Comparison of Ankle Taping and Bracing on Ankle Biomechanics during Landing in Functional Ankle Instability

Lateral ankle sprains are one of the most common injuries in athletics. Injury to lateral ankle ligaments can result in persistent instability of the ankle joint, known as functional ankle instability (FAI). Two methods of treating FAI are ankle taping and ankle bracing. The purpose of this study was to compare the effects of ankle taping and ankle bracing on ankle joint kinematics and kinetics during a landing task. Methods: Seven individuals with FAI and seven healthy controls performed three landing trials in each of three conditions: control, taped and braced. Ground reaction forces and three-dimensional kinematics were collected simultaneously while participants performed single-leg step-off landing trials from a box with a height of 0.6m. Peak ankle joint angles and moments were calculated using customized software. Results: Individuals with FAI produced significantly smaller inversion moments compared to healthy controls (p = 0.006). Ankle stabilization did not significantly alter ankle joint angles, ranges of motion or moments. Discussion: The present findings suggest that individuals with FAI exhibit unique ankle biomechanics independent of ankle stabilization modality. Future research may seek to investigate the multi-joint biomechanical adaptations associated with ankle stabilization in individuals with FAI compared to healthy controls

Rationally designed immunogens enable immune focusing following SARS-CoV-2 spike imprinting

Eliciting antibodies to surface-exposed viral glycoproteins can generate protective responses that control and prevent future infections. Targeting conserved sites may reduce the likelihood of viral escape and limit the spread of related viruses with pandemic potential. Here we leverage rational immunogen design to focus humoral responses on conserved epitopes. Using glycan engineering and epitope scaffolding in boosting immunogens, we focus murine serum antibody responses to conserved receptor binding motif (RBM) and receptor binding domain (RBD) epitopes following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike imprinting. Although all engineered immunogens elicit a robust SARS-CoV-2-neutralizing serum response, RBM-focusing immunogens exhibit increased potency against related sarbecoviruses, SARS-CoV, WIV1-CoV, RaTG13-CoV, and SHC014-CoV; structural characterization of representative antibodies defines a conserved epitope. RBM-focused sera confer protection against SARS-CoV-2 challenge. Thus, RBM focusing is a promising strategy to elicit breadth across emerging sarbecoviruses without compromising SARS-CoV-2 protection. These engineering strategies are adaptable to other viral glycoproteins for targeting conserved epitopes

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ankle work and dynamic joint stiffness in high- compared to low-arched athletes during a barefoot running task

High- (HA) and low-arched (LA) athletes have an exaggerated risk of injury. Ankle joint stiffness is a potential underlying mechanism for the greater rate of injury within these two functionally different groups. An alternative candidate mechanism of injury in HA and LA athletes pertains to the efficacy of the foot as a rigid lever during propulsion. The purpose of this study was to quantify the differences in ankle dynamic joint stiffness, and ankle braking work and ankle propulsive work during stance phase of running. Methods: Ten HA and ten LA athletes performed five barefoot running trials while ground reaction forces and three-dimensional kinematics were recorded. Ankle dynamic joint stiffness was calculated as the slope of the ankle joint moment-ankle joint angle plot during load attenuation. Ankle braking and propulsive work values were calculated for the stance phase. Results: HA athletes had significantly greater ankle dynamic joint stiffness and significantly smaller ankle net and propulsive work than LA athletes. Conclusions: These data demonstrate that HA and LA athletes exhibit unique biomechanical patterns during running. These patterns may be related to lower extremity injury. © 2014 Elsevier B.V

The immediate effect of atlanto-axial high velocity thrust techniques on blood flow in the vertebral artery: A randomized controlled trial

Background: High velocity thrust (HVT) cervical techniques have been associated with serious vertebral artery (VA) trauma. Despite numerous studies, the nature of this association is uncertain. Previous studies have failed to demonstrate haemodynamic effects on the VA in simulated pre-thrust positions. No study has investigated haemodynamic affects during or immediately following HVT, nor sufficiently controlled for the influence of the thrust. Objectives: To investigate the immediate effects of HVT of the atlanto-axial joint upon haemodynamics in the sub-occipital portion of the vertebral artery (VA3). Design: Randomized Controlled Trial. Method: Twenty-three healthy participants (14 women, 9 men; mean age 40, range 27-69 years of age) were randomly assigned to two groups: an intervention group (MANIP, n=11) received HVT to the atlanto-axial segment whilst a control group (CG, n=12) was held in the pre-manipulative hold position. Colour-flow Doppler ultrasound was used to measure VA3 haemodynamics. Primary outcome measures were peak systolic (PSV) and end diastolic velocities (EDV) of three cardiac cycles measured at neutral (N1), pre-HVT (PreMH), post-HVT (PostMH), post-HVT-neutral (N2) positions. Results: Test-retest reliability for the Doppler measures demonstrated intra-class correlation coefficient (ICC) of 0.99 (95% CI 0.98-1.0) for PSV and 0.91 (95% CI 0.84-0.96) for EDV. Visually, EDV were lower in the MANIP group than in the CONTROL group across the four measurements. However, there were no significantly different changes (at p≤0.01) between the MANIP and CONTROL groups for any measurement variable. Conclusions: HVT to the atlanto-axial joint segment does not affect the haemodynamics of the sub-occipital portion of the vertebral artery during or immediately following HVT in healthy subjects