{"$schema":"/schema/csx-article.schema.json","generated":"2026-10-01","articles":[{"id":"csx-001","doi":"10.67999/csx.001","type":"Critical review","crossref_type":"report","title":"Who Stops the Fight?","subtitle":"A Critical Review of Neidecker, John, and Wheelock (2025) on Ringside Physician Stoppage Authority in United States Combat Sports Commissions","authors":[{"given":"Casey C.","family":"Sears","orcid":"https://orcid.org/0009-0000-6344-1143","affiliation":"Alabama Athletic Commission","place":"Birmingham, Alabama, USA"}],"publisher":"Sears Publishing Company","date_published":"2026-09-22","language":"en","landing_url":"https://combatsports.searspublishing.net/articles/csx-001/","pdf_url":"https://combatsports.searspublishing.net/articles/csx-001/csx-001.pdf","citation_exports":{"bib":"https://searspublishing.net/assets/citations/csx-001.bib","ris":"https://searspublishing.net/assets/citations/csx-001.ris","json":"https://searspublishing.net/assets/citations/csx-001.json","enw":"https://searspublishing.net/assets/citations/csx-001.enw"},"review_designation":"Critical review; author as printed in the publication: Casey C. Sears.","keywords":["ringside physician","referee","sole arbiter","combat sports regulation","boxing","mixed martial arts","policy surveillance","measurement error","misclassification","athlete disclosure","Muhammad Ali American Boxing Revival Act","correction and retraction"],"abstract":[{"label":"Background","text":"Neidecker, John, and Wheelock surveyed United States combat sports commissions by telephone and electronic mail and reported 23 jurisdictions with independent physician authority to stop a bout, 21 with the referee as sole arbiter, and 3 sport-dependent; they characterized this as a significant shift and recommended an Association of Ringside Physicians position statement advocating physician authority in all jurisdictions."},{"label":"Objective","text":"To evaluate the article’s validity; audit its classification of every jurisdiction against primary legal sources; and examine the fighter-safety premise of the allocation it advocates."},{"label":"Methods","text":"Reconstruction of the reported proportions; primary-source coding of current statutes and regulations for the jurisdictions in the article’s population and the two excluded states with regulatory text; application of a written three-tier taxonomy (direct, binding, advisory); a verification review with reported agreement statistics; and review of the literature on athlete disclosure, examiner-gatekeeper effects, and diffusion of responsibility."},{"label":"Results","text":"The article uses inconsistent denominators and mislabels proportions of jurisdictions as proportions of states. Alabama is misclassified; correcting Alabama alone ties the modal categories at 22. On the full census with statute controlling, physician authority in both sports exists in 20 jurisdictions, the referee alone in 20, a sport-dependent allocation in 6, and the text is indeterminate in 1. Direct authority in both sports, claimed for 23 jurisdictions, is supportable in 11. Between 13 and 19 of the 47 cells are misclassified against current text. The primary classification and verification review agreed on 46 of 48 jurisdictions (kappa 0.93)."},{"label":"Conclusion","text":"The article’s principal finding does not survive verification against primary legal sources. Its dataset, map, and claimed shift are unreliable as a basis for policy. The fighter-safety analysis also challenges the assumption that independent physician stoppage authority improves protection, because making the cageside examination dispositive increases the incentive to conceal or manipulate information on which the examination depends."}],"relations":[{"type":"isReviewOf","identifier_type":"uri","identifier":"https://ringsidearp.org/wp-content/uploads/2025/11/ARP-Journal-November-2025-v3.pdf","description":"Neidecker J, John T, Wheelock S. Authority of ringside physician to stop fights: prevalence in US combat sports commissions. J Combat Sports Med. 2025;7(1):6-8."},{"type":"isSupplementedBy","identifier_type":"doi","identifier":"10.67999/csx.001.s1","description":"Supplement S1: Audit Protocol, Coding Record, Source Transcriptions, and Journal Correspondence."}],"references":[{"key":"ref1","text":"Neidecker J, John T, Wheelock S. Authority of ringside physician to stop fights: prevalence in US combat sports commissions. 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Available at: https://www.leg.state.nv.us/Register/RegsReviewed/$R089-22A.PDF. Accessed September 9, 2026."},{"key":"ref65","text":"Kan. Admin. Regs. §§ 128-4-7 (amended December 20, 2013), 128-6-1 (amended December 20, 2013), 128-6-4 (amended April 21, 2017). Available at: https://www.law.cornell.edu/regulations/kansas/K-A-R-128-4-7; https://www.law.cornell.edu/regulations/kansas/K-A-R-128-6-1; https://www.law.cornell.edu/regulations/kansas/K-A-R-128-6-4. Accessed September 22, 2026."},{"key":"ref66","text":"Code Me. R. 99-650 (Combat Sports Authority of Maine), pt. 1, ch. 5, § 4, ch. 9, § 3; pt. 2, ch. 5, § 5, ch. 9, § 3 (current through June 25, 2025); 8 M.R.S. ch. 20. Available at: https://regulations.justia.com/states/maine/99/650/part-2/chapter-9/section-650-2-9-3; https://regulations.justia.com/states/maine/99/650/part-2/chapter-5/section-650-2-5-5; https://regulations.justia.com/states/maine/99/650/part-1/chapter-9/section-650-1-9-3; https://legislature.maine.gov/statutes/8/title8ch20.pdf. Accessed September 22, 2026."},{"key":"ref67","text":"Md. Code Regs. (COMAR) 09.14.04.05, 09.14.07.03, 09.14.07.04, 09.14.16.01, 09.14.16.08 (Library of Maryland Regulations, current). Available at: https://regs.maryland.gov/us/md/exec/comar/09.14.04.05; https://regs.maryland.gov/us/md/exec/comar/09.14.07.03; https://regs.maryland.gov/us/md/exec/comar/09.14.16.08. Accessed September 22, 2026."},{"key":"ref68","text":"Mich. Comp. Laws § 338.3657 (Michigan Unarmed Combat Regulatory Act); Mich. Admin. Code R 339.219, 339.223, 339.223a (current through Vol. 25-10, June 15, 2025). Available at: https://ombudsman.legislature.mi.gov/documents/mcl/pdf/MCL-403-2004-5.pdf; https://regulations.justia.com/states/michigan/licensing-and-regulatory-affairs/corporations-securities-and-commercial-licensing/unarmed-combat/unarmed-combat/part-2/section-r-339-223/; https://regulations.justia.com/states/michigan/licensing-and-regulatory-affairs/corporations-securities-and-commercial-licensing/unarmed-combat/unarmed-combat/part-2/section-r-339-219/. Accessed September 22, 2026."},{"key":"ref69","text":"Wyoming Combat Sports Commission Rules, ch. 11 (Requirements for Officials), § 4; ch. 17 (Professional Boxing), § 1 (current through June 13, 2025). Available at: https://regulations.justia.com/states/wyoming/agency-046/sub-agency-0001/chapter-11/section-11-4; https://regulations.justia.com/states/wyoming/agency-046/sub-agency-0001/chapter-17/section-17-1/. Accessed September 22, 2026."},{"key":"ref70","text":"Ga. Comp. R. & Regs. rr. 85-1-.07 (eff. June 9, 2024), 85-3-.12 (eff. July 1, 2007). Available at: https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-85-1-.07; https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-85-3-.12. Accessed September 22, 2026."},{"key":"ref71","text":"16 Tex. Admin. Code §§ 61.41, 61.46, 61.107, 61.111 (current through Register 50, No. 26, June 27, 2025); Tex. Occ. Code ch. 2052 (2025). Available at: https://regulations.justia.com/states/texas/title-16/part-4/chapter-61/section-61-41; https://regulations.justia.com/states/texas/title-16/part-4/chapter-61/section-61-111; https://law.justia.com/codes/texas/occupations-code/title-13/subtitle-b/chapter-2052/. Accessed September 22, 2026."},{"key":"ref72","text":"20 CSR 2040-4.030, 2040-4.040, 2040-5.040 (eff. October 30, 2024), 2040-8.180 (current through Register Vol. 50, No. 12, June 16, 2025). Available at: https://regulations.justia.com/states/missouri/title-20/division-2040/chapter-4/section-20-csr-2040-4-030; https://www.law.cornell.edu/regulations/missouri/20-CSR-2040-5-040; https://regulations.justia.com/states/missouri/title-20/division-2040/chapter-8/section-20-csr-2040-8-180. Accessed September 22, 2026."},{"key":"ref73","text":"Utah Admin. Code R457-1-203, R457-1-515, R457-1-516, R457-1-605, R457-1-801 (adopted eff. August 18, 2023; amended eff. February 20, 2024; current through Bulletin 2025-12, June 15, 2025). Available at: https://regulations.justia.com/states/utah/cultural-and-community-engagement/title-r457/rule-r457-1/section-r457-1-203/; https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R457-1-605; https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R457-1-515. Accessed September 22, 2026."},{"key":"ref74","text":"Fla. Stat. § 548.046 (2025); Fla. Admin. Code rr. 61K1-3.004 (eff. December 5, 2024), 61K1-3.012. Available at: https://www.flsenate.gov/Laws/Statutes/2025/548.046; https://www.law.cornell.edu/regulations/florida/Fla-Admin-Code-Ann-R-61K1-3-004; https://www.law.cornell.edu/regulations/florida/Fla-Admin-Code-Ann-R-61K1-3-012. Accessed September 22, 2026."},{"key":"ref75","text":"Ind. Code § 4-33-22-27; 68 Ind. Admin. Code 24-3-35, 24-4-8, 24-5-8 (current through June 25, 2025). Available at: https://www.in.gov/igc/files/athletics/FinalCompilation.pdf (official compilation); https://regulations.justia.com/states/indiana/title-68/article-24/rule-4/section-8/; https://regulations.justia.com/states/indiana/title-68/article-24/rule-5/section-8/. Accessed September 22, 2026."},{"key":"ref76","text":"Miss. Admin. Code tit. 30, pt. 301 (Mississippi Athletic Commission Rules and Regulations), rr. 1.11(I), 2.1, 4.5(J), 4.8(B) (current through June 12, 2025). Available at: https://www.sos.ms.gov/ACCode/00000302c.pdf (official); https://regulations.justia.com/states/mississippi/title-30/part-301/. Accessed September 22, 2026."},{"key":"ref77","text":"N.C. Gen. Stat. § 143-651 (2025); 14B N.C. Admin. Code 10 .0406 (amended January 9, 2018), 10 .0412 (current through Register Vol. 39, No. 24, June 16, 2025). Available at: https://law.justia.com/codes/north-carolina/chapter-143/article-68/section-143-651/; https://regulations.justia.com/states/north-carolina/title-14b/chapter-10/section-0400/section-10-0406/; https://regulations.justia.com/states/north-carolina/title-14b/chapter-10/section-0400/section-10-0412/. Accessed September 22, 2026."},{"key":"ref78","text":"Okla. Admin. Code §§ 92:10-3-6, 92:10-3-10, 92:10-5-10, 92:10-5-15, 92:10-11-1, 92:10-11-8 (official Title 92 compilation; § 92:10-3-10 current through Vol. 42, No. 19, June 16, 2025). Available at: https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/organization/oklahoma-state-athletic-commission/1023title92osac.pdf; https://regulations.justia.com/states/oklahoma/title-92/chapter-10/subchapter-3/section-92-10-3-10/; https://www.law.cornell.edu/regulations/oklahoma/OAC-92-10-11-8. Accessed September 22, 2026."},{"key":"ref79","text":"Tenn. Code Ann. § 68-115-404 (2024); Tenn. Comp. R. & Regs. 0145-01-.07, 0145-02-.10, 0145-02-.14, 0145-03-.03, 0145-03-.11 (current through June 26, 2025). Available at: https://law.justia.com/codes/tennessee/title-68/safety/chapter-115/part-4/section-68-115-404/; https://regulations.justia.com/states/tennessee/title-0145/chapter-0145-02/section-0145-02-14/; https://regulations.justia.com/states/tennessee/title-0145/chapter-0145-03/section-0145-03-11/. Accessed September 22, 2026."},{"key":"ref80","text":"Wis. Stat. § 444.12 (2025); Wis. Admin. Code SPS 192.20, 192.21 (current through May 27, 2025). Available at: https://law.justia.com/codes/wisconsin/chapter-444/section-444-12/; https://regulations.justia.com/states/wisconsin/sps/sps-1-299/sps-190-199/chapter-sps-192/subchapter-iii/section-sps-192-20/. Accessed September 22, 2026."},{"key":"ref81","text":"Haw. Rev. Stat. §§ 440-19, 440-21, 440E-16, 440E-17 (2025); Haw. Admin. Rules §§ 16-74-97, 16-74-109, 16-74-117, 16-74-118 (compiled October 5, 1991). Available at: https://law.justia.com/codes/hawaii/title-25/chapter-440/section-440-21/; https://law.justia.com/codes/hawaii/title-25/chapter-440e/section-440e-17/; https://cca.hawaii.gov/pvl/files/2013/08/har_74-c2.pdf. Accessed September 22, 2026."},{"key":"ref82","text":"S.D. Admin. R. 20:81:04:04, 20:81:04:19 (eff. July 28, 2014); 20:81:05:07, 20:81:05:21 (eff. December 18, 2017); S.D. Codified Laws ch. 42-12. Available at: https://sdlegislature.gov/api/Rules/Rule/20:81:04:04.html; https://sdlegislature.gov/api/Rules/Rule/20:81:05:21.html; https://law.justia.com/codes/south-dakota/title-42/chapter-12/. Accessed September 22, 2026."},{"key":"ref83","text":"4 Colo. Code Regs. 740-1 (Colorado Combative Sports Commission), rr. 1.8, 1.10, 1.15 (current compilation; incorporated Unified Rules of Mixed Martial Arts eff. November 1, 2024); Colo. Rev. Stat. §§ 12-110-101 to -116. Available at: https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=12057&fileName=4+CCR+740-1; https://law.justia.com/codes/colorado/title-12/business-professions-and-occupations/article-110/. Accessed September 22, 2026."},{"key":"ref84","text":"Regs. Conn. State Agencies §§ 29-143j-2a, 29-143j-36a, 29-143j-39a, 29-143j-68a, 29-143j-73a (Boxing and Mixed Martial Arts), as filed with the Secretary of the State (§ 29-143j-2a current through June 16, 2025). Available at: https://portal.ct.gov/-/media/DESPP/SLFU/boxing/BoxingMMAregulationsasfiledwiththeSecretaryofStatepdf.pdf; https://regulations.justia.com/states/connecticut/title-29/subtitle-143j/boxing-and-mixed-martial-arts/section-29-143j-2a/. Accessed September 22, 2026."},{"key":"ref85","text":"Or. Admin. R. 230-080-0111, 230-080-0530, 230-080-0660, 230-140-0390 (current through Register Vol. 64, No. 6, June 1, 2025); Or. Rev. Stat. § 463.047. Available at: https://regulations.justia.com/states/oregon/chapter-230/division-80/section-230-080-0111/; https://oregon.public.law/rules/oar_230-080-0530; https://regulations.justia.com/states/oregon/chapter-230/division-140/section-230-140-0390/; https://oregon.public.law/statutes/ors_463.047. Accessed September 22, 2026."},{"key":"ref86","text":"230-RICR-30-30-1 (Boxing), §§ 1.3, 1.9; 230-RICR-30-30-6 (Mixed Martial Arts), §§ 6.3, 6.9, 6.12 (eff. January 4, 2022). 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Accessed September 9, 2026."}],"contributors":[{"given":"Casey C.","family":"Sears","orcid":"https://orcid.org/0009-0000-6344-1143","role":"author","sequence":"first","affiliation":"Alabama Athletic Commission"}],"pages":55,"byline_as_printed":"Casey C. Sears","correspondence":"Casey C. Sears, Commissioner, Alabama Athletic Commission; Chair, Rules and Procedures Committee. Email: editor@searspublishing.net.","doi_status":"deposit prepared","doi_status_checked":"2026-09-27","rights":"Copyright © 2026 Sears Publishing Company. All rights reserved.","reference_count":153},{"id":"csx-003","doi":"10.67999/csx.003","type":"Systematic review","crossref_type":"report","title":"Standardized Post-Bout Ringside Concussion Screening in Combat Sports","subtitle":"Systematic Evidence Review and Development of the RACE1 Ringside Acute Concussion Examination","authors":[{"given":"Casey C.","family":"Sears","orcid":"https://orcid.org/0009-0000-6344-1143","affiliation":"Alabama Athletic Commission","place":"Alabama, USA"}],"publisher":"Sears Publishing Company","date_published":"2026-10-01","version":"1.0","language":"en","landing_url":"https://combatsports.searspublishing.net/articles/csx-003/","pdf_url":"https://combatsports.searspublishing.net/articles/csx-003/csx-003.pdf","citation_exports":{"bib":"https://searspublishing.net/assets/citations/csx-003.bib","ris":"https://searspublishing.net/assets/citations/csx-003.ris","json":"https://searspublishing.net/assets/citations/csx-003.json","enw":"https://searspublishing.net/assets/citations/csx-003.enw"},"license":"https://combatsports.searspublishing.net/articles/csx-003/#rights","review_designation":"Preprint, not peer reviewed; released to seek co-authors and initial peer review. Author as printed in the publication: Casey C. Sears.","keywords":["boxing","concussion","sideline assessment","combat sports","ringside physician","mixed martial arts"],"abstract":[{"label":"Context","text":"The objective was a standardized post-bout ringside concussion protocol for combat sports regardless of rule set: professional boxing, mixed martial arts (MMA), bare-knuckle boxing, kickboxing, Toughman contests, amateur MMA and amateur boxing. Amateur boxing was the model for its stricter rules (mandatory post-bout examination, Sport Concussion Assessment Tool after a knockout or head-blow stoppage, tiered restrictions)."},{"label":"Evidence Acquisition","text":"PubMed/MEDLINE, Consensus, Scholar Gateway, Wiley Scholar Gateway, SciSpace, alphaXiv and ClinicalTrials.gov were searched on September 30, 2026, without limits, plus citation searching. One reviewer screened and extracted; the author verified a 10% sample. Synthesis followed the Synthesis Without Meta-analysis guideline."},{"label":"Study Design","text":"Clinical review (systematic search with synthesis without meta-analysis) and instrument description."},{"label":"Level of Evidence","text":"Level 3."},{"label":"Results","text":"Of 2,250 records, 2,063 were screened and 214 core records were included (53 amateur); 137 rested on the abstract. Of 33 primary studies judged on full text, 16 were at high risk of bias. No amateur study measured the accuracy or reliability of any ringside item; nothing was pooled. Diagnosed concussion was recorded infrequently with incompatible denominators, stoppage could not substitute for diagnosis, and an abstract reported evolving cognitive slowing after 2 of 160 bouts in boxers not suspected at ringside. In other sports, single components were mostly specific, with limited sensitivity. Amateur evidence for every screening item was SORT Level 3. RACE1 is an 18-card post-bout screen, compared with a pre-bout baseline where possible, scored out of 20, with 3 provisional dispositions."},{"label":"Conclusions","text":"A multidomain post-bout screen can standardize ringside findings, but a normal screen cannot exclude concussion. RACE1 is used only after the bout and never clears an athlete or permits same-day return. Evidence is mainly from amateur boxing; RACE1 has not been evaluated in any sport."},{"label":"Strength-of-Recommendation Taxonomy (SORT)","text":"After the bout, any sign, symptom or examination deficit precludes a \"no deficit detected\" result; absence of signs does not exclude concussion (B). Use brief items from several domains, never one domain alone (B). Transport any boxer with a red flag to a pre-identified trauma center with computed tomography and neurosurgical cover (C). A normal screen is not clearance (C)."}],"references":[{"n":1,"text":"Aderman MJ, Roach MH, Ward-Kantanas K, et al. 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Br J Sports Med. 2006;40(8):670-674. https://doi.org/10.1136/bjsm.2006.025924","doi":"10.1136/bjsm.2006.025924"}],"pages":84,"byline_as_printed":"Casey C. Sears","correspondence":"Casey C. Sears. Email: editor@searspublishing.net.","doi_status":"deposit prepared","doi_status_checked":"2026-10-01","rights":"Copyright © 2026 Sears Publishing Company. All rights reserved.","reference_count":116},{"id":"csx-003-s7","doi":"10.67999/csx.003.s7","type":"Supplementary file","crossref_type":"report","title":"RACE1 Ringside Acute Concussion Examination Card Deck (Edition 4)","subtitle":"Supplementary File S7","authors":[{"given":"Casey C.","family":"Sears","orcid":"https://orcid.org/0009-0000-6344-1143","affiliation":"Alabama Athletic Commission","place":"Alabama, USA"}],"publisher":"Sears Publishing Company","date_published":"2026-10-01","version":"1.0","language":"en","landing_url":"https://combatsports.searspublishing.net/articles/csx-003/s7/","pdf_url":"https://combatsports.searspublishing.net/articles/csx-003/s7/csx-003-s7.pdf","citation_exports":{"bib":"https://searspublishing.net/assets/citations/csx-003-s7.bib","ris":"https://searspublishing.net/assets/citations/csx-003-s7.ris","json":"https://searspublishing.net/assets/citations/csx-003-s7.json","enw":"https://searspublishing.net/assets/citations/csx-003-s7.enw"},"license":"https://combatsports.searspublishing.net/articles/csx-003/s7/#rights","review_designation":"Preprint supplement, not peer reviewed. Author as printed in the publication: Casey C. Sears.","keywords":["boxing","concussion","sideline assessment","combat sports","ringside physician","mixed martial arts"],"abstract":[{"label":"Summary","text":"This supplementary file reproduces, as a standalone citable document, Appendix C of the CSX-003 systematic evidence review: the complete RACE1 Ringside Acute Concussion Examination card deck, edition 4. The 18 cards (20 half-letter pages, including the reverse sides of Cards 5 and 18) are issued for review and comment exactly as they appear in the article. RACE1 is a post-bout screen used only after the bout has ended, against a pre-bout baseline where possible; it is never used during a bout, between rounds, or to permit return to participation the same day or in the same competition. It records standardized findings to assist the ringside physician, does not diagnose or exclude concussion, and never clears an athlete. Items and score bands are provisional and have not been validated in any sport."}],"is_supplement_to":"10.67999/csx.003","pages":23,"byline_as_printed":"Casey C. Sears","correspondence":"Casey C. Sears. Email: editor@searspublishing.net.","doi_status":"deposit prepared","doi_status_checked":"2026-10-01","rights":"Copyright © 2026 Sears Publishing Company. All rights reserved."}]}