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Since the United States’ first woman began medical school less than two centuries ago, medicine has become increasingly gender diverse. Women now make up the current majority of medical students and are predominant in fields such as pediatrics, obstetrics and gynecology, child and adolescent psychiatry and neonatal-perinatal medicine. Despite this progress, representation of women in many medical subspecialties, such as orthopaedic surgery sports medicine and primary care sports medicine is still consistent with historic origins of gender inequality. In 2018, women made up only 5.3% of orthopaedic surgeons and 12.1% of orthopaedic surgery sports medicine residents and fellows. Similarly, data from 2019 suggest 27.2% of family medicine sports medicine physicians are women. Female representation in positions of leadership within these subspecialties highlight further inequalities. Through current initiatives to provide early exposure and mentorship to prospective residency applicants, there have been small advances in diversifying these fields. However, these advances have been largely inadequate for women of minority and marginalized groups. Adequate female representation is paramount to gain the benefits field diversification presents, including accessible representation, provider advocacy, prioritization of women’s health, mentorship, and diverse thought and innovation. By simultaneously analyzing the historic barriers facing women in operative and nonoperative fields of sports medicine, and the benefits of gender diversity for patient care, we can recommend actions necessary in promoting gender diversity moving forward.

Airborne murine coronavirus was assessed for its sensitivity to the vapors of chemicals commonly used to disinfect indoor surfaces. As a model for the chemical sensitivity of airborne SARS-CoV-2, the infectious potential of airborne Mouse Hepatitis Virus (MHV) was tracked in the presence of the following pure chemical vapors, each of which was below its permissible exposure limit (PEL) as regulated by the US National Institute of Occupational Safety and Health (NIOSH): < 50 ppmv for glycol; < 1ppmv for HOCl; and, < 1ppmv for H2O2. Along with its growth media, infectious MHV was aerosolized in a particle size distribution between 0.5 μm and 3.2 μm into a sealed, dark, 9 m3 chamber maintained at 220C and 60% RH, including levels of chemical vapors maintained below their respective PELs. As judged by the TCID50 of airborne MHV collected by condensation, this airborne virus was rapidly inactivated by HOCl vapor, incurring an average of 99% infectious potential loss after 16 ± 4 minutes exposure to ≤0.2 ppmv HOCl. Airborne MHV responded with a 99% loss of infectious potential in 38 ± 10 minutes of exposure to ≤0.9 ppmv H2O2; and, a 99% loss of infectious potential in 33 ± 15 minutes when exposed to a gas-phase dipropylene glycol blend ≤20 ppmv as TVOC. The juxtaposition of quantitative RT-PCR and TCID50 responses suggest that even low levels of gas-phase HOCl exposures can damage the genome of airborne coronavirus in relatively short time frames (c.a. < 5 mins).

The Male Athlete Triad is a medical syndrome most common in adolescent and young adult male athletes in sports that emphasize a lean physique, especially endurance and weight-class athletes. The 3 interrelated conditions of the Male Athlete Triad occur on spectrums of energy deficiency/low energy availability (EA), suppression of the hypothalamic-pituitary-gonadal axis, and impaired bone health, ranging from optimal health to clinically relevant outcomes of energy deficiency/low EA with or without disordered eating or eating disorder, functional hypogonadotropic hypogonadism, and osteoporosis or low bone mineral density with or without bone stress injury (BSI). Because of the importance of bone mass acquisition and health concerns in adolescence, screening is recommended during this time period in the at-risk male athlete. Diagnosis of the Male Athlete Triad is best accomplished by a multidisciplinary medical team. Clearance and return-to-play guidelines are recommended to optimize prevention and treatment. Evidence-based risk assessment protocols for the male athlete at risk for the Male Athlete Triad have been shown to be predictive for BSI and impaired bone health and should be encouraged. Improving energetic status through optimal fueling is the mainstay of treatment. A Roundtable on the Male Athlete Triad was convened by the Female and Male Athlete Triad Coalition in conjunction with the 64th Annual Meeting of the American College of Sports Medicine in Denver, Colorado, in May of 2017. In this second article, the latest clinical research to support current models of screening, diagnosis, and management for at-risk male athlete is reviewed with evidence-based recommendations.

Despite the worldwide popularity of running as a sport for children, relatively little is known about its impact on injury and illness. Available studies have focused on adolescent athletes, but these findings may not be applicable to preadolescent and pubescent athletes. To date, there are no evidence or consensus-based guidelines identifying risk factors for injury and illness in youth runners, and current recommendations regarding suitable running distances for youth runners at different ages are opinion based. The International Committee Consensus Work Group convened to evaluate the current science, identify knowledge gaps, categorise risk factors for injury/illness and provide recommendations regarding training, nutrition and participation for youth runners.

Background: Bone stress injury (BSI) is a common reason for missed practices and competitions in elite track and field runners. Hypothesis: It was hypothesized that, after accounting for medical risk factors, higher plantar loading during running, walking, and athletic movements would predict the risk of future BSI in elite collegiate runners. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 39 elite collegiate runners (24 male, 15 female) were evaluated during the 2014-2015 academic year to determine the degree to which plantar pressure data and medical history (including Female and Male Athlete Triad risk factors) could predict subsequent BSI. Runners completed athletic movements while plantar pressures and contact areas in 7 key areas of the foot were recorded, and the measurements were reported overall and by specific foot area. Regression models were constructed to determine factors related to incident BSI. Results: Twenty-one runners (12 male, 9 female) sustained ≥1 incident BSI during the study period. Four regression models incorporating both plantar pressure measurements and medical risk factors were able to predict the subsequent occurrence of (A) BSIs in female runners, (B) BSIs in male runners, (C) multiple BSIs in either male or female runners, and (D) foot BSIs in female runners. Model A used maximum mean pressure (MMP) under the first metatarsal during a jump takeoff and only misclassified 1 female with no BSI. Model B used increased impulses under the hindfoot and second through fifth distal metatarsals while walking, and under the lesser toes during a cutting task, correctly categorizing 83.3% of male runners. Model C used higher medial midfoot peak pressure during a shuttle run and triad cumulative risk scores and correctly categorized 93.3% of runners who did not incur multiple BSIs and 66.7% of those who did. Model D included lower hindfoot impulses in the shuttle run and higher first metatarsal MMP during treadmill walking to correctly predict the subsequent occurrence of a foot BSI for 75% of women and 100% without. Conclusion: The models collectively suggested that higher plantar pressure may contribute to risk for BSI.

Bone stress injury (BSI) of the tibia, a spectrum of impairments that include conditions commonly referred to as medial tibial stress syndrome (MTSS), tibial stress reaction, and tibial stress fracture, is relatively common in athletes of various ages and levels of competition. While simple rest from the offending activities remains the primary method of treatment, identification of nutritional, hormonal, and biomechanical risk factors is crucial to prevent persistent or recurrent injury. Perhaps the most basic and important mechanical risk factor, especially in those with chronic or recurrent injury, may be abnormalities in gait and ankle flexibility, which can range from subtle to severe. While magnetic resonance imaging-based (MRI) injury grading can provide a framework for expected healing time, treatment must be individualized and evolution of a patient’s symptoms should guide the progression to return to sport after a prescribed period of rest. The vast majority of tibial BSIs can be managed nonoperatively and surgery is largely reserved for those who have undergone exhaustive conservative management without success, those with multiple recurrences, or high-level competitive athletes with the most severe grades of injury. The current review aims to highlight current concepts in the treatment of tibial BSI, with a particular focus on the high-risk population of adolescent athletes.

PURPOSE OF REVIEW: This review article seeks to highlight common youth athlete knee conditions due to overuse or trauma and elucidate differences from the adult populations. RECENT FINDINGS: Overuse conditions presented include apophysitis, osteochondritis dissecans plica syndrome, and discoid meniscus. Traumatic conditions presented include patellar instability, patellar sleeve fracture, and patellofemoral osteochondral fractures. SUMMARY: Knee injuries affect a significant proportion of youth athletes. These injuries place athletes at higher risk of chronic pain and potentially osteoarthritis. We have reviewed common overuse and traumatic knee injuries and differentiating factors between the adult population to improve and expedite the diagnosis, treatment, and prognosis for youth athletes with knee injuries.

Objectives: To describe demographic and presenting clinical characteristics, diagnostic features, treatment approaches, and clinical outcomes of adolescent tarsal navicular BSI’s. Methods: A retrospective chart review of patients with tarsal navicular BSIs was performed at eight academic centers. Diagnosis was confirmed by radiologic imaging in all cases. The following variables were collected utilizing a REDCap database and analyzed with basic descriptive and comparative statistics: age, sex, primary sport, physical exam (PE) findings, diagnostic imaging modality, treatment modalities, surgical technique (when applicable), time of protected weight-bearing, time to running, and time to return to sport. Results: 110 patients (mean age: 14.7 years +/-2.7 years; 65% female) met inclusion criteria, 103 (94%) of whom reported a primary sport, most commonly cross country/track and field (33%) and gymnastics/dance (27%). Common PE findings included navicular tenderness (96%), pain with walking (89%), and pain with resisted inversion (55%). Both x-ray and MRI were obtained in the majority of patients (91%), while CT was obtained for 30%. A radiologically detectable fracture line was present in 44%, most commonly on the dorsal navicular cortex. Non-operative treatment was successful in 85% of patients, consisting of protective boot (79%) or cast (21%). Operative treatment was pursued for 15% of patients, with 73% treated with open reduction internal fixation and 27% undergoing percutaneous screw fixation. All operative patients underwent fixation with either 1 (50%) or 2 screws (50%). Bone grafting was performed in 5 patients (31%). Significant differences between non-operative and operative cohorts included presence of fracture line (38% vs. 88%, PConclusions: Adolescent tarsal navicular BSIs occur most commonly in sports involving repetitive loading, such as cross country, track and field, gymnastics, and dance. The most common PE findings are navicular tenderness to palpation, pain with walking, and pain with resisted inversion. Patients that ultimately require surgical treatment were more likely to have a radiologic fracture line, prolonged return to weightbearing, running and sport than those successfully treated non-operatively. [Table: see text][Table: see text]

Background: The female athlete triad (Triad) has been associated with increased risk of bone stress injury (BSI) in certain populations. Purpose: The purpose of this study is to evaluate the prevalence of Triad risk factors and identify hormonal and extrinsic factors that may influence Triad risk in high school (HS) distance runners. Methods: Thirty-nine female HS distance runners completed a questionnaire, which included disordered eating (DE)/eating disorder (ED), menstrual irregularities, BSI history, and height/weight. Serum labs were obtained, including ferritin, 25-hydroxyvitamin D, estradiol, insulin-like growth factor, and free T3. Runners completed dual-energy x-ray absorptiometry to measure bone mineral density (BMD) using Z-scores that are age, sex and ethnicity-matched. Body fat percentage was also obtained. A risk score was then calculated using energy availability (EA), body mass index (BMI), age of menarche, oligomenorrhea, BMD, and history of BSI. The statistical model used was Spearman correlation coefficient. P-values

Background: Increased neck strength may be a protective factor for reducing concussions in youth athletes. However, little research exists regarding validated neck strength training methods among this demographic. Purpose: To determine whether a 7-week neck strength training period is sufficient to achieve significant gains in neck strength and size amongst high school football players. Additionally, to assess if increased neck strength influences concussion outcomes. Methods: This study enrolled 54 male high school football players, ages 14-17, in a 7-week strength training protocol in which neck exercises were incorporated into preseason strength and conditioning workouts (figure 1). Pre- and post-neck strength was assessed in four directions: forward flexion (FF), extension (EXT), right lateral flexion (RLF) and left lateral flexion (LLF). Strength was measured as maximal isometric head pressure applied into a pre-inflated sphygmomanometer cuff (figure 2). Concussion totals from the subsequent 2018 season were compared with totals from the 2017 and 2016 seasons per data obtained from the team’s athletic trainer. Results: Fifty athletes in total were analyzed; 4/54 athletes did not complete final testing due to scheduling conflicts. A two sample t-test of neck circumferences revealed a statistically significant increase of 0.37 cm from pre- to post-neck strength training (p=0.0025, figure 3). Single sample strength t-test analysis (corrected for cuff pre-inflation) demonstrated a statistically significant post-test strength increase of 19.8% (FF), 11.0% (EX), 18.8% (RLF), and 18.0% (LLF) (pConclusion This study demonstrates that increases in neck size and strength can be achieved amongst high school athletes using easily implemented training methods during a 7-week preseason training period. The additional observation of reduced concussion outcomes is not conclusive, though these initial results are promising. Additional research is needed to investigate the potential of neck strengthening in modifying concussion risk. Funding provided by the Stanford Medical Scholars Fellowship Program [Figure: see text][Figure: see text][Figure: see text]

Background: The Female Athlete Triad (Triad) is the interrelationship of low energy availability, reproductive irregularities, and low bone mineral density. It is theorized that mental health illness can both contribute to and result from low energy availability. Limited data exists that describes the relationship between the Female Athlete Triad and mental health symptoms. Hypothesis/Purpose: The purpose of this study was to investigate the relationship between the Triad and mental health illness, specifically depression and anxiety symptoms, in high school athletes. Methods: This was a cross-sectional survey study of high school athletes distributed via social media with responses accepted from 12/30/20 – 2/15/21. Data was collected including age, sex, training history, menstrual history, history of bone stress injuries, and eating behaviors. The Female Athlete Triad Coalition Consensus Statement Cumulative Risk Assessment Tool was used to score athletes (range: 0-10 points) and to classify them as low-, moderate-, or high-risk for Female Athlete Triad. Mental health was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress Depression and Anxiety short form questionnaires. Mental health scores were scored as none, mild, moderate, or severe self-reported depressive or anxious symptoms. Ordinal logistic regressions were performed. Results: There were 78 self-reported female high school participants (mean age = 16). Depression symptoms were reported in 74% of participants (19% mild, 40% moderate, 15% severe). Anxiety symptoms were reported in 64% of participants (18% mild, 26% moderate, 21% severe). Triad risk assessment responses categorized participants as 45% low risk, 41% moderate risk, and 14% high risk of developing the Triad. Depression symptoms were significantly associated with increasing Triad risk assessment score: Odds Ratio (per 1 point Triad risk score) = 1.245 (1.004 – 1.544) ( p = .0462). Anxiety symptoms were also significantly associated with increasing Triad risk assessment score: Odds Ratio (per 1 point Triad risk score) = 1.264 (1.020 – 1.567) ( p = .0319). Conclusion: Anxiety and depression symptoms were both significantly associated with increasing Triad risk scores in this preliminary cross-sectional study. Notably, this study is limited by sampling bias. Further research is needed to explore the relationship between mental health illness and the Female Athlete Triad.

Violence researchers have highlighted a need to understand connections between campus characteristics and violent victimization among students. Responding to those calls, we systematically reviewed research examining the characteristics of secondary and post-secondary educational settings associated with sexual violence and related victimization experiences, including dating/intimate partner violence, stalking, bullying, hate crimes, and crime more broadly. We screened 1124 quantitative and qualitative records, 43 of which met the inclusion criteria for this systematic review. Evidence emerged for institution demographics, institution type, institution climate, institution financial characteristics, and educational characteristics being related to various forms of victimization; institution setting (urban vs. rural) was not associated with victimization. Additionally, evidence was observed for institution location and size/density. Some factors, including institution type and campus demographics, operated differently for different forms of victimization. We highlight limitations of existing data, including variability in the measurement of victimization outcomes, lack of power to detect differences at the campus level, and challenges of creating a database on victimization that contains campus identifiers. We also reinforce calls for more intersectional research, both in terms of the types of victimization experienced by students as well as in the disproportionate impact victimization may have on students with marginalized identities.

There appears a linear relationship between small increases in running speed and cardiovascular health benefits. Encouraging or coaching recreational runners to increase their running speed to derive these health benefits might be more effective if their joint level kinematic and kinetic strategy was understood. The aim of this investigation was to compare the peak sagittal plane motions, moments, and powers of the hip, knee and ankle at 85%, 100%, 115% and 130% of self-selected running speed. Overground running data were collected in 12 recreational runners (6 women, 6 men) with a full body marker set using a 12-camera Vicon MX system with an AMTI force plate. Kinematics and kinetics were analyzed with Vicon Nexus software. Participants chose to run at 2.6 ± 0.5 m/s (85%); 3.0 ± 0.5 m/s (100%); 3.3 ± 0.5 m/s (115%); and 3.7 ± 0.5 m/s (130%); these four speeds approximately correspond to 6:24-, 5:33-, 5:03-, and 4:30-min kilometer running paces. Running speed had a significant effect (P 0.05) on peak kinematic and kinetic variables of the hips, knees and ankles, with peak sagittal hip moments invariant (P 0.54) and the peak sagittal ankle power generation (P 0.0001) the most highly responsive variable. The timing of the peak sagittal extensor moments and powers at the hip, knee and ankle were distributed across stance in a sequential manner. This study shows that running speed affects lower limb joint kinematics and kinetics and suggests that specific intersegmental kinetic strategies might exist across the narrow range of running speeds.

Background: A multidisciplinary approach is an intrinsic part of the sports medicine management process as providers, therapists and athletic trainers frequently interact to deliver optimal care to athletes both in clinic and on the sideline. Establishing effective communication and engaging athletes in the decision making process as treatment plans are developed may help increase compliance and improve health outcomes. Gender preference of patients for their providers has been found to influence patient satisfaction and health outcomes but has not been studied in depth. Purpose: The purpose of this study was to systematically review the literature to identify and characterize young athletes’ gender preferences for their sports medicine providers. Methods: This review was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses Group (PRISMA) guidelines. Pubmed, Embase, CINAHL and PsycInfo databases were searched utilizing MeSH terms, with results limited to English-language publications from the year 1945 to present day. The investigators assessed study eligibility independently and limited to studies that had quantitative outcome measures related to gender preference and participants ≤ 22 years of age. The Appraisal Tool for Cross-Sectional Studies (AXIS) was utilized to assess studies for bias. Results: Six cross-sectional studies met the eligibility criteria. Across studies, there were a total of 2,159 participants with mean ages ranging from 14.7 to 21.0 years. Of the five studies that reported the gender of participants, 50.6% were female. Participants were more likely to have a preference for a gender-concordant sports medicine provider when their chief complaint was related to their genital region and/or their sexual health. Participants of both genders favored a female provider when the health issue pertained to behavioral and/or psychosocial health, such as depression. Female athletes preferred a female provider when the issue was related to body image and/or disordered eating. For strength and conditioning coaches, male athletes reported a strong preference for male providers, but female athletes did not express a gender preference. Two of the studies’ quality was categorized as “good” by the AXIS criteria and four were “fair”. Conclusions: Young athletes’ gender preference for their sports medicine providers is situation-dependent. However, there is a paucity of studies examining gender provider preferences in pediatric athletes. Further studies are necessary to address this void in the literature as this may impact health outcomes.

Background: Investigations of the female athlete triad (Triad) in high school athletes have found that 36% had low energy availability, 54% had menstrual abnormalities, and 16% had low bone mineral density (BMD). Limited data are available showing the prevalence of these risk factors in high school distance runners or regarding best practice on screening for the Triad in the adolescent population. Purpose: To (1) evaluate the prevalence of Triad risk factors and iron supplementation in high school distance runners and (2) pilot a screening tool for Triad risk score. Study Design: Descriptive epidemiology study. Methods: The study population included female high school athletes who participated in cross-country/track. Participants completed a survey including questions regarding dietary habits, menstrual history, and bone stress injury (BSI) history. They then underwent evaluation of 25-hydroxyvitamin D, free triiodothyronine (T3), and dual-energy x-ray absorptiometry scan to measure body fat and BMD through use of age-, sex-, and ethnicity-matched Z scores. Triad scores were calculated. Relationships were analyzed using Spearman correlation coefficient. Results: There were 38 study participants (mean age, 16.9 years). Average body mass index was 19.8 kg/m2. Disordered eating or eating disorders were reported in 76.3% of runners; in addition, 23.7% reported delayed menarche, 45.9% had a history of amenorrhea or oligomenorrhea, 42.1% had low BMD ( Z score < –1.0), and 15.8% reported prior BSI. Low free T3 was significantly associated with higher Triad risk scores ( r S = –0.36; P = .028). More than 42% of athletes were supplementing iron. Conclusion: The prevalence of Triad risk factors in high school distance runners was high. Free T3 was inversely associated with Triad score, which may serve as an indicator of low energy availability. Nearly half of the athletes were using iron supplementation.

Objective To determine whether endometriosis ultimately results in an increased risk of embryonic aneuploidy. Design Retrospective cohort. Setting Infertility clinic. Patient(s) Patients participating in an in vitro fertilization (IVF) cycle from 2009-2015 using preimplantation genetic screening (PGS) who had endometriosis identified by surgical diagnosis or by ultrasound findings consistent with a persistent space-occupying disease whose sonographic appearance was consistent with endometriosis. Intervention(s) None. Main outcome measure(s) Rate of aneuploidy in endometriosis patients undergoing IVF compared to controls without endometriosis undergoing IVF. Result(s) There were 305 patients with endometriosis who produced 1,880 blastocysts that met the criteria for inclusion in the endometriosis group. The mean age of the patients with endometriosis was 36.1 ± 3.9 years. When the aneuploidy rates in patients with endometriosis and aneuploidy rates in patients without endometriosis were stratified by Society for Assisted Reproductive Technology age groups and compared, there were no statistically significant differences in the rate of aneuploidy (odds ratio 0.85; 95% confidence interval, 0.84-0.85). Conclusion(s) Patients with endometriosis undergoing IVF have aneuploidy rates equivalent to their age-matched peers in IVF population who do not have endometriosis.

The Proton Radius Puzzle refers to the ~7{\sigma} discrepancy that exists between the proton charge radius determined from muonic hydrogen and that determined from electronic hydrogen spectroscopy and electron-proton scattering. One possible partial resolution to the puzzle includes errors in the extraction of the proton radius from ep elastic scattering data. This possibility is made plausible by certain fits which extract a smaller proton radius from the scattering data consistent with that determined from muonic hydrogen. The reliability of some of these fits that yield a smaller proton radius was studied. We found that fits of form factor data with a truncated Taylor series expansion are unreliable and systematically give values for the proton radius that are too small. Additionally, a Taylor series expansion fit with a \chi^2_{reduced} ~ 1 is not a sufficient indication for a reliable result.