cte - a modern sporting crisis - patrick o'farrell

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CTE A Modern Sporting Crisis

Patrick O'Farrell

ThinkQuest 2014 !!!!

!1PATRICK O'FARRELLCTE: A MODERN SPORTING CRISIS

Contents !1.Introduction 3 !2.CTE 5 !3. Tau 10 !4. Examples 13 !5. "Macho" Culture & The Nature of Sport 36 !6. The Coverup & The Lawsuits 45 !7. Solutions 49 !8. Survey 60 !9. Awareness Campaign 89 !10. Conclusion 94 !11. Bibliography 96 !


1. Introduction Sport

Around the world sport has been ingrained into culture and has evolved with civilisations into a celebration of ability, passion and the will to win. We see it in the despair brought about by defeat, the smiles on the faces of young fans and the dedicated attitude of tragics and veterans of the couch or the pitch. An athlete retiring is often mourned as the loss of a loved one. Sport is for everyone, all shapes, all sizes. Rugby, running, soccer, gridiron. !Australia has built itself up as the "sporting" nation, from outstanding international athletes to each weekend containing a match or race of some form. In America, Thanksgiving is celebrating with a turkey and watching "America's Team" the Dallas Cowboys play in the NFL. Furthermore the Olympic "Dream Team" has left a legacy in the sport of basketball none will forget. And of course the football in South America and Europe that some would value as highly as oxygen, which never fails to create mass hysteria. !Sport has become a big business, morphed from the purity of athletic endeavour. Athletes are glorified as fighters, as gladiators and warriors who charge into battle each week for the people they represent. Crowds flock to colossal stadiums, they cheer for their team and jeer the opposition, sometimes even officials. Fans beg and plead for downed players to get back up after substantial contact and has created a creed among players to fuel the passion and return to the action, meet the “expectation” of their supporters and their contract. Those who are able to tolerate horrific injuries and jarring blows are hailed as heroes.


The futuristic AT&T stadium, home of the NFL's Dallas

Cowboys, can host a maximum of 105,000 screaming fans to watch

one American football match.

Despite the glory and wonder of sport, it has been ravaged multiple times by drugs, corruption and violence. We have seen regimented programs of substance abuse completed, almost, flawlessly by sporting organisations and individuals. It has called into question whether the talent we see is natural or manufactured. Thus we see meticulous testing at major sporting events and within competitions and leagues. Regardless, the activities of sporting clubs, such as the Essendon Bombers and Lance Armstrong took some years to uncover.

!Furthermore we have seen racial inequity seep into the sporting venues in which all who participate are supposed to be held in the same regard. Today the image of Jesse Owens' mistreatment and of monochromatic South African sporting teams conjure bitter memories of archaic and shameful ideologies that infected simple human competition. In a similar vein is the exclusion of women from participating in or spectating sport. !Sport has had many tragedies, Hillsborough, in 1989, saw 96 people of all ages lose their lives at a football game, and the subsequent masquerade of the damage was just as tragic. The infamy of the 1972 Olympics will be eternalised as hosting some of the darkest days sport will ever see and people will forever remember Jim McKay's harrowing words, "They're all gone".

!Sport has been through corruption, injustice and tragedy, however it has come to light that a new chapter may be unfolding in the history of sport. CTE. !!!!


Lance Armstrong, champion cyclist, was stripped of his seven Tour de France titles after he was found to have participated in a

blood doping program.

2. CTE Chronic Traumatic

Encephalopathy

The effect CTE has on the brain, extreme shrinkage is clear. !The Term Despite its length, and polysyllabic nature, the term is quite easy to understand if it is broken into its medical terms. !Chronic Something that is "chronic" persists for a long time. It frequently and constantly recurs. People who have chronic conditions are rarely without pain. There are many types of chronic conditions. Alzheimer's is one, lung cancer another, as well as arthritis.

!Traumatic The trauma is an injury to living tissue caused by an extrinsic agent, something that comes from outside. In the case of these athletes it is an opponent's shoulder or the ball. It is being hit or struck.

!


Encephalopathy This is the degeneration of brain function. It can be caused by a range of disorders and can lead to a wide variety of symptoms.

!Together Basically CTE is a disease of the brain that leads to its degeneration. The disease is caused by multiple concussive and sub-concussive blows to the head. This causes a protein called tau to form. The "tangles" of this protein lead to CTE's symptoms as they impair brain function. At this point in time the damage is permanent and irreversible.

!With understanding of the term it is now possible to describe the disease with more depth and provide further information about it. !!What it is When people saw retired boxers who struggled to get around, suffered from early onset dementia, speech impairments, cognitive impairments, what they suffered from was coined "Punch Drunk Syndrome", however there was a lack of scientific knowledge about it. Now, we know much more... !As stated previously this is a degenerative disease that is caused by blows to the head and has certain symptoms that impair brain function. Without proper brain function, people cannot live normally and their lives begin to deteriorate. The symptoms of this damage are shocking and horrifying. !!!


Boxing was the first sport in which CTE became

identifiable, due to the multiple blows to the head

and face.

The people who are affected by this disease become unrecognisable to their friends and family, not physically, but mentally, socially and emotionally. They begin to suffer from memory loss, confusion, amnesia and progressive dementia. They forget things, memories dear to them are lost, others see a loved one fading away.

!But there is more. Impulse control problems and impaired judgement also come to the fore. Sufferers lose control. Many fall into bankruptcy and debt. They develop gambling, alcohol and drug problems. They become unable to make the right decisions and the decisions that they would normally make. !

Even further is the development of Parkinsonism (Parkinson's disease) and potentially ALS (Lou Gehrig's disease). Although this link is not thorough, investigation has proven the possibility of this connection. !Finally aggression, anxiety, depression and suicidality are also symptoms. People with this disease become shadows of their former selves, forced into dark depressions as their world crumbles around them. Many result to violence. Calm and humble people begin to abuse and hurt partners and friends. Finally the sad fact is that many these people take their own lives as a result of this disease !So, this disease is clearly much more than a simple degenerative brain disorder. It is a disease that tears lives apart. It leads to the sharp spiral of stable, outgoing individuals into abusive brutes. It could also lead to motor neuron disease and most certainly leads to premature death. !!!


Many sufferers are forced into bankruptcy due to alcoholism

and gambling.

Causes and Who it Affects Currently it is believed that CTE is mainly caused by repetitive blows to the head. This could be concussive blows or subconcussive blows. The constant knocks cause an abnormal form of the protein tau to form, which blocks brain function and causes the symptoms mentioned above. !Sport, particularly professional sport is a key catalyst for CTE, Thus athletes are especially susceptible to the disease. High powered athletes charge at each other. They face all kinds of contact. Direct headclashes, jarring connections between knees and heads, limbs hurled; hoping for a knockout. Caught in the crossfire of the adrenaline fueled contests and pride filled fisticuffs a body that, sometimes, simply cannot bear it is caught in the middle.

!Another demographic that has been found to suffer from CTE, besides athletes, is soldiers. The blast of a bomb or an explosion can cause concussion and severely damage the brain. The air displaced by an IED (Improvised Explosive Device) after the initial blast, in the secondary "blast wind" can move at 530 kilometers an hour. Category 5 hurricanes have wind speeds of 250 km/h. !


Athletes face immense hits and blows to the head as part of their occupation, often it will lead to concussions.

Thus we are now seeing athletes suffering from this debilitating illness, often years after they have finished playing, struck by it in the aftermath of years of hard hits and blows. 73 out of 75 cases studied by the Boston University School of Medicine have tested positive for CTE. Examples of these people are in section four. !At least that is how it has been up until recently. Today some victims are appearing at a much younger age, even at eighteen. But why is this? I believe it is because the nature of sport has changed. I develop this theme further in section five. !Science still has questions to answer in regards to this disease, not all people who suffer concussions will develop CTE, yet some who have never suffered concussions may. The pathological causes of CTE and what a concussion is are covered in the next section. !!!!!!!!!!!!!!!!!!!


3. Tau The Science of CTE

!Protein Protein starts with your DNA. The DNA codes for RNA, this in turn is used to produce amino acids. A string of amino acids is a polypeptide and when these connect you have protein. Thus if there are issues with your DNA you may not produce the correct protein or the correct amount of protein or any of the protein that is necessary for bodily function. Protein codes for hormones, enzymes and other chemicals your body uses so that you can get by everyday. Protein functions to maintain homeostasis in your body, keeping it in a stable and steady condition. If you start bleeding a protein called factor 8 is secreted to clot the blood and prevent the bleeding, to preserve the original state of the body. Protein is extremely relevent to CTE as it comes about when a certain protein changes into an abnormal state. !!Tau Protein Tau works in the body as a regulatory protein for neurons (nerve cells). It is in the lining of the cell and is important for its regulation and maintenance. In CTE it is in an abnormal form. It is hyperphosphorylated, meaning too much phosphate has been added to the cell. Phosphate is needed for mitosis (the division of cells) as it regulates the pathways in cells. This overload of phosphate leads to neurodegeneration as the cells cannot deal with the mass intake. This in turn leads to neurofibrillary degeneration. This is when fibres, called filaments, appear in the brain. The filaments, formed by the abnormal, hyperphosphorylated tau create tangles. These tangles block and impair brain function. This is similar to other


DNA acts as the guideline for protein production, without it protein could not

be produced.

diseases, such as Alzheimer’s Disease and Supranuclear Palsy, thus the symptoms overlap. However the tau patterns in CTE are unique, making it distinct from the aforementioned diseases. It is more widespread throughout the brain and is in different areas, such as the amygdala, hippocampus and thalamus. The hyperphosphorylation is caused by glycosylation, which is when glucose attaches to protein molecules.

CTE is also accelerated by concussions. Concussions can cause axonal injury, damage of the axon, the body of the neuron. This allows for the degeneration of cerebral white matter, the pathway for electrical impulses between cells in the brain. Thus causes synapses to not work properly. A process called excitotoxicity occurs. Receptors are over stimulated and release excessive amounts of a neurotransmitter called glutamate. It causes an uncontrolled entry of calcium into neurons, killing them. Concussions can also lead to gliosis. Gliosis is the “scarring of the central nervous system”. In the part of the brain that has been injured glial cells congregate, as they are responsible for clearing away dead neurons. It creates a fibrous glial scar. !!!!!


The comparison of sections of a normal brain with those affected by tau and CTE.

The areas that are brown have a buildup of tau and dead neurons.

Concussions can lead to the breakdown of communication in the nervous system, through damage to white matter, excitotoxicity and gliosis. Glycosylation relies on communication between neurons. If there are issues with this, it could lead to the hyperphosphorylation of tau, leading to the neurofibrillary tangles and CTE. !!The Science of Concussions Many sports are plagued by concussion, even those considered to only have partial contact. Between 2012 and 2013 in American high schools there were 153,000 concussions in American football, 100,000 in soccer and even 29,000 in basketball. Concussions are hard to recognise. They have certain symptoms that athletes can try to mask and they seldom appear through imaging and scans. !A concussion is an injury to the brain. It occurs when the skull collides with something. The brain continues on its course of motion, due to inertia, and hits a wall of the skull; this is called a coup injury. The brain may rebound and hit the opposite wall of the skull, causing a contrecoup injury. The contact with the skull can cause blood vessels in the brain to tear. It can lead to blood clots and bruising. This in turn leads to swelling, which impairs speech, behaviour and breathing. Playing through a first concussion increases the likelihood of a second one. !Some may question how concussions can occur in American football players at such a high rate if they are all wearing helmets. This occurs because the helmets that they wear are designed to protect the skull, not the brain within. This is much the same with the headgear that is worn in rugby union and league. Furthermore often in gridiron the helmet is used as a battering ram, putting the head in the line of fire in regards to contact. Wearing headgear can give rugby players the confidence to put their head wherever they please. This is dangerous as they can still be injured and are putting themselves at greater risk of injury.


A diagram to illustrate what occurs in a concussion, the coup and contrecoup are

labelled.

4. Examples The Faces of CTE

!Example 1: Brett Favre

While he played American football Brett Favre embodied one of the most important, yet one of the most difficult abilities for any professional athlete to possess, being injury free. He holds the record for most consecutive games started, 297, excluding playoff games. To put this into perspective that is more than 18 seasons and is essentially two seasons ahead of the player in second place. Because of his longevity as a player Favre holds over eleven NFL records and already has a place reserved in the NFL Hall of Fame. !However, as he has discovered now, every rose has its thorn. Favre’s incredible record for consecutive starts was achieved by playing through injury, often. The most common injury he suffered was concussion. When asked how many games he would have missed, had the current concussion policy been implemented the simple, however frightening, answer was, “A lot”. Recent memory lapses, including forgetting time spent with his eldest daughter are beginning to reveal that he could be suffering from CTE and reveal that even the “Iron Man of the NFL” is susceptible to this degenerative illness. Playing through injury is a double-edged sword. Whether it be a fracture or a concussion, the greater the time spent playing on the greater the damage and risk for additional harm to be done.


Example 2: Jovan Belcher

Jovan Belcher was a linebacker for the Kansas City Chiefs. He was an outstanding athlete, an All-American (an honorary team in American college sport) for wrestling and for American football. Furthermore he graduated from university with a degree. Finally he partook in the NFL’s “Play 60” initiative, he gave back to the community. Due to a successful season throughout 2012 it appeared that his career would soon take flight. !On the 1st of December 2012 he murdered his girlfriend, Kassandra Perkins, before driving to the Chief ’s training facility and committing suicide. This is a drastic turn from the man who was a strong student and returned to his old high school to give pregame speeches. The hysteria from the event rocked the NFL, was devastating for every member of his team and of course his family. Nobody was able to deduce why he had done it. He had been found to be double the legal alcohol limit at the time of his death, however his mother asked for his body to be exhumed and filed a wrongful death suit, she wanted his brain to be tested for CTE. When the test results came back it was discovered that Belcher did indeed suffer from CTE. Some of the symptoms of the disease, as mentioned previously are, unpredictable mood swings and uncharacteristic aggression. Thus CTE is a potential reason for why he committed this act. !


This is a key example of why it is imperative that children and parents know that CTE exists. This man was only 25, he did not have the years of suffering head knocks in the NFL like Brett Favre, however he had played gridiron since he was young, when his brain was developing and at its most vulnerable. If the measures for awareness of the dangers of head knocks were available lives could well have been saved. !!!!!!!!!!!!!!!!!!!!!


Example 3: Mike Webster

!!!!!!!!!!Mike Webster played at the centre position from 1974 to 1990. At college he was an honors student, after 16 years in the NFL “Iron Mike” was inducted into the Hall of Fame in 1997. He started 150 consecutive games, played in nine Pro Bowls and won the Superbowl four times. There is not much more a gridiron player could ask for. !The line of scrimmage is the most brutal location in American football. It’s where the biggest men are. Often they are "man eating monsters" but Webster was intelligent. The quarterback is the person who is the leader on the field for the offense, but, oddly, often Mike would turn around, after seeing something in the defense and tell this leader to change the play. At home the most important thing to him was family and he was extremely humble and outgoing. But when his career finished Webster declined quickly. He fell victim to dementia and depression and his life fell apart. He would use a Taser to shock himself into unconsciousness, lived out of his pickup truck and fell into bankruptcy. He died at the age of 50. There had to be an explanation for the disaster. !Thus during the autopsy Dr Bennet Omalu discovered CTE, this is further explained in section six. !


!Example 4: Tiaina Baul "Junior" Seau

! Junior Seau was one of the most popular players in the NFL and came to be the face of San Diego, he played for 20 seasons, a linebacker for the San Diego Chargers and New England Patriots. He was an All-American and went to the Pro Bowl twelve times. !He was a brutal player and many described him as a “larger than life” player. His teammates say that he surely had multiple concussions but he was never reported as having one. After two decades of having his head and body battered and smashed when he retired Seau’s life began to fall apart. He struggled with gambling issues, had severe behavioural changes and suffered from depression and amnesia. One night he was found by his son sitting on his bed simply staring at a blank television screen. There was no explanation for his harrowing downward spiral. It ended with his suicide in 2012. As soon as he passed away Dr Bennet Omalu asked to have Seau’s brain tested for CTE. The NFL interfered, however, in the end, he was diagnosed with CTE. !!!!


Example 5: David Duerson

!!!!!!!!!!!!Dave Duerson primarily played safety for the Chicago Bears. Altogether he played for ten years. He was renowned for his vicious and tenacious style of play. After his playing days he made it clear of his attitude towards how the game should be played. “There is nothing like hearing the air rush out of another man”. !The man who graduated from Notre Dame University with honors and was an All-American began to decline around 2006. For the following five years his life would fall apart. He struggled to speak, his memory faded, his wife left him and his business was forced into receivership. !On February 17th 2011 Duerson committed suicide, he shot himself in the heart and left a suicide that read, “Please, see that my brain is given to the NFL’s brain bank”. Soon after his death he was found to have CTE and “no other disorders”. !!!!!


Example 6: Ray Easterling !!

!!!!!!!Ray Easterling played safety for the Atlanta Falcons between 1972 and 1979. He was a key part and a leader of the “Grits Blitz” in 1977, the defense that allowed the fewest points in NFL history. In 1978 he suffered a serious elbow injury that in his final season caused him to tackle and lead more with his head than his arms and shoulders. !However after his career he suffered from dementia, insomnia and depression. His dementia began at around the age of 40. His wife, Mary Ann believed it was brought on by concussion that were undiagnosed, ignored or too lightly treated. People described him as “not thinking right”. Often he would forget how a conversation came to its current topic. Furthermore he transformed from being a bright, happy, successful businessman to a mere shell of this. In 2011 he joined the court case, along with fellow players accusing the NFL for damages. In 2012, at the age of 62, he committed suicide. After his death the medical examiners report found he his brain had signs “consistent with Chronic Traumatic Encephalopathy”. !!!!!!


Example 7: Tony Dorsett

Tony Dorsett was a superstar coming out of the University of Pittsburgh. To begin he was the first freshman in 29 years to be named an All-American. In 1976 he won the college national championship. He won the Heisman Trophy, the ultimate achievement for a college football player, the best player for that season. Finally he broke the NCAA (National Collegiate Athletic Association) record for rushing in a college career. !He was drafted by the Dallas Cowboys with the second pick of the 1977 NFL Draft and instantly became a force to be reckoned with. He played twelve seasons before finishing with the Denver Broncos. In the NFL he won the Superbowl in 1977, was the rushing champion, holds the NFL record for running 99 yards for a touchdown, played in five NFC championship games, was elected to the Pro Bowl four times and is now a Hall of Famer. !However this has changed now, much like Brett Favre he is one of few people to be diagnosed with CTE while living, from certain signs and symptoms he has displayed. He is prone to outbursts at his wife and daughters, he has been diagnosed as being depressed, at his lowest moments he has had suicidal thoughts. In fact the day that he caught a plane to have his brain tested for CTE he could not remember why he was on it. !!!!


Example 8: Kurt Warner

Kurt Warner was an unlikely superstar. He first earned a starting position at quarterback at age 27, with no NFL history and unproven in the sport’s most prestigious competition, he had played Arena Football for a year previously. However when he was given the opportunity he exploded. The yards he threw for were ridiculous, the number of touchdowns soared, no wonder the combination of Warner, Faulk and Bruce led to the nickname, “The Greatest Show on Turf ”. Each game was more than a game, it was a performance, genuine entertainment. Of course in 1999 the team Warner played for, the St Louis Rams, won the SuperBowl with him at the helm as MVP. He would return two more times, losing both and played through until he was 37, when he started to struggle with injury problems, particularly concussion. !Kurt Warner doesn’t show signs of CTE, no slurred speech, issues with memory or behaviour. Instead what he has said is intriguing and he is not the first one to say it. He sees his children playing football as a “scary thing” and prefers that they don’t. It’s rather strange because football was Warner’s life. It was his job, his love. He worked his way through the ranks from the bottom, working $5.50 an hour at a supermarket and then going to practice to being league MVP… twice, most people don’t even win it once! He has been called out by Amani Toomer, one of his wide receivers at the Giants who called it “disingenuous” for the same reasons. Of course just because you have not played the game as a child does not mean you cannot make a career out of the sport. For example. Tom Brady, the superstar quarterback of the New England Patriots, was held out of football by his father until he turned 14.


Example 9: Owen Thomas

Owen Thomas played guard for Pennsylvania University and had played football throughout his childhood. He was a well-rounded person to be at an Ivy-League school and on their football team. !The day after Thomas was named Penn’s football team captain he committed suicide. The fact was nobody knew why. He had previously called his parents telling them he was stressed, worried, thought he might fail some of his courses, but otherwise he was fine. However his brain was donated to Boston University and he was found to have CTE. Owen Thomas had never suffered a concussion and although his parents believed he would be one to play through it, he had never once complained of having a headache. Doctors place it down to a multitude of subconcussive blows in his playing time. !The scariest thing about this case is that it sheds light on a susceptible demographic that many researchers had not considered. Youths and adolescents, rather than retired and ageing players. As our brains develop they are more susceptible to change, particularly chemical change, as we see with puberty. However CTE and constant hits provide this chemical imbalance as the tau protein becomes abnormal. Should extra precautions be taken around children and young adults playing contact sports? !!!!


Example 10: Kenny Nuzum

Kenny Nuzum was an Irish rugby union player for Landsdowne rugby club. He played for the team from the time he left school at 18 until around the age of 50. He became a legend in the club scene and it is believed only his lack of discipline stopped him from playing at a higher level. !During the time in which Nuzum played rugby, the 70’s and 80’s, the game of rugby was a lot less controlled and was not managed as well as it is today. The process of a scrum is very cautious and smooth, however previously it was a brutal head-on collision. Often the front row would clash heads at immense force as they were driven into each other. Players like Nuzum were even known to deliberately head-butt opposition props in the scrum to scare them. Nuzum was known for enforcing a brand of rugby few had ever seen before, extremely physical and extremely brutal. !Around 2006 Nuzum’s life began to fall apart. It began with memory issues. Struggling to remember contracts and clients of the business he ran with his son. Eventually it was decided to have him diagnosed. He was found to have PSP (Progressive Supranuclear Palsy), a disorder causing issues with co-ordination and balance. He would go walking and fall over, get lost, call his children hopelessly upset, confused. In 2013 he developed pneumonia and died of multi-organ failure. After his death it was discovered he suffered from CTE. The pathologist at his autopsy described his brain’s condition as “ten times worse than any PSP”, the tau deposits were everywhere, even in areas uncharacteristic of PSP.


Example 11: Barry “Tizza” Taylor !

!!!!!!!Barry Taylor began playing rugby union at age 10. He was a scrappy player, involved in all tackles, all contests and never backed down on the field. If he could still run, he could still play, nothing would stop him. He played 235 games for Manly and went on to coach the NSW Waratahs, after 19 years playing the game. Of course this plan of action on the field often put him in harm’s way, as his wife Enid puts it simply, “Tizza was concussed many, many times and just played through it”. !When he reached the age of 57 he began to disintegrate. When his condition worsened at age 60 his family simply thought he was becoming “a cranky old man”. As time went on his outbursts of anger became more severe and more erratic. His dementia intensified. His son, Steven, recalls taking him for a walk and asking him, “What’s your name?” The reply was a shrug of the shoulders. Eventually it got to the point where he forgot what he did each day. He passed away in April of 2013 !After his death his brain was donated to Boston University, becoming the first Australian to be tested for CTE. When the tests were conducted he was found to have CTE. !!!!


Example 12: Liam Fulton

Liam Fulton played in the NRL for Wests Tigers for a number of years at the lock position. After an excellent junior career, including playing for the Australian Schoolboys side, he was ready for the NRL. He played well throughout his time, often putting his body on the line for the team. He was commended by teammates such as Benji Marshall for his dedication and led the Tigers in tackles for the 2013 season and was also awarded “Best and Fairest” and the “Player’s Player” award for the club. !Despite this success this season, 2014, was his final, as his career was cut short abruptly, due to a plethora of concussions, four in six games played. For this reason he made the difficult, however brave decision to retire from the game he loved. He had begun to suffer from headaches, dizziness and short term memory loss. Knowing the responsibility he had to his family he made this decision. !Fulton did not make the decision alone. After trainers and doctors warned him of the threat his future could be at, particularly in regard to his mental health and family, he retired. He received condolences from many players throughout the NRL. Furthermore an ice hockey player by the name of Kerry Goulet gave him support, who understood the aid a player required in this time and commended Fulton for making the difficult but correct decision. Goulet had also suffered many concussions in his time as an ice hockey player. !


Example 13: Kyle Turner

Kyle Turner was a rookie this year, 2014, for the South Sydney Rabbitohs, after a successful season playing NSW Cup. !Here’s what’s special about Kyle Turner. He has suffered six concussions in the last twelve months and he is still playing. He played in the Grand Final this year even though there was serious doubt in regards to the issues with his head. During the season he started wearing headgear and was concussed playing against the Roosters, the week before the final. The fact that he took the field shows a lack of care and responsibility by his club and by the league, especially given the “crackdown on concussion” that had been preached before the season started. When Christopher Nowinski from the Sports Legacy Institute saw the information he said he was, “sickened that Kyle Turner would be cleared and asked to play again. In America he would have been shut down for an extended period of time after the third concussion and retirement would have been discussed after the fourth in a year”. !Kyle Turner when asked about his condition, believes that concussion is a part of the game. He’s right they are, however his participation after six in a year should not be part of any game. !!!!!


Example 14: Karmichael Hunt

Karmichael Hunt has played all but one of Australia’s major football codes. He has played rugby league for the Brisbane Broncos, and made it to State of Origin (New South Wales vs Queensland in a three match series) as well as the international level. He has also played AFL for the Gold Coast Suns. In 2015 he will be playing rugby union in the Super 15 competition for the Queensland Reds. His ability to play at the highest level across a variety of sports define him as a stellar sportsman. !When he played rugby league he was renowned for playing with an aggressive style. Always looking for contact and running the ball hard. Due to his tendency to run the ball back he often suffered head knocks and concussions, he cannot remember parts of some of the games he has played in, particularly his Test debut for Australia. During his time in the AFL he had a final season that was plagued by concussion. At one point he suffered “three head knocks in 30 minutes.” He returned a week too early and while playing he struggled to see the ball and had to be taken off of the roster for a number of weeks. !Despite what he now knows about the damage that all of the head knocks could be doing him Hunt has stated that he would not play the game differently, even if he could go back and change it. As he loved the physicality of football he was also quite unsettled when the NRL outlawed the shoulder charge. !!


Example 15: George Smith

George Smith played rugby union in the Super 12 (now the Super 15), the provincial rugby tournament between the best Australian, South African and New Zealand sides. He played for the ACT Brumbies for a collective 12 years and the Wallabies as a flanker. He was picked for Australia soon after his first appearance for the Brumbies. He was the first player to receive the John Eales Medal (2002) and the first player to receive it twice (2008), the John Eales Medal is the greatest award for an Australian rugby player, signifying they were the greatest player in the nation for that year. !George Smith made a dramatic return from Japanese rugby to play for the Wallabies when the British and Irish Lions toured in 2012. In the match that clinched the title for the Lions, Smith was concussed mere minutes into the game. He was completely dazed. He had to be walked off of the field by trainers and meandered to the sideline. Within five minutes of the hit he had returned to the field, after taking a sideline concussion test and being cleared to finish the match. He was ineffectual for the rest of the match due to his injury-hindered state. There was great outcry from sports reporters and rugby officials around the world following the match. No concussion can be diagnosed and as Peter Fitzsimmons rightly stated, “In what other field of employment would an employee who had just suffered a major brain trauma be allowed/encouraged to get back to it five minutes later?” This statement highlights the ridiculousness of what professional athletes are forced to subject themselves to when they play their sport in regard to playing through injury. George Smith is a perfect example of how ineffective the administration of the Pitchside Suspected Concussion Assessment (PSCA) is. !


Example 16: 2014 NRL Grand Final

The NRL Grand Final was a historic day for South Sydney Rabbitohs fans and a day of great celebration, after breaking a 43-year drought without a premiership after their 30-6 victory over the Canterbury Bulldogs. It was a poignant win for South Sydney player Sam Burgess as it would be his final match for the cardinal and myrtle before returning to England to continue his rugby league career in the Super League competition. !However the grand final was plagued by a silent concussion scandal before and during the match. Prior to the game’s commencement it was found that rookie Kyle Turner would play in the match. A young man who had suffered six concussions in a twelve-month period. The fact that he played was ridiculous. Furthermore on the very first tackle of the game, Bulldog James Graham tackled South Sydney lock, Sam Burgess. Graham frequently leads with his head while tackling and a head clash ensued. Burgess fractured his cheekbone and his eye socket in the collision yet continued to play the full eighty minutes of the match. It was later discovered that the injury could have potentially led to blindness if he had suffered another aggressive hit. Furthermore it is believed that Burgess suffered a concussion as he stated that he could hardly remember the game in the days following. His brother George Burgess was concussed, “passed” the sideline concussion test and returned to the field. Finally South Sydney player Dave Tyrrell was taken to hospital after none other than James Graham knocked him unconscious.


Example 17: Daniel Bell !!!!!!!!!Daniel Bell played in the AFL, Australian Football League, for the Melbourne Demons. His career was relatively short, lasting eight years. He played in the backline, the defense of an AFL team. !Throughout his career, even as a child Bell was frequently concussed. The concussions began to manifest into vision, memory and concentration problems. These occurred at all times, not just when Bell was playing AFL. After the 2010 season Bell did testing on tasks with a neuropsychologist. It was discovered that his ability in areas such as memory, concentration and task switching were all below average. It was believed he had already suffered brain damage. He was advised to never play football again, so as not to further damage his brain. In March 2011 he announced his retirement. !Daniel Bell’s situation raises questions about the dangers of sport and also is important for highlighting the dangers of concussion to people who are unaware of the damage that they can do. !!!!!


Example 18: Robert Probert !!!!!!!!!!Robert Probert played in the NHL (National Hockey League) for seventeen years as a feared enforcer around the league. Throughout his career he was renowned for being a tough guy and a fighter. He participated in over 200 fights with other players on the ice throughout his career of 935 matches. He is fifth on the all time list of players to receive the most penalty minutes with 3300, penalty minutes is time spent off the ice for an infringement of the rules, fighting is considered an instant major penalty and the player involved receives five penalty minutes. He was half of the pair known as the “Bruise Brothers”, which consisted of himself and Red Wing teammate Joey Kocur, one of their slogans was “Real men drop their gloves”, implying that they fight. !Probert died of a heart condition in 2010. His brain was transported to Boston University and he was found to have CTE. However it was a relatively minor case. He would only briefly have fits of road rage and forgetfulness and Dr Cantu of Boston University noted that Probert’s CTE was not as severe as the cases studied in gridiron, however it was important discovery that it was in the brain of another hockey player, following the diagnosis of Reggie Fleming. !One thing to make mention of is that in the case of Robert Probert researchers are unsure whether his CTE stemmed from the way he played ice hockey or from the immense amount of fighting that he did on the ice. !


Example 19: Derek Boogard !!!!!!!!!!Derek Boogard was an enforcer in the NHL. He played for the Minnesota Wild and the New York Rangers and earned the nickname, “The Boogeyman”. He was a player known for sticking up for his teammates and often defending them. There was an incident when he was younger in which a riot broke out on the ice. He ran to the opposition bench and proceeded to brawl with members of the team on his own. He was ejected from the game, however after it a junior hockey team approached him, a pathway for him to be noticed by NHL teams. When he reached the NHL teams expected and relied on his fighting and aggression to come out frequently in games. Because of this he partook in at least 61 fights in 277 NHL games. !However as seasons bore on the nature of his play began to take a toll on his body. He had multiple teeth knocked out and was prescribed multiple painkillers by team doctors. He was found dead in his apartment due to a combination of drug overdose and alcohol abuse. Later he was diagnosed with CTE. He was unrecognisable to players when he returned from drug rehabilitation for an addiction to prescription drugs. When he returned from this his personality and demeanour had become blank and expressionless. It could have been the preliminary signs of CTE. !The scariest thing in regard Boogard’s CTE is that he was diagnosed with it in the prime of his career.


Example 20: Ryan Freel

! Ryan Freel played in the MLB (Major League Baseball) for a number of years, after breaking out of the minor league following years as a standout player. He was nimble, stealing many bases, running to second base before the pitch is thrown, and extremely energetic. Always fearing being cut and dropped back down to the minors. Whenever he had the opportunity to play he took it. He frequently battled with depression and bipolar disorder on the occasions that he was. He committed suicide with a shotgun in December 2012 and was later diagnosed with CTE. !He excited spectators, players and commentators with his all-out style of play. As previously mentioned he would steal bases, slide into the clay and run into the walls that border the outfield to take catches. He put his body on the line for the sport that he played, always looking to contribute for the win. Of course the result was his diagnosis. His former wife, Christie Freel believes that Ryan would have played the way he did even if he knew he would develop CTE. !Baseball is a relatively contactless sport, however Freel still managed to contract CTE. It was Stage II CTE, which is not as severe as that sustained by many of the gridiron players in this section. Freel sustained concussions from running into other players, sliding into bases and being hit in the head with the ball. The fact that there is minimal contact raises questions about whether players of sports such as cricket could develop CTE. !


Despite the fact that this is a rather isolated case in terms of CTE in a baseball player, the MLB took huge strides to prevent future concussions. The organisation implemented rule changes and introduced new equipment, such as helmets better at absorbing shock. !!!!!!!!!!!!!!!!!!!!!!!!!!!!


Example 21: Patrick Grange

Patrick Grange played soccer from a young age. He continued through high school and college and had dreams of making it into the MLS. He quickly became a star player on the University of New Mexico soccer team and certainly had the potential to become a professional. All of this was destroyed when he was diagnosed with ALS at the age of 27; it prevented him from walking, speaking and living his life properly. Just 17 months later he passed away !Throughout his playing time he had suffered a small number of heavy concussions. He also had headed the ball from the age of 3. After his death it was found that Grange suffered from CTE. Furthermore he had extensive frontal lobe damage, around the area where he would head the ball, although Dr Ann McKee, who evaluated his brain is unsure if this is CTE related. !Thus it is largely believed that Grange’s CTE was caused by a mixture of concussions and repetitive subconcussive blows caused by frequent heading of the ball. His diagnoses displays that a sport characterised as “soft” can also have players who can contract CTE. !!!!


5. "Macho" Culture & The Nature Of Sport

Why We Play !What Is Macho Culture? To compare macho culture to an adjective, it is being stoic, particularly on the sports field. Macho culture is the glorification of this extreme valour and toughness. Macho culture is an attitude that has been ingrained into sport by coaches and players who teach and carry it out at training and during matches. !!Athletes are taught to run from siren to siren, punch from bell to bell. When you are knocked down you get up, dust yourself off and charge back into the action, looking to hurt whoever hurt you. It is fighting until time is up, overcoming the barriers of fatigue and injury and battling even if the odds are against you. !!Why is this attitude in sport? "It's just what you do", many an athlete has said. They do it for pride, themselves, their teammates, their fans. They do it to show they will not give in. Not giving the opposition any credence, not appearing weak to coaches, inspiring those they play with. Furthermore it is a competition. Inside the lines is where a battle is fought. The opposition is the enemy and the contest must be won at all costs. Body on the line, a hundred miles an hour, raging, fiery intensity. !!


Macho culture spurs players in this situation back into the

action.

Where do we see this ideal appear in sport? We see it in the inspiring pre-game speeches. We see it in the players who push through an injury. Sam Burgess fractured his cheekbone in the first tackle of this year's NRL grand final and played through to the final siren as it gradually swelled and the pain became unbearable, as he said at halftime, "it's gone" but he continued to play. Finally we see it in the players who go down only to return and finish the game. George Smith is an example. !What is the value of macho culture to sport? It makes sport interesting to watch seeing players overcome barriers for an optimum performance, ignoring injury. It makes matches more intense, rivalries run deeper than adrenaline alone and makes heroes out of the players who are often compared to soldiers and warriors going into battle. !Why Is Macho Culture An Issue? So what is wrong with macho culture? The premise is brilliant, making sport the physical, grueling and tenacious contest it should be. It livens competition, makes it more exciting. Creating a greater atmosphere and hype before and during matches and pushing players to their absolute limit. !The first issue is that players should by all means be tested to this limit but not when it comes to injury. Macho culture increases the chance of an athlete's exposure to injury. Amateur players do not have the incentive nor requirement for this as a professional player would, however it is the same for these professionals, despite their contract. Being pressured and forced to strain through an injury will only aggravate and worsen it. If it has happened once it is likely to happen again and have a more grave effect as the tissue and muscle is already weakened. Furthermore it can lead to the understatement of the severity of an injury, potentially a serious one. If a coach or trainer who is not a professional sees you are raring and willing to return to the game they may overlook the pain you are in. !!!


The second issue is that this is not a positive ideology and mentality to be installing in amateurs and young people. Teaching them to play though injury teaches them nothing about injury prevention and management, one of the aims of sport should be educating players how to be active and play the game the way it should without getting injured and preventing future injury by learning to look after an incurred one. It is also an ideal that can encourage violence. If it makes participants view sport as going into battle they are going into this conflict with as much aggression as possible, why do we see it spill over into brawls and fistfights so often? Overexcited players looking to assert their dominance. !Why macho culture is present and has originated is due to the nature of sport, which will be discussed soon, but first. !How Is Macho Culture Relevant To CTE It is imperative for me to prove macho culture’s link to CTE and further push this issue. !CTE develops from concussive and subconcussive blows. The macho mentality is to charge into the eye of the storm with reckless abandon, be thrown out injured and run back in again. So, how do the two combine? Macho culture causes athletes to be more prone to injury as they are more aggressive, their opponents are more aggressive and as they are expected to continue through an injury that has already been sustained. CTE comes about through multiple head knocks over the course of a game, over the course of a season, over the course of a career; often these are put off and ignored. It is believed they can be played through as they are harmless or go unnoticed. What does a build of head knocks lead to? Concussions are caused, they go unreported, worse concussions are sustained and you have CTE. Where is the proof ? The examples? You have read a whole section on it but to summarise...


Macho culture causes many violent brawls in sports as

players defend their integrity and are excessively aggressive

during play.

Brett Favre played the most consecutive games of any NFL player. He often played through injury, particularly concussion. How many games would concussion have forced him to miss, "a lot". Junior Seau was never on the NFL's injury report for having suffered a concussion, how did he get CTE? Ignoring head knocks, playing through concussion. Jovan Belcher was much the same and just as he was about to reach a turning point in his career he committed a murder suicide. Barry Taylor epitomises the link between macho culture and CTE. !Thus there is a startling trend that is blindingly obvious. Macho culture has led to athletes continuing to play and be in the frontline to a barrage of blows to the head which, when ignored, have led to concussions and in turn those concussions have caused a buildup of the tau protein in the brain, concluding with CTE later in life. But macho culture has originated from the nature of sport and thus we must look at this to go deeper into this issue. !!What Is The Nature Of Sport? What is the ultimate goal when playing sport, competing in this battle? Waking up at all hours of the morning to train? Whether it be running around a track as fast as you can or running down the sideline to the goalposts, the ultimate and simple answer is to win. Be premiers of the competition, hoist the trophy, hold the gold medal. Along this road a dose of "machoism" may be required, heroics from players to get the greatest effort out of them and to inspire and invigorate teammates.

!


!The nature of sport tends to center around victory. It is also important to consider the

journey to a championship, rather than ignore it.

Thus to achieve this goal coaches, players, parents, fans are caught in the attempt of victory. They would go to all ends just to win. They lose sight of some of the other reasons for playing sport and its alternative aspects. Sport has also become more dangerous as larger players have been employed in recent years, bigger, better, faster, stronger. !The reason we play sport must be reconsidered and some of the more subtle reasons recognised. !Why It Must Change & To What As described previously the nature of sport must change as it is making people forget some of the real aims of sport, leading to macho culture and also to a rather blind ambition of winning. !Working towards a premiership and going through a season with teammates is a journey. It is about growth of character and development of relationships as much as it is about winning and victory and glory. There is more to playing sport than taking the opportunity for granted to see how many trophies or medals you can be awarded. Stopping to ask "are we there yet?" is an important question on the winding road of a sports season to stop and take in what is going on around you, because, fundamentally, sport should be about enjoyment. If you are not having fun and appreciating the opportunity to have recreational and leisure time while developing fitness and conditioning, why play? Much like how money cannot buy you happiness, victory will not necessarily win it either. If you are so focused on boosting your own ego with how many championships you can win and seeing how great you are, what is the point? !A true athlete has the mental ability to see positives in times of trouble, the times of loss and the times of disappointment. Being wholly focused on winning only leads to a struggle and pessimism throughout these experiences. A true athlete also understands to put everything on the line for the team but not to push a mere human body to unexplored limits and past their own boundaries; they have a life to live off of the field as well as on it.


This is what sport must change to. It must be a home for these "true" athletes. However the truth is that the caricature I have painted of a "true" athlete, is merely just a smart athlete. !It is time for sport to be played smarter not harder. Times have changed. However even with the lengths franchises, clubs, even schools, have gone to for athletes in terms of diet, recovery and metabolism management, this attitude has not changed. The answer to CTE is in this attitude. That sport can still be played at full speed, but it must be done with heightened awareness to injury.

Training for coaches of all levels on how to identify and deal with concussed players is a necessity. Education for athletes, presenting them with the damage that they could be doing to themselves by playing through injury before they get injured is necessary. The eradication of senseless drills such as "Bull in the Ring" and "Oklahoma", as well, search them, if that's what has to be dealt with at training, multiple times a week, each week, the damage could be horrendous. The helmet to hemet contact is brutal, bone chilling and shockingly audible. !!!!!


The Oklahoma drill sees american football players square off in a tight space, to simulate a game.

Why It Will Be Difficult To Change Macho culture and people's attitude about returning from injury is a force to be reckoned with. !Firstly it is what we are taught, as I have already explained. There is an ingrained ideology passed down from parent to child, coach to player of how sport should be played. Sport is "supposed" to be hard, tough, gritty, “you get knocked down, you get up again”. Thus in game situations players are spurred on by this, when something has become so ingrained. The issue with this is as I stated it is doctrine that has been passed down. It is caught in the past and does not display what it should be like today. !As an active athlete when you have to step from the game for a period of time due to injury, it can be unbearable. Seeing the rest of the team training, playing. You want to get into the thick of it again. You feel the fitness sliding away and know how painful the return will be. Furthermore you could be giving a teammate the chance to take your spot on the field. On a scientific level running around, exercising, releases dopamine. When players are concussed, often they don't want to abandon their teammates, let them down or lose their position; they want to put their body on the line for the team and their career. Thus there is a psychological reason and a physiological reason for people throwing caution to the wind regarding injury. !Linking with this idea of the team's perception is that often this leads to a brutal and cruel cycle regarding injury. Players who do exactly as they should in regard to looking after their bodies when injured are ridiculed. They are labelled as "soft" or "precious", often worse. This exceeding peer pressure ultimately leads to players being "bullied" back onto the field too soon and forces them not to retreat when injured in the future. The counter to this attitude is summed up perfectly in the conclusion of an article Clyde Rathbone, famous rugby union player for the Wallabies and the ACT Brumbies, which is, "This attitude might be accused of "being" precious. But what is more precious than a human brain?" !


The final reason deals with the idea of being pressured to play in professional sport. It is incredible how sports have evolved from sets of rules into an entire industry; the commerce is tremendous. Fans at games buy tickets, merchandise, and beverages. Companies advertise in the programs, arena or stadium, on the television. Franchises and clubs have deep wallets to load the salaries of trainers, coaches and of course players. !This is exponentially exacerbated in America in contrast to other countries. In Australia the highest paid NRL players are Cameron Smith and Johnathan Thurston, each earning $1M for the next four years. The highest paid NFL player, Jay Cutler, quarterback of the Chicago Bears, recently signed a seven-year $126.7M contract. The highest paid baseball player, Miguel Cabrera, of the Detroit Tigers has an eight-year contract worth $248M. The average person would only see a fraction of this fortune in their lifetime.

!!!!


The biggest contracts in the NRL (Johnathan Thurston), NFL (Jay Cutler) and MLB (Miguel Cabrera). They signify the extent to which sport has become an industry as they

are in possession of immense contracts, although the American players have a far greater pay cheque.

Basically the reason macho culture is so prevalent in professional sport is because jobs are on the line. Professional athletes earn their pay cheque by being on the field. Thus if a concussion is going to sideline them they will ignore it and keep playing. Furthermore their coach needs them, his career is just as much on the line if the team is not successful. Often players who opt out of playing through injury are "discriminated" by coaches. They tend not to pick them, let them play less. Thus to meet this expectation, especially if a player is young and needs to prove themself and maintain their position, they will play through injury. !Because sport has become a business if you are injured, you are stagnant. You cannot practice and improve. You cannot play and advance the team's record. Your contribution stops, the media attention stops, the fans’ attention wanes. If you cannot contribute then you are simply eating away at the team's budget, which could now be spent better elsewhere. !It is a brutal reality, for any player. For example, Peyton Manning, one of the greatest players in NFL history was cut from the Indianapolis Colts, his career-long team, in 2012, due to the fact that they doubted his ability to return successfully from neck surgery. In 2013 he was the MVP and this year he has set the NFL record for most passing touchdowns, progressing past Brett Favre's 508. !This commercial and utilitarian approach to sport is difficult to change. Players will want to be the difference to maintain the respect of the coach, teammates and also their contract. !!!!!!!


6. The Coverup & The Lawsuits

A League of Denial !Due to its power the NFL has turned into a multibillion-dollar organisation. Scientists, Bennet Omalu, in particular threatened this, by proving that their sport had caused some players to become insane before they died. Rather than accept this collegially and work together for change, they instead sought to discredit the scientists, leading to the league becoming plagued by denial and desperation through an immense cover-up and resulting in a huge lawsuit upon the players’ discovery of the NFL’s fraudulence. !The Cover-Up Doctor Bennet Omalu was the person who diagnosed the first case of Chronic Traumatic Encephalopathy. One day in September 2002 he conducted the autopsy of Mike Webster. He inspected Webster’s heart, as he had died of a heart attack. After this he wished to inspect Webster’s brain, being a neuropathologist, he was curious as to what had caused the erratic behaviour that had been rumoured regarding Iron Mike. When he surveyed the brain it appeared normal and after analysing the CT and MRI scans again he could not find anything, yet he still believed that something was wrong with Webster’s brain. He asked permission to run microscopic analysis on the tissue in Webster’s brain. !!


Dr Bennet Omalu, the man who discovered CTE

in the brain of Mike Webster, through his curious nature and

passion for research and discovery.

His request was granted and from there he spent hours working on analysis, examining slides that had been stained for him and producing the next set to be stained. Until one day on the first slide of a new set he examined something very different. He saw the abnormal tau proteins that had killed cells in the areas of Mike Webster’s brain responsible for mood, emotion and behaviour. After showing this to his colleagues, all concurred that it was disease none had seen before. He wrote a paper of his research and sent it to a scientific journal, Neuosurgery he thought that NFL doctors would be impressed with his work and findings.

His article was released in the July 2005 edition of the journal. Three scientists, paid by the NFL, requested that the article be retracted. They were on the NFL’s Mild Traumatic Brain Injury (MTBI) Committee and they stated that he had misinterpreted his own results. None of them were neuropathologists and the chief; Elliot Pellman was a rheumatologist, a doctor responsible for joints, muscles and ligaments, not the brain. !

However by now Omalu had obtained a second brain, that of Terry Long. He found identical patterns of tau to Mike Webster and again diagnosed CTE. He sent his findings from this to Neurosurgery once again. From here he continued to receive the brains of deceased NFL players and was able to diagnose them with CTE. He formed a team with Bob Fitzsimmons, the lawyer for Mike Webster, Julian Bailes, chairman of neurosurgery at West Virginia University Hospitals at the time, and Christopher Nowinski, a former professional wrestler. They called it the Sports Legacy Institute. !However the NFL still attempted to marginalise Omalu and label him as a whistle blower. In 2007 the NFL convened a meeting on concussion, at which all 32 teams were required to send trainers and doctors, Bailes was invited, Omalu was not. The MTBI committee produced its own “evidence” that concussions did not lead to brain long-term brain damage, however Omalu gave his research to Bailes to present, the scientific, research-backed evidence.


Neurosurgery, the journal to which Omalu sent his

findings.

Soon other institutions began to follow in Omalu’s path, producing their own studies and finding similar results. The University of North Carolina produced two separate studies. Whatever researchers tried to prove about CTE they would be rejected by the NFL. Told their results were “flawed”. The only flawless results produced came from scientists paid by the NFL. !As time went on Omalu became tired of the constant rejection by the NFL and instead decided to conduct his research privately, splitting with the Sports Legacy Institute. Christopher Nowinski took control of this and partnered with the Boston University School of Medicine. !Omalu, with Fitzsimmons and Bailes have organised The Brain Injury Group, a brain bank, with a $30M research facility, where Omalu continues to diagnose former NFL players with CTE. The three men are looking into a way of preventing CTE. One of Omalu’s ideas is a pill taken before a game that prevents tau buildup. !The Lawsuits There have been multiple cases of fraudulent action on the part of the NFL in years gone by. In many cases it has been what has lead to CTE in former players in such great magnitude. Players had no idea what concussions were, the league glorified the violence of the game and trainers sent concussed players back onto the field.

!!


In the time of Tony Dorsett and Mike Webster players did not have the knowledge of what a

concussion was.

In Mike Webster’s time players were unaware of what concussions were and the dangers of them. Mike Webster understood that he got “dinged”, “had his bell rung”, and “saw stars” often but was clueless as to what it meant. He would have headaches, blurred vision and memory loss but was unknowing of the fact that this was called a concussion. Thus he suffered multiple concussions, which led to the tau buildup in his brain. !The NFL also glorified the violence of the game and teams managed concussions poorly. Merril Hoge, gridiron player for the Chicago Bears was able to sue his former team in 2000 for the way they improperly managed the concussions he suffered in the 1994 season that forced him to retire. Even as recently as 2011 the NFL has struggled to control coaches and players glorifying violence in sport that causes concussions. In 2012 it released its findings in regards to the New Orleans Saints’ bounty culture, in which players were given bonuses for injuries they caused and hard hits they made on opposition players. !Thus the NFL has been caught in a huge class action case with over 4500 plaintiffs, a person bringing a case against another in a court of law, as opposition. They claim that the NFL knew about and then concealed the dangers of head injury, particularly concussions, in regards to brain damage. The NFL ignored and refuted research conducted by scientists. Instead they fabricated their own, which displayed the opposite to the findings of independent scientists. This is what occurred to Dr Bennet Omalu. The claimants range from those who are cognitively impaired with dementia and other symptoms of CTE from their time playing gridiron to those who fear that they will one day develop these signs of brain damage. !The case has reached a final settlement whereby there is no cap on the payout. Originally it was set at $675M for players displaying symptoms of neurological disease but has since been altered to cater for the individual and their age and illness. Diseases such as ALS in a younger person receive a far greater payout than the early stages of dementia in sn older person.

!


7. Solutions Potential Protection

!Research and Awareness A basic step that needs to be taken to counter CTE and its spread throughout the community of athletes is further medical research. This is already underway, however there is a long way yet to make headway into discovering more about the disease. !What we currently know is relatively basic. We know the mechanism by which the disease occurs, but there is a lack of knowledge in frequency of the disease’s occurrence. Some people who play sport all of their life will not develop the disease. Some will develop it in later life, like Tony Dorsett or Mike Webster. Others again will develop it as young as 18, such as Owen Thomas. What is the factor that decides the victim of CTE? Is there a difference between people’s tolerance to concussive and subconcussive blows before they develop it? !A team of clinicians at Boston University has led a great deal of the research. A CTE Center has been organised as well as a brain bank. This was formed through the combination of the Boston University School of Medicine (BUSM) and the Sports Legacy Institute. This is the institution that has conducted majority of the research into CTE. Barry Taylor’s brain was flown from Australia to this center so that it could be tested and scanned for CTE. The head researchers are Christopher Nowinski, a former WWE wrestler of the Sports Legacy Institute, Dr Ann McKee of the BUSM, who is a specialist in neuropathology and Dr Robert Cantu, of the BUSM, who is a world-renowned leader on concussion.


The figureheads at the BUSM, Dr

Robert Cantu, Dr Ann McKee and

Christopher Nowinski.

However this research struggles without public awareness of the issue. To continue research funding is required, donated brain samples to be used for analysis are required. These of course come from the public, if they are unaware of the issue then the process of continuing research and working towards the full depiction of CTE grinds to a halt. !!!!!!!!!!!!!!!!!!!!!!!!!!


Temporary Abstinence and People Power Of course a main way to prevent CTE would be to manage head injuries properly and also to leave the field when appropriate. However if CTE is caused by blows that may not be noticeable and are repeated so much they are simply dulled, maybe the best option is to not put yourself at risk at a young age. Pat Grange had extensive frontal lobe damage, in the area where a football player normally “heads” the ball. He had been doing this since age three. Players such as Owen Thomas had played since early childhood. This early exposure, when the brain is most vulnerable, surely has a detrimental effect on the brain, it is simply unprotected. !The answer could be to wait. Wait for the child to mature, develop, and then begin. Some may argue that to build up the skill to take that sporting ability anywhere, state and national teams, it has to be started at an early age. Is there a middle ground? Tom Brady is an exceptional player and has had an outstanding career to this point. He didn’t play gridiron until he was 14. Of course not everyone is like this, can pick up a ball and play for a college team in as few as four years and turn it into a multimillion dollar profession from there. Is there a solution?

!!


Tom Brady started playing American football at age 14 and has gone on to have an

outstanding career thus far.

In junior baseball, coaches obsess over the number of pitches each pitcher throws, looking to protect their arms and shoulders for the future. Similarly in cricket young bowlers are limited in the number of overs they are permitted to bowl. Perhaps a similar system could be implemented for football and rugby in terms of minutes, snaps or hits. Particularly in juniors it provides the needed safety and also allows for equal participation among players, which the grassroots level of all sports must try to have as a goal. !Another action is people standing up and advocating. If CTE is not hammered out as a problem around the world, in all codes of sport, nothing will be done about it. If children are stuck with parents and coaches who force-feed macho culture how will they know any different? !People seeing a legend like Kurt Warner make the statement about his children playing football has a deep impact. Imagine if Wally Lewis had said that when he was younger, if Andrew Johns said it tomorrow? These people many held as sporting role models growing up, who have experienced the most brutal level of competition who are still around today can have a great impact when those fans have grown up.

Furthermore it also includes being smart with the media and not glorifying macho culture. In a recent press conference Marvin Lewis, the head coach of the Cincinnati Bengals, made a comment about how these days, due to the media broadcasting topics such as CTE and the danger of head knocks that players spend more time out of the game when they have concussions, “The media makes concussions last longer.” The NFL Live crew proceeded to criticise his comment, noting that concussions last longer now due to greater medical awareness of their danger. !!


In a press conference in August, Marvin Lewis

made a statement insensitive to the

dangers of concussion

This ruling out of Lewis’ comment due to its lack of grounding should set the bar as an example and it needs to be followed. Think about who saw him say that. All of the Cincinnati fans, in America; down in Australia, I saw it. This brazen glorification of machoism is broadcast everywhere, when it happens it needs to be shut down. !One of the poor messages this spreads is that sport is becoming “soft”. Players are too worried about injuries and need to develop greater grit. Seeing a head coach in the NFL emphasise this ideal makes the people who believe in and spread this message believe they have justification. One of the things it is important for these people to know is that sport and its players are not getting “soft”. They charge into each collision at full speed, sprinting at full flight down the sideline. Only when they get injured do they take time off. To ensure proper recovery and recuperation, because what’s worse than a re-injury? !!!!!!!!!!!!!!


Training and Coaching One of the reasons many players suffer concussions is due to the fact that they are poorly trained and do not know how to tackle or go to ground without getting injured and doing so properly. In gridiron many players will lead with their heads, rather than their shoulders. They are opening themselves up to the beating whatever body part it hits provides and they are completely vulnerable. They need to be taught technique based on “Hit, Stick, Drive”. Hit with the shoulder, wrap your arms around the opposition, drive them to the ground. !As we see in the case of Ray Easterling, without having learnt this technique and having injured his shoulder he couldn’t tackle properly and started to lead with his head. His CTE may have been caused or accelerated by the barrage of blows to the head that he opened himself up to when he was playing as he flung himself, and his head, directly at knees, elbows and boots. !Also on this issue is that in some drills which players are forced to do head knocks are endemic. “Bull in the Ring”, a gridiron drill forces a player to stand in the middle with all of the other players in the team surrounding him. The other players are called at random to charge from the middle at the “bull” to tackle him and he is expected to survive the onslaught and stay standing. Another is the “Oklahoma” drill, which simulates being at the line of scrimmage. The halfback is expected to stay in a tiny boundary without getting tackled by the defensive lineman. The tiny space and violent players leads to multiple headknocks and intense, brutal competition. !Recently the NFL has taken action with a new education program for coaches to teach proper tackling, the “Head’s Up Football” Program. The intention is to educate coaches with a proper course so that they are certified to coach and to teach youth footballers how to tackle. !!!


One of the components is aimed at players. The idea is to drill into children from a young age not to tackle with the helmet but to tackle with the head up. There are five steps to this, the breakdown position, buzzing the feet, getting into the hit position, the shoot and the rip position.

The other component is aimed at coaches and leagues. Enroling in the program has a range of benefits. There are tests for accreditation for coaches of all age groups. The tests cover a variety of areas, such as heat and hydration, concussion awareness and equipment fitting. !However this program is being dismantled and criticised. Some describe the testing process as being too easy, the questions too simple and obvious. In regards to the tackling initiative some see tackles as too hard to control, sometimes when trying to bring down the person across from you your technique is abandoned. Furthermore others have seen it as a marketing ploy. Becoming an accredited coach opens up insurance opportunities and the “Heat and Hydration” section of the test is littered with Gatorade propaganda. As well as it potentially merely acting as a placebo for worried parents to register their children for football. Finally who created the initiative is extremely indistinct. It appears to have swayed between both the NFL and USA Football or just one of the two organisations. !


The Head's Up football initiative incorporates an element regarding tackling, as can be seen in the image the steps are "breakdown, buzz,

hit, rip and shoot"

Technology We live in a digital age. We incorporate technology into all facets of our lives, school, leisure and recreation. It is becoming intrinsic to workplaces around the world in industries such as medicine, entertainment and economics. It is time for it to combine with the world of sports. The potential for technology to be integrated into sport is limitless and there is plenty of opportunity for it to be utilised as we try to prevent CTE. !One path currently being taken in a plethora of sports is wearing a helmet with sensors. Hockey, equestrian, football and many more. Participants in all of these sports could be wearing helmets such as the “Shockbox”. The sensors provide a reading of the G-force experienced in a hit. This is automatically relayed to coaches and trainers on the sideline with a device such as a phone or a tablet. Hits of differing G-force are given a colour ranking. !One of the issues with this is calibration. There is no way of someone being hit and determining they have a concussion normally, never mind while wearing one of these helmets. Concussions are characterised by their symptoms. We know the range in terms of G-force when a concussion has occurred, however there is great variation between players. Contact in sport is dynamic; each collision is different from the next. A slight change in the angle of the hit or its location can skew the result. !Another issue is opposition trying to “light up” players. If a tackler can force a player from the field with a hit that registers as a “red” it may encourage them to do it more often. It puts the tackler at risk of making a mistake and puts the ball carrier at an even greater risk of suffering a huge hit. !


The "Shockbox" has an impact sensor at the top of the

helmet to detect the force sustained from hits.

Another field of technology that has opened thanks to the IPad and an application called “C3 Logix”, is baseline tracking. Essentially all of the players have measurements taken with the IPad, such as reaction times with a quick activity, balance using the IPad’s gyroscope. As the season goes on these “control” tests can be referred back to and are extremely useful in diagnosing concussion as the players ability to perform these tests will drop when they have suffered a concussion. !This is also a far better alternative to the flimsy “sideline concussion test” run by the NRL and ARU that has seen concussed players return to the action. Rather than having a one-off test theses statistics have been established weeks in advance and the difference is marked. !!!!!!!!!!!!!!!!!!!!!!


Rule Changes As sport evolves the rules that govern it must also. Methods of play change and the game becomes more professional. Sport is becoming extremely elitist. Colleges scout prospects in high school and in turn have regimented programs for athletes. The players on the field are bigger, better, faster and stronger than those of yesterday. The rules must adapt with the players so that the game can be played safely in the present. !In 2013 the NFL introduced a rule regarding the crown of the helmet. If a ball carrier or tackler leads with their helmet, using it as a weapon, a 15-yard penalty will be the result. This initiative by the NFL aims to take the head out of the game so that players do not use it as a battering ram. This type of contact results in concussions as well as neck injuries. !In the NRL the 2014 season marked an overhaul of the league’s concussion policies. To prevent a player who is concussed returning to the field the league took action to make it the club’s responsibility to make sure concussed players are sidelined. If they failed to fulfil this requirement then there would be strict punishments enforced with new penalties introduced. These include the loss of competition points, fines and also the suspension of the registration of trainers and coaches. They have made it the team’s trainer’s responsibility to determine whether a player should return to the field, after they have completed concussion tests. In Week five of this year’s season the Wests Tigers were fined $20,000 for a breach of the new policies regarding Liam Fulton.

!


In 2014 the NRL has taken large strides to counter concussion through the

implementation of new laws with more severe punishments.

Sideline concussion tests have been one of the mechanisms implemented with these new rules. However these have found to be flimsy on a number of occasions and the rules regarding concussions, above, ineffectual. In the Grand Final Sam Burgess was concussed on the first play and did not come off, his brother George Burgess was concussed and after leaving the field for a concussion test returned. The NRL has needed to fine a number of clubs for breaches of the new concussion policies this year. The problem with the new rules is that punishment comes after the game has finished. Also, as I made note of in regards to macho culture, clubs and teams are looking for the win and can show disregard to player safety, a better alternative would be to have the decision made by an independent doctor or medical professional. Clubs have too much “self interest” to be responsible for taking the players off, it is like putting Dracula in charge of the blood bank. !Another rule change that has appeared in the NRL regards tackling and shoulder charges. Shoulder charges have been classified as an illegal tackle as it has been proven throughout the game’s history that injuries are common for the ballcarrier, particularly head injuries, and often players are knocked unconscious. Another was the ban of tackles in which the ballcarrier’s head is pointed and heading for the ground. This can lead to severe neck and head injuries. Players who have committed these offences by taking part in these tackles are vulnerable to suspension for a number of weeks. !The MLB also added a rule regarding home plate, when runners are approaching in an attempt to score a run. This situation often garners concussions as runners as well as catchers will try to initiate contact and move into each other’s paths. The catcher will move into the path of the runner, to prevent the runner scoring the run, or the runner will dive into, or run into the catcher to knock the catcher over and stop him from getting them out. !!!!!


8. Survey Researching Awareness

!One of the issues with CTE is that, outside and even inside of America there is very little awareness about it. Teenagers are a group that are very prone to brain damage as their brains are still developing, yet lack knowledge about CTE. Furthermore hormonal change has a startling effect, as we can see through puberty. Tau occurring in the brain would be disastrous. !Thus to justify an awareness campaign I wanted to evaluate if there is any base of knowledge of CTE in a group that is at risk of potentially developing it one day. !I believe this investigation is worthwhile as it provides relevant and current information from a group in which CTE is heavily concerned. This is due to the fact that often adolescents suffer multiple concussions and can disregard future development by playing on. It is also a primary source, controlled by myself and I can relate to its validity easily. I can set particular questions to investigate areas in which I have interest. !My initial intention was to survey the 190 boys in Year 10 at Saint Joseph's College, however after consultation with Dr Mark Fenech, I decided to take a random sample of 50 boys from Year 10. !!!!!!!!!


Questions !Question 1: CTE stands for… !A. Cardio Technical Exam B. Cartilage Tumour Extraction C. Chronic Traumatic Encephalopathy D. I do not know !Reasoning: This question allows me evaluate whether the group in question have heard the term at all and have any idea what it stands for. If they do not know the term they are told not to guess and select D. The two other terms have been made up and are not actual medical terms. !!Question 2: Do you have any idea what CTE relates to? !Reasoning: Much like the last question I am simply trying to determine whether there is any knowledge however basic about CTE. Given the next question on the test mentions concussions that is not an acceptable answer for this question. !Potential Answers: • Progressive degenerative disease of the brain • Examples of people who have had it • Causes/risk factors (beside simply concussion) • Symptoms !!!!


Question 3: Are you aware of what was done this year to strengthen the NRL’s concussion laws? If so can you give an example? !Yes/No !Reasoning: This allows me to see if the group is aware of public action being taken to prevent repeated concussions, now that the risk and dangers of CTE and concussion have been realised. !Potential Answers: • Loss of competition points • Substantial fine • Suspension of registration of club personnel • Greater onus on clubs to identify concussion in players !!Question 4: Have you ever thought to count the number of head knocks you suffer while playing sports (per game)? !Yes/No !Reasoning: This question allows me to investigate whether athletes have taken an interest, however minimal, in trying to protect themselves from concussion and also have identified that head knocks have the potential to do great damage. !!!!!!!


Question 5: Have you ever suffered a concussion playing sport? How many? !Yes/No _________ !Reasoning: This allows me to see if there has been an exposure to concussions by the age of 15/16 and how severe this exposure is. In further questions it allows me to examine the response to these concussions and if anything has been done to actively manage and prevent them in future. !!Question 6: What is the shortest time you have spent away from sport while recovering from a concussion? !Reasoning: This question allows me to see if there is knowledge of the dangers of concussion in the group or if they are willing to play through it. Furthermore if the return is instant, then it could show the effects of macho culture within the sample. If people are not aware of the relatively basic dangers of concussion at this age the result could be lethal later in life. !!!!!!!!!!!!!


Question 7: Do you think the NRL’s updated concussion laws are… !A. Too strict B. Fine C. Not strict enough !Reasoning: This question is purely to see what the opinion is amongst the group of public action attempting to prevent concussion and furthermore CTE. By analysing their view on the new rules it allows me to form an impression of what this view is. !Note: Participants are told the new rules before this question. !!Question 8: In your eyes is Sam Burgess playing through two fractures and a concussion in the NRL grand final heroic and would you do the same? !Yes/No I would/would not do the same !Reasoning: This question revolves around the investigation of the presence of macho culture in the group. The extremely recent example of Sam Burgess’ courage in the grand final is permeated with macho culture. The group’s view on this and what they would do in the same scenario is conducive to discovering how pervasive macho culture is in a vulnerable demographic. !!!!!!!!


Question 9: The best part of contact sport to you is… !A. The big hits B. Fantastic tries C. The players D. The atmosphere !Reasoning: Again this is an investigation into macho culture and also risk of head injury. It is rather sickening the enjoyment that can be gained from watching and rewatching the huge collisions between players on a sports field and then trying to live them out ourselves. Whether it be palming someone away, smashing them with a tackle or simply running straight over, or through, them. I am trying to determine if this enjoyment is shared and emphasised within the group. !!Question 10: Mental health in later life to you is… !A. Very important B. Important C. Unimportant D. Completely unimportant !!Reasoning: This questions aims to contrast how the group views their own mental health with their knowledge of the damage they could be doing to themselves in this area and also their attitude towards macho culture and the head injuries it could be causing. !!!!!


The Survey !The survey is to be completed on the 30th of October, consisting of 50 boys from Year 10 at Saint Joseph’s College, with a five person trial the night before. !The five on the 29th are: !!The 50 on the 30th are: Note: Three individuals were absent thus the survey was out of 47, all 50 are listed below however. !

!My hypothesis with the survey is that there will be relatively little knowledge about CTE. This would be exhibited by a lack of response to the first three questions. Furthermore there will be a tendency for macho culture to be prevalent and rather exaggerated. This would be evidenced by the Sam Burgess event being viewed as “badge of honour” scenario that they would replicate and for short return times from concussion. However this could easily be an underestimate.

Jackson, Armstrong Oliver, Hearne Jordan, Lewis William, Neilson Henry, Murphy

Ryley, Angles-Corke Christopher, Doyle Warray, Howes Dom, Munro Joshua, Smyth

Corey, Aylett Fraser, Edwards Nelson, Kanaan Will, Nicholls Joe, Stanley

Zac, Banu-Lawrence Joe, Flannery John, Keesing Connor, O'Grady Aaroon, Suebhait

Daniel, Barry David, Fox Daniel, Keneally Jackson, Parfitt Joe, Sykes

Thomas, Brennan Jacob, Goodwin Julian, Kochanowicz Harrison, Pearce Noah, Tanous

Matt, Calleja Vedant, Grover Kevin, Law Patrick, Quigley Christopher, Thompsett

Blaine, Caton Tim, Hallion James, Macaskill Austin, Rewell Angus, Vivers

Will, Corti Josh, Henry Joseph, McCarthy Liam, Ryan Tom, Wilde

Jared, Da Silva Adrian Hoferek Henry, McKewen Theron, Sims Ethan, Wilks

Lachlan, Day Andrew, Iorfino Tom, Melo Ben, Smith Tristan, Wyatt-Spratt


Again, from this survey I wish to test the base of knowledge in a sample from a group at risk of one day developing CTE, the base of knowledge being their familiarity with the term CTE and concussions. Furthermore to see if there is an undertone of macho culture within the group. !!!!!!!!!!!!!!!!!!!!!!!!!!!!!


Results !Question 1: CTE stands for… !A. Cardio Technical Exam B. Cartilage Tumour Extraction C. Chronic Traumatic Encephalopathy D. I do not know !Five Person Trial: !A. 0 (Cardio Technical Exam) B. 0 (Cartilage Tumour Extraction) C. 0 (Chronic Traumatic Encephalopathy D. 5 (I do not know) !47 Person Survey: !A. 2 (Cardio Technical Exam) B. 3 (Cartilage Tumour Extraction) C. 20 (Chronic Traumatic Encephalopathy) D. 22 (I do not know) !Observations: The majority of people in both cases stated that they did not know what the term CTE stood for. In the full survey there was contention by the actual term, with 20 people stating it as Chronic Traumatic Encephalopathy. After the survey, through discussion with participants some genuinely knew this, however others admitted to guessing. I believe guessing was a factor as some of the answers were changed from “D” to “C”. This is also supported by the fact that five people were incorrect, with “A” (Cardio Technical Exam) and “B” (Cartilage Tumour Extraction) they are fictional terms that I created. Thus they were clearly guessing and instead should have selected (“I do not know). !!!


Five Person Trial:

!47 Person Survey:


Question 1: CTE stands for...

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A B C D

Question 1: CTE stands for…

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A B C D

Question 2: Do you have any idea what CTE relates to? !The responses are marked as being: Incorrect- Detailing something irrelevant to CTE. No- No given knowledge of CTE Basic- An equivalent answer to “No” that is a short response stating “the brain”, “concussions” or “head injury”, all of which could be inferred through completion of the survey. Developed- An answer more thorough than “Basic” that includes information about long term effects. Definitive- A complete answer of what CTE is. !Five Person Trial: !Incorrect: 0 No: 3 Basic: 2 Developed: 0 Definitive: 0 !47 Person Survey !Incorrect: 5 No: 14 Basic: 24 Developed: 4 Definitive: 0 !Observations: Although there may be knowledge of what CTE stand for there is a lack of knowledge in regards to what it actually is. Nobody was able to label it as a disease. Four people referenced the long term effects of repeated concussions, however the vast majority delivered a response that showed this lack of knowledge. Being an Incorrect response, a response of “no” or a basic response of “concussion” or “head injury”. Majority of responses are “illegitimate” due to the fact that they are invalid, a statement of a lack of knowledge or provide minute information about CTE.


Five Person Trial:

!47 Person Survey:


Question 2: Do you have any idea what CTE relates to?

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Incorrect No Basic Developed Definitive

Question 2: Do you have any idea what CTE relates to?

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Incorrect No Basic Developed Definitive

Question 3: Are you aware of what was done this year to strengthen the NRL’s concussion laws? If so can you give an example? !Yes/No !The questions are marked as being: Yes: If “Yes” was circled and a correct example was provided No: If no was signalled or if an illegitimate example for “Yes” was provided !Five Person Trial: Yes: 0 No: 5 !47 Person Survey: Yes: 17 No: 30 !Observations: The responses to this question demonstrate that while some of the participants are aware of public action being taken to reduce concussion in sport, in this case the NRL, the majority do not. This displays so far that there is a lack of knowledge about what CTE is, what is being done to stop and how to stop it. !!!!!!!!!!!!


Five Person Trial:

47 Person Survey:


Question 3: Are you aware of what was done this year to strengthen the NRL’s concussion laws? If so can you give an example?

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Yes No

Question 3: Are you aware of what was done this year to strengthen the NRL’s concussion laws? If so can you give an example?

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Yes No

Question 4: Have you ever thought to count the number of head knocks you suffer while playing sports (per game)? !Yes/No !Five Person Trial !Yes: 2 No: 3 !47 Person Survey !Yes: 5 No: 42 !Observations: The responses to this question display that there is a lack of awareness of the danger of head knocks. This is a relatively minimalistic way of maintaining stability in regards to the management of head injury, by monitoring the amount of minor blows. At this point it is evident that an awareness campaign is required as there is minimal knowledge about what CTE is and also some of the things to invest in to take care of themselves. CTE has occurred in people who have suffered multiple concussions, however it has also occurred in people who have never suffered one. Repetitive subconcussive blows that are not as injurious or painful can cause it and these need to be kept track of. !!!!!!!!!!


Five Person Trial:

47 Person Survey:

!!75PATRICK O'FARRELLCTE: A MODERN SPORTING CRISIS

Question 4: Have you ever thought to count the number of head knocks you suffer while playing sports (per game)?

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Question 4: Have you ever thought to count the number of head knocks you suffer while playing sports (per game)?

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Yes No

Question 5: Have you ever suffered a concussion playing sport? How many? !Yes/No _________ !Five Person Trial !Part 1: (Yes/No) Yes: 2 No: 3 !Part 2: (Number of Concussions) (2 People) 1: 1 2: 1 3: 0 4: 0 !47 Person Survey !Part 1: (Yes/No) Yes: 28 No: 19 !Part 2: (Number of Concussions) (28 People) 1: 14 2: 8 3: 3 4: 3 Observations: The results from this question evidence that the group has been exposed to concussions, with over half having suffered at least one. Majority of the concentration is in the area of having only suffered one, however there are just as many who have suffered two or more. It will be interesting to see how this compares with future questions regarding how quick their return to sport was and also how they view Sam Burgess’ grand final concussion. !!


Five Person Trial: (Part 2, 2 People)

!47 Person Survey: (Part 2, 28 People)

!

!!


Question 5: Part 1: Have you ever suffered a concussion playing

sport?

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Question 5: Part 2: How many?

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Number of Concussions

1 2 3 4

Question 5: Part 1: Have you ever suffered a concussion

playing sport?

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14

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28

Yes No

Question 5: Part 2: How many?

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Number of Concussions

1 2 3 4

Question 6: What is the shortest time you have spent away from sport while recovering from a concussion? !Five Person Trial: (2 People) Instant: 1 1 Week or less: 1 1-2 Weeks: 0 3-4 Weeks 0 !47 Person Survey: (28 People) Instant: 4 1 Week or less: 14 1-2 Weeks: 5 3-4 Weeks: 5 !Observations: The results of this question evidence that the group has, for the most part, returned too soon from concussion. The majority have returned in within two weeks or less. While each concussion may vary, doctors usually recommend that three weeks be the minimum. Furthermore the concussion policy at Saint Joseph’s College is that players must wait at least three weeks. This is worrying, as participants may have already done damage to themselves with such rapid returns, particularly those who returned to play straight away. !!!!!!!!!!!!


Five Person Trial: (2 People)

!47 Person Survey: (28 People)


Question 6: What is the shortest time you have spent away from sport while recovering from a concussion?

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Instant 1 Week or Less 1-2 Weeks 3-4 Weeks

Question 6: What is the shortest time you have spent away from sport while recovering from a concussion?

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Instant 1 Week or Less 1-2 Weeks 3-4 Weeks

Question 7: Do you think the NRL’s updated concussion laws are… !A.Too strict B.Fine C.Not strict enough !Five Person Trial: !A. 2 (Too strict) B. 3 (Fine) C. 0 (Not strict enough) !47 Person Survey (46 People) !A. 6 (Too strict) B. 35 (Fine) C. 5 (Not strict enough) !Observations: This response merely provides some information about what the group believes about the improvement of the NRL’s concussion laws. In regards to the punishment for keeping a concussed player in the game, majority of the group believe that fines, loss of competition points and the suspension of registration of trainers and coaches is an adequate penalty for failing to look after a player who has suffered a head injury. !!!!!!!!!!!


Five Person Trial:

!47 Person Survey (46 People):


Question 7: Do you think the NRL's updated concussion laws are...

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Too Strict Fine Not Strict Enough

Question 7: Do you think the NRL's updated concussion laws are...

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Too Strict Fine Not Strict Enough

Question 8: In your eyes is Sam Burgess playing through two fractures and a concussion in the NRL grand final heroic and would you do the same? !Yes/No I would/would not do the same !Five Person Trial: !Part 1: (Yes/No- Heroic?) Yes: 4 No: 1 !Part 2: (Would/Would not do the same) Would: 2 Would not: 3 !47 Person Survey: !Part 1: (Yes/No- Heroic?) Yes: 36 No: 11 !Part 2: (Would/Would not do the same 44 People) Would: 27 Would not: 17 !Observations: The majority of people perceived Sam Burgess playing through injury in the grand final as a heroic thing. This establishes that macho Culture is evident within the group as the vast majority describe it as a “badge of honour” scenario. Furthermore it is signalled as being something that they admire as the majority, again, would do the same. This idea of somebody displaying a gross amount of macho culture and glorification of playing through injury could be a very dangerous thing in regards to young people copying and doing the same. !!!


Five Person Trial: !


!

!!!


Question 8: Part 1: In your eyes is Sam Burgess playing through two fractures

and a concussion in the NRL grand final heroic?

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Question 8: Part 2: Would you do the same?

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Would Would Not

Question 8: Part 1: In your eyes is Sam Burgess playing through two fractures

and a concussion in the NRL grand final heroic

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Question 8: Part 2: Would you do the same?

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Question 9: The best part of contact sport to you is… !A. The big hits B. Fantastic tries C. The players D. The atmosphere !Five Person Trial: !A. 2 (The big hits) B. 2 (Fantastic tries) C. 1 (The players) D. 0 (The atmosphere) !47 Person Survey (44 People): !A. 18 (The big hits) B. 15 (Fantastic tries) C. 2 (The players) D. 9 (The atmosphere) !Observations: This reinforces that macho culture is evident in the group as it can be seen that they find “Big hits” to be the most entertaining and enjoyable part of viewing and playing contact sport. The previous question displays this to a greater degree as there was a greater majority. In this case “A” was slightly ahead of “B”. Which signifies that there is a smaller majority in this regard towards macho culture. !!!!!!!!


Five Person Trial:



Question 9: The best part of contact sport to you is...

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The Big Hits Fantastic Tries The Players The Atmosphere

Question 9: The best part of contact sport to you is...

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The Big Hits Fantastic Tries The Players The Atmosphere

Question 10: Mental health in later life to you is… !A. Very important B. Important C. Unimportant D. Completely unimportant !Five Person Trial: !A. 3 (Very important) B. 2 (Important) C. 0 (Unimportant) D. 0 (Completely unimportant) !47 Person Survey: !A. 23 (Very important) B. 14 (Important) C. 0 (Unimportant) D. 0 (Completely unimportant) !Observations: There is definitely a desire for positive mental health. This is clear with a majority of people choosing the option signifying exceptional mental health. Furthermore the rest of the group chose the second best option in regards to mental health, meaning no one selected the options evidencing that there was an absence of the value of mental health. Thus the contrast that I wished to see has been evidenced due to the fact that while majority value mental health the majority also value what Sam Burgess did, have returned from concussion too soon and do not know what CTE is. !


Five Person Trial:

!!47 Person Survey:


Question 10: Mental health in later life to you is...

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Very Important Important Unimportant Completely Unimportant

Question 10: Mental health in later life to you is...

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Very Important Important Unimportant Completely Unimportant

Summing Up In regard to the survey I see it as a great success. I was able to get the results that I was hoping for. What I see in the results is a group that has minimal knowledge of what CTE is. They can provide little evidence beyond what the term stands for and struggled to describe what it actually is. The group has also been exposed to concussion and in many cases has returned too quickly from this type of injury. There were individuals who returned instantly and many were playing sport within a week of the injury. Furthermore the group responded in a way that displayed macho culture regarding Sam Burgess' injury and playing through this injury. In contrast to this however they exhibited a desire for positive mental health in the future, which conflicts with their previous answers.

!!!!!!!!!


9. Awareness Campaign Raising Awareness

! As demonstrated by the survey, there is minimal knowledge about what CTE is and what it relates to. Thus the group are at risk of falling victim to it. !Movie One of the aspects of my awareness campaign is a movie. To begin I accumulated GoPro footage from YouTube, I did this to display the reasons we play sport, by inserting the audience directly into the moment. The rushing adrenaline sprinting past defenders in a sport such as gridiron or rugby, doing flips on a mere bicycle in an extreme sport such as BMX and hitting a boundary in cricket can be experienced from a first hand viewpoint. !To juxtapose the enjoyable side of sport I then produced a montage of big hits, constantly streaming, displaying the brutality and ugly side of sport. This contrast of why we play sport and the painful side of sport alludes to the next segment of the video. !After this I revealed the bleak news reports of CTE, to suggest the consequence of the big hits. Breaking news announcements, reporters detailing the issues associated with it and the threat it poses to young athletes. This was quickly edited together to display the intensity with which the issue must be covered as well as the nature of the news reports. !!!!!!


Posters Another way to raise awareness is through the creation of posters. They can be placed anywhere and can easily capture someone's attention with bright colours and a simple message.

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10. Conclusion Final Notes

! In this document all facets of CTE, to date, have been covered. I have taken you through what it is, on a symptomatic and pathological scale, who it is affecting, across a variety of sports, what is making it more prevalent in sports, macho culture, how it created a legal scandal for the NFL, public action being taken to solve the problem, conducted my own research into knowledge of the issue in a vulnerable group and produced an awareness campaign to counter their lack of knowledge of CTE. !In summary it can be seen that in the past head knocks and concussions were put off by athletes as innocuous and thus they played through them, only to discover the true danger today, often many years later. Now, although it is best for players to leave the field once they have suffered a concussion, it is not always the easiest thing to do and can be an idealistic hope. In professional sport, players earn money with time spent on the field. Thus if coming off will leave them at a disadvantage for selection and their contract, ignoring concussions could very easily continue. They are not the best judge of their own welfare in this situation. !Sports players are the heroes of young children, adults, and entire cities. They carry with them the hopes and dreams of the people they represent through their uniform and carry the legacy and expectation of those who wore it before them. Sport is a mass contributor to commerce globally, in terms of merchandise, tickets and advertising. When playing on the greatest stage the greatest levels of ability, skill and toughness are expected to be shown. This may include playing through a head injury. !!!


Later in life CTE scars those who chose to play through these head injuries. It forces dementia, anxiety, depression, suicidality, among other symptoms upon a player trying to retire comfortably with their family, such as Tony Dorsett or a young player at the start of the path to a professional career, such as Owen Thomas. Much like other diseases CTE does not discriminate, if you have suffered a large cumulative number of concussive and subconcussive blows throughout life, whether it involves sport or not, CTE could be the end result. Whether you are a player of gridiron, rugby, AFL, football or baseball, as a superstar or as a backup. It is not a positive thing to know that teams and organisations such as the NFL do not care about the injured by covering up the issue for many years. It is why athletes have been compared to pieces of meat, once they are bruised, new ones are bought to quickly replace the spoiled. !For professionals it is a dilemma of livelihood versus lifestyle. However for junior players it is far less sinister. In the case of junior athletes keeping them from continuing through a concussion does not place anything at stake, and should merely be considered part of a coach’s duty of care to look after a player and prevent them from doing harm to their future mental wellbeing. !The final thing I will leave you with is that while there is an issue with the trauma being suffered in sport, leading to concussions, the greater problem creating CTE is how this trauma is dealt with and how much recuperation the players are allowed after they have been injured. !Thank you for reading about an issue relevant to many aspects of our society and the questions that accompany it. CTE is an issue that I hope will receive greater coverage as further developments are made in its research. !I would like to give special thanks to Mrs Lesley Maher, Mrs Michelle O'Brien and my parents for their support, particularly with editing in the process of creating this major work, I greatly appreciate the time they have put into assisting me. !


11. Bibliography My Sources

225.pitt.edu, (n.d.). Tony Dorsett: Gold-Standard Running Back | 225 Years | University of Pittsburgh. [online] Available at: http://www.225.pitt.edu/story/tony-dorsett [Accessed 10 Nov. 2014].

!2014 Grand Final. (2014). [image] Available at: http://www.theguardian.com [Accessed 10 Nov. 2014].

!Adrian Arrington, Derek Owens, Mark Turner and Angela Palacios individually and on behalf of all others similarly situated v National Collegiate Athletic Association [2011]11-cv-06356 1 (United States District Court Northern District of Illinois Eastern Division).

!Allen, K. and Brady, E. (2011). Tough guys concerned about news of Probert's brain disease - USATODAY.com. [online] USATODAY.COM. Available at: http://usatoday30.usatoday.com/sports/hockey/nhl/2011-03-03-bob-probert-brain-disease_N.htm [Accessed 10 Nov. 2014].

!Almasy, S. (2014). Dan Marino sues NFL over concussions. [online] CNN. Available at: http://edition.cnn.com/2014/06/02/us/dan-marino-concussion-lawsuit/ [Accessed 10 Nov. 2014].

!Almasy, S. and McLaughlin, E. (2013). Tony Dorsett struggles with memory loss, personality changes. [online] CNN. Available at: http://edition.cnn.com/2013/11/07/health/nfl-tony-dorsett-cte-diagnosis/ [Accessed 10 Nov. 2014].

!Alzforum.org, (2012). Boxing: Study of Human Model for CTE Enters Second Round. [online] Available at: http://www.alzforum.org/news/conference-coverage/boxing-study-human-model-cte-enters-second-round [Accessed 10 Nov. 2014].

!Apple.com, (2014). Apple - iPad - Concussion Game Plan. [online] Available at: https://www.apple.com/your-verse/concussion-game-plan/ [Accessed 11 Nov. 2014].


http://225.pitt.edu

http://www.225.pitt.edu/story/tony-dorsett

http://www.theguardian.com

http://USATODAY.com

http://USATODAY.COM

http://usatoday30.usatoday.com/sports/hockey/nhl/2011-03-03-bob-probert-brain-disease_N.htm

http://edition.cnn.com/2014/06/02/us/dan-marino-concussion-lawsuit/

http://edition.cnn.com/2013/11/07/health/nfl-tony-dorsett-cte-diagnosis/

http://Alzforum.org

http://www.alzforum.org/news/conference-coverage/boxing-study-human-model-cte-enters-second-round

http://Apple.com

https://www.apple.com/your-verse/concussion-game-plan/

AT&T Stadium. (2014). [image] Available at: https://theboysareback.wordpress.com/category/community/cowboys-stadium-att-stadium-att-cowboys-stadium/ [Accessed 10 Nov. 2014].

!Balm, J. (2014). The subway of the brain â€“ Why white matter matters.. [online] Blogs.biomedcentral.com. Available at: http://blogs.biomedcentral.com/bmcblog/2014/03/14/the-subway-of-the-brain-why-white-matter-matters/ [Accessed 10 Nov. 2014].

!Bankrupt Image. (n.d.). [image] Available at: http://marcisischo.com/2014/10/21/todays-news-ebola-parkinsons-hover-boards-batman-robin/ [Accessed 17 Nov. 2014].

!Barry Taylor. (2014). [image] Available at: http://www.smh.com.au [Accessed 10 Nov. 2014].

!BBC News, (2014). NFL concussion lawsuit approved. [online] Available at: http://www.bbc.com/news/world-us-canada-28204513 [Accessed 10 Nov. 2014].

!Behind the Steel Curtain, (2014). The NFL Concussion Lawsuit: Unlimited money, continuing tragedy. [online] Available at: http://www.behindthesteelcurtain.com/steelers-2014-preview-preseason-news-updates-roster-depth-chart-salary-cap/2014/7/24/5925353/nfl-concussion-lawsuit-results-status-update-money-2014 [Accessed 10 Nov. 2014].

!Bella, T. (2014). Before and after Ryan Freel: How MLB stepped up to concussions | Al Jazeera America. [online] America.aljazeera.com. Available at: http://america.aljazeera.com/watch/shows/america-tonight/articles/2014/10/1/ryan-freel-mlb-concussions.html [Accessed 10 Nov. 2014].

Bennett, D. (2011). Dave Duerson's Suicide Note: "Please, See That My Brain Is Given To The NFL's Brain Bank". Business Insider, [online] p.1. Available at: http://www.businessinsider.com.au/dave-duersons-suicide-note-2011-2 [Accessed 10 Nov. 2014].

!Biography.com, (n.d.). Kurt Warner. [online] Available at: http://www.biography.com/people/kurt-warner-519490#early-career [Accessed 10 Nov. 2014].

!Biology-online.org, (n.d.). Neurofibrillary degeneration - definition from Biology-Online.org. [online] Available at: http://www.biology-online.org/dictionary/Neurofibrillary_degeneration [Accessed 10 Nov. 2014].


https://theboysareback.wordpress.com/category/community/cowboys-stadium-att-stadium-att-cowboys-stadium/

http://Blogs.biomedcentral.com

http://blogs.biomedcentral.com/bmcblog/2014/03/14/the-subway-of-the-brain-why-white-matter-matters/

http://marcisischo.com/2014/10/21/todays-news-ebola-parkinsons-hover-boards-batman-robin/

http://www.smh.com.au

http://www.bbc.com/news/world-us-canada-28204513

http://www.behindthesteelcurtain.com/steelers-2014-preview-preseason-news-updates-roster-depth-chart-salary-cap/2014/7/24/5925353/nfl-concussion-lawsuit-results-status-update-money-2014

http://America.aljazeera.com

http://america.aljazeera.com/watch/shows/america-tonight/articles/2014/10/1/ryan-freel-mlb-concussions.html

http://www.businessinsider.com.au/dave-duersons-suicide-note-2011-2

http://Biography.com

http://www.biography.com/people/kurt-warner-519490#early-career

http://Biology-online.org

http://Biology-Online.org

http://www.biology-online.org/dictionary/Neurofibrillary_degeneration

Blaylock, R. and Maroon, J. (2011). Immunoexcitotoxicity as a central mechanism in chronic traumatic encephalopathy-A unifying hypothesis. Surg Neurol Int, [online] 2(1), p.107. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157093/ [Accessed 10 Nov. 2014].

!Blaylock, R. and Maroon, J. (2011). Immunoexcitotoxicity as a central mechanism in chronic traumatic encephalopathy-A unifying hypothesis. Surg Neurol Int, [online] 2(1), p.107. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157093/#!po=12.1795 [Accessed 10 Nov. 2014].

!Bolton, J. (2014). My fears over multiple concussions. Sydney Morning Herald, [online] p.1. Available at: http://www.smh.com.au/afl/afl-news/my-fears-over-multiple-concussions-20140312-hvhqk.html [Accessed 10 Nov. 2014].

!Brain Comparison. (n.d.). [image] Available at: http://staytuned.ninenet.org/episodes/student-athlete-safety/ [Accessed 10 Nov. 2014].

!Brainline.org, (n.d.). What Is Tau and Its Role in Chronic Traumatic Encephalopathy?. [online] Available at: http://www.brainline.org/content/multimedia.php?id=4115 [Accessed 10 Nov. 2014].

!Branch, J. (2014). Brain Trauma Extends to the Soccer Field. The New York Times, [online] p.1. Available at: http://www.nytimes.com/2014/02/27/sports/soccer/researchers-find-brain-trauma-disease-in-a-soccer-player.html [Accessed 10 Nov. 2014].

!Breslow, J. (2013). NFL Reaches $765 Million Settlement In Concussion Lawsuit â€“ League of Denial: The NFL's Concussion Crisis - FRONTLINE. [online] FRONTLINE. Available at: http://www.pbs.org/wgbh/pages/frontline/sports/league-of-denial/nfl-reaches-765-million-settlement-in-concussion-lawsuit/ [Accessed 9 Nov. 2014].

!Brett Favre. (n.d.). [image] Available at: http://www.pinterest.com [Accessed 11 Nov. 2014].

!BU Today, (2014). CTE Found in Dead College Football Player | BU Today | Boston University. [online] Available at: http://www.bu.edu/today/2010/cte-found-in-dead-college-football-player/ [Accessed 10 Nov. 2014].


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157093/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157093/#!po=12.1795

http://www.smh.com.au/afl/afl-news/my-fears-over-multiple-concussions-20140312-hvhqk.html

http://staytuned.ninenet.org/episodes/student-athlete-safety/

http://Brainline.org

http://www.brainline.org/content/multimedia.php?id=4115

http://www.nytimes.com/2014/02/27/sports/soccer/researchers-find-brain-trauma-disease-in-a-soccer-player.html

http://www.pbs.org/wgbh/pages/frontline/sports/league-of-denial/nfl-reaches-765-million-settlement-in-concussion-lawsuit/

http://www.pinterest.com

http://www.bu.edu/today/2010/cte-found-in-dead-college-football-player/

C3logix.com, (2014). c3logix.com. [online] Available at: http://www.c3logix.com/ [Accessed 10 Nov. 2014].

!CBC Sports, (2011). Probert had degenerative brain disease: study. [online] Available at: http://Probert had degenerative brain disease: study - Hockey - CBC [Accessed 10 Nov. 2014].

!Cbsnews.com, (2013). Autopsy: Former Falcons safety Ray Easterling had brain disease associated with concussions. [online] Available at: http://www.cbsnews.com/news/autopsy-former-falcons-safety-ray-easterling-had-brain-disease-associated-with-concussions/ [Accessed 10 Nov. 2014].

!Chappell, B. (2011). NFL To Adopt New Concussion Evaluation Process. [online] NPR.org. Available at: http://www.npr.org/blogs/thetwo-way/2011/02/23/134000896/nfl-to-adopt-new-concussion-evaluation-process [Accessed 10 Nov. 2014].

!CNN, (2014). NFL Concussions Fast Facts. [online] Available at: http://edition.cnn.com/2013/08/30/us/nfl-concussions-fast-facts/index.html [Accessed 10 Nov. 2014].

!Coates, T. (2012). NFL Standout Ray Easterling Had CTE. The Atlantic, [online] p.1. Available at: http://www.theatlantic.com/entertainment/archive/2012/07/nfl-standout-ray-easterling-had-cte/260406/ [Accessed 10 Nov. 2014].

!Concussion Diagram. (n.d.). [image] Available at: http://nurse-thought.blogspot.com/2009/03/nursing-care-plans-for-cerebral.html [Accessed 10 Nov. 2014].

!Crain, Z. (2014). Tony Dorsett Is Losing His Mind. D Magazine, [online] (1). Available at: http://www.dmagazine.com/publications/d-magazine/2014/february/dallas-cowboys-tony-dorsett-is-losing-his-mind?single=1 [Accessed 10 Nov. 2014].

!CTE Stages. (n.d.). [image] Available at: http://www.sportslegacy.org/wp-content/uploads/2014/10/SLI-Press-Kit-2014.pdf [Accessed 10 Nov. 2014].

!Daniel Bell. (n.d.). [image] Available at: http://www.proactive-ageing.com/index_files/Consultations.htm [Accessed 10 Nov. 2014].


http://C3logix.com

http://c3logix.com

http://www.c3logix.com/

http://Probert

http://Cbsnews.com

http://www.cbsnews.com/news/autopsy-former-falcons-safety-ray-easterling-had-brain-disease-associated-with-concussions/

http://NPR.org

http://www.npr.org/blogs/thetwo-way/2011/02/23/134000896/nfl-to-adopt-new-concussion-evaluation-process

http://edition.cnn.com/2013/08/30/us/nfl-concussions-fast-facts/index.html

http://www.theatlantic.com/entertainment/archive/2012/07/nfl-standout-ray-easterling-had-cte/260406/

http://nurse-thought.blogspot.com/2009/03/nursing-care-plans-for-cerebral.html

http://www.dmagazine.com/publications/d-magazine/2014/february/dallas-cowboys-tony-dorsett-is-losing-his-mind?single=1

http://www.sportslegacy.org/wp-content/uploads/2014/10/SLI-Press-Kit-2014.pdf

http://www.proactive-ageing.com/index_files/Consultations.htm

Dave Duerson. (n.d.). [image] Available at: http://brainhealthresources.wordpress.com [Accessed 10 Nov. 2014].

!Derek Boogard Fighting. (n.d.). [image] Available at: http://www.imageslides.com [Accessed 10 Nov. 2014].

!Diamond, D. (2014). NFL Players Have 30% Chance Of Alzheimer's Or Dementia, New NFL Concussion Data Suggests. Forbes. [online] Available at: http://www.forbes.com/sites/dandiamond/2014/09/12/nfl-players-have-30-chance-of-alzheimers-or-dementia-new-nfl-concussion-data-suggests/ [Accessed 10 Nov. 2014].

!DNA. (n.d.). [image] Available at: https://www.haikudeck.com/--uncategorized-presentation-Ri3gz3i1Yc [Accessed 10 Nov. 2014].

!Doucleff, M. and Cole, A. (2013). Are NFL Football Hits Getting Harder And More Dangerous?. [online] NPR.org. Available at: http://www.npr.org/blogs/health/2013/01/31/170764982/are-nfl-football-hits-getting-harder-and-more-dangerous [Accessed 10 Nov. 2014].

!Dr. Benett Omalu. (n.d.). [image] Available at: http://giccb.com [Accessed 10 Nov. 2014].

!Easterbrook, G. (2011). Easterbrook: The bigger, stronger player. [online] ESPN.com. Available at: http://espn.go.com/espn/page2/story/_/id/6933214/tmq-mel-kiper-jr-size-increase-football-players [Accessed 10 Nov. 2014].

!Elliott, J. (n.d.). Concussion Concludes Craig Clarkeâ€™s Connacht Career. [online] Pundit Arena. Available at: http://www.punditarena.com/rugby/jelliot/concussion-concludes-craig-clarke-connacht-career/ [Accessed 10 Nov. 2014].

!ESPN.com, (2010). Penn player who killed self had brain disease. [online] Available at: http://sports.espn.go.com/ncf/news/story?id=5569329 [Accessed 10 Nov. 2014].

!ESPN.com, (2013). Report: CTE present when Freel killed self. [online] Available at: http://espn.go.com/mlb/story/_/id/10142581/cte-present-ryan-freel-killed-self-report-says [Accessed 10 Nov. 2014].


http://brainhealthresources.wordpress.com

http://www.imageslides.com

http://www.forbes.com/sites/dandiamond/2014/09/12/nfl-players-have-30-chance-of-alzheimers-or-dementia-new-nfl-concussion-data-suggests/

https://www.haikudeck.com/--uncategorized-presentation-Ri3gz3i1Yc

http://NPR.org

http://www.npr.org/blogs/health/2013/01/31/170764982/are-nfl-football-hits-getting-harder-and-more-dangerous

http://giccb.com

http://ESPN.com

http://espn.go.com/espn/page2/story/_/id/6933214/tmq-mel-kiper-jr-size-increase-football-players

http://www.punditarena.com/rugby/jelliot/concussion-concludes-craig-clarke-connacht-career/

http://ESPN.com

http://sports.espn.go.com/ncf/news/story?id=5569329

http://ESPN.com

http://espn.go.com/mlb/story/_/id/10142581/cte-present-ryan-freel-killed-self-report-says

ESPN.com, (2013). Saints Bounty Scandal. [online] Available at: http://espn.go.com/nfl/topics/_/page/new-orleans-saints-bounty-scandal [Accessed 11 Nov. 2014].

!ESPN.com, (2011). Researchers: Hockey enforcer Probert had CTE. [online] Available at: http://sports.espn.go.com/nhl/news/story?id=6177474 [Accessed 10 Nov. 2014].

!Ezell, L. (2013). Timeline: The NFLâ€™s Concussion Crisis â€“ League of Denial: The NFL's Concussion Crisis - FRONTLINE. [online] FRONTLINE. Available at: http://www.pbs.org/wgbh/pages/frontline/sports/league-of-denial/timeline-the-nfls-concussion-crisis/ [Accessed 10 Nov. 2014].

!Fainaru, S. and Fainaru-Wada, M. (2014). OTL: NFL youth tackling program in question. [online] ESPN.com. Available at: http://espn.go.com/espn/otl/story/_/id/10276129/popular-nfl-backed-heads-tackling-method-questioned-former-players [Accessed 10 Nov. 2014].

!Fairnu, S. and Fairnu-Wada, M. (2013). OTL: Concussion researchers conflicted?. [online] ESPN.com. Available at: http://espn.go.com/espn/otl/story/_/id/9135869/two-prominent-concussion-researchers-including-nfl-adviser-served-paid-consultants-law-firms-suing-nfl-behalf-players [Accessed 10 Nov. 2014].

!Fanning, B. (2014). â€˜Heâ€™d go wandering. Heâ€™d fall over. He had no control over anythingâ€™. [online] Brendan Fanning on Rugby. Available at: http://brendanfanningrugby.wordpress.com/ [Accessed 10 Nov. 2014].

!Fanning, B. (2014). Coroner finds concussion caused ex-player's death. Independent, [online] p.1. Available at: http://www.independent.ie/sport/rugby/coroner-finds-concussion-caused-explayers-death-30319564.html [Accessed 10 Nov. 2014].

!Fink, D. (2014). Concussion Article Links â€“ MUST READ. [Blog] The Concussion Blog. Available at: http://theconcussionblog.com/2012/05/09/concussion-article-links-must-read/ [Accessed 10 Nov. 2014].

!!


http://ESPN.com

http://espn.go.com/nfl/topics/_/page/new-orleans-saints-bounty-scandal

http://ESPN.com

http://sports.espn.go.com/nhl/news/story?id=6177474

http://www.pbs.org/wgbh/pages/frontline/sports/league-of-denial/timeline-the-nfls-concussion-crisis/

http://ESPN.com

http://espn.go.com/espn/otl/story/_/id/10276129/popular-nfl-backed-heads-tackling-method-questioned-former-players

http://ESPN.com

http://espn.go.com/espn/otl/story/_/id/9135869/two-prominent-concussion-researchers-including-nfl-adviser-served-paid-consultants-law-firms-suing-nfl-behalf-players

http://brendanfanningrugby.wordpress.com/

http://www.independent.ie/sport/rugby/coroner-finds-concussion-caused-explayers-death-30319564.html

http://theconcussionblog.com/2012/05/09/concussion-article-links-must-read/

Fitzsimmons, P. (2014). Accepting facts on long-term effects of concussions among athletes should be a no-brainer. Sydney Morning Herald, [online] p.1. Available at: http://www.smh.com.au/rugby-league/league-news/accepting-facts-on-longterm-effects-of-concussions-among-athletes-should-be-a-nobrainer-20140625-zslmu.html [Accessed 10 Nov. 2014].

!Fitzsimmons, P. (2014). Damage is done: NRL response to Sam Burgess' injuries too little, too late. Sydney Morning Herald, [online] p.1. Available at: http://www.smh.com.au/rugby-league/league-news/damage-is-done-nrl-response-to-sam-burgess-injuries-too-little-too-late-20141009-113i97.html [Accessed 10 Nov. 2014].

!Frank Gore Head Clash. (2013). [image] Available at: http://www.bbcnfl.com [Accessed 10 Nov. 2014].

!Garber, G. (2005). A tormented soul. [online] ESPN.com. Available at: http://sports.espn.go.com/nfl/news/story?id=1972285 [Accessed 10 Nov. 2014].

!Garber, G. (2008). Garber: Closing the gap between Brady and perfection. [online] ESPN.com. Available at: http://sports.espn.go.com/nfl/playoffs07/columns/story?id=3219092 [Accessed 10 Nov. 2014].

!George Smith Walking Off. (n.d.). [image] Available at: http://www.theguardian.com [Accessed 10 Nov. 2014].

!George Smith Sitting. (n.d.). [image] Available at: http://www.stuff.co.nz [Accessed 10 Nov. 2014].

!Glover, B. (2013). NRL makes another change to shoulder charge rule to further protect players from injury. [online] Fox Sports. Available at: http://www.foxsports.com.au/nrl/nrl-premiership/nrl-makes-another-change-to-shoulder-charge-rule-to-further-protect-players-from-injury/story-fn2mcuj6-1226618526636 [Accessed 10 Nov. 2014].

!Government, A. (n.d.). Chronic Diseases. [online] AIHW. Available at: http://www.aihw.gov.au/chronic-diseases/ [Accessed 10 Nov. 2014].


http://www.smh.com.au/rugby-league/league-news/accepting-facts-on-longterm-effects-of-concussions-among-athletes-should-be-a-nobrainer-20140625-zslmu.html

http://www.smh.com.au/rugby-league/league-news/damage-is-done-nrl-response-to-sam-burgess-injuries-too-little-too-late-20141009-113i97.html

http://www.bbcnfl.com

http://ESPN.com

http://sports.espn.go.com/nfl/news/story?id=1972285

http://ESPN.com

http://sports.espn.go.com/nfl/playoffs07/columns/story?id=3219092

http://www.theguardian.com

http://www.stuff.co.nz

http://www.foxsports.com.au/nrl/nrl-premiership/nrl-makes-another-change-to-shoulder-charge-rule-to-further-protect-players-from-injury/story-fn2mcuj6-1226618526636

http://www.aihw.gov.au/chronic-diseases/

Granderson, L. (2010). Granderson: Warner, Chrebet illustrate players' issues with concussion decisions. [online] ESPN.com. Available at: http://sports.espn.go.com/espn/commentary/news/story?id=5611512 [Accessed 10 Nov. 2014].

!Greenemeier, L. (2012). Self-Worth Shattering: A Single Bomb Blast Can Saddle Soldiers with Debilitating Brain Trauma. [online] Scientificamerican.com. Available at: http://www.scientificamerican.com/article/soldier-blast-chronic-traumatic-encephalopathy-cte/ [Accessed 10 Nov. 2014].

!Grisak, B. (2014). St. Louis Rams: Remembering The Greatest Show On Turf. [online] Ramblin' Fan. Available at: http://ramblinfan.com/2014/10/13/st-louis-rams-remembering-greatest-show-turf/ [Accessed 10 Nov. 2014].

!Hagen, P. (2014). New rule on home-plate collisions put into effect. [online] Major League Baseball. Available at: http://m.mlb.com/news/article/68267610/mlb-institutes-new-rule-on-home-plate-collisions [Accessed 10 Nov. 2014].

!Hall, G., Lee, V., Lee, G. and Yao, J. (2001). Staging of Neurofibrillary Degeneration Caused by Human Tau Overexpression in a Unique Cellular Model of Human Tauopathy. The American Journal of Pathology, 158(1), pp.235-246.

!Haugh, D. (2012). Duerson wrong symbol for a safer NFL. Chicago Tribune, [online] p.1. Available at: http://articles.chicagotribune.com/2012-02-25/sports/ct-spt-0226-haugh-duerson--20120225_1_dave-duerson-brain-damage-tregg-duerson [Accessed 10 Nov. 2014].

!Heads Up Football Tackle Steps. (n.d.). [image] Available at: http://www.goyouthfootball.org [Accessed 10 Nov. 2014].

!Helmet-Off Hit. (2013). [image] Available at: http://bleacherreport.com [Accessed 10 Nov. 2014].

!Hussain, R. (2000). Hoge Wins Lawsuit Against Doctor. Chicago Tribune. [online] Available at: http://articles.chicagotribune.com/2000-07-22/sports/0007220191_1_hoge-concussions-brain-damage [Accessed 10 Nov. 2014].


http://ESPN.com

http://sports.espn.go.com/espn/commentary/news/story?id=5611512

http://Scientificamerican.com

http://www.scientificamerican.com/article/soldier-blast-chronic-traumatic-encephalopathy-cte/

http://ramblinfan.com/2014/10/13/st-louis-rams-remembering-greatest-show-turf/

http://m.mlb.com/news/article/68267610/mlb-institutes-new-rule-on-home-plate-collisions

http://articles.chicagotribune.com/2012-02-25/sports/ct-spt-0226-haugh-duerson--20120225_1_dave-duerson-brain-damage-tregg-duerson

http://www.goyouthfootball.org

http://bleacherreport.com

http://articles.chicagotribune.com/2000-07-22/sports/0007220191_1_hoge-concussions-brain-damage

Ice Hockey Fight. (n.d.). [image] Available at: http://kenh14.vn [Accessed 11 Nov. 2014].

Iqbal K, e. (n.d.). Mechanisms of neurofibrillary degeneration and the formation of neu... - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9700655 [Accessed 10 Nov. 2014].

!Jacobi, A. (2010). Former Penn captain who killed self had C.T.E.. [online] Cbssports.com. Available at: http://www.cbssports.com/mcc/blogs/entry/24156338/24557819 [Accessed 10 Nov. 2014].

!Jay Cutler. (n.d.). [image] Available at: http://voices.suntimes.com/arts-entertainment/the-daily-sizzle/the-league-creators-look-to-draft-fantasy-football-comedys-next-bear/ [Accessed 10 Nov. 2014].

!Johnathan Thurston. (2014). [image] Available at: http://www.18th-man.com/2013_01_01_archive.html [Accessed 10 Nov. 2014].

!Jovan belcher Tackling Doug Martin. (2014). [image] Available at: http://bit.ly/1odNp4B [Accessed 10 Nov. 2014].

!Junior Seau. (n.d.). [image] Available at: http://www.who2.com [Accessed 10 Nov. 2014].

!Kamenetzky, B. (2013). Volumetric Electromagnetic Phase-Shift Spectroscopy of Brain Edema and Hematoma. PLoS ONE, [online] 8(5), p.e63223. Available at: http://www.digitaltrends.com/sports/technology-solving-the-nfls-concussion-problem-is-a-no-brainer-right-not-exactly/ [Accessed 10 Nov. 2014].

!Kaplen, M. and De Caro, S. (2013). Players and Public Lose While NFL Reigns Victorious. [online] The Huffington Post. Available at: http://www.huffingtonpost.com/michael-v-kaplen/players-and-public-lose-w_b_4071524.html [Accessed 10 Nov. 2014].

!Karmichael Hunt. (n.d.). [image] Available at: http://www.news.com.au/sport/rugby/karmichael-hunt-reveals-key-difference-between-afl-and-nrl-cultures/story-fndpt9s1-1227045087963 [Accessed 10 Nov. 2014].


http://kenh14.vn

http://Ncbi.nlm.nih.gov

http://www.ncbi.nlm.nih.gov/pubmed/9700655

http://Cbssports.com

http://www.cbssports.com/mcc/blogs/entry/24156338/24557819

http://voices.suntimes.com/arts-entertainment/the-daily-sizzle/the-league-creators-look-to-draft-fantasy-football-comedys-next-bear/

http://www.18th-man.com/2013_01_01_archive.html

http://bit.ly/1odNp4B

http://www.who2.com

http://www.digitaltrends.com/sports/technology-solving-the-nfls-concussion-problem-is-a-no-brainer-right-not-exactly/

http://www.huffingtonpost.com/michael-v-kaplen/players-and-public-lose-w_b_4071524.html

http://www.news.com.au/sport/rugby/karmichael-hunt-reveals-key-difference-between-afl-and-nrl-cultures/story-fndpt9s1-1227045087963

Kenny Nuzum. (2014). [image] Available at: http://www.independent.ie [Accessed 10 Nov. 2014].

!Key Researchers at Boston University. (2014). [image] Available at: http://www.bu.edu [Accessed 10 Nov. 2014].

!Kurt Warner. (n.d.). [image] Available at: http://newyork.cbslocal.com [Accessed 10 Nov. 2014].

Kyle Turner Being Tackled. (n.d.). [image] Available at: http://www.zimbio.com [Accessed 10 Nov. 2014].

!Lance Armstrong. (2012). [image] Available at: http://www.parameter.sk/rovat/sport/2012/10/11/dopping-armstrong-ellen-vallottak-korabbi-csapattarsai [Accessed 10 Nov. 2014].

!Landau, E. (2013). High schools tackle football concussions. [online] CNN. Available at: http://edition.cnn.com/2013/08/30/health/high-school-football-safety/index.html [Accessed 10 Nov. 2014].

Lane, S. (2011). Former AFL player seeks compensation. The Age. [online] Available at: http://www.theage.com.au/afl/afl-news/former-afl-player-seeks-compensation-20110330-1cgf7.html [Accessed 10 Nov. 2014].

!Laskas, J. (2009). Game Brain. GQ, [online] pp.1-6. Available at: http://www.gq.com/sports/profiles/200909/nfl-players-brain-dementia-study-memory-concussions [Accessed 10 Nov. 2014].

!Levs, J., Almasy, S. and Sutton, J. (2013). Paul Oliver's suicide is latest in a string among former NFL players. [online] CNN. Available at: http://edition.cnn.com/2013/09/25/us/former-nfl-player-suicide/ [Accessed 10 Nov. 2014].

!Liam Fulton Injured. (2014). [image] Available at: http://www.foxsports.com.au [Accessed 10 Nov. 2014].

!Lillibridge, M. (2012). Ex-NFLer on Playing Injured vs. Hurt. [online] Bleacher Report. Available at: http://bleacherreport.com/articles/1303698-injured-or-hurt-a-former-players-perspective-on-nfl-injuries [Accessed 10 Nov. 2014].


http://www.independent.ie

http://www.bu.edu

http://newyork.cbslocal.com

http://www.zimbio.com

http://www.parameter.sk/rovat/sport/2012/10/11/dopping-armstrong-ellen-vallottak-korabbi-csapattarsai

http://edition.cnn.com/2013/08/30/health/high-school-football-safety/index.html

http://www.theage.com.au/afl/afl-news/former-afl-player-seeks-compensation-20110330-1cgf7.html

http://www.gq.com/sports/profiles/200909/nfl-players-brain-dementia-study-memory-concussions

http://edition.cnn.com/2013/09/25/us/former-nfl-player-suicide/

http://www.foxsports.com.au

http://bleacherreport.com/articles/1303698-injured-or-hurt-a-former-players-perspective-on-nfl-injuries

Liu, F., Zaidi, T., Iqbal, K., Grundke-Iqbal, I., Merkle, R. and Gong, C. (2002). Role of glycosylation in hyperphosphorylation of tau in Alzheimerâ€™s disease. FEBS Letters, [online] 512(1-3), pp.101-106. Available at: http://www.febsletters.org/article/S0014-5793(02)02228-7/abstract [Accessed 10 Nov. 2014].

!Lutton, P. (2014). Karmichael Hunt has no regrets over concussions. Sydney Morning Herald. [online] Available at: http://www.smh.com.au/rugby-union/union-news/karmichael-hunt-has-no-regrets-over-concussions-20141029-11drfd.html [Accessed 10 Nov. 2014].

!Magary, D. (2014). I Got Certified To Coach Heads Up Football And It Was A Joke. [online] Deadspin. Available at: http://deadspin.com/i-got-certified-to-coach-heads-up-football-and-it-was-a-1583159680 [Accessed 10 Nov. 2014].

!Mandal, A. (2010). What are Tau Proteins?. [online] News-Medical.net. Available at: http://www.news-medical.net/health/What-are-Tau-Proteins.aspx [Accessed 10 Nov. 2014].

Manfred, T. (2014). One GIF That Shows How NFL Players Are Exploding In Size. Business Insider. [online] Available at: http://www.businessinsider.com.au/nfl-player-size-over-time-2014-7 [Accessed 10 Nov. 2014].

!Marcus, N. (2013). Chronic Traumatic Encephalopathy (Brain Damage) - Boxing.com. [online] Boxing.com. Available at: http://www.boxing.com/chronic_traumatic_encephalopathy_brain_damage.html [Accessed 11 Nov. 2014].

!Marvin Lewis. (n.d.). [image] Available at: http://www.cbssports.com [Accessed 10 Nov. 2014].

Mayoclinic.org, (n.d.). Concussion Symptoms - Diseases and Conditions - Mayo Clinic. [online] Available at: http://www.mayoclinic.org/diseases-conditions/concussion/basics/symptoms/con-20019272 [Accessed 10 Nov. 2014].

!McCarthy, M. (2013). The Hidden Victims Of The NFL's Concussion Crisis. [online] Regressing. Available at: http://regressing.deadspin.com/the-hidden-victims-of-the-nfls-concussion-crisis-1443101890 [Accessed 10 Nov. 2014].

!!


http://www.febsletters.org/article/S0014-5793(02)02228-7/abstract

http://www.smh.com.au/rugby-union/union-news/karmichael-hunt-has-no-regrets-over-concussions-20141029-11drfd.html

http://deadspin.com/i-got-certified-to-coach-heads-up-football-and-it-was-a-1583159680

http://News-Medical.net

http://www.news-medical.net/health/What-are-Tau-Proteins.aspx

http://www.businessinsider.com.au/nfl-player-size-over-time-2014-7

http://Boxing.com

http://Boxing.com

http://www.boxing.com/chronic_traumatic_encephalopathy_brain_damage.html

http://www.cbssports.com

http://Mayoclinic.org

http://www.mayoclinic.org/diseases-conditions/concussion/basics/symptoms/con-20019272

http://regressing.deadspin.com/the-hidden-victims-of-the-nfls-concussion-crisis-1443101890

McKee, A., Stein, T., Nowinski, C., Stern, R., Daneshvar, D., Alvarez, V., Lee, H., Hall, G., Wojtowicz, S., Baugh, C., Riley, D., Kubilus, C., Cormier, K., Jacobs, M., Martin, B., Abraham, C., Ikezu, T., Reichard, R., Wolozin, B., Budson, A., Goldstein, L., Kowall, N. and Cantu, R. (2012). The spectrum of disease in chronic traumatic encephalopathy. Brain, [online] 136(1), pp.43-64. Available at: http://brain.oxfordjournals.org/content/early/2012/12/02/brain.aws307.long [Accessed 10 Nov. 2014].

!McKee, A., Cantu, R., Nowinski, C., Hedley-Whyte, E., Gavett, B., Budson, A., Santini, V., Lee, H., Kubilus, C. and Stern, R. (2009). Chronic Traumatic Encephalopathy in Athletes. Journal of Neuropathology and Experimental Neurology, [online] 68(7), pp.709-735. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945234/ [Accessed 10 Nov. 2014].

!Micky Ward. (n.d.). [image] Available at: http://www.aworldofboxing.com/Micky-Ward.html [Accessed 10 Nov. 2014].

!Miguel Cabrera Batting. (n.d.). [image] Available at: http://ask.fm [Accessed 10 Nov. 2014].

!Mihoces, G. (2012). Parents weigh risks of youth football amid concussion debate. [online] USATODAY.COM. Available at: http://usatoday30.usatoday.com/sports/football/story/2012-05-16/Parents-weigh-youth-football-risks/55150850/1 [Accessed 10 Nov. 2014].

!Mihoces, G. (2013). Study gives hope for brain disease treatment. [online] Usatoday.com. Available at: http://www.usatoday.com/story/sports/nfl/2013/01/22/nfl-concussions-cte-junior-seau/1855555/ [Accessed 10 Nov. 2014].

!Mike Webster. (n.d.). [image] Available at: http://www.pinterest.com [Accessed 10 Nov. 2014].

Milhoces, G. (2013). Background: Who was Jovan Belcher?. USA Today, [online] p.1. Available at: http://www.usatoday.com/story/sports/nfl/2012/12/01/background-who-is-jovan-belcher-kansas-city-chiefs-university-of-maine/1739063/ [Accessed 10 Nov. 2014].

!Mohney, G. (2014). Death by Header? 1st Soccer Player Found With CTE. [online] ABC News. Available at: http://abcnews.go.com/Health/soccer-player-diagnosed-cte-brings-sports-risks/story?id=22697477 [Accessed 10 Nov. 2014].


http://brain.oxfordjournals.org/content/early/2012/12/02/brain.aws307.long

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945234/

http://www.aworldofboxing.com/Micky-Ward.html

http://ask.fm

http://USATODAY.COM

http://usatoday30.usatoday.com/sports/football/story/2012-05-16/Parents-weigh-youth-football-risks/55150850/1

http://Usatoday.com

http://www.usatoday.com/story/sports/nfl/2013/01/22/nfl-concussions-cte-junior-seau/1855555/

http://www.pinterest.com

http://www.usatoday.com/story/sports/nfl/2012/12/01/background-who-is-jovan-belcher-kansas-city-chiefs-university-of-maine/1739063/

http://abcnews.go.com/Health/soccer-player-diagnosed-cte-brings-sports-risks/story?id=22697477

Mudher, A. (n.d.). How does tau cause nerve cells to die? - Alzheimer's Society. [online] Alzheimers Society. Available at: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1436 [Accessed 10 Nov. 2014].

!Neurosurgery. (n.d.). [image] Available at: http://www.linkedin.com [Accessed 10 Nov. 2014].

NFL.com, (n.d.). Federal judge approves NFL concussion settlement. [online] Available at: http://www.nfl.com/news/story/0ap2000000363672/article/federal-judge-approves-nfl-concussion-settlement [Accessed 10 Nov. 2014].

!NRL Logo. (n.d.). [image] Available at: http://www.pdb3.com.au [Accessed 10 Nov. 2014].

Oklahoma. (n.d.). [image] Available at: http://article.wn.com/view/2014/10/12/Oklahoma_31_Texas_26_Postgame_links_and_observations/ [Accessed 10 Nov. 2014].

!Oregon Herald, (2013). Teddy Bridgewater hit by Jon Bostic. [image] Available at: http://www.oregonherald.com/news/story.cfm?bid=5978830 [Accessed 10 Nov. 2014].

!Owen Thomas. (n.d.). [image] Available at: http://www.huffingtonpost.com/tag/owen-thomas-death/ [Accessed 10 Nov. 2014].

!Park, M. (2010). College football player who committed suicide had brain injury - CNN.com. [online] Edition.cnn.com. Available at: http://edition.cnn.com/2010/HEALTH/09/14/thomas.football.brain/ [Accessed 10 Nov. 2014].

!Patrick Grange. (2014). [image] Available at: http://www.ibtimes.co.uk [Accessed 10 Nov. 2014].

Patterson, C. (2014). Former Missouri State player had CTE when he died at 25. [online] CBSSports.com. Available at: http://www.cbssports.com/collegefootball/eye-on-college-football/24680538/former-missouri-state-player-had-cte-when-he-died-at-25 [Accessed 10 Nov. 2014].

!Penn, N. (2013). The Violent Life and Sudden Death of Junior Seau. GQ, [online] pp.1-4. Available at: http://www.gq.com/entertainment/sports/201309/junior-seau-nfl-death-concussions-brain-injury [Accessed 10 Nov. 2014].

!


http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1436

http://www.linkedin.com

http://NFL.com

http://www.nfl.com/news/story/0ap2000000363672/article/federal-judge-approves-nfl-concussion-settlement

http://www.pdb3.com.au

http://article.wn.com/view/2014/10/12/Oklahoma_31_Texas_26_Postgame_links_and_observations/

http://www.oregonherald.com/news/story.cfm?bid=5978830

http://www.huffingtonpost.com/tag/owen-thomas-death/

http://CNN.com

http://Edition.cnn.com

http://edition.cnn.com/2010/HEALTH/09/14/thomas.football.brain/

http://www.ibtimes.co.uk

http://CBSSports.com

http://www.cbssports.com/collegefootball/eye-on-college-football/24680538/former-missouri-state-player-had-cte-when-he-died-at-25

http://www.gq.com/entertainment/sports/201309/junior-seau-nfl-death-concussions-brain-injury

Piercenet.com, (n.d.). Protein Glycosylation. [online] Available at: http://www.piercenet.com/method/protein-glycosylation [Accessed 10 Nov. 2014].

!Popplewell, B. (2013). Ryan Freel seemed to have it allâ€”a major league career, a loving family, a few million in the bank. But life without baseball was more than he could bear â€” (Sportsnet). [online] SSRI Stories. Available at: http://ssristories.org/ryan-freel-seemed-to-have-it-all-a-major-league-career-a-loving-family-a-few-million-in-the-bank-but-life-without-baseball-was-more-than-he-could-bear-sportsnet/ [Accessed 10 Nov. 2014].

!Proactive-ageing.com, (n.d.). Testimonials, Daniel Bell, Elite AFL Football Player, ConcussionRehabilitation, Brain Training Proof Point. [online] Available at: http://www.proactive-ageing.com/index_files/Testimonials.htm [Accessed 10 Nov. 2014].

!Profootballhof.com, (n.d.). Hall of Famers Â» TONY DORSETT. [online] Available at: http://www.profootballhof.com/hof/member.aspx?PlayerId=59 [Accessed 10 Nov. 2014].

!Psychologytoday.com, (n.d.). Dopamine. [online] Available at: http://www.psychologytoday.com/basics/dopamine [Accessed 11 Nov. 2014].

!Rashean Mathis Walking Off. (2011). [image] Available at: http://blackandteal.com/2012/05/17/questions-moving-forward/ [Accessed 10 Nov. 2014].

!Rathbone, C. (2014). Sportsmen are 'guinea pigs' for head trauma. Sydney Morning Herald. [online] Available at: http://www.smh.com.au/rugby-union/union-news/sportsmen-are-guinea-pigs-for-head-trauma-20140228-33r5l.html [Accessed 10 Nov. 2014].

!Ray Easterling. (n.d.). [image] Available at: http://espn1005.com [Accessed 10 Nov. 2014].

!Riddle, R. (2013). View of Concussion from Inside the Helmet. [online] Bleacher Report. Available at: http://bleacherreport.com/articles/1801126-a-view-of-concussions-from-inside-an-nfl-helmet [Accessed 10 Nov. 2014].

!Robert Griffin III Walking Off. (2012). [image] Available at: http://hamptonroads.com/2012/10/rgiii-knocked-out-concussion-loss-falcons [Accessed 10 Nov. 2014].


http://Piercenet.com

http://www.piercenet.com/method/protein-glycosylation

http://ssristories.org/ryan-freel-seemed-to-have-it-all-a-major-league-career-a-loving-family-a-few-million-in-the-bank-but-life-without-baseball-was-more-than-he-could-bear-sportsnet/

http://Proactive-ageing.com

http://www.proactive-ageing.com/index_files/Testimonials.htm

http://Profootballhof.com

http://www.profootballhof.com/hof/member.aspx?PlayerId=59

http://Psychologytoday.com

http://www.psychologytoday.com/basics/dopamine

http://blackandteal.com/2012/05/17/questions-moving-forward/

http://www.smh.com.au/rugby-union/union-news/sportsmen-are-guinea-pigs-for-head-trauma-20140228-33r5l.html

http://espn1005.com

http://bleacherreport.com/articles/1801126-a-view-of-concussions-from-inside-an-nfl-helmet

http://hamptonroads.com/2012/10/rgiii-knocked-out-concussion-loss-falcons

Robert Probert. (n.d.). [image] Available at: http://www.thesportsbank.net [Accessed 10 Nov. 2014].

!Roy, J. (2013). What NFL's New Helmet Rule Means for Football. [online] Bleacher Report. Available at: http://bleacherreport.com/articles/1578475-nfl-crown-of-the-helmet-rule-the-end-of-football-as-we-know-it [Accessed 10 Nov. 2014].

!Ryan Fitzpatrick Concussed. (n.d.). [image] Available at: http://www.scpr.org/events/2013/01/31/984/traumatic-brain-injury-pee-wee-leagues-nfl/ [Accessed 10 Nov. 2014].

!Ryan Freel Diving. (n.d.). [image] Available at: http://deadspin.com [Accessed 10 Nov. 2014].

!Shenke, J. (2013). Purdue News - Expert: Junior Seau CTE was not caused by football concussions. [online] Purdue.edu. Available at: http://www.purdue.edu/newsroom/releases/2013/Q1/expert-junior-seau-cte-was-not-caused-by-football-concussions.html [Accessed 10 Nov. 2014].

!ShockBox Helmet. (n.d.). [image] Available at: http://www.gizmag.com [Accessed 10 Nov. 2014].

!Shwarz, A. (2011). Duersonâ€™s Brain Trauma Diagnosed. The New York Times, [online] p.1. Available at: http://www.nytimes.com/2011/05/03/sports/football/03duerson.html?_r=0 [Accessed 10 Nov. 2014].

!Shwarz, A. (2010). Suicide Reveals Signs of a Disease Seen in N.F.L. The New York Times. [online] Available at: http://www.nytimes.com/2010/09/14/sports/14football.html?pagewanted=all&_r=0 [Accessed 10 Nov. 2014].

!Shwarz, A. (2011). Hockey Brawler Paid Price, With Brain Trauma. The New York Times. [online] Available at: http://www.nytimes.com/2011/03/03/sports/hockey/03fighter.html?pagewanted=all&_r=0 [Accessed 10 Nov. 2014].

!


http://www.thesportsbank.net

http://bleacherreport.com/articles/1578475-nfl-crown-of-the-helmet-rule-the-end-of-football-as-we-know-it

http://www.scpr.org/events/2013/01/31/984/traumatic-brain-injury-pee-wee-leagues-nfl/

http://deadspin.com

http://Purdue.edu

http://www.purdue.edu/newsroom/releases/2013/Q1/expert-junior-seau-cte-was-not-caused-by-football-concussions.html

http://www.gizmag.com

http://www.nytimes.com/2011/05/03/sports/football/03duerson.html?_r=0

http://www.nytimes.com/2010/09/14/sports/14football.html?pagewanted=all&_r=0

http://www.nytimes.com/2011/03/03/sports/hockey/03fighter.html?pagewanted=all&_r=0

SI.com, (2011). A year after suicide of Penn football player, many questions remain. [online] Available at: http://www.si.com/more-sports/2011/05/10/owen-thomas [Accessed 10 Nov. 2014].

!Singer, M. (2014). Doctors find first case of CTE in deceased former soccer player. [online] CBSSports.com. Available at: http://www.cbssports.com/general/eye-on-sports/24457911/doctors-find-first-case-of-cte-in-deceased-former-soccer-player [Accessed 10 Nov. 2014].

!Smith, M. (2012). Merril Hoge: Kurt Warner is uneducated andÂ irresponsible. [online] Profootballtalk.nbcsports.com. Available at: http://profootballtalk.nbcsports.com/2012/05/04/merril-hoge-kurt-warner-is-uneducated-and-irresponsible/ [Accessed 10 Nov. 2014].

!Smith, S. (2011). Footballer: 'Are you OK with destroying a kid's brain for this game?'. [online] Edition.cnn.com. Available at: http://edition.cnn.com/2011/HEALTH/02/04/tackle.technique.concussion/ [Accessed 10 Nov. 2014].

!Smith, S. (2014). First soccer, rugby players diagnosed with CTE. [online] CNN. Available at: http://edition.cnn.com/2014/02/28/health/cte-soccer-rugby/ [Accessed 10 Nov. 2014].

!Smith, S. (2013). Head impact sensors: On-the-field placebo or danger?. [online] CNN. Available at: http://edition.cnn.com/2013/11/15/health/youth-head-sensors/index.html [Accessed 10 Nov. 2014].

!Smith, S. (2011). Duerson brain tissue analyzed: Suicide linked to brain disease. [online] Edition.cnn.com. Available at: http://edition.cnn.com/2011/HEALTH/05/02/duerson.brain.exam.results/ [Accessed 10 Nov. 2014].

!Smith, S. (2010). Warner: Playing through concussion 'part of the game'. [online] Edition.cnn.com. Available at: http://edition.cnn.com/2010/HEALTH/11/22/playing.through.concussions/ [Accessed 10 Nov. 2014].

!!!


http://SI.com

http://www.si.com/more-sports/2011/05/10/owen-thomas


http://www.cbssports.com/general/eye-on-sports/24457911/doctors-find-first-case-of-cte-in-deceased-former-soccer-player

http://Profootballtalk.nbcsports.com

http://profootballtalk.nbcsports.com/2012/05/04/merril-hoge-kurt-warner-is-uneducated-and-irresponsible/


http://edition.cnn.com/2011/HEALTH/02/04/tackle.technique.concussion/

http://edition.cnn.com/2014/02/28/health/cte-soccer-rugby/

http://edition.cnn.com/2013/11/15/health/youth-head-sensors/index.html


http://edition.cnn.com/2011/HEALTH/05/02/duerson.brain.exam.results/


http://edition.cnn.com/2010/HEALTH/11/22/playing.through.concussions/

Solomon, J. (2014). NCAA settlement: Football players carry 3 times risk of CTE symptoms. [online] CBSSports.com. Available at: http://www.cbssports.com/collegefootball/writer/jon-solomon/24643655/ncaa-settlement-football-players-3-times-more-likely-to-have-cte-symptoms [Accessed 10 Nov. 2014].

!Solotaroff, P. (2011). Dave Duerson: The Ferocious Life and Tragic Death of a Super Bowl Star. Men's Journal, [online] p.1. Available at: http://www.mensjournal.com/magazine/dave-duerson-the-ferocious-life-and-tragic-death-of-a-super-bowl-star-20121002 [Accessed 10 Nov. 2014].

!Spasaro, J. (2014). Ice hockey player backs Liam Fulton over concussions. [online] Northern Star. Available at: http://www.northernstar.com.au/news/liam-fulton-ice-hockey-player-backs-concussions/2328150/ [Accessed 10 Nov. 2014].

!Sportslegacy.org, (n.d.). Ray Easterling | Sports Legacy Institute. [online] Available at: http://www.sportslegacy.org/research/legacy-donors/ray-easterling/ [Accessed 10 Nov. 2014].

Stahl, R. (n.d.). Chronic Traumatic Encephalopathy. In: CVS Pharmacy, 1st ed. [online] Available at: http://health.cvs.com/GetContent.aspx?token=f75979d3-9c7c-4b16-af56-3e122a3f19e3&chunkiid=744866 [Accessed 10 Nov. 2014].

!Steven Gerrard Holding Cup. (n.d.). [image] Available at: http://joeyisared.wordpress.com [Accessed 10 Nov. 2014].

!Tepper, K., Biernat, J., Kumar, S., Wegmann, S., Timm, T., Hubschmann, S., Redecke, L., Mandelkow, E., Muller, D. and Mandelkow, E. (2014). Oligomer Formation of Tau Hyperphosphorylated in Cells. Journal of Biological Chemistry. [online] Available at: http://www.jbc.org/content/early/2014/10/22/jbc.M114.611368 [Accessed 10 Nov. 2014].

!The Australian, (2013). Rugby's concussion test under review following George Smith collision. [online] Available at: http://www.theaustralian.com.au/sport/rugby-union/rugbys-concussion-test-under-review-following-george-smith-collision/story-e6frg7o6-1226681199974 [Accessed 10 Nov. 2014].

!



http://www.cbssports.com/collegefootball/writer/jon-solomon/24643655/ncaa-settlement-football-players-3-times-more-likely-to-have-cte-symptoms

http://www.mensjournal.com/magazine/dave-duerson-the-ferocious-life-and-tragic-death-of-a-super-bowl-star-20121002

http://www.northernstar.com.au/news/liam-fulton-ice-hockey-player-backs-concussions/2328150/

http://Sportslegacy.org

http://www.sportslegacy.org/research/legacy-donors/ray-easterling/

http://health.cvs.com/GetContent.aspx?token=f75979d3-9c7c-4b16-af56-3e122a3f19e3&chunkiid=744866

http://joeyisared.wordpress.com

http://www.jbc.org/content/early/2014/10/22/jbc.M114.611368

http://www.theaustralian.com.au/sport/rugby-union/rugbys-concussion-test-under-review-following-george-smith-collision/story-e6frg7o6-1226681199974

The New York Times, (2012). Ryan Freel, Concussion-Plagued Baseball Player, Dies at 36. [online] Available at: http://www.nytimes.com/2012/12/25/sports/baseball/ryan-freel-concussion-plagued-baseball-player-dies-at-36.html?_r=0 [Accessed 10 Nov. 2014].

!Theshockbox.com, (2014). Shockbox - Concussion Management Helmet Sensors. [online] Available at: https://www.theshockbox.com/ [Accessed 10 Nov. 2014].

!Thompson, H. (2012). Evidence Mounts Linking Head Hits To Permanent Brain Injury. [online] NPR.org. Available at: http://www.npr.org/blogs/health/2012/12/03/166406662/evidence-mounts-linking-head-hits-to-permanent-brain-injury [Accessed 10 Nov. 2014].

!Tierney, M. (2012). Football Player Who Killed Himself Had Brain Disease. The New York Times, [online] p.1. Available at: http://www.nytimes.com/2012/07/27/sports/football/ray-easterling-autopsy-found-signs-of-brain-disease-cte.html?_r=0 [Accessed 10 Nov. 2014].

!Tom Brady Throwing. (n.d.). [image] Available at: http://fantasysportsnetwork.com [Accessed 10 Nov. 2014].

!Tony Dorsett. (n.d.). [image] Available at: http://imgarcade.com [Accessed 10 Nov. 2014].

!Tony Dorsett. (n.d.). [image] Available at: http://sportsthenandnow.com [Accessed 10 Nov. 2014].

!Trauma. (n.d.). In: Merriam-Webster, 1st ed. [online] Available at: http://www.merriam-webster.com/medical/trauma [Accessed 10 Nov. 2014].

!Usafootball.com, (2014). Youth Football | USA Football | Football's National Governing Body. [online] Available at: http://usafootball.com/ [Accessed 10 Nov. 2014].

!USATODAY.COM, (2012). Autopsy: Late Falcon Ray Easterling had brain disease. [online] Available at: http://usatoday30.usatoday.com/sports/football/nfl/story/2012-07-27/Ray-Easterling-autopsy-CTE/56539352/1 [Accessed 10 Nov. 2014].

!


http://www.nytimes.com/2012/12/25/sports/baseball/ryan-freel-concussion-plagued-baseball-player-dies-at-36.html?_r=0

http://Theshockbox.com

https://www.theshockbox.com/

http://NPR.org

http://www.npr.org/blogs/health/2012/12/03/166406662/evidence-mounts-linking-head-hits-to-permanent-brain-injury

http://www.nytimes.com/2012/07/27/sports/football/ray-easterling-autopsy-found-signs-of-brain-disease-cte.html?_r=0

http://fantasysportsnetwork.com

http://imgarcade.com

http://sportsthenandnow.com

http://www.merriam-webster.com/medical/trauma

http://Usafootball.com

http://usafootball.com/

http://USATODAY.COM

http://usatoday30.usatoday.com/sports/football/nfl/story/2012-07-27/Ray-Easterling-autopsy-CTE/56539352/1

USATODAY.COM, (2012). Warren Moon promotes new helmet in fight against concussions. [online] Available at: http://content.usatoday.com/communities/thehuddle/post/2012/05/warren-moon-promotes-new-helmet-in-fight-against-concussions/1#.VGiMBFeUdBW [Accessed 10 Nov. 2014].

!Van Natta Jr, D. (2013). Book: NFL denied concussion link to football. [online] ESPN.com. Available at: http://espn.go.com/espn/otl/story/_/id/9745797/ [Accessed 10 Nov. 2014].

!Vecsey, G. (2011). College Athletes Move Concussions Into the Courtroom. The New York Times, [online] p.1. Available at: http://www.nytimes.com/2011/11/30/sports/ncaafootball/college-players-move-concussions-issue-into-the-courtroom.html?pagewanted=all&_r=1& [Accessed 10 Nov. 2014].

!Wagoner, N. (2014). Kurt Warner looks back at the Greatest Show on Turf. [online] ESPN.com. Available at: http://espn.go.com/blog/st-louis-rams/post/_/id/12441/kurt-warner-looks-back-at-the-greatest-show-on-turf [Accessed 10 Nov. 2014].

!Walker, D. (2011). In youth sports, being head-smart wins over being headstrong. [online] Jsonline.com. Available at: http://www.jsonline.com/news/health/In-youth-sports-being-head-smart-wins-over-being-headstrong.html [Accessed 10 Nov. 2014].

!Walker, P. and Glenza, J. (2014). Third death of US teen in a week renews focus on football's lethal potential. [online] The Guardian. Available at: http://www.theguardian.com/sport/2014/oct/03/american-football-third-us-teen [Accessed 10 Nov. 2014].

!Walter, B. (2014). Wests Tigers' Liam Fulton looms as test case for concussion rules. Sydney Morning Herald. [online] Available at: http://www.smh.com.au/rugby-league/league-news/wests-tigers-liam-fulton-looms-as-test-case-for-concussion-rules-20140612-zs5vi.html [Accessed 10 Nov. 2014].

!Walton, A. (2012). The Stages Of Traumatic Brain Injury: Learning From The Brains Of Athletes, Veterans, And One Head-Banger. Forbes, [online] p.1. Available at: http://www.forbes.com/sites/alicegwalton/2012/12/05/the-stages-of-repetitive-brain-injury-learning-from-the-brains-of-athletes-veterans-and-one-head-banger/ [Accessed 10 Nov. 2014].


http://USATODAY.COM

http://content.usatoday.com/communities/thehuddle/post/2012/05/warren-moon-promotes-new-helmet-in-fight-against-concussions/1#.VGiMBFeUdBW

http://ESPN.com

http://espn.go.com/espn/otl/story/_/id/9745797/

http://www.nytimes.com/2011/11/30/sports/ncaafootball/college-players-move-concussions-issue-into-the-courtroom.html?pagewanted=all&_r=1&

http://ESPN.com

http://espn.go.com/blog/st-louis-rams/post/_/id/12441/kurt-warner-looks-back-at-the-greatest-show-on-turf

http://Jsonline.com

http://www.jsonline.com/news/health/In-youth-sports-being-head-smart-wins-over-being-headstrong.html

http://www.theguardian.com/sport/2014/oct/03/american-football-third-us-teen

http://www.smh.com.au/rugby-league/league-news/wests-tigers-liam-fulton-looms-as-test-case-for-concussion-rules-20140612-zs5vi.html

http://www.forbes.com/sites/alicegwalton/2012/12/05/the-stages-of-repetitive-brain-injury-learning-from-the-brains-of-athletes-veterans-and-one-head-banger/

Wang JZ, e. (2013). Abnormal hyperphosphorylation of tau: sites, regulation, and molecu... - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22710920 [Accessed 11 Nov. 2014].

!Webster, P. (2013). Pam Webster.

!Weinbaum, W. and Delshohn, S. (2014). OTL: Ex-NFL stars show CTE signs. [online] ESPN.com. Available at: http://espn.go.com/espn/otl/story/_/id/9931754/former-nfl-stars-tony-dorsett-leonard-marshall-joe-delameilleure-show-indicators-cte-resulting-football-concussions [Accessed 10 Nov. 2014].

!Wexler, E. (2013). How CTE Affects the Brain â€“ League of Denial: The NFL's Concussion Crisis - FRONTLINE. [online] FRONTLINE. Available at: http://www.pbs.org/wgbh/pages/frontline/sports/league-of-denial/the-four-stages-of-cte/ [Accessed 10 Nov. 2014].

!Wiki.iop.kcl.ac.uk, (n.d.). hyperphosphorylated. [online] Available at: http://wiki.iop.kcl.ac.uk/default.aspx/Neurodegeneration/hyperphosphorylated.html [Accessed 10 Nov. 2014].

!wiseGEEK, (n.d.). What Is Gliosis? (with pictures). [online] Available at: http://www.wisegeek.org/what-is-gliosis.htm#didyouknowout [Accessed 10 Nov. 2014].

!Zakowicz, H. (2011). What Does Tau Protein Have to Do with Football, Dementia, and Suicide?. [online] Promega Connections. Available at: http://promega.wordpress.com/2011/03/21/what-does-tau-protein-have-to-do-with-football-dementia-and-suicide/ [Accessed 10 Nov. 2014].

!Zeitlin, D. (2010). Penn Gazette | Gazetteer. [online] Upenn.edu. Available at: http://www.upenn.edu/gazette/1110/gaz12.html [Accessed 10 Nov. 2014].


http://Ncbi.nlm.nih.gov

http://www.ncbi.nlm.nih.gov/pubmed/22710920

http://ESPN.com

http://espn.go.com/espn/otl/story/_/id/9931754/former-nfl-stars-tony-dorsett-leonard-marshall-joe-delameilleure-show-indicators-cte-resulting-football-concussions

http://www.pbs.org/wgbh/pages/frontline/sports/league-of-denial/the-four-stages-of-cte/

http://Wiki.iop.kcl.ac.uk

http://wiki.iop.kcl.ac.uk/default.aspx/Neurodegeneration/hyperphosphorylated.html

http://www.wisegeek.org/what-is-gliosis.htm#didyouknowout

http://promega.wordpress.com/2011/03/21/what-does-tau-protein-have-to-do-with-football-dementia-and-suicide/

http://Upenn.edu

http://www.upenn.edu/gazette/1110/gaz12.html

cte - a modern sporting crisis - patrick o'farrell

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