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The influence of surgeon seniority and intestinal failure experience on identifying malnourished patients in emergency general surgery: a national survey
Get PDFBackground
Variation exists in how consultant surgeons identify malnutrition in emergency general surgery (EGS) patients. These relate to differences in surgeon knowledge, understanding, ownership and hospital setting. Little is known regarding how these relate to nonconsultant surgeons, or those with experience of intestinal failure (IF).
Aims
This study aimed to characterise the awareness, practice and training of general surgeons in the identification of malnutrition in the emergency setting.
Methods
The survey focused on three domains: perceptions, current practices and nutrition training. Following piloting, EGS surgeons were invited to complete an online survey. Responses were gathered using Qualtrics. Descriptive analysis and associations with surgeon seniority and IF were performed in SPSSv26. Ethical approval was obtained (UREC 050436). Results are reported with reference to the CHERRIES guidelines.
Results
The completion rate was 52.1% (148/284), of whom 49.7% were nonconsultant surgeons and 46.6% had experience of IF. Surgeons from all UK regions completed the survey. There was strong agreement across participants that malnutrition can affect surgical outcomes and identifying it was an important skill for surgeons. However, only 37.2% (55/148) were confident in doing so. Surgeons with IF experience were significantly more confident than those without (49.3% vs 26.6%). Training was reportedly poor, and local teaching or a short course aimed at surgeons in training was considered most helpful in the future.
Conclusions
Identifying malnutrition in EGS is recognised as an important skill most surgeons feel they are lacking. Support for formal training in this area was high
How is missing data handled in cluster randomized controlled trials? A review of trials published in the NIHR Journals Library 1997–2024
Get PDFBackground:
Cluster randomized controlled trials are increasingly used to evaluate the effectiveness of interventions in clinical and public health research. However, missing data in cluster randomized controlled trials can lead to biased results and reduce statistical power if not handled appropriately. This study aimed to review, describe and summarize how missing primary outcome data are handled in reports of publicly funded cluster randomized controlled trials.
Methods:
This study reviewed the handling of missing data in cluster randomized controlled trials published in the UK National Institute for Health and Care Research Journals Library from 1 January 1997 to 31 December 2024. Data extraction focused on trial design, missing data mechanisms, handling methods in primary analyses and sensitivity analyses.
Results:
Among the 110 identified cluster randomized controlled trials, 45% (50/110) did not report or take any action on missing data in either primary analysis or sensitivity analysis. In total, 75% (82/110) of the identified cluster randomized controlled trials did not impute missing values in their primary analysis. Advanced methods like multiple imputation were applied in only 15% (16/110) of primary analyses and 28% (31/110) of sensitivity analyses. On the contrary, the review highlighted that missing data handling methods have evolved over time, with an increasing adoption of multiple imputation since 2017. Overall, the reporting of how missing data is handled in cluster randomized controlled trials has improved in recent years, but there are still a large proportion of cluster randomized controlled trials lack of transparency in reporting missing data, where essential information such as the assumed missing mechanism could not be extracted from the reports.
Conclusion:
Despite progress in adopting multiple imputation, inconsistent reporting and reliance on simplistic methods (e.g. complete case analysis) undermine cluster randomized controlled trial credibility. Recommendations include stricter adherence to CONSORT guidelines, routine sensitivity analyses for different missing mechanisms and enhanced training in advanced imputation techniques. This review provides updated insights into how missing data are handled in cluster randomized controlled trials and highlight the urgency for methodological transparency to ensure robust evidence generation in clustered trial designs
A Volume of a 'Different Hue': Transatlantic Print and the Making of the Aurora Borealis, a Quaker Literary Annual
No full textThis article directs attention to a short-lived Quaker literary annual, the Aurora Borealis. It was immediately successful on both sides of the Atlantic. However, its editors discontinued their work after a single issue when faced with the opposition of London publishers who saw it as a threat to their domination of the market. The article recovers the history of this unfamiliar volume using two archives located on different sides of the Atlantic. The literary ambitions of a group of Friends were channeled into the production of a publication that modeled itself on a highly popular secular genre while shaping it along denominational lines. The annual's producers borrowed from commercial techniques to advertise and produce a volume that was familiar but nonetheless distinctive due to its nonmetropolitan origins and its Quaker content. The article argues that the existence of the annual enables further speculation about other publishing ventures on both sides of the Atlantic that should be demanding our attention, reimagining the contours of Quaker literary history and transatlantic print
Travelling activists, radical hospitality, and the intimate history of socialist organising in Britain, c.1880-1914
No full textThis article considers the political lecture tour, and particularly the travelling socialist caravan tours organised by Clarion socialists at the end of the 19th century, to argue that, for socialist lecturers, touring produced everyday experiences of comradery, cross-cultural connection and deliberative forms of hospitality that could powerfully embody socialist ideas for new audiences.The article shows that by looking to intimate encounters on the road – be that the sharing of meals or bedrooms, suffering misfortune with a stranger, meeting family members or making friends – we might tell a different story of the development and organisation of socialist ideas in late-Victorian Britain. Crucially, it suggests that by looking to the intimate, unceremonial and happenstance meetings that characterised socialist lecture tours, we can conceive of itinerant activists not just as messengers or organisers, but also as producers of the everyday forms of cross-cultural connection and provincial internationalisms that would prove transformative to the development of socialist thought in Britain
Disaggregation of a tracer cloud in accelerating transitional pipe flow
Get PDFPrevious studies on longitudinal solute transport in a pipe during acceleration from laminar to turbulent flow highlighted a disaggregation of the tracer cloud resulting in two peaks occurring downstream from a single pulse injection. It was hypothesized that the disaggregation was caused by the spatially nonuniform acceleration of flow at different radial locations. This study improves the previous understanding of solute transport during accelerating flow using novel laboratory measurements of pipe cross-sectional tracer distribution from planar laser-induced fluorescence and radial velocity profiles from an ultrasonic velocity profiler. Disaggregation of the tracer cloud was observed, with the tracer not being uniformly distributed within the cross-section at the first peak but cross-sectionally well-mixed at the second peak. The relative magnitude of the first peak, compared with the second peak, decreased with the time of injection (and therefore with increased Reynolds number) after the start of the acceleration. Radial velocity profiles showed that the central core of the flow exhibited a smooth, linear increase in velocity compared with the flow closer to the pipe boundary. The data also revealed, for the first time to our knowledge, that the transition time to different flow regimes increased with distance downstream. A model based on the 2D advection-dispersion equation, parameterized using experimental data, was employed to describe the flow and mixing processes during the acceleration. In addition to the combined effects of the radial velocity profile and radial diffusion coefficient, this study confirms that it is essential to also include the delay in the transition time at downstream locations to create the observed disaggregation
Brexit and the emergence of a Transnational European Community of Practice: From grassroots mobilisations to supranational political opportunity structures in the struggle for citizens' rights
Get PDFBrexit ignited an unprecedented sense of shared European identity and belonging, catalysing pro-EU social movements among EU nationals in the United Kingdom and amongst British citizens residing in the EU and leading to the formation of a transnational European community of practice. This mobilisation coalesced around grassroots organisations whose claim-making strategy was rooted in the institution of EU citizenship, which also grounded their legitimacy. Drawing on a relational approach to diasporic and transnational social movements, mixed methods empirical research including the findings of an online survey of mobile citizens (n = 1919), archival and documentary analysis, expert interviews and policy analysis, the article analyses the significance of supranational political opportunity structures to the emergence of a transnational European community of practice during Brexit and the formation of an alliance between two of the primary grassroots organisations advocating for citizens' rights – the3million and British in Europe
Valuing child and adolescent health states for use in economic evaluation: A good practices report of an ISPOR task force
No full textEconomic evaluations of interventions that target or include children require health state utilities (HSUs). Despite the availability of preference-weighted measures for children, methods for valuing child health states and estimating child utilities are not as well established as those for adult HSUs. The objective of this Task Force was to develop emerging good practice recommendations for valuing child and adolescent health to generate HSUs for use in economic evaluation.
This Task Force identified and described the interrelated methodological choices regarding valuation of child health to generate HSUs. The Task Force considered available evidence related to four key issues: (a) whose preferences should be sought; (b) whose health is imagined; (c) which method should be used; and (d) the comparability between adult and child utilities.
Best practices may vary depending on the modeling context, characteristics of the health states, and the health technology assessment setting in which the HSUs will be used. For any individual study, methods will be informed by empirical evidence, value judgments, and recommendations from healthcare decision-makers. Rather than recommending an approach that would apply to every study, this Task Force presents options to consider when determining the preference elicitation approach to generate utilities for child health states, along with strengths and limitations of each. Given that child HSUs can impact the outcomes of a cost-utility analysis and subsequent decisions about healthcare resource allocation, this Task Force recommends that researchers be transparent about methodological choices and their impact on HSUs
‘I’m taking the Costa Brava plane’: affluent British workers’ holidays to Spain in the 1950s and 1960s
No full textFrom the 1950s, millions of newly affluent British workers began to holiday abroad for the first time with the majority travelling to Spain. We enjoy no detailed social and cultural history of this transformation which turned Spain into a major site for British social history. But studying this history can help us re-think our understanding of both affluent workers and tourists while enriching Spanish tourism history and British social history. To do this the article focuses on the life narratives of early British mass tourists and how holidays became linked to their sense of personal development and framed around joy in overcoming fear, benefiting from new opportunities, demonstrating personal adaptability, and experiencing personal growth. In this way, it shifts the debate on affluent workers from concerns around income and status to considering how leisure and holidays became linked to consumerism as identity making and the forging of meaning. It also highlights the importance of understanding tourists historically and within their own life narratives. This helps shift the Spanish historiography on tourism from the effects of tourism to the tourist experience and opens up a new field of agency and experience to British social history
Exploring implementation of the UK Misogyny in Music report’s recommendations to address gender inequalities in music education in England
No full textIn 2024, the Women and Equalities Select Committee in the UK Parliament published a report entitled Misogyny in Music. It included the recommendations that ‘music colleges, conservatoires and other educational settings need to do more to address the gendering of instruments, roles and genres and improve the visibility of and support for female role models’. While there is a dearth of policy levers available to implement this recommendation, this article critically analyses three existing policy/regulatory frameworks that could be used for its implementation in England. The article also highlights a significant limitation of the report – its exclusion of trans and non-binary musicians
Temperature gradient driven motion of magnetic domains in a magnetic metal multilayer by entropic forces
Get PDFWe studied the displacement of magnetic domains under temperature gradients in perpendicularly magnetized Ta/[Pt/Co₆₈B₃₂/Ir]ₓ₁₀/Pt multilayer tracks with microfabricated Pt heaters and thermometers by magnetic force microscopy. Subtracting out the effects of the Oersted field from the heating current reveals the pure temperature gradient driven motion, which is always toward the heater. The higher the thermal gradient along the track is (owing to the proximity to the heater or larger heater currents), the greater the observed displacements of the domains are, up to a velocity of around 1 nm/s in a temperature gradient of 20 K/µm. This velocity lies in the creep regime. Quantitative estimates of the strength of different driving mechanisms for the effect that have been proposed theoretically show that entropic forces dominate over those arising from the spin Seebeck and spin-dependent Seebeck effects in driving the domain motion
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