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1.  Comparative cervical profiles of adult and under-18 front-row rugby players: implications for playing policy 
BMJ Open  2014;4(5):e004975.
Objective
To compare the cervical isometric strength, fatigue endurance and range of motion of adult and under-18 age-grade front-row rugby players to inform the development of a safe age group policy with particular reference to scrummaging.
Design
Cross-sectional cohort study.
Setting
‘Field testing’ at Murrayfield stadium.
Participants
30 high-performance under-18 players and 22 adult front-row rugby players.
Outcome measures
Isometric neck strength, height, weight and grip strength.
Results
Youth players demonstrated the same height and grip strength as the adult players; however, the adults were significantly heavier and demonstrated substantially greater isometric strength (p<0.001). Only two of the ‘elite’ younger players could match the adult mean cervical isometric strength value. In contrast to school age players in general, grip strength was poorly associated with neck strength (r=0.2) in front-row players; instead, player weight (r=0.4) and the number of years’ experience of playing in the front row (r=0.5) were the only relevant factors in multivariate modelling of cervical strength (R2=0.3).
Conclusions
Extreme forces are generated between opposing front rows in the scrum and avoidance of mismatch is important if the risk of injury is to be minimised. Although elite youth front-row rugby players demonstrate the same peripheral strength as their adult counterparts on grip testing, the adults demonstrate significantly greater cervical strength. If older youths and adults are to play together, such findings have to be noted in the development of age group policies with particular reference to the scrum.
doi:10.1136/bmjopen-2014-004975
PMCID: PMC4025467  PMID: 24797427
Sports Medicine; Rugby; Neck
2.  Age-related differences in the neck strength of adolescent rugby players 
Bone & Joint Research  2012;1(7):152-157.
Objectives
To evaluate the neck strength of school-aged rugby players, and to define the relationship with proxy physical measures with a view to predicting neck strength.
Methods
Cross-sectional cohort study involving 382 rugby playing schoolchildren at three Scottish schools (all male, aged between 12 and 18 years). Outcome measures included maximal isometric neck extension, weight, height, grip strength, cervical range of movement and neck circumference.
Results
Mean neck extension strength increased with age (p = 0.001), although a wide inter-age range variation was evident, with the result that some of the oldest children presented with the same neck strength as the mean of the youngest group. Grip strength explained the most variation in neck strength (R2 = 0.53), while cervical range of movement and neck girth demonstrated no relationship. Multivariable analysis demonstrated the independent effects of age, weight and grip strength, and the resultant model explained 62.1% of the variance in neck strength. This model predicted actual neck strength well for the majority of players, although there was a tendency towards overestimation at the lowest range and underestimation at the highest.
Conclusion
A wide variation was evident in neck strength across the range of the schoolchild-playing population, with a surprisingly large number of senior players demonstrating the same mean strength as the 12-year-old mean value. This may suggest that current training regimes address limb strength but not neck strength, which may be significant for future neck injury prevention strategies. Age, weight and grip strength can predict around two thirds of the variation in neck strength, however specific assessment is required if precise data is sought.
doi:10.1302/2046-3758.17.2000079
PMCID: PMC3626274  PMID: 23610685
Rugby; Adolescent; Neck; Strength; Physical assessment; Injury prevention
8.  Career Earnings 
British Medical Journal  1974;3(5927):415.
PMCID: PMC1613162
9.  The Westminster Hospital coronary unit—experience with 260 patients admitted consecutively with a diagnosis of acute myocardial infarction 
Postgraduate Medical Journal  1969;45(521):163-169.
In successive years since the opening of a Coronary Care Unit at Westminster Hospital the mortality has been 26 and 20% and for the first 4 months of 1968, 5·3%. Overall mortality for 260 patients was 20%.
Resuscitation has been successful in 59% of cardiac arrests within the unit and in 27% of those outside the unit caused by myocardial infarction. Seventeen patients left hospital alive and well who presumably would not have survived had they been treated at home.
Given efficient nursing staff and a resuscitation team, there can no longer be any justification for the treatment of patients with myocardial infarction anywhere other than in a coronary care unit, where such facilities are made available, providing admission is arranged within 3 days of the infarcting episode. The disadvantage of an ambulance journey to a patient with a recent infarct after this period of time may outweigh the advantage incurred by the coronary care unit.
The Peel Coronary Prognostic Index remains a very useful guide to prognosis in spite of this author's attempts to demonstrate any inaccuracies in its predictions.
A high (20%) ‘misdiagnosis’ rate must be accepted if some patients with bona fide myocardial infarction are not to be excluded from the unit.
The occurrence of 435 deaths reported to Her Majesty's Coroner for Westminster in the relevant period due to myocardial infarction suggests that the time may be ripe for a ‘flying squad’ resuscitation service in London.
PMCID: PMC2466811  PMID: 5785423
11.  Drip Infusion Cholangiography 
PMCID: PMC1902273  PMID: 20919025
18.  Lipodystrophy Progressiva and Pregnancy 
Postgraduate Medical Journal  1958;34(396):530-534.
Images
PMCID: PMC2501782  PMID: 13591063
19.  THE PROBLEM OF LEAD POISONING 
PMCID: PMC1591464  PMID: 18117246

Results 1-19 (19)