Vertical Strength Transfer Phenomenon Between Upper Body and Lower Body Exercise: Systematic Scoping Review.

BACKGROUND: There are a myriad of exercise variations in which upper body (UB) and lower body (LB) exercises have been intermittently used. However, it is still unclear how training of one body region (e.g. LB) affects adaptations in distant body areas (e.g. UB), and how different UB and LB exercise configurations could help facilitate physiological adaptations of either region; both referred to in this review as vertical strength transfer. OBJECTIVE: We aimed to investigate the existence of the vertical strength transfer phenomenon as a response to various UB and LB exercise configurations and to identify potential mechanisms underpinning its occurrence. METHODS: A systematic search using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for Scoping Reviews protocol was conducted in February 2024 using four databases (Web of Science, MEDLINE, Scopus and CINAHL) to identify peer-reviewed articles that investigated the vertical strength transfer phenomenon. RESULTS: Of the 5242 identified articles, 24 studies met the inclusion criteria. Findings suggest that the addition of UB strength training to LB endurance exercise may help preserve power-generating capacity for the leg muscle fibres. Furthermore, systemic endocrine responses to high-volume resistance exercise may beneficially modulate adaptations in precedingly or subsequently trained muscles from a different body region, augmenting their strength gains. Last, strength training for LB could result in improved strength of untrained UB, likely due to the increased central neural drive. CONCLUSIONS: Vertical strength transfer existence is enabled by neurophysiological mechanisms. Future research should involve athletic populations, examining the potential of vertical strength transfer to facilitate athletic performance and preserve strength in injured extremities.

Physical match demands across different playing positions during transitional play and high-pressure activities in elite soccer.

This study explored physical match demands across different playing positions during transitional play, to inform the need for position-specific training interventions. Data was collected using 10 Hz GPS units from 10 competitive matches including 23 elite soccer players of the 1st Polish Division (Ekstraklasa) in season 2020-21. A total of 4249 positional observations were made; center backs (n = 884), full backs (n = 972), central defensive midfielders (n = 236), central attacking midfielders (n = 270), central midfielders (n = 578), wingers (n = 778), and attackers (n = 531). Match data reflected distances covered per minute (m · min-1): total distance (TD), high-speed running distance (HSRD, > 19.8 km · h-1), sprint distance (SD, > 25.2 km · h-1), and the frequency of high-intensity accelerations and decelerations (A+D, > 3 m · s-2; n · min-1). Total absolute sprint distance (SD, > 25.2 km · h-1) and total relative sprint distance (Rel B5) were also quantified. A univariate analysis of variance revealed position-specific differences. Significant effects of position were found for all analysed metrics during transitional play (large ESs; p <.001). Central attacking midfielders displayed higher TD (m · min-1), fullbacks covered highest SD (m · min-1) and wingers achieved the highest A+D (n · min-1) (p ≤ 0.05). Centre backs displayed the lowest physical outputs when compared to all other positions, except in A+D (n · min-1) during defensive transitions (p ≤ 0.05). Attackers displayed the highest physical metrics during high pressure activities (p ≤ 0.05). Coaches should carefully consider positional transitional demands to better inform training design. With specific attention paid to drills that replicate game play.

An Analysis of Positional Generic and Individualized Speed Thresholds Within the Most Demanding Phases of Match Play in the English Premier League.

OBJECTIVES: To analyze the positional distances covered above generic and individualized speed thresholds within the most demanding phases of match play. Categorized by position, 17 English Premier League players' match data were analyzed over 2 consecutive seasons (2019-20 and 2020-21). The most demanding phases of play were determined using a rolling average across 4 periods of 1, 3, 5, and 10 minutes. Distance covered in the time above the standard speed of 5.5 m/s was analyzed, with individualized metrics based on the maximal aerobic speed (MAS) test data. RESULTS: Central defenders displayed lower values for high-intensity periods when compared with fullbacks, midfielders, and wide midfielders for both generic and individualized metrics. MAS during 1-minute periods was significantly higher for forwards when compared with central defenders (82.9 [18.9] vs 67.5 [14.8] for maximum high-speed running [HSR] and 96.0 [15.9] vs 75.7 [13.8] HSR for maximum MAS activity). The maximum effect size differences between the central midfielders, wide midfielders, and fullbacks for HSR and MAS measures under the maximum HSR criterion was 0.28 and 0.18 for the 1-minute period, 0.36 and 0.19 for the 3-minute period, 0.46 and 0.31 for the 5-minute period, and 0.49 and 0.315 for the 10-minute period. CONCLUSIONS: Individualized speed metrics may provide a more precise and comparable measure than generic values. Data appear to be consistent across playing positions except for central defenders. This information may allow practitioners to directly compare individualized physical outputs of non-central defenders during the most demanding phases of play regardless of the players' positional group. This may provide coaches with important information regarding session design, training load, and fatigue monitoring.

Worst Case Scenarios in Soccer Training and Competition: Analysis of Playing Position, Congested Periods, and Substitutes.

Aim: To understand mean (WCSmean) and peak (WCSpeak) worst case scenarios within training and game play in male professional soccer. Methods: Thirty-one (n = 31) first team players were monitored across 37 matches and 14 MD-3 sessions. Playing status was distinguished, football drills analyzed, and performance explored in long-period: >6 days, moderate-period: 5-6 days, and congested-period: ≤4 days. Relative total distance (TD), high-speed running distance (HSRD, >19.8 km·h-1), sprint distance (SD, >25.2 km·h-1), accelerations/decelerations (A+D, >3 m·s-2), accelerations (Acc, >3 m·s-2), and decelerations (Dec, >-3 m·s-2) were measured as well as Maximum acceleration (Max Acc; m·s-2) and deceleration (Max Dec; m·s-2). Results: Analysis of variance found differences between matches and training in WCSmean for TD, HSRD, SD, and Max Dec in all positions (p < .001; partial η2 > .275). Fullbacks displayed differences between match and training in Max Acc (moderate ESs; p < .001), while center backs and central midfielders in Max Dec (large ESs; p > .05). Main effects of playing status were discovered for all metrics except Max Dec (p < .001; partial η2 > .124). Analysis showed differences between long- and congested-period for A+D and Dec (large ESs; p ≤ .05). Conclusions: Findings provide more insights into short peak intensity demands of soccer showing that the maximum high velocity action of acceleration and deceleration is not being replicated in training. Nonstarters lack maximum intensity exposure in matches (WCSpeak) increasing the gap between training and competition even higher during congested fixture periods.

Methods of Measuring Laryngeal Muscle Tension in Patients with Muscle Tension Dysphonia: A Scoping Review.

BACKGROUND: In clinical practice and research relating to Muscle Tension Dysphonia (MTD), several laryngeal muscle tension measurement methods are used to diagnose, to identify specific muscle strengths and deficits, and to measure therapeutic outcomes. The variety and reliability of available measurement methods presents challenges within diagnosis and treatment. The lack of methodical standardization presents a barrier to homogeneous practice in this area. There is a need for a comprehensive scoping review of laryngeal muscle tension measurement methods. STUDY DESIGN: Scoping review. OBJECTIVES: (1) To identify current methods of laryngeal muscle measurement which have been developed or tested with people with MTD; and (2) To identify the construct/s measured, reliability, validity, ability to detect change, efficiency and accessibility of identified methods. METHOD: This scoping review was conducted using the Arksey and O'Malley framework. Studies were identified through searches of 4 major databases. The reviewer independently assessed titles, abstracts, and full-text articles. RESULTS: Twenty seven papers published from 2000 to 2022 that satisfied the inclusion criteria were selected from 194 studies. The papers showed a variety of approaches with regards to the measurement of laryngeal activity and tension in subjects with MTD. Just over a quarter (25.9%) were reviews of the validity of assessment methods of MTD, including surface electromyography (sEMG), while 22.2% discussed surface electromyography as a measurement of muscle activity in subjects with MTD. 96.3% used a published methodological framework. CONCLUSIONS: Assessment methods for Primary MTD are multifaceted, including patient history, laryngoscopic examination, and voice-related musculoskeletal features. Potential use of objective measurement methods, including sEMG, Real Time Elastosonography, Magnetic Resonance Imaging was noted. Due to variability in assessment methods and results, there is a need for greater objective practical methodological standardization to ensure accurate diagnosis, appropriate care, and chart patient progress.

Peak Running Speeds in Professional Male Football: Influence of Division and Playing Position.

ABSTRACT: Fahey, JT, Aldred, K, Greig, M, and Rhodes, D. Peak running speeds in professional male football: Influence of division and playing position. J Strength Cond Res 37(3): 636-640, 2023-Well-established physical demands of competitive professional football facilitate prescription and monitoring of training. However, many factors influence these physical demands with implications for efficacious practice. Match-play data were analyzed over 2 seasons using global positioning systems technology, differentiating English Championship (33 matches) and League One (27 matches) demands. Playing position categorized wide and central defenders and midfielders and forwards. Peak running speeds defined the outcome measure, assessing the influence of the competition level and playing position across 1, 5, and 10-minute rolling average durations using a linear mixed model. Significant effects were detected for the competition level (F1,324.5 = 5.44, p = 0.02) and playing position (F4,328.3 = 89.90, p < 0.001). League One matches demonstrated greater peak running speeds than Championship matches (mean difference = 2.72 m·min-1 [95% confidence intervals: 0.4, 5.0]). No difference was observed between central and wide midfielders (mean difference = 0.62 m·min-1 [95% confidence intervals: -3.1, 4.3]). Wide midfielders presented faster peak running speeds than forwards (mean difference = 18 m·min-1 [95% confidence intervals:14.1, 22.1], p < 0.05), central defenders (mean difference = 25 m·min-1 [95% confidence intervals: 21.7, 29.8], p < 0.05), and wide defenders (mean difference = 12 m·min-1 [95% confidence intervals: 8.2, 16.5], p < 0.05). Interaction effects were found for division*position (F4,328.3 = 2.57, p = 0.038) demonstrating greater running speeds in League One, except for central defenders. Wide midfielders presented greater peak 1-minute running speeds, whereas 5 and 10-minute peak running speeds were greatest in central midfielders. The sensitivity of peak running speeds to competition level and playing position has implications for training prescription, monitoring particularly when transitioning between competition levels, determining and monitoring positional training intensities, and objective targets for progressive overload during rehabilitation.

Inflammatory profiles, gut microbiome, and kidney function are impacted after high-fidelity firefighter training.

BACKGROUND: Firefighters are frequently exposed to high temperatures, environmental toxicants, and strenuous physical demands. The health impacts of these occupational exposures on processes including inflammation and kidney function as well as on the gut microbiota are poorly understood. A firefighter training course may provide a controlled environment to assess these health risks. METHODS: Basic health measures, stool, and blood samples were obtained from 24 firefighters participating in a one-week, heat-intensive training course. Indicators of inflammation, gut permeability, kidney health, and stool microbiota composition were measured before and after the training course in 18 participants. Urine specific gravity was measured before and after a heat-intensive training day to evaluate dehydration. RESULTS: The majority of firefighters in this cohort were categorized as hypertensive and experienced multiple heat-related illness symptoms during the training week and dehydration after the heat-intensive training day. While plasma IL-1ß, CXCL8, and NGAL decreased over the training week, other indicators of inflammation and acute kidney injury increased, and estimated kidney function declined. Microbiota composition shifted over the course of the training week, with changes in Peptostreptococcus anaerobius and Streptococcus. CONCLUSIONS: This pilot study conducted in a controlled field setting suggests that the occupational environment of firefighters may increase their risk for systemic inflammation and kidney disease.

The mean and peak physical demands during transitional play and high pressure activities in elite football.

The aim of the present study was to establish the effect of transitional activities (TA) on physical metrics. Global Positioning System technology was utilized on 23 elite outfield footballers over 10 games to quantify absolute metrics per minute such as total distance (TD; m · min-1), sprint distance (SD; m · min-1), the number of high-intensity accelerations and decelerations (A+D; n · min-1), and high-speed running distance (HSRD; m · min-1). TD - total distance; HSRD - high-speed running distance; SD - sprint distance and high-intensity acceleration distance (Acc B3 Dist) were also quantified. Metrics were observed in relation to 4 TA's commonly observed in football matches. Positive Transitions (PT), Negative Transitions (NT), Fast Attacks (FA) and High Pressure Activities (HP). Main effects for transition and game were observed. Comparisons were also made between 90 minute averages and transitional mean scores. NT displayed the highest TD (m · min-1) when compared to other TA's (p ≤ 0.05). Observation of SD (m · min-1) for all transitions highlighted higher outputs when in PT (p ≤ 0.05). HP TA displayed the lowest output in all metrics (p ≤ 0.05), except high-intensity accelerations and decelerations A+D (n · min-1). The mean average and peak average outputs for TA and 90min average detailed elevated physical outputs across all metrics. Absolute physical metrics are increased when observing transitional play, representing the maximum physical exposure that athletes experience in games. This knowledge should be utilized when implementing high-velocity exposures within a weekly microcycle, to best prepare players for match play.

Biomechanical and Neuromuscular Performance Requirements of Horizontal Deceleration: A Review with Implications for Random Intermittent Multi-Directional Sports.

Rapid horizontal accelerations and decelerations are crucial events enabling the changes of velocity and direction integral to sports involving random intermittent multi-directional movements. However, relative to horizontal acceleration, there have been considerably fewer scientific investigations into the biomechanical and neuromuscular demands of horizontal deceleration and the qualities underpinning horizontal deceleration performance. Accordingly, the aims of this review article are to: (1) conduct an evidence-based review of the biomechanical demands of horizontal deceleration and (2) identify biomechanical and neuromuscular performance determinants of horizontal deceleration, with the aim of outlining relevant performance implications for random intermittent multi-directional sports. We highlight that horizontal decelerations have a unique ground reaction force profile, characterised by high-impact peak forces and loading rates. The highest magnitude of these forces occurs during the early stance phase (< 50 ms) and is shown to be up to 2.7 times greater than those seen during the first steps of a maximal horizontal acceleration. As such, inability for either limb to tolerate these forces may result in a diminished ability to brake, subsequently reducing deceleration capacity, and increasing vulnerability to excessive forces that could heighten injury risk and severity of muscle damage. Two factors are highlighted as especially important for enhancing horizontal deceleration ability: (1) braking force control and (2) braking force attenuation. Whilst various eccentric strength qualities have been reported to be important for achieving these purposes, the potential importance of concentric, isometric and reactive strength, in addition to an enhanced technical ability to apply braking force is also highlighted. Last, the review provides recommended research directions to enhance future understanding of horizontal deceleration ability.

Utilisation of performance markers to establish the effectiveness of cold-water immersion as a recovery modality in elite football.

Optimal strategies for recovery following training and competition in elite athletes presents ongoing debate. The effects of cold-water immersion (CWI) compared to passive recovery (PR) though a triad of performance measures after fatiguing exercise within a normal micro-cycle, during mid-competitive training cycle, in elite male footballers were investigated. Twenty-four elite footballers (age 20.58 ± 2.55 years; height 179.9 ± 5.6 cm; weight 75.7 ± 7.5 kg; body fat 6.2 ± 1.7%) were randomly assigned to CWI or PR following a fatiguing training session. Objective measures included eccentric hamstring strength, isometric adductor strength, hamstring flexibility and skin surface temperature (T sk ). Subjective measures included overall wellbeing. Data were collected at match day+3, immediately post-training, immediately post-intervention and 24 hrs post-intervention. Physiological, biomechanical and psychological measures displayed significant main effects for timepoint for eccentric hamstring strength, T sk , overall wellbeing, sleep, fatigue, stress and group for eccentric hamstring strength, T sk and sleep (groups combined). Group responses identified significant effects for timepoint for CWI and PR, for eccentric hamstring strength peak force, sleep, fatigue, and muscle soreness for CWI. Significant differences were displayed for eccentric hamstring strength (immediately post-intervention and immediately post-training) for peak force and between CWI and PR eccentric hamstring strength immediately post-intervention. Linear regression for individual analysis demonstrated greater recovery in peak torque and force for CWI. CWI may be useful to ameliorate potential deficits in eccentric hamstring strength that optimise readiness to train/play in elite football settings. Multiple measures and individual analysis of recovery responses provides sports medicine and performance practitioners with direction on the application of modified approaches to recovery strategies, within mid-competitive season training cycles.

Effects of contemporary cryo-compression on post-training performance in elite academy footballers.

Fatigue is a predisposing risk factor for injury commonly investigated in elite football populations. Little evidence advocates the most beneficial recovery strategies including contemporary cooling applications. The aim of the study was to examine immediate effects of the Game Ready® on physiological and biomechanical measures in a population of elite male academy footballers, following a fatiguing training session mid-competitive season. Twenty, elite male footballers took part (180.2 ± 8.7cm, 75.0 ± 11.4kg, 18 ± 0.5years). Following a normal fatiguing training session, players were randomly assigned to receive either cryotherapy (Game Ready®) (20-minutes at medium compression (5-55 mm Hg)) or passive recovery (PAS). Data was collected at match-day+1, immediately post-training and immediately post-intervention. Performance measures included countermovement jump (CMJ), isometric adductor strength (IAS), hamstring flexibility (HF), and skin surface temperature (Tsk). Significant main effects for group for CMJ data following exposure to cooling were displayed (p = < 0.05). Individual group analysis displayed a significant reduction in CMJ performance in the group exposed to cryotherapy (p = < 0.05) immediately post, but not for PAS. No main effects were identified for cryotherapy or PAS group for IAS or HF (p = > 0.05). Tsk reduced significantly (p = < 0.05) in the cryotherapy group, meeting therapeutic Tsk range. Reductions in performance immediately following exposure to pneumatic cryo-compressive devices may negate the justification of this recovery strategy if neuromuscular mechanisms are required in immediate short term. Application of such recovery strategies however are dependent on the type of recovery demand and should be adapted individually to suit the needs of the athlete to optimise readiness to train/play.

Test-Retest Reliability of the Isometric Soleus Strength Test in Elite Male Academy Footballers.

BACKGROUND: Currently there is no reliability data available for the isometric soleus strength test (ISST), commonly used as a monitoring tool in elite football settings. Isometric strength testing for other muscle groups, most notably the hamstrings, is utilized to identify injury risk and readiness to train/play. To profile athletes efficiently, performance practitioners require optimal measures that are reliable. The aim of this study was to investigate the test-retest reliability of the isometric strength test of the soleus and propose a standardized protocol for its use within an elite male football population. STUDY DESIGN: Test-retest reliability single cohort study. METHODS: Thirty elite male footballers (age = 22.8±5.0 years, height = 180.0±0.08 cm, weight = 70.57±4.0 kg) performed the ISST, through three maximum 3-second hold efforts with one minute rest between repetitions and 48 hours between tests, in each test. The test was performed mid-competitive season. All data bilaterally were checked for normality using the Shapiro-Wilk test before a Pearson's Correlations and Bland-Altman's analyses were performed. RESULTS: Test-retest reliability demonstrated high reliability for ISST bilaterally (Right: r = 0.89; Left: r = 0.79, p<0.05). The standard error of measurement (SEM) (%) was 9.09 - 12.47% and minimal detectable change (MDC) was 25.19 - 34.56 (N) for Peak Force (PF) measures of the ISST. Bilateral levels of agreement were found to be +/- 2 standard deviations (SD) of the interval of agreement bilaterally for ISST (Levels of agreement (LOA): Right: Upper 352.49 - Lower -494.76; Left: Upper 523.82 - Lower -591.30. Bilaterally no significant difference was detected between values (Right: p=0.09, CI: -153.21-10.95; Left: p=0.52, CI: -139.81-72.33). CONCLUSION: The results of this study demonstrate high reliability for the ISST. The ISST displays a high test-retest reliability for assessing PF characteristics of the soleus in elite male academy footballers. This test may be beneficial for performance practitioners for profiling soleus function of athletes.

Drop jump neuromuscular performance qualities associated with maximal horizontal deceleration ability in team sport athletes.

The purpose of this study was to investigate associations between, and within, drop jump (DJ) neuromuscular performance (NMP) qualities and maximal horizontal deceleration ability. We also compared DJ NMP qualities in "high" versus "low" horizontal deceleration ability athletes. Twenty-nine university athletes performed: (1) DJs on force plates from 20 (DJ20) and 40 cm (DJ40) heights and (2) maximal horizontal deceleration, measured using radar, following a 20 m acceleration. Maximal horizontal deceleration was evaluated using deceleration (HDEC; m·s-2), across the entire deceleration phase and during early and late deceleration sub-phases. Of the DJ variables assessed, DJ20 and DJ40 reactive strength index (RSI) and concentric mean force had the largest correlations with HDEC (r = -0.54 to -0.61) and the largest differences between high and low HDEC groups (d = 1.20 to 1.40). These correlations were stronger with the early than late HDEC sub-phase (r = -0.54 to -0.66 vs. r = -0.24 to -0.40). Notably, eccentric mean force in DJ40 had large correlations with both DJ20 and DJ40 concentric mean force (r = 0.67 to 0.77), whereas at DJ20 these correlations were small (r = 0.22 to 0.40). Similarly, DJ40 eccentric mean force had a much larger difference between the high and low HDEC groups than DJ20 (d = 1.11 vs. 0.51). These findings suggest DJ RSI from either height may be used as a proxy for HDEC ability, while DJ kinetic analyses should use a higher height to distinguish those with a better capacity to generate eccentric braking forces under increased eccentric loading demands. HIGHLIGHTSPlayers with greater drop jump reactive strength index (RSI) demonstrated superior horizontal deceleration ability.Drop jump RSI had a greater association with the early compared to the late horizontal deceleration sub-phase.Of the drop jump kinetic variables examined, concentric mean force had the largest associations with horizontal deceleration ability.

Case Study: The Conservative Management of a Complex Mid Foot Injury in an Elite Professional Footballer.

Lisfranc injuries, often accompanied with tarsometatarsal joint (TMTJ) disruption, are not well documented in football despite becoming increasingly more prevalent within other athletic populations. Currently there is a paucity of evidence documenting prognosis, rehabilitation strategy and outcome. The presented case summarizes the conservative rehabilitation and return to play of a 26-year-old elite professional footballer who presented with a Lisfranc injury alongside a 3rd TMTJ coalition stress response. Injury was sustained when landing awkwardly from a jump causing the midfoot to be forced into a hyper-plantarflexed position. Palpation identified tenderness over the 2nd and 3rd MT, with a positive piano key test. Magnetic resonance imaging (MRI), computed tomography (CT), stork view x-ray and review from a leading foot and ankle specialist confirmed diagnosis, post-contradictory MRI results. Presented is a summary of the assessment process, conservative management of the injury and the resultant rehabilitation process followed, which led to the successful return to play of the athlete.

The Effect of High-Intensity Accelerations and Decelerations on Match Outcome of an Elite English League Two Football Team.

OBJECTIVES: Previous research has highlighted the frequency of high-intensity accelerations and decelerations in elite football. The influence of these actions on match performance outcomes has not been established. The aim of the present study was to identify the influence of high-intensity accelerations and decelerations on match performance outcomes (i.e., win, draw, lost). Comparisons were also made between team and positional high-intensity accelerations and decelerations recorded within the games. METHODS: 26 elite outfield footballers from an elite English Football League (EFL) Two team completed the present study. Global Positioning System (GPS) technology was utilised to quantify high-intensity accelerations and decelerations during 45 games in a competitive season. Magnitude analysis and the effects of results, positions and fixture periods were observed. RESULTS: Significant effects of results, periods and positions were observed (p ≤ 0.05), with the highest outputs observed in games won. Positionally, fullbacks and centre forwards in a 4-3-3 formation exhibited the greatest frequency of high-intensity accelerations and decelerations. Very large differences were observed between the frequency of high-intensity decelerations compared to accelerations in games won (g = 2.37), drawn (g = 2.99) and lost (g = 3.59). The highest team frequencies of high-intensity accelerations (n = 3330) and decelerations (n = 6482) were completed in games won. CONCLUSIONS: The frequency of high-intensity accelerations and decelerations has a significant impact on match performance outcomes in an elite English League Two football team. Consideration needs to be given to specific conditioning and recovery strategies to optimise high-intensity acceleration and deceleration performance in games. Caution should be taken as these findings are representative of one team within the EFL.

Impact of early versus late administration of bamlanivimab on readmissions in patients with high-risk COVID-19.

BACKGROUND: Recombinant monoclonal antibody therapies have been utilized under emergency use authorization (EUA) for the prevention of clinical decompensation in high-risk COVID-19 positive patients for up to 10 days from symptom onset. The purpose of this study was to determine the impact of the timing of the monoclonal antibody, bamlanivimab, on clinical outcomes in high-risk COVID-19 positive patients. METHODS: This was an IRB-approved, retrospective evaluation of adult patients who received bamlanivimab per EUA criteria in the emergency department (ED). Patients were dichotomized into two groups- 3 days of symptoms or less (early) versus 4 to 10 days (late). The primary outcome was hospitalization for COVID-related illness at 28 days (or treatment failure). Secondary outcomes were COVID-related ED visits at 28 days, hospital and intensive care unit (ICU) length of stay (LOS), and in-hospital mortality at 28 days. RESULTS: A total of 839 patients were included in the analysis. There was no difference observed in COVID-related hospitalization rates within 28 days between the early and late bamlanivimab administration groups (7.5% vs. 8.2%, p = 0.71). There was no difference in COVID-related ED visits within 28 days with 13% of patients returning to the ED. CONCLUSIONS: In conclusion, there were no differences in the rates of hospitalization at 28 days when bamlanivimab was administered in the first 3 days of illness versus days 4 to 10. Future prospective studies are warranted to expand upon the characteristics of patients that may or may not benefit from monoclonal antibody therapy.

Nerve guidance conduit development for primary treatment of peripheral nerve transection injuries: A commercial perspective.

Commercial nerve guidance conduits (NGCs) for repair of peripheral nerve discontinuities are of little use in gaps larger than 30 mm, and for smaller gaps they often fail to compete with the autografts that they are designed to replace. While recent research to develop new technologies for use in NGCs has produced many advanced designs with seemingly positive functional outcomes in animal models, these advances have not been translated into viable clinical products. While there have been many detailed reviews of the technologies available for creating NGCs, none of these have focussed on the requirements of the commercialisation process which are vital to ensure the translation of a technology from bench to clinic. Consideration of the factors essential for commercial viability, including regulatory clearance, reimbursement processes, manufacturability and scale up, and quality management early in the design process is vital in giving new technologies the best chance at achieving real-world impact. Here we have attempted to summarise the major components to consider during the development of emerging NGC technologies as a guide for those looking to develop new technology in this domain. We also examine a selection of the latest academic developments from the viewpoint of clinical translation, and discuss areas where we believe further work would be most likely to bring new NGC technologies to the clinic. STATEMENT OF SIGNIFICANCE: NGCs for peripheral nerve repairs represent an adaptable foundation with potential to incorporate modifications to improve nerve regeneration outcomes. In this review we outline the regulatory processes that functionally distinct NGCs may need to address and explore new modifications and the complications that may need to be addressed during the translation process from bench to clinic.