Citations

Abstract Background Despite the reported benefits, lung cancer screening (LCS) uptake remains alarmingly low in comparison to other cancer screening programs. Objective To develop and evaluate an automated, electronic health record (EHR)-embedded LCS outreach program designed to increase screening uptake while minimizing workload for referring providers and schedulers. Methods We developed an automated outreach and referral program at two Mayo Clinic campuses (Rochester [RST] and northwest Wisconsin [NWW]) coupled with a streamlined virtual care delivery process. Eligible patients were identified based on the information in the EHR regarding US Preventive Services Task Force guidelines for screening and were contacted through either a patient portal message, letter, or both. Outreach included LCS educational materials and self-scheduling instructions for a telephone or video shared decision-making (SDM) visit. During the visit, a licensed care team member discussed the risks and benefits of a low dose computed tomography (LDCT) scan with patients who could choose to enroll in the Lung Cancer Screening Program or decline. Results During the study period, 8,845 eligible patients (RST: 2201, NWW: 6644) were contacted using automated portal messages, letters, or both. Among the RST cohort, 2,156 portal messages and 1,060 letters were distributed in comparison to 7,642 portal messages, 6,441 letters, and 618 text messages in the NWWI cohort. The study showed increase in shared decision-making visits completion and screenings for eligible patients across both groups. Portal engagement was higher among the RST group 75.4% than 55.8% in the NWWI group, as was digital brochure access (14.1% vs 6.5%). Scheduling for share-decision-making visits was noted to be higher among the RST group (22% vs 13.6%), though visit completion rates were similar across sites (12.6 vs 13.6%). A lower opt-out rate was noted among the RST group (12.6% vs. 14.3%). Collectively, both campuses demonstrated meaningful patient engagement. Conclusion The automated outreach program effectively increased lung cancer screening engagement and uptake for eligible patients without adding significant administrative burden on primary care providers and clinical staff. Observed differences in engagement between sites, as well as relatively low completion rates highlight the need for further investigation into contextual and operational factors influencing program performance. This abstract is funded by: none

Abstract VanZile, AW, Jones, DD, McHugh, LJ, Clickovich, GL, Morales, MA, Reimschisel, RK, Widenhoefer, TL, Baughman, JT, Urquidi, MD, Conner, DJ, Dobbs, WC, Jagim, AR, Luedke, JA, and Almonroeder, TG. Examining countermovement jump performance and dynamic balance among male high school athletes with varying levels of sports specialization. J Strength Cond Res 39(11): 1163–1168, 2025—Specializing at a young age may limit an athlete's motor development, since focusing on a single sport potentially exposes athletes to less variety of movements and neuromuscular demands. However, there are few studies examining the association between sport specialization and movement performance/control. The purpose of this study was to compare countermovement jump performance and dynamic balance among high school athletes of varying levels of sports specialization. 110 male high school athletes completed countermovement jump testing and the Y-Balance Test (YBT). Ground reaction forces were recorded during countermovement jumps and used to derive peak force, peak velocity, peak power, jump height, and the modified reactive strength index. Y-Balance Test composite scores were calculated to assess dynamic balance across multiple directions, for the dominant and non-dominant limbs. Athletes were grouped into high ( n = 46), moderate ( n = 39), and low ( n = 25) specialization groups based on their sport participation habits. There were no between-group differences for any of the countermovement jump metrics ( p > 0.05). For the YBT composite scores, there was not a group-by-limb interaction effect ( p = 0.28); however, there was a main effect of group ( p = 0.03). Post hoc tests indicated that the high specialization group exhibited lower YBT composite scores compared to the moderate specialization group ( p = 0.01) and a trend toward lower scores compared to the low specialization group ( p = 0.05). In general, highly specialized male athletes exhibited poorer dynamic balance compared to less specialized athletes.

Objectives The purpose of the current study was to evaluate differences in total sleep time and heart rate variability (HRV) in active-duty firefighters between on-shift and off-shift days. Methods 59 structural firefighters (age: 37.3±7.3 years; height: 1.80±0.08 m; weight: 88.9±14.1 kg and body mass index (BMI): 27.5±4.1 kg/m2) participated in this longitudinal observation study. Each morning for 15 weeks, firefighters were asked to sync a smart ring with a smartphone application to download night-time data, which were then extracted to a cloud-based software application for later analysis. The software also computed a readiness score each morning. All day types were coded as on-shift or off-shift. Results The average nightly sleep time for all firefighters was 6.95±1.24 hours. When off-shift, firefighters recorded more sleep compared with on-shift nights (off-shift: 6.97±0.50 hours vs on-shift: 6.68±0.52 hours; p<0.0001). HRV (p<0.0001) and readiness scores (p=0.02) were lower off-shift compared with on-shift. For the lagged correlation analysis, total sleep time was moderately positively correlated with the following day’s readiness score. Conclusions Firefighters recorded more total sleep time when off-shift compared with on-shift; however, HRV and readiness scores were higher on-shift. The lag-time correlations indicate an association between sleep time and HRV or readiness scores, with approximately half of the variability in readiness being attributable to changes in total sleep time, which highlights the complexity of the readiness and HRV signals/systems.

Abstract Dobbs, WC, Almonroeder, TG, Carpenter, M, Schmitt, RE, Jacobson, AK, Luedke, JA, Roberts, BM, and Jagim, AR. Relationships between the Army Combat Fitness Test scoring structure and laboratory measurements of physical fitness in reserve officer training corps cadets. J Strength Cond Res 39(7): 798–808, 2025—The Army Combat Fitness Test (ACFT) assesses aerobic and anaerobic fitness capabilities in the U.S. Army. The aim of this study was to evaluate the association between raw and composite ACFT scores and laboratory-based measurements of fitness. Nineteen Reserve Officers' Training Corp cadets performed a battery of laboratory-based fitness testing. Tests included a movement screening (Fusionetics), countermovement jumps, and maximal isometric mid-thigh pulls on portable force plates to determine power and strength. A Wingate test involving maximal cycling for 30 seconds was used to determine peak and mean power. On a separate day, cadets completed body composition and a graded exercise test on a motorized treadmill to determine peak oxygen uptake (V̇ o 2 peak). Pearson correlations and partial corrections with 2000 bootstraps were used to compare ACFT scores (raw, composite, gender-neutral composite, and z -scores) with laboratory results. Significant associations were identified as 95% confidence intervals, not including zero. The results indicated that V̇ o 2 peak ( r = 0.61, [0.08–0.84]), body fat percentage ( r = −0.4, [−0.72 to −0.06]), and relative peak power ( r = 0.38, [0.02–0.68]) were associated with the total ACFT composite score when partialled by sex. All laboratory tests, except the movement screening, showed meaningful associations with total ACFT z -scores and gender-neutral ACFT scores ( r > 0.54). However, most relationships were eliminated when partialled out by sex, which may be due to a low sample size of women. This suggests the current scoring structure utilized for men is representative of aerobic and anaerobic fitness parameters and may be able to discriminate performance levels.

The Neurohospitalist Core Competencies comprise a set of competency-based learning objectives that encapsulate the knowledge, skills, and attitudes of neurohospitalitists who specialize in the care of hospitalized patients with neurologic conditions. These competencies serve to characterize the rapidly expanding field of neurohospitalist medicine. The 27 chapters are divided into 3 sections entitled: neurological conditions, clinical interventions and interpretation of ancillary studies, and neurohospitalist role in the healthcare system. Each individual learning objective in the chapters describes a specific concept with an action verb to illustrate the behavior that the neurohospitalist exhibits. The individual neurohospitalist may not exhibit mastery in each of the topics included as individual practices vary in scope and practice pattern. A few examples of how the complete set of competencies may be used include in the creation of curricula for neurohospitalist fellowships, to assist in defining the scope of practice of neurohospitalists for administrative leaders of hospitals and departments, and in influencing the direction of further research and quality improvement in the field.

Background/Objectives: Firefighters, tactical police officers, and warriors often engage in periodic, intermittent, high-intensity physical work in austere environmental conditions and have a heightened risk of premature mortality. In addition, tough decision-making challenges, routine sleep deprivation, and trauma exacerbate this risk. Therefore, identifying strategies to bolster these personnel’s health and occupational performance is critical. Creatine monohydrate (CrM) supplementation may offer several benefits to firefighters and tactical athletes (e.g., police, security, and soldiers) due to its efficacy regarding physical performance, muscle, cardiovascular health, mental health, and cognitive performance. Methods: We conducted a narrative review of the literature with a focus on the benefits and application of creatine monohydrate among firefighters. Results: Recent evidence demonstrates that CrM can improve anaerobic exercise capacity and muscular fitness performance outcomes and aid in thermoregulation, decision-making, sleep, recovery from traumatic brain injuries (TBIs), and mental health. Emerging evidence also suggests that CrM may confer an antioxidant/anti-inflammatory effect, which may be particularly important for firefighters and those performing tactical occupations exposed to oxidative and physiological stress, which can elicit systemic inflammation and increase the risk of chronic diseases. Conclusions: This narrative review highlights the potential applications of CrM for related tactical occupations, with a particular focus on firefighters, and calls for further research into these populations.

Abstract Jagim, AR, Harty, PS, Jones, MT, Fields, JB, Magee, M, Smith-Ryan, AE, Luedke, J, and Kerksick, CM. Fat-free mass index in sport: normative profiles and applications for collegiate athletes. J Strength Cond Res 38(9): 1687–1693, 2024—Recent concerns have been raised regarding the ethical considerations of conducting body composition assessments in sports. Specific apprehensions pertain to the inappropriate use of percent body fat and the limited application of the results to performance and recovery. Fat-free mass index (FFMI), a height-adjusted assessment of FFM, can serve as an alternative body composition metric to focus on in sports. Fat-free mass index provides valuable context regarding an optimal amount of FFM, accounting for skeletal frame and height while helping to qualify an athlete's FFM as low, moderate, or high. This review posits that shifting the focus of body composition measures to FFM can support more ideal targets across athletic seasons, careers, and the return to play after injury. In addition, a FFM focus may help change the perception of body composition assessment and how athletes perceive their current body because of the increased focus on the FFM compartment and the goal of maximizing tissue accrual, rather than focusing on fat loss. Fat-free mass index is calculated by dividing FFM (kg) by height (m 2 ) and can serve to normalize FFM, relative to height, and enable comparisons across athletes, sport types, and sex. Previous research has identified differences in FFMI across sex and among sport categories. Still, there is a need for more published data to develop optimal ranges for FFMI across sex, sports, and positions. As more data become available, FFMI has the potential to provide normative guidelines for optimal FFM development, performance, and injury risk reduction. The purpose of the current review was to summarize FFMI values across collegiate sport categories and competitive status to provide normative profiles, according to sex and sport type.

Abstract Jagim, AR, Luedke, J, Erickson, JL, Fields, JB, and Jones, MT. Validation of bioelectrical impedance devices for the determination of body fat percentage in firefighters. J Strength Cond Res 38(8): e448–e453, 2024—To cross-validate bioelectrical impedance devices for the determination of body fat percentage (BF%) in firefighters. Twenty-eight structural firefighters were evaluated (female, n = 2; male, n = 26 [mean ± SD ] age: 38.2 ± 8.3 years; height: 180.2 ± 7.5 cm; body mass: 86.7 ± 20.8 kg; body mass index: 25.8 ± 7.8 kg·m −2 ) using multifrequency bioelectrical impedance analysis (MFBIA) hand-to-foot device, and single-frequency BIA foot scale (F2FBIA), and a single-frequency handheld BIA device (HHBIA). Dual X-ray absorptiometry served as the criterion. Validity metrics were examined to establish each method's performance. Body fat % values produced by MFBIA ( r = 0.913), F2FBIA ( r = 0.695), and HHBIA ( r = 0.876) were strongly associated ( p < 0.001) with criterion BF% measures. However, MFBIA, F2FBIA, and HHBIA all significantly ( p < 0.001) underestimated BF% when compared with the criterion measure. Constant error ranged between 4.0 and 5.5% across all BIA devices. Despite strong associations between the BIA devices included in the current study and the criterion measure, all BIA devices underestimated BF%, which resulted in an overestimation of fat-free mass. In addition, proportional bias was observed in which BF% was overestimated at lower values and underestimated at higher values.

The strength of the shoulder musculature involved with internal rotation and arm extension plays an important role in the overhead throwing motion for baseball athletes, both for throwing-related performance and injury risk. The maintenance of shoulder strength is a high priority for baseball athletes throughout a season; however, little is known in regards to the expected changes in strength throughout a season. To examine pre-post changes in shoulder strength, lower body power, and body composition among collegiate baseball players after the completion of a summer baseball league season. Amateur baseball players (n = 12; age: 20.9 ± 1.0 years.; height: 181.6 ± 5.6 cm; body mass: 86.4 ± 11.1 kg; BMI: 26.0 ± 2.6 kg/m2) participated in the current study. Pre- and post-competitive season, the participants completed shoulder strength assessments and body composition and countermovement vertical jump (CMJ) tests. An upper-body isometric test (athletic shoulder [ASH] test) was used to evaluate shoulder strength for each arm. Each subject completed maximal isometric contractions for both the throwing and non-throwing arms at four separate angles of abduction (180°, ‘I’; 135°, ‘Y’; 90°, ‘T’; and −180°, ‘A’) while lying in a prone position. For shoulder strength, the primary dependent variable of interest was a composite measure that represented the average of the forces produced across all four positions of the ASH test (I, Y, T, A). For the ASH test composite measure, there was a trend toward a significant arm-by-time interaction effect (p = 0.08), as shoulder strength decreased by 9.03% for the throwing arm (ES = 0.72; 95% CI = [−0.27, −0.01]), compared to only 2.03% for the non-throwing arm (ES = 0.15; 95% CI = [−0.16, 0.09]), over the course of the season. The main effects of time (p = 0.16) and arm (p = 0.58) were not significant for the ASH test composite measure. There was no relationship between lower body power and throwing arm strength at baseline (r = 0.20, p = 0.56), and only a non-significant weak relationship at post-test (r = 0.28, p = 0.41). Throughout a season, baseball players may experience reductions in shoulder strength of the throwing arm with minimal changes in shoulder strength in the non-throwing arm.

Abstract Witte, BC, Schouten, TC, Westphal, JA, VanZile, AW, Jones, DD, Widenhoefer, TL, Dobbs, WC, Jagim, AR, Luedke, JA, and Almonroeder, TG. The modified reactive strength index is a valid measure of lower-body explosiveness in male and female high school athletes. J Strength Cond Res 38(8): 1428–1432, 2024—The modified reactive strength index (mRSI) is a commonly used metric to quantify lower-body explosiveness during countermovement jump (CMJ) performance. However, few studies have attempted to examine its validity as a measure of explosiveness, particularly among high school athletes. The purpose of this study was to examine the validity of the mRSI as a measure of lower-body explosiveness among a relatively large sample of male and female high school athletes from various sports. As part of this study, male ( n = 132) and female ( n = 43) high school athletes performed CMJs, while ground reaction forces were recorded using a force platform. The vertical ground reaction force data collected during the CMJs were used to derive the following variables: peak force (PF), peak power, time to PF, time to take-off, peak rate of force development, and the mRSI. Principal component analysis was applied and reduced these variables into 2 components related to “force” and “speed.” The mRSI loaded on both the force (loading = 0.82) and speed (loading = −0.46) components, indicating that it incorporates elements of both force and speed, although it loaded more strongly on the force component than the speed component. The observed pattern of cross-loading suggests that the mRSI is generally a valid measure of lower-body explosiveness for male and female high school athletes.