Citations

Tools used for the identification, evaluation, and monitoring of concussion have not been sufficiently studied in youth or real-world settings. Normative and reliability data on sideline concussion assessment measures in the youth athlete population is needed. Pre-season normative data for 515 athletes (93.5% male) aged 5 to 16 on the Standardized Assessment of Concussion (SAC/SAC-Child), modified Balance Errors Scoring System (mBESS), Timed Tandem Gait (TTG), and the King–Devick Test (KDT) are provided. A total of 212 non-injured athletes repeated the measures post-season to assess test–retest reliability. Mean performance on the SAC-C, mBESS, TTG, and KDT tended to improve with age. KDT was the only measure that demonstrated good to excellent stability across age ranges (ICC = 0.758 to 0.941). Concentration was the only SAC/SAC-C subtest to demonstrate moderate test–retest stability (ICC = 0.503 to 0.706). TTG demonstrated moderate to good (ICC = 0.666 to 0.811) reliability. mBESS demonstrated poor to moderate reliability (ICC = −0.309 to 0.651). Commonly used measures of concussion vary regarding test–retest reliability in youth. The data support the use of at least annual sport concussion baseline assessments in the pediatric population to account for the evolution in performance as the child ages. Understanding the variation in the stability and the evolution of baseline performance will enable improved identification of possible injury.

Background: Mohs micrographic surgery (MMS) is a promising treatment modality for melanoma in situ (MIS). However, variations in surgical technique limit the generalizability of existing data and may impede future study of MMS in clinical trials. Methods: A modified Delphi method was selected to establish consensus on optimal MMS techniques for treating MIS in future clinical trials. The Delphi method was selected due to the limited current data, the wide range of techniques used in the field, and the intention to establish a standardized technique for future clinical trials. A literature review and interviews with experienced MMS surgeons were performed to identify dimensions of the MMS technique for MIS that (1) likely impacted costs or outcomes of the procedure, and (2) showed significant variability between surgeons. A total of 8 dimensions of technical variation were selected. The Delphi process consisted of 2 rounds of voting and commentary, during which 44 expert Mohs surgeons across the United States rated their agreement with specific recommendations using a Likert scale. Results: Five of eight recommendations achieved consensus in Round 1. All 3 of the remaining recommendations achieved consensus in Round 2. Techniques achieving consensus in Round 1 included the use of a starting peripheral margin of ≤5 mm, application of immunohistochemistry, frozen tissue processing, and resecting to the depth of subcutaneous fat. Consensus on the use of Wood’s lamp, dermatoscope, and negative tissue controls was established in Round 2. Conclusions: This study generated 8 consensus recommendations intended to offer guidance for Mohs surgeons treating MIS. The adoption of these recommendations will promote standardization to facilitate comparisons of aggregate data in multicenter clinical trials.

Background: Understanding nutrition’s role in multiple sclerosis (MS) can guide recommendations and intervention-based studies. Objective: Evaluate the association between nutrition and pediatric-onset MS outcomes. Methods: Prospective longitudinal multicenter study conducted as part of the US Network of Pediatric MS centers. Predictors were collected using a food screener estimating intake of various dietary food groups (e.g. dairy and fruits) and additional calculated indices (e.g. Healthy Eating Index (HEI)). Outcomes included time-from-enrollment to clinical relapse, new magnetic resonance imaging (MRI) T2 lesions, and Expanded Disability Status Scale (EDSS) increase. Results: 353 children with MS were enrolled (mean ± SD age 15.4 ± 2.9, follow-up 3.9 ± 2.6 years). Multivariable analysis demonstrated that increased dairy by 50% of recommended intake was associated with increased relapse risk by 41% (adjusted hazard ratio (HR) 1.41, 95% CI 1.07–1.86), and risk of T2 progression by 40% (1.40, 1.12–1.74). Increased intake of fruit or vegetable above recommended, and every five-point HEI increase decreased relapse risk by 25% (0.75, 0.60–0.95), 45% (0.55, 0.32–0.96), and 15% (0.84, 0.74–0.96), respectively. No associations were found with EDSS. Conclusion: This work supports the influence of dietary intake on MS course, particularly with dairy intake. Future prospective study is required to establish causation.

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.

Date Presented 03/21/24 OTs believe they offer a unique contribution to pelvic health by recognizing the role of mental health and using interventions to reduce stress. This study contributes to evidence of the value of OTPs in pelvic health. Primary Author and Speaker: Jennifer Fyhrie Contributing Authors: Arlene Schmid, Eleanor Le Fevre, Jennifer Weaver, Christine A. Fruhauf

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.

Abstract Floersch, S, Vidden, C, Askow, AT, Jones, MT, Fields, JB, and Jagim, AR. Seasonal changes in match demands and workload distribution in collegiate soccer across two seasons. J Strength Cond Res 38(8): 1440–1446, 2024—The purpose of this study was to examine seasonal changes in match demands in a collegiate women's soccer team. Forty-eight NCAA Division III women soccer athletes (age: 19.5 ± 1.2 years; height: 1.67 ± 0.05 m; body mass: 64.8 ± 7.4 kg; fat-free mass: 50.0 ± 4.5 kg; body fat %: 22.6 ± 6.0) were equipped with wearable global positioning systems with inertial sensors and heart rate (HR) monitors during matches throughout the 2019 ( n = 22) and 2021 seasons ( n = 26). Players were classified by position: flank player (FP; n = 28), center midfielder (CM; n = 11), and center back fielder (CB; n = 9) and as starters (S, n = 17) or reserves (R, n = 31). Variables included HR, training load, total distance, high-speed distance, distance per minute, and weighted distance. Differences in match and practice session demands were analyzed using linear mixed-effects models with season (2 levels; 2019 and 2021) as a fixed factor, with alpha set to p = 0.05. Data across all matches and training sessions were collapsed and presented as mean ± SD for descriptive purposes and then grouped by session type (i.e., match or training) and position. Athletes traveled more distance at high speeds during match play in the 2021 season compared with 2019 (mean difference, 95% confidence intervals [CI]) (200, 95% CI: 104, 304 km; p < 0.05) but had a lower training load in 2021 compared with 2019 (−50, 95% CI: −63, −36; p < 0.05) during match play. For training sessions, mean HR (4, 95% CI: 2, 5 bpm), total distance (0.5, 95% CI: 0.4, 0.7), distance per minute (5.6, 95% CI: 4.5, 6.7 m·min −1 ), high-speed distance (43, 95% CI: 43, 18, 67 m), high accelerations (8.6, 95% CI: 5.4, 11.8 n ), and high accelerations per minute (0.1, 95% CI: 0.1, 0.1 n ·min −1 ) were all higher in 2021 compared with 2019 ( p < 0.05). As a team, several differences in measures of external workload were found between seasons in both session types (training and matches). Variations in positional demands of match play appear to fluctuate by year.

With an annual cumulative occurrence of approximately 15,000 in North America, all childhood cancers are rare. Very rare cancers as defined by both the European Cooperative Study Group for Rare Pediatric Cancers (EXPeRT) and the Children’s Oncology Group (COG) fall into two principal categories: those so uncommon (fewer than 2 cases/million) that their study is challenging even through cooperative group efforts (e.g. pleuropulmonary blastoma, desmoplastic small round cell tumor) and those that are far more common in adults and therefore rarely studied in children (e.g. thyroid, melanoma, gastrointestinal stromal tumor). [1](#ref-0001) Treatment strategies for these latter tumors are typically based on adult guidelines, although the pediatric variants of these tumors may harbor different genetic signatures and demonstrate different behavior. If melanoma and differentiated thyroid cancer are excluded, other rare cancer types account for only 2% of the cancers in children aged 0 to 14.[1](#ref-0001) This article highlights several of the most common rare tumor types.