UNASSIGNED: As individuals with occupational status and power, sport leaders (e.g., coaches and athletic administrators) are responsible for enforcing cultures of inclusion within institutions of athletics. Yet, sport leaders who possess LGBTQ+ sexual identities are frequently marginalized and stigmatized by entities within and outside of athletics (e.g., athletes, parents of athletes, colleagues). Therefore, LGBTQ+ sport leaders are often faced with a challenging set of circumstances: negotiate the authenticity of their sexual orientation in the context of sport, or leave the profession entirely.
UNASSIGNED: The purpose of this study was to conduct a systematic review of research related to LGBTQ+ sport leader experiences. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), research across six countries (China/Taiwan/Hong Kong, Italy, New Zealand, Norway, United Kingdom, United States) between 1997 and 2021 was analyzed.
UNASSIGNED: Themes across included studies (N = 34) describe intrapersonal experiences of LGBTQ+ sport leaders, interpersonal studies examining stakeholder attitudes (i.e., parents and athletes) toward LGBTQ+ sport leaders, and sport manager attitudes toward LGBTQ+ topics.
UNASSIGNED: Findings convey that sport leaders continue to face marginalization due to the presence of heterosexism and heteronormativity in athletics. Future research should continue to explore LGBTQ+ sport leader experiences, behaviors, attitudes, and identities to determine their impact on fostering inclusion and belonging within athletic spaces.

UNASSIGNED: Concussion is a serious concern in sport, with the potential to cause short- and long-term health consequences. These concerns highlight the need for the translation of concussion management guidelines into use in real-world sports settings. This qualitative study explores community rugby players\' concussion experiences as part of New Zealand Rugby\'s concussion management pathway.
UNASSIGNED: Semi-structured interviews were conducted with 36 rugby players (35 males and 1 female; 22 played at school and 14 at club-level; mean age 19.8 ± 4.8) Thematic analysis was utilized to analyze data.
UNASSIGNED: Four themes were identified i) the symptom journey, ii) the role of a dedicated concussion management pathway in shaping players\' experiences, iii) the influence of coaches and physiotherapists, and iv) rugby culture. Support received as part of the concussion management pathway, and from individuals who were part of players\' concussion journey, deeply impacted their overall experience. However, players identified insufficient guidance while returning to school/work. At times, the sport\'s collective cultural values made it difficult for players to enact positive concussion management behavior.
UNASSIGNED: The findings highlight the importance of a defined management pathway to support players\' recovery. Addressing negative aspects of rugby\'s collectivist culture remains critical for optimal concussion management and recovery.

UNASSIGNED: This study aimed to clarify the relationship between psychological factors (goal orientation and desire for approval from others) and the severity of sports injuries experienced by young Japanese athletes.
UNASSIGNED: A total of 560 young Japanese athletes (328 males and 232 females) aged 18-24 years completed an online survey in 2022-2023. A web questionnaire was used to investigate participants\' task and ego orientations, desire for approval from others (e.g., coaches and friends/families), and history of injury. The samples were then split into 3 groups on the basis of the rest duration due to the injury: noninjury group (0 days), mild-to-moderate injury group (1-27 days), and severe injury group (>28 days). Spearman\'s test examined a correlation between task and ego orientation scores among all samples. The Mann-Whitney U test was used to compare the scores between the severe injury and noninjury groups.
UNASSIGNED: A significant positive correlation was found between task and ego orientation scores from all samples (ρ=0.27, p<0.001). The severe injury group had significantly higher task orientation scores and desire for approval scores than the noninjury group (ρ=0.001, p<0.001).
UNASSIGNED: Japanese young athletes with high task orientation and approval desire may be at risk of severe sports injuries requiring >4 weeks to return to sports. The goal orientation profiles should be interpreted with caution. Future research should examine contextual effects such as the perceived motivational climate, in addition to the goal orientation profiles.

UNASSIGNED: Mandating headgear for field players in girls\' lacrosse to reduce head injuries, including concussion, has been heavily debated. However, research regarding the need and effectiveness of mandated headgear use in girls\' lacrosse is still developing. Therefore, this qualitative study aimed to identify the need for and barriers to the development of mandated headgear use policies in girls\' lacrosse in Ohio.
UNASSIGNED: We conducted six virtual focus groups, three with concussion experts (clinicians and researchers) and three with girls\' lacrosse stakeholders (high school players, parents, coaches, and officials). A focus group guide was developed to explore study participants\' perceptions and opinions on concussion in girls\' lacrosse, headgear use among players, and policies and policy development related to headgear use or a headgear mandate. We developed the codebook using an inductive and iterative approach based on focus group transcripts and used ATLAS.TI to code and analyze the transcript data.
UNASSIGNED: Concussion experts and stakeholders understood the potential consequences of concussion but did not perceive concussion as a pervasive problem in girls\' lacrosse. The prevention of head and facial injuries was regarded as a potential benefit of headgear use. However, stakeholders expressed that the myriad of arguments discussed opposing mandated headgear use including increased aggressive play and/or targeting, concerns over changes in the game, and cost strongly outweighed the benefits. Finally, both concussion experts and stakeholders identified multiple organizations, including USA Lacrosse, who could act as facilitators and/or barriers to developing, enacting, and implementing headgear policies.
UNASSIGNED: Concussion experts and stakeholders identified possible reasons for headgear use related to injury prevention but also identified several important barriers to the development of a headgear mandate for girls\' lacrosse in Ohio.

BACKGROUND: Clinical trials examining lifestyle interventions for weight loss in cancer survivors have been demonstrated to be safe, feasible, and effective. However, scalable weight loss programs are needed to support their widespread implementation. The ASPIRE trial was designed to evaluate real-world, lifestyle-based, weight loss programs for cancer survivors throughout Maryland.
OBJECTIVE: The objectives of this protocol paper are to describe the design of a nonrandomized pragmatic trial, study recruitment, and baseline characteristics of participants.
METHODS: Participants were aged ≥18 years, residing in Maryland, with a BMI ≥25 kg/m2, who reported a diagnosis of a malignant solid tumor, completed curative treatment, and had no ongoing or planned cancer treatment. Enrollment criteria were minimized to increase generalizability. The primary recruitment source was the Johns Hopkins Health System electronic health records (EHRs). Participants selected 1 of 3 remotely delivered weight loss programs: self-directed, app-supported, or coach-supported program.
RESULTS: Participants were recruited across all 5 geographic regions of Maryland. Targeted invitations using EHRs accounted for 287 (84.4%) of the 340 participants enrolled. Of the 5644 patients invited through EHR, 5.1% (287/5644) enrolled. Participants had a mean age of 60.7 (SD 10.8) years, 74.7% (254/340) were female, 55.9% (190/340) identified as non-Hispanic Black, 58.5% (199/340) had a bachelor\'s degree, and the average BMI was 34.1 kg/m2 (SD 5.9 kg/m2). The most common types of cancers were breast (168/340, 49.4%), prostate (72/340, 21.2%), and thyroid (39/340, 8.5%). The self-directed weight loss program (n=91) included 25 participants who agreed to provide weights through a study scale; the app-supported program (n=142) included 108 individuals who agreed to provide their weight measurements; and the coach-supported weight loss program included 107 participants. We anticipate final analysis will take place in the fall of 2024.
CONCLUSIONS: Using EHR-based recruitment efforts, this study took a pragmatic approach to reach and enroll cancer survivors into remotely delivered weight loss programs.
BACKGROUND: ClinicalTrials.gov NCT04534309; https://clinicaltrials.gov/study/NCT04534309.
UNASSIGNED: DERR1-10.2196/54126.

Digital inclusion is considered a pivotal social determinant of health, particularly for older adults who may face significant barriers to digital access due to physical, sensory, and social limitations. Avatar for Global Access to Technology for Healthy Aging (AGATHA) is a virtual healthy aging coach developed by the World Health Organization to address these challenges. Designed as a comprehensive virtual coach, AGATHA comprises a gamified platform that covers multiple health-related topics and modules aimed at fostering user engagement and promoting healthy aging.
The aim of this study was to explore the perception and user experience of Malaysian older adults in their interactions with the AGATHA app and its avatar. The focus of this study was to examine the engagement, usability, and educational impact of the app on health literacy and digital skills.
We performed a qualitative study among adults 60 years and older from suburban and rural communities across six states in Malaysia. Participants were purposefully recruited to ensure representation across various socioeconomic and cultural backgrounds. Each participant attended a 1-hour training session to familiarize themselves with the interface and functionalities of AGATHA. Subsequently, all participants were required to engage with the AGATHA app two to three times per week for up to 2 weeks. Upon completion of this trial phase, an in-depth interview session was conducted to gather detailed feedback on their experiences.
Overall, the participants found AGATHA to be highly accessible and engaging. The content was reported to have a comprehensive structure and was delivered in an easily understandable and informative manner. Moreover, the participants found the app to be beneficial in enhancing their understanding pertaining to health-related issues in aging. Some key feedback gathered highlighted the need for increased interactive features that would allow for interaction with peers, better personalization of content tailored to the individual\'s health condition, and improvement in the user-experience design to accommodate older users\' specific needs. Furthermore, enhancements in decision-support features within the app were suggested to better assist users in making health decisions.
The prototype digital health coaching program AGATHA was well received as a user-friendly tool suitable for beginners, and was also perceived to be useful to enhance older adults\' digital literacy and confidence. The findings of this study offer important insights for designing other digital health tools and interventions targeting older adults, highlighting the importance of a user-centered design and personalization to improve the adoption of digital health solutions among older adults. This study also serves as a useful starting point for further development and refinement of digital health programs aimed at fostering an inclusive, supportive digital environment for older adults.

UNASSIGNED: Body dysmorphic disorder (BDD) is severe and undertreated. Digital mental health could be key to expanding access to evidence-based treatments, such as cognitive behavioral therapy for BDD (CBT-BDD). Coach guidance is posited to be essential for effective uptake of digital interventions. However, little is known about how different patients may use coaching, what patterns correspond to meaningful outcomes, and how to match coaching to patient needs.
UNASSIGNED: Participants were 77 adults who received a 12-week guided smartphone CBT-BDD. Bachelor\'s-level coaches were available via asynchronous messaging. We analyzed the 400 messages sent by users to coaches during treatment. Message content was coded using the efficiency model of support (i.e., usability, engagement, fit, knowledge, and implementation). We aimed to clarify when and for what purposes patients with BDD used coaching, and if we can meaningfully classify patients by these patterns. We then assessed potential baseline predictors of coach usage, and whether distinct patterns relate to clinical outcomes.
UNASSIGNED: Users on average sent 5.88 messages (SD = 4.51, range 1-20) and received 9.84 (SD = 5.74, range 2-30). Regarding frequency of sending messages, latent profile analysis revealed three profiles, characterized by: (1) peak mid-treatment (16.88 %), (2) bimodal/more communication early and late in treatment (10.39 %), and (3) consistent low/no communication (72.73 %). Regarding content, four profiles emerged, characterized by mostly (1) engagement (51.95 %), (2) fit (15.58 %), (3) knowledge (15.58 %), and (4) miscellaneous/no messages (16.88 %). There was a significant relationship between frequency profile and age, such that the early/late peak group was older than the low communication group, and frequency profile and adherence, driven by the mid-treatment peak group completing more modules than the low contact group. Regarding content, the engagement and knowledge groups began treatment with more severe baseline symptoms than the fit group. Content profile was associated with dropout, suggesting higher dropout rates in the miscellaneous/no contact group and reduced rates in the engagement group. There was no relationship between profile membership and other outcomes.
UNASSIGNED: The majority of participants initiated little contact with their coach and the most common function of communications was to increase engagement. Results suggest that older individuals may prefer or require more support than younger counterparts early in treatment. Additionally, whereas individuals using coaching primarily for engagement may be at lower risk of dropping out, those who do not engage at all may be at elevated risk. Findings can support more personalized, data-driven coaching protocols and more efficient allocation of coaching resources.

UNASSIGNED: Mentoring and coaching practices have supported the career and skill development of healthcare professionals (HCPs); however, their role in digital technology adoption and implementation for HCPs is unknown. The objective of this scoping review was to summarize information on healthcare education programs that have integrated mentoring or coaching as a key component.
UNASSIGNED: The search strategy and keyword searches were developed by the project team and a research librarian. A two-stage screening process consisting of a title/abstract scan and a full-text review was conducted by two independent reviewers to determine study eligibility. Articles were included if they: (1) discussed the mentoring and/or coaching of HCPs on digital technology, including artificial intelligence, (2) described a population of HCPs at any stage of their career, and (3) were published in English.
UNASSIGNED: A total of 9473 unique citations were screened, identifying 19 eligible articles. 11 articles described mentoring and/or coaching programs for digital technology adoption, while eigth described mentoring and/or coaching for digital technology implementation. Program participants represented a diverse range of industries (i.e., clinical, academic, education, business, and information technology). Digital technologies taught within programs included electronic health records (EHRs), ultrasound imaging, digital health informatics, and computer skills.
UNASSIGNED: This review provided a summary of the role of mentoring and/or coaching practices within digital technology education for HCPs. Future training initiatives for HCPs should consider appropriate resources, program design, mentor-learner relationship, security concerns and setting clear expectations for program participants. Future research could explore mentor/coach characteristics that would facilitate successful skill transfer.

Sport governing bodies, such as the International Olympic Committee, have recommended youth sport organizations develop policies, procedures, and/or ethical guidelines to prevent and respond to sexual harassment and abuse (SHA) experienced by young athletes. To our knowledge, no studies have investigated SHA policies or procedures in U.S. youth sport programs. The purpose of this exploratory study was to examine U.S. youth sport programs\' policies regarding SHA. The results are based on a cross-sectional survey completed by youth sport coaches (n = 200) from various organizations (e.g., public recreation organizations, private nonprofit organizations, and interscholastic sports). Findings suggest that most organizations have several SHA policies, such as education and training requirements, written policies and codes of conduct regarding coach-athlete sexual relationships, and formal complaint and disclosure procedures for investigating SHA. A bivariate analysis suggests that the presence of several SHA policies was associated with an increased number of self-reported SHA incidents. Moreover, youth sport programs located in urban areas had a greater extent of SHA policies compared to those located in suburban or rural areas. These results are discussed with respect to the potential relationships between the presence of policies and increased cases of SHA. Also, we discussed advocating for equitable resources among youth sport programs regardless of geographic and/or demographic factors. Future research should identify social and cultural barriers that inhibit the successful implementation of SHA policies. While developing and implementing SHA policies is a step in the right direction, it may not be used as the only means to address this complex, systematic, and structural issue.

The continually increasing demands placed on physicians have led to high levels of burnout, and breast radiologists are no exception. Professional coaching is a means to guide and support the radiologist through a process of positive thinking, stress reduction, goal setting, mental growth, work-life balance, and behavioral change. Professional coaching may be effective in preparation for leadership roles or in response to workplace issues or conflict. The radiologist, with the help of a coach, establishes goals, expands perception and mindset, and collaboratively may find ways to resolve issues by taking new and different approaches. This article discusses why radiologists should seek out a certified coach and what a coach can offer radiologists during these trying times, as well as outlining the coaching process. Coaching has proven useful in addressing professional growth, workplace issues, and physician burnout. At the conclusion of the article, the readers will be able to discern whether coaching can support a better quality of life for them.