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Introduction: Mattresses need to provide enough support to keep spinal alignment close to a neutral posture, whilst minimising muscle activity and providing optimum pressure relief. There is limited evidence to sug­gest that a 'one size fits all' mattress provides the appropriate support for individuals with diverse body shapes, so a greater understanding of how different mattresses affect the human body is key. By having a more objective approach to choosing a mattress an individual may have an improved quality of sleep. \ud Materials and methods: A ten-camera infrared movement analysis sys­tem recorded the movement of retro-reflective markers placed on the Upper-Mid Thoracic, Mid-Lower Thoracic, Lower Thoracic-Upper Lumbar, Upper-Lower Lumbar and Lower Lumbar-Pelvic areas of the spine. A static image of the spine was taken in a standing position and was used to define each individual's neutral posture. Deviations away from this neutral po­sition were assessed under three different conditions in side lying. Three visually identical mattresses were tested, internally each mattress con­tained a different firmness of spring unit (soft, medium, firm) with an identical gel foam comfort layer. In addition, height, weight, shoulder width and hip circumference measurements were taken to determine differences in body types. \ud Results: Spinal alignment was assessed on 59 healthy participants and no significant differences were seen between the different mattress config­urations. However, further analysis showed significant differences in spi­nal alignment between the different mattress conditions within different body shape subgroups. Subgroups were defined using body weight, height, BMI, shoulder width and hip circumference. Those with a higher body weight had a more neutral spinal alignment when on a firmer mattress, whereas those with a lower body weight were better suited to a softer mattress. Shorter people were better aligned on a softer mattress, and a medium mattress kept the spine in a more neutral position amongst taller people. There were no differentiating factors between shoulder width or BMI groups. However, those with a larger hip circumference had signifi­cantly greater spinal deviations when on a softer mattress. implying that a softer mattress should be avoided by this subgroup. \ud Conclusions: This study suggests that a ·one size fits all' approach to mattresses may not be appropriate. Contrasting body types need different levels of support to improve overall spinal alignment, allowing the inter­vertebral disc to re-hydrate, and spinal muscles to relax throughout the night. The use of simple anthropometric measurements could make the selection of the most appropriate mattress easier for the general public. Acknowledgements: This is part of an Innovate UK Knowledge Transfer Partnership between the University of Central Lancashire and Silentnight Group Ltd.

Introduction There is limited evidence to suggest that a ‘one-size fits all’ mattress provides the appropriate support in individuals with diverse body shapes, a greater understanding of how different mattresses affect the human body is required. By having a more objective approach to choosing a mattress, individuals may improve quality of sleep. Materials A ten-camera infrared movement analysis system recorded Upper-Mid Thoracic, Mid-Lower Thoracic, Lower Thoracic–Upper Lumbar, Upper-Lower Lumbar and Lower Lumbar–Pelvic areas of the spine in side lying. Deviations away from a neutral position were assessed under different conditions. Three aesthetically identical mattresses were tested, internally each mattress contained a different firmness of spring unit (soft, medium, firm). In addition, height, weight, shoulder width and hip circumference measurements were taken to determine differences in body types. Results Spinal alignment was assessed on sixty healthy participants and no significant differences were seen between the different mattress configurations. However further analysis showed significant differences in spinal alignment between the different mattress conditions within different body shape subgroups. Subgroups were defined using body weight, height, BMI, shoulder width and hip circumference. Those with a higher body weight had a more neutral spinal alignment when on a firmer mattress, whereas those with a lower body weight were better suited to a softer mattress. Shorter people were better aligned on a softer mattress, and a medium mattress kept the spine in a more neutral position amongst taller individuals. Discussion This study suggests that a ‘one-size fits all’ approach to mattresses may not be appropriate and contrasting body types need different levels of support to improve overall spinal alignment. The use of simple anthropometric measurements could make the selection of the most appropriate mattress easier for the public.

Clinical assessment and management of musculoskeletal conditions of different joints may be broken down into considerations of Pain, Alignment, Strength and Stability (PASS). In recent years these factors have allowed a systematic approach and has enabled the development in our understanding of clinical subgroups, which enable targeted or stratified care. This paper considers the use of the PASS concept to determine the most appropriate treatment and interventions, specifically when considering treatment of two common musculoskeletal conditions, patellofemoral pain and low back pain.

Background The current investigation aimed to investigate the effects of an intervention using knee bracing on pain symptoms and patellofemoral loading in male and female recreational athletes. Methods Twenty participants (11 males & 9 females) with patellofemoral pain were provided with a knee brace which they wore for a period of 2 weeks. Lower extremity kinematics and patellofemoral loading were obtained during three sport specific tasks, jog, cut and single leg hop. In addition their self-reported knee pain scores were examined using the Knee injury and Osteoarthritis Outcome Score. Data were collected before and after wearing the knee brace for 2 weeks. Findings Significant reductions were found in the run and cut movements for peak patellofemoral force/pressure and in all movements for the peak knee abduction moment when wearing the brace. Significant improvements were also shown for Knee injury and Osteoarthritis Outcome Score subscale symptoms (pre: male = 70.27, female = 73.22 & post: male = 85.64, female = 82.44), pain (pre: male = 72.36, female = 78.89 & post: male = 85.73, female = 84.20), sport (pre: male = 60.18, female = 59.33 & post: male = 80.91, female = 79.11), function and daily living (pre: male = 82.18, female = 86.00 & post: male = 88.91, female = 90.00) and quality of life (pre: male = 51.27, female = 54.89 & post: male = 69.36, female = 66.89). Interpretation Male and female recreational athletes who suffer from patellofemoral pain can be advised to utilise knee bracing as a conservative method to reduce pain symptoms.

Minimalist footwear has been the subject of much attention in footwear research. More recently, maximalist footwear, which feature an oversized midsole have been developed. The aim of the current investigation was to compare the kinetics and kinematics of running in minimalist, maximalist and conventional footwear. Twelve male runners ran over an embedded force platform at 4.0 m s−1 in the three footwear conditions. Lower limb kinematics were collected using an eight-camera motion capture system, and tibial accelerations were obtained using an accelerometer. Differences in kinetics and kinematics between footwear were examined using one-way repeated measures ANOVA. The results showed that both instantaneous loading rate and peak tibial acceleration were significantly larger in the minimalist (305.58 BW/s and 9.54 g) compared to the maximalist (141.67 BW/s and 7.99 g) and conventional (127.30 BW/s and 6.73 g) footwear. In addition, peak tibial internal rotation was significantly larger in the minimalist (9...

Background: Kicking actions have been implicated in the aetiology of soccer injuries, and the unilateral nature of kicking may influence this. The aim of the current investigation was to determine whether soccer players exhibit bilateral differences in support limb patellar tendon loads. Material/Methods: Fifteen male soccer players were examined whilst kicking a stationary soccer ball with both their dominant and non-dominant feet. Patellar tendon kinetics were obtained from each limb and then contrasted using paired samples t-tests. Results: Significant increases in patellar tendon kinetics were found when using the non-dominant limb. Conclusions: The findings from the current investigation have clinical significance and support the notion that kicking with the non-dominant limb may be associated with increased risk for patellar tendon injury aetiology.

The current investigation aimed to comparatively examine the effects of minimalist, maximalist and conventional footwear on Achilles tendon forces (ATF) during running. Twelve male runners (age 23.11±5.01 years, height 1.78±0.10 cm and body mass 77.13±7.89 kg) ran at 4.0 m/s in the three footwear conditions. ATF’s were calculated using Opensim software allowing the magnitudal and temporal aspects of the ATF to be quantified. Differences between footwear were examined using one-way repeated measures ANOVA. The results showed the peak ATF was significantly larger in minimalist footwear (5.97±1.38 body weight (BW)) compared to maximalist (5.07±1.42 BW). In addition it was revealed that ATF per mile was significantly larger in minimalist (492.31±157.72 BW) in comparison to both maximalist (377.31±148.06 BW) and conventional (402.71±125.51 BW) footwear. Given the relationship between high ATF and Achilles tendon degradation, the current investigation indicated that minimalist footwear may increase runners risk for Achilles tendon injury.

Background\ud The aim of the current investigation was to examine the effects of semi-custom and off-the-shelf orthotics on the loads experienced by the patellofemoral joint and the Achilles tendon in female runners.\ud Material/Methods\ud Twelve female recreational runners ran at 4.0 m.s 1 whilst wearing no orthotics, semi-custom orthotics and off-the-shelf orthotics. Kinetics and kinematics of running were obtained via a force platform and a motion capture system. Differences between orthotic conditions were contrasted using one-way repeated measures ANOVA.\ud Results\ud The results showed that both patellofemoral contact force and pressure were significantly lower in the no-orthotic (force = 3.21 B.W & pressure = 8.18 MPa) condition in comparison to the off-the-shelf (force = 3.60 MPa & pressure = 9.07 B.W) and semi-custom orthoses (force = 3.69 B.W & pressure = 9.30 MPa).\ud Conclusions\ud The current investigation indicates that foot orthoses such as those examined in the current investigation may place female runners at increased risk from patellofemoral disorders, although future prospective research is required before this can be substantiated.

The aim of the current study was to explore the effects of minimalist, maximalist and energy return footwear of equal mass on economy and substrate utilisation during steady state running. Ten male runners completed 6 min steady state runs in minimalist, maximalist and energy return footwear. The mass of the footwear was controlled by adding lead tape to the lighter shoes. Running economy, shoe comfort, rating of perceived exertion and % contribution of carbohydrate to total calorie expenditure were assessed. Participants also subjectively indicated which shoe condition they preferred for running. Differences in shoe comfort and physiological parameters were examined using paired samples t-tests, whilst shoe preferences were tested using a chi-square test. The results showed firstly that running economy was significantly improved in the energy return (35.9 ml∙kg/min) compared to minimalist footwear (37.8 ml∙kg/min). In addition % carbohydrate was significantly greater in the minimalist (76.4%) in comparison to energy return footwear (72.9%). As running economy was improved and carbohydrate utilisation reduced in the energy return in comparison to minimalist footwear, the current investigation shows that these footwear are more economical when shoe mass is controlled.

The current study aimed to comparatively examine the effects of minimalist, maximalist, and conventional footwear on the loads experienced by the patellofemoral joint during running. Twenty male participants ran over a force platform at 4.0 m×s–1. Lower limb kinematics were collected using an 8-camera motion capture system allowing patellofemoral kinetics to be quantified using a musculoskeletal modeling approach. Differences in patellofemoral kinetic parameters were examined using one-way repeatedmeasures ANOVA. The results showed the peak patellofemoral force and pressure were significantly larger in conventional (4.70 ± 0.91 BW, 13.34 ± 2.43 MPa) and maximalist (4.74 ± 0.88 BW, 13.59 ± 2.63 MPa) compared with minimalist footwear (3.87 ± 1.00 BW, 11.59 ± 2.63 MPa). It was also revealed that patellofemoral force per mile was significantly larger in conventional (246.81 ± 53.21 BW) and maximalist (251.94 ± 59.17 BW) as compared with minimalist (227.77 ± 58.60 BW) footwear. As excessive loading of the patellofemoral joint has been associated with the etiology of patellofemoral pain symptoms, the current investigation indicates that minimalist footwear may be able reduce runners’ susceptibility to patellofemoral disorders.

IntroductionSituation Awareness For Everyone (S.A.F.E)1 is a two year programme led by the Royal College of Paediatrics and Child Health in partnership with NHS hospitals, to aid the development of a range of quality improvement techniques with the aim of reducing preventable deaths and errors occurring in the UK’s paediatric departments.The neonatal unit began daily safety huddles to identify ward risks and share learning points in September 2015. An NHS Trust piloted the ‘druggle’, a ‘ward-based safety huddle’ with ward pharmacist, doctors and nurses, as part of the S.A.F.E project, on their neonatal ward in July 2015.AimThe aims of the druggles are to increase communication between pharmacists, the medical team and nursing staff, and to educate all staff regarding specific drug related topics. They enable the team to receive feedback on anonymised errors in real time, draw attention to areas for improvement, encourage discussion and share learning points from them.MethodThe druggles were developed as drug related safety briefings. They are presented once a week as part of the daily huddle. The basic format of the sessions is a weekly ‘hot topic’, for example recent BNFc changes, an ‘error of the week’ and celebration of good prescribing practice. Themes are identified by members of staff and discussed at the druggles as they arise. This enables timely education and discussion of topics as they occur.The neonatal pharmacy team completed a baseline prescribing standards audit in February 2016 (after the induction of the new medical team) which will be repeated before the doctors rotate in August. This audit provided information about common prescribing errors and helped to identify possible ‘hot topics’ for discussion. A ‘zero tolerance’ audit of 5 randomly chosen prescription charts is completed weekly to assess prescribing standards in real time. A chart ‘fails’ when the first prescribing error, or deviation from prescribing standards, is picked up.ResultsThe baseline audit of all charts on the unit showed poor compliance with prescribing standards overall, particularly when transcribing or cancelling prescriptions. Subsequent weekly ‘zero tolerance’ audits have shown an improvement from 20% of prescription charts with no prescribing error to 65% with no errors over the first 12 weeks.ConclusionAn improvement of prescribing standards has been observed from the initial findings of the ‘zero tolerance’ audit. The druggles have encouraged more discussions, allowed the MDT to work together to improve the standards of prescribing and have proved to be an invaluable tool when implementing new processes. Developments have also been made to existing processes, such as the separation of babies’ drug charts from their mothers’ charts on the postnatal ward as a result of an error discussed at a druggle. The druggles have now begun to be implemented throughout the Children’s Hospital.ReferenceRoyal College of Paediatrics and Child Health. Situation awareness for everyone (S.A.F.E.) programme2016. http://www.rcpch.ac.uk/safe [Accessed: 6 July 2016].

The aim of the current investigation was to examine the effects of cooled footwear on the kinetics and kinematics of running in comparison to footwear at normal temperature. Twelve participants ran at 4.0 m/s ± 5% in both cooled and normal temperature footwear conditions over a force platform. Two identical footwear were worn, one of which was cooled for 30 min. Lower extremity kinematics were obtained using a motion capture system and tibial accelerations were measured using a triaxial accelerometer. Differences between cooled and normal footwear temperatures were contrasted using paired samples t-tests. The results showed that midsole temperature (cooled = 4.21 °C and normal = 23.25 °C) and maximal midsole deformation during stance (cooled = 12.85 mm and normal = 14.52 mm) were significantly reduced in the cooled footwear. In addition, instantaneous loading rate (cooled = 186.21 B.W/s and normal = 167.08 B W/s), peak tibial acceleration (cooled = 12.75 g and normal = 10.70 g) and tibial acceleration slope (cooled = 478.69 g/s and normal = 327.48 g/s) were significantly greater in the cooled footwear. Finally, peak eversion (cooled = −10.57 ° and normal = −7.83°) and tibial internal rotation (cooled = 10.67 ° and normal = 7.77°) were also shown to be significantly larger in the cooled footwear condition. This study indicates that running in cooled footwear may place runners at increased risk from the biomechanical parameters linked to the aetiology of injuries.

Purpose. Female runners are known to be at greater risk from chronic running injuries than age-matched males, although the exact\ud mechanisms are often poorly understood. The aim of the current investigation was to determine if female recreational runners\ud exhibit distinct limb and joint stiffness characteristics in relation to their male counterparts. Methods. Fourteen male and fourteen\ud female runners ran over a force platform at 4.0 m · s–1. Lower limb kinematics were collected using an eight-camera optoelectric\ud motion capture system operating at 250 Hz. Measures of limb and joint stiffness were calculated as a function of limb length and\ud joint moments divided by the extent of limb and joint excursion. All stiffness and joint moment parameters were normalized\ud to body mass. Sex differences in normalized limb and knee and ankle joint stiffness were examined statistically using independent\ud samples t tests. Results. The results indicate that normalized limb (male = 0.18 ± 0.07, female = 0.37 ± 0.10 kN · kg · m–1) and knee\ud stiffness (male = 5.59 ± 2.02, female = 7.34 ± 1.78 Nm · kg · rad–1) were significantly greater in female runners. Conclusions. On\ud the basis that normalized knee and limb stiffness were shown to be significantly greater in female runners, the findings from the\ud current investigation may provide further insight into the aetiology of the distinct injury patterns observed between sexes.\ud Key words: running, sex, limb stiffness, biomechanics