human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT To determine if testing environment affects Balance Error Scoring System ( BESS ) scores in healthy collegiate baseball players . DESIGN Experimental , r and omized , repeated- measures design with a sample of convenience . SETTING Uncontrolled sideline and controlled locker room baseball environments . PATIENTS OR OTHER PARTICIPANTS A total of 21 healthy collegiate baseball players ( age = 20.1 + /- 1.4 years , height = 185.1 + /- 6.8 cm , mass = 86.3 + /- 9.5 kg ) with no history of head injury within the last 12 months , no lower extremity injuries reported within the past 2 months that caused them to miss 1 or more days of practice or game time , and no history of otitis media , Parkinson disease , or Meniere disease . MAIN OUTCOME MEASURE(S ) Participants performed the  BESS test  in 2 environments , controlled locker room and uncontrolled sideline , in 2 testing sessions 1 week apart during the baseball preseason . The BESS scores were evaluated for each of the 6 conditions and total score across the testing sessions . Separate , paired- sample s t tests with Bonferroni adjustment ( P < .008 ) were used to examine differences between testing environments for each BESS subcategory and total score . Cohen d tests were calculated to evaluate effect sizes and relative change . RESULTS Significant group mean differences were found between testing environments for single-leg foam stance ( P = .001 ) , with higher scores reported for the uncontrolled sideline environment ( 7.33 + /- 2.11 errors ) compared with the controlled clinical environment ( 5.19 + /- 2.16 errors ) . Medium to large effect sizes ( 0.53 to 1.03 ) were also found for single-leg foam , t and em foam , and total BESS scores , with relative increases ( worse scores ) of 30 % to 44 % in the sideline environment compared with the clinical environment . CONCLUSIONS The BESS performance was impaired when participants were tested in a sideline environment compared with a clinical environment . Baseline testing for postural control using the BESS should be conducted in the setting or environment in which testing after injury will most likely be conducted Background : Sports-related concussion commonly affects the visual pathways . Current sideline protocol s test cognition and balance but do not include assessment s of visual performance . We investigated how adding a vision-based test of rapid number naming could increase our ability to identify concussed athletes on the sideline at youth and collegiate levels . Methods : Participants in this prospect i ve study included members of a youth ice hockey and lacrosse league and collegiate athletes from New York University and Long Isl and University . Athletes underwent preseason baseline assessment s using : 1 ) the King – Devick ( K-D ) test , a < 2-minute visual performance measure of rapid number naming , 2 ) the St and ardized Assessment of Concussion ( SAC ) , a test of cognition , and 3 ) a timed t and em gait test of balance .  The SAC and timed t and em gait are components of the currently used Sport Concussion Assessment Tool , 3rd Edition ( SCAT3 and Child-SCAT3 ) . In the event of a concussion during the athletic season , injured athletes were retested on the sideline/rink-side . Nonconcussed athletes were also assessed as control participants under the same testing conditions . Results : Among 243 youth ( mean age 11 ± 3 years , range 5–17 ) and 89 collegiate athletes ( age 20 ± 1 years , range 18–23 )  , baseline time scores for the K-D test were lower ( better ) with increasing participant age ( P < 0.001 , linear regression models ) . Among 12 athletes who sustained concussions during their athletic season , K-D scores worsened from baseline by an average of 5.2 seconds ; improvement by 6.4 seconds was noted for the nonconcussed controls ( n = 14 ) . The  vision-based K-D test  showed the greatest capacity to distinguish concussed vs control athletes based on changes from preseason baseline to postinjury ( receiver operating characteristic [ ROC ] curve areas from logistic regression models , accounting for age = 0.92 for K-D , 0.87 for timed t and em gait , and 0.68 for SAC ; P = 0.0004 for comparison of ROC curve areas ) . Conclusions : Adding a vision-based performance measure to cognitive and balance testing enhances the detection capabilities of current sideline concussion assessment . This observation in patients with mild traumatic brain injury reflects the common involvement and widespread distribution of brain pathways dedicated to vision OBJECTIVE Concussion is the most common type of traumatic brain injury , and results from impact or impulsive forces to the head , neck or face . Due to the variability and subtlety of symptoms , concussions may go unrecognized or be ignored , especially with the pressure placed on athletes to return to competition . The King-Devick ( KD ) test , an oculomotor test originally design ed for reading evaluation , was recently vali date d as a concussion screening tool in collegiate athletes . A prospect i ve study was performed using high school football players in an attempt to study the KD as a concussion screening tool in this younger population . METHODS 343 athletes from four local high school football teams were recruited to participate . These athletes were given baseline KD tests prior to competition . Individual demographic information was collected on the subjects . St and ard team protocol was employed to determine if a concussion had occurred during competition . Immediately after diagnosis , the KD test was re-administered to the concussed athlete for comparison to baseline . Post-season testing was also performed in non-concussed individuals . RESULTS Of the 343 athletes , nine were diagnosed with concussions . In all concussed players , cumulative read times for the KD test were significantly increased ( p<0.001 ) . Post-season testing of non-concussed athletes revealed minimal change in read times relative to baseline . Univariate analysis revealed that history of concussion was the only demographic factor predictive of concussion in this cohort . CONCLUSION The KD test is an accurate and easily administered sideline screening tool for concussion in adolescent football players AIM To use the King-Devick ( KD ) test and Sports Concussion Assessment Tool 2 ( SCAT2 ) in amateur rugby union players to identify witnessed and unrecognised episodes of concussion that occurred from match participation . METHODS A prospect i ve observational cohort study was conducted on a premier club level amateur rugby union team during the 2012 competition in New Zeal and . Every player completed a pre-competition question naire on concussion history , a baseline PCSS and two trials of the KD before they participated in any match activities . RESULTS For players reporting a concussion in the previous three years there was an average of 4.0±2.8 concussions per player . There were 22 concussive incidents recorded over the duration of the competition ( 46 per 1000 match hours ) . Five concussive incidents were witnessed ( 11 per 1000 match hours ) and 17 unrecognised concussive incidents were identified with the KD ( 37 per 1000 match hours ) . Witnessed concussions recorded , on average , a longer KD on the day of injury ( 5.5±2.4s ) than unrecognised concussions ( 4.4±0.9s ) when compared with their baseline KD . DISCUSSION The KD was able to identify players that had not shown , or reported , any signs or symptoms of a concussion but who had meaningful head injury . The current rate of concussion reported was a ten-fold increase in previously reported concussion injury rates . This makes the KD suitable for rapid assessment in a limited time frame on the sideline such as a five-minute window to assess and review suspected concussed players in rugby union AIM To use the King-Devick ( K-D ) test in senior amateur rugby union and rugby league players over a domestic competition season to see if it could identify witnessed and unwitnessed episodes of concussion that occurred from participation in competition matches over three years . METHODS A prospect i ve observational cohort study was conducted on a club level senior amateur rugby union team ( n=36 players in 2012 and 35 players in 2013 ) and a rugby league team ( n=33 players in 2014 ) during competition seasons in New Zeal and . All 104 players completed two trials 10min apart of the K-D at the beginning of their competition season . Concussions ( witnessed or unwitnessed ) were only recorded if they were formally diagnosed by a health practitioner . RESULTS A total of 52 ( 8 witnessed ; 44 unwitnessed ) concussive events were identified over the duration of the study result ing in a concussion injury incidence of 44 ( 95 % CI : 32 to 56 ) per 1000 match participation hours . There was a six-fold difference between witnessed and unwitnessed concussions recorded . There were observable learning effects observed between the first and the second K-D test baseline testing ( 50 vs. 45s ; z=-8.81 ; p<0.001 ) . For every 1 point reduction in each of the post-injury SAC components there was a corresponding increase ( worsening ) of  K-D test times post-match for changes in orientation ( 2.9s ) , immediate memory ( 1.8s ) concentration ( 2.8s ) , delayed recall ( 2.0s ) and SAC total score ( 1.7s ) . DISCUSSION The rate of undetected concussion was higher than detected concussions by using the K-D test routinely following matches . Worsening of the K-D test post-match was associated with reduction in components of the SAC . The appeal of the K-D test is in the rapid , easy manner of its administration and the reliable , objective results it provides to the administrator . The K-D test helped identify cognitive impairment in players without clinical ly observable symptoms Abstract Disconjugate eye movements have been associated with traumatic brain injury since ancient times . Ocular motility dysfunction may be present in up to 90 % of patients with concussion or blast injury . We developed an algorithm for eye tracking in which the Cartesian coordinates of the right and left pupils are tracked over 200 sec and compared to each other as a subject watches a short film clip moving inside an aperture on a computer screen . We prospect ively eye tracked 64 normal healthy noninjured control subjects and compared findings to 75 trauma subjects with either a positive head computed tomography ( CT ) scan ( n=13 ) , negative head CT ( n=39 ) , or nonhead injury ( n=23 ) to determine whether eye tracking would reveal the disconjugate gaze associated with both structural brain injury and concussion . Tracking metrics were then correlated to the clinical concussion measure Sport Concussion Assessment Tool 3 ( SCAT3 ) in trauma patients . Five out of five measures of horizontal disconjugacy were increased in positive and negative head CT patients relative to noninjured control subjects . Only one of five vertical disconjugacy measures was significantly increased in brain-injured patients relative to controls . Linear regression analysis of all 75 trauma patients demonstrated that three metrics for horizontal disconjugacy negatively correlated with SCAT3 symptom severity score and positively correlated with total St and ardized Assessment of Concussion score . Abnormal eye-tracking metrics improved over time toward baseline in brain-injured subjects observed in follow-up . Eye tracking may help quantify the severity of ocular motility disruption associated with concussion and structural brain injury Objective : The purpose was to examine the influence of a live sporting sideline environment on balance error scoring system ( BESS ) performance . Design : Prospect i ve longitudinal cohort study . Setting : The BESS was performed by all participants at 3 locations : ( 1 ) quiet laboratory , ( 2 ) football stadium sidelines , and ( 3 ) basketball arena sidelines . Participants : The experimental group had 38 participants ( age : 20.1 ± 1.1 years ; height : 170.0 ± 7.7 cm ; mass : 66.7 ± 9.5 kg ) who were female intercollegiate student-athletes ( SA ) . The control group consisted of 38 recreationally active female college students ( age : 20.8 ± 1.1 years ; height : 162.6 ± 6.0 cm ; mass : 63.7 ± 10.6 kg ) . Interventions : The 2 groups performed the tests at the same locations , the SA group during live sporting events and the control group when no event was occurring . Main Outcome Measures : The dependent variable was the total BESS score . Separate 2 × 3 mixed methods analyses of variance investigated the influence of the environment and practice effect . Results : There was a significant interaction for group by environment ( P = 0.004 ) , and the SA group committed more errors at both the football and the basketball setting s than the control group . The SA group also committed more errors at football ( P = 0.028 ) than baseline . The control group demonstrated a likely practice effect with fewer errors during each administration . Conclusions : The BESS score deteriorated when performed on the sidelines of a live sporting event potentially challenging the clinical utility of the BESS . Clinicians need to consider the role of the local environment when performing the BESS test and should perform postinjury tests in the same environment as the baseline test . Clinical Relevance : When performing balance testing of patients with suspected concussions , clinicians need to consider the environment in which the test is performed and attempt to match the preseason testing environment Background Concussion is one of the most commonly occurring injuries in sport today . The Sport Concussion Assessment Tool ( SCAT ) is a commonly used paper neurocognitive tool . To date , little is known about SCAT baseline normative values in youth athletes . Objective The purpose of this study was to determine normative values on the SCAT for male and female youth hockey players . Methods This is a secondary data analysis of pooled data from three prospect i ve cohort 
    Output:
    
agent
Summary / conclusions The SCAT is the most widely accepted and deployable sport concussion assessment and screening tool currently available .
There is some degree of support for using the SCAT2/SCAT3 and ChildSCAT3 in the evaluation of SRC , with and without baseline data .
The addition of an oculomotor examination seems indicated , although the most valid method for assessing oculomotor function is not clear .
Video-observable signs of concussion show promise , but there is insufficient evidence to warrant widespread use at this time
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT To determine if testing environment affects Balance Error Scoring System ( BESS ) scores in healthy collegiate baseball players . DESIGN Experimental , r and omized , repeated- measures design with a sample of convenience . SETTING Uncontrolled sideline and controlled locker room baseball environments . PATIENTS OR OTHER PARTICIPANTS A total of 21 healthy collegiate baseball players ( age = 20.1 + /- 1.4 years , height = 185.1 + /- 6.8 cm , mass = 86.3 + /- 9.5 kg ) with no history of head injury within the last 12 months , no lower extremity injuries reported within the past 2 months that caused them to miss 1 or more days of practice or game time , and no history of otitis media , Parkinson disease , or Meniere disease . MAIN OUTCOME MEASURE(S ) Participants performed the  BESS test  in 2 environments , controlled locker room and uncontrolled sideline , in 2 testing sessions 1 week apart during the baseball preseason . The BESS scores were evaluated for each of the 6 conditions and total score across the testing sessions . Separate , paired- sample s t tests with Bonferroni adjustment ( P < .008 ) were used to examine differences between testing environments for each BESS subcategory and total score . Cohen d tests were calculated to evaluate effect sizes and relative change . RESULTS Significant group mean differences were found between testing environments for single-leg foam stance ( P = .001 ) , with higher scores reported for the uncontrolled sideline environment ( 7.33 + /- 2.11 errors ) compared with the controlled clinical environment ( 5.19 + /- 2.16 errors ) . Medium to large effect sizes ( 0.53 to 1.03 ) were also found for single-leg foam , t and em foam , and total BESS scores , with relative increases ( worse scores ) of 30 % to 44 % in the sideline environment compared with the clinical environment . CONCLUSIONS The BESS performance was impaired when participants were tested in a sideline environment compared with a clinical environment . Baseline testing for postural control using the BESS should be conducted in the setting or environment in which testing after injury will most likely be conducted Background : Sports-related concussion commonly affects the visual pathways . Current sideline protocol s test cognition and balance but do not include assessment s of visual performance . We investigated how adding a vision-based test of rapid number naming could increase our ability to identify concussed athletes on the sideline at youth and collegiate levels . Methods : Participants in this prospect i ve study included members of a youth ice hockey and lacrosse league and collegiate athletes from New York University and Long Isl and University . Athletes underwent preseason baseline assessment s using : 1 ) the King – Devick ( K-D ) test , a < 2-minute visual performance measure of rapid number naming , 2 ) the St and ardized Assessment of Concussion ( SAC ) , a test of cognition , and 3 ) a timed t and em gait test of balance .  The SAC and timed t and em gait are components of the currently used Sport Concussion Assessment Tool , 3rd Edition ( SCAT3 and Child-SCAT3 ) . In the event of a concussion during the athletic season , injured athletes were retested on the sideline/rink-side . Nonconcussed athletes were also assessed as control participants under the same testing conditions . Results : Among 243 youth ( mean age 11 ± 3 years , range 5–17 ) and 89 collegiate athletes ( age 20 ± 1 years , range 18–23 )  , baseline time scores for the K-D test were lower ( better ) with increasing participant age ( P < 0.001 , linear regression models ) . Among 12 athletes who sustained concussions during their athletic season , K-D scores worsened from baseline by an average of 5.2 seconds ; improvement by 6.4 seconds was noted for the nonconcussed controls ( n = 14 ) . The  vision-based K-D test  showed the greatest capacity to distinguish concussed vs control athletes based on changes from preseason baseline to postinjury ( receiver operating characteristic [ ROC ] curve areas from logistic regression models , accounting for age = 0.92 for K-D , 0.87 for timed t and em gait , and 0.68 for SAC ; P = 0.0004 for comparison of ROC curve areas ) . Conclusions : Adding a vision-based performance measure to cognitive and balance testing enhances the detection capabilities of current sideline concussion assessment . This observation in patients with mild traumatic brain injury reflects the common involvement and widespread distribution of brain pathways dedicated to vision OBJECTIVE Concussion is the most common type of traumatic brain injury , and results from impact or impulsive forces to the head , neck or face . Due to the variability and subtlety of symptoms , concussions may go unrecognized or be ignored , especially with the pressure placed on athletes to return to competition . The King-Devick ( KD ) test , an oculomotor test originally design ed for reading evaluation , was recently vali date d as a concussion screening tool in collegiate athletes . A prospect i ve study was performed using high school football players in an attempt to study the KD as a concussion screening tool in this younger population . METHODS 343 athletes from four local high school football teams were recruited to participate . These athletes were given baseline KD tests prior to competition . Individual demographic information was collected on the subjects . St and ard team protocol was employed to determine if a concussion had occurred during competition . Immediately after diagnosis , the KD test was re-administered to the concussed athlete for comparison to baseline . Post-season testing was also performed in non-concussed individuals . RESULTS Of the 343 athletes , nine were diagnosed with concussions . In all concussed players , cumulative read times for the KD test were significantly increased ( p<0.001 ) . Post-season testing of non-concussed athletes revealed minimal change in read times relative to baseline . Univariate analysis revealed that history of concussion was the only demographic factor predictive of concussion in this cohort . CONCLUSION The KD test is an accurate and easily administered sideline screening tool for concussion in adolescent football players AIM To use the King-Devick ( KD ) test and Sports Concussion Assessment Tool 2 ( SCAT2 ) in amateur rugby union players to identify witnessed and unrecognised episodes of concussion that occurred from match participation . METHODS A prospect i ve observational cohort study was conducted on a premier club level amateur rugby union team during the 2012 competition in New Zeal and . Every player completed a pre-competition question naire on concussion history , a baseline PCSS and two trials of the KD before they participated in any match activities . RESULTS For players reporting a concussion in the previous three years there was an average of 4.0±2.8 concussions per player . There were 22 concussive incidents recorded over the duration of the competition ( 46 per 1000 match hours ) . Five concussive incidents were witnessed ( 11 per 1000 match hours ) and 17 unrecognised concussive incidents were identified with the KD ( 37 per 1000 match hours ) . Witnessed concussions recorded , on average , a longer KD on the day of injury ( 5.5±2.4s ) than unrecognised concussions ( 4.4±0.9s ) when compared with their baseline KD . DISCUSSION The KD was able to identify players that had not shown , or reported , any signs or symptoms of a concussion but who had meaningful head injury . The current rate of concussion reported was a ten-fold increase in previously reported concussion injury rates . This makes the KD suitable for rapid assessment in a limited time frame on the sideline such as a five-minute window to assess and review suspected concussed players in rugby union AIM To use the King-Devick ( K-D ) test in senior amateur rugby union and rugby league players over a domestic competition season to see if it could identify witnessed and unwitnessed episodes of concussion that occurred from participation in competition matches over three years . METHODS A prospect i ve observational cohort study was conducted on a club level senior amateur rugby union team ( n=36 players in 2012 and 35 players in 2013 ) and a rugby league team ( n=33 players in 2014 ) during competition seasons in New Zeal and . All 104 players completed two trials 10min apart of the K-D at the beginning of their competition season . Concussions ( witnessed or unwitnessed ) were only recorded if they were formally diagnosed by a health practitioner . RESULTS A total of 52 ( 8 witnessed ; 44 unwitnessed ) concussive events were identified over the duration of the study result ing in a concussion injury incidence of 44 ( 95 % CI : 32 to 56 ) per 1000 match participation hours . There was a six-fold difference between witnessed and unwitnessed concussions recorded . There were observable learning effects observed between the first and the second K-D test baseline testing ( 50 vs. 45s ; z=-8.81 ; p<0.001 ) . For every 1 point reduction in each of the post-injury SAC components there was a corresponding increase ( worsening ) of  K-D test times post-match for changes in orientation ( 2.9s ) , immediate memory ( 1.8s ) concentration ( 2.8s ) , delayed recall ( 2.0s ) and SAC total score ( 1.7s ) . DISCUSSION The rate of undetected concussion was higher than detected concussions by using the K-D test routinely following matches . Worsening of the K-D test post-match was associated with reduction in components of the SAC . The appeal of the K-D test is in the rapid , easy manner of its administration and the reliable , objective results it provides to the administrator . The K-D test helped identify cognitive impairment in players without clinical ly observable symptoms Abstract Disconjugate eye movements have been associated with traumatic brain injury since ancient times . Ocular motility dysfunction may be present in up to 90 % of patients with concussion or blast injury . We developed an algorithm for eye tracking in which the Cartesian coordinates of the right and left pupils are tracked over 200 sec and compared to each other as a subject watches a short film clip moving inside an aperture on a computer screen . We prospect ively eye tracked 64 normal healthy noninjured control subjects and compared findings to 75 trauma subjects with either a positive head computed tomography ( CT ) scan ( n=13 ) , negative head CT ( n=39 ) , or nonhead injury ( n=23 ) to determine whether eye tracking would reveal the disconjugate gaze associated with both structural brain injury and concussion . Tracking metrics were then correlated to the clinical concussion measure Sport Concussion Assessment Tool 3 ( SCAT3 ) in trauma patients . Five out of five measures of horizontal disconjugacy were increased in positive and negative head CT patients relative to noninjured control subjects . Only one of five vertical disconjugacy measures was significantly increased in brain-injured patients relative to controls . Linear regression analysis of all 75 trauma patients demonstrated that three metrics for horizontal disconjugacy negatively correlated with SCAT3 symptom severity score and positively correlated with total St and ardized Assessment of Concussion score . Abnormal eye-tracking metrics improved over time toward baseline in brain-injured subjects observed in follow-up . Eye tracking may help quantify the severity of ocular motility disruption associated with concussion and structural brain injury Objective : The purpose was to examine the influence of a live sporting sideline environment on balance error scoring system ( BESS ) performance . Design : Prospect i ve longitudinal cohort study . Setting : The BESS was performed by all participants at 3 locations : ( 1 ) quiet laboratory , ( 2 ) football stadium sidelines , and ( 3 ) basketball arena sidelines . Participants : The experimental group had 38 participants ( age : 20.1 ± 1.1 years ; height : 170.0 ± 7.7 cm ; mass : 66.7 ± 9.5 kg ) who were female intercollegiate student-athletes ( SA ) . The control group consisted of 38 recreationally active female college students ( age : 20.8 ± 1.1 years ; height : 162.6 ± 6.0 cm ; mass : 63.7 ± 10.6 kg ) . Interventions : The 2 groups performed the tests at the same locations , the SA group during live sporting events and the control group when no event was occurring . Main Outcome Measures : The dependent variable was the total BESS score . Separate 2 × 3 mixed methods analyses of variance investigated the influence of the environment and practice effect . Results : There was a significant interaction for group by environment ( P = 0.004 ) , and the SA group committed more errors at both the football and the basketball setting s than the control group . The SA group also committed more errors at football ( P = 0.028 ) than baseline . The control group demonstrated a likely practice effect with fewer errors during each administration . Conclusions : The BESS score deteriorated when performed on the sidelines of a live sporting event potentially challenging the clinical utility of the BESS . Clinicians need to consider the role of the local environment when performing the BESS test and should perform postinjury tests in the same environment as the baseline test . Clinical Relevance : When performing balance testing of patients with suspected concussions , clinicians need to consider the environment in which the test is performed and attempt to match the preseason testing environment Background Concussion is one of the most commonly occurring injuries in sport today . The Sport Concussion Assessment Tool ( SCAT ) is a commonly used paper neurocognitive tool . To date , little is known about SCAT baseline normative values in youth athletes . Objective The purpose of this study was to determine normative values on the SCAT for male and female youth hockey players . Methods This is a secondary data analysis of pooled data from three prospect i ve cohort 
    Output:
    