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Recent outbreaks of culture war have posed questions about how to respond to them politically and analytically. In this conversation we explore the ways in which culture war strategies aim to create new articulations of politics, culture and power. They do so as part of an ongoing effort to create narratives that construct and solidify political blocs and produce popular consent. We reflect on the problems such strategies cause for Labour – and for the left more generally. These are recurrent problems, reflecting a long–running distinction between 'real' politics and the ephemeral distractions of 'identity politics' and the 'merely cultural'. We suggest that this restrictive view of what constitutes 'real' politics tends to ignore the left's roots in cooperative, associational, mutual and internationalist forms of politics, perhaps for fear of being branded as 'socialist', while marginalising or refusing a diverse array of social movements and their struggles for rights and redistribution. In contrast, we argue for the importance of recognising and contesting the field of culture as a site of politics and political mobilisations, highlighting the value of building a view of how culture, politics and power are entangled. As Stuart Hall argued, a progressive politics involves crafting an identity in which we can recognise ourselves as a collective political force.

Background: The American Foregut Society (AFS) is dedicated to advancing patient care and digestive health within the realm of foregut disease. One of the most common and debilitating esophageal conditions is gastroesophageal reflux disease (GERD). The Hill grade is an endoscopic classification of the esophagogastric junction (EGJ) based on the appearance of the gastroesophageal flap valve from a retroflexed view of the hiatus. This endoscopic classification provides insight into the anatomic disruption of the EGJ which has been shown to correlate with GERD. However, clinical utilization of this classification by endoscopists has been limited due to the perceived relevance and subjectivity of the classification. With the advent of endoscopic treatment options for GERD, there is renewed enthusiasm to develop a grading system of the EGJ that can objectively define anatomical impairment and reduce interobserver grading variability. Methods: The AFS convened a 13-member working group tasked with reviewing the Hill grade classification and formulating a proposal for its revision utilizing a modified Delphi method. This white paper summarizes the output from this working group. Results: The working group concluded that all components of the antireflux barrier—the lower esophageal sphincter and its sling fibers, the crural diaphragm, and the gastroesophageal flap valve—contribute to EGJ integrity. Using defined objective parameters of extent of hiatal axial herniation and crural disruption and presence or absence of a flap valve, the new AFS classification stratifies EGJ integrity from normal (grade 1) to increasing degrees of EGJ disruption (grade 2-4) beginning with loss of the flap valve and progressing to increasing degrees of crural disruption and hiatus hernia. This AFS classification also stipulates appropriate endoscopic methodology to utilize in making the assessment and provides a basic nomenclature for communication among endoscopists. Conclusions: The AFS endoscopic classification of the EGJ expands on the Hill classification by including assessment of axial hiatal hernia length (L), hiatal aperture diameter (D), and presence or absence of the flap valve (F) making it more comprehensive - LDF components. Future directions include validation studies correlating the ability of the AFS classification in predicting the presence and severity of GERD.

The history of water escape from Mars has been a topic of intense interest among the scientific community. Water escape from Mars is generally studied by measuring the escape rate of atomic hydrogen from its exosphere and tracing it back in time to determine the total amount lost by the planet. However, the loss rates are estimated assuming thermal properties for the H atoms, and are therefore a lower limit. Past analyses of spacecraft observations presented indirect evidence for the existence of an energetic non-thermal H population. However, all these observations lacked a clear detection. Here we present the first unambiguous observational signature of non-thermal H at Mars, consistent with solar wind charge exchange as the primary driver for its production. The calculated non-thermal H escape rates reach as high as ~26% of the thermal escape rate near aphelion. An active Sun today would increase the present-day escape rate of H and a younger energetic Sun likely contributed towards a significant loss of water from Mars, thereby shortening the martian water escape history timeline.

We present simultaneous Juno and Hubble Space Telescope of Jupiter's far-ultraviolet auroras obtained as part of a programme of observations covering 3 years of Juno's Extended Mission. We show that bright, expanded dusk-side southern main emission is associated with large-scale convection dynamics, dusk-side main emission arcs are associated with field-aligned currents, and equatorward diffuse emission and patches are associated with plasma injections in the middle magnetosphere occurring within intervals of enhanced plasma density, ongoing interchange motion and magnetospheric convection. These results shed light on the relation between the main auroral emission and magnetosphere-ionosphere coupling currents, and radial force balance in the magnetosphere. We also report on unusually bright and expanded southern auroral emissions observed during PJ 43.

The architectural history of healthcare in South Africa remains greatly understudied, as do the consequences of the 1918–19 Spanish Flu, which ravaged its population. Yet that pandemic had great consequences for South African society, spatial planning and the development of healthcare, of which the latter two were still in their infancy at the time. This article explores the link between disease and design in South Africa through the presentation of the histories of selected hospitals, maternity homes, orphanages and a special care school designed by émigré Dutch architects from the 1920s to the 1970s. It is the product of desktop and archival research, site visits and interviews undertaken in both South Africa and the Netherlands. It outlines the disparity of care that was provided for different groups and is a first attempt to identify healthcare ideas transposed into the subcontinent fuelled by the tragic experiences of the Spanish Flu pandemic. Due to this health crisis, communities – structured in terms of language, faith and race – attempted to develop their own facilities for the care of their own. Where communities had no means of their own, charitable organisations tried to fill the void. Over the course of the twentieth century, public healthcare was centralised, but many of the community and charitable institutions persist. By chance or choice, émigré Dutch architects made a disproportionately large contribution to the development of healthcare facilities in South Africa, not only in the number and range of facilities they designed, but also by introducing contemporary ideas into South African healthcare design.

BMC medical ethics 22(1), 161 (2021). doi:10.1186/s12910-021-00730-3, Published by BioMed Central, London

Introduction The induced membrane technique (IMT), frequently called Masquelet technique, is an operative, two-staged technique for treatment of segmental bone loss. Previous studies mainly focused on radiological outcome parameters and complication rates, while functional outcomes and health-related quality of life after the IMT were sparsely reported. Materials and methods Retrospective study containing of a chart review as well as a clinical and radiological follow-up examination of all patients treated with the IMT at a single institution. The clinical outcomes were evaluated using the Lower Extremity Functional Scale (LEFS), the Short-Form-36 (SF-36) and the visual analog scale (VAS) for pain. The radiographic evaluation contained of standard anteroposterior and lateral, as well as hip-knee-ankle (HKA) radiographs. Results Seventeen patients were included in the study. All had suffered high-energy trauma and sustained additional injuries. Ten bone defects were localized in the femur and seven in the tibia. Ten patients underwent additional operative procedures after IMT stage 2, among them three patients who contracted a postoperative deep infection. The median LEFS was 59 (15–80), and the SF-36 physical component summary (PCS) and mental component summary (MCS) were 41.3 (24.0–56.1) and 56.3 (13.5–66.2), respectively. The median length of the bone defect was 9 (3–15) cm. In 11 patients, union was obtained directly after IMT stage 2. Bone resorption was observed in two patients. At follow-up, 16 of the 17 bone defects had healed. The median follow-up was 59 months (13–177). Conclusion Our results show a high occurrence of complications after IMT stage 2 in segmental bone defects of femur and tibia requiring additional operative procedures. However, fair functional outcomes as well as a good union rate were observed at follow-up.

This study aimed to examine individual exercise response rates across a range of cardiometabolic variables, cardiorespiratory fitness, and body composition in adults.A retrospective analysis of data from three randomized controlled trials was used in this study. Participants include those who completed the given trial (control, n = 87; intervention, n = 251). Anthropometric (weight, body mass index, waist circumference), cardiorespiratory fitness (V̇O 2peak ), MRI-measured total adipose tissue (AT), abdominal subcutaneous AT, and visceral AT and common cardiometabolic variables were assessed pre- and postintervention using standard methodologies. The technical error (TE), which includes both the day-to-day variability and instrument error, was calculated using pre- and postintervention data from the time-matched control group.On average, all anthropometric, MRI, and V̇O 2peak variables improved significantly after intervention compared with the control group ( P0.05). With the exception of glucose disposal rate (37%), after intervention less than 13% of participants improved cardiometabolic outcome measures beyond the day-to-day variability of measurement. In other words, the individual response for 63%-96% of participants fell within the uncertain range (2 TE). Similarly, for absolute V̇O 2peak (L·min -1 ), only 45% of participants improved beyond 2 TE. By comparison, for MRI-derived variables, the majority of participants (77%, 58%, and 51% for total AT, abdominal subcutaneous AT, and visceral AT, respectively) improved beyond 2 TE. The observed reductions beyond 2 TE for WC and body weight were 53% and 63%, respectively.The findings suggest extreme caution when inferring that the cardiometabolic and cardiorespiratory fitness response for a given individual is attributable to the exercise dose prescribed.

Optimal ambulatory reflux monitoring methodology in symptomatic reflux patients continues to be debated.To utilise published literature and expert opinion to develop recommendation statements addressing use of ambulatory reflux monitoring in clinical practice METHODS: The RAND Appropriateness Method (RAM) was utilised among 17 experts with discussion, revision and two rounds of ranking of recommendation statements. Ambulatory reflux monitoring protocol, methodology and thresholds ranked as appropriate by ≥80% of panellists met the criteria for appropriateness.Prolonged (96-h recommended) wireless pH monitoring off proton pump inhibitor (PPI) was identified as the appropriate diagnostic tool to assess the need for acid suppression in patients with unproven gastro-oesophageal reflux disease (GERD) and persisting typical reflux symptoms despite once-daily PPI. Acid exposure time (AET)4.0% on all days of monitoring with negative reflux-symptom association excludes GERD and does not support ongoing PPI treatment. Conversely, AET6.0% across ≥2 days is conclusive evidence for GERD and supports treatment for GERD, while AET10% across ≥2 days identifies severe acid burden that supports escalation of anti-reflux treatment. In previously proven GERD, impedance-pH monitoring on PPI is helpful in defining refractory GERD and mechanisms of continued symptoms; the presence of40 reflux events, AET 2.0% and a negative reflux-symptom association does not support escalation of anti-reflux treatment. In contrast, AET 4.0% and positive reflux-symptom association support escalation of anti-reflux treatment, including use of invasive therapeutics.Statements meeting appropriateness for average clinical care have been identified when utilising reflux monitoring in patients with typical reflux symptoms and PPI non-response.

Electrons accelerated on Earth by a rich variety of wave scattering or stochastic processes generate hard non-thermal X-ray bremsstrahlung up to >~ 1 MeV and power Earth's various types of aurorae. Although Jupiter's magnetic field is an order of magnitude larger than Earth's, space-based telescopes have previously detected X-rays only up to ~7 keV. On the basis of theoretical models of the Jovian auroral X-ray production, X-ray emission in the ~2-7 keV band has been interpreted as thermal (arising from electrons characterized by a Maxwell-Boltzmann distribution) bremsstrahlung. Here we report the observation of hard X-rays in the 8-20 keV band from the Jovian aurorae, obtained with the NuSTAR X-ray observatory. The X-rays fit to a flat power-law model with slope 0.60+/-0.22 - a spectral signature of non-thermal, hard X-ray bremsstrahlung. We determine the electron flux and spectral shape in the keV to MeV energy range using coeval in situ measurements by the Juno spacecraft's JADE and JEDI instruments. Jovian electron spectra of the form we observe have previously been interpreted to arise in stochastic acceleration, rather than coherent acceleration by electric fields. We reproduce the X-ray spectral shape and approximate flux observed by NuSTAR, and explain the non-detection of hard X-rays by Ulysses, by simulating the non-thermal population of electrons undergoing precipitating electron energy loss, secondary electron generation and bremsstrahlung emission in a model Jovian atmosphere. The results highlight the similarities between the processes generating hard X-ray auroras on Earth and Jupiter, which may be occurring on Saturn, too., 39 pages, 6 figures, 2 tables. Published in Nature Astronomy (https://www.nature.com/articles/s41550-021-01594-8)

Being mostly connected via closed magnetic field lines, the aurorae at the two poles display two broadly similar signatures of the same magnetospheric processes. However, differences are sometimes observed, indicative of asymmetries either in the polar regions (e.g. different solar illumination, magnetic anomalies, etc.) or in the magnetosphere (e.g. twisting of the magnetotail), thus showing two complementary sides of the magnetosphere-ionosphere coupling.Whatever the planet, seeing the aurorae on both poles at the same time is challenging. Either both polar regions can be seen at once, but then only from the side, with poor spatial coverage (especially close and beyond the limb), or we need (at least) two observatories. Here we use the latter option to observe the two faces of the UV aurorae on Jupiter. In the last years, several Hubble Space Telescope observations with the Space Telescope Imaging Spectrograph (STIS) have been planned during close-up perijove observations of the poles with the UV spectrograph (UVS) on board the Juno spacecraft. The aurorae at Jupiter can be divided into three main components, with the Main Emissions, a quasi-continuous, but sometimes irregular, ribbon of auroral emissions, delimitating the outer emissions outside of it and the polar emissions inside of it. We compare the global morphology and the relative power emitted by the different auroral features in these three regions. Former studies also indicated that synchronized quasi-periodic flares could be observed in both hemispheres and we will look after similar events in this new dataset. Finally, even if the observations are delayed by approximately one hour, we can still compare the mean emitted power before (north) and after (south) each Juno perijove to look for a global trend.