“He was my best subaltern#8221;: The Life and Death of Lieutenant Herrick S. Duggan, 70th Field Company, Royal Engineers

At 0400 hours on 21 October 1915, 24 year–old First Lieutenant Herrick “Heck” Stevenson Duggan died of wounds in Béthune, France. One of the 61,000 casualties suffered by the British Army during its failed Loos offensive (25 September to 19 October 1915), Herrick differed from the vast majority of the dead and wounded because he was Canadian, not British. Based primarily on correspondence between Herrick Duggan and his family during the years 1913–15, this article explores Duggan’s life and experiences leading up to, and during, the Great War. In doing so it examines how the “war to end all wars” impacted one Canadian and his family, as well as exploring the nature of British society during the early years of the war. Indeed, Duggan’s letters are a valuable source for understanding the social and military aspects of the Great War. Duggan was a candid and observant writer who held little back. He was not afraid to tender criticism and concern about the Allied war effort and objectives—not to mention government figures—when he felt it was necessary to do so. Furthermore, he was often quite open with his own feelings and emotions with regard to the position in which he found himself

Opening Closed Doors and Breaching High Walls: Some Approaches for Studying Intellectual Disability in Canadian History

Historians who have studied mental illness and intellectual disability have tended to focus, with some notable exceptions, on institutions and those who administered them, rather than on patients and their families. This emphasis on the asylum has given it a disproportionate place in the history of intellectual disability and mental illness. A number of possible paths are open to historians in adding the experiences of people with intellectual disabilities to the historical record. Some individuals with intellectual disabilities can be enabled to tell their own stories, or at least to provide some insight into their motivations and experiences. As well, many paths of investigation that may start within the confining walls of the asylum offer historians a chance to piece together the lives of people with intellectual disabilities outside the institutions built for their care and incarceration.Les historiens qui ont étudié la maladie mentale et la déficience intellectuelle ont eu tendance à mettre l’accent, à quelques exceptions notables près, sur les établissements et ceux qui les administraient plutôt que sur les personnes malades et leurs familles. Cette insistance sur l’asile a conféré à celle-ci une place disproportionnée dans l’histoire de la déficience intellectuelle et de la maladie mentale. Un certain nombre d’avenues s’offrent aux historiens qui souhaitent ajouter aux annales de l’histoire les expériences des personnes aux prises avec une déficience intellectuelle. Il serait possible d’aider certaines d’entre elles à raconter leur propre histoire ou, à tout le moins, de nous éclairer sur leurs motivations et leur vécu. De nombreuses avenues qui pourraient commencer au pied des murs confinants de l’asile offrent aux historiens l’occasion de comprendre la vie des personnes ayant une déficience intellectuelle hors des établissements construits pour les soigner et les incarcérer

Impact of Treatment Delay on Outcome in the International Subarachnoid Aneurysm Trial

Background and Purpose - ISAT (International Subarachnoid Aneurysm Trial) demonstrated that 1 year after aneurysmal subarachnoid hemorrhage, coiling resulted in a significantly better clinical outcome than clipping. After 5 years, this difference did not reach statistical significance, but mortality was still higher in the clipping group. Here, we present additional analyses, reporting outcome after excluding pretreatment deaths. Methods - Outcome measures were death with or without dependency at 1 and 5 years after treatment, after exclusion of all pretreatment deaths. Treatment differences were assessed using relative risks (RRs). With sensitivity and exploratory analyses, the relation between treatment delay and outcome was analyzed. Results - After exclusion of pretreatment deaths, at 1-year follow-up coiling was favorable over clipping for death or dependency (RR, 0.77 [95% CI, 0.67-0.89]) but not for death alone (RR, 0.88 [95% CI, 0.66-1.19]). After 5 years, no significant differences were observed, neither for death or dependency (RR, 0.88 [95% CI, 0.77-1.02]) nor for death alone (RR, 0.82 [95% CI, 0.64-1.05]). Sensitivity analyses showed a similar picture. In good-grade patients, coiling remained favorable over clipping in the long-term. Time between randomization and treatment was significantly longer in the clipping arm (mean 1.7 versus 1.1 days; P<0.0001), during which 17 patients died because of rebleeding versus 6 pretreatment deaths in the endovascular arm (RR, 2.81 [95% CI, 1.11-7.11]). Conclusions - These additional analyses support the conclusion of ISAT that at 1-year follow-up after aneurysmal subarachnoid hemorrhage coiling has a better outcome than clipping. After 5 years, with pretreatment mortality excluded, the difference between coiling and clipping is not significant. The high number of pretreatment deaths in the clipping group highlights the importance of urgent aneurysm treatment to prevent early rebleeding

The World Rugby and International Rugby Players Contact Load Guidelines: From conception to implementation and the future

Managing training load in rugby union is crucial for optimising performance and injury prevention. Contact training warrants attention because of higher overall injury and head impact risk, yet players must develop physical, technical, and mental skills to withstand the demands of the game. To help coaches manage contact loads in professional rugby, World Rugby and International Rugby Players convened an expert working group. They conducted a global survey with players to develop contact load guidelines. This commentary aims to describe the contact load guidelines and their implementation, and identify areas where future work is needed to support their evolution.

Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study.

This is the final version of the article. Available from the publisher via the DOI in this record.OBJECTIVE: Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions. METHODS: We undertook a prospective mixed-methods study of 12 MDTs in London and North Thames. Data were collected by observation of 370 MDT meetings, interviews with 53 MDT members, and from 2654 patient medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation, whether their preferences and other clinical/health behaviours were mentioned) and MDT features (as measured using the 'Team Climate Inventory' and skill mix) on the implementation of MDT treatment plans. RESULTS: The adjusted odds (or likelihood) of implementation was reduced by 25% for each additional professional group represented at the MDT meeting. Implementation was more likely in MDTs with clear goals and processes and a good 'Team Climate' (adjusted OR 1.96; 95% CI 1.15 to 3.31 for a unit increase in Team Climate Inventory (TCI) score). Implementation varied by disease category, with the lowest adjusted odds of implementation in mental health teams. Implementation was also lower for patients living in more deprived areas (adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60, 95% CI 0.39 to 0.91). CONCLUSIONS: Greater multidisciplinarity is not necessarily associated with more effective decision making. Explicit goals and procedures are also crucial. Decision implementation should be routinely monitored to ensure the equitable provision of care.This project was funded by the NIHR Health Services and Delivery Research programme (project number 09/2001/ 04) and will be published in full in the Health Services and Delivery Research Journal. Further information available at: (http://www.netscc.ac.uk/hsdr/projdetails.php?ref=09-2001-04). In accordance with NIHR regulations, the findings reported here are to be referred to as initial until the NIHR final report has been published. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, the writing of the report, or the decision to submit the report for publication

Spin-Charge Separation, Anomalous Scaling and the Coherence of Hopping in exactly solved Two Chain Models

The coherence of transport between two one-dimensional interacting Fermi liquids, coupled by single particle hopping and interchain interaction, is examined in the context of two exactly soluble models. It is found that the coherence of the inter-chain hopping depends on the interplay between inter-chain hopping and inter-chain interaction terms, and not simply on the ground state spectral properties of an isolated chain. Specifically, the splitting of levels in associated with interchain hopping in a $g_4$ soluble model is found to be enhanced by the introduction of interchain interaction. It is also shown that, for an exactly solvable model with both $g_2$ and $g_4$ interactions, coherent interchain hopping coexists with anomalous scaling and non-Fermi liquid behavior in the chain direction.Comment: Two postscript figure