Emergency cardiac care in athletic training education

In the field of athletic training, preventing sudden cardiac arrest (SCA) has become a vital component of undergraduate athletic training students’ education. Specifically, SCA is the “leading cause of death in young athletes due to a structural cardiac abnormality” (Casa et. al, 2012, p. 15). Numerous studies about sudden death in athletics have been conducted but there is a gap in educational literature. Teaching students how to respond to catastrophic injury or illness is still an area that needs to be expanded upon. Educational competencies and standards have rapidly evolved with each edition of the National Athletic Trainers’ Association (NATA) educational competencies. A mixed-methods survey was sent out to all Commission on Accreditation of Athletic Training (CAATE) accredited program directors in order to determine if NATA competencies regarding SCA are being addressed, the availability of equipment and various teaching methods in the classroom versus clinical setting, and if program directors are covering the psychosocial aspect of SCA in their curriculum. Results show that program directors are covering the required competencies and addressing the emotional aftermath of SCA; however, there is a gap between the availability of tools between the classroom and the clinic. Program directors also reported teaching techniques commonly used in other areas of medical education, such as the use of simulators and standardized patients. Future research should be conducted on the availability of equipment used to teach SCA in the classroom and clinical setting, along with other teaching strategies to address SCA in athletic training education. Keywords: sudden cardiac arrest, athletic training education, athletic training students, National Athletic Trainers’ Association educational competencies, catastrophic injury or illness, Commission on Accreditation of Athletic Training Education

Mentorship Experiences of Doctoral Students: Understanding Desired Attributes of Doctoral Student Mentors

Background: Mentorship is a critical aspect of the professional development of the doctoral student who wishes to pursue a role in higher education. Continued understanding is needed regarding the needs of the doctoral student when it comes to mentorship. Purpose: The purpose of this study is to describe the needs of a doctoral student from their mentoring relationships, as they work towards their terminal degree. Methods: This is a descriptive, phenomenological qualitative research study within universities that offer doctoral education. One-on-one, semi-structured interviews were conducted using Zoom video conference technology. Each interview, after transcribed, was analyzed following the step-wise approach of a phenomenological study. Credibility was established by 1) research triangulation, 2) bracketing/reflexivity, and 3) peer review. Results: Twelve doctoral students (7 females, 5 males) who were enrolled in doctoral programs with a focus on allied health or exercise science completed the Zoom interviews. Our participants were an average age of 28 3 years, and all twelve had graduate assistantship positions in association with their doctoral programs. Three main themes materialized from the data analyses including 1) guided autonomy, 2) humanistic nature, and 3) professional advocate. Doctoral students want guidance to develop the technical skills necessary for success by providing opportunities to perform with the chance to gain feedback. Mentors were identified as needing to demonstrate humanistic qualities that were rooted in being interpersonal. The importance of a mentor serving as a professional advocate to help the student grow and develop as a professional was also discussed. Conclusions: Doctoral students need their mentors to demonstrate both personal and professional attributes in the mentor relationship. Specifically, they are looking for guidance and feedback through independent learning, as well as a mentor who values them, is relatable, and is invested in their development as a professional

Heat Safety in the Workplace:Modified Delphi Consensus to Establish Strategies and Resources to Protect U.S Workers

The purpose of this consensus document was to develop feasible, evidence‐based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus‐based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best‐practices and protect worker health and productivity

Can Self-Talk Improve Athletic Performance? A Critically Appraised Topic

Clinical Scenario: Athletes are constantly searching for alternative mechanisms to improve performance in sport. In addition to modifying physical training, psychological training tools (e.g., self-talk) have been used to elevate athletes from the average competitor. Athletes can use self-talk to navigate challenges in competition and improve self-confidence in tasks leading to potential increases in performance. However, literature relaying performance benefits for adolescent and adult athletes using self-talk is unclear. Clinical Question: In athletic populations, does the implementation of motivational or goal-setting self-talk increase athletic performance? Summary of Key Findings: Four studies were identified exploring self-talk on athletic performance outcomes. Methodology of included studies were randomized between-subjects, within-participant repeated-measures, within subjects, and multiple baseline design. Clinical Bottom Line: Supporting evidence exists demonstrating that motivational and goal-setting self-talk assists physical performance in adolescent and adult athletes. Strength of Recommendation: Based on the Oxford Centre for Evidence-Based Medicine Scale, Level 2 evidence exists for self-talk affecting athletic performance

Mentorship Experiences of Doctoral Students: Understanding Desired Attributes of Doctoral Student Mentors

Background: Mentorship is a critical aspect of the professional development of the doctoral student who wishes to pursue a role in higher education. Continued understanding is needed regarding the needs of the doctoral student when it comes to mentorship. Purpose: The purpose of this study is to describe the needs of a doctoral student from their mentoring relationships, as they work towards their terminal degree. Methods: This is a descriptive, phenomenological qualitative research study within universities that offer doctoral education. One-on-one, semi-structured interviews were conducted using Zoom video conference technology. Each interview, after transcribed, was analyzed following the step-wise approach of a phenomenological study. Credibility was established by 1) research triangulation, 2) bracketing/reflexivity, and 3) peer review. Results: Twelve doctoral students (7 females, 5 males) who were enrolled in doctoral programs with a focus on allied health or exercise science completed the Zoom interviews. Our participants were an average age of 28 3 years, and all twelve had graduate assistantship positions in association with their doctoral programs. Three main themes materialized from the data analyses including 1) guided autonomy, 2) humanistic nature, and 3) professional advocate. Doctoral students want guidance to develop the technical skills necessary for success by providing opportunities to perform with the chance to gain feedback. Mentors were identified as needing to demonstrate humanistic qualities that were rooted in being interpersonal. The importance of a mentor serving as a professional advocate to help the student grow and develop as a professional was also discussed. Conclusions: Doctoral students need their mentors to demonstrate both personal and professional attributes in the mentor relationship. Specifically, they are looking for guidance and feedback through independent learning, as well as a mentor who values them, is relatable, and is invested in their development as a professional.</jats:p

Does Dehydration Affect the Adaptations of Plasma Volume, Heart Rate, Internal Body Temperature, and Sweat Rate During the Induction Phase of Heat Acclimation?

Clinical Scenario: Exercise in the heat can lead to performance decrements and increase the risk of heat illness. Heat acclimation refers to the systematic and gradual increase in exercise in a controlled, laboratory environment. Increased duration and intensity of exercise in the heat positively affects physiological responses, such as higher sweat rate, plasma volume expansion, decreased heart rate, and lower internal body temperature. Many heat acclimation studies have examined the hydration status of the subjects exercising in the heat. Some of the physiological responses that are desired to elicit heat acclimation (ie, higher heart rate and internal body temperature) are exacerbated in a dehydrated state. Thus, euhydration (optimal hydration) and dehydration trials during heat acclimation induction have been conducted to determine if there are additional benefits to dehydrated exercise trials on physiological adaptations. However, there is still much debate over hydration status and its effect on heat acclimation. Clinical Question: Does dehydration affect the adaptations of plasma volume, heart rate, internal body temperature, skin temperature, and sweat rate during the induction phase of heat acclimation? Summary of Findings: There were no observed differences in plasma volume, internal body temperature, and skin temperature following heat acclimation in this critically appraised topic. One study found an increase in sweat rate and another study indicated greater changes in heart rate following heat acclimation with dehydration. Aside from these findings, all 4 trials did not observe statistically significant differences in euhydrated and dehydrated heat acclimation trials. Clinical Bottom Line: There is minimal evidence to suggest that hydration status affects heat acclimation induction. In the studies that met the inclusion criteria, there were no differences in plasma volume concentrations, internal body temperature, and skin temperature. Strength of Recommendation: Based on the Oxford Centre for Evidence-Based Medicine Scale, Level 2 evidence exists.</jats:p

Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review

Background and Objectives: The purpose of this systematic review is to synthesize the influence cooling modality has on survival with and without medical complications from exertional heat stroke (EHS) in sport and military populations. Methods and Materials: All peer-reviewed case reports or series involving EHS patients were searched in the following online databases: PubMed, Scopus, SPORTDiscus, Medline, CINAHL, Academic Search Premier, and the Cochrane Library: Central Registry of Clinical Trials. Cooling methods were subdivided into &ldquo;adequate&rdquo; (&gt;0.15 &deg;C/min) versus &ldquo;insufficient&rdquo; (&lt;0.15 &deg;C/min) based on previously published literature on EHS cooling rates. Results: 613 articles were assessed for quality and inclusion in the review. Thirty-two case reports representing 521 EHS patients met the inclusion criteria. Four hundred ninety-eight (498) patients survived EHS (95.58%) and 23 (4.41%) patients succumbed to complications. Fischer&rsquo;s Exact test on 2 &times; 2 contingency tables and relative risk ratios were calculated to determine if modality cooling rate was associated with patient outcomes. EHS patients that survived who were cooled with an insufficient cooling rate had a 4.57 times risk of medical complications compared to patients who were treated by adequate cooling methods, regardless of setting (RR = 4.57 (95%CI: 3.42, 6.28)). Conclusions: This is the largest EHS dataset yet compiled that analyzes the influence of cooling rate on patient outcomes. Zero patients died (0/521, 0.00%) when treatment included a modality with an adequate cooling rate. Conversely, 23 patients died (23/521, 4.41%) with insufficient cooling. One hundred seventeen patients (117/521, 22.46%) survived with medical complications when treatment involved an insufficient cooling rate, whereas, only four patients had complications (4/521, 0.77%) despite adequate cooling. Cooling rates &gt;0.15 &deg;C/min for EHS patients were significantly associated with surviving EHS without medical complications. In order to provide the best standard of care for EHS patients, an aggressive cooling rate &gt;0.15 &deg;C/min can maximize survival without medical complications after exercise-induced hyperthermia

Hydration Status and Acute Kidney Injury Biomarkers in NCAA Female Soccer Athletes During Preseason Conditioning

Exercise training in extreme temperatures concurrent with hypohydration status may potentiate the development of acute kidney injury (AKI) in young, healthy persons. Background/Objectives: It is unknown how repeated training bouts in ambient higher temperatures and humidity may influence measures of AKI. The purpose of this study was to investigate hydration status and renal biomarkers related to AKI in NCAA Division I female soccer athletes during preseason conditioning. Methods: A convenience sample of n = 21 athletes were recruited (mean &plusmn; SEM; age: 19.3 &plusmn; 0.25 y; height: 169.6 &plusmn; 1.36 cm; mass: 68.43 &plusmn; 2.46 kg; lean body mass: 45.91 &plusmn; 1.13 kg; fat mass: 22.51 &plusmn; 1.69 kg; body fat %: 32.22 &plusmn; 1.32%). The average temperature was 27.43 &plusmn; 0.19 &deg;C, and the humidity was 71.69 &plusmn; 1.82%. Body composition, anthropometric, workload, and 14 urine samples were collected throughout the preseason training period for urine specific gravity (USG), creatinine (uCr), cystatin C (uCyst-C), and neutrophil gelatinase-associated lipocalin (uNGAL) analyses. Results: Our investigation showed that, when compared to baseline (D0), the athletes maintained a USG-average euhydrated status (1.019 &plusmn; 0.001) and were euhydrated prior to each exhibition game (D5-Pre: p = 0.03; 1.011 &plusmn; 0.001; D10-Pre: p = 0.0009; 1.009 &plusmn; 0.001); uCr was elevated on D8 (p = 0.001; 6.29 &plusmn; 0.44 mg&middot;dL&minus;1&middot;LBM&minus;1) and D10-Post (p = 0.02; 6.61 &plusmn; 0.44 mg&middot;dL&minus;1&middot;LBM&minus;1); uCyst-C was elevated on D6 through D10 (p = 0.001; ~0.42 &plusmn; 0.01 mg&middot;dL&minus;1); no differences were found in uNGAL concentration. The highest distance (m) displaced was found during exhibition games (D5: p = &lt;0.0001; ~8.6 km and D10: p = &lt;0.0001; ~9.6 km). During the preseason conditioning, the athletes maintained a euhydrated status (~1.019) via USG, an increase in uCr that averaged within a normal range (208 mg&middot;dL&minus;1), and an increase in uCyst-C to near AKI threshold levels (0.42 mg&middot;L&minus;1) for several practice sessions, followed by an adaptive decline. No differences were found in uNGAL, which may be explained by athlete variation, chosen time sample collection, and variation in training and hydration status. Conclusions: The athletes maintained a euhydrated status, and this may help explain why urinary markers did not change or meet the reference threshold for AKI

Exertional Heat Stroke, Modality Cooling Rate, and Survival Outcomes: A Systematic Review

Background and Objectives: The purpose of this systematic review is to synthesize the influence cooling modality has on survival with and without medical complications from exertional heat stroke (EHS) in sport and military populations. Methods and Materials: All peer-reviewed case reports or series involving EHS patients were searched in the following online databases: PubMed, Scopus, SPORTDiscus, Medline, CINAHL, Academic Search Premier, and the Cochrane Library: Central Registry of Clinical Trials. Cooling methods were subdivided into “adequate” (&gt;0.15 °C/min) versus “insufficient” (&lt;0.15 °C/min) based on previously published literature on EHS cooling rates. Results: 613 articles were assessed for quality and inclusion in the review. Thirty-two case reports representing 521 EHS patients met the inclusion criteria. Four hundred ninety-eight (498) patients survived EHS (95.58%) and 23 (4.41%) patients succumbed to complications. Fischer’s Exact test on 2 × 2 contingency tables and relative risk ratios were calculated to determine if modality cooling rate was associated with patient outcomes. EHS patients that survived who were cooled with an insufficient cooling rate had a 4.57 times risk of medical complications compared to patients who were treated by adequate cooling methods, regardless of setting (RR = 4.57 (95%CI: 3.42, 6.28)). Conclusions: This is the largest EHS dataset yet compiled that analyzes the influence of cooling rate on patient outcomes. Zero patients died (0/521, 0.00%) when treatment included a modality with an adequate cooling rate. Conversely, 23 patients died (23/521, 4.41%) with insufficient cooling. One hundred seventeen patients (117/521, 22.46%) survived with medical complications when treatment involved an insufficient cooling rate, whereas, only four patients had complications (4/521, 0.77%) despite adequate cooling. Cooling rates &gt;0.15 °C/min for EHS patients were significantly associated with surviving EHS without medical complications. In order to provide the best standard of care for EHS patients, an aggressive cooling rate &gt;0.15 °C/min can maximize survival without medical complications after exercise-induced hyperthermia.</jats:p

The Relationship between %BML, Urine Color, Thirst Level and Urine Indices of Hydration Status

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Dehydration is known to impair health, quality of daily life, and exercise performance [&lt;xref ref-type="bibr" rid="ref1"&gt;1&lt;/xref&gt;]. While several methods are utilized to assess fluid balance, there is no gold standard to assess hydration status [&lt;xref ref-type="bibr" rid="ref2"&gt;2&lt;/xref&gt;]. Cheuvront and Kenefick [&lt;xref ref-type="bibr" rid="ref3"&gt;3&lt;/xref&gt;] suggested the use of a Venn diagram, which consists of % body mass weight (BML), urine color, and thirst level (WUT) to measure hydration status and fluid needs. However, no study to date has examined the relationship between the WUT criteria and hydration status measured by urine indices. &lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; The purpose of this study was to investigate the relationships between urine-specific gravity (USG), urine osmolality (&lt;i&gt;U&lt;/i&gt;&lt;sub&gt;OSM&lt;/sub&gt;), and the WUT criteria. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Twenty-two females (mean ± SD; age, 20 ± 1 year; weight, 65.4 ± 12.6 kg) and twenty-one males (age, 21 ± 1 year; body mass, 78.7 ± 14.6 kg) participated in this study. First-morning body mass, urine color, USG, &lt;i&gt;U&lt;/i&gt;&lt;sub&gt;OSM&lt;/sub&gt;, and thirst level were collected for 10 consecutive days. First 3 days were utilized to establish a euhydrated baseline body weight. %BML &amp;#x3e;1%, urine color &amp;#x3e;5, and thirst level ≥5 were used as the dehydration thresholds. The number of markers that indicated dehydration levels was summed when each variable met each threshold. One-way ANOVA with Tukey pairwise comparison was used to assess the differences in USG and &lt;i&gt;U&lt;/i&gt;&lt;sub&gt;OSM&lt;/sub&gt;, followed by a calculation of effect size (ES). &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Figure &lt;xref ref-type="fig" rid="f01"&gt;1&lt;/xref&gt; indicates the differences of &lt;i&gt;U&lt;/i&gt;&lt;sub&gt;OSM&lt;/sub&gt; based on the WUT criteria. For &lt;i&gt;U&lt;/i&gt;&lt;sub&gt;OSM&lt;/sub&gt;, “2 markers indicated” (mean [M] ± SD [ES], 705 ± 253 mOsmol [0.43], &lt;i&gt;p&lt;/i&gt; = 0.018) was significantly higher than “1 marker indicated” (M ± SD, 597 ± 253 mOsmol). Additionally, “zero marker indicated” (509 ± 249 mOsmol) was significantly lower than “3 markers indicated” (M ± SD [ES], 761 ± 250 mOsmol, [1.01], &lt;i&gt;p&lt;/i&gt; = 0.02) and “2 markers indicated” ([ES], [0.78], &lt;i&gt;p&lt;/i&gt; = 0.004). However, there was no statistical difference between “3 markers indicated” ([ES], [0.65], &lt;i&gt;p&lt;/i&gt; = 0.13) and “1 marker indicated.” For USG, “3 markers indicated” (M ± SD [ES], 1.021 ± 0.007 [0.57], &lt;i&gt;p&lt;/i&gt; = 0.025) and “2 markers indicated” (M ± SD [ES], 1.019 ± 0.010 [0.31], &lt;i&gt;p&lt;/i&gt; = 0.026) were significantly higher than “1 marker indicated” (M ± SD, 1.016 ± 0.009). Additionally, “zero marker indicated” (1.014 ± 0.005) was significantly lower than “3 markers indicated” ([ES], [1.21], &lt;i&gt;p&lt;/i&gt; = 0.005) and “2 markers indicated” ([ES], [0.54], &lt;i&gt;p&lt;/i&gt; = 0.009). &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; When 3 markers indicated dehydration levels, &lt;i&gt;U&lt;/i&gt;&lt;sub&gt;OSM&lt;/sub&gt; and USG were greater than euhydrated cut points. When 2 markers indicated dehydration levels, USG was higher than the euhydrated cut point. Additionally, &lt;i&gt;U&lt;/i&gt;&lt;sub&gt;OSM&lt;/sub&gt; and USG were significantly lower when zero or 1 marker indicated dehydration levels. Thus, the WUT criteria are a useful tool to assess hydration status. Athletes, coaches, sports scientists, and medical professions can use this strategy in the field settings to optimize their performance and health without consuming money and time. </jats:p