bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of an Algorithm to Predict Menstrual-Cycle Phase at the Time of Injury
Authors: Tourville Timothy W. , Shultz Sandra J. , Vacek Pamela M. , Knudsen Emily J. , Bernstein Ira M. , Tourville Kelly J. , Hardy Daniel M. , Johnson Robert J. , Slauterbeck James R. , Beynnon Bruce D. 
Published: September 2016

Context
Women are 2 to 8 times more likely to sustain an anterior cruciate ligament (ACL) injury than men, and previous studies indicated an increased risk for injury during the preovulatory phase of the menstrual cycle (MC). However, investigations of risk rely on retrospective classification of MC phase, and no tools for this have been validated.

Objective
To evaluate the accuracy of an algorithm for retrospectively classifying MC phase at the time of a mock injury based on MC history and salivary progesterone (P4) concentration.

Design
Descriptive laboratory study.

Setting
Research laboratory.

Participants
Thirty-one healthy female collegiate athletes (age range, 18−24 years) provided serum or saliva (or both) samples at 8 visits over 1 complete MC.

Main Outcome Measure(s)
Self-reported MC information was obtained on a randomized date (1−45 days) after mock injury, which is the typical timeframe in which researchers have access to ACL-injured study participants. The MC phase was classified using the algorithm as applied in a stand-alone computational fashion and also by 4 clinical experts using the algorithm and additional subjective hormonal history information to help inform their decision. To assess algorithm accuracy, phase classifications were compared with the actual MC phase at the time of mock injury (ascertained using urinary luteinizing hormone tests and serial serum P4 samples). Clinical expert and computed classifications were compared using κ statistics.

Results
Fourteen participants (45%) experienced anovulatory cycles. The algorithm correctly classified MC phase for 23 participants (74%): 22 (76%) of 29 who were preovulatory/anovulatory and 1 (50%) of 2 who were postovulatory. Agreement between expert and algorithm classifications ranged from 80.6% (κ = 0.50) to 93% (κ = 0.83). Classifications based on same-day saliva sample and optimal P4 threshold were the same as those based on MC history alone (87.1% correct). Algorithm accuracy varied during the MC but at no time were both sensitivity and specificity levels acceptable.

Conclusions
These findings raise concerns about the accuracy of previous retrospective MC-phase classification systems, particularly in a population with a high occurrence of anovulatory cycles.
Exploring Summer Medical Care Within the National Collegiate Athletic Association Division I Setting: A Perspective From the Athletic Trainer
Authors: Mazerolle Stephanie M. , Eason Christianne M. , Goodman Ashley 
Published: September 2016

Over the last few decades, the National Collegiate Athletics Association (NCAA) has made changes related to the increase in sanctioned team activities during summer athletics. These changes may affect how athletic training services are provided.Context:
To investigate the methods by which athletic training departments of NCAA institutions manage expectations regarding athletic training services during the summer.Objective:
Mixed-methods qualitative and quantitative study.Design:
The NCAA Division I.Setting:
Twenty-two athletic trainers (13 men, 9 women) participated. All were employed full time within the NCAA Division I setting. Participants were 35 ± 8 years of age (range, 26−52 years), with 12 ± 7 years (range, 3−29 years) of athletic training experience.Patients or Other Participants:
All participants completed a series of questions online that consisted of closed- (demographic and Likert-scale 5-point) and open-ended items that addressed the research questions. Descriptive statistics, frequency distributions, and phenomenologic analyses were completed with the data. Peer review and multiple-analyst triangulation established credibility.Data Collection and Analysis:
Summer athletic training services included 3 primary mechanisms: individual medical care, shared medical care, or a combination of the 2. Participants reported working 40 ± 10 hours during the summer. Likert-item analysis showed that participants were moderately satisfied with their summer medical care structure (3.3 ± 1.0) and with the flexibility of summer schedules (3.0 ± 1.2). Yet the qualitative analysis revealed that perceptions of summer medical care were more positive for shared-care participants than for individual- or combination-care participants. The perceived effect on the athletic trainer included increased workload and expectations and a negative influence on work-life balance, particularly in terms of decreased schedule flexibility and opportunities for rejuvenation. For many, the summer season mimicked the hours, workload, and expectations of the nontraditional season.Results:
The NCAA rule changes and medical care expectations affected the summer workload of athletic trainers, but job sharing seemed to help them manage conflict associated with providing summer athletic training services.Conclusions:
Sex Differences in Reported Concussion Injury Rates and Time Loss From Participation: An Update of the National Collegiate Athletic Association Injury Surveillance Program From 2004–2005 Through 2008–2009
Authors: Covassin Tracey , Moran Ryan , Elbin R. J. 
Published: September 2016

Epidemiologic studies have identified differences in concussion incidence between the sexes. However, few authors to date have updated injury rates (IRs) and time loss between male and female concussed athletes.Context:
To examine sex differences in IRs and time loss in concussed National Collegiate Athletic Association (NCAA) athletes.Objective:
Descriptive epidemiologic study.Design:
National Collegiate Athletic Association athletics.Setting:
A total of 1702 concusssed NCAA athletes, consisting of 903 females and 779 males participating in soccer, basketball, ice hockey, lacrosse, softball, or baseball over a 5-year period from 2004–2005 through 2008–2009.Patients or Other Participants:
Using the NCAA Injury Surveillance Program, athletic trainers reported concussions, athlete-exposures (AEs), and time loss across 10 NCAA sports. An IR is the number of injuries in a particular category divided by the number of AEs in that category.Main Outcome Measure(s):
During the study period, 1702 concussions were reported during 4 170 427 AEs for an overall total of 5.47 per 10 000 AEs. In sex-comparable sports, females had a 1.4 times higher overall concussion IR than males (IRs = 4.84 and 3.46, respectively), with greater rates in women's baseball/softball, basketball, ice hockey, and soccer than men. Female soccer and basketball players also displayed more time loss after concussion compared with male basketball and soccer players.Results:
Female athletes sustained a higher rate of concussion and, in all sports except lacrosse, had greater time loss from concussion than male athletes. Additional research is needed on sex differences in time loss after concussions.Conclusions:
Physiologic and Perceptual Responses to Cold-Shower Cooling After Exercise-Induced Hyperthermia
Authors: Butts Cory L. , McDermott Brendon P. , Buening Brian J. , Bonacci Jeffrey A. , Ganio Matthew S. , Adams J. D. , Tucker Matthew A. , Kavouras Stavros A. 
Published: September 2016

Exercise conducted in hot, humid environments increases the risk for exertional heat stroke (EHS). The current recommended treatment of EHS is cold-water immersion; however, limitations may require the use of alternative resources such as a cold shower (CS) or dousing with a hose to cool EHS patients.Context:
To investigate the cooling effectiveness of a CS after exercise-induced hyperthermia.Objective:
Randomized, crossover controlled study.Design:
Environmental chamber (temperature = 33.4°C ± 2.1°C; relative humidity = 27.1% ± 1.4%).Setting:
Seventeen participants (10 male, 7 female; height = 1.75 ± 0.07 m, body mass = 70.4 ± 8.7 kg, body surface area = 1.85 ± 0.13 m2, age range = 19–35 years) volunteered.Patients or Other Participants:
On 2 occasions, participants completed matched-intensity volitional exercise on an ergometer or treadmill to elevate rectal temperature to ≥39°C or until participant fatigue prevented continuation (reaching at least 38.5°C). They were then either treated with a CS (20.8°C ± 0.80°C) or seated in the chamber (control [CON] condition) for 15 minutes.Intervention(s):
Rectal temperature, calculated cooling rate, heart rate, and perceptual measures (thermal sensation and perceived muscle pain).Main Outcome Measure(s):
The rectal temperature (P = .98), heart rate (P = .85), thermal sensation (P = .69), and muscle pain (P = .31) were not different during exercise for the CS and CON trials (P &gt; .05). Overall, the cooling rate was faster during CS (0.07°C/min ± 0.03°C/min) than during CON (0.04°C/min ± 0.03°C/min; t16 = 2.77, P = .01). Heart-rate changes were greater during CS (45 ± 20 beats per minute) compared with CON (27 ± 10 beats per minute; t16 = 3.32, P = .004). Thermal sensation was reduced to a greater extent with CS than with CON (F3,45 = 41.12, P &lt; .001).Results:
Although the CS facilitated cooling rates faster than no treatment, clinicians should continue to advocate for accepted cooling modalities and use CS only if no other validated means of cooling are available.Conclusions:
Immediate Effect of Patterned Electrical Neuromuscular Stimulation on Pain and Muscle Activation in Individuals With Patellofemoral Pain
Authors: Glaviano Neal R. , Saliba Susan A. 
Published: September 2016

For individuals with patellofemoral pain (PFP), altered muscle activity and pain are common during functional tasks. Clinicians often seek interventions to improve muscle activity and reduce impairments. One intervention that has not been examined in great detail is electrical stimulation.Context:
To determine whether a single patterned electrical neuromuscular stimulation (PENS) treatment would alter muscle activity and pain in individuals with PFP during 2 functional tasks, a single-legged squat and a lateral step down.Objective:
Cohort study.Design:
Sports medicine research laboratory.Setting:
A total of 22 individuals with PFP (15 women, 7 men; age = 26.0 ± 7.9 years, height = 173.8 ± 8.1 cm, mass = 75.1 ± 17.9 kg).Patients of Other Participants:
Participants were randomized into 2 intervention groups: a 15-minute PENS treatment that produced a strong motor response or a 15-minute 1-mA subsensory (sham) treatment.Intervention(s):
Before and immediately after the intervention, we assessed normalized electromyography amplitude, percentage of activation time across functional tasks, and onset of activation for the vastus medialis oblique, vastus lateralis, gluteus medius, adductor longus, biceps femoris, and medial gastrocnemius muscles during a single-legged squat and a lateral step down. Scores on the visual analog scale for pain were recorded before and after the intervention.Main Outcome Measure(s):
After a single treatment of PENS, the percentage of gluteus medius activation increased (0.024) during the lateral step down. Visual analog scores decreased during both the single-legged squat (PENS: preintervention = 2.7 ± 1.9, postintervention = 0.9 ± 0.7; sham: preintervention = 3.2 ± 1.6, postintervention = 2.8 ± 1.9; group × time interaction: P = .041) and lateral step down (PENS: preintervention = 3.4 ± 2.4, postintervention = 1.1 ± 0.8; sham: preintervention = 3.9 ± 1.7, postintervention = 3.3 ± 2.0; group × time interaction: P = .023). No changes in electromyography or pain measures were noted in the sham group.Results:
The PFP participants who received PENS had immediate improvement in gluteus medius activation and a reduction in pain during functional tasks.Conclusions:
A Meta-Analysis to Determine if Lower Extremity Muscle Strengthening Should Be Included in Military Knee Overuse Injury-Prevention Programs
Authors: Kollock Roger O. , Andrews Corey , Johnston Ashlyn , Elliott Teresa , Wilson Alan E. , Games Kenneth E. , Sefton JoEllen M. 
Published: September 2016

Context: Knee overuse injuries are the most common musculoskeletal complaints in military trainees and are common in active-duty warfighters. Muscle strengthening is usually recommended; however, research is conflicting in this area, which makes it difficult to develop effective screening, prevention, and training interventions for warfighters.
Objective: To determine if lower extremity muscular weakness contributes to knee overuse injuries and identify specific muscular involvement.
Data Sources: We searched MEDLINE, PubMed, Web of Science, SPORTDiscus, CINAHL, and Military & Government Collection and reference lists of relevant articles published between January 1, 2000, and January 1, 2013.
Study Selection: For inclusion, requirements were uninjured and injured groups; provision of the sample size, means, and standard deviations for all groups; identification of the specific muscles assessed; and clearly defined knee injury.
Data Extraction: Sample size, sex, and muscle strength means and standard deviations.
Data Synthesis: Twenty-five studies met these criteria. We used the Scottish Intercollegiate Guidelines Network algorithm to determine the appropriate tool for appraising article quality. Unweighted random-effects model meta-analyses were conducted. Separate meta-analyses were performed for the moderators of strength measurement scale (absolute or normalized muscle strength), muscle group, and sex. A weighted random-effects model with a Hedges g effect metric and 95% confidence intervals were used for comparison across studies.
Conclusions: Our meta-analysis suggests that individuals with symptoms of a knee overuse injury have lower absolute and normalized hip muscle strength. Specifically, they had lower absolute hip external-rotator, knee-extensor, and knee-flexor strength, as well as lower normalized hip external-rotator, hip-extensor, and hip-abductor strength, compared with asymptomatic control participants. The findings suggest a possible link between lower hip and thigh strength and knee overuse injuries. Further research is needed to determine if weakness is a cause or a result of knee overuse injuries before screening and intervention can be developed for at-risk warfighters.
Quantifying Emergency Department Visits From Sport and Recreation: Focus on the Lower Extremity and Knee, 1997–2009
Authors: Tenan Matthew S. 
Published: September 2016

Few authors have reported nationally representative data on the number of sport and recreation (SR) injuries resulting in emergency department (ED) visitation. The existing studies have only provided 1 or 2 years of data and are not longitudinal in nature.Context:
To use a novel algorithmic approach to determine if ED visitation is due to SR, resulting in a substantially larger longitudinal dataset.Objective:
Descriptive epidemiology study.Design:
Hospital.Setting:
The National Hospital Ambulatory Medical Care Survey, a stratified random-sample survey of US hospital EDs was combined for years 1997–2009. There were 15 699 unweighted patient visits determined to be from SR.Patients or Other Participants:
A custom algorithm classified SR visits based on the International Classification of Diseases, Ninth Revision, Clinical Modification E-code and pattern recognition of narrative text. Sport and recreation visits were assessed by age and categorized according to broad injury classifications. Additional quantification was performed on SR visits for lower extremity and knee-specific injuries. Sample weights were applied to provide national annual estimates.Main Outcome Measure(s):
Annually, 4 243 000 ED visits resulted from SR. The largest classification of injury from SR was sprains and strains (896 000/y). Males had substantially more SR-related ED visits than females (2 929 000/y versus 1 314 000/y). For patients 10–49 years old, 1 093 000 lower extremity and 169 000 knee-specific injury visits annually were from SR. For both injury types, males had a higher rate of ED visitation; however, females had 25% and 39% greater odds of visitation for lower extremity and knee-specific injury, respectively.Results:
The burden on the health system of ED visits from SR was substantial. Males presented in the ED at a higher rate for SR injury, though females had a higher proportion of lower extremity and knee-specific injury ED visitations from SR. This longitudinal analysis of population-level data provides the information to target research on specific subpopulations to mitigate SR injury.Conclusions:
“Playing Through It”: Delayed Reporting and Removal From Athletic Activity After Concussion Predicts Prolonged Recovery
Authors: Asken Breton M. , McCrea Michael A. , Clugston James R. , Snyder Aliyah R. , Houck Zachary M. , Bauer Russell M. 
Published: September 2016

Preclinical research has demonstrated a window of vulnerability in the immediate aftermath of concussion wherein continued activity and stimulation can impair or prolong neurobehavioral recovery. However, this concept has not been quantified in a human population.Context:
To examine the effect of delayed reporting and removal from athletic activity after concussion on recovery time.Objective:
Cross-sectional study.Design:
A National Collegiate Athletic Association Division I university.Setting:
Ninety-seven athletes who sustained a sport-related concussion between 2008 and 2015 were analyzed (age = 20.4 ± 1.3 years). Athletes were grouped as immediate removal from activity (I-RFA) or delayed removal from activity (D-RFA).Patients or Other Participants:
Days missed was defined as the number of days between the concussion-causing event and clearance for return to contact. Associations between RFA group and prolonged (8 or more days') versus normal (7 or fewer days') recovery were also analyzed.Main Outcome Measure(s):
Fifty (51.5%) of the 97 athletes did not immediately report concussion symptoms. The D-RFA athletes averaged 4.9 more days missed than the I-RFA athletes. Membership in the specific RFA group predicted days missed even after controlling for sex, concussion history, learning disability or attention-deficit/hyperactivity disorder diagnosis, diagnosed psychological disorder, and acute symptom severity (R 2 change = 0.097, β = .319, P = .002). The D-RFA athletes were approximately 2.2 times more likely to have a prolonged recovery (8 or more days) compared with the I-RFA athletes (χ2 = 10.268, P = .001, φ = 0.325).Results:
Athletes who do not immediately report symptoms of a concussion and continue to participate in athletic activity are at risk for longer recoveries than athletes who immediately report symptoms and are immediately removed from activity. Continuing to participate in athletic activity during the immediate aftermath of a concussion potentially exposes the already injured brain to compounded neuropathophysiologic processes.Conclusions:
Osteoarthritis and the Tactical Athlete: A Systematic Review
Authors: Cameron Kenneth L. , Driban Jeffrey B. , Svoboda Steven J. 
Published: September 2016

Objective: Although tactical athletes (eg, military service members, law enforcement personnel, fire fighters) are exposed to several known risk factors, it remains unclear if they are at increased risk for osteoarthritis (OA). The purpose of this systematic review was to investigate the association between serving as a tactical athlete and the incidence and prevalence of OA.
Data Sources: We completed a comprehensive systematic literature search in November 2014 using 12 bibliographic databases (eg, PubMed, Ovid, SportDiscus) supplemented with manual searches of reference lists.
Study Selection: Studies were included if they met the following criteria: (1) an aim of the study was to investigate an association between tactical athletes and OA; (2) the outcome measure was radiographic OA, clinical OA, total joint replacement, self-reported diagnosis of OA, or placement on a waiting list for a total joint replacement; (3) the study design was a cohort study; and (4) the study was written in English.
Data Extraction: One investigator extracted data from articles that met all inclusion criteria (eg, group descriptions, measures of disease burden, source of nonexposed controls).
Data Synthesis: Twelve articles met the inclusion criteria and described retrospective cohort studies. Firefighters, active-duty military service members, and veteran military parachutists consistently had a higher incidence or prevalence of knee, hip, or any OA diagnosis (4 studies). Active-duty pilots and veteran military parachutists may have a higher prevalence of spine OA, but this was not statistically significant (2 studies). Occupational risk factors for OA among tactical athletes include rank and branch of military service. The risk of OA among individuals who completed mandatory national military service remains unclear (6 studies).
Conclusions: The incidence of OA among tactical athletes appears to be significantly higher when compared with nonexposed controls. Further research is needed to specifically identify modifiable risk factors within this high-risk population to develop and implement effective risk-reduction strategies.
National Collegiate Athletic Association Division I Certified Athletic Trainers' Perceptions of the Benefits of Sport Psychology Services
Authors: Zakrajsek Rebecca A. , Martin Scott B. , Wrisberg Craig A. 
Published: September 2016

Context: Certified athletic trainers (ATs) are responsible for integrating relevant professionals into the rehabilitation team to assist with the holistic care of injured athletes.
Objective: To explore National Collegiate Athletic Association Division I (DI) ATs' experience with sport psychology consultants (SPCs), willingness to encourage athletes to use SPCs for injury rehabilitation, and perceptions of the benefits of sport psychology services.
Design: Quantitative study.
Setting: A Web-based survey was administered to a national sample of DI ATs.
Patients or Other Participants: A total of 659 (341 men, 318 women) ATs completed the survey.
Main Outcome Measure(s): Athletic trainers' experience with SPCs, willingness to encourage athletes to seek sport psychology services, and perceptions of the benefits of those services in injury-rehabilitation settings were self-reported using a rating scale that ranged from 1 (never or not at all) to 5 (definitely or extremely).
Results: Logistic regression revealed that the availability of SPCs, previous encouragement to athletes to seek sport psychology services, and previous positive interactions with SPCs predicted the ATs' willingness to encourage athletes to use these services (P &lt; .0001). The services ATs rated the highest for injury rehabilitation were managing anxiety and emotion, improving coping techniques, and building confidence (ie, confidence in returning to sport and building confidence). Chi-square analyses indicated that female ATs' ratings of perceived benefits were higher (P ≤ .001) than those of male ATs, and the ratings of ATs who were likely to encourage the use of SPCs were higher (P ≤ .001) than those who were unlikely to encourage SPC service use.
Conclusions: Athletic trainers in our study who had previous positive SPC experiences were most likely to use SPCs and their services during the injury-rehabilitation process. Possible implications are offered for how ATs interested in sport psychology services might call on SPCs to complement their work with injured athletes.