In team handball, an anterior cruciate ligament injury often occurs during landing after a jump shot. Many intervention programs try to reduce the injury rate by instructing athletes to land more safely. Video is an effective way to provide feedback, but little is known about its influence on landing technique in sport-specific situations. To test the effectiveness of a video-overlay feedback method on landing technique in elite handball players. Controlled laboratory study. Laboratory. A total of 16 elite female handball players assigned to a control group (n = 8; age = 17.61 ± 1.34 years, height = 1.73 ± 0.06 m, mass = 69.55 ± 4.29 kg) or video group (n = 8; age = 17.81 ± 0.86 years, height = 1.71 ± 0.03 m, mass = 64.28 ± 6.29 kg). Both groups performed jump shots in a pretest, 2 training sessions, and a posttest. The video group received video feedback of an expert model with an overlay of their own jump shots in training sessions 1 and 2, whereas the control group did not. We measured ankle, knee, and hip angles in the sagittal plane at initial contact and peak flexion; range of motion; and Landing Error Scoring System (LESS) scores. One 2 × 4 repeated-measures analysis of variance was conducted to analyze the group, time, and interaction effects of all kinematic outcome measures and the LESS score. The video group improved knee and hip flexion at initial contact and peak flexion and range of motion. In addition, the group's average peak ankle flexion (12.0° at pretest to 21.8° at posttest) and LESS score (8.1 pretest to 4.0 posttest) improved. When we considered performance variables, no differences between groups were found in shot accuracy or vertical jump height, whereas horizontal jump distance in the video group increased over time. Overlay visual feedback is an effective method for improving landing kinematics during a sport-specific jump shot. Further research is warranted to determine the long-term effects and transfer to training and game situations.Context:
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Automated Quantification of the Landing Error Scoring System With a Markerless Motion-Capture System
The Landing Error Scoring System (LESS) can be used to identify individuals with an elevated risk of lower extremity injury. The limitation of the LESS is that raters identify movement errors from video replay, which is time-consuming and, therefore, may limit its use by clinicians. A markerless motion-capture system may be capable of automating LESS scoring, thereby removing this obstacle. To determine the reliability of an automated markerless motion-capture system for scoring the LESS. Cross-sectional study. United States Military Academy. A total of 57 healthy, physically active individuals (47 men, 10 women; age = 18.6 ± 0.6 years, height = 174.5 ± 6.7 cm, mass = 75.9 ± 9.2 kg). Participants completed 3 jump-landing trials that were recorded by standard video cameras and a depth camera. Their movement quality was evaluated by expert LESS raters (standard video recording) using the LESS rubric and by software that automates LESS scoring (depth-camera data). We recorded an error for a LESS item if it was present on at least 2 of 3 jump-landing trials. We calculated κ statistics, prevalence- and bias-adjusted κ (PABAK) statistics, and percentage agreement for each LESS item. Interrater reliability was evaluated between the 2 expert rater scores and between a consensus expert score and the markerless motion-capture system score. We observed reliability between the 2 expert LESS raters (average κ = 0.45 ± 0.35, average PABAK = 0.67 ± 0.34; percentage agreement = 0.83 ± 0.17). The markerless motion-capture system had similar reliability with consensus expert scores (average κ = 0.48 ± 0.40, average PABAK = 0.71 ± 0.27; percentage agreement = 0.85 ± 0.14). However, reliability was poor for 5 LESS items in both LESS score comparisons. A markerless motion-capture system had the same level of reliability as expert LESS raters, suggesting that an automated system can accurately assess movement. Therefore, clinicians can use the markerless motion-capture system to reliably score the LESS without being limited by the time requirements of manual LESS scoring.Context:
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The effect of unilateral cryotherapy-facilitated rehabilitation exercise on involved-limb quadriceps function and limb symmetry in individuals with quadriceps dysfunction after anterior cruciate ligament reconstruction (ACLR) remains unclear. To measure the effect of a 2-week unilateral cryotherapy-facilitated quadriceps-strengthening program on knee-extension strength and quadriceps central activation ratio (CAR) in participants with ACLR. Controlled laboratory study. Laboratory. A total of 10 volunteers with unilateral ACLR (1 man, 9 women; age = 21.0 ± 2.8 years, height = 164.6 ± 5.0 cm, mass = 64.0 ± 6.1 kg, body mass index = 23.7 ± 2.7 kg/m2) and 10 healthy volunteers serving as control participants (1 man, 9 women; age = 20.8 ± 2.5 years, height = 169.1 ± 6.2 cm, mass = 61.1 ± 6.4 kg, body mass index = 21.4 ± 2.3 kg/m2) participated. Participants with ACLR completed a 2-week unilateral cryotherapy-facilitated quadriceps-strengthening intervention. Bilateral normalized knee-extension maximal voluntary isometric contraction (MVIC) torque (Nm/kg) and quadriceps CAR (%) were assessed preintervention and postintervention. Limb symmetry index (LSI) was calculated at preintervention and postintervention testing. Preintervention between-groups differences in unilateral quadriceps function and LSI were evaluated using independent-samples t tests. Preintervention-to-postintervention differences in quadriceps function were evaluated using paired-samples t tests. Cohen d effect sizes (95% confidence interval [CI]) were calculated for each comparison. Preintervention between-groups comparisons revealed less knee-extension MVIC torque and quadriceps CAR for the ACLR limb (MVIC: P = .01, Cohen d = −1.31 [95% CI = −2.28, −0.34]; CAR: P = .004, Cohen d = −1.48 [95% CI = −2.47, −0.49]) and uninvolved limb (MVIC: P = .03, Cohen d = −1.05 [95% CI = −1.99, −0.11]; CAR: P = .01, Cohen d = −1.27 [95% CI = −2.23, −0.31]) but not for the LSI (MVIC: P = .46, Cohen d = −0.34 [95% CI = −1.22, 0.54]; CAR: P = .60, Cohen d = 0.24 [95% CI = −0.64, 1.12]). In the ACLR group, participants had improved knee-extension MVIC torque in the involved limb (P = .04, Cohen d = 0.32 [95% CI = −0.56, 1.20]) and uninvolved limb (P = .03, Cohen d = 0.29 [95% CI = −0.59, 1.17]); however, the improvement in quadriceps CAR was limited to the involved limb (P = .02, Cohen d = 1.16 [95% CI = 0.21, 2.11]). We observed no change in the LSI with the intervention for knee-extension MVIC torque (P = .74, Cohen d = 0.09 [95% CI = −0.79, 0.97]) or quadriceps CAR (P = .61, Cohen d = 0.26 [95% CI = −0.62, 1.14]). Two weeks of cryotherapy-facilitated exercise may improve involved-limb quadriceps function while preserving between-limbs symmetry in patients with a history of ACLR.Context:
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Researchers have reported increased variability in frontal-plane movement at the ankle during jumping in individuals with chronic ankle instability (CAI), which may increase their risk of recurrent ankle sprain. It is not known if this behavior is present during running gait or how fatigue affects the amount of frontal-plane–movement variability in individuals with CAI. To investigate the amount of roll-angle variability at the foot during a fatiguing exercise protocol in participants with CAI. Controlled laboratory study. Motion-analysis research laboratory. A total of 18 volunteers with CAI (10 men, 8 women; age = 29.8 ± 9.2 years, height = 175.8 ± 11.2 cm, mass = 75.4 ± 10.7 kg) and 17 volunteers serving as controls (8 men, 9 women; age = 28.2 ± 6.3 years, height = 172.3 ± 10.6 cm, mass = 68.8 ± 12.9 kg). Kinematic data for foot position were collected while participants performed a functional fatigue protocol based on shuttle runs. Variability (ie, standard deviation) of the roll angle of the foot about the x-axis, corresponding to inversion-eversion, was measured at 2 discrete times: 50 milliseconds before foot strike and 65% of stance. No differences in roll-angle range or variability were observed between limbs in either group. At 65% of stance, we found a main effect for time, whereby both groups demonstrated decreased roll-angle ranges at the end of the fatigue protocol (P = .01). A between-groups effect in the roll-angle variability at 65% of stance was noted (P = .04), with the CAI group exhibiting higher levels of variability. No between-groups differences were observed at 50 milliseconds before foot strike. Chronic ankle instability is a complex, multifactorial condition that can affect patients in diverse ways. Identifying excessive foot-position variability in particular situations could potentially inform targeted rehabilitation programs.Context:
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Although an association between concussion and musculoskeletal injury has been described in collegiate and professional athletes, no researchers have investigated an association in younger athletes. To determine if concussion in high school athletes increased the risk for lower extremity musculoskeletal injury after return to activity. Observational cohort study. One hundred ninety-six high schools across 26 states. We used data from the National Athletic Treatment, Injury and Outcomes Network surveillance system. Athletic trainers provided information about sport-related concussions and musculoskeletal injuries in athletes in 27 sports, along with missed activity time due to these injuries. Three general estimating equations were modeled to predict the odds of sustaining (1) any lower extremity injury, (2) a time-loss lower extremity injury, or (3) a non–time-loss lower extremity injury after concussion. Predictors were the total number of previous injuries, number of previous concussions, number of previous lower extremity injuries, number of previous upper extremity injuries, and sport contact classification. The initial dataset contained data from 18 216 athletes (females = 39%, n = 6887) and 46 217 injuries. Lower extremity injuries accounted for most injuries (56.3%), and concussions for 4.3% of total injuries. For every previous concussion, the odds of sustaining a subsequent time-loss lower extremity injury increased 34% (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.13, 1.60). The number of previous concussions had no effect on the odds of sustaining any subsequent lower extremity injury (OR = 0.97; 95% CI = 0.89, 1.05) or a non–time-loss injury (OR = 1.01; 95% CI = 0.92, 1.10). Among high school athletes, concussion increased the odds of sustaining subsequent time-loss lower extremity injuries but not non–time-loss injuries. By definition, time-loss injuries may be considered more severe than non–time-loss injuries. The exact mechanism underlying the increased risk of lower extremity injury after concussion remains elusive and should be further explored in future research.Context:
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Capturing baseline data before a concussion can be a valuable tool in individualized care. However, not all athletes, including dancers, have access to baseline testing. When baseline examinations were not performed, clinicians consult normative values. Dancers are unique athletes; therefore, describing values specific to dancers may assist those working with these athletes in making more informed decisions. To describe values for key concussion measures of dancers. Our secondary aim was to examine whether differences existed between sexes and professional status. Finally, we explored factors that may affect dancers' scores. Cross-sectional study. Professional dance companies and a collegiate dance conservatory. A total of 238 dancers (university = 153, professional = 85; women = 171; men = 67; age = 21.1 ± 4.8 years). We calculated the total symptom severity from the Sport Concussion Assessment Tool–3rd edition; the Standardized Assessment of Concussion score; the modified Balance Error Scoring System score; and the King-Devick score for each participant. Group differences were analyzed with Mann-Whitney or t tests, depending on the data distribution. We used bivariate correlations to explore the effects of other potential influencing factors. Participants demonstrated the following baseline outcomes: symptom severity = 16.6 ± 12.8; Standardized Assessment of Concussion = 27.5 ± 1.8; modified Balance Error Scoring System = 3.2 ± 3.1 errors; and King-Devick = 41.5 ± 8.2 seconds. A Mann-Whitney test revealed differences in King-Devick scores between female (40.8 ± 8.0 seconds) and male (43.4 ± 8.4 seconds) dancers (P = .04). An independent-samples t test also demonstrated a difference in modified Balance Error Scoring System scores between female (2.95 ± 3.1 errors) and male (3.8 ± 3.1 errors) dancers (P = .02). Age, hours of sleep, height, and history of concussion, depression, or injury did not display moderate or strong associations with any of the outcome measures. Dancers' symptom severity scores appeared to be higher than the values reported for other athletes. Additional studies are needed to establish normative values and develop a model for predicting baseline scores.Context:
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Sports officials can play an important role in concussion safety by calling injury timeouts so that athletic trainers can evaluate athletes with possible concussions. Understanding the determinants of whether officials call an injury timeout when they suspect a concussion has important implications for the design of interventions to better support officials in this role. To assess the knowledge of US collegiate football officials about concussion symptoms and to determine the associations between knowledge, perceived injunctive norms, and self-efficacy in calling injury timeouts for suspected concussions. Cross-sectional study. Electronic survey. Of the 3074 US collegiate football officials contacted, 1324 (43% response rate) participated. Concussion knowledge, injunctive norms (belief about what others would want them to do), and behavioral self-efficacy (confidence in their ability to call injury timeouts for suspected concussions in athletes during challenging game-day conditions). Officials reported calling approximately 1 injury timeout for a suspected concussion every 4 games during the 2015 season. Structural equation modeling indicated that officials with more concussion-symptom knowledge had greater self-efficacy. Independent of an official's symptom knowledge, injunctive norms that were more supportive of calling an injury timeout were associated with greater self-efficacy. Concussion education for officials is important because when officials are aware of concussion symptoms, they are more confident in calling injury timeouts. Beyond increasing symptom knowledge, fostering sports environments that encourage concussion safety can support officials in calling injury timeouts. Athletic trainers can help by educating stakeholders, including officials, about the importance of concussion safety. When officials believe that other stakeholders support concussion safety, they are more likely to call injury timeouts if they suspect a concussion has occurred.Context:
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Diminished hip-abductor strength has been suggested to increase the risk of noncontact lateral ankle sprains. To determine prospectively whether baseline hip-abductor strength predicts future noncontact lateral ankle sprains in competitive male soccer players. Prospective cohort study. Athletic training facilities and various athletic fields. Two hundred ten competitive male soccer players. Before the start of the sport season, isometric hip-abductor strength was measured bilaterally using a handheld dynamometer. Any previous history of ankle sprain, body mass index, age, height, and weight were documented. During the sport season (30 weeks), ankle injury status was recorded by team medical providers. Injured athletes were further classified based on the mechanism of injury. Only data from injured athletes who sustained noncontact lateral ankle sprains were used for analysis. Postseason, logistic regression was used to determine whether baseline hip strength predicted future noncontact lateral ankle sprains. A receiver operating characteristic curve was constructed for hip strength to determine the cutoff value for distinguishing between high-risk and low-risk outcomes. A total of 25 noncontact lateral ankle sprains were confirmed, for an overall annual incidence of 11.9%. Baseline hip-abductor strength was lower in injured players than in uninjured players (P = .008). Logistic regression indicated that impaired hip-abductor strength increased the future injury risk (odds ratio = 1.10 [95% confidence interval = 1.02, 1.18], P = .010). The strength cutoff to define high risk was ≤33.8% body weight, as determined by receiver operating characteristic curve analysis. For athletes classified as high risk, the probability of injury increased from 11.9% to 26.7%. Reduced isometric hip-abductor strength predisposed competitive male soccer players to noncontact lateral ankle sprains.Context:
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The National Athletic Trainers' Association recommends using onsite wet-bulb globe temperature (WBGT) measurement to determine whether to modify or cancel physical activity. However, not all practitioners do so and instead they may rely on the National Weather Service (NWS) to monitor weather conditions. To compare regional NWS WBGT estimates with local athletic-surface readings and compare WBGT measurements among various local athletic surfaces. Observational study. Athletic fields. Measurements from 2 identical WBGT devices were averaged on 10 athletic surfaces within an NWS station reporting radius. Athletic surfaces consisted of red and black all-weather tracks (track), blue and black hard tennis courts (tennis), nylon-knit artificial green turf, green synthetic turfgrass, volleyball sand, softball clay, natural grass (grass), and a natural lake (water). Measurements (n = 143 data pairs) were taken over 18 days (May through September) between 1 pm and 4:30 pm in direct sunlight 1.2 m above ground. The starting location was counterbalanced across surfaces. The NWS weather data were entered into an algorithm to model NWS WBGT. Black tennis, black track, red track, and volleyball sand WBGT recordings were greater than NWS estimates (P ≤ .05). When all athletic-surface measurements were combined, NWS (26.85°C ± 2.93°C) underestimated athletic-surface WBGT measurements (27.52°C ± 3.13°C; P < .001). The range of difference scores (−4.42°C to 6.14°C) and the absolute mean difference (1.71°C ± 1.32°C) were large. The difference between the onsite and NWS WBGT measurements resulted in misclassification of the heat-safety activity category 45% (65/143) of the time ( Clinicians should use an onsite WBGT device to determine environmental conditions and the need for modification of athletic events, especially as environmental conditions worsen. Given the large WBGT variability among athletic surfaces, WBGT measurements should be obtained from each athletic surface.Context:
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= 3.857, P = .05). The WBGT of water was 1.4°C to 2.7°C lower than that of all other athletic surfaces (P = .04). We observed no other differences among athletic surfaces but noted large WBGT measurement variability among athletic playing surfaces.Conclusions:
Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238–244. Does the use of proprioceptive training as a sole intervention decrease the incidence of initial or recurrent ankle sprains in the athletic population? The authors completed a comprehensive literature search of MEDLINE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (PEDro) from inception to October 2013. The reference lists of all identified articles were manually screened to obtain additional studies. The following key words were used. Phase 1 population terms were sport*, athlet*, and a combination of the two. Phase 2 intervention terms were propriocept*, balance, neuromusc* adj5 train*, and combinations thereof. Phase 3 condition terms were ankle adj5 sprain*, sprain* adj5 ankle, and combinations thereof. Studies were included according to the following criteria: (1) the design was a moderate- to high-level randomized controlled trial (>4/10 on the PEDro scale), (2) the participants were physically active (regardless of previous ankle injury), (3) the intervention group received proprioceptive training only, compared with a control group that received no proprioceptive training, and (4) the rate of ankle sprains was reported as a main outcome. Search results were limited to the English language. No restrictions were placed on publication dates. Two authors independently reviewed the studies for eligibility. The quality of the pertinent articles was assessed using the PEDro scale, and data were extracted to calculate the relative risk. Data extracted were number of participants, intervention, frequency, duration, follow-up period, and injury rate. Of the initial 345 studies screened, 7 were included in this review for a total of 3726 participants. Three analyses were conducted for proprioceptive training used (1) to prevent ankle sprains regardless of history (n = 3654), (2) to prevent recurrent ankle sprains (n = 1542), or (3) as the primary preventive measure for those without a history of ankle sprain (n = 946). Regardless of a history of ankle sprain, participants had a reduction in ankle-sprain rates (relative risk [RR] = 0.65, 95% confidence interval [CI] = 0.55, 0.77; numbers needed to treat [NNT] = 17, 95% CI = 11, 33). For individuals with a history of ankle sprains, proprioceptive training demonstrated a reduction in repeat ankle sprains (RR = 0.64, 95% CI = 0.51, 0.81; NNT = 13, 95% CI = 7, 100). Proprioceptive training as a primary preventive measure demonstrated significant results (RR = 0.57, 95% CI = 0.34, 0.97; NNT = 33, 95% CI = 16, 1000). Proprioceptive training programs were effective in reducing the incidence rates of ankle sprains in the athletic population, including those with and those without a history of ankle sprains.Reference:
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Hegedus EJ, McDonough S, Bleakley C, Cook CE, Baxter GD. Clinician-friendly lower extremity physical performance measures in athletes: a systematic review of measurement properties and correlation with injury. Part 1: the tests for knee function including the hop tests. Br J Sports Med. 2015;49(10):642−648. Do individual physical performance tests (PPTs) used as measures for lower extremity function have any relationship to injuries in athletes aged 12 years or older? Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to locate articles. The authors searched PubMed, EMBASE, and SPORTDiscus, in addition to searching by hand. The search strategy combined the terms athlete, lower extremity, and synonyms of performance test with the names of performance tests. Studies were included if they involved a test that met the operational definition for a PPT. The included studies assessed components of sport function (eg, speed, agility, and power), determined readiness for return to sport, or predicted injury to the lower extremity. All PPT measures could be performed on the field, courtside, or in a gym with affordable, portable, and readily available equipment. Studies were excluded if they made use of 3-dimensional motion capture, force platforms, timing gates, treadmills, stationary bikes, metabolic charts, or another nonportable, costly testing device. Athletes were categorized on the Tegner Scale at a minimum of level 5, which is the lowest level that still encompasses competitive athletes. Studies were included if 50% or more of the participants were rated above 5 on the Tegner Scale. Studies were excluded if the sole purpose was to judge movement quality or range of motion. Studies were selected if they identified the knee or a knee injury as a focal point of the paper. The Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) was used to critique the methodologic quality of each paper with a 4-point Likert scale. The title and methods of each paper were extracted. Extracted data were summarized using ratings of unknown, conflicting, limited, moderate, and strong. An initial search revealed 3379 original articles for consideration. After initial review, 169 full-text articles were evaluated and 29 articles were included in the systematic review. Six tests were examined for the best evidence of methodologic quality: (1) 1-legged single hop for distance, (2) 1-legged triple hop for distance, (3) 6-m timed hop, (4) crossover hop for distance, (5) triple jump, and (6) 1-legged vertical jump. A summary of the methodologic properties of the 6 tests showed fair/poor reliability, fair/poor hypothesis testing, good criterion validity, and good/poor responsiveness. No tests predicted knee injury in athletes. Although numerous authors have evaluated PPTs at the knee, evidence for the measurement quality of these functional tests is limited and conflicting. Ample opportunity exists for researchers to further examine PPTs for the knee. Until more knowledge is gained about these PPTs, clinicians should exercise caution when making clinical decisions based on the results of these tests.Reference:
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Quality improvement (QI) is a health care concept that ensures patients receive high-quality (safe, timely, effective, efficient, equitable, patient-centered) and affordable care. Despite its importance, the application of QI in athletic health care has been limited. To describe the need for and define QI in health care, to describe how to measure quality in health care, and to present a QI case in athletic training. As the athletic training profession continues to grow, a widespread engagement in QI efforts is necessary to establish the value of athletic training services for the patients that we serve. A review of the importance of QI in health care, historical perspectives of QI, tools to drive QI efforts, and examples of common QI initiatives is presented to assist clinicians in better understanding the value of QI for advancing athletic health care and the profession. By engaging clinicians in strategies to measure outcomes and improve their patient care services, QI practice can help athletic trainers provide high-quality and affordable care to patients.Context:
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A collegiate women's soccer player sustained an isolated anterior cruciate ligament (ACL) tear and expressed a desire to continue her season without surgical intervention. Case report. Using the results of a randomized controlled trial and published clinical guidelines, the clinicians classified the patient as an ACL-deficient coper. The patient completed her soccer season without incident, consistent with the findings of the established clinical guidelines. However, 6 months later, she sustained a meniscal tear, which was not unexpected given that 22% of ACL-deficient copers in the randomized controlled trial incurred a meniscal tear within 24 months of ACL injury. The external evidence was helpful in making informed clinical decisions regarding patient care.Background:
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Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making
Driving After Concussion: Clinical Measures Associated with Post-concussion
The role of shoulder posture in pitching mechanics and injury risk in high school baseball pitchers
Corticospinal Excitability during Standing and Its Association with Postural Control Following Acute Lateral Ankle Sprain.
The socio-economic cost of anterior cruciate ligament injuries and lateral ankle sprains in amateur football and basketball.
JAT eISSN: 1938-162X
JAT ISSN: 1062-6050
ATEJ ISSN: 1947-380X