The International Olympic Committee framework on fairness, inclusion and nondiscrimination on the basis of gender identity and sex variations does not protect fairness for female athletes.

The International Olympic Committee (IOC) recently published a framework on fairness, inclusion, and nondiscrimination on the basis of gender identity and sex variations. Although we appreciate the IOC's recognition of the role of sports science and medicine in policy development, we disagree with the assertion that the IOC framework is consistent with existing scientific and medical evidence and question its recommendations for implementation. Testosterone exposure during male development results in physical differences between male and female bodies; this process underpins male athletic advantage in muscle mass, strength and power, and endurance and aerobic capacity. The IOC's "no presumption of advantage" principle disregards this reality. Studies show that transgender women (male-born individuals who identify as women) with suppressed testosterone retain muscle mass, strength, and other physical advantages compared to females; male performance advantage cannot be eliminated with testosterone suppression. The IOC's concept of "meaningful competition" is flawed because fairness of category does not hinge on closely matched performances. The female category ensures fair competition for female athletes by excluding male advantages. Case-by-case testing for transgender women may lead to stigmatization and cannot be robustly managed in practice. We argue that eligibility criteria for female competition must consider male development rather than relying on current testosterone levels. Female athletes should be recognized as the key stakeholders in the consultation and decision-making processes. We urge the IOC to reevaluate the recommendations of their Framework to include a comprehensive understanding of the biological advantages of male development to ensure fairness and safety in female sports.

Healthcare worker safety program in a coronavirus disease 2019 (COVID-19) alternate care site: The Javits New York Medical Station experience.

OBJECTIVE: In March 2020, New York City became the epicenter of the coronavirus disease 2019 (COVID-19) pandemic in the United States. Because healthcare facilities were overwhelmed with patients, the Jacob K. Javits Convention Center was transformed into the nation's largest alternate care site: Javits New York Medical Station (hereafter termed Javits). Protecting healthcare workers (HCWs) during a global shortage of personal protective equipment (PPE) in a nontraditional healthcare setting posed unique challenges. We describe components of the HCW safety program implemented at Javits. SETTING: Javits, a large convention center transformed into a field hospital, with clinical staff from the US Public Health Service Commissioned Corps and the US Department of Defense. METHODS: Key strategies to ensure HCW safety included ensuring 1-way flow of traffic on and off the patient floor, developing a matrix detailing PPE required for each work activity and location, PPE extended use and reuse protocols, personnel training, and monitoring adherence to PPE donning/doffing protocols when entering or exiting the patient floor. Javits staff who reported COVID-19 symptoms were immediately isolated, monitored, and offered a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction (RT-PCR) test. CONCLUSIONS: A well-designed and implemented HCW safety plan can minimize the risk of SARS-CoV-2 infection for HCWs. The lessons learned from operating the nation's largest COVID-19 alternate care site can be adapted to other environments during public health emergencies.

The Effects of Biofeedback on Performance and Technique of the Boxing Jab.

A growing body of research has addressed the application of movement-based biofeedback techniques for improving sports performers' gross motor skills. Unlike in previous research, we aimed in this study to quantify the effects of this "external" biofeedback on selected performance and technique variables for the boxing jab among both novices and experts. The technical setup included two inertial measurement units linked wirelessly to a video game system with audio output. The units were configured to provide auditory external biofeedback, based on the peak acceleration of the bag (i.e., biofeedback with an external attentional focus). Sixteen participants (8 novices and 8 experts) performed boxing jabs against the bag in blocked phases of biofeedback. When compared to baseline, the acute effects of externally focused biofeedback on peak bag acceleration were possibly positive in both retention phases for novices (d = 0.29; d = 0.41) and likely positive for experts (d = 0.41; d = 0.30), respectively. The experts' performance improvements were accompanied by substantive increases in trunk rotation, though this was not true for the novices. Thus, technique improvements can be promoted indirectly via externally focused biofeedback, but only when these actions are within the performers' motor repertoire. Overall, biofeedback via inertial sensors appears to be a potent technique for modifying human movement patterns in both experts and novices. This low-cost technology could be used to support training across sports, rehabilitation and human-computer interactions.

Competitive Performance Effects of Psychological Skill Training for Youth Swimmers.

This study assessed the effect of two different psychological methods of skills training-self-talk and goal setting-on the swimming performance of youth swimmers. We allocated a convenience sample of club and county level youth swimmers (N = 49; Mage = 10.8, SD = 1.25) to one of the three groups: self-talk, goal setting, or a control group engaged in no systematic psychological method of skills training. The groups were balanced in terms of competitive performance ability, age, and gender. Participants in the experimental conditions (self-talk and goal setting) completed a 5-week psychological skills intervention program and were measured on pre- and post-200-m swimming time in competition. After controlling for level of engagement in the program, analysis of covariance revealed a significant omnibus effect (p = .006, ηp2 = .20) with post hoc pairwise comparisons using magnitude-based statistics demonstrating that goal setting had a small positive effect compared with self-talk (η2 = .40; ± 0.45). Both self-talk (η2 = .50; ±0.48) and goal setting (η2 = .71; ±0.4) showed a small and moderate positive effect, respectively, relative to the control group. A social validation check confirmed that the swimmers found the intervention to be relevant, beneficial, and meaningful for improving performance. Psychological skills training may be effective in improving youth swimming performance; specific mechanisms underlying these benefits need further exploration.

Relationships Between Flow, Mental Toughness, and Subjective Performance Perception in Various Triathletes.

This study examined the relationship between mental toughness (MT), subjectively perceived performance, and dispositional flow in a sample of 114 high-performing ironmen and standard distance triathletes ( Mage = 28.81 years, SD = 3.45) recruited from triathlon clubs. Participants completed the Mental Toughness Questionnaire, Dispositional Flow Scale, and self-rated subjectively perceived performance. Pearson's correlations between these measures revealed a significant, positive relationship between global MT and subjective performance ratings ( r = .62, p < .01) and between global MT and all Dispositional Flow subscales ( r = .67-.81, p < .05). Linear regression analyses found that MT subscales accounted for 64% of the variance in dispositional flow. Subjective performance ratings did not add significantly to the regression model. Overall, these findings suggest that MT may contribute positively to ironman competitors' and triathletes' exertion of the cognitive and emotional control necessary to experience flow and perform better. We discuss these results in the context of ironman and triathlon competitions.

Mental toughness of mixed martial arts athletes at different levels of competition.

This study investigated whether mental toughness distinguishes mixed martial arts (MMA) athletes competing at different levels. It was theorized that higher mental toughness would separate those competing at the professional level compared to lower levels. Male MMA competitors (N = 136, M age = 27.1 yr., SD = 4.8) were categorized as amateur, semi-professional, or professional and assessed by questionnaire using the Psychological Performance Inventory-A and the Sports Mental Toughness Questionnaire. There were statistically significant differences between the three groups on mental toughness. The professional group had higher scores compared to semi-professional and amateur groups with regard to confidence, positive cognition, and determination. The findings supported previous work that athletes performing at higher levels have superior mental toughness.