World Rugby

: The Sixth Amendment of the U.S. Constitution states that In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the State and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor; and to have the Assistance of Counsel for his defense. It guarantees defendants the right to confront the witnesses that stand against them, which is a principle known as the confrontation clause. Court cases such as Maryland v. Craig (1990) and Crawford v. Washington (2004) helped shape how state and federal courts interpret the right to confrontation in cases where witness safety is a large concern. The purpose of this research is to examine how the confrontation clause from the Sixth Amendment of the United States has been utilized in court cases, especially when witness safety is a concern, and how the fundamentals of said system could be modified for the future. As courts recognize the necessity of witness protection, the balance of the defendants right to a fair trial has been a rising concern. Current situations may be limiting fairness to both parties. In addition, witness protection programs may indirectly and directly require personal sacrifices from the witness, particularly on the part of third-party members, leading the equity of these practices to become a concern. To improve this flawed system, the legal structure must adapt to change, providing more funding and risk assessment to ensure more fairness.

Failure to listen has been a recurrent issue for recent users of maternity services in the UK. The need to listen to women has been recognised in successive reports. Listening is particularly difficult when the population is unheard such as those who have experienced child sexual abuse. Despite its prevalence and lasting impact on physical and mental health, care of women who have experienced child sexual abuse is not usually part of healthcare professional or student education. This paper discusses the benefits of trauma-informed care to meet the needs of survivors of child sexual abuse. It also discusses the co-production of an e-resource on trauma-informed care for women and birthing people who have experienced child sexual abuse. The resource addresses the related educational gap for healthcare professionals and enables the powerful words of this silent, hidden population to be heard.

There is growing concern that exposure to head acceleration events (HAEs) may be associated with long-term neurological effects. To quantify the incidence and probability of HAEs during men's professional rugby league match-play on a group and individual basis using instrumented mouthguards (iMGs). A total of 91 men's professional rugby league players participating in the 2023 Super League season wore iMGs, resulting in the collection of 775 player matches (mean 8.3 matches per player). Incidence of HAEs (rate of HAEs per median playing time) was calculated via generalised linear mixed models. Probability of HAEs (likelihood of experiencing an HAE during a tackle-event) was calculated using an ordinal mixed effects regression model. The meanincidence of HAEs exceeding 25g per median playing time ranged from 0.86-1.88 for backpositions and 1.83-2.02 for forwardpositions. The probability of exceeding 25g during a tackle event was higher for ball-carriers (6.29%, 95% confidence intervals [CI] 5.27-7.58) than tacklers (4.26%, 95% CI 3.48-5.26). Several players exhibited considerably higher incidence and probability than others, e.g. one player averaged 5.02 HAEs exceeding 25g per median playing time and another had a probability of 20.00% of exceeding 25g during a tackle event as a ball-carrier and 34.78% as a tackler. This study quantifies the incidence and probability of HAEs in men's rugby league match-play, advancing our understanding of HAE exposure in men's rugby league. These findings support the development of individualised HAE mitigation strategies targeted at individuals with elevated HAE exposures.

Head acceleration events (HAEs) can potentially have adverse consequences for athlete brain health. In sports, in which head injuries have the highest incidence, identifying strategies to reduce HAE frequency and magnitude is a priority. Neck training is a potential strategy to mitigate against the magnitude of HAEs. This two-part study aimed to (1) systematically review the literature of neck training interventions in sport and (2) undertake an expert Delphi consensus on the best practices for neck training implementation to reduce HAEs in sport. Part I: a systematic search of four databases was undertaken from the earliest records to September 2024. The PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines were followed, and a quality assessment was completed using a modified Downs and Black assessment tool and the GRADE (Grading of Recommendations Assessment, Development and Evaluation). Papers were eligible if they both (1) implemented a reproducible exercise intervention targeting the neck within collision, combat or motor sport, and (2) assessed outcomes relating to either: the physical profile of the neck; head/neck injury incidence; and/or HAEs. Part II: 18 international experts, with experience in research and/or applied practice of neck exercise training, concussion and/or HAEs, reviewed the part I findings before completing a three-round Delphi consensus process. Part I included 21 papers, highlighting the heterogeneity of existing interventions. Part II resulted in 57 statements coded into five categories: contextual factors (n=17), neck training periodisation (n=12), training adaptations (n=10), neck training content (n=15) and athlete adherence (n=3). This study presents recommendations for neck exercise training aiming to reduce HAEs in sport, supporting both practice and future research.

Purpose National Collegiate Athletic Association (NCAA) artistic sports, including gymnastics and diving, require inversion, somersaulting, and rotational movements where concussions account for 8.4% and 10.38% of injuries, respectively.This study describes the epidemiology and common characteristics of sport-related concussion (SRC) in men's and women's collegiate gymnastics and diving from 2013/14 to 2023/24.Methods Clinical SRC incidence (concussions/100-athletes, 95% confidence intervals [95%CI] by sport and ratios (CIR; 95%CI) were calculated based on Ivy League-Big Ten Epidemiology of Concussion Study surveillance.Mechanisms of injury (MOI) patterns were classified via proportions: activity at time of injury, head impact object (e.g., apparatus, water), and descriptive narratives.Results Of 183 total SRC, clinical incidence was higher in women's gymnastics (CIR: 2.91 [95%CI: 1.37-7.40];women: 8.98/100-athletes [95%CI: 7.52-10.6];men: 3.08/100-athletes [95%CI: 1.25-6.25]).There was no significant difference in diving clinical incidence (CIR: 1.41 [95%CI 0.76-2.77];women: 6.12/100-athletes [95%CI: 4.34-8.33];men: 4.34/ 100-athletes [95%CI: 2.45-7.05]).80.8% (n=105/130) gymnastics SRC and 81.1% (n=43/53) diving SRC occurred during practice activities.In gymnastics floor contact was the most common MOI (n=78/130, 60.0%).Similarly, water impact was the most common diving MOI (n=43/53, 81.1%).Approximately 67.7% of gymnastics SRC (n=88/130) and 52.8% of diving SRC (n=28/53) had symptom resolution within two weeks.Conclusion Clinical incidence of SRC was comparable to football (approximately 7.60/100-athletes [95%CI: 7.17-8.04]),yet artistic sports are underrepresented in the research.Clinical incidence was higher in women than men in gymnastics.Most SRC occurred due to contact with the floor or water during practice activities motivating targeted prevention interventions.

ObjectivesTo evaluate if the tackler correctly adhering to, or not, four different instructions of legal front-on one-on-one torso tackles altered the tackler and/or ball carrier peak inertial head kinematics. DesignControlled laboratory study. MethodFifteen rugby-code players measured with three-dimensional optoelectronic motion capture performed two tackle instructions from the Australian National Rugby League (NRL) coaching manual on under (Dominant NRL [DNRL]) and over (Smother NRL [SNRL]) the ball tackles, and two novel variants of these (under, Dominant, Torso Stick [DTS]; over, Smother, Pop, Lock [SPL]) that changed the tackler's contact height. A series of mixed general linear models identified if the tackler adhering to (n = 455), or not (n = 139) to the tackle instructions altered peak inertial head kinematics. ResultsThe tackler's peak inertial head kinematics did not significantly change whether they adhered to each of the tackle instructions. When the tackler did adhere to the instructions, the ball carrier sustained a lower peak inertial head kinematics (p < 0.01) in the SNRL tackle but higher in the SPL. ConclusionThe ball carriers' inertial head kinematics but not the tacklers were increased when the tackler adhered to this study's variants of the over and under the ball tackle instructions, suggesting that the tacklers were more effective in their tackle performance than the traditional tackle instructions when adhering to the tackle instruction. Tacklers were able to adhere to the under the ball instructions but not the over the ball tackle instructions, reflecting more difficult of tacklers adhering to over the ball tackle instructions.

ObjectivesThe purpose of this study was to investigate head kinematic variables in elite men’s and women’s rugby union and their ability to predict player removal for an off-field (HIA1) head injury assessment.MethodsInstrumented mouthguard (iMG) data were collected for 250 men and 132 women from 1865 and 807 player-matches, respectively, and synchronised to video-coded match footage. Head peak resultant linear acceleration (PLA), peak resultant angular acceleration (PAA) and peak change in angular velocity (dPAV) were extracted from each head acceleration event (HAE). HAEs were linked to documented HIA1 events, with ten logistical regression models for men and women, using a random subset of non-case HAEs, calculated to identify kinematic variables associated with HIA1 events. Receiver operating characteristic curves (ROC) were used to describe thresholds for HIA1 removal.ResultsIncreases in PLA and dPAV were significantly associated with an increasing likelihood of HIA1 removal in the men’s game, with an OR ranging from 1.05–1.12 and 1.13–1.18, respectively. The optimal values to maximise for both sensitivity and specificity for detecting an HIA1 were 1.96 krad⋅s−2, 24.29 g and 14.75 rad⋅s−1 for PAA, PLA and dPAV, respectively. Only one model had any significant variable associated with increasing the likelihood of a HIA1 removal in the women’s game—PAA with an OR of 8.51 (1.23–58.66). The optimal values for sensitivity and specificity for women were 2.01 krad⋅s−2, 25.98 g and 15.38 rad⋅s−1 for PAA, PLA and dPAV, respectively.ConclusionPLA and dPAV were predictive of men’s HIA1 events. Further HIA1 data are needed to understand the role of head kinematic variables in the women’s game. The calculated spectrum of sensitivity and specificity of iMG alerts for HIA1 removals in men and women present a starting point for further discussion about using iMGs as an additional trigger in the existing HIA process.

The aim of this study was to investigate the difference in head acceleration event (HAE) incidence between training and match-play in women's and men's players competing at the highest level of domestic rugby union globally. Players from Women's (Premiership Women's Rugby, Farah Palmer Cup) and Men's (Premiership Rugby, Currie Cup) rugby union competitions wore instrumented mouthguards during matches and training sessions during the 2022/2023 seasons. Peak linear (PLA) and angular (PAA) acceleration were calculated from each HAE and included within generalized linear mixed-effects models. The incidence of HAEs was significantly greater in match-play compared to training for all magnitude thresholds in both forwards and backs, despite players spending approximately 1.75-2.5 times more time in training. For all HAEs (PLA > 5 g and PAA > 400 rad/s2), incidence rate ratios (IRRs) for match versus training ranged from 2.80 (95% CI: 2.38-3.30; men's forwards) to 4.00 (3.31-4.84; women's forwards). At higher magnitude thresholds (PLA > 25 g; PAA > 2000 rad/s2), IRRs ranged from 3.64 (2.02-6.55; PAA > 2000 rad/s2 in men's backs) to 11.70 (6.50-21.08; PAA > 2000 rad/s2 in women's forwards). Similar trends were observed in each competition. Players experienced significantly more HAEs during match-play than training, particularly at higher magnitude thresholds. Where feasible, HAE mitigation strategies may have more scope for HAE reduction if targeted at match-play, particularly where higher magnitude HAEs are the primary concern. However, the number of HAEs associated with different training drills requires exploration to understand if HAEs can be reduced in training, alongside optimizing match performance (e.g., enhancing contact technique).

BackgroundThe rapid growth of women's rugby union has underscored the need for female-specific player welfare protocols, particularly regarding the risk of head injuries. Instrumented mouthguards (iMGs) play a vital role in gathering comprehensive data on head acceleration events (HAEs), including their frequency, magnitude, and spatial distribution during games and training. By doing so, iMGs offer valuable context for circumstances in women's matches that may increase player risk.ObjectivesThe study aimed to contextualize HAEs in female community rugby players using instrumented mouthguards and video review.MethodsThis prospective, observational cohort study involved 332 female rugby players across 38 matches and 80 training sessions during the 2021/2022 seasons. Players were representative of four playing grades: U13 (N = 9), U15 (N = 111), U19 (N = 95) and Premier women (N = 115). HAEs were recorded using boil-and-bite iMGs, with a single-axis recording threshold of 5 g. The incidence and prevalence of HAEs was expressed by grade, years of experience, playing positions, and session types (match or training). The effect of playing grade and previous playing experience on HAE propensity during tackles and rucks was also examined.ResultsThroughout the study, 9151 iMG events over 5 g were recorded, with 80% verified for analysis. Overall, the incidence rate (IR) was highest for HAEs between 10 and 29 g, 12–18 times higher than the IR for > 30-g events. Premier grade players had the highest weekly HAE load (26.2 per player per week) and the highest prevalence of players (49%) exposed to events over 30 g. An inverse relationship was found between years of rugby experience and peak angular acceleration (PAA) in U13–U19 players (p = 0.002, 95% CI [47,177 rads/s2]), showing that more experienced school-age players had lower rotational acceleration during HAEs. However, propensity for HAEs in tackle events was highest in Premier players with > 9 years of experience compared with U13–U19 grade players with similar years of experience (RR = 1.21, 95% CI 1.06–1.37; p = 0.004). Ball carries consistently resulted in the highest propensity of events over 30 g, regardless of playing grade or experience.ConclusionsThis research presents unique information regarding head accelerations that occur during women’s community rugby matches and practices. The results have significant implications for recognising populations that are at the highest risk of experiencing high cumulative and acute head accelerations. The findings may assist in managing training loads and instructing skill execution in high-risk activities, particularly for younger players who are new to the sport.Consideration of playing grade, experience, and contact phases is crucial for understanding head acceleration exposure and injury risk in female rugby players. These insights can inform injury prevention strategies.