for the Pediatric Emergency Research Canada (PERC) Concussion Team IMPORTANCE Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. OBJECTIVE To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. EXPOSURES All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. MAIN OUTCOMES AND MEASURES The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. RESULTS In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n = 2006 in the derivation cohort; n = 1057 in the validation cohort) and 2584 of whom (n = 1701 [85%] in the derivation cohort; n = 883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n = 510 [30.0%] in the derivation cohort and n = 291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. CONCLUSIONS AND RELEVANCEA clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.

A widely distributed network of brain areas contributes to emotional processing. Among these regions, the right dorsomedial prefrontal cortex is one main area mediating self-reference. By providing a personal perspective in the evaluation of emotional stimuli, the right dorsomedial prefrontal cortex may mediate cognitive processes, such as those involved in psychotherapy, that guide self-regulation of emotional experience.

Previous experiments have found that individuals with Alzheimer's disease (AD) show increased activity in prefrontal regions compared with healthy age-matched controls during cognitive tasks. This has been interpreted as compensatory reallocation of cognitive resources, but direct evidence for a facilitating effect on performance has been lacking. To address this we measured neural activity during semantic and episodic memory tasks in mildly demented AD patients and healthy elderly controls. Controls recruited a left hemisphere network of regions, including prefrontal and temporal cortices in both the semantic and episodic tasks. Patients engaged a unique network involving bilateral dorsolateral prefrontal and posterior cortices. Critically, activity in this network of regions was correlated with better performance on both the semantic and episodic tasks in the patients. This provides the most direct evidence to date that AD patients can use additional neural resources in prefrontal cortex, presumably those mediating executive functions, to compensate for losses attributable to the degenerative process of the disease.

Over the past several decades, researchers have taken an interest in theatre as a unique method of analysing data and translating findings. Because of its ability to communicate research findings in an emotive and embodied manner, theatre holds particular potential for health research, which often engages complex questions of the human condition. In order to evaluate the research potential of theatre, this article critically examines examples of evaluated health research studies that have used theatre for the purposes of data analysis or translation. We examine these studies from two perspectives. First, the literature is divided and categorized into four theatre genres: (1) non-theatrical performances; (2) ethnodramas, which can be interactive or non-interactive; (3) theatrical research-based performances; and (4) fictional theatrical performances. This categorization highlights the importance of these genres of theatre and provides an analysis of the benefits and disadvantages of each, thus providing insight into how theatre may be most effectively utilized in health research. Second, we explore the efficacy of using theatre for the purposes of data analysis and knowledge transfer, and critically examine potential approaches to the evaluation of such endeavours.

The authors administered social cognition tasks to younger and older adults to investigate age-related differences in social and emotional processing. Although slower, older adults were as accurate as younger adults in identifying the emotional valence (i.e., positive, negative, or neutral) of facial expressions. However, the age difference in reaction time was largest for negative faces. Older adults were significantly less accurate at identifying specific facial expressions of fear and sadness. No age differences specific to social function were found on tasks of self-reference, identifying emotional words, or theory of mind. Performance on the social tasks in older adults was independent of performance on general cognitive tasks (e.g., working memory) but was related to personality traits and emotional awareness. Older adults also showed more intercorrelations among the social tasks than did the younger adults. These findings suggest that age differences in social cognition are limited to the processing of facial emotion. Nevertheless, with age there appears to be increasing reliance on a common resource to perform social tasks, but one that is not shared with other cognitive domains.

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In children, the importance of detecting deficits after mild traumatic brain injury (mTBI) or concussion has grown with the increasing popularity of leisure physical activities and contact sports. Whereas most postconcussive symptoms (PCS) are similar for children and adults, the breadth of consequences to children remains largely unknown. To investigate the effect of mTBI on brain function, we compared working memory performance and related brain activity using blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) in 15 concussed youths and 15 healthy age-matched control subjects. Neuropsychological tests, self-perceived PCS, and levels of anxiety and depression were also assessed. Our results showed that, behaviorally, concussed youths had significantly worse performances on the working memory tasks, as well as on the Rey figure delayed recall and verbal fluency. fMRI results revealed that, compared to healthy children, concussed youths had significantly reduced task-related activity in bilateral dorsolateral prefrontal cortex, left premotor cortex, supplementary motor area, and left superior parietal lobule during performance of verbal and nonverbal working memory tasks. Additionally, concussed youths also showed less activation than healthy controls in the dorsal anterior cingulate cortex, left thalamus, and left caudate nucleus during the nonverbal task. Regression analysis indicated that BOLD signal changes in bilateral dorsolateral prefrontal cortex were significantly correlated with performance such that greater activities in these regions, relative to the control condition, were associated with greater accuracy. Our findings confirmed functional alterations in brain activity after concussion in youths, a result similar to that observed in adults. However, significant differences were noted. In particular, the observation of reduced working memory accuracy suggests that youths may be unable to engage compensatory strategies to maintain cognitive performance after mTBI. This has significant implications for safe return to daily activities, including competitive sport.