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New surgical procedures can expose patients to harm and should be carefully evaluated before widespread use. The InSpace balloon (Stryker, USA) is an innovative surgical device used to treat people with rotator cuff tears that cannot be repaired. We aimed to determine the effectiveness of the InSpace balloon for people with irreparable rotator cuff tears.We conducted a double-blind, group-sequential, adaptive randomised controlled trial in 24 hospitals in the UK, comparing arthroscopic debridement of the subacromial space with biceps tenotomy (debridement only group) with the same procedure but including insertion of the InSpace balloon (debridement with device group). Participants had an irreparable rotator cuff tear, which had not resolved with conservative treatment, and they had symptoms warranting surgery. Eligibility was confirmed intraoperatively before randomly assigning (1:1) participants to a treatment group using a remote computer system. Participants and assessors were masked to group assignment. Masking was achieved by using identical incisions for both procedures, blinding the operation note, and a consistent rehabilitation programme was offered regardless of group allocation. The primary outcome was the Oxford Shoulder Score at 12 months. Pre-trial simulations using data from early and late timepoints informed stopping boundaries for two interim analyses. The primary analysis was on a modified intention-to-treat basis, adjusted for the planned interim analysis. The trial was registered with ISRCTN, ISRCTN17825590.Between June 1, 2018, and July 30, 2020, we assessed 385 people for eligibility, of which 317 were eligible. 249 (79%) people consented for inclusion in the study. 117 participants were randomly allocated to a treatment group, 61 participants to the debridement only group and 56 to the debridement with device group. A predefined stopping boundary was met at the first interim analysis and recruitment stopped with 117 participants randomised. 43% of participants were female, 57% were male. We obtained primary outcome data for 114 (97%) participants. The mean Oxford Shoulder Score at 12 months was 34·3 (SD 11·1) in the debridement only group and 30·3 (10·9) in the debridement with device group (mean difference adjusted for adaptive design -4·2 [95% CI -8·2 to -0·26];p=0·037) favouring control. There was no difference in adverse events between the two groups.In an efficient, adaptive trial design, our results favoured the debridement only group. We do not recommend the InSpace balloon for the treatment of irreparable rotator cuff tears.Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health and Care Research partnership.

Introduction Despite the recent Department of Defense emphasis on traumatic brain injury (TBI) education and improvements in treatment, social, and attitudinal beliefs instilled in the military community hinder seeking medical assistance at the time of injury. This survey research presents injury reporting and care seeking behavioral patterns of service members (SMs) stationed in the Landstuhl catchment area in the context of TBI. This descriptive study investigated whether sociocultural factors influence health decision-making among SMs stationed abroad and how these compare to the SMs stationed in Fort Bliss and Fort Hood. Materials and Methods A total of 969 of U.S. Army, Air Force, and Navy SMs completed a voluntary and anonymous 2- to 5-minute paper survey during the month of March 2019. As a result of illegibility and incompleteness, 15 survey responses were removed from the total sample. Results Data analyses show three main findings about SMs in the Landstuhl catchment area: (a) older population (25-34, ≥48%; 18-24, 26.1%; +35, 25.4%) when compared to Fort Hood and Fort Bliss (≥48%; 18-24); (b) more years in service (7-13 years; 30.2%) versus 6 years or less in both Fort Hood and Fort Bliss (≥69%); (c) 54.8% of participants did not think TBI requires care versus 63.5% in both Fort Bliss and Fort Hood. Conclusion Results suggest that TBI beliefs and influences are constant variables hindering health decision-making choices in the military population. Beliefs about thinking that the injury does not require care, fear to jeopardize the career, and knowledge about TBI and treatments vary among the respondents and all these components influence treatment-seeking behaviors. The findings provide a preliminary framework to further investigate the role of culture in reporting and seeking treatment behaviors among SMs.

Purpose Comparatively, men have poorer physical and mental health outcomes than women, with a significantly higher suicide rate. Contributory factors are thought to be social and biological, leading to reduced access to health-care services. The study aims to develop and implement community-based support to increase awareness of and access to men’s mental health support networks and groups. Design/methodology/approach The project involved three key work-packages discussed in this paper: raising awareness of men’s mental health needs in health care, educational and community settings; collaboration between National Health Services (NHS) and non-NHS health-care support organisations to build multi-sector partnership working; and developing a supported sports-based community intervention aimed at men living with mental health conditions. The acceptability and feasibility of these work-packages were pragmatically evaluated through mixed-methods surveys and qualitative content analysis. Findings Overall, both community events and sports groups successfully engaged men living with mental health problems. Organisations interested in men’s mental health are continuing to engage in a partnership initiative. Community events were well-attended and received positive feedback, particularly regarding the educative and real-life experiences approach promoted in the events. The sports intervention is feasible and well-accepted by participants, who described feeling supported with their physical and mental health needs, with increased mental well-being reported. Research limitations/implications The main limitations of this project are that the authors only evaluated a football group rather than all work areas. The project collected outcomes relating to participants’ demographics and qualitative reflections of participating in the football group along with a retrospective survey of perceived benefits, but the project did not undertake a pre- and post-comparison of well-being outcomes owing to low completion of these measures. Future work could focus on collecting more pre- and post-measures related to well-being, recovery and inclusion and compare these with men not involved in the football groups or public events. Practical implications This paper discusses the development and feasibility of setting up community-based men’s mental health support networks, involving public events, partnership working and targeted-sports interventions. All initiatives were well-received and successfully attended by men living with mental health conditions. Evaluation of the programme revealed the value placed on education about mental health and the role that community sports interventions may play in men’s mental health care. Social implications This project has demonstrated three different ways of supporting men’s mental health needs in the community. Community public events were held to raise awareness of men’s mental health needs and issues were well-attended and highlighted the need for health promotion and education in this area across all the communities. The men’s football group demonstrated the feasibility of moving mental health support out into a non-clinical and more community arena in a way that men engaged effectively. Finally, the creation of MensNet has bought together disparate multi-sector organisations successfully to lead public health mechanisms to support men’s mental health needs. Originality/value This paper describes a new multi-disciplined approach to supporting health-seeking challenges among men, in particular, how partnership working across NHS and non-NHS sectors can successfully support an identified public health need pragmatically using existing services and organisations.

This chapter explores what roles ' cham has traditionally played in Tibetan communities and examines some of their transformations in contemporary Reb kong, with particular emphasis on the relationship between institutional and popular perceptions of and engagement in its performative ritual practice. In doing so, it will look at notions of blessing or empowerment and explore ways in which the phenomena of trance dancing occurring during contemporary Bon po 'cham practices in Reb kong can be understood.. The performance of ritual dances can be viewed as being practiced within the context of rituals found in the Indic Tantric traditions from which many Tibetan Tantric practices derive. Tibetan communities, both Buddhist and Bon po, in the Tibetan regions of the People's Republic of China glossed here as the Tibetan Plateau, in the Himalayas and in Diaspora, perform a variety of dances known as ' cham or gar as part of ritual practices. Keywords: cham ; Reb Kong; Tibetan communities; trance dancers

Self-harm is about communication. It is like a scream without sound: painful, distraught, frightening and perplexing. It can be confusing and terrifying for those who witness it and for those who do it. In this paper, I shall attempt to explore some thoughts about how we can begin to understand acts of self-injury and their implications for clinical work. My hypothesis is that self-injury is a symptom. This symptom may take the place of words, and functions as a means of communication. In particular, I will be suggesting that self-injury is a specific consequence of childhood abuse. Recent statistics from research at ‘Hackney Off Centre’ indicate that for those young people that self-injure, 75 per cent have been sexually abused in childhood. (These statistics bear close resemblance to Bristol Crisis Service for Women and 42nd Street 1995 among others.)

• We used multivariate analysis to determine whether survival following perforations of the gastrointestinal tract could be accurately predicted from preoperative data. Of 12 variables tested, four were found to have predictive value. These were age, pulmonary disease, preoperative shock, and the attending surgeon. When these four variables were employed in a logistic regression equation on 42 patients, it correctly predicted which 21 patients died before leaving the hospital. To produce an equation useful for other hospitals, we recalculated it without the attending surgeon variable. Again, the equation was used to predict survival. The correlation of predicted vs observed outcome remained high, and, using a 2×2 χ 2 test, the correlation was significant. We then cross validated the three-variable model on data from a second hospital. The model accurately predicted the new data equally well. We believe that predictive models can identify risk factors in a variety of patient populations and can determine who is likely to benefit from specific treatment modalities. ( Arch Surg 1988;123:354-357)