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Mechanisms of brain impact injuries and their prediction: A review

Brain injuries are a significant contributor to morbidity and mortality. Currently a great deal of controversy exists concerning the mechanism of these injuries and concussion in particular. The following review discusses the anatomical mechanisms which are known to cause brain injuries and the variables currently used to predict their incidence. This review examines how current engineering techniques and measurements are being used to research brain injury mechanisms. The text examines the past and current measurement techniques and their benefits and drawbacks when it comes to predicting brain injuries and understanding brain injury research. Finally, future methods of quantifying brain injury are discussed with concluding remarks concerning the efficacy of current measurement techniques to predict brain injuries.

Updates From the Third Federal Interagency Conference on Traumatic Brain Injury

Updates From the Third Federal Interagency Conference on Traumatic Brain Injury

Feasibility of a multicenter prospective cohort study on the evaluation of prognosis in severe traumatic brain injury

Conducting prospective research in severe traumatic brain injury (TBI) patients is challenging. To prepare for a large-scale multicenter study to evaluate long-term prognosis in severe TBI, we conducted a prospective pilot study evaluating the patterns of enrollment, the compliance to the schedule of prognostic tests and the completeness of follow-up for 6-month functional outcome measures.

An Overview of Published Research about the Acute Care and Rehabilitation of Traumatic Brain Injured and Spinal Cord Injured Patients

Knowledge of the breadth, nature, and volume of traumatic brain injury (TBI) and spinal cord injury (SCI) research can aid in research planning. This study aimed to provide an overview of existing TBI and SCI research to inform identification of knowledge translation (KT), systematic review (SR), and primary research opportunities. Topics and relevant articles from three large neurotrauma evidence resources were synthesized: the Global Evidence Mapping (GEM) Initiative (129 topics and 1644 articles), the Acquired Brain Injury Evidence-Based Review (ERABI; 152 topics and 732 articles), and the Spinal Cord Injury Rehabilitation Evidence (SCIRE) Project (297 topics and 1650 articles). A de-duplicated dataset of SRs, randomized controlled trials (RCTs), and other studies identified by these projects was created. In all, 145 topics were identified (66 TBI and 79 SCI), yielding 3466 research articles (1256 TBI and 2210 SCI). Topics with KT potential included cognitive therapies for TBI and prevention/management of urinary tract problems post-SCI, which accounted for 17% and 18%, respectively, of the TBI and SCI yield. Topics that may require SR included management of raised intracranial pressure in TBI, and ventilation and intermittent positive pressure interventions following SCI. Topics for which primary research may be needed included pharmacological therapies for neurological recovery post-TBI, and management of sleep-disordered breathing post-SCI. There was a larger volume of non-intervention (epidemiological) studies in SCI than in TBI. This comprehensive overview of TBI and SCI research can aid funding agencies, researchers, clinicians, and other stakeholders in prioritizing and planning TBI and SCI research.

Comparison between Hybrid III and Hodgson–WSU headforms by linear and angular dynamic impact response

In brain injury research, linear and angular resultant acceleration data have been considered important mechanisms contributing to various levels of brain injury. The development of biofidelic headforms with similar dimensions and weight to that of a real human head has allowed for researchers to repeatedly collect data related to the effects of different impacts on the human head. Currently, there are different types of headforms available for impact testing, each with varying degrees of biofidelity and repeatability. Two commonly used headforms were tested: the Hybrid III and the Hodgson–WSU (NOCSAE). The two headforms were outfitted with nine single-axis accelerometers positioned orthogonally following a 3–2–2–2 array. Both headforms show good linearity and correlate well throughout the different velocities and are, therefore, reliable tools. Significant differences are observed in peak linear and peak angular accelerations between Hybrid III and Hodgson–WSU headforms. The shapes of the loading curves are visually different and thus may have significant impact on the output from FE modelling of the brain response.

Safety of Granulocyte-Colony Stimulating Factor (G-CSF) administration for post-rehabilitation spinal cord injury patients: a phase I open-label study

Background and Objective: Spinal cord injury (SCI) is a devastating neurological disorder causing various symptoms depending on the location, extent and degree of the damage. Granulocyte-colony stimulating factor (G-CSF) is a major growth factor in the activation and differentiation of granulocytes. This cytokine has been widely and safely employed clinically in different conditions over many years. On the other hand, the beneficial effects of G-CSF administration in spinal cord injury models have been shown in different studies. Patients and methods: This study was conducted in the Brain and Spinal Injury Research Center and all of its procedures were approved by Tehran University of Medical Sciences Ethics Committee. A total of 11 patients with spinal cord injury were enrolled in the study and subcutaneous administration of GCSF was performed for 5 days in all of them. Follow up period was about 1 year. The American Spinal Injury Association (ASIA) scale used for motor and sensory assessment and the Spinal Cord Independence Measure (SCIM III) was used to evaluate the changes on the ability of performing basic everyday tasks. Results: Based on ASIA neurological examination scale, mean upper extremity motor score changed from 28.36 ± 19.64(Mean ± SD) to 29.91 ± 19.95 and there was no change in lower extremity motor score, light touch and pin prick sensory score had a modest improvement 3.91 and 1.27 scores respectively. However, changes in motor and sensory scores were statistically significant (P

The essential role of psychosocial risk and protective factors in pediatric traumatic brain injury research.

This article builds upon Traumatic Brain Injury Common Data Elements (TBI CDE) version 1.0 and the pediatric CDE Initiative by emphasizing the essential role of psychosocial risk and protective factors in pediatric TBI research. The goals are to provide a compelling rationale for including psychosocial risk and protective factors in addition to socioeconomic status (SES), age, and sex in the study design and analyses of pediatric TBI research and to describe recommendations for core common data elements in this domain. Risk and protective factor research is based on the ecological theory of child development in which children develop through a series of interactions with their immediate and more distant environments. Home, school, religious, and social influences are conceptualized as risk and/or protective factors. Child development and TBI researchers have interpreted risk and protective variables as main effects or as interactions and have used cumulative risk indices and moderation models to describe the relationship among these variables and outcomes that have to do with development and with recovery from TBI. It is likely that the number, type, and interaction among risk and protective factors each contribute unique variance to study outcomes. Longitudinal designs in TBI research will be essential to understanding the reciprocal relationships between risk/protective factors and the recovery/outcome made by the child. The search for effective interventions to hasten TBI recovery mandates the need to target modifiable risks and to promote protective factors in the child's environment.

What domains of the International Classification of Functioning, Disability and Health are covered by the most commonly used measurement instruments in traumatic brain injury research?

ObjectiveTo identify the most frequently used outcome measurement instruments reported in clinical studies on TBI and to provide a content comparison in the framework of the International Classification of Functioning, Disability and Health (ICF). Patients and methodsA systematic literature review of clinical studies in TBI was performed using Medline, EMBASE and PsychINFO. The items of the measurement instruments present in more than 20% of the studies were linked to the ICF language. Results193 papers fulfilled the eligibility criteria. The frequency analysis identified six instruments: Functional Independence Measure (50%), Glasgow Outcome Scale (34%), Disability Rating Scale (32%), Wechsler Adult Intelligence Scale (29%), Trail Making Test (26%) and Community Integration Questionnaire (22%). The analysed instruments focus on different aspects of body functions (especially DRS, WAIS and TMT) and aspects of activities and participation in life (especially CIQ and FIM). Inter-researcher agreement for the ICF linking process was 0.83. ConclusionsTranslating the items of different measurement instruments into the ICF language provides a practical tool to facilitate content comparisons among different outcome measures. The comparison can assist clinical researchers to integrate information acquired from different studies and different tools.

Modeling the Encephalopathy of Prematurity in Animals: The Important Role of Translational Research

Translational research in preterm brain injury depends upon the delineation of the human neuropathology in order that animal models faithfully reiterate it, thereby ensuring direct relevance to the human condition. The major substrate of human preterm brain injury is the encephalopathy of prematurity that is characterized by gray and white matter lesions reflecting combined acquired insults, altered developmental trajectories, and reparative phenomena. Here we highlight the key features of human preterm brain development and the encephalopathy of prematurity that are critical for modeling in animals. The complete mimicry of the complex human neuropathology is difficult in animal models. Many models focus upon mechanisms related to a specific feature, for example, loss of premyelinating oligodendrocytes in the cerebral white matter. Nevertheless, animal models that simultaneously address oligodendrocyte, neuronal, and axonal injury carry the potential to decipher shared mechanisms and synergistic treatments to ameliorate the global consequences of the encephalopathy of prematurity.

Contributors

Contributors

Neurocritical care monitoring correlates with neuropathology in a swine model of pediatric traumatic brain injury.

Small-animal models have been used in traumatic brain injury (TBI) research to investigate the basic mechanisms and pathology of TBI. Unfortunately, successful TBI investigations in small-animal models have not resulted in marked improvements in clinical outcomes of TBI patients. To develop a clinically relevant immature large-animal model of pediatric neurocritical care following TBI. Eleven 4-week-old piglets were randomly assigned to either rapid axial head rotation without impact (n = 6) or instrumented sham (n = 5). All animals had an intracranial pressure monitor, brain tissue oxygen tension (Pbto(2)) probe, and cerebral microdialysis probe placed in the frontal lobe and data collected for 6 hours following injury. Injured animals had sustained elevations in intracranial pressure and lactate-pyruvate ratio (LPR), and decreased Pbto(2) compared with sham. Pbto(2) and LPR from separate frontal lobes had strong linear correlation in both sham and injured animals. Neuropathologic examination demonstrated significant axonal injury and infarct volumes in injured animals compared with sham at 6 hours postinjury. Averaged over time, Pbto(2) in both injured and sham animals had a strong inverse correlation with total injury volume. Average LPR had a strong correlation with total injury volume. LPR and Pbto(2) can be utilized as serial nonterminal secondary markers in our injury model for neuropathology, and as evaluation metrics for novel interventions and therapeutics in the acute postinjury period. This translational model bridges a vital gap in knowledge between TBI studies in small-animal models and clinical trials in the pediatric TBI population.

Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide

Following his discovery of chronic traumatic encephalopathy (CTE) in football players in 2002, Dr. Bennet Omalu hypothesized that posttraumatic stress disorder (PTSD) in military veterans may belong to the CTE spectrum of diseases. The CTE surveillance at the Brain Injury Research Institute was therefore expanded to include deceased military veterans diagnosed with PTSD. The authors report the case of a 27-year-old United States Marine Corps (USMC) Iraqi war veteran, an amphibious assault vehicle crewman, who committed suicide by hanging after two deployments to Fallujah and Ramadi. He experienced combat and was exposed to mortar blasts and improvised explosive device blasts less than 50 m away. Following his second deployment he developed a progressive history of cognitive impairment, impaired memory, behavioral and mood disorders, and alcohol abuse. Neuropsychiatric assessment revealed a diagnosis of PTSD with hyperarousal (irritability and insomnia) and numbing. He committed suicide approximately 8 months after his honorable discharge from the USMC. His brain at autopsy appeared grossly unremarkable except for congestive brain swelling. There was no atrophy or remote focal traumatic brain injury such as contusional necrosis or hemorrhage. Histochemical and immunohistochemical brain tissue analysis revealed CTE changes comprising multifocal, neocortical, and subcortical neurofibrillary tangles and neuritic threads (ranging from none, to sparse, to frequent) with the skip phenomenon, accentuated in the depths of sulci and in the frontal cortex. The subcortical white matter showed mild rarefaction, sparse perivascular and neuropil infiltration by histiocytes, and mild fibrillary astrogliosis. Apolipoprotein E genotype was 3/4. The authors report this case as a sentinel case of CTE in an Iraqi war veteran diagnosed with PTSD to possibly stimulate new lines of thought and research in the possible pathoetiology and pathogenesis of PTSD in military veterans as part of the CTE spectrum of diseases, and as chronic sequelae and outcomes of repetitive traumatic brain injuries.

Emerging imaging tools for use with traumatic brain injury research.

This article identifies emerging neuroimaging measures considered by the inter-agency Pediatric Traumatic Brain Injury (TBI) Neuroimaging Workgroup. This article attempts to address some of the potential uses of more advanced forms of imaging in TBI as well as highlight some of the current considerations and unresolved challenges of using them. We summarize emerging elements likely to gain more widespread use in the coming years, because of 1) their utility in diagnosis, prognosis, and understanding the natural course of degeneration or recovery following TBI, and potential for evaluating treatment strategies; 2) the ability of many centers to acquire these data with scanners and equipment that are readily available in existing clinical and research settings; and 3) advances in software that provide more automated, readily available, and cost-effective analysis methods for large scale data image analysis. These include multi-slice CT, volumetric MRI analysis, susceptibility-weighted imaging (SWI), diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), arterial spin tag labeling (ASL), functional MRI (fMRI), including resting state and connectivity MRI, MR spectroscopy (MRS), and hyperpolarization scanning. However, we also include brief introductions to other specialized forms of advanced imaging that currently do require specialized equipment, for example, single photon emission computed tomography (SPECT), positron emission tomography (PET), encephalography (EEG), and magnetoencephalography (MEG)/magnetic source imaging (MSI). Finally, we identify some of the challenges that users of the emerging imaging CDEs may wish to consider, including quality control, performing multi-site and longitudinal imaging studies, and MR scanning in infants and children.

Engineering a High Throughput Axon Injury System

Several key biological mechanisms of traumatic injury to axons have been elucidated using in vitro stretch injury models. These models, however, are based on the experimentation of single cultures keeping productivity slow. Indeed, low yield has hindered important and well-founded investigations requiring high throughput methods such as proteomic analyses. To meet this need, we engineered a multi-well high throughput injury device to accelerate and accommodate the next generation of traumatic brain injury research. This modular system stretch injures neuronal cultures in either a 24-well culture plate format or 6 individual wells simultaneously. Custom software control allows the user to accurately program the pressure pulse parameters to achieve the desired substrate deformation and injury parameters. Analysis of the pressure waveforms showed that peak pressure was linearly related to input pressure and valve open times and that the 6- and 24-well modules displayed rise times, peak pressures, and decays with extremely small standard deviations. Data also confirmed that the pressure pulse was distributed evenly throughout the pressure chambers and therefore to each injury well. Importantly, the relationship between substrate deformation and applied pressure was consistent among the multiple wells and displayed a predictable linear behavior in each module. These data confirm that this multi-well system performs as well as currently used stretch injury devices and can undertake high throughput studies that are needed across the field of neurotrauma research.

Re-orientation of clinical research in traumatic brain injury: report of an international workshop on comparative effectiveness research.

During the National Neurotrauma Symposium 2010, the DG Research of the European Commission and the National Institutes of Health/National Institute of Neurological Disorders and Stroke (NIH/NINDS) organized a workshop on comparative effectiveness research (CER) in traumatic brain injury (TBI). This workshop reviewed existing approaches to improve outcomes of TBI patients. It had two main outcomes: First, it initiated a process of re-orientation of clinical research in TBI. Second, it provided ideas for a potential collaboration between the European Commission and the NIH/NINDS to stimulate research in TBI. Advances in provision of care for TBI patients have resulted from observational studies, guideline development, and meta-analyses of individual patient data. In contrast, randomized controlled trials have not led to any identifiable major advances. Rigorous protocols and tightly selected populations constrain generalizability. The workshop addressed additional research approaches, summarized the greatest unmet needs, and highlighted priorities for future research. The collection of high-quality clinical databases, associated with systems biology and CER, offers substantial opportunities. Systems biology aims to identify multiple factors contributing to a disease and addresses complex interactions. Effectiveness research aims to measure benefits and risks of systems of care and interventions in ordinary settings and broader populations. These approaches have great potential for TBI research. Although not new, they still need to be introduced to and accepted by TBI researchers as instruments for clinical research. As with therapeutic targets in individual patient management, so it is with research tools: one size does not fit all.

Recommendations for the use of common outcome measures in pediatric traumatic brain injury research.

This article addresses the need for age-relevant outcome measures for traumatic brain injury (TBI) research and summarizes the recommendations by the inter-agency Pediatric TBI Outcomes Workgroup. The Pediatric Workgroup's recommendations address primary clinical research objectives including characterizing course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements (CDE) Workgroups, the Pediatric TBI Outcomes Workgroup adopted the standard three-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in pediatric TBI from each identified domain including academics, adaptive and daily living skills, family and environment, global outcome, health-related quality of life, infant and toddler measures, language and communication, neuropsychological impairment, physical functioning, psychiatric and psychological functioning, recovery of consciousness, social role participation and social competence, social cognition, and TBI-related symptoms. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges.

Lateral Fluid Percussion: Model of Traumatic Brain Injury in Mice

Traumatic brain injury (TBI) research has attained renewed momentum due to the increasing awareness of head injuries, which result in morbidity and mortality. Based on the nature of primary injury following TBI, complex and heterogeneous secondary consequences result, which are followed by regenerative processes 1,2. Primary injury can be induced by a direct contusion to the brain from skull fracture or from shearing and stretching of tissue causing displacement of brain due to movement 3,4. The resulting hematomas and lacerations cause a vascular response 3,5, and the morphological and functional damage of the white matter leads to diffuse axonal injury 6-8. Additional secondary changes commonly seen in the brain are edema and increased intracranial pressure 9. Following TBI there are microscopic alterations in biochemical and physiological pathways involving the release of excitotoxic neurotransmitters, immune mediators and oxygen radicals 10-12, which ultimately result in long-term neurological disabilities 13,14. Thus choosing appropriate animal models of TBI that present similar cellular and molecular events in human and rodent TBI is critical for studying the mechanisms underlying injury and repair.Various experimental models of TBI have been developed to reproduce aspects of TBI observed in humans, among them three specific models are widely adapted for rodents: fluid percussion, cortical impact and weight drop/impact acceleration 1. The fluid percussion device produces an injury through a craniectomy by applying a brief fluid pressure pulse on to the intact dura. The pulse is created by a pendulum striking the piston of a reservoir of fluid. The percussion produces brief displacement and deformation of neural tissue 1,15. Conversely, cortical impact injury delivers mechanical energy to the intact dura via a rigid impactor under pneumatic pressure 16,17. The weight drop/impact model is characterized by the fall of a rod with a specific mass on the closed skull 18. Among the TBI models, LFP is the most established and commonly used model to evaluate mixed focal and diffuse brain injury 19. It is reproducible and is standardized to allow for the manipulation of injury parameters. LFP recapitulates injuries observed in humans, thus rendering it clinically relevant, and allows for exploration of novel therapeutics for clinical translation 20.We describe the detailed protocol to perform LFP procedure in mice. The injury inflicted is mild to moderate, with brain regions such as cortex, hippocampus and corpus callosum being most vulnerable. Hippocampal and motor learning tasks are explored following LFP.

Lateral Fluid Percussion: Model of Traumatic Brain Injury in Mice

Traumatic brain injury (TBI) research has attained renewed momentum due to the increasing awareness of head injuries, which result in morbidity and mortality. Based on the nature of primary injury following TBI, complex and heterogeneous secondary consequences result, which are followed by regenerative processes 1,2. Primary injury can be induced by a direct contusion to the brain from skull fracture or from shearing and stretching of tissue causing displacement of brain due to movement 3,4. The resulting hematomas and lacerations cause a vascular response 3,5, and the morphological and functional damage of the white matter leads to diffuse axonal injury 6-8. Additional secondary changes commonly seen in the brain are edema and increased intracranial pressure 9. Following TBI there are microscopic alterations in biochemical and physiological pathways involving the release of excitotoxic neurotransmitters, immune mediators and oxygen radicals 10-12, which ultimately result in long-term neurological disabilities 13,14. Thus choosing appropriate animal models of TBI that present similar cellular and molecular events in human and rodent TBI is critical for studying the mechanisms underlying injury and repair. Various experimental models of TBI have been developed to reproduce aspects of TBI observed in humans, among them three specific models are widely adapted for rodents: fluid percussion, cortical impact and weight drop/impact acceleration 1. The fluid percussion device produces an injury through a craniectomy by applying a brief fluid pressure pulse on to the intact dura. The pulse is created by a pendulum striking the piston of a reservoir of fluid. The percussion produces brief displacement and deformation of neural tissue 1,15. Conversely, cortical impact injury delivers mechanical energy to the intact dura via a rigid impactor under pneumatic pressure 16,17. The weight drop/impact model is characterized by the fall of a rod with a specific mass on the closed skull 18. Among the TBI models, LFP is the most established and commonly used model to evaluate mixed focal and diffuse brain injury 19. It is reproducible and is standardized to allow for the manipulation of injury parameters. LFP recapitulates injuries observed in humans, thus rendering it clinically relevant, and allows for exploration of novel therapeutics for clinical translation 20. We describe the detailed protocol to perform LFP procedure in mice. The injury inflicted is mild to moderate, with brain regions such as cortex, hippocampus and corpus callosum being most vulnerable. Hippocampal and motor learning tasks are explored following LFP.

The importance of angiographic and venographic cranial imaging in intracerebral hemorrhage occurring during pregnancy and the puerperium

European Journal of NeurologyVolume 18, Issue 9 p. e112-e113 LETTER TO THE EDITOR The importance of angiographic and venographic cranial imaging in intracerebral hemorrhage occurring during pregnancy and the puerperium M. A. Kirkman, M. A. Kirkman Brain Injury Research Group, The University of Manchester, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, SalfordSearch for more papers by this authorP. J. Tyrrell, P. J. Tyrrell Brain Injury Research Group, The University of Manchester, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, Salford Department of Stroke Medicine, The University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, SalfordSearch for more papers by this authorA. T. King, A. T. King Brain Injury Research Group, The University of Manchester, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, Salford Department of Neurosurgery, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, Salford, UKSearch for more papers by this authorH. C. Patel, H. C. Patel Brain Injury Research Group, The University of Manchester, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, Salford Department of Neurosurgery, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, Salford, UKSearch for more papers by this author M. A. Kirkman, M. A. Kirkman Brain Injury Research Group, The University of Manchester, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, SalfordSearch for more papers by this authorP. J. Tyrrell, P. J. Tyrrell Brain Injury Research Group, The University of Manchester, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, Salford Department of Stroke Medicine, The University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, SalfordSearch for more papers by this authorA. T. King, A. T. King Brain Injury Research Group, The University of Manchester, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, Salford Department of Neurosurgery, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, Salford, UKSearch for more papers by this authorH. C. Patel, H. C. Patel Brain Injury Research Group, The University of Manchester, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, Salford Department of Neurosurgery, Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust, Salford, UKSearch for more papers by this author First published: 11 August 2011 https://doi.org/10.1111/j.1468-1331.2011.03463.xCitations: 1 Matthew A. Kirkman, Brain Injury Research Group, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK (tel.: +44 (0) 7886608978; fax: +44 (0) 161 7076534; e-mail: [email protected]). Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume18, Issue9September 2011Pages e112-e113 RelatedInformation