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LPIC-2 Exam 201, fragment 1 of 2, version 4.5
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Your League: ARRL Reply Comments Cite "Fundamental Misunderstanding" of "Symbol Rate" Petition
In reply comments filed on its "symbol rate" Petition for Rule Making (RM-11708), the ARRL said comments opposed to its initiative reflect a "fundamental misunderstanding" of the petition's intent. The League's petition now tops the FCC's list of "Most vigorous Proceedings." More than 800 comments were filed as of January 7, some of them posted after the December 23 cut-off date and most favoring the ARRL's proposal. The ARRL earlier filed comments with the FCC on its own Petition (plus Erratum). RM-11708 proposes to drop the symbol rate circumscribe in §97.307(f) of the FCC amateur Service rules, substituting a maximum occupied bandwidth of 2.8 kHz for HF data emissions. The ARRL said those opposing the Petition execute not, in general, challenge the removal of the symbol rate circumscribe for data emissions in corps segments where RTTY and data emissions are now permitted.
"Rather, they mind to view the proposal to establish a maximum occupied bandwidth of 2.8 kHz for data emissions in the medium-frequency (MF) and high-frequency (HF) bands where data emissions are permitted now as an enabling provision," the ARRL said. Instead, the League said, its Petition is intended to impose "a limitation on the maximum bandwidth of data emissions where not a bit exists now." Given state-of-the-art data technologies, the League said, there is no necessary correlation between the symbol rate and the bandwidth of a data emission. The current symbol rate "acts only as a circumscribe on the efficiency of data emissions in the HF bands as a practical matter, and as an simulated and capricious filter on the types of emissions that can be utilized by radio amateurs."
The ARRL said its suggested 2.8 kHz maximum bandwidth reflects a balanced approach that will permit complete currently used data emissions, embolden experimentation with data emissions that the current symbol rate restriction prohibits, and preclude the utilize of wider-bandwidth data emissions that could usurp the limited RTTY/data subbands. Petition opponents, the ARRL went on to say, "offer no evidence" that the rule changes it proposes will lead to a situation where data transmissions overwhelm the subband and preclude narrow bandwidth emission communications.
"The Commission has properly chastised the amateur Service for resisting deregulatory proposals that are designed to enable amateur experimenters to refine and accommodate technologies," the League said in its reply comments. "ARRL is of the view that outdated Commission regulations that needlessly preclude experimentation with data technologies should not be preserved. Outdated regulations are not a viable alternative to cooperative sharing arrangements in the HF bands through intentional corps plans."
Some of those opposing its petition, the ARRL went on to say, expressed the belief that the proposed rule change would impose wider-bandwidth data emissions in spectrum where narrow-bandwidth modes such as CW and PSK31 now operate, to the detriment of the narrow-bandwidth modes. Other opponents contended that the Petition will benefit a few operators at the expense of the many now operating narrowband data, RTTY, and CW on the HF bands.
"It is illogical to argue on the one hand that the Petition is intended to benefit 'the few' who are data emission experimenters and users, and on the other hand to foretell that the relief requested in the Petition would create a flood of 'wide-bandwidth' data emissions, swamping the corps segments used for CW, RTTY, and narrow-bandwidth data emissions," the League pointed out. "If the concern is that the rule changes will embolden more radio amateurs to experiment with data emissions, that would be a positive outcome." The ARRL further asserted that the dread of interference from automatically controlled stations "is not a cogent one."
Its Petition, the ARRL concluded, "is not a referendum on the value of MF or HF data emissions or data experimentation in those bands," but intended to embolden experimentation now restricted artificially by outdated rules. "It is instead a proposal to delete outdated limitations on amateur Radio experimentation, which Commission policy supports, and which the basis and purpose of the amateur Radio Service necessitates."
Your League: ARRL-Sponsored Medium-Frequency Experiment Continues as Hams Hope for new Band
The ARRL-sponsored medium-frequency experiment, operating as WD2XSH, continues apace in an endeavor to demonstrate the viability of 472 to 479 kHz as a secondary amateur Radio allocation. At the selfsame time, the FCC has been tightlipped regarding the ARRL's November 2012 Petition for Rule Making that asked the Commission to get this segment of the spectrum available to radio amateurs in the US. Delegates to the 2012 World Radiocommunication Conference approved a 7 kHz-wide secondary allocation between 472 and 479 kHz for the amateur Radio Service, with a power circumscribe of 5 W EIRP (or 1 W EIRP, depending on location). The FCC has indicated that it will address the issue within the context of its Notice of Proposed Rule Making in ET Docket No 12-338, to formally reflect the Final Acts of WRC 2007 in its rules. In his quarterly WD2XSH update, Experiment Coordinator Fritz Raab, W1FR, reported that 514 contacts -- 10 in the last quarter -- believe been logged among those taking fragment in the experiment across the US.
WD2XSH experiment participant Patrick Hamel, W5THT, in Mississippi, stands next to his antenna tuning unit. [Photo courtesy of Patrick Hamel, W5THT]
"As usual, activity increased as conditions improved during the fall. Much of the recent activity has involved WSPR-15," Raab reported. "Reception over significant distances (eg, Europe, Alaska) has been reported. Much of the activity is being undertaken by a few new experimental licensees." Raab eminent that WD2XSH participant Brian Justin, WA1ZMS, transmitted Fessenden commemorative broadcasts on AM via his own experimental license, WG2XFQ, during the December holidays.
In the US, the 472-479 kHz corps is fragment of the larger 435-495 kHz segment that is allocated on a primary basis to the Maritime Mobile Service (federal and non-federal users), and on a secondary basis for federal government aeronautical radionavigation. The ARRL stated in its Petition that it is unaware of any domestic assignments that might fight with the allocation of 472 to 479 kHz to the amateur Radio Service, and there is almost no power line carrier (PLC) operation in this corps segment. The FCC in 2003 cited the potential for interference to utility-operated PLC systems when it turned down an ARRL petition seeking an LF "sliver band" at 135.7 to 137.8 kHz.
The WD2XSH experiment involves more than three dozen stations and includes complete geographic areas of the US, including Alaska and Hawaii. Most of the stations are in the eastern half of the US. Raab has reported no interference issues during the WD2XSH experiment, begun in 2006 and initially using spectrum in the vicinity of 500 kHz. Read more.
Your League: National Contest Journal (NCJ) Debuts new Website!
National Contest Journal (NCJ), the ARRL publication devoted to amateur Radio contesting, has a fresh, new presence on the web, although the URL remains the same.
"The new site was designed with simplicity and ease of utilize in mind," said NCJ Editor Kirk Pickering, K4RO. "The site contains selected feature articles as well as a group of tools for setting up teams and submitting logs for NCJ-sponsored contests. It moreover offers an archive of scores for complete NCJ going back to 2001. The site soundless has latitude to accommodate new features in the future, so remain tuned."
Pickering said the new NCJ website was a collaborative effort, and he expressed his appreciation to Bruce Horn, WA7BNM, "for his untiring advocate of the NCJ website from its inception" as well as to George Fremin, K5TR, who has served as the systems administrator. Pickering moreover thanked his partner Susie Coleman, who helped design the spy and feel.
"We hope that you will find the new site useful. Thanks to complete who believe helped to get this happen," said Pickering, who invited comments on the new site and design.
Published every other month, NCJ features general-interest and technical articles and columns by top contesters, operator profiles, editorial comments, and correspondence from readers, as well as scores for the North American QSO Party and North American Sprint, which NCJ sponsors.
International: IARU Showcases amateur Radio at ITU Telecom World 2013
The International amateur Radio Union (IARU) got some visibility for amateur Radio at ITU Telecom World 2013, sponsored by the International Telecommunication Union. The event was held November 19-22 in Bangkok, Thailand. The IARU and IARU Region 3 leaders arranged the pomp in cooperation with the ITU. A large, flat-screen TV in the booth displayed videos of amateur Radio activities. Special event station HS2013ITU was on the air from the site. IARU President Tim Ellam, VE6SH, spoke at one of the forums. A highlight of the present for the IARU contingent was a visit by ITU Secretary common Dr Hamadoun Toure, HB9EHT. He took a turn at the operating position of HS2013ITU while there.
ITU Secretary common Hamadoun Toure, HB9EHT, takes up the operating position of HS2013ITU, as IARU Region 3 Chairman Gopal Madhavan, VU2GMN (left), and Sakol Nakin, HS1JNB, spy on. [Tony Waltham, HS0ZDX, photo]
"We had a number of high-profile visitors to the booth, including ministers of communications and government regulators from various countries," said IARU Region 3 Director Peter Lake, ZL2AZ, and Region 3 Chairman Gopal Madhavan, VU2GMN, in a report. "They were keen to debate the situation in their respective countries and the association with IARU and to learn about amateur Radio and its capabilities. Telecom World 2013 gave the IARU a unique occasion to showcase amateur Radio at the highest level."
ITU Telecom World 2013 moreover offered an occasion for the IARU representatives to influence leaders who can favorably impact radio regulations and national attitudes toward amateur Radio. "The presence of IARU, and its endeavor to showcase amateur Radio and its capabilities, was well appreciated by complete who visited the booth, and the endeavor was well worthwhile," said the IARU's report. "We moreover laid a foundation under the new ITU Telecom World structure to gain some similar space at the next event in 2014 in Qatar." Read more.
International: Yasme Foundation Announces Supporting Grants
To further the development of amateur Radio around the world, The Yasme Foundation has announced the recipients of four supporting grants:
WRTC-2014, to serve defray the expenses of the World Radiosport Team Championship in new England this July.
The invert Beacon Network (RBN), to purchase a receiver and necessary accessories to upgrade the RBN node in Bangalore, India.
CWOps CW Academy, to serve defray the expenses of providing online CW training courses.
The ARRL Second Century Fund, to advocate the goal of the ARRL Second Century thrust of opening a path to passionate involvement in amateur Radio by new generations, providing opportunities for educational enrichment, community service, and personal achievement through the exploration and utilize of radio communication.
The Yasme Foundation is a not-for-profit corporation organized to conduct scientific and educational projects related to amateur Radio, including DXing and the introduction and promotion of amateur Radio in developing countries. The Foundation supports individuals and organizations providing or creating useful services for the amateur Radio community, regardless of originality or novelty, to further the development of amateur Radio around the world.
Radiosport: new ARRL Single-Operator Unlimited Contest Category Now in Effect
Responding to many requests, the ARRL Programs and Services Committee in 2013 accepted the Contest Advisory Committee (CAC) recommendation to add the Single-Operator Unlimited category to the ARRL 10 Meter Contest, ARRL 160 Meter Contest, RTTY Roundup, and the IARU HF Championship. "This particular issue has been a long time coming," said CAC Chairman Al Dewey, K0AD.
The new category permits the utilize of spotting information within the Single-Operator class. In the past, using spotting information placed a station in the Multioperator category. Per the revised rules, "Single-Operator Unlimited: The utilize of spotting assistance or automated, multi-channel decoders is permitted."
Ham Radio Business: Tokyo Hy-Power Files for Bankruptcy
Tokyo Hy-Power, a manufacturer of amateur Radio amplifiers, antenna tuners, and other equipment, is in bankruptcy, and its plant, in Saitama Prefecture near Tokyo, has been shuttered. Telephones at the company no longer are being answered, and its Japanese website has been taken down, although the company's US website remains working. Company CEO/President Nobuki Wakabayashi, JA1DJW, founded Tokyo Hy-Power Labs in 1975. He blamed "the recent depression in the industrial RF power products belt [which] has led to the very difficult fiscal position."
The Tokyo Hy-Power factory in Saitama, Japan. [Tokyo Hy-Power photo]
Tokyo Hy-Power's early products were HF antenna couplers, although within a brace of years it began manufacturing amplifiers for the amateur Radio market, including solid-state mobile amplifiers. Among its early products was the HL-4000 linear amplifier, which the company claimed was "the first true HF corps high-power linear of its kindhearted in Japan." It has been manufacturing RF products for the industrial market since 1984.
The company moreover once marketed the HT-750, a portable, low-power SSB/CW transceiver for 40, 15, and 6 meters in a hand-held transceiver shape factor. At Dayton Hamvention® 2013, the company displayed a prototype of the XT-751, an advanced model it hoped to develop, covering 40 through 6 meters and with an internal antenna tuner. Among its latest products were solid-state HF amplifiers, as well as amplifiers for 6 and 2 meters.
In a December 26 news release, Ham Radio Outlet (HRO) reacted with "disappointment" and said it was "deeply saddened" to learn that Tokyo Hy-Power had gone into bankruptcy.
"This action in Japan appears to be similar to a Chapter 7 action here within the United States, as the process in this case appears to be the liquidation of organizational assets in order to attempt to fund some portion of its debt obligation(s)," the HRO release said. "This appears to testify that a court has deemed the organization unable to be effectively reorganized under Japan's Civil Reconstruction Code."
HRO said it was working with AVSL, the current US service provider for Tokyo Hy-Power products "to debate the occasion of continued maintenance at the component flush of the US-sold Tokyo Hy-Power line of amplifiers." Read more.
Ham Radio Business: CQ to Realign Publications, Launch Digital Supplement
CQ Communications Inc has announced plans to realign its publications lineup and to launch a new online supplement to its flagship magazine, CQ amateur Radio.
"The hobby radio market is changing," said CQ Communications President and Publisher Dick Ross, K2MGA, "and they are changing what they execute and how they execute it in order to continue providing leadership to complete segments of the radio hobby."
Effective with the February 2014 issue of CQ, said Ross, content from the magazine's three sister publications -- accepted Communications, CQ VHF and WorldRadio Online -- will be incorporated into CQ's digital edition as a supplement to be called CQ Plus. The print editions of accepted Communications and CQ VHF will be phased out, and WorldRadio Online will no longer exist as a separate online publication. Current accepted Communications, CQ VHF and WorldRadio Online subscribers will be converted to CQ subscribers and receive CQ Plus at no additional charge. Details will be posted on each magazine's website.
CQ Communications says the change will present hobby radio enthusiasts a single source for articles from shortwave listening and scanner monitoring to personal two-way services and Internet radio, as well as amateur Radio. Richard Fisher, KI6SN, currently editor of both accepted Communications and WorldRadio Online, will be editor of CQ Plus. Read more.
Ham Radio Business: InnovAntennas Acquires obligate 12
InnovAntennas has acquired the legendary obligate 12 antenna company and product line and has moved the obligate 12 factory from Bridgeport, Texas, to stately Junction, Colorado, into a facility shared with InnovAntennas America. InnovAntennas Ltd in England is now manufacturing obligate 12 products for the European market at its Canvey Island plant.
The stately Junction facility is up and running, manufacturing and shipping antennas. InnovAntennas says it plans to produce updated versions of classic obligate 12 antennas as well as all-new models. InnovAntennas Founder Justin Johnson, G0KSC, was at the Colorado facility in late 2013 to assist in setting up and laying out the factory, and the company was expected to be at complete production this month. -- Thanks to The ARRL Contest Update
DX: ARRL DXCC Desk Approves ZD9KX Operations
The ARRL DXCC Desk has approved the 2012 and 2013 operation of ZD9KX -- Tristan Da Cunha & Gough Islands for DX Century Club credit. If a request for DXCC credit for this operation has been rejected in a prior application, contact ARRL Awards branch Manager Bill Moore, NC1L, to be placed on the list for an update to your record. please note the submission date and/or reference number of your application in order to expedite the search for any rejected contacts.
DXCC is amateur Radio's premier award that hams can earn by confirming on-the-air contacts with 100 DXCC "entities," most of which are countries in the traditional sense. You can originate with the basic DXCC award and toil your route up to the DXCC honor Roll. Learn more. -- ARRL Awards branch Manager Bill Moore, NC1L
Shortwave Listening: Voice of Russia to Continue Shortwave Broadcasting in 2014
To paraphrase track Twain, reports of the demise of the Voice of Russia (VOR) may believe been greatly exaggerated. Earlier this year the Voice of Russia -- the former Radio Moscow during the Soviet Era -- appeared poised to cease shortwave broadcasts as of January 1, 2014. In the wake of a December decree signed by Russian President Vladimir Putin that merged the Voice of Russia with several other state-run news agencies, SWL Tom Witherspoon, K4SWL, contacted VOR.
"We are joyful to let you know that the Voice of Russia will remain on the air in 2014, however, considerable changes in their frequency schedule are expected," the broadcaster told Witherspoon and as he reports on his blog.
The posted VOR schedule, which runs through March, indicates 38 aggregate hours of shortwave broadcasts to complete parts of the world, most beamed at the Middle East and Asia. Shortwave broadcasts to Europe, Latin America, Oceania, and Africa account for just 15 aggregate hours. VOR, which claims to be the first radio station to broadcast internationally, moreover broadcasts online, via satellite, on FM, and via three medium-wave transmitters. In 2003 VOR was among the first major international radio broadcasters to launch daily broadcasts to Europe in Digital Radio Mondiale (DRM).
Propagation: Solar Flux Record towering Could Herald Better Conditions
The 10.7 centimeter solar flux index (SFI) jumped to a Cycle 24 record of 262 on January 4, suggesting that Cycle 24 has not yet begun drawing to a nigh and may be approaching or at a "second peak." The previous peak for the current cycle was 190 on September 24, 2011. As NASA's Marshall Space Flight center (MSFC) explains, the flux of the sun's radio emissions at 10.7 centimeter (2.8 GHz) is another indicator of solar activity levels, since it tends to ensue changes in the solar ultraviolet that influence Earth's upper atmosphere and ionosphere.
"Many models of the upper atmosphere utilize the 10.7 centimeter flux (F10.7) as input to determine atmospheric densities and satellite drag," NASA/MSFC noted, adding that SFI "has been shown to ensue the sunspot number quite closely." The January 6 sunspot count was 225. The Cycle 24 sunspot count peaked at 282 on November 17, 2013, according to WM7D.net.
Solar flux between 1995 and (predicted) 2020. [NASA/MSFC graphic]
Canada's Dominion Radio Astrophysical Observatory (DRAO) indicated an "official" flux of 262 at 2000 UTC on Saturday, January 3. The official design for Sunday, January 5, was 217.5. ARRL solar observer Tad Cook, K7RA, who reports 10.7 centimeter flux numbers in his weekly "Solar Update" bulletins, suggests that they are not as valuable as sunspot numbers in predicting radio propagation. The solar flux was over the January 4-5 weekend was far higher what was anticipated, judging by predictions Cook reported in his January 3 "Solar Update" for this past weekend and the week ahead. NASA/MFSC indicates a 95 percent predicted flux for the month of January at 146.5, continuing at about the selfsame flush through the first half of the year.
The Daily DX said the SFI was expected to remain above 200 for this week. As Ian Poole, G3YWX, explained solar flux in his article, "Understanding Solar Indices" in the September 2002 edition of QST, "[H]igh values generally testify there is sufficient ionization to advocate long-distance communication at higher-than-normal frequencies." He pointed out, though, that it can remove a few days of towering values for conditions to present improvement. "Typically values in excess of 200 will be measured during the peak of a sunspot cycle, with towering values of up to 300 being experienced for shorter periods," Poole wrote. Read more.
ARRL Centennial: W100AW Hits the Airwaves!
At the stroke of midnight Eastern Time on January 1, Hiram Percy Maxim Memorial station W1AW at ARRL Headquarters in Newington took to the air to debut its special ARRL Centennial summon sign, W100AW. ARRL Chief Executive Officer Dave Sumner, K1ZZ and Membership and Volunteer Programs Manager Dave Patton, NN1N, and ARRL Station Manager Joe Carcia, NJ1Q, were at the helm into the wee hours of new Year's Day.
ARRL Station Manager Joe Carcia, NJ1Q, makes the very first W100AW QSO just after midnight local time on January 1, 2014. [Sean Kutzko, KX9X, photo]
Daylight hours saw ARRL Chief Operating Officer Harold Kramer, WJ1B; Membership and Volunteer Programs lieutenant Manager Norm Fusaro, W3IZ; Public Relations Manager Sean Kutzko; KX9X and QST Editor in Chief Steve Ford, WB8IMY, taking their turns at the operating positions. By mid-afternoon, several thousand contacts were in the log on SSB, CW and RTTY.
"This is just the beginning," said Kutzko. "Hams will hear W100AW throughout 2014 on every mode possible. When you hear us, spot us on the cluster!"
Not surprising, 20 meter SSB yielded the most contacts -- 1121 of the 3700 logged -- during the 19 hours of new Year's Day operation from W100AW. Ten meter phone was in second spot with 639 contacts.
W100AW contacts will be uploaded to Logbook of The World (LoTW). QSL cards sent by mail will be acknowledged as well.
W1AW Portable Operations, ARRL Centennial QSO Party
The ARRL Centennial "W1AW WAS" operations are taking spot throughout 2014 from each of the 50 states, relocating each Wednesday (UTC) to a new pair of states (this week, South Carolina and Utah. Listen for W1AW/4 and W1AW/7). During 2014 W1AW will be on the air from every condition at least twice and from most US territories, and it will be light to toil complete states solely by contacting W1AW portable operations.
In conjunction with the 100th anniversary of the ARRL, the ARRL Centennial QSO Party moreover kicked off January 1 for a year-long operating event in which participants can accumulate points and win awards. The event is open to all, although only ARRL members and appointees, elected officials, HQ staff and W1AW are worth ARRL Centennial QSO Party points. Working W1AW/x from each condition is worth 5 points per contact.
To earn the "Worked complete States with W1AW Award," toil W1AW operating portable from complete 50 states. (Working W1AW or W100AW in Connecticut does not count for Connecticut, however. For award credit, participants must toil W1AW/1 in Connecticut.) A W1AW WAS certificate and plaque will be available (pricing not yet available).
Some Statistics
As of today (January 9), more than 6700 stations believe earned points in the Centennial QSO Party by uploading qualifying QSOs to Logbook of The World (LoTW). Operating from North Carolina and West Virginia during the first week of the W1AW portable operations, W1AW/4 and W1AW/8 logged approximately 33,000 contacts.
"The second week is off to a roaring start from South Carolina and Utah," reported ARRL Membership and Volunteer Programs Manager Dave Patton, NN1N.
ARRL Centennial: A Century of amateur Radio and the ARRL
Editor's note: "A Century of amateur Radio and the ARRL" will be a weekly feature as the ARRL celebrates its Centennial in 2014.
In amateur Radio, as in complete fields, 100 years has brought about incredible progress and changes. During 2014, they will give you a sense of the ARRL's and amateur Radio's history by looking through the issues of QST from its humble genesis to the present. We'll examine the requisite topics and events of interest to amateurs, such as technology, operating tips and events, ARRL's doings, and FCC actions. Because of the limited space available here, the comments will be brief, but they will provide citations to original QST articles for your further reading.
The next century will bring about changes that will be mind-boggling to us, because technology advances at an exponential rate. Being cognizant of the past 100 years of ham-related events is valuable to us for historical reasons, and it moreover makes us account what might palter ahead. Next time: A spy at the earliest years of amateur Radio and the ARRL. -- Al Brogdon, W1AB
Milestones: Founder and President Emeritus of 4U1UN, Max de Henseler, HB9RS, SK
Max de Henseler, HB9RS. [Clin d'Ailes Swiss Air obligate Museum, HB4FR, photo]
Max de Henseler, HB9RS, the founder and president emeritus of 4U1UN at United Nations headquarters in new York, died December 30. He was 80. A ham since 1955, de Henseler had been a short-wave listener since the late 1940s. In 1976, while in new York as the UN's chief cartographer, de Henseler reactivated the United Nations Radio Club station K2UN at its new home in midtown Manhattan. As Jack Troster, W6ISQ, explained in the July 1989 issue of QST, "Through his efforts, the Secretary common approved the operation of a specifically designated UN amateur station using the summon 4U1UN in early 1978."
De Henseler introduced the new summon token on February 4, 1978, during the first weekend of the then two-weekend ARRL International DX phone contest, surprising many contesters. 4U1UN was approved for DXCC credit, due to the efforts of "Mister UN Radio."
The 4U1UN United Nations Headquarters Station was dismantled in 2010 due to the extensive renovation project on the Secretariat Building. Read more. -- Thanks to The Daily DX
Milestones: QST Author, CW Key Maker Jerry Pittenger, K8RA, SK
QST author and CW key crafter Jerry Pittenger, K8RA, of Powell, Ohio, died January 2 of pancreatic cancer. He was 66. Licensed in 1960, Pittenger was a retired systems engineer. He earned a bachelor's degree at Miami University and an MS in systems engineering from Ohio State.
Jerry Pittenger, K8RA, at Dayton Hamvention 2013. [Joe Eisenberg, K0NEB, photo]
Pittenger enjoyed edifice his own equipment, and some of his amplifier projects were featured in QST, The ARRL Handbook, and RF Amplifier Classics. More recently he manufactured a line of solid-brass iambic and single-lever CW keys sold worldwide, until illness forced him to quit.
"Making my CW keys fills much of my time, but it is a labor of love," Pittenger said in his online profile. "I can salvage lost in time machining metals and making things in the shop for the radio." His friends Mike Freeman, NT8O, and Fred Freeman, N8BX, believe taken over the production of the K8RA line. Read more.
Milestones: Austin amateur Radio Supply Owner Johnny Paul, WA5BGO, SK
The owner of Austin amateur Radio Supply, John E. "Johnny" Paul, WA5BGO, of Austin, Texas, died December 10. He was 74. Paul was the proprietor of Austin amateur Radio for 45 years. First licensed in 1960, Paul was a past president of the Austin amateur Radio Club and was an avid photographer of nature and landscapes. Services were December 16.
Solar Update
Tad Cook, K7RA, in Seattle, reports: A astronomical storm is brewing! At 2324 UTC on January 8 the Australian Space Forecast Centre issued this geomagnetic disturbance warning: "Increased geomagnetic activity expected due to coronal mass ejection from 09-10 January 2014."
NOAA forecasters estimate a 90 percent casual of geomagnetic storms on January 9. The predicted planetary A indices for January 9 through January 13 are 73, 41, 15, 8 and 5. While an emblematic number for hams, 73 is a huge value for the planetary A index. One has to spy way, route back to find a value enjoy this. The planetary A index was 67 on both March 9, 2012, and September 26, 2011, but nothing exceeds what is predicted for January 9 except the planetary A index of 104 on December 15, 2006, and 105 on September 11, 2005.
This has been an exciting week for sun watchers. The daily sunspot number reached 245 on January 6, and solar flux was 237.1 on January 8. The GOES-15 X-ray background flux has moreover been high, and that may be more significant for enhanced HF propagation than a towering solar flux. NOAA's Space Weather Prediction center maintains an archive of X-ray flux, solar flux, and sunspot numbers (check the links marked "DSD.txt." The links marked "DGD.txt" will give you daily geomagnetic indicators).
Over the past week, average daily sunspot numbers rose more than 80 points to 188.1, and average daily solar flux was up by more than 62 points to 201.6. Predicted solar flux for the near term is 195 on January 9-12, 190 on January 13, 160 on January 14, 155 on January 15-16, and 150 on January 17-19. It then rises to a peak of 190 on January 29 through February 3.
Predicted planetary A index values are 73, 41, 15 and 8 on January 9-12, 5 on January 13-22, 10 on January 23, 8 on January 24, 5 on January 25-27, then 10, 18 and 8 on January 28-30, then 5 again until February 6.
For the Friday, January 10, "Solar Update," spy for an update on the latest disturbance and forecast, as well as reports from readers. I welcome your reports and observations via e-mail.
Getting It Right!
In The ARRL Letter, December 19, 2013, they inadvertently omitted 20 meters from the list of bands available for the ARRL Centennial QSO Party.
Just Ahead in Radiosport
Jan 10 -- QRP Fox Hunt
Jan 10 -- NCCC Sprint Ladder
Jan 11 -- musty new Year Contest
Jan 11-12 -- UK DX BPSK63 Contest
Jan 11-12 -- MI QRP January CW Contest
Jan 11-12 -- SKCC Weekend Sprintathon
Jan 11-12 -- North American QSO Party, CW
Jan 12 -- NRAU-Baltic Contest, CW (0630-0830 UTC)
Jan 12 -- NRAU-Baltic Contest, SSB (0900-1100 UTC)
Jan 12 -- DARC 10-Meter Contest
Jan 12 -- Midwinter Contest
Jan 15 -- QRP Fox Hunt
Upcoming ARRL Section, condition and Division Conventions and Events
January 17-18 -- North Texas Section Convention, Fort Worth, Texas
January 19-26 -- Quartzfest Convention, Quartzsite, Arizona
January 24-25 -- Mississippi condition Convention, Jackson, Mississippi
January 25 -- Georgia ARES Convention, Forsyth, Georgia
January 25-26 -- Puerto Rico condition Convention, Hatillo, Puerto Rico
January 31-February 1 -- Southern Florida Section Convention, Miami, Florida
February 1 -- Virginia condition Convention (Frostfest), Richmond, Virginia
February 1 -- South Carolina condition Convention, North Charleston, South Carolina
February 7-9 -- Northern Florida Section Convention (Orlando HamCation® -- Regional ARRL Centennial Event), Orlando, Florida
February 14-15 -- Arizona Section Convention, Yuma, Arizona
February 22 -- Vermont condition Convention, South Burlington, Vermont
March 1-2 -- Alabama Section Convention (BirmingHAMfest 2014), Birmingham, Alabama
March 7-8 -- North Carolina Section Convention (Charlotte Hamfest), Concord, North Carolina
March 7-8 -- West Gulf Division Convention, Claremore, Oklahoma
March 14-15 -- Delta Division Convention, Rayne, Louisiana
March 15 -- Nebraska condition Convention, Lincoln, Nebraska
March 15 -- West Texas Section Convention, Midland, Texas
March 22 -- South Texas Section Convention (Greater Houston Hamfest), Rosenberg, Texas
March 22-23 -- Communications Academy, Seattle, Washington
April 19 -- Roanoke Division Convention, Raleigh, North Carolina
April 25-27 -- Idaho condition Convention, Boise, Idaho
April 26 -- Aurora '14 Conference, White stand Lake, Minnesota
Find conventions and hamfests in your area.
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Consensus Statement on Concussion in Sport—the 4th International Conference on Concussion in Sport Held in Zurich, November 2012 | killexams.com true questions and Pass4sure dumps
Preamble
This paper is a revision and update of the recommendations developed following the 1st (Vienna 2001), 2nd (Prague 2004) and 3rd (Zurich 2008) International Consensus Conference on Concussion in Sport and is based on the deliberations at the 4 thInternational Conference On Concussion In Sport held in Zurich, November 2012.1–3
The new 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A circumstantial description of the consensus process is outlined at the remain of this document under the “background” section. This document is developed for utilize by physicians and health reliance professionals primarily who are involved in the reliance of injured athletes, whether at the recreational, elite, or professional level.
While agreement exists pertaining to principal messages conveyed within this document, the authors concede that the science of concussion is evolving and therefore management and recrudesce to play decisions remain in the realm of clinical judgment on an individualized basis. Readers are encouraged to copy and dole freely the Zurich Consensus document, the Concussion Recognition instrument (CRT), the Sport Concussion Assessment instrument version 3 (SCAT3), and/or the Child-SCAT3 card and neither is subject to any restriction, provided it is not altered in any route or converted to a digital format. The authors’ request that the document and/or the accompanying tools be distributed in their complete and complete format.
This consensus paper is broken into a number of sections:
The Zurich 2012 document examines sport concussion and management issues raised in the previous Vienna 2001, Prague 2004, and Zurich 2008 documents and applies the consensus questions from Section 3 to these areas.1–3
Definition of Concussion
Panel discussion regarding the definition of concussion and its separation from mild traumatic brain injury (mTBI) was held. There was acknowledgement by the Concussion in Sport Group (CISG) that although the terms mild traumatic brain injury (mTBI) and concussion are often used interchangeably in the sporting context and particularly in the US literature, others utilize the term to mention to different injury constructs. Concussion is the historical term representing low velocity injuries that occasions brain “shaking” resulting in clinical symptoms and which are not necessarily related to a pathological injury. Concussion is a subset of TBI and the term concussion will be used in this document. It was moreover eminent that the term commotio cerebri is often used in European and other countries. Minor revisions were made to the definition of concussion and it is defined as follows:
Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:
The majority (80%-90%) of concussions resolve in a short (7-10 day) period, although the recovery time frame may be longer in children and adolescents.2
Symptoms and Signs of Acute Concussion
The diagnosis of acute concussion usually involves the assessment of a compass of domains including clinical symptoms, physical signs, cognitive impairment, neurobehavioral features, and sleep disturbance. Furthermore, a circumstantial concussion history is an requisite fragment of the evaluation both in the injured athlete and when conducting a preparticipation examination. The circumstantial clinical assessment of concussion is outlined in the SCAT3 and Child-SCAT3 forms, which is an appendix to this document.
The suspected diagnosis of concussion can comprise 1 or more of the following clinical domains:
If any 1 or more of these components is present, a concussion should be suspected and the usurp management strategy instituted.
On-Field or Sideline Evaluation of Acute Concussion
When a player shows ANY features of a concussion:
Sufficient time for assessment and adequate facilities should be provided for the usurp medical assessment both on and off the domain for complete injured athletes. In some sports, this may require rule change to allow an usurp off-field medical assessment to occur without affecting the rush of the game or unduly penalizing the injured player’s team. The final determination regarding concussion diagnosis and/or fitness to play is a medical determination based on clinical judgment.
Sideline evaluation of cognitive office is an essential component in the assessment of this injury. Brief neuropsychological test batteries that assess attention and memory office believe been shown to be practical and effective. Such tests comprise the SCAT3, which incorporates the Maddocks questions4,5 and the Standardized Assessment of Concussion (SAC).6–8 It is worth noting that yardstick orientation questions (eg, time, place, person) believe been shown to be unreliable in the sporting situation when compared with memory assessment.5,9 It is recognized, however, that abbreviated testing paradigms are designed for rapid concussion screening on the sidelines and are not meant to replace comprehensive neuropsychological testing which should ideally be performed by trained neuropsychologists that are sensitive to subtle deficits that may exist beyond the acute episode; nor should they be used as a stand-alone instrument for the ongoing management of sports concussions.
It should moreover be recognized that the appearance of symptoms or cognitive deficit might be delayed several hours following a concussive episode and that concussion should be seen as an evolving injury in the acute stage.
Evaluation in Emergency latitude or Office by Medical Personnel
An athlete with concussion may be evaluated in the emergency latitude or doctor’s office as a point of first contact following injury or may believe been referred from another reliance provider. In addition to the points outlined above, the key features of this exam should encompass:
In large part, these points above are included in the SCAT3 assessment.
Concussion Investigations
A compass of additional investigations may be utilized to assist in the diagnosis and/or exclusion of injury. Conventional structural neuroimaging is typically orthodox in concussive injury. Given that caveat, the following suggestions are made: Brain CT (or where available MR brain scan) contributes tiny to concussion evaluation but should be employed whenever suspicion of an intra-cerebral or structural lesion (eg, skull fracture) exists. Examples of such situations may comprise prolonged disturbance of conscious state, focal neurological deficit, or worsening symptoms.
Other imaging modalities such as fMRI demonstrate activation patterns that correlate with symptom severity and recovery in concussion.10–14 Whilst not fragment of routine assessment at the present time, they nevertheless provide additional insight to pathophysiological mechanisms. Alternative imaging technologies (eg, positron emission tomography, diffusion tensor imaging, magnetic resonance spectroscopy, functional connectivity), while demonstrating some compelling findings, are soundless at early stages of development and cannot be recommended other than in a research setting.
Published studies, using both sophisticated obligate plate technology, as well as those using less sophisticated clinical equilibrium tests (eg, equilibrium oversight Scoring System [BESS]), believe identified acute postural stability deficits lasting approximately 72 hours following sport-related concussion. It appears that postural stability testing provides a useful instrument for objectively assessing the motor domain of neurologic functioning, and should be considered a amenable and cogent addition to the assessment of athletes suffering from concussion, particularly where symptoms or signs testify a equilibrium component.15–21
The significance of Apolipoprotein (Apo) E4, ApoE promotor gene, Tau polymerase, and other genetic markers in the management of sports concussion risk or injury outcome is unclear at this time.22,23 Evidence from human and animal studies in more ascetic traumatic brain injury demonstrate induction of a variety of genetic and cytokine factors such as: insulin-like growth factor-1 (IGF-1), IGF binding protein-2, Fibroblast growth factor, Cu-Zn superoxide dismutase, superoxide dismutase -1 (SOD-1), nerve growth factor, glial fibrillary acidic protein (GFAP), and S-100. How such factors are affected in sporting concussion is not known at this stage.24–31 In addition, biochemical serum and cerebral spinal fluid biomarkers of brain injury [including S-100, neuron specific enolase (NSE), myelin basic protein (MBP), GFAP, tau, etc] believe been proposed as means by which cellular damage may be detected if present.32–38 There is currently insufficient evidence, however, to justify the routine utilize of these biomarkers clinically.
Different electrophysiological recording techniques (eg, evoked response potential [ERP], cortical magnetic stimulation, and electroencephalography) believe demonstrated reproducible abnormalities in the postconcussive state; however not complete studies reliably differentiated concussed athletes from controls.39–45 The clinical significance of these changes remains to be established.
Neuropsychological Assessment
The application of neuropsychological (NP) testing in concussion has been shown to be of clinical value and contributes significant information in concussion evaluation.46–51 Although in most cases cognitive recovery largely overlaps with the time course of symptom recovery, it has been demonstrated that cognitive recovery may occasionally precede or more commonly ensue clinical symptom resolution, suggesting that the assessment of cognitive office should be an requisite component in the overall assessment of concussion and in particular, any recrudesce to play protocol.52,53 It must be emphasized however, that NP assessment should not be the sole basis of management decisions. Rather, it should be seen as an aid to the clinical decision-making process in conjunction with a compass of assessments of different clinical domains and investigational results.
It is recommended that complete athletes should believe a clinical neurological assessment (including assessment of their cognitive function) as fragment of their overall management. This will normally be done by the treating physician often in conjunction with computerized NP screening tools.
Formal NP testing is not required for complete athletes, however when this is considered necessary then it should ideally be performed by a trained neuropsychologist. Although neuropsychologists are in the best position to interpret NP tests by virtue of their background and training, the ultimate recrudesce to play determination should remain a medical one in which a multidisciplinary approach, when possible, has been taken. In the absence of NP and other (eg, formal equilibrium assessment) testing, a more conservative recrudesce to play approach may be appropriate.
Neuropsychological testing may be used to assist recrudesce to play decisions and is typically performed when an athlete is clinically asymptomatic, however NP assessment may add requisite information in the early stages following injury.54,55 There may be particular situations where testing is performed early to assist in determining aspects of management eg, recrudesce to school in a pediatric athlete. This will normally be best determined in consultation with a trained neuropsychologist.56,57
Baseline NP testing was considered by the panel and was not felt to be required as a mandatory aspect of every assessment however may be helpful or add useful information to the overall interpretation of these tests. It moreover provides an additional educative occasion for the physician to debate the significance of this injury with the athlete. At present, there is insufficient evidence to recommend the widespread routine utilize of baseline NP testing.
Concussion Management
The cornerstone of concussion management is physical and cognitive comfort until the acute symptoms resolve and then a graded program of exertion prior to medical clearance and recrudesce to play. The current published evidence evaluating the outcome of comfort following a sport-related concussion is sparse. An initial term of comfort in the acute symptomatic term following injury (24-48 hours) may be of benefit. Further research to evaluate the long-term outcome of rest, and the optimal amount and type of rest, is needed. In the absence of evidence-based recommendations, a sensible approach involves the gradual recrudesce to school and gregarious activities (prior to contact sports) in a manner that does not result in a significant exacerbation of symptoms.
Low-level exercise for those who are laggard to recoup may be of benefit, although the optimal timing following injury for initiation of this treatment is currently unknown.
As described above, the majority of injuries will recoup spontaneously over several days. In these situations, it is expected that an athlete will proceed progressively through a stepwise recrudesce to play strategy.58
Graduated recrudesce to Play Protocol
Return to play (RTP) protocol following a concussion follows a stepwise process as outlined in Table 1.
With this stepwise progression, the athlete should continue to proceed to the next flush if asymptomatic at the current level. Generally, each step should remove 24 hours so that an athlete would remove approximately 1 week to proceed through the complete rehabilitation protocol once they are asymptomatic at comfort and with provocative exercise. If any postconcussion symptoms occur while in the stepwise program then the patient should drop back to the previous asymptomatic flush and try to progress again after a further 24-hour term of comfort has passed.
Same Day RTP
It was unanimously agreed that no recrudesce to play on the day of concussive injury should occur. There are data demonstrating that at the collegiate and towering school level, athletes allowed to RTP on the selfsame day may demonstrate NP deficits postinjury that may not be evident on the sidelines and are more likely to believe delayed onset of symptoms.59–65
The ‘Difficult’ or Persistently Symptomatic Concussion Patient
Persistent symptoms (>10 days) are generally reported in 10%-15% of concussions. In general, symptoms are not specific to concussion and it is requisite to account other pathologies. Cases of concussion in sport where clinical recovery falls outside the expected window (ie, 10 days) should be managed in a multidisciplinary manner by health reliance providers with suffer in sports-related concussion.
Psychological Management and Mental Health Issues
Psychological approaches may believe potential application in this injury, particularly with the modifiers listed below.66,67 Physicians are moreover encouraged to evaluate the concussed athlete for affective symptoms such as depression and anxiety, as these symptoms are common in complete forms of traumatic brain injury.58
The Role of Pharmacological Therapy
Pharmacological therapy in sports concussion may be applied in 2 distinct situations. The first of these situations is the management of specific and/or prolonged symptoms (eg, sleep disturbance, anxiety, etc). The second situation is where drug therapy is used to modify the underlying pathophysiology of the condition with the aim of shortening the duration of the concussion symptoms.68 In broad terms, this approach to management should be only considered by clinicians experienced in concussion management.
An requisite consideration in RTP is that concussed athletes should not only be symptom free, but moreover should not be taking any pharmacological agents/medications that may mask or modify the symptoms of concussion. Where antidepressant therapy may be commenced during the management of a concussion, the determination to recrudesce to play while soundless on such medication must be considered carefully by the treating clinician.
The Role of Preparticipation Concussion Evaluation
Recognizing the importance of a concussion history, and appreciating the fact that many athletes will not recognize complete the concussions they may believe suffered in the past, a circumstantial concussion history is of value.69–72 Such a history may preidentify athletes that felicitous into a high-risk category and provides an occasion for the health reliance provider to educate the athlete in esteem to the significance of concussive injury. A structured concussion history should comprise specific questions as to previous symptoms of a concussion and length of recovery, not just the perceived number of past concussions. It is moreover worth noting that dependence upon the recall of concussive injuries by teammates or coaches has been demonstrated to be unreliable.69 The clinical history should moreover comprise information about complete previous head, face, or cervical spine injuries, as these may moreover believe clinical relevance. It is worth emphasizing that in the setting of maxillofacial and cervical spine injuries, coexistent concussive injuries may be missed unless specifically assessed. Questions pertaining to disproportionate impact versus symptom severity matching may alert the clinician to a progressively increasing vulnerability to injury. As fragment of the clinical history it is advised that details regarding protective gear employed at time of injury be sought, both for recent and remote injuries.
There is an additional and often unrecognized benefit of the preparticipation examination insofar as the evaluation allows for an educative occasion with the player concerned as well as consideration of modification of playing deportment if required.
Modifying Factors in Concussion Management
A compass of ‘modifying’ factors may influence the investigation and management of concussion and, in some cases, may foretell the potential for prolonged or persistent symptoms. However, in some cases, the evidence for their efficacy is limited. These modifiers would be requisite to account in a circumstantial concussion history and are outlined in Table 2.
Female Gender
The role of female gender as a workable modifier in the management of concussion was discussed at length by the panel. There was not unanimous agreement that the current published research evidence is conclusive enough for this to be included as a modifying factor, although it was accepted that gender may be a risk factor for injury and/or influence injury severity.73–75
The Significance of Loss of Consciousness (LOC)
In the overall management of temper to ascetic traumatic brain injury, duration of LOC is an acknowledged predictor of outcome.76 Whilst published findings in concussion recount LOC associated with specific early cognitive deficits, it has not been eminent as a measure of injury severity.77,78 Consensus discussion determined that prolonged (>1 minute duration) LOC would be considered as a factor that may modify management.
The Significance of Amnesia and Other Symptoms
There is renewed interest in the role of posttraumatic amnesia and its role as a surrogate measure of injury severity.64,79,80 Published evidence suggests that the nature, burden, and duration of the clinical postconcussive symptoms may be more requisite than the presence or duration of amnesia alone.77,81,82 Further it must be eminent that retrograde amnesia varies with the time of measurement postinjury and hence is poorly reflective of injury severity.83,84
Motor and Convulsive Phenomena
A variety of immediate motor phenomena (eg, tonic posturing) or convulsive movements may conduct a concussion. Although dramatic, these clinical features are generally benign and require no specific management beyond the yardstick treatment of the underlying concussive injury.85,86
Depression
Mental health issues (such as depression) believe been reported as a consequence of complete levels of traumatic brain injury including sport-related concussion. Neuroimaging studies using fMRI hint that a depressed humor following concussion may reflect an underlying pathophysiological abnormality consistent with a limbic-frontal model of depression.34,87–97 While such mental health issues may be multifactorial in nature, it is recommended that the treating physician account these issues in the management of concussed patients.
SPECIAL POPULATIONS The Child and Adolescent Athlete
The evaluation and management recommendations contained herein can be applied to children and adolescents down to the age of 13 years. Below that age, children report concussion symptoms different from adults and would require age-appropriate symptom checklists as a component of assessment. An additional consideration in assessing the child or adolescent athlete with a concussion is that the clinical evaluation by the healthcare professional may exigency to comprise both patient and parent input, and possibly teacher and school input when appropriate.98–104 A Child-SCAT3 has been developed to assess concussion (see Appendix II) for subjects aged 5 to 12 years.
The determination to utilize NP testing is broadly the selfsame as the adult assessment paradigm although there are some differences. Timing of testing may disagree in order to assist planning in school and home management. If cognitive testing is performed then it must be developmentally sensitive until late teen years due to the ongoing cognitive maturation that occurs during this term which, in turn, makes the utility of comparison to either the person’s own baseline performance or to population norms limited.20 In this age group it is more requisite to account the utilize of trained paediatric neuropsychologists to interpret assessment data, particularly in children with learning disorders and/or ADHD who may exigency more sophisticated assessment strategies.56,57,98
It was agreed by the panel that no recrudesce to sport or activity should occur before the child/adolescent athlete has managed to recrudesce to school successfully. In addition, the concept of ‘cognitive rest’ was highlighted with special reference to a child’s exigency to circumscribe exertion with activities of daily live that may exacerbate symptoms. School attendance and activities may moreover exigency to be modified to avoid provocation of symptoms. Children should not be returned to sport until clinically completely symptom free, which may require a longer time frame than for adults.
Because of the different physiological response and longer recovery after concussion and specific risks (eg, diffuse cerebral swelling) related to head impact during childhood and adolescence, a more conservative recrudesce to play approach is recommended. It is usurp to extend the amount of time of asymptomatic comfort and/or the length of the graded exertion in children and adolescents. It is not usurp for a child or adolescent athlete with concussion to RTP on the selfsame day as the injury regardless of the flush of athletic performance. Concussion modifiers apply even more to this population than adults and may mandate more cautious RTP advice.
Elite Versus Nonelite Athletes
All athletes, regardless of flush of participation, should be managed using the selfsame treatment and recrudesce to play paradigm. The available resources and expertise in concussion evaluation are of more importance in determining management than a separation between elite and nonelite athlete management. Although formal NP testing may be beyond the resources of many sports or individuals, it is recommended that in complete organized high-risk sports, consideration be given to having this cognitive evaluation, regardless of the age or flush of performance.
Chronic Traumatic Encephalopathy (CTE)
Clinicians exigency to be mindful of the potential for long-term problems in the management of complete athletes. However, it was agreed that CTE represents a distinct tauopathy with an unknown incidence in athletic populations. It was further agreed that a occasions and outcome relationship has not yet been demonstrated between CTE and concussions or exposure to contact sports.105–114 At present, the interpretation of causation in the modern CTE case studies should proceed cautiously. It was moreover recognized that it is requisite to address the fears of parents/athletes from media pressure related to the possibility of CTE.
INJURY PREVENTION Protective Equipment—Mouthguards and Helmets
There is no righteous clinical evidence that currently available protective gear will obviate concussion, although mouthguards believe a pellucid role in preventing dental and oro-facial injury. Biomechanical studies believe shown a reduction in impact forces to the brain with the utilize of headgear and helmets, but these findings believe not been translated to present a reduction in concussion incidence. For skiing and snowboarding there are a number of studies to hint that helmets provide protection against head and facial injury and hence should be recommended for participants in alpine sports.115–118 In specific sports such as cycling, motor, and equestrian sports, protective helmets may obviate other forms of head injury (eg, skull fracture) that are related to falling on arduous surfaces and may be an requisite injury prevention issue for those sports.118–130
Rule Change
Consideration of rule changes to reduce the head injury incidence or severity may be usurp where a clear-cut mechanism is implicated in a particular sport. An case of this is in football (soccer) where research studies demonstrated that upper limb to head contact in heading contests accounted for approximately 50% of concussions.131 As eminent earlier, rule changes moreover may be needed in some sports to allow an effective off-field medical assessment to occur without compromising the athlete’s welfare, affecting the rush of the game or unduly penalizing the player’s team. It is requisite to note that rule enforcement may be a critical aspect of modifying injury risk in these settings and referees play an requisite role in this regard.
Risk Compensation
An requisite consideration in the utilize of protective gear is the concept of risk compensation.132 This is where the utilize of protective gear results in behavioral change such as the adoption of more Dangerous playing techniques, which can result in a paradoxical augment in injury rates. The degree to which this phenomena occurs is discussed in more detail in the review published in the BJSM supplement. This may be a particular concern in child and adolescent athletes where head injury rates are often higher than in adult athletes.133–135
Aggression Versus Violence in Sport
The competitive/aggressive nature of sport that makes it fun to play and watch should not be discouraged. However, sporting organizations should be encouraged to address violence that may augment concussion risk.136,137 objective play and respect should be supported as key elements of sport.
Knowledge Transfer
As the faculty to treat or reduce the effects of concussive injury after the event is minimal, education of athletes, colleagues, and the common public is a mainstay of progress in this field. Athletes, referees, administrators, parents, coaches and health reliance providers must be educated regarding the detection of concussion, its clinical features, assessment techniques and principles of safe recrudesce to play. Methods to help education including Web-based resources, educational videos, and international outreach programs are requisite in delivering the message. In addition, concussion working groups, plus the advocate and endorsement of enlightened sport groups such as Fédération Internationale de Football Association (FIFA), International Olympic Commission (IOC), International Rugby Board (IRB), and International Ice Hockey Federation (IIHF) who initiated this endeavor believe huge value and must be pursued vigorously. objective play and respect for opponents are ethical values that should be encouraged in complete sports and sporting associations. Similarly, coaches, parents, and managers play an requisite fragment in ensuring these values are implemented on the domain of play.58,138–150
SECTION 2: STATEMENT ON BACKGROUND TO THE CONSENSUS PROCESS
In November 2001, the 1st International Conference on Concussion in Sport was held in Vienna, Austria. This meeting was organized by the IIHF in partnership with FIFA and the Medical Commission of the IOC. As fragment of the resulting mandate for the future, the exigency for leadership and future updates were identified. The 2nd International Conference on Concussion in Sport was organized by the selfsame group with the additional involvement of the IRB and was held in Prague, Czech Republic in November 2004. The original aims of the symposia were to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, rugby, football (soccer) as well as other sports. To this end, a compass of experts were invited to both meetings to address specific issues of epidemiology, basic and clinical science, injury grading systems, cognitive assessment, new research methods, protective equipment, management, prevention, and long-term outcome.1,2
The 3rd International Conference on Concussion in Sport was held in Zurich, Switzerland on October 29-30, 2008 and was designed as a formal consensus meeting following the organizational guidelines set forth by the US National Institutes of Health. (Details of the consensus methodology can be obtained at: http://consensus.nih.gov/ABOUTCDP.htm). The basic principles governing the conduct of a consensus development conference are summarized below:
The panel chairperson (WM) did not identify with any advocacy position. The chairperson was amenable for directing the consensus session and guiding the panel’s deliberations. Panelists were drawn from clinical practice, academic, and research in the domain of sport-related concussion. They execute not represent organizations per se but were selected for their expertise, experience, and understanding of this field.
The 4th International Conference on Concussion in Sport was held in Zurich, Switzerland on November 1-3, 2012 and followed the selfsame silhouette as for the 3rd meeting. complete speakers, consensus panel members, and abstract authors were required to token an ICMJE shape for Disclosure of Potential Conflicts of Interest. circumstantial information related to each authors affiliations and conflicts of interests will be made publicly available on the CISG Web site and published with the BJSM supplement.
Medical Legal Considerations
This consensus document reflects the current condition of scholarship and will exigency to be modified according to the development of new knowledge. It provides an overview of issues that may be of importance to healthcare providers involved in the management of sport-related concussion. It is not intended as a yardstick of care, and should not be interpreted as such. This document is only a guide, and is of a common nature, consistent with the reasonable exercise of a healthcare professional. Individual treatment will depend on the facts and circumstances specific to each individual case.
It is intended that this document will be formally reviewed and updated prior to December 1, 2016.
SECTION 3: ZURICH 2012 CONSENSUS QUESTIONS
Note that each question is the subject of a separate systematic review that is published in the British Journal of Sports Medicine (2013; 47(5): April 2013). As such complete citations and details of each topic will be covered in those reviews.
1. When you assess an athlete acutely and they execute not believe concussion, what is it? Is a cognitive injury the key component of concussion in making a diagnosis?
The consensus panel agreed that concussion is an evolving injury in the acute angle with rapidly changing clinical signs and symptoms, which may reflect the underlying physiological injury in the brain. Concussion is considered to be among the most complex injuries in sport medicine to diagnose, assess, and manage. The majority of concussions in sport occur without loss of consciousness or open neurologic signs. At present, there is no impeccable diagnostic test or marker that clinicians can rely on for an immediate diagnosis of concussion in the sporting environment. Because of this evolving process, it is not workable to rule out concussion when an injury event occurs associated with a ephemeral neurological symptom. complete such cases should be removed from the playing domain and assessed for concussion by the treating physician or health reliance provider as discussed below. It was recognised that a cognitive deficit is not necessary for acute diagnosis as it either may not be present or detected on examination.
2. Are the existing tools/exam sensitive and amenable enough on the day of injury to get or exclude a diagnosis of concussion?
Concussion is a clinical diagnosis based largely on the observed injury mechanism, signs, and symptoms. The vast majority of sport-related concussions (hereafter, referred to as concussion) occur without loss of consciousness or open neurologic signs.151–154 In milder forms of concussion, the athlete might be slightly confused, without clearly identifiable amnesia. In addition, most concussions cannot be identified or diagnosed by neuroimaging techniques (eg, computed tomography or magnetic resonance imaging). Several well-validated neuropsychological tests are usurp for utilize in the assessment of acute concussion in the competitive sporting environment. These tests provide requisite data on symptoms and functional impairments that clinicians can incorporate into their diagnostic formulation, but should not solely be used to diagnose concussion.
3. What is the best exercise for evaluating an adult athlete with concussion on the “field of play” in 2012?
Recognizing and evaluating concussion in the adult athlete on the domain is a challenging responsibility for the health reliance provider. Performing this stint is often a rapid assessment in the midst of competition with a time constraint and the athlete interested to play. A standardized objective assessment of injury, which includes excluding more grave injury, is critical in determining character decisions for the athlete. The on-field evaluation of sport-related concussion is often a challenge given the elusiveness and variability of presentation, difficulty in making a timely diagnosis, specificity and sensitivity of sideline assessment tools, and the reliance on symptoms. Despite these challenges, the sideline evaluation is based on recognition of injury, assessment of symptoms, cognitive and cranial nerve function, and balance. Serial assessments are often necessary. Concussion is often an evolving injury, and signs and symptoms may be delayed. Therefore, erring on the side of caution (keeping an athlete out of participation when there is any suspicion for injury) is important. A standardized assessment of concussion is useful in the assessment of the athlete with suspected concussion but should not remove the spot of clinician judgment.
4. How can the SCAT2 be improved?
It was agreed that a variety of measures should be employed as fragment of the assessment of concussion to provide a more complete clinical profile for the concussed athlete. requisite clinical information can be ascertained in a streamlined manner through the utilize of a multimodal instrument such as the Sport Concussion Assessment instrument (SCAT). A baseline assessment is advised wherever possible. However, it is acknowledged that further validity studies exigency to be performed to concede this specific issue.
A future SCAT test battery (i.e, SCAT3) should comprise an initial assessment of injury severity using the Glasgow Coma Scale (GCS), immediately followed by observing and documenting concussion signs. Once this is complete, symptom endorsement and symptom severity, neurocognitive function, and equilibrium office should be assessed in any athlete suspected of sustaining a concussion. It is recommended that these latter steps be conducted following a minimum 15-minute comfort term on the sideline to avoid the influence of exertion or fatigue on the athlete’s performance. While it is eminent that this time frame is an capricious one, nevertheless the expert panel agreed that a term of comfort was requisite prior to assessment. Future research should account the efficacy for inclusion of vision tests such as the King Devick Test and clinical reaction time tests.155,156 Recent studies hint that these may be useful additions to the sideline assessment of concussion. However, the exigency for additional gear may get them impractical for sideline use.
It was further agreed that the SCAT3 would be suitable for adults and youths age 13 and over, while a new instrument (Child-SCAT3) be developed for younger children.
5. Advances in neuropsychology: are computerized tests sufficient for concussion diagnosis?
Sport-related concussions are frequently associated with 1 or more symptoms, impaired balance, and/or cognitive deficits. These problems can be measured using symptom scales, equilibrium testing, and neurocognitive testing. complete 3 modalities can identify significant changes in the first few days following injury, generally with normalization over 1 to 3 weeks. The presentation of symptoms and the rate of recovery can be variable, which reinforces the value of assessing complete 3 areas as fragment of a comprehensive sport concussion program.
Neuropsychological assessment has been described by the Concussion in Sport Group as a ‘cornerstone’ of concussion management. Neuropsychologists are uniquely qualified to interpret neuropsychological tests and can play an requisite role within the context of a multifaceted-multimodal and multidisciplinary approach to managing sport-related concussion. Concussion management programs that utilize neuropsychological assessment to assist in clinical decision-making believe been instituted in professional sports, colleges, and towering schools. Brief computerized cognitive evaluation tools are the mainstay of these assessments worldwide given the logistical limitation in accessing trained neuropsychologists, however it should be eminent that these are not substitutes for formal neuropsychological assessment. At present, there is insufficient evidence to recommend the widespread routine utilize of baseline neuropsychological testing.
7. What evidence exits for new strategies/technologies in the diagnosis of concussion and assessment of recovery?
A number of novel technological platforms exist to assess concussion including (but not limited to) iPhone/smart phone apps, quantitative electroencephalography, robotics – sensory motor assessment, telemedicine, eye tracking technology, functional imaging/advanced neuroimaging and head impact sensors. At this stage only limited evidence exists for their role in this setting and not a bit believe been validated as diagnostic. It will be requisite to reconsider the role of these technologies once evidence is developed.
8. Advances in the management of sport concussion: what is evidence for concussion therapies?
The current evidence evaluating the outcome of comfort and treatment following a sport-related concussion is sparse. An initial term of comfort may be of benefit. However, further research to evaluate the long-term outcome of rest, and the optimal amount and type of rest, is needed. Low-level exercise for those who are laggard to recoup may be of benefit, although the optimal timing following injury for initiation of this treatment is currently unknown. Multimodal physiotherapy treatment for individuals with clinical evidence of cervical spine and/or vestibular dysfunction may be of benefit. There is a stout exigency for high-level studies evaluating the effects of a resting period, pharmacological interventions, rehabilitative techniques, and exercise for individuals who believe sustained a sport-related concussion.
9. The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) post concussive symptoms?
Persistent symptoms (>10 days) are generally reported in 10%-15% of concussions. This may be higher in inevitable sports (eg, elite ice hockey) and populations (eg, children). In general, symptoms are not specific to concussion and it is requisite to account and manage co-existent pathologies. Investigations may comprise formal neuropsychological testing and conventional neuroimaging to exclude structural pathology. Currently there is insufficient evidence to recommend routine clinical utilize of advanced neuroimaging techniques or other investigative strategies. Cases of concussion in sport where clinical recovery falls outside the expected window (i.e. 10 days) should be managed in a multidisciplinary manner by health reliance providers with suffer in sports-related concussion. requisite components of management after the initial term of physical and cognitive comfort comprise associated therapies such as cognitive, vestibular, physical and psychological therapy, consideration of assessment of other causes of prolonged symptoms, and consideration of commencement of a graded exercise program at a flush that does not exacerbate symptoms.
10. Revisiting concussion modifiers: how should the evaluation and management of acute concussion disagree in specific groups?
The literature demonstrates that number and severity of symptoms and previous concussions are associated with prolonged recovery and/or increased risk of complications. Brief loss of consciousness (LOC), duration of posttraumatic amnesia and/or impact seizures execute not reliably foretell outcome following concussion, although a cautious approach should be taken in an athlete with prolonged LOC (ie, >1 minute). Children generally remove longer to recoup from concussions and assessment batteries believe yet to be validated in the younger age group. Currently there are insufficient data on the influence of genetics and gender on outcome following concussion. Several modifiers are associated with prolonged recovery or increased risk of complications following concussion and believe requisite implications for management. Children with concussion should be managed conservatively, with the emphasis on recrudesce to learn before recrudesce to sport. In cases of concussion managed with limited resources (eg, nonelite players), a conservative approach should moreover be taken such that the athlete does not recrudesce to sport until fully recovered
11. What are the most effective risk reduction strategies in sport concussion? - from protective gear to policy.
No new cogent evidence was provided to hint that the utilize of current yardstick headgear in rugby, or mouthguards in American football, can significantly reduce players’ risk of concussion. No evidence was provided to hint an association between neck might increases and concussion risk reduction. There was evidence to hint that eliminating corpse checking from Pee Wee ice hockey (ages 11-12 years) and fair-play rules in ice hockey were effective injury prevention strategies. Helmets exigency to be able to protect from impacts resulting in a head change in velocity of up to 10 m/s in professional American football, and up to 7 m/s in professional Australian football. It moreover appears that helmets must be capable of reducing head resultant linear acceleration to below 50 g and angular acceleration components to below 1500 rad/s2 to optimize their effectiveness. Given that a multifactorial approach is needed for concussion prevention, well-designed and sport-specific prospective analytical studies of sufficient power are warranted for mouthguards, headgear/helmets, facial protection, and neck strength. Measuring the outcome of rule changes should moreover be addressed with future studies, not only assessing new rule changes or legislation, but moreover alteration or reinforcement to existing rules.
12. What is the evidence for confirmed concussion-related changes? - behavioural, pathological, and clinical outcomes.
It was agreed that confirmed traumatic encephalopathy (CTE) represents a distinct tauopathy with an unknown incidence in athletic populations. It was further agreed that CTE was not related to concussions solitary or simply exposure to contact sports. At present, there are no published epidemiological, cohort, or prospective studies relating to modern CTE. Due to the nature of the case reports and pathological case string that believe been published, it is not workable to determine the causality or risk factors with any certainty. As such, the speculation that repeated concussion or sub-concussive impacts causes CTE remains unproven. The extent to which age-related changes, psychiatric or mental health illness, alcohol/drug use, or co-existing medical or dementing illnesses contribute to this process is largely unaccounted for in the published literature. At present, the interpretation of causation in the modern CTE case studies should proceed cautiously. It was moreover recognized that it is requisite to address the fears of parents/athletes from media pressure related to the possibility of CTE.
13. From consensus to action: how execute they optimize scholarship transfer, education, and faculty to influence policy?
The value of scholarship transfer (KT) as fragment of concussion education is increasingly becoming recognized. Target audiences benefit from specific learning strategies. Concussion tools exist, but their effectiveness and impact require further evaluation. The media is valuable in drawing attention to concussion, but efforts exigency to ensure that the public is cognizant of the right information. gregarious media as a concussion education instrument is becoming more prominent. Implementation of KT models is one approach organizations can utilize to assess scholarship gaps; identify, develop, and evaluate education strategies; and utilize the outcomes to facilitate determination making. Implementing KT strategies requires a defined plan. Identifying the needs, learning styles and preferred learning strategies of target audiences, coupled with evaluation, should be a piece of the overall concussion education confound to believe an impact on enhancing scholarship and awareness.
Author and coauthor affiliations and disclosures.
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McAfee [8 Certification Exam(s) ]
McData [3 Certification Exam(s) ]
Medical [69 Certification Exam(s) ]
Microsoft [375 Certification Exam(s) ]
Mile2 [3 Certification Exam(s) ]
Military [1 Certification Exam(s) ]
Misc [1 Certification Exam(s) ]
Motorola [7 Certification Exam(s) ]
mySQL [4 Certification Exam(s) ]
NBSTSA [1 Certification Exam(s) ]
NCEES [2 Certification Exam(s) ]
NCIDQ [1 Certification Exam(s) ]
NCLEX [2 Certification Exam(s) ]
Network-General [12 Certification Exam(s) ]
NetworkAppliance [39 Certification Exam(s) ]
NI [1 Certification Exam(s) ]
NIELIT [1 Certification Exam(s) ]
Nokia [6 Certification Exam(s) ]
Nortel [130 Certification Exam(s) ]
Novell [37 Certification Exam(s) ]
OMG [10 Certification Exam(s) ]
Oracle [282 Certification Exam(s) ]
P&C [2 Certification Exam(s) ]
Palo-Alto [4 Certification Exam(s) ]
PARCC [1 Certification Exam(s) ]
PayPal [1 Certification Exam(s) ]
Pegasystems [12 Certification Exam(s) ]
PEOPLECERT [4 Certification Exam(s) ]
PMI [15 Certification Exam(s) ]
Polycom [2 Certification Exam(s) ]
PostgreSQL-CE [1 Certification Exam(s) ]
Prince2 [6 Certification Exam(s) ]
PRMIA [1 Certification Exam(s) ]
PsychCorp [1 Certification Exam(s) ]
PTCB [2 Certification Exam(s) ]
QAI [1 Certification Exam(s) ]
QlikView [1 Certification Exam(s) ]
Quality-Assurance [7 Certification Exam(s) ]
RACC [1 Certification Exam(s) ]
Real-Estate [1 Certification Exam(s) ]
RedHat [8 Certification Exam(s) ]
RES [5 Certification Exam(s) ]
Riverbed [8 Certification Exam(s) ]
RSA [15 Certification Exam(s) ]
Sair [8 Certification Exam(s) ]
Salesforce [5 Certification Exam(s) ]
SANS [1 Certification Exam(s) ]
SAP [98 Certification Exam(s) ]
SASInstitute [15 Certification Exam(s) ]
SAT [1 Certification Exam(s) ]
SCO [10 Certification Exam(s) ]
SCP [6 Certification Exam(s) ]
SDI [3 Certification Exam(s) ]
See-Beyond [1 Certification Exam(s) ]
Siemens [1 Certification Exam(s) ]
Snia [7 Certification Exam(s) ]
SOA [15 Certification Exam(s) ]
Social-Work-Board [4 Certification Exam(s) ]
SpringSource [1 Certification Exam(s) ]
SUN [63 Certification Exam(s) ]
SUSE [1 Certification Exam(s) ]
Sybase [17 Certification Exam(s) ]
Symantec [135 Certification Exam(s) ]
Teacher-Certification [4 Certification Exam(s) ]
The-Open-Group [8 Certification Exam(s) ]
TIA [3 Certification Exam(s) ]
Tibco [18 Certification Exam(s) ]
Trainers [3 Certification Exam(s) ]
Trend [1 Certification Exam(s) ]
TruSecure [1 Certification Exam(s) ]
USMLE [1 Certification Exam(s) ]
VCE [6 Certification Exam(s) ]
Veeam [2 Certification Exam(s) ]
Veritas [33 Certification Exam(s) ]
Vmware [58 Certification Exam(s) ]
Wonderlic [2 Certification Exam(s) ]
Worldatwork [2 Certification Exam(s) ]
XML-Master [3 Certification Exam(s) ]
Zend [6 Certification Exam(s) ]
AccessData [1 Certification Exam(s) ]
ACFE [1 Certification Exam(s) ]
ACI [3 Certification Exam(s) ]
Acme-Packet [1 Certification Exam(s) ]
ACSM [4 Certification Exam(s) ]
ACT [1 Certification Exam(s) ]
Admission-Tests [13 Certification Exam(s) ]
ADOBE [93 Certification Exam(s) ]
AFP [1 Certification Exam(s) ]
AICPA [2 Certification Exam(s) ]
AIIM [1 Certification Exam(s) ]
Alcatel-Lucent [13 Certification Exam(s) ]
Alfresco [1 Certification Exam(s) ]
Altiris [3 Certification Exam(s) ]
Amazon [2 Certification Exam(s) ]
American-College [2 Certification Exam(s) ]
Android [4 Certification Exam(s) ]
APA [1 Certification Exam(s) ]
APC [2 Certification Exam(s) ]
APICS [2 Certification Exam(s) ]
Apple [69 Certification Exam(s) ]
AppSense [1 Certification Exam(s) ]
APTUSC [1 Certification Exam(s) ]
Arizona-Education [1 Certification Exam(s) ]
ARM [1 Certification Exam(s) ]
Aruba [6 Certification Exam(s) ]
ASIS [2 Certification Exam(s) ]
ASQ [3 Certification Exam(s) ]
ASTQB [8 Certification Exam(s) ]
Autodesk [2 Certification Exam(s) ]
Avaya [101 Certification Exam(s) ]
AXELOS [1 Certification Exam(s) ]
Axis [1 Certification Exam(s) ]
Banking [1 Certification Exam(s) ]
BEA [5 Certification Exam(s) ]
BICSI [2 Certification Exam(s) ]
BlackBerry [17 Certification Exam(s) ]
BlueCoat [2 Certification Exam(s) ]
Brocade [4 Certification Exam(s) ]
Business-Objects [11 Certification Exam(s) ]
Business-Tests [4 Certification Exam(s) ]
CA-Technologies [21 Certification Exam(s) ]
Certification-Board [10 Certification Exam(s) ]
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CheckPoint [43 Certification Exam(s) ]
CIDQ [1 Certification Exam(s) ]
CIPS [4 Certification Exam(s) ]
Cisco [318 Certification Exam(s) ]
Citrix [48 Certification Exam(s) ]
CIW [18 Certification Exam(s) ]
Cloudera [10 Certification Exam(s) ]
Cognos [19 Certification Exam(s) ]
College-Board [2 Certification Exam(s) ]
CompTIA [76 Certification Exam(s) ]
ComputerAssociates [6 Certification Exam(s) ]
Consultant [2 Certification Exam(s) ]
Counselor [4 Certification Exam(s) ]
CPP-Institue [2 Certification Exam(s) ]
CPP-Institute [2 Certification Exam(s) ]
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CWNA [1 Certification Exam(s) ]
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Dassault [2 Certification Exam(s) ]
DELL [11 Certification Exam(s) ]
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ECCouncil [21 Certification Exam(s) ]
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EMC [129 Certification Exam(s) ]
Enterasys [13 Certification Exam(s) ]
Ericsson [5 Certification Exam(s) ]
ESPA [1 Certification Exam(s) ]
Esri [2 Certification Exam(s) ]
ExamExpress [15 Certification Exam(s) ]
Exin [40 Certification Exam(s) ]
ExtremeNetworks [3 Certification Exam(s) ]
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Financial [36 Certification Exam(s) ]
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Fortinet [13 Certification Exam(s) ]
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IRS [1 Certification Exam(s) ]
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ISACA [4 Certification Exam(s) ]
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ISEB [24 Certification Exam(s) ]
Isilon [4 Certification Exam(s) ]
ISM [6 Certification Exam(s) ]
iSQI [7 Certification Exam(s) ]
ITEC [1 Certification Exam(s) ]
Juniper [65 Certification Exam(s) ]
LEED [1 Certification Exam(s) ]
Legato [5 Certification Exam(s) ]
Liferay [1 Certification Exam(s) ]
Logical-Operations [1 Certification Exam(s) ]
Lotus [66 Certification Exam(s) ]
LPI [24 Certification Exam(s) ]
LSI [3 Certification Exam(s) ]
Magento [3 Certification Exam(s) ]
Maintenance [2 Certification Exam(s) ]
McAfee [8 Certification Exam(s) ]
McData [3 Certification Exam(s) ]
Medical [69 Certification Exam(s) ]
Microsoft [375 Certification Exam(s) ]
Mile2 [3 Certification Exam(s) ]
Military [1 Certification Exam(s) ]
Misc [1 Certification Exam(s) ]
Motorola [7 Certification Exam(s) ]
mySQL [4 Certification Exam(s) ]
NBSTSA [1 Certification Exam(s) ]
NCEES [2 Certification Exam(s) ]
NCIDQ [1 Certification Exam(s) ]
NCLEX [2 Certification Exam(s) ]
Network-General [12 Certification Exam(s) ]
NetworkAppliance [39 Certification Exam(s) ]
NI [1 Certification Exam(s) ]
NIELIT [1 Certification Exam(s) ]
Nokia [6 Certification Exam(s) ]
Nortel [130 Certification Exam(s) ]
Novell [37 Certification Exam(s) ]
OMG [10 Certification Exam(s) ]
Oracle [282 Certification Exam(s) ]
P&C [2 Certification Exam(s) ]
Palo-Alto [4 Certification Exam(s) ]
PARCC [1 Certification Exam(s) ]
PayPal [1 Certification Exam(s) ]
Pegasystems [12 Certification Exam(s) ]
PEOPLECERT [4 Certification Exam(s) ]
PMI [15 Certification Exam(s) ]
Polycom [2 Certification Exam(s) ]
PostgreSQL-CE [1 Certification Exam(s) ]
Prince2 [6 Certification Exam(s) ]
PRMIA [1 Certification Exam(s) ]
PsychCorp [1 Certification Exam(s) ]
PTCB [2 Certification Exam(s) ]
QAI [1 Certification Exam(s) ]
QlikView [1 Certification Exam(s) ]
Quality-Assurance [7 Certification Exam(s) ]
RACC [1 Certification Exam(s) ]
Real-Estate [1 Certification Exam(s) ]
RedHat [8 Certification Exam(s) ]
RES [5 Certification Exam(s) ]
Riverbed [8 Certification Exam(s) ]
RSA [15 Certification Exam(s) ]
Sair [8 Certification Exam(s) ]
Salesforce [5 Certification Exam(s) ]
SANS [1 Certification Exam(s) ]
SAP [98 Certification Exam(s) ]
SASInstitute [15 Certification Exam(s) ]
SAT [1 Certification Exam(s) ]
SCO [10 Certification Exam(s) ]
SCP [6 Certification Exam(s) ]
SDI [3 Certification Exam(s) ]
See-Beyond [1 Certification Exam(s) ]
Siemens [1 Certification Exam(s) ]
Snia [7 Certification Exam(s) ]
SOA [15 Certification Exam(s) ]
Social-Work-Board [4 Certification Exam(s) ]
SpringSource [1 Certification Exam(s) ]
SUN [63 Certification Exam(s) ]
SUSE [1 Certification Exam(s) ]
Sybase [17 Certification Exam(s) ]
Symantec [135 Certification Exam(s) ]
Teacher-Certification [4 Certification Exam(s) ]
The-Open-Group [8 Certification Exam(s) ]
TIA [3 Certification Exam(s) ]
Tibco [18 Certification Exam(s) ]
Trainers [3 Certification Exam(s) ]
Trend [1 Certification Exam(s) ]
TruSecure [1 Certification Exam(s) ]
USMLE [1 Certification Exam(s) ]
VCE [6 Certification Exam(s) ]
Veeam [2 Certification Exam(s) ]
Veritas [33 Certification Exam(s) ]
Vmware [58 Certification Exam(s) ]
Wonderlic [2 Certification Exam(s) ]
Worldatwork [2 Certification Exam(s) ]
XML-Master [3 Certification Exam(s) ]
Zend [6 Certification Exam(s) ]
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