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Context: Omega-3 in pasture-fed beef and lamb is related to its availability in the forage species grazed. The variation in omega-3 content of several forages has been examined in the USA and UK, but not in south-eastern Australia across different stages of maturity. Aims: This study aimed to determine the change in omega-3, at different stages of plant development, in four species of forage commonly grazed by ruminants in south-eastern Australia. Methods: Four species, oats (Avena sativa L. cv. Eurabbie), annual ryegrass (Lolium perenne L. cv. Rambo), phalaris (Phalaris aquatica L. cv HoldfastGT) and subterranean clover (Trifolium subterrraneum L. cv. Coolamon) were grown in a replicated pot trial and harvested at seven stages of maturity corresponding to early vegetative, late vegetative, stem elongation, boot, anthesis, soft dough and ripening for oats, phalaris and ryegrass, or relative to day of flowering in clover. Proximate analysis and the concentration of fatty acids including C18:3n-3 and C18:2n-6 as well as the ratio of n-6:n-3 was determined. Key results: The mean (±s.e.) proportion of C18:3n-3 was highest in clover (50.6 ± 0.8), and higher in ryegrass (45.1 ± 0.5) and phalaris (44.0 ± 0.6) compared with oats (39.4 ± 0.5). Omega-3 proportion decreased with increasing maturity for oats (13.9 ± 0.86 vs 64.3 ± 0.68), ryegrass (17.3 ± 0.86 vs 68.2 ± 0.65) and phalaris (21.6 ± 1.63 vs 65.1 ± 0.79) but not to the same extent for sub clover (41.5 ± 1.38 vs 57.4 ± 0.79). The proportion of omega-3 was positively correlated with crude protein content. Conclusions: Omega-3 levels decreased in forages during development and was positively related to crude protein content, which is likely associated with total leaf chloroplasts. Although crude protein content remained higher for clover compared with other species, this did not translate to a higher proportion of omega-3 for any crude protein level. Implications: Grazing forages at earlier stages of maturity and maximising the amount of crude protein available for growth will increase the amount of omega-3 in plant material. The availability of this omega-3 for incorporation into meat and milk should be examined. Omega-3 levels in pasture-fed beef and lamb are related to its availability in the forage plants grazed by livestock. We measured how omega-3 levels changed at different stages of plant development in four species of forages in south-eastern Australia. Omega-3 was richest in clover and least abundant in oats, diminishing as plants matured. Grazing forages at earlier developmental stages and maximising the amount of crude protein available for growth will increase the amount of omega-3 in plant material. [ABSTRACT FROM AUTHOR]

Background: After an anterior cruciate ligament reconstruction (ACLR), only 47% of military members return to full duty, possibly due to persistent neuromuscular asymmetries. Psychological factors may also contribute to reduced return to duty in military members., Hypothesis: Psychological factors and time since surgery would be associated negatively with neuromuscular asymmetries, asymmetries would be greater in cadets postsurgery when compared with healthy controls, and asymmetries would be greater at earlier timepoints after ACLR., Study Design: Case control., Level of Evidence: Level 4., Methods: This study examined the relationship between psychological factors and time since surgery with neuromuscular asymmetry, compared neuromuscular asymmetries between cadets with and without a history of ACLR, and explored differences in neuromuscular asymmetries at different timepoints in cadets with a history of ACLR. A total of 37 cadets post-ACLR (18.3 ± 9 months) and 28 controls participated. Psychological factors were assessed using the Tampa Scale of Kinesiophobia and Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI). Participants performed a drop-jump landing, joint positioning sense (JPS), and isometric quadriceps strength testing. Peak vertical ground-reaction forces (vGRF), absolute angle of replication, peak quadriceps torque, rate of torque development (RTD), and RTD time torque interval 200 ms (TTI 200 ) were analyzed., Results: The ACL-RSI score was significantly related to limb symmetry index (LSI) peak quadriceps torque ( r = 0.617, P < 0.01), LSI RTD (r = 0.367, P = 0.05), and LSI TTI 200 (r = 0.0489, P < 0.01), but not time since surgery, JPS, or LSI peak vGRF. Cadets with a history of ACLR had significantly lesser ACL-RSI scores and greater asymmetries compared with controls., Conclusion: Reduced psychological readiness was associated with increased neuromuscular asymmetries after ACLR., Clinical Relevance: Clinicians should assess psychological readiness during rehabilitation after ACLR., Competing Interests: The following author declared potential conflicts of interest: K.L.C. has received research grants from Department of Defense CDMRP and royalties from Springer.

Background: Static balance is often impaired in patients after ankle sprains. The ability to identify static balance impairments is dependent on an effective balance assessment tool. The Sway Balance Mobile Application (SWAY App) (Sway Medical, Tulsa, OK) uses a smart phone or tablet to assess postural sway during a modified Balance Error Scoring System (mBESS) assessment and shows promise as an accessible method to quantify changes in static balance after injury., Purpose: The primary purposes of this study were to determine the ability to differentiate between those with ankle sprain versus controls (construct validity) and ability to detect change over time (responsiveness) of a mBESS assessment using a mobile device application to evaluate static balance after an acute ankle sprain., Study Design: Case-control study., Methods: Twenty-two military academy Cadets with an acute ankle sprain and 20 healthy Cadets were enrolled in the study. All participants completed an assessment measuring self-reported function, ankle dorsiflexion range of motion (via the weightbearing lunge), dynamic balance, and static balance. Static balance measured with the mBESS using the SWAY App was validated against laboratory-based measures. Cadets with ankle sprains completed their assessment twice: once within two weeks of injury (baseline) and again after four weeks of rehabilitation that included balance training. Independent and paired t-tests were utilized to analyze differences over time and between groups. Effect sizes were calculated and relationships explored using Pearson's correlation coefficients., Results: The mBESS scores measured by the SWAY App were lower in participants with acute ankle sprains than healthy Cadets ( t = 3.15, p = 0.004). Injured participants improved their mBESS score measured by SWAY at four weeks following their initial assessments ( t = 3.31, p = 0.004; Baseline: 74.2 +/- 16.1, 4-weeks: 82.7 +/- 9.5). The mBESS measured by the SWAY App demonstrated moderate to good correlation with a laboratory measure of static balance ( r = -0.59, p \< 0.001)., Conclusion: The mBESS assessed with a mobile device application is a valid and responsive clinical tool for evaluating static balance. The tool demonstrated construct (known groups) validity detecting balance differences between a healthy and injured group, concurrent validity demonstrating moderate to good correlation with established laboratory measures, and responsiveness to changes in static balance in military Cadets during recovery from an acute ankle sprain., Level of Evidence: Level 3., Competing Interests: The authors report no conflicts of interest., (© The Author(s).)

Background: Concussions are often accompanied by balance disturbances. Clinically accurate evaluation systems are often expensive, large, and inaccessible to most clinicians. The Sway Balance Mobile Application (SWAY) is an accessible method to quantify balance changes., Purpose: To determine the known groups and convergent validity of the SWAY to assess balance after a concussion., Study Design: Case-Control Study., Methods: Twenty participants with acute concussion and twenty controls were recruited. At initial, one-week, and final return to activity (RTA) evaluations, all participants completed the Sports Concussion Assessment Tool (SCAT-5), and balance control measured by SWAY mBESS and NeuroCom Balance Master Sensory Organization Test (SOT). Mixed model ANOVAs were used to detect differences in SWAY mBESS and NeuroCom SOT scores with time (initial, one-week, final RTA) as the within-subjects factor and group (concussed, healthy) as the between-subjects factor. Spearman's Rho correlations explored the associations between NeuroCom SOT scores, SWAY scores, SCAT-5 symptom scores, and time in days to final RTA., Results: The sampled population was predominantly male and age (20 ± 1), and BMI differences were insignificant between groups. The SWAY did not detect differences between healthy and concussed participants and did not detect change over time [F(2,40) = .114, p = 0.89; F(2,40)= .276, p =0.60]. When assessing the relationship between the SWAY and the SOT, no correlation was found at any time point (r = -0.317 to -0.062, p > 0.05). Time to RTA demonstrated a moderate correlation with both SCAT-5 symptom severity score (r = .693, p < 0.01) and SCAT-5 total symptom score (r = .611, p < 0.01) at the one-week follow-up., Conclusion: The SWAY mBESS does not appear to be a valid balance assessment for the concussed patient. The SWAY mBESS in patients with concussion failed to demonstrate convergent validity and did not demonstrate an ability to validate known groups. When assessing the time to final RTA, the one-week post-initial assessment SCAT-5 symptom severity and total scores may help determine the length of recovery in this population., Level of Evidence: Level 3., Competing Interests: The authors declare no conflicts of interest. This work was funded by the Telemedicine and Advanced Technology Research Center (TATRC) at the U.S. Army Medical Research and Development Command through the Advanced Medical Technology Initiative (AMTI). The views, opinions and/or findings contained in this research/presentation/publication are those of the author(s)/company and do not necessarily reflect the views of the Department of Defense and should not be construed as an official DoD/Army position, policy or decision unless so designated by other documentation. No official endorsement should be made. Reference herein to any specific commercial products, process, or service by trade name, trademark, manufacturer, or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favoring by the U.S. Government., (© The Author(s).)

Introduction: The U.S. Army is updating the physical fitness assessment for soldiers to the six-event Army Combat Fitness Test (ACFT). A paucity of data regarding the ACFT maximum deadlift (MDL) event, especially in military populations, has increased concern over the objectivity of the test. The reliability of scoring the MDL has not been established. It is unknown if grader professional experience impacts the reliability of scoring, and if so, what level of experience is required for reliable assessment. Performance and assessment of the MDL could impact military occupational selection, promotion, and retention within the Army. The purposes of this study were to determine the inter- and intra-rater reliabilities of raters with varying degrees of professional experience on scoring the MDL and to determine the relationships between load lifted, overall lift success, sex, and body mass index (BMI)., Methods: The design is a reliability study. Approval was granted by the Naval Medical Center-Portsmouth Institutional Review Board. Fifty-five healthy soldiers and cadets from the U.S. Military Academy were recruited. Participants completed one data collection session, performing one MDL attempt. The attempt was video recorded using three devices: two handheld tablets placed perpendicular to the sagittal and frontal planes recording at 240 Hz and one digital camera positioned at a 45° angle recording at 30 Hz. A reference standard was established through slow-motion analysis of the sagittal and frontal plane recordings. Six raters with varying degrees of professional experience viewed the 45° camera recordings at real-time speed independently, in a random order, on two separate occasions. Lift success was dichotomously assessed as successful or unsuccessful according to the MDL standards. Cohen's kappa was computed to determine inter- and intra-rater reliabilities among raters. Bivariate correlation was used to assess associations among load lifted, BMI, and sex. A chi-squared test of independence assessed the relationship between sex and overall lift success., Results: Inter-rater reliability between the six raters ranged from 0.29 to 0.69. Inter-rater reliability between the raters to the reference standard ranged from 0.28 to 0.61. Intra-rater reliability ranged from 0.51 to 0.84. Inter-rater reliability of raters who had attended a Training and Doctrine Command-approved ACFT certification course ranged from 0.51 to 0.66, while those who had not ranged from 0.34 to 0.46. BMI and sex were associated with load lifted (r = 0.405, P = .002; r = -0.727, P < .001, respectively). Overall lift success was not associated with load lifted (r = -0.047, P = .731). Overall lift success was not related to sex (χ2 = 0.271, P = .602)., Conclusion: Inter-rater reliability of the six raters ranged from poor to substantial, while intra-rater reliability ranged from moderate to excellent. Compared to a reference standard, inter-rater reliability ranged from poor to substantial. The wide range in consistency demonstrated in this study, both between and within raters, brings into question the current subjective methods used to grade the MDL. More research is needed to understand the most feasible, valid, and reliable way to assess performance standards like the MDL that may affect a soldier's career progression., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Traumatic shoulder instability is a common injury in athletes and military personnel. Surgical stabilization reduces recurrence, but athletes often return to sport before recovering upper extremity rotational strength and sport-specific abilities. Blood flow restriction (BFR) may stimulate muscle growth without the need for heavy resistance training post-surgically., Hypothesis/purpose: To observe changes in shoulder strength, self-reported function, upper extremity performance, and range of motion (ROM) in military cadets recovering from shoulder stabilization surgery who completed a standard rehabilitation program with six weeks of BFR training., Study Design: Prospective case series., Methods: Military cadets who underwent shoulder stabilization surgery completed six weeks of upper extremity BFR training, beginning post-op week six. Primary outcomes were shoulder isometric strength and patient-reported function assessed at 6-weeks, 12-weeks, and 6-months postoperatively. Secondary outcomes included shoulder ROM assessed at each timepoint and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), the Upper Extremity Y-Balance Test (UQYBT), and the Unilateral Seated Shotput Test (USPT) assessed at the six-month follow-up., Results: Twenty cadets performed an average 10.9 BFR training sessions over six weeks. Statistically significant and clinically meaningful increases in surgical extremity external rotation strength ( p < 0.001; mean difference, .049; 95% CI: .021, .077), abduction strength ( p < 0.001; mean difference, .079; 95% CI: .050, .108), and internal rotation strength ( p < 0.001; mean difference, .060; CI: .028, .093) occurred from six to 12 weeks postoperatively. Statistically significant and clinically meaningful improvements were reported on the Single Assessment Numeric Evaluation ( p < 0.001; mean difference, 17.7; CI: 9.4, 25.9) and Shoulder Pain and Disability Index ( p < 0.001; mean difference, -31.1; CI: -44.2, -18.0) from six to 12 weeks postoperatively. Additionally, over 70 percent of participants met reference values on two to three performance tests at 6-months., Conclusion: While the degree of improvement attributable to the addition of BFR is unknown, the clinically meaningful improvements in shoulder strength, self-reported function, and upper extremity performance warrant further exploration of BFR during upper extremity rehabilitation., Level of Evidence: 4, Case Series., Competing Interests: The authors have no relevant or material financial interests that relate to this study. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the United States Army or Department of Defense.