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2. The International Olympic Committee framework on fairness, inclusion and nondiscrimination on the basis of gender identity and sex variations does not protect fairness for female athletes

Author

Lundberg, T. R., Tucker, R., McGawley, Kerry, Williams, A. G., Millet, G. P., Sandbakk, Ø., Howatson, G., Brown, G. A., Carlson, L. A., Chantler, S., Chen, M. A., Heffernan, S. M., Heron, N., Kirk, C., Murphy, M. H., Pollock, N., Pringle, J., Richardson, A., Santos-Concejero, J., Stebbings, G. K., Christiansen, A. V., Phillips, S. M., Devine, C., Jones, C., Pike, J., Hilton, E. N., Lundberg, T. R., Tucker, R., McGawley, Kerry, Williams, A. G., Millet, G. P., Sandbakk, Ø., Howatson, G., Brown, G. A., Carlson, L. A., Chantler, S., Chen, M. A., Heffernan, S. M., Heron, N., Kirk, C., Murphy, M. H., Pollock, N., Pringle, J., Richardson, A., Santos-Concejero, J., Stebbings, G. K., Christiansen, A. V., Phillips, S. M., Devine, C., Jones, C., Pike, J., and Hilton, E. N.

Abstract

The International Olympic Committee (IOC) recently published a framework on fairness, inclusion, and nondiscrimination on the basis of gender identity and sex variations. Although we appreciate the IOC's recognition of the role of sports science and medicine in policy development, we disagree with the assertion that the IOC framework is consistent with existing scientific and medical evidence and question its recommendations for implementation. Testosterone exposure during male development results in physical differences between male and female bodies; this process underpins male athletic advantage in muscle mass, strength and power, and endurance and aerobic capacity. The IOC's “no presumption of advantage” principle disregards this reality. Studies show that transgender women (male-born individuals who identify as women) with suppressed testosterone retain muscle mass, strength, and other physical advantages compared to females; male performance advantage cannot be eliminated with testosterone suppression. The IOC's concept of “meaningful competition” is flawed because fairness of category does not hinge on closely matched performances. The female category ensures fair competition for female athletes by excluding male advantages. Case-by-case testing for transgender women may lead to stigmatization and cannot be robustly managed in practice. We argue that eligibility criteria for female competition must consider male development rather than relying on current testosterone levels. Female athletes should be recognized as the key stakeholders in the consultation and decision-making processes. We urge the IOC to reevaluate the recommendations of their Framework to include a comprehensive understanding of the biological advantages of male development to ensure fairness and safety in female sports.

Published
2024
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4. Refining a primary care shared decision-making aid for lifestyle change: a mixed-methods study.

Author

Heron, N, O'Connor, SR, Kee, F, Thompson, DR, Cupples, M, Donnelly, M, Heron, N, O'Connor, SR, Kee, F, Thompson, DR, Cupples, M, and Donnelly, M

Abstract

BACKGROUND: The important role of primary care in promoting healthy lifestyle behaviours needs informed support. AIM: To elicit views on a 39-item shared decision-making (SDM) aid (SHARE-D) for lifestyle change and refine it to improve implementation. DESIGN & SETTING: Mixed-methods study. METHOD: Health professionals, patients, and support workers, with experience of managing or a history of cardio- or cerebrovascular disease, were purposively recruited based on age, sex, and urban/rural location (n = 34). Participants completed a survey, rating the importance of including each item in a decision-aid, designed for use by patients with health professionals, and suggesting modifications. Semi-structured interviews (n = 30/34) were conducted and analysed thematically. RESULTS: Substantial agreement was observed on rating item inclusion. Based on survey and interview data, 9/39 items were removed; 13 were amended. Qualitative themes were: 1) core content of the decision-aid; 2) barriers to use; 3) motivation for lifestyle change; and 4) primary care implementation. 'Self-reflective' questions and goal setting were viewed as essential components. The paper-based format, length, clarity, and time required were barriers to its use. Optional support considered within the aid was seen as important to motivate change. A digital version, integrated into patient record systems was regarded as critical to implementation. A revised 30-item aid was considered suitable for facilitating brief conversations and promoting patient autonomy. CONCLUSION: The SHARE-D decision aid for healthy lifestyle change appears to have good content validity and acceptability. Survey and interview data provided in-depth information to support implementation of a refined version. Further studies should examine its effectiveness.

Published
2022

6. Exploration of sedentary behaviour among general practitioners: A cross-sectional study

Author

Mayne, RS, Hart, ND, Tully, MA, Wilson, JJ, Brønd, JC, and Heron, N

Subjects
RA0421, R1
Abstract

BACKGROUND: Sedentary behaviour, which may have increased among GPs due to increasing use of telemedicine, is associated with many illnesses and increased all-cause mortality. AIM: To explore levels of sedentary behaviour among GPs and General Practice Specialty Trainees (GPSTs). DESIGN & SETTING: Sequential, cross-sectional design (initial online sedentary behaviour questionnaire, subsequent thigh-worn accelerometer sub-study) of GPs and GPSTs in Northern Ireland. METHOD: Self-reported questionnaire data were aggregated and compared with device-measured accelerometry data. RESULTS: Data from 353 participants (17.7% of GPs and GPSTs in Northern Ireland) revealed doctors in general practice self-reported higher workday sedentary time (10.33 (SD =2.97) hours) than those in secondary care (7.9 (SD =3.43) hours) (MD 2.43 hours; P

Published
2021

7. Musculoskeletal pain and its impact on prognosis following hospitalisation for acute coronary syndrome or cerebrovascular accident: a linked electronic health record cohort study (MSKCOM)

Author

Mason, KJ, Jordan, K, Achana, F, Bailey, J, Chen, Y, Frisher, M, Heron, N, Huntely, A, Mallen, C, Mamas, M, Marshall, M, Png, ME, Tatton, S, White, S, and Edwards, JJ

Subjects
RC925, R1, RA
Abstract

Background: There is evidence that painful musculoskeletal conditions are associated with increased risk of cardiovascular disease, but less is known about whether this impacts on prognosis of cardiovascular disease. The aim was to determine whether patients with painful musculoskeletal conditions have poorer prognosis following acute coronary syndrome (ACS) or cerebrovascular accident (CVA). The Approach: Data were obtained from national primary care records (Clinical Practice Research Datalink; CPRD) with linkage to hospitalisation and mortality records. Patients aged >45 years with incident ACS/CVA recorded in primary care and a hospital admission within ±30 days were included. Patients were stratified by consultations in primary care for painful musculoskeletal conditions (by severity and by conditions) in the 24 months prior to ACS/CVA. Severe musculoskeletal pain was defined as prescription of strong analgesia or referral in the 6 months before ACS/CVA. Outcomes included short-term (length of stay; readmission and mortality within 30 days of discharge), management (procedures during admission; prescriptions in the 3 months post-admission) and long-term (further ACS/CVA or mortality >30 days post-discharge). Findings: There were 171,670 patients with incident ACS (median age 70 years; 36% female) and 138,512 with incident CVA (median age 76 years; 49% female); 30% of patients consulted for musculoskeletal pain prior to ACS/CVA. Patients with musculoskeletal pain were not at increased risk of worse outcomes after ACS/CVA compared to those without pain after adjustment for socio-demographics and comorbidity. Patients with severe musculoskeletal pain or inflammatory condition were more likely to receive a procedure for ACS, and prescriptions for ACS and CVA management. Implications: Whilst this study is reassuring given the high prevalence and disabling nature of musculoskeletal conditions, it has highlighted the complexity of patients with severe musculoskeletal pain and new onset ACS and CVA including their burden of cardiovascular risk and prognostic factors.

Published
2021

8. Infographic: A Journey Around the COVID-19 vaccine for Athletes

Author

Rankin, A., McLarnon, M., Hull, J.H., Gomes, C., and Heron, N.

Subjects
SDG 3 - Good Health and Well-being, vaccine, Covid 19, athlete, COVID-19 guidance
Abstract

IntroductionThis infographic outlines considerations for athletes and their teams around vaccination against the SARS-CoV-2 (Covid-19) virus. There are currently three vaccines approved for use in the United Kingdom (UK); Pfizer/BioNTech, Moderna and Oxford/AstraZenica. It is important for athletes and their physicians to be aware of the potential side effects from any given COVID-19 vaccination, pros and cons of vaccination in a low-risk population, and the logistics of training around vaccination administration. Finally, education surrounding vaccination may help combat vaccine hesitancy in an athletic population.

Published
2021

9. MOVE YOUR FEET, LOSE YOUR SEAT

Author

Rhonda Mayne, Hart, N., and Heron, N.

Subjects
general practice, Medicine(all), Game Changers, Sedentary Behavior
Published
2021

10. A review of the quality and content of mobile apps to support lifestyle modifications following a transient ischaemic attack or 'minor' stroke.

Author

O'Connor, SR, Kee, F, Thompson, DR, Cupples, ME, Donnelly, M, Heron, N, O'Connor, SR, Kee, F, Thompson, DR, Cupples, ME, Donnelly, M, and Heron, N

Abstract

OBJECTIVE: Secondary prevention is recommended to reduce cardiovascular risk after transient ischaemic attack (TIA) or 'minor' stroke. Mobile health interventions can provide accessible, cost-effective approaches to address modifiable risk factors, such as physical inactivity, hypertension and being overweight. The objective of this study was to evaluate the quality of apps for supporting lifestyle change following a TIA or 'minor' stroke. METHODS: Systematic searches of Google Play and the Apple Store were carried out to identify mobile apps released between 1 November 2019 and 1 October 2021. Keywords were used including stroke, TIA, lifestyle, prevention and recovery. Quality was assessed using the Mobile Application Rating Scale (MARS). Common components were identified with the Behaviour Change Technique (BCT) Taxonomy. Descriptive statistics were used to summarize the performance results for each app. RESULTS: Searches identified 2545 potential apps. Thirty remained after removing duplicates and screening titles and descriptions. Six were eligible after full review of their content. All apps included at least one BCT (range: 1-16 BCTs). The most frequent BCTs included 'information about health consequences' (n = 5/6), 'verbal or visual communication from a credible source' (n = 4/6) and 'action planning' (n = 4/6). The mean MARS score was 2.57/5 (SD: 0.51; range: 1.78-3.36). No apps were of 'good' overall quality (scoring more than 4/5). CONCLUSIONS: This is the first review of mobile health interventions for this population. Only a small number of apps were available. None were targeted specifically at people with a TIA or 'minor' stroke. Overall quality was low. Further work is needed to develop and test accessible, user designed, and evidence-informed digital interventions in this population.

Published
2021

11. Development of a Digital Lifestyle Modification Intervention for Use after Transient Ischaemic Attack or Minor Stroke: A Person-Based Approach.

Author

Heron, N, O'Connor, SR, Kee, F, Thompson, DR, Anderson, N, Cutting, D, Cupples, ME, Donnelly, M, Heron, N, O'Connor, SR, Kee, F, Thompson, DR, Anderson, N, Cutting, D, Cupples, ME, and Donnelly, M

Abstract

This paper describes the development of the 'Brain-Fit' app, a digital secondary prevention intervention designed for use in the early phase after transient ischaemic attack (TIA) or minor stroke. The aim of the study was to explore perceptions on usability and relevance of the app in order to maximise user engagement and sustainability. Using the theory- and evidence-informed person-based approach, initial planning included a scoping review of qualitative evidence to identify barriers and facilitators to use of digital interventions in people with cardiovascular conditions and two focus groups exploring experiences and support needs of people (N = 32) with a history of TIA or minor stroke. The scoping review and focus group data were analysed thematically and findings were used to produce guiding principles, a behavioural analysis and explanatory logic model for the intervention. Optimisation included an additional focus group (N = 12) and individual think-aloud interviews (N = 8) to explore perspectives on content and usability of a prototype app. Overall, thematic analysis highlighted uncertainty about increasing physical activity and concerns that fatigue might limit participation. Realistic goals and progressive increases in activity were seen as important to improving self-confidence and personal control. The app was seen as a useful and flexible resource. Participant feedback from the optimisation phase was used to make modifications to the app to maximise engagement, including simplification of the goal setting and daily data entry sections. Further studies are required to examine efficacy and cost-effectiveness of this novel digital intervention.

Published
2021

12. 'Active consulting' during and post covid-19: opportunities for clinicians to move more

Author

Mayne, Richard S., Hart, N. D., and Heron, N.

Subjects
Medicine(all), SDG 3 - Good Health and Well-being, Physical activity, Health promotion, Sedentary behaviour
Abstract

IntroductionPrior to the COVID-19 pandemic, the majority of clinical work for most healthcare professionals involved face-to-face consultation with patients. Throughout the working day, in both inpatient and outpatient settings, clinicians had many opportunities to expend energy by breaking up their sedentary time with physical activity. In the hospital setting, working on wards and in emergency departments has always required physical movement among staff in order to provide effective care for patients. This has remained a necessity despite the COVID-19 pandemic. In many hospital settings, the energy expenditure of staff may even have increased due to the wearing of personal protective equipment (PPE)1. In the outpatient and community settings, however, the arrival of the COVID-19 pandemic has resulted in rapid changes to traditional consulting practices which may have detrimental effects on the levels of sedentary behaviour and physical activity among clinicians in these environments. Almost overnight, when the first wave of COVID-19 infections was reaching its peak, most clinicians in outpatient and community settings switched to remote consulting where possible, using telehealth methods such as telephone and video2-4. There are many advantages of telehealth, such as reduced transmission of communicable diseases, and the potential for better time-efficiency2,4. There are also numerous disadvantages, such as reduced patient rapport, and less ability to pick up on non-verbal cues and incidental findings2,4. The pros and cons of remote consulting could be debated extensively, and vary depending on the clinical and situational context. Regardless of the positive and negative consequences of this rapid shift towards remote consulting, it is likely that it is here to stay. Addressing all of the good and bad points of remote consulting is beyond the scope of this paper. Instead, this paper examines the effects of remote consulting on the sedentary behaviour and physical activity of healthcare professionals.

Published
2020

15. Abstracts from the NIHR INVOLVE Conference 2017

Author

Muir, D., Vat, L.E., Keller, M., Bell, T., Jørgensen, C.R., Eskildsen, N.B., Johnsen, A.T., Pandya-Wood, R., Blackburn, S., Day, R., Ingram, C., Hapeshi, J., Khan, S., Baird, W., Pavitt, S.H., Boards, R., Briggs, J., Loughhead, E., Patel, M., Khalil, R., Cooper, D., Day, P., Boards, J., Wu, J., Zoltie, T., Barber, S., Thompson, W., Kenny, K., Owen, J., Ramsdale, M., Grey-Borrows, K., Townsend, N., Johnston, J., Maddison, K., Duff-Walker, H., Mahon, K., Craig, L., Collins, R., O’Grady, A., Wadd, S., Kelly, A., Dutton, M., McCann, M., Jones, R., Mathie, E., Wythe, H., Munday, D., Millac, P., Rhodes, G., Roberts, N., Simpson, J., Barden, N., Vicary, P., Wellings, A., Poland, F., Jones, J., Miah, J., Bamforth, H., Charalambous, A., Dawes, P., Edwards, S., Leroi, I., Manera, V., Parsons, S., Sayers, R., Pinfold, V., Dawson, P., Gibbons, B., Gibson, J., Hobson-Merrett, C., McCabe, C., Rawcliffe, T., Frith, L., Gudgin, B., Wellings, A.., Horobin, A., Ewart, C., Higton, F., Vanhegan, S., Stewart, J., Wragg, A., Wray, P., Widdowson, K., Brighton, L.J., Pask, S., Benalia, H., Bailey, S., Sumerfield, M., Etkind, S., Murtagh, F.E.M., Koffman, J., Evans, C.J., Hrisos, S., Marshall, J., Yarde, L., Riley, B., Whitlock, P., Jobson, J., Ahmed, S., Rankin, J., Michie, L., Scott, J., Barker, C.R., Barlow-Pay, M., Kekere-Ekun, A., Mazumder, A., Nishat, A., Petley, R., Brady, L-M.., Templeton, L., Walker, E., Moore, D., Shaw, L., Nunns, M., Thompson Coon, J., Blomquist, P., Cochrane, S., Edelman, N., Calliste, J., Cassell, J., Mader, L.B., Kläger, S., Wilkinson, I.B., Hiemstra, T.F., Hughes, M., Warren, A., Atkins, P., Eaton, H., Keenan, J., Rhodes, C., Skrybrant, M., Chatwin, L., Darby, M-A., Entwistle, A., Hull, D., Quann, N., Hickey, G., Dziedzic, K., Eltringham, S.A., Gordon, J., Franklin, S., Jackson, J., Leggett, N., Davies, P., Nugawela, M., Scott, L., Leach, V., Richards, A., Blacker, A.., Abrams, P., Sharma, J., Donovan, J.., Whiting, P., Stones, S.R., Wright, C., Boddy, K., Irvine, J., Harris, J., Joseph, N., Kok, M., Gibson, A., Evans, D., Grier, S., MacGowan, A., Matthews, R., Papoulias, C., Augustine, C., Hoffman, M., Doughty, M., Surridge, H., Tembo, D., Roberts, A., Chambers, E., Beever, D., Wildman, M., Davies, R.L., Staniszewska, S., Stephens, R., Schroter, S., Price, A., Richards, T., Demaine, A., Harmston, R., Elliot, J., Flemyng, E., Sproson, L., Pryde, L., Reed, H., Squire, G, Stanton, A.., Langley, J., Briggs, M., Brindle, P., Sanders, R., McDermott, C., Coyle, D., Heron, N., Davies, S., Wilkie, M., Coldham, T., Ballinger, C., Kerridge, L., Mullee, M., Eyles, C., Johns, T., Paylor, J., Turner, K., Whiting, L., Roberts, S., Petty, J., Meager, G., Grinbergs-Saull, A., Morgan, N., Collins, F., Gibson, S., Passmore, S., Evans, L., Green, S.A., Trite, J., Thomson, R., Green, D., Atkinson, H., Mitchell, A., Corner, L., McKenzie AM, A., Nguyen, R, Frank, B., McNeil, N., and Harrison, H.

Subjects
lcsh:R5-920, lcsh:R, lcsh:Medicine, lcsh:Medicine (General), Meeting Abstracts
Published
2017

18. Femoral exostosis causing vastus medialis pain in an active young lady: a case report

Author

Heron, N

Subjects
Medicine(all), Biochemistry, Genetics and Molecular Biology(all), R1, RA
Abstract

BACKGROUND:Musculoskeletal conditions are a common reason for consultation to General Practitioners (GPs)/family physicians in primary care. Osteochondromas are the most common benign bone tumours and usually occur in the metaphyseal region of long bones. Despite the distal femur being the commonest location to find these benign bone tumours, this is the first case report in the literature specifically describing vastus medialis muscle pain as the presenting symptom due to underlying bursa formation secondary to local pressure effects.CASE PRESENTATION:Twenty nine year old female of white British ethnic origin, presenting to a primary care clinic with a three year history of intermittent left distal medial thigh pain.CONCLUSION:The benign bone tumour, femoral exostosis/osteochondroma, was diagnosed via Magnaetic Resonance Imaging (MRI) and treated conservatively, with surgical excision an option if not resolving. GPs/family physicians need to be aware of this diagnosis and that femoral exostosis/osteochondroma can present to primary care physicians, particularly within the second decade of life.

Published
2015
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19. Abstracts

Author

Frankenfeld John W., Schulz Wolfgang, McMurty George J., Petersen Gary W., May G. A., Hering F. S., Schwartz J. I., Heywood J. B., Chigier N. A., Grohse E. W., Walker J. D., Colwell R. R., Petrakis L., Pergament H. S., Thorpe R. D., Schoepf Richard W., Krzyczkowski Roman, Henneman Suzanne S., Hudson Charles L., Putnam Evelyn S., Thiesen Donna J., Parks G. A., McCarty Perry L., Leckie J. O., Schrumpf Barry J., Simonson G. H., Paine D. P., Lawrence R. D., Pyott W. T., Leh M., Elders W., Combs J., Caplen T., Harrison F. L., Wong K. M., Heft. R. E., Charnell Robert L., Lehmann Edward J., Mallon Lawrence G., Hatfield Cecile, Adams Gerald H., Johanning James, Talvitie Antti, Noll Kenneth E., Miller Terry, Smiarowski Joseph F., Willis Cleve E., Foster John H., Schlesinger Benjamin, Daetz Douglas, Lear Donald U., Smith Mona F., Hundemann Audrey S., Crockett Pernell W., Werner Kirk G., Carroll Thomas E., Maase David L., Genco Joseph E., Ifeadi Christopher N., Lowman F. G., Christensen S. W., Van Winkle W., Mattice J. S., Harrison Elizabeth A., Barker James C., Chesness Jerry L., Smith Ralph E., Shaheeen Donald G., Raney R. Keith, Borton T., Wezernak C. T., Raney R. K., Sherwani Jabbor K., Moreau David H., Eisenberg Norman A., Lynch Cornelius J., Breeding Roger J., Johnson J. D., Foster K. E., Mouat D. A., Clark R., Hyden John William, Owen, Wilfred, Bayfield, Neil G., Barrow, Graham C., Stolz, Stephanie B., Wienckowski, Louis A., Brown, Betram S., Keyfitz, Nathan, Wilson, W. L., Newman, Peter W. G., Bammi, Deepak, Bammi, Dalip, Goddard, James E., Chisholm, Tony, Walsh, Cliff, Brennan, Geoffrey, Thompson, K. S., Richardson, R., Jensen, Clayton E., Brown, Dail W., Mirabito, John A., Cowing, Thomas G., Binghamton, Suny, Siehl, George H., Albrecht, O. W., Alexander, Ariel, Barde, Jean -Philippe, Darby, William P., McMichael, Francis Clay, Dunlap, Robert W., Muckleston, Keith W., Frankenhoff, Charles A., Giulini, Lorenzo T., Wyatt, T., Black, Peter E., Keating, William Thomas, Leonard, M. E., Fisher, E. L., Brunelle, M. F., Dickinson, J. E., Pethig, Rudiger, Clapham, Jr., W. B., Boserup, Ester, James, Jr., Franklin J., Parenteau, Patrick A., Catz, Robert S., Seneca, Joseph J., Davis, Robert K., Sievering, H., Sinopoli, J., Gamble, Hays B., Bevins, Malcolm I., Cole, Gerald L., Donald, Donn Derr, Tobey, M., Domokos, Mikklos, Weber, Jean, Duckstein, Lucien, Knudson, Douglas M., Barron, J. C., Dickinson, T. E., Schwartz, S. I., Hansen, D. E., Myrup, L. O., Rogers, D. L., Bodege, R., Braatz, U., Heger, H., McConnell, K. E., Duff, Virginia A., Adede, A. O., Zeckhauser, Richard, Kolbye, A. C., Schussel, George, Pisano, Mark A., Bartolotta, R. J., Budnitz, Robert J., Holdren, John P., Wills, Richard H., Sen, P. K., Ghoshal, S. N., Wonders, William C., Bartolotta, Robert J., Leich, Harold H., Gwvnne, P., Miller, S. S., Picardi, Anthony C., Seifer, William W., Bowbrick, P., Hunt, S. E., Keays, J. L., Fisher, Anthony C., Peterson, Frederick M., Cesario, F. J., Knetsch, J. L., Wood, C., Lee, N., Puechl, Karl H., Robert, J., Hansen, David E., Foin, T. C., Wolpert, Julian, Moskow, Michael H., Phillips, Joseph A., Hicks, Jesse L., Nobbs, Christopher L., Pearce, David W., Schoenbau, Thomas J., Rosenberg, Ronald H., Ravenholt, R. T., Kim, K. D., Groves, David L., McCart, Gerald D., Ewald, Jr., W. R., Dando, W. A., Gebelein, C. A., Martin, W. H., Mason, S., Ostrovskii, A. A., Currie, David P., Payne, P. R., Rosentraub, Mark S., Warren, Robert, Irland, Lloyd C., Booth, A., Kolb, Kenneth H., Caldwell, Lynton K., Johnson, W. H., Brewer, Max C., Bowden, Gerald, Haney, Paul D., Logue, D. E., Sweeney, R. J., Egbuniwe, Nnamdi, Heron, N., Franssen, H. T., Wranglen, G., Fairfax, Sally K., Pinhey, Thoma K., Paterson, Karen W., Sitterlev, John H., Connaughton, Charles A., De Viedman, M. G., Leon, F., Coronado, R., Myers, John G., Nakamura, Leonard I., Madrid, Norman R., Bar-Shalom, Y., Cohen, A. J., Seldman, Neil N., Hardy, Jr., William E., Grissom, Curtis L., Quarles, Jr., John R., Gee, Edwin A., Chaudhri, D. P., Infanger, Craig L., Bordeauz, Jr., A. Frank, Dougal, Merwin D., Ganotis, C. G., Hopper, R. E., Boyd, J., Woodard, Kim, Haedrich, R. L., Thompson, R. G., Lievano, R. J., Stoneburner, D. L., Smock, L. A., Eichhorn, H. C., Montalvo, J. G., Lee, C. G., von Jeszensky, T., Dunn, I. J., Wilson, M. J., Swindle, Jr., D. W., Runove, T. G., Pearson, T. H., Rosenberg, R., Sharp, Jr., John M., Greist, David A., Kinard, J. T., Tisdale, J., Alexander, E., Stone, Ralph, Willis, Robert, Anderson, Donald R., Dracup, John A., Rogers, C. J., Hunter, John M., Cassola, Fabio, Lovari, Sandro, Tew, R. W., Egdorf, S. S., Deacon, J. E., Sly, George R., Brandvold, D. K., Popp, C. J., Brierley, J. A., Zeidler, Ryszard B., Gonzalez, R. H., Lapage, S. P., Cornish, Edward S., Ryerson, Foresman, D. K., Walejko, R. N., Paulson, W. H., Pendleton, J. W., Fowler, Bruce A., Minckler, Leon S., Wallis, I. G., Nebel, C., Gottschling, R. D., Unangst, P. C., O'Neill, H. J., Zintel, G. V., Reid, F., Ricci, L. J., Odum, Eugene P., Johnson, J. H., Sturino, E. E., Bourne, S., Richerson, Jim V., Cameron, E. Alan, Brown, Elizabeth A., Stopford, W., Goldwater, L. J., Gray, John, Jorgensen, S. E., Santhirasegaram, K., Chapman, J. D., Skelton, Thomas E., Stahl, D., Herzog, Jr., Henry W., Matsunaka, S., Kuwatsuka, S., Tatsukawa, R., Wakimoto, T., Moyle, Peter B., Kornilov, B. A., Timoshkina, V. A., Johnstone, Peter A., McMinn, James W., Hewlett, John D., Cunha, T. J., Cameron, Guy N., Blais, J. R., Macgregor, Alan, Martin, G. D., Mulholland, R. J., Thornton, K. W., Spano, L. A., Medeiros, J., Ostarhild, H., Minnick, D. R., Hayden, Bruce P., Dolan, Robert, Rendel, J., Lee, J. A., Leistra, M., Frye, R. D., Ramse, David, Safferman, R. S., Morris, Mary -Ellen, Lisella, Frank S., Johnson, Wilma, Lewis, Claudia, Kutt, E. C., Martin, D. F., Prakash, A., Kunkle, S. H., Mrak, E. M., Bruce, R. R., Harper, L. A., Leonard, R. A., Snyder, W. M., Thomas, A. W., Eckholm, Erik P., Snelling, John C., Veblen, Thomas T., Buckhouse, J. C., Gifford, G. F., Fosberg, F. R., Naveh, Z., Kelcey, J. G., Scanlon, John W., Lijinsky, W., Elias, Thomas S., Philip, M. S., Kverno, Nelson B., Mitchell, G. Clay, Gysin, H., Morita, M., Mimura, S., Ohi, G., Yagyu, H., Nishizawa, T., Worcester, B. K., Brun, L. J., Doering, E. J., Hiatt, V., Huff, J. E., Pfeffer, J. T., Liebman, J. C., Ray, William, Ramamurthy, V. C., Black, A. H., Coty, A., Kassler, H., Dixon, R. L., Trout, Thomas J., Smith, James L., McWhorter, David B., Rowe, M. C., Quinlan, A. V., Paynter, H. M., Born, D., Roth, D., Wall, G., Schindler, D. W., Frost, P. G. H., Siegfried, W. R., Cooper, J., MacDonald, S., Mason, C. F., Bar, F., Moore, G., Coldrick, John, Selman, P. H., Dempster, J. P., King, M. L., Lakhani, K. H., Evans, G. Clifford, Coote, D. R., Haith, D. A., Zwerman, P. J., Herricks, Edwin E., Shanholtz, Vernon O., Smith, V. K., Johnson, D. Gale, Mitsch, W. J., Fried, Maurice, Tanji, Kenneth K., Van De Pol, Ronald M., Dawson, Allan, Smith, Malcolm, McLaren, Neil, Cooley, James L., Moran, J. W., Witter, L. D., Tomlinson, E. J., Cheremisinoff, Paul N., Holcomb, William F., Hall, J. M., Kerut, E. G., Irico, J., Bower, L. C., Duggan, J. B., Cleasby, J. L., Klein, David H., Andren, Anders W., Bolton, Newell E., Joshi, Ramesh C., Duncan, Donald M., McMaster, Howard M., Russell, George A., Hochstein, Anatoly B., Elgohary, F. A., Brooks, D. J., Brainard, F. S., Ott, W. R., Thorn, G. C., Panicker, N. N., Middleton, A. C., Lawrence, A. W., Hannigan, John T., Post, R. F., Hall, D. G., White, K. E., Shaw, E. M., Sidwick, J. M., Preston, J. R., Nichol, Janet E., Maxwell, Bruce, Watson, M. B., Kammer, W. A., Langley, N. P., Selzer, L. A., Beck, R. L., Munn, Harold C., Peirano, Lawrence E., Cooper, Charles F., Kruger, Paul, Zebroski, E., Levenson, M., Mason, B. J., Rehberger, Glenn W., Field, A. A., Jones, John F., Penner, S. S., Black, Francis M., High, Larry E., Sigsby, John E., Janssens, M., Darns, R., Giebel, J., Dilaj, Michael, Lenard, John F., Beran, D. W., Linden, H. R., Bodle, W. W., Lee, B. S., Vyas, K. C., Golueke, Clarence G., McCurdy, P. H., Hines, W. G., Rickert, D. A., McKenzie, S. W., Bennett, J. P., Goldstein, Elliot, Ragaini, Richard C., Pearl, Richard Howard, Turner, Norma, Miller, Terry L., Noll, Kenneth E., Etzel, James E., Bell, John M., Lindermann, Eckhart G., Lancelot, Charles J., Lane, Dennis D., Stukel, James J., Lee, G. F., Morse, Frederick H., Simmons, Melvin K., Alpert, S. B., Lundberg, R. M., Schmidt, Richard A., Hill, George R., Anspaugh, Lynn R., Harem, F. E., Bielman, K. O., Worth, J. E., Kuester, J. L., Lutes, L., Henten, M. Patricia, Tazieff, Haroun, Patrick, P. K., Baker, Ralph N., Kalhammer, Fritz R., Schneider, Thomas R., Landwehr, J. Maciunas, Deininger, R. A., Rattien, Stephen, Eaton, David, Dezeeuw, R. E., Haney, E. B., Wong, R. B., De Planque Burke, Gail, Siegrist, Robert, Witt, Michael, Boyle, William C., Rickert, David A., Hines, Walter G., McKenzie, Stuart W., Brutsaert, W., Gross, G. W., McGehee, R. M., Hyzer, William G., Mohr, Adolph W., Wildman, S. V., Goldsmith, T. J., Sargent, Frederick O., Brande, Justin H., Work, Jr., Edgar A., Gilmer, David S., Hord, B. Michael, Brooner, William, Baraby, Frank, Snodgrass, W. J., O'Melia, C. R., Rollier, M. A., Kunz, R. G., Giannelli, J. F., Stensel, H. D., Moyer, W. W., Osman, F. P., Campbell, W. J., Wilson, E. M., Freeman, H. M., Hogan, B. J., Dick, R. I., Tangborn, Wendell V., Rasmussen, Lowell A., Ruff, James F., Skinner, Morris M., Winkley, Brian R., Simons, Daryl B., Dorratcague, Dennis E., Lanterman, B. A., Staudenmire, J. H., Fritz, Norman L., Williams, Richard D., Wood, Richard, Huillet, F. D., Muzyka, Ann, Fantasia, John F., Goodman, Joseph M., Anderl, Bernhard, Attmanspacher, Walter, Singh, Vijay P., Peleg, H., Scavia, D., Park, R. A., Niemann, Jr., Bernard J., Bonilla, Xavier A., Bruno, S. Richards, Rose, Richard A., Meyer, Charles F., Tempo, G E, Klumb, D., Maddock, Jr., Thomas, Chermisinoff, Paul N., Bethea, Robert M., Hellman, Thomas M., Laren, Oscar Bud, Leenheer, J. A., Malcolm, R. L., White, W. R., McNamara, John R., Windheim, L. S., Wodder, R. R., Smith, D. D., Mallan, G. M., Titlow, E. I., Peleg, M., Greco, I. R., Gregory, D. P., Pangborn, J. B., Somers, Edward V., Berg, Daniel, Fickett, Arnold P., Larsen, R. I., Heck, W. W., Cochran, Neal P., Ulaby, Fawwaz T., Bush, Thomas F., Cunningham, Ernest R., Nakada, M., Wyndham, H. B., Schulte, Harry F., Serpa, Douglas P., Young, R. L., Spell, J. E., Slu, H. M., Philip, R. H., Jones, E. R., Sprowl, James A., Kohout, Ladislav J., Gaines, Brian R., McCoy, K., Mejer, H., Reutlinger, Shlomo, Lieberman, M. A., LaNier, R., Crampton, C. B., Sabadell, J. Eleonora, Axtmann, Robert C., Josephson, J., Gutierrez, A. P., Regev, U., Summers, C. G., Daniels, A., Bach, W., Mairs, John W., Bengtsson, L., Oleckno, William A., Wildman, W. E., Neja, R. A., Clark, J. K., Larson, Don, Wagner, Frederick W., Durabb, Edwin J., Barnes, H. M., Homolya, J. B., Jacoby, Neil H., Kispert, R. G., Sadek, S. E., Wise, D. L., Nihoul, J. C. J., Foyster, A. M., Gessaman, Paul H., Sisler, Daniel G., Pinkham, C. F. A., Pearson, J. G., MacAdam, W. K., Gribbin, John, Schwartz, Seymour I., Green, F. H. W., Viscomi, B. V., Gray, S. L., McKean, J. R., Usher, M. B., Svestka, Milan, Eckholm, E. P., Johnston, H., Mausel, Paul W., Leivo, Carl Eric, Lewellen, Michael T., Nilles, Jack M., Gray, Paul, Campbell, Thomas C., Wogman, N. A., Bockris, John M., Jenne, E. A., Avotins, Peter, Nelson, D. W., Sommers, L. E., Scott, Frank M., Benz, L. C., Sandoval, F. M., Willis, W. O., Chapman, Peter F., MacDougall, E. B., Peakall, David B., Office of Technology Assessment, and Office of Science and Technology

Published
1977
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26. MOVE YOUR FEET, LOSE YOUR SEAT.

Author

Mayne, R., Hart, N., and Heron, N.

Abstract

The article reports that World Health Organisation advises individuals to minimise and break up periods of sedentary behaviour where possible after evidence linking excessive sedentary behaviour to many health problems, with a cumulative dose-response relationship with mortality risk. It mentions that one way of minimising sedentary behaviour is by using an "active workstation," such as a height-adjustable sit-stand desk.

Published
2021

27. Experimental and theoretical studies on a distributed temperature sensor based on Brillouin scattering

Author

Bao, X., Dhliwayo, J., Heron, N., Webb, David J., Jackson, David A., Bao, X., Dhliwayo, J., Heron, N., Webb, David J., and Jackson, David A.

Abstract

Results are reported from recent research on the use of the Brillouin gain/loss mechanism for distributed sensing. A theoretical model of the interaction of the pulsed and CW beams is described and compared with experiments. Results from a system with a 51 km sensing length are presented. We finally investigate issues related to the variation within the sensing fiber of the polarizations of the two beams.

Published
1995

35. Primary human herpesvirus 7 infection: A comparison of human herpesvirus 7 and human herpesvirus 6 infections in children

Author

Caserta, M.T., Hall, C.B., Schnabel, K., Long, C.E., and D'Heron, N.

Abstract

Objective: To define the clinical and virologic characteristics of primary human herpesvirus 7 (HHV-7) infection and to compare these characteristics with those of primary human herpesvirus 6 (HHV-6) infection. Study design: A prospective convenience sample study of 496 children @?3 years old. HHV-7 and HHV-6 infections were identified by viral isolation. Polymerase chain reaction and serology for HHV-7 and HHV-6 were performed. Clinical and laboratory characteristics of patients were obtained from medical records and follow-up interviews. Results: Children with primary HHV-7 infection (n = 8) were identified and compared with children with primary HHV-6 infection (n = 29) detected during the same time period. All children were febrile (mean temperature 39.8^o C) with no difference in the degree of fever, frequency of rash, or gastrointestinal complications between the groups. The median age of children with primary HHV-7 infection was 26 months, significantly older than that of children with primary HHV-6 infection (median, 9 months). Children with primary HHV-7 infection were also more likely than those with primary HHV-6 infection to have seizures associated with the illness (P = .004). Conclusion: Primary infection with HHV-7 can cause a highly febrile illness in childhood, complicated by seizures. The serologic diagnosis of primary HHV-6 and HHV-7 infections may be confounded by cross-reacting antibodies. (J Pediatr 1998;133:386-9)

Published
1998
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37. Modelling the cost effectiveness of a potential new neck collar for patients with motor neurone disease

Author

Latimer, N, Dixon, S, McDermott, CJ, McCarthy, A, Tindale, W, Heron, N, and Shaw, PJ

Abstract

Background\ud Patients with motor neurone disease (MND) suffer from reduced motility and strength of the neck muscles over time. This commonly results in difficulties with correct positioning for communicating, eating and breathing. There are a number of neck braces which available for MND patients, however they are inadequate for the majority of MND patients, and a new collar is set to be designed. This paper conducts a brief analysis of the potential cost effectiveness of such a collar.\ud \ud Methods\ud A cost-utility analysis was undertaken using a simple three state Markov model of disease progression. The key input to this model were utilities from a small health valuation survey based around scenarios describing MND and the associated symptoms and limitation relating to reduced neck motility and strength. A scenario sensitivity analysis was used to identify the price at which new neck braces could be cost-effective given different effets on uptake and effectiveness.\ud \ud Results\ud Four scenarios were examined that examined different impacts on rates of use of a neck brace and effectiveness of the new neck brace. For moderate effectiveness and no impact on non-use the maximum annual incremental collar cost to the NHS, using a funding threshold of £20,000 per quality adjusted life year, was £720. Adjusting this scenario for a large effect increases the maximum allowable cost to £960. Altering these two scenarios to include a large impact on rates of non-use produced maximum allowable costs of £800 and £1,040, respectively,\ud \ud Conclusions\ud Our analysis suggests that there is considerable scope for a new neck brace for MND patients with moderate and severe neck pain to represent a cost effective use of NHS resources. Even with a brace costing around £1,000, it is possible that it will be cost-effective. However, these results should be interpreted with great caution: the potential brace has not yet reached the final design stage and although we do not assume in this analysis that it will prove adequate for all MND patients with neck weakness, we do assume that it provides a very substantial increase in adequacy rates (18% to 50% for moderate patients, and 0% to 30-50% for severe patients).

40. 15 Variance in self-reported opioid prescribing practices by junior doctors at a district general hospital: implications for medical education

Author

Crispin, HK and Heron, N

Abstract

IntroductionOpioids are commonly prescribed by Junior Doctors in the acute hospital setting. Here we describe the self-reported behaviour of this professional group in relation to opioid prescribing for palliative in-patients at a District General Hospital.MethodA structured survey was completed by twenty-seven training grade doctors from F1-CT3 (85.2% F1 or F2). The anonymous responses related to self-reported behaviour based on recall of patient care episodes.ResultsTwo thirds of respondents were involved in the care of palliative patients on a weekly basis. Therefore, the prescribing of opioids and evaluation of treatment efficacy should be embedded into their practice.When monitoring the side-effects of opioid therapy, patients may not automatically declare these, so it is advisable to directly enquire. Seventy-three percent of respondents reported that they do so for less than half of their patients. Constipation and nausea were reported as most likely to be assessed; being ascertained at least half of the time by ninety-six percent and eighty-five percent of respondents, respectively. None of the respondents routinely enquired about bad dreams, myoclonic jerks or hallucinations.The occurrence of opioid-associated side effects, or the absence of these, are crucial findings to document in the medical record. Forty-five percent of respondents reported that they do not always document when a patient is experiencing side-effects from opioid therapy. Forty-eight percent of respondents reported that they never document the absence of opioid-associated side effects.ConclusionThis account indicates scope for improvement in the monitoring and documentation of side effects associated with opioid therapy by the Junior Doctors at this District General Hospital. These findings highlight a need for education of this staff group at a local level, and may well indicate a need for enhanced education in opioid prescribing in Medical Undergraduate Curricula.

Published
2018
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47. Reply to Williams et al.: Fair and Safe Eligibility Criteria for Women's Sport.

Author

Tucker R, Hilton EN, McGawley K, Pollock N, Millet GP, Sandbakk Ø, Howatson G, Brown GA, Carlson LA, Chen MA, Heron N, Kirk C, Murphy MH, Pringle J, Richardson A, Santos-Concejero J, Christiansen AV, Jones C, Alonso JM, Robinson R, Jones N, Wilson M, Parker MG, Chintoh A, Hunter S, Senefeld JW, O'Connor MI, Joyner M, Carneiro EM, Devine C, Pike J, and Lundberg TR

Published
2024
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48. Weight management with orlistat in type 2 diabetes: an electronic health records study.

Author

Ghosal S, Heron N, Mason KJ, Bailey J, and Jordan KP

Subjects
Humans, Female, Male, Middle Aged, Obesity, United Kingdom, Aged, Adult, Hypoglycemic Agents therapeutic use, Cohort Studies, Practice Patterns, Physicians' statistics & numerical data, Diabetes Mellitus, Type 2 drug therapy, Orlistat therapeutic use, Anti-Obesity Agents therapeutic use, Weight Loss, Electronic Health Records, Prediabetic State drug therapy
Abstract

Background: Orlistat is recommended as an adjunct to diet and exercise for weight loss in the treatment of type 2 diabetes mellitus (T2DM)., Aim: To explore associations between patient characteristics and orlistat prescribing, and to determine associations of orlistat with weight loss in T2DM and prediabetes., Design and Setting: Cohort study using anonymised health records from a UK database of general practice., Method: The UK Clinical Practice Research Datalink (CPRD) Aurum database was searched to compile a cohort of patients aged ≥18 years, first diagnosed with T2DM or prediabetes in 2016 or 2017. Once the data had been collated, multivariable logistic regression models were used to determine associations with starting orlistat and stopping it early (<12 weeks of prescriptions) and orlistat's associations with weight loss in those who had not been prescribed second-line antidiabetic medications., Results: Out of 100 552 patients with incident T2DM or prediabetes, 655 (0.8%) patients with T2DM and 128 (0.7%) patients with prediabetes were prescribed orlistat. Younger people, females, those in areas of deprivation, current smokers, those coprescribed metformin, and those recorded as having hypertension were statistically significantly more likely to be prescribed orlistat; higher baseline glycated haemoglobin levels were associated with early stopping. In comparison with patients not on orlistat, those who continued using it for ≥12 weeks were more likely to lose ≥5% weight (adjusted odds ratio [AOR] 1.69, 95% confidence interval [CI] = 1.07 to 2.67) but those who stopped orlistat early were less likely to lose ≥5% weight (AOR 0.56, 95% CI = 0.29 to 1.09)., Conclusion: Orlistat was significantly associated with weight loss in patients with T2DM and prediabetes when taken for at least 12 weeks; however, it was infrequently prescribed and often taken for <12 weeks. Orlistat may be a useful adjunct to lifestyle modifications for patients with T2DM and prediabetes, but barriers to continued use means it may not be effective for everyone in managing weight loss., (© The Authors.)

Published
2024
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49. A systematic review protocol of injuries and illness across all the competitive cycling disciplines, including track cycling, mountain biking, road cycling, time trial, cyclocross, gravel cycling, BMX freestyle, BMX racing, e-sport, para-cycling and artistic cycling.

Author

Fallon T and Heron N

Abstract

Introduction: The sport of cycling has witnessed phenomenal growth over the past decade. Globally, over 200 million television hours across five continents watched the recent inaugural World Championships in Glasgow, in 2023. The Union Cycliste Internationale (UCI), the world cycling governing body, has highlighted its mission to " promote and support research in cycling epidemiology and medicine, especially for the benefit of lesser-known disciplines" within its 2030 Agenda. This paper outlines a proposed protocol to conduct a systematic review that comprehensively analyses and synthesises the existing literature about cycling-related injuries and illness across all competitive disciplines., Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines will be followed through each stage of this systematic review. Cycling is an umbrella term used for many individual disciplines. Investigation of all types of injuries and/or illnesses sustained during training and/or competition among competitive athletes across all disciplines will be included in this review. A computerised, systematic literature search will be conducted in electronic databases MEDLINE, Scopus, Embase, and Cochrane Library. Independent screening by two reviewers in a two-step process: title/abstract screening followed by full-text review. The reference lists of included articles will be searched to identify any other potentially relevant articles. Narrative synthesis and tabular/charted presentation of the extracted data will be included., Discussion: This protocol paper outlines the methodology to conduct a systematic review of injuries and illness across all competitive cycling disciplines. The aims of outlining this systematic review protocol are to aid research transparency, help reduce publication bias, prevent selective publication, and prevent the selective reporting of results. Future systematic reviews based on the proposed protocol will summarise the known prevalence, incidences, locations and burden of injury and illness across the sport of cycling., Trial Registration: This study has been registered with the PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42024502703)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Fallon and Heron.)

Published
2024
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50. 'Downhill race for a rainbow jersey': the epidemiology of injuries in downhill mountain biking at the 2023 UCI cycling world championships-a prospective cohort study of 230 elite cyclists.

Author

Fallon T, Palmer D, Bigard X, Elliott N, Lunan E, and Heron N

Abstract

Objectives: This study aims to understand the prevalence, incidence rate, anatomical sites, injury severity and main medical actions carried out during official training and racing by elite downhill mountain biking (DHMTB) riders during the 2023 Union Cycliste Internationale (UCI) Cycling World Championships., Methods: The participants of this prospective, observational study were elite male and female cyclists competing at the UCI DHMTB World Championships located in the Nevis range in Fort William, Scotland, in 2023. This study followed the injury reporting guidelines established by the International Olympic Committee, which include the Strengthening the Reporting of Observational Studies in Epidemiology-Sports Injury and Illness Surveillance (SIIS) and the cycling-specific extension. Injuries were defined as 'tissue damage or other derangement of normal physical function due to participation in sports, resulting from rapid or repetitive transfer of kinetic energy requiring medical attention'. All epidemiological data were collected by the local organising committee medical professionals working at the event through an online survey. All data inputted were screened daily by the lead event physician and UCI medical delegate., Results: Throughout 5 days of the championships, 10.4% of the 230 cyclists sustained at least one injury. The overall injury incidence rate was 3.3 (95% CI 3.1 to 3.5) per 100 rides. The incidence rates were higher in the training 4.3 (95% CI 4.0 to 4.6)/100 rides than in the racing 2.2 (95% CI 2.1 to 2.3)/100 rides. There was a greater incidence of injury in female cyclists in the training 5.8 (95% CI 5.0 to 6.6)/100 rides and racing 4.5 (95% CI 3.9 to 4.9)/100 rides compared with male cyclists. Female cyclists experienced more severe injuries, with an average of 12.6 (±14, 95% CI 5.66 to 19.54) days lost to injury compared with 5.5 (±1.6 95% CI 1.89 to 9.11) seen in male cyclists. The main event medical actions were lifting, immobilisation and helmet removal., Conclusion: This study provides insights into the risk of injury to athletes within DHMTB. Our findings suggest more focus should be placed on the female DHMTB athlete. Additionally, this study provides unique information about common medical actions required of medical professionals working at DHMTB events and the importance of pre-event scenario training., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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