Computerized testing for ADHD

This article discusses a computerized test for ADHD in children at least six years old.

Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood condition characterized by more than normal difficulty with focus, behavior control, impulsivity and hyperactivity. It affects nine percent of children younger than 18 and about approximately four percent of American adults, according to the National Institute of Mental Health. Boys are four times more likely to be diagnosed with the condition as girls but after adolescence, males and females are diagnosed in equal numbers. Some kids grow out of it, and some never do.

Arti Lal, MD, a pediatrician who specializes in treating patients at the ADHD Clinic at Scott & White in North Austin, is currently utilizing a new technology on patients which is called the Quotient® ADHD Test. It is FDA-cleared for the objective measurement of hyperactivity, impulsivity and inattention, as an aid in the assessment of ADHD. The test measures motion and analyzes shifts in attention state to give an assessment of the core symptom areas of ADHD: • Hyperactivity • Impulsivity • Inattention "Since ADHD shares traits with other mental health conditions, it can be difficult to diagnose. So, a thorough assessment by a trained professional is critical. The test is a more objective test than previous methods of diagnosis and will serve as an additional tool for us as clinicians," Dr. Lal said. "Testing can be done from age six to 55 years."

The test can also be used to quantify severity of deficits in brain function associated with controlling motion and sustaining attention. The results are objective and allow the patient, parent and physician to see the progress when treatment is working and help to guide decisions about how to optimize the treatment plan for each individual.

Bradley R. Berg, MD, PhD, Medical Director at Scott & White Clinic -- Round Rock Pediatrics says treatment for ADHD varies with age. For very young children, he explained that "After age six, medications in combination with therapy generally work best."

The test takes 15 minutes for children aged six to 12 or 20 minutes for adolescents and adults. The clinician can present a treatment plan to the patient/parent. Dr. Lal added that ""the test also has a 94% negative predictive value, which means it can say with 94% certainty that you do not have ADHD, which is a very powerful statistic." Berg added "we're also able to see patients from other pediatric or family medicine, neurology, psychiatry offices in and around the Central Texas area to help the primary care physician with a diagnosis."

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Autism study conducted entirely online

This article discusses a clinical trial for autism that was done completely online.

UC San Francisco researchers have completed the first Internet-based clinical trial for children with autism, establishing it as a viable and cost effective method of conducting high-quality and rapid clinical trials in this population.

In their study, published in the June 2014 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, the researchers looked at whether an Internet-based trial was a feasible way to evaluate whether omega-3 fatty acids helped reduce hyperactivity in children with autism. The authors found that not only was it a valuable platform for conducting the randomized clinical trial, but that it was both cost and time effective, as well.

"Recruitment for clinical trials in children with autism is one of the biggest challenges we face in studying potential treatments, and we found that process to be accelerated and streamlined by using existing online communities for enrollment," said lead author Stephen Bent, associate professor of medicine at UCSF. "This trial can serve as a model for how to efficiently test potential treatments through the growing power of online communities."

Using the Interactive Autism Network's (IAN) robust online community of parents, the researchers enrolled 57 children from 28 states into the randomized trial.

The enrolled children were randomly assigned to either receive 1.3 grams of omega-3 fatty acids or an identical placebo daily for six weeks. Once a week the participants' parents received an email asking them to complete outcome measures on how their child was doing and report on the child's level of hyperactivity. The children's teachers reported on changes in hyperactivity as well. The parent and teacher responses were submitted to a database, allowing the researchers to access the data immediately.

Because the IAN requires that parents complete a short questionnaire and verify that their child has been professionally diagnosed in order to participate in the online network, the researchers were able to confirm the participants met the diagnostic criteria for autism without a clinic visit.

While the researchers found that the omega-3 fatty acids did not lead to a statistically significant reduction in hyperactivity, they concluded the online trial was a promising technique for evaluating treatments for autism.

"The entire study was completed in slightly more than three months from the start of enrollment, and demonstrates there are many advantages including low cost, rapid enrollment, high completion rate, convenience for participating families, and the ability to participate from virtually any location," said Bent. "We had 100 percent completion of all outcome measures from parents and teachers, indicating that there is an ease to this method of testing that engages parents at a higher rate than traditional trials."

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An app to screen for autism

This article discusses an app that helps to screen for autism.

Most schools across the United States provide simple vision tests to their students -- not to prescribe glasses, but to identify potential problems and recommend a trip to the optometrist. Researchers are now on the cusp of providing the same kind of service for autism.

Researchers at Duke University have developed software that tracks and records infants' activity during videotaped autism screening tests. Their results show that the program is as good at spotting behavioral markers of autism as experts giving the test themselves, and better than non-expert medical clinicians and students in training.

"We're not trying to replace the experts," said Jordan Hashemi, a graduate student in computer and electrical engineering at Duke. "We're trying to transfer the knowledge of the relatively few autism experts available into classrooms and homes across the country. We want to give people tools they don't currently have, because research has shown that early intervention can greatly impact the severity of the symptoms common in autism spectrum disorders."

The study focused on three behavioral tests that can help identify autism in very young children.

In one test, an infant's attention is drawn to a toy being shaken on the left side and then redirected to a toy being shaken on the right side. Clinicians count how long it takes for the child's attention to shift in response to the changing stimulus. The second test passes a toy across the infant's field of view and looks for any delay in the child tracking its motion. In the last test, a clinician rolls a ball to a child and looks for eye contact afterward -- a sign of the child's engagement with their play partner.

In all of the tests, the person administering them isn't just controlling the stimulus, he or she is also counting how long it takes for the child to react -- an imprecise science at best. The new program allows testers to forget about taking measurements while also providing more accuracy, recording reaction times down to tenths of a second.

"The great benefit of the video and software is for general practitioners who do not have the trained eye to look for subtle early warning signs of autism," said Amy Esler, an assistant professor of pediatrics and autism researcher at the University of Minnesota, who participated in some of the trials highlighted in the paper.

"The software has the potential to automatically analyze a child's eye gaze, walking patterns or motor behaviors for signs that are distinct from typical development," Esler said. "These signs would signal to doctors that they need to refer a family to a specialist for a more detailed evaluation."

According to Hashemi and his adviser, Guillermo Sapiro, professor of electrical and computer engineering and biomedical engineering at Duke, because the program is non-invasive, it could be useful immediately in homes and clinics. Neither, however, expects it to become widely used -- not because clinicians, teachers and parents aren't willing, but because the researchers are working on an even more practical solution.

Later this year, the Duke team (which includes students and faculty from engineering and psychiatry) plans to test a new tablet application that could do away with the need for a person to administer any tests at all. The program would watch for physical and facial responses to visual cues played on the screen, analyze the data and automatically report any potential red flags. Any parent, teacher or clinician would simply need to download the app and sit their child down in front of it for a few minutes.

The efforts are part of the Information Initiative at Duke, which connects researchers from disparate fields to experts in computer programming to help analyze large data sets.

"We're currently working with autism experts at Duke Medicine to determine what sorts of easy tests could be used on just a computer or tablet screen to spot any potential concerns," said Sapiro. "The goal is to mimic the same sorts of social interactions that the tests with the toys and balls measure, but without the toys and balls. The research has shown that the earlier autism can be spotted, the more beneficial intervention can be. And we want to provide everyone in the world with the ability to spot those signs as early as possible."

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Sleep, academics, and behavior all improved by limited screen time

A study shows that limiting screen time improves sleep quality, academic performance, and behavior in children. JR

Parents may not always see it, but efforts to limit their children's screen time can make a difference. A new study, published inJAMA Pediatrics, found children get more sleep, do better in school, behave better and see other health benefits when parents limit content and the amount of time their children spend on the computer or in front of the TV.

Douglas Gentile, lead author and an associate professor of psychology at Iowa State, says the effect is not immediate and that makes it difficult for parents to recognize. As a result, parents may think it is not worth the effort to monitor and limit their children's media use. But Gentile says they have more power than they realize.

"When parents are involved it has a powerful protective effect across a wide range of different areas that they probably never would have expected to see," Gentile said. "However, parents aren't likely to notice that putting limits on the children's media is having these effects seven months later."

Considering that children average more than 40 hours of screen time a week, not counting time spent on a computer at school, even small changes can make a difference, researchers said. They are not suggesting parents completely eliminate screen time, but find a healthy balance.

The study found there is a ripple effect associated with the benefits of limiting both screen time and media content. Gentile is not surprised to see a direct impact on sleep, academics and behavior. However, limited screen time also indirectly affects body mass index. The study found that children got more sleep if parents limited screen time, which also resulted in lower risk of obesity. Parents limiting exposure to violent media resulted in increased prosocial behavior and lowered aggressive behavior seven months later.

Researchers analyzed the media habits of more than 1,300 school children who were recruited to participate in an obesity prevention program. Students and parents were surveyed about everything from screen time limits, to violent media exposure, to bedtimes and behavior. Teachers reported grades and commented on student behavior and school nurses measured each student's height and weight.

Data were collected at the start of the program and seven months later at the end of the program. By looking at these factors collectively with a group of children over a school year, it was easier for researchers to identify patterns that are hard to recognize in individual children.

"As parents, we don't even see our children get taller and that's a really noticeable effect. With media, what we're often looking for is the absence of a problem, such as a child not gaining weight, making it even more difficult to notice," Gentile said.

"Even with changes that we do notice, we really don't recognize in the moment how all these things are related to each other across time," he added. "Yes, as screen time goes up, school performance goes down, but that doesn't happen overnight. If I watch a lot of TV today, I don't get an F in my class tomorrow."

Doctors can make a difference, too

The American Association of Pediatrics recommends no more than one to two hours of screen time a day for children two years and older. Reality far exceeds those recommendations, which might explain why doctors feel it is futile to talk with parents about guidelines for media use, Gentile said. The study provides further evidence of why pediatricians need to have that conversation.

"Hopefully, this study will give pediatricians a better sense of efficacy that it's worth taking the time to talk to parents," Gentile said. "Even if doctors only influence 10 percent of the parents, that's still millions of children having much better health outcomes as a result."

Researchers recommend doctors talk with parents about setting limits and actively monitoring media use. This can include talking with children about media content, explaining the purpose of various media and providing overall guidance.

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Smartphones hurting our ability to sleep and work

An article from the Wall Street Journal discusses how smartphones make us tired which can both hurt our ability to sleep at night and to be productive during the day.

For a productive day at work tomorrow, give the smartphone a rest tonight.

Reading and sending work email on a smartphone late into the evening doesn’t just make it harder to get a decent night’s sleep. New research findings show it also exhausts workers by morning and leaves them disengaged by the next afternoon.

That means the way most knowledge workers do their jobs—monitoring their iPhones for notes from the boss long after the office day is done and responding to colleagues at all hours—ultimately makes them less effective, posit researchers from University of Florida, Michigan State University and University of Washington.

The scholars conducted two studies of workers’ nighttime technology habits, sleep duration and quality, energy and workplace engagement. In the first study, 82 mid- to high-level managers were asked every morning how many minutes they used their smartphone after 9:00 pm the night before and how many hours they slept. Then, they were asked to rate their agreement with statements like “I feel drained” and “Right now, it would take a lot of effort for me to concentrate on something.”

In the afternoon, they had to assess statements about work engagement, such as “Today while working, I forgot everything else around me.”

Prior studies have shown that staying focused and resisting distractions takes a lot of effort, so when smartphone use interferes with sleep, it takes a toll the next day.

“The benefit of smartphone use may…be offset by the inability of employees to fully recover from work activities while away from the office,” the researchers write.

After accounting for sleep quality, the researchers found that work-related smartphone use in the evening was associated with fewer hours of sleep. The subjects who recorded shorter nights also reported depleted reserves of self-control, and those who felt morning exhaustion also indicated they were less engaged during the day, a domino effect that shows how an unending workday ultimately leads to poorer work.

The second study, which involved 161 workers, measured how late-night tech use—on smartphones, laptops, tablets and TV—can disrupt sleep and next-day work engagement.

In her book, “Sleeping With Your Smartphone,” Harvard Business School professor Leslie Perlow studied executives at Boston Consulting Group who were given a chance to disconnect on a regular basis. The executives became more excited about their work, felt more satisfied about their professional and personal lives and even became more collaborative and efficient.

Using any kind of electronic device affects sleep quantity and focus the following day, but smartphones are especially draining. That’s partly because the always-on, always-handy phone the first device we turn to, says Christopher M. Barnes, an assistant professor of management at University of Washington’s Michael G. Foster School of Business and a co-author of the paper. Having a screen so close to our faces probably doesn’t help us prepare for sleep, he adds.

The researchers don’t yet know if there’s a particular threshold at which smartphone use begins to affect sleep habits, but even 30 minutes before bedtime can take a toll, Barnes says.

The fix, researchers say, is to put down the phone and enjoy the evening. But that’s easier said than done, so long as managers send emails at 10:30 p.m. and expect responses by 10:31 pm. Barnes says real change will have to come from the top, with managers setting an example by not sending those messages in the first place, or at least toning down expectations on response time.

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Blue light can fight fatigue during the day

A study shows that blue light from phones and computers can alleviate fatigue throughout the day.

Researchers from Brigham and Women's Hospital (BWH) have found that exposure to short wavelength, or blue light, during the biological day directly and immediately improves alertness and performance. These findings are published in the February issue ofSleep.

"Our previous research has shown that blue light is able to improve alertness during the night, but our new data demonstrates that these effects also extend to daytime light exposure," said Shadab Rahman, PhD, a researcher in BWH's Division of Sleep Medicine and lead author of this study. "These findings demonstrate that prolonged blue light exposure during the day has an an alerting effect."

In order to determine which wavelengths of light were most effective in warding off fatigue, the BWH researchers teamed with George Brainard, PhD, a professor of neurology at Thomas Jefferson University, who developed the specialized light equipment used in the study. Researchers compared the effects of blue light with exposure to an equal amount of green light on alertness and performance in 16 study participants for 6.5 hours over a day. Participants then rated how sleepy they felt, had their reaction times measured and wore electrodes to assess changes in brain activity patterns during the light exposure.

The researchers found that participants exposed to blue light consistently rated themselves as less sleepy, had quicker reaction times and fewer lapses of attention during the performance tests compared to those who were exposed to green light. They also showed changes in brain activity patterns that indicated a more alert state.

"These results contribute to our understanding of how light impacts the brain and open up a new range of possibilities for using light to improve human alertness, productivity and safety," explained Steven Lockley, PhD, neuroscientist at BWH and senior investigator of the study. "While helping to improve alertness in night workers has obvious safety benefits, day shift workers may also benefit from better quality lighting that would not only help them see better but also make them more alert."

Researchers note that the next big challenge is to figure out how to deliver better lighting. While natural light is ideal, many people do not have access to daylight in their schools, homes or work places. In addition to improvements in daylight access, the advent of new, more controllable lighting technologies may help enable researchers to develop 'smart' lighting systems designed to maximize the beneficial effects of light for human health, productivity and safety.

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Expensive computer programs for children with ADHD don't help their grades

Reports show that expensive computer programs and therapies for children with ADHD are not effective and do not help their grades.

Many parents spend thousands of dollars on computer-based training programs that claim to help children with ADHD succeed in the classroom and in peer relationships while reducing hyperactivity and inattentiveness. But a University of Central Florida researcher says parents are better off saving their hard-earned cash.

Psychology professor Mark Rapport's research team spent two years analyzing the data from 25 studies and found that those programs are not producing significant or clinically meaningful long-term improvements in children's cognitive abilities, academic performance or behavior.

"Parents are desperate for help," said Rapport, who runs the Children's Learning Clinic IV at UCF. "If they can afford it, they are willing to spend the money, and some parents even enroll their children in private schools because they offer these cognitive training programs. But there is no empirical evidence to show those investments are worthwhile."

Rapport initiated the study because many parents of children who have been evaluated at his clinic asked him whether they should invest in the programs. The study is featured in the December issue of Clinical Psychology Review.

His team analyzed published studies sponsored by the companies themselves as well as all independent published studies in the literature -- and he drew his conclusions based on analyzing "blinded" studies, meaning studies in which researchers and independent raters used objective measures and did not know which children were assigned to the cognitive training programs as opposed to an inactive placebo condition.

Working memory represents one of the most important core deficits in children with ADHD, and improvements in working memory are associated with improved academic performance, behavior, peer relationships and other intellectual abilities. Surprisingly, although a majority of the cognitive training programs claimed to train this important aspect of brain functioning, closer examination of their training exercises revealed that they actually train short-term memory.

Short-term memory stores information in mind for a brief interval, whereas working memory uses the stored information for accomplishing a wide range of cognitive tasks, such as reading comprehension, mental math, and multitasking.

Rapport said his conclusions do not mean that the computer-based programs cannot become a helpful tool for children with ADHD. If programs can be designed to focus on working memory, it is worth evaluating whether they can help children's cognitive abilities, academic performance and behavior, he said.

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Why technology doesn't belong in a child's bedroom

This article discusses why technology in a child's bedroom is detrimental to their sleep quality.

Technology such as computers and smartphones in children's bedrooms can cause anxiety and sleep loss, scientists at Canada's Dalhousie University report.

Having technology such as televisions, smartphones and game consoles in the bedroom teaches the brain to see the room as an entertainment experience rather than a place for quiet and rest, they said.

Playing violent video games in the bedroom conditions the brain to see it as a place of danger, leading it to stay in a state of alert rather than resting, they added.

"One of the biggest culprits for inadequate and disturbed sleep is technology," Dalhousie researcher Jennifer Vriend, the study's lead author, said.

"Many teenagers sleep with their phones and they are awakened regularly by it ringing or vibrating throughout the night when they get a text, email or Facebook message.

"Having televisions and game consoles in the bedroom is also a problem," she said. "It sets up the brain to see the room as an entertainment zone rather than a quiet, sleepy environment."

Losing just one hour's sleep can reduce a child's performance at school, the study published in the Journal of Pediatric Psychology found.

"Even modest differences in sleep duration, accumulated over a few days, can affect critical cognitive and emotional functions in children," the study authors wrote.

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Common migraine triggers to avoid

This article discusses seven common migraine triggers that those prone to migraines should avoid.

It’s estimated that 28 million americans suffer from migraines. Migraines are intense headaches that are often accompanied by nausea, vomiting and sensitivity to light. They don’t simply come and go; each migraine can last between four hours and three days. Most migraine sufferers know to avoid certain things like dairy, alcohol and food with excessive additives, but there are other external factors that could trigger a migraine. Here are some to watch out for.

1. Change in Routine

For some migraine sufferers, routine is key to keeping the headaches at bay.  Change in sleep patterns, work hours or even holidays can create stress and lead to migraines.

2. Stress

As mentioned above, migraines and stress are strongly linked. Some people report migraines start when stress reduces, sometimes leading to “weekend headaches” after a stressful work week.

3. The Environment 

High altitude, weather changes and humidity can all trigger migraines.

4. Computer Screens

Both the posture you take when sitting in front of a computer and the glare from the screen can lead to migraine pain. Be sure to sit comfortably to avoid muscle tension and use an anti-glare screen.

5. Lack of Food

Insufficient food is one of the main dietary triggers of migraines. Avoid missing meals or snacking on treats high in sugar. Eating small, nutritious snacks throughout the day can help control migraine attacks.

6. Hormonal Change (In Women)

Fluctuation in estrogen may cause headaches in women who suffer from migraines. These women often report an increase in migraines immediately before or during their menstrual cycle, when there is a major drop in estrogen levels.

7. Sensory Overstimulation

Bright lights, loud noises and unusual smells, including perfume and secondhand smoke can trigger migraines. 

Migraine triggers are unique to every individual, and can happen as early as 6 to 8 hours prior to a migraine attack.

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Light at night may cause depression for those with sleep apnea

Research claims that dim light at night can increase depression for people who have obstructive sleep apnea.

New research suggests the estimated 12 million Americans who have obstructive sleep apnea should sleep in a very dark room.

Scientists at Ohio State University Wexner Medical Center have found exposure to dim light at night can interact with sleep apnea and lead to increased levels of depression and anxiety in mice.

“Although it is unclear at the present time whether sleep apnea causes depression, both conditions are commonly seen together in patients. Our research suggests that sleeping even with a minimum amount of light may increase symptoms of depression in those with sleep apnea,” says Dr. Ulysses Magalang, director of Ohio State’s Sleep Disorders Center and a co-author of the study.

Obstructive sleep apnea is a common problem, especially among smokers and people who are overweight. The disorder causes abnormal breathing while sleeping, lowers oxygen levels and is linked to high blood pressure, diabetes, and higher risk of stroke and heart failure. The most common signs include loud snoring, daytime sleepiness, irritability and memory problems.

Magalang offers these suggestions for improving sleep and reducing light exposure at night:

• Use room-darkening drapes or shades on windows to block outside light from traffic, streetlights and neighboring buildings.
• Turn off the television, computer and other electronic devices before going to sleep.
• Choose clocks or night lights with red lighting instead of blue or green.

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Electronic media affects children's sleeping patterns

Research shows that children's sleeping patterns can be negatively affected due to the amount of time a child spends with electronic media.

Children's sleep disruption is worse with increased time spent watching TV or playing on the computer, finds research in Biomed Central's open access journal BMC Public Health. The greater the e-media use was at the start of the study, the shorter the sleep duration and the later the bedtime was eighteen months later. The academics suggest that where children are struggling to sleep, or are tired, their media habits should be taken into consideration.

The amount of sleep children get has a direct bearing on their performance in school and their mental and physical health. Snap shot studies suggest that the more kids use electronic media the less sleep they get, and that their sleep is more likely to be disturbed. But how much does watching TV or playing on the computer affect sleep patterns as children grow up?

To answer this question researchers from Folkhälsan Research Center, Finland, compared computer use and TV viewing with sleep patterns in 10-11 year olds and then reassessed them eighteen months later. Children with a TV or computer in their bedroom, compared with the frequency of usage, demonstrated a greater delay when going to bed on school days and the weekend which resulted in less sleep. However girls may be catching up at the weekends as they tended to sleep in more as they got older.

When the researchers looked at boys and girls separately they found that there were other gender differences -- boys with a computer or TV in their bedroom went to bed later than the girls and had a larger increase in bed time.

Teija Nuutinen, who led this study commented, "Children need extra sleep as they go through puberty but our study finds that TV and computer use affect the sleep of children. This is especially true during the week and may be impacting their school work as well as their development. Media viewing habits should be considered for kids who are tired and struggling to concentrate, or who have behaviour problems caused by lack of sleep."

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Technology hurting your sleep

Light from phones, tablets and computers can interfere with a person's natural melatonin production and interfere with sleep.

Smartphones and tablets can make for sleep-disrupting bedfellows. One cause is believed to be the bright light-emitting diodes that allow the use of mobile devices in dimly lit rooms; the light exposure can interfere with melatonin, a hormone that helps control the natural sleep-wake cycle. But there may be a way to check your mobile device in bed and still get a good night's sleep. A Mayo Clinic study suggests dimming the smartphone or tablet brightness settings and holding the device at least 14 inches from your face while using it will reduce its potential to interfere with melatonin and impede sleep.

The research was among Mayo Clinic studies being presented at SLEEP 2013, the Associated Professional Sleep Societies annual meeting in Baltimore.

"In the old days people would go to bed and read a book. Well, much more commonly people go to bed and they have their tablet on which they read a book or they read a newspaper or they're looking at material. The problem is it's a lit device, and how problematic is the light source from the mobile device?" says co-author Lois Krahn, M.D., a psychiatrist and sleep expert at Mayo Clinic in Scottsdale, Ariz.

"There's a lot of concern about using mobile devices and that prompted me to wonder, are they always a negative factor for sleep?" Dr. Krahn says. "We found that only at the highest setting was the light over a conservative threshold that might affect melatonin levels. If it's at the mid setting or at a low setting it's bright enough to use."

In the study, researchers experimented with two tablets and a smartphone in a dark room, using a meter on its most sensitive setting to measure the light the devices emitted at various settings when held various distances from a person's face. They discovered that when brightness settings were lowered and the devices were held just over a foot from a user's face, it reduced the risk that the light would be bright enough to suppress melatonin secretion and disrupt sleep.

Other Mayo research presented at the conference includes the finding that some sleep apnea patients may not need annual follow-up visits. Patients with obstructive sleep apnea being treated with positive airway pressure are less likely to need a yearly check-up.

The researchers suggest developing a screening tool to assess which of these patients need annual follow-up visits.

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Identifying conditions contributing to concussions and brain damage

A new computer model claims to help reduce concussions and brain injury in athletes and soldiers.

Concussions can occur in sports and in combat, but health experts do not know precisely which jolts, collisions and awkward head movements during these activities pose the greatest risks to the brain. To find out, Johns Hopkins engineers have developed a powerful new computer-based process that helps identify the dangerous conditions that lead to concussion-related brain injuries. This approach could lead to new medical treatment options and some sports rule changes to reduce brain trauma among players.

The research comes at a time when greater attention is being paid to assessing and preventing the head injuries sustained by both soldiers and athletes. Some kinds of head injuries are difficult to see with standard diagnostic imaging but can have serious long-term consequences. Concussions, once dismissed as a short-term nuisance, have more recently been linked to serious brain disorders.

"Concussion-related injuries can develop even when nothing has physically touched the head, and no damage is apparent on the skin," said K. T. Ramesh, the Alonzo G. Decker Jr. Professor of Science and Engineering who led the research at Johns Hopkins. "Think about a soldier who is knocked down by the blast wave of an explosion, or a football player reeling after a major collision. The person may show some loss of cognitive function, but you may not immediately see anything in a CT-scan or MRI that tells you exactly where and how much damage has been done to the brain. You don't know what happened to the brain, so how do you figure out how to treat the patient?"

To help doctors answer this question, Ramesh led a team that used a powerful technique called diffusion tensor imaging, together with a computer model of the head, to identify injured axons, which are tiny but important fibers that carry information from one brain cell to another. These axons are concentrated in a kind of brain tissue known as "white matter," and they appear to be injured during the so-called mild traumatic brain injury associated with concussions. Ramesh's team has shown that the axons are injured most easily by strong rotations of the head, and the researchers' process can calculate which parts of the brain are most likely to be injured during a specific event.

The team described its new technique in the Jan. 8 edition of the Journal of Neurotrauma. The lead author, Rika M. Wright, played a major role in the research while completing her doctoral studies in Johns Hopkins' Whiting School of Engineering, supervised by Ramesh. Wright is now a postdoctoral research fellow at Carnegie Mellon University. Ramesh is continuing to conduct research using the technique at Johns Hopkins with support from the National Institutes of Health.

Beyond its use in evaluating combat and sports-related injuries, the work could have wider applications, such as detecting axonal damage among patients who have received head injuries in vehicle accidents or serious falls. "This is the kind of injury that may take weeks to manifest," Ramesh said. "By the time you assess the symptoms, it may be too late for some kinds of treatment to be helpful. But if you can tell right away what happened to the brain and where the injury is likely to have occurred, you may be able to get a crucial head-start on the treatment."

Armed with this knowledge, Ramesh and his colleagues want to use their new technology to examine athletes, particularly football and hockey players, who are tackled or struck during games in ways that inflict that violent side-to-side motion on the head. In the recent journal article, the authors point out that many professional sports games are recorded in high-definition video from multiple angles. This, they write, could allow researchers to reconstruct the motions involved in sport collisions that lead to the most serious head injuries.

The authors also noted that some sports teams equip their players' helmets or mouth guards with instruments that can measure the acceleration of the head during an impact. Such data, entered into the researchers' computer model, could help determine the likely location of brain damage. These results, combined with neuropsychological tests, could be used to guide the athlete's treatment and rehabilitation, the authors said, and to help a sports team decide when an athlete should be allowed to resume playing. This strategy also may help reduce the risk to athletes arising from a degenerative disease linked to repeated concussions.

More research, testing and validation must be conducted before the computer model can become useful in a clinical setting. This will include animal experiments and the correlation of data from event reconstruction to make sure the model accurately identifies brain injuries.

Ideally, Ramesh would like to collect digital brain images from soldiers and athletes before they enter combat or join highly physical sports activities. "We would then be able to track a high-risk population and keep records detailing what types of head injuries they experience," he said. "Then, we could look at how their brains may have changed since the original images were collected. This will also help guide the physicians and health professionals who provide treatment after critical events."

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TV and Devices in Kids' Bedrooms Linked to Poor Sleep and Obesity

A study looks at the impact televisions and other devices in childrens' bedrooms has on their quality of sleep.

Children who bask in the nighttime glow of a TV or computer don't get enough rest and suffer from poor lifestyle habits, new research from the University of Alberta has shown.

A province-wide survey of Grade 5 students in Alberta showed that as little as one hour of additional sleep decreased the odds of being overweight or obese by 28 per cent and 30 per cent, respectively. Children with one or more electronic devices in the bedroom -- TVs, computers, video games and cellphones -- were also far more likely to be overweight or obese.

"If you want your kids to sleep better and live a healthier lifestyle, get the technology out of the bedroom," said co-author Paul Veugelers, a professor in the School of Public Health, Canada Research Chair in Population Health and Alberta Innovates -- Health Solutions Health Scholar.

Veugelers, director of the Population Health Intervention Research Unit that works with the Alberta Project Promoting active Living and healthy Eating (APPLE Schools), said the research is the first to connect the dots on the relationship between sleep, diet and physical activity among kids.

Nearly 3,400 Grade 5 students were asked about their nighttime sleep habits and access to electronics through the REAL Kids Alberta survey. Half of the students had a TV, DVD player or video game console in their bedroom, 21 per cent had a computer and 17 per cent had a cellphone. Five per cent of students had all three types of devices.

Some 57 per cent of students reported using electronics after they were supposed to be asleep, with watching TV and movies being the most popular activity. Twenty-seven per cent of students engaged in three or more activities after bedtime.

Researchers found that students with access to one electronic device were 1.47 times as likely to be overweight as kids with no devices in the bedroom. That increased to 2.57 times for kids with three devices, with similar results reported among obese children.

More sleep also led to significantly more physical activity and better diet choices, researchers found.

Co-author Christina Fung noted that children today are not sleeping as much as previous generations, with two-thirds not getting the recommended hours of sleep per night. In addition to healthy lifestyle habits, a good night's sleep has been linked to better academic outcomes, fewer mood disorders and other positive health outcomes, she said.

"It's important to teach these children at an earlier age and teach them healthy habits when they are younger."

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