MRI segmentation of tooth tissue in age prediction of sub-adults - a new method for combining data from the 1st, 2nd, and 3rd molars.

PURPOSE: We aimed to establish a model combining MRI volume measurements from the 1st, 2nd and 3rd molars for age prediction in sub-adults and compare the age prediction performance of different combinations of all three molars, internally in the study cohort. MATERIAL AND METHOD: We examined 99 volunteers using a 1.5 T MR scanner with a customized high-resolution single T2 sequence. Segmentation was performed using SliceOmatic (Tomovision©). Age prediction was based on the tooth tissue ratio (high signal soft tissue + low signal soft tissue)/total. The model included three correlation parameters to account for statistical dependence between the molars. Age prediction performance of different combinations of teeth for the three molars was assessed using interquartile range (IQR). RESULTS: We included data from the 1st molars from 87 participants (F/M 59/28), 2nd molars from 93 (F/M 60/33) and 3rd molars from 67 (F/M 45/22). The age range was 14-24 years with a median age of 18 years. The model with the best age prediction performance (smallest IQR) was 46-47-18 (lower right 1st and 2nd and upper right 3rd molar) in males. The estimated correlation between the different molars was 0.620 (46 vs. 47), 0.430 (46 vs. 18), and 0.598 (47 vs. 18). IQR was the smallest in tooth combinations including a 3rd molar. CONCLUSION: We have established a model for combining tissue volume measurements from the 1st, 2nd and 3rd molars for age prediction in sub-adults. The prediction performance was mostly driven by the 3rd molars. All combinations involving the 3rd molar performed well.

Menstrual cycle characteristics, perceived impact on performance, and barriers to communication: Perspectives of high-performance adolescent athletes in Singapore.

The purpose of this study was to examine the menstrual cycle (MC) characteristics, explore the impact on performance, and identify barriers to and facilitators of MC-related communication among high-performance female adolescent athletes in Singapore. Ninety athletes (15.4 ± 1.8 years) from multiple sports completed an online questionnaire. Eighty-four athletes were postmenarcheal (menarcheal age 11.9 ± 1.3 years), including two who were using an oral contraceptive pill (OCP). Secondary amenorrhea, current or history of, was self-reported in 16% of athletes. Sixty-two percent and 67% of non-OCP athletes perceived that the MC affected their ability to train and compete, respectively. Athletes preferred speaking to a parent (85%) and a female figure (67%) about MC-related concerns. Through thematic analysis, three barriers to communication were constructed: (1) pervasive menstrual stigma, (2) constraints of the training environment, and (3) the low value placed on MC-related conversations. Two facilitators of communication were constructed: (1) respect athletes' individual experiences as menstruating girls and (2) foster a safe space for MC-related conversations. Findings demonstrated that menstrual irregularities are common in adolescent athletes and screening for MC disorders, particularly primary amenorrhea should be undertaken in this population, with clear support pathways for management including symptom mitigation. To support athletes in raising MC-related concerns when needed, structured communication pathways that consider individual preferences and involve a (female) point of contact should be established within the training environment. Improving menstrual health literacy among adolescent athletes before any misinformation or negative perceptions are firmly established may contribute to longevity in their athletic careers.

Which training load indicators are greater correlated with maturation and wellness variables in elite U14 soccer players?

BACKGROUND: Monitoring of training load is done to improve physical performance and minimize the incidence of injuries. The study examined the correlation between accumulated training load parameters based on periods with maturity (i.e., maturity offset and peak height velocity -PHV- and wellness variables -e.g., stress and sleep quality-). The second aim was to analyze the multi-linear regression between the above indicators. METHODS: Twenty elite young U14 soccer players (M = 13.26 ± 0.52 years, 95% CI [13.02, 13.51]) were evaluated over 26 weeks (early, mid, and end-season) to obtain stress, sleep quality, and measures of workload in the season (accumulated acute workload [AW], accumulated chronic workload [CW], accumulated acute: chronic workload ratio [ACWLR], accumulated training monotony [TM], accumulated training strain [TS]). RESULTS: The analysis revealed a moderate, statistically significant negative correlation between sleep quality and training monotony (r = -0.461, p < 0.05). No significant correlations were observed between other variables (p > 0.05). In the multi-linear regression analysis, maturity, PHV, sleep, and stress collectively accounted for variances of 17% in AW, 17.1% in CW, 11% in ACWLR, 21.3% in TM, and 22.6% in TS. However, individual regression coefficients for these predictors were not statistically significant (p > 0.05), indicating limited predictive power. CONCLUSION: The study highlights the impact of sleep quality on training monotony, underscoring the importance of managing training load to mitigate the risks of overtraining. The non-significant regression coefficients suggest the complexity of predicting training outcomes based on the assessed variables. These insights emphasize the need for a holistic approach in training load management and athlete wellness monitoring.

SCAT5 baseline values, test-retest reliability, and reliable change metrics in high school athletes.

OBJECTIVE: In the United States, more than 1 million sport-related concussions afflict children annually, with many cases undetected or unreported. The Sport Concussion Assessment Tool (SCAT) is widely used to detect concussions in high school, collegiate, and professional sports. The objective of this study was to establish baseline values for the SCAT version 5 (SCAT5) in high school athletes. METHODS: Baseline SCAT5 evaluations were conducted in students (ages 14-19 years) from 19 high schools in central Illinois who were participating in various school-sponsored sports. The SCAT5 evaluations were retrospectively extracted from the electronic medical record system for analysis. Statistical analyses included the Wilcoxon rank-sum test for continuous variables and the chi-square test for categorical variables, considering significance at p < 0.05. Test-retest reliability at < 6 months, 10-14 months, and 16-20 months was computed using intraclass correlation and Spearman's rho (ρ). Reliable change indices are provided using the Iverson formula. RESULTS: A total of 2833 unique athletes were included, and the average age was 15.5 ± 1.14 (SD) years. There were 721 female (25.5%) and 2112 male (74.5%) athletes. Students ≥ 15 years old had more prior concussions (p < 0.001), and male athletes were more frequently hospitalized for head injury (p = 0.013). Female athletes exhibited a significantly higher prevalence of mood disorders (14.7% vs 4.6%, p < 0.001), whereas attention-deficit/hyperactivity disorder was more common in male athletes (5.2% vs 13.2%, p < 0.001). Symptom number and severity were significantly greater in female athletes (3.17 ± 4.39 vs 2.08 ± 3.49, p < 0.001; 5.47 ± 9.21 vs 3.52 ± 7.26, p < 0.001, respectively), with mood-related symptoms representing the largest differences. Female athletes and students ≥ 15 years old performed better on most cognitive assessments. Female athletes and students < 15 years old performed better on the modified Balance Error Scoring System (p < 0.001). Test-retest reliability was poor to moderate for most assessment components. Reliable change index cutoff values differed slightly by sex, with female athletes often having a greater cutoff value. CONCLUSIONS: This study underscores the variability of SCAT5 baseline values influenced by age, sex, and medical history among adolescent athletes. It provides a robust dataset, delineating baseline values stratified by sex and age within this demographic. Additionally, the results provide enhanced guidance to clinicians for interpretation of change and reliability of baselines.

SARS-CoV-2 transmission in teenagers and young adults in Fútbol Club Barcelona's Multidisciplinary Sports Training Academy.

Most studies, aimed at determining the incidence and transmission of SARS-CoV-2 in children and teenagers, have been developed in school settings. Our study conducted surveillance and inferred attack rates focusing on the practice of sports. Prospective and observational study of those attending the sports facilities of Fútbol Club Barcelona (FCB), in Barcelona, Spain, throughout the 2020-2021 season. Participants were young players (from five different sports) and adult workers, who belonged to stable teams (shared routines and were involved in same quarantine rules). Biweekly health questionnaires and SARS-CoV-2 screening were conducted. From the 234 participants included, 70 (30%) both lived and trained in the FCB facilities (Recruitment Pathway 1;RP1) and 164 (70%) lived at their own household and just came to the facilities to train (RP2). During the study, 38 positive cases were identified; none had severe symptoms or needed hospitalization. The overall weekly incidence in the cohorts did not differ compared to the one expected in the community, except for 2 weeks when an outbreak occurred. The attack rate (AR) was three times higher for the participants from RP1, in comparison to those from RP2 (p < 0.01). A Basketball team showed a significant higher AR.  Conclusion: Physical activities in stable teams are not related to an increased risk of transmission of SARS-CoV-2, since there were the same observed cases than expected in the community. The risk is higher in indoor sports (Basketball vs. Football), and in closed cohort living settings (RP1 vs. RP2). The fulfilment of preventive measures is essential. What is Known: • Despite the low numerical impact caused in paediatric hospitalizations during COVID-19 pandemic, the social impact has been maximum. • The transmission potential in children and teenagers is limited, and it had been widely demonstrated in school settings. What is New: • Group physical activities in children and teenagers are not also related to an increased risk of transmission of SARS-CoV-2, when preventive measures, such as washing hands, and screening protocols are applied. • Routine and semi-professional sports activities seem safe environments to promote during this pandemic.

Intra-observer reproducibility and inter-observer agreement of Fels skeletal age assessments among male tennis players 8-16 years.

BACKGROUND: Skeletal age (SA) is an estimate of biological maturity status that is commonly used in sport-related medical examinations. This study considered intra-observer reproducibility and inter-observer agreement of SA assessments among male tennis players. METHODS: SA was assessed with the Fels method in 97 male tennis players with chronological ages (CA) spanning 8.7-16.8 years. Radiographs were evaluated by two independent trained observers. Based on the difference between SA and CA, players were classified as late, average or early maturing; if a player was skeletally mature, he was noted as such as an SA is not assigned. RESULTS: The magnitude of intra-individual differences between repeated SA assessments were d = 0.008 year (observer A) and d = 0.001 year (observer B); the respective coefficients of variation were 1.11% and 1.75%. Inter-observer mean differences were negligible (t = 1.252, p = 0.210) and the intra-class correlation coefficient was nearly perfect (ICC = 0.995). Concordance of classifications of players by maturity status between observers was 90%. CONCLUSION: Fels SA assessments were highly reproducible and showed an acceptable level of inter-observer agreement between trained examiners. Classifications of players by skeletal maturity status based on assessments of the two observers were highly concordant, though not 100%. The results highlight the importance of experienced observers in skeletal maturity assessments.

Peak height velocity in young athletes: A longitudinal meta-analysis.

The present longitudinal meta-analysis aimed to estimate the growth curves and age at peak height velocity (PHV) in young male athletes, considering anthropometric data from available longitudinal studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, studies with repeated measurements in young male athletes were identified from searches across four databases (MEDLINE, SPORTDiscus, Web of Science, and SCOPUS). Estimations were based on multilevel polynomial models using a fully Bayesian framework. After a full-text screening of 317 studies meeting the eligibility criteria, 31 studies were considered. Studies were excluded mainly due to study design, repeated reporting, and incomplete reporting of the outcomes. Of the 31 studies analysed, 26 (84%) focused on young European athletes. The average age at PHV for the total sample of studies with young athletes was 13.1 years (90% credible interval: 12.9; 13.4). When considering data by sport, there was substantial variation in the age at PHV estimates (range: 12.4 to 13.5 years). As most studies in the meta-analysis focused on young European football players (52%), predictions for young athletes from other sports may be limited. The age at PHV in the available data occurred earlier than in general paediatric populations.

A machine learning approach for the classification of sports based on a coaches' perspective of environmental, individual and task requirements: A sports profile analysis.

Well-designed talent programmes in sports with a focus on talent identification, orientation, development, and transfer support the engagement of young individuals and the pursuit of elite performance. To facilitate these processes, an analysis of task, environmental and individual characteristics per sport is much needed. The aims of this study were to 1) analyse whether unique profiles per sport could be established by generic characteristics and 2) to discuss similarities and differences for the potential application in talent development and transfer. By means of a validated survey, 1247 coaches from 34 sports ranked 18 characteristics on importance to their sports (0 = not important - 10 = very important). To discriminate the responses per sport a Discriminant Analysis (DA) was carried out. To refine the DA-classification, Uniform Manifold Approximation and Projection (UMAP) with CatBoost classifier was performed. To test the performance of the CatBoost classifier-algorithm, a confusion-matrix was generated. The cross-validated DA showed that 70.2% of the coaches were correctly classified to their sport. The UMAP/CatBoost technique revealed 75.1% accuracy with correctly predicted responses per sport ranging from 18.2% (sailing) to 98.2% (soccer). With varying precision, the algorithm was able to differentiate sports by importance of its characteristics indicating similarities and differences per sport.

Virtual Workshops as an Effective and Engaging Policy Implementation Strategy: Lessons From the National Youth Sports Strategy.

BACKGROUND.: Implementation is an important piece of effective policymaking, but connecting local organizations with federal policy can be challenging. A virtual workshop structure can help engage implementation partners, especially when in-person events are not possible. The workshops described here leveraged virtual outreach and facilitation methods to foster community engagement, forge connections, and build relationships at the regional, state, and local levels. METHODS.: This article focuses on five virtual workshops. The planning phase consisted of selecting the geographic scope of each workshop, developing outreach and facilitation materials, and supporting event logistics. The execution and summary phase included tailoring materials, hosting the events, and producing follow-up materials. Networking, resource sharing, collaboration, and active facilitation were employed to promote engagement. RESULTS.: Registration for the virtual workshops included 223 individuals representing organizations in 28 states. Participants shared 133 resources. In a post-event evaluation, 93% of respondents indicated they could identify at least one new resource to support their efforts to increase youth sports participation in their community, and 94% indicated they plan to follow up and explore potential partnerships/collaborations with others they met or heard from at the workshop. Networking and resource sharing were identified as the most useful aspects of the workshops. CONCLUSIONS.: With careful planning and collaboration, virtual workshops represent a useful community engagement mechanism to bring policy into practice. Creating events focused on the participant experience supports health promotion professionals, engages communities, and takes a policy off the page and out to the people.

Sports Specialization, Physical Literacy, and Physical Activity Levels in Young Adults.

CONTEXT: Youth sport specialization may be associated with physical literacy and physical activity in young adulthood. The purposes of this study were to compare young adult (18-25 y) physical literacy and physical activity by high school sport specialization status and to examine the relationship between current physical activity and physical literacy. DESIGN: Retrospective, cross-sectional study design. METHODS: Participants were recruited from ResearchMatch, university classes, and social media posts. Participants (N = 172; aged 22.1 [2.1] y; 80.1% female) completed the following anonymous surveys on REDCap to assess: demographics and injury history, sport specialization, physical literacy (PLAYself), and physical activity (Godin Leisure-Time Exercise Questionnaire). RESULTS: When controlling for age, there were no statistically significant differences in physical literacy (F2,166 = 2.02, P = .14) or moderate to vigorous physical activity (F2,161 = 0.24, P = .79) between sport specialization groups. There was a moderate, positive relationship between physical literacy and physical activity (r = .33, P < .001). CONCLUSIONS: Young adult physical literacy and physical activity were similar regardless of youth sport specialization level. Young adult physical literacy was positively associated with physical activity. Future studies should consider physical literacy as a possible correlate of physical activity among young adults.

Results from the United Arab Emirates 2022 report card on physical activity for children and adolescents.

Objective: The United Arab Emirates (UAE) 2022 Report Card provides a systematic evaluation of the physical activity (PA) levels of children and adolescents in the UAE. Methods: The 2022 Report Card utilized data from 2017 to 2021 to inform 10 core PA indicators that were common to the Global Matrix 4.0. Results: One in five (19%) UAE school children achieved the recommended amount of moderate-to-vigorous PA (i.e. ≥60 min/d; Total Physical Activity Grade F). Less than 1% of school children used active transport to and from school (Active Transportation Grade F). One in four (26%) secondary school children achieved the recreational screen time recommendations (i.e. ≤2 h/d; Sedentary Behaviours Grade D-). A quarter of adults reported achieving the recommended PA level (i.e. ≥150 min of moderate-intensity PA per week, or equivalent) (Family and Peers Grade D-). All school children are taught physical education (PE) by a specialist with at least a bachelor's degree in PE; however, the duration of weekly PE classes varied between schools (School Grade A-). The UAE Government has invested significant funds and resources into developing and implementing strategies and facilities that will increase PA across the entire population (Government Grade B+). Organised Sport and Physical Activity, Active Play, Physical Fitness, and Community and Environment indicators were graded 'Incomplete' (INC) due to a lack of available data. Conclusions: Overall, PA levels remain low and sedentary behaviours remain high amongst UAE children and adolescents. The UAE Government has sustained investment in further developing PA opportunities for all children and adults which should translate to increased PA and health improvements at a population level.

Effects of body mass-based resistance training on measures of physical fitness and musculotendinous injury incidence and burden in U16 male soccer players.

This study examined the effects of body mass-based resistance training (bmRT) on selected measures of physical fitness and injury incidence and burden in soccer players. Forty-six U16 male soccer players were randomly assigned to an control (CG; n = 26) or experimental group (EG; n = 20) Countermovement jump (CMJ), change of direction (CoD) (i.e., 20 m with one CoD), and linear sprint over 30 m were assessed before and after a 15-weeks training. Any type of musculotendinous injury that occurred throughout the intervention period was recorded. Between-group difference was noted at post-test for CMJ (p = 0.008). Pre-to-post training values increased in the EG (effect size [ES] = 1.01) while in the CG no pre-to-post changes were detected (ES = 0.27). No between-group differences at post-test were observed for sprint and CoD tests. Differences in injury burden were reported (33.28 [CG] vs. 9.55 [EG] absence days/1,000 hours exposure, rate ratio = 3.49, 95% CI 2.03-6.00, p < 0.001), but not in injury incidence. A bmRT programis suitable for improving jumping height but not linear and CoD speed performance. Additionally, bmRT may reduce injury burden, and therefore, the severity of musculotendinous injuries in U16 male soccer players.

Factors associated with body size perception among adolescent goal-oriented sports participants and non-participants: a cross-sectional Finnish study.

BACKGROUND: Regardless of competitive athletes' body image pressures, only few studies have focused on adolescent sport participants' body image and the findings are inconclusive. Furthermore, the role of competitive goals in sports on adolescents' body size perception has not been studied. We examined the factors associated with adolescents' competitive goals in sports and body size perception, and the associations between adolescents' competitive goals in sports and body size perception. METHODS: The cross-sectional study consisted of 475 goal-oriented sports club participants and 936 reference youths (aged 14-16 years). The study questionnaire included multiple choice items on health behaviours, motives to exercise, competitive goals in sports and body size perception. The multinomial logistic regression analysis was used to investigate the associations. RESULTS: Adolescents with competitive goals in sports perceived their body size as about the right size more frequently than reference youths (68% vs 47%, p < 0.001 in girls; 74% vs 61%, p < 0.001 in boys). More than one-fourth of girls with competitive goals in sports perceived themselves as overweight, although only 7% of them were overweight. Adolescents with appearance/weight motives to exercise and poor perceived physical fitness had higher odds of perceived fatness. Additionally, BMI was positively associated with perceived fatness and negatively with perceived thinness. Having competitive goals in sports was not independently associated with perceived fatness or perceived thinness. CONCLUSIONS: Adolescents' BMI, appearance/weight motives to exercise, and perceived physical fitness were more strongly associated with body size perception than their competitive goals in sports. However, perceived fatness among girls with competitive goals in sports should be considered in organized sports.

Early Sport Specialization and Past Injury in Competitive Youth Rock Climbers.

INTRODUCTION: Sport specialization has been shown to have negative effects on athletes but has not been studied within rock climbing. This study seeks to evaluate the proportion and impact of specialization in pediatric climbers. METHODS: Climbers (ages 8-18 y) were recruited from throughout the United States to complete a 1-time survey regarding climbing experience, training patterns, and injury history. The main outcome of proportion of climbers suffering an injury was assessed within the last 12 mo and within their entire climbing experience (defined as "lifetime" injury). Early specialization was defined as exclusive participation in climbing, with training for >8 mo‧y-1, prior to age 12 y (late specialization if after age 12 y). RESULTS: Participants (n=111, 14±3 y [mean±SD], 69 females) were high-level climbers. Fifty-five percent of participants specialized in climbing, and 69% of those specialized early. Hand and ankle injuries occurred most commonly. Seventy-eight percent of late specialized climbers had a lifetime injury. Late specialized climbers were 1.6 times (95% CI: 1.1-2.3) more likely than early specialized climbers to have had a lifetime injury and 1.8 times (95% CI: 1.1-2.8) more likely to have had an injury in the last 12 mo. No difference in overuse injuries was found between specialization groups. CONCLUSIONS: Early specialization is common among youth climbers but was not associated with an increase in injuries. Late specialization was associated with a higher likelihood of having had a climbing injury in the last 12 mo and during an entire climbing career.

Influence of Special Education, ADHD, Autism, and Learning Disorders on ImPACT Validity Scores in High School Athletes.

OBJECTIVE: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly used to assist with post-concussion return-to-play decisions for athletes. Additional investigation is needed to determine whether embedded indicators used to determine the validity of scores are influenced by the presence of neurodevelopmental disorders (NDs). METHOD: This study examined standard and novel ImPACT validity indicators in a large sample of high school athletes (n = 33,772) with or without self-reported ND. RESULTS: Overall, 7.1% of athletes' baselines were judged invalid based on standard ImPACT validity criteria. When analyzed by group (healthy, ND), there were significantly more invalid ImPACT baselines for athletes with an ND diagnosis or special education history (between 9.7% and 54.3% for standard and novel embedded validity criteria) when compared to athletes without NDs. ND history was a significant predictor of invalid baseline performance above and beyond other demographic characteristics (i.e., age, sex, and sport), although it accounted for only a small percentage of variance. Multivariate base rates are presented stratified for age, sex, and ND. CONCLUSIONS: These data provide evidence of higher than normal rates of invalid baselines in athletes who report ND (based on both the standard and novel embedded validity indicators). Although ND accounted for a small percentage of variance in the prediction of invalid performance, negative consequences (e.g., extended time out of sports) of incorrect decision-making should be considered for those with neurodevelopmental conditions. Also, reasons for the overall increase noted here, such as decreased motivation, "sandbagging", or disability-related cognitive deficit, require additional investigation.

Seasonal changes in the physical activity levels of youth Gaelic football players.

This study quantified changes in physical activity (PA) levels attained by adolescents during Gaelic football (GF) participation across two time points in a season and determined if these changes affected their overall daily PA levels. A total of 130 adolescents (65 females;15.3 ± 1.5 years) wore an activPAL accelerometer to determine total moderate PA (MPA), vigorous PA (VPA) and moderate-to-vigorous PA (MVPA) during a seven-day measurement period, including during GF. The PA measurement was completed at "preseason" (T1) and "in-season" (T2) timepoints. Between T1 and T2, females significantly increased time spent in MVPA daily (p < 0.001, d = 0.95), on Gaelic football days (GFDs) (p = 0.036; d = 0.30), on non-Gaelic football days (NGFDs) (p < 0.001; d = 0.43), and during GF (p < 0.001, d = 0.90). Males did not record any significant changes in PA over time (p > 0.05). At T2, there were no significant differences in time spent in MVPA daily, on GFDs and NGFDs, and during GF between the genders (p > 0.05). The results suggest that the change in daily PA levels by females is a consequence of increased MVPA during GF and reduced PA barriers across the season.

Scoping review of tests to assess tactical knowledge and tactical performance of young soccer players.

This scoping review aimed to systematically map studies/tests for assessing the tactical domain of young soccer players. The study followed the PRISMA-ScR and Joanna Briggs Institute guidelines. The databases searched were Scopus, SPORTDiscus, SciELO, LILACS, and BDTD. The eligibility criteria were defined based on the elements of population, context, and concept, without restrictions on the period, language, and type of publication. Twenty-four papers were included, from 1997 to 2020, totalling 29 tests/instruments for the assessment of the tactical domain, with the majority of studies having an European sample. Twelve terms were used to nominate the tactical component, regardless of the assessment method and approach. Six tests met eight or nine criteria in the critical appraisal: TCTOF, TACSIS Spanish version, Semi-Structured Interview, TCTP-OE, GPET, and FUTSAT. Thus, it is concluded that studies and tests for the assessment of the tactical domain of young soccer players are recent and mainly European; there is no consensus about the adopted terminology; and few tests met the majority of the quality criteria. Therefore, we suggest: a) the construction/adaptation of tests with samples from other continents; b) the use of the proposed criteria; and c) that the terms tactical knowledge and tactical performance are adopted.

Improving Youth Sports Safety: Implementing an Emergency Action Plan for Sudden Cardiac Arrest.

BACKGROUND: Children who participate in youth sports are at risk for sudden cardiac arrest (SCA) related to undetected cardiac anomalies or abrupt impact to the chest. Nurse-led interventions may prevent sudden cardiac death by helping leagues implement an emergency action plan to respond to SCA and improve safety. A youth soccer league in the Southeast with participants between the ages of 5-19 years, led by volunteer board members and coaches, did not have reliable access to automated external defibrillators or receive standardized education on SCA and cardiopulmonary resuscitation with a site-specific action plan. METHODS: A nurse-led quality improvement pilot project used partnerships to provide league access to automated external defibrillators, institute preseason SCA and cardiopulmonary resuscitation training, and establish an emergency action plan for the league's volunteers. Anonymous pre- and post-training testing was conducted to measure participant knowledge, confidence, and willingness to respond to SCA. A cross-sectional survey, using a convenience sample of board members and coaches, evaluated sustainability of the intervention at midseason. INTERVENTION: Training targeted board members (Blue Shirts) to serve as leaders on the field during an SCA event and educated coaches on activating the emergency action plan. RESULTS: Blue Shirts and coaches showed significant (p < .05) improvement of knowledge, confidence, and willingness to respond to SCA after receiving the standardized preseason intervention; Blue Shirts' changes were sustained at midseason. CONCLUSION: Nurses are ideal for helping youth sports leagues implement a sustainable SCA action plan based on best-practice recommendations for emergency health and safety.

The Protective Effect of Neuromuscular Training on the Medial Tibial Stress Syndrome in Youth Female Track-and-Field Athletes: A Clinical Trial and Cohort Study.

CONTEXT: Few reports have analyzed the effects of neuromuscular (NM) training programs on the injury incidence among youth female track-and-field athletes. OBJECTIVE: To determine the effects of NM training on reducing lower limb injury incidence and to establish its effects on countermovement jump performance, balance, 30-m sprint, and joint position sense in youth female track-and-field athletes. DESIGN: Single-blind, randomized controlled clinical trial. SETTING: Sports research laboratory. PARTICIPANTS: Twenty-two female athletes were allocated into 2 groups: Conventional (CONV) training (n = 11; age = 15.3 [2.1] y) and NM training (n = 11; age = 15.0 [2.7] y). INTERVENTIONS: Interventions were performed during the preseason of 6 weeks. The CONV training included anaerobic, strength, and aerobic training. The NM training consisted of a multicomponent program that integrated jumps, landings, and running with strength, endurance, agility, balance, and CORE training. MAIN OUTCOME MEASURES: A follow-up of the cohorts was carried out through the evaluation of lower limb injuries (main outcome) during a regular season (weeks 7-18). Secondary outcomes were measured before and after the intervention: Y-balance test, active joint repositioning, ground reaction force, and countermovement jump height. RESULTS: The injury incidence rate was 17.89 injuries per 1000 hours athlete-exposure in CONV training, and 6.58 in NM training (relative risk = 0.38; 95% confidence interval,  0.18 to 0.82; P = .044). Particularly, the medial tibial stress syndrome incidence rate was 5.96 injuries per 1000 hours athlete-exposure in CONV training and 0.82 in NM training (relative risk = 0.17; 95% confidence interval, 0.02 to 1.12; P = .012). In addition, a significant training × time interaction was noted, favoring improvements in 30-m sprint and countermovement jump height after NM. CONCLUSION: The NM training may improve youth female athlete's physical fitness and reduce their injury relative risk of medial tibial stress syndrome injury.

Reproducibility and inter-observer agreement of Greulich-Pyle protocol to estimate skeletal age among female adolescent soccer players.

BACKGROUND: Skeletal age (SA) is considered the best method of assessing biological maturation. The aim of this study was to determine intra-observer (reproducibility) and inter-observer agreement of SA values obtained via the Greulich-Pyle (GP) method. In addition, the variation in calculated SAs by alternative GP protocols was examined. METHODS: The sample was composed of 100 Portuguese female soccer players aged 12.0-16.7 years. SAs were determined using the GP method by two observers (OB1: experience < 100 exams using GP; OB2: experience > 2000 exams using several methods). The radiographs were examined using alternative GP protocols: (wholeGP) the plate was matched to the atlas as an overall approach; (30-boneGP) bone-by-bone inspections of 30-bones; (GPpmb) bone-by-bone inspections of the pre-mature bones only. For the 30-boneGP and GPpmb approaches, SA was calculated via the mean (M) and the median (Md). RESULTS: Reproducibility ranged 82-100% and 88-100% for OB1 and OB2, respectively. Inter-observer agreement (100 participants multiplied by 30 bones) was 92.1%. For specific bones, agreement rates less than 90% were found for scaphoid (81%), medial phalange V (83%), trapezium (84%) and metacarpal V (87%). Differences in wholeGP SAs obtained by the two observers were moderate (d-cohen was 0.79). Mean differences between observers when using bone-by bone SAs were trivial (30-boneGP: d-cohen less than 0.05; GPpmb: d-cohen less than 0.10). The impact of using the mean or the median was negligible, particularly when analyses did not include bones scored as mature. CONCLUSION: The GP appeared to be a reasonably reproducible method to assess SA and inter-observer agreement was acceptable. There is evidence to support a recommendation of only scoring pre-mature bones during later adolescence. Further research is required to examine whether these findings are consistent in younger girls and in boys.