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1.  Motivations associated with non-disclosure of self-reported concussions in former collegiate athletes 
Previous studies examining non-disclosure among athletes in various settings have found substantial proportions of athletes with undisclosed concussions. Substantial gaps exist in our understanding of the factors influencing athletes’ disclosure of sports-related concussions.
This cross-sectional study examined prevalence of, and factors associated with, non-disclosure of recalled concussions in former collegiate athletes.
Study Design
Cross-sectional survey.
Former collegiate athletes (n=797) completed an online questionnaire. Respondents recalled self-identified sports-related concussions (SISRC) that they sustained while playing sports in high school, college, or professionally, and whether they disclosed these SISRC to others. Respondents also recalled motivations for non-disclosure. We computed the prevalence of non-disclosure among those who recalled SISRC. Multivariate binomial regression estimated adjusted prevalence ratios (PR) with 95% confidence intervals (CI) controlling for sex, level of contact in sport, and year began playing college sports.
Two-hundred-and-fourteen (26.9%) respondents reported sustaining at least one SISRC. Of these, 71 (33.2%) reported not disclosing at least one SISRC. Former football athletes were most likely to report non-disclosure (68.3% of those recalling SISRC); female athletes who participated in low/non-contact sports were the least likely to report non-disclosure (11.1% of those recalling SISRC). The prevalence of non-disclosure was higher among males than females in the univariate analysis, (PR=2.88; 95%CI: 1.62, 5.14) multivariate analysis (PR=2.11; 95%CI: 1.13, 3.96), and multivariate analysis excluding former football athletes (PR=2.11; 95%CI: 1.12, 3.94). The most commonly reported motivations included: did not want to leave the game/practice (78.9)%; did not want to let the team down (71.8%); did not know it was a concussion (70.4%); and did not think it was serious enough (70.4%).
Consistent with previous studies, a substantial proportion of former athletes recalled SISRC that were not disclosed. Males were less likely to disclose all their SISRC than females.
PMCID: PMC4722948  PMID: 26582799
epidemiology; sport; reporting; traumatic brain injury
2.  Methods and Descriptive Epidemiology of Services Provided by Athletic Trainers in High Schools: The National Athletic Treatment, Injury and Outcomes Network Study 
Journal of Athletic Training  2015;50(12):1310-1318.
Research is limited on the extent and nature of the care provided by athletic trainers (ATs) to student-athletes in the high school setting.
To describe the methods of the National Athletic Treatment, Injury and Outcomes Network (NATION) project and provide the descriptive epidemiology of AT services for injury care in 27 high school sports.
Descriptive epidemiology study.
Athletic training room (ATR) visits and AT services data collected in 147 high schools from 26 states.
Patients or Other Participants
High school student-athletes participating in 13 boys' sports and 14 girls' sports during the 2011−2012 through 2013−2014 academic years.
Main Outcome Measure(s)
The number of ATR visits and individual AT services, as well as the mean number of ATR visits (per injury) and AT services (per injury and ATR visit) were calculated by sport and for time-loss (TL) and non–time-loss (NTL) injuries.
Over the 3-year period, 210 773 ATR visits and 557 381 AT services were reported for 50 604 injuries. Most ATR visits (70%) were for NTL injuries. Common AT services were therapeutic activities or exercise (45.4%), modalities (18.6%), and AT evaluation and reevaluation (15.9%), with an average of 4.17 ± 6.52 ATR visits and 11.01 ± 22.86 AT services per injury. Compared with NTL injuries, patients with TL injuries accrued more ATR visits (7.76 versus 3.47; P < .001) and AT services (18.60 versus 9.56; P < .001) per injury. An average of 2.24 ± 1.33 AT services were reported per ATR visit. Compared with TL injuries, NTL injuries had a larger average number of AT services per ATR visit (2.28 versus 2.05; P < .001).
These findings highlight the broad spectrum of care provided by ATs to high school student-athletes and demonstrate that patients with NTL injuries require substantial amounts of AT services.
PMCID: PMC4741258  PMID: 26678290
medical coverage; sports; injury surveillance; NATION
3.  Reference Values for the Marx Activity Rating Scale in a Young Athletic Population 
Sports Health  2015;7(5):403-408.
Activity-related patient-reported outcome measures are an important component of assessment after knee ligament injury in young and physically active patients; however, normative data for most activity scales are limited.
To present reference values by sex for the Marx Activity Rating Scale (MARS) within a young and physically active population while accounting for knee ligament injury history and sex.
Study Design:
Cross-sectional study.
Level of Evidence:
Level 2.
All incoming freshman entering a US Service Academy in June of 2011 were recruited to participate in this study. MARS was administered to 1169 incoming freshmen (203 women) who consented to participate within the first week of matriculation. All subjects were deemed healthy and medically fit for military service on admission. Subjects also completed a baseline questionnaire that asked for basic demographic information and injury history. We calculated means with standard deviations, medians with interquartile ranges, and percentiles for ordinal and continuous variables, and frequencies and proportions for dichotomous variables. We also compared median scores by sex and history of knee ligament injury using the Kruskal-Wallis test. MARS was the primary outcome of interest.
The median MARS score was significantly higher for men when compared with women (χ2 = 13.22, df = 1, P < 0.001) with no prior history of knee ligament injury. In contrast, there was no significant difference in median MARS scores between men and women (χ2 = 0.47, df = 1, P = 0.493) who reported a history of injury. Overall, median MARS scores were significantly higher among those who reported a history of knee ligament injury when compared with those who did not (χ2 = 9.06, df = 1, P = 0.003).
Assessing activity as a patient-reported outcome after knee ligament injury is important, and reference values for these instruments need to account for the influence of prior injury and sex.
PMCID: PMC4547111  PMID: 26502414
activity scales; patient-reported outcome measures; knee ligament injury
4.  Migration, multiple sexual partnerships, and sexual concurrency in the Garífuna population of Honduras 
AIDS and behavior  2015;19(9):1559-1570.
The Garífuna, an ethnic minority group in Honduras, have been disproportionately affected by HIV. Previous research suggests that migration and high rates of multiple sexual partnerships are major drivers of the epidemic. Using data from a 2012 population-based survey, we assessed whether temporary migration was associated with 1) multiple sexual partnerships and 2) sexual concurrency among Garífuna men and women in Honduras. Among both men and women, temporary migration in the last year was associated with an increased likelihood of multiple sexual partnerships and with concurrency, though only the association between migration and multiple sexual partnerships among men was statistically significant (Adjusted Prevalence Ratio 1.7, 95% CI 1.2-2.4). Migration may contribute to HIV/STI vulnerability among Garífuna men and women via increases in these sexual risk behaviors. Research conducted among men and women at elevated risk of HIV should continue to incorporate measures of mobility, including history of internal migration.
PMCID: PMC4714585  PMID: 26242612
5.  A Link Between Integral Membrane Protein Expression and Simulated Integration Efficiency 
Cell reports  2016;16(8):2169-2177.
Integral membrane proteins (IMP) control the flow of information and nutrients across cell membranes, yet IMP mechanistic studies are hindered by difficulties in expression. We investigate this issue by addressing the connection between IMP sequence and observed expression levels. For homologs of the IMP TatC, observed expression levels widely vary and are affected by small changes in protein sequence. The effect of sequence changes on experimentally observed expression levels strongly correlates with the simulated integration efficiency obtained from coarse-grained modeling, which is directly confirmed using an in vivo assay. Furthermore, mutations that improve the simulated integration efficiency likewise increase the experimentally observed expression levels. Demonstration of these trends in both Escherichia coli and Mycobacterium smegmatis suggests that the results are general to other expression systems. This work suggests that IMP integration is a determinant for successful expression, raising the possibility of controlling IMP expression via rational design.
PMCID: PMC5001948  PMID: 27524616
6.  Third Places for Health Promotion with Older Adults: Using the Consolidated Framework for Implementation Research to Enhance Program Implementation and Evaluation 
This study extends the concept of third places to include community sites where older adults gather, often for meals or companionship. The Consolidated Framework for Implementation Research guided program implementation and evaluation. Depending upon health promotion program needs, the physical infrastructure of a site is important, but a supportive director (champion) can often overcome identified deficits. Senior centers may be locally classified into four types based upon eligibility requirements of residents in affiliated housing and services offered. Participants who attend these centers differ in important ways across types by most sociodemographic as well as certain health and health care characteristics.
PMCID: PMC5052145  PMID: 27562878
Community-based programs; Health promotion; Health service delivery; Older adults; Oral health
7.  UbiX is a flavin prenyltransferase required for bacterial ubiquinone biosynthesis 
Nature  2015;522(7557):502-506.
Ubiquinone, or coenzyme Q, is a ubiquitous lipid-soluble redox cofactor that is an essential component of electron transfer chains1. Eleven genes have been implicated in bacterial ubiquinone biosynthesis, including ubiX and ubiD, which are responsible for decarboxylation of the 3-octaprenyl-4-hydroxybenzoate precursor2. Despite structural and biochemical characterization of UbiX as an FMN-binding protein, no decarboxylase activity has been detected3–4. We report here that UbiX produces a novel flavin-derived cofactor required for the decarboxylase activity of UbiD5. UbiX acts as a flavin prenyltransferase, linking a dimethylallyl moiety to the flavin N5 and C6 atoms. This adds a fourth non-aromatic ring to the flavin isoalloxazine group. In contrast to other prenyltransferases6–7, UbiX is metal-independent and requires dimethylallyl-monophosphate as substrate. Kinetic crystallography reveals that the prenyl transferase mechanism of UbiX resembles that of the terpene synthases8. The active site environment is dominated by π-systems, which assist phosphate-C1’ bond breakage following FMN reduction, leading to formation of the N5-C1’ bond. UbiX then acts as a chaperone for adduct reorientation, via transient carbocation species, leading ultimately to formation of the dimethylallyl C3’-C6 bond. The study establishes the mechanism for formation of a new flavin-derived cofactor, extending both flavin and terpenoid biochemical repertoire.
PMCID: PMC4988493  PMID: 26083743
8.  The National Athletic Treatment, Injury and Outcomes Network (NATION): Methods of the Surveillance Program, 2011–2012 Through 2013–2014 
Journal of Athletic Training  2015;50(8):862-869.
Previous epidemiologic researchers have examined time-loss (TL) injuries in high school student-athletes, but little is known about the frequency of non–time-loss (NTL) injuries in these athletes.
To describe the methods of the National Athletic Treatment, Injury and Outcomes Network (NATION) Surveillance Program and provide descriptive epidemiology of TL and NTL injuries across athletes in 27 high school sports.
Descriptive epidemiology study.
Aggregate injury and exposure data collected from 147 high schools in 26 states.
Patients or Other Participants
High school student-athletes participating in 13 boys' sports and 14 girls' sports during the 2011–2012 through 2013–2014 academic years.
Main Outcome Measure(s)
Athletic trainers documented injuries and exposures using commercially available injury-tracking software packages. Standard injury-tracking software was modified by the software vendors to conform to the surveillance needs of this project. The modified software exported a set of common data elements, stripped of personally identifiable information, to a centralized automated verification and validation system before they were included in the centralized research database. Dependent measures were injury and exposure frequencies and injury rates with 95% confidence intervals stratified by sport, sex, and injury type (TL or NTL).
Over the 3-year period, a total of 2337 team seasons across 27 sports resulted in 47 014 injuries and 5 146 355 athlete-exposures. The NTL injuries accounted for 38 765 (82.45%) and TL injuries for 8249 (17.55%) of the total.
The NTL injuries accounted for a substantial amount of the total number of injuries sustained by high school student-athletes. This project demonstrates the feasibility of creating large-scale injury surveillance systems using commercially available injury-tracking software.
PMCID: PMC4629944  PMID: 26067620
incidence; injury epidemiology; injury surveillance; sport
9.  Estimating Contact Exposure in Football Using the Head Impact Exposure Estimate 
Journal of Neurotrauma  2015;32(14):1083-1089.
Over the past decade, there has been significant debate regarding the effect of cumulative subconcussive head impacts on short and long-term neurological impairment. This debate remains unresolved, because valid epidemiological estimates of athletes' total contact exposure are lacking. We present a measure to estimate the total hours of contact exposure in football over the majority of an athlete's lifespan. Through a structured oral interview, former football players provided information related to primary position played and participation in games and practice contacts during the pre-season, regular season, and post-season of each year of their high school, college, and professional football careers. Spring football for college was also included. We calculated contact exposure estimates for 64 former football players (n=32 college football only, n=32 professional and college football). The head impact exposure estimate (HIEE) discriminated between individuals who stopped after college football, and individuals who played professional football (p<0.001). The HIEE measure was independent of concussion history (p=0.82). Estimating total hours of contact exposure may allow for the detection of differences between individuals with variation in subconcussive impacts, regardless of concussion history. This measure is valuable for the surveillance of subconcussive impacts and their associated potential negative effects.
PMCID: PMC4504255  PMID: 25603189
subconcussive impacts; traumatic brain injury
10.  Let us stop throwing out the baby with the bathwater: towards better analysis of longitudinal injury data 
British Journal of Sports Medicine  2015;50(12):712-715.
PMCID: PMC4941195  PMID: 26392594
Statistics; Injuries; Epidemiology
11.  Quality of care and contraceptive use in urban Kenya 
Family planning is highly beneficial to women’s overall health, morbidity, and mortality, particularly in developing countries. Yet, in much of sub-Saharan Africa, contraceptive prevalence remains low while unmet need for family planning remains high. It has been frequently hypothesized that the poor quality of family planning service provision in many low-income settings acts as a barrier to optimal rates of contraceptive use but this association has not been rigorously tested.
Using data collected from 3,990 women in 2010, this study investigates the association between family planning service quality and current modern contraceptive use in five cities in Kenya. In addition to individual-level data, audits of select facilities and service provider interviews were conducted in 260 facilities. Within 126 higher-volume clinics, exit interviews were conducted with family planning clients. Individual and facility-level data are linked based on the source of the woman’s current method or other health service. Adjusted prevalence ratios are estimated using binomial regression and we account for clustering of observations within facilities using robust standard errors.
Solicitation of client preferences, assistance with method selection, provision of information by providers on side effects, and provider treatment of clients were all associated with a significantly increased likelihood of current modern contraceptive use and effects were often stronger among younger and less educated women.
Efforts to strengthen contraceptive security and improve the content of contraceptive counseling and treatment of clients by providers have the potential to significantly increase contraceptive use in urban Kenya.
PMCID: PMC4548971  PMID: 26308259
12.  The Role of Parental ADHD in Sustaining the Effects of a Family-School Intervention for ADHD 
This study investigated the extent to which parental Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms impact child and parent outcomes following a multimodal family-school intervention, the Family School Success (FSS) program, when compared to an active-control condition (CARE).
Participants were 139 children with ADHD (67% male; 91% non-Hispanic; 77% Caucasian; grades 2–6) and their primary caretaker (91% female; aged 26–59) who participated in a randomized clinical trial evaluating the efficacy of FSS. Associations were examined between parent-reported ADHD symptoms at baseline and intervention outcomes reported by parents and teachers after treatment and at a 3-month follow-up, including child homework and classroom impairments, child ADHD and oppositional defiant disorder symptoms, parenting behaviors, and parent-teacher relationship quality.
Across both treatment conditions, parental ADHD was not associated with parent or child outcomes at post-assessment. However, differences emerged between the two treatment groups at follow-up for parents with ADHD, particularly when an empirically-supported symptom cutoff was used to identify parents at-risk for having ADHD. In FSS, but not in CARE, parental ADHD was associated with declines in treatment gains in the quality of the parent-teacher relationship and the child’s homework performance.
Parents at-risk for ADHD had difficulty maintaining treatment effects for themselves and their child in the FSS intervention, but not in CARE. The supportive and educational components central to the CARE intervention may be helpful in promoting the sustainability of psychosocial interventions for children with ADHD who have parents with elevated ADHD symptoms.
PMCID: PMC4466093  PMID: 25496523
ADHD; family-school intervention; adult ADHD; treatment sustainability
13.  Anterior Urethral Stricture Disease Negatively Impacts the Quality of Life of Family Members 
Advances in Urology  2016;2016:3582862.
Purpose. To quantify the quality of life (QoL) distress experienced by immediate family members of patients with urethral stricture via a questionnaire given prior to definitive urethroplasty. The emotional, social, and physical effects of urethral stricture disease on the QoL of family members have not been previously described. Materials and Methods. A questionnaire was administered prospectively to an immediate family member of 51 patients undergoing anterior urethroplasty by a single surgeon (SBB). The survey was comprised of twelve questions that addressed the emotional, social, and physical consequences experienced as a result of their loved one. Results. Of the 51 surveyed family members, most were female (92.2%), lived in the same household (86.3%), and slept in the same room as the patient (70.6%). Respondents experienced sleep disturbances (56.9%) and diminished social lives (43.1%). 82.4% felt stressed by the patient's surgical treatment, and 83.9% (26/31) felt that their intimacy was negatively impacted. Conclusions. Urethral stricture disease has a significant impact on the family members of those affected. These effects may last decades and include sleep disturbance, decreased social interactions, emotional stress, and impaired sexual intimacy. Treatment of urethral stricture disease should attempt to mitigate the impact of the disease on family members as well as the patient.
PMCID: PMC4791496  PMID: 27034658
15.  Parent attendance and homework adherence predict response to a family-school intervention for children with ADHD 
This study examined the relative contribution of two dimensions of parent engagement, attendance and homework adherence, to parent and child treatment response and explored whether early engagement was a stronger predictor of outcomes than later engagement.
The sample consisted of parents of participants (n = 92; M age 9.4 years, SD = 1.27; 67% male; 69% White) in a 12-session evidence-based family-school intervention for children with ADHD. Attendance was assessed using clinician records, and homework adherence was measured by rating permanent products. Outcomes included parent and teacher ratings of family involvement in education, parenting practices, and child functioning.
Accounting for the contributions of baseline scores and attendance, homework adherence was a significant predictor of parental self-efficacy, the parent-teacher relationship, parenting through positive involvement, and the child’s inattention to homework and homework productivity. Accounting for the contribution of baseline scores and homework adherence, attendance was a significant predictor of one outcome, the child’s academic productivity. Early homework adherence appeared to be more predictive of outcomes than later adherence, whereas attendance did not predict outcomes during either half of treatment.
These results indicate that, even in the context of evidence-based practice, it is the extent to which parents actively engage with treatment, rather than the number of sessions they attend, that is most important in predicting intervention response. Because attendance is limited as an index of engagement and a predictor of outcomes, increased efforts to develop interventions to promote parent adherence to behavioral interventions for children are warranted.
PMCID: PMC3751991  PMID: 23688140
parent engagement; attendance; homework adherence; intervention; ADHD
16.  Odors from Sewage Sludge and Livestock: Associations with Self-Reported Health 
Public Health Reports  2014;129(6):505-515.
Class B treated sewage sludge (TSS) contains microbes and toxicants and is applied to land in areas where livestock wastes may be present. We evaluated relationships of reports of TSS and livestock odors with acute symptoms and excessive flies.
A total of 158 adults living near liquid TSS application sites, 85 living near cake TSS application sites, and 188 living in comparison areas responded to a household survey regarding odors, health, and demographics. We identified symptom groups using factor analysis. We used generalized estimating equations to fit linear models for associations between factor scores and odors, and Poisson models for associations with specific symptoms.
Most factor scores were similar between exposure groups. Covariate-adjusted z-scores for lower respiratory symptoms were 0.28 (95% confidence interval [CI] –0.10, 0.65) higher among residents who reported moderate to very strong liquid TSS odor than among residents in comparison areas, and 0.28 (95% CI 0.05, 0.50) higher among residents who reported moderate to very strong livestock odor compared with residents reporting no or faint livestock odor. The factor score for dermatologic conditions was higher among residents who reported higher liquid sludge odor (0.27, 95% CI –0.13, 0.68), primarily due to skin rash (prevalence ratio = 2.21, 95% CI 1.13, 4.32). Excessive flies were reported twice as commonly among respondents who reported moderate to very strong TSS odor than among other residents.
Reported odors from TSS and livestock were associated with some acute symptoms. Health departments should monitor land applications of human and animal wastes and conduct surveillance of health problems reported by neighbors.
PMCID: PMC4187293  PMID: 25364052
17.  Testicular Leydig Cell Tumor with Metachronous Lesions: Outcomes after Metastasis Resection and Cryoablation 
Case Reports in Urology  2015;2015:748495.
Leydig cell tumors represent 3% of testicular masses and usually occur in prepubertal boys and men between 30 and 60 years of age. Leydig cell tumors are benign in children but can be malignant in 10% of adults. This case report describes a 41-year-old patient who was diagnosed with a Leydig cell tumor that originated in his right testicle that subsequently metastasized to his liver, lungs, and retroperitoneum. We discuss the patient's presentation and review the radiographic findings, surgical treatment, surgical pathology, chemotherapeutic treatment, and published literature on this rare pathology.
PMCID: PMC4615212  PMID: 26525589
18.  The Impact of Medicaid Expansion on Oral Health Equity for Older Adults: A Systems Perspective 
This paper uses a collaborative, interdisciplinary systems science inquiry to explore implications of Medicaid expansion on achieving oral health equity for older adults. Through an iterative modeling process oriented toward the experiences of both patients and oral health care providers, complex feedback mechanisms for promoting oral health equity are articulated that acknowledge the potential for stigma as well as disparities in oral health care accessibility. Multiple factors mediate the impact of Medicaid expansion on oral health equity.
PMCID: PMC4596543  PMID: 26457047
19.  Evidence From ElderSmile for Diabetes and Hypertension Screening in Oral Health Programs 
The ElderSmile clinical program was initiated in northern Manhattan in 2006. ElderSmile is a comprehensive community-based program offering education, screening and treatment services for seniors in impoverished communities. Originally focused on oral health, ElderSmile was expanded in 2010 to include diabetes and hypertension education and screening. More than 1,000 elders have participated in the expanded program to date. Quantitative and qualitative findings support a role for dental professionals in screening for these primary care sensitive conditions.
PMCID: PMC4594879  PMID: 26451080
20.  New species without dead bodies: a case for photo-based descriptions, illustrated by a striking new species of Marleyimyia Hesse (Diptera, Bombyliidae) from South Africa 
ZooKeys  2015;117-127.
A new bombyliid species Marleyimyia xylocopae Marshall & Evenhuis, sp. n., an apparent mimic of the carpenter bee Xylocopa flavicollis (De Geer), is described from South Africa on the basis of photographs only. The pros and cons of species descriptions in the absence of preserved type specimens are discussed.
PMCID: PMC4607853  PMID: 26487819
South Africa; bee fly; mimicry; Xylocopa; type specimens; photography; taxonomy
21.  Seven Steps for Developing and Implementing a Preventive Training Program: Lessons Learned from JUMP ACL and Beyond 
Clinics in sports medicine  2014;33(4):615-632.
Musculoskeletal injuries during military and sport-related training are common, costly and potentially debilitating. Thus, there is a great need to develop and implement evidence-based injury prevention strategies to reduce the burden of musculoskeletal injury. The lack of attention to implementation issues is a major factor limiting the ability to successfully reduce musculoskeletal injury rates using evidence-based injury prevention programs. We propose 7 steps that can be used to facilitate successful design and implementation of evidence-based injury prevention programs within the logical constraints of a real-world setting by identifying implementation barriers and associated solutions. Incorporating these 7 steps along with other models for behavioral health interventions may improve the overall efficacy of military and sport-related injury prevention programs.
PMCID: PMC4185282  PMID: 25280612
implementation; injury prevention; research framework; program design; sports; military
22.  Testicular Interposition Flap for Repair of Perineal Urinary Fistulae: A Novel Surgical Technique 
Case Reports in Urology  2015;2015:836454.
Rectourinary fistulae and urinary-cutaneous fistulae are a rare yet devastating complication. Current options for tissue interposition include rectus, gracilis, or gluteal muscle, omentum, or intestine for use in coloanal pull-through procedures. In elderly patients, testicular interposition flaps may be an excellent tissue option to use when vitalized tissue is necessary to supplement fistula repair. Elderly patients frequently have increased spermatic cord length, potentially offering a longer flap reach than use of a muscle flap. Additionally, mobilizing one of the testicles and developing it through the external inguinal ring may be a less morbid and less costly procedure than harvesting and tunneling a muscle flap. Longer follow-up and further studies are needed to determine the outcomes of this novel technique.
PMCID: PMC4592900  PMID: 26483985
23.  Injury Rates in Age-Only Versus Age-and-Weight Playing Standard Conditions in American Youth Football 
Orthopaedic Journal of Sports Medicine  2015;3(9):2325967115603979.
American youth football leagues are typically structured using either age-only (AO) or age-and-weight (AW) playing standard conditions. These playing standard conditions group players by age in the former condition and by a combination of age and weight in the latter condition. However, no study has systematically compared injury risk between these 2 playing standards.
To compare injury rates between youth tackle football players in the AO and AW playing standard conditions.
Study Design:
Cohort study; Level of evidence, 2.
Athletic trainers evaluated and recorded injuries at each practice and game during the 2012 and 2013 football seasons. Players (age, 5-14 years) were drawn from 13 recreational leagues across 6 states. The sample included 4092 athlete-seasons (AW, 2065; AO, 2027) from 210 teams (AW, 106; O, 104). Injury rate ratios (RRs) with 95% CIs were used to compare the playing standard conditions. Multivariate Poisson regression was used to estimate RRs adjusted for residual effects of age and clustering by team and league. There were 4 endpoints of interest: (1) any injury, (2) non–time loss (NTL) injuries only, (3) time loss (TL) injuries only, and (4) concussions only.
Over 2 seasons, the cohort accumulated 1475 injuries and 142,536 athlete-exposures (AEs). The most common injuries were contusions (34.4%), ligament sprains (16.3%), concussions (9.6%), and muscle strains (7.8%). The overall injury rate for both playing standard conditions combined was 10.3 per 1000 AEs (95% CI, 9.8-10.9). The TL injury, NTL injury, and concussion rates in both playing standard conditions combined were 3.1, 7.2, and 1.0 per 1000 AEs, respectively. In multivariate Poisson regression models controlling for age, team, and league, no differences were found between playing standard conditions in the overall injury rate (RRoverall, 1.1; 95% CI, 0.4-2.6). Rates for the other 3 endpoints were also similar (RRNTL, 1.1 [95% CI, 0.4-3.0]; RRTL, 0.9 [95% CI, 0.4-1.9]; RRconcussion, 0.6 [95% CI, 0.3-1.4]).
For the injury endpoints examined in this study, the injury rates were similar in the AO and AW playing standards. Future research should examine other policies, rules, and behavioral factors that may affect injury risk within youth football.
PMCID: PMC4622300  PMID: 26672778
epidemiology; youth football; injury risk
24.  The ElderSmile TimeMap: Benefits of Connecting Statistics With Time and Place 
American journal of public health  2015;105(9):1748-1750.
Community-based programs are critical for locally targeted public health education and accessible service delivery. Deriving useful information from such programs is important for their own evaluation and improvement and may facilitate research collaboration with partners and experts. Here we present an interactive Web-based application designed for a community-based oral health outreach program called ElderSmile to demonstrate how data can be summarized, filtered, compared, and visualized by time and place to inform program planning, evaluation, and research. The ElderSmile TimeMap ( is an emergent product of a US National Institutes of Health–funded collaboration of knowledge sharing among multidisciplinary team members at the University at Buffalo, Columbia University, and New York University.
PMCID: PMC4529788  PMID: 26180989
25.  Asthma Symptoms Among Adolescents Who Attend Public Schools That Are Located Near Confined Swine Feeding Operations 
Pediatrics  2006;118(1):e66-e75.
Little is known about the health effects of living in close proximity to industrial swine operations. We assessed the relationship between estimated exposure to airborne effluent from confined swine feeding operations and asthma symptoms among adolescents who were aged 12 to 14 years.
During the 1999–2000 school year, 58 169 adolescents in North Carolina answered questions about their respiratory symptoms, allergies, medications, socioeconomic status, and household environments. To estimate the extent to which these students may have been exposed during the school day to air pollution from confined swine feeding operations, we used publicly available data about schools (n = 265) and swine operations (n = 2343) to generate estimates of exposure for each public school. Prevalence ratios and 95% confidence intervals for wheezing within the past year were estimated using random-intercepts binary regression models, adjusting for potential confounders, including age, race, socioeconomic status, smoking, school exposures, and household exposures.
The prevalence of wheezing during the past year was slightly higher at schools that were estimated to be exposed to airborne effluent from confined swine feeding operations. For students who reported allergies, the prevalence of wheezing within the past year was 5% higher at schools that were located within 3 miles of an operation relative to those beyond 3 miles and 24% higher at schools in which livestock odor was noticeable indoors twice per month or more relative to those with no odor.
Estimated exposure to airborne pollution from confined swine feeding operations is associated with adolescents’ wheezing symptoms.
PMCID: PMC4517575  PMID: 16818539
asthma; environmental health; epidemiology; school age children; school health

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