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The purpose of this study was to examine how Hawaiian music teachers describe their uses of Hawaiian culture–based educational approaches in the music classroom. The theoretical lens of culture-based education framed the study in that it emphasizes increased attention to questions of cultural restoration within Indigenous communities. A collective descriptive case-study design was used to illuminate the complexities and particularities of the phenomenon of Hawaiian culture–based education utilized by four participant music teachers in their own particular contexts. Data collection included three interviews with each teacher participant, a student focus group interview at each school site, and field notes taken from in-person observations of each music classroom. Analysis revealed four themes central to the participants’ experiences, including teachers’ diverse approaches to culture-based education, their sources of cultural understanding, how they addressed or navigated challenges, and the multiple layers of meaning that they and their students derived from these culture-based approaches. Particularly compelling were findings related to each teacher’s identity and relationship to Hawaiian culture, complicated issues of authenticity related to performing and teaching Hawaiian music, and the centrality of positive relationships to culture-based approaches.

Background and Aim Professional soccer players’ self-reported dietary intakes often do not meet recommended sport nutrition guidelines. Although behaviour change models have previously explored barriers and enablers to nutritional adherence, the cultural factors influencing players’ nutritional habits also warrant investigation. Accordingly, we aimed to explore players’ perceptions of the nutrition culture within the professional soccer environment. Methods An interpretivist paradigm, which emphasises that reality is subjectively and socially constructed, underpins this study. Qualitative, face-to-face semi-structured interviews (comprising open-ended questions) were conducted with purposively sampled male soccer players from the English Premier League (EPL) (five British, five migrant; mean age: 26 ± 6 years; mean EPL appearances: 106 ± 129). Data were abductively analysed using thematic analysis according to Bourdieu’s concepts of habitus, capital, field and doxa practices. Results This study revealed five key themes: (1) players’ habitus, as shaped by familial, ethnic and religious backgrounds, influences their dietary habits; (2) social capital, via managers (head coaches), teammates and online influences, impact players’ dietary practices; (3) the increase in both soccer clubs’ and players’ economic capitals has advanced nutrition provision; (4) an unequal distribution of economic capitals has led to hierarchical practice in the performance nutrition field with personalised nutrition being somewhat enacted at the higher levels; and (5) body composition measurement is a ‘doxic’ practice in professional soccer that warrants challenge. Conclusions Soccer players’ habitual nutritional practices are influenced by personal upbringing and the club context, including economic resources and social capital from managers. The performance nutrition field within professional soccer is also shaped by stakeholders’ doxic beliefs surrounding the perceived optimal body composition of players, with managers exerting social capital.

Background The training characteristics and training intensity distribution (TID) of elite athletes have been extensively studied, but a comprehensive analysis of the TID across runners from different performance levels is lacking. Methods Training sessions from the 16 weeks preceding 151,813 marathons completed by 119,452 runners were analysed. The TID was quantified using a three-zone approach (Z1, Z2 and Z3), where critical speed defined the boundary between Z2 and Z3, and the transition between Z1 and Z2 was assumed to occur at 82.3% of critical speed. Training characteristics and TID were reported based on marathon finish time. Results Training volume across all runners was 45.1 ± 26.4 km·week −1 , but the fastest runners within the dataset (marathon time 120–150 min) accumulated > three times more volume than slower runners. The amount of training time completed in Z2 and Z3 running remained relatively stable across performance levels, but the proportion of Z1 was higher in progressively faster groups. The most common TID approach was pyramidal, adopted by > 80% of runners with the fastest marathon times. There were strong, negative correlations ( p  < 0.01, R 2  ≥ 0.90) between marathon time and markers of training volume, and the proportion of training volume completed in Z1. However, the proportions of training completed in Z2 and Z3 were correlated ( p  < 0.01, R 2  ≥ 0.85) with slower marathon times. Conclusion The fastest runners in this dataset featured large training volumes, achieved primarily by increasing training volume in Z1. Marathon runners adopted a pyramidal TID approach, and the prevalence of pyramidal TID increased in the fastest runners.

Background Advances in instrumented mouthguards (iMGs) allow for accurate quantification of single high-acceleration head impacts and cumulative head acceleration exposure in collision sports. However, relationships between these measures and risk of brain cell injury remain unclear. Aim The purpose of this study was to quantify measures of non-concussive head impact exposure and assess their association with blood glial fibrillary acidic protein (GFAP), neurofilament light (NfL) and phosphorylated-tau-181 (p-tau-181) levels in male Australian football players. Methods A total of 31 athletes underwent in-season (24 h post-match) and post-season (> 5 weeks) blood collections and/or wore HITIQ Nexus A9 iMGs measuring peak linear (PLA) and rotational (PRA) acceleration. Match footage was used to verify and code impacts. Blood GFAP, NfL, and p-tau-181 were quantified using Simoa and natural log transformed for analysis. Associations between post-match biomarkers and within match maximum single impact and cumulative PLA/PRA were assessed with linear mixed models. Results In-season versus post-season elevations were found for GFAP (mean difference 0.14, 95% CI 0.01–0.26, p  = 0.033), NfL (mean difference = 0.21, 95% CI 0.09–0.32, p  = 0.001) and p-tau-181 (mean difference = 0.49, 95% CI 0.33–0.65, p  < 0.001). Post-match GFAP was associated with maximum single impact PLA ( B  = 0.003, 95% CI 0.0002–0.005, p  = 0.036), cumulative PLA ( B  = 0.001, 95% CI 0.0002–0.002, p  = 0.017), cumulative PRA ( B  = 0.01, 95% CI 0.002–0.02, p  = 0.014), and impact number ( B  = 0.03, 95% CI 0.003–0.05, p  = 0.029) within a single match. Change in NfL levels between two-matches correlated with cumulative PLA ( r  = 0.80, 95% CI 0.38–0.95, p  = 0.005), PRA ( r  = 0.71, 95% CI 0.19–0.92, p  = 0.019) and impact number ( r  = 0.63, 95% CI 0.05–0.89, p  = 0.038). Conclusion Maximum and cumulative head accelerations in Australian football, measured by iMGs, were associated with elevated blood biomarkers of brain injury, highlighting the potential of both technologies for head impact management in collision sports.

Background Sports nutrition guidelines recommend carbohydrate (CHO) intake be individualized to the athlete and modulated according to changes in training load. However, there are limited methods to assess CHO utilization during training sessions. Objectives We aimed to (1) quantify bivariate relationships between both CHO and overall energy expenditure (EE) during exercise and commonly used, non-invasive measures of training load across sessions of varying duration and intensity and (2) build and evaluate prediction models to estimate CHO utilization and EE with the same training load measures and easily quantified individual factors. Methods This study was undertaken in two parts: a primary study, where participants performed four different laboratory-based cycle training sessions, and a validation study where different participants performed a single laboratory-based training session using one of three exercise modalities (cycling, running, or kayaking). The primary study included 15 cyclists (five female; maximal oxygen consumption [ V ˙ O 2 max], 51.9 ± 7.2 mL/kg/min), the validation study included 21 cyclists (seven female; V ˙ O 2 max 53.5 ± 11.0 mL/kg/min), 20 runners (six female; V ˙ O 2 max 57.5 ± 7.2 mL/kg/min), and 18 kayakers (five female; V ˙ O 2 max 45.6 ± 4.8 mL/kg/min). Training sessions were quantified using six training load metrics: two using heart rate, three using power, and one using perceived exertion. Carbohydrate use and EE were determined separately for aerobic (gas exchange) and anaerobic (net lactate accumulation, body mass, and O 2 lactate equivalent method) energy systems and summed. Repeated-measures correlations were used to examine relationships between training load and both CHO utilization and EE. General estimating equations were used to model CHO utilization and EE, using training load alongside measures of fitness and sex. Models were built in the primary study and tested in the validation study. Model performance is reported as the coefficient of determination ( R 2 ) and mean absolute error, with measures of calibration used for model evaluation and for sport-specific model re-calibration. Results Very-large to near-perfect within-subject correlations ( r  = 0.76–0.96) were evident between all training load metrics and both CHO utilization and EE. In the primary study, all models explained a large amount of variance ( R 2  = 0.77–0.96) and displayed good accuracy (mean absolute error; CHO = 16–21 g [10–14%], EE = 53–82 kcal [7–11%]). In the validation study, the mean absolute error ranged from 16–50 g [15–45%] for CHO models to 53–182 kcal [9–31%] for EE models. The calibrated mean absolute error ranged from 9–20 g [8–18%] for CHO models to 36–72 kcal [6–12%] for EE models. Conclusions At the individual level, there are strong linear relationships between all measures of training load and both CHO utilization and EE during cycling. When combined with other measures of fitness, EE and CHO utilization during cycling can be estimated accurately. These models can be applied in running and kayaking when used with a calibration adjustment.

Background The identification of concussion risk factors, such as visible signs and mechanisms of injury, improves concussion identification. Exploring individual risk factors, such as concussion history, may help to improve existing concussion risk models and algorithms. Objectives The primary aim of the current study was to use machine learning techniques to develop a comprehensive, prospectively coded concussion risk model in professional hockey among players exhibiting visible signs. The secondary aim was to examine whether including concussion history improves model performance. Methods Data from the National Hockey League (NHL) spotter program, including coded visible signs and mechanisms of injury associated with possible concussive events, were extracted from the 2018–2019 to the 2021–2022 seasons. Each unique spotter event was matched with data extracted from the medical record to determine whether the event was associated with a subsequent physician diagnosed concussion. We compared the ability of three machine learning-based approaches to identify the likelihood of physician diagnosed concussion: conditional inference tree, conditional inference random forest, and logistic regression. Results A total of 1563 unique events with visible signs were identified by spotters (183 leading to a concussion diagnosis). A randomly selected training sample had 1250 events (146 concussions) and the remaining set-aside test sample had 313 events (37 concussions). The obtained models performed at a high level with large effects in the training [area under the receiver operating characteristic curve (AUC) = 0.79] and set-aside test data (AUC = 0.82). Concussion history was retained in the tree and logistic regression models, with each additional prior concussion associated with a 1.32 times increased odds of concussion diagnosis. Conclusions We present simple tree and logistic algorithms for concussion screening and as diagnostic aids. Our results show that player concussion history can explain additional risk above and beyond that explained by visible signs and mechanisms of injury alone.

Introduction Prolonged strenuous exercise can transiently decrease cardiac function. Other studies have identified three major exercise-induced pulmonary changes: bronchoconstriction, dynamic hyperinflation and pulmonary oedema with reduced alveolar–capillary membrane diffusing capacity. This study investigated whether athletes with one of these pulmonary dysfunctions following a very long-distance triathlon exhibit similar cardiac alterations as those without dysfunctions. Methods Sixty trained male triathletes (age 39 ± 9 years) underwent baseline and post-race assessments, including echocardiography (with standard, 2D-strain and myocardial work assessments), spirometry and double-diffusion technique to evaluate alveolar–capillary membrane diffusing capacity for carbon monoxide (DM CO ). Cardiac function in athletes with exercise-induced bronchoconstriction (> 10% decrease FEV 1 ), dynamic hyperinflation (> 10% decrease inspiratory capacity) or impaired diffusion capacity (> 20% decrease DM CO /alveolar volume) were compared with those without these dysfunctions. Results The race lasted 14 h 20 min ± 1 h 26 min. Both systolic and diastolic cardiac functions declined post-race. Post-race, 18% of athletes had bronchoconstriction, 58% dynamic hyperinflation and 40% impaired diffusing capacity. Right and left ventricular standard and 2D-strain parameters were similar before the race in all subgroups and changed similarly post-race, except E/E′, which decreased in the bronchoconstriction subgroup and increased in those with diffusion impairment. Global constructive work decreased by ~ 19% post-race (2302 ± 226 versus 1869 ± 328 mmHg%, P  < 0.001), more pronounced in athletes with diffusion impairment compared with others (− 26 ± 13 versus − 15 ± 9%, P  = 0.001) and positively correlated with DM CO /alveolar volume reduction. Conclusion After a very long-distance triathlon, bronchoconstriction and hyperinflation were not associated with significant cardiac changes, whereas impaired alveolar–capillary membrane diffusing capacity was associated with a more significant decline in myocardial function. These findings highlight the complex relationship between pulmonary gas exchange abnormalities and cardiac fatigue following prolonged strenuous exercise.

Purpose: Despite the recognized clinical value of exome-based diagnostics, methods for comprehensive genomic interpretation remain immature. Diagnoses are based on known or presumed pathogenic variants in genes already associated with a similar phenotype. Here, we extend this paradigm by evaluating novel bioinformatics approaches to aid identification of new gene–disease associations. Methods: We analyzed 119 trios to identify both diagnostic genotypes in known genes and candidate genotypes in novel genes. We considered qualifying genotypes based on their population frequency and in silico predicted effects we also characterized the patterns of genotypes enriched among this collection of patients. Results: We obtained a genetic diagnosis for 29 (24%) of our patients. We showed that patients carried an excess of damaging de novo mutations in intolerant genes, particularly those shown to be essential in mice ( P = 3.4 × 10 −8 ). This enrichment is only partially explained by mutations found in known disease-causing genes. Conclusion: This work indicates that the application of appropriate bioinformatics analyses to clinical sequence data can also help implicate novel disease genes and suggest expanded phenotypes for known disease genes. These analyses further suggest that some cases resolved by whole-exome sequencing will have direct therapeutic implications. Genet Med 17 10, 774–781.

Background Athletes often report gastrointestinal (GI) complaints. Standardized validated tests validated in athletes are lacking. Objective The objective of the current study was to investigate the test–retest reliability of the gastrointestinal symptoms rating scale (GSRS), a disease-specific instrument of 15 items to quantify the severity of various GI symptoms. Methods For this purpose, a 3-week repeated measurements design was used. The mean difference (Wilcoxon signed rank test), associations (Spearman correlations), and systematic difference using Bland–Altman calculations for repeated measurements, as well as its internal consistency (Cronbach’s alpha) on testing day 1 and day 2 were analyzed, with significance set at p  ≤ 0.05. A total of n  = 70 well-trained athletes (26.1 ± 5.4 years, of which 40% were female) were included. Results A high Cronbach’s α for GSRS was found on testing day 1 (0.825), and day 2 (0.823), suggesting a good and comparable internal consistency of the questionnaire. When assessing the multilevel temporal stability for total GSRS scores (28.0, IQR 22.0–36.3 vs 26.5, IQR 18.0–35.0), there was a small but significant difference ( Z  =  − 2.489, and p  = 0.013), but a fair correlation between day scores ( r  = 0.68, p  < 0.001), and a Bland–Altman reporting difference between questionnaires within 10% of the total GSRS score, without significant reporting bias ( p  = 0.38). In most cases, except for hunger, burping, and loose stools, the individual GSRS items were reported in line with total scores and similar for sex. Conclusion In conclusion, the GSRS is reliable when used with athletes, with good internal consistency for most symptoms independently of sex, except for hunger, burping, and loose stools.