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IntroductionFace-to-face group-based diabetes prevention programmes have been shown to be effective in many settings. Digital delivery may suit some patients, but research comparing the effectiveness of digital with face-to-face delivery is scarce. The aim was to assess if digital delivery of the English National Health Service Diabetes Prevention Programme (NHS DPP) is non-inferior to group-based face-to-face delivery in terms of weight change, and evaluate factors associated with differential change. The study included those recruited to the NHS DPP in 2017-2018.Research design and methodsIndividual-level data from a face-to-face cohort was compared to two cohorts on a digital pilot who (i) were offered no choice of delivery mode, or (ii) chose digital over face-to-face. Changes in weight at 6 and 12 months were analysed using mixed effects linear regression, having matched participants from the digital pilot to similar participants from face-to-face.ResultsWeight change on the digital pilot was non-inferior to face-to-face at both time points: it was similar in the comparison of those with no choice (difference in weight change: −0.284kg [95% CI: −0.712, 0.144] at 6 months) and greater in digital when participants were offered a choice (−1.165kg [95% CI: −1.841, −0.489]). Interactions between delivery mode and sex, ethnicity, age and deprivation were observed.ConclusionsDigital delivery of the NHS DPP achieved weight loss at least as good as face-to-face. Patients who were offered a choice and opted for digital experienced better weight loss, compared to patients offered face-to-face only.

Introduction The potential of AI systems to support pre-hospital clinical decision-making is significant. However, whilst such algorithms are increasingly available, far less attention has been paid to understanding the impact of such systems on clinical performance. This study had two aims; first, to compare the performance of expert clinicians against an AI system in a real-world clinical setting and second, to assess the impact of augmenting expert clinical prediction with an AI system. Method We performed a prospective study at two UK Air Ambulances services over a six-month period. Expert pre-hospital clinicians’ judgement of the risk of Trauma Induced Coagulopathy (TIC) in injured patients was assessed and compared to the performance of an AI system. Two TIC risk predictions were generated for every patient: an AI prediction and a human prediction. Results Overall, 51 expert clinicians were enrolled in the study providing 184 patient interactions for analysis. Aim 1 The AI system performed better than clinicians; higher discrimination [AUROC 0.87 (0.79, 0.95) versus 0.83 (0.74, 0.92)] better calibration [0.37 (-0.14, 0.89) versus -1.19 (-1.73, -0.65)] and more accurate [Brier Skill Score 0.34 (0.19, 0.48) versus 0.00 (-0.41, 0.30)]. Aim 2 Risk prediction was better in all performance metrics when clinicians were assisted with the AI system [AUROC 0.88 (0.80, 0.95) versus 0.83 (0.74, 0.92)] Conclusions AI systems can improve human risk prediction in the pre-hospital setting. In settings of low resources where a lack of senior clinical expertise may affect outcomes, the benefit of implementing predictive AI is substantial.

Background The NHS Diabetes Prevention Programme for England, “Healthier You”, encourages behaviour change regarding healthy eating and physical exercise among people identified to be at high risk of developing type 2 diabetes. The aim of this research was to examine change, and factors associated with change, in measures of HbA1c and weight in participants and completers of the programme between 2016 and 2019. Methods Participant-level data collected by programme service providers on referrals prior to March 2018 was analysed. Changes from baseline to both 6 months and completion in HbA1c and weight were examined using mixed effects linear regression, adjusting for patient characteristics, service provider and site. Results Completers had average improvements in HbA1c of 2.1 mmol/mol [95% CI: − 2.2, − 2.0] (0.19% [95% CI: − 0.20, − 0.18]) and reductions of 3.6 kg [95% CI: − 3.6, − 3.5] in weight, in absolute terms. Variation across the four providers was observed at both time points: two providers had significantly smaller average reductions in HbA1c and one provider had a significantly smaller average reduction in weight compared to the other providers. At both time points, ex- or current smokers had smaller reductions in HbA1c than non-smokers and those from minority ethnic groups lost less weight than White participants. For both outcomes, associations with other factors were small or null and variation across sites remained after adjustment for provider and case mix. Conclusions Participants who completed the programme, on average, experienced improvements in weight and HbA1c. There was substantial variation in HbA1c change and smaller variation in weight loss between providers and across different sites. Aside from an association between HbA1c change and smoking, and between weight loss and ethnicity, results were broadly similar regardless of patient characteristics.

As Clarence Darrow argued at the Scopes trial, fundamentalism has often been portrayed as simply anti-science and anti-intellectual. Yet many fundamentalists professed to highly value reason and science. It is helpful to see the issue as an instance of “paradigm conflict,” as has been described by Thomas Kuhn. Fundamentalists typically held on to a “common sense” or “Baconian” idea of rationality and truth. Rational inquiry, they believed, could find unchanging truths. Modern thought, such as Darwinism, was built around change. J. Gresham Machen provides an example of trust in common-sense understanding of unchanging facts. Charles Blanchard offered a similar approach. In Blanchard’s view, modern thought was moving toward a sort of collective insanity in denying common sense principles of truth and morality. Evangelist Billy Sunday expressed such views in a more truly anti-intellectual way.

Fundamentalists fought on two fronts: doctrinal battles in major northern denominations, and battles, especially against biological evolution, in the larger culture. The liberal Protestant formation of the idealist Interchurch World Movement also created alarms among conservatives. The denominational doctrinal battles had begun especially on the mission fields just after World War I. Foreign missions were a central concern for evangelicals, and concern about modernism on the mission fields helped make fundamentalism an interdenominational movement. Curtis Lee Laws in the Northern Baptist Convention expressed many such concerns as he mobilized the fundamentalist party. William Jennings Bryan became prominent in the movement when he entered the crusade against teaching biological evolution in public schools. That also highlighted fundamentalist concerns to restore Christian civilization in America.

Dwight L. Moody’s closest associates were evangelists who also became leading proponents of dispensational premillennialism or dispensationalism. The associates included Reuben A. Torrey, James M. Gray, C. I. Scofield, William J. Erdman, A. C. Dixon, and A. J. Gordon. John Nelson Darby was the progenitor of this system. Dispensationalism became one of the foundations for much of fundamentalism. It was a system for interpreting biblical prophesies. It proponents also emphasized personal piety. American revivalism tended to include these emphases: simple ways of interpreting the Bible, warm emotions, and personal piety and purity. Reuben Torrey, who came closest to being Moody’s successor, particularly illustrates this combination of emphases.

Distinctly American aspects of fundamentalism may be seen by comparison with similar movements with which fundamentalists were connected in Great Britain. One contrast is that anti-evolution was never nearly as popular among religious conservatives in Britain as in America. “The dynamics of unopposed revivalism” offers part of the explanation for the difference. England had a state church and a tradition of Christendom, while popular religion in the United States was dominated by revivalism. That helped contribute to tendencies in American popular religion to accept simple antitheses and dichotomies. While England had long traditions and historical development, American evangelicals tended to interpret history in common sense or either/or categories.

“The Great Reversal” is a term that has been used for the shift when socially progressive views were prominent in American evangelicalism to when they became rare. In the mid-nineteenth century, Charles Finney’s postmillennialism and anti-slavery views illustrate evangelical social reform. Jonathan Blanchard, founder of Wheaton College in Illinois, held similar views. As late as 1900, James M. Gray preached a progressive social reform sermon, even though later when he was president of Moody Bible Institute his political views were conservative. The broadest explanation for “The Great Reversal” is that after about 1900 the “Social Gospel” became associated with liberal theology. Most later fundamentalists, in rejecting liberal theology, rejected liberal social teachings as well.

Almost every major American denomination experienced controversy sometime between 1870 and World War I. These were responses to modern cultural views and to liberal or modernist developments in biblical interpretation or theology. In the South, the controversies were generally short-lived, with conservatives prevailing. For instance, Southern Presbyterian and Southern Methodist controversies led to banning teaching biological evolution of humans. In the North, the greatest controversies were within the large Presbyterian and Baptist denominations. In the Northern Baptist Convention, the divinity school at the University of Chicago became a center for “modernist” teachings. Meanwhile, the dominant conservative party was relatively moderate. That is illustrated in the theology of Augustus Strong.

The Scopes trial in Dayton, Tennessee, had a negative impact on the fundamentalist image. William Jennings Bryan debated Clarence Darrow over the teaching of evolution in public schools. Bryan was ridiculed by the sophisticated press, as well as by H. L. Mencken. Some of the leaders of fundamentalism, such as J. Frank Norris or T. T. Shields, were becoming more extreme. By the later 1920s liberals were proclaiming the demise of the movement. But fundamentalism was not declining so much as relocating in areas where it would take deeper root. It found fertile ground in the South, where varieties of conservative evangelicalism often flourished without much opposition.

Various emerging fundamentalists adopted a spectrum of views regarding the relation of Christianity to culture. At one extreme were the radical dispensationalists, such as Arno G. Gaebelein. Such leaders took seriously the implications of premillennial pessimism regarding culture, and condemned modern ideologies. They insisted that Christians must separate into pure churches. William B. Riley, by contrast, embodied the central tension in the movement between premillennial pessimism and continuing hopes for a more Christian America. Moody Bible Institute exemplified that same tension. Evangelist Billy Sunday dramatically embodied the tension between separatism and Americanism. William Jennings Bryan represents a third position, trying to preserve and reform Christian civilization in a progressive but biblically based direction. Conservative Presbyterians like B. B. Warfield and J. Gresham Machen, while staying away from direct political involvement, were more confident that biblically based and rational theological outlooks could challenge modern thought.

In 1870 most Americans assumed their nation was “Christian,” and the dominant form of Christian was evangelical Protestant. Evangelicals were committed to soul-changing and Bible-based Christianity. They also hoped to continue to shape the nation, as in campaigns for social reform, Sabbatarianism, or prohibition of alcohol. Their outlooks also helped shape the schools and colleges. Common Sense Philosophy was still prominent. The recent advent of Darwinism helped precipitate an intellectual crisis. These issues were debated at the Evangelical Alliance meeting of 1873. In the debates over such issues, one can see the impending division of evangelical Protestantism into a progressive liberal faction and a more conservative faction that anticipated later fundamentalism.

The dispensational scheme of biblical interpretation reflected the Baconian ideal. In the earlier nineteenth century, many American religious thinkers celebrated the tradition of Francis Bacon, which looked for inductive facts. That was also compatible with the heritage of “common sense” philosophy. Dispensationalists, such as Arthur T. Pierson, Reuben Torrey, or C. I. Scofield, editor of the Scofield Bible that became a fundamentalist norm, adopted such outlooks for interpreting the Bible. They saw the Bible as a set of “facts.” It was also “inerrant.” It just needed a “common sense” set of tools to provide an interpretive scheme that was the key to solving some puzzles. With those, any ordinary reader could trust his or her interpretations.

From its beginnings, fundamentalism was often interpreted as a political phenomenon. Faith and theology were at the center of the movement, but some political concerns were always there. Most of these were conservative, and by 1930 progressive political outlooks had virtually disappeared among fundamentalists. Fundamentalists saw the future of Christian civilization as being at stake. Most of their political views, however, were haphazard. They were not tied to one political party. Anti-communism was a frequent concern. Their view of the universe can be seen as “Manichean,” as divided between forces of light and darkness. They were accordingly often susceptible to conspiracy theories. They also sometimes became super-patriotic.

America’s entry into World War I transformed much of the emerging fundamentalist movement. It added a heightened sense of cultural crisis to other concerns. A good many fundamentalists at first opposed the war. Premillennialist journals, Our Hope and The King’s Business, emphasized fulfilled prophecies but opposed America’s entry into the war. William Jennings Bryan accepted the war only reluctantly. By contrast, Billy Sunday became a leading super-patriot. Modernist theologians, such as Shailer Mathews or Shirley Jackson Case, at first criticized the premillennialists who opposed the war. Soon, however, almost all emerging fundamentalists were taking positions such as that of William Bell Riley, as super-patriots. That would help establish a long-standing tension in the movement as a mix of premillennial cultural pessimism and American patriotic zeal to build a more Christian culture.

The Fundamentals was a twelve-volume series published between 1910 and 1915. The project was financed by oil magnate Lyman Stewart. A. C. Dixon, Louis Meyer, and Reuben Torrey served terms as editors. The volumes were collections of essays, some previously published. They anticipated the fundamentalist movement and helped furnish its name. The essays included topics such as criticisms of various modern “isms.” Some essays were personal testimonies. Some defended the integrity of the Bible. Some promoted Keswick teachings. Overall, the tone of the essays was not as strident as much of later fundamentalism. For instance, some writers allowed that God might have used biological evolution as a means of creation.

Dwight L. Moody was a Horatio Alger figure who started as a shoe salesman, became active in the evangelical YMCA, and eventually became America’s most famous evangelist and built an empire of related organizations. Moody preached a basic Gospel message emphasizing the prime importance of the salvation of individual souls. He also was influenced by holiness traditions and emphasized personal piety and purity. His outlook reflected the American individualism of the time. He was a premillennialist and saw the culture as getting worse, which was an incentive for evangelism and missions. Though Moody himself was irenic, some of his younger colleagues played major roles in shaping the late fundamentalist movement.

The white middle-class “Victorian” Americans of the decades beginning with the Civil War in the 1860s faced a series of cultural crises, including war, reconstruction, industrialization, urbanization, and rapid intellectual changes. The diverging paths in Protestant responses are here represented by the contrast between Henry Ward Beecher and the Blanchards, Jonathan and his son Charles. Beecher exemplified the progressive spirit of emerging liberal theology. God was revealed in the Bible but also in the Christian moral improvements of the modern age, such as in the defeat of slavery. Beecher presented a “Progressive Orthodoxy” that was part of a “New Theology.” Jonathan Blanchard, founder of Wheaton College (IL), was a biblicist evangelical abolitionist. He was also a postmillennialist. His son Charles, who succeeded him at Wheaton, was influenced by Dwight L. Moody, became a premillennialist, and promoted anti-modernist militancy of fundamentalism.

From its origins fundamentalism was primarily a religious movement. It was a movement among American “evangelical” Christians, people professing complete confidence in the Bible and preoccupied with the message of God’s salvation of sinners through the death of Jesus Christ. Evangelicals were convinced that sincere acceptance of this “Gospel” message was the key to virtue in this life and to eternal life in heaven; its rejection meant following the broad path that ended with the tortures of hell. Unless we appreciate the immense implications of a deep religious commitment to such beliefs—implications for one’s own life and for attitudes toward others—we cannot appreciate the dynamics of fundamentalist thought and action....

In 1922 and 1923, fundamentalists had high hopes that they could impose their standards on some major northern denominations. Fundamentalists were strongest in the Northern Baptist Convention and in the Presbyterian Church in the U. S. A. At the Northern Baptist Convention meeting in 1922, they hoped to have the body adopt a traditional creedal statement. But the move was soundly defeated. In 1922 Harry Emerson Fosdick, a modernist Baptist filling a Presbyterian pulpit, preached, “Shall the Fundamentalists Win?” That set off a heated controversy in the Presbyterian Church in the U. S. A. Conservative William Jennings Bryan narrowly lost election as moderator for the 1923 General Assembly. But the assembly reaffirmed the five-point Presbyterian essential doctrines. Clarence McCartney, a leading conservative preacher, answered Fosdick in a sermon, “Shall Unbelief Win?” J. Gresham Machen issued Christianity and Liberalism in 1923, arguing that traditional Christianity and modernism were really two different religions.

Fundamentalism took shape as a distinct movement in the midst of the cultural crisis following World War I. The “Red Scare” and fear of Bolshevism was one factor. Fears of doctrinal changes in churches and changing social mores were allied to these concerns. While the concerns confirmed premillennial pessimism, they also led to a rise in emphasis on restoring America’s Christian character. Presbyterians were especially strong in expressing such concern. In 1920 Curtis Lee Laws, editor of the Watchman-Examiner, in mobilizing conservatives in the Northern Baptist Convention called their party “fundamentalists.” Fundamentalists such as William B. Riley increasingly emphasized that the future of America civilization was at stake. A prototypical fundamentalist Baptist activist was John Roach Straton, a pastor in New York City. Straton campaigned strongly for moral reform in the city. His characterizations of America wavered between seeing it as Babylon or the New Israel.

Prior to the Civil War, postmillennialism had been more common among most American evangelical Protestants than had premillennialism. Both were taught, however. After the Civil War, more progressive or liberal Protestants turned postmillennialism into a doctrine emphasizing the progress of modern civilization as evidence of the coming of Christ’s Kingdom on earth. William Newton Clark and A. C. McGiffert illustrate that approach. By contrast, the dispensational premillennialists developed a literalist reading of biblical prophecies. They divided world history into seven dispensations, each ending in human failure and divine judgment. At the end of our own last dispensation would be the “secret rapture” of the saints, a brief era of tribulation, and the return of Christ to set up a kingdom on earth for one thousand years.