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The early years of the NHS have been characterised as ‘provider capture’ by opponents, with services organised around professional interests rather than patients. This analysis, whilst flawed, has influenced subsequent attempts by politicians to manage medicine. Such an analysis when applied locally illuminates the diffuse and ethereal influence wielded by doctors in the realisation of services. Drawing on archival and published sources relating to the Lancaster Medical Book Club, this paper contextualises how competing professional, educational and social purposes of medical association influenced local leadership in the early years of the NHS from the 1940s to the 1960s.

There are limits in articulating political struggles around the NHS and the imagined geographies of the nation: struggles based on nostalgia for the post-war welfare state risk co-opting the NHS for an exclusionary, nationalist politics. In tracing the times and spaces of the health service the article asks: when was the NHS? and where is the NHS? The idea of universal healthcare - and changing ideas of nation, state and welfare - are articulated in particular political conjunctures. The whereabouts of the NHS is more than a question of devolution and territorial politics in an increasingly disunited Kingdom; there are also questions of borders, and of workers who are trained and drawn into the NHS from overseas: it is impossible to imagine the NHS without grappling with the ways in which colonialism is integral to the formation of the post-war national welfare state. As both a residual of the national welfare state, and as an emergent site of political and cultural work, the NHS is continuously reworked within dominant politics; while it also offers an emotionally powerful political resource to galvanise popular public support that resists such tendencies. We therefore insist on the need to get to grips with the complex and partial embedding of private interests and market logics within the organisation of healthcare - often framed, rather crudely, in terms of the 'Americanisation' of the NHS. But we also warn of the analytical limits, and political dangers, of framing political struggles around national spatial imaginaries when seeking to 'protect' the NHS in these times of crisis.

This study investigated the relationship between physical qualities and contact technique proficiency in rugby union players. Thirty-eight (n = 38) male academy rugby union players participated in the study. Physical measures of anthropometry, functional mobility, strength endurance, strength, power, speed, agility, and anaerobic and aerobic endurance were assessed. Tackler, ball-carrier, and ruck technique were assessed using video analysis of a standardised two-on-two contact drill. Seven physical qualities were moderately associated with tackler technique; Push-ups (r2 = 0.2; β = 0.04; p = 0.005; ES = 0.26), Sit-ups (r2 = 0.2; β = 0.08; p = 0.004; ES = 0.27), Relative 1RM Bench Press (r2 = 0.2; β = 2.32; p = 0.003; ES = 0.29), Broad Jump (r2 = 0.2; β = 0.03; p = 0.009; ES = 0.22), Agility (r2 = 0.2; β = −0.47; p = 0.019; ES = 0.19), 40m-Speed with Ball (r2 = 0.1; β = 0.93; p = 0.027; ES = 0.16) and Functional Mobility (r2 = 0.2; β = 0.16; p = 0.007; ES = 0.25). There was a large association between ball-carrier technique and Medicine Ball Throw (r2 = 0.3; β = 1.13; p = 0.001; ES = 0.37), and a moderate association between ruck technique and agility without (r2 = 0.2; β = −0.75; p = 0.005; ES = 0.21) and with (r2 = 0.2; β = −0.55; p = 0.015; ES = 0.29) the ball. The findings demonstrate the important contribution of physical strength and conditioning to contact technique in rugby union players. Contact technique training should be accompanied with physical strength and conditioning, as improvements in physical qualities may serve as foundational components to underpin improvements in technique.

The Health and Care Act 2022 affirmed the ‘primacy of place’ in the National Health Service (NHS) through major structural reforms replacing General Practitioner (GP) led Clinical Commissioning Groups (CCGs) with 42 Integrated Care Boards (ICBs). The intention behind the Act was to strengthen engagement between the NHS, local authorities, and other stakeholders in place-based systems providing collaborative, integrated health and social care services across organisational and financial boundaries. This reversed longstanding political commitment to competition. However, identical intentions – about facilitating consensus, cooperation and cost-effectiveness between health and social services – underpinned the first major reorganisation of the NHS in 1974. Drawing upon a unique central government file dedicated to the problems the reorganisation raised for South Westmorland, this paper explores the gap between neat structural reforms imagined by the centre and their messy realisation in the periphery, highlighting similar tensions in the present.

The Covid-19 pandemic constituted an unprecedented public health crisis for the National Health Service (NHS) since its inception in 1948. The crisis exposed the fragmented nature of health services, the centralisation of decision-making, and the weakened position of the Director of Public Health (DPH) to provide essential local leadership. This position reflects years of uncertainty along with a pyrrhic ‘return’ to local government for public health in 2013. Using the career of Westmorland County Medical Officer (CMO) John A. Guy, this paper offers a historical examination of the problems of practicing public health in local government until its absorption into reformed NHS structures in 1974. The case study reflects upon the shape of current community health services in Lancashire and South Cumbria, the ambiguous place of local public health in a nationalised service, and the ability of individual leadership to overcome structural constraints.

Doctors are typically portrayed as active agents in their work lives. However, this paper argues that this construction of agency ignores the effects of the healthcare structures that constrain choice, which in turn affects population health outcomes. Medical training pathways, regional boundaries, and rationalisation all have a long‐lasting impact on the provision of healthcare. Using a mobilities lens to examine the movement of doctors, this paper examines how the expectation of movement built into training programmes perpetuates unequal access to healthcare. Long waiting times, poor care quality and lack of preventative care all perpetuate health inequalities; as one of the socio‐economic determinants, access to healthcare affects health outcomes.

As part of the South African Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP), the annual SARU Youth Week tournaments’ injury data are recorded and investigated by SA Rugby. The BokSmart National Rugby Safety Programme has been collecting and analysing these data annually since 2011 for the SARU Boy’s Youth Week tournaments. In 2015, the SARU Girls’ Youth Week data collection began; this report being the first to analyse the Girls’ Youth Week data. The analysis shows injury patterns over time between tournaments, and collectively, for the girls’ u16 and u18 SARU Youth Weeks. Additionally, the analysis compares the profiles of injured players at each individual tournament. When investigating these patterns, areas of concern are identified, changes in the game, tournament structure or medical support services are considered or contested against the evidence, and injury specific interventions can be created and implemented, where the evidence indicates such a need. Each medical facility at the SARU Youth Week tournaments has a designated researcher onsite, who together with the tournament medical doctors, records the tournament injury data daily. Three injury cases were removed from the analysis. These data were recorded but did not appear to be accurate on follow-up and were therefore removed. Unfortunately, inaccuracy can occur during data collection and measures have been implemented to ensure that this is limited. This 2019 SARU Girls’ Youth Week report focuses on the Girls’ tournaments, comprising of the Girls u16 Week (Gu16W) and Girls u18 Week (Gu18W) held in 2019. The tournaments consisted of 32 teams and 48 matches. Comparisons are made between SARU Girls’ Youth Week tournaments and over time between 2015 and 2019. It must be noted that no Gu16W tournament was held in 2017. In 2019, the Gu16W recorded a higher Time-Loss injury incidence at 22 (11 - 33) [mean (95% confidence intervals)] injuries per 1000 player hours. Gu18W recorded slightly lower Time-Loss injury incidence at 19 (10 – 28) injuries per 1000 player hours. The collective tournament average was measured at 21 (13 to 28) injuries per 1000 player hours. When combining the injury incidence data collected over the five years, Gu18W had a lower Time-Loss injury incidence. In 2019, the Tackler and Open Play, followed by the Ball Carrier, were the most frequent injury-causing events in that order. Tackling front-on (regulation), Tackling LOW side-on, and Tackling LOW front-on, were the most frequent injury causing mechanisms involved in the Tackler phases of play. While Collision in Open Play was the most frequent injury causing mechanism in Open Play. The most common injury type was Central Nervous System injuries, where Gu18W recorded a higher incidence. Head and Neck were the most common injury locations in 2019, accounting for 69% of the injuries, with most of these injuries occurring in the Gu18W. Scrumhalves and flyhalves were the player positions with the highest normalised injury incidence per player per position across all tournaments. As expected, the injury incidence of ‘New’ injuries was higher than subsequent ‘Recurrent’ injuries. The majority of ‘New’ injuries were injuries to the joint, while most ‘Recurrent’ injuries were ligament and joint injuries. Fourteen concussions occurred across the two tournaments in 2019, which has dropped since the spike recorded in 2018. The Gu18W had the higher concussion incidence of the two tournaments. Furthermore, the act of Tackling contributed to 50% of the events causing concussions. The tackle contest is clearly an event that requires additional injury prevention focus for coaches on preparing their younger female players better for rugby, and requires more time spent on teaching them safer techniques and body positions in the tackle contest.

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The enduring image of general practice during the “classic” NHS, from its creation in 1948 until its first major reform in 1974, is that provided by John Berger’s poetic prose and Jean Mohr’s captivating photographs in their 1967 study A fortunate man. It paints a picture of a country doctor equipped with almost universal medical expertise singularly devoted to his patients and his rural Gloucestershire community to the exclusion of everything else. Whilst such an image of general practice as a slow, idyllic cottage industry is alluring given the modern experience of industrialised primary care, it fails to capture the pressures and constraints of working under the NHS. Pressures were different but similarly inexorable, and noticeable by their absence from Berger and Mohr. Instead, it is far more accurate to see general practitioners (GPs) as “penny collectivists” within a burgeoning socialised medical economy which favoured the extension of hospital services. Within this health economy GPs were effectively impoverishedentrepreneurs being squeezed from below by rising patient demand, expectations, and professional rivalries, and from above through a complex corporate bureaucracy. This paper captures this dynamic through the oral histories of GPs who practised in Lancashire and Westmorland combined with archival records of local primary care bureaucracy from 1948 to 1974.

To evaluate the evidence and produce a summary and recommendations for the most common heart and lung point-of-care ultrasound (PoCUS). We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendations were produced, including assigning levels of evidence (LoE) and grading of recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement of the summary and recommendation for each question (using a 5-point Likert scale), which was approved in the case of a level of agreement of greater than 75 %. A level of agreement was defined as a summary of "strongly agree" and "agree" on the Likert scale responses. One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1), the remaining 9 questions achieved broad agreement with an assigned LoE of 4 and a weak GRADE recommendation (question 2), three achieved an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8) and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10). These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings.ZIEL: Bewertung der Evidenz und Erstellung einer Zusammenfassung sowie von Empfehlungen für die häufigsten Herz- und Lungenanwendungen des Point-of-Care-Ultraschalls (PoCUS). Wir überprüften 10 klinische Bereiche bzw. Fragen im Zusammenhang mit den häufigsten Herz- und Lungenanwendungen des PoCUS. Nach der Überprüfung der Evidenz wurden eine Zusammenfassung und Empfehlungen erstellt, einschließlich der Zuordnung von Evidenzgraden (“Level of Evidence” LoE) und der Einstufung der Empfehlung, Bewertung, Entwicklung und Evaluierung (GRADE). Die Expert Review Group (ERG), bestehend aus 38 internationale Experten, wurde aufgefordert, die für jede Fragestellung vorgelegte Evidenz zu überprüfen. Eine Zustimmung von über 75 % war erforderlich, um zum nächsten Teilbereich überzugehen. Anschließend überprüfte die ERG die Ergebnisse und gab den Grad der Zustimmung (mittels 5-stufiger Likert-Skala) bezüglich der Zusammenfassung und Empfehlung für jede Fragestellung an. Diese wurde anerkannt, wenn der Grad der Zustimmung – definiert als Summe der Antworten „stimme voll zu“ und „stimme zu“ auf der Likert-Skala – mehr als 75 % betrug. Bei einer Frage wurde ein starker Konsens bei einem zugeordneten LoE von 3 und einer schwachen GRADE-Empfehlung erzielt (Frage 1). Die übrigen 9 Fragen erzielten eine breite Zustimmung, wobei eine Frage einen LoE von 4 und eine schwache GRADE-Empfehlung erhielt (Frage 2), 3 Fragen erreichten einen LoE von 3 mit schwacher GRADE-Empfehlung (Fragen 3–5), 3 Fragen erreichten einen LoE von 3 mit starker GRADE-Empfehlung (Fragen 6–8) und die verbleibenden 2 Fragen erhielten einen LoE von 2 mit einer starken GRADE-Empfehlung (Fragen 9 und 10). Diese konsensbasierten Empfehlungen sollen die klinische Praxis unterstützen und Bereiche für weitere Forschung hinsichtlich des PoCUS in der Akutversorgung aufzeigen.

To evaluate the evidence and produce a summary and recommendations for the most common heart and lung applications of point-of-care ultrasound (PoCUS). We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendation were produced, including assignment of levels of evidence (LoE) and grading of the recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement regarding the summary and recommendation for each question (using a 5-point Likert scale), which was approved if a level of agreement of greater than 75 % was reached. A level of agreement was defined as a summary of "strongly agree" and "agree" on the Likert scale responses. One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1). The remaining 9 questions achieved broad agreement with one assigned an LoE of 4 and weak GRADE recommendation (question 2), three achieving an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8), and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10). These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings.ZIEL: Bewertung der Evidenz und Erstellung einer Zusammenfassung sowie von Empfehlungen für die häufigsten Herz- und Lungenanwendungen des Point-of-Care-Ultraschalls (PoCUS). Wir überprüften 10 klinische Bereiche bzw. Fragen im Zusammenhang mit den häufigsten Herz- und Lungenanwendungen des PoCUS. Nach der Überprüfung der Evidenz wurden eine Zusammenfassung und eine Empfehlung erstellt, einschließlich der Zuordnung von Evidenzgraden („Level of Evidence“ LoE) und der Einstufung der Empfehlung, Bewertung, Entwicklung und Evaluierung (GRADE). Die Expert Review Group (ERG), bestehend aus 38 internationalen Experten, wurde aufgefordert, die für jede Fragestellung vorgelegte Evidenz zu überprüfen. Eine Zustimmung von über 75 % war erforderlich, um zum nächsten Teilbereich überzugehen. Anschließend überprüfte die ERG die Ergebnisse und gab den Grad der Zustimmung (mittels 5-stufiger Likert-Skala) bezüglich der Zusammenfassung und Empfehlung für jede Fragestellung an. Diese wurde anerkannt, wenn der Grad der Zustimmung – definiert als Summe der Antworten „stimme voll zu“ und „stimme zu“ auf der Likert-Skala – mehr als 75 % betrug. Bei einer Frage wurde ein starker Konsens bei einem zugeordneten LoE von 3 und einer schwachen GRADE-Empfehlung erzielt (Frage 1). Die übrigen 9 Fragen erzielten eine breite Zustimmung, wobei eine Frage einen LoE von 4 und eine schwache GRADE-Empfehlung erhielt (Frage 2), 3 Fragen erreichten einen LoE von 3 mit schwacher GRADE-Empfehlung (Fragen 3–5), 3 Fragen erreichten einen LoE von 3 mit starker GRADE-Empfehlung (Fragen 6–8) und die verbleibenden 2 Fragen erhielten einen LoE von 2 mit einer starken GRADE-Empfehlung (Fragen 9 und 10). Diese konsensbasierten Empfehlungen sollen die klinische Praxis unterstützen und Bereiche für weitere Forschung im Bereich des PoCUS in der Akutversorgung aufzeigen.

The Lancashire and South Cumbria New Hospitals Programme (NHP) contends that the region has a ‘once in a generation opportunity’ to transform hospitals for 1.8 million local people by 2030. The NHP is the central pillar of a regional strategy developed by Lancashire and South Cumbria Health and Care Partnership (HCP), one of 42 Integrated Care Systems (ICS) constituted by the Conservative Government’s National Health Service (NHS) reform outlined in Integration and Innovation as the building block of services. The strategy envisions organising services as a ‘network’ comprising existing hospital sites and services as spokes which centre around a new world-leading hospital hub. However, rather than being ‘once in a generation’, this model mirrors exactly the intentions of the original architects of the NHS. The NHP is, in fact, a generation gap. The 2030 vision is the realisation of the model which planners conceived in 1948. This paper shows how the original 1948 model emerged and how, ultimately, it was rejected. The rejection was not due to clinical or service failings in the model, but to the rivalries and jealousies of hospitals, services, and universities. This history has several lessons for current health services leaders and the NHP.

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In this paper, I attempt a comparison between the sacred significance of fat and honey in the myths and rituals of the San peoples of southern Africa and the ancient Greeks. As Biesele (1993) and Lewis-Williams (2015) have convincingly demonstrated, the creation narratives of the diverse linguistic groups which constitute the /Xam (San) peoples of southern Africa, arguably the first peoples to call this country ‘home’, reveal strong links between the gathering and possession of animal fat and honey, and access to spiritual power. In ancient Greek mythology, as is well known from Callimachus and many later texts (e.g., Apollodorus and Nonnus), the infant Zeus was fed on honey by the bee-woman, Melissa. Many fundamental rites in ancient Greek religion, as reflected in texts from Homer onwards—libations, some sacrifices, ritual offerings such as the ‘panspermia’, and funerary rites—all provide evidence of the Greek belief in the spiritual potency of fat and honey. I thus analyse the similarities and differences between the significance of the fat-honey nexus in these two religious traditions and reflect on cross-cultural comparisons, their history, and their purpose in contemporary South Africa.

This sub-study within the JAKIDS longitudinal cohort study compares medical and psychosocial outcomes of pregnancy in younger adolescent mothers (16 years), older adolescent mothers (16-19 years) and adult mothers (19 years) in Jamaica. Participants were recruited from July to September 2011 and included 9521 mother-infant dyads; mean maternal age 26.0 years (SD 6.8). Adolescent mothers represented 19.1% (n = 1822) of the sample - 1704 older adolescent mothers (17.9%) and 118 younger adolescent mothers (1.2%). Participants completed interviewer-administered questionnaires regarding their sexual and reproductive health history, feelings about the current pregnancy, and presence of anxious and depressive symptoms. Data on delivery and perinatal and neonatal outcomes were extracted from hospital charts. Younger adolescent mothers were more likely to deliver preterm (

The launch of the Troubled Families Programme in 2011 has thrown into sharp relief how governments develop policies and practices to intervene in the lives of so‐called ‘troubled families’. Commentators were quick to make comparisons with historic efforts to rehabilitate ‘problem families’ in the post‐war period. However, beyond discursive similarities, there are also marked continuities in how family policies have been developed and implemented. This review narrates the rise, fall and rise of concern about ‘problem’ and ‘troubled’ families in England in the context of anxieties about child and family welfare, and the appropriate response of the state.

Although a growing body of literature has demonstrated that justice-involved people with mental illnesses have criminogenic risk factors at similar or elevated rates as compared to justice-involved people without mental illnesses, more information about how criminogenic risks vary by intensity of mental health symptoms is needed. This information is particularly important for probation agencies who supervise the vast majority of justice-involved individuals with mental illnesses and who are increasingly implementing specialty mental health supervision approaches. To this end, this study examines the relationship between criminogenic risk and intensity of self-reported symptoms of mental illnesses among 201,905 individuals on probation from a large southeastern state. Self-report measures of symptoms of mental illnesses were categorized as low, moderate or high and criminogenic risks were compared among the following three groups: (1) those with no or low self-reported symptoms of mental illness; (2) those reporting moderate levels of symptoms; and (3) those reporting high or elevated levels of symptoms. Our findings suggest that the strength of relationships between symptoms of mental illnesses and criminogenic risks varies by type of criminogenic risk. Also, elevated symptoms of mental illness are associated with higher levels of criminogenic risks. More research about interventions that address mental illnesses and criminogenic risks is needed to inform practice and policy.

In 1988, the US Central Intelligence Agency (CIA) declassified a research paper with the title, “Unrest in the Caucasus and the challenge of Nationalism” on the Nagorno-Karabakh autonomous oblast time when the conflict between Armenia and Azerbaijan was emerging. It lasted until 1994.

The content of the report is based on data collected by the SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP) steering group.

Objective: Public stigma impedes marginalized populations from accessing health and social services. However, little is known about public stigma as a potential barrier to engagement with maltreatment prevention programs such as parenting interventions. This study presents an initial examination of the psychometric properties of an adapted version of the Stigma Scale for Receiving Psychological Help (SSRPH) used with a sample of fathers/male caregivers eligible for a parenting support intervention implemented at Head Start. Method: The psychometric properties of the adapted SSRPH were assessed using cognitive interviews, confirmatory factor analysis, and measures of internal consistency. Descriptive statistics from the adapted SSRPH were used to describe the level of stigma experienced in this sample. Results: Consistent findings from cognitive interviews and positive psychometric results [χ2 (5, N = 83) = 6.99, p = .22], TLI = .96, CFI = .98, RMSEA = .07 (90% confidence interval [0.00, 0.18], alp...

Introduction The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest. Methods The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol. Results Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the “4 F” approach: fluid, form, function, filling. Conclusion An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.

The Troubled Families Programme (TFP) was launched by the UK Coalition Government in December 2011. Following the riots that took place in towns and cities across England during that summer, the then Prime Minister David Cameron promised to put ‘rocket boosters’ under plans to ‘turn around’ the lives of the country's ‘most troubled families’ by the end of the Coalition's term of office in May 2015. In his ‘fightback’ speech, delivered just a week after the riots had ended, Cameron (2011a) stated that the riots were not about poverty or race or government cuts. Instead, he argued that that the riots were ‘about behaviour: people showing indifference to right and wrong; people with a twisted moral code; people with a complete absence of self-restraint’.

To evaluate the accuracy of PoCUS in predicting return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD) in adult non-traumatic, non-shockable out-of-hospital or emergency department cardiac arrest.Medline, EMBASE, Cochrane, CINAHL, ClinicalTrials.gov and the World Health Organization Registry were searched for eligible studies. Data analysis was completed according to PRISMA guidelines. A random-effects meta-analysis model was used with I-squared statistics for heterogeneity.Ten studies (1486 participants) were included. Cardiac activity on PoCUS had a pooled sensitivity of 60.3% (95% confidence interval 38.1%-78.9%) and specificity of 91.5%(80.8%-96.5%) for ROSC. The sensitivity of cardiac activity on PoCUS for predicting ROSC was 26.1%(7.8%-59.6%) in asystole compared with 76.7% (61.3%-87.2%) in PEA. Cardiac activity on PoCUS, compared to absence, had odd ratios of 16.90 (6.18-46.21) for ROSC, 10.30(5.32-19.98) for SHA and 8.03(3.01-21.39) for SHD. Positive likelihood ratio (LR) was 6.87(3.21-14.71) and negative LR was 0.27(0.12-0.60) for ROSC.Cardiac activity on PoCUS was associated with improved odds for ROSC, SHA, and SHD in non-traumatic, non-shockable cardiac arrest. We report a lower sensitivity and higher negative likelihood ratio, but greater heterogeneity compared to previous systematic reviews. PoCUS may provide valuable information in the management of non-traumatic PEA or asystole, but should not be viewed as the sole predictor in determining outcomes.

Importance Chest radiography is the most common diagnostic imaging examination performed in emergency departments (EDs). Augmenting clinicians with automated preliminary read assistants could help expedite their workflows, improve accuracy, and reduce the cost of care. Objective To assess the performance of artificial intelligence (AI) algorithms in realistic radiology workflows by performing an objective comparative evaluation of the preliminary reads of anteroposterior (AP) frontal chest radiographs performed by an AI algorithm and radiology residents. Design, Setting, and Participants This diagnostic study included a set of 72 findings assembled by clinical experts to constitute a full-fledged preliminary read of AP frontal chest radiographs. A novel deep learning architecture was designed for an AI algorithm to estimate the findings per image. The AI algorithm was trained using a multihospital training data set of 342 126 frontal chest radiographs captured in ED and urgent care settings. The training data were labeled from their associated reports. Image-based F1 score was chosen to optimize the operating point on the receiver operating characteristics (ROC) curve so as to minimize the number of missed findings and overcalls per image read. The performance of the model was compared with that of 5 radiology residents recruited from multiple institutions in the US in an objective study in which a separate data set of 1998 AP frontal chest radiographs was drawn from a hospital source representative of realistic preliminary reads in inpatient and ED settings. A triple consensus with adjudication process was used to derive the ground truth labels for the study data set. The performance of AI algorithm and radiology residents was assessed by comparing their reads with ground truth findings. All studies were conducted through a web-based clinical study application system. The triple consensus data set was collected between February and October 2018. The comparison study was preformed between January and October 2019. Data were analyzed from October to February 2020. After the first round of reviews, further analysis of the data was performed from March to July 2020. Main Outcomes and Measures The learning performance of the AI algorithm was judged using the conventional ROC curve and the area under the curve (AUC) during training and field testing on the study data set. For the AI algorithm and radiology residents, the individual finding label performance was measured using the conventional measures of label-based sensitivity, specificity, and positive predictive value (PPV). In addition, the agreement with the ground truth on the assignment of findings to images was measured using the pooled κ statistic. The preliminary read performance was recorded for AI algorithm and radiology residents using new measures of mean image-based sensitivity, specificity, and PPV designed for recording the fraction of misses and overcalls on a per image basis. The 1-sided analysis of variance test was used to compare the means of each group (AI algorithm vs radiology residents) using the F distribution, and the null hypothesis was that the groups would have similar means. Results The trained AI algorithm achieved a mean AUC across labels of 0.807 (weighted mean AUC, 0.841) after training. On the study data set, which had a different prevalence distribution, the mean AUC achieved was 0.772 (weighted mean AUC, 0.865). The interrater agreement with ground truth finding labels for AI algorithm predictions had pooled κ value of 0.544, and the pooled κ for radiology residents was 0.585. For the preliminary read performance, the analysis of variance test was used to compare the distributions of AI algorithm and radiology residents' mean image-based sensitivity, PPV, and specificity. The mean image-based sensitivity for AI algorithm was 0.716 (95% CI, 0.704-0.729) and for radiology residents was 0.720 (95% CI, 0.709-0.732) (P = .66), while the PPV was 0.730 (95% CI, 0.718-0.742) for the AI algorithm and 0.682 (95% CI, 0.670-0.694) for the radiology residents (P

The ability of the attacking team to break through the defensive line is a key indicator of success as it creates opportunities to score tries. The aim of this study was to analyse line breaks and identify the associated skills and playing characteristics. The 2013 Super Rugby season (125 games) was analysed, in which 362 line breaks were identified and coded using variables that assessed team patterns and non-contact attacking skills in the phases preceding the line break. There was an average of 3 line breaks per game, with 39% of line breaks resulting in a try. Line breaks occurred when the ball-carrier was running fast [61%, x2(4) = 25.784, p = 0.000, Cramer’s v = 0.1922, weak]. At a moderate distance, short lateral passes (19%) and skip passes (15%) attributed to the highest percentage of line breaks [x2(26) = 50.899, p = 0.036, Cramer’s v = 0.2484, moderate]. Faster defensive line speeds resulted in more line breaks [x2(12) = 61.703, p < 0.001, Cramer’s v = 0.3026, moderate]. Line breaks are associated with overall team success and try scoring opportunities. Awareness of the defenders line speed and depth, fast running speed when receiving the ball and quick passing between attackers to the outside backs creates line break opportunities. During training, coaches should emphasise the movement speed of the ball between attackers and manipulate the speed and distance of the defenders.

Gary Wilder, Freedom Time: Negritude, Decolonization, and the Future of the World. Durham: Duke University Press, 2015. 384 pp.Aime Cesaire and Leopold Sedar Senghor were two intellectual and political iconoclasts of imperial France in the 20th century. Born in the early years of the century (Senghor in 1906 and Cesaire in 1913) in the distant reaches of the French Empire (Senghor in Senegal and Cesaire in Martinique), these two men would meet as students in Paris where they joined forces as founders of the influential negritude movement. After World War II, they each returned to their respective homelands where they would become leading political figures. Cesaire would serve as longtime elected mayor of Fort-de-France and deputy to the French National Assembly. Senghor would win election as deputy to the French National Assembly and then, following independence, serve for 20 years as Senegal's first president. Following the end of their political careers, both men, despite having had origins far from metropolitan France, would be honored as favored sons of the French republic. In 1983, Senghor became the first African elected to the prestigious Academie francaise, and, in 2011, a plaque honoring Cesaire was installed in the Pantheon in Paris.The complex relationship that held between these authors and France sets the stage for Freedom Time. The apparent conservatism of Cesaire and Senghor-pioneers of a francophone countercultural movement who had established themselves as leading politicians and public intellectuals in their homeland - presents itself as a bit of a puzzle. Following World War II, while much of the colonized world, from Ghana to Vietnam, was advocating for independence and national sovereignty, Cesaire and Senghor imagined a very different path out of the colonial era. Neither advocated for outright independence or the territorial sovereignty of their respective homelands. Instead, they proposed a future in which the colonial arrangement would be undone, but some form of political integration with France would be maintained. Aime Cesaire, as elected deputy of Martinique to the French assembly, would help negotiate the political incorporation of Martinique into France as an overseas department which enjoyed, at least in principle, the same rights and responsibilities as any other French department. And Senghor, while his homeland of Senegal would become independent in 1960, during the years leading up to independence advocated for a different outcome. Rather than advocate for Senegalese territorial sovereignty, Senghor proposed a continued political relationship between former French imperial territories in Africa and metropolitan France, albeit one that was not colonial. This relationship would take the form of a "federation of federations within a larger confederation" (153).Some scholars have been at a loss to make sense of the seemingly conservative positions of these two intellectual and political icons of the 20th century. Are they to be read as proto-nationalists, precursors to a more radical and nationalist Frantz Fanon, or simply dismissed as conservative stooges, dupes who unwittingly laid the groundwork for the French neocolonial project that, in the case of Africa, came to be famously known as frangafrique? In this book, Gary Wilder unabashedly revisits the political projects of Cesaire and Senghor. Wilder does not hide his admiration for what Senghor and Cesaire aspired to achieve. He takes at face value their political visions-for a world in which colonialism will be undone without the former colonies claiming territorial sovereignty-as proposals to be taken seriously, both then and now. While the text possesses a rueful "what if" tone, Wilder is not merely looking back on a future that never came to be. Rather, ultimately his aim is to look at our time forward. He revisits the controversial positions of these francophone public intellectuals to highlight the relevance of their ideas to those currently "attempting to rethink democracy, solidarity, and pluralism beyond the limitations of methodological nationalism" (3). …

Objective A systematic review was conducted to determine the health burden of preventable disease in Australia. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines were followed to identify, screen and describe the protocols used in the systematic review. Results Eleven studies were included in the review. Data on the health burden associated with lifestyle-related risk factors were extracted by disease with outcomes reported in attributable number and proportion of deaths, years of life lost, years lived with disability and disability-adjusted life years (DALYs). Around one-third of DALYs was attributed to all modifiable risk factors. The range of estimates of DALYs attributable to each prioritised risk factor was: combined dietary risk factors, 7.2% to 9.7%; tobacco, 7.9% to 9.0%; alcohol, 5.1% to 12.2%; high body mass, 5.5% to 8.3%; and physical inactivity, 1.2% to 5.5%. Conclusions Although the methods used to estimate preventable health burden varied greatly between studies, all found that a substantial amount of death and disability was attributable to lifestyle-related risk factors. Implications for public health: There is a large health burden in Australia caused by modifiable risk factors and further action is warranted to address this burden.

There is little published information about the measures that probation agencies in the United States use to identify individuals with mental illnesses who are under community supervision. This study used statewide administrative data to estimate and compare the prevalence of mental illnesses among probationers using officer report and offender self-report data. Prevalence estimates of mental illnesses ranged from 15 percent to 19 percent, which is consistent with prior studies that used formal diagnostic assessments. In the absence of costly and time-consuming diagnostic assessments, probation agency-developed mental health scales can aid in identifying those who might be in need of additional mental health assessment.

To meet a critical and growing need for a standardized approach to emergency point of care ultrasound (PoCUS) worldwide, emergency physicians must be trained to deliver and teach this skill in an accepted and reliable format. Currently, there is no globally recognized, standard PoCUS curriculum that defines the accepted applications, as well as standards for training and practice of PoCUS by specialists and trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine (IFEM) convened a sub-committee of international experts in PoCUS to outline a curriculum for training of specialists in emergency PoCUS. This curriculum document represents the consensus of recommendations by this sub-committee. The curriculum is designed to provide a framework for PoCUS education in emergency medicine.The focus is on the processes required to select core and enhanced applications, as well as the key elements required for the delivery of PoCUS training from introduction through to continuing professional development and skill maintenance. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance PoCUS education in emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems but in particular for developing nations or for nations seeking to develop PoCUS training programs within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational environment, resources and goals of educational programs.

The current education reform model in America emphasizes uniform standards and data collection through standards-aligned assessments with the goal of producing “college- and career-ready” graduates. To this end, students and teachers, rather than being seen as individuals, are increasingly being identified as the data generated. However, through an emphasis on personal narrative, familiarity with the archetypes of myth and the journey of the hero, and the application of these concepts to their own lives, students can maintain familiarity with their own “inner landscapes” and, hopefully, graduate high school with a sense of purpose beyond the impersonal demands of society.

Children who experience polyvictimization in high-income countries (HICs) are at higher risk for mental health-related trauma symptoms. There is limited information on the impact of polyvictimisation on children with high levels of exposure, as occurs in some low- and middle-income countries (LMICs). This study investigates the impact of poyvictimization on Jamaican children's intellectual functioning, achievement, and disruptive behaviors. Data from a geographical subgroup (n = 1171) of a 1986 population based birth cohort study were utilised. At age 11-12 years, the sub-group completed questionnaires on exposure to violence at school, at home and in their communities, and tests of academic and intellectual functioning. Their parents completed questionnaires on family resources (socioeconomic status) and children's behaviour. Findings from Structural Equational Modelling indicated that for both genders, exposure to polyvictimisation had a direct negative effect on intellectual functioning, and an indirect negative effect on achievement mediated through intellectual functioning. For boys, polyvictimisation had a direct negative effect on behavioural risk. Family resources was negatively associated with exposure to polyvictimisation. In Jamaica, a LMIC country with high levels of polyvictimisation, there is a significant negative effect of polyvictimisation on children. The secondary- and tertiary-level interventions to address these effects are costly to LMICs with limited financial resources. Prevention of exposure to violence in all its forms is therefore the recommended approach to reduce violence-related morbidity.

The commitment of the appointed Director General of the Troubled Families Unit, Louise Casey, that the Troubled Families Programme (TFP) was ‘an opportunity not to repeat the failed attempts of the past’ masks several enduring continuities (Casey, 2012: 3). This review article argues that the TFP should be seen as part of a wider spectrum of policies which locates ‘troubles’ or ‘problems’ in the family itself and emphasises behaviour as the target of action without regard to wider social or economic considerations. This policy process must be understood within a wider context of not only historical efforts ‘to constrain the redistributive potential of state welfare’ (Macnicol, 1987: 316) but also of contemporary forms of neoliberal governance of ‘the family’ (Butler, 2014; Crossley, 2016a; Gillies, 2014).