Re-programming Our Hardware: Autism and the Athletic Trainer

One day while working at a summer basketball camp, a coach brings you a young middle school boy who is crying.  As the Athletic Trainer (AT) for that camp, you begin to ask some general questions to find out what happened to this young boy.  Some of these questions would include: what happened to you?  How did it happen? Have you ever been hurt before?  This young camper becomes very emotional, crying, aggravated, and ends up running outside.  As a healthcare provider, what would you do?

  • Tell the coach/counselor to bring him back inside?
  • Call the parents?
  • Find the young boy and talk to him?

After asking the counselor about the mechanism of injury, you find out that the young boy reached to intercept a cross-court pass and the ball hit his hand at a high rate of speed.  The counselor also tells you that this young boy is autistic, which may have been the cause for his reactions to the injury examination.

The CDC recently released new data stating that 1 in 68 children have been identified as having some kind of autism spectrum disorder¹ (ASD).  Many of these children are high functioning and can be an active participant in the classroom as well as on the field.  The presentation, behaviors and mannerisms of autism are also becoming better well-known as more famous and successful citizens are announcing that they, too, have autism or another ASD.  From Clay Marzo and Jim Eisenreich, to Dan Aykroyd and Mozart, we are finding that autism is not a disorder that disables, but rather can empower a person to become the next big movie, music, literary or sports star.  So what does this mean for ATs?

Just like a smart phone, computer or new tech gadget, we as healthcare providers need to update our software to adapt to the changes and discoveries that are happening in our profession on a daily and yearly basis.  Autistic and ASD patients (ADD/ADHD/Asperger’s, etc.) are highly intelligent and functioning individuals who have the same processing organs of all human beings; their internal hardware is just wired differently.  As ATs, we need to be aware that our approach to treating, evaluating and communicating injury information or rehabilitation will need to be slightly altered in order for these patients to comprehend and process what is being conveyed to them.

For patients with ADD/ADHD, it may be best to place them in a quiet, private space away from high patient traffic to eliminate distractions.  Some patients on the autism spectrum may get anxious or cannot focus when in loud environments, around large groups of people or being asked questions with complicated medical terms that they might not be able to understand.  We must adapt, use a different application or switch modes to be able to communicate and meet the needs of these patients.

Going back to the story at the beginning of this blog, now knowing this young camper has some kind of autistic history, how would you address or change your interactions with him moving forward?  How would you adapt to make the patient comfortable, less anxious and provide an environment outside of the basketball court where he can thrive and be a successful individual?  Check your internal athletic training software, and see if it could use some updating or refreshing.

April is National Autism Awareness Month. There is hope through research and in increasing awareness.


Written by:

Elizabeth Wolfe

Remembering the 2013 Boston Marathon

April 21, 2014, will hold a lot of meaning to a lot of people. It is the 118th running of the Boston Marathon and the one year anniversary of the tragic events of April 15th at last year’s marathon.  The course is expected to have over 36,000 runners with an estimated 5,000 to 10,000 unregistered runners. This would make it the second largest field ever (1996 had over 38,000 runners for the 100th running of the marathon). A lot of work and many volunteers are needed to take care of an event this large and to make it run smoothly.

According to Chris Troyanos, ATC, Medical Director of the Boston Marathon for the past 20 years, the Boston Marathon is a “Medical Flash Mob” where volunteers from different fields and different backgrounds, who do not know each other, get together on one day and provide amazing care for all of the runners. This year there were about 2,500 medical professionals who applied to volunteer. Only 1,900 were accepted, 500 more than last year.  Mr. Troyanos is in charge of all of the volunteers, who range from physicians, nurses, Athletic Trainers (ATs), athletic training students, physical therapists, physical therapy students, paramedics, EMTs and podiatrists. ATs and the rest of the volunteers come from all across the country to be a part of the marathon.

There are many reasons why ATs and athletic training students volunteer at the Boston Marathon. Larry Venis, MEd, ATC, Head AT at Boston University, works the marathon because it is an exciting challenge with the weather, amount of runners and opportunity to work with a wide range of medical professionals – and he gets to reconnect with old friends. This is going to be his 27th year volunteering. It is going to be one of the most emotional years for him but one he is looking forward to. Larry was at the finish line last year and sprang into action without a second thought.

Ami Matsumoto, MS, ATC, LAT, CES, with Onsite Innovations and Head AT at Frito Lay, volunteers because she loves the atmosphere and being part of a team that will help anyone with any problem they have. Ami and her fiancé, William Adams, MS, ATC, LAT, who met while volunteering at the Boston Marathon, have volunteered at two previous marathons; like many others, the moment they heard the news about last year’s events, they knew they were going to volunteer this year.

Other than preparing for more patients with an increased field, Chris Troyanos said that the biggest obstacle with the increased security is making sure that all volunteers allow enough time to get through security for a meeting regarding policies and procedures. There will be no major changes in terms of medical care. Chris said that “even though it was a tragic event, the best possible outcome occurred.” The bombs went off close to the finish line where over 1,000 medical personnel were located.

Larry Venis used this event as a tool to reassess mass causality events (track meets and wrestling matches with multiple mats) and other potential situations in cooperation with Student Health Services, the Dean of Students Office and the campus police department.

Other ATs used this to reassess their Emergency Action Plans and some of the NATA’s Position Statements on various topics related to marathons (Exertional Heat Illnesses, Emergency Planning In Athletics and Fluid Replacements For Athletes).

For many people, including ATs and students, this marathon is part of the healing process from last year. While some spectators and runners had physical injuries, many others suffered emotional wounds that heal differently. The race this year will help heal some of those wounds and provide closure for many of the volunteers who were evacuated after they cared for the injured. They left without breaking down the medical tents, saying goodbye to friends or knowing what exactly was going on. The start of this race will help put an end to last year’s turmoil and help heal emotional wounds.

The 118th Boston Marathon will be a very special one. It will be a day of remembrance, reconnection with old friends and celebration. If you have the chance, I would recommend going to watch the race. Marathons also are a great way to volunteer, network and learn about new topics.

A big thank you should go out to all of the medical volunteers, including ATs at last year’s and this upcoming marathon.

Written By:
Brian Bradley, MS, ATC, LAT, CSCS



World-renowned author Rushworth Kidder published a book called Moral Courage (2003), in which he defines the paradigms as a practical sense approach to consider and resolve ethical dilemmas.  These paradigms are helpful to Athletic Trainers (ATs) as they help us define which “direction” to head when values conflict with each other.  Kidder defines the paradigms as: Truth versus Loyalty; Individual versus Community; Short Term versus Long Term; and Justice versus Mercy.  It is common to encounter dilemmas where as we consider the consequences or impact of our actions, we are torn between the extremes of these paradigms.  Our role is to find a comfort level in resolving the dilemmas, so that we can be comfortable with our decision.

Using Kidder’s Paradigms, consider the following case.

1.  Which of these paradigms are most prevalent in the analysis of this dilemma?

2.  What are the potential issues associated with this situation?   Issues related to the stepfather? Student-athlete? You as a healthcare provider?

3.  What additional information do you need to completely resolve this dilemma?  What are the risks associated with seeking additional information?

4.  Would it matter to you if the student-athlete is a “good kid” in your mind or a kid who has been in trouble at school and has been caught lying about other issues?

Written By:
Kimberly S. Peer, EdD, ATC, FNATA

Dr. Peer is an Associate Professor at Kent State University. She holds a Doctorate in Higher Education Administration with a Cognate in Health Care Management. Kimberly was recently appointed as the editor-in-chief for the Athletic Training Education Journal and serves on the Commission on Accreditation of Athletic Training Education Ethics Committee as well as the NATA Committee on Professional Ethics. Her national contributions include service to the BOC, NATA, JAT and REF in multiple capacities. Her statewide service includes the Governor’s appointment to the Ohio licensure board and over 12 years of service to the OATA.

Peer received the NATA Fellow Award and OATA Hall of Fame Award in 2012 and has been lauded with other national, regional and state level awards for her contributions to the profession and athletic training education. Dr. Peer has published and presented extensively on the international and national levels about ethics education and pedagogy and has co-authored with Dr. Gretchen Schlabach the first textbook on ethics in athletic training.

Highlights from the 5th Annual Youth Sports Safety Alliance Summit

The Youth Sport Safety Alliance (YSSA) is a growing group of healthcare, sports organizations and parent activists who have one goal: make America’s sports programs safer for young athletes.1Organized by the National Athletic Trainers’ Association (NATA) in 2010, the Alliance has grown to over 140 members. I had the opportunity to attend the YSSA’s 5th Annual Summit, and I’d like to share some highlights.

First was the presentation by former student-athletes Lauren Long and Samantha Sanderson. These two young women suffered career-ending and life-changing brain injuries as the result of their competitive soccer careers. They shared their injury history and their recovery and rehabilitation journeys with the audience. It’s so powerful to hear from someone who has walked the walk, and these two ladies were great. What was more powerful was how they are creating a place for injured athletes to share their stories – so athletes, parents and others supporting brain injured athletic patients can see they’re not alone. Their organization Concussion Connection is just getting off the ground. I urge you to browse the page and read the stories. Besides the one-on-one interviews with World Champion goalie Briana Scurry and former NFL offensive lineman Kyle Turley, the site allows injured athletes to share their personal stories.

Dr. Brian Hainline, MD, the first Chief Medical Officer of the National Collegiate Athletic Association (NCAA), shared his thoughts on the current initiatives of the NCAA in the areas of student-athlete safety. He reminded the audience that the NCAA was formed as the result of President Theodore Roosevelt’s push for rule changes in football – to protect the student-athletes, due to the increasing number of injuries in college football. In “1906 the Intercollegiate Athletic Association of the United States aka IAAUS was formed. In 1910 the IAAUS became the NCAA”.2 Look for proposed legislation this summer from the NCAA regarding the accountability and reporting structure of the healthcare team at NCAA member institutions.

Riana Pryor, MS, ATC, Director of Research for the Korey Stringer Institute (KSI), shared the current status of KSI’s project CATCH ON – Collaboration for Athletic Training Coverage at High schools: an Ongoing National survey – Public Schools. This is a huge project providing a much needed update to the previous estimate that 42% of high schools had access to an AT. They are moving on to their second phase – surveying private schools.

Groups such as SafeKids, Simon’s Fund, the Nick of Time Foundation and the Kendrick Fincher Hydration Foundation shared their organizations’ work in promoting awareness of safety, sudden cardiac arrest and hydration risks in concurrent sessions. The work by these foundations and smaller groups are no less important than those of the NCAA, NATA and NFL in raising awareness. Their stories are often more powerful because of the unfortunate loss that served as their motivation for creating these groups, which is to carry the message that this does not have to happen again!

Written By:
Denise Fandel, MBA, CAE

1 National Action Plan for Sports Safety
2 Article Source: accessed 4-3-2014   


Wrapping Up National Athletic Training Month 2014

Pennsylvania Athletic Trainers’ Society at NBC Today Show Rockefeller Center NYC.

March was an amazing month for National Athletic Training Month (NATM), and it was great to see what everyone did to promote “We’ve got your back” and the profession.

Al Roker and Scott Dietrich.

Scott Dietrich, an athletic training professor at East Stroudsburg University (ESU) in Pennsylvania, was one of the organizers of an NATM Today Show trip to New York City. Students and faculty from ESU attended the Today Show for the first time on February 28th, thanks to a Pennsylvania Athletic Trainers’ Society (PATS) Fundly online campaign to get sponsorships and donations to finance the trip. Students had the opportunity to attend with just an expense of $10. PATS members and students were grateful for the contributions that helped spread the word about the profession.

Lauren Stephenson, an athletic training faculty member at Stony Brook University located in New York, coordinated the agenda for the NYC-NATM day, while Scott coordinated the poster party at ESU and charter bus. A group of about 60 people, which included students and faculty from ESU, Lock Haven University and California University of Pennsylvania, gathered at ESU the night before and ate pizza while making posters for display on camera. The bus left at 4:30am for the 70-mile drive and arrived at the Today Show at 5:45am just in time to fill out waivers and get through the gates. It was 7 degrees out, but everyone was thrilled to join close to 150 others people from District 2, all waving signs and proclaiming National Athletic Training Month! Athletic Trainers (ATs) were even appropriately mentioned by Al Roker in this TV clip.

Pennsylvania Athletic Trainers’ Society at NBC Today Show Rockefeller Center NYC.

PATS does not limit promoting the profession to just the month of March. On April 1st, they took to the state capitol in Harrisburg, PA, to speak with more than 16 legislators to encourage hiring ATs in the approximately 150 schools that currently do not have access to AT services. On April 27th, the athletic training programs in Northeastern PA will host the 12th annual NEPA Athletic Training Scholarship 5K race to raise money for a student scholarship. This event has been going on for the past 12 years, and the combined effort with King’s College, Marywood, Alvernia and East Stroudsburg Universities has earned over $22,000 in scholarship funds.

What was your favorite part about NATM? Share your moments in the comments.

Written By:
Brittney Ryba

BOC Volunteers Critical for Achieving Mission

National Volunteer Week, April 6-12, 2014, is about inspiring, recognizing and encouraging people to seek out imaginative ways to engage in their communities. This year marks the 40th anniversary of National Volunteer Week, a program of Points of Light demonstrating the enduring importance of recognizing our country’s volunteers for their vital contributions.

We thank the hundreds of volunteers who serve in various capacities. The contribution of volunteers such as BOC item writers, committee members and Board of Directors is critical in developing the high professional standards expected of today’s Athletic Trainers (ATs).We are proud to have a board of nine directors, five committees, over 180 home study reviewers, over 100 exam item writers and 10 bloggers who provide their valuable service.

2013 BOC volunteer accomplishments:

• Administered 4,862 certification exams

• Continually developed more than 400 new exam items for experimental testing

• Approved 328 home study courses

When you multiply the 344 volunteers by what they should be paid ($22.14/hour), at two hours a month, you get an annual total of $182,788 worth of in-kind service.

“Volunteers are critical to the BOC achieving our mission to provide exceptional credentialing programs for healthcare professionals to assure protection of the public,” says Denise Fandel, BOC Executive Director. “We are grateful to this group of professionals who help us serve the profession and their patients.”

National Volunteer Week was established in 1974 and has grown exponentially each year, with thousands of volunteer projects and special events scheduled throughout the week.

Written By:

Brittney Ryba

Putting the BOC Facility Principles Document to Use

The BOC Facility Principles document has become quite useful to the Athletic Training Program at Catawba College.  It is being integrated into our Athletic Training Policies and Procedures document.  The document contains many of the “checklist items” we have been performing all along as an athletic training staff and with our athletic training students but have never really “written down” and documented on paper.  One area that we have been doing great all along is having our therapeutic modalities inspected on an annual basis and maintaining that documentation, along with having our campus maintenance department inspect our electrical outlets.  We have documented these inspections via a letter kept on file from the facilities director.  One area that never had formal documentation was in educating our staff and students per slips, trips and falls prevention. This is being addressed with a Power Point education component and a handout with educational tips for preventing falls.  Areas that we strengthened were our Exposure Control Plan and Adverse Medical Event Reporting.  I researched more thoroughly what should be included in both of these sections and made changes as needed.

My personal goal is: Should there ever be ‘formal accreditation’ of collegiate athletic training facilities per the BOC Facility Principles, Catawba College gets that “gold star” next to our name.  Should BOC Facility Principles become a required or a mandated standard for CAATE accredited institutions, Catawba College is ahead of the curve and has the “facilities accreditation status”!  In addition, should the BOC Facility Principles be included or required in the next go-around of CAATE accreditation documentation, again we are ahead of the curve with our document done and ready to go.  By using the BOC Facility Principles, we are finding some areas that may be weak or need further enhancement per our athletic training operations, policies and procedures. This document is helping us recognize those areas to be addressed.

Also, if there is an item that requires additional funding or resources, this document can serve as an ‘avenue of proof and justification’ to our administration showing a need for such financial assistance.  As I am putting the BOC Facility Principles document together, I am treating this similarly to the CAATE accreditation process.  I am collating materials into a three-ring binder and creating appendices with the supporting documentation items and forms for each section. My plan is for the athletic training staff every May and December to review this document per our “compliance” and to make any necessary changes or adjustments as needed.  Also, we can review our educational components for ourselves as a staff and what we need to review and teach the athletic training students and/or work-study students.  Some of the items have already been included as part of the clinical experiences for the athletic training students.

Written By:

Bob Casmus, MS, LAT, ATC
Head Athletic Trainer
Catawba College

Improve Patient Outcomes with Evidence Based Practice

Providing the best possible patient care involves staying up-to-date on advances in the healthcare profession. That’s why the BOC added a new continuing education (CE) category beginning in 2014. The Evidence Based Practice (EBP) category helps Athletic Trainers (ATs) infuse the best new evidence into clinical decision-making, with the goal of improving patient outcomes.

By completing activities in the EBP category, ATs learn how to find and analyze the most current research evidence available. Then, with research in hand, ATs can use clinical expertise and their patients’ own values to make healthcare decisions.

To assure that ATs have the opportunity to learn about new healthcare research, the BOC now requires a certain number of EBP continuing education units (CEUs) to maintain certification.

Requirements for Certification Maintenance

ATs are required to complete a minimum number of EBP CEUs to maintain their BOC certification. All CEUs are due by December 31, 2015.

  • ATs certified before 2014 must complete 50 CEUs, including at least 10 EBP CEUs
  • ATs certified in 2014 must complete 25 CEUs, including at least five EBP CEUs

BOC Approved EBP programs are listed on the BOC website. Approved programs are updated monthly

Two types of EBP programs are available:

  • Foundations of EBP – programs help clinicians understand EBP methodology, find and evaluate evidence, and apply it to their clinical practice
  • Clinical EBP – programs are organized around a clinically appraised topic, such as evaluation, treatment and rehabilitation of injuries and illnesses. These programs follow a five-step EBP process

Only those programs listed on the BOC website are eligible for EBP Category CEUs, and programs are only eligible for credit on or after their approval date.

EBP Course Approval

Some CE programs may appear to follow EBP principles. However, only programs that have been approved by the BOC for the EBP Category are eligible for credit in this category. Providers, not ATs, are responsible for getting BOC approval.

BOC Approved Providers who would like to offer EBP Category programs are invited to submit the activity for BOC approval. The application asks providers to follow a five-step EBP process during program development to ensure that basic EBP principles are followed.

Once a program is submitted, it will undergo peer review to ensure basic EBP principles are incorporated into the program. The BOC then lists approved programs on its website .

For complete information on the EBP category, check out the new 2014-2015 Certification Maintenance Requirements document.

Written By:
Melissa Breazile

History of Women in Athletic Training

March is full of important awareness events, including Women’s History Month. Since the passage of Title IX in 1972, there has been exponential growth of participation of females in sports at all levels as well as an increase of women in the athletic training profession.

Gail Weldon – NATA Hall of Fame 1995

Iconic Women in the Profession

In 1972, Sherry Bagagian became the first woman to sit for the certification exam given by the National Athletic Trainers’ Association (NATA) at that time (now it is given through the Board of Certification (BOC)). According to archive records with the NATA, not long after Bagagian sat for the exam, Gail Weldon sat for the NATA exam. Weldon became an icon of women in the athletic training profession with a wide array of accomplishments. She was the first female Athletic Trainer (AT) hired  by the US Olympic Committee in 1976, the first female Head AT for the 1979 Pan American Games, and the first female chief AT for the 1980 US Olympic Team. She was also the director of athletic training and physical therapy for the 1984 Olympic Games, and was selected again by the Committee as the Medical Director for the 1991 US Olympic Festival.

In 1980, Weldon left her position as the Head Women’s AT at UCLA to become the founder and owner of Women’s Training Room and Conditioning Center. Weldon was the first woman inducted into the NATA Hall of Fame in 1995, four years after her death. Today, the NATA holds a Gail Weldon Award of Excellence, which recognizes one AT each year who displays a “commitment to mentoring, professional development and life balancing for women athletic trainers or significant contributions to improve the health care of females provided by ATs.” Weldon is known as one of the most influential pioneers in the athletic training profession and serves as a role model for all women, paving the road for women to become active members of the NATA and hold a strong position in the profession.

Majorie J. Albohm is also recognized as a pivotal female figure in the profession of athletic training. She was one of the first women to be certified along with Gail Weldon and Sherry Bagagian. In addition, she was the first female AT at Indiana University and was also an original member of the NATA Foundation Board and Foundation President. In 2007, Albohm was elected to be the president of the NATA, the second woman to hold this position after Julie Max.

Read more about the chronicle of women in the profession in The Role of Women in Athletic Training: A Review of the Literature.

Breaking the Glass Ceiling

In recent years, more women have been joining the athletic training profession than men. In 2005, 47.6 percent of NATA members were women, but in 2011 that number climbed to 50.9 percent. Student memberships illustrate the trend even more, with 60 percent of those held by women.

Even though women are now a majority in the industry — a result of women coming into the business during the past decade — they hold just a few of the most lucrative jobs. Although certain areas of the profession are based around the quality of care and not by gender of the provider, there are still some areas of athletic training that remain gender biased.

Sue Falsone

Sue Falsone was the first female Head AT for the Los Angeles Dodgers when hired in 2012. Falsone broke through the glass ceiling with working for a major professional team, a job that is conspicuous in Major League Baseball, a male-dominated sport where women who aren’t reporters are rarely seen on the field and in the clubhouse. She remained the only woman in a head spot with a baseball team until she made the decision to step down last October to consult and pursue other projects.

Other women who have broken through the glass ceiling include Judy Seto, who works for the Lakers, and Ariko Iso, who was an Assistant AT for the Steelers and is now the Head AT at Oregon State University, her alma mater.

Alyssa Alpert, a 26-year-old AT, has been named the Head AT for the New York Cosmos, a legendary team in its second season in the North American Soccer League. Alpert’s older sister Alana works for Clarkson as an AT for the hockey team. Read more about their story in “Female athletic trainers making strides,” from ESPNw.

Much of the credit for the continued growth of women in the athletic training profession goes to the female ATs who have faced gender bias and discrimination and broken down many of the professional barriers.

Written By:
Brittney Ryba


Return To Play Post-Concussion: Who’s Calling The Shots?

With the explosion of lawsuits shining a harsh light on a history of poor concussion management in professional sports, it’s no surprise that neurological and sporting associations are rushing to pour effort and resources into developing policies and procedures. These plans guiding sideline personnel on when to approve an athlete’s “return to play” are not only being developed at the professional level, but all the way down to the elementary school level as well.

All of these policies and plans boil down to one absolute point: the Athletic Trainer (AT) should be calling the shots on return to play. ATs are the most qualified members of a sideline team, with the training, expertise and, most importantly, hands on experience to spot the sometimes subtle symptoms of a concussion.

(1) Why are ATs like Paul Welliver being fired for refusing to return students to play after concussion? Trained medical professionals are being ignored, bullied and dismissed when trying to do the right thing for their athletes.

Who is really calling the shots?

Putting the Power Back in The ATs Hands

The American Academy of Neurology (AAN) feels that concussion management to be a team effort (2), but is that the right call? Being part of a team carries the danger of pressure to conform to group think, to support the best interest of the team over the best interest of the athlete.

The most obvious solution to the lack of consistent implementation of concussion management is to place complete and total authority on return to play decisions into the hands of the AT directly involved with the athlete.

Many ATs believe that they should be a distinctly separate unit, not a part of the coaching staff. The distinction must be made that they are, first and foremost, medical providers whose primary focus is the care of injured athletes. And until all ATs and administrators are able to differentiate between those two roles, they believe that their professionals “will never be supported the right way to make the unpopular decisions required for the safety of our athletes”(3).

While taking on the collective goliath of professional, collegiate and high school sporting associations to bring about change to concussion management should be the ultimate goal, ATs at every level can affect change much more simply.

How? With education.

ATs should be working to educate athletes on the long-term consequences of concussions. Parents should be enlightened on the dangers of relying on medical personnel lacking comprehensive and hands-on concussion management experience. Coaching staff need to learn that concussions aren’t just “bumps on the head” and that the signs can be difficult to read to the untrained eye. And associations need to learn that athletic trainers aren’t there to cost them money, or to be difficult.

Most of all, what everyone needs to learn is to trust and respect the training, skills and expertise of certified ATs. Their number one priority is the athlete.

About the Author:

Amy-lynn Engelbrecht is the Online Content Specialist at offers quality online continuing education courses for Athletic Trainers, Certified Strength and Conditioning Specialists, Massage Therapists, Physical Therapists, Physical Therapist Assistants, Occupational Therapists, Occupational Therapist Assistants, and Speech Language Pathologists.

1. “Athletic Trainer Removed from Post for Standing Ground on Concussions”, Dustin Fink, The Concussion Blog, March 1st, 2013

2. “Summary of evidence-based guideline update: Evaluation and management of concussion in sports”, Neurology June 11, 2013 vol. 80 no. 24 2250-2257 March 18, 2013.

3. “Coach Makes the Call”, Brad Wolverton, The Chronicle of Higher Education, September 2, 2013.