Headgear mandates in high school girls' lacrosse: investigating differences in impact rates and game play behaviors.

BACKGROUND/OBJECTIVE: Headgear designed to protect girls' lacrosse athletes is widely available and permitted for voluntary use; however, it remains unknown how policies mandating headgear use may change the sport and, particularly regarding impacts during game-play. Therefore, this study compares the impact rates and game play characteristics of girls' high school lacrosse in Florida which mandates headgear use (HM), with states having no headgear mandate (NHM). MATERIALS AND METHODS: Video from 189 randomly-selected games (HM: 64, NHM: 125) were analyzed. Descriptive statistics, Impact Rates (IR), Impact Rate Ratios (IRR), Impact Proportion Ratios (IPR), and 95% Confidence Intervals (CI) were calculated. IRRs and IPRs with corresponding CIs that excluded 1.00 were deemed statistically significant. RESULTS: 16,340 impacts (HM:5,821 NHM: 10,519; 86.6 impacts/game, CI: 88.6-93.3) were identified using the Lacrosse Incident Analysis Instrument (LIAI). Most impacts directly struck the body (n = 16,010, 98%). A minority of impacts directly struck a player's head (n = 330, 2%). The rate of head impacts was significantly higher in the HM cohort than NHM cohort (IRR = 2.1; 95% CI = 1.7-2.6). Most head impacts (n = 271, 82%) were caused by stick contact in both groups. There was no difference in the proportion of penalties administered for head impacts caused by stick contact between the HM and NHM cohorts (IPR IRRHM/NHM = 0.98; CI = 0.79-1.16). However, there was a significantly greater proportion of head impacts caused by player contact that resulted in a penalty administered in the HM cohort (IPR = 1.44 CI = 1.17-1.54). CONCLUSION: These findings demonstrate that mandating headgear use was associated with a two-fold greater likelihood of sustaining a head impact during game play compared to NHM states. A majority of head impacts in both HM and NHM states were caused by illegal stick contact that did not result in penalty.

High school girls' lacrosse athletes participating in a state with a headgear mandate was twice as likely to sustain a head impact than those participating in states without headgear mandates.Stick contact remains the most common mechanism of head impacts in girls' lacrosse, regardless of mandating headgear.Regardless of whether headgear was or was not mandated, most head impacts caused by stick contact did not result in a penalty.

Kinesiophobia in Injured Athletes: A Systematic Review.

Athletes have a high risk of injury. Kinesiophobia is a condition in which an individual experiences a fear of physical movement and activity after an injury occurs. Our purpose was to systematically review the literature about Kinesiophobia in athletes. A systematic review was conducted in February 2023 using PubMed, CINAHL, SPORTDiscus, Web of Science, Cochrane Library, and Medline. Studies were included if they were peer-reviewed, in English, within the last 20 years and included athletes who had been injured and tracked Kinesiophobia. Articles were checked for quality via the modified Downs and Black checklist. Fourteen studies were included in the review and had an average "fair" quality score. Authors examined Kinesiophobia in injured athletes with mostly lower-extremity injuries. Kinesiophobia was associated with lower physical and mental outcomes. Kinesiophobia exists in athletes and can affect both physical and mental factors. The Tampa Scale of Kinesiophobia (TSK) was the most common tool used to examine Kinesiophobia. Common mental factors associated with Kinesiophobia include anxiety, low confidence, and fear avoidance.

Multifactorial Exercise Intervention Decreases Falls Risk in High-risk and Low-risk Older Adults.

BACKGROUND: Each year, 1 in 4 people over the age of 65 years of age will experience a fall. It is important to identify and address modifiable risk factors that are associated with falls in adults at high and low risk for falls. HYPOTHESIS: Falls risk improves in both high-risk and low-risk participants with the implementation of Stay Active and Independent for Life (SAIL). STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Seventy-eight older adults (age, 70.9 ± 5.1 years) were included in this study and categorized into high risk and low risk for falling based on the falls risk score from the Physiological Profile Assessment. High risk was defined as having a preintervention falls risk score >1, whereas low risk was defined as having a preintervention falls risk score <1. Both groups had the same 10-week intervention. A multivariate analysis of covariance was used to compare differences pre- and postintervention, using preintervention falls risk score as covariate. RESULTS: Results showed that regardless of preintervention falls risk, participants showed significant improvements in right and left knee extensor strength and sit-to-stand after participation in the 10-week SAIL program. Also, noteworthy is that 15 participants who were considered at high risk for falling preintervention were considered low risk for falling postintervention. CONCLUSION: The positive outcomes noted on modifiable risk factors suggest SAIL can be beneficial for decreasing falls risk in older adults, regardless of risk of falling, using a multifactorial exercise intervention. Our results also showed that it was possible for participants not only to improve falls risk but to improve to such a degree that they change from high risk to low risk of falling. CLINICAL RELEVANCE: Our results demonstrated that SAIL was effective in improving overall fall risk after a 10-week intervention. Targeted community-based interventions for the aging population can bring physical health benefits that can decrease falls risk.

Physicochemical properties of micellar casein retentates generated at different microfiltration temperatures.

Processing temperature has a significant influence on the composition and functionality of the resulting streams following microfiltration (MF) of skim milk. In this study, MF and diafiltration (DF) were performed at 4 or 50°C to produce ß-casein (ß-CN)-depleted and nondepleted (i.e., native casein profile) micellar casein isolate retentates, respectively. Microfiltration combined with extensive DF resulted in a 40% depletion of ß-CN at 4°C, whereas no ß-CN depletion occurred at 50°C. Microfiltration at 4°C led to higher transmission of calcium into permeates, with retentate generated at 4°C containing less total calcium compared with retentate generated at 50°C, based on the volume of retentate remaining. Higher heat stability at 120°C was measured for retentates generated at 4°C compared with those at 50°C, across all pH values measured. Retentates generated at 4°C also had significantly lower ionic calcium values at each pH compared with those generated at 50°C. Higher apparent viscosities at 4°C were measured for retentates generated at 4°C compared with retentates generated at 50°C, likely due to increased voluminosity of ß-CN-depleted casein micelles. The results of this study provide new information on how changing the composition of MF retentate, by appropriate control of processing temperature and DF, can alter physicochemical properties of casein micelles, with potential implications for ingredient functionality.

Toward a dynamic national transportation noise map: Modeling temporal variability of traffic volume.

The National Transportation Noise Map (NTNM) gives time-averaged traffic noise across the continental United States (CONUS) using annual average daily traffic. However, traffic noise varies significantly with time. This paper outlines the development and utility of a traffic volume model which is part of VROOM, the Vehicular Reduced-Order Observation-based model, which, using hourly traffic volume data from thousands of traffic monitoring stations across CONUS, predicts nationwide hourly varying traffic source noise. Fourier analysis finds daily, weekly, and yearly temporal traffic volume cycles at individual traffic monitoring stations. Then, principal component analysis uses denoised Fourier spectra to find the most widespread cyclic traffic patterns. VROOM uses nine principal components to represent hourly traffic characteristics for any location, encapsulating daily, weekly, and yearly variation. The principal component coefficients are predicted across CONUS using location-specific features. Expected traffic volume model sound level errors-obtained by comparing predicted traffic counts to measured traffic counts-and expected NTNM-like errors, are presented. VROOM errors are typically within a couple of decibels, whereas NTNM-like errors are often inaccurate, even exceeding 10 decibels. This work details the first steps towards creation of a temporally and spectrally variable national transportation noise map.

Language Matters: Comparisons of Concussion Assessments Among English and Spanish Speaking Middle School Athletes.

CONTEXT: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) is among the most widely used international pediatric concussion evaluation tools. The tool's English-only development may limit its use for patients who speak different languages. Prior research suggests preferred language (i.e., home language) could be associated with concussion assessments in adults, however this is not well understood among pediatric athletes. OBJECTIVE: To compare baseline Child SCAT5 assessment outcomes between middle school athletes whose home language is Spanish and matched controls whose home language is English. DESIGN: Case-Control. SETTING: Middle School Athletics. PATIENTS OR OTHER PARTICIPANTS: Athletes self-reported their home language (i.e., "language spoken at home"). Athletes indicating their home language was Spanish were individually matched to athletes that spoke English at home on age, gender, sport, school, and pertinent comorbidities (e.g., concussion history). The final sample included 144 athletes (Spanish home language: n=72, English home language: n=72). DATA COLLECTION AND ANALYSIS: Mann Whitney U tests compared the home language groups (i.e., 19 Spanish vs English) on the Child SCAT5 component scores. RESULTS: Athletes in the Spanish home language group scored lower on the Standardized Assessment of Concussion - Child version (p<.01, r=-.25), Immediate Memory (p<.01, r=-0.45), and Total Modified Balance Error Scoring System scores (p<.01, r=-0.25) compared to the English home language group. CONCLUSIONS: Matched athletes whose home language was Spanish versus English scored differently on baseline Child SCAT5 assessment components. Those with the home language of Spanish scored lower on cognitive and balance tasks compared to those whose home language was English. These findings may serve as rationale for future concussion assessment tools to properly capture clinically relevant data representative language differences among pediatric athletes.

Community arts engagement supports perceptions of personal growth in older adults.

PURPOSE: The effects of arts engagement on older adults have been well-documented. However, the ways older adults overcome common situational and dispositional barriers to enhance personal growth and well-being are less known. METHODS: Fifty-six community dwelling older adults (71.3 ± 4.6 years) took part in dance, music, or a control workshop two times/week for ten weeks. Participants' personal growth was examined through focus groups and surveys in this mixed-methods study. RESULTS: Focus group and survey results revealed participants experienced personal growth through engaging in the dance and music arms of the experiment. Participants, especially those in arts workshops, described personal growth experiences aligning with four themes: increased social connections, developed new skills, utilized a growth mindset, and used creativity to overcome situational and dispositional barriers to participation. The barriers included musculoskeletal challenges, hearing impairments, and difficulty retaining new information. CONCLUSIONS: The study yielded high adherence and retention rates, and participants reported increased engagement within their communities. Our observations provide avenues for future practitioners and facilitators to create programming that empowers older adults and utilizes participants' ongoing feedback to support access, inclusion, and sense of community.

Feature selection for a continental-scale geospatial model of environmental sound levels.

Modeling environmental sound levels over continental scales is difficult due to the variety of geospatial environments. Moreover, current continental-scale models depend upon machine learning and therefore face additional challenges due to limited acoustic training data. In previous work, an ensemble of machine learning models was used to predict environmental sound levels in the contiguous United States using a training set composed of 51 geospatial layers (downselected from 120) and acoustic data from 496 geographic sites from Pedersen, Transtrum, Gee, Lympany, James, and Salton [JASA Express Lett. 1(12), 122401 (2021)]. In this paper, the downselection process, which is based on factors such as data quality and inter-feature correlations, is described in further detail. To investigate additional dimensionality reduction, four different feature selection methods are applied to the 51 layers. Leave-one-out median absolute deviation cross-validation errors suggest that the number of geospatial features can be reduced to 15 without significant degradation of the model's predictive error. However, ensemble predictions demonstrate that feature selection results are sensitive to variations in details of the problem formulation and, therefore, should elicit some skepticism. These results suggest that more sophisticated dimensionality reduction techniques are necessary for problems with limited training data and different training and testing distributions.

Bisphenol A substitutes and obesity: a review of the epidemiology and pathophysiology.

The prevalence of obesity, a condition associated with increased health risks, has risen significantly over the past several decades. Although obesity develops from energy imbalance, its etiology involves a multitude of other factors. One of these factors are endocrine disruptors, or "obesogens", when in reference to obesity. Bisphenol A (BPA), a known endocrine disruptor used in plastic materials, has recently been described as an environmental obesogen. Although BPA-free products are becoming more common now than in the past, concerns still remain about the obesogenic properties of the compounds that replace it, namely Bisphenol S (BPS), Bisphenol F (BPF), and Bisphenol AF (BPAF). The purpose of this review is to investigate the relationship between BPA substitutes and obesity. Literature on the relationship between BPA substitutes and obesity was identified through PubMed and Google Scholar, utilizing the search terms "BPA substitutes", "bisphenol analogues", "BPS", "BPF", "BPAF", "obesity", "obesogens", "adipogenesis", "PPARγ", and "adipocyte differentiation". Various population-based studies were assessed to gain a better understanding of the epidemiology, which revealed evidence that BPA substitutes may act as obesogens at the pathophysiological level. Additional studies were assessed to explore the potential mechanisms by which these compounds act as obesogens. For BPS, these mechanisms include Peroxisome proliferator-activated receptor gamma (PPARγ) activation, potentiation of high-fat diet induced weight-gain, and stimulation of adipocyte hypertrophy and adipose depot composition. For BPF and BPAF, the evidence is more inconclusive. Given the current understanding of these compounds, there is sufficient concern about exposures. Thus, further research needs to be conducted on the relationship of BPA substitutes to obesity to inform on the potential public health measures that can be implemented to minimize exposures.

Female Collegiate Dancers' Physical Fitness across Their Four-Year Programs: A Prospective Analysis.

Dance is physically demanding, requiring physical fitness (PF) that includes upper body, lower body, core fitness, and balance for successful performance. Whether PF changes as dancers advance from when they enter (freshmen) to when they graduate from their collegiate program (seniors) is unclear. We prospectively compared collegiate dancers' freshman-to-senior PF. We recorded PF in regard to upper body strength endurance (push-ups), core strength endurance (front, left-side, right-side, and extensor plank hold times), lower body power (single leg hop-SLH-distances % height; Leg Symmetry Index: LSI = higher/lower × 100, %), and balance (anterior reach balance, % leg length, LL; LSI balance = higher/lower × 100, %) in 23 female collegiate dancers (freshman age = 18.2 ± 0.6 years). Repeated measures ANOVAs (p ≤ 0.05) were used to compare measures from freshman to senior years. Across their collegiate programs, dancers' PF remained unchanged. Specifically, their upper body strength endurance push-up numbers (p = 0.93), their core strength endurance plank times (left: p = 0.44, right: p = 0.67, front: p = 0.60, p = 0.22), their SLH distances (left: p = 0.44, right: p = 0.85), and their symmetry (p = 0.16) stayed similar. Also, dancers' right leg (p = 0.08) and left leg balance (p = 0.06) remained similar, with better balance symmetry (p < 0.001) in seniors. Overall, dancers' PF did not change across their collegiate programs. Thus, female dancers' freshman PF may be an adequate baseline reference measure when devising rehabilitation programs and determining readiness-to-return-to-activity post injury.

Plant-Based Alternatives to Cheese Formulated Using Blends of Zein and Chickpea Protein Ingredients.

In this study, zein protein isolate (ZPI) and chickpea protein concentrate (CPC) ingredients were used to formulate five plant-based cheese alternatives. Ingredient ratios based on protein contributions of 0:100, 25:75, 50:50, 75:25 and 100:0 from ZPI and CPC, respectively, were used. Formulations were developed at pH ~4.5, with a moisture target of 59%. Shea butter was used to target 15% fat, while tapioca starch was added to target the same carbohydrate content for all samples. Microstructural analysis showed differences among samples, with samples containing ZPI displaying a protein-rich layer surrounding the fat globules. Schreiber meltability and dynamic low amplitude oscillatory shear rheological analyses showed that increasing the proportion of ZPI was associated with increasing meltability and greater ability to flow at high temperatures. In addition, the sample containing only CPC showed the highest adhesiveness, springiness and cohesiveness values from the texture profile analysis, while the sample containing only ZPI exhibited the highest hardness. Furthermore, stretchability increased with increasing ZPI proportions. This work will help understanding of the role and potential of promising plant-protein-ingredient blends in formulating plant-based alternatives to cheese with desirable functional properties.

Structural, Binding and Functional Properties of Milk Protein-Polyphenol Systems: A Review.

Polyphenols (PP) are linked to health benefits (e.g., prevention of cancer, cardiovascular disease and obesity), which are mainly attributed to their antioxidant activity. During digestion, PP are oxidised to a significant degree reducing their bio-functionality. In recent years, the potential of various milk protein systems, including ß-casein micelles, ß-lactoglobulin aggregates, blood serum albumin aggregates, native casein micelles and re-assembled casein micelles, to bind and protect PP have been investigated. These studies have yet to be systematically reviewed. The functional properties of the milk protein-PP systems depend on the type and concentration of both PP and protein, as well as the structure of the resultant complexes, with environmental and processing factors also having an influence. Milk protein systems protect PP from degradation during digestion, resulting in a higher bioaccessibility and bioavailability, which improve the functional properties of PP upon consumption. This review compares different milk protein systems in terms of physicochemical properties, PP binding performance and ability to enhance the bio-functional properties of PP. The goal is to provide a comprehensive overview on the structural, binding, and functional properties of milk protein-polyphenol systems. It is concluded that milk protein complexes function effectively as delivery systems for PP, protecting PP from oxidation during digestion.

Pilot study to explore girls' lacrosse players' attitudes toward headgear.

Headgear adoption is a controversial issue in girls' lacrosse due to concerns that headgear use will facilitate greater risk-taking by players and contribute to more aggressive game play behaviours. The purpose of this pilot study was to evaluate high school girls' lacrosse players' attitudes towards headgear before and after a season of use. Twenty-five high school girls' lacrosse athletes wore headgear for one competitive season and completed a pre- and post-season survey. The survey evaluated players' attitudes towards headgear use, with Aggressiveness, and Anger scales. Wilcoxon ranked tests were conducted to compare scores pre- and post-season. Players' attitude towards headgear largely remained unchanged and "neutral" after a season of wearing headgear. Players endorsed slightly greater agreement for three Headgear survey items post-season compared to pre-season: " … headgear allows me to be more aggressive … " (p = .01), " … players should wear more protective equipment " (p = .04) and " … wearing headgear increases how often I am hit in the head … " (p = .04). However, Aggressiveness and Anger scale scores were not changed following headgear use. Our findings suggest the perception of headgear use in high school girls' lacrosse is complex and could be associated with minor perceived changes in game play behaviours.

Footwear Type and Testing Environment Do Not Affect Baseline Modified Balance Error Scoring System Performance Among Middle School Athletes.

CONTEXT: Limited evidence exists to demonstrate the effect of extrinsic factors, such as footwear worn or the testing environment, on performance of the modified balance error scoring system (mBESS) in the middle school age (10-14 y) population. Therefore, the purpose of our study was to investigate the effect of footwear types and testing environments on performance of the mBESS by middle school athletes. DESIGN: Cross-sectional. METHODS: In total, 2667 middle school athletes (55.9% boys and 44.1% girls; age = 12.3 [0.94] y) were administered the mBESS while wearing their self-selected footwear (barefoot, cleats, or shoes) either indoors (basketball court) or outdoors (football field or track). The number of errors committed (range = 0-10) during the double-leg, single-leg, and tandem stances of the mBESS were summed to calculate a total score (range = 0-30). Kruskal-Wallis tests were used to assess for differences among the footwear groups for each mBESS stance and the total score. Mann-Whitney U tests with calculated nonparametric effect sizes (r) were used to assess for differences between the footwear groups and testing environments when appropriate. RESULTS: There were significant differences for the number of committed errors among the footwear groups in the single-leg (P < .001) and tandem (P < .001) stances of the mBESS and mBESS total scores (P < .001). Significantly fewer errors (better) were committed while wearing shoes compared with other footwear in the single-leg and tandem stances of the mBESS (Ps ≤ .032, r = .07-.13). Participants assessed indoors committed significantly fewer errors than those assessed outdoors in each stance of the mBESS (Ps ≤ .022, r = .04-.14). Lower (better) mBESS total scores were observed for participants while wearing shoes (Ps ≤ .002, r = .10-.15) or assessed indoors (P = .001, r = .14). CONCLUSIONS: Although our data suggest that the type of footwear worn and the testing environment have a significant effect on mBESS scores of middle school athletes, the magnitudes of these differences are negligible.

Factors Influencing Motivation to Perform Mental and Physical Tasks During the Initial Lockdown Period of the COVID-19.

Drastic changes to lifestyles have occurred during the COVID-19 pandemic. An unintended consequence of stay at home orders is increased isolation and less social interaction for many people. For overall wellbeing it is important to stay both physically and mentally active; however, for many individual's motivation may be a barrier. There are non-modifiable (e.g. sex, age, personality, infection rates in the area) and modifiable factors (e.g. physical activity, diet, sleep) that may be associated with motivation to perform physical and mental tasks. We collected data from 794 subjects using an online survey between April 13th to May 3rd of 2020. Survey questionnaires included demographics, personality traits, diet, sleep, physical activity levels, mental workload and motivation to perform mental and physical tasks. Multiple linear regression analyses were used to assess the association between non-modifiable and modifiable variables on motivation to perform mental and physical tasks. The results of our analyses suggest that those who reported a higher quality of diet (REAP-S score), exercised vigorously, and reduced their sedentary time, reported higher motivation to perform both mental and physical tasks. Those who were employed and had higher grit were more motivated to perform physical tasks. Lower trait physical energy was associated with greater motivation to perform mental tasks. Our findings support that during challenging times, such as the COVID-19 pandemic, it is important for healthcare practitioners to emphasize the importance healthy lifestyle behaviors to prevent individuals from experiencing a lack of motivation to perform both mental and physical tasks. Future research should focus on trying to determine the directionality of the relationship between specific healthy lifestyle behaviors and motivation.

Dance, Music, and Social Conversation Program Participation Positively Affects Physical and Mental Health in Community-Dwelling Older Adults: A Randomized Controlled Trial.

INTRODUCTION: As the world population ages, practitioners use community-engaged interventions to help older adults stay healthy. Engaging in arts programs (e.g., dance or music) reportedly improves physical and mental health, but little research exists examining these effects in community-dwelling older adults. Our purposes were to examine how taking part in 10-week, twice per week community arts programs (dance and music) and control (social conversation) affected physical and mental health in community-dwelling older adults and their perceptions after program participation.
Methods: In this randomized controlled trial, 64 older adults over 65 years of age (71.3 ± 4.6 years, 166.9 ± 8.3 cm, 78.1 ± 18.1 kg) took part in community-engaged arts programs: ballroom dance (n = 23), music (ukulele-playing, n = 17), or control (social conversation n = 24), two times per week for 10 weeks. Participants' physical health using the Short Physical Performance Battery (SPPB; score 0 = worst to 12 = best) and mental health using the Montreal Cognitive Assessment (MoCA; score = 0 to 30, where less than 26 = normal) were tested three times: 1. before (pre), 2. at the end of 10 weeks (post-1), and 3. 1 month after intervention (post-2). Separate 3 (group) x 3 (time) ANOVAs and adjusted Bonferroni pairwise comparisons as appropriate examined changes across groups and time. Focus group interviews and surveys were audio recorded, transcribed, and analyzed using inductive thematic analyses to examine participants' perceptions.
Results: Across all groups, participants had an 87.8% attendance and an 87.5% retention rate. Participants' SPPB performance improved over time (pre = 10.5 ± 1.4, post-1 = 10.7 ± 1.3, post-2 = 11.3 ± 1.0; p < 0.001), but similarly across groups (p = 0.40). Post-hoc analyses revealed that performance improved from pre to post-1 (p = 0.002) and pre to post-2 (p < 0.001). Participants' cognition improved over time (pre = 26.3 ± 2.8, post-1 = 27.3 ± 2.6, post-2 = 27.5 ± 2.5, p < 0.001), and similarly across groups (p = 0.60). Post-hoc analyses revealed that cognition improved from pre- to post-1 (p = 0.002), and pre- to post-2 (p = 0.001). Participants consistently mentioned increased social engagement as the major reason for participation.
Conclusions: Overall, taking part in community-engaged arts (dance and music) and social conversation programs positively influenced physical and mental health in older adults. Still, as all groups improved equally, the results may partly be due to participants having normal physical and mental function pre-participation and due to them learning the test over time. These study findings imply that providing fun and free community-engaged programs that empower participants to be more engaged can positively influence physical and mental health and promote successful aging in older adults.

The Clinical Utility of the Child SCAT5 for Acute Concussion Assessment.

BACKGROUND: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) was developed to evaluate children between 5 and 12 years of age for a suspected concussion. However, limited empirical evidence exists demonstrating the value of the Child SCAT5 for acute concussion assessment. Therefore, the purpose of our study was to examine differences and assess the diagnostic properties of Child SCAT5 scores among concussed and non-concussed middle school children on the same day as a suspected concussion. METHODS: Our participants included 34 concussed (21 boys, 13 girls; age = 12.8 ± 0.86 years) and 44 non-concussed (31 boys, 13 girls; age = 12.4 ± 0.76 years) middle school children who were administered the Child SCAT5 upon suspicion of a concussion. Child SCAT5 scores were calculated from the symptom evaluation (total symptoms, total severity), child version of the Standardized Assessment of Concussion (SAC-C), and modified Balance Error Scoring System (mBESS). The Child SCAT5 scores were compared between the concussed and non-concussed groups. Non-parametric effect sizes ([Formula: see text]) were calculated to assess the magnitude of difference for each comparison. The diagnostic properties (sensitivity, specificity, diagnostic accuracy, predictive values, likelihood ratios, and diagnostic odds ratio) of each Child SCAT5 score were also calculated. RESULTS: Concussed children endorsed more symptoms (p < 0.001, [Formula: see text]=0.45), higher symptom severity (p < 0.001, [Formula: see text]=0.44), and had higher double leg (p = 0.046, [Formula: see text]=0.23), single leg (p = 0.035, [Formula: see text]=0.24), and total scores (p = 0.022, [Formula: see text]=0.26) for the mBESS than the non-concussed children. No significant differences were observed for the SAC-C scores (p's ≥ 0.542). The quantity and severity of endorsed symptoms had the best diagnostic accuracy (AUC = 0.76-0.77), negative predictive values (NPV = 0.84-0.88), and negative likelihood ratios (-LR = 0.22-0.31) of the Child SCAT5 scores. CONCLUSIONS: Clinicians should prioritize interpretation of the symptom evaluation form of the Child SCAT5 as it was the most effective component for differentiating between concussed and non-concussed middle school children on the same day as a suspected concussion.

Association of headgear mandate and concussion injury rates in girls' high school lacrosse.

OBJECTIVES: Headgear use is a controversial issue in girls' lacrosse. We compared concussion rates among high school lacrosse players in an American state with a headgear mandate (HM) to states without an HM. METHODS: Participants included high schools with girls' lacrosse programmes in the USA. Certified athletic trainers reported athlete exposure (AE) and injury data via the National Athletic Treatment, Injury and Outcomes Network during the 2019-2021 seasons. The HM cohort was inclusive of high schools from the state of Florida, which mandates the use of ASTM standard F3137 headgear, while the non-HM (NHM) cohort was inclusive of high schools in 31 states without a state-wide HM. Incidence rate ratios (IRRs) and 95% CIs were calculated. RESULTS: 141 concussions (HM: 25; NHM: 116) and 357 225 AEs were reported (HM: 91 074 AEs; NHM: 266 151 AEs) across all games and practices for 289 total school seasons (HM: 96; NHM: 193). Overall, the concussion injury rate per 1000 AEs was higher in the NHM cohort (0.44) than the HM cohort (0.27) (IRR=1.59, 95% CI: 1.03 to 2.45). The IRR was higher for the NHM cohort during games (1.74, 95% CI: 1.00 to 3.02) but not for practices (1.42, 95% CI: 0.71 to 2.83). CONCLUSIONS: These findings suggest a statewide HM for high school girls' lacrosse is associated with a lower concussion rate than playing in a state without an HM. Statewide mandates requiring ASTM standard F3137 headgear should be considered to reduce the risk of concussion.

Interpreting change on the Child Sport Concussion Assessment Tool 5th Edition.

OBJECTIVES: The purpose of this study was to examine the one-year test-retest reliability of Child Sport Concussion Assessment Tool 5th Edition component scores and provide recommendations for interpreting change on its component tests. DESIGN: A prospective cohort study was conducted across two years via the Advancing Healthcare Initiatives for Underserved Students (ACHIEVES) Project. METHODS: Participants were 219 children (ages 11 to 12, M = 11.7, SD = 0.5; 52.1% girls, 47.9% boys) playing competitive school-sponsored sports in nine middle schools across a large public-school division in Virginia, USA during the 2017-2018 and 2018-2019 academic years. Athletic Trainers administered the baseline Child Sport Concussion Assessment Tool 5th Edition each year. RESULTS: Test-retest reliability estimates for each Child Sport Concussion Assessment Tool 5th Edition component were low to moderate (ICCs=0.40-0.55). A minority of middle school athletes (15-31%) scored within a different normative classification range upon re-assessment. The following test-retest difference scores occurred in 20% or fewer of the sample: +5 total symptoms, +7 symptom severity, -2 in the Standardized Assessment of Concussion - Child Version total score, and +4 total Modified Balance Error Scoring System balance errors. CONCLUSIONS: Child Sport Concussion Assessment Tool 5th Edition component scores had poor to moderate test-retest reliability coefficients over a one-year period, though most children were classified as falling within the same interpretive category upon re-testing based on local norms. We report the raw score changes that were uncommon in our sample of uninjured children to help clinicians identify changes that might be clinically meaningful.