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The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes.
- ethics- medical
- ethics
- ethics- research
- cultural diversity
- decision making
Data availability statement
No data are available.
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In 2017, the Berlin Concussion in Sport Group Consensus Statement (CiSG CS) was published alongside the Concussion Assessment Tool 5, the SCAT5 and Child SCAT5, 'with the objective of offering a simple, clear message with tools that equip the practitioner to diagnose and manage concussion in various different sports'.1 Despite the plethora of professional and scientific guides, consensuses and reviews of concussion and other head injuries in sport, it is undoubtedly the leading professional locus of state-of-the-art knowledge for sport physicians (SPs), healthcare professionals (HCPs) and other stakeholders such as athletes or, more specifically, athletes when considered as patients (AP), event organisers and sport governing bodies. Despite the undeniable development in sophistication of the CSs, the CiSG, there has been a plenitude of criticisms that range from challenges concerning the narrowness in scope of the research, to ethical problems arising from various sources including conflicts of interest (CoIs), the reductionist or exclusive character of particular methodologies, and the problem of how to amalgamate highly diverse sources of evidence. The present article is the product of a symposium held at KU Leuven, 10 September 2022–21 September 2022 that sought—from multidisciplinary perspectives (medical ethics, genetic ethics, philosophy of science, policy studies, political sociology, professional ethics, sport ethics, sport law, sport sociology and sport medicine ethics) to broaden the scope of the CSs and make progress on conceptual, ethical and scientific challenges by establishing a multidisciplinary concussion research agenda beyond biomedical science and practice.
Whose expertise: which research?
CiSG members have pointed to relevant expertise as important to the success of process that results in each iteration of the CS.2
Every 4 years researchers and clinicians with expertise in SRC (sports-related concussion)i are brought together to summarise the published literature and provide updated, evidence informed recommendations regarding the evaluation and management of concussions… Authors have been selected based on their research and clinical expertise in the area of concussion.2
The coalescence of experts within this nascent medical field has happened relatively rapidly. The previous lead of the CiSG recalled that when they began their career as a team doctor even very experienced sports-medicine practitioners understood almost nothing about concussion, and in the years prior to the creation of the CiSG 'any management recommendations were purely anecdotal.'3 Given how widely disseminated and influential the recommendations of the CiSG have become, it is pertinent to think more deeply about questions related to the nature of expertise and the power of experts. Exactly who is an expert, and why (when it comes to concussion management)?
Philosophical accounts of expertise reveal both epistemic conditions (ie, advanced knowledge or competency), but also social acknowledgement.4 Having 'expertise' is distinct from being credited as an 'expert', which is a quality ascribed to someone who fills a certain social role.5 The latter is not merely acknowledged but conferred.6 Expert status thus depends on recognition or legitimation, in socially, culturally and politically constructed ways. Recognition of expert status is therefore contingent on power dynamics. Being an expert is not simply a matter of what one knows, but also a matter of the processes that establish: who is 'recognised'?; who is given a platform?; how they got there?; who influences/controls what is and is not researched?; who pays the bills?; which values and norms are evoked?; and of course, which voices are not included?. These questions are relevant to any critical examination of how expertise and expert status have informed all the iterations of the CSs, given that these documents provide an authoritative platform validating the expertise they claim.
How might recognition of these processes inform criticism of the CSs or challenge the claim that it represents the best synthesis of the current evidence? The composition of the group, the agenda, the scope, the implementation and the influence are contingent on structural and political factors. But what is considered to be expertise in this area can, in some ways, be constructed by entities with much to gain (or lose). It is, therefore, critical from an ethical, scientific and policy making perspective that the CiSG Scientific Committee and the pool of experts it draws on is selected from a broad pool of experts. Whether a group comprised of different concussion experts would reach the same 'consensus' is a moot point. This issue leads immediately to the concept of 'consensus' itself. How much agreement is required? Is this a mere quantitative question (eg, 80% of the conference audience) or a qualitative one (to what extent can experts still reasonably disagree about scientific and policy matters that fall within the purview of the CS while remaining a Consensus)? And finally, what is critical here for confidence in the CS is the matter of public awareness: how are the groups, selection processes and their workings made transparent?
Having drawn attention to the social and political dimensions of expertise it is necessary also to draw out the ethical corollaries. The motives of powerful groups directly or indirectly facilitate expert status subjecting CSs to many interest groups, including large professional sporting leagues, private companies and funding bodies.7 Declarations of competing interests in previous CSs have been varied in terms of their comprehensiveness, and this aspect of the CiSG's activities is very much a work in progress.ii How is this to be reconciled given that their recommendations are intended to be practical and independent? A declaration of interest is not necessarily a sufficient response to potential or perceived CoIs. The challenge is that leaders of the concussion movement may have legitimate claims to expert status and CoIs. It may ultimately be that contributing to the powerful consensus positions is incompatible with holding leading positions with other stakeholders whose influence could—or could be seen to—motivate bias or partiality. Others may argue that this is a case of throwing the baby out with the bathwater. Further discussion of professional ethics and academic integrity is required here.
Whose research, with and for whom?
Many sports generate a substantial proportion of their revenue from the elite level, yet the long-term maintenance of interest in the sport requires participation at all levels from the recreational to the elite. Sports federations also have a prudential interest in mitigating known or perceived health risks that can potentially reduce present or future participation by children or adults. Moreover, they have an ethical interest in maintaining a relation of reciprocity with the grassroots participants.8 Sports federations are the 'dominant self-regulators' in sport,9 and this status generates a duty of care or diligence.10 This extends directly to an obligation to initiate, facilitate and fund independent knowledge generation, that is, research about serious sports-related injuries. These prudential (ie, self-interested) and reciprocity-based reasons also support obligations to initiate, facilitate and fund research. The ability of a particular sports federation to discharge these research obligations depends on the resources available, but those who can fund should, and of course, their decisions should be guided by impartial state-of-the-art reviews and CSs.
Moreover, it is increasingly recognised in biomedical research that research projects improve if patients are involved in choosing the research questions and study design. This is usually termed patient and public involvement and engagement and is now a requirement imposed by many funders. Similarly, concussion research in sport is likely to be better and more relevant if, for instance, active athletes, coaches and officials are involved in the form of APIE (athlete participation, involvement and engagement). The reasons for making APIE an integral part of research are fourfold. First, it is likely to promote buy-in from athletes, coaches and officials to the research itself, but also to the implementation of any interventions flowing from the research. Second, implementation science shows convincingly, that unless the end-users of knowledge are involved in the knowledge production at all stages, obstacles to implementation are likely to be overlooked.11 12 Third, there are aspects of being an active athlete that enables more immediate access to knowledge and experience than most researchers have. This is not to say that other people cannot get access to this knowledge, but recognising that it would require work to get it, and that it can only be obtained by asking the right questions. Philosophically, this can be explicated as a moderate form of standpoint epistemology, that is, the idea that those who are engaged in a practice or are in a particular social position have privileged access to knowledge about that practice.13 In this sense, HCPs cannot claim convincingly to speak for their APs. Fourth, the consequences of concussion that are of primary interest to athletes may be slightly different from those of primary interest to researchers and HCPs, just as authors of the CS cannot necessarily claim to speak for HCPs practising across all levels of sport. This may especially be true in relation to the more acute neurological symptoms following a concussion, or in relation to the implications of concussion incidents for amateur athletes in relation to work or education.
Which evidence counts?
Talk of consensus in concussion research leads inexorably to scientific questions around methodology, but also crucially, to normative discussions around which methodologies are privileged and why. Research into concussion, concussion prevention and concussion management has hitherto aimed at finding causal relations (how can they be accurately diagnosed; what are the long-term effects; how can the effects be mitigated, etc). Establishing the quality of evidence that contributes to a consensus has been open to considerable dispute across previous CSs (and their underlying processes).
First, the various SCs have used the PROSPERO protocol. In line with evidence-based medicine recommendations,14 systematic reviews would usually focus on a meta-analysis of randomised controlled trials (RCTs) are focused on, meaning that research arising from case studies or case series, such as those for chronic traumatic encephalopathy (CTE), which have been evaluated using the Bradford Hill criteria,15 have hitherto not been incorporated into the CSs. RCTs are widely regarded as the gold standard for causal research in evidence-based medicine. In addition, systematic reviews involving meta-analyses of RCTs are sometimes called the platinum standard; an honorific title not without its critics.16 17 Yet RCTs are not always feasible due to a variety of reasons: ethical (eg, deliberately inflicting concussions in humans even with their consent is unlikely to pass any kind of ethical review board) and practical (eg, how to keep participants blinded with respect to their assigned group?). Many alternative methodologies exist, on humans (case–control, cohort, etc), on animals (laboratory RCTs), in vitro (mechanistic studies on, eg, brain tissue), and in silico (computer simulations). Within evidence-based medicine, these are typically considered of lower quality (see, eg, the Oxford Centre for Evidence Based Medicine (OCEBM) levels of evidence).14 But when faced with the dilemma to either (1) ignore scientific evidence beneath RCTS (cf. the purely anecdotal management recommendations mentioned above—even where promoted by experts) or (2) settle for a combination of alternative methodologies, the second option definitely should be preferred. Naturally, an appropriate justification for the use of any methodology in a particular context should be provided. Second, where one's primary sources are methodologically homogeneous (eg, where all are studies based on RCTs using similar protocols), systematic reviewing and meta-analysis are relatively straightforward. Yet this is not the case in concussion science. Unsurprisingly, amalgamating strongly diverging/heterogeneous primary studies is much more difficult.
The integration of heterogeneous evidentiary bases does not represent an insuperable problem. A similar problem plaguing cancer epidemiology has been addressed by the International Agency for Research on Cancer (IARC) during the past six decades.18 Due to ethical considerations, few if any human-based RCTs identifying carcinogenic hazards exist. For most purported hazards, however, there do exist both observational (non-experimental) epidemiological studies in humans, and laboratory RCTs on animals as well as mechanistic studies. IARC combines these diverse streams of evidence in workgroup meetings aimed at peer review and consensus. This procedure could, with appropriate revisions, serve as a source of inspiration for the CiSG, though it could be argued that other medical conditions might serve as better analogues, if more pluralistic approaches have been found to be applicable and efficacious.
Genetic-ethical considerations
How might genetic science contribute to concussion science and care? Various studies have investigated the role of genetic factors in (A) predicting the risk of concussion and traumatic brain injury19 and (B) predicting recovery and management from concussion.20 Nevertheless, promises of identification of those athletes/APs at greater risks of poor outcomes or those of improved diagnosis, therapy and prevention by such genomic susceptibility testing should be analysed critically. For many associations, the predictive value is low and more studies are necessary to validate findings.21 The vast majority of tests for common disorders are still purely research-based and have not received any formal evaluation in terms of clinical validity and utility.22
Various ethical concerns follow the introduction of such tests. Although genetic susceptibility information has a probabilistic nature, this type of information is often interpreted with a sense of determinism and by reduction of an individual to its genetic characteristic23 A risk stratification that puts someone at low risk of concussion (because of behavioural traits) is based on a simplistic causal relationship between genetic variants associated with cautious behaviour and avoidance of concussion. This might also create stigmatisation and labelling, privacy concerns, and inappropriate stratification. One might also be concerned with inappropriate use by insurers, medical professionals, or coaches when making decisions regarding return to play (RTP).24Moreover, as testing for concussion might also include variants in the APOE gene,25 it might, as a byproduct, disclose an 'incidental' increased risk for Alzheimer disease.26 This opens various other problems regarding counselling, informed consent, family risk, right not to know, insurance, etc. The prospects of genetic medicine in the area of concussion look, at this juncture, limited. Therefore, the CiSG Scientific Committee ought seriously to consider a public statement as to the utility of direct-to-consumer genetics tests for concussion.27
Ethical framework for management of concussion: beyond respect for autonomy
The 2017 CS frames postbrain trauma situations as involving two independent agents, an AP and an SP/HCP, whose primary interest is the protection and promotion of health. Brain trauma management protocols based on dyadic clinical frameworks have successfully provided APs with greater protection. Remove-from-play protocols insulate APs from some of the pressures to continue playing after suffering trauma, and information and awareness programmes help APs and sport medicine professionals better understand the severity of head injuries. Arriving at more robust and ethically defensible RTP protocols has clearly been one of the successes of the 2017 CS process. Nevertheless, all such frameworks face limitations. Health-related decisions can hardly be understood as simply involving two agents who agree on the primacy of clinical criteria and prioritise health-related interests. This framing obscures two critical elements: (A) APs make (more or less informed) choices in complex contexts and (B) APs, often as a result of contextual elements, deprioritise health-related concerns.
SRCs incorporate complex processes originating from myriad agents and factors. APs' decision-making contexts comprise specific individuals (eg, relatives, teammates, coaches), institutions (eg, team, family) and policies (eg, contract, legal frameworks), all of which have rich histories and traditions (consider the self-sacrifice culture in high-contact sports like Rugby Union and American Football).28–31 All these elements can affect APs' decision making. Moreover, all AP-clinician encounters arise in specific contexts. Compare an adult AP playing football in a prestigious US university and a female amateur rugby player competing in a community-based tournament. Failing to account for contextual elements is likely to undermine the effectiveness of concussion management protocols for at least two reasons. First, the protocols misalign with APs' experiences, placing unworkable expectations on APs and issuing unfeasible recommendations; second, management protocols can only be effective if they follow clinicians' recommendations.
The CS recognises that 'treatment should be individualised and target specific medical, physical and psychosocial factors'32 and recommends approaching brain trauma incidents through multidisciplinary lenses. This typically means different disciplines within healthcare and medicine, not beyond it and in doing so, prioritises biologically based factors at the expense of others. For example, sociocultural elements are mentioned once, at the end of the 'Prevention' section, but the document leaves unexplained the relevance of these factors—other than noting that they 'play a significant role in the uptake of any injury-prevention strategy.'32
Within the medical or healthcare domain, all SPs and HCPs are aware that informed consent requires mental capacity (especially reasonable comprehension of sufficient information) as well as voluntariness and the absence of coercive forces. Concussion management should always follow these norms and rules, adapting them specifically to their AP. The use of the SCAT test can at best serve as a proxy for mental capacity. Some cases (eg, children/adolescents/athletes with intellectual impairments) will clearly require special measures—even for the implementation of SCAT5, let alone other significant decisions. Also, relevant non-paternalistic reasons, such as the protection of other players, may require removing a player. In general, however, efforts must be made to involve players in decision making. This might involve advance directives for situations of unestablished (or unknown) mental capacity. Justified policies must go beyond medical facts. Individuals' preferences and especially assessment of medical considerations differ widely. In contradistinction to the perspectives of many SP, the promotion and protection of health cannot generally be presumed to be athletes' main, or even only, concern.33
Sufficiently informing players requires openness about possible postconcussion long-term effects. Especially important is transparency about the difference between risks and uncertainties, as these must be assessed differently.34 Risks resulting from playing sports can be individually weighed because the relevant facts, including probabilities of brain injury, are sufficiently established. In contrast, evidence concerning the nature of pertinent chronic health conditions and the role brain injuries may have in their progression is weaker.35–38 This uncertainty, and accordingly, the problem for individuals to weigh their options, is not merely due to lack of knowledge about causal connections between repeated concussions and chronic conditions. Rather, the problem stems from the population-specific character of extant evidence. Relevant studies examine particular groups of people, such as elite athletes, and perhaps compare them with other groups in specific respects. Consequently, potential health impacts also apply to these abstract group categories. Epidemiological studies result in statistical generalisations.39 Individual players ignore the specific probability of long-term harm to weigh against the benefits of play. Thus, they lack adequate information. In such a situation, players need support to make autonomous choices. For instance, they can be provided with information about natural frequencies of chronic brain diseases in specific populations. Making people health literate is an established goal of public health measures to broaden their medical perspective and help them recognise ethical considerations.40 Reflecting on autonomy, philosophers have attempted to devise formulae to safeguard individual decision making without leaving people alone in the formidable task of making autonomous decisions. For instance, the idea of scaffolding autonomy has been discussed and would be one idea to build on when considering the autonomy of APs in situations of relative uncertainty.41 42
Considerations for children and adolescents
A paucity of research exists into concussion in children, especially younger children. Children are vulnerable in virtue of their emerging capacity to make complex decisions or take actions that influence their lives, meaning that parents or other proxy decision-makers are required. Furthermore, children are potentially physiologically vulnerability due to growth and development of different systems at different ages.43 These considerations must be factored into welfare discussions, specifically in relation to brain injuries. Children may also not be able to identify SRC for themselves, and there may not be trained medical staff at their sporting events able to provide care.
The presence of trained staff and infrastructure for dealing with concussion is more likely at the elite level. This point applies to many issues concerning SRC, and so the development of the Concussion Recognition Tool (CRT5), designed for use by all stakeholders, is most welcome.44 Nevertheless, at the recreational level, parents and coaches may not be familiar with CRT5 use. Even if used correctly, a range of ethical considerations arise. Children are dependent on their parents to access medical care, which may not be available or affordable. Where medical services are available, questions remain about proxy decision-making. Parents at all sporting levels may not always act in the best interests of their child. Parents may not believe the child regarding their symptoms, wish for a faster RTP (especially in higher levels of sport competition), or not acknowledge or even be aware of the process of recovery or the risks posed by early RTP. Equally, they may simply be overprotective based on a failure to understand these protocols.
Equally, coaches may also not recognise the significance of a (sub)concussive episode, insisting on a timeline for RTP that is unrealistic, especially in the absence of reliable biomarkers. Some will recover in days to weeks, while up to 30% of children and youth may have on-going symptoms 30 days following concussion.43 44 The literature in this area continues to evolve. The SP or HCP may struggle to balance the needs of the AP with the expectations of the coach and the child's parents, especially when seeking parental consent.
Given that concussions are more likely or severe in contact/collision sport, the judgement around a child's participation must entail an estimation of likelihood and severity of the potential harm.45 Two possible frameworks for such judgements should be considered. The best interests (BI) framework (which clinicians might typically use) aims to maximise a child's interests, based on a trade-off among their various interests. BI judgements are unlikely to support participation where concussion is both likely and severe. It is, however, notoriously difficult to determine what is in a child's BI especially when uncertainty exists. Moreover, and more generally, no society requires all decisions to be in the child's BI,1 instead, parents and the State are only required to ensure that a child receives a certain level of care.46
An oft-cited alternative to BI is the 'right to an open future' (ROF)47—any decision made for a child must not limit the child's future options. 'The principle holds that children possess a unique class of rights called rights in trust—rights that they cannot yet exercise, but which they will be able to exercise when they reach maturity'.48 A concussion with persisting symptoms may limit the child's future decision-making capacity. ROF is especially applicable to concussion in children as they may experience long-term sequelae from significant or repeated incidents. Although less restrictive than BI, ROF judgements struggle to balance the opportunity costs involved in conflicting potential future lives.49 When making decisions on behalf of a child all emerging evidence must be considered in line with the precautionary principle and in association with BI and/or ROF.
Race and risk for adverse outcomes following (repetitive) head injuries
Recent data on active and former American football players who self-identify as black point to increased risk factors for long-term adverse neurological outcomes following repetitive head injuries.50–52 Several aspects of this standpoint warrant critical scrutiny. First, self-identified racial identity depends on several kinds of psychological, cultural and social factors not always explicitly recognised in the methodology.53–55 The observed associations between self-identified racial identities and adverse outcomes following TBI in the recent data on former football players who self-identify as black could be explained only with the psychosocial, economic and cultural factors for which self-identified race is used as a proxy.
Many studies56 57 demonstrate that perceived racial discrimination through a phenomenon known as 'allostatic effect' have an adverse effect on health in general through epigenetic stress mechanisms and leads to predispositions to a variety of multifactorial diseases.58 Negative feedback loops triggered by using concepts such as self-identified race as a proxy for increased risks of adverse outcomes reinforce stereotype threats, leading to athletes ruling themselves out from sports for which they think have no predisposition, or perform at a diminished level.59 60 Therefore, using self-identified race as a proxy for the multitude of factors associated with adverse health outcomes is neither epistemologically, nor ethically justified.53 Notwithstanding repeated calls by to the contrary,61 62 we argue that it is problematic that NIH requires the use of self-identified race in research, as it leads to the biological reification/reinscription of a social concept.
More research is needed to investigate the psychosocial, economic and cultural factors which can lead to adverse neurological outcomes following concussion. Robust social epidemiological studies of health disparities exist in other contexts, which should be taken as trustworthy exemplars and applied to this context.57 58 63
Gender and SRC
The growing body of research on SRC and gender suggests that females experience concussion more frequently, experience more severe symptoms and take longer than males to recover.64–67 These studies correct the historic male bias in SRC research, which led previous CSs to rely on evidence drawn from study samples that were overall 80.1% male.68 Also concerning is the dominance in this literature that attributes patterns of incidence and impact to physical (eg, visual awareness, neck strength) and physiological (eg, hormonal, brain structure) rather than social factors (eg, reporting behaviours). The prioritisation of physiological and physical factors is in contrast to the dominant sport injury models, which either propose a multifactorial aetiology69 or target individual behavioural prevention initiatives.70 The promotion of different explanatory paradigms to explain male and female SRCs replicates the historical gender bias in sports science medical research71 72 that has recently come under increasing scrutiny.73 The policy recommendations that currently have been proposed on the basis of this research call for sex-differentiated risk mitigation, treatment and athlete surveillance; yet, these should all be rejected on ethical and social justice principles. A preferable approach is to ensure that activities are revised to be safe for all participants rather than risk the exclusion of more vulnerable populations. Such an approach would bring the response to SRC into alignment with the principles of occupational health,74 and thus is likely to be more broadly socially acceptable.
Accommodating difference and disability in SRC science and care
Para athletes, a smaller class than athletes with disabilities who compete/participate in activities not regulated by the International Paralympic Committee, can be broadly considered to fit into one of three major diagnostic categories: visual impairment, physical impairment and intellectual impairment.75 Of and within these three categories, athletes who are visually impaired, athletes with limb deficiency, athletes with cerebral palsy and athletes with spinal cord injury constitute the largest Para athlete groups.
Concussion in Para sport (CIPS) has largely been unrecognised and under-reported.76 Nevertheless, head, neck and facial injuries (often observed as loss of consciousness or subsequent ataxia) have been documented in both summer and winter Games settings.77 78 From these data, several sports have been identified as of potential higher risk of SRC, particularly those with speed, collision and contact as inherent risk factors. These sports include blind football and alpine skiing, as well as certain cycling, equestrian, and track and field events.
Aspects related to these inherent sport risks in the setting of impairment(s) of APs increases the complexity and uncertainty regarding aspects of SRC recognition, diagnosis, management and RTP decisions, all of which make this population further vulnerable. Specific examples of these vulnerabilities include the fact that Para APs have already adapted to congenital or acquired impairments, and a recognition of this is challenging to accommodate in clinical and team management discussions. AP disclosure to the SP or HCP may vary significantly because of this. Second, the fitness-for-purpose of the SCAT5 has not been significantly evaluated by researchers across a range of Para-sport categories. It is also known that baseline testing scores are sometimes different in the Para AP population.56 Third, it is not fully clear how adaptations related to SRC management should be implemented, for example, the concept of rest is different to a wheelchair-using AP who is expending significant energy as part of daily living.
A greater understanding of existing knowledge gaps and attitudes towards SRC among para APs, coaches and medical staff, are topics only recently receiving sustained attention and research focus in the para sports medicine arena, as efforts to work together with all stakeholders to reduce SRC gather momentum.79 The CiSG group should consider, along with the newly formed CIPS, how the resulting data can be effectively integrated.
Intervening in sport regulation change
Rule adaptation and practice-related changes within sports competition and training are almost inevitable. Within sports, rules can be categorised as either constitutive or regulative.80 The distinction has proved fertile in analyses of the rule structures in sport.81 Constitutive rules create an activity the existence of which is logically dependent on the rules. The rules make sense only in the practice they define. Regulative rules regulate pre-existing activities whose existence is independent of the rules. What are the implications of this distinction in the context of SRC?
As indicated in previous CSs, most preventive rule adaptations focus on concussion management itself.82 83 Perhaps, however, the main cause of concerns about SRC lie in the nature of sport itself, which expose APs to SRC risks. One radical solution is to reject the constitutive rules in sports with concussion risk assessments above a set level. For example, the World Medical Association previously recommended a ban on boxing.84 Less radical measures focus on the modification of constitutive rules (eg, body checking in Canadian youth ice hockey that led to reduced injury and SRC rates).85
For a holistic understanding, biomedical approaches to SRC should be augmented by, or framed within, 'thicker' sociocultural understandings. This requires nuanced insight and understanding of the standards of excellence in particular sports, including how safety-based concerns can be evaluated against sports with foreseeable head injuries without eradicating, where at all possible, their defining internal goods, values or excellences.80 This contextualissation of SRC risks enables a distinction between relevant and non-relevant risks. Some SRC risks (eg, in boxing and downhill skiing) are intimately linked to the standards of excellence of these sports. In this sense, they are 'relevant' though not necessarily ethically acceptable. The constitutive rules of boxing encourage the exposure of opponents to increased SRC risks and could be considered unacceptable,84 whereas SRC risk in downhill skiing is considered an unavoidable element of skiing skills and may be considered acceptable (up to a certain level). Other forms of risk (eg, failure to use protective headgear in boxing and downhill skiing) are not connected to sporting standards of excellence and can be deemed both non-relevant and non-acceptable. What is required is the appraisal of both risks and the defining excellences and goods of the activity to locate pressure points and to debate them with appropriate medical, philosophical, regulatory and sociocultural expertise.
A pragmatic legal response to SRC
Legal structures have little to offer as a global one-size-fits-all solution to SRC concerns. Statutory responses unfairly shift responsibility onto coaches and match officials; personal injury law demands the near-impossibility of showing both a breach of the duty of care and establishing causation in respect of conditions that can be incredibly difficult to detect in sports settings; and neither approach facilitates recognition and response to a condition which might not present itself until several days later.86 Further, if one accepts that SRC is a global phenomenon that, by definition, demands global responses, then whether at the elite or grass roots level, and whether the concern is with adults or children, it is not 'law's territory'.
There has been much discussion of athletes' workplace status as a key issue in determining the applicability of SRC-related rights and obligations arising under (eg) national health and safety laws, disability and other forms of discrimination, whistleblowing and vicarious (employer) liability. But in some individual sports especially, athletes are often regarded as self-employed in some countries, while, under the same conditions, they would have worker or employee status elsewhere. In the English case of Varnish v British Cycling UKEAT/0022/20/LA, for example, an Olympic Cyclist was held to be self-employed and was thus unable to bring a sex discrimination claim, while Northwestern University and College Athletes Players Association Case 13-RC-121359 explains why US college football players cannot unionise under national law. By contrast, many jurisdictions have legislation in the form of Sports Acts,87 which confirm the employment status of elite athletes and that workplace status can facilitate union membership or other forms of collective representation as well as provide access to the remedies noted above. No conversations about SRC at the elite level should take place without high-level engagement with athlete unions or other player representatives, but if SRC-related rights and obligations are rooted in domestic law, they will inevitably vary across jurisdictions as much as they vary across disciplines. That cannot be reconciled with the evident need for a global approach to the problem.
Protocols, which either apply globally to a particular sport or to every sport within a particular country, have far more to offer than reverting to legal remedy. Much can be learnt from the Scottish experience with If in Doubt, Sit Them Out, a national SRC strategy launched in 2015 with the support of all sports and the Scottish government, employing a precautionary approach, mandating a minimum level of education, awareness and accountability regardless of the level of participation, supporting removal from play where decision makers are in any doubt.88 The strategy is not without its weaknesses, notably in broader applicability. While reliance on volunteers is a key feature of the European Model of Sports,89 so much so that grass roots participation could not function without them,90 a key difficulty with If in Doubt is that volunteers, employees and workers are expected to understand and implement advice on detection and response which sports organisations, the government and medical experts had taken several years to develop. The usefulness of if in doubt is currently limited by the unrealistic expectations it places on stakeholders and, crucially, the lack of awareness among those groups. In some ways, it is a failed performative,91 but it provides a starting point that individual countries and global sports can build on; it has far more to offer than recourse to law, helps overcome some inevitable jurisdictional differences and gives agency to participants and other sporting stakeholders that legal strategies would deny.
From SRC research to policy development
The role of science is to set out what the evidence says, whereas the role of policy is to consider whether the evidence merits a policy response, given the policy purpose. Effective policy for SRC must have a clear and credible policy purpose. The CiSG consensus statements92 aim 'to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries…for use by…people involved in the care of injured athletes, whether at the recreational, elite or professional level'. This sets a clear purpose: to mitigate the acute health impact of SRC episodes. Nevertheless, it is not credible for policy for SRC to be limited to mitigating acute health impacts of SRC episodes once they occur. Thus, a complementary policy purpose to reduce SRC incidence could be added to the purpose of the CiSG statements.
Policy arising from the CS must be informed by efficacy (what works in ideal controlled conditions) and effectiveness (what works in the real world) evidence that policy recommendations can achieve their policy purpose by the means proposed.93 Despite being informed by evidence from 12 systematic reviews,20 94–104 and thus having assumptive 'theoretical efficacy', there is currently very limited postimplementation evidence for the effectiveness of the CS recommendations in relation to relevant policy purposes.
The CS includes discussions on prevention, risk reduction and 'sequelae' (long-term effects)92 95 105–107 but the latter refer only to whether and what long-term effects exist. In the latest CS94 specific recommendations for the former, informed by a commissioned systematic review,108 are included but extend only to snow-sport helmets and rule enforcement for high elbows in soccer.
A more comprehensive policy purpose would be to improve long-term brain health outcomes, to which mitigating the acute health impact of SRC may or may not contribute, and towards which there is a clear role for a more extensive focus on incidence reduction. Debates about a demonstrable cause-and-effect relationship rest on discussions, highlighted earlier, concerning what evidence counts in relation to SRC, including long-term effects and conditions such as CTE. Nevertheless, the mere existence of the debate, and its prominence within concussion science, demands that a policy response be considered. In turn, greater cooperation between the various stakeholders could facilitate more credible SRC policy.109
Conclusions: joined up research to accommodate ethical, cultural and governance reform
While the 2017 CS identifies education as 'a mainstay of progress in this field', progress does not match the expectations of campaigners.110 This has led to calls for a 'cultural change' regarding SRC policy relating to reporting behaviours, treatment compliance, attitudes, behaviours and social norms.111 112 As increasing multidisciplinary knowledge and more precautionary attitudes towards concussion have arisen, progress must be evaluated against greater attention to context: on the cultural and structural aspects of sport's organisation of which sport medicine will play an important role.
At an organisational level, explicit identification of responsibility for the management of concussion should be encouraged at recreational levels. Responsibility should be accompanied by regulatory empowerment. For non-elite athletes, consideration should be given to the responsibility for decisions to remove participants from play, the ongoing monitoring of symptoms, and supervision of RTP. The lower the skill levels/qualifications available, the wider that responsibility should be shared, following broad principles of precaution. Care should be taken to enable concussed athletes to remain both integrated and integral to sports teams/organisations in the longer term, as this will encourage precautionary behaviours.
In medical terms, the introduction of independent medical assessments and diagnoses for concussion is to be welcomed. Further clinical autonomy, appropriately coordinated, across sports medicine should facilitate positive cultural change. Relevant mechanisms would consider recruitment and appointment procedures, ethical and legally sound protocols for managing information exchange between coaching and medical staff, and improved understanding of medical ethics within sports organisations.
We have attempted to demonstrate by example and argument how a broader multidisciplinary approach can augment and better situate biomedical research and clinical practice in SRC more holistically. With the SRC widely acknowledged as a form of global problem, now is not the time for HPCs, SPs and biomedical researchers to turn inwards. Mutually respectful and inclusive research-based dialogue is essential for the development of the SRC agenda.
Data availability statement
No data are available.
Ethics statements
Patient consent for publication
Twitter @silviacamporesi
Contributors All authors contributed to the whole manuscript. All authors reviewed the final manuscript. The lead author was responsible for the original conception and final editing of all revisions. He is responsible for the overall content and is the guarantor of such.
Funding This study was supported by International Olympic Committee (Financial support for Concussion symposium organisation).
Competing interests MM: co-chair of the Concussion in Sport Group (CiSG); DM received payment for expert testimony (Rylands Solicitors company); WD is a member of the IPC Medical Commission.
Provenance and peer review Not commissioned; externally peer reviewed.
↵Although there is no definitive label for the phenomenon of concussion in sport, sport-related concussion will be used throughout. This is in acknowledgement of the fact that the CiSG have adopted this label and because biomedical researchers and clinicians have typically tended to distinguish brain trauma into military blast, road trauma and sport categories. Thanks to Gavin Davies for this clarification.
↵We acknowledge that measures in place for the 2022 Amsterdam conference and the resultant Systematic Reviews and CS itself have improved the state of affairs.
Other content recommended for you
- Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022
- Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016
- American Medical Society for Sports Medicine position statement on concussion in sport
- Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012
- Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS) Group
- Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York
- Medical assessment of potential concussion in elite football: video analysis of the 2016 UEFA European championship
- American Medical Society for Sports Medicine position statement: concussion in sport
- Amsterdam 2022 process: A summary of the methodology for the Amsterdam International Consensus on Concussion in Sport
- How to identify and manage sports related concussions in primary care


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About This Quiz
In tough economic times, we all start to look at trimming our expenses. Take the budgeting quiz to find out how savvy you are with your money and get a few money-saving tips along the way.A mortgage payment is a fixed expense because you can predict you'll pay it on a consistent basis. Other fixed expenses include other loan payments, tuition, rent and fixed utilities that don't vary from month to month.
A typical financial planner will advise you to try to make an emergency fund with enough money to get by two to three months without any other income.
Using a money market account for an emergency fund can help you make money on your savings while you aren't using it. Money markets draw more interest than basic savings or checking accounts, and you can still get to the money if you need it.
Generic prescription drugs are chemically identical to brand name, so it is cheaper and not unsafe to defer to generic. Just ask your doctor to prescribe the generic version of your drugs.
A large part of improving your financial situation means getting out of debt, and the longer you wait to pay off credit card debt, the more you'll have to pay in the long run. Making a grocery list and using cash are both good ways to stay on track.
A discretionary expense is one that you don't need but would like to have.
While pre-cubed, pre-pounded or pre-seasoned meats or poultry can save you preparation time, they cost a lot more than plain cuts of meat. If you can spare a few minutes to cut, pound or season your meat, you'll find the savings are significant.
Some critics say that putting money into an emergency fund is illogical if you have a Home Equity Line of Credit (HELOC). HELOCs come with checks that you can write immediately in the case of an emergency, and you can repay the money once you are past the disaster. However, you must figure in the interest and fees. Using HELOCs can be dangerous if you're not careful.
Both shifting to neutral when you are at a long traffic light and not riding on the brake will improve fuel economy and save you money on gas.
Money difficulties are known to cause stress, which in turn even make your immune system weaker. In addition, money problems and arguments are a major cause of divorce.

subset: commoncrawl


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Listen to this rundown on the evils of super-banks by recently-arisen British political superstar Nick Clegg. The Guardian's Oliver Burkeman recently called him the new Obama, but when was the last time Barack Obama spoke the truth about fix-is-in banking practices as bluntly and plainly as Clegg says it here? Obama should aspire to be the American Clegg.
"A week ago, most people in Britain considered Nick Clegg, the 'little-known leader' of the Liberal Democrats, to be, by all measures, a long shot to become Britain's next prime minister," a 4.21 Huffington Post summary reads. "But that was before 'Cleggmania' swept the country.
"The origins of Cleggmania can be traced to last week's televised debate — a first in Great Britain — in which Clegg was widely considered to have stolen the show from the leaders of Britain's two largest political parties: current Prime Minister Gordon Brown of the Labour Party, and Conservative Party leader David Cameron. The headline the next day in the London Times read 'Clegg comes of age.' A poll taken after the debate led the Guardian to declare that 'Clegg is now in contention as potential PM.'
"To top it off, the latest YouGov poll shows the Liberal Democrats to now be in the lead with 34 percent of the vote. The Conservative Party came in second with 31 percent. A week ago the Liberal Dems were hovering around 16 percent. Andrew Sullivan of the Daily Dish referred to the poll result as 'the earthquake in Britain.' John Curtice of the Independent has called the Liberal Dems' surge 'the biggest shock to the electoral landscape in years.'"
Here's an insightful, well-written piece about Clegg by the Globe and Mail's Doug Saunders.


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Lessons from the Edge
I like to say that "I had my 15 minutes of fame 17 years ago". That was when the book I co-authored came out. Lessons from the Edge […]
Read moreJeff is a deal maker. Throughout his career, he has structured and completed various types of financings – angel, family office, venture capital, private equity and public venture capital.
He has also bought and sold businesses of various sizes and industries. The purchase or sale of a business is typically one of the most important and largest transactions in a person's life. It is critical to surround yourself with a trusted advisor.
He understands the perspective of both the entrepreneur and investor, having been on both sides during his career. He has acted as both advisor and principal, bringing an important perspective to any transaction.
Jeff has extensive experience with private equity, venture capital, angel investors and family offices. He has worked with all forms of corporate financings, including SAFEs, convertible debt, mezzanine financing, bank debt and equity. He has been involved in over $2 Billion of financing during his career.


text: Indoor localization is becoming increasingly important for mobileapplications. WLAN fingerprinting is a compelling technique becauseit builds upon existing infrastructure and client hardware availablein off-the-shelf mobile devices. We evaluate different methods forWLAN fingerprint classification with a focus on on-device localization.The main scientific contribution of this approach is that any Androidbased device can localize itself (without any server being able todetermine the current location) using existing WLAN infrastructure(no additional access points have to be installed, the firmware ofexisting access points doesn't have to be changed). This approachwas chosen to make indoor localization feasible in non-academic usecases.With a functional implementation and a simple procedure for collectingWLAN fingerprints, we currently achieve an accuracy of 4,m in 90%of all cases with a mean error of only 2.2,m when the same deviceis used for training and testing. Next steps are calibration betweendifferent mobile devices, post-processing in terms of movement, andautomatic downloading of the required WLAN fingerprint databaseson a global scale.


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Beautiful * Natural * Durable * Sustainable * Renewable * Recyclable
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Standard section sizes:
5" x 5-1/2" up to 18' fixture height above soil grade or top of foundation
6-3/4" x 6-3/4" up to 24' fixture height above soil grade or top of foundation
8-1/2" x 8-1/4" up to 28' fixture height above soil grade or top of foundation
Center wire route: Manufactured with a 1" x 1-1/4" full-length center wire route designed to protect and conceal electrical wiring.
Surface Textures
· Smooth (standard)
· Rough sawn
Fabrication Styles
· Radiused edges (1/4" standard)
· 1/2" radiused edges
· 1" chamfered edges
Factory Staining
EroVista light poles can be pre-stained or stained/painted in the field to achieve a desired color. When painted or stained, periodic retreatment may be required to maintain the original color. If left unstained, the wood will weather to a natural attractive silver-gray color. Customers choosing to purchase light standards pre-stained must specify a Sherwin-Williams SuperDeck Semi-Transparent Stain ( SW _ _ _ _ color number).
Tenon Top & Protective Caps
Specify a MC metal tenon cap to accommodate top mounted luminaries or a PC protective cap for side-mounted luminaries. All metal cap hardware is made from powder coated 10 gauge steel, powder coated flat black.
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Cross arms by others or EroVista's CA cross arms can be specified for side mount fixture applications. CA cross arms can be custom manufactured to include a vertical tenon at the end of the arm.
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For pedestal mount installations, specify metal base plates (BP or BP-H base plates with a hand hole). AC cover skirts are included to conceal anchor bolts. Anchor bolts and pedestal foundations are supplied by others and should be designed by a licensed professional engineer per local soil conditions and building codes. All metal BP, BP-H and AC hardware is made from primary steel and powder coated flat black.
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· EroVista light poles are shipped job lot wrapped or can be individually paper wrapped at an additional cost.
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If you're embarking on the adventure of inviting a puppy to join your family, you've probably already done at least some of your homework. You've likely chosen the right breed, thought about names, and you might even have started stocking up on toys, bedding, and food. If this sounds like you—nice work! Unfortunately, though, you're not done quite yet—you still have to do your homework on how to pick a good dog breeder!
What can we say; anything worth doing is worth doing properly, and getting a dog is no exception.
One of the less exciting parts of the journey to buying a puppy involves thinking about what to look for in a dog breeder. Though it's not quite as fun as shopping for squeaky toys or coming up with a unique name, understanding the best way to find a puppy breeder will ensure your pup is as happy and healthy as possible, right from the get-go. It'll also mean you aren't giving money to bad breeders, which Puppy Hero dislikes even more than cleaning up dog poop.
Pretty much everyone is familiar with the phrase "adopt, don't shop". While adoption can do wonders for a lonely dog who needs a home, adoption simply isn't feasible for everyone.
People may choose to buy from a breeder because:
Though specific breeds can be found in shelters, a breeder is the way to go if you want to be super sure of the legitimacy of your pup's breed.
Unfortunately, some shelter dogs have had a pretty rough start in life. Resulting from mistreatment or neglect, it's hard to be certain that a shelter dog won't have additional needs or behavioral problems. While an experienced dog owner with no little ones at home might be super keen to take on the challenge of a shelter pup, this might not be the best option for first-time owners or those with young kids.
As well as being a better option for some families, you're also preventing re-traumatising a pooch who has to be returned for behaving badly!
Visiting your new furry friend in the breeder's home is a great way to check on the background of your dog. As well as getting to see their surroundings and check up on the mom, your breeder should also give you information on your dog's family and genetics. This means you'll be aware of any nasty health problems that might crop up in the future, as well as getting a little peek into some doggy history!
If adopting isn't for you, using a trusted site such as Puppy Hero is a great way to find a reputable puppy breeder. Instead of trawling through social media, newspaper ads, or craigslist trying to suss out whether you're being scammed, or if that guy really does need your bank details to secure a deposit, Puppy Hero can do all the hard work for you.
All of our breeders are pre-screened and verified to ensure that they raise the pups in the best possible environment, and we have a zero-tolerance policy on working with puppy mills. We also exclusively work with breeders who offer a health guarantee and vet checks, so we've got your back when it comes to making sure you'll be returning home with a happy and healthy four-legged friend.
If you decide to go it alone and find a breeder elsewhere, there are some responsibilities you'll need to take on yourself to find a reputable puppy breeder. The best way to find a puppy breeder who you can be sure is taking proper care of their pooches is by doing a little detective work.
Arming yourself with a set of questions to ask the breeder is definitely advised. You'll want to ask about whether your new addition will be vaxxed, dewormed, and microchipped, as well as any other questions you might want answering about their general health.
You'll also want to meet the pups and their mom before committing to anything so that you can ensure the breeder is taking care of them properly. You'll be looking out for things like clean bedding, a comfortable pen, and access to fresh water. If a breeder makes excuses as to why you can't make a visit, this is a major red flag!
Last but not least, it's definitely worth checking that they have solid references, as well as vet records, dog breeder certifications, and registration with a certified kennel club such as the AKC. Being registered with a kennel club is a way by which a breeder can register their pups with an official organization that helps to ensure its members are carrying out ethical breeding.
Just as there are green flags that let you know you're picking a good dog breeder, the opposite is also true.
You should be wary of interacting with a breeder who:
From getting scammed out of your hard-earned cash to giving money to a puppy mill operator, putting your faith in the wrong breeder can have some pretty nasty consequences.
Though you may be tempted to take a pup out of a puppy mill owner, or bad breeder's hands and give one of them a good home, in doing so, you're contributing to their continued ill-treatment of dogs—and no one wants to be a Cruella enabler.
If you're suspicious of a breeder, it's best to go with your gut and cease all contact. If you're particularly worried about the welfare of the dogs under their care, you can file a complaint with the kennel club associated with the breeder, get in touch with animal welfare charities such as the ASPCA, or even speak to your local law enforcement agency.


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Avatr to Launch New Electric Sedan, Avatr 12, with Huawei's Systems
Avatr, the electric vehicle brand owned by Changan and CATL, is set to expand its lineup with the launch of the Avatr 12, an all-new electric sedan. According to a recent patent filing, the Avatr 12 will feature a slightly flatter design than its predecessor, the Avatr 11 electric SUV. Both the front and rear designs of the new model show similarities with the Avatr 11.
Huawei provides the complete platform for the EVs in the Avatr lineup, including the Avatr 12. The new model will be powered by two electric motors with a total output of 425kWh, and will offer two battery options: 90kWh or 116kWh, both from CATL. The Avatr 12 will run on Huawei's Harmony OS with the full support of the EP1 platform, and is expected to have a driving range of over 555km for the smaller battery and 680km for the larger battery, thanks to its more aerodynamic design.
The Avatr 12 is already in advanced testing stages, with test cars spotted several times. Some images of the interior of the Avatr 11 are also circulating online, revealing features such as a giant center screen and a similar steering wheel to the Avatr 11. The pre-production model of the Avatr 12 is expected to be showcased at the Shanghai Auto Show next month, although there are no pricing details or release date for the Chinese market yet.
Avatr: A Brief Overview
Avatr was established in 2018 by Nio and Changan, and is now owned by Changan and CATL. The Avatr 11 electric SUV is marketed by Huawei via its showrooms across China, and the brand's EVs are powered by Huawei's systems.
The launch of the Avatr 12 electric sedan is a significant step for Avatr and Huawei, as they continue to expand their presence in the EV market. With its sleek design, powerful performance, and advanced technology, the Avatr 12 is sure to attract attention from EV enthusiasts and tech-savvy consumers alike.
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Tagzania is closing
Next March 31st Tagzania will stop working. Be sure to download all your data in your profile view before that date. Thank you for all your support these years.
Tagzania ixtera doa
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Miami As A Top Tourist Attraction Points
Miami is the major city in the state of Florida which metropolitan area as the forth largest urban area in the United States. This city weather is generally hot to warm which summer months of June-September will see most day time highs over 90o centigrade. I went to see nearly a car or home without running air conditioning. Miami is the most popular destination, nightlife, sightseeing and one of the most attraction cities for tourists. By the internet I reserved cheap airfare ticket online at cheap rates. I found this great accommodation from an online reservation hotels site which gives me a list of hotels in miami with all the facilities at discount offer. But I reached that city by Miami International Airport. This airport was good facilities in tourist include taxi, bus, and train which were an important hub for traffic between North America and Latin America, and one of the largest airports in the world. The airport was very clean and beautifully. But I called a taxi and reached to my marriott miami hotels at noon. I put my bags in room and get fresh and I went to lunch after lunch, I am back and I rested the room and I planned my trip for next day. This city I went to see the good attractions points include Jewish museum of Florida, wolfsonian-florida international university, Venetian pool, bay front park, Oleta river state recreation park, Miami metro zoo, Lummus park beach. In Miami the famous festival which was called South Beach and Wine Food Festival. This is great fun with more adventure festival and held in February. In party I also took the part. At beach side the fish food and some drink that so amazing experience for me. At night people multitude and sit round circle near to fire light. And make the celebrations of the fest. Many fun and entertainment activities are take place. After that I visit to the market for shopping in central shopping Lincoln Road where I bought some clothes, gifts, chocolates goods. After shopping I came back to last minute hotel deals where I leave my room and went to airport for leaving this city. While returning back, I remembered my all day to which them I spend in this city.
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The Health and Wellness Center at Florida Hospital Wesley Chapel will host "Beach Bash: Ladies Night Out" on July 12 from 5:30 p.m. to 8 p.m. This will be an evening of fun, friendship and health information. Wear your most creative beach hat and be entered to win a prize. There will be limited spots available for screening mammograms. To register for event, call (813) 929-5432. To schedule a mammogram, call (813) 929-5555
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Winter 1992 // Volume 30 // Number 4 // Ideas at Work // 4IAW6
Calendar Delivers Environmental Issues Information
An Extension calendar can provide timely information and repeated exposure to reinforce the importance of this educational message.
Increasing concern over environmental issues in the residential landscape includes addressing the impact of pesticides and fertilizers on water quality and the reduction of yard waste in landfills. An Extension calendar can provide timely information and repeated exposure to reinforce the importance of this educational message.
In 1989 and 1990, grants provided funds for the production and distribution of Virginia gardener calendars addressing water quality. The text of the calendars alerted homeowners to the connection between improper management of pesticides or fertilizers and water pollution and recommended good gardening practices (such as mulching, cover-cropping, and soil-testing) to minimize the need for chemicals in the residential landscape. The calendars were advertised to the public through local Extension offices, Master Gardeners, radio, and various Extension publications. The public responded enthusiastically, and over 14,000 were distributed to home gardeners each year.
In 1991, a recycling calendar was developed addressing management of yard waste and use of household wastes in the landscape. Lacking a grant to fund this project, the calendars were offered for sale at $6 initially and reduced to $4 later in the year. Sufficient calendars were sold to cover the cost of printing, handling, and shipping. Additionally, sales covered the cost of 3,000 extra calendars used in school garden programs and Master Gardener activities.
A random survey of the recipients indicated that 91% changed their gardening practices in some way because of the information contained in the calendar, and 93% indicated they found the information practical or useful. In addition, 87% said they shared the calendar information with others.
The calendar format is well-known and suitable for presenting information in short, concise passages. A calendar is used by clients all year. It's looked at every day by some clients, making it ideal for transmitting information most relevant to certain times of the year. In addition, portions of the calendar text can later be used to create other publications at little additional cost. Given these characteristics, calendars should prove useful as formats for transmitting information and changing behavior in other areas considered important by Extension. Future plans are to produce residential landscape calendars addressing environmental issues as a fund-raising activity for the Master Gardeners.


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Saturday, July 1st 10:00 AM
Meet-up point was on West Lake Sylvia
The Lake Sylvia Boat Parade, sponsored by GLSA, was a wonderful success. Special thanks to Jenny Pixley for initiating and organizing the goodie bags, awards, and supplying her bundle of enthusiasm with Vicki Hoien helping out. Nineteen (19) amazingly decorated boats checked in on Saturday morning on the West Lake near the channel. The parades went around each lake with some boats covering both lakes. Several docks were filled with festive spectators.
Boat Decorating Contest Winners
The Wilkes -1st place, lily pad donated by Anchor Dock
The Lanses - 2nd place, a gift certificate to Little Jim's
The Gerulis's - 3rd place, a tube donated by A-1 Marine
Katie Mika & her crew - 4th place, a gift certificate to Petty Bros
Thank you to our sponsors and all the amazing participants!
Join us again for the fun next year at the Lake Sylvia Boat Parade!


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What's up in Texas? Houston home buying is more than just a home. For us, it's part of the amazing lifestyle we get to enjoy living in the greatest state in the US! From nature, to zoos, to nightlife, and so much more, we blog about our best picks across the state. The information you read here is culled from our team's best picks – because we know and love the local vibes.
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Video Games That Are Revolutionizing The World
July 5, 2018
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This Vintage bum bag is designed as a small sized bum bag. This style features two compartments, one main compartment with zip closure, adjustable strap, comes in a pink colourway and is made of a canvas fabrication.
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width: 25cms
Height: 17cms
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Rent Relief
Rental Assistance: One day left to apply for assistance and avoid eviction
March 31, 2022 is the cutoff for California residents to be able to apply for rental assistance that can help them avoid being evicted. This is part of the California COVID-19 Rent Relief program. The ... more
How will New York get rent relief money out the door faster? More state employees, faster application for renters
New York Governor Kathy Hochul, who took office on Tuesday, said she is not satisfied with the speed at which financial relief has been dispersed across the state. Hochul praised the work of President Joe ... more


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Tax collectors (τελώνης/telṓnēs) appear only in the Synoptic Gospels: in the context of Jesus' table fellowship (Mark 2:15f. par.; Luke 15:1f.; 19:5f.), in the calling of disciples (Mark 2:14 par.), and in passages that make a special point of Jesus' friendship with them (Matt 11:19 par.; also Luke 19:1–10). Although tax collectors are mentioned alongside sinners (Mark 2:15f. par.; Matt 11:19 par.; Luke 15:1), prostitutes (Matt 21:31f.), and Gentiles (Matt 18:17), despite their bein…
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Tax Collectors (New Testament)(339 words)
Cite this page
Horn, Friedrich Wilhelm, "Tax Collectors (New Testament)", in: Religion Past and Present. Consulted online on 03 March 2024 <http://dx.doi.org/10.1163/1877-5888_rpp_SIM_026539>
First published online: 2011
First print edition: ISBN: 9789004146662, 2006-2013
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MyBucks advises customers to remain vigilant against fraudsters
Sylvester Chalira, the Head of Risk at MyBucks, explained that the warning is intended to encourage customers to participate in the safeguarding of their funds.
MALAWI: MyBucks Banking Corporation, one of the country's fastest-growing financial institutions, has warned its customers to be wary of fraudsters who use deception to steal people's money.
MyBucks Head of Risk, Sylvester Chalira, said that the caution comes as a means of engaging customers to take part in safeguarding their money.
"Our customers work hard to earn their money and the reason they bring it to the bank is to save it safely. We, therefore, implore them to take part in safeguarding their money by keeping their Mobile Banking, Internet Banking, Agency Banking and ATM PINs and passwords safe at all times," Chalira said.
Customers should check their surroundings whenever they transact at an ATM to ensure that no one sees them enter their PIN, he advised.
Customers must not share private information such as ATM PINs with anyone under any circumstances, he added, and MyBucks employees will never ask for a customer's password.
Chalira also advised customers to contact the MyBucks toll-free call center at 358 if they suspect their account has been hacked, and to report the incident to the authorities.
According to him, MyBucks will keep on helping its customers to be alert against fraudsters in the country that are seeking to steal people's money.
"The bank will continue advising and safeguarding customers from treacherous behaviors with relevant information through various platforms, including the bank's website and other official online platforms, in line with the Reserve Bank of Malawi's directives on consumer protection," He said.
Blantyre, Lilongwe, Mzuzu, Zomba, Mangochi, Dzaleka, and Kasungu are among the 14 branches of MyBucks Malawi, which is a fully-fledged bank. There are also more than 80 agents, 30 ATMs, three Forex Bureaus, and a Microfinance Division.
The bank also provides a comprehensive range of banking products and services, as well as Bancassurance and Microfinance.


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The Government appears to be pressing ahead with plans to scrap the Human Rights Act in an attempt to control the UK's borders.
It comes as Home Secretary Priti Patel has warned that failing to increase co-operation with Europe could cause "even worse scenes" in the Channel this winter than the capsizing that killed 27 people.
She vowed to "continue to push" for improvement next week, despite being disinvited by the French from a meeting of European colleagues to tackle the migration crisis.
Take back control
Last week Tory MP Scott Benton tweeted: "I've made this point in Parliament 3 times during the last week. The only way we can fully take back control of our immigration policy is by scrapping the ridiculous Human Rights Act."
Right wing media outlets seem very keen on the idea, one example can be seen from an article titled "Boris Johnson planning to SCRAP Human Rights Act" Reform needed – "The Human Rights Act has been identified as one of the main obstacles to tackling the migrant crisis because it is used by activist leftwing lawyers to prevent deportations and force the Government to provide accommodation and spending money to illegal migrants."
However it comes as Border Force staff have joined the legal fight to stop Priti Patel from "pushing back" migrant boats in the Channel, branding the government's plan "cruel and inhumane", reports the Independent.
Mark Serwotka, general secretary of PCS, said: "The Pushback policy being pursued by the Home Secretary is unlawful, unworkable and above all morally reprehensible.
"Our border force members are aghast at the thought they will be forced to implement such a cruel and inhumane policy.
"Migrants who are trying to reach this country should be allowed to so via safe routes so that their claims can be assessed here."
In response to Benton's comments Hannah Rose Woods tweeted: "Sorry about the red tape getting in the way of your inhumanity, but that's what it's specifically there for."
Related: Watch: Patel's 'economic migrants' narrative destroyed in 'cry for humanity' clip


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US scientists think they're on track to develop a 'universal' vaccine that will protect people against all kinds of influenza. |
The standard flu vaccine causes the body to produces antibodies, which target parts of the virus that frequently mutate. But in a new study, researchers used a vaccine aimed at a different part of the virus.
Gary Nabel heads the US government's Vaccine Research Center at the National Institutes of Health and was the study's lead author: "There are parts of the flu virus that could be the target of what we would hope eventually could be a universal influenza vaccine. They don't mutate, and the reason they don't mutate is that if they try to, the virus can't survive if you have mutations in these sites."
To get at these non-mutating parts of the virus, Nabel and his colleagues used a two-step vaccination process, called "prime-boost." The first step uses a bit of influenza DNA to get the patient's immune system to begin fighting off the flu, and then the protection is given a "boost" some time later by the second step, which can be either another bit of DNA or a conventional flu vaccine.
In his paper, which was published online by the journal Science, Nabel describes the results of animal tests in ferrets and mice using the 1999 vaccine for the boost.
"The antibodies that we were able to elicit could neutralize [varieties of flu virus] as far back as 1934 and as recently as 2007. So it really gave a broad coverage against a range of seasonal viruses that wouldn't be covered by the traditional flu vaccine," he said.
Preliminary phase one tests of this new type of flu vaccine have already started in humans, but in an interview, Nabel said that even if all goes well, it will still be years before a universal flu vaccine is widely available.
"It's certainly not going to be with us in anything less than three years, and I think it's more likely that we're in a five to ten year time frame."
Gary Nabel of the US Vaccine Research Center points out that his universal flu vaccine would have another benefit. A DNA-based vaccine wouldn't have to be grown in chicken eggs, doing away with the time-consuming and finicky manufacturing process of the current flu vaccine.
ferret: a small fierce animal with a long thin body, kept for chasing rabbits from their holes, killing rats, etc.(雪貂)
finicky: needing great care and attention to detail(需认真仔细对待的;需要注意细节的)
Researchers seek genetic clues to deadly bacterial epidemics
A new AIDS plan for the US, and new hopes for a vaccine


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Bearing 29432EX (NACHI)
Axial angular contact roller bearings 29432EX
Bearing number : 29432EX
Size (mm) : 160x320x95
Brand : NACHI
Bore Diameter (mm) : 160
Outer Diameter (mm) : 320
Width (mm) : 95
Bearing dimensions and specification in NACHI catalogue:
d – 160 mm
D – 320 mm
T – 95 mm
d1 – 283,8 mm
r min. – 5 mm
A – 99 mm
B – 62,5 mm
B1 – 85,7 mm
C – 45 mm
D1 – 222 mm
Weight – 33,4 Kg
Basic dynamic load rating (C) – 1820 kN
Basic static load rating (C0) – 5750 kN
(Grease) Lubrication Speed – 750 r/min
(Oil) Lubrication Speed – 1000 r/min
Tags : NACHI,160x320x95HRD Bearing Co.,Limited. has been engaged in bearing industry for many years, we provide a wide selections of brands
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Bible Crossword Puzzles For Adults Printable Printable Crossword Puzzles
Bible Crossword Puzzles For Adults Printable Printable Crossword Puzzles
Printable Christian Crossword Puzzles – Many people wonder What do I do to print a crossword puzzle? Or, where can I find the free puzzles? If you've struggled to find a way you can find free crosswords on the internet, this article will help you find the best ones. Here are a few of the most effective options. Find out more. How Do I Print a Crossword Puzzle? And Where Can I Find Free Online Crossword Puzzles?
Which Method Do I Use To Print The Crossword Puzzle?
Perhaps you're wondering how to print the crossword puzzle. If you're using a desktop printer or laptop, there are important things to know. Utilizing your browser to print a crossword puzzle is the most straightforward option however, there are a few steps to follow before starting. To begin, open Adobe Reader and choose File -> > Print Preview. This will bring up your print image preview for the piece.
After you've decided regarding whether you want to print an interactive or paper copy, it's time to have find out how to print a crossword puzzle. If you're using an online platform it is recommended to choose the print option on the top of the grid. Select this option , and then choose the size of your paper. Select A4 paper as the print preview will allow you to alter the size prior to print.
Where Can You Find Free Online Crossword Puzzles?
Crossword puzzles can be fun to solve and will test your logical and vocabulary abilities. Most of these puzzles involve identifying words from a word bank, deciphering clues and connecting words. Many puzzle websites have a huge crossword database to choose from. Some even offer games for you to play along with your friends. After that, you can play your crossword puzzles on any device.
The Washington Post has a crossword archive which you can print and play on paper , or play using an electronic version. You can play the game with timers to help you keep track of your progress. The AARP website also has daily crossword game that is expertly designed by a professional. In actuality, the website includes over 1,000 crosswords at no cost. It is worth the cost.
Printable Christian Crossword Puzzles
Where Can I Get Free Crosswords?
The free printable crossword puzzles are an excellent option to get your daily dose of brain-teasers. The majority of newspapers have these puzzles and many are time-sensitive. You can use them to test your spelling or complete a tricky puzzle with no cost, free printable crosswords can be an excellent way to get both. It's time to get your pen and paper and get yourself a great pair of thinking glasses and writing equipment ready to take on the challenge.
If you'd rather solve a no-cost printable crossword puzzle, consider making an 80s Movies crossword or a DC or Marvel crossword. Or, if you want to expand your knowledge and get some exercise by doing some Bible facts or 20-element facts. Whatever you pick you'll discover something you'll enjoy. The most appealing thing? All of them are free! Therefore, take the time to print several out, and take pleasure in a mental exercise.


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Click the 'person icon' to login and to view your profile.(Or the 'boxed arrow' if using a mobile device)
Four days dedicated to sewing. 10 tutors, 20 workshops to choose from.
Go to AUSSEW Convention 2022 for full details and booking information
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This is a past event.
Are you interested in a career helping to develop the next generation of automotive vehicles and batteries? Here's a fantastic opportunity to learn more about the EV industry and EV-focused companies and careers, network with potential employers … and receive a $10,000 scholarship.
An EV Scholars kick-off info session will take place virtually on February 1, 2023, at 5 p.m.
In particular, Michigan Tech juniors and seniors majoring in Software Engineering, Computer Science, Cybersecurity, Computer Network and System Administration, Electrical Engineering, Computer Engineering, and related programs are encouraged to participate.
Michigan Tech EV Scholars will participate in seminars, networking events, and internships with Michigan companies focused on electric vehicles and batteries. Successful EV Scholars will qualify for a $10,000 scholarship upon acceptance of a qualifying position in Michigan's EV industry.
Read the blog post here: https://blogs.mtu.edu/computing/2023/01/24/help-develop-the-next-generation-of-ev-technology-with-this-10k-scholarship/
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I have been hypothesizing a case where a legal owner of some digital asset (e.g. a software, film, music ,etc.) is worried about the illegal distribution of the copyrighted material and wants to hire a large number of machines to act as relays on the network to track down the illegal downloads and uploads of the copyrighted material. For this particular example if someone donates enough machines and bandwidth to the network and communicate between the machines they would very likely be able to track down some of the downloads.
Could this idea be turned into a source of business itself? Dominating the network first, and then selling out the information (IP address, time of access, etc.) to the copyright holders?


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WADENA — A 23-year-old man arrested by Wadena RCMP is one of two more people who have been arrested in connection with the 2017 homicide of Tyler Owen Morin in Saskatoon. A second man, 26 years old, was taken into custody by Regina Police Service.
The arrests were made on May 5. Both are facing charges of first-degree murder.
The Saskatoon Police Service Major Crime Section had already charged a 22-year-old man this week with first-degree murder in connection to the 2017 homicide. A 22-year-old man who was already in custody due to an unrelated matter was arrested Tuesday in Prince Albert.
On Nov. 4, 2017 at around 6:15 a.m. Tyler Owen Morin, then 30, was shot in a residence in the 200-block Avenue V South. He died as a result of his injuries on Nov. 11, 2017. The 2017 murder was Saskatoon's fifth homicide of the year.


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MoonBox Finance to USD Chart
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