The Currie Cup Premiership Competition Injury Surveillance Report 2019

The content of the report is based on data collected by the SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP) steering group

‘Do we know if we need to reduce head impact exposure?’: A mixed-methods study highlighting the varied understanding of the longterm risk and consequence of head impact exposure across all stakeholders at the highest level of rugby union

Background: One strategy to prevent and manage concussion is to reduce head impacts, both those resulting in concussion and those that do not. Because objective data on the frequency and intensity of head impacts in rugby union (rugby) are sparse, stakeholders resort to individual perceptions to guide contact training. It is unknown whether there is a level of contact training that is protective in preparing elite players for contact during matches.  Objectives: This study aimed to describe how contact training is managed in elite male rugby, and how staff and players perceive contact training load and head impact load. Methods: This was a sequential explanatory mixed-methods study. Forty-four directors of rugby, defence coaches, medical and strength/conditioning staff and 23 players across all 13 English Premiership Rugby Union clubs and the National senior team participated in semi-structured focus groups and completed two bespoke questionnaires. Results: The study identified the varied understanding of what constitutes head impact exposure across all stakeholder groups, resulting in different interpretations and a range of management strategies. The findings suggest that elite clubsconduct low levels of contact training; however, participants believe that some exposure is required to prepare players andthat efforts to reduce head impact exposure must allow for individualised contact training prescription. Conclusion: There is a need for objective data, possibly from instrumented mouthguards to identify activities with a high risk for head impact and possible unintended consequences of reduced exposure to these activities. As data on head impact exposure develop, this must be accompanied with knowledge exchange within the rugby community.

SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP): The Carling Currie Cup Premiership Competition Injury Surveillance Report 2021

The content of the report is based on data collected by the SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP) steering group

Injuries in elite men’s Rugby Union:An updated (2012-2020) meta-analysis of 11,620 match and training injuries

BACKGROUND: The most recent meta-analytic review of injuries in elite senior men’s Rugby Union was published in 2013. The demands of the game at the elite level are continually changing alongside law amendments and developments in player preparation. As such, an updated meta-analysis of injury data in this setting is necessary. OBJECTIVE: To meta-analyse time-loss injury data in elite senior men’s Rugby Union between 2012 and 2020. METHODS: Electronic databases were searched using the keywords ‘rugby’ and ‘inj*’. Nineteen studies met the inclusion criteria. Injury incidence rate data were modelled using a mixed-effects Poisson regression model. Days missed data were modelled using a general linear mixed model. RESULTS: The included data encompassed a total of 8819 match injuries and 2801 training injuries. The overall incidence rate of injuries in matches was 91 per 1000 h (95% confidence interval (CI) 77–106). The estimated mean days missed per match injury was 27 days (95% CI 23–32). The overall incidence rate of match concussions was 12 per 1000 h (95% CI 9–15). The overall incidence rate of training injuries was 2.8 per 1000 h (95% CI 1.9–4.0). Playing level was not a significant effect modifier for any outcome. CONCLUSIONS: The injury incidence rate and mean days missed per injury in the present meta-analysis were higher, but statistically equivalent to, the 2013 meta-analysis (81 per 1000 h and 20 days, respectively). The injury incidence rate for match injuries in elite senior men’s Rugby Union is high in comparison to most team sports, though the training injury incidence rate compares favourably. The tackle event and concussion injuries should continue to be the focus of future preventative efforts. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40279-021-01603-w

Trends in match injury risk in professional male rugby union: a 16-season review of 10851 match injuries in the English Premiership (2002-2019):The Professional Rugby Injury Surveillance Project

Objectives The Professional Rugby Injury Surveillance Project is the largest and longest running rugby union injury surveillance project globally and focuses on the highest level of rugby in England.Methods We examined match injuries in professional men’s rugby over the period 2002/2003 to 2018/2019 and described trends in injuries over this time.Results Over the period 2002/2003–2018/2019, 10 851 injuries occurred in 1 24 952 hours of match play, equating to a mean of 57 injuries per club per season and one injury per team per match. The mean incidence, severity (days absence) and burden (days absence/1000 hours) of injury were 87/1000 hours (95% CI 82 to 92), 25 days (95% CI 22 to 28) and 2178 days/1000 hours (95% CI 1872 to 2484), respectively. The tackle accounted for 43% injuries with running the second most common activity during injury (12%). The most common injury location was the head/face with an incidence of 11.3/1000 hours, while the location with the highest overall burden was the knee (11.1 days/1000 hours). Long-term trends demonstrated stable injury incidence and proportion of injured players, but an increase in the mean and median severity of injuries. Concussion incidence, severity and burden increased from the 2009/2010 season onwards and from 2011 to 2019 concussion was the most common injury.Conclusion The rise in overall injury severity and concussion incidence are the most significant findings from this work and demonstrate the need for continued efforts to reduce concussion risk as well as a greater understanding of changes in injury severity over time

Tackling sport-related concussion: Effectiveness of lowering the maximum legal height of the tackle in amateur male rugby - A cross-sectional analytical study

Objective Rugby union ( € rugby') is popular globally, with most of its participants being amateur. Concern regarding sport-related concussion (SRC) sustained during rugby is increasing. SRC occurs most frequently in the tackle, yet few interventions have aimed to mitigate this risk factor. This study investigated the influence of a lowered legal tackle height on SRC incidence in amateur rugby. Design Cross-sectional analytical study: 2018 (control - standard tackle height) and 2019 (intervention - lowered legal tackle height) seasons. Setting South African collegiate student rugby competition. Participants Between 800 and 900 male amateur student players (age: 20±1.6 years) in each year. Intervention Maximum legal tackle height lowered from line of the shoulder on the ball carrier to the line of the armpit. Outcome measures Number of overall (medical attention) and time-loss (≥1 day lost) injuries, head injuries and SRCs in 2018 and 2019 (dependent variables); events associated with injury incidents (independent variables). Results There was no statistically significant difference in incidences of time-loss injuries (IRR: 0.79; 95% CI: 0.6 to 1.1; p=0.13), head injuries (IRR: 0.83; 95% CI: 0.5 to 1.3; p=0.42) and SRC (IRR: 0.69; 95% CI: 0.4 to 1.2; p=0.20). In 2018 and 2019, most time-loss head injuries (57%, n=43) and SRCs (55%, n=26) occurred during the tackle. Conclusions Despite a trend towards reducing injuries, head injuries and SRC, lowering maximum legal tackle height to armpit level did not change SRC incidence in this amateur male rugby cohort. Most time-loss head injuries and SRCs occurred during the tackle. Further tackle-related interventions to reduce SRC incidence require investigation

Energy expenditure of acutely ill hospitalised patients

OBJECTIVE: To measure energy expenditure of acutely ill elderly patients in hospital and following discharge in the community. DESIGN: Sixty-three consecutive hospitalised acutely ill elderly patients were recruited. Eight patients were studied to assess the reliability of the Delta Tract Machine as a measure of energy expenditure; 35 patients had their energy expenditure studied in hospital on two occasions and 20 patients had their energy expenditure measured in hospital and at 6 weeks in the community RESULTS: Men had higher basal energy expenditure (BMR) values compared to women however the difference was not statistically significant [Men, mean (SD) 1405 (321) Kcal, women 1238 (322) kcal; mean difference (95% CI) 166 kcal (-17 to 531), p = 0.075]. After adjusting for age, gender and body mass index both medication and C-reactive protein (CRP), concentrations showed significant correlation with measured energy expenditure in hospital, (r = -0.36, "p < 0.05"; r = -0.29, "p < 0.05" respectively). However, in a multivariate analysis for all 63 subjects combined CRP explained most of the variance in BMR in hospital. The Harris Benedict equation predicted within ± 10% measured BMR in only 47% of individuals in hospital. CONCLUSION: Tissue inflammation and medications were associated with change in measured energy expenditure in acutely ill patients

The World Rugby and International Rugby Players Contact Load Guidelines: From conception to implementation and the future

Managing training load in rugby union is crucial for optimising performance and injury prevention. Contact training warrants attention because of higher overall injury and head impact risk, yet players must develop physical, technical, and mental skills to withstand the demands of the game. To help coaches manage contact loads in professional rugby, World Rugby and International Rugby Players convened an expert working group. They conducted a global survey with players to develop contact load guidelines. This commentary aims to describe the contact load guidelines and their implementation, and identify areas where future work is needed to support their evolution.

Counter-Insurgency against ‘kith and kin’?: the British Army in Northern Ireland, 1970–76

This article argues that state violence in Northern Ireland during the period 1970–1976—when violence during the Troubles was at its height and before the re-introduction of the policy of police primacy in 1976—was on a greatly reduced scale from that seen in British counterinsurgency campaigns in the colonies after the Second World War. When the army attempted to introduce measures used in the colonies—curfews, internment without trial—these proved to be extremely damaging to London's political aims in Northern Ireland, namely the conciliation of the Catholic minority within the United Kingdom and the defeat of the IRA. However, the insistence by William Whitelaw, secretary of state for Northern Ireland (1972–73), on ‘throttling back'—the release of internees and the imposition of unprecedented restrictions on the use of violence by the army—put a serious strain on civil-military relations in Northern Ireland. The relatively stagnant nature of the conflict—with units taking casualties in the same small ‘patch’ of territory without opportunities for the types of ‘positive actions’ seen in the colonies—led to some deviancy on the part of small infantry units who sought informal, unsanctioned ways of taking revenge upon the local population. Meanwhile, a disbelieving and defensive attitude at senior levels of command in Northern Ireland meant that informal punitive actions against the local population were often not properly investigated during 1970–72, until more thorough civilian and military investigative procedures were put in place. Finally, a separation of ethnic and cultural identity between the soldiers and the local population—despite their being citizens of the same state—became professionally desirable in order for soldiers to carry out difficult, occasionally distasteful work

Antibodies against endogenous retroviruses promote lung cancer immunotherapy

B cells are frequently found in the margins of solid tumours as organized follicles in ectopic lymphoid organs called tertiary lymphoid structures (TLS). Although TLS have been found to correlate with improved patient survival and response to immune checkpoint blockade (ICB), the underlying mechanisms of this association remain elusive. Here we investigate lung-resident B cell responses in patients from the TRACERx 421 (Tracking Non-Small-Cell Lung Cancer Evolution Through Therapy) and other lung cancer cohorts, and in a recently established immunogenic mouse model for lung adenocarcinoma. We find that both human and mouse lung adenocarcinomas elicit local germinal centre responses and tumour-binding antibodies, and further identify endogenous retrovirus (ERV) envelope glycoproteins as a dominant anti-tumour antibody target. ERV-targeting B cell responses are amplified by ICB in both humans and mice, and by targeted inhibition of KRAS(G12C) in the mouse model. ERV-reactive antibodies exert anti-tumour activity that extends survival in the mouse model, and ERV expression predicts the outcome of ICB in human lung adenocarcinoma. Finally, we find that effective immunotherapy in the mouse model requires CXCL13-dependent TLS formation. Conversely, therapeutic CXCL13 treatment potentiates anti-tumour immunity and synergizes with ICB. Our findings provide a possible mechanistic basis for the association of TLS with immunotherapy response