Anatomically grounded estimation of hindlimb muscle sizes in Archosauria.

In vertebrates, active movement is driven by muscle forces acting on bones, either directly or through tendinous insertions. There has been much debate over how muscle size and force are reflected by the muscular attachment areas (AAs). Here we investigate the relationship between the physiological cross-sectional area (PCSA), a proxy for the force production of the muscle, and the AA of hindlimb muscles in Nile crocodiles and five bird species. The limbs were held in a fixed position whilst blunt dissection was carried out to isolate the individual muscles. AAs were digitised using a point digitiser, before the muscle was removed from the bone. Muscles were then further dissected and fibre architecture was measured, and PCSA calculated. The raw measures, as well as the ratio of PCSA to AA, were studied and compared for intra-observer error as well as intra- and interspecies differences. We found large variations in the ratio between AAs and PCSA both within and across species, but muscle fascicle lengths are conserved within individual species, whether this was Nile crocodiles or tinamou. Whilst a discriminant analysis was able to separate crocodylian and avian muscle data, the ratios for AA to cross-sectional area for all species and most muscles can be represented by a single equation. The remaining muscles have specific equations to represent their scaling, but equations often have a relatively high success at predicting the ratio of muscle AA to PCSA. We then digitised the muscle AAs of Coelophysis bauri, a dinosaur, to estimate the PCSAs and therefore maximal isometric muscle forces. The results are somewhat consistent with other methods for estimating force production, and suggest that, at least for some archosaurian muscles, that it is possible to use muscle AA to estimate muscle sizes. This method is complementary to other methods such as digital volumetric modelling.

Decelerated dinosaur skull evolution with the origin of birds.

The evolutionary radiation of birds has produced incredible morphological variation, including a huge range of skull form and function. Investigating how this variation arose with respect to non-avian dinosaurs is key to understanding how birds achieved their remarkable success after the Cretaceous-Paleogene extinction event. Using a high-dimensional geometric morphometric approach, we quantified the shape of the skull in unprecedented detail across 354 extant and 37 extinct avian and non-avian dinosaurs. Comparative analyses reveal fundamental differences in how skull shape evolved in birds and non-avian dinosaurs. We find that the overall skull shape evolved faster in non-avian dinosaurs than in birds across all regions of the cranium. In birds, the anterior rostrum is the most rapidly evolving skull region, whereas more posterior regions-such as the parietal, squamosal, and quadrate-exhibited high rates in non-avian dinosaurs. These fast-evolving elements in dinosaurs are strongly associated with feeding biomechanics, forming the jaw joint and supporting the jaw adductor muscles. Rapid pulses of skull evolution coincide with changes to food acquisition strategies and diets, as well as the proliferation of bony skull ornaments. In contrast to the appendicular skeleton, which has been shown to evolve more rapidly in birds, avian cranial morphology is characterised by a striking deceleration in morphological evolution relative to non-avian dinosaurs. These results may be due to the reorganisation of skull structure in birds-including loss of a separate postorbital bone in adults and the emergence of new trade-offs with development and neurosensory demands. Taken together, the remarkable cranial shape diversity in birds was not a product of accelerated evolution from their non-avian relatives, despite their frequent portrayal as an icon of adaptive radiations.

A proposed standard for quantifying 3-D hindlimb joint poses in living and extinct archosaurs.

The last common ancestor of birds and crocodylians plus all of its descendants (clade Archosauria) dominated terrestrial Mesozoic ecosystems, giving rise to disparate body plans, sizes, and modes of locomotion. As in the fields of vertebrate morphology and paleontology more generally, studies of archosaur skeletal structure have come to depend on tools for acquiring, measuring, and exploring three-dimensional (3-D) digital models. Such models, in turn, form the basis for many analyses of musculoskeletal function. A set of shared conventions for describing 3-D pose (joint or limb configuration) and 3-D kinematics (change in pose through time) is essential for fostering comparison of posture/movement among such varied species, as well as for maximizing communication among scientists. Following researchers in human biomechanics, we propose a standard methodological approach for measuring the relative position and orientation of the major segments of the archosaur pelvis and hindlimb in 3-D. We describe the construction of anatomical and joint coordinate systems using the extant guineafowl and alligator as examples. Our new standards are then applied to three extinct taxa sampled from the wider range of morphological, postural, and kinematic variation that has arisen across >250 million years of archosaur evolution. These proposed conventions, and the founding principles upon which they are based, can also serve as starting points for measuring poses between elements within a hindlimb segment, for establishing coordinate systems in the forelimb and axial skeleton, or for applying our archosaurian system more broadly to different vertebrate clades.

Computational modelling of muscle fibre operating ranges in the hindlimb of a small ground bird (Eudromia elegans), with implications for modelling locomotion in extinct species.

The arrangement and physiology of muscle fibres can strongly influence musculoskeletal function and whole-organismal performance. However, experimental investigation of muscle function during in vivo activity is typically limited to relatively few muscles in a given system. Computational models and simulations of the musculoskeletal system can partly overcome these limitations, by exploring the dynamics of muscles, tendons and other tissues in a robust and quantitative fashion. Here, a high-fidelity, 26-degree-of-freedom musculoskeletal model was developed of the hindlimb of a small ground bird, the elegant-crested tinamou (Eudromia elegans, ~550 g), including all the major muscles of the limb (36 actuators per leg). The model was integrated with biplanar fluoroscopy (XROMM) and forceplate data for walking and running, where dynamic optimization was used to estimate muscle excitations and fibre length changes throughout both gaits. Following this, a series of static simulations over the total range of physiological limb postures were performed, to circumscribe the bounds of possible variation in fibre length. During gait, fibre lengths for all muscles remained between 0.5 to 1.21 times optimal fibre length, but operated mostly on the ascending limb and plateau of the active force-length curve, a result that parallels previous experimental findings for birds, humans and other species. However, the ranges of fibre length varied considerably among individual muscles, especially when considered across the total possible range of joint excursion. Net length change of muscle-tendon units was mostly less than optimal fibre length, sometimes markedly so, suggesting that approaches that use muscle-tendon length change to estimate optimal fibre length in extinct species are likely underestimating this important parameter for many muscles. The results of this study clarify and broaden understanding of muscle function in extant animals, and can help refine approaches used to study extinct species.

Base of thumb osteoarthritis in UK interface services-a cohort and survey-based study to assess current practice.

OBJECTIVE: Base of thumb OA (BTOA) is a common age-related disease that has a significant negative impact on quality of life, while little is known about the structure and pathways of interface services. Our aim was to assess disease burden, referral pathways, service structure and management pathways in UK interface services. METHODS: A structured questionnaire was carried out with a participating clinician at each centre to detail the local guidelines and management of BTOA. Five patients referred with BTOA were prospectively identified in each of 32 UK interface centres. RESULTS: Most centres (72%) had a local guideline and a standardized treatment regime consisting of education (100%), joint protection (100%), range of motion exercises (84%), strengthening exercises (88%), splintage (100%) and use of assistive devices (78%). No centre routinely offered a steroid injection at the first appointment and no centre had a specific threshold for offering an injection. Injection delivery was variable. Most patients had not been referred previously (82%). Most patients used analgesia (72%), but a minority of patients had been treated with a splint (46%), therapy (43%) and steroid injection (27%) prior to their latest attendance. CONCLUSION: Most BTOA patients newly referred to interface services have been treated with analgesics and have not received comprehensive multimodal intervention. The management of BTOA at interface services is standardized in terms of education, splintage and therapy. However, there is a lack of standardization in terms of both the threshold for, timing of and mode of delivery of injection therapy.

Musculoskeletal modelling of the Nile crocodile (Crocodylus niloticus) hindlimb: Effects of limb posture on leverage during terrestrial locomotion.

We developed a three-dimensional, computational biomechanical model of a juvenile Nile crocodile (Crocodylus niloticus) pelvis and hindlimb, composed of 47 pelvic limb muscles, to investigate muscle function. We tested whether crocodiles, which are known to use a variety of limb postures during movement, use limb orientations (joint angles) that optimise the moment arms (leverages) or moment-generating capacities of their muscles during different limb postures ranging from a high walk to a sprawling motion. We also describe the three-dimensional (3D) kinematics of the crocodylian hindlimb during terrestrial locomotion across an instrumented walkway and a treadmill captured via X-ray Reconstruction of Moving Morphology (biplanar fluoroscopy; 'XROMM'). We reconstructed the 3D positions and orientations of each of the hindlimb bones and used dissection data for muscle lines of action to reconstruct a focal, subject-specific 3D musculoskeletal model. Motion data for different styles of walking (a high, crouched, bended and two types of sprawling motion) were fed into the 3D model to identify whether any joints adopted near-optimal poses for leverage across each of the behaviours. We found that (1) the hip adductors and knee extensors had their largest leverages during sprawling postures and (2) more erect postures typically involved greater peak moment arms about the hip (flexion-extension), knee (flexion) and metatarsophalangeal (flexion) joints. The results did not fully support the hypothesis that optimal poses are present during different locomotory behaviours because the peak capacities were not always reached around mid-stance phase. Furthermore, we obtained few clear trends for isometric moment-generating capacities. Therefore, perhaps peak muscular leverage in Nile crocodiles is instead reached either in early/late stance or possibly during swing phase or other locomotory behaviours that were not studied here, such as non-terrestrial movement. Alternatively, our findings could reflect a trade-off between having to execute different postures, meaning that hindlimb muscle leverage is not optimised for any singular posture or behaviour. Our model, however, provides a comprehensive set of 3D estimates of muscle actions in extant crocodiles which can form a basis for investigating muscle function in extinct archosaurs.

Mandibular nerve block in juvenile Nile crocodile: a cadaveric study.

OBJECTIVE: To develop a technique for performing the mandibular nerve block in Nile crocodiles. STUDY DESIGN: Experimental cadaveric study. ANIMALS: A total of 16 juvenile Nile crocodile heads. METHODS: To study the course of the mandibular nerve, one head was dissected. Computed tomography (CT) examination was performed in two heads to identify useful landmarks. Thereafter, a hypodermic needle was inserted through the external mandibular fenestra of 17 hemimandibles (13 heads), and a mixture of methylene blue and iohexol was injected. Injection volumes were 0.5 (n = 7) and 1.0 mL (n = 10) for hemimandibles < 15 and ≥ 15 cm long, respectively. Iohexol spread and nerve staining with methylene blue were assessed with CT and anatomical dissection, respectively. Data were analysed with one-sample t test or Mann-Whitney U test. Significance was set at p < 0.05. RESULTS: Both anatomical dissection and imaging confirmed the external mandibular fenestra as a useful anatomical landmark for needle insertion. The CT images acquired after needle positioning confirmed that its tip was located on the medial bony mandibular surface formed by the fusion of the angular and coronoid bones in 100% cases. In all the hemimandibles, the rostrocaudal spread of contrast was > 23 mm. The length of the stained mandibular nerve in the temporal region and of the stained medial branch of the mandibular nerve, as well as the dorsoventral and mediolateral spread of iohexol, was greater in group 1.0 than in group 0.5 (p < 0.001). The caudal spread of iohexol was greater in group 1.0 than in group 0.5 (p = 0.01). CONCLUSIONS AND CLINICAL RELEVANCE: The technique developed in this study is feasible. Both injection volumes resulted in staining of the mandibular nerve. The spread of contrast in the anatomical region of interest may result in successful sensory block.

Anesthesia and Anesthetic-Related Complications of 8 Elegant-Crested Tinamous (Eudromia elegans) Undergoing Experimental Surgery.

The aim of this study was to describe the anesthetic effects of an injectable anesthetic protocol, based on ketamine, midazolam, and medetomidine, followed by inhalational sevoflurane, in 8 elegant-crested tinamous (Eudromia elegans) undergoing experimental surgery. Initial doses for both injectable agents were tested in 1 bird and then refined with an algorithm based on the effects observed in the pilot procedure. Heart and respiratory rates, as well as nociceptive reflexes, were evaluated before anesthesia (baseline) and intraoperatively, at 10 minute intervals. The time from injection to anesthetic induction and surgical anesthesia, as well as the time from atipamezole injection to recovery, was recorded for each bird. The median doses of medetomidine and ketamine were 0.075 mg/kg and 33 mg/kg, respectively. Anesthetic induction was achieved within 10 (range, 4-45) minutes from intramuscular injection, whereas time to surgical anesthesia was 22 ±16 minutes. The baseline heart rate values were significantly higher than those measured intraoperatively at any time point (P = .001). Intraoperatively, 5 of 8 tinamous (63%) developed cardiac arrhythmias. Other encountered complications were regurgitation in 2 birds (25%), cardiac arrest in 1 bird (13%) soon after injection of the anesthetic agents, and prolonged recovery in another bird (13%), which was euthanized. Necropsy of the 2 fatal outcomes (25%) showed evidence of hepatic lipidosis in both (100%) and intramyocardial fat accumulation in 1 bird (50%). This report highlights the challenges of tinamou anesthesia. Cardiac complications are common in this species, and close monitoring of intraoperative cardiovascular variables is recommended for prompt recognition and treatment.

Medetomidine-ketamine-sevoflurane anaesthesia in juvenile Nile crocodiles (Crocodylus niloticus) undergoing experimental surgery.

OBJECTIVE: To describe the anaesthetic, physiological and side effects of intramuscular (IM) medetomidine and ketamine, followed by inhalational anaesthesia with sevoflurane, in Nile crocodiles (Crocodylus niloticus). STUDY DESIGN: Observational trial. ANIMALS: Ten juvenile captive-bred Nile crocodiles undergoing surgical implantation of skeletal beads and muscular electrodes. METHODS: During preanaesthetic examination, the following variables were assessed: heart (HR) and respiratory (fR) rates, and response to palpebral, corneal and toe- and tail-pinch withdrawal reflexes. The crocodiles were injected IM with an initial combination of medetomidine and ketamine and re-evaluated at 5 minute intervals for 20 minutes, or until they appeared unresponsive. If that did not occur, the drugs were redosed according to a decision tree based on the observed effects. The righting, biting and palatal valve reflexes were assessed in the unresponsive crocodiles, and used to confirm anaesthetic induction. Anaesthesia was maintained with sevoflurane in oxygen. At the end of surgery, medetomidine was antagonized with IM atipamezole. RESULTS: The decision tree identified 0.3 mg kg-1 medetomidine and 15 mg kg-1 ketamine as a useful drug combination, which resulted in anaesthetic induction and surgical anaesthesia 16 ± 8 and 16 (25-20) minutes after injection, respectively. Compared to baseline, HR and fR significantly decreased after anaesthetic induction (p < 0.001), but then remained stable throughout surgery. Intraoperatively, cloacal temperature [27 (26-30) °C] did not change over time (p = 0.48). The total dose of atipamezole was 2 (1-3) mg kg-1 and time to recovery was 36 (20-60) minutes. Perioperative complications were not observed. CONCLUSIONS: and clinical relevance Medetomidine and ketamine, injected IM and followed by sevoflurane anaesthesia, may be regarded as a useful anaesthetic technique for juvenile Nile crocodiles undergoing minimally invasive experimental surgery.

The scaling of postcranial muscles in cats (Felidae) II: hindlimb and lumbosacral muscles.

In quadrupeds the musculature of the hindlimbs is expected to be responsible for generating most of the propulsive locomotory forces, as well as contributing to body support by generating vertical forces. In supporting the body, postural changes from crouched to upright limbs are often associated with an increase of body mass in terrestrial tetrapods. However, felids do not change their crouched limb posture despite undergoing a 300-fold size increase between the smallest and largest extant species. Here, we test how changes in the muscle architecture (masses and lengths of components of the muscle-tendon units) of the hindlimbs and lumbosacral region are related to body mass, to assess whether there are muscular compensations for the maintenance of a crouched limb posture at larger body sizes. We use regression and principal component analyses to detect allometries in muscle architecture, with and without phylogenetic correction. Of the muscle lengths that scale allometrically, all scale with negative allometry (i.e. relative shortening with increasing body mass), whereas all tendon lengths scale isometrically. Only two muscles' belly masses and two tendons' masses scale with positive allometry (i.e. relatively more massive with increasing body mass). Of the muscles that scale allometrically for physiological cross-sectional area, all scale positively (i.e. relatively greater area with increasing body mass). These muscles are mostly linked to control of hip and thigh movements. When the architecture data are phylogenetically corrected, there are few significant results, and only the strongest signals remain. None of the vertebral muscles scaled significantly differently from isometry. Principal component analysis and manovas showed that neither body size nor locomotor mode separate the felid species in morphospace. Our results support the inference that, despite some positively allometric trends in muscle areas related to thigh movement, larger cats have relatively weaker hindlimb and lumbosacral muscles in general. This decrease in power may be reflected in relative decreases in running speeds and is consistent with prevailing evidence that behavioural changes may be the primary mode of compensation for a consistently crouched limb posture in larger cats.

The scaling of postcranial muscles in cats (Felidae) I: forelimb, cervical, and thoracic muscles.

The body masses of cats (Mammalia, Carnivora, Felidae) span a ~300-fold range from the smallest to largest species. Despite this range, felid musculoskeletal anatomy remains remarkably conservative, including the maintenance of a crouched limb posture at unusually large sizes. The forelimbs in felids are important for body support and other aspects of locomotion, as well as climbing and prey capture, with the assistance of the vertebral (and hindlimb) muscles. Here, we examine the scaling of the anterior postcranial musculature across felids to assess scaling patterns between different species spanning the range of felid body sizes. The muscle architecture (lengths and masses of the muscle-tendon unit components) for the forelimb, cervical and thoracic muscles was quantified to analyse how the muscles scale with body mass. Our results demonstrate that physiological cross-sectional areas of the forelimb muscles scale positively with increasing body mass (i.e. becoming relatively larger). Many significantly allometric variables pertain to shoulder support, whereas the rest of the limb muscles become relatively weaker in larger felid species. However, when phylogenetic relationships were corrected for, most of these significant relationships disappeared, leaving no significantly allometric muscle metrics. The majority of cervical and thoracic muscle metrics are not significantly allometric, despite there being many allometric skeletal elements in these regions. When forelimb muscle data were considered in isolation or in combination with those of the vertebral muscles in principal components analyses and MANOVAs, there was no significant discrimination among species by either size or locomotory mode. Our results support the inference that larger felid species have relatively weaker anterior postcranial musculature compared with smaller species, due to an absence of significant positive allometry of forelimb or vertebral muscle architecture. This difference in strength is consistent with behavioural changes in larger felids, such as a reduction of maximal speed and other aspects of locomotor abilities.

Endocranial Morphology of the Extinct North American Lion (Panthera atrox).

The extinct North American lion (Panthera atrox) is one of the largest felids (Mammalia, Carnivora) to have ever lived, and it is known from a plethora of incredibly well-preserved remains. Despite this abundance of material, there has been little research into its endocranial anatomy. CT scans of a skull of P. atrox from the Pleistocene La Brea Tar pits were used to generate the first virtual endocranium for this species and to elucidate previously unknown details of its brain size and gross structure, cranial nerves, and inner-ear morphology. Results show that its gross brain anatomy is broadly similar to that of other pantherines, although P. atrox displays less cephalic flexure than either extant lions or tigers, instead showing a brain shape that is reminiscent of earlier felids. Despite this unusual reduction in flexure, the estimated absolute brain size for this specimen is one of the largest reported for any felid, living or extinct. Its encephalization quotient (brain size as a fraction of the expected brain mass for a given body mass) is also larger than that of extant lions but similar to that of the other pantherines. The advent of CT scans has allowed nondestructive sampling of anatomy that cannot otherwise be studied in these extinct lions, leading to a more accurate reconstruction of endocranial morphology and its evolution.

Functional anatomy and feeding biomechanics of a giant Upper Jurassic pliosaur (Reptilia: Sauropterygia) from Weymouth Bay, Dorset, UK.

Pliosaurs were among the largest predators in Mesozoic seas, and yet their functional anatomy and feeding biomechanics are poorly understood. A new, well-preserved pliosaur from the Kimmeridgian of Weymouth Bay (UK) revealed cranial adaptations related to feeding. Digital modelling of computed tomography scans allowed reconstruction of missing, distorted regions of the skull and of the adductor musculature, which indicated high bite forces. Size-corrected beam theory modelling showed that the snout was poorly optimised against bending and torsional stresses compared with other aquatic and terrestrial predators, suggesting that pliosaurs did not twist or shake their prey during feeding and that seizing was better performed with post-symphyseal bites. Finite element analysis identified biting-induced stress patterns in both the rostrum and lower jaws, highlighting weak areas in the rostral maxillary-premaxillary contact and the caudal mandibular symphysis. A comparatively weak skull coupled with musculature that was able to produce high forces, is explained as a trade-off between agility, hydrodynamics and strength. In the Kimmeridgian ecosystem, we conclude that Late Jurassic pliosaurs were generalist predators at the top of the food chain, able to prey on reptiles and fishes up to half their own length.

Complex rostral neurovascular system in a giant pliosaur.

Pliosaurs were a long-lived, ubiquitous group of Mesozoic marine predators attaining large body sizes (up to 12 m). Despite much being known about their ecology and behaviour, the mechanisms they adopted for prey detection have been poorly investigated and represent a mystery to date. Complex neurovascular systems in many vertebrate rostra have evolved for prey detection. However, information on the occurrence of such systems in fossil taxa is extremely limited because of poor preservation potential. The neurovascular complex from the snout of an exceptionally well-preserved pliosaur from the Kimmeridgian (Late Jurassic, c. 170 Myr ago) of Weymouth Bay (Dorset, UK) is described here for the first time. Using computed tomography (CT) scans, the extensive bifurcating neurovascular channels could be traced through the rostrum to both the teeth and the foramina on the dorsal and lateral surface of the snout. The structures on the surface of the skull and the high concentrations of peripheral rami suggest that this could be a sensory system, perhaps similar to crocodile pressure receptors or shark electroreceptors.

United Kingdom physiotherapists injection therapy practice for musculoskeletal complaints: A cross-sectional survey.

BACKGROUND: Physiotherapists in the United Kingdom (UK), who have received additional training can adopt injection therapy for the treatment of musculoskeletal (MSK) disorders. OBJECTIVES: The objective of this practice survey was to explore (i) the frequency of use of injection therapy by UK physiotherapists for MSK disorders; and (ii) the clinical reasoning for selection of injectate, dose and pre/post injection practice. DESIGN: Cross-sectional online survey. METHODS: The online survey was disseminated via social media and professional networks over a 3-month period. Responses to closed multiple choice survey questions were analysed with descriptive data, with reporting of confidence intervals at 95%. Open questions were analysed using content analysis. RESULTS: The survey received 320 responses. The majority (86.6%, n = 277) used landmark guided approaches. The highest frequency of injections administered were for trigger digits, sub acromial pain and the knee joint. Corticosteroid drugs were widely used (99.7%, n = 319, CI 95% 98 to 100) with Triamcinolone (Kenalog) being the most frequently utilised for both joints (58.8%, n = 160, 53 to 65) and soft tissues (46.3%, n = 126, 40 to 52). Drug choice was largely based on availability in clinic (47.1%, n = 128, 41 to 53). Drug doses for common injection sites varied among the respondents with variation also evident in pre and post-injection practice. CONCLUSION: Marked variation across some elements of injection therapy practice was evident. Notable differences in corticosteroid preparation used, the doses of drug injected, and the use of local anaesthetic were reported by respondents. Injecting physiotherapists should endeavour to ensure practice is aligned to best available evidence.

Recommendations on patient-facing websites regarding diagnostic imaging for low back, knee, and shoulder pain: A scoping review.

Objective: To describe and synthesise the content of public-facing websites regarding the use of diagnostic imaging for adults with lower back pain, knee, and shoulder pain. Methods: Scoping review conducted in accordance with PRISMA guidance. A Google search was performed to identify public-facing websites that were either United Kingdom-based, or National Health Service affiliated. The DISCERN tool was used to appraise website quality before information regarding the use of imaging was synthesised using thematic analysis. Results: Eighty-six websites were included, with 48 making reference to the use of imaging. The information within the majority (n = 43) of public-facing websites aligns with best available evidence. Where there is inconsistency, this may be explained by lower website quality. Three themes were apparent regarding the use of imaging - imaging to inform diagnosis and management; imaging in context; patient experience and expectations. Conclusion: The recommendations and rationale for use of imaging contained within public-facing websites does not appear to justify the increase in imaging rates for musculoskeletal pain in the UK. Innovation: Publicly available information following a novel search strategy, is largely aligned with best evidence, further understanding is required to determine reasons for requesting imaging from a patient and clinician perspective.

Cranial functional morphology of the pseudosuchian Effigia and implications for its ecological role in the Triassic.

Pseudosuchians, archosaurian reptiles more closely related to crocodylians than to birds, exhibited high morphological diversity during the Triassic with numerous examples of morphological convergence described between Triassic pseudosuchians and post-Triassic dinosaurs. One example is the shuvosaurid Effigia okeeffeae which exhibits an "ostrich-like" bauplan comprising a gracile skeleton with edentulous jaws and large orbits, similar to ornithomimid dinosaurs and extant palaeognaths. This bauplan is regarded as an adaptation for herbivory, but this hypothesis assumes morphological convergence confers functional convergence, and has received little explicit testing. Here, we restore the skull morphology of Effigia, perform myological reconstructions, and apply finite element analysis to quantitatively investigate skull function. We also perform finite element analysis on the crania of the ornithomimid dinosaur Ornithomimus edmontonicus, the extant palaeognath Struthio camelus and the extant pseudosuchian Alligator mississippiensis to assess the degree of functional convergence with a taxon that exhibit "ostrich-like" bauplans and its closest extant relatives. We find that Effigia possesses a mosaic of mechanically strong and weak features, including a weak mandible that likely restricted feeding to the anterior portion of the jaws. We find limited functional convergence with Ornithomimus and Struthio and limited evidence of phylogenetic constraints with extant pseudosuchians. We infer that Effigia was a specialist herbivore that likely fed on softer plant material, a niche unique among the study taxa and potentially among contemporaneous Triassic herbivores. This study increases the known functional diversity of pseudosuchians and highlights that superficial morphological similarity between unrelated taxa does not always imply functional and ecological convergence.

Rapid implementation and improvement of a virtual student placement model in response to the COVID-19 pandemic.

Practice-based learning via clinical placement is a core part of a physiotherapy degree with the Chartered Society of Physiotherapy requiring completion of 1000 placement hours over a preregistration degree programme. In April 2020, as a result of the COVID-19 pandemic and subsequent lockdown Connect Health had to cancel 10 student placements as we transitioned to virtual consultations for all clinics. This cancellation of student placements was replicated across the nation with many Higher Education Institutes reporting a backlog of student placements. Without the requisite placement hours students are unable to progress into the next academic year or are unable to graduate. This then reduces the flow of new-graduate physiotherapists into the workforce at a time when there is a plan to grow the physiotherapy workforce to meet primary care demand. In response to this problem a novel placement model to facilitate virtual student placements ('virtual placements') was developed, tested and then rolled out across Connect Health using the Plan-Do-Study-Act quality improvement methodology. The model combines shadowing a broad range of virtual clinics with delivery of patient-facing online exercise classes via the Facebook Live platform and completion of virtual projects to support knowledge consolidation. This virtual student placement model enabled an increase in student capacity of over 400% compared with 2018-2019 with 182 students starting between May and August 2020. The model runs using widely available technology, requires no additional investment and has enabled these students to continue their studies and progress towards qualifying as physiotherapists.

Examination of the neck when a patient complains of shoulder pain: a global survey of current practice (2019).

BACKGROUND: Shoulder pain is a common musculoskeletal problem. Despite this, much uncertainty still exists regarding diagnosis, prognosis and effectiveness of treatments. One diagnostic challenge is determining the role of the neck when a patient complains of shoulder pain. The aim of this survey was to investigate healthcare professionals' indications for examining the neck in this case and subsequent methods used. METHODS: An online survey was developed and distributed via Twitter and the authors' professional networks. Responses were collected over a 4-week period in 2019. RESULTS: In total, 918 respondents replied; 804 completed the full survey. The majority were physiotherapists. Over 80% would examine the neck of patients presenting with shoulder pain. The most commonly used method was neck active range-of-movement testing (n = 822/95.3%), followed by neurological examination (n = 713/78.1%). Less commonly used tests were neck resistance testing, palpation of the neck and Spurling's test. Fewer numbers (n = 176/22%) resorted to using diagnostic tests such as imaging. CONCLUSIONS: This survey provides some insight as to how healthcare practitioners examine the neck when a patient complains of shoulder pain. Most would examine based on anterolateral shoulder pain, using variable combinations of movement, resistance, neurological and palpation/other testing. A minority would perform diagnostics or imaging. The results of the survey highlight that practice in this area is mixed, which may be due to uncertainty regarding optimal methods. This highlights the need for further work to understand this clinical dilemma better.

Musculoskeletal risk stratification tool to inform a discussion about face-to-face assessment during the COVID-19 pandemic.

The COVID-19 pandemic and lockdown caused clinicians in the UK to switch to delivering musculoskeletal care using telephone or video consultations. NHS England (an executive non-departmental public body of the Department of Health and Social Care, England) recommended prioritisation of more urgent conditions, including those people whose condition has deteriorated and those waiting the longest as part of a phased return to pre-COVID-19 service provision. Clinicians will need to assess an individual's risk factors for complications from COVID-19 alongside their clinical priority to inform a shared decision-making discussion about appropriate face-to-face care delivery. This paper outlines a risk stratification tool that informs that discussion and aims to reduce the subjectivity in the risk assessment between clinicians.