Teenagers have traditionally been the most dangerous drivers on the road, with accident rates four times that of older drivers. A recent AAA study calculates just how their risk of a fatal crash is multiplied when they have other teenagers in the car.

The risk of a fatal crash increases by nearly half when a 16- or 17-year-old driver has one teenage passenger; it doubles with two teen passengers; and it quadruples with three or more passengers.

As reported by the Washington Post, the study is the latest report to raise concerns about teenage drivers. In reviewing preliminary data from the first six months of 2011, the Governors Highway Safety Association found a slight increase in the number of fatal crashes involving 16- and 17-year-old drivers. If the trend continued, 2011 would reverse a recent trend of falling teenage fatalities.

In another study, the National Highway Traffic Safety Administration last month said its research found that drivers under the age of 24 were much more likely than older drivers to send and receive text messages while driving.

Full article via Auto Accident Lawyers Northern Va -Burnett & Williams

These findings, published in the May issue of the Journal of Neuroscience, advance research in the field of traumatic brain injury (TBI), enabling researchers to better understand what brain structural or functional changes underlie posttraumatic disorders – a question that until now has remained unclear.

Previous research has shown that even a mild case of TBI can result in long-lasting neurological issues that include slowing of cognitive processes, confusion, chronic headache, posttraumatic stress disorder and depression.

The VCU team, led by Kimberle M. Jacobs, Ph.D. , associate professor in the Department of Anatomy and Neurobiology , demonstrated for the first time, using sophisticated bioimaging and electrophysiological approaches, that mild injury can cause structural disruption of axons in the brain while also changing the way the neurons fire in areas where they have not been structurally altered. Axons are nerve fibers in the brain responsible for conducting electrical impulses. The team used models of mild traumatic brain injury and followed morphologically identified neurons in live cortical slices.

“These findings should help move the field forward by providing a unique bioimaging and electrophysiological approach to assess the evolving changes evoked by mild TBI and their potential therapeutic modulation,” said co-investigator, John T. Povlishock, Ph.D. , professor and chair of the VCU School of Medicine’s Department of Anatomy and Neurobiology and director of the Commonwealth Center for the Study of Brain Injury.

According to Povlishock, additional benefit may also derive from the use of this model system with repetitive injuries to determine if repeated insults exacerbate the observed abnormalities.

The study, led by Tracey Covassin of MSU’s Department of Kinesiology, found females performed worse than males on visual memory tests and reported more symptoms postconcussion.

Additionally, high school athletes performed worse than college athletes on verbal and visual memory tests, and some of the younger athletes still were impaired up to two weeks after their injuries.

“While previous research suggests younger athletes and females may take longer to recover from a concussion, little was known about the interactive effects of age and sex on symptoms, cognitive testing and postural stability,” said Covassin, a certified athletic trainer at MSU.

“This study confirms that age and sex have an impact on recovery, and future research should focus on developing treatments tailored to those differences.”

The research funded by a two-year grant from the National Operating Committee on Standards for Athletic Equipment, appears in the current edition of the American Journal of Sports Medicine.

Between 2001 and 2005, federal statistics reveal more than 150,000 sport-related concussions occurred among youth ages 14 to 19. However, the actual number is likely much higher, as current statistics reflects only concussions that involved visits to the emergency departments.

The study led by Covassin looked at nearly 300 concussed athletes from multiple states over two years. All of the athletes had previously completed a baseline test before taking three different postconcussion tests, the same ones used in professional sports, after being injured.

When it comes to sex differences, Covassin – who has worked with thousands of young athletes across mid-Michigan since coming to MSU in 2005 – said what often is needed most is simple education.

“We need to raise awareness that yes, female athletes do get concussions,” she said. “Too often, when we speak with parents and coaches, they overlook the fact that in comparable sports, females are concussed more than males.”

Coupled with the fact that high school athletes take longer to recover than collegiate athletes, Covassin said the study reveals a real potential danger to younger athletes by not fully recovering after a concussion.

“Younger athletes appear more at risk for second-impact syndrome, where a second concussion can come with more severe symptoms,” she said. “While it is rare, there is a serious risk for brain damage, and the risk is heightened when athletes are coming back before they heal.”

The next steps, Covassin said, are to investigate sex and age differences at the youth sport level and whether treatment options needed to be tailored for an athlete’s age.

“If we can develop treatments that speak directly to sex and age, I think we can better protect athletes from the long-term side effects of concussions,” she said.

Global Health Care Company Abbott Laboratories Inc. has pleaded guilty and agreed to pay $1.5 billion to resolve its criminal and civil liability arising from the company’s unlawful promotion of the prescription drug Depakote for uses not approved as safe and effective by the Food and Drug Administration (FDA), the Justice Department announced today.  The resolution – the second largest payment by a drug company – includes a criminal fine and forfeiture totaling $700 million and civil settlements with the federal government and the states totaling $800 million.  Abbott also will be subject to court-supervised probation and reporting obligations for Abbott’s CEO and Board of Directors.

“Today’s settlement shows further evidence of our deep commitment to public health and our determination to hold accountable those who commit fraud,” said James M. Cole, Deputy Attorney General.  “We are resolute in stopping this type of activity and today’s settlement sends a strong message to other companies.”  

The FDA is responsible for approving drugs as safe and effective for specified uses. Under the Food, Drug and Cosmetic Act (FDCA), a company in its application to the FDA must specify each intended use of a drug.  A company’s promotional activities must be limited to only the intended uses that FDA approved.   In fact, promotion by the manufacturer for other uses – known as “off-label” uses – renders the product misbranded.

Abbott has pleaded guilty to misbranding Depakote by promoting the drug to control agitation and aggression in elderly dementia patients and to treat schizophrenia when neither of these uses was FDA approved.   In an agreed statement of facts filed in the criminal action, Abbott admits that from 1998 through 2006, the company maintained a specialized sales force trained to market Depakote in nursing homes for the control of agitation and aggression in elderly dementia patients, despite the absence of credible scientific evidence that Depakote was safe and effective for that use.   In addition, from 2001 through 2006, the company marketed Depakote in combination with atypical antipsychotic drugs to treat schizophrenia, even after its clinical trials failed to demonstrate that adding Depakote was any more effective than an atypical antipsychotic alone for that use.

Illegal Promotion of Depakote to Control Agitation and Aggression in Dementia Patients

       The FDA approved Depakote for only three uses: epileptic seizures, bipolar mania and the prevention of migraines.  The FDA never approved the drug as safe and effective for the off-label use of controlling behavioral disturbances in dementia patients.  In 1999, Abbott was forced to discontinue a clinical trial of Depakote in the treatment of dementia due to an increased incidence of adverse events, including somnolence, dehydration and anorexia experienced by the elderly study participants administered Depakote.

Abbott trained its sales force to promote Depakote to health care providers and employees of nursing homes as advantageous over antipsychotic drugs for controlling agitation and aggression in elderly dementia patients because Depakote was not subject to certain provisions of the Omnibus Budget Reconciliation Act of 1987 (OBRA) and its implementing regulations designed to prevent the use of unnecessary medications in nursing homes.   Exploiting the fact that certain OBRA provisions did not yet apply to Depakote, Abbott sales representatives stated that by using Depakote, nursing homes could avoid the administrative burdens and costs of complying with OBRA.

Abbott’s off-label promotion of Depakote was multifaceted.   The company entered into contracts that provided long-term care pharmacy providers with payments of rebates based on increases in the use of Depakote in nursing homes serviced by the providers.   In addition to using its sales force to promote the drug to health care providers and employees of nursing homes, Abbott created programs and materials to train the pharmacy providers’ consultant pharmacists about the off-label use of Depakote to encourage them to recommend the drug for this unapproved use.   Under these contracts, Abbott paid millions of dollars in rebates to the pharmacy providers.

 “Not only did Abbott engage in off-label promotion, but it targeted elderly dementia patients and downplayed the risks apparent from its own clinical studies,” said Acting Associate Attorney General Tony West.  “As this criminal and civil resolution demonstrates, those who put profits ahead of patients will pay a hefty price.”

Illegal Off-Label Promotion of Depakote for Schizophrenia

In the agreed statement of facts, Abbott also admitted that from 2001 through 2006, the Company misbranded Depakote by marketing the drug to treat schizophrenia.  Abbott funded two studies of the use of Depakote to treat schizophrenia, and both failed to meet the main goals established for the study.  When the second study failed to show a statistically significant treatment difference between antipsychotic drugs used in combination with Depakote and antipsychotic drugs alone, Abbott waited nearly two years to notify its own sales force about the study results and another two years to publish those results.  During this time, Abbott continued to promote Depakote off-label to treat schizophrenia.

 “ Today’s settlement demonstrates our continued scrutiny of the sales and marketing practices of pharmaceutical companies that put profits ahead of patient health,” said U.S. Food and Drug Administration Commissioner Margaret Hamburg, M.D.  “The FDA will continue its due diligence and hold pharmaceutical companies accountable for marketing practices that undermine the drug approval process.”

Criminal Plea

Today’s global resolution has criminal, civil and administrative components.   First, Abbott has pleaded guilty to a criminal misdemeanor for misbranding Depakote in violation of the FDCA.   Under the plea agreement, Abbott will pay a criminal fine of $500 million, forfeit assets of $198.5 million, and submit to a term of probation for five years.   In addition, Abbott will also pay $1.5 million to the Virginia Medicaid Fraud Control Unit.   As a condition of probation, Abbott will report any probable FDCA violations to the probation office, its CEO will certify compliance with this reporting requirement, and its board will report annually on the effectiveness of the company’s compliance program.   In addition, Abbott agrees that during the term of probation, the company will not compensate sales representatives for off-label sales, will ensure that continuing medical education grant-making decisions are not controlled by sales and marketing, will require that letters communicating medical information to healthcare providers be accurate and unbiased, and will have policies designed to ensure that clinical trials are approved by the company’s medical or scientific organizations and published in a consistent and transparent manner.   Abbott’s guilty plea and sentence are not final until accepted by the U.S. District Court for the Western District of Virginia.

“As the agreed statement of facts filed in court today demonstrates, Abbott promoted Depakote to control behaviors in elderly dementia and schizophrenia patients without significant evidence of its effectiveness for that use, and even after clinical data established that it was not effective,” said Timothy Heaphy, U.S. Attorney for the Western District of Virginia.   “The resolution announced today includes a self-policing mechanism by which Abbott’s board of directors will monitor compliance with the law and report any violations, as well as a period of probation and court supervision.   We credit Abbott’s acceptance of responsibility and encourage other pharmaceutical companies to impose the similar mechanisms to prevent off-label marketing, which damages health care consumers.”

Civil Settlement

Under the civil settlement, Abbott has agreed to pay $800 million to the federal government ($560,851,357) and the states ($239,148,643) that opt to participate in the agreement to resolve claims that its unlawful marketing and illegal remuneration practices caused false claims to be submitted to government health care programs such as Medicare, Medicaid, TRICARE and to the Federal Employees Health Benefit Program, the Department of Veterans’ Affairs and the Department of Labor’s Office of Workers’ Compensation Programs.  

The civil settlement addresses broader allegations by the United States that from 1998 through 2008, Abbott unlawfully promoted Depakote for unapproved uses, including behavioral disturbances in dementia patients, psychiatric conditions in children and adolescents, schizophrenia, depression, anxiety, conduct disorders, obsessive-compulsive disorder, post-traumatic stress disorder, alcohol and drug withdrawal, attention deficit disorder and autism.   .   Some of these unapproved uses were not medically accepted indications for which the United States and state Medicaid programs provided coverage for Depakote.  The United States contends that this promotion included, in part, making false and misleading statements about the safety, efficacy, dosing and cost-effectiveness of Depakote for some of these unapproved uses, and claiming use of Depakote to control behavioral disturbances in dementia patients would help nursing homes avoid the administrative burdens and costs of complying with OBRA regulatory restrictions applicable to antipsychotics.  

The civil settlement also covers allegations that Abbott offered and paid illegal remuneration to health care professionals and long term care pharmacy providers to induce them to promote and/or prescribe Depakote and to improperly and unduly influence the content of company sponsored Continuing Medical Education programs, in violation of the Federal Anti-Kickback Statute.   The claims settled by the civil agreement are allegations only and there has been no determination of liability, except to the extent that Abbott has admitted facts in the civil settlement agreement or in the criminal plea and agreed statement of facts filed in the criminal action.

The civil settlement resolves four lawsuits pending in federal court in the Western District of Virginia under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery.  As part of today’s resolution, the whistleblowers will receive $84 million from the federal share of the settlement amount.

Corporate Integrity Agreement

In addition to the criminal and civil resolutions, Abbott has also executed a Corporate Integrity Agreement (CIA) with the Department of Health and Human Services, Office of Inspector General (HHS-OIG).   The five-year CIA requires, among other things, that Abbott’s board of directors review the effectiveness of the company’s compliance program, that high-level executives certify to compliance, that Abbott maintain standardized risk assessment and mitigation processes, and that the company post on its website information about payments to doctors.   Abbott is subject to exclusion from federal health care programs, including Medicare and Medicaid, for a material breach of the CIA and subject to monetary penalties for less significant breaches.

 “As a result of OIG’s joint investigation with our federal and state partners, Abbott Laboratories will enter one of the pharmaceutical industry’s largest settlements and pay $1.5 billion for unlawfully promoting its drug Depakote, including to nursing home patients with dementia,” said HHS Inspector General Daniel R. Levinson.  “Our integrity agreement will hold Abbott accountable for preventing future violations of federal health care laws and FDA requirements, which will protect federal programs, taxpayers and our most vulnerable patients.”

A Multilateral Effort

The criminal case is being prosecuted by the U.S. Attorney’s Office for the Western District of Virginia and the Civil Division’s Consumer Protection Branch.   The civil settlement was reached by the U.S. Attorney’s Office for the Western District of Virginia and the Civil Division’s Commercial Litigation Branch.   Assistance w as provided by representatives of the HHS Office of Counsel to the Inspector General; the Center for Medicare and Medicaid Services (CMS) and Office of the General Counsel, CMS Division; FDA’s Office of Chief Counsel; and the National Association of Medicaid Fraud Control Units.

 “Crimes involving the misbranding of drugs for financial gain will not be tolerated,” stated Richard Weber, Chief IRS Criminal Investigation.  “The special agents of IRS Criminal Investigation will use all their investigative tools, including the use of asset forfeiture statutes, to combat financial crimes and hold corporations accountable for their actions.”

This matter was investigated by the Virginia Attorney General’s Medicaid Fraud Control Unit; the Internal Revenue Service – Criminal Investigation; the FDA – Office of Criminal Investigation; the Defense Criminal Investigative Service; the Health and Human Services – Office of Inspector General; the West Virginia State Police; the Office of Personnel Management – Office of Inspector General; the Department of Veterans’ Affairs Office of Inspector General; the Department of Labor – Office of Inspector General; and TRICARE Program Integrity.

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Kathleen Sebelius, Secretary of HHS.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $7.4 billion since January 2009 in cases involving fraud against federal health care programs.  With the settlement announced today, the Justice Department’s total recoveries in False Claims Act cases since January 2009 will exceed $10.2 billion.   During this same time, the department has secured $3.9 billion in criminal fines, forfeiture, disgorgement, and restitution relating to violations of the FDCA.

Testing the various football helmets for their ability to reduce the risk of concussions, from left to right, are: Ray Daniel, a doctoral candidate in the Virginia Tech -- Wake Forest School of Biomedical Engineering and Sciences (SBES), Steven Rowson, an assistant professor in SBES, and Stefan Duma, the Harry C. Wyatt Professor and department head of SBES. Credit: Virginia TechBlacksburg, Va., May 1, 2012 - Virginia Tech released today the results of its 2012 rating for adult football helmets that is designed to assess a helmet's ability to reduce the risk of concussion. A total of three helmets achieved a "5 star" mark, which is the highest rating awarded by the Virginia Tech Helmet Ratings™. In addition to the Riddell Revolution Speed, which was the only helmet to receive 5 stars last year, the Rawlings Quantum Plus and Riddell 360 also earned 5 stars as the best available helmets.

The process used for evaluating the head protector involves performing 120 impacts on each helmet model at multiple locations and impact energies. To date, the Virginia Tech Helmet Ratings™ for adult football include 15 helmet models that were evaluated using more than 2000 laboratory tests. The ratings, first introduced in 2011, utilize the STAR Evaluation System to assess helmet performance. The STAR, an acronym for the Summation of Tests for the Analysis of Risk, evaluation system was developed using data collected from over 1.8 million head impacts experienced by football players throughout an eight-year span.

“This is a perfect example of a National Institutes of Health (NIH) funded project resulting in translational research. The NIH supported the development of the sensors and data collection that provided the foundation for our rating system. Specifically, you can see Riddell and Rawlings using this research to develop the very best helmets,” said project director Stefan Duma, the Harry C. Wyatt Professor and Department Head of the Virginia Tech – Wake Forest School of Biomedical Engineering and Sciences (SBES).

A total of five new adult football helmet models by Rawlings, Riddell, and Xenith have been released since the Virginia Tech Helmet Ratings™ were first made available in 2011. The Riddell 360 (5 stars), Rawlings Quantum Plus (5-stars), Rawlings Impulse (4-stars), and Rawlings Quantum (4 stars) were new models that are recommended by the researchers. “We recommend any of the 4 or 5 star helmets for players. The specific helmet a player chooses will be dependent on other factors such as a fit and comfort,” said Duma. The remaining new helmet model included in the 2012 ratings was the Xenith X2, which earned a 3 star rating.

Seven helmets are now rated with 4 stars in the 2012 Virginia Tech Helmet Ratings™: Schutt ION 4D, Schutt DNA Pro+, Rawlings Impulse, Xenith X1, Riddell Revolution, Rawlings Quantum, and Riddell Revolution IQ. The remaining five football helmet models were rated with 3 stars or less. The complete ratings are publicly available online www.SBES.vt.edu/nid so that consumers can make educated decisions when purchasing football helmets.

“The three lowest rated helmets from last year are now all off the market. It is encouraging to see this positive shift towards better head protection,” said Steven Rowson, assistant professor of biomedical engineering at Virginia Tech. Rowson was responsible for the development of the STAR Evaluation System and testing of the helmets. “Four of the five new helmet models introduced in the last year earned a 4 or 5 star rating. This helps demonstrate that a data-driven approach can be utilized to optimize helmet design to reduce concussion risk,” he said.

In the future, the researchers will expand the Virginia Tech Helmet Ratings™ to include other sports as well as youth football helmets. To this end, Duma and his team collected the first dataset on head impacts experienced by youth football players last year. In the fall of 2012, researchers at Virginia Tech and Wake Forest will expand this dataset by instrumenting over 300 youth football players from ages 6 to 18 in what is called the KIDS study (Kinematics of Impact Data Set). “As we learn more about youth head impact exposure, we can begin to develop methods to evaluate youth-specific helmet designs,” Duma added.

The Virginia Tech Helmet Ratings are independent of any helmet manufacturer and utilized funding from private donations, the School of Biomedical Engineering and Sciences, and the Institute for Critical Technology and Applied Science. Detailed downloadable reports that outline the methodology and resulting data are available on the web site. As noted on the data sheets, any player may sustain a concussion with even the best equipment, Duma said.

Adil H. Haider, M.D., M.P.H., F.A.C.S., of the Johns Hopkins University School of Medicine, Baltimore, presented the findings of the study at a JAMA media briefing at the National Press Club.

“Trauma remains the leading cause of death and disability among young people around the world. In the United States, more than 50 million people are injured per year, resulting in approximately 169,000 annual deaths and a life-time cost of $406 billion,” according to background information in the article. The use of helicopter emergency medical services (EMS) and its possible effect on outcomes for traumatically injured patients has been the subject of debate. “Because helicopter transport is a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground EMS is warranted.”

Dr. Haider and colleagues conducted a study to compare the association between the use of helicopter vs. ground EMS and survival among adults with traumatic injuries. The study included 223,475 patients older than 15 years who had an injury severity score that was defined as major trauma, and sustaining blunt or penetrating trauma that required transport to U.S. level I or II trauma centers. The patients data were recorded in the 2007-2009 versions of the American College of Surgeons National Trauma Data Bank. The measured outcomes included survival to hospital discharge and discharge disposition.

Of the study population, 61,909 patients were transported by helicopter and 161,566 by ground to trauma centers. Unadjusted mortality was higher for those transported by helicopter (n = 7,813; 12.6 percent) than those by ground (n = 17,775; 11 percent); however, a higher proportion of both level I and level II patients transported by helicopter had higher Injury Severity Scores. After further analyses and controlling for multiple known confounders (factors that can influence outcomes), for patients transported to level I trauma centers, helicopter transport was associated with a 16 percent improved odds of survival compared with ground transport (absolute risk reduction, 1.5 percent). For patients transported to level II trauma centers, helicopter transport was associated with a 15 percent improved odds of survival (absolute risk reduction, 1.4 percent). “Thus, for patients transported to level I trauma centers by helicopter, 65 patients would need to be transported to save 1 life; for patients transported to level II trauma centers, the number needed to treat is 69,” the authors write.

When considering patient disposition following hospital discharge, results suggest a higher injury severity in the helicopter group than in the ground transport group. At level I centers, fewer patients in the helicopter groups were discharged home without services (47.6 percent) than in the ground transport group (57.3 percent). A higher proportion of those transported by helicopter to level I trauma centers were discharged to rehabilitation (18.2 percent vs. 12.7 percent in ground transport group) and to intermediate facilities (9.3 percent vs. 6.5 percent, respectively). Patients transported by ground services were more likely to be discharged from level I centers to a nursing home.

The authors note that it is not clear which aspect of helicopter transport is responsible for the mortality benefit in this highly stratified sample. “Future studies should investigate specific components of helicopter EMS such as prehospital interventions, total prehospital time, crew configuration, and distance as factors that may in part or whole explain the benefit of helicopter EMS for adults with major trauma because understanding the effectiveness of each may help determine which patients benefit most from this resource.”

The researchers add that to date, the development and use of effective prehospital triage tools that can identify adults with a high injury severity score have remained elusive. “Future studies should focus on efficient and user-friendly prehospital assessment tools to properly identify injured adults who will be the most likely to benefit from helicopter transport.”

The increase is alarming and indicates more coaches and athletic trainers should change how they teach the fundamental skills of the game, according to researchers based at the University of North Carolina at Chapel Hill.

Until recently, the number of football-related brain injuries with permanent disability in high school had remained in the single digits since 1984. However, the tally rose to 10 injuries in 2008 and 2009, and there were 13 in 2011, according to the latest catastrophic football injury research annual report from the UNC-based National Center for Catastrophic Sports Injury Research.

“These 2011 numbers are the highest since we began collecting catastrophic brain injury data,” said Fred Mueller, Ph.D., the report’s lead author, director of the center and professor emeritus of exercise and sports science in the College of Arts and Sciences. “This is a major problem.”

About 4.2 million football players compete nationwide, including 1.1 million high schoolers.

The center has collected data and published annual reports on catastrophic football injuries, including fatalities, disabilities and serious injuries, for 48 years. The National Collegiate Athletic Association, National Federation of State High School Associations and the American Football Coaches Association fund the research.

The center’s work is believed to be directly responsible for nearly eliminating football fatalities, as well as drastically reducing the number of cervical cord injuries to single digits, between the late 1960s and the early 1990s.

Since 1977, about 67 percent of football-related catastrophic injuries have been suffered by players as they made tackles. Mueller said part of the problem is that despite being prohibited in 1976, head-to-head contact – such as butt-blocking, face tackling or spearing tackles – is still occurring. These strategies make the head the initial and primary contact point with an opposing player, and often lead to cervical spine fractures or permanent brain injuries.

Some players recover fully after surgery and rehabilitation following injuries. However, many only recover partially, living with paralysis or mental deficiency, relying on intensive lifetime medical care. Since 1984, there have been 488 cervical cord and cerebral injuries with incomplete recovery, including 164 brain injuries, of which 148 were among high schoolers. Additionally, the years between 2001 to 2010 saw a 25 percent jump in football-related disability brain injuries over the previous decade, increasing to 66 from 52 incidents among all types of players.

Other potential reasons for the apparent increase in brain injuries may be because of heightened awareness of the issue. Also, this year’s report updated the number of football participants. However, Mueller noted that neither of these factors likely influenced the overall figures, since the report’s definition of catastrophic injuries (defined as injuries that resulted in brain or spinal cord injury or skull or spine fracture, which involved some disability at the time of the accident) and data collection methods have remained unchanged.

Mueller said reversing the trend required several changes, which some in the football community are already implementing. Coaches must be well versed in the signs and symptoms of concussions, such as headaches, dizziness, nausea and light sensitivity, and pull players from games if they exhibit those indicators. Players should not return to play until cleared by a physician. Teams also should hold pre-season meetings to discuss concussions, conduct medical evaluations of all players and emphasize that the head should not be used in tackling or blocking.

The report’s recommendations also note that schools should hire coaches who teach proper fundamental skills, and retain athletic trainers certified by the National Athletic Trainers’ Association. Referees must be vigilant about throwing flags when they see illegal tackles and parents also must be involved in meetings and discussions about concussions.

“All of these measures are important if we want to continue to make a positive impact on the game,” he said. “We have to continue research in this area. Accurate data not only indicate problem spots, but they also help us offer appropriate precautions and reveal the adequacy of our preventive measures.”

“We don’t tend to think of child labor as a major issue in the U.S. but we should,” said the study’s lead author Carol Runyan, Ph.D., MPH, and professor of epidemiology at the Colorado School of Public Health. “Laws governing the employment of youth ages 14 to 17 in this country are often very lenient and in the case of family farms virtually non-existent.”

Runyan, who led a group of American and Canadian scholars and public health professionals on the project, is now calling for stricter oversight of working conditions for the young including those employed in agriculture.

“Work can help young people develop skills, explore career options, earn money and gain self-esteem,” she said. “But without adequate safeguards in place, work can also be dangerous for youth.”

The report, published last week in Public Health Reports, found that 88 youths under age 20 died from work-related injuries in 2010 while 20,000 missed work in private industry due to occupational-related illness or injury.

Young people comprise a significant part of the U.S. and Canadian labor force. More than 17.6 million workers under age 25 are employed in the U.S. In Canada, nearly three million workers between ages 15 and 24 were employed in 2010.

Runyan said that while work holds many positives for young people, it can also expose them to unsafe tasks and environments with limited supervision.

“For example, a recent national U.S. study reported that 26 percent of workers younger than 18…worked at least part of the day without an adult supervisor and as many as one-third of them reported not having any health and safety training,” Runyan said.

Working youths are at risk in many ways. They can be burned in fast food restaurants, cut by sharp tools in grocery stores, robbed at retail businesses, fall from roofs at construction sites or be involved in traffic collisions. But one of the most dangerous occupations, Runyan said, is farm work.

“From a fatality standpoint, farm work is the most dangerous occupation for kids,” she said. “In farm work, youths are working around heavy equipment, digging and cutting with sharp implements. There are deaths almost every year from young people suffocating in grain bins.”

Youths working on family farms have practically no legal protections and often drive while underage and operate tractors and other heavy equipment.

Runyan began her research while director of the University of North Carolina Injury Prevention Research Center. She now directs the University of Colorado’s Pediatric Injury Prevention, Education and Research Program.

Runyan and colleagues John Lewko, Ph.D., of Laurentian University in Ontario and Kimberly Rauscher, ScD, of West Virginia University, are using the report to advocate for stronger federal monitoring of youth worker safety, including assuring that children working on farms are better protected. They are also encouraging more research into preventing workplace injuries among young people.

Runyan also stressed the need for parental involvement.

“We need to make sure that the jobs our kids take are safe,” she said. “But ultimately it’s not the responsibility of 15-year-olds to ensure their safety –it’s the responsibility of employers.”

Elder abuse encompasses mistreatment, neglect, and exploitation of a physical, psychological, or sexual nature. The Elder Justice Act was signed into law as part of 2010′s Patient Protection and Affordable Care Act, yet it has received no appropriations to date.

PPAR article author Marie-Therese Connolly, JD, a 2011 recipient of a MacArthur Foundation fellowship, presents an extensive analysis of the numerous agencies with responsibility for addressing elder abuse but whose efforts continue to lack adequate coordination and direction. She currently is the director of the nonprofit Life Long Justice, a senior scholar at the Woodrow Wilson International Center for Scholars, and is a consulting expert on the federal government’s Elder Justice Roadmap Project.

“The human and economic toll exacted by elder abuse is vast, cruel, and costly,” said Connolly. “It’s an issue where real federal leadership and a modest investment of resources — by Congress, the Administration, and private funders — could have a profound impact, mitigating the suffering of millions of people and saving billions of dollars.”

She also found that the mistreatment of the senior population can cause a cascade of consequences with implications for the health and economic security of victim, family, community, and nation. Connolly demonstrated that elder abuse has been shown to increase rates of mortality, injury, and disease, as well as a four-fold increase in nursing home admissions.

Other authors focus on data showing that elder abuse remains seriously under-addressed by public policy, as well as a recommended agenda for future research, education, training, and advocacy.

“We are humbled by the collective work of many pioneers and dedicated community, state, and federal organizations to combat the issues of elder abuse, neglect and exploitation — all with the synergistic purposes to improve health and aging, to give voice to those victims who could not, and to protect an extremely vulnerable population from the egregious human right violations,” said XinQi Dong, MD, MPH, a Rush University Medical Center professor who was instrumental in organizing this publication.

The man, 57, whose identity and current city of residence are withheld at his request, sued last August after he was diagnosed less than one year earlier with mesothelioma, an always fatal cancer linked to asbestos exposure, according to court documents.

Weitz & Luxenberg attorney Daniel Wasserberg, Esq., said, “Our client was a construction worker who, in the 1970s and 1980s, helped install underground water and sewer lines. These pipes — 6 to 48 inches in diameter — were made of a concrete-asbestos composite material for strength but also for ease of fabrication. The defendants made, sold or delivered them.”

The plaintiff’s job in part was to cut asbestos-concrete pipes so they could be properly laid and connected beneath public and private streets in and around the Sacramento Valley city of Chico, court documents show.

However, according to the court filing, the task of cutting this particular type of pipe posed extreme health risks.

“Our client performed his work with a gasoline-operated saw,” said Brent Zadorozny, Esq., a Weitz & Luxenberg California mesothelioma attorney. “The cuts generated an enormous amount of cement-asbestos dust, which flew in every direction from the saw’s whirring blades and engine exhaust blast. This veritable snowstorm of asbestos dust was at times so thick you couldn’t see the person standing three feet away from you.”

By the end of each workday, the plaintiff was covered from head to toe in a thick layer of asbestos dust, said Stephen Healy, another Weitz & Luxenberg California mesothelioma attorney and the author of a law textbook on asbestos litigation.

Asbestos is a mineral once widely used in the U.S. as an ingredient in the manufacture of more than 3,000 consumer and industrial products, including shipboard thermal insulation, automobile brake pads, and home roofing and siding products. However, inhalation of “asbestos dust and particles is known to cause malignant mesothelioma, lung cancer, other cancers, asbestosis, and other life-threatening health problems that typically surface decades after exposure,” explained Healy.

Malignant mesothelioma is a rare form of cancer that affects the thin membranes lining organs in the chest (pleura) and abdomen (peritoneum), Healy said. “Mesothelioma is closely linked with asbestos; the only known and scientifically established cause of malignant mesothelioma is from asbestos exposure,” he continued. “Malignant mesothelioma is generally fatal within eight to 16 months of initial onset of symptoms.”

In the litigation just settled, the defendants — two from Southern California, the others from out of state — contended there was no asbestos exposure because their products were not delivered to the construction sites where the plaintiff worked or at the times he worked there, court records show.

The Weitz & Luxenberg California mesothelioma lawyers countered with documents they uncovered indicating that the pipes at issue were in fact delivered where and when the plaintiff worked, said Benno Ashrafi, Esq., head of Weitz & Luxenberg in Los Angeles.

“As so often happens in these kinds of cases, the key to eventually prevailing is solid detective work,” Ashrafi said. “It’s a lot like looking for a needle in a haystack because the evidence is often buried way down deep somewhere within thousands and thousands of pages of records. Weitz & Luxenberg happens to be exceptionally good at hunting down information we hope will tip the scales of justice in favor of our clients.”

The trial originally was to be held in Los Angeles, although the injury occurred in and around Chico. “Los Angeles was where most of our client’s expert witnesses were,” explained Ari Friedman, Esq., a Weitz & Luxenberg Los Angeles office California mesothelioma attorney who also worked on the case. “However, despite our objections, the defendants were able to have the trial be moved to Chico, more than 400 miles to the north. In the end, this did nothing to prevent us from fully pressing our case. If anything, the relocation handed us yet another opportunity to demonstrate that Weitz and Luxenberg will go anywhere and do everything to fight for justice for our clients.”