extended to other type of contaminated soil references. Contaminated soils by light non-aquous phase liquids (LNAPL) bearing capacity reduction has been previously investigated from a forensic point of view. To date, all the research works have been published based on the assumption of constant contaminant saturation for the entire soil mass. In contrast, the actual LNAPLs distribution plumes exhibit complex flow patterns which are subject to physical and chemical changes with time and distance travelled from the release source. This aspect has been considered along the present text. A typical Madrid arkosic soil formation is commonly known as Miga sand. Geotechnical tests have been carried out, with Miga sand specimens, in incremental series of LNAPL concentrations in order to observe the soil engineering properties variation due to a contamination increase. Results are discussed in relation with previous studies and as a matter of fact, soil mechanics parameters change in the presence of LNAPL, showing different tendencies according to each test and depending on the LNAPL content, as well as to the specimen’s initially planned relative density, dense or loose. Geotechnical practical implications are also commented on and analyzed. Variation on geotechnical properties may occur only within the external contour of contamination distribution plume. This scope has motivated the author to develop a physical model based on transparent soil technology. The model aims to reproduce the distribution of LNAPL into the ground due to an accidental release from a storage facility. Preliminary results indicate that the model is a potentially complementary tool for hydrogeological applications, site-characterization and remediation treatment testing within the framework of soil pollution events. A description of the test setup of an innovative three dimensional physical model for the flow of two or more phases, in porous media, is presented herein, along with a summary of the advantages, limitations and future applications for modeling with transparent material. En los primeros años de la década de los años 90, del siglo pasado, coincidiendo con la Guerra del Golfo en 1991, se investigó intensamente sobre la reutilización de suelos afectados por grandes volúmenes de vertidos de crudo, fomentándose la evaluación geotécnica de los suelos contaminados. Se describen, en el estado del arte de esta tésis, una serie de trabajos aislados en relación con la caracterización geotécnica de suelos contaminados con hidrocarburos, descripción ampliada mediante referencias relacionadas con otros tipos de contaminación de suelos. Existen estudios previos de patología de cimentaciones que analizan la reducción de la capacidad portante de suelos contaminados por hidrocarburos líquidos ligeros en fase no acuosa (acrónimo en inglés: LNAPL de “Liquid Non-Aquous Phase Liquid”). A fecha de redacción de la tesis, todas las publicaciones anteriores estaban basadas en la consideración de una saturación del contaminante constante en toda la extensión del terreno de cimentación. La distribución real de las plumas de contaminante muestra, por el contrario, complejas trayectorias de flujo que están sujetas a cambios físico-químicos en función del tiempo y la distancia recorrida desde su origen de vertido. Éste aspecto ha sido considerado y tratado en el presente texto. La arena de Miga es una formación geológica típica de Madrid. En el ámbito de esta tesis se han desarrollado ensayos geotécnicos con series de muestras de arena de Miga contaminadas con distintas concentraciones de LNAPL con el objeto de estimar la variación de sus propiedades geotécnicas debido a un incremento de contaminación. Se ha realizado una evaluación de resultados de los ensayos en comparación con otros estudios previamente analizados, resultando que las propiedades mecánicas del suelo, efectivamente, varían en función del contenido de LNAPL y de la densidad relativa con la que se prepare la muestra, densa o floja. Se analizan y comentan las implicaciones de carácter práctico que supone la mencionada variación de propiedades geotécnicas. El autor ha desarrollado un modelo físico basado en la tecnología de suelos transparentes, considerando que las variaciones de propiedades geotécnicas únicamente deben producirse en el ámbito interior del contorno de la pluma contaminante. El objeto del modelo es el de reproducir la distribución de un LNAPL en un terreno dado, causada por el vertido accidental de una instalación de almecenamiento de combustible. Los resultados preliminares indican que el modelo podría emplearse como una herramienta complementaria para el estudio de eventos contaminantes, permitiendo el desarrollo de aplicaciones de carácter hidrogeológico, caracterización de suelos contaminados y experimentación de tratamientos de remediación. Como aportación de carácter innovadora, se presenta y describe un modelo físico tridimensional de flujo de dos o más fases a través de un medio poroso transparente, analizándose sus ventajas e inconvenientes así como sus limitaciones y futuras aplicaciones.

Assessment of the ozone sensitivity of 22 native plant species from mediterranean annual pastures based on visible injury

Ozone (O3) phytototoxicity has been reported on a wide range of plantspecies, inducing the appearance of specific foliar injury or increasing leaf senescence. No information regarding the sensitivity of plantspecies from dehesa Mediterranean grasslands has been provided in spite of their great biological diversity. A screening study was carried out in open-top chambers (OTCs) to assess the O3-sensitivity of 22 representative therophytes of these ecosystems based on the appearance and extent of foliar injury. A distinction was made between specific O3injury and non-specific discolorations. Three O3 treatments (charcoal-filtered air, non-filtered air and non-filtered air supplemented with 40 nl l−1 O3 during 5 days per week) and three OTCs per treatment were used. The Papilionaceae species were more sensitive to O3 than the Poaceae species involved in the experiment since ambient levels induced foliar symptoms in 67% and 27%, respectively, of both plant families. An O3-sensitivity ranking of the species involved in the assessment is provided, which could be useful for bioindication programmes in Mediterranean areas. The assessed Trifoliumspecies were particularly sensitive since foliar symptoms were apparent in association with O3 accumulated exposures well below the current critical level for the prevention of this kind of effect. The exposure indices involving lower cut-off values (i.e. 30 nl l−1) were best related with the extent of O3-induced injury on these species.

Mejora de la seguridad de las presas de escollera frente a percolación accidental mediante protecciones tipo repié

Esta tesis doctoral es el fruto de un trabajo de investigación cuyo objetivo principal es definir criterios de diseño de protecciones en forma de repié en presas de materiales sueltos cuyo espaldón de aguas abajo esté formado por escollera. La protección propuesta consiste en un relleno de material granular situado sobre el pie de aguas abajo de la presa y formado a su vez por una escollera con características diferenciadas respecto de la escollera que integra el espaldón de la presa. La función de esta protección es evitar que se produzcan deslizamientos en masa cuando una cantidad de agua anormalmente elevada circula accidentalmente por el espaldón de aguas abajo de la presa por distintos motivos como pueden ser el vertido por coronación de la presa o la pérdida de estanqueidad del elemento impermeable o del cimiento. Según los datos de la International Commission on Large Dams (ICOLD 1995) el 70% de las causas de rotura o avería grave en presas de materiales sueltos en el mundo están dentro de las que se han indicado con anterioridad. Esta circulación accidental de agua a través del espaldón de escollera, típicamente turbulenta, se ha denominado en esta tesis percolación (“through flow”, en inglés) para diferenciarla del término filtración, habitualmente utilizada para el flujo laminar a través de un material fino. El fenómeno físico que origina la rotura de presas de materiales sueltos sometidas a percolación accidental es complejo, entrando en juego diversidad de parámetros, muchas veces no deterministas, y con acoplamiento entre procesos, tanto de filtración como de arrastre y deslizamiento. En esta tesis se han realizado diferentes estudios experimentales y numéricos con objeto de analizar el efecto sobre el nivel de protección frente al deslizamiento en masa que producen los principales parámetros geométricos que definen el repié: la anchura de la berma, el talud exterior y su altura máxima desde la base. También se han realizado estudios sobre factores con gran influencia en el fenómeno de la percolación como son la anisotropía del material y el incremento de los caudales unitarios en el pie de presa debidos a la forma de la cerrada. A partir de los resultados obtenidos en las distintas campañas de modelación física y numérica se han obtenido conclusiones respecto a la efectividad de este tipo de protección para evitar parcial o totalmente los daños provocados por percolación accidental en presas de escollera. El resultado final de la tesis es un procedimiento de diseño para este tipo de protecciones. Con objeto de completar los criterios de dimensionamiento, teniendo en cuenta los mecanismos de rotura por erosión interna y arrastre, se han incluido dentro del procedimiento recomendaciones adicionales basadas en investigaciones existentes en la bibliografía técnica. Finalmente, se han sugerido posibles líneas de investigación futuras para ampliar el conocimiento de fenómenos complejos que influyen en el comportamiento de este tipo de protección como son el efecto de escala, la anisotropía de la escollera, las leyes de resistencia que rigen la filtración turbulenta a través de medios granulares, los efectos de cimentaciones poco competentes o la propia caracterización de las propiedades de la escollera de presas. This thesis is the result of a research project that had the main objective of defining criteria to design rockfill toe protections for dams with a highly‐permeable downstream shoulder. The proposed protection consists of a rockfill toe berm situated downstream from the dam with specific characteristics with respect to the rockfill that integrates the shoulder of the main dam. The function of these protections is to prevent mass slides due to an abnormally high water flow circulation through the dam shoulder. This accidental seepage flow may be caused by such reasons as overtopping or the loss of sealing at the impervious element of the dam or its foundation. According to data from the International Commission on Large Dams (ICOLD 1995), 70% of the causes of failure or serious damage in embankment dams in the world are within that described previously. This accidental seepage of water through the rockfill shoulder, typically turbulent, is usually called through‐flow. The physical phenomenon which causes the breakage of the rockfill shoulder during such through‐flow processes is complex, involving diversity of parameters (often not deterministic) and coupling among processes, not only seepage but also internal erosion, drag or mass slide. In this thesis, numerical and experimental research is conducted in order to analyze the effects of the main parameters that define the toe protection, i.e. the toe crest length, its slope and maximum height. Additional studies on significant factors which influence the seepage, such as the anisotropy of the material and the increase of the unit flows at the dam toe due to the valley shape are also performed. In addition, conclusions regarding the effectiveness of this type of protection are obtained based on the results of physical and numerical models. The main result of the thesis is a design procedure for this type of protection to avoid mass sliding. In order to complete the design criteria, additional recommendations about internal and external erosion based on the state of the art are included. Finally, new lines of research are suggested for the future to expand the level of knowledge of the complex phenomena that influence the behavior of this type of protection, such as the effects of scale, rockfill anisotropy, non‐linear seepage laws in turbulent seepage through granular media, effects of erodible foundations, or new procedures to characterize the properties of dam rockfill as a construction material.

Feasibility and utility of population-level geospatial injury profiling : prospective, national cohort study

The Health Services Research Unit receives funding from the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The opinions expressed in this article are those of the authors alone. The GEOS study was funded by the North of Scotland Planning Group.

Traumatic brain damage prevented by the non-N-methyl-D-aspartate antagonist 2,3-dihydroxy-6-nitro-7-sulfamoylbenzo[f] quinoxaline.

The mechanisms of neuronal degeneration following traumatic head injury are not well understood and no adequate treatment is currently available for the prevention of traumatic brain damage in humans. Traumatic head injury leads to primary (at impact) and secondary (distant) damage to the brain. Mechanical percussion of the rat cortex mimics primary damage seen after traumatic head injury in humans; no animal model mimicking the secondary damage following traumatic head injury has yet been established. Rats subjected to percussion trauma of the cortex showed primary damage in the cortex and secondary damage in the hippocampus. Morphometric analysis demonstrated that both cortical and hippocampal damage was mitigated by pretreatment with either the N-methyl-D-aspartate (NMDA) antagonist 3-((+/-)- 2-carboxypiperazin-4-yl)-propyl-1-phosphonate (CPP) or the non-NMDA antagonist 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo[f]quinoxaline (NBQX). Neither treatment prevented primary damage in the cortex when therapy was started after trauma. Surprisingly, delayed treatment of rats with NBQX, but not with CPP, beginning between 1 and 7 hr after trauma prevented hippocampal damage. No protection was seen when therapy with NBQX was started 10 hr after trauma. These data indicate that both NMDA- and non-NMDA-dependent mechanisms contribute to the development of primary damage in the cortex, whereas non-NMDA mechanisms are involved in the evolution of secondary damage in the hippocampus in rats subjected to traumatic head injury. The wide therapeutic time-window documented for NBQX suggests that antagonism at non-NMDA receptors may offer a novel therapeutic approach for preventing deterioration of the brain after head injury.

The Utility of the CVLT-C as an Embedded Validity Indicator After Pediatric Mild Traumatic Brain Injury.

Results of neuropsychological examinations depend on valid data. Whereas clinicians previously believed that clinical skill was sufficient to identify non-credible performance by examinees on standard tests, research demonstrates otherwise. Consequently, studies on measures to detect suspect effort in adults have received tremendous attention in the previous twenty years, and incorporation of validity indicators into neuropsychological examinations is now seen as integral. Few studies exist that validate methods appropriate for the measurement of effort in pediatric populations. Of extant studies, most evaluate standalone measures originally developed for use with adults. The present study examined the utility of indices from the California Verbal Learning Test – Children's Version (CVLT-C) as embedded validity indicators in a pediatric sample. Participants were 225 outpatients aged 8 to 16 years old referred for clinical assessment after mild traumatic brain injury (mTBI). Non-credible performance (n = 39) was defined as failure of the Medical Symptom Validity Test (MSVT). Logistic regression demonstrated that only the Recognition Discriminability index was predictive of MSVT failure (OR = 2.88, p < .001). A cutoff of z ≤ -1.0 was associated with sensitivity of 51% and specificity of 91%. In the current study, CVLT-C Recognition Discriminability was useful in the identification of non-credible performance in a sample of relatively high-functioning pediatric outpatients with mTBI. Thus, this index can be added to the short list of embedded validity indicators appropriate for pediatric neuropsychological assessment.

Injury incidence in judokas at the Spanish National University Championship

Background and Study Aim: Understanding injury incidence rates will be a great help with regards to preventing potential future damages. It is for this reason that this study suggests studying a large number of variables. The purpose of research is the relationship of events (empirical variables) that are usually taken into account in developing injury prevention programs during the battles and training in judo tournament. Material and methods: In this research project, 57 male judokas taking part in the Spanish National University Championship in 2009 were asked to complete a retrospective questionnaire. We analysed the following events: the most commonly injured body regions, the medical diagnosis, how and when the injury happened, the type of injury, the side of the body and the type of medical attention received. For the statistical analysis, we used the SPSS statistics programme to apply the Chi-square test in order to determine the significance levels for non-parametric tests from p<.05. Results: Significant differences were found in the most commonly injured body region, the shoulder/clavicle (p<.05), and in the most common diagnosis, the sprain (p<.05). Impact injuries (p<.05) are the most common and training (p<.05) is the most dangerous time. About the type of injury, 78.38% are new injuries (p<.05) and 69.05% affect the right hand side of the body (p<.05). Doctors are the most consulted specialists, but the physiotherapists obtained the best marks. Have been out due to injury for over 21 days 36.36% of the participants, but not for the entire season. Conclusions: The most common diagnosis in university student judokas coincides with those of elite judokas, with the sprain being the most common. University student judokas have a higher rate of shoulder/clavicle injuries, while professional judokas are prone to a higher rate of knee injuries. Training is the most common moment in which injuries occur, both in university student judokas and professional judokas. New injuries are the most common types of injuries in university student judokas and, while doctors are the most consulted specialists, the physiotherapists obtained the best marks.

Urinary Biomarkers Indicative of Apoptosis and Acute Kidney Injury in the Critically Ill.

BACKGROUND Apoptosis is a key mechanism involved in ischemic acute kidney injury (AKI), but its role in septic AKI is controversial. Biomarkers indicative of apoptosis could potentially detect developing AKI prior to its clinical diagnosis. METHODS As a part of the multicenter, observational FINNAKI study, we performed a pilot study among critically ill patients who developed AKI (n = 30) matched to critically ill patients without AKI (n = 30). We explored the urine and plasma levels of cytokeratin-18 neoepitope M30 (CK-18 M30), cell-free DNA, and heat shock protein 70 (HSP70) at intensive care unit (ICU) admission and 24h thereafter, before the clinical diagnosis of AKI defined by the Kidney Disease: Improving Global Outcomes -creatinine and urine output criteria. Furthermore, we performed a validation study in 197 consecutive patients in the FINNAKI cohort and analyzed the urine sample at ICU admission for CK-18 M30 levels. RESULTS In the pilot study, the urine or plasma levels of measured biomarkers at ICU admission, at 24h, or their maximum value did not differ significantly between AKI and non-AKI patients. Among 20 AKI patients without severe sepsis, the urine CK-18 M30 levels were significantly higher at 24h (median 116.0, IQR [32.3-233.0] U/L) than among those 20 patients who did not develop AKI (46.0 [0.0-54.0] U/L), P = 0.020. Neither urine cell-free DNA nor HSP70 levels significantly differed between AKI and non-AKI patients regardless of the presence of severe sepsis. In the validation study, urine CK-18 M30 level at ICU admission was not significantly higher among patients developing AKI compared to non-AKI patients regardless of the presence of severe sepsis or CKD. CONCLUSIONS Our findings do not support that apoptosis detected with CK-18 M30 level would be useful in assessing the development of AKI in the critically ill. Urine HSP or cell-free DNA levels did not differ between AKI and non-AKI patients.

Verbal recall after mild traumatic brain injury: Sensitivity of the rapid screen of concussion

The present study aimed to determine whether including a sensitive test of immediate and delayed recall would improve the diagnostic validity of the Rapid Screen of Concussion (RSC) in mild Traumatic Brain Injury (mTBI) versus orthopaedic clinical samples. Two studies were undertaken. In Study 1, the performance of 156 mTBI and 145 orthopaedic participants was analysed to identify the number of individuals who performed at ceiling on the verbal memory subtest of the RSC, as this test required immediate and delayed recall of only five words. A second aim was to determine the sensitivity and specificity levels of the RSC. Study 2 aimed to examine whether replacement of the verbal memory subtest with the 12-word Hopkins Verbal Learning Test (HVLT) could improve the sensitivity of the RSC in a new sample of 26 mTBI and 30 orthopaedic participants. Both studies showed that orthopaedic participants outperformed mTBI participants on each of the selected measures. Study 1 showed that 14% of mTBI participants performed at ceiling on the immediate and 21.2% on delayed recall test. Performance on the original battery yielded a sensitivity of 82%, specificity of 80% and overall correct classification of 81.5% participants. In Study 2, inclusion of the HVLT improved sensitivity to a level of 88.5%, decreased specificity to a level of 70% and resulted in an overall classification rate of 80%. It was concluded that although inclusion of the five-word subtest in the RSC can successfully distinguish concussed from non-concussed individuals, use of the HVLT in this protocol yields a more sensitive measure of subtle cognitive deficits following mTBI.

Referral to rehabilitation following traumatic brain injury: practitioners and the process of decision-making

The study aimed to examine the factors influencing referral to rehabilitation following traumatic brain injury (TBI) by using social problems theory as a conceptual model to focus on practitioners and the process of decision-making in two Australian hospitals. The research design involved semi-structured interviews with 18 practitioners and observations of 10 team meetings, and was part of a larger study on factors influencing referral to rehabilitation in the same settings. Analysis revealed that referral decisions were influenced primarily by practitioners' selection and their interpretation of clinical and non-clinical patient factors. Further, practitioners generally considered patient factors concurrently during an ongoing process of decision-making, with the combinations and interactions of these factors forming the basis for interpretations of problems and referral justifications. Key patient factors considered in referral decisions included functional and tracheostomy status, time since injury, age, family, place of residence and Indigenous status. However, rate and extent of progress, recovery potential, safety and burden of care, potential for independence and capacity to cope were five interpretative themes, which emerged as the justifications for referral decisions. The subsequent negotiation of referral based on patient factors was in turn shaped by the involvement of practitioners. While multi-disciplinary processes of decision-making were the norm, allied health professionals occupied a central role in referral to rehabilitation, and involvement of medical, nursing and allied health practitioners varied. Finally, the organizational pressures and resource constraints, combined with practitioners' assimilation of the broader efficiency agenda were central factors shaping referral. (C) 2004 Elsevier Ltd. All rights reserved.

Differences in prevalence of pre-existing morbility between injured and non-injured populations

Objectives To identify and examine differences in pre-existing morbidity between injured and non-injured population-based cohorts. Methods Administrative health data from Manitoba, Canada, were used to select a population-based cohort of injured people and a sample of non-injured people matched on age, gender, aboriginal status and geographical location of residence at the date of injury. All individuals aged 18-64 years who had been hospitalized between 1988 and 1991 for injury (International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) code 800-995) (n = 21032), were identified from the Manitoba discharge database. The matched non-injured comparison group comprised individuals randomly selected 1: 1 from the Manitoba population registry. Morbidity data for the 12 months prior to the date of the injury were obtained by linking the two cohorts with all hospital discharge records and physician claims. Results Compared to the non-injured group, injured people had higher Charlson Comorbidity Index scores, 1.9 times higher rates of hospital admissions and 1.7 times higher rates of physician claims in the year prior to the injury. Injured people had a rate of admissions to hospital for a mental health disorder 9.3 times higher, and physician claims for a mental health disorder 3.5 times higher, than that of non-injured people. These differences were all statistically significant (P < 0.001). Conclusion Injured people were shown to differ from the general non-injured population in terms of pre-existing morbidity. Existing population estimates of the attributable burden of injury that are obtained by extrapolating from observed outcomes in samples of injured cases may overestimate the magnitude of the problem.

Kinematic analysis of jaw function in children following traumatic brain injury

Primary objective: To investigate jaw movements in children following traumatic brain injury (TBI) during speech using electromagnetic articulography (EMA). Methods and procedures: Jaw movements of two non-dysarthric children ( aged 12.75 and 13.08 years) who had sustained a TBI were recorded using the AG-100 EMA system (Carstens Medizineletronik) during word-initial consonant productions. Mean quantitative kinematic parameters and coefficient of variation ( variability) values were calculated and individually compared to the mean values obtained by a group of six control children ( mean age 12.57 years, SD 1.52). Main outcomes and results: The two children with TBI exhibited word-initial consonant jaw movement durations that were comparable to the control children, with sub-clinical reductions in speed being offset by reduced distances. Differences were observed between the two children in jaw kinematic variability, with one child exhibiting increased variability, while the other child demonstrated reduced or comparable variability compared to the control group. Conclusions: Possible sub-clinical impairments of jaw movement for speech were exhibited by two children who had sustained a TBI, providing insight into the consequences of TBI on speech motor control development.

Unprotected eyes in squash: not seeing the risk of injury

The use of appropriate eyewear in squash can protect the eyes against injury. However, few adult squash players adequately protect their eyes against potential severe injuries. We describe the characteristics of non-users of protective eyewear and examine predictors of appropriate eyewear use. Self-report surveys of adult players were conducted in metropolitan Melbourne, Australia. Information on players' knowledge, behaviours and attitudes associated with protective eyewear use was collected, in addition to player demographic data. Appropriate eyewear was defined as Standards-approved polycarbonate lens eyewear. The majority 92.2% of players did not adequately protect their eyes while playing squash. Significant predictors of reported eyewear use were: previous eye injury; playing squash on average more than 2 hr per wk; having played for more than 20 y; and having more favourable attitudes towards eye safety in squash. The significant predictors of appropriate eyewear use were: being female; previous eye injury; playing squash on average more than 2 hr per week; and having more favourable attitudes towards eye safety in squash. Understanding the characteristics of both users and non-users of appropriate eye protection in squash is essential for informing future prevention strategies.

Physical and psychological factors predict outcome following whiplash injury

Predictors of outcome following whiplash injury are limited to socio-demographic and symptomatic factors, which are not readily amenable to secondary and tertiary intervention. This prospective study investigated the predictive capacity of early measures of physical and psychological impairment on pain and disability 6 months following whiplash injury. Motor function (ROM; kinaesthetic sense; activity of the superficial neck flexors (EMG) during cranio-cervical flexion), quantitative sensory testing (pressure, thermal pain thresholds, brachial plexus provocation test), sympathetic vasoconstrictor responses and psychological distress (GHQ-28, TSK, IES) were measured in 76 acute whiplash participants. The outcome measure was Neck Disability Index scores at 6 months. Stepwise regression analysis was used to predict the final NDI score. Logistic regression analyses predicted membership to one of the three groups based on final NDI scores (< 8 recovered, 10-28 mild pain and disability, > 30 moderate/severe pain and disability). Higher initial NDI score (1.007-1.12), older age (1.03-1.23), cold hyperalgesia (1.05-1.58), and acute post-traumatic stress (1.03-1.2) predicted membership to the moderate/severe group. Additional variables associated with higher NDI scores at 6 months on stepwise regression analysis were: ROM loss and diminished sympathetic reactivity. Higher initial NDI score (1.03-1.28), greater psychological distress (GHQ-28) (1.04-1.28) and decreased ROM (1.03-1.25) predicted subjects with persistent milder symptoms from those who fully recovered. These results demonstrate that both physical and psychological factors play a role in recovery or non-recovery from whiplash injury. This may assist in the development of more relevant treatment methods for acute whiplash. (c) 2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Articulatory function following traumatic brain injury in childhood: A perceptual and instrumental analysis

Primary objective: To investigate the articulatory function of a group of children with traumatic brain injury (TBI), using both perceptual and instrumental techniques. Research design: The performance of 24 children with TBI was assessed on a battery of perceptual (Frenchay Dysarthria Assessment, Assessment of Intelligibility of Dysarthric Speech and speech sample analysis) and instrumental ( lip and tongue pressure transduction systems) assessments and compared with that of 24 non-neurologically impaired children matched for age and sex. Main outcomes: Perceptual assessment identified consonant and vowel imprecision, increased length of phonemes and overall reduction in speech intelligibility, while instrumental assessment revealed significant impairment in lip and tongue function in the TBI group, with rate and pressure in repetitive lip and tongue tasks particularly impaired. Significant negative correlations were identified between the degree of deviance of perceptual articulatory features and decreased function on many non-speech measures of lip function, as well as maximum tongue pressure and fine force tongue control at 20% of maximum tongue pressure. Additionally, sub-clinical articulatory deficits were identified in the children with TBI who were non-dysarthric. Conclusion: The results of the instrumental assessment of lip and tongue function support the finding of substantial articulatory dysfunction in this group of children following TBI. Hence, remediation of articulatory function should be a therapeutic priority in these children.