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The tragic story of Captain Robert Falcon Scott and the British Antarctic Expedition (1910-13) is a cornerstone of British cultural memory. While Scott's heroism has been widely studied in historiography and biography, the commercial mobilization of his public image has received comparatively little attention. This paper offers the first systematic analysis of advertisements associated with Scott's final expedition, combining visual social semiotic analysis with archival research to examine the interplay of commercial representations and public perceptions of polar exploration. Building on the work of Nielsen, it identifies three overlapping themes-Heroic Masculinity in Extreme Environments, Domestic Comfort andCivilizedConsumption, and Scientific Authority andRationalizedExpertise-through which advertisers constructed Scott's image and conveyed values associated with the expedition. The analysis shows that scientific labour was consistently marginalized; instead, brands prioritized emotionally imagery of endurance, suffering and-following Scott's death-martyrdom. When invoked, science served primarily to signal technical ingenuity and product reliability, often supported by testimonials. At the same time, references to domestic comfort served to bridge Antarctica and home, enabling consumers to participate imaginatively in the expedition. The paper also examines more recent reinterpretations of Scott's image in advertising, demonstrating how he endures as a flexible cultural symbol and a lasting emblem of British exceptionalism.
Hallux valgus is the most prevalent forefoot condition and is associated with substantial pain, functional impairment and reduced health-related quality of life. Despite established clinical effectiveness, since 2021 an increasing number of Integrated Care Boards in the UK have classified surgical correction as a procedure of limited clinical benefit, citing a perceived absence of population-level cost-effectiveness data. National-scale evidence is required to inform commissioning decisions and ensure equitable access to care. A cost-utility analysis was performed from the perspective of the UK National Health Service (NHS) using British Orthopaedic Foot and Ankle Society (BOFAS) Registry data for adults undergoing primary hallux valgus correction by osteotomy (open or minimally invasive surgery, MIS). Fusion procedures were excluded. EuroQol-5 Dimension five-level (EQ-5D-5L) utility scores at baseline and 12 months were used to estimate quality-adjusted life year (QALY) gains. A six-state Markov model simulated lifetime costs and outcomes over 40 annual cycles from the UK NHS perspective, with costs and benefits discounted at 3.5% per annum. Incremental cost-effectiveness ratios (ICERs) were calculated against conservative management and deterministic sensitivity analysis was performed across procedural cost, utility gain and benefit duration. A pre-specified subgroup analysis compared open and MIS techniques. From 1111 registry pathways, 306 patients had complete EQ-5D-5L datasets for cost-utility modelling, comprising 129 open and 177 MIS procedures. EQ-5D-5L utility improved from 0.69 (95% CI 0.65-0.72) at baseline to 0.84 (95% CI 0.81-0.88) at 12 months in the open group, and from 0.69 (95% CI 0.66-0.72) to 0.82 (95% CI 0.79-0.84) in the MIS group (both p < 0.001). The base-case lifetime Markov model produced an ICER of £ 8737 per QALY for open correction and £ 11,969 per QALY for MIS correction, both well below the NICE willingness-to-pay threshold. In sensitivity analysis using incremental costs against conservative management, the ICER ranged from cost-saving (-£374 per QALY) to £ 3219 per QALY across all tested scenarios. Open correction was the dominant strategy in the pre-specified subgroup analysis, primarily driven by lower implant costs and higher removal rates in current literature. Hallux valgus correction surgery is highly cost-effective from the UK NHS perspective, with cost per QALY values substantially below those reported for total hip and total knee arthroplasty. The current restriction of access in some UK regions is not supported by national health-economic evidence. III (economic and decision analysis based on prospective registry data).
These guidelines are an update to the 2008 UK guidelines for the management of sexual and reproductive health of people living with HIV. The writing group has followed updated British Association for Sexual Health and HIV (BASHH) guideline methodology, notably using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for assessing evidence and making recommendations. We have made significant changes to the recommendations which are summarised below.
Clinical guidelines now recommend administering intrapartum antibiotic prophylaxis (IAP) before skin incision at caesarean section to prevent maternal infection. However, this practice exposes the fetus to antibiotics, raising concerns about potential long-term effects on the infant microbiome and the risk of childhood obesity. To assess whether the timing of IAP at caesarean section-before skin incision versus after umbilical cord clamping-is associated with childhood obesity at age 4-5 years. We conducted a quasi-experimental study of a hospital-wide policy change in clinical practice using data from two birth cohorts (Born in Bradford [BiB] and Born in Bradford's Better Start [BiBBS]). The study included 1985 children of White British or Pakistani heritage born by caesarean section between 2007 and 2019. Children exposed to pre-incision IAP (n = 324) were compared with those unexposed (post-cord clamping IAP; n = 1661). The primary outcome was obesity (BMI z-score > 95th percentile) at age 4-5 years. Adjusted Risk Ratios (aRR) were estimated using multivariable Poisson regression stratified by ethnicity. The prevalence of obesity was 11.9%. Adjusted risk ratios for obesity were 1.25 (95% CI 0.53 to 2.98) for White British children and 1.25 (95% CI 0.64 to 2.43) for Pakistani children. Similarly, estimates for BMI z-score had wide confidence intervals indicating, limited precision. We did not observe a clear difference in childhood obesity at 4-5 years between pre-incision and post-cord clamping prophylactic antibiotics at caesarean section. Confidence intervals were wide, and modest clinically relevant effects cannot be excluded. Findings are compatible with no large adverse effect and may provide reassurance regarding the metabolic safety of current clinical practice.
In the summer of 2021, the Canadian province of British Columbia (B.C.) experienced an unprecedented extreme heat event, which resulted in 619 heat-related deaths across the province (Henderson et al., 2022). This evaluation aims to assess the sensitivity and specificity of a surveillance algorithm to identify heat illness-related emergency department (ED) visits during this period, as well as to explore the impact of adjusting the case definition to enhance algorithm performance. A chart review of ED visits across a regional health authority in B.C. during the 2021 period of extreme heat was conducted. This was considered the most accurate information to which the algorithm was compared. Sensitivity and specificity were calculated for the original algorithm, as well as for an expanded algorithm including heat-related illnesses and the following additional diagnoses: syncope, altered level of consciousness, acute kidney injury, acute renal failure, and general weakness. The original algorithm focusing on explicitly recorded heat illnesses has a sensitivity of 59% and a specificity of 100%. The expanded algorithm produced a sensitivity of 80% and a specificity of 96%. Surveillance sensitivity for heat-related illness may be substantially impacted by the inclusion of diagnoses not explicitly naming effects of heat. Other jurisdictions could consider expanding heat-related illness definitions to include additional heat-associated diagnoses to gain a more comprehensive understanding of the impact of heat on health to support monitoring and action. RéSUMé: OBJECTIFS: Au cours de l’été 2021, la province canadienne de la Colombie-Britannique (C.-B.) a connu une vague de chaleur extrême sans précédent, qui a entraîné 619 décès liés à la chaleur à travers la province (Henderson et al., 2022). Cette évaluation vise à déterminer la sensibilité et la spécificité d’un algorithme de surveillance permettant d’identifier les visites aux urgences en lien avec des maladies liées à la chaleur pendant cette période, ainsi qu’à examiner les répercussions d’un ajustement de la définition de cas sur l’amélioration des performances de l’algorithme. MéTHODES: Une analyse des dossiers relatifs aux visites aux urgences au sein d’une autorité sanitaire régionale de la C.-B. a été menée pendant la période de chaleur extrême de 2021. Ces données ont été considérées comme les informations les plus précises auxquelles comparer l’algorithme. La sensibilité et la spécificité ont été calculées pour l’algorithme initial, ainsi que pour un algorithme plus large incluant les maladies liées à la chaleur et les diagnostics supplémentaires suivants: syncope, altération de l’état de conscience, lésion rénale aiguë, insuffisance rénale aiguë et faiblesse générale. RéSULTATS: L’algorithme initial, axé sur les cas de maladies liées à la chaleur explicitement recensés, présente une sensibilité de 59% et une spécificité de 100%. L’algorithme plus large a donné une sensibilité de 80% et une spécificité de 96%. CONCLUSION: La sensibilité de la surveillance des maladies liées à la chaleur peut être considérablement influencée par l’inclusion de diagnostics ne mentionnant pas explicitement les effets de la chaleur. D’autres régions pourraient envisager d’élargir la définition des maladies liées à la chaleur afin d’y inclure d’autres diagnostics associés à la chaleur pour obtenir une compréhension plus complète des répercussions de la chaleur sur la santé et de faciliter ainsi le suivi et les interventions.
Preterm Births (PTBs) are viewed as one of the major causes of neonatal morbidity, mortality and health-system cost in England. The incidence of preterm is persistently greatest among those experiencing socioeconomic and ethnic inequalities. This study aims to quantify deprivation and ethnicity gradients, using the available dataset, in PTBs and subsequently to translate deprivation-related inequality into policy-relevant priority bands. It analyses aggregated live-birth data for England (2020-2021), stratified separately by gestational age × Index of Multiple Deprivation (IMD), and gestational age × maternal ethnicity. Socioeconomic inequalities are summarised using the Slope Index of Inequality (SII), Relative Index of Inequality (RII), deprivation-attributable excess cases, and the population attributable fraction (PAF) with the least deprived quintile as reference. Subsequently, a two-axis rule combining relative risk and share of excess burden is applied to derive the prioritised target bands. The data analysed comprises 1,179,195 live births in 2020-2021, demonstrating a monotonic increment across populations, from 6.39% in the least deprived quintile to 8.71% in the most deprived. The most deprived quintile accounted for 57.7% of deprivation-attributable excess PTBs. Differences across ethnic disparities were also evident, with the highest PTB rate being among Black Caribbeans (10.22%; RR 1.37 vs White British births). Translation of inequalities into deprivation-based priority bands provides an empirical bridge between surveillance and targeted universalist prevention policy, thus supporting proportionate resource allocation in high-burden populations.
Managing the neonatal and infant airway is challenging due to several anatomic and physiologic differences compared to adults. In 2024, the European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia published joint guidelines on airway management in neonates and infants (defined as <1 year). The guidelines recommend using history and physical examination to predict a difficult airway. They recommend using sedatives such as etomidate or ketamine to ensure appropriate anaesthesia combined with neuromuscular blocking agents. Videolaryngoscopy is the first choice for intubation, and apneic oxygenation should be used during the intubation attempt. A supraglottic device can be used for rescue oxygenation and ventilation if tracheal intubation is unsuccessful. The number of attempts should be limited, with consideration of changing to a different technique, provider, or both after each unsuccessful attempt. A stylet should be used for hyperangulated videolaryngoscopy blades and airways that are anatomically anterior. End-tidal capnography should be used to verify intubation. The guidelines also incorporate considering human factors to improve patient care and reduce harm. This review summarizes the 2024 guideline recommendations for management of the neonatal and infant airway with an emphasis on their impact on emergency medicine.
This study explored the lived experience of British drag performers, focusing on the complex relationship between their persona and sense of self. Against the backdrop of drag's growing mainstream acceptance, this research addressed a gap in a field dominated by US accounts of cisgender male performers. Using interpretative phenomenological analysis, semi-structured interviews were conducted with six drag performers of diverse gender identities, sexualities, and drag styles with the aim of understanding how drag personas and personal identities intersect. Analysis yielded three superordinate themes: 1) "The Paradox of Integration," which positioned the persona-self relationship on a spectrum from clear separation to deep integration; 2) "Persona as Protector," which examined the persona's function as a psychological buffer against internal vulnerabilities and external threats; and 3) "Peak Me," which captured the transcendent and motivating experience of heightened self-expression during performance. The findings suggested the persona was not merely a theatrical role but also a psychological partner, protector, and a source of profound pleasure. This study proposed a "spectrum of integration" to understand this interplay and highlighted an underexplored psychological desire of performers to return to the heightened state achieved in performance.
This article is based on the Hugh Greenwood Lecture delivered at the 2026 Congress of the British Association of Paediatric Surgeons. Childhood injury remains one of the leading causes of death and disability worldwide, disproportionately affecting children in low- and middle-income countries despite the availability of effective prevention strategies. This paper argues that paediatric surgeons have an important role that extends beyond the operating theatre and presents a practical roadmap for reducing childhood injury based on the public health approach to injury prevention. Seven interdependent pillars are proposed: surveillance, risk factor identification, intervention development, implementation, trauma system strengthening, evaluation and advocacy. Together, these provide a framework for translating evidence into sustained reductions in childhood injury through contextually appropriate prevention, stronger trauma systems and leadership from the paediatric surgical community. EVIDENCE LEVEL: Level V.
We aimed to conduct a systematic review and study-level meta-analysis of randomized controlled trials and observational studies comparing intravascular ultrasound (IVUS) guidance with angiography guidance for peripheral artery disease (PAD) endovascular revascularization, as current evidence is lacking. We searched Medline, Embase and CENTRAL from inception until November 22, 2025. Trials and observational studies were analyzed separately. We used random-effects as our primary analysis and assessed the certainty of evidence using GRADE. Key outcomes included restenosis, reintervention, major amputation, and mortality. We included 2 randomized trials (n = 387), and 19 observational studies (n = 1,164,329). According to randomized data, IVUS-guidance likely reduces restenosis compared to angiography-guidance (RR 0.59, 95% CI 0.42 - 0.83; moderate certainty). However, IVUS may not reduce reintervention (risk ratio (RR) 0.68, 95% confidence interval (CI) 0.44 - 1.08, low certainty), or mortality (RR 1.13, 95% 0.37 - 3.42, low certainty), while its effect on major amputation is very uncertain (RR 0.97, 95% 0.14 - 6.73, very low certainty). However, based on observational data, IVUS may reduce restenosis (RR 0.70, 95% CI 0.54 - 0.90, low certainty), reintervention (RR 0.66, 95% CI 0.48 -0.90, low certainty), major amputation (RR 0.83, 95% CI 0.72 - 0.96, low certainty), and mortality (RR 0.88, 95%CI 0.84, 0.93, low certainty). IVUS guidance likely reduces restenosis based on limited randomized evidence. Observational studies suggest potential benefits across several outcomes, although the certainty of evidence is low. Larger randomized trials are required to clarify the potential benefits of IVUS guidance.
A low dose of the selective endothelin A receptor antagonist zibotentan in combination with the sodium - glucose co-transporter 2 inhibitor (SGLT2i) dapagliflozin reduced urinary albumin-to-creatinine ratio (UACR) by ~30% compared to dapagliflozin alone in a phase 2b study without increasing the risk of fluid retention. These findings supported the design and conduct of the ZENITH High Proteinuria trial (NCT06087835) to assess the long-term efficacy and safety of a fixed-dose combination zibotentan/dapagliflozin in delaying the progression of chronic kidney disease (CKD). ZENITH High Proteinuria is an ongoing randomized, double-blind, placebo-controlled phase 3 trial enrolling participants with CKD (defined as UACR >700 mg/g or urinary protein-to-creatinine ratio >1000 mg/g and estimated glomerular filtration rate [eGFR] ≥20-<90 mL/min/1.73 m2) with and without type 2 diabetes. Eligible participants were randomized 1:1 to zibotentan/dapagliflozin 0.25/10 mg (if eGFR<45 mL/min/1.73 m2)/0.75/10 mg (if eGFR ≥45 mL/min/1.73 m2) or placebo/dapagliflozin on top of standard of care, including maximum tolerated renin-angiotensin-system blockade. The primary efficacy outcome is the mean eGFR change from baseline to Month 24. Secondary efficacy outcomes include time to the composite of end-stage kidney disease, sustained ≥ 40% decrease in eGFR, or renal death. Adverse events are collected to assess safety. Participants were enrolled from November 2023 to November 2024 from 30 countries. Overall, 2910 patients were screened, of whom 1833 were randomized and treated. Mean age at baseline was 61 years and 28% were female. Mean (standard deviation) eGFR was 44.0 (18.2) mL/min/1.73 m2, median (interquartile range) UACR was 1262 (801-2097) mg/g, and median (interquartile range) B-type natriuretic peptide was 44 (23-86) ng/L. To evaluate the effect of zibotentan and dapagliflozin combination therapy, the ZENITH High Proteinuria study has successfully recruited a population at high risk of CKD progression for whom novel therapies remain necessary. Results are expected in 2027.
In patients with heart failure with reduced ejection fraction (HFrEF), determining the aetiology of cardiac dysfunction has important therapeutic and prognostic implications. Cardiovascular magnetic resonance (CMR) enables comprehensive phenotyping of HFrEF; however, it remains uncertain whether the choice of pharmacological stress agent influences the hyperaemic response required for reliable ischaemia assessment. We sought to compare the hyperaemic effects of adenosine and dobutamine in patients with HFrEF using quantitative perfusion CMR. Patients with HFrEF [left ventricular ejection fraction (LVEF) ≤40%] prospectively underwent 3-Tesla CMR comprising functional cine imaging, late gadolinium enhancement (LGE), and first-pass perfusion imaging at rest and during pharmacological stress with (i) adenosine (140-210 μg/kg/min) and (ii) dobutamine (10-30 µg/kg/min). Perfusion maps were reconstructed inline with automated, pixel-wise quantification of myocardial blood flow (MBF). The hyperaemic response, defined by global myocardial perfusion reserve (MPR), was calculated as the quotient of stress and rest MBF and compared between stress protocols. Fifty-three patients with HFrEF (mean age 63 ± 10 years, 77% male, mean LVEF 36 ± 10%, infarction 59%, and non-ischaemic focal fibrosis 21%) with paired adenosine and dobutamine stress-perfusion data were analysed. Compared with dobutamine, adenosine produced a higher global MPR [mean difference: +0.61 (95% CI: 0.35, 0.88); P < 0.001], which remained significant at the segmental level following adjustment for age, sex, type 2 diabetes, LVEF, and LGE presence [mean difference: +0.63 (95% CI: 0.55, 0.71); P < 0.001]. In patients with HFrEF, adenosine induces a greater hyperaemic response than dobutamine; however, whether this impacts on the diagnostic assessment of ischaemia remains to be established (Trial registration: NCT03661827).
Undiagnosed and retained aspirated foreign bodies are a well-recognized cause of pulmonary morbidity, yet diagnosis of this clinical entity is often delayed, particularly when the foreign body is radiolucent, or the history of aspiration cannot be recalled. We report the longest documented case of a retained airway foreign body to date: a 59-year-old woman who aspirated a plastic Barbie doll house cup at age 8, 51 years prior. She experienced recurrent right lower lobe (RLL) pneumonias, and CT imaging eventually revealed chronic RLL collapse and bronchial obstruction. Flexible bronchoscopy confirmed and enabled successful removal of the foreign body. This case underscores the importance of maintaining clinical suspicion for foreign body aspiration in adults with persistent or recurrent respiratory symptoms, even when the initial aspiration event occurred many years prior. It also highlights the diagnostic challenges associated with radiolucent foreign bodies and the potential for long-term pulmonary complications when diagnosis is delayed.
Progress on malaria elimination has stalled, especially in Africa where approximately 600,000 deaths occurred in 2024. Gene drive-modified mosquito (GDMM) technologies are a potentially transformational new tool to prevent malaria transmission by Anopheles mosquitoes. Gene drive-modified mosquito technologies have been successful in contained (caged) testing, and field testing is being planned. Gene drive-modified mosquitoes are designed to be more specific vector control tools than chemical insecticides. However, the potential for spread and persistence of engineered gene drive constructs within interbreeding mosquito populations has raised concerns about possible negative effects on biodiversity. Postrelease safety monitoring of GDMMs will be an important component of risk management, yet scientifically based strategies for evaluating the environmental safety of GDMMs are lacking. Drawing from experience with related technologies in use, we propose a systematic approach to safety monitoring that is risk proportionate, considers ecological priorities and stakeholder concerns, and is practicable to implement in malaria-endemic countries. Suggested methods aim to achieve maximal decision-making value within available resources. Indicators of possible adverse impacts are selected strategically according to ecological analyses using a transparent ranking system. Intensity and coverage of monitoring reflect characteristics of both the GDMMs and the ecological indicator species, with allowance for adjusting the plan in response to initial results, ongoing observations, and regulator feedback. Although developed for early field testing, the framework can also help to guide later phase research and postimplementation environmental monitoring of GDMMs for malaria control in Africa, and it may inform the development of other genetic biological control technologies.
Culturally responsive support is essential for Indigenous mothers to sustain breastfeeding; however, tailored support remains limited. For thousands of years Indigenous women have nourished their infants and children through breastfeeding, as the primary source of nutrition and an important cultural and spiritual practice. In Canada, Australia, New Zealand, and the United States (CANZUS), Indigenous breastfeeding practices have been disrupted by the ongoing impacts of colonisation. This scoping review aimed to identify breastfeeding supports for Indigenous women in CANZUS countries, whether the supports had been evaluated, describe their development, and explore women's experiences accessing and using these supports. A scoping review was conducted following Phillips-Beck et al. and the PRISMA-ScR guidelines to identify literature on breastfeeding support for Indigenous women in CANZUS countries. Multiple academic databases and online sources were systematically searched. Screening and review were managed in Covidence, and findings were synthesized narratively. Fourteen studies were included: eight from Australia, four from Canada and two from the USA. Breastfeeding support were examined across health settings (3), community (home visits, health education, telehealth) (9), and multiple settings (2). Breastfeeding supports by and for Indigenous women remain scarce. Factors linked to successful support included continuity of care, mother-centred and holistic practices, wrap-around services, and trust-building. Notably, few studies detailed culturally responsive components in these supports. Indigenous-led research and programs are critical to develop and deliver effective, culturally responsive breastfeeding support across CANZUS countries.
Carlton George Smith, M.Sc., M.D., Ph.D., R.C.N.V.R. (1905-2003) was a Canadian anatomist and professor at the University of Toronto. He was highly regarded as an outstanding teacher, cutting-edge neuroscience researcher, and accomplished author. Dr. Smith became a member of the AAA in 1938 and joined the prestigious Cajal Club in 1950. In 1942, he joined the Naval Medical Research Unit in Halifax, eventually becoming its Commanding Officer, where he assisted with landmark research related to naval and military operational barriers during World War II. This research further bolstered his interests in the neuroanatomical bases of the special senses. Dr. Smith pioneered 3-dimensional (3D) teaching of neuroanatomy long before the era of technological advancement, using geometrical forms to describe the anatomical relationships between pathways and structures of the central nervous system. His innovative and evidence-based approaches, based on meticulous dissections, providing the foundation for both simple line drawings and detailed illustrations that were incorporated into several neuroanatomy books. He later developed a series of plaster models with his wife, Marguerite "Rita" Harland Smith, that highlight the complex 3D relationships of the human brain, head, and neck. Dr. Smith and Rita's legacy lives on through the models he donated to medical schools across Canada and at the University of Toronto through the endowment of scholarships and lectures. This article will include notable milestones in Dr. Smith's life with an emphasis on his scholarly and educational contributions to the field of neuroanatomy.
Despite the important role that hope plays in the well-being of children with cancer, there is a lack of appropriate knowledge about the process of developing hope in children living with leukemia. To explore the process of developing hope among Iranian children with leukemia. A qualitative study using the grounded theory method was conducted at the Tehran Medical Center Hospital in Iran. Theoretical sampling was used, and the study included 23 children with leukemia, aged 6 to 12 years. Data were collected through interviews and arts-based participatory techniques with children with leukemia. The process of developing hope in children with leukemia begins with the experience of receiving a cancer diagnosis and progresses as they give meaning to the treatment process. They encounter hopeful resources throughout the disease and treatment process, which allows them to develop their inner beliefs and move towards restoring hope for the future. Findings on the components of hope formation can inform supportive interventions for children with cancer and their families, as well as guide healthcare professionals and care systems in improving care practices. Such approaches offer promising pathways to promote the physical, psychological, spiritual, and social well-being of children living with leukemia. Cancer nurses can support children's hope by facilitating meaningful relationships, recognizing signs of recovery valued by children, involving families in care, and creating supportive environments.
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