Cost-effectiveness of swab versus tissue sampling for infected diabetic foot ulcers from the CODIFI2 randomised controlled trial

This multi-centre, Phase III, prospective, unblinded, two-arm parallel group, randomised controlled trial compared clinical (reported elsewhere) and economic outcomes of swab versus tissue sampling over a 52–104 week period. Resource use was logged using case record forms and patient questionnaire at weeks 4, 12, 26, 39, 52 and 104, costed using laboratory and published sources from the UK NHS perspective, at 2021/2022 price-year. EQ-5D-3L questionnaires issued at these time points were used to derive quality-adjusted life-years (QALYs). To account for imbalances such as age, a regression-based approach was used to estimate survival, expected costs and QALYs between the sampling arms. Available case analysis (ACA) and multiple imputation methods were applied for self reported missing data, and ACA for researcher-collected data (survival, hospitalisations and antibiotic use). Probabilistic sensitivity analysis was used to assess the uncertainty of economic results. Results We recruited 149 participants (75 swab, 74 tissue) from 21 UK sites, between 07 May 2019 and 28 April 2022 (last follow-up 28 April 2023). Planned sample size was 730 participants, for 90% power to detect 12.5% difference in healing at 52 weeks, but the trial stopped early due to low recruitment. Expected QALYs in the swab-sampling arm were greater than in the tissue-sampling arm at weeks 26, 52 and 104. The cost of tissue sampling was greater than of swabbing when including antibiotics and hospitalisation. Swab sampling participants had higher QALYs and lower costs across weeks 26–52, reducing slightly by week 104. Conclusions Because of higher costs, lower QALYs and lack of evidence of benefit, potentially due to the trial being underpowered, tissue sampling was dominated by wound swabbing in the cost-effectiveness analysis

Symptom Burden, Treatment Goals, and Information Needs of Younger Women with Pelvic Organ Prolapse: A Content Analysis of ePAQ-Pelvic Floor Free-Text Responses

Background/Objectives: Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life. Research has focused largely on older women, while experiences of younger women remain relatively underexplored despite challenges unique to this population. Informed by the biopsychosocial model of illness, this study aims to assess the symptom burden, treatment goals, and information needs of younger women complaining of prolapse by analyzing questionnaire responses from an existing electronic Personal Assessment Questionnaire—Pelvic Floor (ePAQ-PF) dataset. Methods: Mixed-methods content analysis was conducted using free-text data from an anonymized multi-site ePAQ-PF dataset of 5717 responses collected across eight UK NHS trusts (2018–2022). A quantitative, deductive approach was first used to identify younger women (≤50 years old) with self-reported prolapse. ePAQ-PF scores for younger women with prolapse were compared with those aged >50 years, using Mann–Whitney tests. Free-text response data were analyzed inductively to qualitatively explore younger women’s symptom burden, treatment goals, and information needs. Results: Of the 1473 women with prolapse identified, 399 were aged ≤50 years. ePAQ-PF scores of the younger cohort demonstrated significantly greater symptom severity and bother than those aged >50, particularly in bowel, prolapse, vaginal, body image, and sexual health domains (p < adjusted threshold). Qualitative analysis undertaken to understand women’s concerns and priorities produced five health-related themes (physical health; functionality; psychosocial and emotional wellbeing; reproductive and sexual health; and healthcare journeys) and a sixth intersecting theme representing information needs. Conclusions: The findings highlight the substantial symptom burden of younger women with prolapse, as well as treatment goals and information needs specific to this population. The development of age-specific resources is identified as a requirement to support this group

Tackle Height and Tackle Success—An Analysis of 52,204 Tackle Events

To compare the probability of tackle success (the tackler preventing the ball‐carrier and ball from progressing towards the tackler try‐line) when contacting the ball‐carrier at different heights (shoulder, mid‐torso and legs) for different types of tackles (active, passive, smother and arm) while accounting for other tackler situational factors within seven playing levels. Video footage of 271 male rugby union matches were analysed across seven playing groups (Under [U] 12, n = 25 matches; U14, n = 35; U16, n = 39; U18 Amateur n = 39; U18 Elite n = 38; Senior Amateur, n = 40 and Senior Elite, n = 50) across England, New Zealand, South Africa, Portugal and USA (a total of 51,106 tackles). A multi‐level logistic regression model with tackle success as the outcome variable and first point of contact and type of tackle as the explanatory variables were computed. Included in the model as cofounders were the situational variables tackle direction, tackle sequence, number of players in the tackle and attacker intention. Post‐estimation marginal effects were used to calculate the probabilities (expressed as a percentage %) of tackle success for each interaction between tackle type (active shoulder, smother, passive shoulder and arm) and the first point of contact (shoulder, mid‐torso and legs). The probability of tackle success in relation to where the ball‐carrier is contacted varied by tackle type and within each age group. The probabilities (Pr) for contacting the shoulder versus mid‐torso at the senior levels (elite and amateur) did not differ in relation to tackle success (for instance, for active shoulder tackles within senior elite; shoulder Pr 86% 95% CI 82–89 and mid‐torso Pr 82% 95% CI 77–86), whereas at the junior levels, contacting the shoulder had a higher probability than other points of contact. Active shoulder tackles had the highest probability of tackle success across the different playing levels across the different contact heights, whereas arm tackles had the lowest probability (for instance, for mid‐torso tackles within senior elite, active Pr 82% 95% CI 77–86 vs. arm Pr 69% 95% CI 64–75). Coaches and practitioners can use this information to improve tackle training design and planning within the different age groups and facilitate player development

TOPSIS Model (TOPMod) Tool Assessment and Validation for the Sustainable Redevelopment of Abandoned Public Office Buildings

Public building abandonment has a detrimental impact on the advancement of a nation such as Nigeria. Rebuilding such infrastructure sustainably poses several challenges, as identified in the literature. A flexible and dynamic approach is required by decision makers that draws on a range of attributes, alternatives and criteria. This study aims to assess a sustainable, accessible and flexible tool that decision makers can use in place of engaging with complex mathematical calculations and formulas. To test the validity of the tool, two sets of participants (first Demonstration/pilot study – 7 participants and second Demonstration/Expert Validation − 11 participants) were identified for the testing and the validation of the tool. A quantitative data collection approach, making use of a survey and a case study, was considered the most appropriate approach for this study following the demonstration of the model to the participants. From the four alternatives: Refurbishment, Conversion, Demolition and Outright selling, supported with embedded mathematical formulas and calculations, the validated tool presented refurbishment as the most flexible and optimal solution. This study argues that the integration of this tool into the redevelopment process enhances the recognition of a range of solutions for abandoned public buildings in Nigeria. In addition, it concludes that incorporating suitable model configurations into an appropriate tool can foster appropriate decision-making procedures

A cross-sectional analysis of emotional and binge eating in UK adults enrolled on the NHS Low-Calorie Diet Pilot for Type 2 Diabetes

Aims: This study presents data gathered as part of the Re:Mission evaluation of the NHS low-calorie diet programme pilot for Type 2 Diabetes, to address two research questions: 1) What is the presence and severity of emotional and binge eating within this population? 2) Are demographic and health factors associated with the presence of binge eating or the severity of emotional eating? Methods: An online survey gathered data from n = 580 individuals who were enrolled on the programme but had not yet begun total diet replacement. The survey assessed emotional eating (TFEQ-R21), potential Binge Eating Disorder diagnosis (BEDS-7), wellbeing (Short Warwick-Edinburgh Mental Wellbeing Scale), quality of life (EQ-5D-5L), frequency of weight cycling and demographic factors (collected via NHS England programme monitoring). Descriptive statistics and regression analyses were used to address the research questions. Results: The mean emotional eating score from the TFEQ-R21 was 2.58 (0.96), and the presence of potential Binge Eating Disorder diagnosis was demonstrated in 26.0% of the sample. Regression analyses suggested that being female and engaging in more frequent weight cycling was associated with higher emotional eating and greater likelihood of binge eating. Lower wellbeing and lower quality of life were associated with emotional and binge eating, respectively. Conclusions: Rates of emotional and binge eating in the NHS low-calorie diet pilot sample are higher than in the general public, and in other similar samples. Consideration should be given to screening for emotional and disordered eating, and for additional tailored support and monitoring for such individuals

The Minimal Element of Writing

Jacques Derrida claims that the mark constitutes the minimal element of writing — what he calls ‘the irreducible atom’1 at the asemic origin for the metaphysics of meaning itself (be this origin in the biogenetic code of life or the cybernetic code of data). The writing of the mark, the grapheme, underpins the transmission of information, even before the advent of our phonetic language (for which the mark might seem to constitute the written glyph that evolves to capture an uttered sound). Each extant mark refers, beyond itself, to an absent mark, alluding to this absence, again and again, via iteration and recursion, doing so through a series of sequential references, none of which can terminate in a last mark. The meaning of a mark thus finds itself characterized both by a differing across sites of signification and by a deferring across times of signification.

S.J. Celestine Edwards: Placing Anti-Racism in Victorian Print Culture

In the 1890s, a Dominican named S.J. Celestine Edwards (1858-1894) became the first black editor of a British periodical. In fact, he edited two. Having established himself as a popular speaker in east London, where he defended Christianity against rising atheistic belief, in August 1892 he created a weekly newspaper promoting the Christian Evidence movement, titled Lux. The following July he took over the editorship of the Society for Recognition of the Brotherhood of Man’s monthly magazine, which had previously been called Anti-Caste, and which he retitled Fraternity. In Fraternity, he helped combat prejudice and violence predicated on racial and cultural difference. This article explores how these two ostensibly separate causes were interlinked in Edwards’s thought, as well as his editorial and networking activities. Analysing both papers alongside contemporary press reportage, I observe that Edwards placed the emerging cause of anti-racism before audiences both textually, in editorials and in advertisements and other columns of Lux that announce Fraternity, and geographically and temporally, in lecturing about racial and imperial violence in the afternoons in cities where Edwards had spent the morning speaking on behalf of Christian Evidence. I find it is restrictive to view Edwards’s anti-racist credentials in isolation from his anti-atheism. With regards to Victorian culture and society at large, Edwards’s strategies highlight the potential for other aspects of thought and debate to intersect with anti-racism. With Edwards, we can see the late-Victorian period anew, as one defined not simply by its racism but by its potential to challenge racism

Guidelines for Recommended Footwear for Healthy Children and Adolescents: A Rapid Scoping Review to Characterise the Nature and Extent of Footwear Research and Clinical Policy Guidelines

Background/Objectives: Clinical guidelines for children’s footwear vary widely across governmental and clinical sources, reflecting inconsistencies in best practices for paediatric foot health. These discrepancies arise from differing research interpretations, regional priorities, and clinical expertise. This scoping review evaluates existing guidelines and examines the evidence supporting them. The objective of this scoping review was to identify and map existing footwear guidelines for healthy children and adolescents across governmental, professional, and clinical sources, and to evaluate the type and strength of evidence underpinning these recommendations. Methods: A systematic search of PubMed, Google Scholar, ScienceDirect, and governmental databases was conducted. Studies on footwear recommendations for healthy children aged 18 months to 18 years were included. Articles published between 1970 and 2024 were considered, as 1970 marked the first mass marketing of running shoes/trainers. Results: Footwear guidelines lack standardisation, with variations in definitions, recommendations, and supporting evidence. Key inconsistencies exist in parameters such as fit, flexibility, and toe allowance, with most recommendations based on expert opinion rather than empirical data. Discrepancies in commercial footwear sizing further complicate proper fit assessment. Conclusions: This is the first comprehensive review of children’s footwear guidelines, integrating governmental, professional body, and clinical recommendations. While there is consensus on the importance of properly fitting shoes, the literature reveals inconsistencies and reliance on expert opinion rather than high-quality research. This review highlights the need for standardised, evidence-based criteria to guide footwear recommendations and serves as a foundation for future research aimed at bridging the gap between research and practice

Agoraphobia with panic disorder in a psychiatric setting

Background: Agoraphobia diagnosis has largely remained unchanged, with its criteria based on persistent fear and avoidance of certain clusters of situations. The controversial diagnosis of Agoraphobia with or without a history of panic disorder has also been retained in classification systems; with the understanding that patients either generally have never fully met or meet the diagnostic criteria for panic attacks. Case report: A 49-year old female presented to an outpatient Psychiatric clinic with a 12-year history of fear of enclosed spaces which was precipitated by an unstable relationship with a male partner who frequently assaulted, abused, and neglected her because she refused to terminate an unplanned pregnancy, she had for him. According to ICD-11, she was diagnosed with Agoraphobia with panic attacks, she was treated with Tab. Fluoxetine 20mg daily and Cognitive Behavioural Therapy and in the past two years she improved significantly with appropriate consistency in her follow-up visits. Conclusion: This case report shines a beam of light on the very few reported cases of agoraphobia and its incapacitating course on those who suffer from it. In Nigeria, there is scanty literature on agoraphobia, for multiple reasons such as stigma, the embarrassing nature of the illness, and no disclosure of illness. Conclusion: The knowledge of febrile seizures among mothers in Calabar is fair, however, interventions with harmful traditional practices remains a challenge and community-based healt

Revisiting the ‘Menten Affair’: Poland’s 1950 Extradition Request to the Netherlands

This article analyses the Dutch legal response to Poland’s 1950 extradition request of Pieter Menten and the questions underpinning the reasoning of the authorities and courts, along with other less visible issues then in play. The article begins with an overview of Menten’s activities in pre- and WW2 Poland, which include his involvement in massacres in 1941, as well as the looting of art. The Dutch court’s position on the matter reveals larger questions about the Dutch approach towards accountability for war crimes in the immediate post-WW2 period. The article adopts an international historical methodology in its analysis to demonstrate how concepts of extradition and war crimes were underdeveloped in the post-WW2 period. In this case, the intertwining of constitutional, criminal, and international laws provided a way for the political decision to prevail. Extradition, because it is an interplay between law and politics, was at odds with international criminal justice discourse during this period