Upon antigen recognition and co-stimulation, T lymphocytes upregulate the metabolic machinery necessary to proliferate and sustain effector function. This metabolic reprogramming in T cells regulates ...T cell activation and differentiation but is not just a consequence of antigen recognition. Although such metabolic reprogramming promotes the differentiation and function of T effector cells, the differentiation of regulatory T cells employs different metabolic reprogramming. Therefore, we hypothesized that inhibition of glycolysis and glutamine metabolism might prevent graft rejection by inhibiting effector generation and function and promoting regulatory T cell generation. We devised an anti-rejection regimen involving the glycolytic inhibitor 2-deoxyglucose (2-DG), the anti-type II diabetes drug metformin, and the inhibitor of glutamine metabolism 6-diazo-5-oxo-L-norleucine (DON). Using this triple-drug regimen, we were able to prevent or delay graft rejection in fully mismatched skin and heart allograft transplantation models.
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•Metabolic reprogramming is crucial for effector T cell differentiation and function•Blocking glycolysis and glutamine metabolism can prevent allograft rejection•Targeting effector cell metabolism preserves mechanisms of immunoregulation•Targeting metabolism represents a paradigm-shifting approach to transplantation
Lee et al. demonstrate that simultaneously blocking glycolysis and glutamine pathways can effectively inhibit allo-specific T cell responses while preserving mechanisms of immune regulation. Such a regimen represents a paradigm-shifting approach toward inhibiting acute rejection and promoting allograft survival.
Perceived stress and burnout are significant concerns among athletic trainers (ATs) due to growing professional demands. The global COVID-19 pandemic brought additional stressors, especially for ...health care providers, including the need to learn and integrate new skill sets in order to continue providing safe and effective patient care.
To explore the influence of COVID-19 stressors on ATs engaged in patient care.
Cross-sectional study.
Internet survey.
A total of 429 ATs (age = 33 ± 9 years; experience = 11 ± 9 years; 74 men, 355 women) currently providing patient care.
We recruited participants from social media sites to complete a questionnaire with the Coronavirus Anxiety Scale (CAS), Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP), and qualitative questions related to the effects of COVID-19. We calculated correlations between CAS and MBI-HSS MP composite scores (emotional exhaustion, personal accomplishment, and depersonalization) and used regression analysis to explore if CAS scores could be predicted by vaccination status (vaccinated or unvaccinated), sex, and MBI-HSS MP composite scores. We analyzed the qualitative data using a phenomenological, inductive approach with multianalyst triangulation and peer review as trustworthiness strategies.
Significant correlations existed between CAS and MBI-HSS MP composite scores (P < .001). Emotional exhaustion (P < .001) and depersonalization (P = .008) explained 28% of the variance in CAS scores (F2,405 = 81.29, P < .001). Three major areas of focus emerged: effects on wellness, emphasis on the value of athletic training, and the lessons learned and future innovation to inform potential long-term changes in the athletic training profession.
Key factors of emotional exhaustion and depersonalization during the pandemic may have exacerbated the potential for burnout among ATs. The pandemic affected ATs' wellness, changed perceptions of ATs, and altered operating procedures. Healthy coping strategies and organizational support are suggested for those who are struggling.
Athletic trainers (ATs) face organizational-professional conflict (OPC), often surrounding return-to-sport decisions. To prioritize patient safety and establish a healthy work environment, OPC must ...be mitigated, yet little research has determined how ATs manage conflicts with stakeholders.
To explore ATs' experiences with OPC in the secondary school setting.
Qualitative study.
Telephone interviews.
16 ATs (9 females, 7 males; age = 43±11 years; years certified = 17±9; years in their current positions = 9±6).
We digitally recorded telephone interviews and had them professionally transcribed. Data saturation guided recruitment efforts, and was met. To ensure rigor and trustworthiness of the data, we completed basic member checks along with multiple analyst triangulation. We analyzed the qualitative data using an interpretive phenomenological approach.
Four themes emerged: effective communication, professional relationships, stakeholder education and professional experience. Participants used effective communication described as frequent, open, and direct, during interactions with stakeholders to manage OPC. OPC was reduced when ATs built professional relationships with stakeholders centered on trust and respect. Participants used stakeholder education as a primary strategy for managing OPC by educating stakeholders about prognosis and return-to-sport timelines post-injury and providing rationale for decisions made. Additionally, years of experience served as a mitigating factor of conflict, in that as ATs gained experience and confidence, they perceived less OPC.
Participants suggested various interpersonal relationship development strategies that can be implemented to manage OPC, especially when starting a new position or building rapport with stakeholders. Specifically, educating various stakeholders on reasons for clinical decisions via effective communication and developing strong professional relationships built on mutual respect assisted in avoiding OPC. Since professional experience appears to alleviate conflict, OPC management strategies should be taught during professional preparation and used early during transition to autonomous practice.
Injuries in professional soccer are a significant concern for teams, and they are caused amongst others by high training load. This cohort study describes the relationship between workload parameters ...and the occurrence of non-contact injuries, during weeks with high and low workload in professional soccer players throughout the season. Twenty-one professional soccer players aged 28.3 ± 3.9 yrs. who competed in the Iranian Persian Gulf Pro League participated in this 48-week study. The external load was monitored using global positioning system (GPS, GPSPORTS Systems Pty Ltd) and the type of injury was documented daily by the team's medical staff. Odds ratio (OR) and relative risk (RR) were calculated for non-contact injuries for high- and low-load weeks according to acute (AW), chronic (CW), acute to chronic workload ratio (ACWR), and AW variation (Δ-Acute) values. By using Poisson distribution, the interval between previous and new injuries were estimated. Overall, 12 non-contact injuries occurred during high load and 9 during low load weeks. Based on the variables ACWR and Δ-AW, there was a significantly increased risk of sustaining non-contact injuries (
p
< 0.05) during high-load weeks for ACWR (OR: 4.67), and Δ-AW (OR: 4.07). Finally, the expected time between injuries was significantly shorter in high load weeks for ACWR 1.25 vs. 3.33, rate ratio time (RRT) and Δ-AW (1.33 vs. 3.45, RRT) respectively, compared to low load weeks. The risk of sustaining injuries was significantly larger during high workload weeks for ACWR, and Δ-AW compared with low workload weeks. The observed high OR in high load weeks indicate that there is a significant relationship between workload and occurrence of non-contact injuries. The predicted time to new injuries is shorter in high load weeks compared to low load weeks. Therefore, the frequency of injuries is higher during high load weeks for ACWR and Δ-AW. ACWR and Δ-AW appear to be good indicators for estimating the injury risk, and the time interval between injuries.
Abstract
Football helmets are expected to break down with use, and reconditioning recommendations are required to be stated by manufacturers. However, the degree of change in helmet impact mitigation ...performance as a function of usage is not generally known. Therefore, this study aimed to compare the ability of football helmets to attenuate impacts after a single season of regular collegiate use to unused helmets. Three never-used Riddell
®
Speed™ helmets were tested and compared to three used helmets which had been used during one season of Division 1 collegiate football. Helmets were tested at three velocities (3.46, 4.88, and 5.46 m s
−1
) on six locations in ambient temperature, simulating National Operating Committee on Standards for Athletic Equipment certification drop tests. The interaction between helmet age and location during all three velocities (
P
⩽
0.0001), indicating that there were differences in Gadd severity index (GSI) between new and used helmets after accounting for location-specific differences. Similar analysis for peak linear acceleration (PLA) found significant interactions for all three velocities (
P
⩽
0.003). Additional analyses found differences in velocity-dependence for several impact locations. In most cases, used helmets yielded lower GSI and PLA relative to new helmets. The reduction in impact metrics for used helmets indicates initial break-in with impact mitigation benefits, but the long-term consequences of continued use are unclear. The implications of these differences on injury risk and susceptibility remain unknown; however, the results suggest that further studies could inform helmet reconditioning guidelines and development of new smart materials designed to monitor and/or prevent breakdown in padding.
The transition to autonomous clinical practice for early professionals (EPs) has been found to be a stressful time, but no studies with multiple stakeholder groups have been completed.
To examine the ...perceptions of EPs' integration during role transition from multiple stakeholder groups.
Qualitative study.
Online interviews.
Seventeen EPs in the first 2 years of their first job postcertification (9 women, 8 men, age = 26 ± 5 years, experience = 9.5 ± 5 months), 16 supervisors and mentors of EPs (6 women, 10 men, age = 52 ± 11 years), and 10 faculty members and 8 preceptors (11 women, 7 men, age = 43 ± 10 years).
Semistructured interviews using a validated interview guide based on the current literature were conducted. We analyzed data using consensual qualitative research principles. Multiple-analyst triangulation (n = 3), member checking, and peer review served as trustworthiness strategies.
We identified 4 themes that defined the integration of EPs during role transition. The integration of EPs was facilitated through role inductance and mentoring. Early professionals struggle finding balance to avoid burnout as they are new to the profession and feel obligated to exceed expectations from a coverage standpoint rather than focusing on the quality of care delivered. Finally, stakeholders suggested a timeline by which EPs become fully integrated into autonomous professional practice and understand all aspects of their role that typically takes anywhere from 1 to 3 years.
Early professionals benefited from appropriate graded autonomy during clinical education to develop their clinical reasoning skills, confidence, and mentoring network with past preceptors. Ongoing personal and professional support are needed during the initial few years to ease EPs' role inductance while they gain more experience and establish their clinician identity. Expectations for EPs should be reasonable to allow for the provision of quality care, adequate work-life balance, and integration into the profession without guilt.
Early professional (EP) athletic trainers (ATs) may encounter adjustments and develop individual identities to master a new role, which can be difficult while transitioning from student to autonomous ...professional. Previous literature lacks content about the transition to practice of credentialed ATs who identify as Black, Indigenous, or people of color (BIPOC).
To identify challenges during the professional education and transition to practice of EP ATs identifying as BIPOC.
Qualitative study.
Virtual interviews.
Fifteen recently credentialed ATs (13 women, 2 men; age = 26.73 ± 1.41 years, experience = 13.80 ± 4.03 months) who self-identified as BIPOC.
We used an interview guide, validated by peer (n = 1) and expert (n = 3) review, to structure the data collection sessions. Data saturation guided recruitment, and we achieved theoretical redundancy after the final interview. We analyzed the data with a phenomenological approach and used multianalyst triangulation (n = 2) and peer review (n = 2) as credibility strategies.
All participants mentioned being victims of microaggressions because of their race during either their professional preparation, work environment, or both. Those who chose to report the incidents felt a lack of support from work supervisors, faculty, peers, and preceptors. Participants noted a preference for racially concordant mentoring to facilitate talking to a person who could better understand BIPOC EPs' experiences. Respondents also relied on outside support from friends and family as coping mechanisms. Finally, participants experienced perceived incompetency from supervisors due to their limited work experience as EPs and felt their professional preparation was stunted by the COVID-19 pandemic.
Participants perceived that their transition to practice was stressful due to the microaggressions encountered, a lack of support, and a lack of racially concordant mentoring. Diversity, equity, and inclusion training should be incorporated into athletic training education and workspaces to assist in providing more welcoming environments for BIPOC EP ATs and students.
To explore diverse stakeholders' perceptions of headgear use in collegiate women's lacrosse.
189 collegiate women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32).
...Participants completed online open-ended qualitative questions surrounding headgear use in the sport. Responses were coded by the research team via inductive reasoning.
Stakeholders felt that incorporating headgear use into women's lacrosse would increase aggression and change the nature of the sport. Some felt that headgear was important for injury risk mitigation and invoked a need for research and development. Stakeholders raised the need for coaching and officiating improvement as primary injury prevention measures. Players were concerned about esthetics and performance limitations. Finally, many felt that it should be left to player choice to wear headgear or not.
Most stakeholders invoke concerns of risk compensation and changing the nature of the sport of women's lacrosse, and are in favor of headgear remaining optional.
Nobari, H, Alves, AR, Abbasi, H, Khezri, D, Zamorano, AD, and Bowman, TG. Are metabolic power distribution and accelerometer-based GPS variables associated with odds ratios of noncontact injuries in ...professional soccer players? J Strength Cond Res XX(X): 000-000, 2022-The present study was intended to i) investigate the relationship between metabolic power average (MPA), acceleration (AcZ) and deceleration (DcZ) zones, and their differences (Δ) on 3 load levels with noncontact injuries in professional players throughout a full soccer season and ii) to analyze the injury risk associated between high-load versus low-load levels for each of the aforementioned parameters with odds ratios (OR) and relative risk (RR), respectively. Twenty-one professional soccer players (age = 28.3 ± 3.9 years) were monitored during a full season (48 weeks) through global positioning system (GPS). A relationship between MPA and accelerometer-based GPS, mainly in explosive actions (i.e., AcZs and DcZs), was found. A higher incidence of injuries in the high-load weeks compared with the low-load weeks were reported (mainly in MPA, AcZ1, AcZ2, and DcZ3 variables). Moreover, significant means of OR (mean = 4.3) and RR (mean = 2.6) of noncontact injuries were established in intense periods with higher metabolic load (i.e., power accelerations, AcZ1, x2 = 0.022). Our results may be useful for coaches, sports scientists, and researchers regarding the optimization of the athletes' performance, as well as providing insights about the impact of intense exercise.
IMPORTANCE: Surgical care is widely unavailable in developing countries; advocates recommend that countries evaluate and report on access to surgical care to improve availability and aid health ...planners in decision making. OBJECTIVE: To analyze the infrastructure, capacity, and availability of surgical care in Zambia to inform health policy priorities. DESIGN, SETTING, AND PARTICIPANTS: In this observational study, all hospitals providing surgical care were identified in cooperation with the Zambian Ministry of Health. On-site data collection was conducted from February 1 through August 30, 2011, with an adapted World Health Organization Global Initiative for Emergency and Essential Surgical Care survey. Data collection at each facility included interviews with hospital personnel and assessment of material resources. Data were geocoded and analyzed in a data visualization platform from March 1 to December 1, 2015. We analyzed time and distance to surgical services, as well as the proportion of the population living within 2 hours from a facility providing surgical care. MAIN OUTCOMES AND MEASURES: Surgical capacity, supplies, human resources, and infrastructure at each surgical facility, as well as the population living within 2 hours from a hospital providing surgical care. RESULTS: Data were collected from all 103 surgical facilities identified as providing surgical care. When including all surgical facilities (regardless of human resources and supplies), 14.9% of the population (2 166 460 of 14 500 000 people) lived more than 2 hours from surgical care. However, only 17 hospitals (16.5%) met the World Health Organization minimum standards of surgical safety; when limiting the analysis to these hospitals, 65.9% of the population (9 552 780 people) lived in an area that was more than 2 hours from a surgical facility. Geographic analysis of emergency and essential surgical care, defined as access to trauma care, obstetric care, and care of common abdominal emergencies, found that 80.7% of the population (11 704 700 people) lived in an area that was more than 2 hours from these surgical facilities. CONCLUSIONS AND RELEVANCE: A large proportion of the population in Zambia does not have access to safe and timely surgical care; this percentage would change substantially if all surgical hospitals were adequately resourced. Geospatial visualization tools assist in the evaluation of surgical infrastructure in Zambia and can identify key areas for improvement.
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