Coal to swole: A survey of anabolic steroid use and muscularity concerns in coalfield areas of Wales

BACKGROUND: Growing male anabolic steroid use is often framed as symptomatic of a post-industrial masculinity crisis, but little quantitative evidence exists for this account. We examine whether steroid use is associated with geographic exposure to industrial decline, namely historical coal mining, and whether any association is mediated by masculine norms. METHODS: We fielded a quota-sampled survey of 18-49 year-old men in Wales (N = 1425). Data were geo-linked to the extent of historic coal mining locally to respondents. Generalised linear mixed models were fitted to test our hypotheses. RESULTS: Steroid use (odds ratio = 1.99, 1.10-3.60), but not body image (B = 1.06, -2.02-4.13), was positively associated with mining extent. However, this was not mediated by conformity to masculine norms. DISCUSSION: While use of steroids is more common in former mining areas, this is not due to more prevalent body image issues nor mediated by masculine norms. Thus, accounts of a post-industrial 'thwarted masculinity' do not fit the data. Steroid use in post-industrial areas is an issue for public health and these communities may benefit from targeted interventions to reduce risk of harms

Cost-effectiveness of swab versus tissue sampling for infected diabetic foot ulcers from the CODIFI2 randomised controlled trial

This multi-centre, Phase III, prospective, unblinded, two-arm parallel group, randomised controlled trial compared clinical (reported elsewhere) and economic outcomes of swab versus tissue sampling over a 52–104 week period. Resource use was logged using case record forms and patient questionnaire at weeks 4, 12, 26, 39, 52 and 104, costed using laboratory and published sources from the UK NHS perspective, at 2021/2022 price-year. EQ-5D-3L questionnaires issued at these time points were used to derive quality-adjusted life-years (QALYs). To account for imbalances such as age, a regression-based approach was used to estimate survival, expected costs and QALYs between the sampling arms. Available case analysis (ACA) and multiple imputation methods were applied for self reported missing data, and ACA for researcher-collected data (survival, hospitalisations and antibiotic use). Probabilistic sensitivity analysis was used to assess the uncertainty of economic results. Results We recruited 149 participants (75 swab, 74 tissue) from 21 UK sites, between 07 May 2019 and 28 April 2022 (last follow-up 28 April 2023). Planned sample size was 730 participants, for 90% power to detect 12.5% difference in healing at 52 weeks, but the trial stopped early due to low recruitment. Expected QALYs in the swab-sampling arm were greater than in the tissue-sampling arm at weeks 26, 52 and 104. The cost of tissue sampling was greater than of swabbing when including antibiotics and hospitalisation. Swab sampling participants had higher QALYs and lower costs across weeks 26–52, reducing slightly by week 104. Conclusions Because of higher costs, lower QALYs and lack of evidence of benefit, potentially due to the trial being underpowered, tissue sampling was dominated by wound swabbing in the cost-effectiveness analysis

The Benefits of Assistive Technology for the Elderly and Disabled People: A Baseline Study

Purpose Housing adaptation enables the elderly and disabled people to live healthy, productive, independent, and dignified lives by making it easier to carry out everyday tasks in a safer environment. Assistive technology enables them to perform tasks that would otherwise be difficult or impossible to achieve independence. Therefore, the new guidance for local authorities in England on Disabled Facilities Grants (DFG) recommends assistive and smart technology as part of a DFG award package to maximise the benefits of home adaptations. Through a baseline study, this paper examines the disabled and elderly peoples’ level of digital engagement, the challenges and the impact of smart devices on their daily living and well-being. Design/methodology/approach A baseline study approach was used through the co-production of knowledge. The study relies on a questionnaire survey and the Most Significant Change (MSC) research technique through structured interviews. A percentage of the total approach is used in analysing the quantitative data by comparing the pre- and post-baseline results. Findings The major challenges the clients face are Wi-Fi connectivity, system compatibility issues, and skills in navigating different applications and operating systems. The pilot study demonstrates that assistive technology supports independent and healthy living and promotes a secure and safe environment. It also promotes social inclusion and improves the elderly and disabled people’s comfort and engagement. However, the results show that the overall impact is minimal; therefore, a longitudinal study is needed to understand the impacts over a long period. Practical implications The findings will help policymakers to understand the impacts of assistive technology on improving the elderly and disabled people’s quality of life. Originality/value A comparable baseline study was carried out to serve as a reference point for other similar future studies. The paper also highlights the challenges faced by the elderly and disabled people, their digital skill level and the impact of smart devices on their daily living and well-being

Banned for doping: Using composite vignettes to portray rugby players’ experiences of anti-doping rule violations

Objective: Understanding the lived experiences of athletes who have been sanctioned for violating anti-doping rules presents the opportunity to listen and learn. Yet, the academic field seldom draws on the voices of those affected when considering doping in sport. Our aim was to illuminate important aspects of sanctioned athletes’ experiences and highlight opportunities for prevention and rehabilitation. Design: A semi-structured interview research design was used, and data informed the development of composite vignettes, a form of creative non-fiction. Method: Semi-structured interviews were conducted with two elite rugby players sanctioned for violating the anti-doping rules within rugby league (n=1) and rugby union (n=1). Three composite vignettes were created illuminating player experiences before, during and after the violations. Findings: The vignettes highlight in participants’ own words the multiple impacts of sport demands and drug use: (1) Leading up to the violation: ‘You’re just treading water, you’re surviving’ (2) ‘There’s just this massive amount of social pressure in rugby, not just on the game, but on who you’re supposed to be’ (3) ‘It was like being hit by a train’. The ADRV aftermath. Conclusions: The role of social identity in the transitions experienced by a rugby player following a critical incident (e.g., serious injury) was a key influencing factor for doping. Alongside addressing the demands of the sport, the need for early intervention and evidence-based support for players experiencing critical incidents (e.g., injury) and transitions was evident to prevent doping violations

Making sense of metal in the United Kingdom and the future of metal music studies: A case study of Wytch Hazel and Arð

Heavy metal in the United Kingdom, as in many countries around the world, is thriving and has become a respectable form of popular culture, and its fans and musicians are seen everywhere. The same position of respectability has been gained by academics and the once-mocked subject field of metal music studies. In this article, I try to map metal in the United Kingdom today through a case study of Wytch Hazel and Arð, two bands located in the north of England. I will argue that metal in the United Kingdom is still a space for resistance to the commodification of the mainstream and the construction of imaginary, imagined communities. I will then argue that the future of metal music studies depends on whether metal itself continues to thrive as a place of polyvalent identities, as well as whether academics can negotiate their own epistemological and ontological uncertainties in the marketplace of higher education

Head Acceleration Event Exposure During Elite Men’s and Women’s Rugby Union Training

Objectives The aim of this study was to describe the incidence and magnitude of head acceleration events (HAEs) during elite men’s and women’s rugby union training for different contact training levels and drill types. Method Data were collected during the 2022–23 and 2023–24 seasons from 203 men and 125 women from 13 clubs using instrumented mouthguards (iMGs) during in-season training. One author reviewed the training videos to identify the contact level and drill type. HAE incidence was calculated per player minute. Results For men’s forwards and backs, only 4.7% and 5.8% of HAEs were ≥ 25 g and ≥ 1.5 Krad/s2, and 3.4% and 4.4% for women’s forwards and backs, respectively. The incidence of ≥ 5 g and ≥ 0.4 Krad/s2 was highest during full-contact training for men’s forwards (0.20/min) and backs (0.16/min) and women’s forwards (0.10/min). HAE incidence was 2–3 times higher during repetition-based compared with game-based training drills for men’s forwards (0.25/min vs 0.09/min) and backs (0.22/min vs 0.09/min) and women’s forwards (0.09/min vs 0.04/min) and backs (0.08/min vs 0.03/min). HAE incidences were halved when repetition-based training drills used pads compared with no pads for men’s forwards (0.21/min vs 0.44/min) and backs (0.17/min vs 0.30/min), and women’s forwards (0.06/min vs 0.14/min) and backs (0.06/min vs 0.10/min). Conclusion The average HAE incidence (~ 13–20% of weekly HAEs) and magnitude during an in-season training week is very low compared with matches. Opportunities to materially reduce HAE exposure in training are likely more limited than previously assumed. Future research on HAE load and injury, and understanding players’ specific weekly training exposure, may inform effective individual player management

Post-concussion symptom burden and dynamics: Insights from a digital health intervention and machine learning

Individuals who sustain a concussion can experience a range of symptoms which can significantly impact their quality of life and functional outcome. This study aims to understand the nature and recovery trajectories of post-concussion symptomatology by applying an unsupervised machine learning approach to data captured from a digital health intervention (HeadOn). As part of the 35-day program, patients complete a daily symptom diary which rates 8 post-concussion symptoms. Symptom data were analysed using K-means clustering to categorize patients based on their symptom profiles. During the study period, a total of 758 symptom diaries were completed by 84 patients, equating to 6064 individual symptom ratings. Fatigue, sleep disturbance and difficulty concentrating were the most prevalent symptoms reported. A decline in symptom burden was observed over the 35-day period, with physical and emotional symptoms showing early rates of recovery. In a correlation matrix, there were strong positive correlations between low mood and irritability (r = 0.84), and poor memory and difficulty concentrating (r = 0.83). K-means cluster analysis identified three distinct patient clusters based on symptom severity. Cluster 0 (n = 24) had a low symptom burden profile across all the post-concussion symptoms. Cluster 1 (n = 35) had moderate symptom burden but with pronounced fatigue. Cluster 2 (n = 25) had a high symptom burden profile across all the post-concussion symptoms. Reflecting the severity of the clusters, there was a significant relationship between the symptom clusters for both the Rivermead (p = 0.05) and PHQ-9 (p = 0.003) questionnaires at 6-weeks follow-up. By leveraging digital ecological momentary assessments, a rich dataset of daily symptom ratings was captured allowing for the identification of symptom severity clusters. These findings underscore the potential of digital technology and machine learning to enhance our understanding of post-concussion symptomatology and offer a scalable solution to support patients with their recovery

Evaluating the Probability of Head-Acceleration Events in Elite Men’s and Women’s Rugby Union Match-Play: The Impact of Tackle Height and Body Position

Background Head acceleration events (HAEs) are an increasing concern in collision sports owing to potential negative health outcomes. Objectives The objective of this study is to describe the probabilities of HAEs in tackles of differing heights and body positions in elite men’s and women’s rugby union. Methods Instrumented mouthguards (iMGs) were worn in men’s (n = 24 teams, 508 players, 782 observations) and women’s (n = 26 teams, 350 players, 1080 observations) rugby union matches. Tackle height (i.e. point of contact on ball-carrier) and body positions of tacklers and ball-carriers were labelled for all tackles in which a player wore an iMG. HAEs from the initial impact were identified. Mean player, tackler and ball-carrier exceedance probabilities for various peak linear and angular acceleration thresholds were estimated from ordinal mixed-effects models. Results Contact with ball-carriers’ head/neck resulted in the highest mean HAE probabilities for both sexes. The probability of an HAE to the ball-carrier decreased as tackle height lowered. The highest probability for the tackler was initial contact to the ball-carriers upper leg. Body position influenced the probability of HAEs, with falling/diving ball-carriers resulting in higher mean probabilities. When a player, regardless of role, was bent-at-waist, elevated HAE probabilities were observed in men’s competitions. Women’s data demonstrated similar probabilities of an HAE for all body positions. Conclusions Initial contact to the ball-carrier’s head/neck had the highest chance of an HAE, whilst role-specific differences are apparent for different tackle heights and body positions. Future player-welfare strategies targeting contact events should therefore consider HAE mechanisms along with current literature

Lessons learnt in other people's classrooms

Third Angel was a theatre company born out of interdisciplinary practice, and created by theatre graduates Rachael Walton and myself, who then trained as teacher and film-maker, respectively. Without identifying it as interdisciplinary, what we were interested in from the outset was collaboration. Drawing on the expertise and experience of a varied group of practitioners, our stated aim was to make something none of us would have made on our own. Something more than the sum of its parts. Our unstated (at the time) aim was to demonstrate that theatre was more than plays. We were interested in cross-art form work – ‘multi-media’ was the in phrase at the time; when an idea reminded us of a film or novel, it seemed worth pursuing; if it reminded us of a piece of theatre we had seen, it would often get forgotten about. This chapter reflects on two decades of collaboration between Third Angel and a number of scientists and specialists from other disciplines. These collaborations produced projects in theatre, live art, film, video, and participation, which were presented throughout the UK and internationally. We did not specifically set out to make interdisciplinary work: we followed our curiosity and discovered that ethos as we travelled. We were believers in the value of serendipity in a devising process, and recognised that we did not know what we did not know. We were always interested in collaborating with people with different approaches, born out of different experiences to our own. When we wanted to learn more about a subject, we approached people who knew more than us and, always fascinated by other people’s workshops and studios, we asked if we could go and visit them in the place they worked. We began to value spending time, literally and metaphorically, in other people’s classrooms

Clinimetrics: The vertical single leg hop test

Description: The vertical single leg hop test (VSLHT) is a functional performance outcome measuring maximum single leg jump height (cm).1 The VSLHT is intended to assess sport-related movements and musculoskeletal loading demands.1,2 To perform this test, an individual stands on one leg, executes a rapid countermovement to a self-selected depth, jumps as high as possible, and then lands on the same leg.2, 3, 4 Height can be measured using instrumentation (eg, contact timing mat)2, 3, 4 or the chalk on wall method. The VSLHT can be completed on both legs in 10 to 15 minutes, including a dynamic warm-up and practice trials (three to five). Typically, multiple maximum effort attempts (minimum of three) are performed with 20 to 30 seconds of rest between attempts