{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:16:50Z","timestamp":1785417410523,"version":"3.56.0"},"reference-count":34,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"unspecified","delay-in-days":147,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Law. Med. Ethics"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1073110525101125_sec15\">\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Evidence-based concussion practices have been codified into legislation, yet implementation has been narrowly evaluated. We examined implementation of concussion practices in Massachusetts high schools and adopted a disproportionality lens to assess the relationship between school sociodemographic and policy implementation and examine whether differences in policy implementation represent systematic disparities consistent with the disproportionality literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1073110525101125_sec16\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was sent to Massachusetts high school nurses (N=304). Responses (n=201; 68.1% response rate) were tallied so that higher scores indicated greater policy implementation. School demographic data were collected using publicly available datasets and were linked to survey responses. Descriptive statistics, correlations, k-means clustering, and groupwise comparisons were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1073110525101125_sec17\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Policy implementation is varied across schools and is associated with school sociodemographic variables. As percentages of marginalized identities in student population increased, implementation rates decreased. K-means cluster analysis revealed two discrete groups based on policy implementation scores, with significant differences in sociodemographic variables between groups. Schools with low implementation scores had a greater percentage of students who identified as African American\/Black and nurses with less experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1073110525101125_sec18\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings highlight current disparities in the implementation of concussion management policies and support adoption of a disproportionality lens in this sphere.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/jme.2025.10112","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T03:24:19Z","timestamp":1748402659000},"page":"281-288","source":"Crossref","is-referenced-by-count":2,"title":["Concussion Management Policy Implementation in High Schools: Examining Policy Through a Disproportionality Lens"],"prefix":"10.1017","volume":"53","author":[{"given":"Courtney W","family":"Hess","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00f54p054","id-type":"ROR","asserted-by":"publisher"}],"name":"Stanford University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia K","family":"Campbell","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0130frc33","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Hackman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/010b9wj87","id-type":"ROR","asserted-by":"publisher"}],"name":"Boston Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Hayden","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04ydmy275","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Massachusetts Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Howland","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/010b9wj87","id-type":"ROR","asserted-by":"publisher"}],"name":"Boston Medical Center"},{"id":[{"id":"https:\/\/ror.org\/05qwgg493","id-type":"ROR","asserted-by":"publisher"}],"name":"Boston University Chobanian & Avedisian School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"S1073110525101125_r25","first-page":"90","article-title":"Review on Determining Number of Cluster in K-Means Clustering","volume":"1","author":"Kodinariya","year":"2013","journal-title":"International Journal"},{"key":"S1073110525101125_r24","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/1467-9868.00293","article-title":"Estimating the Number of Clusters in a Data Set Via the Gap Statistic","volume":"63","author":"Tibshirani","year":"2001","journal-title":"Journal of the Royal Statistical Society: Series B (Statistical Methodology)"},{"key":"S1073110525101125_r15","unstructured":"15. Bradshaw et al., supra note 10; Sullivan et al., supra note 8."},{"key":"S1073110525101125_r8","doi-asserted-by":"crossref","DOI":"10.1177\/0022219410374236","article-title":"Disproportionality and Learning Disabilities: Parsing Apart Race, Socioeconomic Status, and Language","volume":"44","author":"Shifrer","year":"2011","journal-title":"Journal of Learning Disabilities"},{"key":"S1073110525101125_r28","unstructured":"28. Hess et al., supra note 7"},{"key":"S1073110525101125_r19","unstructured":"19. Howland et al., supra note 7."},{"key":"S1073110525101125_r26","first-page":"226","article-title":"Research on K-Value Selection Method of K-Means Clustering Algorithm","volume":"2","author":"Yuan","year":"2019","journal-title":"J"},{"key":"S1073110525101125_r14","unstructured":"14. Shifrer et al., supra note 8; Unproven Links, supra note 8; Sullivan and Bal, supra note 8."},{"key":"S1073110525101125_r7","article-title":"Concussion Management in United States College Sports: Compliance with National Collegiate Athletic Association Concussion Policy and Areas for Improvement","volume":"43","author":"Baugh","year":"2014","journal-title":"American Journal of Sports Medicine"},{"key":"S1073110525101125_r10","doi-asserted-by":"publisher","DOI":"10.1037\/a0018450"},{"key":"S1073110525101125_r12","unstructured":"12. Bradshaw et al., supra note 10; Shifrer et al., supra note 8; Race, supra note 8."},{"key":"S1073110525101125_r31","first-page":"17","article-title":"A School-Based Multidisciplinary Response to Student-Athletes\u2019 Mild Traumatic Brain Injury","volume":"9","author":"Hayden","year":"2017","journal-title":"Journal of Multidisciplinary Research"},{"key":"S1073110525101125_r34","unstructured":"34. Id."},{"key":"S1073110525101125_r22","unstructured":"22. Hess et al., supra note 7"},{"key":"S1073110525101125_r33","volume-title":"Seeing Past the \u2018Colorblind\u2019Myth of Education Policy: Why Policymakers Should Address Racial\/Ethnic Inequality and Support Culturally Diverse Schools","author":"Wells","year":"2014"},{"key":"S1073110525101125_r4","doi-asserted-by":"publisher","DOI":"10.1249\/JSR.0000000000000505"},{"key":"S1073110525101125_r16","unstructured":"16. Shifrer et al., supra note 8; Sullivan and Bal, supra note 8."},{"key":"S1073110525101125_r27","volume-title":"R: A Language and Environment for Statistical Computing","year":"2021"},{"key":"S1073110525101125_r5","doi-asserted-by":"publisher","DOI":"10.1177\/0009922814567305"},{"key":"S1073110525101125_r1","doi-asserted-by":"crossref","first-page":"e20154635","DOI":"10.1542\/peds.2015-4635","article-title":"Sports-and Recreation-Related Concussions in Us Youth","volume":"138","author":"Bryan","year":"2016","journal-title":"Pediatrics"},{"key":"S1073110525101125_r20","doi-asserted-by":"crossref","DOI":"10.1186\/s40621-020-00240-7","article-title":"Perceptions of Implementation of Massachusetts Sports Concussion Regulations: Results of a Survey of Athletic Directors","volume":"7","author":"Howland","year":"2020","journal-title":"Injury Epidemiology"},{"key":"S1073110525101125_r2","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2016.1152602"},{"key":"S1073110525101125_r6","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2016-2151","article-title":"Variations in State Laws Governing School Reintegration Following Concussion","volume":"138","author":"Thompson","year":"2016","journal-title":"Pediatrics"},{"key":"S1073110525101125_r3","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2014-041479"},{"key":"S1073110525101125_r23","doi-asserted-by":"publisher","DOI":"10.1007\/BF02289263"},{"key":"S1073110525101125_r30","doi-asserted-by":"publisher","DOI":"10.1037\/amp0000298"},{"key":"S1073110525101125_r11","doi-asserted-by":"publisher","DOI":"10.3102\/0013189X12445320"},{"key":"S1073110525101125_r21","volume":"105","year":"2014","journal-title":"Head Injuries and Concussions in Extracurricular Athletic Activities"},{"key":"S1073110525101125_r29","unstructured":"29. Bradshaw et al., supra note 10; Herbers et al., supra note 11; Parsing, supra note 8; Race, supra note 8; Sullivan et al., supra note 8."},{"key":"S1073110525101125_r17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem-2020-000752"},{"key":"S1073110525101125_r32","unstructured":"32. Rosen et al., supra note 30."},{"key":"S1073110525101125_r9","doi-asserted-by":"publisher","DOI":"10.1177\/10634266070150010401"},{"key":"S1073110525101125_r18","unstructured":"18. Hess et al., supra note 7."},{"key":"S1073110525101125_r13","doi-asserted-by":"crossref","DOI":"10.14507\/epaa.v8n1.2000","article-title":"Teacher Quality and Student Achievement","volume":"8","author":"Darling-Hammond","year":"2000","journal-title":"Education Policy Analysis Archives"}],"container-title":["Journal of Law, Medicine &amp; Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1073110525101125","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T11:59:17Z","timestamp":1765799957000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1073110525101125\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":34,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025]]}},"alternative-id":["S1073110525101125"],"URL":"https:\/\/doi.org\/10.1017\/jme.2025.10112","relation":{},"ISSN":["1073-1105","1748-720X"],"issn-type":[{"value":"1073-1105","type":"print"},{"value":"1748-720X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]}}}