Learning from the Canadian Corps on the Western Front

There is a curious paradox about the Canadian Corps that is summed up in this quotation from Canadian Brass, Stephen J. Harris’s study of the evolution of a professional army in Canada. How did this military organisation become so effective in war, considering the background it had and the structure that supported it for most of its existence? This model of tactical excellence was born amid the chaos of Canadian Minister of Defence Sam Hughes’ egomaniacal control at Valcartier Camp. It was beset by jealousies, political backhanders, corruption and influence peddling, and saddled with favourites as incompetent officers who at best were ’very weak” and had “no power or habit of command.”2 Hughes determined to ensure that no Regular soldier received a command appointment, and instead put in his favourites. These were drawn from the citizen militia, whose ability was summed up by the young iconoclast and future military theorist J.F.C. Fuller, who remarked that the Canadians had potential only “if the officers could all be shot.”3 Yet the Canadian Expeditionary Force (CEF) rose above this administrative nightmare, even if its impact continued to haunt the force for most of its existence

Pointers to earlier diagnosis of endometriosis: a nested case-control study using primary care electronic health records

Background Endometriosis is a condition with relatively non-specific symptoms, and in some cases a long time elapses from first-symptom presentation to diagnosis. Aim To develop and test new composite pointers to a diagnosis of endometriosis in primary care electronic records. Design and setting This is a nested case-control study of 366 cases using the Practice Team Information database of anonymised primary care electronic health records from Scotland. Data were analysed from 366 cases of endometriosis between 1994 and 2010, and two sets of age and GP practice matched controls: (a) 1453 randomly selected females and (b) 610 females whose records contained codes indicating consultation for gynaecological symptoms. Method Composite pointers comprised patterns of symptoms, prescribing, or investigations, in combination or over time. Conditional logistic regression was used to examine the presence of both new and established pointers during the 3 years before diagnosis of endometriosis and to identify time of appearance. Results A number of composite pointers that were strongly predictive of endometriosis were observed. These included pain and menstrual symptoms occurring within the same year (odds ratio [OR] 6.5, 95% confidence interval [CI] = 3.9 to 10.6), and lower gastrointestinal symptoms occurring within 90 days of gynaecological pain (OR 6.1, 95% CI = 3.6 to 10.6). Although the association of infertility with endometriosis was only detectable in the year before diagnosis, several pain-related features were associated with endometriosis several years earlier. Conclusion Useful composite pointers to a diagnosis of endometriosis in GP records were identified. Some of these were present several years before the diagnosis and may be valuable targets for diagnostic support systems

Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648

Improving Customer Access to Council Services in the London Borough of Greenwich

This project's purpose was to help the London Borough of Greenwich implement the Internet as an access channel ; however, new technology breeds new problems. Many citizens, in the Borough and around the world, are "digitally excluded," due to factors including lack of motivation, access or skill. The data collected showed that those who live in deprived areas, are older, have a lower income, or are disabled are known to be affected. The Council was advised on how to develop its digital services while not excluding particular groups of residents

Veery wheats carry an allele of Vrn-A1 that has implications for freezing tolerance in winter wheats

Two winter alleles of Vrn-A1 were recently found in wheat cultivars adapted to the Great Plains of the USA. Using a diagnostic marker for a single-nucleotide polymorphism (SNP) in exon 4, which distinguishes the alleles, the allele in the Great Plains cultivar ‘Jagger’ was common in Australian and CIMMYT cultivars, but ‘Veery’ cultivars carried the alternate allele from their Russian ancestor, which was the same as the allele in the Great Plains cultivar ‘Wichita’. The ‘Wichita’ allele was in North American winter cultivars, and chromosome substitution lines with a high level of tolerance to freezing, but not in substitution lines with a lower level of tolerance. The SNP between the alleles alters the predicted Vrn-A1 protein sequence, and this potentially explains differences in freezing tolerance. We suggest that these winter alleles could be coded as Vrn-A1v for the ‘Jagger’ allele and Vrn-A1w for the ‘Wichita’ allele. Cultivars with the spring Vrn-A1a or Vrn-A1b alleles carried the same SNP allele as ‘Jagger’, suggesting that the mutation from winter to spring for these alleles occurred in a Vrn-A1v genotype.Howard A. Eagles, Karen Cane and Ben Trevaski