The Effects of Tempur Insoles on Ground Reaction Forces and Loading Rates in Running

Runners often experience over-use injuries. Ground reaction force (GRFs) patterns have been associated with these over-use injuries; however, it is not solely the magnitude of GRFs, but also the rate at which they are applied that lead to lower extremity injury. Many recreational runners will use over-the-counter insoles as a method of treating or preventing injury. Therefore, the purpose of this study was to examine the efficacy of two insoles on peak GRFs and loading rates. It was hypothesized that no differences in peak GRFs or loading rates would exist with the addition of two insoles during running. Twelve subjects (7 females; 5 males) performed seven running trials in each of the following conditions: no insoles (NORM), over-the-counter insoles (OTC) and memory-foam insoles (TEMPUR). GRFs were recorded using a force plate (1440Hz; AMTI) while subjects ran across a 15 meter lab. A 2 x 3 (gender x insole) repeated measures ANOVA was used to compare the effects of insoles on loading rate and ground reaction forces. Alpha level was set at p \u3c0.05. The current study found no statistical differences in loading rate or GRFs between the insole and no insole conditions. Furthermore, there was no gender effect in any condition. The findings of the current study suggest that insoles do not attenuate shock or decrease loading rate. The lack of shock attenuation associated with insoles suggests they do not protect the lower extremity from injury

The Effects of Insoles on Loading Rate in Level Running

Introduction: Running is one of the most popular recreational sports in America with over 250 million regular runners. Recreational and competitive runners often experience over-use injuries including plantar fasciitis, Achilles tendinitis and stress fractures. Previous research has shown that the transmission of ground reaction force through the lower extremity leads to these over-use injuries; however, it is not solely the magnitude of vertical ground reaction forces, but also the rate at which these forces are applied that may lead to lower extremity injury. Many recreational runners will use over-the-counter insoles as a method of treating an injury or as a way of prolonging or renewing and old pair of running shoes. Therefore, the purpose of this study was to examine the efficacy of two insoles on peak vertical ground reaction forces and loading rates. It was hypothesized that no differences in peak vertical ground reaction forces or loading rates would exist with the addition of two insoles during running. Methods: Twelve subjects (7 females; 5 males) performed seven trials in each of the following conditions: no insoles, over-the-counter insoles and custom made memory-foam insoles. Over-the-counter insoles were made by Dr. Scholl’s while the memory-foam insoles were made of tempur-pedic material. Ground reaction forces were recorded using a force plate (1440Hz; AMTI) while subjects ran across a 15 meter lab. Loading rate was calculated as the quotient of the peak vertical ground reaction force during load response and the time from heel strike to peak vertical ground reaction force in load response. A 2 x 3 (gender x insole) repeated measures ANOVA was used to compare the effects of insoles on loading rate. Alpha level was set at p \u3c0.05. Results: The current study found no statistical differences in normalized or non-normalized loading rate between the insole and no insole conditions. Furthermore, there was no effect of gender on loading rate. Discussion and Conclusions: The findings of the current study suggest that insoles do not attenuate shock or decrease loading rate. The lack of shock attenuation associated with the insoles suggests they are not effective in prolonging the life of a pair of running shoes by improving shock absorption. Furthermore, these data suggest that insoles will not aid in the prevention or treatment of injury in running

Estimating ancestral proportions in a multi-ethnic US sample: implications for studies of admixed populations

<p>Abstract</p> <p>This study was designed to determine the ancestral composition of a multi-ethnic sample collected for studies of drug addictions in New York City and Las Vegas, and to examine the reliability of self-identified ethnicity and three-generation family history data. Ancestry biographical scores for seven clusters corresponding to world major geographical regions were obtained using STRUCTURE, based on genotypes of 168 ancestry informative markers (AIMs), for a sample of 1,291 African Americans (AA), European Americans (EA), and Hispanic Americans (HA) along with data from 1,051 HGDP-CEPH ‘diversity panel’ as a reference. Self-identified ethnicity and family history data, obtained in an interview, were accurate in identifying the individual major ancestry in the AA and the EA samples (approximately 99% and 95%, respectively) but were not useful for the HA sample and could not predict the extent of admixture in any group. The mean proportions of the combined clusters corresponding to European and Middle Eastern populations in the AA sample, revealed by AIMs analysis, were 0.13. The HA subjects, predominantly Puerto Ricans, showed a highly variable hybrid contribution pattern of clusters corresponding to Europe (0.27), Middle East (0.27), Africa (0.20), and Central Asia (0.14). The effect of admixture on allele frequencies is demonstrated for two single-nucleotide polymorphisms (118A > G, 17 C > T) of the <it>mu</it> opioid receptor gene (<it>OPRM1</it>). This study reiterates the importance of AIMs in defining ancestry, especially in admixed populations.</p

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research