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I love a sunburnt country

10 Mar, 16 | by Bridie Scott-Parker

I received an email this week from a friend and colleague, alerting me to a report recently released by the Royal Flying Doctor Service:  The Royal Flying Doctor Service: Responding to injuries in remote and rural Australia.

The reports on falls, burns, poisonings, transport accidents, workplace injuries, drownings, self-harm and assault, with Australians living in remote and very remote areas:

  • Almost twice as likely as city residents to sustain an injury, and 2.2 times more likely to be hospitalised for an injury;
  • Four times more likely to die from a transport related injury than major city residents;
  • 3.8 times (remote) and 4.2 times (very remote) more likely to die from assault than major city residents; and
  • 1.7 times (remote) and 1.8 times (very remote) more likely to die from suicide than major city residents.

Injuries are a leading cause of death and hospitalisation among children—more children die from injuries (36%), than from cancer (19%) and diseases of the nervous system (11%) combined; Indigenous Australians; and agricultural workers.

While, as an injury prevention researcher, I encourage you all to become familiar with the report and the findings, the email sparked two memories for me. The first was a conversation with US colleagues after I invited them to come to visit Australia as we worked collaboratively. If you search the internet, you will find many animals might try to kill you. We have crocodiles, irukandji jellyfish, snakes, spiders, and my colleagues could share many more animals-of-death. Having lived in Australia my whole life, I reassured them that the likelihood of them meeting an untimely demise during their trip was pretty low, and the good news is they went home in one piece.

The second memory – sparked almost instantaneously – was a flashback to my childood. During primary school we learnt the most wonderful poem, My Country, by Dorothea Mackellar, by rote. This stanza in particular has always remained with me:

I love a sunburnt country,

A land of sweeping plains,

Of ragged mountain ranges,

Of droughts and flooding rains.

I love her far horizons,

I love her jewel sea,

Her beauty and her terror –

The wide brown land for me!

Despite the beauty of the poem, and that I love thinking about how this poem resonates with me, growing up in the country can be dangerous for many reasons, including the fact that medical assistance is not always close by.

Another editor hits the dust

8 Mar, 16 | by Barry Pless

We recently discovered that the Canadian Medical Association has fired the editor of its flagship journal, the CMAJ, for reasons that are entirely unclear and also dismissed the oversight committee put in place after the previous editor was fired. I am deeply disturbed. What follows is what I posted on WAME in response to comments by Lundberg and Kassirer about the dismissal. For the record, Injury Prevention, has never had any such conflict with its owners, the BMJ Publishing Group. I posted a similar note ‘to the editor’ in response to the editorial written by the board announcing this sad event. (PS I lay claim to coining the new adjective “Trumpist” to describe outrageous behaviour of this kind!)

Lundberg and Kassirer have responded with their customary perceptive and helpful suggestions. Undoubtedly this is about money not a ‘falling reputation’. As a Canadian I strongly favour Lundberg’s first option. The Journal is a source of pride and has been ever since John Hoey’s stewardship. In spite of what the CMA president or its executive may think, it has a sterling international reputation. To be guided by impact factors, (whatever they may be) is simply evidence of the CMA’s insufficient knowledge of the complex world of medical publishing. Hence I wonder why the onus for reform, etc. falls on the Journal rather than on the CMA leadership, especially given the history of its relationship with the Journal. I would be interested to learn whether the membership was consulted or informed about this decision before it was taken. if the membership was not involved it smells greatly of Trumpist behaviour. If the membership was not part of this vital decision perhaps the logical next step is not to focus on the Journal and its stalwart hanging-in editors, but rather on the CMA itself.

p values misused

8 Mar, 16 | by Barry Pless

Don’t ask me why but I follow Retraction Watch faithfully. Recently there was a posting about p values I thought would be of interest to our readers and contributors. Here it is verbatim.

“We’re using a common statistical test all wrong. Statisticians want to fix that.

After reading too many papers that either are not reproducible or contain statistical errors (or both), the American Statistical Association (ASA) has been roused to action. Today the group released six principles for the use and interpretation of p values. P-values are used to search for differences between groups or treatments, to evaluate relationships between variables of interest, and for many other purposes. But the ASA says they are widely misused. Here are the six principles from the ASA statement:

P-values can indicate how incompatible the data are with a specified statistical model.
P-values do not measure the probability that the studied hypothesis is true, or the probability that the data were produced by random chance alone.
Scientific conclusions and business or policy decisions should not be based only on whether a p-value passes a specific threshold.
Proper inference requires full reporting and transparency.
A p-value, or statistical significance, does not measure the size of an effect or the importance of a result.
By itself, a p-value does not provide a good measure of evidence regarding a model or hypothesis.
We spoke with Ron Wasserstein, ASA’s executive director, about the new principles.

Retraction Watch: Why release these “six principles” now? What about this moment in research history made this a particularly pertinent problem?

Ron Wasserstein: We were inspired to act because of the growing recognition of a reproducibility crisis in science (see, for example, the National Academy of Sciences recent report) and a tendency to blame statistical methods for the problem. The fact that editors of a scholarly journal – Basic and Applied Social Psychology — were so frustrated with research that misused and misinterpreted p-values that they decided to ban them in 2015 confirmed that a crisis of confidence was at hand, and we could no longer stand idly by.

Retraction Watch: Some of the principles seem straightforward, but I was curious about #2 – I often hear people describe the purpose of a p value as a way to estimate the probability the data were produced by random chance alone. Why is that a false belief?

Ron Wasserstein: Let’s think about what that statement would mean for a simplistic example. Suppose a new treatment for a serious disease is alleged to work better than the current treatment. We test the claim by matching 5 pairs of similarly ill patients and randomly assigning one to the current and one to the new treatment in each pair. The null hypothesis is that the new treatment and the old each have a 50-50 chance of producing the better outcome for any pair. If that’s true, the probability the new treatment will win for all five pairs is (½)5 = 1/32, or about 0.03. If the data show that the new treatment does produce a better outcome for all 5 pairs, the p-value is 0.03. It represents the probability of that result, under the assumption that the new and old treatments are equally likely to win. It is not the probability the new treatment and the old treatment are equally likely to win.

This is perhaps subtle, but it is not quibbling. It is a most basic logical fallacy to conclude something is true that you had to assume to be true in order to reach that conclusion. If you fall for that fallacy, then you will conclude there is only a 3% chance that the treatments are equally likely to produce the better outcome, and assign a 97% chance that the new treatment is better. You will have committed, as Vizzini says in “The Princess Bride,” a classic (and serious) blunder.

Retraction Watch: What are the biggest mistakes you see researchers make when using and interpreting p values?

Ron Wasserstein: There are several misinterpretations that are prevalent and problematic. The one I just mentioned is common. Another frequent misinterpretation is concluding that a null hypothesis is true because a computed p-value is large. There are other common misinterpretations as well. However, what concerns us even more are the misuses, particularly the misuse of statistical significance as an arbiter of scientific validity. Such misuse contributes to poor decision making and lack of reproducibility, and ultimately erodes not only the advance of science but also public confidence in science.

Retraction Watch: Do some fields publish more mistakes than others?

Ron Wasserstein: As far as I know, that question hasn’t been studied. My sense is that all scientific fields have glaring examples of mistakes, and all fields have beautiful examples of statistics done well. However, in general, the fields in which it is easiest to misuse p-values and statistical significance are those which have a lot of studies with multiple measurements on each participant or experimental unit. Such research presents the opportunity to p-hack your way to findings that likely have no scientific merit.

Retraction Watch: Can you elaborate on #4: “Proper inference requires full reporting and transparency”?

Ron Wasserstein: There is a lot to this, of course, but in short, from a statistical standpoint this means to keep track of and report all the decisions you made about your data, including the design and execution of the data collection and everything you did with that data during the data analysis process. Did you average across groups or combine groups in some way? Did you use the data to determine which variables to examine or control, or which data to include or exclude in the final analysis? How are missing observations handled? Did you add and drop variables until your regression models and coefficients passed a bright-line level of significance? Those decisions, and any other decisions you made about statistical analysis based on the data itself, need to be accounted for.

Retraction Watch: You note in a press release accompanying the ASA statement that you’re hoping research moves into a “post p<0.05” era – what do you mean by that? And if we don’t use p values, what do we use instead?

Ron Wasserstein: In the post p<0.05 era, scientific argumentation is not based on whether a p-value is small enough or not. Attention is paid to effect sizes and confidence intervals. Evidence is thought of as being continuous rather than some sort of dichotomy. (As a start to that thinking, if p-values are reported, we would see their numeric value rather than an inequality (p=.0168 rather than p<0.05)). All of the assumptions made that contribute information to inference should be examined, including the choices made regarding which data is analyzed and how. In the post p<0.05 era, sound statistical analysis will still be important, but no single numerical value, and certainly not the p-value, will substitute for thoughtful statistical and scientific reasoning.

Retraction Watch: Anything else you’d like to add?

Ron Wasserstein: If the statement succeeds in its purpose, we will know it because journals will stop using statistical significance to determine whether to accept an article. Instead, journals will be accepting papers based on clear and detailed description of the study design, execution, and analysis, having conclusions that are based on valid statistical interpretations and scientific arguments, and reported transparently and thoroughly enough to be rigorously scrutinized by others. I think this is what journal editors want to do, and some already do, but others are captivated by the seeming simplicity of statistical significance.

Pless note: I would be interested if any readers disagree. Please outline your views in 20 words or less. (Just kidding)

Planning the implementation of an injury prevention programme

22 Feb, 16 | by Sheree Bekker

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(Photo: Steve CC BY-NC-ND 2.0)

I have invited Dr Alex Donaldson (follow him on Twitter @AlexDonaldson13), of the Australian Centre for Research into Injury in Sport and its Prevention, to share a little more about their new paper published open access in Injury Prevention: “We have the programme, what next? Planning the implementation of an injury prevention programme“.

The Translating Research into Injury Prevention Practice (TRIPP) framework, developed by Caroline Finch a decade ago, built on van Mechelen and colleagues’ ‘sequence of prevention’ for sports injuries. TRIPP highlighted the fact that only research that can, and will, be adopted by sports participants, their coaches and sporting bodies will prevent sports injuries. Stage 5 of TRIPP (‘Describe intervention context to inform implementation strategies) introduced the (then) novel idea of focusing research attention on understanding how the outcomes of efficacy research (TRIPP Stage 4) could be translated into interventions (policies, programmes, environmental or technical modifications) that could be actually implemented in the real-world context. This included developing an understanding of the best way to target and market evidence-based interventions to sport bodies and their participants.

However, implementing injury prevention programmes in the real-world is challenging and there is precious little information available in the scientific literature about how to transition from having an evidence-based intervention to getting that intervention widely, properly and sustainably implemented. As a consequence, most research remains in the early stages of these models/frameworks (i.e. describing the extent of the problem and identify causes or mechanisms of injury) which limits the potential for injuries to be prevented.

In a soon to be completed study investigating the factors that influence the translation of evidence-based injury prevention interventions into practice in community sport, I (as the project manager) found myself in the situation where my colleagues and I had:

What we then needed was an implementation plan for FootyFirst. The burning question was how can we ensure that the programme we had developed will be used and maintained for as long as it is needed by community-level Australian Football coaches and players?

Luckily for me, I had recently attended a short training course facilitated by Guy Parcel (then Dean Emeritus of the University Texas School of Public Health (Austin) on Intervention Mapping (IM). IM is a framework for health promotion intervention development underpinned by the notion that the impact of a health promotion (or injury prevention) programme is a function of the programme (its efficacy) and its implementation (whether people actually use it properly for sustained periods of time). IM is a six-step tool for planning and developing health promotion programmes. Like other programme planning frameworks, it starts with needs assessment and ends in evaluation. However, unlike other frameworks, it includes a step (Step 5) specifically focused on planning programme adoption, implementation and sustainability. IM Step 5 comprises seven tasks that are operationalised through six core processes (see Figure 1) and can be used independent of the other IM steps.

1

The thing I found particularly useful about IM Step 5 was that it helped me to focus my attention on answering some key questions during the FootyFirst implementation planning process including:

  1. Who will decide to use FootyFirst and who will deliver it to the players?
  2. How can we involve the delivers (coaches) and participants (players) in developing the implementation plan for FootyFirst?
  3. What do community-AF coaches actually need to do to adopt and implement FootyFirst?
  4. What is likely to influence whether coaches adopt and implement FootyFirst?
  5. What needs to change for coaches to adopt and implement FootyFirst?
  6. What strategies could be used to help, support or encourage coaches to achieve the identified changes?
  7. Why do we think a particular implementation strategy is likely to work – what is the evidence or theoretical underpinnings for the selected strategy?

Programme effects have been shown to be up to three times higher when programmes are well implemented. If your target audience doesn’t know about your programme, use it properly and use it for a sustained period of time, it is unlikely your injury prevention programme will achieve the holy grail of ‘making a difference in the real-world’. For me, using IM Step 5 helped to ensure that our programme implementation planning process was:

  • based on a partnership between health promotion, implementation science, and injury prevention researchers, and community sports administrators and coaches;
  • informed by behaviour change theory, implementation science frameworks and published evidence about effective implementation strategies for safety programmes in community sport; and
  • supplemented with in-depth knowledge of the implementation context and input from the programme end-users.

This in turn enabled us to develop an implementation plan specifically designed to bridge the gap between research (top-down) and community (bottom-up) driven programme implementation processes.

Our experience demonstrates the critical importance of researchers, practitioners and community end-users collaborating early in the implementation planning process underpinned by a mutual respect for the knowledge, skills and experience that these different groups bring to the implementation planning process.

 

 

Focusing on the ‘why’ and the ‘how’

20 Jan, 16 | by Sheree Bekker

 

 

I draw attention to a recent post  from The BMJ blog – Chris Baker: Child obesity in India? Tell me something I don’t know! as it struck me as relevant to the field of injury prevention. 

The BMJ blog post centres around the fact that only two qualitative studies have been published in the past 15 years on the issue of child obesity in India, with the majority of research being prevalence studies – and concludes:

…let us divert resources away from the “what” and “who” of child obesity towards the “why” and “how.” These questions require the application of qualitative research methods with families and health professionals to explore the lived experience of being overweight or obese, and the broader social and cultural beliefs related to this growing burden.

As we know, and as a quick search for qualitative studies in Injury Prevention shows, our field does indeed recognise the importance of qualitative work, with skilled researchers using qualitative methods to answer the types of ‘why’ and ‘how’ questions that we encounter with regards to our injury prevention interventions.

Over and beyond the qualitative/quantitative debate however, this blog post struck me as pertinent to readers of Injury Prevention as it raises the important point of relevancy. Relevancy of methods to the research question, and relevancy of research questions to the population.

Relevancy matters.

Do make sure to read the post for thought-provoking points that are raised as to the types of questions we should be asking, and thus the deeper issues that we can seek to uncover and address through our intervention research.

On career building: networking and mentoring

7 Dec, 15 | by Sheree Bekker

 

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(SB) Recently, Bridie Scott-Parker and I attended the 12th Australasian Injury Prevention and Safety Promotion Conference in Sydney Australia. We had never met before, yet Bridie and I have been working together both on the executive board of the Australian Injury Prevention Network (which hosted the conference along with The George Institute for Global Health), as well as here on the social media editorial team for Injury Prevention. I was, therefore, delighted to meet Bridie in person. It seems this has been a pattern in my own networking recently: online before in person, as I reflected here on cementing online networks and collaborations. Those of you who read this blog, and have perhaps followed my musings on other platforms, will know that I often wax lyrical about the power of social media for this purpose – particularly for postgraduates.

At the conference, as the student representative of the AIPN, I coordinated a discussion panel for student delegates. The panellists brought diverse points of view: full professors, early career researchers, practitioners, and PhD students (and not a manel in sight). This session was designed to be organic in nature, and evolved into a discussion largely around career paths, networking, mentoring, and also the ‘mess’ (or ‘dirt’ – inside joke for those that were there) of work-life balance.

It is often assumed that formal mentoring and networking are the cornerstones of career development advice for postgraduate students. Yes, these are important and should be formalised, especially for women. However, well-meaning advice often translates into flawed advice that negates the lived experiences of students themselves (particularly when those include experiences of structural inequality). Indeed, when I was planning the student panel session, and after talking to some fellow students, it became clear that generic mentoring and networking advice was not what students want to hear.

From my point of view, as a current PhD scholar, it was fascinating to see how willing more established researchers are to opening up and having honest conversations about the very same struggles and failures that we have – if they are only asked about them. Impostor syndrome, introversion, emotional work…holding space for vulnerable conversations about these topics made more of a difference for many of us than formal career advice ever will. It is so easy to forget that academics are humans too, and it is this personal side that students like me find encouraging to hear about.

In talking career pathways, it was encouraging to hear from panellists that a career is not a linear pathway. So often the stories we hear are of successful people who were ‘in the right place at the right time’, or ‘lucky’ that their careers evolved as they did. But in reality there were, in fact, clear and often difficult choices that panellists had made over the course of their careers. The importance of personal boundaries set in place from which career risks can then be taken, or moves that can then be professionally and/or personally made were mentioned by all panellists. We each have a guiding instinct as to where we want to go – trust it. Career paths are sideways and forwards and backwards and upwards and onwards  – and that is okay.

On the dreaded “networking!”: building a network is more about quality of connection than quantity. One new strong connection is better than a fistful of business cards. Yes, flattery will open up a conversation (top tip: don’t know how to initiate a conversation with an academic? Comment on their work! Even better if it is a favourable comment), however genuine conversation, and giving something back to others will sustain it. More often than not, people want to help other people – and are happy to do so. This may not need to be in the form of a formal mentor or networking connection – often one quick coffee together can be enough to impart valuable tacit knowledge.

As a personal note to other postgraduate students, it is well worth the effort to get involved in an executive board of an organisation, or a conference organising committee. The true value in any career building/mentoring/networking opportunity lies in adding value yourself. It has taken me a long time to figure this out. In my opinion, you will get more out of being useful and getting involved, than you ever will out of being given passive advice by others. How can you be useful? This does not need to be a grand gesture or even include a highly specialised skill – in my case, offering to do social media has been my easiest path to making myself useful. Prove yourself competent at something, no matter how small, and people will take notice.

The best mentoring/networking relationships lie not in a one-way give-and-take, but rather are two-way streets. The very best mentors and colleagues learn as much from students, as students learn from them. That is your gauge as to whether a professional relationship is worth the effort. I often think that emerging researchers can, and should, be more discerning as to who they choose to learn from. Also remember that it is good to have more than one mentor – people have skills in different areas, and not everyone can be everything to everyone. In our wide-eyed idealism we are often a little too keen to make every connection that we can into everything we can.

In this spirit of great connections, I have asked my ten-minute one-off networking-mentor Bridie Scott-Parker (I saw her great networking skills in action during a valuable ten-minute conversation at the conference) to add her perspective here as a panellist at the session.

(BSP) I have blogged previously on the importance of attending conferences, with one of the most beneficial aspects being the opportunity to network with others in the field. After chatting with Sheree – in person after many email and telephone conversations – I realised that the value in networking really lies in both parties having the chance to learn as they share different perspectives. In this respect no matter at what stage you are currently at in your injury prevention career someone can learn from you and you can learn from others. Network away!

For me, the conference panel was an opportunity to show students that life as an injury prevention researcher is not a bed of roses upon which you frolic with unicorns, rather that there is no one path that everyone will follow and that is okay. For me personally, the panel was also an opportunity for me to be kinder to myself, as you will be hard pressed to find a greater critic of me than myself. I became very ill during one of my undergraduate degrees, and I thought I would only ever be the ‘token disabled person’ in my classes and in any employment I ever achieved, if I could achieve any employment. I also had the double-whammy of juggling two small children – another great source of anxiety, as what the heck am I doing studying and trying to work, while juggling fun things like medication trials, when I should be focused on being Mum?

I think sharing a snapshot of some of the self-doubt I have felt, the relentless voice that tells me I am the equal opportunity person when I am not, and how I ended up in injury prevention after a long and winding road, and not just how I managed to succeed academically and in the increasingly-competitive domain of research, resonated with some of the students who may themselves be struggling with self-doubt, feeling like a failure as a Mum who cannot get any semblance of a work-life balance, and who cannot see any clear trajectory from where they have come from to where they aspire to be in the future. In many ways, that is the magic of life, but that phrase would have been cold-comfort to me as a stressed student! And that is okay.

(SB) Yes! I will repeat: academics are humans too.

 

More on writing

5 Dec, 15 | by Barry Pless

I am not a fan of Elsevier and thus ambivalent about posting this. But, on balance, it may help some novice authors and perhaps some more experienced ones as well. Check out this link to the Elsevier Publishing Campus… many pdfs available to download on various aspects of writing and publishing. Hope it works.

https://www.publishingcampus.elsevier.com/pages/154/Colleges/College-of-Skills-Training/Resources-for-Skills-Training/Quick-Guides-and-Downloads.html

“The Beautiful Game”… minus headers?: Discussing USSF’s recent announcement to limit headers in youth soccer leagues

23 Nov, 15 | by Angy El-Khatib

In the United States, sports-related traumatic brain injuries (concussions and otherwise) have been a HOT topic. In 2013, approximately 4,500 former NFL players sued the league, claiming that the NFL failed to educate, manage, and protect its players from head injuries. Judges approved a settlement of $765 million that would fund concussion-related compensation, including medical exams and research for ex-players. This past year, Chris Borland, a 24 year-old, highly revered linebacker, decided to retire after playing only one year of professional football. His reasoning was that football was “not worth the risk” to his health.

The NFL is not the only sporting organization looking at concussions among its players; other organizations include the National Hockey League (NHL) and the National Collegiate Athletic Association (NCAA). Most recently, the U.S. Soccer Federation (USSF) announced that it has developed a set of guidelines for its youth leagues in which it recommends a ban on headers for players ages 10 and under and a limit on headers for players between 11 and 13 years of age. The USSF also developed a standard protocol in which medical professionals, as opposed to coaches or referees, make decisions about return-to-play for players who are suspected of sustaining a concussion.

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The USSF developed these guidelines in response to a class-action lawsuit which targeted six of the largest youth soccer groups, including FIFA, U.S. Youth Soccer, and the American Youth Soccer Organization. The lawsuit claims that these organizations have “failed to adopt effective policies to evaluate and manage concussions.”

But will policy changes – “banning headers” – solve the concussion problem among youth soccer players?

Unlikely.

A September 2015 study in JAMA by Comstock, et al. evaluated trends in soccer concussions among youth players. The study found that the most common concussion mechanism was contact with another player (player-player), not a ball – this is consistent with other literature.

The most common mechanism for all concussions was contact with another player, accounting for 68.8% of all concussions among boys and 51.3% among girls. The most common mechanism among heading-related concussions was also contact with another player, accounting for 78.1% of heading-related concussions among boys and 61.9% among girls.

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Among soccer-specific activities, heading was responsible for 30.6% of concussions among boys and 25.3% of concussions among girls.

The study concludes that reducing athlete-athlete contact across all phases of play – not just headers – would be more likely to prevent concussions. It also mentions that, culturally, banning headers may not be a feasible prevention effort. After all, an integral part of the Beautiful Game is headers (Robin Van Persie during the 2014 FIFA World Cup, anyone?). The soccer community, anecdotally, seems exceptionally resistant to the prospect of banning headers. As injury researchers, we know that one of the most important aspects of a successful and effective public health intervention is cultural feasibility.

With this in mind, I don’t think it is likely the USSF’s announcement about banning or limiting headers will significantly affect the epidemiology of concussions in youth soccer.  At most, this sends a strong message to coaches and brings safety management to the forefront. (The new rule which requires a Health Care Professional, [shoutout to Athletic Trainers!] to be present to make decisions regarding concussions instead of coaches or referees could be positive, though!)

Either way, one has to commend USSF’s attempt at targeted prevention efforts to bring soccer to its high and honorable state:

 

Joga Bonito!

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P.S. – you’re not allowed to make fun of me for calling it “soccer” instead of “football”! 🙂

Undergraduate research experience

9 Nov, 15 | by Bridie Scott-Parker

I read an interesting blog last week in which two undergraduate students shared their perspectives after completing a research placement, and it prompted me to reflect upon my own research training, and how much of what we researchers – while it sometimes feels as if it is innate – is actually learned skills and abilities (oft by trial and error) that need to be shared with our up-and-coming researchers. Today I want to share a recent experience with an undergraduate student from another Queensland university.

I was approached by Sehana last month regarding the potential to gain some experience in research during her summer semester studies. I invited her to accompany myself and my University of the Sunshine Coast (USC) Research Assistant Ms Jamie Caldwell as we collected data during week four of the the first wave of an 18-month longitudinal study. Today Sehana shares her story:

When speaking to the placement officer at USC regarding a work experience in research, Bridie Scott-Parker was the first name she mentioned.  She thought the placement would be perfect for me especially because of Bridie’s extensive knowledge in research and having recently being awarded the Tall Poppy Science award for her research contributions. 
 
From reading about her extensive research online, reading a couple of her published papers, and speaking to her about her work, I am now a full convert to “the dark side of research” – as she calls it.
 
Throughout my degree I have done numerous research assignments, doing certain sections of a report for various courses.  You are always given data, or parts of the report are completed for you and you do the rest.  I have never been involved in any research related activities out in the real world. 
 
We visited a school, collecting and distributing surveys and sleep diaries to adolescent school children.  From the beginning there were issues that as a novice researcher caught me off guard.  The students came in drips and drabs, many did not have their sleep diaries, others had multiple from previous weeks, some students did not attend at all. 
 
I stood there the entire time panicking with “missing data” running through my head, while Bridie and Jamie casually took it all in their stride.  It wasn’t until I reflected on it at the end that my theoretical learning and practical experience actually fit together.  And it was exactly that – experience – which they had and I didn’t that made the difference. 
 
I could see that Bridie and Jamie both had enough experience to know the little things such as bringing spare pens and surveys.  It was when I heard them speaking about participant codes for the research that I realised my degree may have taught me how to do ANOVAs and correlations, but experience like this, out in the real world, surrounded by real participants (and real missing data) is invaluable. 
 
The first day of any job is nerve wrecking, but I feel this experience has taken away much of the anxiety associated with being a graduate fresh in the research field.  I would highly recommend to anyone who is leaning towards a research career to spend time with real researchers, speak to them, help collect data and just see how it all works in the real world. 

Ms Sehana Naz

Howzat?! An Injury Prevention and Prediction App for Cricket?

8 Nov, 15 | by dbui

As the 1st test is underway between Australia and New Zealand at the Gabba, British Medical Journal Injury Prevention brings you an interview with Dr Naj Soomro, a physician with a passion for Technology and Sports Medicine in Cricket. I met Dr Soomro at the National Conference of Sports Medicine Australia last month where I was representing the University of New South Wales Sports Medicine Society, and his presentation was one of my personal highlights of the conference! He presented on a novel Injury Surveillance, Prevention and Prediction App, “Cricket Predict”.

Dr Soomro kindly agreed to answer a few questions for the blog!

Q1. Tell us about Cricket Predict; what is it and how did you come up with the concept?

I’ve been interested in prediction for a long time now. Today, we use technology and science to predict everything from the weather to cardiovascular risk. This carries into Sport as well: If you have a look at NFL, previous injury is used extensively in determining injury risk; Rugby players are similarly triaged using GPS data and the number of tackles per game. My aim was to develop a similar system for Cricket.

Cricket predict is a mobile app that harnesses technology in the surveillance of injuries, measures risk factors for injury and ultimately, aims to predict (and prevent!) injury. By tracking risk factors for injury in real-time, medical and coaching staff can receive alerts when an individual player’s risk profile is high – and interventions can be implemented. Further, whenever a player is injured, there is an electronic injury form which can be filled out through the app that goes onto a central online database, helping with identification of injuries.

Q2. Cricket predict utilises a number of different risk factors to help predict injury, what is the evidence for using these risk factors specifically?
The risk factors that are used in Cricket Predict are all validated in the literature. They include:
I. Cricket workload, such as number of balls bowled
II. Non-cricket workload e.g. Strength and conditioning sessions, cross-training
III. Psychological status – measured by a modified Profile of Mood States (POMS) questionnaire, usually 76 items but modified to 10 items to be cricket-specific and “player-friendly”.
IV. Sleep, a measure of fatigue and documented risk factor for injury, measured by an accelerometer and analysed by Activ Graph.
V. Previous injury profile
VI. Pre-season strength parameters, including Internal Rotation to External Rotation ratio (predicts injury in Throwing Athletes), Hamstring to Quadriceps ratio (predicts hamstring injury)

Cricket Predict’s algorithm incorporates all of these risk factors and displays to the user a graphical representation of the player’s injury risk. However, exactly how predictive these risk factors are in cricket players is yet to be studied and my research group is running a prospective validation study to do just that.
Q3. What are the implications of the findings of this study for readers?
There are 2 main implications of this research:

One of the biggest implications of my research is the integration of technology into Sports Medicine, which I see as the way forward. Its one of the reasons I developed this mobile app. Developing an electronic injury surveillance system makes data collection very easy, and numerous studies have demonstrated that electronic injury surveillance systems are superior to paper-based systems. Additionally, with the advent of wearable technology, large amounts of quantitative data can be incorporated.

Secondly, if the algorithm in Cricket Predict is validated, this research will revolutionise the way that Sportspeople play the game. Based on what we prove and validate, the coaches are going to change their coaching techniques, they will be able to select the best players for their teams, and develop policies for junior players as well.

Q4. Has this type of research been undertaken in other sports?
There is a recent article by Tim Gabbett which studied an injury prediction model in Australian Rugby League in which he was able to predict approximately 50-80% of soft-tissue non contact injuries over the course of 2 seasons. In the course of a tournament, an injury to a key player can change the balance of a team. Even if an algorithm can predict 10-20% of injuries, for an elite team that is very significant.

Q5. This research is heavily reliant on Technology, where do you see Technology and Medicine, or Technology and Injury Prevention going forward?
A lot of data that we get these days is subjective data from players, and I think the best way to quantify data and validate data is to get data electronically from the use of sensors. Sensor-based technology and imaging technology is going to go very far in terms of performance analysis and the usage of physical characteristics of players. I see the usage of wearable technology being really big in sports. What I mean by this is the use of accelerometers or gyroscopes to look at movement patterns, similar sensors to look at medical data such as the amount of perspiration, and the amount of stress hormones such as Cortisol that can be measured in saliva and also in sweat. We can also look at blood sugar levels, heart rate, oxygen saturations – all of these things can be measured using wearable technology which can send wireless information to the medical and coaching staff. One of the most important things coaches can get out of this is the amount of fatigue of their players. If we can use technology to quantify this fatigue, that is going to revolutionise sport.

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If you’d like to keep this conversation going, or be involved with Cricket Predict in the future, please get in touch with Dr Najeeb Soomro via email cricdoctor@gmail.com or Twitter @CricDoctor. Specifically, if you are a cricket club, sports scientist or health professional interested in doing injury surveillance or helping to validate the app, Dr Soomro is happy to share the app with you! 
Let us know what you think @BMJ_IP too!

David Bui is a final year medical student at the University of New South Wales and outgoing President of the University of New South Wales Sports Medicine Society. He has an interest in Orthopaedics, Sports Medicine and Injury – in all forms! @David_Bui_

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