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Full-Text Articles in Sports Medicine
Implementation Of Patient Care Documentation Standard For Athletic Training Staff In Intercolle, Lucas Bianco, Maria Popek, Bri Durics, Christian Miles
Implementation Of Patient Care Documentation Standard For Athletic Training Staff In Intercolle, Lucas Bianco, Maria Popek, Bri Durics, Christian Miles
Clinical Practice in Athletic Training
Documentation is a professional standard for all health care professions. As part of a relatively young profession, athletic trainers have had to adjust to the expectations around documentation to stay at the same level as other health care providers. Documentation is often a highly discussed topic with more and more education sessions and resources being provided by NATA, BOC and NATA Research Education Foundation. The need for Continuous Quality Improvement projects and subsequent studies has continued to grow. Projects with a focus on documentation can be completed then disseminated to determine the most effective ways to improve documentation across our …
The Use Of Primal Reflex Release Technique To Address Pain And Stress: An Exploratory Case Series, Nathan R. Reep, Sydney N. Leverett, Rebecca M. Heywood, Zachary Johnson, Alan Nasypany, James May, Scott W. Cheatham
The Use Of Primal Reflex Release Technique To Address Pain And Stress: An Exploratory Case Series, Nathan R. Reep, Sydney N. Leverett, Rebecca M. Heywood, Zachary Johnson, Alan Nasypany, James May, Scott W. Cheatham
Clinical Practice in Athletic Training
The majority of the world population is experiencing more stress after the COVID-19 pandemic. Working in an outpatient healthcare setting it can be expected that patients will present with stress in combination with other perceptions of pain related to injury. Stress alone may be the cause of pain perception especially in patients who present with no specific mechanism of injury. There is a need for a quick full-body approach to assessment and treatment while considering the stress response to injury. Therefore, the purpose of this study was to determine the immediate effects of Primal Reflex Release Technique (PRRT) Primals on …
Concussions In Women’S Rugby: A Timely Review Of Available Data, Shannon M. Wright
Concussions In Women’S Rugby: A Timely Review Of Available Data, Shannon M. Wright
Clinical Practice in Athletic Training
Rugby is a growing full-contact sport across the world for both men and women; as a full-contact sport with no protective equipment, it has a reputation for high injury rates, including concussions. Organized men’s rugby has been established for over a century, whereas organized women’s rugby has struggled to achieve the same success over the years. With a much shorter amount of time to track injuries, women’s rugby lacks data to assess when, where, and what kinds of injuries are most common. The guiding study attempts to examine epidemiological trends for concussion in women’s rugby union and league. After pooling …
Effective Anterior Cruciate Ligament Injury Prevention Programming In Young Female Athletes: An Evidence-To-Practice Review, Janay Ward, Kina M. Ingram, Jackson Biffle, Emily E. Hildebrand, Peter Lisman
Effective Anterior Cruciate Ligament Injury Prevention Programming In Young Female Athletes: An Evidence-To-Practice Review, Janay Ward, Kina M. Ingram, Jackson Biffle, Emily E. Hildebrand, Peter Lisman
Clinical Practice in Athletic Training
Anterior cruciate ligament (ACL) injuries are common in adolescents, in particular females participating in sports requiring frequent jumping, pivoting, and rapid acceleration. Consequently, the prevention of ACL injury is a principal concern of athletic trainers and other sports medicine professionals. Neuromuscular training (NMT) programs have been effective in reducing ACL injury risk in athletic populations, though additional clarity on programmatic factors, such as exercise selection, timing, and training dosage is warranted. Therefore, the primary purpose of this evidence-to-practice review was to present which components of NMT programs have been found to be most effective in reducing ACL injury incidence in …
Treating Type Ii Medial Tibial Stress Syndrome With Primal Reflex Release Technique: A Novel Approach, Shelli Green, Jenna Morogiello, Kurrel Fabian, James May, Alan Nasypany
Treating Type Ii Medial Tibial Stress Syndrome With Primal Reflex Release Technique: A Novel Approach, Shelli Green, Jenna Morogiello, Kurrel Fabian, James May, Alan Nasypany
Clinical Practice in Athletic Training
Five NCAA Division I cheerleaders (age 20 ± 1.4; 3 males, 2 females) presented with Medial Tibial Stress Syndrome (MTSS). Following an evaluation, all patients diagnosed with MTSS were treated using Primal Reflex Release Technique (PRRT). Immediate improvements in reported pain were demonstrated after one treatment. Improvements in perceived dysfunction were demonstrated after 4.2 (± 0.84) treatments over 15.4 (± 5.86) days with no time lost. All improvements were maintained at two-week follow-up. Type II MTSS patients treated with PRRT may experience an immediate, lasting reduction in pain, improvement in function, and shorter time to overall resolution.
A Descriptive Examination Of Perceived Stress And Coping Among Athletic Trainers Employed In The National Collegiate Athletic Association, Stephanie M. Singe, Elisabeth M. Mckenna, Alexandrya Cairns, Christianne Eason
A Descriptive Examination Of Perceived Stress And Coping Among Athletic Trainers Employed In The National Collegiate Athletic Association, Stephanie M. Singe, Elisabeth M. Mckenna, Alexandrya Cairns, Christianne Eason
Clinical Practice in Athletic Training
Time and work demands are high for the collegiatea athletic trainer, which can increase work stress and burnout may result. High perceived levels of stress and burnout can impact an athletic trainer’s mental health and wellness. Data were collected via an online descriptive, cross-sectional survey (Qualtrics) examining the perceived stress and coping strategies used among athletic trainers employed in the collegiate setting. Respondents completed the pereceived stress scale (ɑ=.90), and a series of close-ended questions related to their self-reported strategy of coping. Data was collected during September of 2022. We had 987 (men 371, women 607, did not disclose 9) …
Driving After A Concussion In Adolescents And Young Adults, What Is The Current Research And Consensus?, Melanie Kwok, Tamara Valovich Mccleod
Driving After A Concussion In Adolescents And Young Adults, What Is The Current Research And Consensus?, Melanie Kwok, Tamara Valovich Mccleod
Clinical Practice in Athletic Training
N/a
Comparison Of Patellar Taping And Strapping For Treating Patellofemoral Pain, Kaison Ames, Eric G. Post
Comparison Of Patellar Taping And Strapping For Treating Patellofemoral Pain, Kaison Ames, Eric G. Post
Clinical Practice in Athletic Training
Among collegiate athletes, patellofemoral pain (PFP) represents nearly one-third of all sport-related injuries. There have been multiple studies using a patellar tendon strap as an intervention to treat PFP that showed an improvement in knee pain, as well as studies showing improvement in knee pain when using patellar taping for PFP. However, there is very limited research written that compares the effectiveness of a patellar tendon strap versus a patellar tendon taping technique for patients with PFP. Therefore, the purpose of this study was to compare the effectiveness of patellar taping versus patellar strapping to reduce PFP in collegiate athletes. …
Thoracic Mobility And The Effects It Has On The Human Body: An Evidence To Practice Review, Megan Kurzec, Barton E. Anderson
Thoracic Mobility And The Effects It Has On The Human Body: An Evidence To Practice Review, Megan Kurzec, Barton E. Anderson
Clinical Practice in Athletic Training
Decreased thoracic mobility, stability, and strength are prevalent issues in athletes, contributing to various musculoskeletal problems. This Evidence to Practice Review synthesizes findings from a guiding systematic review that identified exercises targeting the thoracic spine in athletes. The review included a comprehensive search across six databases, five journals, and five social media platforms, yielding 38 exercises designed to improve thoracic mobility, motor control, work capacity, and strength. Despite the low level of evidence (Level D), these exercises are widely used in clinical practice. This review provides a framework for exercise prescription, offering athletic trainers a range of exercise options to …
Psychological Effects Of Number Of Knee Surgeries In Female Collegiate Soccer Athletes, Jun Yamada, Eric G. Post
Psychological Effects Of Number Of Knee Surgeries In Female Collegiate Soccer Athletes, Jun Yamada, Eric G. Post
Clinical Practice in Athletic Training
Psychological readiness is an important factor for returning to sport successfully following anterior cruciate ligament (ACL) reconstruction. To date, no studies have determined the effect of the number of knee surgery to psychological readiness. The primary purpose of this investigation was to determine whether the number of knee surgeries impacts psychological readiness. The secondary purpose was to examine the relationship between the number of surgeries and knee function. Data was collected from participants on the women’s soccer teams at a local division Ⅰ, Ⅲ, and NAIA college. Inclusion criteria were 1) currently fully participating in activities without any limitations, and …
Treating Chronic Low Back Pain And Plantar Fasciitis With Myokinesthetic System: A Case Study, Sadie Buboltz-Dubs, Russell Baker
Treating Chronic Low Back Pain And Plantar Fasciitis With Myokinesthetic System: A Case Study, Sadie Buboltz-Dubs, Russell Baker
Clinical Practice in Athletic Training
The purpose of this case study was to report the effects of the MyoKinesthetic (MYK) System on the pain and function of a collegiate softball player previously diagnosed with chronic non-specific low back pain and foot pain. The patient had been experiencing bilateral foot pain since childhood and conservative treatment options had failed to resolve her pain long term. Additionally, the patient had been experiencing persistent back tightness and soreness. Upon arrival at the university, the patient was evaluated using the MYK postural analysis to identify if a primary nerve root dysfunction could be the cause of her pain. The …
Supporting Mental Wellness In Transgender Athletes, Abaigeal C. Fields, Zachary K. Winkelmann
Supporting Mental Wellness In Transgender Athletes, Abaigeal C. Fields, Zachary K. Winkelmann
Clinical Practice in Athletic Training
N/a
A Review Of Automated External Defibrillator Considerations In Athletic Training, Bryana M. Mammana, Susan W. Yeargin, Zachary K. Winkelmann
A Review Of Automated External Defibrillator Considerations In Athletic Training, Bryana M. Mammana, Susan W. Yeargin, Zachary K. Winkelmann
Clinical Practice in Athletic Training
N/a
Correlation Between Pre-Season Single-Leg Hop Testing Data And Lower Extremity Injuries In Collegiate Soccer Players, Ashley Kuchenbuch, Justin M. Stanek
Correlation Between Pre-Season Single-Leg Hop Testing Data And Lower Extremity Injuries In Collegiate Soccer Players, Ashley Kuchenbuch, Justin M. Stanek
Clinical Practice in Athletic Training
Lower extremity injuries are very common in collegiate soccer athletes and often lead to long-term rehabilitation programs and a decline in the athlete’s overall quality of life. Using single leg hop tests to identify “at-risk” athletes before the competitive season begins could allow medical staff to implement injury prevention programs that could help reduce the incidence of lower extremity injuries throughout the season. The purpose of this study was to determine if data taken from single leg hop (SLH) testing could help predict lower extremity injuries in female collegiate soccer players. A convenience sample of twenty-one participants were chosen to …
College Student-Athlete Perceptions Of Characterizations And Interpersonal Trust In Their Athletic Trainer: A Point-Of-Care Research Study, Ryan N. Moran, Deidre Leaver-Dunn, Jeff Allen, Jessica Wallace
College Student-Athlete Perceptions Of Characterizations And Interpersonal Trust In Their Athletic Trainer: A Point-Of-Care Research Study, Ryan N. Moran, Deidre Leaver-Dunn, Jeff Allen, Jessica Wallace
Clinical Practice in Athletic Training
Patient-centered care is essential in athletic training with limited research examining the relationship between patient and clinician. Previous theory has identified constructs of quality athletic trainers (ATs); however, it remains unknown how current athletes perceive these theorized constructs in the ATs providing them medical care. The purpose of this study was to determine the perceptions of characterizations of a quality athletic trainer and interpersonal trust between the student-athlete and AT in the collegiate setting and establish reliability of these surveys. A second aim was to explore differences between sex, previous exposure to an AT, and having had access to an …
The Impact Of Video-Assisted Education On Knowledge And Retention Compared To Paper Education Material, Keiona M. Nance, Matthew J. Drescher, Lindsey E. Eberman, Matthew J. Rivera
The Impact Of Video-Assisted Education On Knowledge And Retention Compared To Paper Education Material, Keiona M. Nance, Matthew J. Drescher, Lindsey E. Eberman, Matthew J. Rivera
Clinical Practice in Athletic Training
When educating patients, clinicians must be effective to assure patients understand their treatment plan and abide by such to achieve optimal outcomes. Teaching methods that stimulate numerous senses more positively impact learning outcomes. The purpose of this study is to compare paper and video-assisted education at the point-of-care with the aim of changing patient education and local practice in a system for individuals undergoing total hip arthroplasties (THAs). We used a randomized cohort design to explore patient knowledge and retention and educational method at the point-of-care. We compared the current education method (paper) to video-assisted materials using pre and post-education …
Exploratory Clinical Assessment And Treatment Of Autonomic Nervous System Dysregulation Post Concussion: A Case Study, Megan Coker, James May
Exploratory Clinical Assessment And Treatment Of Autonomic Nervous System Dysregulation Post Concussion: A Case Study, Megan Coker, James May
Clinical Practice in Athletic Training
The physiological alterations in autonomic nervous system (ANS) function due to concussion are suggested to play a role in persistent post-concussion symptoms (PPCS). Currently, there are few objective and clinically feasible measurements to assess ANS vitality in patients experiencing PPCS. The following case study details an assessment and treatment protocol targeted towards regulating the ANS in an adolescent female suffering from PPCS one month after injury. Pre-intervention, patient-reported outcome measures (PROMs) used to assess perceived pain, anxiety, stress, and breathing function were administered as well as a physical assessment performed for breath function and vagus nerve integrity. The patient was …
Comparing Mental Health Between Ncaa Division Iii Student-Athletes Competing In Team- And Individual-Sports, Autumn Presley, Tiffany Franklin, Jeffrey Williams
Comparing Mental Health Between Ncaa Division Iii Student-Athletes Competing In Team- And Individual-Sports, Autumn Presley, Tiffany Franklin, Jeffrey Williams
Clinical Practice in Athletic Training
Mental health is a topic that has gained attention in recent years, but few studies have examined NCAA Division III student-athletes. Division III student-athletes are known to experience high levels of distress, and previous literature indicates there may be a significant psychological difference between student-athletes who compete in individual-sports compared to those who participate in team-sports. The purpose of this study was to explore mental health challenges (levels of depression, stress, and anxiety symptoms) among Division III student-athletes, particularly between those participating in team- and individual-sports. A cross-sectional survey design was used. The independent variable was group (team-sport athletes and …
Medical Disqualification As A Barrier To Healthcare In Military Service Members, Kaitlyn A. Jones, Joshua R. Jaime, Zachary K. Winkelmann
Medical Disqualification As A Barrier To Healthcare In Military Service Members, Kaitlyn A. Jones, Joshua R. Jaime, Zachary K. Winkelmann
Clinical Practice in Athletic Training
N/a
Anxiety And Depression Amongst Female Athletes, Dp Golden, Re Obmann, Em Moore
Anxiety And Depression Amongst Female Athletes, Dp Golden, Re Obmann, Em Moore
Clinical Practice in Athletic Training
Context: Anxiety (categorized by a feeling of fear, dread, and uneasiness) and depression (mood disorder causing feelings of persistent sadness and loss of interest in things an individual once loved) are two major mental health disorders effecting females considerably who participate in sport. Females are more likely to present with anxiety (55-60%)1 and depression (1.844 times)2 compared to males. The purpose of this study was to examine the prevalence between mental health comorbidities (anxiety and depression), across female athletes aged 18-40. Methods: An anonymous survey was distributed via snowball sampling using social media. Demographic data, Generalized Anxiety Disorder-7 (GAD-7), validated …
Effects Of Sex Hormones And The Menstrual Cycle On Knee Joint Laxity In Physically Active Females: A Critically Appraised Topic, Ae Eicher, Rj Gage, K Park-Braswell
Effects Of Sex Hormones And The Menstrual Cycle On Knee Joint Laxity In Physically Active Females: A Critically Appraised Topic, Ae Eicher, Rj Gage, K Park-Braswell
Clinical Practice in Athletic Training
Clinical Scenario: In recent years, females have exhibited increased physical activity and sport participation than ever before. Recent studies have identified a rising incidence rate of ACL injuries and indicate that the risk of ACL tears is greater in females than males. Knee laxity and physiological variation in women during the menstrual cycle have demonstrated increased ligament laxity, therefore, varying hormone concentrations may contribute to changes in ligamentous mechanical properties. Despite these findings, it remains unclear whether fluctuating sex hormone concentrations directly correlate to measurable changes in knee laxity. Clinical Question: How do fluctuations in sex hormones throughout the menstruation …
Individual Goal And Velocity Based Throwing Program For Collegiate Baseball Pitchers With Medial Elbow Injuries, Le Trail, Jm Cline, Ap Jacobsen
Individual Goal And Velocity Based Throwing Program For Collegiate Baseball Pitchers With Medial Elbow Injuries, Le Trail, Jm Cline, Ap Jacobsen
Clinical Practice in Athletic Training
Background: A 22-year-old male collegiate baseball pitcher experienced sudden pain in the medial left elbow following feeling a pop when pitching. The pitcher was removed from the competition and was evaluated with a point-of-care ultrasound at the conclusion of the competition. Ultrasound revealed an intact ulnar collateral ligament (UCL) and no edema. Differential Diagnosis: UCL sprain, Wrist flexor strain Treatment: The patient was referred to a primary care sports medicine physician for further evaluation. The physician found no tenderness or laxity at the UCL and ordered an MRI arthrogram for further diagnostic information. MRI revealed a grade II flexor digitorum …
Presentation Of An Accessory Navicular Bone In A Collegiate Women’S Field Hockey Player: A Type 3 Clinical Case Study, N Sutker, J Franco, K Mallory, B Hansberger
Presentation Of An Accessory Navicular Bone In A Collegiate Women’S Field Hockey Player: A Type 3 Clinical Case Study, N Sutker, J Franco, K Mallory, B Hansberger
Clinical Practice in Athletic Training
Background: The accessory navicular is an extra bone located posterior and medial to the navicular tuberosity. The prevalence of accessory navicular has been reported to be 4 - 21% in the general population though this anatomical variant may often be overlooked during differential diagnosis. This case presents a female collegiate field hockey patient that was initially diagnosed with a midfoot sprain but was later determined to have an accessory navicular bone which required surgical removal. Patient: A 19-year-old female Division I collegiate field hockey patient presented to the athletic training clinic with pain in her left medial foot. The patient …
Changes In Neural Excitability Following 6-Week Of Balance Training In Individuals With Chronic Ankle Instability, Sh Chung, J Freeman, Rs Mccann
Changes In Neural Excitability Following 6-Week Of Balance Training In Individuals With Chronic Ankle Instability, Sh Chung, J Freeman, Rs Mccann
Clinical Practice in Athletic Training
Context: Individuals with chronic ankle instability (CAI) often struggle with balance issues due to changes in the central nervous system (CNS). Specifically, difficulties in modulating spinal reflexive excitability and enhancing corticospinal excitability contribute to poor balance, indicating challenges in transferring control to supraspinal centers. A recent study found that a single session of balance training could positively impact the CNS, improving spinal reflexive excitability modulation and corticospinal excitability in CAI patients. However, there is limited research on the effects of long-term balance training on neural excitability in CAI individuals. Therefore, this study aimed to investigate the effects of a 6-week …
Chronic Neck Pain, Vasculopathy, And Pre-Syncope In A Young Adult: A Type 4 Case Study, Tn Crane, K Moore, A Field
Chronic Neck Pain, Vasculopathy, And Pre-Syncope In A Young Adult: A Type 4 Case Study, Tn Crane, K Moore, A Field
Clinical Practice in Athletic Training
Background: The patient is a 23-year-old college female presenting with chronic cervicalgia, bilateral upper extremity neurovascular symptoms, and insidious pre-syncope episodes over the past 3.5 years. Upper extremity neurovascular symptoms include bilateral numbness and tingling into the hands and bilateral throbbing arm pain originating proximal to the elbow and traveling to the fingers, which worsens with cervical rotation bilaterally. The patient has experienced 10 episodes of pre-syncope lasting less than 30 seconds that occur with cervical flexion, extension, or bilateral rotation. Pre-syncope symptoms include lightheadedness, blurry vision, increased neck/arm pain, headache, and malaise. Upon clinical evaluation, no obvious deformity, discoloration, …
Cyclops Lesion In A Collegiate Men’S Lacrosse Player: A Type 4 Clinical Case Study, K Powers, R Moen, G Siarkas
Cyclops Lesion In A Collegiate Men’S Lacrosse Player: A Type 4 Clinical Case Study, K Powers, R Moen, G Siarkas
Clinical Practice in Athletic Training
Background: In late July 2023, a 20-year-old male division I lacrosse player reported to the Athletic Training clinic with pain, swelling, and an inability to fully extend his left knee. Evaluation revealed an extension deficit of 5 – 10° during active range of motion (ROM). The patient had previously undergone a double-bundle procedure to repair a torn anterior cruciate ligament (ACL) in his left knee in November 2022. Following this surgery, the patient completed a standard but conservative ACL reconstruction (ACLR) rehabilitation program as prescribed by the sports medicine team but switched to a light strength training regimen on his …
How Comorbidity With Adhd Impacts On Neurocognitive Performance In Adolescents After Sport-Related Concussions: A Scoping Review, T Chiba, Dm Emerson
How Comorbidity With Adhd Impacts On Neurocognitive Performance In Adolescents After Sport-Related Concussions: A Scoping Review, T Chiba, Dm Emerson
Clinical Practice in Athletic Training
Context: The number of sport-related concussions (SRCs) is higher in adolescents than in other age groups and accounts for 32% of concussions. Athletes with attention-deficit hyperactivity disorder (ADHD) have a higher risk of previous history of concussion and future concussion risk compared with those without ADHD. People with ADHD present lower baseline scores of neurocognitive performances compared with those without ADHD. Neurocognitive deficits after SRC lead to increase risk of musculoskeletal injuries or another concussion after return to play (RTP) and affect RTP process. There is no consensus regarding the management of SRCs for those with ADHD. This scoping review …
A Qualitative Study Evaluating Athletic Trainers’ Self-Perceived Knowledge And Knowledge Acquisition Of Concussion Biomarkers, Kgs Swindell, T Mccormick, Jm Allen
A Qualitative Study Evaluating Athletic Trainers’ Self-Perceived Knowledge And Knowledge Acquisition Of Concussion Biomarkers, Kgs Swindell, T Mccormick, Jm Allen
Clinical Practice in Athletic Training
Context: Rapid movement of the brain caused by a concussion can damage brain cells and create chemical changes within the brain, which may cause lasting neurological, cognitive, and behavioral symptoms. It is suggested that following a trauma, biomarkers can be released which may be useful in accurately diagnosing concussions. Potential biomarkers being studied include β-amyloid peptide 42 [Aβ42], S100 calcium-binding protein B [S100B], glial fibrillation acidic protein [GFAB], microtubule-associated protein 2 [MAP2], and 2’,3’-cyclic-nucleotide 3'- phosphodiesterase [CNPase]. This study focuses on evaluating AT knowledge and awareness of biomarkers, with sub-analyses evaluating ATs’ perception of current knowledge of biomarkers, and the …
An Investigation Of Lower Extremity Injuries In Soccer Athletes Related To Their Playing Environment, Ak Whitlock, K Francis, H Maloney
An Investigation Of Lower Extremity Injuries In Soccer Athletes Related To Their Playing Environment, Ak Whitlock, K Francis, H Maloney
Clinical Practice in Athletic Training
Context: The goal of this study was to investigate a connection between cleat type, surface type, and increased lower extremity injury rates in soccer athletes. Our hypothesis was that the cleat model, surface type, and facility affected the lower extremity injury rate among soccer athletes. Methods: A review of survey results distributed to the male and female soccer from an NCAA D-I program was completed. The survey investigated athlete injury history related to the specific shoe worn and the field surface information where the injury occurred. Measures of central tendency were calculated. Data was analyzed using a correlation analysis with …
Anaerobic Capacity And Lower Body Strength Deficits Related To Thermal Protective Gear In Rural Volunteer Firefighters, J Diggins, R Shagena, T Patrick, A Catanese
Anaerobic Capacity And Lower Body Strength Deficits Related To Thermal Protective Gear In Rural Volunteer Firefighters, J Diggins, R Shagena, T Patrick, A Catanese
Clinical Practice in Athletic Training
Context: Firefighting is a dangerous job with occupational hazards, strenuous shifts, and increased work- related fatigue that contributes to risk of injury. The weight of thermal protective gear (TPG) may increase neuromuscular challenges while on-duty. The purpose of this study was to investigate the influence of TPG on volunteer firefighters’ anaerobic and lower body strength performance. Methods: Nine healthy males (mean±SD: age= 41±9.3 years; ungeared body mass= 96.47 ± 14.51kg; ungeared height=181.67 ± 4.48cm; VFF experience 8 years) participated in a cross-sectional correlation study during three visits to a university research laboratory. Participants’ TPG included thermal pants, jacket, boots, and …