Indian Supercourse Network in Epidemiology - Development and Evaluation

There are many advantages to using locally produced health information, such as its cultural appropriateness, geographic specificity, and flexibility. The Indian Supercourse is an online repository of lectures in Epidemiology, written by authors in India, on topics of particular interest to teachers and students in India.The purpose of this dissertation is to describe the planning, development and evaluation of the Indian Supercourse Network. The Indian Supercourse Network has 6,000 faculty members in India, and more than 200 epidemiology lectures written by authors in India. Evaluation of the Indian Supercourse Network included an assessment of utilization of these educational materials in India using page views measured by web statistics analysis software. The main hypothesis compared page views from India, between the Indian Supercourse and the Main Supercourse. The results of the Wilcoxon Rank-Sum test showed that there were significantly more page views from India to the Indian Supercourse as compared to the Main Supercourse (p < 0.0001). This means that users in India prefer to use the Indian Supercourse more than the Main Supercourse. This may be because information in the Indian Supercourse is more pertinent to the epidemiology education needs of users in India. In contrast, there were significantly more page views from non-Indian countries to the Main Supercourse as compared to the Indian Supercourse (p < 0.0001). Interestingly, there was no significant difference (p = 0.0642) in total page views from all countries considered together, between the Indian Supercourse and the Main Supercourse.Public Health Significance - In India, there is a lack of an adequate system for formal epidemiology education. The Indian Supercourse has made epidemiology education available to everyone interested in learning epidemiology in India. The results of this study have shown that the Indian Supercourse is being utilized by people in India. Information contained on the Indian Supercourse website can eventually be disseminated across the digital divide via low-bandwidth methods and the postal system in India

THE RELATIONSHIP BETWEEN MUSCULOSKELETAL STRENGTH, PHYSIOLOGICAL CHARACTERISTICS, AND KNEE KINESTHESIA FOLLOWING FATIGUING EXERCISE

Fatiguing exercise may result in impaired functional joint stability and increased risk of unintentional injury. While there are several musculoskeletal and physiological characteristics related to fatigue onset, their relationship with proprioceptive changes following fatigue has not been examined. The purpose of this study was to establish the relationship between musculoskeletal and physiological characteristics and changes in proprioception, measured by threshold to detect passive motion (TTDPM), following fatiguing exercise. Twenty, physically active females participated (age: 28.65 ± 5.6 years, height: 165.6 ± 4.3 cm, weight: 61.8 ± 8.0 kg, BMI: 22.5± 2.3 kg/m2, BF: 23.3 ± 5.4%). During Visit 1, subjects completed an exercise history and 24-hour dietary questionnaire, and body composition, TTDPM familiarization, isokinetic knee strength, and maximal oxygen uptake/lactate threshold assessments. During Visit 2, subjects completed TTDPM and isometric knee strength testing prior to and following a fatiguing exercise protocol. Wilcoxon signed rank tests determined TTDPM and isometric knee strength changes from pre- to post- fatigue. Spearman’s rho correlation coefficients determined the relationship between strength and physiological variables with pre- to post-fatigue changes in TTDPM and with pre-fatigue and post-fatigue TTDPM in extension and flexion (α=0.05). No significant differences were demonstrated from pre-fatigue to post-fatigue TTDPM despite a significant decrease in isometric knee flexion strength (P<0.01) and flexion/extension ratio (P<0.05) following fatigue. No significant correlations were observed between strength or physiological variables and changes in TTDPM from pre- to post-fatigue in extension or flexion. Flexion/extension ratio was significantly correlated with pre-fatigue TTDPM in extension (r=-0.231, P<0.05). Peak oxygen uptake was significantly correlated with pre-fatigue (r=-0.500, P<0.01) and post-fatigue (r=-0.520, P<0.05) TTDPM in extension. No significant relationships were demonstrated between musculoskeletal and physiological characteristics and changes in TTDPM following fatigue. The results suggest that highly trained individuals may have better proprioception, and that the high fitness level of subjects in this investigation may have contributed to absence of TTDPM deficits following fatigue despite reaching a high level of perceptual and physiological fatigue. Future studies should consider various subject populations, other musculoskeletal strength characteristics, and different modalities of proprioception to determine the most important contributions to proprioceptive changes following fatigue

THE EFFECT OF LOADED FATIGUE ON LOADED POSTURAL STABILITY

Military personnel are often required to carry heavy loads for long distances over unpredictable terrain. Additional load carriage, in conjunction with fatigue, has the potential to influence postural control mechanisms which may in turn increase injury risk. The purpose of this study was to determine if a loaded incremental march to fatigue negatively influences loaded postural stability. Loaded postural stability was measured using the NeuroCom Sensory Organization Test (SOT) and kinetic force plate variables (vertical ground reaction forces: SDvGRF, and TotSway) before and after a loaded incremental march to fatigue in 23 physically active men and women (age: 24.1 4.0 years, height: 172.3 11.1 cm, weight: 162.2 38.2 lbs) while subjects were adorned with a weighted vest equating to 30% of their body weight. The SOT consisted of six conditions (C1-C6) aimed to perturb the sensorimotor system, which were performed before and after a loaded fatigue protocol. C1, C2 and C3 challenged the somatosensory system, C4 challenged the visual system, while C5 and C6 challenged the vestibular system. Fatigue was induced with a treadmill march at 4mph with increasing grades of 2% every three minutes until volitional fatigue. After testing for normality, paired sample t-tests or Wilcoxon signed rank tests were conducted to assess pre- to post-fatigue differences. Significant reductions in SOT scores were found in overall composite scores (pre: 82.8 4.7, post: 81.6 5.2, p = 0.010), SDvGRF of C1 (pre: 1.3 0.5, post: 2.0 0.9, p < 0.001), C2 (pre: 1.4 0.6, post: 1.9 1.2, p < 0.001), C3 (pre: 1.4 0.5, post: 2.1 1.8, p = 0.026), and C6 (pre: 2.5 2.2, post: 3.5 3.2, p < 0.001) and TotSway of all conditions. Results suggest that significant changes in loaded postural stability were caused by loaded fatigue. Findings could aid in future postural stability screenings, load carriage training and strategies for injury prevention in the military

Impact of Increased Load Carriage Magnitude on the Dynamic Postural Stability of Men and Women

The impact of load carriage on dynamic postural stability affects the survivability of the Warfighter by influencing performance capabilities and injury incidence. Further, sex may interact with the relationship between load carriage and dynamic postural stability to further compromise survivability. PURPOSE: To investigate the effect of load carriage magnitude on dynamic postural stability of men and women and its relationship to jumping ability. METHODS: 32 subjects (16 men, 16 women) were investigated for maximum jump height and dynamic postural stability. Dynamic postural stability was assessed by subjects jumping a horizontal distance of 40% their height over a 30cm hurdle, landing on one leg on a force plate (sample rate = 1200 Hz). 3 trials were completed for 3 load conditions: +0, +20 and +30% body weight (BW). Dynamic postural stability was determined from ground reaction force data during landings, by calculation of the dynamic postural stability index (DPSI). Maximum jump height was assessed by subjects performing 3 countermovement jumps (sample rate = 1000 Hz). Two-way repeated measures ANOVA were used to compare mean DPSI scores between sexes and conditions (α = 0.05). Pearson’s Correlation Coefficients were used to determine the relationship between jump height and change in DPSI scores between conditions (α = 0.05). RESULTS: Load condition significantly affected DPSI (F = 100.304, p = 0.001). DPSI scores increased between the 0% (0.359 ± 0.041), 20% (0.396 ± 0.034) and 30% (0.420 ± 0.028) BW load conditions. No significant effect of sex on DPSI was found (F = 0.131). No significant sex by load interaction on DPSI was found (F = 0.393). No significant correlations were found between jump height and change in DPSI scores between conditions. CONCLUSION: Increased load was found to negatively affect dynamic postural stability, most likely as a result of modifying the demands of the task. Therefore, the dynamic postural stability of men and women changes comparably in response to increased load carriage magnitude. Future research should focus on the effects of load on dynamic postural stability under higher loads and during more military-specific tasks

The Lived Clinical Experiences of Expatriate Athletic Trainers

Context: The international practice setting is gaining popularity for athletic trainers (ATs). Little has been investigated about the clinical experiences and challenges this setting presents. The purpose of this study was to create a baseline of understanding surrounding AT’s lived clinical experiences within the international practice setting. Methods: We used a consensual qualitative design and recruited credentialed ATs who are practicing the athletic training skillset outside the US. The Board of Certification supplied email addresses for recruitment (Sample: 23 total; 11 females, 12 males; 34 ± 7 years old. Representation was from fifteen different countries. Participants completed an electronic informed consent and demographic survey (Qualtrics® Inc., Provo, UT). Based on previous literature and in consultation with an international sports medicine expert, both interview and survey tools were developed, validated, and piloted. Semi-structured interviews were conducted and transcribed by the lead investigator using teleconferencing software (Zoom, San Jose, CA). Three researchers coded transcripts using a consensual codebook to confirm domains, codes, and data saturation. Member checking, peer reviewing, and multiple researchers were used to triangulate data and enhance trustworthiness. Results: Three domains emerged during analysis: (1) Professional and Cultural Adaptations, (2) Healthcare Landscape, and (3) Personal Pathways and Motivators. Participants voiced struggles with self-efficacy, as well as detailed incongruities of their clinical roles and others’ understanding of their skill set as ATs. Clinicians detailed the versatility of ATs’ skillset filling clinical gaps within their country’s healthcare landscape. Institutional and intraprofessional relationships were expanded on and emphasized personal connections. Participants voiced challenges surrounding resources and adapting to their country’s legal systems. Interprofessional practice and collaboration, as well as cultural competence, was discussed as imperative to practice. A wide range of work settings within countries were regularly found. Conclusions: International ATs expressed a variety of ways that the AT skillset fits a unique international need. Both interprofessional relationships and intraprofessional practice were crucial; relationships were enhanced through communication skills, empathy, and cultural competence. While native clinicians had a consistent lack of knowledge of the AT skill, clinical advocacy and a strong desire to grow the international practice setting was salient to practitioners

Epidemiology of High School Sports-related Injuries: A descriptive epidemiological study of a single high school during the 2021-2022 academic year

Millions of high school students participate in school-sanctioned athletic events each year in the United States. Participation in athletics comes with inherent adverse consequences including sports-related injury. Current epidemiological studies aim to describe the pattern of injuries between several demographic groups to enhance clinical knowledge, develop injury risk profiles, and employ prevention strategies. Purpose: The purpose of this descriptive epidemiological study was to describe patterns and incidence of anatomic location, injury type, mechanism and onset of injury, injury timing, and sport-specific injury patterns in a group of high school athletes at a private high school. The secondary and tertiary aims of this study were to compare incidence and patterns of injuries between sexes and compare incidence and patterns of injuries between single sport and interscholastic multi-sport athletes. Methods: The current study employed a descriptive epidemiological study design. Data from SOAP (subjective, objective, assessment, plan) notes were extracted and analyzed with the goal of establishing relationships between various demographic variables and incidence of sports-related injuries within a population of adolescent female and male athletes at a private high school during a single academic year. Results: The key findings of this study included a higher injury incidence for boys than girls, a higher overall incidence of acute injuries compared to chronic injuries, a higher overall incidence of non-contact injuries, and a higher incidence of injuries in football, basketball, and soccer. Furthermore, the most common injury location was the lower extremity, sprains were the most common injury. Overall, and injuries were sustained most often during practice. The percentage of interscholastic multisport (ISMA) athletes who sustained an injury (39/115 = 33.9%) was lower than the percentage of single-sport athletes who sustained an injury (40/66 = 60.6%). This difference was significant (p < 0.001). Conclusion: Adolescent participation in athletics is accompanied by inherent, often unmodifiable, risks of injury. Despite the potential negative consequences, participation in athletics provides youth with several physical, cognitive, and social benefits. Preservation of the positive impacts of sports participation may encourage continued engagement and minimize the physical and financial burden associated with sports-related injuries

The effects of fatiguing exercise and load carriage on the perception and initiation of movement

Perceptual-motor coordination relies on the accurate coupling of the perceptual and movement systems. However, individuals must also be able to recalibrate to perturbations to perceptual and movement capabilities. We examined the effects of fatigue and load carriage on perceptual-motor coordination for a maximal leaping task. 23 participants completed an incremental fatigue protocol (light to fatiguing intensity stages) on two separate occasions (loaded/unloaded). At baseline and the end of every stage of the protocol, participants made perceptual judgments for the affordance of leaping. The accuracy of responses and reaction times were calculated and mean differences were assessed across exercise intensity and load carriage conditions. No interaction of exercise intensity and load carriage was detected, or main effect of load carriage. A main, quadratic effect of exercise intensity was detected on reaction times, with times decreasing through the moderate stage and increasing through post-fatigue. No effect of exercise/fatigue was detected on perceptual accuracy. The results indicate that exercise at high intensities through fatigue has a significant effect on perceptual-motor calibration. Contrastingly, in response to an action-scaled task, individuals can adequately recalibrate to increased load carriage

Prediction of exertional lower extremity musculoskeletal injury in tactical populations: protocol for a systematic review and planned meta-analysis of prospective studies from 1955 to 2018

Abstract Background Musculoskeletal injuries (MSI) represent more than half of all injuries in tactical populations (i.e., military service and public safety workers including police, firefighters, emergency medical services (EMS)). Most lower extremity MSIs result from physical exertion during training, occupational tasks, and recreation. Such exertional lower extremity injuries (ELEI) produce a significant human and financial cost. Accordingly, significant efforts have been made to identify sensitive, specific, and reliable predictors of ELEI. There is a need to synthesize and evaluate the predictive value of risk factors for ELEI while addressing the influence of occupation, sex, exposure, injury characteristics, and study quality. Therefore, the purpose of this systematic review and planned meta-analysis is to evaluate risk factors for ELEI in tactical populations. Methods After the development of a search strategy, comprehensive searches will be conducted in MEDLINE, EMBASE, Cochrane, and CINAHL databases. Articles will be screened with a multi-user process and delimited to prospective comparative cohort studies that directly measure injury occurrence in the target population(s). Extracted data will be synthesized and assessed for reporting bias, meta-bias, and overall quality, with subgroup analyses to determine the influence of participant, injury, and exposure characteristics in addition to study quality. Discussion This systematic review and planned meta-analysis will comprehensively evaluate ELEI risk factors. Information gained will inform injury prevention protocols, facilitate the use of improved measurements, and identify requirements for future research. Trial Registration The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 3 Jan 2018 (registration number CRD42018056977)

Prevention of exertional lower body musculoskeletal injury in tactical populations: protocol for a systematic review and planned meta-analysis of prospective studies from 1955 to 2018

Abstract Background Exertional lower body musculoskeletal injuries (ELBI) cost billions of dollars and compromise the readiness and job performance of military service and public safety workers (i.e., tactical populations). The prevalence and burden of such injuries underscores the importance of prevention efforts during activities necessary to sustain core occupational competencies. Attempts to synthesize prevention techniques specific to tactical populations have provided limited insight on the comparative efficacy of interventions that do not modify physical training practices. There is also a need to assess the influence of sex, exposure, injury classification scheme, and study design. Thus, the primary purpose of the systematic review and planned meta-analysis detailed in this protocol is to evaluate the comparative efficacy of ELBI prevention strategies in tactical populations. Methods A systematic search strategy will be implemented in MEDLINE, EMBASE, Cochrane, and CINAHL. A multi-tiered process will be used to capture randomized controlled trials and prospective cohort studies that directly assess the prevention of ELBI in tactical population(s). Extracted data will be used to compare prevention strategies and assess the influence of heterogeneity related to occupation, sex, exposure, injury characteristics, and study quality. In addition, individual risk of bias, meta-bias, and the quality of the body of evidence will be rigorously tested. Discussion This systematic review and planned meta-analysis will comprehensively evaluate ELBI mitigation strategies in tactical populations, elucidate factors that influence responses to treatment, and assess the overall quality of the body of research. Results of this work will guide the prioritization of ELBI prevention strategies and direct future research efforts, with direct relevance to tactical, health and rehabilitation science, and human performance optimization stakeholders. Systematic review registration The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 3 Jan 2018 (registration number CRD42018081799)