Service Academy Research Articles

Characterizing the Effects of Concussion and Head Impact Exposure: Design, Methods, and Participant Traits of the CARE 2.0 Study.

This article describes the design, methods, and participant characteristics of the second phase of the Concussion Assessment, Research, and Education (CARE) Consortium study ("CARE 2.0") of the effects of concussion and repetitive head impact exposure on neuropsychiatric health. The authors conducted a prospective multisite observational study of male and female collegiate athletes and military service academy cadets and midshipmen participating in the CARE study. Participants were assessed at three time points: undergraduate baseline (UB), before departure from university or service academy (exit), and up to 6 years following graduation (postgrad) via an online battery of brain health assessments. Participant characteristics were compared across the three time points and four levels of head impact exposure. A total of 4,643 participants completed the exit assessment, and 3,981 completed the postgrad assessment. Relative to the UB assessment cohort, the exit and postgrad assessment cohorts differed with respect to the percentage of women, baseline Wechsler Test of Adult Reading scores, National Collegiate Athletic Association division category, sport contact level, and number of previous concussions. The median standardized difference across balancing variables, assessment time points, and degree of head impact exposure was 0.12 (with 90% of effect sizes ≤0.29). Although there were some statistically significant differences between participants across assessments, the effect sizes were modest, and overall the data suggest that the exit and postgrad cohorts reflect the characteristics of the baseline cohort. The CARE study design and its large, richly characterized sample provide an opportunity to answer important questions about cumulative and persistent effects of concussion and repetitive head impact exposure on neuropsychiatric health.

Military college alumni application of leadership competencies in the workplace

PurposeThe purpose of this study was to explore the leadership competencies that are effectively transferring into the workplaces of recent military college alumni from both their curricular and co-curricular experiences.Design/methodology/approachThrough semi-structured interviews, this study explored 15 military college alumni’s perspectives on the leadership competencies they developed in college and currently apply in the workplace.FindingsThe findings indicated the 15 military college alumni participants developed and applied the following student leadership competencies at work: productive relationships, helping others, supervision, empathy, ethics, functioning independently, resiliency, positive attitude and scope of competence.Originality/valueLimited research explores leadership learning at military colleges and service academies in the United States. Yet these collegiate military environments have a missional focus on leadership education and development. This article highlights the importance of the alumni lens in assessing leadership learning in collegiate military environments and provides recommendations to administrators of this institution type.

ACFT Performance Based On Sport Skill Affiliation Of U.S. Service Academy Subjects; Implications To Military Training

ACFT Performance Based On Sport Skill Affiliation Of U.S. Service Academy Subjects; Implications To Military Training

Sex Differences Across Concussion Characteristics in US Service Academy Cadets: A CARE Consortium Study.

To describe sex differences in concussion characteristics in US Service Academy cadets. Descriptive epidemiology study. Four US service academies. 2209 cadets (n = 867 females, n = 1342 males). Sex. Injury proportion ratios (IPR) compared the proportion of injuries by sex (females referent) for injury situation, certainty of diagnosis, prolonged recovery, recurrent injuries, mental status alterations, loss of consciousness (LOC), posttraumatic amnesia (PTA), retrograde amnesia (RGA), motor impairments, delayed symptom presentation, and immediate reporting. Concussions from varsity/intercollegiate sports [IPR of 1.73, 95% confidence interval (CI) 1.43-2.10] and intramurals (IPR of 1.53, 95% CI 1.02-2.32) accounted for a larger proportion in males, whereas concussions outside of sport and military activities accounted for a smaller proportion among males (IPR of 0.70, 95% CI 0.58-0.85). The proportion of concussions with prolonged recovery was lower among males (IPR of 0.69, 95% CI 0.60-0.78), while concussions with altered mental status (IPR of 1.23, 95% CI 1.09-1.38), LOC (IPR of 1.67, 95% CI 1.17-2.37), PTA (IPR of 1.94, 95% CI 1.43-2.62), and RGA (IPR of 2.14, 95% CI 1.38-3.31) accounted for a larger proportion among males. A larger proportion of concussions that were immediately reported was observed in males (IPR of 1.15, 95% CI 1.00-2.31). Proportions of other characteristics (e.g., recurrent injuries) were not different between sexes. A higher proportion of concussions occurred outside of sport and military training for female cadets, who also displayed proportionally longer recovery times than males, despite males demonstrating a higher proportion of LOC, PTA, and RGA. Possible factors may include different mechanisms of injury outside of sport and military training, different biopsychosocial states associated with sex or injury context, and delayed injury reporting when outside of an observed environment, possibly secondary to perceived stigma about reporting injuries.

Optimizing Concussion Care Seeking: Using Machine Learning to Predict Delayed Concussion Reporting.

Early medical attention after concussion may minimize symptom duration and burden; however, many concussions are undiagnosed or have a delay in diagnosis after injury. Many concussion symptoms (eg, headache, dizziness) are not visible, meaning that early identification is often contingent on individuals reporting their injury to medical staff. A fundamental understanding of the types and levels of factors that explain when concussions are reported can help identify promising directions for intervention. To identify individual and institutional factors that predict immediate (vs delayed) injury reporting. Case-control study; Level of evidence, 3. This study was a secondary analysis of data from the Concussion Assessment, Research and Education (CARE) Consortium study. The sample included 3213 collegiate athletes and military service academy cadets who were diagnosed with a concussion during the study period. Participants were from 27 civilian institutions and 3 military institutions in the United States. Machine learning techniques were used to build models predicting who would report an injury immediately after a concussive event (measured by an athletic trainer denoting the injury as being reported "immediately" or "at a delay"), including both individual athlete/cadet and institutional characteristics. In the sample as a whole, combining individual factors enabled prediction of reporting immediacy, with mean accuracies between 55.8% and 62.6%, depending on classifier type and sample subset; adding institutional factors improved reporting prediction accuracies by 1 to 6 percentage points. At the individual level, injury-related altered mental status and loss of consciousness were most predictive of immediate reporting, which may be the result of observable signs leading to the injury report being externally mediated. At the institutional level, important attributes included athletic department annual revenue and ratio of athletes to athletic trainers. Further study is needed on the pathways through which institutional decisions about resource allocation, including decisions about sports medicine staffing, may contribute to reporting immediacy. More broadly, the relatively low accuracy of the machine learning models tested suggests the importance of continued expansion in how reporting is understood and facilitated.

The Prevalence and Influence of New or Worsened Neck Pain After a Sport-Related Concussion in Collegiate Athletes: A Study From the CARE Consortium

Background: Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes. Hypothesis: New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport. Study Design: Cohort study; Level of evidence, 2. Methods: Varsity-level athletes from 29 National Collegiate Athletic Association member institutions as well as nonvarsity sport athletes at military service academies were eligible for enrollment. Participants completed a preseason baseline assessment and follow-up assessments at 6 and 24 to 48 hours after a concussion, when they were symptom-free, and when they returned to unrestricted play. Data collection occurred between January 2014 and September 2018. Results: A total of 2163 injuries were studied. New or worsened neck pain was reported with 47.0% of injuries. New or worsened neck pain was associated with patient sex (higher in female athletes), an altered mental status after the injury, the mechanism of injury, and what the athlete collided with. The presence of new/worsened neck pain was associated with delayed recovery. Those with new or worsened neck pain had 11.1 days of symptoms versus 8.8 days in those without (P < .001). They were also less likely to have a resolution of self-reported symptoms in ≤7 days (P < .001). However, the mean duration of the return-to-play protocol was not significantly different for those with new or worsened neck pain (7.5 ± 7.7 days) than those without (7.4 ± 8.3 days) (P = .592). Conclusion: This novel study shows that neck pain was common in collegiate athletes sustaining a concussion, was influenced by many factors, and negatively affected recovery.

Research Letter: Relationship of Blood Biomarkers of Inflammation With Acute Concussion Symptoms and Recovery in the CARE Consortium.

Determine the association of inflammatory biomarkers with clinical measures and recovery in participants with concussion. Multicenter study in National Collegiate Athletic Association member institutions including military service academies. Four hundred twenty-two participants with acute concussion. Clinical visits and blood draws were completed preinjury and at multiple visits postconcussion (0-12hours, 12-36hours, and 36-60hours postinjury). Clinical measures included Sport Concussion Assessment Tool (SCAT) symptom severity, Balance Error Scoring System, Standardized Assessment of Concussion (SAC), Brief Symptom Inventory-18 (BSI-18) scores, time to initiation of graduated return-to-play (RTP) protocol, and time to RTP. Interleukin (IL)-6, IL-10, IL-8, IL-1 receptor antagonist (RA), tumor necrosis factor (TNF), c-reactive protein, and vascular endothelial growth factor (VEGF) were measured in serum. Prespecified analyses focused on IL-6 and IL-1RA at 0 to 12hours; exploratory analyses were conducted with false discovery rate correction. For prespecified analyses, IL-1RA at 0 to 12hours in female participants was positively associated with more errors on the SAC (B(standard error, SE)=0.58(0.27), P <.05) and worse SCAT symptom severity (B(SE)=0.96(0.44), P <.05). For exploratory analyses, higher levels of IL-1RA at 12 to 36hours were associated with higher global (B(SE)=0.55(0.14), q<0.01), depression (B(SE)=0.45(0.10), q <0.005), and somatization scores on the BSI (B(SE)=0.46(0.12), q <0.01) in participants with concussion; Higher TNF at 12 to 36hours was associated with fewer errors on the SAC (B(SE)=-0.46(0.14), q <0.05). Subanalyses showed similar results for male participants and participants who were athletes. No associations were discovered in nonathlete cadets. Higher IL-8 at 0 to 12hours was associated with slower RTP in female participants (OR=14.47; 95% confidence interval, 2.96-70.66, q <0.05); no other associations with recovery were observed. Peripheral inflammatory markers are associated with clinical symptoms following concussion and potentially represent one mechanism for psychological symptoms observed postinjury. Current results do not provide strong support for a potential prognostic role for these markers.

The Interval Between Concussions Does Not Influence Time to Asymptomatic or Return to Play: A CARE Consortium Study.

The purpose of this study was to determine if the time interval between two concussive events influences the number of days to asymptomatic status, days to return to play, or performance on common post-concussion assessments following the second concussion. Data from 448 collegiate athletes and service academy cadets with two concussions (time between concussions: median 295.0days [interquartile range: 125.0-438.2]), 40.0% female) were analyzed from Concussion Assessment Research and Education (CARE) Consortium institutions between 2014 and 2020. Days between concussions was the primary predictor variable. Primary outcome measures included time to asymptomatic and time to return to play following the second concussion. Secondary outcome measures included total number of symptoms, total symptom severity, Balance Error Scoring System total score, and Standardized Assessment of Concussion total score within 48h of their second concussion. Time between concussions did not significantly contribute to the multivariate time to asymptomatic (p = 0.390), time to return to play (p = 0.859), or the secondary outcomes (p-range = 0.165-0.477) models. Time to asymptomatic (p = 0.619) or return to play (p = 0.524) did not differ between same-season and different-season concussions. Sex significantly contributed to the return to play (p = 0.005) multivariate model. Delayed symptom onset and immediate removal from play/competition significantly contributed to the total number of symptoms (p = 0.001, p = 0.014) and symptom severity (p = 0.011, p = 0.022) multivariate models. These results suggest that in a population with a large period between injuries, the time between concussions may not be relevant to clinical recovery.

Jump Landing Kinematics: Establishing Normative Ranges For Male And Female Athletes.

Lower extremity joint (LE) kinematics during landing tasks are important predictors of injury risk and performance outcomes in athletes. To establish sex-related differences and normative ranges for LE kinematics during the jump-landing task in a large cohort of healthy military service academy cadets. Cross-Sectional Study. US Air Force, Naval, and Military Academies. 5308 cadets (2062 females [38.8%]). Sex-related differences in LE kinematics were analyzed using independent samples t-tests. Mean differences (MD) and effect sizes (d) were reported for interpretability. Normative ranges for hip and knee joint angles were established separately for males and females at initial contact (IC) and 50% of the stance phase. Compared to males, moderate effect sizes (d ≥ .5) were observed for knee external rotation (negative value) where females displayed greater motion at IC and at 50% stance (MD: - 3.9˚ and -5.0˚, respectively, p < .001). The following findings were of small effect size (.2 ≥ d > .5). Females exhibited less knee and hip flexion at IC (MD: -1.8˚ and -0.5˚, respectively, p < .001) and at 50% stance (MD: -4.1˚ and -4.6˚, respectfully, p < .001). This was accompanied by females having greater knee valgus (negative value) and hip adduction at IC (MD: -2.2˚ and 1.06˚, respectively, p < .001) and at 50% stance (MD: -3.2˚ and 1.8˚, respectfully, p < .001). This study establishes normative ranges for LE kinematics during the jump-landing task in a large cohort of healthy military service academy cadets entering their first year. Sex- related differences in LE kinematics were observed, highlighting the importance of considering sex as a factor in the evaluation of lower extremity movement quality and management of injury risk.

КРИТЕРИИ ОЦЕНИВАНИЯ ФИЗИЧЕСКОЙ ПОДГОТОВЛЕННОСТИ СОТРУДНИКОВ МЧС РОССИИ

As part of the research of this article, a comparative analysis of the results of the level of physical fitness of employees of the State fire service Academy of EMERCOM of Russia and the evaluation criteria in the control exercise «shuttle run 10 by 10 meters» was carried out. The purpose of this study is to create prerequisites for the qualitative formation of physical qualities of employees of the Ministry of Emergency Situations of Russia through the proposed recommendations for creating a more objective system of criteria for assessing physical qualities in the control exercise «shuttle run 10 by 10 meters».

Effects of 8 Weeks Conditioning Exercises on Muscular Endurance: A Cross-Sectional Study of Female Cadets of Ghana Immigration Service Academy, Assin Fosu, Ghana

Physical conditioning enables athletes to meet all the physical requirements of their sport, perform well, and minimize their risk of injury. This study aims to determine the effects of eight (8) weeks conditioning training on the muscular endurance of Female Cadets of the Ghana Immigration Service Academy. The Army Physical Training Fitness Test (APFT) was used to evaluate muscular endurance levels of the Female Cadets. The quasi-experimental pre-test post-test study design was used to conduct the study. A total of 60 female cadets were randomly stratified into two groups based on APFT age categories (22-26) and (27-31) years. Data was analyzed using descriptive statistics and paired sample t-test and independent sample t-test was used to test the hypothesis. Higher upper body muscular endurance performance as measured by the APFT was observed in the age group (27-31) years compared to age group (22-26) years. Significant difference was found in muscular endurance in the females age groups (22-26) and (27-31) years (P&amp;lt;0.05). Significant positive effect on muscular endurance after conditioning exercises for female Cadets in both age categories, (22-26) and (27-31) years (P&amp;lt;0.05) was observed. Conditioning exercises had a significant impact on APFT upper body muscular endurance performance in the age categories of (22-26) and (27-31) years.

Bring Me Courage: Empowering Student Voices to Reduce Sexual Assault and Harassment Reporting Barriers and Influence Culture

Sexual assault and harassment on college campus, particularly military service academies, is a complex problem requiring student-led culture change. Efforts of the top-down campus administrator to change culture will be ineffective without student buy-in and input. Listening to student voices is necessary to identify barriers and paths to enable behaviors on the peripherals that reinforce desired culture traits. This article highlights a student-led effort at the U.S. Air Force Academy to reduce reporting barriers by disincentivizing peer pressure to remain silent in the face of harassment, bullying, hazing, or assault.

Postinjury Outcomes After Non-Sport-Related Concussion: A CARE Consortium Study.

Concussion research has primarily focused on sport-related mechanisms and excluded non-sport-related mechanisms. In adult populations, non-sport-related concussions (non-SRCs) demonstrated worse clinical outcomes compared with sport-related concussions (SRCs); however, investigations of non-SRCs in college-aged patients are limited. To examine clinical outcomes in collegiate athletes with non-SRCs compared with SRCs and explore sex differences in outcomes among collegiate athletes with non-SRCs. Prospective cohort study. Clinical setting. A total of 3500 athletes were included (n = 555 with non-SRCs, 42.5% female) from colleges or universities and service academies participating in the National Collegiate Athletic Association Department of Defense Concussion Assessment, Research and Education (CARE) Consortium. Dichotomous outcomes (yes or no) consisted of immediate reporting, mental status alterations, loss of consciousness, posttraumatic amnesia, retrograde amnesia, motor impairments, delayed symptom presentation, and required hospital transport. Continuous outcomes were symptom severity, days with concussion symptoms, and days lost to injury. Data were collected within 24 to 48 hours of injury and at return to play. Adjusted relative risks (ARRs) compared the likelihood of dichotomous outcomes by mechanism and by sex within patients with non-SRCs. Multivariate negative binomial regressions were used to assess group differences in continuous variables. Athletes with non-SRCs were less likely to report immediately (ARR = 0.73, 95% CI = 0.65, 0.81) and more likely to report delayed symptom presentation (ARR = 1.17, 95% CI = 1.03, 1.32), loss of consciousness (ARR = 3.15, 95% CI = 2.32, 4.28), retrograde amnesia (ARR = 1.77, 95% CI = 1.22, 2.57), and motor impairment (ARR = 1.45, 95% CI = 1.14, 1.84). Athletes with non-SRCs described greater symptom severity, more symptomatic days, and more days lost to injury (P < .001) compared with those who had SRCs. Within the non-SRC group, female athletes indicated greater symptom severity, more symptomatic days, and more days lost to injury (P < .03) than male athletes. Athletes with non-SRCs had worse postinjury outcomes compared with those who had SRCs, and female athletes with non-SRCs had worse recovery metrics than male athletes. Our findings suggest that further investigation of individuals with non-SRCs is needed to improve concussion reporting and management.

Our Service Academies Must Discard Race-Based Admissions

Our Service Academies Must Discard Race-Based Admissions

I see you in me: measuring mentee-mentor identification in peer-mentoring relationships

ABSTRACT This study developed identification measures between U.S. Service Academy cadet squad members and squad leaders in peer-mentoring relationships, highlighting identification as an important antecedent to mentoring. However, research has failed to show evidence of this relationship, largely because researchers have failed to measure identification, psychometrically test their measures, or differentiate identification from related constructs. Addressing this gap, we use theories of the self and interviews of cadets and faculty members to develop measures of both mentee and mentor identification. We include these measures, along with measures of empathy and similarity, in a longitudinal study of mentoring between cadet squad leaders (n = 96) and squad members (n = 968). Factor analyses revealed a three-factor solution of mentee identification with the mentor, measuring identification, empathy, and similarity. The analyses yielded a four-factor solution of mentor identification with the mentee, measuring two forms of identification, self-image, and empathy. The findings encourage future research to employ these measures for exploring identification’s role in mentoring relationships.

남자간호사의 병원간호사에서 소방공무원으로의 이직 의도

This is a qualitative study that applied the focus group interview research method in order to explore turnover intentions of male nurses from hospital nurses to firefighters. The purpose of this study is to prevent the turnover of male nurses by gaining an in-depth understanding of clinical experiences of male nurses and analyzing major factors in the clinical field that affect the turnover to firefighters, and to provide basic data to prepare measures that can be applied to the clinical site. The study data targeted 10 male firefighters, former male nurses, who were first assigned as firefighters and receiving training at the fire service academy. The main questions were “What motivated you to decide to change your job to a firefighter?” and “How was your clinical work experience?”. As a result of the analysis, 34 meaning units were created, and 15 subcategories and 5 categories were derived. The five categories were analyzed as ‘skepticism about adequate compensation and future vision of nursing,’ ‘organizational culture that is difficult to be harmonized as an insider,’ ‘disrespected role and position,’ ‘vulnerable support system of nursing organization within the hospital,’ and ‘challenges to a new role.’&#x0D; Based on the study results, it was found that in order to prevent the turnover of male nurses, measures to overcome gender stereotypes that reflect the special characteristics of the clinical field should be prepared, and sufficient training courses, generosity that supports the process of juniors’ growth, and servant leadership should be established. It is also believed that systematic institutional support is required to represent the difficulties in clinical fields and improve the rights and treatment of nurses.

Association of Blood Biomarkers of Inflammation With Acute Concussion in Collegiate Athletes and Military Service Academy Cadets.

The objective was to characterize the acute effects of concussion (a subset of mild traumatic brain injury) on serum interleukin (IL)-6 and IL-1 receptor antagonist (RA) and 5 additional inflammatory markers in athletes and military service academy members from the Concussion Assessment, Research, and Education Consortium and to determine whether these markers aid in discrimination of concussed participants from controls. Athletes and cadets with concussion and matched controls provided blood at baseline and postinjury visits between January 2015 and March 2020. Linear models investigated changes in inflammatory markers measured using Meso Scale Discovery assays across time points (baseline and 0-12, 12-36, 36-60 hours). Subanalyses were conducted in participants split by sex and injury population. Logistic regression analyses tested whether acute levels of IL-6 and IL-1RA improved discrimination of concussed participants relative to brain injury markers (glial fibrillary acidic protein, tau, neurofilament light, ubiquitin c-terminal hydrolase-L1) or clinical data (Sport Concussion Assessment Tool-Third Edition, Standardized Assessment of Concussion, Balance Error Scoring System). Participants with concussion (total, N = 422) had elevated IL-6 and IL-1RA at 0-12 hours vs controls (n = 345; IL-6: mean difference [MD] (standard error) = 0.701 (0.091), p < 0.0001; IL-1RA: MD = 0.283 (0.042), p < 0.0001) and relative to baseline (IL-6: MD = 0.656 (0.078), p < 0.0001; IL-1RA: MD = 0.242 (0.038), p < 0.0001), 12-36 hours (IL-6: MD = 0.609 (0.086), p < 0.0001; IL-1RA: MD = 0.322 (0.041), p < 0.0001), and 36-60 hours (IL-6: MD = 0.818 (0.084), p < 0.0001; IL-1RA: MD = 0.317 (0.040), p < 0.0001). IL-6 and IL-1RA were elevated in participants with sport (IL-6: MD = 0.748 (0.115), p < 0.0001; IL-1RA: MD = 0.304 (0.055), p < 0.0001) and combative-related concussions (IL-6: MD = 0.583 (0.178), p = 0.001; IL-1RA: MD = 0.312 (0.081), p = 0.0001). IL-6 was elevated in male (MD = 0.734 (0.105), p < 0.0001) and female participants (MD = 0.600 (0.177), p = 0.0008); IL-1RA was only elevated in male participants (MD = 0.356 (0.047), p < 0.0001). Logistic regression showed the inclusion of IL-6 and IL-1RA at 0-12 hours improved the discrimination of participants with concussion from controls relative to brain injury markers (χ2(2) = 17.855, p = 0.0001; area under the receiver operating characteristic curve [AUC] 0.73 [0.66-0.80] to 0.78 [0.71-0.84]), objective clinical measures (balance and cognition; χ2(2) = 40.661, p < 0.0001; AUC 0.81 [0.76-0.86] to 0.87 [0.83-0.91]), and objective and subjective measures combined (χ2(2) = 13.456, p = 0.001; AUC 0.97 [0.95-0.99] to 0.98 [0.96-0.99]), although improvement in AUC was only significantly relative to objective clinical measures. IL-6 and IL-1RA (male participants only) are elevated in the early-acute window postconcussion and may aid in diagnostic decisions beyond traditional blood markers and common clinical measures. IL-1RA results highlight sex differences in the immune response to concussion which should be considered in future biomarker work.

Diffusion tensor analysis of white matter tracts is prognostic of persisting post-concussion symptoms in collegiate athletes

Background and objectivesAfter a concussion diagnosis, the most important issue for patients and loved ones is how long it will take them to recover. The main objective of this study is to develop a prognostic model of concussion recovery. This model would benefit many patients worldwide, allowing for early treatment intervention. MethodsThe Concussion Assessment, Research and Education (CARE) consortium study enrolled collegiate athletes from 30 sites (NCAA athletic departments and US Department of Defense service academies), 4 of which participated in the Advanced Research Core, which included diffusion-weighted MRI (dMRI) data collection. We analyzed the dMRI data of 51 injuries of concussed athletes scanned within 48 h of injury. All athletes were cleared to return-to-play by the local medical staff following a standardized, graduated protocol. The primary outcome measure is days to clearance of unrestricted return-to-play. Injuries were divided into early (return-to-play < 28 days) and late (return-to-play >= 28 days) recovery based on the return-to-play clinical records. The late recovery group meets the standard definition of Persisting Post-Concussion Symptoms (PPCS). Data were processed using automated, state-of-the-art, rigorous methods for reproducible data processing using brainlife.io. All processed data derivatives are made available at https://brainlife.io/project/63b2ecb0daffe2c2407ee3c5/dataset. The microstructural properties of 47 major white matter tracts, 5 callosal, 15 subcortical, and 148 cortical structures were mapped. Fractional Anisotropy (FA) and Mean Diffusivity (MD) were estimated for each tract and structure. Correlation analysis and Receiver Operator Characteristic (ROC) analysis were then performed to assess the association between the microstructural properties and return-to-play. Finally, a Logistic Regression binary classifier (LR-BC) was used to classify the injuries between the two recovery groups. ResultsThe mean FA across all white matter volume was negatively correlated with return-to-play (r = −0.38, p = 0.00001). No significant association between mean MD and return-to-play was found, neither for FA nor MD for any other structure. The mean FA of 47 white matter tracts was negatively correlated with return-to-play (rμ = −0.27; rσ = 0.08; rmin = −0.1; rmax = −0.43). Across all tracts, a large mean ROC Area Under the Curve (AUCFA) of 0.71 ± 0.09 SD was found. The top classification performance of the LR-BC was AUC = 0.90 obtained using the 16 statistically significant white matter tracts. DiscussionUtilizing a free, open-source, and automated cloud-based neuroimaging pipeline and app (https://brainlife.io/docs/tutorial/using-clairvoy/), a prognostic model has been developed, which predicts athletes at risk for slow recovery (PPCS) with an AUC=0.90, balanced accuracy = 0.89, sensitivity = 1.0, and specificity = 0.79. The small number of participants in this study (51 injuries) is a significant limitation and supports the need for future large concussion dMRI studies and focused on recovery.

Equality, Morality, &amp; Religious Liberty

On June 29, 2023, the Supreme Court ruled that the use of a specific race-conscious “tool” in the admission decisions of public and private colleges to achieve diversity is unconstitutional. However, in his nuanced opinion, Chief Justice John Roberts seemed to renew the Court’s commitment to the anti-discrimination vision of the Civil Rights Act of 1964 and its progeny. Furthermore, the Court’s decision provided the possibility of an exception for its stated restriction, that is, for military service academies. Nonetheless, the Court’s ban on a race-conscious tool is expected to have a substantial, negative effect on the application and enrollment of students who are African-Americans, their pathways to graduate and professional schools, and their employment opportunities, resulting in what I coin as a “Black brain drain.” In response to the decision, the U.S. Department of Education has reiterated the pro-diversity vision of the federal laws and has instructed schools on how to minimize the Court’s projected negative impact on the enrollment of racial minorities of color. This Essay posits that the law should exempt faith-based schools from the Court’s banned approach to affirmative action. This is due to the special missions of these schools, their continuing obligation to anti-discrimination laws, and their unique status in the Court’s constitutional jurisprudence. It utilizes the author’s personal experiences as a Black student who benefited from faith-based education, to call on faith-based schools to actively seek this exemption to fill the pending harm to Black students, their communities, and the Nation.

Overview of the practice of training civil servants in post-Soviet countries in the context of digitalization

Modern conditions of public administration are formed in the BANI world ( Grabmeier, 2020 ), unstable, disturbing, uniquely technological and digital. How many of today's civil servants are capable of functioning in such a world through current training and professional development systems? This issue is particularly relevant for post-Soviet countries, as most of them belong to emerging economies that are still shaping their own unique public administration system. The article is aimed at studying the practice of professional development of civil servants within the framework of additional education in post-Soviet countries in the context of digitalisation. According to the study, it is clear that the Soviet model of supplementary education for civil servants is still valid, with minor differences in the countries studied. This model is characterised by a centralised organisation of training of civil servants within the framework of specially created structures (public service academies). With the transition to digital learning, countries are differentiated by the pace and level of transition to distance and e-learning for public servants.