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Accuracy of junior doctor plain trauma X-ray interpretation: a systematic review and meta-analysis
Full text linkBackground
Plain radiography remains a first-line assessment tool for emergency departments’ trauma patients. Given the urgency of trauma care, emergency department doctors, including junior doctors, often perform initial trauma X-ray interpretations to support timely patient management when there is an unavailability of an immediate radiologist report. However, trauma X-ray interpretation is challenging, and inaccuracies can impact patient care. This study evaluates the diagnostic accuracy of emergency department junior doctors on the initial interpretation of trauma X-rays by systematically reviewing and meta-analysing existing research on the subject.
Method
Studies were identified from PubMed, Scopus, Embase, Cochrane Library, and by checking the reference lists of relevant studies. Quality assessment of included studies was evaluated using the QUADAS-2 tool. Meta-analysis was conducted using bivariate models, with summary estimates reported as sensitivity, specificity, and the SROC. Meta-regression and subgroup analysis was performed to evaluate the sources of heterogeneity. Publication bias was assessed using Deeks’ funnel plot.
Results
Seven studies were included in this meta-analysis. Across the studies, pooled sensitivity, specificity and area under the receiver operating characteristic curve (AUC) were 0.65 (95% CI = 0.47–0.80), 0.89 (95% CI = 0.77–0.95), and 0.86 (95% CI = 0.83–0.89), respectively. Covariate analysis per anatomical region of trauma X-rays showed that for skeletal region, pooled sensitivity, specificity, and AUC were 0.72 (95% CI = 0.55–0.85), 0.86 (95% CI = 0.73–0.93), and 0.87 (95% CI = 0.83–0.89), respectively and for appendicular region, pooled sensitivity, specificity and AUC were 0.68 (95% CI = 0.49–0.82), 0.82 (95% CI = 0.62–0.93), and 0.81 (95% CI = 0.77–0.84), respectively. Substantial heterogeneity was identified but was not due to a threshold effect (Spearman rho = 0.29(p = 0.49)). Meta-regression and subgroup analysis revealed that anatomical-region-specific trauma X-ray interpretation and accuracy assessment techniques influenced heterogeneity. No publication bias was identified (p = 0.41).
Conclusion
Emergency department junior doctors’ accuracy in the initial interpretation of trauma X-rays was moderate. The findings further suggest a high likelihood of missed abnormalities when they interpret trauma X-rays. This highlights the need for support strategies to enhance their diagnostic accuracy to strengthen clinical decision-making in trauma care
Validation of clinical tools to measure grating acuity and contrast sensitivity in children with cerebral visual impairment
No full textThere is a lack of validated clinical tools to measure visual functions in children with cerebral visual impairment (CVI). This study addresses this gap. Children aged 6 months-7 years with and without CVI (CVI, n = 111, mean age: 3.0 ± 1.9 years; 70.2 % male and without CVI, n = 50, mean age: 3.4 ± 1.9 years; 38 % male) were recruited. Grating acuity (GA) was evaluated using Teller Acuity Cards-II (TAC-II) and the Peekaboo Vision app (PV app), and contrast sensitivity (CS) using Hiding Heidi low contrast face cards (HH cards) and Ohio Contrast Cards (OCC). Retests were conducted within one month. The mean difference between the PV app and TAC-II was significant (CVI: −0.25 ± 0.40 logMAR, 95 % LoA: −1.03 to 0.53 logMAR; controls: −0.14 ± 0.30 logMAR, 95 % LoA: −0.72 to 0.44 logMAR). The median difference between the HH cards and OCC was also significant (CVI: 0.00 logCS, IQR: 0.25 logCS, 95 % LoA: −0.43 to 0.67 logCS; controls: 0.25 logCS, IQR: 0.00 logCS, 95 % LoA: −0.01 to 0.56 logCS). Intra-examiner repeatability analysis in children with CVI (n = 21) and controls (n = 16) revealed that TAC-II (CR, CVI = 0.47, controls = 0.27) had better repeatability than the PV app (CR, CVI = 0.99, controls = 0.41), while OCC (CR, CVI = 0.45, controls = 0.19) had better repeatability than HH cards (CR, CVI = 0.90, controls = 0.60). TAC-II and OCC demonstrated better repeatability and comparable testability, testing time, and engagement scores for GA and CS tests respectively in children with CVI. Findings indicate that clinical tools should not be used interchangeably, and clinicians must carefully interpret results based on each test’s repeatability indices
Short-term surface settlements induced by EPBM twin tunnelling in saturated sandy soils
No full texthis paper presents a case study of the construction of a 781-metre-long twin-tunnel, using an Earth Pressure Balance Machine (EPBM), in saturated sandy soils in Ho Chi Minh City, Vietnam. The depths of the tunnels were between 11.4m and 24.6m below the ground surface. The averaged trough width and length parameters were 0.326 and 0.446, which are consistent with previous studies in sands. The volume losses ranged from the anticipated levels of less than 0.5% to notably high values reaching up to 2.44%. Low volume losses were associated with areas of dense soil and effective tail void grouting. The characteristics of effective tail void grouting observed in dense sand in this project were grouting pressures close to porewater pressure, coupled with stable grouting volume that was approximately 130% of the volume of the theoretical tail void for the majority of the drive. However, in very loose sandy soil zones it was observed that even very high tail void grout volume did not prevent large settlements. Soil relative density proved to be an influential factor in ground surface vertical displacement, with large magnitudes occurring mainly in loose soil. A threshold relative density Id ≈ 0.4 divides the normal volume loss of less than 0.7% range, and that of considerably larger volume loss. The results emphasised the need for caution when tunnelling at shallow depth in loose soil, where the combination of low relative density and shallow cover can result in significant ground
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Sensitivity-based measures of discrimination in insurance pricing
Full text linkDifferent notions of fairness and discrimination have been extensively discussed in the machine learning, operations research, and insurance pricing literatures. As not all fairness criteria can be concurrently satisfied, metrics are needed that allow assessing the materiality of discriminatory effects and the trade-offs between various criteria. Methods from sensitivity analysis have been deployed for the measurement of demographic unfairness, that is, the statistical dependence of risk predictions on protected attributes. We produce a sensitivity-based measure for the distinct phenomenon of proxy discrimination, referring to the implicit inference of protected attributes from other covariates. For this, we first define a set of admissible prices that avoid proxy discrimination. Then, the measure is defined as the normalised L2-distance of a price from the closest element in that set. We use variance-based sensitivity analysis and Shapley values to attribute the proxy discrimination measure to individual (or subsets of) covariates and investigate how properties of the data generating process are reflected in those metrics. Furthermore, we build on the global (i.e., portfolio-wide) measures of demographic unfairness and proxy discrimination to propose local (i.e., instance- or policyholder-specific) measures, which allow a fine-grained understanding of discriminatory effects. Finally, we apply the methods developed in the paper to a real-world insurance dataset, where ethnicity is a protected variable. We observe substantial proxy-discriminatory effects for one ethnic group and identify the key variables driving this
Becoming a Sociologist
No full textThis is a personal reflection on becoming a sociologist and the role Ken Plummer played in that journey. This chapter is organized in two halves. I commence by reflecting upon my early work experiences of working in factories, temping in a care home, and my first university experience, and I describe how Ken helped me to make sense of these moments and shape them into my future career as a sociologist. Now as a social researcher I explore the stories of those in social care and through this personal lens I show how Ken’s humanist approach helped me to recognise and adopt a position that puts the individual at the heart of care, to focus appreciatively on what good care can look like, and to make a difference to those visiting, working in, and living in care settings.
In the second half of the chapter, I reflect upon Ken’s passion for sociology, his engagement and generosity in his teaching, and his creativity and humanity in his research. I consider the ways in which he shaped my own approach to teaching and creating the right conditions necessary for thriving at university. One of Ken’s greatest skills was being able to make sociology relevant to students and their everyday life experiences; developing their sociological imaginations. I conclude by highlighting how Ken has been instrumental in creating a new generation of social researchers
Tackling Gender Discrimination and Inequality in Access to Healthcare: scoping possibilities and opportunities for EU law
Full text linkThose who are familiar with either European Union equality law, or health law and policy, may be surprised to learn of any relations between the two. Union equality law is best known for its long-standing contribution to promoting equality in the workplace and in social security, and its more recent contributions to combating violence against women. (Gender) equality in health law and policy may seem like a wholly national competence. This first scoping report on the subject shows that, in fact, there are many points of connection between Union (gender) equality law and access to healthcare. Union law affects gender equality in access to healthcare directly and indirectly through a range of legal instruments. Key provisions include the Goods and Services Directive, the ‘Recast’ Directive, and the Violence Against Women Directive. Many more measures of Union law are also engaged. This legislation is based on a wide range of formal Union competences, including but also going well beyond the ‘traditional’ Union equality law legislation. A scoping report of this nature shows the breadth of possibilities for Union law to tackle gender discrimination and inequality in access to healthcare. It can offer depth only in a few selected areas. The report does so, drawing on comparative national expertise from the European Equality Law Network, on personal and material coverage by national healthcare systems, gender-sensitive healthcare, obstetric violence, and sexual harassment/assault in healthcare settings. We consider regulatory matters and the role of national equality bodies in promoting gender equality in access to healthcare. The opportunities for Union law to contribute to tackling gender discrimination and inequality in access to healthcare are under-appreciated and full of untapped potential. This report – focused only on Union ‘internal’ law, and excluding Union external relations law – shows the extent of these possibilities
A Systematic Review of Cyber Risk Analysis Approaches for Wind Power Plants
Full text linkWind power plants (WPPs), as large-scale cyber–physical systems (CPSs), have become essential to renewable energy generation but are increasingly exposed to cyber threats. Attacks on supervisory control and data acquisition (SCADA) networks can cause cascading physical and economic impacts. The systematic synthesis of cyber risk analysis methods specific to WPPs and cyber–physical energy systems (CPESs) is a need of the hour to identify research gaps and guide the development of resilient protection frameworks. This study employs a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol to review the state of the art in this area. Peer-reviewed studies published between January 2010 and January 2025 were taken from four major journals using a structured set of nine search queries. After removing duplicates, applying inclusion and exclusion criteria, and screening titles and abstracts, 62 studies were examined for analysis on the basis of a synthesis framework. The studies were classified along three methodological dimensions, qualitative vs. quantitative, model-based vs. data-driven, and informal vs. formal, giving us a unified taxonomy of cyber risk analysis approaches. Among the included studies, 45% appeared to be qualitative or semi-quantitative frameworks such as STRIDE, DREAD, or MITRE ATT&CK; 35% were classified as quantitative or model-based techniques such as Bayesian networks, Markov decision processes, and Petri nets; and 20% adopted data-driven or hybrid AI/ML methods. Only 28% implemented formal verification, and fewer than 10% explicitly linked cyber vulnerabilities to safety consequences. Key research gaps include limited integration of safety–security interdependencies, scarce operational datasets, and inadequate modelling of environmental factors in WPPs. This systematic review highlights a predominance of qualitative approaches and a shortage of data-driven and formally verified frameworks for WPP cybersecurity. Future research should prioritise hybrid methods that integrate formal modelling, synthetic data generation, and machine learning-based risk prioritisation to enhance resilience and operational safety of renewable-energy infrastructures
Turkey’s quest for strategic autonomy in the Middle East and the Black Sea regions: navigating uncertainty amid regional and global flux
Full text linkThe study of Turkey’s foreign policy and its quest for strategic autonomy has focused on the country itself. However, the literature has so far not provided a comparative overview of how the foreign policy of strategic autonomy has been pursued and what responses it elicited by key states concerning Turkey’s foreign policy. The introduction to the Special Issue, Turkey’s quest for strategic autonomy in the Middle East and the Black Sea regions: Navigating uncertainty amid regional and global flux, explains how the volume addresses this gap in the literature
Accelerating regional food systems change: Lessons from a FixOurFood knowledge exchange event
Full text linkIn October 2025, FixOurFood and the Centre for Food Policy, City St George’s, University of London, hosted an international knowledge exchange event to explore opportunities to strengthen and accelerate regional food systems change. Our aim was to share and learn across diverse organisations navigating regional food policy and practice in different contexts. The event highlighted the opportunities and challenges of taking more regional approaches to developing and implementing regional (sub-national) food policy and wider food systems change
Why continuity of carer matters in group care: a qualitative analysis of women’s experiences of Pregnancy & Parenting Circles in England
Full text linkBackground
Group Care, here described as Pregnancy and Parenting Circles (PPC), is a holistic model of maternity care characterised by a facilitative and interactive approach. Evidence indicates positive outcomes and experiences for women who participate. Its potential to enhance women’s empowerment, health and wellbeing as well as their relationships with healthcare services positions group care as an innovative model warranting further investigation.
Research Questions
This study examined: 1). the extent to which the PPC model adhered to the core values and components of Pregnancy Circles; 2). how fidelity to the model influenced women’s experiences of care; and 3) how established mechanisms of effect operated within PPC.
Methods
We draw on UK data from an implementation study of Group Care for the First Thousand Days (GC_1000). Data were generated through observations of group sessions and semi-structured interviews with service providers and users. A UK group care randomised controlled trial, REACH (trial registration no: ISRCTN91977441), provided a framework of ‘Core Values and Components’ utilised in an abductive analytical approach for examining model fidelity.
Results
Findings highlight ‘relational continuity’ as a central component of group care. Where core components were implemented with fidelity, relational continuity functioned as a key lever, enabling mechanisms such as enhanced engagement and active participation in health. Lack of fidelity disrupted the model’s mechanisms, weakening its positive effects on women’s experiences of care.
Conclusion
Relational continuity is critical to operationalising the mechanisms underpinning group care. Attention to model fidelity is essential to optimise women’s experiences of group care
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