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Concept: High school football

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A pediatrician is asked by her local school board to help them decide whether to discontinue their high school football program. She reviews the available evidence on the risks of football and finds it hopelessly contradictory. Some scholars claim that football is clearly more dangerous than other sports. Others suggest that the risks of football are comparable to other sports, such as lacrosse, ice hockey, or soccer. She finds very little data on the long-term sequelae of concussions. She sees claims that good coaching and a school culture that prioritizes the health of athletes over winning can reduce morbidity from sports injuries. In this paper, 3 experts also review the evidence about sports risks and discuss what is known and not known about the science and the ethics of high school football.

Concepts: Scientific method, United States, High school, American football, Concussion, Ice hockey, High School Musical, High school football

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The purpose of this study is to determine if the effects of cumulative head impacts during a season of high school football produce changes in diffusional kurtosis imaging (DKI) metrics in the absence of clinically diagnosed concussion. Subjects were recruited from a high school football team and were outfitted with the Head Impact Telemetry System (HITs) during all practices and games. Biomechanical head impact exposure metrics were calculated including: total impacts, summed acceleration, and Risk Weighted cumulative Exposure (RWE). Twenty-four players completed pre- and post-season MRI, including DKI; players who experienced clinical concussion were excluded. Fourteen subjects completed pre- and post-season Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). DKI-derived metrics included mean kurtosis (MK), axial kurtosis (K axial), and radial kurtosis (K radial), and white matter modeling (WMM) parameters included axonal water fraction (AWF), tortuosity of the extra-axonal space, extra-axonal diffusivity (De axial and radial), and intra-axonal diffusivity. These metrics were used to determine the total number of abnormal voxels, defined as 2 standard deviations above or below the group mean. Linear regression analysis revealed a statistically significant relationship between RWECP and MK. Secondary analysis of other DKI-derived and WMM metrics demonstrated statistically significant linear relationships with RWECP after covariate adjustment. These results were compared with the results of DTI-derived metrics from the same imaging sessions in this exact same cohort. Several of the DKI-derived scalars (Da, MK, K axial, and K radial) explained more variance when compared to RWECP, suggesting that DKI may be more sensitive to subconcussive head impacts. No significant relationships between DKI-derived metrics and ImPACT measures were found. It is important to note, the pathological implications of these metrics are not well understood. In summary, we demonstrate a single season of high school football can produce DKI measurable changes in the absence of clinically diagnosed concussion.

Concepts: Regression analysis, Linear regression, Statistics, Variance, Mean, High school, Standard deviation, High school football

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The incidence of sport-related concussion (SRC) in high school football is well documented. However, limited prospective data are available regarding how player characteristics and protective equipment affect the incidence of SRC.

Concepts: High school, Protection, Players, American football, Concussion, Player, High School Musical, High school football

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Little research has examined concussion outcomes in terms of impact location (ie, the area on the head in which the impact occurred). This study describes the epidemiology of concussions resulting from player-to-player collision in high school football by impact location.

Concepts: High school, High school football, Collision

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  Subclinical postural-control changes may persist beyond the point when athletes are considered clinically recovered postconcussion.

Concepts: High school, American football, High School Musical, High school football, The Point

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There is increasing concern about the possible long-term effects of multiple concussions, particularly on the developing adolescent brain. Whether the effect of multiple concussions is detectable in high school football players has not been well studied, although the public health implications are great in this population.

Concepts: Effect, Effectiveness, Cognition, Effects unit, High school, American football, High school football

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To describe determinants of head impact magnitudes between various play aspects in high school football.

Concepts: High school, Texas, American football, High school football

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Guidelines for preventing exertional heat illnesses (EHIs) during extreme heat stress should be specific to regional environments, age, and sport and should be based on evidence of reducing the risk. Each year in the United States, over 1 million high school football players practice in the August heat; however, no published data describe the incidence of EHIs in these athletes.

Concepts: United States, High school, Florida, Texas, Environmental science, American football, Education in the United States, High school football

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There is continued speculation on the value of mouthguards (MGs) in preventing mild traumatic brain injury (MTBI)/concussion injuries. The purpose of this randomized prospective study was to compare the impact of pressure-laminated (LM), custom-made, properly fitted MGs to over-the-counter (OTC) MGs on the MTBI/concussion incidence in high school football athletes over a season of play. Four hundred twelve players from 6 high school football teams were included in the study. Twenty-four MTBI/concussion injuries (5.8%) were recorded. When examining the MTBI/concussion injury rate by MG type, there was a significant difference (P = 0.0423) with incidence rates of 3.6% and 8.3% in the LM MG and OTC MG groups, respectively.

Concepts: Traumatic brain injury, Rates, Injury, High school, Over-the-counter drug, American football, Concussion, High school football