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Concussions Affect Women More Adversely Than Men

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In this May 13, 2004, file photo, San Jose CyberRays soccer star Brandi Chastain is shown during a news conference in Carson, Calif. Chastain, who scored the game-winning penalty kick that gave the United States the 1999 Women’s World Cup title, has pledged to donate her brain for concussion research when she dies. AP Photo/Nick Ut, File

Retired American soccer star Brandi Chastain recently agreed to donate her brain to concussion research after her death. Females are often an unseen part of the concussion story even though they suffer more concussions than males, have more severe symptoms and are slower to recover. Just why is not completely clear, but the deficit in knowledge is slowly beginning to change thanks to women’s advocates behind Pink Concussions. The group gathered last weekend at Georgetown University to review the science behind concussions, and also to develop recommendations on gender-specific prevention protocols and clinical practices on how best to treat females with concussions.

In comparable sports “female rates of concussions are much higher than those of their male counterparts,” says Zachary Kerr, director of the National Collegiate Athletic Association (NCAA) Injury Surveillance Program. Over a five-year period the rates per 1000 athlete-exposures were 6.3 in females versus 3.4 in males in soccer, 6.0 in females versus 3.9 in males in basketball and 3.3 in females versus 0.9 in males in baseball and softball. Only in swimming and diving did male rates (0.3) exceed those of females (0.5). Headache, dizziness and difficulty concentrating were roughly similar among both sexes, Kerr says. But among injured high school athletes, “larger portions of females are reporting sensitivity to light, sensitivity to noise, nausea and drowsiness,” he says. They were also slower to return to normal activity.

The difference between the incidence and severity of concussions between the sexes does not start at birth, because infants and young children of both sexes have similar rates and symptoms with concussions. Puberty, however, which marks a significant developmental fork in the road for males and females, also marks a divergence for concussions. With its onset, females increasingly experience higher incidence of concussions, different and more severe symptoms, and are often slower to recover from the injury. The symptoms of both sexes begin to converge again after females go through menopause, though use of hormone replacement therapy can have an effect.

It is difficult to study the direct effect of hormones on concussions because they change throughout a woman’s estrous cycle. Testosterone levels in both sexes also fluctuate throughout the day; they are best measured by drawing blood. So most of what we know comes from studies in animals, says Michigan State University kinesiologist Tracey Covassin, and the picture is mixed. Estrogen appears to be a protective factor in male rats, but in female rats, it actually exacerbated the injury, while progesterone appears to be a neuroprotective factor in animals. The menstrual cycle can be a predictor of outcomes after mild traumatic brain injury, argues Jeffrey Bazarian, an emergency medicine neurologist at the University of Rochester. “It looks like women injured during the luteal phase, the last two weeks of the cycle, do worse than women injured during the follicular phase. This may help get us thinking about why there might be a difference between the sexes,” he says. His hypothesis is that the ratio of progesterone to testosterone in a woman and abrupt changes in the levels of those hormones may be key.

“Headache is by far the most common symptom of concussion, more than 90 percent” experience it, says Tad Seifert, a Kentucky neurologist who leads the NCAA Headache Task Force. Among the overall population, migraine is about three times more common in women than men, and at midlife about a quarter of women experience migraine. Estrogen is the primary neuromodulator of headache.

“We know that when there is a drop in estrogen that occurs with ovulation and menstruation, that is a precipitant for migraine . . . It is associated with dysfunctional pain modulation,” Seifert says. “Their brains are wired just a little bit differently to respond to the insult.” Women generally have a longer recovery. Given that, Seifert suggests screening for these higher risk characteristics and maybe treating earlier and more aggressively.

Although hormones are a factor in some of these differences, they do not encompass the entire picture, which also involves the structure of the neck, blood flow in the brain, vulnerability to migraines, and social and educational factors of awareness that affect who gets diagnosed. For example, females have 50 percent less isometric neck strength, 23 percent less neck girth, and 43 percent less head-neck segment stiffness during acceleration than males, Covassin says. This less average bone and muscle support makes the head and brain more vulnerable to sudden movement and predicts risk for concussion.

It’s important to pinpoint the underlying biological causes of concussions and devise proper treatments. Concussions, especially in developing adults, may play a role in social development, according to Mayumi Prins, a neurobiologist at the University of California Los Angeles (UCLA). Work in a rat model of concussion has found evidence. “There are not only sex differences but age related sex differences, even within the adolescent time period,” Prins says. “Social interactions were different.” Concussed female animals avoided play and interaction with others. “If a normal animal can pick up that another animal has an injury and it affects their willingness to interact with them . . . this can have serious consequences during a development time period when social interaction is really key to their growth and development,” she says. Repeated concussions, without adequate time for full recovery between them, can have a compounded effect.

But it isn’t all biology—social roles, expectations, and education and training also shape our recognition of and reaction to concussions. Male athletes are more likely to recognize that they have a concussion, but are less likely to disclose the condition because of loyalty to the team, and perhaps because of the lure of a professional career in sports, Covassin says. That has changed over time with education, however, and they are becoming more willing to disclose. “Females did not know it was a concussion,” she says. Part of it is that women receive less education on the matter, there are fewer and less knowledgeable coaches and trainers, and symptoms vary and are less well understood.

The Concussion Research Initiative promises to revolutionize our understanding of concussions, according to Brian Hainline, the NCAA’s first medical officer. It is a joint program with the Department of Defense and the National Institutes of Health that has completed complex baseline assessments – more than 25 million data points – on 15,300 people, and so far includes 472 concussions to date, 157 of which have been females. The longitudinal cohort study will follow participants for decades, much like the still ongoing Framingham study on cardiovascular disease which began in 1948. The first reports will become public in the spring. “It is definitely going to change our perception of concussions,” Hainline says.

Via Scientificamerican.com

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Here’s the real reason teachers are quitting

(it’s not just the money)

The Right Click: Internet Safety Matters workshop

EDITORIAL USE ONLY (Left to right) Teacher Katie Fowler with year 5 pupils Danielle Minkah and Leila Diogo Costaferreira during The Right Click: Internet Safety Matters workshop at St John and St James Primary School in Hackney, London, marking the 100th workshop organised by a partnership between BT and Unicef UK, which aims to empower children and young people to become digitally confident and to safely enjoy the benefits of the internet.

Michael Wilshaw, the chief inspector of schools has complained about a “brain drain” of teachers leaving the country to work abroad – and, as a teacher and now lecturer, I’ve known a number of colleagues who have made that choice. But let’s not forget the other looming type of flight: of teachers from the profession itself.

Wilshaw warned that 18,000 teachers had left the UK to teach in international schools last year, more than the 17,000 who trained via the postgraduate route. He suggested that teachers could be given “golden handcuffs” to keep them: “working in the state system that trained them for a period of time.”

I don’t agree. I think instead we need to improve the working conditions in the state system so that we persuade teachers to stay because they want to – rather than forcing them to.

There are a combination of factors which make teachers leave – both to work abroad and to quit the profession entirely.

Over the past decade, teachers have had to endure constant, chaotic policy change. These have included changes to school structures, through the introduction of academies and free schools, changes to the curriculum and exams, changes to the inspection framework, changes to policies for children with special needs, and much more.

Central government has put unprecedented pressure on schools to attain “top” exam results, with those schools failing to achieve certain benchmarks threatened with takeover or closure.

The issue here is that even the government itself has pointed out that many of these exams are “not fit for purpose”: they do not lead to productive learning in the classroom, but rather mean that teachers are forced to teach to the test.

Testing times. David Davies/PA Archive

The high-stakes nature of England’s current testing system means that teachers I’ve worked with and interviewed feel oppressed by the mechanistic ways in which they are obliged to assess students. The bureaucracy involved in creating the data needed for assessment can be very time-consuming.

This pressure comes to a head with visits from the schools inspectorate Ofsted. Teachers often work in fear that they will be judged as failing by the inspectorate or even by someone acting out the role of inspector – school senior leadership teams frequently run “Mocksteds” whereby teachers have to undergo a “mock” Ofsted, usually run by senior staff.

Not in it for the long-haul

Government policies have encouraged candidates to see the profession as a short-term career option. Teach First is a classic example of this: the very name “Teach First” suggests that its graduate trainees should try teaching “first” and then move on to something better.

The millions that the government has cut from university-led Postgraduate Certificate of Education (PGCE) programmes has further exacerbated the problem of the “brain drain”.

PGCEs are much better at producing graduates who stay in the profession. In a blog last year, Sam Freedman, acting executive director or programmes for Teach First, said that data for the charity’s school-based trainees who gained qualified teacher status in 2005 showed that only 42% were teaching four years later – compared to 73% among those who took a mainstream PGCE.

And yet, PGCE courses – including our own at Goldsmiths – are under threat: the government aims to double the number of teachers completing their training in schools and speed-up reductions in university-based places. A big step to solving the recruitment crisis would be to provide better funding and support for PGCEs, which recent research has shown are still the best way of training teachers.

One of the most recent and thorough academic reviews of school-based training routes, as opposed to university-based ones, says that practitioners believe that the recent changes are: “Leading to a narrowing field of expertise … changes in the structure, length and type of school placements are further strengthening such fears.”

Results on a plate

There are other pressures too, and the expectations of parents and students have become increasingly unrealistic. Education has become marketised: teachers are expected by the government, parents and many students to be more like “customer service agents” delivering a product – a good grade for a student – rather than entering into a meaningful dialogue with learners and their carers about the best ways to learn.

Parents and students have come to expect “results on a plate” and can become very angry with teachers who “don’t deliver”. Over the last few years, pedagogues have endured rising numbers of unwarranted complaints from parents and students. I know of a brilliant, experienced teacher who was verbally abused and threatened at a recent parents’ evening by an angry mother who felt that this teacher should have “got” a better result for her child. The onus has shifted away from students to work for themselves and instead has been placed on the teacher to do the work for the student.

Messages in the media that teachers are “lazy” and “incompetent” don’t help this situation, regular mainstream media pundits such as Melanie Phillips, Katie Hopkins, Toby Youngand Rod Liddle all represent teachers in negative ways.

I don’t think that Wilshaw’s idea to simply give trainee teachers “golden handcuffs” to stay in the state-school system is the best way of solving the teaching recruitment crisis. Rather, the government needs to provide more resources to universities to train teachers, improve conditions of service in schools by cutting back on such high pressure testing and giving teachers more time to assess and prepare lessons. In a nutshell, politicians need to be much more supportive of teachers and the work they do.

via The Conversation US Pilot.

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Supreme Court majority is critical of compelled public employee union fees

111004_scotusjustices_ap_328United States Supreme Court justices.

By Robert Barnes

A majority of the Supreme Court on Monday seemed prepared to hand a significant defeat to organized labor and side with a group of California teachers who claim their free speech rights are violated when they are forced to pay dues to the state’s teachers union.

By their questioning at oral argument, the court’s conservatives appeared ready to junk a decades-old precedent that allows unions to collect an “agency fee” from nonmembers to support collective-bargaining activities for members and nonmembers alike.

It is the most important Supreme Court case of the year for unions and one of a clutch of politically charged cases that puts the justices in the spotlight as the nation turns its attention to the elections of 2016.

The case involves only public-employee unions — not private workers — but those unions are the strongest segment of an organized labor movement that is increasingly tied to the Democratic Party. At the same time, Republican governors across the nation have become embroiled in high-profile battles with the public-employee unions in their states.

Conservative groups have directly asked the court to overturn a 1977 decision, Abood v. Detroit Board of Education, that favored the unions. That ruling said that states could allow public-employee unions to collect fees from nonmembers to cover the costs of workplace negotiations but not to cover the union’s political activities.

The unions say losing those fees would be a heavy blow because there is no incentive for workers to pay for collective-bargaining representation they could receive for free. About 20 states, including California, allow what the unions like to call “fair-share” fees.

But conservative justices sharply questioned whether it was possible to separate public-employee negotiations from the kind of public policy questions — teacher salaries and classroom sizes, for instance, and the tax dollars that must be raised to pay for them — that are raised.

“When you are dealing with a governmental agency, many critical points are matters of public concern,” said Justice Anthony M. Kennedy, who traditionally is the most likely of the court’s conservatives to join with liberals to form a majority.

Some teachers disagree with their unions on issues such as merit pay, promotion and the importance of seniority, Kennedy said.

The fees “require that employees and teachers who disagree with those positions must nevertheless subsidize the union on those very points,” he said.

It is not enough to argue that the teachers can speak out on their own as citizens, he said.

In the current case, union leaders were not counting on Kennedy but on another conservative, Justice Antonin Scalia.

Scalia in the past has expressed sympathy for the view that the unions needed to collect the fees to prevent “free riders” — those who benefit from the agreements that unions reach with government employers but who do not pay for the union’s costs. But he did not pose any questions Monday that favored the union’s view and said he shared Kennedy’s concerns.

“The problem is that everything that is collectively bargained with the government is within the political sphere, almost by definition,” he said.

He also questioned the contention that the unions would not survive without collecting the fees. Already, there are 25 states that do not require their collection, and Scalia said the unions should do a better job of persuading those eligible to join.

California Solicitor General Edward C. DuMont, who was aligned in the case with the teachers union, said the California unions already had extraordinary participation but prohibiting agency fees fights human nature.

“Many people can want something in the sense they view it as very advantageous to themselves, but if they are given a choice, they would prefer to have it for free, rather than to pay for it,” he said. “This is a classic collective-action problem.”

Oral arguments are not always predictive, but it seemed clear that DuMont, California Teachers Association attorney David C. Frederick and Solicitor General Donald B. Verrilli Jr., representing the Obama administration, were treading against the tide.

The court’s five conservatives in 2012 and 2014 had expressed grave doubts about whether the Abood decision had properly taken into account the First Amendment rights of the union objectors.

It has been the pattern of the court headed by Chief Justice John G. Roberts Jr. to take incremental steps toward undermining a precedent with which it disagrees before delivering a final blow.

The court’s liberals said the challengers had not made the case for why the court should abandon a precedent rather than take the normal path of upholding it.

[Two teachers explain why they want to take down their union]

Justice Stephen G. Breyer said the Abood “compromise” had worked pretty well over the last 40 years. When the court starts overruling precedents, he said, “What happens to the country thinking of us as a kind of stability in ­­a world that is tough because it changes a lot?” Breyer asked.

Justice Elena Kagan also pushed that theme, telling Washington attorney Michael A. Carvin, who represented the objecting teachers, that he had a “heavy burden.”

“That’s always true in cases where somebody asks us to overrule a decision. It seems to be particularly true here,” Kagan said. “This is a case in which there are tens of thousands of contracts with these provisions. Those contracts affect millions of employees, maybe as high as 10 million employees. So what special justification are you offering here?”

Carvin replied that the strongest reason for overturning a precedent is when it “erroneously denies a fundamental right’’ — in this case, freedom of speech and association.

Kagan and other justices said the court’s precedents were clear that when government is acting as an employer, it can act as any employer in restricting employee rights.

Frederick argued for leaving the decision about requiring fees to the individual states, rather than forbidding the process. “Different states have different experiences, and this is an opportunity for the states to draw upon those distinctive experiences in coming up with a system that’s fair for everyone,” he argued.

There seemed to be two options if a majority disagreed with Abood but was reluctant to overturn the precedent.

The justices could remand the case to the lower courts. Carvin and his clients had raced through the lower courts in hopes of getting the case to the Supreme Court faster.

The justices could also change how the agency fees are collected. Currently, the fees must be paid, and then employees “opt out” of funding the union’s political activities and receive money back. Objecting employees say that minimizes the burden on them.

But there was limited questioning from the justices about whether such a change might be an alternative to overturning the system.

The case is Friedrichs v. California Teachers Association.

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