# data[].attributes.body
Nigeria is the best country

# data[].attributes.body
there are 3 countries in North America

# data[].attributes.body
If you follow me you'll get a cookie tonight

# data[].attributes.attachment_link.provider_name
Best English Quotes & Sayings: A beautiful appearance will last a few decades...

# data[].attributes.attachment_link.title
Best'English'Quotes'&'Sayings: The fact is, whatever you do, good or bad...

# data[].attributes.body
blue whales are the largest animals in the world

# data[].attributes.body
i like to play outside a lot.

# data[].attributes.body
kittins are the cutest thin on earth

# data[].attributes.body
I like chocolate

# data[].attributes.body
some people like to sing and some don't.

# data[].attributes.body
you have to go to school to get your education.

# data[].attributes.body
purple is better than green

# data[].attributes.body
Dogs are cute

# data[].attributes.body
I don't like dogs

# data[].attributes.body
I  hate noodles

# data[].attributes.body
Some people are really rude

# data[].attributes.body
Cookies are better with milk

# data[].attributes.body
Vanilla ice cream is better than chocolate

# data[].attributes.body
I was born late

# data[].attributes.body
pingues can fly

# data[].attributes.body
I have a galaxy on 5

# data[].attributes.body
Somalia is the best country ever

# data[].attributes.attachment_link.readable_text
I think I have had enough time to digest the information in the 4th Consensus Statement; it is enough time for me to give an opinion. WARNING : My opinion may differ than yours and you may even take umbrage with what I say. However I am going to give my honest opinion. To keep it as succinct as possible I will go in bullet form along with the statement itself.

In general I feel that we as the community in the "know" are muddying the waters more when it comes to concussions. I think there are reasons for this; litigation and emotion mainly. I still strongly feel that concussion identification and immediate assessment by trained personnel is non-complex; its simple. Sure others may think it is hard; I think changing the oil in the car is hard and complicated - a mechanic would find that a mundane task.

Secondly, the now undeniable MASSIVE issue with concussions is not the injury itself, rather, the mismanagement of concussion; which includes but not limited to assessment, rest, rehabilitation, return to learn and return to play. The newest consensus statement address some of this for the first time. Now, the paper...

SECTION 1: SPORT CONCUSSION AND MANAGEMENT

The definition of concussion is more clear for the practitioner.

Starting to address the psychological aspects of concussions - about time.

Clearly states if no trained health care provider present that if any signs/symptoms present players must sit out.

Clearly states that if concussion present, no RTP same day for ANYONE!

Not really a fan of all the sideline assessments out there. No where does it say its mandatory for any of these; rather they are tools at our disposal to help identify concussions.

Here is a novel approach people: use your training and ability to be in-tune with the athletes to make a solid clinical judgement. Oh, wait, not every sport team has an athletic trainer available? <-THIS IS THE PROBLEM WITH IDENTIFICATION AND ASSESSMENT .

The Statement also clearly makes it a point that clinical judgement is the standard of care when it comes to all of this.

Although currently there is not an objective measure of the injury on the brain they have opened the idea it may be coming.

Neuropsych testing was a good section, the take-home point here is that baselines are not part of best practices and that they should not be used as a clearance device, except in the case of a trained neuropsych using the information.

Loved the discussion on "rest", really thought about it a lot since it came up in Zürich. The term "rest" is so subjective as well, but the Statement made a good effort in trying to convey what most of us already did. Concussions are like orthopedic injuries; we still have a 72 hour window where the inflammation response is active.

The graduated RTP protocol remains unchanged - which I am most upset with.

However, the inclusion of (although almost in passing) of return to learn was good to see.
In the RTP steps all the group had to add was a step between 1 & 2; where it is return to school/work/cognitive activity without symptoms. That was obviously too much to ask, because I asked it be included many times while in Zürich.

Still no solutions for the 10-15% of "difficult" patients.

Addressed pharmacological aspects of concussion for the first time, good idea.

The concussion modifiers are a good point for all of us to consider.

Special populations or as I call it - "enhanced muddying of the water" - just gives everyone more loopholes to expose and ways to explain down a concussion. A concussion is a concussion is a concussion is a concussion. Now management of said concussion may be different, but the damn injury is the same across the board. Why can we not grasp this?

Prevention section was refreshing and gaining the most traction early on.

Yes the way the games are being played is a big contributor to concussions. Remember my quick rant about the sports we play?
These sports/games were designed for a different human being in the late 1800's. The size and speed has drastically changed in the athlete, while the game has seen slow and reactive changes that still lag in effectiveness.

Probably the most overlooked portion of Section I is the "Knowledge Transfer" portion. This is absolutely key, this is exactly why the blog exists.

SECTION 2: STATEMENT ON BACKGROUND TO THE CONSENSUS PROCESS

Perfectly honest, didn't read much of it, mainly because I was in Zürich and witnessed the process. What you basically need to know here is that the authors of the paper were the ones that came to "consensus" and in some cases they did a tremendous job of getting somewhere without getting anywhere - making us aware; CTE is the example of this good team work. Yet the select group didn't hear nor heed the concerns of many regarding return to learn (only casual mention).

A lot of the researchers/practitioners in the "consensus" group are very good and nearly void of massive conflict of interest. We must realize that almost everyone there has some "skin in the game". Unfortunately, most if not all of the "good" guys are non-US-based. I can count on one hand the US based authors I trust on this subject, sorry fellas. This sets up my rant.

In the US the concussion issue is not only overly complex in terms of ID and management, it is overly political; too often the pursuit of money or "fame" gets in the way of solid science. There are "elite" groups of researchers that have the proper connections and pull to get the lion share of grant money and innovation money. And more often than not independent voices/views or decent is met with immediate scoffing from the ivory towers.

Also in the section was the medical-legal concerns, worth the read but also worth nothing, because this does nothing for setting the standard of care we all can be protected by.

SECTION 3: QUESTIONS ADDRESSED

Good read

REFERENCES

This is worth the investigation people, read what they cited for a background on why certain things were written.

# data[].attributes.attachment_link.description
I think I have had enough time to digest the information in the 4th Consensus Statement; it is enough time for me to give an opinion. WARNING: My opinion may differ than yours and you may even take umbrage with what I say. However I am going to give my honest opinion.

# data[].attributes.body
The presidant is Donald Trump

# data[].attributes.attachment_link.readable_text
Do you deal in facts? Or do you often unknowingly deal in opinion? Recognising the difference between fact and opinion is important in managing your team, your own life and your relationships with people.

There are several ways of defining fact and opinion. Each is useful in its own right in different contexts.

The simplest differentiation is as follows:

FACT: something that is known to be true and cannot be questioned. Expressing a fact involves stating the truth or saying what is real.

OPINION: a personal view about what someone thinks of something. It is a view based on belief rather than absolute evidence.

These definitions are useful to remind ourselves of what we do and do not really know when we are managing, or are involved in, a conflict.

For example, if someone has told you that they saw an employee doing something wrong, the fact is that someone told you that they saw the employee doing something wrong. It is not an established fact that the employee did something wrong. If three independent people told you the same thing the fact is that the same story has been corroborated by three people.

It is important when managing conflict that we only deal in facts. Dealing in opinion dressed up as facts can easily result in a lack of trust. Dependent on the nature of the opinion we can also be seen as being judgemental. Being perceived to be judgemental in a conflict signals the demise of the perception of us appreciating both sides of an argument.

Another set of definitions delineates fact and opinion based on the source of the information.

EXTERNAL FACT: Quantitative information gathered from external sources such as government economic data, bureau of statistics tables, customs import data, quantitative research.

INTERNAL FACT: Quantitative information gathered from internal organisation reports such as finance reports, sales reports, manufacturing reports and audit data.

EXTERNAL OPINION: Qualitative information gathered from external sources such as qualitative research, conclusions from academic research, the opinions of distributors and customers and conclusions from industry research.

INTERNAL OPINION: Qualitative information gathered from internal sources such as a brainstorming session, conclusions from internal reports and the CEO's view!

These definitions are useful when conducting an analysis of your organisation, for example, during a market sector review, a cost review or a strategy review.

Generally, the hierarchy of relevance of the information is External Fact >> Internal Fact >> External Opinion >> Internal Opinion. However, be cautious. Relying too much on internal opinion will weaken the analysis. Relying too much on external facts will make the review too mechanistic, not taking into account the reality of the culture and processes of the organisation. It is best to have a mix of source types of data looking for corroboration of information rather than relying on one source type.

Another set of definitions of fact and opinion which is useful to understand is:

FACT: Something which can be verified. This may include corroborated opinions of three or more people of what they saw or heard.

INFERRED FACT: Information determined by deductive reasoning from a set of verified facts. For example, "The cherry crop needs at least a week of freezing temperatures for best results, and this winter the temperature stayed several degrees above freezing, so we do not expect a good cherry crop".

SPECULATION: Information determined by inductive reasoning from a set of verified facts. For example, "For university students, your first quiz grade usually indicates how you will do in the course".

OPINION: Something which is an unverified view of one person.

These definitions are useful when completing an investigation. For example, investigating a safety incident requires diligent separation of facts, inferred facts, speculation and opinion when trying to determine the root causes of the incident.

Any study of cause and effect needs to take heed of these defined differences between fact and opinion. Most analysis I have seen of an organisation's current state have relied heavily on speculation and opinion rather than facts and inferred facts.

The worst example I saw was an analysis of deteriorating profit margins in large contracts for commodity products which concluded that the market was getting more competitive and that a severe cost cutting programme was required. The fact was that all large contracts had been written with a fixed dollar value for world scale freight (sea freight costs) instead of a value which escalated and de-escalated in line with actual movements. During the time that the study reviewed, the value of world scale freight trebled. This fact was not revealed by the study. The solution to the problem of deteriorating margins was to renegotiate contracts, not instigate a slashing of marketing investments and significant rolling job losses taking out its core of experienced and technically competent people.

The organisation involved has never recovered from that very poor analysis where opinion and speculation ruled over facts.

# data[].attributes.attachment_link.description
Do you deal in facts? Or do you often unknowingly deal in opinion? Recognising the difference between fact and opinion is important in managing your team, your own life and your relationships with people. There are several ways of defining fact and opinion. Each is useful in its own right in different contexts.

# data[].attributes.body
Opinion

# data[].attributes.body
whales can eat many of fish.

# data[].attributes.body
Can be true or false

# data[].attributes.body
dogs have good hearing

# data[].attributes.body
Fact is something true like geroge washington was the first president.aAopinion is what you like so like you voting for someone .

# data[].attributes.body
Donald Trump is the best president ever

# data[].attributes.body
Something that cant be proven anywhere just what you think

# data[].attributes.body
Fact is a text that can be proven by story/internet.
Example: Obama was the formal president of U.S
An opinion is a text that is not true. It can be and educated guess or something you predict.
Example:All girls are smarter than boys

# data[].attributes.body
dogs are cute

# data[].attributes.body
I think that Donald Trump will do a bad job of being a president

# data[].attributes.body
There cant not be weapons in schools
EX:

# data[].attributes.body
There are 50 stars in the united states of america flag

# data[].attributes.body
There is 50 states in U.S.A.

# data[].attributes.body
Fact There are 13 colonies
Opinion I'm the coolest person.

# data[].attributes.body
We have 7 continents

# data[].attributes.body
people can't fly