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Considering the frequency and magnitude of head impacts occurring during sport participation is important to guide prevention initiatives. Our purpose was to compare magnitude and frequency of lacrosse players’ head impacts based on anticipation level and impact activity. Lacrosse athletes (16 men, 15 women) wore xPatch sensors during games and practices that measured impact magnitude (linear and rotational accelerations) and frequency of video verified head impacts. The interaction between impact activity and preparedness was not significant, multivariate: F(8, 1,730) = ;1.03, p = ;.41, η2 = ;.01. Having a detailed understanding of the characteristics of head impacts could allow for focused interventions to reduce injury risk.

Context Sexual harassment is a concern in health care professions and on college campuses nationwide. Athletic trainers are health care professionals who work in close conjunction with athletes, coaches, officials, and other stakeholders, predisposing them to potential sexual harassment occurrences. Objective To examine the experiences of sexual harassment of professional master's ATSs during their clinical education experiences. Design Mixed-method study. Setting Online questionnaire. Patients or Other Participants Eighty-seven athletic training students (68 women, 19 males; age = 23.40 ± 1.85 years; 44 first-year students, 43 second-year students) currently enrolled in Commission on Accreditation of Athletic Training Education (CAATE)–accredited professional master's athletic training programs. Data Collection and Analysis We sent an online questionnaire to CAATE-accredited professional master's athletic training program directors, along with a recruitment email encouraging program directors to send the questionnaire to students currently enrolled in the programs they lead. We validated the questionnaire using expert and peer review. We used a general inductive approach to analyze the results and used multi-analyst triangulation and peer review to ensure credibility. Results Our study revealed that 28.70% of participants reported they felt as though they were subjected to sexual harassment behaviors during clinical education. Themes reported through recipients' accounts of sexual harassment defined a timeline that started when sexual harassment most commonly manifested through inappropriate comments, followed by ATSs having to adjust after incidents instead of the perpetrators, and finally ended with insufficient resolution in which victims felt the situations should have been handled differently. Conclusions Sexual harassment affects some professional master's ATSs in clinical education settings. Athletic training program administrators should educate students on clearly defined policies and procedures that will lead to resolution when sexual harassment occurs during athletic training clinical education.

Context Racial microaggressions can be comments or actions that are often unconsciously or unintentionally directed toward members of marginalized groups. Athletic trainers have been found to be prone to organizational conflict and harassment; however, no studies have investigated whether racial microaggressions occur during athletic training student (ATS) clinical education experiences. Objective To examine the existence of racial microaggressions directed toward ATSs during clinical education, specifically identifying the resources that existed for students who perceived they were encountering racial microaggressions. Design Qualitative study. Setting Commission on Accreditation of Athletic Training Education–accredited professional master's programs. Patients or Other Participants One hundred fifteen second-year master's students (80 female, 33 male, 1 nonbinary/third gender, 1 wished to not disclose; age = 23.67 ± 3.41 years). Data Collection and Analysis We created a questionnaire based on the purpose of the study and the current literature that we validated via peer and expert review before initiation of the study. We used peer review and multiple-analyst triangulation to provide credibility and analyzed the data with a phenomenological qualitative approach. Results Three main themes emerged: (1) participants experienced forms of microaggression including, but not limited to, microassaults, microinsults, microinvalidations, and stereotypes; (2) participants experienced a lack of action after racial microaggressions; and (3) participants experienced a period of career reconsideration during which they questioned entering the profession because of feeling uncomfortable and discriminated against. Conclusions To reduce the number of racial microaggressions that students face, athletic training education program administrators and preceptors should be educated on racial microaggressions, validate athletic training student emotions, encourage brave spaces where students can openly communicate about what is transpiring at clinical sites, safely identify aggressors, and remove students from harmful environments.

In the event of an acute cardiac event, on-field equipment removal is suggested, although it remains unknown how lacrosse equipment removal may alter time to first chest compression and time to first AED shock.To determine time to first chest compression and first AED shock in 2 chest exposure procedures with 2 different pad types.Crossover study Setting: Simulation laboratory Participants: Thirty-six athletic trainers (21 females, 15 males; age=30.58±7.81) Main Outcome Measures: Participants worked in pairs to provide 2 rescuer CPR intervention on a simulation manikin (QCPR manikin, Laerdal Medical, Wappingers Falls, NY) outfitted with lacrosse pads and helmet. Participants completed a total of 8 trials per pair (2 chest exposure procedures X 2 pad types X 2 participant roles). The dependent variables were time to first compression (s) and time to first AED shock (s). The independent variables were chest exposure procedure with 2 levels (procedure 1: removal of helmet while initiating CPR over the pads followed by pad retraction and AED application; procedure 2: removal of helmet and removal of pads followed by CPR and AED application) and pad type (Warrior Burn Hitman shoulder pads; Warrior Nemesis chest protector).We found a statistically significant interaction between chest exposure procedure and pad type for time to first compression (F1,35=4.66, P=0.04, ω2p=0.10) with significantly faster times during procedure 1 for both the Nemesis pads (16.1±3.4 s) and the Hitman pads (16.1±4.5 s) compared to procedure 2 (Nemesis pads: 49.6±12.9 s, P0.0001; Hitman pads: 53.8±14.5 s, P0.0001).Completing the initial cycle of chest compressions over either shoulder pads or a chest protector hastens time to first chest compression without diminishing CPR quality which may improve patient outcomes. Time to first AED shock was not different between equipment procedure or pad type.

Neurocognitive changes have been found in participants of contact sports without documented concussions, raising concerns regarding the long-term consequences of subconcussive head impacts in sport. However, sex comparisons of neurocognitive change without reported concussions have not been completed for soccer or lacrosse athletes. Our purpose was to determine changes in clinical measures of cognitive function in uninjured collegiate lacrosse and soccer players. Men’s soccer (N=23), women’s soccer (N=36), men’s lacrosse (N=28) and women’s lacrosse (N=31) players wore xPatch head impact monitoring sensors for all practices and games. Sensors measured peak linear accelerations and peak rotational accelerations, allowing for daily density calculations. Participants completed the Sport Concussion Assessment Tool 3 and Immediate Post-Concussion and Cognitive Testing at the beginning and end of the season. For women, multiple statistically significant relationships were identified [decreased reaction time with increased cumulative peak linear acceleration (rs=-0.30, P=0.03), peak linear acceleration daily density (rs=-0.31, P=0.04), and peak rotational acceleration daily density (rs=-0.31, P=0.03) and also Immediate Post-Concussion and Cognitive Testing symptom change increased with increased cumulative peak linear acceleration (rs=-0.38, P=0.008) and cumulative peak rotational acceleration (rs=-0.37, P=0.009)]. For men, cognitive change scores, specifically concentration, had the only statistically significant relationship with cumulative peak rotational acceleration (rs=0.32, P=0.02). Men had a greater number of changes over the course of the season compared to women; however, the changes did not appear related to head impact biomechanics. Women had many statistically significant correlations between head impacts and deterioration in some constructs, especially symptoms.

Context Athletic training is a multifaceted profession characterized by interpersonal relationships and a team approach to care. Collaborative relationships, by nature, open the door to conflict, which has been reported frequently in the collegiate athletic setting. However, secondary school athletic trainers' (ATs') experiences with conflict and pressure in their role are not readily understood. Objective To measure the extent and sources of stress, pressure, and conflict within the secondary school athletic training setting and determine if differences exist across employment characteristics. Design Cross-sectional study. Setting Secondary school athletics. Patients or Other Participants Secondary school ATs (n = 725, age = 39.8 ± 10.5 years, years certified = 16.7 ± 9.7, years in current role = 10.6 ± 7.8). Main Outcome Measures Participants were asked to reply to an online questionnaire with quantitative measures pertaining to organizational conflict and workplace dynamic. Employment type (school district employee, school district teacher, medical or university facility, independent contractor) and status (full time, part time) served as independent variables. Likert-scale scores (1 = strongly agree to 5 = strongly disagree; 1 = always to 5 = never) and perceived sources of stress, pressure, and conflict were the dependent variables. Analyses consisted of Kruskal-Wallis tests with Mann-Whitney U post hoc tests and odds ratios to assess associations between variables of interest. Results We obtained a 15.3% response rate (725/4745). Although the ATs reported experiencing conflict and pressure, these experiences were relatively infrequent and not universal. Compared with part-time ATs, full-time ATs described higher ratings of strong relationships with coaches (P = .003) and principals (P = .002). The most frequently identified sources of conflict were parents (59%) and coaches (53.9%), followed by athletes (32.6%). Full-time ATs were 1.6 times more likely to report experiencing conflict with a coach than part-time ATs (odds ratio = 1.550, 95% CI = 1.037, 2.317; P = .040). Conclusions Secondary school ATs' experiences regarding organizational conflict were relatively positive. Instances of pressure and conflict were noted, though relatively infrequently, and these experiences were largely uninfluenced by employment type.

Context Perceived stress and burnout are significant concerns among athletic trainers (ATs) due to growing professional demands. The global COVID-19 pandemic brought additional stressors, especially for health care providers, including the need to learn and integrate new skill sets in order to continue providing safe and effective patient care. Objective To explore the influence of COVID-19 stressors on ATs engaged in patient care. Design Cross-sectional study. Setting Internet survey. Patients or Other Participants A total of 429 ATs (age = 33 ± 9 years; experience = 11 ± 9 years; 74 men, 355 women) currently providing patient care. Main Outcome Measure(s) We recruited participants from social media sites to complete a questionnaire with the Coronavirus Anxiety Scale (CAS), Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP), and qualitative questions related to the effects of COVID-19. We calculated correlations between CAS and MBI-HSS MP composite scores (emotional exhaustion, personal accomplishment, and depersonalization) and used regression analysis to explore if CAS scores could be predicted by vaccination status (vaccinated or unvaccinated), sex, and MBI-HSS MP composite scores. We analyzed the qualitative data using a phenomenological, inductive approach with multianalyst triangulation and peer review as trustworthiness strategies. Results Significant correlations existed between CAS and MBI-HSS MP composite scores (P < .001). Emotional exhaustion (P < .001) and depersonalization (P = .008) explained 28% of the variance in CAS scores (F2,405 = 81.29, P < .001). Three major areas of focus emerged: effects on wellness, emphasis on the value of athletic training, and the lessons learned and future innovation to inform potential long-term changes in the athletic training profession. Conclusions Key factors of emotional exhaustion and depersonalization during the pandemic may have exacerbated the potential for burnout among ATs. The pandemic affected ATs' wellness, changed perceptions of ATs, and altered operating procedures. Healthy coping strategies and organizational support are suggested for those who are struggling.

Context As athletic training education transitions to a professional master's degree, understanding the perceptions professional master's athletic training students have of athletic training is important. Objective To examine second-year professional master's students' perceptions of the athletic training profession, a career in the profession, and identify the factors that influence their perceptions. Design Convergent mixed methods. Setting Online surveys and individual phone interviews. Patients or Other Participants A total of 80 second-year professional master's students (63 female, 13 male, 4 no response, age = 24.63 ± 2.29 years), who were enrolled in the final semester of their program in the spring of 2019, completed the online survey. Ten survey respondents completed the follow-up phone interviews. Data Collection and Analysis A survey instrument and a semistructured interview guide were developed to answer the research questions. Both were validated externally by 3 independent researchers using a content-validity indexing tool. The data from the survey and interviews were woven together and merged to provide 1 comprehensive results section. Trustworthiness was established using triangulation, member checks, memos, and peer debriefing. Results Three higher-order themes emerged from the data: (1) perceptions of the athletic training profession: lack of appreciation and awareness for the profession from others, rewarding profession, and dynamic profession; (2) perceptions of a career in athletic training: low pay, long hours and inconsistent schedules, and inability to have work-life balance; (3) factors influencing perceptions: clinical experiences and interactions with athletic trainers. Conclusions Second-year professional master's athletic training students developed positive and negative perceptions about the profession and a career in the profession during their professional education experiences. The factors identified were professional socializing agents and should be considered when designing clinical education experiences.

Context Transition to clinical practice is a topic receiving substantial attention. Many reports have focused on the educational program's role and have stopped short of identifying the impact of the initial year of employment on desire to persist and future career goals. Objective To examine the career aspirations of athletic trainers in their first year of employment who graduated from professional master's programs. Design Qualitative. Setting Nine professional master's athletic training programs, variety of employment settings. Patients or Other Participants Seven men and 7 women (age = 25.6 ± 3.7 years). Data Collection and Analysis A general inductive approach was used to analyze data from individual interviews conducted 6 and 12 months into the first year of clinical practice. Multiple-analyst triangulation and peer review ensured credibility. Results Graduates of professional master's programs in athletic training plan to stay in the profession. However, newly credentialed athletic trainers do not plan to remain with their initial employer beyond 2 years; 11 of 14 participants (79%) stated their first job was transitional. The first year of employment did not change participants' perceptions, as the graduates knew upon taking their first job that it would be temporary. Though participants planned to change jobs, most (79%) planned to continue to engage in clinical practice as athletic trainers. Conclusions Understanding newly credentialed athletic trainers' perceptions of the impact of the first year of employment can provide educators and employers important insight to assist in retention and persistence of young professionals. Graduates regard their first years of employment as impermanent. However, the majority do not wish to leave clinical practice. Participants viewed their first job as a way to gain valuable experience that did not dissuade them from continuing in the field. Recent graduates demonstrated ambitions to experience different work settings and higher-level positions with greater responsibilities.

Context Athletic training students (ATSs) have reported increased levels of stress due to balancing a myriad of responsibilities, both as students and with personal life roles. Coping mechanisms to manage their stress are multifactorial. The COVID-19 pandemic has added additional stressors not yet fully understood. Objective Although some understanding of stress and coping of ATSs exists, little is known about how they coped during the COVID-19 pandemic. Therefore, our purpose was to better understand the coping response to stress for ATSs during the COVID-19 pandemic. Design Phenomenological qualitative study. Setting Web-based (Zoom) interviews. Patients or Other Participants Fourteen Professional Master of Athletic Training students (9 female, 5 male) from 14 colleges and universities completed semistructured Web-based interviews. On average, the participants were 26 ± 4 years old. Data Collection and Analysis All interviews were recorded via the Zoom platform and then transcribed by Otter. Basic member checks to ensure accuracy of the transcription process were completed with all participants before analyzing the data. Peer review was also completed. Results Three major themes emerged from the data: (1) the importance of flexibility and adaptability, (2) the need for empathy toward others and self, and (3) various stress management strategies. All themes transcended stress reduction, and each had potential implications for their future roles as athletic trainers. Conclusions Students enrolled in professional master's programs experienced increased stress, not only due to COVID-19 but in general due to the demands of the role of students in health care professional programs. Learning to be effective time and stress managers will be important for professional longevity as other stressful events are likely.

Context As athletic training education continues to evolve to a professional master's degree, understanding the career intentions of students preparing to graduate from professional master's programs is essential. Objective To examine the career intentions of second-year professional master's athletic training students and identify the factors that influence their intentions. Design Convergent mixed methods. Setting Online surveys and individual phone interviews. Patients or Other Participants A total of 80 second-year professional master's students (63 women, 13 men, 4 no response, age = 24.63 ± 2.29 years) who were enrolled in the final semester of their program in spring 2019 participated in the online survey. Ten survey respondents participated in follow-up phone interviews. Data Collection and Analysis An online survey was designed and administered to answer the research questions. Semistructured phone interviews were conducted as a follow-up to the survey to gain further insight into the research questions. The data from the survey and interviews were woven together and merged to provide a comprehensive display of results. Triangulation, member checks, memos, and peer debriefing were completed for trustworthiness. Results Two higher-order themes emerged from the data: career progression and factors influencing career intentions. We identified 3 lower-order themes for career progression: short-term career plans, concerns over lack of experience, and long-term career plans. Two lower-order themes were identified for factors influencing career intentions: clinical experience and mentorship. Conclusions Second-year professional master's athletic training students have short-term and long-term career plans. Their career intentions were influenced by past clinical experiences and the mentorship received from their clinical preceptors and faculty members during their professional education. Unfortunately, many students were having difficulty obtaining positions after graduation due to a lack of professional experience. As a result, some turned to internship or residency positions to gain experience.

Context: The transition to autonomous clinical practice for early professionals (EPs) has been found to be a stressful time but no studies with multiple stakeholder groups have been completed. Objective: Examine the perceptions of EPs' integration during role transition from multiple stakeholder groups. Design: Qualitative study. Setting: Online interviews. Participants: 17 EPs in the first 2 years of their first job post-certification (9 females, 8 males, age=26±5 years, experience=9.5±5 months), 16 supervisors and mentors of EPs (6 females, 10 males, age=52±11 years), and 10 faculty members and 8 preceptors (11 females, 7 males, age=43±10 years). Data Collection and Analysis: Participants completed semistructured interviews using a validated interview guide based on the current literature. We analyzed data using consensual qualitative research principles. Multiple analyst triangulation (n=3), member checking, and peer review served as trustworthiness strategies. Results: We identified 4 themes that defined the integration of EPs during role transition. Integration of EPs was facilitated through role inductance and mentoring. EPs struggle finding balance to avoid burnout as they are new to the profession and feel obligated to exceed expectations from a coverage standpoint rather than focusing on the quality of care delivered. Finally, stakeholders suggested a timeline by which EPs become fully integrated into autonomous professional practice and understand all aspects of their role that typically takes anywhere from 1 to 3 years. Conclusions: EPs benefited from appropriate graded autonomy during clinical education to develop their clinical reasoning skills, confidence, and mentoring network with past preceptors. Ongoing personal and professional support is needed during the initial few years to ease EPs' role inductance while gaining more experience and establishing their clinician identity. Expectations for EPs should be reasonable to allow for the provision of quality care, adequate work-life balance, and integration into the profession without guilt.

To explore diverse stakeholders' perceptions of headgear use in collegiate women's lacrosse.189 collegiate women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32).Participants completed online open-ended qualitative questions surrounding headgear use in the sport. Responses were coded by the research team via inductive reasoning.Stakeholders felt that incorporating headgear use into women's lacrosse wouldMost stakeholders invoke concerns of risk compensation and changing the nature of the sport of women's lacrosse, and are in favor of headgear remaining optional.

Context The transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation. Objective To better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs. Design Qualitative study. Setting Telephone interviews. Patients or Other Participants Fourteen professional master's athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs. Data Collection and Analysis Participants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach. Results We developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies. Conclusions The model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors.

Controversy exists among collegiate lacrosse about the use of headgear and whether its use will facilitate greater risk compensation by players and thus contribute to unsafe gameplay. We aimed to characterize the attitudes of headgear among women's collegiate lacrosse stakeholders. A total of 190 women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32) participated in this study. Participants completed a survey surrounding attitudes of headgear in women's lacrosse. Descriptives, multiple regressions, and Kruskal-Wallis analyses compared attitudes surrounding headgear among stakeholder groups. Scales of Headgear Affects Play (

Our purpose was to compare the mechanical properties of the protective outer shells of various athletic helmets in their final, fully manufactured form. Sections were taken from 3 different helmet shells (Bauer RE-AKT hockey helmet, Cascade R lacrosse helmet, and Riddell Speedflex football helmet) at 4 different locations (front, side, top, and rear) for a total of 12 test specimens. The 4 specimens from each helmet shell were potted together in epoxy resin moulds and mechanically polished. The hardness, elastic modulus and phase angle were measured using dynamic nanoindentation performed at 100 Hz with an oscillation amplitude of 1 nm (rms). Repeated ANOVA analysis was used to compare each of the dependent variables for each of the 3 helmets across the 4 different locations. The interaction between helmet type and location was significant for hardness (F6,63 = 2.84, P = 0.032, Pη2 = 0.21), elastic modulus (F6,63 = 6.412, P < 0.001, Pη2 = 0.38), and phase angle (F6,63 = 7.65, P < 0.001, Pη2 = 0.42). Polycarbonate has a higher ability to dissipate mechanical energy making it the recommended superior choice for helmet shells. In addition, the results lead us to speculate that manufacturing causes changes in the molecular weight or the distribution of fillers across locations for polyethylene but not for polycarbonate since mechanical properties are fairly uniform over the surface of football helmets, at least within a given helmet.

The study objective was to determine the magnitude and frequency of head impacts in NCAA Division III soccer athletes based on player position and type of play (offense, defense, transition). Across player position, male and female soccer defenders sustained the most head impacts (males IR = 18.89, 95% CI = 16.89–20.89; females IR = 8.45, 95% CI = 7.25–9.64; IRR = 2.23, 95% CI = 1.87–2.67). The study revealed a nonstatistically significant interaction between sex, player position, and type of play for both linear (p = .42) and rotational accelerations (p = .16). Defenders sustained the majority of the head impacts in the study sample, suggesting preventative initiatives should be focused on back row players.

Context For an acute cardiac event, on-field equipment removal is suggested, although how lacrosse equipment removal may alter the time to first chest compression and time to first automated external defibrillator (AED) shock remains unknown. Objective To determine the time to first chest compression and first AED shock in 2 chest-exposure procedures with 2 pad types. Design Crossover study. Setting Simulation laboratory. Patients or Other Participants A total of 36 athletic trainers (21 women, 15 men; age = 30.58 ± 7.81 years). Main Outcome Measure(s) Participants worked in pairs to provide 2 rescuer cardiopulmonary resuscitation (CPR) interventions on a simulation manikin outfitted with lacrosse pads and helmet. Participants completed 8 trials per pair (2 chest-exposure procedures × 2 pad types × 2 participant roles). The dependent variables were the time to first compression (seconds) and time to first AED shock (seconds). The independent variables were chest-exposure procedure with 2 levels (procedure 1: removal of the helmet while initiating CPR over the pads, followed by pad retraction and AED application; procedure 2: removal of the helmet and pads, followed by CPR and AED application) and pad type (Warrior Burn Hitman shoulder pads; Warrior Nemesis chest protector). Results We found a significant interaction between chest-exposure procedure and pad type for the time to first compression (F1,35 = 4.66, P = .04, ω2p = 0.10), with faster times during procedure 1 for both the Nemesis pads (16.1 ± 3.4 seconds) and Hitman pads (16.1 ± 4.5 seconds) than during procedure 2 (Nemesis pads: 49.6 ± 12.9 seconds, P < .0001; Hitman pads: 53.8 ± 14.5 seconds, P < .0001). Conclusions Completing the initial cycle of chest compressions over either shoulder pads or a chest protector hastens the time to first chest compression without diminishing CPR quality, which may improve patient outcomes. The time to the first AED shock was not different between equipment procedures or pad types.

ContextTransition to practice is a current topic in athletic training and needs to be explored from a longitudinal perspective. Many athletic training programs and employing organizations are supporting transition to practice, yet little is known about the most common methods. Moreover, transition to practice is an ongoing process that can persist up to a year while current literature draws from snapshots.ObjectiveLongitudinally explore the educational and organizational socialization practices used to support transition to practice.DesignQualitative study.SettingNine higher education institutions.Patients or Other ParticipantsFourteen athletic training students (7 male, 7 female, age = 26 ± 4 years) participated.Data Collection and AnalysisParticipants completed semistructured interviews over the phone 3 times over the course of a 15-month period (before graduation, 4–6 months, and 10–12 months during their first job). All transcribed interviews were analyzed using a general inductive approach. Member checks, multiple analyst triangulation, and peer review were used to ensure trustworthiness.ResultsTwo main educational mechanisms were found to support transition to practice; they included (1) mentorship and (2) past experience. Three main organizational mechanisms were identified to support transition to practice: (1) mentorship, (2) orientation to the job, and (3) living the job.ConclusionsA blend of educational and organizational mechanisms is necessary to help support newly credentialed athletic trainers as they transition into clinical practice. Mentorship is important throughout the process, before and after newly credentialed athletic trainers enter their professional role.

Context Conflict is prevalent between sports medicine professionals and coaching staffs regarding return-to-play decisions for athletes after injury in the National Collegiate Athletic Association (NCAA) Division I setting. The firsthand experiences of athletic trainers (ATs) regarding such conflict have not been fully investigated. Objective To better understand the outside pressures ATs face when making medical decisions regarding patient care and return to play after injury in the NCAA Division I Football Bowl Subdivision (FBS) setting. Design Qualitative study. Setting Semistructured one-on-one telephone interviews. Patients or Other Participants Nine ATs (4 men, 5 women; age = 31 ± 8 years [range = 24–48 years]; years certified = 9 ± 8). Data Collection and Analysis Interviews were audio recorded and later transcribed. Thematic analysis was completed phenomenologically. Researcher triangulation, peer review, and member checks were used to establish trustworthiness. Results Two major themes emerged from the qualitative analysis: (1) pressure is an expected component of the Division I FBS AT role, and (2) strategies can be implemented to mitigate the negative effects of pressure. Three subthemes supported the second major theme: (1) ensuring ongoing and frequent communication with stakeholders about an injured athlete's status and anticipated timeline for return to play, (2) providing a rationale to coaches or administrations to foster an understanding of why specific medical decisions are being made, and (3) establishing positive relationships with coaches, athletes, and administrations. Conclusions External pressure regarding medical decisions was an anticipated occurrence for our sample. Such pressure was described as a natural part of the position, not negative but rather a product of the culture and environment of the Division I FBS setting. Athletic trainers who frequently face pressure from coaches and administration should use the aforementioned strategies to improve the workplace dynamic and foster an environment that focuses on patient-centered care.

Football helmets are expected to break down with use, and reconditioning recommendations are required to be stated by manufacturers. However, the degree of change in helmet impact mitigation performance as a function of usage is not generally known. Therefore, this study aimed to compare the ability of football helmets to attenuate impacts after a single season of regular collegiate use to unused helmets. Three never-used Riddell® Speed™ helmets were tested and compared to three used helmets which had been used during one season of Division 1 collegiate football. Helmets were tested at three velocities (3.46, 4.88, and 5.46 m s−1) on six locations in ambient temperature, simulating National Operating Committee on Standards for Athletic Equipment certification drop tests. The interaction between helmet age and location during all three velocities (P ⩽ 0.0001), indicating that there were differences in Gadd severity index (GSI) between new and used helmets after accounting for location-specific differences. Similar analysis for peak linear acceleration (PLA) found significant interactions for all three velocities (P ⩽ 0.003). Additional analyses found differences in velocity-dependence for several impact locations. In most cases, used helmets yielded lower GSI and PLA relative to new helmets. The reduction in impact metrics for used helmets indicates initial break-in with impact mitigation benefits, but the long-term consequences of continued use are unclear. The implications of these differences on injury risk and susceptibility remain unknown; however, the results suggest that further studies could inform helmet reconditioning guidelines and development of new smart materials designed to monitor and/or prevent breakdown in padding.

Significant evidence has emerged that a high volume of sprinting during training is associated with an increased risk of non-contact injuries in professional soccer players. Training load has been reported as a modifiable risk factor for successive injury in soccer. Sprint workload measures and non-contact injuries were recorded weekly in twenty-one professional soccer players over a one season period. Odds ratio (OR) and relative risk (RR) were calculated based on the weeks of high and low load of total distance (TD), high-speed distance (HSD), sprint distance (SPD). and repeated sprints (RS). The Poisson distribution estimated the interval time between the last injury and the new injury. The weeks with high-load levels increased the risk of non-contact injury associated with TD (OR: 4.1, RR: 2.4), HSD (OR: 4.6, RR: 2.6), SPD (OR: 6.9, RR: 3.7), and RS (OR: 4.3, RR: 2.7). The time between injuries was significantly longer in weeks of low-load in TD (rate ratio time (RRT) 1.5 vs. 4.2), HSD (RRT: 1.6 vs. 4.6), and SPD (RRT: 1.7 vs. 7.7) compared to weeks of high-load. The findings highlight an increased risk of non-contact injuries during high weekly sprint workloads. Possibly, TD, HSD, and SPD measured via a wearable inertial measurement unit could be modeled to track training and to reduce non-contact injuries. Finally, the interval time between the last injury and the new injury at the high-load is shorter than the low-load.

Context Conflict between athletic trainers (ATs) and other stakeholders can occur because of competing interests over medical decisions regarding concussion. However, we are unaware of any studies specifically exploring these situations across various collegiate athletic affiliations. Objective To investigate the challenges faced by ATs when treating concussed student-athletes. Design Qualitative study. Setting Online questionnaire. Patients or Other Participants A total of 434 ATs (267 women, 166 men, 1 missing data; age = 27.73 ± 3.24 years, experience = 5.17 ± 2.67 years) completed the questionnaire (response rate = 14.47%). Our participants represented multiple employment settings within intercollegiate athletics. Data Collection and Analysis We sent an online questionnaire to 3000 ATs working in the collegiate and university setting across the United States. A survey expert verified face, content, and construct validity of the questionnaire in 2 rounds of review, and 3 ATs completed a content-validity tool before we finalized the survey. We analyzed the qualitative data using a general inductive approach and ensured trustworthiness through multiple-analyst triangulation and peer review. Results When we examined the responses from our participants regarding their work with student-athletes who had sustained concussions, we found 2 major themes, each with subthemes. First, educational efforts appeared to be only modestly effective because of a lack of honesty, noncompliant actions, and coach interference. Second, return to learn was challenging because of a lack of communication among stakeholders, athletes being anxious about needing accommodations, and difficulty convincing faculty to provide reasonable accommodations. Conclusions Based on our findings, we recommend continued efforts to improve the culture surrounding concussion in collegiate athletes. Athletic trainers should include key stakeholders such as coaches, student-athletes, parents, faculty, and other educational administrators in their educational efforts to improve the policies and culture surrounding concussion treatment.

In 2015, new practice recommendations to remove equipment prior to transport when cervical spine injury is suspected were released. The purpose of this study was to determine current emergency management practices and perceptions of the new practice recommendation. We received completed mixed-method surveys from 143 athletic trainers practicing in the Mid-Atlantic region (response rate = 10.11%). The majority of respondents stated that the number of personnel required, along with the training and time to practice equipment removal, were barriers to implementation. Requiring assistance from emergency medical services (EMS) was common, but many failed to practice with local EMS. Emergency management procedures should be appropriate given the resources (personnel and training) available. Collaboration between athletic trainers and EMS is needed.

Context Professional master's athletic training students are at high risk for changes in mood state and an increase in burnout levels during an academic semester due to stressors including academic workload, clinical expectations, and/or research projects, among other factors. Objective To determine mood states and burnout levels among professional master's students during the middle and end of an academic semester. Design Cross-sectional study. Setting Online survey. Patients or Other Participants The sample consisted of first and second year professional master's students (males = 11, females = 30, age = 23.39 ± 1.44 years) who attended Commission on Accreditation of Athletic Training Education accredited athletic training programs. Interventions The independent variable was time (midsemester and end of semester). We sent the link to the online survey via e-mail to program directors and asked them to forward it to all students in the professional master's programs they led. Main Outcome Measure(s) The dependent variables were the subsets of burnout (depersonalization [DP], personal accomplishment, and emotional exhaustion [EE]) along with the overall mood state score. We used the modified 22 item Maslach Burnout Inventory and the modified 40 item Profile of Mood States. Results Burnout scores from the personal accomplishment subscale of the Maslach Burnout Inventory were statistically different between the 2 time points ({\rm{\chi }}_1^2 = 5.765, P = .016) in comparison to DP ({\rm{\chi }}_1^2 = 0.027, P = .869) and EE ({\rm{\chi }}_1^2 = 1.256, P = .262). For Profile of Mood States scores, the composite total mood disturbance score was not statistically different between the 2 time points ({\rm{\chi }}_1^2 = 0.200, P = .655). Conclusions Our findings indicated that, as a whole, high level stressors were reported from lack of personal accomplishment. Clinically, mood states were reported to not change from midsemester to end of the semester.

Context Newly credentialed athletic trainers are expected to be independent practitioners capable of making their own clinical decisions. Transition to practice can be stressful and present challenges for graduates who are not accustomed to practicing independently. Objective Explore the perceptions of professional master's students as they prepare to experience role transition from students to autonomous clinical practitioners. Design Qualitative study. Setting Nine higher education institutions. Patients or Other Participants Fourteen athletic training students (7 male, 7 female, age = 25.6 ± 3.7 years) participated. Main Outcome Measure(s) Participants completed a semistructured interview over the phone which focused on the perception of preparedness to enter clinical practice. All transcribed interviews were analyzed using a general inductive approach. Multiple-analyst triangulation and peer review were used to ensure trustworthiness. Results We found themes for facilitators and challenges to transition to autonomous clinical practice. Students felt prepared for independent practice due to (1) mentoring networks they had developed, (2) exposure to the breadth of clinical practice, and (3) autonomy allotted during clinical education. Potential challenges included (1) apprehension with decision making and (2) a lack of confidence. Conclusions Our findings suggest graduates from professional master's programs, although ready for clinical practice, may require more time and exposure to autonomous practice to build confidence. Professional master's program administrators should work to provide clinical education experiences that expose students to a wide variety of clinical situations (patients, settings, preceptors) with appropriate professional role models while providing decision making autonomy within accreditation standards.

The diagnosis and management of concussion is hindered by its diverse clinical presentation and assessment tools reliant on subjectively experienced symptoms. The biomechanical threshold of concussion is also not well understood, and asymptomatic concussion or "subconcussive impacts" of variable magnitudes are common in contact sports. Concerns have risen because athletes returning to activity too soon have an increased risk of prolonged recovery or long-term adverse health consequences. To date, little is understood on a molecular level regarding concussion and subconcussive impacts. Recent research suggests that neuroinflammatory mechanisms may serve an important role subsequent to concussion and possibly to subconcussive impacts. These studies suggest that autoantibodies may be a valuable tool for detection of acute concussion and monitoring for changes caused by cumulative exposure to subconcussive impacts. Hence, we aimed to profile the immunoglobulin (Ig)A autoantibody repertoire in saliva by screening a unique sport-related head trauma biobank. Saliva samples (

Background: Injuries in professional soccer are a significant concern for teams, and they are, mostly, caused by high training load. This cohort study described the relationship between workload parameters with the occurrence of non-contact injuries, during weeks with high and low workload in professional soccer players throughout the season.Methods: Twenty-one professional soccer players aged 28.3±3.9 yrs. who competed in the Iranian Persian Gulf Pro League participated in this 48-week study. The external load was monitored using global positioning system (GPS, GPSPORTS Systems Pty Ltd) and the type of injury was documented by the team's medical staff daily. Odds ratio (OR) and relative risk (RR) were calculated for non-contact injuries for high- and low-load weeks according to acute (AW), chronic (CW), acute to chronic workload ratio (ACWR), and AW variation (Δ-Acute) values. By using Poisson distribution, the interval between previous and new injuries were estimated.Results: Overall, 12 non-contact injuries occurred during high load and 9 during low load weeks. Based on the variables ACWR and Δ-AW, there was a significantly increased risk of sustaining non-contact injuries (p < 0.05) during high-load weeks for ACWR (OR: 4.67), and Δ-AW (OR: 4.07). Finally, the expected time between injuries was significantly shorter in high load weeks for ACWR [1.25 vs 3.33, rate ratio time (RRT)] and Δ-AW [1.33 vs 3.45, RRT] respectively, compared to low load weeks.Conclusion: The risk of sustaining injuries was significantly larger during high workload weeks for ACWR, and Δ-AW compared with low workload weeks. The high numbers for OR in high load weeks indicate that there is a significant relationship between workload and occurrence of non-contact injuries. The predicted time to new injuries is shorter in high load weeks compared to low load weeks. Therefore, the frequency of injuries is higher during high load weeks for ACWR and Δ-AW. ACWR and Δ-AW appear to be good indicators for estimating the injury risk, and the time interval between injuries.

Strength training using high and lower load such as contrast training (CST) seems to be beneficial as it addresses larger adaptive reserves in youth athletes. Therefore, the aim of this study was to investigate the effects of CST on dynamic balance (composite score during dynamic balance test (CS-YBT)), one repetition maximum lower-limb back squat (1RM), jumping performance (single-leg hop (SLH) or countermovement jump height (CMJ)), lower-limb asymmetry (predicted from the single-leg jump performance between two legs [ILA]) in elite youth male volleyball players. Thirty-one male youth volleyball players aged 14 years were randomly assigned to a CST group (n = 16) or a control group (n = 15). The tests were performed before and after 8 weeks of training. Significant group × time interactions was observed for CS-YBT [p < 0.001, ηp2 = 0.70], 1RM [p < 0.001, ηp2 = 0.95], SLH with right and left leg [p < 0.001, ηp2 = 0.69 and 0.51], CMJ [p < 0.001, ηp2 = 0.47]), whilst it was not notable in ILA [p < 0.294]. Post hoc tests showed that CST group demonstrated greater improvement in all of the dependent variables from medium to large effect size (for all p < 0.001). As a result, 8 weeks of CST twice a week can be an effective and efficient training along with volleyball training to improve skill-related fitness measures, except for lower-limb asymmetry in young volleyball players.

Context: Teaching, scholarship, and service are required of all faculty in order to earn tenure. Faculty members hired directly from doctoral programs may not be adequately prepared to face the responsibilities of a full-time position in the professoriate. Objective: To explore what mechanisms as part of doctoral education influenced the perceptions of junior faculty development while transitioning postgraduation. Design: Qualitative phenomenological study. Setting: Fourteen higher education institutions. Patients or Other Participants: Sixteen junior faculty (7 male, 9 female, age = 32 ± 3.5 years) representing 7 National Athletic Trainers' Association districts participated. At the time of the interview, participants were within their first 3 years of a full-time faculty position. All participants earned doctorates from residential programs and had an assistantship position. Main Outcome Measure(s): All participants completed a semistructured telephone interview. The interview guide was focused on the experiences of junior faculty within their first 3 years in a tenure-track position. Questions were grounded within the literature and purpose of the study. We analyzed the interviews through a psychosocial developmental lens using a general inductive approach. Results: Two themes of doctoral preparation emerged that influenced the perceptions of junior faculty transitioning into a faculty role: breadth and depth of the doctoral assistantship and doctoral coursework related to academia. Doctoral assistantships with breadth and depth helped participants develop competence, while doctoral coursework related to academia provided content expertise. Conclusions: Doctoral education is the platform for transition into academia. Our findings suggest that doctoral program assistantships that provided both breadth and depth of experience facilitated transition. Coursework related to academia influenced perceptions of transition into the faculty role by exposing participants to pedagogy and higher education infrastructure.

Context:The responsibilities of new faculty members can be stressful because of the expectations of research, teaching, service, and for some, administration. The strain from transition and role complexity can impact faculty members' perceptions of the experience and therefore professional development.Objective:To understand how individual characteristics and behaviors influenced development of new faculty during their transition from doctoral students to faculty members.Design:Qualitative phenomenology study.Setting:Higher education institutions with Commission on Accreditation of Athletic Training Education-accredited athletic training programs.Patients or Other Participants:Sixteen junior faculty (7 males, 9 females, age = 32 ± 3.5 years) representing 7 National Athletic Trainers' Association districts and 14 different higher education institutions participated.Main Outcome Measure(s):A semistructured telephone interview protocol was used to examine the experiences of junior faculty within their first 3 years of a faculty role. Interviews were coded inductively using a psychosocial developmental interpretive lens. Credibility was established with saturation of the findings and researcher triangulation.Results:The data revealed 3 individual behavioral characteristics positively influenced the development of junior faculty through transition: (1) adaptive perfectionism, (2) competence gained through experience, and (3) the use of a mentor network. Our participants adapted personal expectations in light of outcomes that differed from personal standards; gained competence by seeking experience before, during, and after their doctoral studies; and used a mentor network to ease transition.Conclusions:Our findings suggest that individuals who are able to reflect on their performance and self-adjust personal standards and/or behaviors have a positive perception related to their ability to be successful during transition. Competence gained through experience apart from doctoral assistantships appears to facilitate the transition into higher education. Also, the creation and maintenance of a mentor network that provides a variety of support from multiple sources appears to improve transition by providing comradery, security, and help.