Objective: To determine the relationship between sport specialization and previous injury in elite male youth soccer players. Design: Retrospective survey. Setting: U.S. Soccer Development Academy. Participants: Male youth soccer players (N = 2123). Assessment of Risk Factors: Sport specialization, weekly training volume, training ratio, and age. Main Outcome Measures: Previous sports-related injury, injury type (traumatic vs overuse), injury severity, and injury location. Results: Of 2099 participants (average age 13.2 ± 1.8 years), 61.7% were specialized in soccer (played soccer >8 mo/yr and no other sports) and 38.3% were nonspecialized (played soccer >8 mo/yr and also played other organized sports). Specialized athletes were older than nonspecialized athletes (13.7 ± 1.9 vs 12.5 ± 1.4, P < 0.0001). Thirty-three percent (690/2099) of athletes reported at least one previous sports-related injury for a total of 765 traumatic injuries and 25 overuse injuries. Distribution of injury type was similar for specialized and nonspecialized athletes. Among athletes with overuse injuries, nonspecialized athletes were more likely to report upper-extremity and trunk overuse injuries than specialized athletes. After accounting for age and weekly training volume, specialized athletes had decreased odds of reporting any previous injury compared with nonspecialized athletes [odds ratio (OR), 0.78; 95% confidence interval (CI), 0.64-0.95], and similar odds of reporting a previous lower-extremity (LE) overuse injury as nonspecialized athletes (OR, 0.70; 95% CI, 0.56-1.1). However, specialized athletes missed more practices due to injury than nonspecialized players [median = 3, interquartile range (IQR) 2-4 vs median = 2, IQR 2-4, P = 0.0003]. Conclusions: In this national sample of elite, male youth soccer players, after accounting for age and weekly training volume, specialized athletes had decreased odds of reporting any previous injury and similar odds of reporting a previous LE overuse injury as nonspecialized athletes. These data suggest the need for further research to determine whether injury risk related to sports specialization depends on sex, chosen sport, and skill/competitive level.

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We sought to investigate the experiences of researchers in existing active-control trials in acute ischemic stroke comparing investigational therapy to tissue plasminogen activator (tPA) in order to identify the approaches and challenges in obtaining informed consent. Out of 401 articles evaluated, 14 trials met inclusion criteria. Trial representatives were contacted to complete a survey concerning the consent process. None of the 14 trials published materials related to the informed consent process. Trials with 75% to 100% of patients directly consented had shorter door-totreatment (DTT) times than trials that directly consented less than 50% of patients. Trials that had translators available (for recruiting participants who were not native speakers in the local language) and translated consent documents had longer DTT times. The study findings suggest that differences in the standards of informed consent internationally may allow more patients with moderate strokes to provide direct consent without delaying DTT time. Future trials should emphasize transparency to the public and scientific community in the informed consent process. KEYWORDS human research ethics, human subjects research, acute ischemic stroke, informed consent, randomized controlled trials, literature review

Introduction:Large-scale mass-sporting events are increasingly requiring greater prehospital event planning and preparation to address inherent event-associated medical conditions in addition to incidents that may be unexpected. The Bank of America Chicago Marathon (Chicago, Illinois USA) is one of the largest marathons in the world, and with the improvement of technology, the use of historical patient and event data, in conjunction with environmental conditions, can provide organizers and public safety officials a way to plan based on injury patterns and patient demands for care by predicting the placement and timing of needed medical support and resources.Problem:During large-scale events, disaster planning and preparedness between event organizers, Emergency Medical Services (EMS), and local, state, and federal agencies is critical to ensure participant and public safety.Methods:This study looked at the Bank of America Chicago Marathon, a significant endurance event, and took a unique approach of reviewing digital runner data retrospectively over a five-year period to establish patterns of medical demand geographically, temporally, and by the presenting diagnoses. Most medical complaints were musculoskeletal in nature; however, there were life-threatening conditions such as hyperthermia and cardiac incidents that highlight the need for detailed planning, coordination, and communication to ensure a safe and secure event.Conclusions:The Chicago Marathon is one of the largest marathons in the world, and this study identified an equal number of participants requiring care on-course and at the finish line. Most medical complaints were musculoskeletal in nature; however, there were life-threatening conditions such as hyperthermia and cardiac incidents that highlight the need for detailed planning, multi-disciplined coordination, and communication to ensure a safe and secure event. As technology has evolved, the use, analysis, and implementation of historical digital data with various environmental conditions can provide organizers and public safety officials a map to plan injury patterns and patient demands by predicting the placement and timing of needed medical support, personnel, and resources.

Introduction: Obtaining informed consent from acute ischemic stroke patients poses many challenges, especially in the context of a research setting. Specifically, consenting for alternative acute ischemic stroke treatments to the standard of care, Tissue Plasminogen Activator (tPA), can cause delays leading to increased time to reperfusion and worse outcomes. Objectives: We sought to investigate the experiences of researchers in existing active-control trials in acute ischemic stroke comparing investigational therapy to tPA in order to identify the approaches and challenges in obtaining informed consent in this unique patient population. Methods: Out of 401 articles evaluated, 14 trials met inclusion criteria of patients receiving IV tPA vs alternative treatment within 4.5 hours of onset of symptoms for acute ischemic stroke. Trial representatives were emailed by the study team with a request for a copy of their patient consent form, other documents related to informed consent, and to complete a survey concerning aspects of the consent process. Results: Of the 6 trials conducted across 6 continents that completed the survey in its entirety, 2 were ongoing, 4 were published between 2009 and 2016, and the median NIHSS for each published trial was at least an 8. All published trials in the sample stated that informed consent was obtained, but only half reported involvement of a research ethics committee. Although 3 trials performed in Europe or Asia reported directly consenting 75-100% of enrolled patients, the median NIHSS for these trials represented a moderate stroke. Trials with 75-100% of patients directly consented had shorter door to treatment (DTT) times than trials that directly consented less than 50% of enrolled patients. 5 trials allowed consent by proxy, but only 2 of those trials also required patient assent. 4 trials had translators available and translated consent documents, and these trials had longer DTT times. All trials relied on experienced providers or dedicated research coordinators to obtain informed consent; however, only 2 of 6 trials mentioned specific training with regards to informed consent skills. Conclusions: The current informed consent process is not transparent and poses challenges to investigators in the USA directly comparing tPA to an alternative treatment. International differences in the standards of informed consent, such as deferred consent, may have allowed more patients with moderate strokes to provide direct consent after treatment administration without delaying DTT time. While targeted and innovative approaches for informed consent are needed to improve patient outcomes, we must balance protecting the autonomy of individuals whose willing involvement enables such pivotal discoveries. The stroke community must aim for efficiency, transparency, and inclusion of patients of diverse backgrounds in the informed consent process so that therapeutic advances are possible.