Reducing Severe Traumatic Brain Injury in the U.S.


>>>GOOD AFTERNOON AND WELCOME TO THE CDC PUBLIC HEALTH
GRAND ROUNDS. THERE WILL BE A SIGNUP SHEET. SO THOSE FROM THE CENTER WHO ARE
NOT HERE IN PERSON, WE’LL HAVE A DISCUSSION ABOUT THAT LATER. BUT THOSE OF YOU WHO ARE HERE,
VERY GOOD TO SEE YOU. I ALSO WOULD LIKE TO WELCOME
MANY OF THOSE WHO ARE JOINING US BY INTERNET AND HERE ARE THE WEB
PAGE WHERE PEOPLE CAN WATCH US BASICALLY THROUGH YOUTUBE. TODAY’S TOPIC IS DRAMATIC BRAIN
INJURY. BEFORE WE LAUNCH INTO THE
SESSION, I WOULD LIKE TO TAKE A COUPLE OF MINUTES AND HAVE A
PERSONAL STORY OF A YOUNG GIRL WHO HAS EXPERIENCED TRAUMATIC
BRAIN INJURY BEING SHARED WITH YOU.>>IT WAS JANUARY 10th, 2005. I WAS 17 YEARS OLD AND MY HIGH
SCHOOL BASKETBALL TEAM WAS PLAYING A VARSITY GAME. AND IT WAS AROUND THE SECOND
QUARTER AND I WAS GOING UP FOR A REBOUND AND AS I CAME DOWN, THE
BACK OF MY HEAD COLLIDED WITH THE TOP OF ANOTHER GIRL’S HEAD. THE NEXT DAY, AFTER THE DAY I
GOT HIT, I WENT TO SCHOOL AND I WAS REALLY SICK. I KNOW I HAD A CONCUSSION
BECAUSE I SUFFERED THROUGH A CONCUSSION ANY SEVENTH GRADE
YEAR. I HAD ALL THE SYMPTOMS, DIZZY,
NAUSEOUS, I COULDN’T FOCUS IN SCHOOL. I CONTINUED TO PLAY A SECOND
GAME AFTER THAT AND I HAD PASSED OUT AFTER THE SECOND GAME IN THE
LOCKER ROOM. BASICALLY, I WAS BED RIDDEN IN
MY HOUSE FOR ABOUT SIX MONTHS STRAIGHT. I SLEPT ON THE COUCH BECAUSE OF
THE LIGHT. WE HAD TO PUT DARK SHEETS OVER
THE WINDOWS. MY MOM AND MY SISTER HAD TO HELP
ME WALK AROUND. I LOST MY BALANCE. I COULDN’T REALLY GET THAT BACK
FOR QUITE A WHILE. I DIDN’T KNOW IT COULD GET THIS
BAD. ALL ATHLETES HAVE A STRONG WILL
AND SINCE WE’RE YOUNG, WE KNOW THAT WE HAVE TO SUCK IT UP, SUCK
THINGS UP, WHETHER, YOU KNOW, YOU SPRAIN YOUR ANKLE OR YOU
HURT YOUR FINGER, YOU JUST GO IN THE GAME AND YOU SHAKE IT OFF
AND YOU DON’T COMPLAIN, YOU DON’T CRY. BUT THIS IS THE BRAIN AND HEAD
WE’RE TALKING ABOUT AND YOU CAN’T SUCK IT UP. SO UNFORTUNATELY INSTEAD OF
MISSING A GAME, I MISSED THE SEASON, I MISSED SPORTS FOR THE
REST OF MY LIFE AND I MISS OUT ON A GREAT LIFE THAT I COULD
HAVE HAD. ATHLETES NEED TO KNOW, IF YOU
THINK YOU HAVE A CONCUSSION, DON’T HIDE IT, REPORT IT. IT’S BETTER TO MISS ONE GAME
THAN THE ENTIRE SEASON.>>SPEAKERS, WE ACTUALLY HAVE
ONLY THREE SPEAKERS TODAY, BUT THEY CERTAINLY MAKE UP IN
QUALITY FOR THE FIVE OR FOUR THAT WE NORMALLY HAVE. OUR OWN DR. LISA McGUIRE, DR. DAVID WRIGHT FROM THE EMORY UNIVERSITY AND DR. ART KELLERMANN FROM RAND CORPORATION. EACH ONE OF THEM WILL TALK ABOUT
DIFFERENT ASPECTS OF HOW WE ARE DEALING WITH TRAUMATIC BRAIN
INJURY. THIS IS A COURSE THAT QUALIFIES
FOR THE CONTINUING EDUCATION CREDIT AND FOR THE FIRST TIME
NOW, WE ARE GOING TO BE HAVING Q&A SESSIONS AFTER YOU LISTEN TO
THE SESSION. YOU SHOULD GO TO THE WEB PAGE,
ANSWER FOUR OF THE FIVE QUESTIONS TO BE ABLE TO GET THE
CREDIT FOR THIS SESSION. SO JUST SITTING AND LISTENING IS
NOT ENOUGH ANY MORE. I WOULD ALSO LIKE TO POINT OUT
THAT, AS ALWAYS, WE ARE COORDINATING SLIDE CLIPS WITH
THE TOPIC OF OUR GRAND ROUNDS AND I WOULD LIKE TO THANK OUR
COLLEAGUES FROM THE INJURY CENTER WHO HAVE MADE THE
SELECTION FOR THIS WEEK. FINALLY, THIS IS A GROUP OF
PEOPLE THAT, AS ALWAYS, HAD TO DO SOME TEAM WORK. SO IN THIS TERM, DAVID CALL A
CALL AT THE EMORY AND WE ALL DEALT TO SEE HOW THE PATIENTS
DEAL WITH THESE REALLY SERIOUS AND LIFE THREATENING ISSUES AND
NURSE TONYA OR NURSE JACKIE WAS WATCHING ASIDE AND HAD TO GIVE
AN ENORMOUS AMOUNT OF CREDIT FOR THESE UNBELIEVABLY PROFESSIONALS
WHO HAVE WORKED WITH ME AND TOLERATED A LOT OF LITTLE DO
THIS, DON’T DO THIS TO MAKE THIS WHAT I HOPE IS GOING TO BE,
AGAIN, AN OUTSTANDING SESSION. I’D LIKE TO BRAG ABOUT THE
NUMBER OF PEOPLE THAT COME AND VIEW THIS SESSION BECAUSE IT’S
REALLY NOT JUST THE NUMBER OF PEOPLE IN THE AUDITORIUM. IT’S THOUSANDS OF PEOPLE, AS YOU
CAN SEE FROM THIS CHART, WHO HAVE BEEN WATCHING US LIVE. AND TO BE VERY SPECIFIC IN THE
PAST COUPLE OF YEARS THAT WE HAVE BEEN DOING THIS, WE HAVE
HAD 329,751 PEOPLE WHO HAVE WATCHED US ELECTRONICALLY. IN SOME WAY, WHETHER IT’S LIVE
OR DOWNLOADED OUR SESSIONS. THAT’S A HUGE NUMBER OF PEOPLE
FOR A PUBLIC HEALTH TOPIC. TO ASSURE THAT WE ACTUALLY
CONTINUE WITH THE QUALITY AND WITH THE INTEREST THAT WE HAVE
GOTTEN SO FAR, WE ARE GOING TO BE TAKING A BREAK. AND AFTER TWO YEARS OF DOING
THIS MONTH AFTER MONTH, WHAT WE WOULD LIKE TO DO IS WE WOULD
LIKE TO DO A LITTLE BIT OF REASSESSMENT, WHAT IS IT THAT
WORKS VERY WELL, WHAT IS IT THAT NEEDS TO BE IMPROVED? WE WOULD LIKE TO CONTINUE MAKING
THIS ABOUT SCIENCE AS THE FOUNDATION OF WHAT WE DO, AS THE
FOUNDATION OF DECISIONS THAT ARE BEING MADE AND RECOMMENDATIONS
THAT STEM FROM A LOT OF THESE DECISIONS. WE ALSO WOULD LIKE TO KEEP
EVERYTHING ABOUT PRACTICE AND THE EXCITEMENT OF PUTTING SOME
OF THESE INTERVENTIONS IN PRACTICE, BUT IN THE END, IT
REALLY IS ALL ABOUT YOU, THOSE OF YOU WHO ARE EITHER COMING
HERE IN PERPENDICULAR OR WHO ARE WATCHING US THROUGHOUT THE
COUNTRY AND WORLDWIDE AS THIS POINT, WHAT IS IT THAT MOTIVATES
YOU TO COME HERE, TO LISTEN TO THESE SESSIONS AND WHAT IS IT
THAT YOU TAKE BACK FROM THEM THAT IS USEFUL FOR YOU IN YOUR
WORK? SO WITH THAT, JUST TO GIVE YOU A
SENSE OF WHAT IS COMING IN THE NEXT NINE TO TEN MONTHS — LIKE
I SAID, WE WILL BE TAKING A BREAK IN OCTOBER AND NOVEMBER. THEN WE HAVE ROUND UP ANOTHER
SERIES OF WHAT I THINK YOU WILL FIND EXTREMELY INTERESTING
TOPICS AS I HAVE LISTED HERE. AS IT HAPPENS, WE TRIED TO
COORDINATE A LOT OF EVENTS AND TRIED TO POINT OUT EVENTS THAT
HAPPENED AT THE SAME TIME AS OUR GRAND ROUNDS. SO JUST TODAY, IN OUR NEW
SECTION, WE HAVE A YEAR OF ASSESSMENT OF WHAT IS IT THAT
HAS BEEN DONE IN A BATTLE SESSION, AS YOU KNOW, MOTOR
VEHICLE CRASHES ARE ONE OF CDC’S WINNABLE BATTLES. I’M GOING TO READ TO YOU ONE
SENTENCE FROM THAT ARTICLE THAT CAME TODAY. IN 2009, ABOUT 12,000 MORE
INJURIES WOULD HAVE BEEN PREVENTED AND ABOUT 450 MORE
LIVES SAVED IF ALL STATES HAD PRIMARY ENFORCEMENT SEAT BELT
LAWS. AND YOU WILL SEE THAT SEAT BELT
LAWS, MOTOR VEHICLE CRASHES AND TRAUMATIC BRAIN INJURIES ARE
VERY MUCH INTERTWINED. BEFORE WE MOVE TO OUR
SPECTACULAR SPEAKERS, WE ARE GOING TO MOVE TO OUR SPECTACULAR
CDC DIRECTOR, WHO IS NOT HERE TODAY, BUT IS GOING TO PROVIDE
HIS COMMENTS THAT HE HAS VIDEOTAPED.>>ABOUT 1.7 MILLION AMERICANS
HAVE A TRAUMATIC BRAIN INJURY EACH YEAR. TBIs ARE CAUSED BY FALLS, MOTOR
VEHICLE CRASHES, FIREARMS AND BLAST INJURIES. THE RESULTS CAN RANGE FROM MILD
TO SEVERE. SOME CAN RESULT IN LIFELONG
COGNITIVE IMPAIRMENT OR EVEN DEATH. SEVERE TBIs AFFECT FAMILIES AND
COMMUNITIES AND THEY’RE PREVENTABLE WITH PRIMARY
PREVENTION STRATEGIES, INCLUDING HELMETS AND SEAT BELT USE LAWS. WHEN TBIs OCCUR, EARLY
IDENTIFICATION AND MANAGEMENT ARE KEY TO MINIMIZING SECONDARY
BRAIN INJURY WHILE REHABILITATION IS KEY TO REGAIN
FUNCTION AND MINIMIZE PERMANENT DISABILITY. IMPLEMENTING PREVENTION
STRATEGIES AND RESPONDING TO TBIs IS COMPLICATED BY THE
COMPLEX NATURE OF TBI. NO ONE STRATEGY WILL ADDRESS ALL
RISKS OR CONSEQUENCES OF TBI. WE NEED STRONGER INJURY
SURVEILLANCE, MORE USE OF EXISTING PRIMARY PREVENTION
STRATEGIES AND RESEARCH TO EXPAND OUR EVIDENCE BASE FOR
PREVENTION. THE RULE OF PUBLIC HEALTH AND
REDUCING TBIs INCLUDES KEY ACTIVITIES SUCH AS SUPPORTING
SURVEILLANCE, IDENTIFYING BEST PRACTICES, IMPLEMENTING AND
DISSEMINATING RESPECTIVE INTERVENTION AND RIGOROUSLY
EVALUATING INTERACTION TO SEE IF WE HAVE THE INTENDED IMPACT. THIS SESSION WILL DISCUSS TBIs,
PROMSING TO PREVENT AND TREATMENT THEM AND MANY OF THE
CHALLENGES WE FACE MOVING FORWARD. THANK YOU.>>>GOOD AFTERNOON I’M LISA McGUIRE FROM CDC’S
NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL. I’M GOING TO TALK TO YOU THIS
AFTERNOON ABOUT THE THE PUBLIC HEALTH ROLE IN SEVERE TRAUMATIC
BRAIN INJURY OR TBI. THE CDC DEFINES A TBI AS A BRAIN
INJURY THAT DISRUPTS THE NORMAL FUNCTIONING OF THE BRAIN. IT CAN BE CAUSED BY A BUMP, A
BLOW OR A JOLT TO THE HEAD OR ALSO A PENETRATING HEAD INJURY. THERE ARE AT LEAST 1 MILLION
TBIs SUSTAINED IN THE UNITED STATES EVERY YEAR. THESE NUMBERS UNDERESTIMATE THE
TRUE BURDEN OF TBIs. THEY DO NOT INCLUDE TBIs TREATED
IN NONHOSPITAL BASED BEDDING, SUCH AS A DOCTOR’S OFFICE OR
OUTPATIENT CLINIC. THEY ALSO DO NOT INCLUDE TBIs
THAT WERE SUSTAINED BY MILITARY PERSONNEL THAT HAVE BEEN TREATED
IN EITHER A MILITARY OR VETERAN’S ADMINISTRATION MEDICAL
SETTING. TO ILLUSTRATE THE MAGNITUDE OF
TBI IN THE MILITARY, THE DEPARTMENT OF DEFENSE REPORTED
THAT MORE THAN 31,000 U.S. MILITARY PERSONNEL WERE
DIAGNOSED WITH A TBI IN 2010. FINALLY, TBIs OFTEN GO
UNDIAGNOSED IN THE PRESENCE OF OTHER LIFE THREATENING
CONDITIONS. AT LEAST ONE PERSON SUSTAINS A
TBI EVERY THREE MINUTES IN THE UNITED STATES. MALES ARE MORE LIKELY TO SUSTAIN
A TBI THAN FEMALES AND WHEN MALES DO SUSTAIN A TBI, THEY’RE
THREE TIMES MORE LIKELY TO DIE FROM THAT TBI THAN FEMALES ARE. CDC HAS ESTIMATED THAT 5.3
MILLION PEOPLE LIVE WITH A LONG-TERM COGNITIVE AND
PSYCHOLOGICAL IMPAIRMENT OR OTHER LONG-TERM CONSEQUENCES
ASSOCIATED WITH A TBI. USING LIFETIME ESTIMATES OF COST
OF TBI IN THE U.S. FOR THE YEAR 2000 AND AJUSTING FOR INFLATION,
WE ESTIMATE THAT THE 2010 COST FOR TBIs WERE $76.3 BILLION. OF THAT, $11.5 BILLION WERE DUE
TO DIRECT MEDICAL COSTS AND $64.8 BILLION ARE DUE TO
INDIRECT COSTS SUCH AS LOST WAGES, PRODUCTIVITY LOSS AND
NONMEDICAL RELATED EXPENDITURE. NOW LET’S DISCUSS THE CAUSES OF
TBI. FALLS ARE THE OVERALL LEADING
CAUSE OF TBI AMONG CIVILIAN POPULATIONS. FOR EXAMPLE, ACTRESS NATASHA
RICHARDSON FELL WHILE SKIING. THIS RESULTED IN AN EPIDURAL
HEMATOMA THAT CAUSED HER DEATH. MOTOR VEHICLE CRASHES ARE THE
SECOND LEADING CAUSE OF TBI AND THEY’RE THE LEADING CAUSE OF TBI
RELATED DEATHS. TBIs ACCOUNT FOR NEARLY
ONE-THIRD OF ALL INJURY RELATED DEATHS IN THE U.S. IT’S ALSO IMPORTANT TO KNOW THAT
TBIs DO NOT OCCUR IN ISOLATION. THEY MAY OCCUR IN COMBINATION
WITH OTHER INJURIES WHICH MAY BE SERIOUS OR LIFE THREATENING. WE WILL NOW LOOK AT THE RATES OF
TBI BY AGE AND CAUSE. FALLS ARE THE LEADING CAUSE OF
TBIs. THE RATES ARE HIGHEST IN
CHILDREN AND OLDER ADULTS. FALLS COST APPROXIMATELY 50% OF
THE TBIs IN CHILDREN AGE ZERO TO 14 YEARS AND A LITTLE MORE THAN
60% OF THE TBIs IN ADULTS AGE 65 YEARS OLD AND OLDER. MOTOR VEHICLE CRASHES ARE THE
SECOND LEADING CAUSE OF TBIs. HOWEVER, MOTOR VEHICLE CRASHES
ARE THE LEADING CAUSE OF TBI FOR TEENS AND ADULTS 15 TO 34 YEARS
OLD. MALES AGE 5 TO 24 YEARS OLD AND
ANYBODY WHO IS AGE 85 YEARS OLD AND OLDER HAVE THE HIGHEST RATES
OF TBI DEATH FROM MOTOR VEHICLE CRASHES. TBI SEVERITY IS CLASSIFIED AS
MILD, MODERATE OR SEVERE. FOLLOWING AN INJURY,
CLASSIFICATION MAY BE BASED ON THE LENGTH AND DEPTH OF COMA OR
ALTERED CONSCIOUSNESS. IT ALSO CAN BE BASED ON THE
ANATOMICAL DESCRIPTION OF THE INJURY OR THE FUNCTIONAL
OUTCOME. DR. WRIGHT WILL TELL US A LITTLE
BIT MORE ABOUT THIS IN HIS PRESENTATION. WHY FOCUS ON THIS IN SEVERE TBI? MANY TBI SURVIVORS, PRIMARILY
THOSE WITH SEVERE TBI CAN FACE LONG-TERM DISABILITY. ONE STUDY ESTIMATED THAT
NATIONWIDE 43% OF TBI SURVIVORS WHO HAD BEEN HOSPITALIZED HAD
TBI RELATED DISABILITIES REMAINING ONE YEAR AFTER THEIR
INJURY. ADDITIONALLY, THE COST OF FATAL
TBIs AND TBIs REQUIRING HOSPITALIZATION, MANY OF WHICH
ARE SEVERE, ACCOUNT FOR APPROXIMATELY 90% OF THE TOTAL
TBI MEDICAL COSTS. I WILL NOW DISCUSS NONFATAL TBIs
AND HOW TO REDUCE THE CONSEQUENCES. HERE ARE SOME POTENTIAL
CONSEQUENCES, LET ME HIGHLIGHT JUST ONE, COGNITIVE IMPAIRMENT. COGNITIVE IMPAIRMENT OR DEFICIT
CAN INCLUDE MEMORY LOT LOSS AND DIFFICULTIES AND PLANNING OR
PROBLEM SOLVING. THIS CAN AFFECT THE PERSON’S
ABILITY TO PERFORM EVEN VERY SIMPLE TASKS, SUCH AS
REMEMBERING WHERE THEIR KEYS ARE OR FINDING THEIR WAY HOME AT THE
END OF THE DAY. TBIs AFFECT THE FAMILIES, THE
COMMUNITY AND THE SOCIETY AS A WHOLE. FOR EXAMPLE, FAMILY MEMBERS MAY
NEED TO ADJUST THEIR ROLE WITHIN THE FAMILY IN ORDER TO PROVIDE
CARE. A PRIMARY BREAD WINNER MAY NO
LONGER BE ABLE TO WORK AT THE SAME JOB WITH THE SAME INTENSITY
OR EVEN WORK TODD. AT ALL. SOCIETAL FACTORS MAY INCLUDE
ECONOMIC STRESS, PRODUCTIVITY LOSS, INCREASED DEPEND YANTANCE
ON SOCIAL PROGRAMS OR SUPPORT. THERE ARE THREE WAYS TO REDUCE
THE SEVERE TBI AND ITS CONSEQUENCES. PRIMARY PREVENTION, EARLY
MANAGEMENT AND THE COMPREHENSIVE APPROACH TO REHABILITATION AND
REINTEGRATION. I WILL START WITH HIRING
PREVENTION. THE OPTIMAL WAY TO REDUCE
MORBIDITY, MORTALITY, AND ECONOMIC CONSEQUENCES OF
INJURIES IS TO PREVENT THEIR OCCURRENCE. THERE ARE SEVERAL AVENUES FOR
PREVENTION, INTERVENTION PRESENTED HERE. FALLS ARE THE NUMBER ONE CAUSE
OF TBI. TO REDUCE FALLS, EXERCISE AND
BALANCE TRAINING HAVE BEEN SHOWN TO BE EFFECTIVE. ONE OF THE CHALLENGES WITH
PRIMARY PREVENTION IS ENSURING STRATEGIES ARE BROADLY ADOPTED. MANY ARE BEST IMPLEMENTED
THROUGH POLICY. AND, DOCTOR KELLERMANN WILL
ADDRESS THESE. WHEN TBIs DO OCCUR, RAPID
TRANSPORTATION TO APPROPRIATE TRAUMA CARE IS NECESSARY. CDC SUPPORTED RESEARCH
DEMONSTRATED THAT THE RISK FOR DEATH FOR SEVERELY INJURED
PATIENTS WAS 25% LOWER WHEN THE PATIENT RECEIVED CARE AT A LEVEL
ONE TRAUMA CENTER. THE GUIDELINES FOR FIELD TRIAGE
OF INJURED PATIENTS PROVIDES EMERGENCY MEDICAL SERVICE
PROVIDERS OR EMS WITH THE ABILITY TO IDENTIFY SEVERELY
INJURED PATIENTS. THEN TO RAPIDLY TRANSPORT THEM
TO THE HIGHEST LEVELS OF CARE WITHIN THE TRAUMA SYSTEM. UNFORTUNATELY, NEARLY 45 MILLION
AMERICANS DO NOT HAVE ACCESS TO A LEVEL ONE OR A LEVEL TWO
TRAUMA CENTER WITHIN ONE HOUR EITHER BY GROUND OR AIR
TRANSPORT. THESE FACILITIES HAVE THE
RESOURCES TO TREAT PATIENTS WITH THE MOST LIFE THREATENING
INJURIES. THE BRAIN TRAUMA FOUNDATION
GUIDELINES PROIT PROVIDE HEALTH CARE PROFESSIONALS WITH EVIDENCE
BASED PATIENT CARE TREATMENT RECOMMENDATIONS. SOME EXAMPLES ARE LISTED HERE. CDC RECOMMENDS THE WIDESPREAD
ADOPTION OF THESE GUIDELINES. DR. WRIGHT WILL DISCUSS THIS, AS
WELL. EACH PATIENT NEEDS AN
INDIVIDUALIZED COMPREHENSIVE APPROACH TO REHABILITATION AND
REINTEGRATION. THIS WILL HELP TO ENSURE THE
PATIENT REACHES THEIR MAXIMUM FUNCTIONAL POTENTIAL AND LEARNS
TO ADAPT TO THEIR DISABILITY. U.S. CONGRESSWOMAN GABRIEL
GIFFORDS, AS YOU KNOW, WAS SHOT IN THE HEAD EARLIER THIS YEAR. SHE SUSTAINED A SEVERE TBI. HER ABILITY TO OBTAIN
COMPREHENSIVE REHABILITATION SERVICES IS ONE FACTOR THAT’S
LED TO HER RECOVERY. REHABILITATION REQUIRES A
COMPLEX MIX OF SERVICES. UNFORTUNATELY, NOT EVERY PERSON
IS ABLE TO OBTAIN THESE NEEDED SERVICES. FOR EXAMPLE, SOME SERVICES ARE
NOT PROVIDED IN EVERY GEOGRAPHICAL AREA. AND EVEN WHEN THOSE SERVICES ARE
AVAILABLE, HEALTH INSURANCE CAN LIMIT THE AMOUNT OF TYPE OF
SERVICES THAT A PERSON MIGHT RECEIVE. FINALLY, THE DEVELOPMENT AND
VAEBLGZ OF NEW REHABILITATION INTERVENTION, INCLUDING THE
LENGTH OF TIME FOR RECOVERY MUST INCORPORATE THE GROWING EVIDENCE
OF NEURAL PALACE ADVERTISE TYUR NEURAL PLASTICITY. OUR GOAL IS TO IMPROVEMENT THE
MANAGEMENT OF TBI WHEN IT HAPPENS. KEY ACTIVITIES IN THIS EFFORT
ARE SURVEILLANCE, IDENTIFICATION OF EVIDENCE BASED STRATEGIES AND
DISSEMINATION AND IMPLEMENTATION OF THOSE STRATEGIES. SURVEILLANCE IS IMPORTANT TO ALL
STAGES OF THE PREVENTION RESPONSE. WE AT PUBLIC HEALTH DO HAVE A
ROLE. MANY CURRENT DATA SOURCES DO NOT
PROVIDE THE LEVEL OF DETAIL NEEDED TO FULLY UNDERSTAND THE
EPIDEMIOLOGY AND LONG-TERM CONSEQUENCES AND OUTCOMES OF
TBI. THE DEVELOPMENT OF A STANDARD
DEFINITION FOR TBI, IN ADDITION TO A TRUE NATIONAL INJURY
SURVEILLANCE SYSTEM WILL INFORM PREVENTION EFFORTS. LONGITUDINAL OR FOLLOW-UP
STUDIES WILL HELP US EVALUATE INTERVENTION FOR THEIR
EFFECTIVENESS. WE HAVE A ROLE IN DEVELOPING,
IDENTIFYING, AND DISSEMINATING EVIDENCE-BASED PRIMARY
PREVENTION STRATEGIES. MANY OF THESE STRATEGIES
RECOMMENDED BY CDC’S GUIDE TO COMMUNITY PREVENTIVE SERVICES
ARE BEING IMPLEMENTED ACROSS THE U.S. WE KNOW THAT NOT ONE SIZE FITS
ALL. THE MULTIPLE POTENTIAL CAUSES OF
TBI REQUIRE MULTIPLE INTERVENTION WITH ACTION ON ALL
LEVELS. MOVING FORWARD, WE NEED TO
TAILOR INTERVENTION FOR HIGH RISK POPULATIONS AND TO EVALUATE
PROGRAMS AND POLICIES IN ORDER TO IMPROVE IMPLEMENTATION. THROUGH RESEARCH, PUBLIC HEALTH
CAN ADDRESS GAPS IN EXISTING POLICIES AND WITH STATE ASK
LOCAL COMMUNITIES CAN FULLY IMPLEMENT EFFECTIVE
INTERVENTION. WE HAVE A ROLE IN THE
IDENTIFICATION DISSEMINATION OF EARLY MANAGEMENT STRATEGIES FOR
TBI. ESPECIALLY THROUGH THE
IMPROVEMENT OF GUIDELINES OF FIELD TRIAGE AND TRAUMA SYSTEMS
DEVELOPMENT. ACCESS TO TRAUMA CARE IS CRUCIAL
TO MINIMIZING LONG-TERM CONSEQUENCES OF TBI. HOWEVER, THIS ACCESS IS NOT
AVAILABLE IN ALL AREAS. WE CAN ALSO SUPPORT THE
DEVELOPMENT OF TRAUMA SYSTEMS INTEGRATED WITHIN PUBLIC HEALTH
ACROSS THE UNITED STATES. WE HAVE A ROLE IN SUPPORTING THE
REHABILITATION AND REINTEGRATION OF INDIVIDUALS BACK INTO THEIR
COMMUNITY. THE CURRENT EVIDENCE SHOWS THAT
A COMPREHENSIVE PROGRAM OF REHABILITATION IS THE MOST
EFFECTIVE WAY OF MINIMIZING NEGATIVE CONSEQUENCES. IN ORDER TO SUPPORT THIS, WE
NEED TO WORK WITH PARTNERS TO IDENTIFY MECHANISMS FOR
REIMBURSEMENT THAT ALLOW FOR INCREASED ACCESS TO
COMPREHENSIVE CARE. FURTHER, WE NEED TO COLLABORATE
WITH THE CLINICAL COMMUNITY TO BUILD THE EVIDENCE BASED FOR
COMPREHENSIVE REHABILITATION, INCLUDING LINKAGES TO PUBLIC
HEALTH PREVENTION, INCIDENT HER VENGZ TO SUPPORT LIFELONG
HEALTH. PARTNERSHIPS ARE THE ENGINE THAT
DRIVES PROGRESS TO PREVENT AND TREATMENT TRAUMATIC BRAIN
INJURY. FOR EXAMPLE, ONE COMMON
DEFINITION OF TBI CAN OHM BE REACHED IF ALL PARTNERS AGREE TO
IMPLEMENT IT WITHIN THEIR SURVEILLANCE SYSTEM. ADDITIONALLY, SHARING THE
FINDINGS BETWEEN THE MILITARY AND CIVILIAN MEDICAL COMMUNITIES
CAN ENCOURAGE REHABILITATION ACTIVITY. FEDERAL AGENCIES, STATE AND
LOCAL HEALTH DEPARTMENTS AND NATIONAL AND COMMUNITY
ORGANIZATIONS CAN COOPERATE TO IDENTIFY AND IMPLEMENT EFFECTIVE
PREVENTION STRATEGIES. PUBLIC HEALTH DOES HAVE A ROLE. OUR NEXT SPEAKER THIS AFTERNOON
IS DR. DAVID WRIGHT.>>GOOD AFTERNOON. THANK YOU, LISA. MY NAME IS DAVID WRIGHT. I AM THE DIRECTOR OF EMERGENCY
NEUROSCIENCES AT EMORY UNIVERSITY AT THE DEPARTMENT OF
MEDICINE AND I’M A PRACTICING PHYSICIAN AT GRADY MEMORIAL
HOSPITAL, ARGUABLY, ONE OF THE BUSIEST TRAUMA CENTERS IN THE
NATION. SO TODAY WE ARE GOING TO TALK
ABOUT OR DISCUSS, RATHER, THE IMPORTANCE OF THE FOUNDATION
GUIDELINES AND ALSO KIND OF REVIEW THE EXISTING RESEARCH
GAPS FOR HOPES OF OPPORTUNITIES IN CHANGE AND IMPROVEMENT AND
INTRODUCE WHAT I’M EXCITED ABOUT, A NOVEL AND POTENTIAL
TREATMENT FOR TRAUMATIC BRAIN INJURY. FIRST, I WANT TO COVER A LITTLE
BIT ABOUT WHAT GOES ON AFTER A BRAIN INJURY OCCURS. THE INITIAL TRAUMA IS REALLY
ONLY THE FIRST PHASE OF INJURY. IT’S THE SECONDARY PHASE THAT’S
CHARACTERIZED BY ACTIVATION OVER A WHOLE HOST OF NEUROTOXIC
EVENTS AND ACTIVATION OF PATHWAYS THAT CAUSE PROBABLY
MOST OF THE MORBIDITY AND MORTALITY AFTER SURVIVABLE
INJURIES. THIS SECONDARY INJURY BEGINS
IMMEDIATELY AT THE TIME OF THE ACCIDENT AND THEN CONTINUES TO
OCCUR FOR MONTHS, EVEN UP TO A YEAR AFTER THE INJURY. NOW, THE EARLIEST MECHANISMS
DISCOVERED WERE THE RELEASE OF NEUROTRANSMITTERS, THE INFLUX OF
HUGE AMOUNTS OF CALCIUM INTO THE CELL AND OTHER IONS WHICH
OVERWHELM THE CELL AND CAUSED EVENTUAL NECROSIS AND CELL
DEATH. HOWEVER, I THINK THIS SLIDE IS
PRETTY OBVIOUS TO EVERYONE, RIGHT? WE KNOW IT TO BE MUCH MORE
COMPLICATED THAN THAT. IN FACT, THERE ARE MULTIPLE
PATHWAYS THAT ARE ACTIVATED. IN THIS SLIDE, YOU CAN BEGIN TO
SEE MANY OF THOSE PATHWAYS THAT ARE ACTIVATED, INCLUDING THE
RELEASE OF INFLAMMATORY CYTOKINES, EDEMA AND EVEN
SELF-SUICIDE, SOMETHING CALLED APOTOSIS. SO IT’S IMPORTANT TO RECOGNIZE
THE COMPLEXITY OF BRAIN INJURY AND WHAT’S GOING ON AFTERWARDS
SO THAT WE CAN BETTER INFORM DRUG DISCOVERY AND ALSO DEVELOP
SUCCESSFUL TREATMENT STRATEGIES. HOWEVER, EVEN WITH A CLEARER
UNDERSTANDING OF THE PATH OF PHYSIOLOGY AT TBI AND OVER 150
DIFFERENT TARGETS AVAILABLE FOR US, WE HAVE YET TO FIND A
TREATMENT THAT CAN IMPROVE THE FUNCTIONAL OUTCOME. WHERE ARE WE CURRENTLY TODAY? THERE ARE FLEEMTS AVAILABLE THAT
TARGET THE SECONDARY CASCADE AND IMPROVE FUNCTIONAL OUTCOME. THIS HAS LED EXPERTS AROUND THE
COUNTRY TO EXAMINE WHY IS THIS? WHAT ARE THE RESEARCH GAPS? WHAT ARE THE REASONS FOR
CLINICAL FAILURES? WELL, THE MOST OBVIOUS RESEARCH
GAP IS THE VERY DEFINITION AND CLASSIFICATION OF TRAUMATIC
BRAIN INJURY. WE CURRENTLY — OR OUR CURRENT
APPROACH IS BASED SOLELY ON AN INDIVIDUAL’S RESPONSE TO THE
ENVIRONMENT. HOW AWAKE ARE THEY? THIS CATEGORIZATION OR SCALE
DIVIDES PATIENTS INTO MILD, MODERATE AND SEVERE. THIS IS CRUDE, OKAY? OVEN CONTAMINATED BY ALCOHOL,
OTHER DRUGS, SUCH AS A DRUG THAT WE GIVE THEM, AND IT LACKS, MOST
IMPORTANTLY, ANY PATHOLOGICAL LINK. IT TELLS YOU NOTHING ABOUT
WHAT’S GOING ON IN THE BRAIN AT THE TIME OF THE INJURY. THIS DOES A DECIDES SERVICE TO
THE INJURY AND OUR ABILITY TO ASSESS THE PATIENTS. THIS IS AN EXAMPLE. THIS IS SIX DIFFERENT PATIENTS. EACH OF THESE PATIENTS HAVE A
SCALE OF SIX. NONE OF THEM HAVE THE SAME TYPE
OF INJURY. NONE OF THEM WILL HAVE THE SAME
PROGNOSIS. SO THE LACK OF A GOOD
CLASSIFICATION SYSTEM HAS REALLY IMPACTED BOTH OUR ABILITY TO
ASSESS AND MANAGE PATIENTS, BUT ALSO HAMMERED OUR CLINICAL
TRAUMAS. WE NEED A BETTER CLASSIFICATION
SYSTEM. ANOTHER GAP IS OUR MECHANICISTIC
APPROACH TO DRAMATIC BRAIN INJURY, THAT MAGIC BULLET. SINGLE ION CHANNEL BLOCKERS SUCH
AS CALCIUM CHANNEL BLOCKERS AND OTHER THINGS HAVE BEEN TRIED AND
THEY ACTUALLY WORK IN ANIMALS. WHEN THEY TAKE THEM TO THE
CLINICAL TRIAL, THEY DON’T WORK ANY MORE. SO THESE SINGLE, SINGLE PATHWAY
APPROACHES ARE NOT LIKELY TO BE ROBUST ENOUGH TO WORK IN A HUMAN
MODEL. WHAT WE REALLY NEED IS A MULTI
DIMENSIONAL APPROACH, EITHER DRUGS THAT ARE PLEOTROPIC OR
MULTIPLE DRUGS AT ONE TIME. FORTUNATELY THE NIH IS NOW
EXPLORING MULTIPLE DRUG THERAPIES IN THEIR GRANT
PROGRAM. HOWEVER, TO ME, THE ELEPHANT IN
THE ROOM IS OUR CURRENT THERAPY. AND THE VERY ABILITY CAUSED BY
IT. THE DIFFERENCES IN MORTALITY IN
TRAUMATIC BRAIN INJURY PATIENTS ACROSS THIS COUNTRY IS HUGE,
SOMEWHERE AROUND 20% TO 65% MORTALITY DEPENDING ON WHAT
HOSPITAL YOU GO TO. IT REALLY DOES MATTER WHERE YOU
GO FOR CARE IN THE UNITED STATES. THIS BACKGROUND VARIABILITY IS
UNACCEPTABLE, OKAY? IT IS LIKELY RESPONSIBLE FOR
DROWNING OUT MULTIPLE OR RATHER DROWNING OUT ANY TREATMENT
EFFECT OF OUR PREVIOUSLY PROMISING THERAPIES IN CLINICAL
TRIALS. HERE WE GO. SO, INDEED, THE BETTER
IMPROVEMENT AND OUTCOME THAT 20% IS LINKED ACTUALLY TO FOLLOWING
A SET OF SIMPLE BRAIN TRAUMA FOUNDATION GUIDELINES. NOW, THERE’S CLEAR EVIDENCE THAT
THESE GUIDELINES IMPROVE CARE AND SAVE LIVES. YET THE ADOPTION RATE OF THESE
ARE UNBELIEVABLY ONLY ABOUT 65% IN THE U.S. SO CONSEQUENTLY, THERE’S STILL A
LOT OF VARIABILITY IN A MORTALITY AND MORBIDITY OF
TRAUMATIC BRAIN INJURY PATIENTS. IT’S ESTIMATED THAT IF WE
ADOPTED THESE WIDELY OR UNIVERSALLY, THAT WE WOULD SAVE
SOMEWHERE AROUND $262 MILLION IN MEDICAL CARE COSTS, 43 MILLION
IN REHABILITATION COSTS AND ALMOST 4 BILLION IN LIFETIME
SOCIETAL COSTS EVERY YEAR. SO, AFTER DECADES OF FAILURE IN
THE SEARCH FOR AN EFFECTIVE DRUG TREATMENT, THERE IS HOPE. IN 1991, DR. DONALD STEIN, ONE
OF THE WORLD’S TOP NEUROSCIENTISTS AND A COLLEAGUE
OF MINE HERE AT EMORY SUSPECTED THAT PROGESTERONE MIGHT HAVE
POTENT NERVE PROTECTIVE PROPERTIES. AT THE TIME, THIS RESEARCH WAS
THOUGHT TO BE CRAZY. EVERYBODY THOUGHT DON WAS CRAZY. AFTER ALL, EVERYBODY KNOWS THAT
PROGESTERONE IS JUST A FEMALE HORMONE, RIGHT? HOW COULD IT HELP VICTIMS OF
TRAUMATIC BRAIN INJURY? FORTUNATELY, THE CDC PLAYED A
PIVOTAL ROLE IN THIS EARLY RESEARCH. DON PUT IT THIS WAY, AND I
QUOTE, THE CDC WAS THE FIRST FEDERAL AGENCY WILLING TO TAKE A
GAMBLE ON WHAT MANY AT THE TIME THOUGHT WAS PIE IN THE SKY. THEIR INITIAL TWO-YEAR GRANT TO
MY TEAM KICK STARTED IT ALL. WITH A BOOST FROM THE CBC, DON’S
TEAM INITIATED A WHOLE SERIES OF ELEGANT EXPERIMENTS THAT
PROVIDED THE DATA NECESSARY FOR THE NIH. AND TO GET THE NIH’S ATTENTION. THIS STORY ACTUALLY DEMONSTRATES
AN IMPORTANT LINK BETWEEN CLINICAL MEDICINE AND PUBLIC
HEALTH. BOTH DISCIPLINES WANT TO REDUCE
DISEASE AND INJURY BURDEN. CLINICAL MEDICINE CONSIDERS THE
INDIVIDUAL, WHERE PUBLIC HEALTH, OBVIOUSLY, HAS A BROADER VIEW. IN THIS CASE, THE CDC RELATIONED
THAT THIS UNORTHODOX IDEA HAD THE POTENTIAL TO SAVE HUNDREDS
OF THOUSANDS OF LIVES IN THE U.S. AND ACROSS THE WORLD. WHAT DON DISCOVERED WAS THAT HIS
FEMALE RATS WERE PERFORMING BETTER AFTER A HEAD INJURY. INDEED, WHEN THE RATS WERE
EXCEEDINGLY HIGH IN PROGESTERONE LEVELS, SUCH AS IN PREGNANCY,
THEY HAD MUCH BETTER OUTCOMES THAN THEIR MALE COUNTERPARTS AND
THEIR NONPREGNANT COUNTERPARTS. AND EVEN MORE IMPORTANTLY, BY
GETTING PROGESTERONE TO THESE ANIMALS AFTER THE INJURY, IT
IMPROVED OUTCOME IN BOTH MALE AND FEMALE ANIMALS. MORE RECENTLY, THE MECHANISMS
FOR HOW PROGESTERONE WORKS HAVE BEEN FURTHER DELINEATED. AS IT TURNS OUT, PROGESTERONE IS
PLEO TROPIC, LIKE THE DRUG COCKTAIL THAT I WAS SPEAKING
ABOUT BEFORE, WORKING AT MANY DIFFERENT SITES AND PROVIDING
SOME ROBUST NEUROPROTECTION. SO TODAY, THERE’S OVER 180
SUPPORTED PUBLICATIONS FROM MULTIPLE LABORATORIES THAT
CONFIRM DON’S FINDINGS. IT SEEMS DON WASN’T SO CRAZY
AFTER ALL. BUT THE REAL QUESTION IS, WILL
IT WORK IN HUMANS? SO ON THE STRENGTH OF DON’S LAB
SCIENCE AND OTHERS, ART KELLERMANN AND I SECURED AN NIH
GRANT TO RUN A SMALL POLLUP STUDY OF 100 GRANGER PATIENTS. THIS WORK WAS DONE RIGHT HERE. WE WERE ACTUALLY STUNNED AT THE
RESULTS. OUR STUDIES SHOW THAT
PROGESTERONE WAS NOT ONLY SAFE, IT REDUCED MORTALITY ALMOST 50%. IT’S IMPORTANT TO NOTE THAT THIS
IS A SMALL STUDY, OKAY? SO THE FINDINGS HAVE TO BE
INTERPRETED WITH CAUTION. HOWEVER, THAT SAID, A YEAR
LATER, VERY SIMILAR FINDINGS IN 159 PATIENTS WERE DEMONSTRATED
AND SHOWED AN IMPROVEMENT IN THREE AND SIX-MONTH OUTCOMES. COMBINED, THESE FINDINGS WERE
COMPELLING AND THE NIH IS NOW SPONSORING A HUGE PHASE THREE
CLINICAL TRIAL CALLED PROTECT THREE. MY COLLEAGUES AND I HOPE TO
ENROLL 1140 SUBJECTS IN 31 DIFFERENT TRAUMA CENTERS ACROSS
THE COUNTRY IN WHAT’S KNOWN AS THE NEUROLOGIC EMERGENCY
TREATMENT CENTERS NETWORK. THIS TRIAL SHOULD PROVIDE THE
EVIDENCE WE NEED TO DETERMINE WHETHER PROGESTERONE REALLY IS
THAT LONG, SOUGHT AFTER DRUG FOR TRAUMATIC BRAIN INJURY. SO WHAT IS THE PATH FORWARD? WELL, WE NEED TO REALLY URGE
CLING CLINGISHANS ACROSS THE COUNTRY TO PROVIDE THE
FOUNDATIONS FOR CARE. THIS IS CRITICAL FOR NOT ONLY
PATIENTS’ LIVES, BUT FOR IMPROVING CLINICAL TRIALS AND
HAVING THE HOPE THAT WE CAN ACTUALLY SEE A DIFFERENCE WITH
THE DRUG AT THE CLINICAL STYLE STAGE. SECOND, WE NEED TO DEVELOP A
BETTER CLASSIFICATION SYSTEM FOR BRAIN INJURY. THE ONE WE HAVE CLEARLY DOESN’T
WORK. WHETHER THAT BE BIOMARKERS AND
OTHER STRATEGIES, WE NEED ONE. THIRD, WE NEED TO KEEP TRYING. YES, THERE HAVE BEEN A LOT OF
ALTERNATIVES AND THERE ARE OTHER THERAPIES BEING CONSIDERED AT
NIH AND OTHER PROGRAM WEBS DRUGS THAT PLEOTROPIC OR COMBINATION
THERAPIES ARE MORE LIKELY TO BE SUCCESSFUL. AND LASTLY, WE NEED TO
STRENGTHEN OUR PARTNERSHIPS BETWEEN CLINICAL MEDICINE AND
PUBLIC HEALTH TO IMPROVE PREVENTION, PUBLIC AWARENESS AND
OUTCOMES. IT’S VERY IMPORTANT, THIS LINK
BETWEEN CLINICAL MEDICINE AND PUBLIC HEALTH. IT PROVIDES NOT ONLY A
SURVEILLANCE SYSTEM TO KNOW WHETHER OUR INTERVENTIONS ARE
WORKING, BUT ALSO ALLOWS US TO DISSEMINATE AND ENSURE THAT THE
TRAUMA FOUNDATION GUIDELINES ARE WIDELY ACCEPTED AND USED ACROSS
THE COUNTRY. I’D LIKE TO THANK YOU AND NOW
OUR NEXT SPEAKER IS ARTHUR KELLERMANN.>>GOOD AFTERNOON. I’M ART KELLERMANN, DIRECTOR OF
RAND HEALTH. BEFORE I JOINED RAND, I
PRACTICED EMERGENCY MEDICINE. WHEN I STARTED MY CLINICAL
CAREER, MANY PEOPLE THOUGHT IT ODD THAT AN ER DOC WOULD HAVE A
PUBLIC HEALTH DEGREE. BUT IT MAKES SENSE BECAUSE
EMERGENCY PHYSICIANS SEE WHAT HAPPENS WHEN PUBLIC HEALTH
FAILS. RICHARD THINMAN, NOBEL PRIZE
WINNING PHYSICIST ONCE OBSERVED THAT IT TAKES VERY LITTLE ENERGY
TO SCRAMBLE AN EGG AND ALL OF OUR SCIENCE IS INCAPABLE OF
REVERSING THE TRANSACTION. IT TAKES VERY LITTLE INJURY TO
SCRAMBLE A BRAIN, TOO, WITH EQUALLY LASTING EFFECTS. THAT’S WHY IT’S IMPORTANT TO
PREVENT AS MANY BRAIN INJURIES AS POSSIBLE AND LIMIT THE
SEVERITY OF THOSE THAT OCCUR. ONE OF THE MOST POWERFUL WAYS TO
DO THIS IS THROUGH EFFECTIVE PUBLIC POLICIES. TO ILLUSTRATE MY POINT, CONSIDER
THE SPECTACULAR PROGRESS WE’VE MADE IN REDUCING DEATHS AND
INJURIES FROM MOTOR VEHICLE CRASHES. MOTOR VEHICLE CRASHES ARE ONE OF
THE CDC’S WINNABLE BATTLES. THE FOCUS IS JUSTIFIED. IN ADDITION TO BEING A LEADING
CAUSE OF INJURY-RELATED DEATH IN THE UNITED STATES, MOTOR VEHICLE
CRASHES ARE THE LEADING CAUSE OF TRAUMATIC BRAIN INJURY RELATED
DEATH TO AMERICANS LESS THAN 75 YEARS OF AGE. INJURY CONTROLLED EXPERTS SPEAK
OF THE FOUR Es OF INJURY PREVENTION. THEY ARE EDUCATION, ENFORCEMENT
OF SAFETY LAWS AND REGULATIONS, ENGINEERING AND ECONOMIC
INCENTIVES. ALL FOUR STRATEGIES HAVE A
PUBLIC POLICY DIMENSION. LET’S START WITH THE FIRST “E,”
EDUCATION. DRIVERS ED PROGRAMS ARE A
PERENNIAL FAVORITE WITH STATE LEGISLATORS AND MANY PARENTS. UNFORTUNATELY, THEY DON’T WORK. A REVIEW OF THREE WELL-DESIGNED
NATIONAL EVALUATIONS FOUND THAT DRIVERS ED PROGRAMS MAY
PARADOXICALLY INCREASE CRASHES BY LOWERING THE AGE AT WHICH
TEENAGERS BECOME LICENSE WITHOUT MATERIALLY AFFECTING THEIR CRASH
RATES ONCE THEY DO. THE STUDY MOST FAMILIAR IN THE
UNITED STATES TOOK PLACE RIGHT HERE IN DeKALB COUNTY IN THE
LATE 1970s. OVER 16,000 STUDENTS WERE RAB
COMELY ASSIGNED TO THREE GROUPS, STANDARD DRIVERS EDUCATION,
DRIVERS ED PLUS, AN 80-HOUR LONG COURSE INCLUDING CLASSROOM
SIMULATION, DRIVING RANGE AND ON THE ROAD COMPONENTS AND A
CONTROL GROUP THAT RECEIVED NO FORMAL DRIVER EDUCATION. SUBSEQUENT ANALYSIS FOUND NO
MEANINGFUL DIFFERENCES AMONG THE THREE GROUPS IN THEIR SUBSEQUENT
RATE OF CRASHES OR TRAFFIC VIOLATIONS. PUBLIC EDUCATION DOESN’T WORK SO
WELL, EITHER. EARLY PR CAMPAIGNS TO FIX THE
NUT BEHIND THE WHEEL WERE INEFFECTIVE. SO WERE SUBSEQUENT CAMPAIGNS
DESIGNED TO CONVINCE THE PUBLIC TO VOLUNTARILY BUCKLE UP. NEW PASSENGER CARS HAVE HAD SOME
FORM OF SAFETY BELTS SINCE 1964. BUT AS RECENTLY AS 1982,
VOLUNTARY RATES OF USE WERE DISMAL. THE FIRST WIDESPREAD SURVEY
CONDUCTED THAT YEAR FOUND AN OVERALL USE RATE OF 11% AMONG
DRIVERS AND FRONT CEASE PASSENGER SPASS ENG SEAT
PASSENGERS. THINGS BEGAN TO IMPROVE, BUT BY
THE EARLY 1990s, RATES OF BELT USE STAGNATED AT AROUND 66% TO
86%. LAW ENFORCEMENT AGENCIES
LAUNCHED A CAMPAIGN OF CLICK IT OR TICKET. IT BOOSTED SAFETY BELT USE RATES
ABOVE 80%. PUBLIC AWARENESS AND ATTITUDES
CHANGED, AS WELL. PROGRAMS LIKE CLICK IT OR TICKET
WORK BEST IN PRIMARY ENFORCEMENT STATES WHERE AN OFFICER CAN
ISSUE A CITATION UPON OBSERVING AN UNBELTED MOTORIST. IT’S HARDER TO MOTIVATE THE
PUBLIC IN SECONDARY ENFORCEMENT STATES WHERE AN OFFICER MUST
STOP THE VEHICLE FOR SOME OTHER VIOLATION BEFORE A SEAT BELT
CITATION CAN BE ISSUED. TODAY, IT’S WIDELY ACCEPTED THAT
THE BEST WAY TO BOOST SEAT BELT USE ABOVE 83% AND KEEP IT THERE
IS THROUGH HIGH VISIBILITY ENFORCEMENT, PLUS SPECIAL
PROGRAM TOES REACH HIGH RISK GROUPS SUCH AS OCCUPIANTS OF
PICKUP TRUCKS, RESIDENTS OF RURAL COMMUNITIES AND NIGHTTIME
DRIVERS. IN CONTRAST TO THE STEADY
PROGRESS WITH SAFETY BELT USE, ALCOHOL IMPAIRED DRIVING HAS
PROVEN TO BE A TOUGHER NUT TO CRACK. BETWEEN 1982 AND THE ’90s,
PROGRESS WAS MADE. GRASSROOTS ORGANIZATIONS LIKE
MOTHERS AGAINST DRUNK DRIVING PLAYED A ROLE. SO DID HIGH VISIBILITY DUI
ENFORCEMENT AND AGAINST PUBLICITY. PUBLIC POLICIES HELPED, AS WELL. EXAMPLES INCLUDE STATE LAWS
LOWERING THE LEGAL LIMIT OF BLOOD ALCOHOL CONCENTRATION TO
0.8, ADMINISTRATIVE LICENSE REVOCATION FOR DUI AND RAISING
THE MINIMUM DRINKING AGE FROM 18 TO 21. UNFORTUNATE, SINCE THE MID
1990s, RATES OF ALCOHOL IM IMPAIRED DRIVING HAVE PLATEAUED. AS A RESULT, IM BARED DRIVING
STILL CAUSES ONE-THIRD OF FATAL CRASHES AND AN ONGOING TOLL OF
TRAUMATIC BRAIN INJURIES. IN CONTRAST TO DRIVERS ED,
GRADUATED DRIVER’S LICENSING LAWS WORK. GDL IS A THREE-PHASE SYSTEM FOR
BEGINNING DRIVERS. THE LEARNER’S PERMIT ONLY ALLOWS
DRIVING UNDER THE SUPERVISION OF A FULLY LNSD ADULT, TYPICALLY A
PARENT. AN INTERMEDIATE LICENSE FOLLOWS. IT ALLOWS UNSERVICED DRIVING,
BUT WITH CERTAIN SIGNIFICANT RESTRICTIONS. TOGETHER, THESE TWO PHASES ALLOW
A YOUNG DRIVER TO LOG VITAL HOURS OF EXPERIENCE BEHIND THE
WHEEL BEFORE GRADUATING TO A FULL, UNRESTRICTED LANGUAGE. NOW, THE MOST STRINGENT GDL
PROGRAMS, THOSE WITH AT LEAST A SIX-MONTH HOLDING PERIOD DURING
THE LEARNER STAGE, NIGHTTIME RESTRICTIONS BEGINNING NO LATER
THAN 10:00 P.M. AND ONLY ONE TEEN PASSENGER IN THE CAR WERE
ASSOCIATED WITH A 38% REDUCTION IN FATAL CRASHES AND A 40%
REDUCTION IN INJURY CRASHES AMONG 16-YEAR-OLD DRIVERS. NOW, A NEWSPAPER PUBLISHED JUST
LAST WEEK SUGGESTED SOME OF THESE BENEFITS OF GDL MAY BE
OFFSET BY HIGHER RATES OF FATAL CRASHES INVOLVING 18-YEAR-OLD
DRIVERS. PERHAPS THE THINKING GOES THAT
MORE TEENS ARE PUTTING OFF GETTING THEIR DRIVER’S LICENSE
TO AVOID THE HASSLES OF GDL AND ARE, THEREFORE, GETTING ON THE
ROAD AT 18 WITHOUT THE BENEFIT OF THOSE EXTRA HOURS BEHIND THE
WHEEL. NOW, EVEN IF THIS IS TRUE, AND
MORE RESEARCH IS NEEDED, IT DOESN’T DIMINISH THE BENEFITS OF
GRADUATED DRIVERS LICENSING FOR YOUNGER DRIVERS. MOTORCYCLE HELMET LAWS ARE
EFFECTIVE, AS WELL. THE FIRST HELMET LAW WAS ENACTED
AS FAR BACK AS 1966, BUT BY 1975, UNIVERSAL HELMET LAWS ARE
IN PLACE IN 47 STATES IN THE DISTRICT OF COLUMBIA. BUT AFTER FEDERAL PENALTIES WERE
ELIMINATED IN 1975, ABOUT HALF THE STATES REPEALED THEIR
STATUTES. SINCE THEN, SEVERAL STATES HAVE
REENACTED OR REPEALED THEIR HELMET LAWS. BUT ONE THING IS CLEAR. MOTORCYCLE HELMETS PROTECT
BIKERS’ HEADS IN A CRASH. A REVIEW FOUND THAT HELMETS
DECREASED THE RISK OF DEATH IN A CRASH BY 42% AND DECREASED THE
RISK OF HEAD INJURY BY FULLY 69%. STATES THAT ADOPT HELMET LAWS
QUICKLY SEE USAGE RATES CLIMB TO 90% OR HIGHER. CONVERSE
CONVERSELY, STATES THAT REPEAL THEIR LAWS SEE HELMET USE RATES
PLUMMET TO 15%. AND RATES OF FATAL INJURY
CLOSELY TRACK CHANGING RATES OF HELMET USE. SOME OF OUR BIGGEST POLICIES
HAVEN’T COME FROM THE BEHAVIOR OF CHANGING DRIVERS. THEY COME FROM CHANGING THE
BEHAVIOR OF MANUFACTURERS THROUGH REGULATION. THEY HAVE COME FROM ENCOURAGEING
THAT THIRD “E,” ENGINEERING. TODAY, AUTOMOBILES ARE
ENGINEERED TO BE CRASHWORTHY. KEY FEATURES INCLUDE A STRONG
OCCUPANT COMPARTMENT, THE SAFETY CAGE, CRUMBLE ZONES THAT ENFORCE
A SERIOUS CRASH, SIDE ELEMENTS THAT RESIST INTRUSION AND A
STRNG ROOF THAT WON’T COLLAPSE IN A ROLLOVER. INITIALLY, OCCUPANT RESTRAINTS
WERE LIMITED TO SEAT BELTS AND FRONTAL LAYER BACKS. TODAY, SUPPLEMENTAL SIDE AND
CURRENT AIR BAGS PROTECT YOUR HEAD, YOUR CHEST AND OTHER VITAL
ORGANS FROM SIDE IMPACTS. A CAR WITH CURTAIN AIR BAGS, IN
FACT, SAVED MY SON’S LIFE AND HIS SUFFERING A TRAUMATIC BRAIN
INJURY IN A SIDE IMPACT CRASH. NOW, ONCE MANUFACTURERS FOUGHT
SAFETY REGULATIONS TOOTH AND NAIL. BUT AT SOME POINT, AUTO EXECS
REALIZED, WAIT A MINUTE, IF THE CAR SACRIFICES ITSELF TO SAVE
YOU, YOU’RE GOING TO NEED TO BUY ANOTHER CAR. MANDATORY CRASH TESTING IS
ANOTHER VALUABLE POLICY, BASED ON DYNAMIC TESTING NEW CARS
TODAY EARN A CRASHWORTHINESS RATING. TODAY, SAFETY SELLS. THANKS TO ORGANIZATIONS LIKE
NITSA, CONSUMER REPORTS AND THE INSURANCE INSTITUTE FOR HIGHWAY
SAFETY, CONSUMERS CAN QUICKLY GET OBJECTIVE INFORMATION ABOUT
A CAR’S SAFETY FEATURES AND CRASHWORTHINESS. NO MATTER HOW GOOD WE GET AT
PREVENTING CRASHES, SOME WILL STILL OCCUR. AND WHEN THEY DO, PROMPT AND
EFFECTIVE TREATMENT MAKES ALL THE DIFFERENCE. TRAUMA CENTERS SAVE LIVES. THAT’S WHY REGIONALIZED TRAUMA
CARE SYSTEMS STRIVE TO GET THE RIGHT PATIENT TO THE RIGHT
HOSPITAL AT THE RIGHT TIME. CDC’S NEW TRAUMA TRIAGE
GUIDELINES WILL HELP. PROPERLY IMPLEMENTED, THEY’LL
SAVE THOUSANDS OF LIVES AND TENS OF MILLIONS OF DOLLARS ANNUALLY. SURVIVING THE IMMEDIATE INJURY
IS ONE THING. FULL RECOVERY IS ANOTHER. REHABILITATION BENEFITS BRAIN
INJURY PATIENTS. NOTABLE POLICY GAPS REMAIN. THEY INCLUDE BETTER EVIDENCE ON
HOW TO EVALUATE SPORTS-RELATED CONCUSSIONS AND WHEN AN INJURY
PARTICIPATAN CAN BE ALLOWED TO RETURN TO PLAY. ACCESS TO CARE IS IMPORTANT, NOT
ONLY FOR DAILY EMERGENCIES, BUT IN DISASTERS. CURRENTLY, ACCESS TO TRAUMA CARE
AND REHABILITATION IS INADEQUATE IN MANY PARTS OF THE UNITED
STATES, PARTICULARLY RURAL AND FRONTIER COMMUNITIES. THE BIGGEST POLICY CHALLENGE IN
REHABILITATION IS THE CURRENT DISCONNECTION BETWEEN WHAT
SCIENCE SAYS IS GOOD CARE AND WHAT IS COVERED BY PUBLIC AND
PRIVATE INSURERS. INSURERS SAY THEY WANT TO FIND
EVIDENCE-BASED TREATMENT, BUT THE EVIDENCE BASE IS THIN ON
SEVERAL IMPORTANT QUESTIONS. PUBLIC POLICY IS NOT STATIC. CONCERNS ABOUT PERSONAL FREEDOM
CAN TRUMP EVEN ROBUST EVIDENCE OF THE BENEFIT OF HELMET AND
SEAT BELT LAWS, PRODUCT SAFETY REGULATIONS AND EVEN LAWS THAT
ENCOURAGE EMBARRASSED DRIVING. FUNDING IS ALSO A PROBLEM. AT A TIME WHEN HEALTH CARE IS
CONSIDERING A GROWING SHARE OF FEDERAL, STATE AND FAMILY
BUDGETS, IT WILL BE HARD TO KWON VINCE POLICYMAKERS TO ADEQUATELY
FUND EMS, TRAUMA CARE AND REHABILITATION. NEVERTHELESS, IT’S IMPORTANT TO
ACKNOWLEDGE HOW FAR WE’VE COME. A LITTLE MORE THAN TEN YEARS
AGO, THE CDC IDENTIFIED MOTOR VEHICLE SAFETY AS ONE OF THE TEN
GREATEST PUBLIC HEALTH ACHIEVEMENTS OF THE 20th
CENTURY. AND EARLIER THIS YEAR, THE CDC
RECOGNIZED MOTOR VEHICLE SAFETY AS ONE OF THE TEN SIGNIFICANT
PUBLIC HEALTH ACHIEVEMENTS OF THE LAST DECADE. THANKS SO SMART PUBLIC HEALTH
POLICIES, HUNDREDS OF THOUSANDS OF PEOPLE, INCLUDING MY SON, ARE
ALIVE AND WELL TODAY. MOTOR VEHICLE INJURIES ARE MORE
THAN A WINNABLE BATTLE. IT’S A BATTLE WE’RE WINNING. THANK YOU VERY MUCH. NOW, WE HAVE A FEW MINUTES FOR
QUESTIONS. AND WHILE I AM TODAY, NOW, OUT
OF TOWNER, I USED TO BE A NEAR NEIGHBOR, I HAVE THE PRIVILEGE
OF MODERATING THIS SESSION. SO AS YOU ARE STREAMING TO THE
MICROPHONES, SO THAT FOLKS AT HOME AND ON THEIR WEBSITE CAN
LISTEN TO YOU, I’M GOING TO MOVE BACK OVER TO THE MICROPHONES. I WOULD ENCOURAGE IF YOU HAVE A
QUESTION OR A BRIEF COMMENT, PLEASE SHARE THEM WITH THE
AUDIENCE. I WILL BE AGGRESSIVE IN
ENFORCING THE ONE QUESTION RULE SO THAT EVERYBODY WHO HAS A
QUESTION HAS A CHANCE TO ASK IT. NOW, I KNOW THAT CDC PEOPLE
AREN’T THAT SHY. BUT BECAUSE YOU ARE, I WILL
START WITH THE FIRST QUESTION. LISA, I WONDER IF YOU COULD JUST
ELABORATE A LITTLE BIT MORE ABOUT THE CDC’S HEADS UP
CAMPAIGN. YOU MENTIONED IT, BUT YOU HAD A
LOT OF CONTENT TO COVER AND I WONDER IF YOU COULD ELABORATE A
BIT, PARTICULARLY GIVEN THE OPENING VIDEO.>>THANK YOU. CDC HAS A HEADS UP CAMPAIGN AND
IT ORIGINALLY STARTED WITH OUR MATERIAL AND YOU SAW TRACY AT
THE BEGINNING IN OUR VIDEO. OUR MATERIALS FOR YOUTH SPORTS
ARE DESIGNED FOR STOOUNT STUDENT ATHLETESES, PARENTS, COACHES,
WE’RE EXPANDED TO TRAINER, SCHOOL PROFESSIONALS SO THE
SCHOOL NURSE OR SCHOOL GUIDANCE COUNSELOR WHO SEES THE STUDENT
ATHLETE GOING FROM ONE SPORT TO THE NEXT, THEY TEND TO BE THE
TBAL PERSON IN THAT STUDENT ATH LEETH’S LIFE. WE ALSO HAVE MATERIAL THROUGH
FALLS PREVENTION THAT WE WORK COLLABORATIVELY WITH OUR
COLLEAGUES AND DIVISION OF UNINTENTIONAL INJURY. WE ALSO HAVE MATERIALS ON SHAKEN
BABY SYNDROME, AS WELL.>>QUESTION AT THE MICROPHONE.>>THIS IS FOR DR. KELLERMANN.>>I’M SORRY, YOU NEED TO
IDENTIFY YOURSELF. THEY ALL KNOW WHO YOU ARE, BUT
FOR DAVID AND ME, IF YOU COULD, IDENTIFY YOURSELF AND FOR PEOPLE
WHO ARE LISTENING IN.>>ARLENE GREENSPAN FROM THE
INJURY CENTER. MY QUESTION IS ONE ABOUT POLICY. WE REALLY UNDERSTAND AND
APPRECIATE N INJURY CENTER THE IMPORTANCE THAT POLICY PLAYS IN
REDUCING MORBIDITY AND MORTALITY. HOWEVER, AS YOU MENTIONED, WE’RE
CURRENTLY IN A CLIMATE THAT IS ANTI-REGULATION,
ANTI-LEGISLATION AND OFTEN WE’RE ACCUSED OF BEING A NANCY STATE
WHEN WE SUGGEST POLICIES THAT ARE PUBLIC HEALTH ORIENTED. CAN YOU GIVE SOME INSIGHTS INTO
WHAT STRATEGIES WE CAN USE TO PROMOTE GOOD PUBLIC HEALTH
POLICY AND HOW WE GO ABOUT CONVINCING PEOPLE THAT THIS IS
NOT PART OF BEING A NANNY STATE, BUT MAKES SENSE FISCALLY AS WELL
AS PUBLIC HEALTHWISE?>>IT’S A GREAT QUESTION. AND IT IS VERY TIMELY, GIVEN THE
CURRENT CLIMATE THAT WE’RE IN. FOR 17 YEARS, I WORKED WITH A
HAND FULL OF COLLEAGUES IN GEORGIA TO DEFENSE GEORGIA’S
MOTORCYCLE HELMET LAW, WHICH WAS NOT POPULAR WITH EVERY SINGLE
CONSTITUENT IN THE STATE, BUT WILDLY POPULAR WITH THE MAJORITY
IN THE STATE. BUT THERE WAS A SMALL AND VOCAL
GROUP THAT FEELS THAT THEIR NEED TO FEEL THE FREEDOM OF WIND
BLOWING THROUGH THEIR HAIR IS MORE IMPORTANT THAN THE NEED TO
WEAR A MOTORCYCLE HELMET. THEY HAD A FOLLOWING AND HAVE A
FOLLOWING AT THE GEORGIA GENERAL ASSEMBLY. I HAD A VERY SIMPLE ANSWER TO
THAT, WHICH WAS I ABSOLUTELY BELIEVE IN PERSONAL FREEDOM AND
PERSONAL CHOICE AND PERSONAL RESPONSIBILITY. I ALSO LIKE TO KEEP MY MONEY IN
MY WALLET. AND WHEN PEOPLE HAVE A SEVERE
BRAIN INJURY AND DON’T DIE OR IF THEY HAVE A SEVERE BRAIN INJURY
AND END UP AT A PUBLIC FUNDED TRAUMA CENTER, THE RESOURCE
CONSUMPTION IS ENORMOUS. THE DISABILITY CHALLENGES ARE
PROFOUND. THEY’RE NOT THE ONLY ONE WHO
SUFFERS FOR THAT MISFORTUNE OR THAT INJURY. THEIR FAMILY SUFFERS, THEIR
EMPLOYER SUFFERS, THEIR CHILDREN SUFFERS, THE LOCAL ECONOMY
SUFFERS, THE STATE’S SYSTEM IS COMPROMISED. SO, IN FACT, WE ALL HAVE AN
INTEREST AS A SOCIETY AND BALANCED AGAINST THAT, THE MINOR
INCONVENIENCE OF HAVING A MUSHY HAIR DO WHEN YOU GET TO WHEREVER
YOU’RE GOING IS A SMALL PRICE TO PAY FOR THE PAYOFF. WE DON’T QUESTION, IN MOST
STATES IN THIS COUNTRY MORE THE NEED TO WEAR A SAFETY BELT. THAT IS A BRILLIANT BRAIN INJURY
STRATEGY FOR A MOTOR VEHICLE. WEARING THE HELMET IS THE SAME
EFFECTIVE STRATEGY ON A MOTORCYCLE. SO MY PERSONAL STRATEGY IS TO
APPEAL TO FISCAL CONSERVATIVEISM. THOSE WHO ARE PARTICULARLY THE
STRONGEST LIBERTARIANS ALSO TEND TO BE PHYSICAL CONSERVATIVES AND
CAN RELATE TO THAT ARGUMENT BETTER THAN SOME OTHERS AND IT
IS A POWERFUL, POWERFUL ARGUMENT.>>BRENDAN JACKSON. I’M REALLY GLAD — I WAS
WONDERING WHAT SITUATION IS LIKE FOR PEDESTRIAN BICYCLE INJURIES
AND IS FATALITIES AND WHAT STEPS ARE EFFECTIVE ONES THAT WE CAN
TAKE?>>I’LL GIVE A BRIEF ANSWER, BUT
I ALSO WANT TO LET ME PANELISTS JOIN IN. PEDESTRIAN INJURIES HAVE BEEN A
VERY, VERY CHALLENGING AREA. WE TYPICALLY, SOCIETY, THE FIRST
THING WE ALWAYS THINK ABOUT IS EDUCATION. AND LEFT RIGHT LEFT AND THOSE
SORTS OF THINGS TO TRAIN PEDESTRIANS OR TO TRAIN KIDS IS
IMPORTANT. BUT BY AND LARGE, THE MOST
EFFECTIVE STRATEGIES FOR PEDESTRIAN SAFETY HAVE COME FROM
BETTER LIGHTING IN POORLY LIT AREAS, RESIDENTIAL DESIGN,
THINGS THAT SEPARATE PEDESTRIANS FROM TRAFFIC FLOW, TRAFFIC
CALMING MEASURES THAT SIMPLY SLOW DOIN’ TRAFFICWN TRAFFIC. WHILE WE HAVE MANY PEOPLE
CALLING IN OR LISTENING IN FROM AROUND THE COUNTRY, THOSE OF YOU
IN THIS PART OF THE COUNTRY KNOW THAT BEAUFORT HIGHWAY IS A VERY
DIFFICULT PLACE FOR PEDESTRIANS. YOU HAVE RETAIL STORES AND
GROCERY STORES ON THE OTHER SIDE OF THE TREAT AND RESIDENTS ON
THE OTHER SIDE AND IT CAN BE A HALF MILE OR A MILE TO A
CROSSWALK. THOSE CHALLENGES ARE VERY
DIFFICULT. FOR BICYCLES, WE HAVE SEEN A
STEADY IMPROVEMENT, BUT A PLATEAUING OF THE USE OF BICYCLE
HELMETS, WHICH ARE MORE EFFECTIVE. WE DO MORE MARKING OF LANES IN
THE UNITED STATES, WHEREAS THE EUROPEANS PHYSICALLY SEPARATE
THEIR BIKE LINES FROM VEHICLES. THAT’S A VERY EFFECTIVE
STRATEGY, BUT A LOST COSTLY ONE ON THE FRONT END. WE KNOW STRATEGIES THAT WORK. WE HAVE TO USE THEM MORE
CONSISTENTLY. ANYONE WANT TO WEIGH IN ON THAT? BUT A GOOD QUESTION. THANK YOU.>>>
I HAVE A QUESTION FOR DR. WRIEFT. DAVID, EARLY ON WHEN WE WERE
DOING THIS WORK WITH PROGESTERONE AND EVERYONE THAT
YOU WILL THOUGHT DON WAS CRAZY, WHENEVER I WOULD TELL ANYONE
THAT WE WERE EXPLORING A THERAPY THAT HAD ALL THESE BENEFICIAL
EFFECTS, SEEMED TO WORK WELL IN EXPERIMENTAL ANIMALS AND WE HAVE
SOME PROVOCATIVE CLINICAL DATA IN HUMANS. THEY WOULD GET REALLY EXCITED
AND THEY WOULD GO, WHAT IS IT? WHAT IS IT? AND I WOULD SAY, IT’S
PROGESTERONE. AND THE NEXT REACTION INVARIABLY
WAS THEY WOULD LAUGH. HAS THAT CHANGED?>>WELL, I STILL FEEL LIKE WE’RE
SWIMMING UPSTREAM. AND YEAH, WE STILL GET GIGGLES,
WE GET LAUGHS, WE GET A LOT OF DISBELIEF. THAT IS WHAT OUR PHASE THREE
MULTI CENTER CLINICAL TRIAL IS HERE TO PROVE. IT’S INTERESTING, IF WE HAD
DISCOVERED PROGESTERONE IN THE BRAIN FIRST, IT IS PRODUCED IN
THE BRAIN, IN FACT, IT’S THE ONLY HORMONE/STEROID PRODUCED IN
THE BRAIN. IF WE DISCOVERED IT THERE FIRST,
WE MAY HAVE A COMPLETELY DIFFERENT PERCEPTION OF WHAT
PROGESTERONE DOES. IT’S MADE IN THE BRAIN BY THE
BRAIN FOR THE BRAIN. AND IT ONLY HAPPENED THAT WE
DISCOVERED IT IN THE OVARIES FIRST AND ITS ROLE IN THE
MENSTRUAL CYCLE. IN
INDIED, IT MAY BE THAT ITS EFFECT IN PREGNANCY IS TO COAT
THE BRAIN DURING FETAL DEVELOPMENT. THAT IS HYPOTHESIZES BY A NUMBER
OF GYN AND NEUROEXPERTS. IT’S IMPORTANT HOW THE BODY USES
DIFFERENT COMPOUNDS IN DIFFERENT PLACES FOR DIFFERENT PURPOSES. IT’S A BEAUTIFUL EXAMPLE OF THE
HUMAN BODY AND HOW IT DOES THAT.>>AS YOU ALL HEARD FROM LISA’S
OPENING REMARKS, INJURY IN JOURNAL IN BRAIN INJURY IN
PARTICULAR SEEMS TO BE LINKED TO THE Y CHROMOSOME. I THINK IT’S A CRUEL TRICK OF
FAITH THAT HAD ONLY TESTOSTERONE BEEN THE OF COURSEIVE TRAUMATIC
BRAIN INJURY, WE WOULD HAVE EVERY PHARMACY AROUND THE
COUNTRY STANDING IN LINE WAITING TO BUY IT. I THINK WE HAVE ONE MORE FOR ONE
QUESTION.>>YOU DISCUSS ALCOHOL AND
DRIVING AND THE EFFECT OF SOME OF THE PRESCRIPTION DRUG ABUSE
THAT IS — THAT IS PREVALENT AS WELL AS THE PRESCRIPTION
APPROXIMATED USED WHILE DRIVING, IS THERE ANY SURVEILLANCE ON THE
CDC?>>WELL, THANK YOU FOR THAT
QUESTION. OUR COLLEAGUES IN THE DIVISION
OF UNINTENTIONAL INJURY DO FOCUS ON MEDICATION USED AND MISUSED
IN THAT AND THEY DO LOOK AT THAT IN RELATIONSHIP TO MOTOR VEHICLE
INCIDENTS. AND I’M NOT SURE IF SOMEONE
WOULD LIKE TO COMMENT SPECIFICALLY ON THE SPECIFICS OF
THAT OR WOULD LIKE TO JUST GET WITH YOU AFTER THE SESSION.>>THANK YOU.>>THAT CONCLUDE THESE SESSION. I WOULD LIKE TO THANK ALL OF YOU
WHO ARE PRESENT IN THE AUDITORIUM AND I’D LIKE TO THANK
ALL WHO TUNED IN ON THE WEB AND OVER THE LINES. THANK YOU FOR PARTICIPATING. BRAIN INJURIES MATTER. THEY CAN BE PREVENTED. WE CAN MAKE A DIFFERENCE AND WE
ARE WINNING THIS BATTLE. THANK YOU.>>AND WE ARE GOING TO ASSESS
WHAT KIND OF CHANGES AND MODIFICATIONS WE ARE GOING TO
MAKE IN THE NEXT — IN THE THIRD YEAR OF THE GRAND ROUNDS, WE ARE
HIRING ARTHUR AS OUR PERMANENT MODERATOR. THANK YOU ALL VERY MUCH.

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