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Summary: Background: We have addressed health equity attained by fecal immunochemical testing (FIT) and primary colonoscopy (PCOL), respectively, in the randomised controlled screening trial SCREESCO conducted in Sweden. Methods: We analysed data on the individuals recruited between March 2014, and March 2020, within the study registered with ClinicalTrials.gov, NCT02078804. Swedish population registry data on educational level, household income, country of birth, and marital status were linked to each 60-year-old man and woman who had been randomised to two rounds of FIT 2 years apart (n = 60,123) or once-only PCOL (n = 30,390). Furthermore, we geo-coded each study individual to his/her residential area and assessed neighbourhood-level data on deprivation, proportion of non-Western immigrants, population density, and average distance to healthcare center for colonoscopy. We estimated adjusted associations of each covariate with the colonoscopy attendance proportion out of all invited to respective arms; ie, the preferred outcome for addressing health equity. In the FIT arm, the test uptake and the colonoscopy uptake among the test positives were considered as the secondary outcomes. Findings: We found a marked socioeconomic gradient in the colonoscopy attendance proportion in the PCOL arm (adjusted odds ratio [95% credibility interval] between the groups categorised in the highest vs. lowest national quartile for household income: 2·20 [2·01–2·42]) in parallel with the gradient in the test uptake of the FIT × 2 screening (2·08 [1·96–2·20]). The corresponding gradient in the colonoscopy attendance proportion out of all invited to FIT was less pronounced (1·29 [1·16–1·42]), due to higher proportions of FIT positives in socioeconomically disadvantaged groups. Interpretation: The unintended risk of exacerbating inequalities in health by organised colorectal cancer screening may be higher with a PCOL strategy than a FIT strategy, despite parallel socioeconomic gradients in uptake. Funding: This work was supported by the Swedish Cancer Society under Grant 20 0719. CB and US provided economic support from the Swedish Research Council for Health, Working life, and Welfare under Grant 2020–00962.

Abstract The type VI secretion system (T6SS) is a molecular machine utilised by many Gram-negative bacteria to deliver antibacterial toxins into adjacent cells. Here we present the structure of Tse15, a T6SS Rhs effector from the nosocomial pathogen Acinetobacter baumannii. Tse15 forms a triple layered β-cocoon Rhs domain with an N-terminal α-helical clade domain and an unfolded C-terminal toxin domain inside the Rhs cage. Tse15 is cleaved into three domains, through independent auto-cleavage events involving aspartyl protease activity for toxin self-cleavage and a nucleophilic glutamic acid for N-terminal clade cleavage. Proteomic analyses identified that significantly more peptides from the N-terminal clade and toxin domains were secreted than from the Rhs cage, suggesting toxin delivery often occurs without the cage. We propose the clade domain acts as an internal chaperone to mediate toxin tethering to the T6SS machinery. Conservation of the clade domain in other Gram-negative bacteria suggests this may be a common mechanism for delivery.

Girls and women face persistent negative stereotyping within STEM (science, technology, engineering, mathematics). This field intervention was designed to improve boys' perceptions of girls' STEM ability. Boys (N = 667; mostly White and East Asian) aged 9-15 years in Canadian STEM summer camps (2017-2019) had an intervention or control conversation with trained camp staff. The intervention was a multi-stage persuasive appeal: a values affirmation, an illustration of girls' ability in STEM, a personalized anecdote, and reflection. Control participants discussed general camp experiences. Boys who received the intervention (vs. control) had more positive perceptions of girls' STEM ability, d = 0.23, an effect stronger among younger boys. These findings highlight the importance of engaging elementary-school-aged boys to make STEM climates more inclusive.

Previous research has identified a replicable role for the posterior parietal cortex (PPC) in risk behaviors, but it is unclear whether this relationship is causal. Here, we used a targeted neuromodulation protocol leveraging a single-session of 10-Hz rTMS to the PPC versus a control region in the visual cortex (V5), as well as two active comparison regions [superior frontal gyrus (SFG), dorsolateral prefrontal cortex (DLPFC)] (within-person, randomized order), to examine within-session changes in a comprehensive measure of self-reported risk-taking propensity (the Domain-Specific Risk-Taking or DOSPERT scale). Individuals with tobacco use disorder were selected as sample participants who present with clinically relevant risk-taking propensity (N = 50; 14 women, mean [SE] age=33.1 [1.04] years). Results indicated that stimulating the PPC (versus V5) resulted in trend-level reductions in self-reported risk-taking propensity (region-by-time interaction, P = 0.065). A similar pattern emerged comparing PPC stimulation to effects of stimulating either the DLPFC (P = 0.080) or SFG (P = 0.032). PPC-related reductions in risk-taking propensity were domain general and potentially driven by changes in risk perception rather than perceptions of expected benefits of risk-taking. These findings support a possible causal role of the PPC in risk behaviors that warrants further consideration for therapeutic indications in conditions like tobacco use disorder.

Abstract This research aimed to determine whether accomplished surfers could accurately perceive how changes to surfboard fin design affected their surfing performance. Four different surfboard fins, including conventional, single-grooved, and double-grooved fins, were developed using computer-aided design combined with additive manufacturing (3D printing). We systematically installed these 3D-printed fins into instrumented surfboards, which six accomplished surfers rode on waves in the ocean in a random order while blinded to the fin condition. We quantified the surfers’ wave-riding performance during each surfing bout using a sport-specific tracking device embedded in each instrumented surfboard. After each fin condition, the surfers rated their perceptions of the Drive, Feel, Hold, Speed, Stiffness, and Turnability they experienced while performing turns using a visual analogue scale. Relationships between the surfer’s perceptions of the fins and their surfing performance data collected from the tracking devices were then examined. The results revealed that participants preferred the single-grooved fins for Speed and Feel, followed by double-grooved fins, commercially available fins, and conventional fins without grooves. Crucially, the surfers’ perceptions of their performance matched the objective data from the embedded sensors. Our findings demonstrate that accomplished surfers can perceive how changes to surfboard fins influence their surfing performance.

We report a case of a new-onset, persistent tremor that developed during a clinical trial (NCT02927236) of intermittent theta burst stimulation [iTBS, a form of repetitive magnetic transcranial magnetic stimulation (rTMS)] for cocaine use disorder. Although the participant exhibited an exceptionally strong clinical response, subsequent unblinding revealed that they received sham iTBS. This case highlights the potential for strong functional neurological placebo responses in rTMS trials, and functional disorders might be a marker of a placebo response. Additionally, we note the possibility that the weak e-fields produced by some sham rTMS systems may induce clinically relevant effects.

Aims: Distal femoral resection in conventional total knee arthroplasty (TKA) utilizes an intramedullary guide to determine coronal alignment, commonly planned for 5° of valgus. However, a standard 5° resection angle may contribute to malalignment in patients with variability in the femoral anatomical and mechanical axis angle. The purpose of the study was to leverage deep learning (DL) to measure the femoral mechanical-anatomical axis angle (FMAA) in a heterogeneous cohort. Methods: Patients with full-limb radiographs from the Osteoarthritis Initiative were included. A DL workflow was created to measure the FMAA and validated against human measurements. To reflect potential intramedullary guide placement during manual TKA, two different FMAAs were calculated either using a line approximating the entire diaphyseal shaft, and a line connecting the apex of the femoral intercondylar sulcus to the centre of the diaphysis. The proportion of FMAAs outside a range of 5.0° (SD 2.0°) was calculated for both definitions, and FMAA was compared using univariate analyses across sex, BMI, knee alignment, and femur length. Results: The algorithm measured 1,078 radiographs at a rate of 12.6 s/image (2,156 unique measurements in 3.8 hours). There was no significant difference or bias between reader and algorithm measurements for the FMAA (p = 0.130 to 0.563). The FMAA was 6.3° (SD 1.0°; 25% outside range of 5.0° (SD 2.0°)) using definition one and 4.6° (SD 1.3°; 13% outside range of 5.0° (SD 2.0°)) using definition two. Differences between males and females were observed using definition two (males more valgus; p < 0.001). Conclusion: We developed a rapid and accurate DL tool to quantify the FMAA. Considerable variation with different measurement approaches for the FMAA supports that patient-specific anatomy and surgeon-dependent technique must be accounted for when correcting for the FMAA using an intramedullary guide. The angle between the mechanical and anatomical axes of the femur fell outside the range of 5.0° (SD 2.0°) for nearly a quarter of patients. Cite this article: Bone Jt Open 2024;5(2):101–108.

Abstract Introduction Perianal disease occurs in up to 34% of inflammatory bowel disease (IBD) patients. An estimated 25% of women will become pregnant after the initial diagnosis, thus introducing the dilemma of whether mode of delivery affects perianal disease. The aim of our study was to analyze whether a cesarean section (C-section) or vaginal delivery influence perianal involvement. We hypothesized the delivery route would not alter post-partum perianal manifestations in the setting of previously healed perianal disease. Methods All consecutive eligible IBD female patients between 1997 and 2022 who delivered were included. Prior perianal involvement, perianal flare after delivery and delivery method were noted. Results We identified 190 patients with IBD who had a total of 322 deliveries; 169 (52%) were vaginal and 153 (48%) were by C-section. Nineteen women (10%) experienced 21/322 (6%) post-partum perianal flares. Independent predictors were previous abdominal surgery for IBD (OR, 2.7; 95% CI, 1–7.2; p = 0.042), ileocolonic involvement (OR, 3.3; 95% CI, 1.1–9.4; p = 0.030), previous perianal disease (OR, 22; 95% CI, 7–69; p

Artificial Intelligence (AI) and Machine Learning (ML) can assist producers to better manage recirculating aquaculture systems (RASs). ML is a data-intensive process, and model performance primarily depends on the quality of training data. Relatively higher fish density and water turbidity in intensive RAS culture produce major challenges in acquiring high-quality underwater image data. Additionally, the manual image annotation involved in model training can be subjective, time-consuming, and labor-intensive. Therefore, the presented study aimed to simulate fish schooling behavior for RAS conditions and investigate the feasibility of using computer-simulated virtual images to train a robust fish detection model. Additionally, to expedite the model training and automate the virtual image annotation, a process flow was developed. The ‘virtual model’ performances were compared with models trained on real-world images and combinations of real and virtual images. The results of the study indicate that the virtual model trained solely with computer-simulated images could not perform satisfactorily (mAP = 62.8%, F1 score = 0.61) to detect fish in a real RAS environment; however, replacing a small number of the virtual images with real images in the training dataset significantly improved the model’s performance. The M6 mixed model trained with 630 virtual and 70 real images (virtual-to-real image ratio: 90:10) achieved mAP and F1 scores of 91.8% and 0.87, respectively. Furthermore, the training time cost for the M6 model was seven times shorter than that for the ‘real model’. Overall, the virtual simulation approach exhibited great promise in rapidly training a reliable fish detection model for RAS operations.

To the Editor, We read with interest the paper recently published by Cuomo et al. (1) in your journal reporting on the associations between hypocomplementemia and disease status in systemic sclerosis (SSc). In their report, these investigators found that 16.5% of their study subjects had hypocomplementemia and that those with hypocomplementemia had significantly greater disease activity, severity as well as disability...

Background: Spinopelvic immobility has been reported to increase dislocation risk following total hip arthroplasty. Surgically placing acetabular components in a functional orientation has been shown to mitigate risk. The aim of this study was to evaluate the validity and reliability of novel surgical planning software to generate clinically recommended cup targets. Methods: Hip-spine assessments were performed retrospectively on 40 patients. Five reviewers, including 3 arthroplasty-trained surgical fellows and 2 clinical research scientists performed the assessments. Hip-spine assessments consisted of measuring anterior pelvic plane tilt, sacral slope, pelvic incidence, and lumbar lordosis on standing anteroposterior pelvis and lateral standing and seated hip-spine images. Generated cup targets and a control group (40°/20° relative to the anterior pelvic plane) were compared to clinically recommended cup targets. Agreement was defined as a cup position within the recommended range or within 3° of a specific target (eg, 40° inclination) when no range was provided. Intraclass correlation coefficients were used to assess interrater and intrarater reliability, and McNemar’s chi-square test was used to measure success relative to the control group. Results: The intraclass correlation coefficient was 0.88 for delta sacral slope and 0.92 for pelvic incidence-lumbar lordosis mismatch. For patients with spinopelvic risk factors, the generated targets matched the clinical recommendations in 81% of patients compared to only 16% in the control group. Conclusions: Excellent interrater and intrarater reliability was achieved using the novel surgical planning software. The resultant target values agreed with clinical recommendations to a greater extent than the control group.

Animal behavior is a useful way to evaluate the environment and can be a predictive tool to assess not only the effects of treatments in a laboratory setting, but also the status of ecological habitats. As invasive species of crayfish encroach on territories of native species, the social behaviors and interactions can be informative for ecological studies. For a wider and more impactful effect, training community scientists using a scoring system to record the social interactions of crayfish that includes both the level of aggression and intensity would provide useable data to monitor the environment. Amateur scientists with little training were fairly reliable in their average scoring of the crayfish and the maximum behavior score with an expert as well as among themselves. However, the number of interactions was not as a reliable metric to compare with the expert or just among the amateurs.

Wang et al. use high-speed imaging to examine the in situ movement of inner hair-cell stereocilia in the mouse ear. They report that these individual cilia move semi-independently within their given bundle, which forms part of a larger complex within the inner ear, providing unique filtering opportunity for hearing in mammals.

Abstract Mycoplasma pneumoniae is a significant cause of pneumonia and post infection sequelae affecting organ sites distant to the respiratory tract are common. It is also a model organism where extensive ‘omics’ studies have been conducted to gain insight into how minimal genome self-replicating organisms function. An N-terminome study undertaken here identified 4898 unique N-terminal peptides that mapped to 391 (56%) predicted M. pneumoniae proteins. True N-terminal sequences beginning with the initiating methionine (iMet) residue from the predicted Open Reading Frame (ORF) were identified for 163 proteins. Notably, almost half (317; 46%) of the ORFS derived from M. pneumoniae strain M129 are post-translationally modified, presumably by proteolytic processing, because dimethyl labelled neo-N-termini were characterised that mapped beyond the predicted N-terminus. An analysis of the N-terminome describes endoproteolytic processing events predominately targeting tryptic-like sites, though cleavages at negatively charged residues in P1′ (D and E) with lysine or serine/alanine in P2′ and P3′ positions also occurred frequently. Surfaceome studies identified 160 proteins (23% of the proteome) to be exposed on the extracellular surface of M. pneumoniae. The two orthogonal methodologies used to characterise the surfaceome each identified the same 116 proteins, a 72% (116/160) overlap. Apart from lipoproteins, transporters, and adhesins, 93/160 (58%) of the surface proteins lack signal peptides and have well characterised, canonical functions in the cell. Of the 160 surface proteins identified, 134 were also targets of endo-proteolytic processing. These processing events are likely to have profound implications for how the host immune system recognises and responds to M. pneumoniae.

Background: Dislocation is a challenging problem after total hip arthroplasty (THA). We sought to evaluate the incidence of early dislocation with 2 different posterior repair techniques after THA using a posterior approach. Methods: From September of 2008 to August of 2019, we evaluated 841 THAs performed by a single surgeon using a posterior approach. Before November of 2015, the capsule was repaired to the greater trochanter (group 1, 605 patients). Starting November 2015, the posterior capsule was repaired in a side-to-side fashion (direct soft-tissue repair) (group 2, 236 patients). There was a mean follow-up of 31.1 months (range, 2.5-122.5 months). A multivariable logistic regression model was constructed to assess the impact of baseline patient and operative factors on the dislocation rate. Results: There were 22 dislocations, all of which occurred in group 1. There were no dislocations in group 2. After adjusting for patient and operative factors, the direct soft-tissue repair had a large impact on the overall multivariable model as indicated by its effect likelihood ratio of 10.33 (P = .001); however, the odds ratio was not calculable for this factor, given that there were no dislocations in hips with direct soft-tissue repair. Increasing age was associated with an increased odds of dislocation (odds ratio, 1.04, P = .017), with an effect likelihood ratio of 6.25 (P = .012). Conclusions: Switching from a capsular repair to the greater trochanter to a side-to-side capsular repair was associated with a decreased rate of dislocation in primary THA through a posterior approach.

This study aimed to provide normative data characterising the torsos and breasts of female soldiers and to determine which torso and breast anthropometric measurements contributed to reports of poor body armour fit. Ninety-seven female Australian Army soldiers completed a questionnaire about their experience with current-issue body armour, including perceptions of fit. Participants also attended a single testing session where we took a three-dimensional scan of their breasts and torso and collected several anthropometric measurements to characterise their torso size and shape. Sixteen of the 22 breast and torso measurements collected were significantly related to the perceived fit of current-issue body armour systems. To improve perceptions of fit for female soldiers and, in turn, reduce movement interference, discomfort, and barriers to occupational performance, future body armour systems should cater to the wide range of female breast and torso shapes and sizes.

Abstract Background Individuals with borderline personality disorder (BPD) may experience additional challenges in their parenting role, including increased stress and lower self-efficacy and satisfaction. These difficulties have been shown to impact their children, and may be implicated in the potential intergenerational transmission of personality vulnerabilities. Methods Parental stress and competence variables were examined in a cross-sectional study of 284 parents (94.72% female, M = 37.37, SD = 8.04 years), of which 69 (24.30%) met caseness for BPD criteria. We completed a multivariate analysis of variance to test how parents with ‘high BPD features’ (meeting caseness for BPD) compared to those with ‘low BPD features’ on a range of parenting and mental health variables. Multivariate linear regression modelling was then utilised to explore whether these parenting variables were associated with personality and psychological wellbeing, recalled trauma history, orientation to attachment relationships and reflective capacity. Results Individuals high in BPD features experienced more stress and lower competence in their parenting role than those low in BPD features. These parents also reported more personality vulnerabilities, poorer psychological wellbeing, recalled more traumatic experiences in their childhood, were more likely to endorse insecure attachment styles and had poorer reflective capacity. In the regression model, parenting stress and competence was associated with personality traits, general psychological wellbeing, recalled trauma history, attachment style and reflective capacity variables. Parental reflective capacity had the strongest association with parenting stress, satisfaction, efficacy, the perception of having a difficult child and a difficult parent-child relationship, and psychological wellbeing had the greatest association with parenting distress. Conclusions Parents who were able to imaginatively enter the subjective world of the child and hold the child’s mind in mind with less certainty, reported reduced parenting stress and greater parenting satisfaction and efficacy. Helping to improve personality and mental health functioning, increasing parental reflective capacity and strengthening parent-child attachment relationships, may reduce parenting stress and increase parenting competence in individuals with BPD.

BackgroundSubstance use disorders (SUDs) are a common yet poorly studied comorbidity in individuals with psychotic disorders. The co-occurrence of the two complicates recovery and interferes with pharmacological and behavioral treatment response and adherence. Recently, researchers have been exploring both invasive and non-invasive neuromodulation techniques as potential treatment methods for SUDs. We review the evidence that neuromodulation may reduce substance craving and consumption in individuals with schizophrenia.MethodsA comprehensive literature search of PubMed, MEDLINE, and PsycINFO databases was conducted (N = 1,432). Of these, we identified seven studies examining the effects of repetitive transcranial magnetic stimulation (rTMS) and two studies using transcranial direct current stimulation (tDCS) on drug consumption and craving in schizophrenia or schizoaffective disorders.ResultsDespite the limited number of studies in this area, the evidence suggests that rTMS to the dorsolateral prefrontal cortex (DLPFC) may reduce cannabis and tobacco use in patients with schizophrenia and schizoaffective disorder. Findings with tDCS, however, were inconclusive.DiscussionOur systematic review suggests that rTMS applied to DLPFC is a safe and promising therapeutic technique for the management of comorbid schizophrenia and SUDs, with the majority of the evidence in tobacco use disorder. However, there was substantial heterogeneity in study methods, underscoring the need to optimize stimulation parameters (e.g., frequency, duration, and target regions). Larger clinical trials are needed to establish the efficacy of rTMS in reducing drug consumption and craving in psychotic patients, ideally in comparison to existing pharmacological and behavioral interventions.

Cerebral palsy (CP) is caused by a variety of factors attributed to early brain damage, resulting in permanently impaired motor control, marked by weakness and muscle stiffness. To find out if altered physiology of spinal motoneurons (MNs) could contribute to movement deficits, we performed whole-cell patch-clamp in neonatal rabbit spinal cord slices after developmental injury at 79% gestation. After preterm hypoxia-ischemia (HI), rabbits are born with motor deficits consistent with a spastic phenotype including hypertonia and hyperreflexia. There is a range in severity, thus kits are classified as severely affected, mildly affected, or unaffected based on modified Ashworth scores and other behavioral tests. At postnatal day (P)0–5, we recorded electrophysiological parameters of 40 MNs in transverse spinal cord slices using whole-cell patch-clamp. We found significant differences between groups (severe, mild, unaffected and sham control MNs). Severe HI MNs showed more sustained firing patterns, depolarized resting membrane potential, and fired action potentials at a higher frequency. These properties could contribute to muscle stiffness, a hallmark of spastic CP. Interestingly altered persistent inward currents (PICs) and morphology in severe HI MNs would dampen excitability (depolarized PIC onset and increased dendritic length). In summary, changes we observed in spinal MN physiology likely contribute to the severity of the phenotype, and therapeutic strategies for CP could target the excitability of spinal MNs.

There is mounting evidence that North Americans are better able to remember faces of targets who belong to the same social group, and this is true even when the social groups are experimentally created. Yet, how Western cultural contexts afford the development of this own group face recognition bias remains unknown. This question is particularly important given that recent findings suggest that first-generation East Asian Canadians do not show this bias. In the current research, we examined the own-group bias among first- and second-generation East Asian Canadians, who vary systematically in their exposure to and engagement in a Western cultural context, and tested mediators that could explain any difference. In Study 1, second-generation East Asian Canadians showed better memory for same-group (vs. other-group) faces. In Studies 2 and 3, as well as a meta-analysis of all three studies, we found some additional evidence that second-generation East Asian Canadians show better memory for same-group (vs. other-group) faces, whereas first-generation East Asian Canadians do not, but only when each cultural group was examined separately in each study, as no interaction with generational status emerged. In Study 2, and in a higher powered pre-registered Study 3, we also examined whether second- (vs. first-) generational status had a positive indirect effect on same-group face recognition through the effects of acculturation and perceived relational mobility in the immediate social environment, however this mediation model was not supported by the data. Overall, the results provide some additional evidence that the effect of mere social categorization on face recognition may not be as consistently found among East Asian participants.

Background: Ascent to altitude increases the prevalence of arrhythmogenesis in low-altitude dwelling populations (Lowlanders). High altitude populations (i.e., Nepalese Sherpa) may have arrhythmias resistant adaptations that prevent arrhythmogenesis at altitude, though this has not been documented in other High altitude groups, including those diagnosed with chronic mountain sickness (CMS). We investigated whether healthy (CMS-) and CMS afflicted (CMS +) Andeans exhibit cardiac arrhythmias under acute apneic stress at altitude.Methods and Results: Electrocardiograms (lead II) were collected in CMS- (N = 9), CMS + (N = 8), and Lowlanders (N = 13) following several days at 4330 m (Cerro de Pasco, Peru). ECG rhythm and HR were assessed at both rest and during maximal volitional apnea. Both CMS- and CMS + had similar basal HR (69 ± 8 beats/min vs. 62 ± 11 beats/min), while basal HR was higher in Lowlanders (77 ± 18 beats/min; P < 0.05 versus CMS +). Apnea elicited significant bradycardia (nadir −32 ± 15 beats/min; P < 0.01) and the development of arrhythmias in 8/13 Lowlanders (junctional rhythm, 3° atrio-ventricular block, sinus pause). HR was preserved was prior to volitional breakpoint in both CMS- (nadir −6 ± 1 beat/min) and CMS + (1 ± 12 beats/min), with 2/17 Andeans developing arrhythmias (1 CMS+ and 1 CMS-; both Premature atrial contraction) prior to breakpoint.Conclusion: Andeans showed an absence of arrhythmias and preserved HR response to volitional apnea at altitude, demonstrating that potential cardio-resistant adaptations to arrhythmogenesis exist across permanent HA populations. Acclimatized Lowlanders have further demonstrated an increased prevalence of arrhythmias at altitude.

Interest pertains to an individual’s psychological arousal toward a topic, which is thought to motivate effort allocation and attention. Interest in leadership has been identified as a potential antecedent of leader development; however, supporting empirical evidence has been hindered by the lack of a relevant scale to measure the construct. Study 1 outlines the development of the Interest in Leadership Scale (ILS) using Rasch scale development principles. Study 2 establishes the predictive validity of the ILS with self-rated leadership emergence and transformational leadership behaviors. This measure is likely to prove useful in the future measurement of and research into the topic of interest in leadership.

Abstract Background Medial tibial stress syndrome (MTSS) is a lower leg injury with a reported incidence rate of up to 35% in active individuals. Although numerous prospective studies have tried to identify risk factors for developing MTSS, managing the syndrome remains difficult. One risk factor yet to be extensively explored in MTSS development is reduced lower leg girth. Further investigation of reduced lower leg girth is required due to the important role lower leg musculature plays in attenuating ground reaction forces during the gait cycle. Therefore, the primary aim of this study is to ascertain whether lower leg muscle morphology and function contribute to the development of MTSS. Our ultimate aim is to identify potential risk factors for MTSS that can be targeted in future studies to better manage the injury or, preferably, prevent individuals developing MTSS. Methods This study will be prospective in design and will recruit asymptomatic distance runners. All participants will be tested at base line and participants will have their training data longitudinally tracked over the following 12 months to assess any individuals who develop MTSS symptoms. At base line, outcome measures will include bilateral measures of lower limb anthropometry; cross sectional area (CSA) and thickness of the tibialis anterior, peroneals, flexor digitorum longus, flexor hallucis longus and thickness of soleus, medial and lateral head of gastrocnemius. Tibial bone speed of sound, ankle dorsiflexion range of motion, strength of the six previously described muscles, foot alignment and ankle plantar flexor endurance will also be assessed. Participants will also complete a treadmill running protocol where three-dimensional kinematics, plantar pressure distribution and electromyography data will be collected. Discussion This study will aim to identify characteristics of individuals who develop MTSS and, in turn, identify modifiable risk factors that can be targeted to prevent individuals developing this injury.