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Context Burnout is a psychological syndrome consisting of increased emotional exhaustion (EE), depersonalization (DP), and decreased personal accomplishment (PA). To date, examinations of burnout among athletic training students (ATS) is limited. Objective To determine prevalence and antecedents of burnout among ATS. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants Students enrolled in athletic training programs (ATP). Intervention(s) A survey assessed demographics, stressors, and burnout measured by the Maslach Burnout Inventory–Human Services Survey. Main Outcome Measure(s) Multiple regression analyses were used to determine relationships between variables. Results A total of 725 students participated. Most respondents were undergraduates (n = 582, 80%), female (n = 518, 71%), Caucasian (n = 564, 78%), and single (n = 422, 58%). Mean burnout scores for EE, DP, and PA were 33 ± 10, 17 ± 4.5, and 39 ± 5.8, respectively. Survey responses showed that 70.8% of undergraduate and 62.9% of graduate students reported high EE. All the students (100%) in both samples reported high DP. Undergraduates pursuing internships or residencies (b = −7.69, P < .001) and who were currently enrolled in non–Division I institutions (b = −2.90, P < .01) had decreased EE. Increased stress revealed increased EE (overall stress: b = 3.11, P < .001; social stress: b = 1.32, P < .05; class stress: b = 1.45, P < .05). Increases in clinical hours also related to increased EE (b = 1.49, P < .001). Those pursuing internships or residencies (b = −2.10, P < .05) and who were female (b = −2.10, P < .05) reported decreased DP. Being married (b = 2.87, P < .01), increased clinical hours (b = 0.77, P < .001), and social stress (b = 0.59, P < .05) resulted in increased DP. Increased PA was seen in students intending to pursue graduate education (b = 1.76, P < .05) and female students (b = 1.17, P < .05). Graduate students' stress levels revealed increased EE (b = 6.57, P < .01) and DP (b = 0.98, P < .05). Conclusions Differences exist between undergraduate and graduate burnout scores and associated predictors. Further research is needed to identify student responses to burnout.

Heileson, JL, Peterson, M, Adair, KE, and Funderburk, LK. Comparison of a sucrose-based and rice-based sports beverage on hydration status during a 19.3-km foot march in ROTC cadets. J Strength Cond Res 36(4): 1105-1110, 2022-The purpose of this field study was to determine whether a rice-based sport beverage (RB) maintains hydration status compared to a sucrose-based sports beverage (SB) during a load-bearing 19.3-km foot march. Eighteen Reserve Officer Training Corps (ROTC) cadets (male, n = 11; female, n = 7) were randomly assigned to consume either 2.84 L of an RB (carbohydrate, 114 g; sodium, 1306 mg) or SB (carbohydrate, 170 g; sodium, 1136 mg) throughout the duration of the foot march (temperature 14.44° C, humidity 50%). The sports beverages were distributed once before the event and then every 3.2 km for a total of 6 servings (0.47 L each). Pre- and post-urine specific gravity (USG) and body mass were used to assess hydration status. A survey was used to determine subjective ratings of perceived exertion and gastrointestinal (GI) discomfort. The level of significance was set at p0.05 for all analyses. Sixteen cadets completed the study. Based on USG, both beverages significantly improved hydration status (USG = 1.017 ± 0.010 pre-march vs. 1.011 ± 0.008 post-march, p = 0.04); however, there was no difference between groups (change in USG = -0.009 ± 0.012 for RB group vs. -0.003 ± 0.008 for SB group, p = 0.92). Ratings for perceived exertion and GI discomfort scores were similar between groups. In conclusion, the RB was as effective as the SB at maintaining hydration status and could potentially reduce GI discomfort. Athletes and military personnel concerned with ensuring appropriate hydration during moderate-intensity endurance events can achieve similar fluid balance from a rice-based sports beverage that is lower in calories, carbohydrate, and sugar.

Objective: Dietary guidelines from the Kidney Disease Outcomes Quality Initiative (KDOQI) and the United States Department of Agriculture (USDA) are advised to individuals with mid-spectrum (stages G3a and G3b) chronic kidney disease (CKD), yet typical diets in individuals with CKD remain understudied. The purpose of this study is to assess the self-reported dietary pattern of subjects with diagnosed mid-spectrum CKD and compare the normal dietary intakes to the KDOQI and USDA recommendations. Methods: A cross-sectional analysis of 20 participants with mid-spectrum CKD (n = 6 male [M]; n = 14 female [F]) was conducted to assess subjects’ self-reported dietary intakes for an average of 5 days. Micro and macronutrient analyses were compared to the KDOQI and USDA guidelines by sex to assess nutrition, and an exploratory stepwise multiple linear regression model was used to identify predictors of poor renal function;p-values were considered significant at the α = 0.05 level. Results: All subjects met the recommended caloric intake, but the average consumptions of protein (F = 0.86 ± 0.29g/kg body weight/day, M = 1.18 ± 0.45g/kg body weight/day), saturated fat (F = 12.17 ± 2.28%, M = 13.86 ± 1.20%), and sodium (F = 3.78 ± 2.51g, M = 4.21 ± 0.39g) were high (p < 0.05 for all). The average fiber intakewas low (F = 13.64 ± 4.09g, M = 14.82 ± 7.28g) as well as folate, vitamins D and K, zinc, and calcium intakes compared with the recommendations (p < 0.05 for all). The only significant contributor to higher renal function in the exploratory regression analysis was male sex (p = 0.035).

BackgroundThe use of tranexamic acid (TXA) has become increasingly prevalent for hemorrhage prevention in military trauma patients due to its known survival benefits. There is concern of increased venous thromboembolism (VTE) subsequent to receiving TXA. The purpose of this retrospective study was to determine the rate of VTE in severely injured military personnel during Operation Enduring Freedom (2009–2014).MethodsAn analysis of 859 military trauma patients from the 2009–2014 Department of Defense Trauma Registry included subjects with an injury severity score (ISS) >10 and a massive transfusion (MT) (>10 units of blood products in the first 24 hours). Outcomes included a documented VTE (eg, deep vein thrombosis (DVT) or pulmonary embolism (PE)) during the patient’s hospital course. Comparison between those who did/did not receive TXA was analyzed using three separate multiple regression analyses using listwise deletion, systematic replacement and multiple imputation.ResultsSubjects (n=620) met inclusion criteria with 27% (n=169) having a documented VTE. A total of 30% that received TXA had a documented VTE, 26% that did not receive TXA had a documented VTE and 43% (n=264, n=620) of the sample did not have TXA documented as either given or not given. Multiple regression analyses using listwise deletion and systematic replacement of the TXA variable demonstrated no difference in odds of VTE, whereas the multiple imputation analysis demonstrated a 3% increased odds of VTE, a9.4% increased odds of PE and 8.1% decreased odds of DVT with TXA administration.DiscussionTXA use with an ISS >10 and MT resuscitation had a 3% increased odds of VTE and an increased odds of PE, whereas the odds of DVT were found to be decreased after multiple imputation analysis. Further research on the long-term risks and benefits of TXA usage in the military population is recommended.Level of evidenceIV—therapeutic.

Novel approaches to ameliorating chronic kidney disease (CKD) are warranted as most patients are undiagnosed until they begin displaying symptoms of kidney failure. There is increasing evidence that a whole food plant-based (WFPB) diet may offer benefits that slow the progression of CKD, decrease the incidence cardiovascular disease, decrease rates of diabetes and obesity, and reduce inflammation and cholesterol, which in turn can delay kidney failure and the initiation of dialysis. While animal-based protein ingestion promotes an acidic environment, inflammation and renal hyperfiltration, study authors report plant-based protein can be alkaline-producing and anti-inflammatory and can contain renoprotective properties. Although there may be benefits to adopting a WFPB diet, macronutrient and micronutrient content should be carefully considered and adjusted to avoid malnutrition in CKD patients. Further research needs to be done in order to establish the biological plausibility and feasibility of a WFPB in individuals with diagnosed CKD.

The metabolically unhealthy normal weight (MUN) and metabolically healthy obese (MHO) phenotypes are abnormal metabolic states. The purpose of this study was to report the frequency of the strictly defined MHO and MUN phenotypes and the association between metabolic phenotype and 10-year Framingham cardiovascular disease (CVD) risk score using a sample taken from the 2015-2016 National Health and Nutrition Examination Survey.A cross-sectional sample of 2,316 participants age 18-79 years with complete metabolic health information were selected from the 2015-2016 dataset and included in the present analysis. Metabolic health was defined as the absence of all metabolic abnormalities as outlined by the National Cholesterol Education Program Adult Treatment Panel III criteria, excluding waist circumference. Obesity was defined as body mass index ≥30 kg/mFrequency of the MHO phenotype was 5.5% and the MUN was 44.3%. After adjustment for all covariates, Framingham CVD risk score was higher in the MUN (b = 1.74,p 0.001) and metabolically unhealthy obese (b = 3.32,p 0.001) phenotypes that used BMI to define obesity, and the MHO phenotype had a slight protective effect (b = -2.25,p 0.001) when waist circumference was used as the measure of obesity.Metabolically unhealthy phenotypes had higher CVD risk, while the MHO phenotype was not at any greater risk than the metabolically healthy normal weight.