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Test Code : 201-450
Test designation : LPIC-2 Exam 201, piece 1 of 2, version 4.5
Vendor designation : LPI
: 161 existent Questions

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LPI LPIC-2 Exam 201, Part

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LPIC-2 ( examination codes 201-450 and 202-450 ) is the 2d certification in LPI’s multi-stage knowledgeable certification application. The LPIC-2 will validate the candidate's means to administer diminutive to medium–sized blended networks. The candidate should hold an energetic LPIC-1 certification to receive LPIC-2 certification, but the LPIC-1 and LPIC-2 exams can exist taken in any order.

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  • Your League: ARRL Reply Comments Cite "Fundamental Misunderstanding" of "Symbol Rate" Petition
  • Your League: ARRL-Sponsored Medium-Frequency Experiment Continues as Hams Hope for current Band
  • Your League: National Contest Journal (NCJ) Debuts current Website!
  • International: IARU Showcases professional Radio at ITU Telecom World 2013
  • International: Yasme Foundation Announces Supporting Grants
  • Radiosport: current ARRL Single-Operator Unlimited Contest Category Now in Effect
  • Ham Radio Business: Tokyo Hy-Power Files for Bankruptcy
  • Ham Radio Business: CQ to Realign Publications, Launch Digital Supplement
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  • DX: ARRL DXCC Desk Approves ZD9KX Operations
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  • ARRL Centennial: W100AW Hits the Airwaves!
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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 energetic 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 confine in §97.307(f) of the FCC professional 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 confine for data emissions in party segments where RTTY and data emissions are now permitted.

    "Rather, they attend 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 nobody 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 confine on the efficiency of data emissions in the HF bands as a practical matter, and as an ersatz and arbitrary filter on the types of emissions that can exist utilized by radio amateurs."

    The ARRL said its suggested 2.8 kHz maximum bandwidth reflects a balanced approach that will permit any currently used data emissions, hearten experimentation with data emissions that the current symbol rate restriction prohibits, and preclude the disburse 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 professional Service for resisting deregulatory proposals that are designed to enable professional experimenters to refine and reconcile 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 exist preserved. Outdated regulations are not a viable alternative to cooperative sharing arrangements in the HF bands through intentional party plans."

    Some of those opposing its petition, the ARRL went on to say, expressed the faith 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 capitalize 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 capitalize 'the few' who are data emission experimenters and users, and on the other hand to predict that the relief requested in the Petition would create a flood of 'wide-bandwidth' data emissions, swamping the party segments used for CW, RTTY, and narrow-bandwidth data emissions," the League pointed out. "If the concern is that the rule changes will hearten more radio amateurs to experiment with data emissions, that would exist a positive outcome." The ARRL further asserted that the solicitude of interference from automatically controlled stations "is not a valid 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 hearten experimentation now restricted artificially by outdated rules. "It is instead a proposal to delete outdated limitations on professional Radio experimentation, which Commission policy supports, and which the basis and purpose of the professional Radio Service necessitates."

    Your League: ARRL-Sponsored Medium-Frequency Experiment Continues as Hams Hope for current 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 professional Radio allocation. At the identical time, the FCC has been reserved regarding the ARRL's November 2012 Petition for Rule Making that asked the Commission to do 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 professional Radio Service, with a power confine 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 final quarter -- hold been logged among those taking piece 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 current experimental licensees." Raab illustrious 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 party is piece 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 professional Radio Service, and there is almost no power line carrier (PLC) operation in this party 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 any 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 current Website!

    National Contest Journal (NCJ), the ARRL publication devoted to professional Radio contesting, has a fresh, current presence on the web, although the URL remains the same.

    "The current site was designed with simplicity and ease of disburse 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 furthermore offers an archive of scores for any NCJ going back to 2001. The site soundless has margin to accommodate current features in the future, so stay tuned."

    Pickering said the current NCJ website was a collaborative effort, and he expressed his appreciation to Bruce Horn, WA7BNM, "for his unflagging uphold of the NCJ website from its inception" as well as to George Fremin, K5TR, who has served as the systems administrator. Pickering furthermore thanked his colleague Susie Coleman, who helped design the eye and feel.

    "We hope that you will find the current site useful. Thanks to any who hold helped to do this happen," said Pickering, who invited comments on the current 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 professional Radio at ITU Telecom World 2013

    The International professional Radio Union (IARU) got some visibility for professional 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 array in cooperation with the ITU. A large, flat-screen TV in the booth displayed videos of professional 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 exhibit for the IARU contingent was a visit by ITU Secretary generic Dr Hamadoun Toure, HB9EHT. He took a gyrate at the operating position of HS2013ITU while there.

    ITU Secretary generic Hamadoun Toure, HB9EHT, takes up the operating position of HS2013ITU, as IARU Region 3 Chairman Gopal Madhavan, VU2GMN (left), and Sakol Nakin, HS1JNB, eye 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 contend the situation in their respective countries and the association with IARU and to learn about professional Radio and its capabilities. Telecom World 2013 gave the IARU a unique opportunity to showcase professional Radio at the highest level."

    ITU Telecom World 2013 furthermore offered an opportunity for the IARU representatives to influence leaders who can favorably impact radio regulations and national attitudes toward professional Radio. "The presence of IARU, and its endeavor to showcase professional Radio and its capabilities, was well appreciated by any who visited the booth, and the endeavor was well worthwhile," said the IARU's report. "We furthermore laid a foundation under the current 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 progress of professional Radio around the world, The Yasme Foundation has announced the recipients of four supporting grants:

  • WRTC-2014, to abet defray the expenses of the World Radiosport Team Championship in current England this July.

  • The transpose Beacon Network (RBN), to purchase a receiver and necessary accessories to upgrade the RBN node in Bangalore, India.

  • CWOps CW Academy, to abet defray the expenses of providing online CW training courses.

  • The ARRL Second Century Fund, to uphold the goal of the ARRL Second Century drive of opening a path to passionate involvement in professional Radio by current generations, providing opportunities for educational enrichment, community service, and personal achievement through the exploration and disburse of radio communication.

  • The Yasme Foundation is a not-for-profit corporation organized to conduct scientific and educational projects related to professional Radio, including DXing and the introduction and promotion of professional Radio in developing countries. The Foundation supports individuals and organizations providing or creating useful services for the professional Radio community, regardless of originality or novelty, to further the progress of professional Radio around the world.

    Radiosport: current 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 current category permits the disburse 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 disburse 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 professional 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 area [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 professional Radio market, including solid-state mobile amplifiers. Among its early products was the HL-4000 linear amplifier, which the company claimed was "the first existent HF party high-power linear of its kind in Japan." It has been manufacturing RF products for the industrial market since 1984.

    The company furthermore once marketed the HT-750, a portable, low-power SSB/CW transceiver for 40, 15, and 6 meters in a hand-held transceiver form 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 tidings 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 exist similar to a Chapter 7 action here within the United States, as the process in this case appears to exist 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 exist 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 contend the opportunity 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 current online supplement to its flagship magazine, CQ professional 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 any segments of the radio hobby."

    Effective with the February 2014 issue of CQ, said Ross, content from the magazine's three sister publications -- approved Communications, CQ VHF and WorldRadio Online -- will exist incorporated into CQ's digital edition as a supplement to exist called CQ Plus. The print editions of approved Communications and CQ VHF will exist phased out, and WorldRadio Online will no longer exist as a part online publication. Current approved Communications, CQ VHF and WorldRadio Online subscribers will exist converted to CQ subscribers and receive CQ Plus at no additional charge. Details will exist posted on each magazine's website.

    CQ Communications says the change will offer hobby radio enthusiasts a separate source for articles from shortwave listening and scanner monitoring to personal two-way services and Internet radio, as well as professional Radio. Richard Fisher, KI6SN, currently editor of both approved Communications and WorldRadio Online, will exist editor of CQ Plus. Read more.

    Ham Radio Business: InnovAntennas Acquires compel 12

    InnovAntennas has acquired the legendary compel 12 antenna company and product line and has moved the compel 12 factory from Bridgeport, Texas, to imposing Junction, Colorado, into a facility shared with InnovAntennas America. InnovAntennas Ltd in England is now manufacturing compel 12 products for the European market at its Canvey Island plant.

    The imposing Junction facility is up and running, manufacturing and shipping antennas. InnovAntennas says it plans to relent updated versions of classic compel 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 exist at full 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 exist placed on the list for an update to your record. delight note the submission date and/or reference number of your application in order to expedite the search for any rejected contacts.

    DXCC is professional Radio's premier award that hams can rate by confirming on-the-air contacts with 100 DXCC "entities," most of which are countries in the traditional sense. You can commence with the basic DXCC award and travail your way 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 impress Twain, reports of the demise of the Voice of Russia (VOR) may hold 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 tidings agencies, SWL Tom Witherspoon, K4SWL, contacted VOR.

    "We are lighthearted to let you know that the Voice of Russia will stay 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 any 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 exist the first radio station to broadcast internationally, furthermore 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 lofty 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 nearby and may exist 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 follow changes in the solar ultraviolet that influence Earth's upper atmosphere and ionosphere.

    "Many models of the upper atmosphere disburse 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 follow the sunspot number quite closely." The January 6 sunspot signify was 225. The Cycle 24 sunspot signify 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 pattern 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 identical 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 uphold long-distance communication at higher-than-normal frequencies." He pointed out, though, that it can capture a few days of lofty values for conditions to exhibit improvement. "Typically values in excess of 200 will exist measured during the peak of a sunspot cycle, with lofty 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 current 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 current Year's Day operation from W100AW. Ten meter phone was in second status with 639 contacts.

    W100AW contacts will exist uploaded to Logbook of The World (LoTW). QSL cards sent by mail will exist acknowledged as well.

    W1AW Portable Operations, ARRL Centennial QSO Party

    The ARRL Centennial "W1AW WAS" operations are taking status throughout 2014 from each of the 50 states, relocating each Wednesday (UTC) to a current pair of states (this week, South Carolina and Utah. Listen for W1AW/4 and W1AW/7). During 2014 W1AW will exist on the air from every status at least twice and from most US territories, and it will exist easy to travail any states solely by contacting W1AW portable operations.

    In conjunction with the 100th anniversary of the ARRL, the ARRL Centennial QSO Party furthermore 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 status is worth 5 points per contact.

    To rate the "Worked any States with W1AW Award," travail W1AW operating portable from any 50 states. (Working W1AW or W100AW in Connecticut does not signify for Connecticut, however. For award credit, participants must travail W1AW/1 in Connecticut.) A W1AW WAS certificate and plaque will exist available (pricing not yet available).

    Some Statistics

    As of today (January 9), more than 6700 stations hold 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 professional Radio and the ARRL

    Editor's note: "A Century of professional Radio and the ARRL" will exist a weekly feature as the ARRL celebrates its Centennial in 2014.

    In professional Radio, as in any fields, 100 years has brought about wonderful progress and changes. During 2014, they will give you a sense of the ARRL's and professional Radio's history by looking through the issues of QST from its humble birth to the present. We'll examine the famous 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 exist brief, but they will provide citations to original QST articles for your further reading.

    The next century will bring about changes that will exist mind-boggling to us, because technology advances at an exponential rate. Being aware of the past 100 years of ham-related events is valuable to us for historical reasons, and it furthermore makes us consider what might equivocate ahead. Next time: A eye at the earliest years of professional 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 compel Museum, HB4FR, photo]

    Max de Henseler, HB9RS, the founder and president emeritus of 4U1UN at United Nations headquarters in current 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 current York as the UN's chief cartographer, de Henseler reactivated the United Nations Radio Club station K2UN at its current home in midtown Manhattan. As Jack Troster, W6ISQ, explained in the July 1989 issue of QST, "Through his efforts, the Secretary generic approved the operation of a specifically designated UN professional station using the summon 4U1UN in early 1978."

    De Henseler introduced the current summon note 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 pile 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 collect lost in time machining metals and making things in the shop for the radio." His friends Mike Freeman, NT8O, and Fred Freeman, N8BX, hold taken over the production of the K8RA line. Read more.

    Milestones: Austin professional Radio Supply Owner Johnny Paul, WA5BGO, SK

    The owner of Austin professional Radio Supply, John E. "Johnny" Paul, WA5BGO, of Austin, Texas, died December 10. He was 74. Paul was the proprietor of Austin professional Radio for 45 years. First licensed in 1960, Paul was a past president of the Austin professional Radio Club and was an avid photographer of nature and landscapes. Services were December 16.

    Solar Update

    Tad Cook, K7RA, in Seattle, reports: A colossal 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 rate 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 eye way, way back to find a value dote 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 furthermore been high, and that may exist more significant for enhanced HF propagation than a lofty 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, fair daily sunspot numbers rose more than 80 points to 188.1, and fair 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," eye 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 -- venerable current 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, status 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 status Convention, Jackson, Mississippi

  • January 25 -- Georgia ARES Convention, Forsyth, Georgia

  • January 25-26 -- Puerto Rico status Convention, Hatillo, Puerto Rico

  • January 31-February 1 -- Southern Florida Section Convention, Miami, Florida

  • February 1 -- Virginia status Convention (Frostfest), Richmond, Virginia

  • February 1 -- South Carolina status 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 status 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 status 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 status Convention, Boise, Idaho

  • April 26 -- Aurora '14 Conference, White abide Lake, Minnesota

  • Find conventions and hamfests in your area.

    ARRL -- Your One-Stop Resource for professional Radio tidings and Information

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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 existent 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 current 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 detailed description of the consensus process is outlined at the nearby of this document under the “background” section. This document is developed for disburse by physicians and health care professionals primarily who are involved in the care of injured athletes, whether at the recreational, elite, or professional level.

    While agreement exists pertaining to principal messages conveyed within this document, the authors own that the science of concussion is evolving and therefore management and return to play decisions remain in the realm of clinical judgment on an individualized basis. Readers are encouraged to copy and ration freely the Zurich Consensus document, the Concussion Recognition tool (CRT), the Sport Concussion Assessment tool version 3 (SCAT3), and/or the Child-SCAT3 card and neither is matter to any restriction, provided it is not altered in any way or converted to a digital format. The authors’ request that the document and/or the accompanying tools exist distributed in their full and complete format.

    This consensus paper is broken into a number of sections:

  • (a) A summary of concussion and its management, with updates from the previous meetings.
  • (b) Background information about the consensus meeting process.
  • (c) A summary of the specific consensus questions discussed at this meeting.
  • (d) The Consensus paper should exist read in conjunction with the SCAT3 assessment tool, the Child-SCAT3 and the Concussion Recognition tool (designed for lay use).
  • SECTION 1: SPORT CONCUSSION AND ITS MANAGEMENT

    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 disburse the term to advert to different injury constructs. Concussion is the historical term representing low velocity injuries that understanding 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 exist used in this document. It was furthermore illustrious 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 knotty pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may exist utilized in defining the nature of a concussive head injury include:

  • Concussion may exist caused either by a direct blow to the head, face, neck or elsewhere on the cadaver with an “impulsive” compel transmitted to the head.
  • Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously. However in some cases, symptoms and signs may evolve over a number of minutes to hours.
  • Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on yardstick structural neuroimaging studies.
  • Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is famous to note that in some cases symptoms may exist prolonged.
  • Recovery of Concussion

    The majority (80%-90%) of concussions resolve in a short (7-10 day) period, although the recovery time frame may exist longer in children and adolescents.2

    Symptoms and Signs of Acute Concussion

    The diagnosis of acute concussion usually involves the assessment of a purview of domains including clinical symptoms, physical signs, cognitive impairment, neurobehavioral features, and sleep disturbance. Furthermore, a detailed concussion history is an famous piece of the evaluation both in the injured athlete and when conducting a preparticipation examination. The detailed 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 involve 1 or more of the following clinical domains:

  • (a) Symptoms - somatic (eg, headache), cognitive (eg, ardor dote in a fog) and/or emotional symptoms (eg, lability)
  • (b) Physical signs (eg, loss of consciousness, amnesia)
  • (c) Behavioural changes (eg, irritability)
  • (d) Cognitive impairment (eg, slowed reaction times)
  • (e) Sleep disturbance (eg, insomnia)
  • If any 1 or more of these components is present, a concussion should exist suspected and the commandeer management strategy instituted.

    On-Field or Sideline Evaluation of Acute Concussion

    When a player shows ANY features of a concussion:

  • (a) The player should exist evaluated by a physician or other licensed healthcare provider onsite using yardstick emergency management principles and particular attention should exist given to excluding a cervical spine injury.
  • (b) The commandeer character of the player must exist determined by the treating healthcare provider in a timely manner. If no healthcare provider is available, the player should exist safely removed from exercise or play and exigent referral to a physician arranged.
  • (c) Once the first aid issues are addressed, then an assessment of the concussive injury should exist made using the SCAT3 or other sideline assessment tools.
  • (d) The player should not exist left solitary following the injury and serial monitoring for deterioration is essential over the initial few hours following injury.
  • (e) A player with diagnosed concussion should not exist allowed to return to play on the day of injury.
  • Sufficient time for assessment and adequate facilities should exist provided for the commandeer medical assessment both on and off the territory for any injured athletes. In some sports, this may require rule change to allow an commandeer off-field medical assessment to occur without affecting the flux 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 decision based on clinical judgment.

    Sideline evaluation of cognitive function is an essential component in the assessment of this injury. Brief neuropsychological test batteries that assess attention and reminiscence function hold been shown to exist practical and effective. Such tests involve 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) hold been shown to exist unreliable in the sporting situation when compared with reminiscence 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 exist performed by trained neuropsychologists that are sensitive to subtle deficits that may exist beyond the acute episode; nor should they exist used as a stand-alone tool for the ongoing management of sports concussions.

    It should furthermore exist recognized that the appearance of symptoms or cognitive deficit might exist delayed several hours following a concussive episode and that concussion should exist seen as an evolving injury in the acute stage.

    Evaluation in Emergency margin or Office by Medical Personnel

    An athlete with concussion may exist evaluated in the emergency margin or doctor’s office as a point of first contact following injury or may hold been referred from another care provider. In addition to the points outlined above, the key features of this exam should encompass:

  • (a) A medical assessment including a comprehensive history and detailed neurological examination including a thorough assessment of mental status, cognitive functioning, gait, and balance.
  • (b) A determination of the clinical status of the patient, including whether there has been improvement or deterioration since the time of injury. This may involve seeking additional information from parents, coaches, teammates, and eyewitness to the injury.
  • (c) A determination of the requisite for emergent neuroimaging in order to exclude a more austere brain injury involving a structural abnormality
  • In big part, these points above are included in the SCAT3 assessment.

    Concussion Investigations

    A purview of additional investigations may exist utilized to assist in the diagnosis and/or exclusion of injury. Conventional structural neuroimaging is typically simple in concussive injury. Given that caveat, the following suggestions are made: Brain CT (or where available MR brain scan) contributes miniature to concussion evaluation but should exist employed whenever suspicion of an intra-cerebral or structural lesion (eg, skull fracture) exists. Examples of such situations may involve 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 piece 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 progress and cannot exist recommended other than in a research setting.

    Published studies, using both sophisticated compel plate technology, as well as those using less sophisticated clinical equipoise tests (eg, equipoise oversight Scoring System [BESS]), hold identified acute postural stability deficits lasting approximately 72 hours following sport-related concussion. It appears that postural stability testing provides a useful tool for objectively assessing the motor domain of neurologic functioning, and should exist considered a reliable and valid addition to the assessment of athletes suffering from concussion, particularly where symptoms or signs testify a equipoise 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 austere 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] hold been proposed as means by which cellular damage may exist detected if present.32–38 There is currently insufficient evidence, however, to warrant the routine disburse of these biomarkers clinically.

    Different electrophysiological recording techniques (eg, evoked response potential [ERP], cortical magnetic stimulation, and electroencephalography) hold demonstrated reproducible abnormalities in the postconcussive state; however not any studies reliably differentiated concussed athletes from controls.39–45 The clinical significance of these changes remains to exist established.

    Neuropsychological Assessment

    The application of neuropsychological (NP) testing in concussion has been shown to exist 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 follow clinical symptom resolution, suggesting that the assessment of cognitive function should exist an famous component in the overall assessment of concussion and in particular, any return to play protocol.52,53 It must exist emphasized however, that NP assessment should not exist the sole basis of management decisions. Rather, it should exist seen as an aid to the clinical decision-making process in conjunction with a purview of assessments of different clinical domains and investigational results.

    It is recommended that any athletes should hold a clinical neurological assessment (including assessment of their cognitive function) as piece of their overall management. This will normally exist done by the treating physician often in conjunction with computerized NP screening tools.

    Formal NP testing is not required for any athletes, however when this is considered necessary then it should ideally exist 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 return to play decision should remain a medical one in which a multidisciplinary approach, when possible, has been taken. In the absence of NP and other (eg, formal equipoise assessment) testing, a more conservative return to play approach may exist appropriate.

    Neuropsychological testing may exist used to assist return to play decisions and is typically performed when an athlete is clinically asymptomatic, however NP assessment may add famous information in the early stages following injury.54,55 There may exist particular situations where testing is performed early to assist in determining aspects of management eg, return to school in a pediatric athlete. This will normally exist best determined in consultation with a trained neuropsychologist.56,57

    Baseline NP testing was considered by the panel and was not felt to exist required as a mandatory aspect of every assessment however may exist helpful or add useful information to the overall interpretation of these tests. It furthermore provides an additional educative opportunity for the physician to contend the significance of this injury with the athlete. At present, there is insufficient evidence to recommend the widespread routine disburse 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 return to play. The current published evidence evaluating the upshot of comfort following a sport-related concussion is sparse. An initial epoch of comfort in the acute symptomatic epoch following injury (24-48 hours) may exist 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 return to school and convivial 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 slack to regain may exist of benefit, although the optimal timing following injury for initiation of this treatment is currently unknown.

    As described above, the majority of injuries will regain spontaneously over several days. In these situations, it is expected that an athlete will proceed progressively through a stepwise return to play strategy.58

    Graduated return 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 capture 24 hours so that an athlete would capture approximately 1 week to proceed through the full 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 epoch of comfort has passed.

    Same Day RTP

    It was unanimously agreed that no return to play on the day of concussive injury should occur. There are data demonstrating that at the collegiate and lofty school level, athletes allowed to RTP on the identical day may demonstrate NP deficits postinjury that may not exist evident on the sidelines and are more likely to hold 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 famous to consider other pathologies. Cases of concussion in sport where clinical recovery falls outside the expected window (ie, 10 days) should exist managed in a multidisciplinary manner by health care providers with undergo in sports-related concussion.

    Psychological Management and Mental Health Issues

    Psychological approaches may hold potential application in this injury, particularly with the modifiers listed below.66,67 Physicians are furthermore encouraged to evaluate the concussed athlete for affective symptoms such as depression and anxiety, as these symptoms are common in any forms of traumatic brain injury.58

    The Role of Pharmacological Therapy

    Pharmacological therapy in sports concussion may exist applied in 2 part 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 flush of shortening the duration of the concussion symptoms.68 In broad terms, this approach to management should exist only considered by clinicians experienced in concussion management.

    An famous consideration in RTP is that concussed athletes should not only exist symptom free, but furthermore should not exist taking any pharmacological agents/medications that may mask or modify the symptoms of concussion. Where antidepressant therapy may exist commenced during the management of a concussion, the decision to return to play while soundless on such medication must exist considered carefully by the treating clinician.

    The Role of Preparticipation Concussion Evaluation

    Recognizing the consequence of a concussion history, and appreciating the fact that many athletes will not recognize any the concussions they may hold suffered in the past, a detailed concussion history is of value.69–72 Such a history may preidentify athletes that proper into a high-risk category and provides an opportunity for the health care provider to educate the athlete in respect to the significance of concussive injury. A structured concussion history should involve specific questions as to previous symptoms of a concussion and length of recovery, not just the perceived number of past concussions. It is furthermore worth noting that dependence upon the recall of concussive injuries by teammates or coaches has been demonstrated to exist unreliable.69 The clinical history should furthermore involve information about any previous head, face, or cervical spine injuries, as these may furthermore hold clinical relevance. It is worth emphasizing that in the setting of maxillofacial and cervical spine injuries, coexistent concussive injuries may exist 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 piece of the clinical history it is advised that details regarding protective paraphernalia employed at time of injury exist sought, both for recent and remote injuries.

    There is an additional and often unrecognized capitalize of the preparticipation examination insofar as the evaluation allows for an educative opportunity with the player concerned as well as consideration of modification of playing conduct if required.

    Modifying Factors in Concussion Management

    A purview of ‘modifying’ factors may influence the investigation and management of concussion and, in some cases, may predict the potential for prolonged or persistent symptoms. However, in some cases, the evidence for their efficacy is limited. These modifiers would exist famous to consider in a detailed concussion history and are outlined in Table 2.

    Female Gender

    The role of female gender as a possible 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 exist included as a modifying factor, although it was accepted that gender may exist a risk factor for injury and/or influence injury severity.73–75

    The Significance of Loss of Consciousness (LOC)

    In the overall management of qualify to austere traumatic brain injury, duration of LOC is an acknowledged predictor of outcome.76 Whilst published findings in concussion portray LOC associated with specific early cognitive deficits, it has not been illustrious as a measure of injury severity.77,78 Consensus discussion determined that prolonged (>1 minute duration) LOC would exist 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 exist more famous than the presence or duration of amnesia alone.77,81,82 Further it must exist illustrious 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 escort 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) hold been reported as a consequence of any levels of traumatic brain injury including sport-related concussion. Neuroimaging studies using fMRI hint that a depressed temper 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 exist multifactorial in nature, it is recommended that the treating physician consider these issues in the management of concussed patients.

    SPECIAL POPULATIONS The Child and Adolescent Athlete

    The evaluation and management recommendations contained herein can exist 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 requisite to involve 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 decision to disburse NP testing is broadly the identical as the adult assessment paradigm although there are some differences. Timing of testing may vary in order to assist planning in school and home management. If cognitive testing is performed then it must exist developmentally sensitive until late teen years due to the ongoing cognitive maturation that occurs during this epoch 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 famous to consider the disburse of trained paediatric neuropsychologists to interpret assessment data, particularly in children with learning disorders and/or ADHD who may requisite more sophisticated assessment strategies.56,57,98

    It was agreed by the panel that no return to sport or activity should occur before the child/adolescent athlete has managed to return to school successfully. In addition, the concept of ‘cognitive rest’ was highlighted with special reference to a child’s requisite to confine exertion with activities of daily alive that may exacerbate symptoms. School attendance and activities may furthermore requisite to exist modified to avoid provocation of symptoms. Children should not exist 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 return to play approach is recommended. It is commandeer to extend the amount of time of asymptomatic comfort and/or the length of the graded exertion in children and adolescents. It is not commandeer for a child or adolescent athlete with concussion to RTP on the identical 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 exist managed using the identical treatment and return to play paradigm. The available resources and expertise in concussion evaluation are of more consequence in determining management than a separation between elite and nonelite athlete management. Although formal NP testing may exist beyond the resources of many sports or individuals, it is recommended that in any organized high-risk sports, consideration exist given to having this cognitive evaluation, regardless of the age or flush of performance.

    Chronic Traumatic Encephalopathy (CTE)

    Clinicians requisite to exist mindful of the potential for long-term problems in the management of any athletes. However, it was agreed that CTE represents a part tauopathy with an unknown incidence in athletic populations. It was further agreed that a understanding and upshot 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 furthermore recognized that it is famous 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 obliging clinical evidence that currently available protective paraphernalia will prevent concussion, although mouthguards hold a part role in preventing dental and oro-facial injury. Biomechanical studies hold shown a reduction in impact forces to the brain with the disburse of headgear and helmets, but these findings hold not been translated to exhibit 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 exist recommended for participants in alpine sports.115–118 In specific sports such as cycling, motor, and equestrian sports, protective helmets may prevent other forms of head injury (eg, skull fracture) that are related to falling on arduous surfaces and may exist an famous injury prevention issue for those sports.118–130

    Rule Change

    Consideration of rule changes to reduce the head injury incidence or severity may exist commandeer where a clear-cut mechanism is implicated in a particular sport. An example 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 illustrious earlier, rule changes furthermore may exist needed in some sports to allow an effectual off-field medical assessment to occur without compromising the athlete’s welfare, affecting the flux of the game or unduly penalizing the player’s team. It is famous to note that rule enforcement may exist a critical aspect of modifying injury risk in these settings and referees play an famous role in this regard.

    Risk Compensation

    An famous consideration in the disburse of protective paraphernalia is the concept of risk compensation.132 This is where the disburse of protective paraphernalia results in behavioral change such as the adoption of more uncertain playing techniques, which can result in a paradoxical multiply 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 exist 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 exist discouraged. However, sporting organizations should exist encouraged to address violence that may multiply concussion risk.136,137 objective play and respect should exist 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 generic public is a mainstay of progress in this field. Athletes, referees, administrators, parents, coaches and health care providers must exist educated regarding the detection of concussion, its clinical features, assessment techniques and principles of safe return to play. Methods to improve education including Web-based resources, educational videos, and international outreach programs are famous in delivering the message. In addition, concussion working groups, plus the uphold 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 hold vast value and must exist pursued vigorously. objective play and respect for opponents are ethical values that should exist encouraged in any sports and sporting associations. Similarly, coaches, parents, and managers play an famous piece in ensuring these values are implemented on the territory 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 piece of the resulting mandate for the future, the requisite for leadership and future updates were identified. The 2nd International Conference on Concussion in Sport was organized by the identical 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 purview of experts were invited to both meetings to address specific issues of epidemiology, basic and clinical science, injury grading systems, cognitive assessment, current 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 exist obtained at: http://consensus.nih.gov/ABOUTCDP.htm). The basic principles governing the conduct of a consensus progress conference are summarized below:

  • A broad-based non-government, nonadvocacy panel was assembled to give balanced, objective and knowledgeable attention to the topic. Panel members excluded anyone with scientific or commercial conflicts of interest and included researchers in clinical medicine, sports medicine, neuroscience, neuroimaging, athletic training, and sports science.
  • These experts presented data in a public session, followed by probe and discussion. The panel then met in an executive session to prepare the consensus statement.
  • A number of specific questions were prepared and posed in foster to define the scope and usher the direction of the conference. The principle stint of the panel was to elucidate responses to these questions. These questions are outlined below.
  • A systematic literature review was prepared and circulated in foster for disburse by the panel in addressing the conference questions.
  • The consensus statement is intended to serve as the scientific record of the conference.
  • The consensus statement will exist widely disseminated to achieve maximum impact on both current health care exercise and future medical research.
  • 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 territory of sport-related concussion. They execute not depict 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 identical silhouette as for the 3rd meeting. any speakers, consensus panel members, and abstract authors were required to note an ICMJE form for Disclosure of Potential Conflicts of Interest. detailed information related to each authors affiliations and conflicts of interests will exist made publicly available on the CISG Web site and published with the BJSM supplement.

    Medical Legal Considerations

    This consensus document reflects the current status of lore and will requisite to exist modified according to the progress of current knowledge. It provides an overview of issues that may exist of consequence to healthcare providers involved in the management of sport-related concussion. It is not intended as a yardstick of care, and should not exist interpreted as such. This document is only a guide, and is of a generic 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 exist formally reviewed and updated prior to December 1, 2016.

    SECTION 3: ZURICH 2012 CONSENSUS QUESTIONS

    Note that each question is the matter of a part systematic review that is published in the British Journal of Sports Medicine (2013; 47(5): April 2013). As such any citations and details of each topic will exist covered in those reviews.

    1. When you assess an athlete acutely and they execute not hold 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 aspect with rapidly changing clinical signs and symptoms, which may reflect the underlying physiological injury in the brain. Concussion is considered to exist among the most knotty injuries in sport medicine to diagnose, assess, and manage. The majority of concussions in sport occur without loss of consciousness or straightforward 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 possible to rule out concussion when an injury event occurs associated with a transitory neurological symptom. any such cases should exist removed from the playing territory and assessed for concussion by the treating physician or health care provider as discussed below. It was recognised that a cognitive deficit is not necessary for acute diagnosis as it either may not exist present or detected on examination.

    2. Are the existing tools/exam sensitive and reliable enough on the day of injury to do 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 straightforward neurologic signs.151–154 In milder forms of concussion, the athlete might exist slightly confused, without clearly identifiable amnesia. In addition, most concussions cannot exist identified or diagnosed by neuroimaging techniques (eg, computed tomography or magnetic resonance imaging). Several well-validated neuropsychological tests are commandeer for disburse in the assessment of acute concussion in the competitive sporting environment. These tests provide famous data on symptoms and functional impairments that clinicians can incorporate into their diagnostic formulation, but should not solely exist 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 territory is a challenging responsibility for the health care provider. Performing this stint is often a rapid assessment in the midst of competition with a time constraint and the athlete involved 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, vicissitude 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 exist 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 capture the status of clinician judgment.

    4. How can the SCAT2 exist improved?

    It was agreed that a variety of measures should exist employed as piece of the assessment of concussion to provide a more complete clinical profile for the concussed athlete. famous clinical information can exist ascertained in a streamlined manner through the disburse of a multimodal instrument such as the Sport Concussion Assessment tool (SCAT). A baseline assessment is advised wherever possible. However, it is acknowledged that further validity studies requisite to exist performed to reply this specific issue.

    A future SCAT test battery (i.e, SCAT3) should involve 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 equipoise function should exist assessed in any athlete suspected of sustaining a concussion. It is recommended that these latter steps exist conducted following a minimum 15-minute comfort epoch on the sideline to avoid the influence of exertion or fatigue on the athlete’s performance. While it is illustrious that this time frame is an arbitrary one, nevertheless the expert panel agreed that a epoch of comfort was famous prior to assessment. Future research should consider 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 exist useful additions to the sideline assessment of concussion. However, the requisite for additional paraphernalia may do them impractical for sideline use.

    It was further agreed that the SCAT3 would exist suitable for adults and youths age 13 and over, while a current tool (Child-SCAT3) exist 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 exist measured using symptom scales, equipoise testing, and neurocognitive testing. any 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 exist variable, which reinforces the value of assessing any 3 areas as piece 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 famous role within the context of a multifaceted-multimodal and multidisciplinary approach to managing sport-related concussion. Concussion management programs that disburse neuropsychological assessment to assist in clinical decision-making hold been instituted in professional sports, colleges, and lofty schools. Brief computerized cognitive evaluation tools are the mainstay of these assessments worldwide given the logistical limitation in accessing trained neuropsychologists, however it should exist illustrious that these are not substitutes for formal neuropsychological assessment. At present, there is insufficient evidence to recommend the widespread routine disburse of baseline neuropsychological testing.

    7. What evidence exits for current 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 nobody hold been validated as diagnostic. It will exist famous 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 upshot of comfort and treatment following a sport-related concussion is sparse. An initial epoch of comfort may exist 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 slack to regain may exist 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 exist of benefit. There is a sturdy requisite for high-level studies evaluating the effects of a resting period, pharmacological interventions, rehabilitative techniques, and exercise for individuals who hold 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 exist higher in certain sports (eg, elite ice hockey) and populations (eg, children). In general, symptoms are not specific to concussion and it is famous to consider and manage co-existent pathologies. Investigations may involve formal neuropsychological testing and conventional neuroimaging to exclude structural pathology. Currently there is insufficient evidence to recommend routine clinical disburse 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 exist managed in a multidisciplinary manner by health care providers with undergo in sports-related concussion. famous components of management after the initial epoch of physical and cognitive comfort involve 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 vary 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 predict outcome following concussion, although a cautious approach should exist taken in an athlete with prolonged LOC (ie, >1 minute). Children generally capture longer to regain from concussions and assessment batteries hold yet to exist 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 hold famous implications for management. Children with concussion should exist managed conservatively, with the accent on return to learn before return to sport. In cases of concussion managed with limited resources (eg, nonelite players), a conservative approach should furthermore exist taken such that the athlete does not return to sport until fully recovered

    11. What are the most effectual risk reduction strategies in sport concussion? - from protective paraphernalia to policy.

    No current valid evidence was provided to hint that the disburse 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 strength increases and concussion risk reduction. There was evidence to hint that eliminating cadaver checking from Pee Wee ice hockey (ages 11-12 years) and fair-play rules in ice hockey were effectual injury prevention strategies. Helmets requisite to exist 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 furthermore appears that helmets must exist 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 upshot of rule changes should furthermore exist addressed with future studies, not only assessing current rule changes or legislation, but furthermore alteration or reinforcement to existing rules.

    12. What is the evidence for inveterate concussion-related changes? - behavioural, pathological, and clinical outcomes.

    It was agreed that inveterate traumatic encephalopathy (CTE) represents a part 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 progression that hold been published, it is not possible 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 furthermore recognized that it is famous 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 lore transfer, education, and faculty to influence policy?

    The value of lore transfer (KT) as piece of concussion education is increasingly becoming recognized. Target audiences capitalize 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 requisite to ensure that the public is aware of the prerogative information. convivial media as a concussion education tool is becoming more prominent. Implementation of KT models is one approach organizations can disburse to assess lore gaps; identify, develop, and evaluate education strategies; and disburse the outcomes to facilitate decision making. Implementing KT strategies requires a defined plan. Identifying the needs, learning styles and preferred learning strategies of target audiences, coupled with evaluation, should exist a piece of the overall concussion education bewilder to hold an impact on enhancing lore and awareness.

    Author and coauthor affiliations and disclosures.

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    CyberArk [1 Certification Exam(s) ]
    Dassault [2 Certification Exam(s) ]
    DELL [11 Certification Exam(s) ]
    DMI [1 Certification Exam(s) ]
    DRI [1 Certification Exam(s) ]
    ECCouncil [21 Certification Exam(s) ]
    ECDL [1 Certification Exam(s) ]
    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) ]
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    ExtremeNetworks [3 Certification Exam(s) ]
    F5-Networks [20 Certification Exam(s) ]
    FCTC [2 Certification Exam(s) ]
    Filemaker [9 Certification Exam(s) ]
    Financial [36 Certification Exam(s) ]
    Food [4 Certification Exam(s) ]
    Fortinet [13 Certification Exam(s) ]
    Foundry [6 Certification Exam(s) ]
    FSMTB [1 Certification Exam(s) ]
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    IBM [1533 Certification Exam(s) ]
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    Liferay [1 Certification Exam(s) ]
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    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) ]
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    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) ]
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    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) ]





    References :












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