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Background:Little is known about the adoption by athletic administrators (AAs) of exertional heat illness (EHI) policies, and the corresponding facilitators and barriers of such policies within high school athletics. This study describes the adoption of comprehensive EHI policies by high school AAs and explores factors influencing EHI policy adoption.Hypothesis:We hypothesized that <50% of AAs would report adoption of an EHI policy, and that the most common facilitator would be access to an athletic trainer (AT), whereas the most common barrier would be financial limitations.Study Design:Cross-sectional.Level of Evidence:Level 4.Methods:A total of 466 AAs (82.4% male; age, 48 ± 9 years) completed a validated online survey to assess EHI prevention and treatment policy adoption (11 components), as well as facilitators and barriers to policy implementation. Access to athletic training services was ascertained by matching the participants? zip codes with the Athletic Training Locations and Services Project. Policy adoption, facilitators, and barriers data are presented as summary statistics (proportions, interquartile range (IQR)). A Welch t test evaluated the association between access to athletic training services and EHI policy adoption.Results:Of the AAs surveyed, 77.9% (n = 363) reported adopting a written EHI policy. The median of EHI policy components adopted was 5 (IQR = 1,7), with only 5.6% (n = 26) of AAs reporting adoption of all policy components. AAs who had access to an AT (P = 0.04) were more likely to adopt a greater number of EHI-related policies, compared with those without access to an AT. An AT employed at the school was the most frequently reported facilitator (36.9%).Conclusion:Most AAs reported having written EHI policy components, and access to an AT resulted in a more comprehensive policy.Clinical Relevance:Employment of an AT within high school athletics may serve as a vital component in facilitating the adoption of comprehensive EHI policies.
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Introduction/Purpose Athletic administrators (AA) in U.S. high schools are uniquely positioned to provide guidance and endorsement for the prevention and management of common sport-related catastrophic injuries, such as the development of a spinal cord injury management (SCIM) policy. The purpose of this project was to evaluate AA’s knowledge of comprehensive SCIM policies in U.S. high schools. Secondarily, we aimed to investigate the factors, facilitators, and barriers to the development and adoption of comprehensive policies. Methods An online questionnaire was distributed to 6423 AA working in U.S.-based high school athletics, with 366 included in the final data analysis. The questionnaire evaluated AA’s knowledge of comprehensive SCIM policies addressing components of adoption, documentation, and communication. The questionnaire was developed based on the 2002 “National Athletic Trainers’ Association Position Statement: Acute Management of the Cervical Spine-Injured Athlete.” The questionnaire also inquired about facilitators and barriers to developing and adopting comprehensive policies. Proportions were calculated for policy adoption, and independent-samples t-tests evaluated the influence of athletic training services on comprehensive SCIM policies. Results About half of AA (49.2%, n = 180/366) reported having all recommended components of a written SCIM policy. AA who had access to an athletic trainer (yes = 62.9%, no = 18.1%, unknown = 19%) were more likely to have a comprehensive SCIM policy compared with those without access (80.6% vs 19.4%, χ21 = 7.091, P = 0.008, prevalence ratio = 1.24, 95% confidence interval = 1.03–1.50). The most commonly reported facilitator (49.9%) was “having a medical professional at the school,” and the main barrier (30.2%) was “my school would need more information, resources, assistance, etc.” Conclusions The findings identify areas for improvement in supporting the health and safety of children in high school participating in interscholastic athletics. Future dissemination and implementation research should develop strategies tailored to individual school community and need to improve SCIM policy adoption and implementation.
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Current methods of concussion assessment lack the objectivity and reliability to detect neurological injury. This multi-site study uses combinations of neuroimaging (diffusion tensor imaging and resting state functional MRI) and cognitive measures to train algorithms to detect the presence of concussion in university athletes. Athletes (29 concussed, 48 controls) completed symptom reports, brief cognitive evaluation, and MRI within 72 h of injury. Hierarchical linear regression compared groups on cognitive and neuroimaging measures while controlling for sex and data collection site. Logistic regression and support vector machine models were trained using cognitive and neuroimaging measures and evaluated for overall accuracy, sensitivity, and specificity. Concussed athletes reported greater symptoms than controls (∆R2 = 0.32, p < .001), and performed worse on tests of concentration (∆R2 = 0.07, p < .05) and delayed memory (∆R2 = 0.17, p < .001). Concussed athletes showed lower functional connectivity within the frontoparietal and primary visual networks (p < .05), but did not differ on mean diffusivity and fractional anisotropy. Of the cognitive measures, classifiers trained using delayed memory yielded the best performance with overall accuracy of 71%, though sensitivity was poor at 46%. Of the neuroimaging measures, classifiers trained using mean diffusivity yielded similar accuracy. Combining cognitive measures with mean diffusivity increased overall accuracy to 74% and sensitivity to 64%, comparable to the sensitivity of symptom report. Trained algorithms incorporating both MRI and cognitive performance variables can reliably detect common neurobiological sequelae of acute concussion. The integration of multi-modal data can serve as an objective, reliable tool in the assessment and diagnosis of concussion.
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- Journal Article (3)
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- English (3)