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.
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.
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.
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.
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.
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.
Chemokine and chemokine receptors (CKRs) regulate cell growth, tumor immunity, migration, angiogenesis, and metastasis. We evaluated associations of inherited chemokine/CKR variants with subsequent primary melanomas among patients with a previous melanoma. Our population-based cohort included 2458 incident single primary and 1205 multiple primary melanoma (MPM) cases. We examined 215 a priori candidate polymorphisms selected based on prior evidence and predicted functional relevance, along with nine haplotype blocks. Logistic regression estimated odds ratios and 95% confidence intervals, adjusting for age at diagnosis, sex, age-by-sex interaction, and study center. Thirty variants across 14 genes were nominally associated with MPM (P < 0.05), with effect sizes ranging from 16 to 80%. Five haplotypes in CXCL12, CCL18, CXCR2, and CCR9 were significantly associated with MPM (Pglobal < 0.03) with stronger effects than individual-effect alleles. Functional annotation identified 160 associated index variants and linkage disequilibrium proxies acting as skin expression quantitative trait loci for CXCR2, XCR1, BCL9L, FYCO1, PNKD, RUFY4, and RP11-378A13.1 (P < 1.06E-05 to 4.3E-34). These variants were classified functionally as candidate causal variants based on convergent regulatory annotation and skin‑specific expression quantitative trait locus evidence, linking chemokine/CKR variants and haplotypes to downstream genes involved in epithelial-mesenchymal-like transition, matrix remodeling, and other tumorigenic processes, thereby implicating immune regulatory mechanisms in melanoma development. To the best of our knowledge, this is the first study to demonstrate an association of a priori chemokine/CKR variants with subsequent melanoma risk. Validation and evaluation of associations with tumor characteristics and survival are warranted.
Insomnia has been associated with adverse stress-related outcomes among university students. However, evidence from Sub-Saharan Africa remains limited, and the factors underlying these associations are poorly understood. This study examined the associations between insomnia symptoms and stress-related outcomes among undergraduate students in Ghana and explored potential effect modification and mediating factors. We analyzed data from a cross-sectional survey of 1,047 students aged ≥ 18 years in Ghana. Insomnia symptoms were assessed using the Insomnia Severity Index, while perceived stress and academic stress were measured using validated scales. Parallel mediation and multivariable OLS regression models evaluated the associations. After full adjustment, insomnia symptoms were positively associated with higher perceived stress (B = 0.05, 95% CI: 0.03-0.08) and academic stress (B = 0.21, 95% CI: 0.18-0.24) scores. These associations varied by sex and place of residence, with significant associations observed for perceived stress among female students and students residing in urban areas. In the mediation models, self-rated health and physical inactivity statistically accounted for approximately 20% and 26% of the association between insomnia symptoms and perceived stress, and approximately 4% and 26% of the association with academic stress, respectively. Addressing stress-related issues among university students in Ghana may benefit from attention to insomnia symptoms, health status, and lifestyle behaviors.
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.
This cohort study examines data for a large population-based cohort to identify and characterize any cases of primary Epstein-Barr virus infection that occurred after the onset of multiple sclerosis.
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.
Intracranial pressure (ICP) monitoring is an essential component of severe traumatic brain injury (sTBI) care. This study aimed to assess the current utilization of ICP monitoring among Chinese neurosurgeons, identify barriers to its implementation, and explore potential strategies to promote its broader adoption in the management of sTBI. We conducted a nationwide, cross-sectional, web-based survey in September 2025, targeting neurosurgeons who managed patients with sTBI. It comprised five domains: (1) Hospital characteristics (level, neurosurgery and intensive care units (ICU) capacity, ICP equipment availability); (2) Professional background (title, experience, subspecialty); (3) ICP monitoring practice (surgical and non-surgical cases); (4) Barriers and resource constraints; and (5) Training needs and preferences. Data were analyzed descriptively using frequency distributions and proportions. A total of 292 valid responses from 29 provinces were included. ICP equipment was fully sufficient in 57% of respondents, partially sufficient in 34% of respondents. Scenario-specific barriers prominently included Diagnosis Related Groups (DRG)/Big Data Diagnosis-Intervention Packet (DIP) constraints (88%). Only 36% received structured procedural training before first independent ICP insertion. Among those favoring probe-based monitoring (88%), ventricular placement was preferred (68%). Infection and tract hemorrhage ranked as the leading complications of concern. Interest in capacity building prioritized proctorship and high-fidelity simulation, with top content needs in standardized operative technique (87%), dynamic data interpretation (71%), and complication. The implementation of ICP monitoring in China is low and uneven, not only due to shortages of funds and resources but also due to cross-cutting barriers such as insufficient training.
The domestication of plants in southwest Asia was an evolutionary process that took place over several millennia in the Early Holocene. During this time, domestic species developed distinct traits that distinguished them from their wild counterparts. Current models of plant domestication emphasize the role of genetic selection in the evolution of these traits, viewing these as heritable adaptations that arose in response to selective pressures associated with human cultivation. In cereals, domestication resulted in the evolution of nonshattering rachis and increased grain size, two traits that can be tracked directly in the archaeobotanical record. Analyses of Early Neolithic cereal remains demonstrate that grain size increase occurred prior to the evolution of nonshattering rachis, a sequence that is often interpreted as evidence of selection for larger grains under cultivation, specifically tillage. Here, we combine morphological and metrical analyses of cereal remains, stable carbon isotope analysis, and weed ecology to test this hypothesis, using three assemblages from the southern Levant: Pre-Pottery Neolithic A Sharara (c. 9250-9200 cal BCE), Pre-Pottery Neolithic A el-Hemmeh (c. 9400-8700 cal BCE), and Late Pre-Pottery Neolithic B el-Hemmeh (c. 7500-7000 cal BCE). Our findings indicate that increased grain size in the Early Holocene can be better understood as a plastic response to variation in growing conditions, specifically moisture, rather than as a result of genetic selection for increased grain size under cultivation. We propose that cereal evolution in southwest Asia was initially driven by developmental plasticity, followed by genetic selection.
Neuroendocrine prostate cancer (NEPC) persists in a profoundly hypoxic microenvironment, yet the mechanisms enabling tumor adaptation to this metabolically challenging niche remain undefined. Here, we identify the lipid kinase PIKfyve as overexpressed in NEPC, functioning as a central node in a stress-adaptive lipid kinase axis that supports adaptation to persistent endoplasmic reticulum (ER) stress. Mechanistically, NEPC requires PIKfyve-mediated lysosomal degradation and lipid recycling to maintain metabolic homeostasis under hypoxia. PIKfyve inhibition disrupts lysosomal function, exacerbates ER stress, and activates a compensatory sterol regulatory element-binding protein (SREBP)-dependent de novo lipogenesis program essential for NEPC survival. This stress-lipid axis creates a synthetic vulnerability between PIKfyve and fatty acid synthase (FASN), where dual inhibition synergistically amplifies ER stress, triggers the terminal unfolded protein response, and induces tumor cell death. These findings reveal a metabolic adaptation in NEPC and provide preclinical evidence that co-targeting PIKfyve and FASN can overcome hypoxia-associated stress adaptation.