Participation among female youth in competitive rugby league has grown rapidly, leading to an increased injury rate. Collecting female injury data in rugby league seasons helps identify injury patterns, enabling targeted interventions to reduce injuries. This study aimed to describe the site, type, and mechanism of injuries in under-17 and under-19 female rugby league players. A retrospective study on injury epidemiology in two female rugby league competitions during the 2025 season was conducted. Injuries were reported via a standardised form that documented the site, type, and mechanism across 20 teams. Descriptive statistics, chi-square tests of independence, Fisher's exact pairwise comparisons, and standardised residuals were calculated appropriately. 16 out of 20 teams provided injury data, with a total of 492 injuries. Independently, the most common injuries per site, type, and mechanism were those in the ankle (83), ligament and joint (177), and contact (343), respectively. Pairwise comparison revealed the highest observed frequencies were ankle joint and ligament injuries (65; site and type), arm/hand tackling injuries (34, site and mechanism), and joint and ligament tackled injuries (49, type and mechanism). Monitoring injury trends among female rugby league players may enable practitioners to refine sport-specific techniques and physical preparedness programmes that could reduce injury risk.
Moore, DA, Darrall-Jones, JD, Weakley, JJS, Sawczuk, TS, Heyward, OW, Jones, BL, and Till, K. Countermovement jump responses during an academy rugby league in-season. J Strength Cond Res XX(X): 000-000, 2026-The countermovement jump (CMJ) is widely used to assess lower-body force-time characteristics in rugby league; however, how these characteristics change across the in-season period remains unclear. The purpose of this study was to investigate changes in lower-body force-time characteristics over an 8-week in-season period using CMJ outcome, driver, and strategy metrics derived from force plates. Twenty-five male academy rugby league players (17.0 ± 1.9 years) completed CMJ assessments twice weekly (2 trials per session): 24 hours prematch and 24-72 hours postmatch, while engaging in regular field training, resistance training, and weekly competition. Force plate-derived variables included outcome (i.e., jump height, relative peak power), driver (phase-specific mean force, impulse), and strategy (i.e., countermovement depth, contraction time) metrics. Linear mixed-effects models were used to assess acute (24-72 hours) and preobservation to postobservation window (8 weeks) changes, with "week" included as a fixed effect and "athlete identity" as a random effect. Hedges' g effect sizes with 95% confidence intervals were reported. Results demonstrated trivial reductions in CMJ performance across the observation window. Jump height and concentric impulse remained unchanged, but countermovement depth exhibited a moderate increase (Δ = 3.46 ± 1.60 cm, g = 0.61 (0.33-0.89); p < 0.001). These findings suggest athletes adopt compensatory patterns, characterized by greater ranges of motion and contraction time, to sustain performance under conditions of accumulating load. Incorporating outcome, driver and strategy metrics enhances the utility of CMJ testing for athlete monitoring, informing training adjustments, guiding recovery strategies and supporting long-term athlete development.
The optimal graft choice for anterior cruciate ligament reconstruction (ACLR) remains a subject of ongoing debate. In practice, graft selection in ACLR is multifactorial, with patient characteristics, activity level, and surgeon preference/training background all playing a crucial role in the clinical decision-making process. While graft trends have been reported across select professional sports leagues, none have focused specifically on professional soccer. To report current trends in graft preference for ACLR among Major League Soccer (MLS) surgeons. Cross-sectional study. A 39-question survey was distributed to 27 orthopaedic surgeons affiliated with MLS teams in January 2025. The questionnaire captured each respondent's preferences regarding ACLR management in both the general population and high-level/professional soccer athletes. Descriptive statistics were used to summarize responses. Surgeons averaged 7.7 years caring for MLS teams and performed a mean of 80 ± 27 ACLRs annually. In primary ACLR for professional soccer athletes, the bone-patellar tendon-bone (BPTB) autograft was preferred (74%), followed by the quadriceps tendon (QT) autograft (22.2%). The hamstring tendon (HT) autograft was uncommon (3.7%). Similar trends were reported for the general population: BPTB autograft (70%), QT autograft (22.2%), and HT autograft (3.7%). For revision procedures, QT autograft was favored (48.2%), followed by BPTB autograft (25.9%) and BPTB allograft (11.1%). Contralateral autografts were more common in revisions (44.4%) than in primary cases (7.4%). Lateral extra-articular augmentation (LEA) was performed in 31.5% of primary cases and 76% of revision cases; iliotibial band tenodesis was favored over anterolateral ligament reconstruction (74.1% vs 25.9%). LEA utilization increased compared with 5 years prior (6.4% vs 29.4%). Among orthopaedic surgeons caring for MLS athletes, BPTB autografts were the preferred graft for primary ACLR. QT autografts were preferred over HT autografts in primary ACLR, and QT autografts were most commonly used in revision surgery. HT autografts were rarely used in primary ACLR and were not preferred in revision scenarios. LEA procedures were widely used among professional soccer athletes.
To evaluate quadriceps injury rates, return-to-play (RTP) durations, and postinjury performance in Major League Soccer (MLS) athletes with quadriceps injuries. Data from MLS players with quadriceps injuries (2010-2021) were analyzed using the MLS Injury Surveillance database. Injury rates, RTP times, and reinjury rates were compared across 2 periods (2010-2015 vs 2016-2021). Uninjured players matched 2:1 by position, age, and experience served as controls. Postinjury performance metrics including games played, minutes played, goals, assists, and clean sheets were compared longitudinally across 3 seasons. A total of 1550 MLS players were included. The average age of injured players was 25.57 ± 4.03 years. Injury rates slightly decreased from 7.70% (2010-2015) to 6.51% (2016-2021, P = .111). RTP times significantly increased from 14.4 to 23.0 days (P < .001). Reinjury rates declined from 5.08% (2010-2015) to 0.82% (2016-2021) (P = .098). RTP after reinjury was longer in 2016-2021 but nonsignificant (P = .647). Game-related injuries had shorter RTP (16.4 vs 20.7 days, P = .030). Acute contact injuries resulted in shorter RTP (9.55 days) compared with noncontact (27.0 days) or chronic injuries (16.2 days, P < .001). Weather at the time of injury influenced RTP, with shorter durations in rainy/snowy conditions (11.0 vs 18.75 days, P < .0001). Field type had no significant impact (P = .361). Defenders experienced significant declines in minutes played per season and at 3 years after injury (P = .002, P = .004, respectively). No significant differences were found in goals, assists, or clean sheets. In this study, reductions in injury and reinjury rates were not statistically significant. Longer RTP durations may reflect a cautious recovery approach or may also reflect end-of-season timing or off-season transitions. Position-specific rehabilitation, particularly for defenders, may enhance outcomes. Level III, retrospective comparative study.
Understanding and predicting fan consumption behavior is a central challenge in professional sports, yet most recommender systems rely primarily on historical interactions and pay limited attention to relationship-marketing factors that shape fan engagement. To address this gap, this study develops MLP-PA (Multi-Layer Perceptron with Pyramid Attention) and examines whether incorporating fans' relational states-such as satisfaction, trust, commitment, and reciprocity-can improve recommendation effectiveness across multiple consumption scenarios among Chinese Super League (CSL) fans. Using a multi-scenario dataset covering ticketing, merchandise, membership, and digital content, empirical results show that recommendations generated by MLP-PA achieve significantly higher Top-N ranking accuracy than conventional collaborative filtering approaches, with particularly pronounced improvements in sparse and long-tail settings. The analysis further reveals that different relationship factors are associated with distinct consumption patterns: commitment and reciprocity are more strongly linked to repeated and high-involvement behaviors, whereas satisfaction and trust mainly influence initial and short-term responses. These findings demonstrate that relationship-marketing factors play a substantive and differentiated role in fan consumption behavior, offering actionable insights for personalized engagement strategies and digital operations in professional football.
Shoulder instability and labral pathology are common in National Football League (NFL) players, yet contemporary return-to-play (RTP), return-to-performance (RTPf), and postreturn career longevity outcomes after surgical labral repair are incompletely characterized. To (1) describe RTP timing and rates after surgical labral repair, (2) quantify season-to-season changes in usage and performance versus matched controls, and (3) evaluate post-RTP career longevity. Cohort study; Level of evidence, 3. Using publicly available NFL data (2015-2024), 111 labral repair episodes were identified and indexed to surgery date. RTP was defined as the first in-game snap after surgery, with rates summarized at 2, 6, 12 and 24 months and overall (ever RTP). For RTPf, episodes required ≥100 snaps in both a preindex season (T1) and a first post-RTP season (M1); 60 cases met criteria and were matched 1:2 to 120 controls by season and position group, with additional matching on age and T1 snap rate. Changes from T1→M1 (and T1→M2 when available) were compared between groups. Outcomes included usage (games, total snaps, snaps/game) and Pro Football Focus (PFF) season grades. Career longevity post-RTP was assessed using Kaplan-Meier and stratified Cox models. Among 111 episodes, defensive backs (25.2%) and offensive linemen (21.6%) were the most common position groups. Overall, 86.5% returned at a median 265 days (IQR, 234-316); 3.6% returned within 6 months, 73.9% within 1 year, and 84.7% within 2 years. In the matched RTPf cohort (60 cases; 120 controls), usage changes from T1→M1 did not differ (all P > .05). Offensive PFF grade trended lower versus controls (Δdiff -3.78; P = .09), while defensive PFF grade declined significantly more (Δdiff -7.13; P = .01). In the M2 subset (34 cases; 68 controls), usage and offensive PFF remained nonsignificant, whereas defensive PFF remained significantly lower (Δdiff -10.12; P = .02). Career longevity did not differ between cases and controls by log-rank or stratified Cox analyses (all P > .05). NFL players undergoing isolated labral repair demonstrated high RTP rates with preserved postreturn workload and career longevity versus matched controls. However, defensive players showed a sustained reduction in performance grades through 2 postreturn seasons, suggesting that RTP may not uniformly translate to RTPf and may vary by position.
Introduction Anterior cruciate ligament (ACL) injuries are common in professional soccer; however, limited research has described the situational mechanisms of injury in men's major league soccer (MLS) in the United States and Canada. Understanding these mechanisms is essential for developing targeted prevention and rehabilitation strategies. Objective This study aims to identify situational patterns and positional characteristics associated with ACL injuries in MLS players. Methods Across five and a half MLS seasons, 65 ACL injuries were identified. Video footage was available for 33 injuries, which were analyzed to determine the mechanism of injury, player activity at the time of injury, knee position, and external factors, including field type, month of injury, and timing within the game. Results Non-contact injuries were most common (64%), followed by direct (21%) and indirect-contact (15%) injuries. Injuries most frequently occurred during defensive pressing (76%) and offensive driving (58%). Knee valgus (82%) and flexion (85%) were the predominant positions at the time of injury. All indirect-contact injuries involved force applied to the upper body, increasing stress on the knee. Injuries occurred more commonly on grass fields during the second half or overtime (61%) and demonstrated a bimodal distribution across the season. Overall, 79% of ACL injuries occurred without direct contact to the affected knee. Conclusion ACL injuries in MLS primarily result from non-contact or indirect-contact mechanisms, often during pressing or driving movements, with the knee loaded in valgus and flexion. These findings can inform sport-specific prevention strategies aimed at reducing ACL injury risk and prolonging athlete participation in professional soccer.
Shoulder and elbow injuries are a significant source of morbidity among Major League Baseball (MLB) pitchers, yet comprehensive injury and economic burden analyses remain limited. To quantify the epidemiological and economic burden of shoulder and elbow injuries among MLB pitchers from 2015 to 2025, including trends in injury incidence and salary lost over time. Descriptive epidemiological study. All MLB pitcher injured list (IL) placements for shoulder and elbow injuries from 2015 to 2025 were identified using publicly available databases (ie, Fangraphs, Spotrac). Salary lost was calculated using the daily rate methodology and adjusted for inflation in US dollars, based on the 2025 inflation rate. Injury incidence rates were calculated per 1000 athlete-exposures. Linear regression assessed temporal trends in injury costs and incidence. A total of 1122 MLB pitchers sustained shoulder or elbow IL placements during the study period, comprising 2365 total IL stints and $3.33 billion in cumulative salary lost. Elbow injuries accounted for 68.3% ($2.28 billion) and shoulder injuries 31.7% ($1.06 billion). Ulnar collateral ligament (UCL) injuries were the costliest diagnosis ($1.29 billion, 539 events). Significant increasing trends were observed for overall injury incidence (slope = 0.187 per 1000 athlete-exposures per year, P < .001), with elbow incidence rising 2.9 times faster than shoulder incidence (elbow slope = 0.140 per 1000 athlete-exposures per year, P < .001; shoulder slope = 0.047 per 1000 athlete-exposures per year, P = .022). Relief pitchers demonstrated 27.4 IL days per 1000 pitches compared to 15.3 for starters, representing approximately 80% higher injury burden per pitch. Shoulder and elbow injuries among MLB pitchers represent a substantial and growing time-loss and economic burden, with cumulative salary lost exceeding $3.3 billion over the study period. Elbow injuries accounted for most of this burden, and UCL injuries represented the single costliest injury category. These findings quantify the considerable financial and roster burden associated with shoulder and elbow IL placements among MLB pitchers.
To update the Asia-Pacific League of Associations for Rheumatology (APLAR) treatment recommendations for rheumatoid arthritis (RA) by incorporating new evidence and reassessing the validity of previous guidance: METHODS: A literature search for relevant publications from January 2018 to August 2023 was conducted, supplemented by earlier studies where relevant. Recommendations were formulated based on this evidence and refined through a modified-Delphi process during a series of online meetings. The quality of evidence and strength of recommendations were assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. This update comprises 14 statements that achieved consensus during the meetings. Topics covered include measurement of disease activity and treatment response, the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), the use of targeted therapies, vaccination and screening for infections and the use of DMARDs during pregnancy. The recommendations address the selection of disease activity scores, initiation and intensification of therapy using csDMARDs and targeted therapies, and management of RA in patients at risk of reactivation of infectious diseases. These recommendations are discussed in the context of the clinical landscape encountered in the Asia-Pacific region. These updated recommendations complement previous APLAR guidelines and aim to support best practice management of RA across the Asia-Pacific region. They provide a practical framework for national rheumatology associations to develop local guidelines adapted to their specific needs and clinical practice.
The management of reproductive health in individuals with autoimmune rheumatic diseases (AIRDs) has evolved into a primary clinical priority. Wide variations in clinical practice and drug availability in the Asia-Pacific regions necessitate localized frameworks. These consensus statements, developed by the Asia Pacific League of Associations for Rheumatology (APLAR) Special Interest Group for Women's Health & Reproductive Issues in Rheumatic and Musculoskeletal Diseases, aim to bridge the gaps within the region, foster multidisciplinary collaboration, and address regional knowledge deficits. An expert panel comprising 16 members of the 13 APLAR member nation organizations formulated 23 research questions using the PICO framework. A systematic review of English-language literature up to July 2025 was conducted across the MEDLINE, Scopus, Google Scholar, and Cochrane Library databases, supplemented by a manual search of journals from the APLAR regions. Evidence from the APLAR region was appraised using the GRADE system. A modified Delphi online voting process was employed to reach consensus, pre-defined as ≥ 75% agreement. The panel approved four overarching principles and 86 statements, organized into 16 broad categories. These statements cover all three phases of pregnancy in AIRDs, the safety of medications during pregnancy and lactation, contraception, assisted reproductive techniques, fertility preservation, and hormonal replacement therapy, covering both female and male aspects as relevant. In a field often lacking high-quality data, these consensus statements from APLAR provide expert opinion-based guidance to support clinical decision-making. It is envisaged that it will assist in educational and training purposes and help shape future research priorities.
This scoping review examined existing interventions designed to promote and educate about HPV vaccination in the league of Arab states (LAS). Following PRISMA-ScR guidelines and using a PICOS-informed approach, a comprehensive search was conducted across 16 databases to identify peer-reviewed intervention studies published between 2010 and August 2025. Twenty-two studies met the inclusion criteria. Most interventions originated from Egypt and Saudi Arabia and were delivered in academic or clinical settings using short, didactic, one-group pre-post designs. Only a few studies incorporated behavioral theories, digital modalities, or multi-component strategies. Nearly all studies reported short-term improvements in HPV-related knowledge and attitudes, but few assessed behavioral intention, long-term retention, or actual vaccine uptake. No interventions targeted adolescents, fathers, or school communities, and only one study evaluated cost-effectiveness. The evidence demonstrates early progress in HPV vaccine education across the LAS but reveals substantial methodological, theoretical, and population-level gaps. Education alone produced limited behavioral change, underscoring the need for interventions that integrate system-level supports, provider engagement, and mechanisms for reinforcing behavior over time. HPV vaccine education efforts in the LAS show promise but remain fragmented, narrow in reach, and insufficient to meaningfully influence vaccination uptake. Future initiatives should prioritize theory-driven, multi-component approaches that engage families, adolescents, healthcare providers, and community structures. Regional collaboration and implementation research will be essential to strengthen HPV vaccination strategies and reduce the burden of cervical cancer across the LAS.
As cannabis legalization expands and professional sports organizations reassess cannabinoid policies, elite contact sport athletes are increasingly exposed to cannabis use for therapeutic, recovery, and recreational purposes. Despite these shifts, limited evidence-based education and persistent stigma may hinder informed decision-making and athlete-clinician communication. Professional and elite-level contact sport athletes exhibit inconsistent knowledge and perspectives regarding cannabis use, shaped by stigma, inadequate education, and regulatory ambiguity. Qualitative descriptive study. Level 4. A total of 10 semi-structured interviews were conducted with current or former elite contact sport athletes from professional and collegiate leagues, including the National Hockey League, National Football League, National Basketball Association, American Hockey League, National Collegiate Athletic Association, and USports. Interviews explored athletes' knowledge, attitudes, and experiences related to cannabis and cannabinoid products in sport. Transcripts were analyzed using Braun and Clarke's 6-step thematic analysis framework to identify recurring patterns and themes. A total of 5 primary themes emerged: (1) athletes use cannabis; (2) insufficient education and lack of credible information sources; (3) persistent stigma and fear of judgment; (4) limited trust and communication with medical staff; and (5) inconsistency in laws, policies, and organizational responses. Athletes reported cannabis use for pain management, sleep, recovery, and mental health, typically with deliberate control over dosage, timing, and administration methods. Across interviews, participants emphasized the need for accessible, evidence-based education for both athletes and medical personnel. Elite contact sport athletes use cannabis intentionally for recreational, therapeutic, and recovery purposes but face systemic barriers related to misinformation, stigma, and inconsistent policy guidance. Enhancing athlete and clinician education and standardizing cannabis-related regulations across leagues may support safer, evidence-informed practices. This study identifies critical educational and policy gaps regarding cannabis in elite sport and underscores the need for multidisciplinary collaboration to guide responsible cannabinoid use among athletes.
Isolated cuboid dislocation is rare, with only 7 cases described in the literature. We describe three cases, two in professional rugby league players. The mechanism of injury was the same in the rugby league players with an external rotation injury to the midfoot during a tackle. The dislocation is easily missed on X-rays and CT would appear to be the investigation of choice. None of the dislocations could be reduced closed and all underwent open reduction and wire stabilisation. The wires were removed at 6 weeks. The short and long term functional results were good. Both rugby league players returned to play. One player was reviewed 6 years and 8 months post dislocation. He was still playing professional rugby league. His AOFAS midfoot score was 100. His X-rays however showed marked post traumatic arthritis in his 4th and 5th tarsometatarsal joints. Clinically this was asymptomatic. The second player was reviewed 4 years and 2 months after the injury, achieving an AOFAS Midfoot Score of 88/100. He reported some clicking and discomfort in the affected foot, particularly in the mornings. However, he did not require analgesia and had no limitations to activity.
To evaluate return-to-competition rates, posterior shoulder instability recurrences, and revision surgeries following arthroscopic posterior labral repair in this elite cohort. A retrospective review of prospectively collected data included professional contact athletes undergoing primary arthroscopic posterior labral repair by a single surgeon (June 2016 to February 2024). Inclusion required age ≥18, active professional status at surgery, and minimum 12-month follow-up. Patients with concomitant cuff repairs or bony procedures were excluded. Outcomes included return-to-competition (defined as the first postoperative professional game), time to return-to-competition, instability recurrence, games per season, and career longevity using public performance data. Seventeen professional male contact-sport athletes (mean age 24 ± 3.7 years) met inclusion criteria. Ten were National Hockey League hockey players and 7 were National Football League football players. All (100%) returned to their pre-injury level at a median of 173 days (range 89-370 days). At mean follow-up of 45 ± 22.9 months, 1 athlete experienced recurrent instability, which was managed nonoperatively. No athlete retired postoperatively. Fourteen of 17 played more games per season following surgery, with a mean increase of 26.6% ± 21.8%. Arthroscopic posterior labral repair is a highly effective surgical intervention for restoring shoulder stability and enabling a reliable return to play among professional contact-sport athletes. In this cohort of elite-level, professional competitors, most athletes returned to their pre-injury level of competition and continued playing without issue, with only 1 case of recurrent instability that did not require revision surgery at a minimum 1-year follow-up. Level IV, retrospective therapeutic case series.
Global rheumatology training faces immense challenges, with over 1.7 billion people affected by musculoskeletal diseases and pronounced regional disparities in specialist access. Diverse curricula, resource limitations, and variable career pathways underscore the urgency for targeted harmonisation efforts. This study aims to present a vision for harmonising rheumatology training worldwide, highlighting the contributions of continental societies and innovative young networks, based on insights from the EMerging European Alliance of Associations for Rheumatology (EULAR) NETwork (EMEUNET) Presents session at EULAR Congress 2025 'Rheumatology Training Around the Globe'. A narrative review of current training models across Africa, Asia-Pacific, Pan-America, and Europe using data from EULAR 2025 Congress supplemented with session slides and speaker insights. Programmes in Africa remain limited and fragmented, with severe workforce shortages and few structured training opportunities; regional responses include Young African Rheumatologists Network and select international partnerships. Asia-Pacific features multicountry, exam-based curricula governed centrally, but faces shortfalls in infrastructure and fellowship access, addressed in part by Asia Pacific League of Associations for Rheumatology-Young Rheumatology's educational initiatives. Pan-America is marked by significant programme heterogeneity and access barriers, with the United States standing out for its highly structured American College of Rheumatology-accredited programmes, robust educational events, and comprehensive resources. Pan-American League of Associations for Rheumatology Joven and digital education initiatives are reducing training gaps and advancing collaboration. Europe combines robust, competency-focused national programmes, with EULAR and European Union of Medical Specialties actively supporting harmonisation despite persistent local variation, and EMEUNET enhancing mentorship and career support. Future harmonisation in rheumatology training requires flexible, competency-driven frameworks, expanded digital platforms, multilevel mentorship, and sustainable investment, integrating national programmes into global networks.
Muscle injuries account for approximately 31% of all time-loss injuries in professional football, yet existing prediction models are constrained by small sample sizes, dependence on proprietary physiological data, limited interpretability, and inadequate temporal validation designs. This study develops an interpretable, strictly prospective prediction framework trained on 438,219 player-season records sourced from Transfermarkt, spanning 15 seasons (2010/11-2024/25) across 32 leagues. To ensure temporal integrity, all predictive features are constructed exclusively from prior-season data, and models are evaluated under a chronological hold-out design in which earlier seasons serve as training data and the two most recent seasons constitute the test set. We propose a multi-method stability-weighted feature selection (MSFS) strategy that cascades filter-based redundancy removal, four-method ensemble voting, and cross-validation stability verification, reducing 57 candidate features to a robust subset. Under cost-sensitive learning designed for severe class imbalance (6.2% positive rate), TabNet attains the highest discrimination among five candidate classifiers with an area under the receiver operating characteristic curve (AUC) of 0.812 (95% CI: 0.804-0.820), outperforming XGBoost (0.806), LightGBM (0.803), long short-term memory network (LSTM) (0.789), and logistic regression (0.761). Ablation experiments confirm that stability-verified feature selection and metaheuristic hyperparameter optimisation yield complementary performance gains, and direct comparison with Bayesian optimisation demonstrates that the detective behaviour algorithm provides competitive tuning across architectures. A seven-layer Shapley additive explanations (SHAP) interpretability analysis reveals that under the prospective design, injury history emerges as the most important feature category (33%), surpassing market-and-career features (29%), confirming that the temporal correction elevates genuine recurrence risk over reporting-related proxies. A two-stage risk architecture is identified in which market-and-career features establish a baseline risk stratum, whereas historical injury burden acts as a multiplicative amplifier among predisposed individuals. Individual-level decompositions further indicate that substitution-based rotation patterns are associated with attenuated age-related risk elevation. Sensitivity analyses excluding market value features quantify the extent to which predictive performance reflects genuine injury risk versus differential reporting completeness across leagues. These findings demonstrate that publicly accessible transfer-market data, combined with attention-based deep tabular learning and rigorous temporal validation, can support meaningful and interpretable injury risk stratification without proprietary monitoring systems.
This perspective report examines temporal trends in concussion rates in relation to changes in permitted physical contact in the Swedish Women's Hockey League (SDHL). Over three seasons, the league gradually allowed more physical play, culminating in the current permission of body checking from the 2022/2023 season. Contrary to traditional assumptions, reported concussion rates declined during a period of progressively increased permitted physical contact. However, these observational findings should be interpreted with caution, as multiple contextual factors may have influenced the results. Also, the results do not establish a causal relationship between body checking policy and concussion incidence and rather than supporting immediate policy change, the findings highlight the need for continued monitoring and further research into how rules, education, and player behavior interact to influence concussion risk.
Epilepsy semiology is a major component of epilepsy diagnosis and plays a crucial role in its clinical management. This study aimed to develop the "Standard for Epilepsy Semiology and Semiological Description Dataset" to provide a reference for clinical practice and research, and to promote the standardization of relevant data. This work lays the foundation for the further development and construction of specialized epilepsy databases. A modified Delphi method was employed to reach a consensus on the framework and content of the dataset. Two rounds of the Delphi process were conducted. Participants included experts from the fields of neurosurgery, neurology, pediatrics, and clinical neurophysiology, all specializing in epilepsy. The development was primarily based on the 2025 International League Against Epilepsy (ILAE) "Updated Classification of Seizures by the International League Against Epilepsy: Position Statement". The draft was also informed by previously published guidelines and consensus statements, case reports, and semiological reports extracted from clinical examination records of epilepsy patients. Data analysis included the expert positive coefficient, expert authority coefficient (Cr), expert coordination coefficient (Kendall's W), and coefficient of variation (CV) to reflect reliability and consensus. Consensus was reached on 285 key indicators for the dataset standard. To organize the data systematically, the standard was designed into two sections: the "Standard for Epilepsy Semiology and Semiological Description Dataset - Main Table"and the "Standard for Epilepsy Semiology and Semiological Description Dataset - Semiological Description Table". The first section includes 10 Level-1 indicators and 93 Level-2 indicators. The second section includes 6 Level-1 indicators, 88 Level-2 indicators, and 88 Level-3 indicators (encompassing 832 free-text fields). The expert authority coefficient was 0.83 for both rounds. Kendall's coefficient of concordance (W) was 0.222 (p < 0.001) in the first round and 0.175 (p < 0.001) in the second round, indicating a statistically significant degree of consistency among the experts. This study employed a modified Delphi method to develop the "Standard for Epilepsy Semiology and Semiological Description Dataset". By standardizing and integrating relevant terminology, this standard incorporates Chinese-specific synonym fields, aiming to provide a reliable data foundation for clinical practice and scientific research. The outcomes not only offer standardized references for specialists but also serve as practical tools for grassroots physicians in epilepsy semiological data collection, thereby effectively promoting the standardization of data in this field and laying a solid foundation for the in-depth utilization, sharing of epilepsy data, and the construction of specialized disease databases.
In 2022, the Swedish Women's Elite Ice Hockey League (SDHL) became the first women's league to introduce bodychecking. Using insurance data, this study examined injury incidence before and after the implementation of this rule. Since 2019, the SDHL has comprised 10 teams with 20-25 players on each. All players in SDHL have license insurance to take care of ice hockey injuries. All injuries that lead to contact with the insurance company are registered in a database. The insurance covers accidental injuries occurring during matches, organized team practices, hockey school sessions, and direct travel to and from these activities. Injury data from all seasons between 2019-2020 and 2024-2025 were analyzed. Injury rates (IR) per 1,000 player-game hours were calculated and compared across seasons and between pre-implementation (2019-2022) and post-implementation (2022-2025) periods. A total of 120 injuries were recorded among 92 players. IR per 1,000 player-game hours increased from 6.6 (95% CI 3.8-10.7) in season 2021-2022 to 16.7 (11.6-23.2) in 2022-2023, with moderately elevated rates remaining in subsequent seasons. When grouped by period before and after body checking implementation, IR increased from 6.0 (4.4-8.1) pre-implementation to 11.0 (8.6-13.7) post-implementation (p < 0.05). The injury incidence was highest during the first season with body checking and declined in subsequent seasons compared with this initial post-implementation peak. The introduction of body checking in the SDHL was associated with a significant increase in injuries recorded through the insurance system, indicating that this rule change may lead to a higher injury burden. More research on this topic is needed if body checking is to be widely incorporated into women's ice hockey.
Incentive-based strategies are widely used to promote physical activity. However, behavioural responses around predefined targets and their long-term persistence remain insufficiently understood. The aim of this study was to examine changes in daily step count distributions following the introduction of a non-financial incentive and their persistence over long-term application use. This observational study used large-scale data from users of Pa-League Walk, a baseball fandom-based gamified smartphone application in Japan. Daily step-count data from March 2016 to December 2022 were analysed. A non-financial incentive in the form of a digital player photo reward for achieving 10,000 steps per day was introduced in October 2016. Changes in the proportion of days achieving the 10,000-step goal and daily step count distributions were examined using bunching estimation. Analyses were conducted according to application use duration (<1 year to ≥6 years). Among 49,008 users with 11,129,438 daily observations, excess mass at the 10,000-step threshold was not significant prior to the introduction of the incentive. However, a clear accumulation of observations around the threshold emerged after the incentive was introduced. Additionally, the proportion of days achieving the 10,000-step goal increased. These distributional features persisted across application usage durations and were sustained for more than six years among long-term users. In a gamified smartphone application, the introduction of a non-financial, repeated incentive was associated with sustained behavioural adjustments toward a predefined step-count target. These findings suggest that well-designed non-financial incentives may support long-term physical activity behaviours in a subset of users.