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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.

What is ‘fake news’? Undoubtedly, the phenomenon has become one of the defining characteristics of our recent past – in 2016 Oxford Dictionaries defined ‘post-truth’ to be its ‘word of the year’. But what might its significance be 100 years from now, and how ‘new’ is ‘fake news’? This article reflects on propaganda in the twentieth and twenty-first centuries to argue that we now face the ‘perfect storm’: the speed, scope and scale of modern communications, complicated by the uncertain status of social media as neither platform nor publisher and the hidden algorithms used to control the information we see; the building frustration of those who feel disempowered by elites; the desire of some to destabilize the entire social and political system through psychological warfare campaigns and by creating a situation where all views are of equal value regardless of the evidential base; where psychological warriors can operate under the radar in the largely unregulated ‘wild west’ of the internet. But what is genuinely new about this situation, and how might history help us to find appropriate solutions to ‘fake news’ within a liberal democracy?

BackgroundInfection, particularly in the first 5 years of life, is a major cause of childhood deaths globally, many deaths from infections such as pneumonia and meningococcal disease are avoidable, if treated in time. Some factors that contribute to morbidity and mortality can be modified. These include organisational and environmental factors as well as those related to the child, family or professional.ObjectiveExamine what organizational and environmental factors and individual child, family and professional factors affect timing of admission to hospital for children with a serious infectious illness.DesignSystematic review.Data sourcesKey search terms were identified and used to search CINAHL Plus, Medline, ASSIA, Web of Science, The Cochrane Library, Joanna Briggs Institute Database of Systematic Review.Study appraisal methodsPrimary research (e.g. quantitative, qualitative and mixed methods studies) and literature reviews (e.g., systematic, scoping and narrative) were included if participants included or were restricted to children under 5 years of age with serious infectious illnesses, included parents and/or first contact health care professionals in primary care, urgent and emergency care and where the research had been conducted in OECD high income countries. The Mixed Methods Appraisal Tool was used to review the methodological quality of the studies.Main findingsThirty-six papers were selected for full text review; 12 studies fitted the inclusion criteria. Factors influencing the timing of admission to hospital included the variability in children's illness trajectories and pathways to hospital, parental recognition of symptoms and clinicians non-recognition of illness severity, parental help-seeking behaviour and clinician responses, access to services, use and non-use of 'gut feeling' by clinicians, and sub-optimal management within primary, secondary and tertiary services.ConclusionsThe pathways taken by children with a serious infectious illness to hospital are complex and influenced by a variety of potentially modifiable individual, organisational, environmental and contextual factors. Supportive, accessible, respectful services that provide continuity, clear communication, advice and safety-netting are important as is improved training for clinicians and a mandate to attend to 'gut feeling'.ImplicationsRelatively simple interventions such as improved communication have the potential to improve the quality of care and reduce morbidity and mortality in children with a serious infectious illness.

This article examines the historiography of rumour and its relationship to other disciplines, particularly psychology. The article explores the methodological problems of defining rumours and interpreting source material, as well as the limitations of psychological interpretations. It examines the ways in which rumours can allow us to access pass mentalities and understand popular and elite politics. It analyses attempts by governments to monitor rumours and what they can tell us about the relationship between the individual and the state. Finally, it explores how the interpretations of rumours shaped, and were shaped by, race, gender, social differences, and cultural attitudes. Although social scientists and historians have approached the study of rumour in very different ways, closer collaboration between the two can illuminate our understanding of this complex and fascinating phenomena.

Despite extensive scholarship on British documentary in the period from 1929 to 1950, the role of female documentary film-makers has received relatively little attention, partly due to their fragmented and partial ‘archival trace’. Combining neglected materials in the BECTU oral history project, the personnel records of the GPO Film Unit, and the personal papers of leading female documentarists, this article challenges the standard narrative of wartime opportunity and postwar decline that tends to characterise the examination of women's employment more broadly in this period. It uses women's experience in documentary film production to offer a more complex explanation of the effect of war within a wider chronological framework and within the context of workflow, labour patterns, training and networks within the industry itself. It examines female documentarists’ own accounts, through oral histories, to suggest that such sources should be ‘read against the light’ to offer insights into the memory of the Second World War, contending that the place of gender in defining individual careers both during and after the conflict remains contested, a site of the continued struggle for professional recognition, achievement and identity.

In October 1957, John Grierson, the founder of the British documentary film movement, made the transition to a new medium: television. His series for STV, This Wonderful World, which ran in its original form until August 1965, introduced audiences to international documentary in an ‘inter-generic’ magazine format and was among the most popular broadcasts of the fledgling station, which was formed in August 1957 following the introduction of Independent Television (ITV) in 1954. This article analyses how cinematic documentarists made the transition to television and what their experiences reveal of the documentary's place in British society in the 1950s and 1960s. It argues that Grierson's series stood at the centre of debates over ‘prestige’ programming and ‘cultural uplift’, as well as over fears of the allegedly negative influence of ITV on the mass audience, and shows how British television negotiated an increasingly global media and the emergence of the modern television personality. It concludes with an examination of the legacy of early British documentary on television and demonstrates how its pioneers exploited the memory of the 1930s in order to carve out their place in the genre's history.

T the British mind, accent has long been an indicator of social status and individual or collective identities. During the Second World War, it came to play a significant role in defining the new social positioning resultant from the cultural construct of the “people’s war.” At a time when British propagandists concentrated on the image of the “ordinary” man and woman and, in particular, their integration within the organic whole, the problem of social identity was brought into sharp focus, representing the nation reconfigured. In attempting to connect the wider populace with the war effort and the drive for unity, propagandists knew that representations of the “ordinary” had to be realistic, creating an individualized, personal identification with the role of the “everyman” and foregrounding “his” experience. Naturally, accent and language played a key role in this process, featuring prominently in appeals set within the “people’s

The best propaganda idea man, of course, is the Film Commissioner for Canada. John Grierson, 19411 John Grierson is best remembered for two distinct phases in his life prior to 1945. Firstly, as th...

Shareen Blair Brysac, Resisting Hitler: Mildred Harnack and the Red Orchestra, Oxford, Oxford University Press, 2000; pp. xiv + 498; ISBN 0 19 513269 6 Pierre Galante with Eugene Silianoff, Operation Valkyrie: The German Generals' Plot against Hitler (translated from the French by Mark Howson and Cary Ryan), New York, First Cooper Square Press, 2002; pp. x + 299; ISBN 0 8154 1179 0 David Alan Johnson, Righteous Deception: German Officers against Hitler, Westport, CT and London, Praeger, 2001; pp. x +239; ISBN 0 275 96953 3 Ian Kershaw, Popular Opinion and Political Dissent in the Third Reich. Bavaria 1933-1945, Oxford, Clarendon Press, reprinted 1999; pp. xvi + 425; ISBN 0 19 821971 7 Arieh J. Kochavi, Post-Holocaust Politics. Britain, the United States and Jewish Refugees, 1945-1948, Chapel Hill and London, University of North Carolina Press, 2001; pp. xviii + 377; ISBN 0 8078 2620 0 Pamela Shatzkes, Holocaust and Rescue. Impotent or Indifferent? AngloJewry 1938-1945, Basingstoke and New York, Palgrave, 2002; pp. xiv + 322; ISBN 0 333 96039 4

This paper encourages the inclusion of cartobibliographic instruction as another path in the library instruction program. Cartographic resources including maps, globes, charts, gazetteers, and atlases are too often overlooked in such programs. Bibliographic access to, and problems associated with the use of cartographic sources, and general geographical concepts are discussed. This paper also highlights the abundance of these sources across the curriculum with special emphasis on the humanities, social sciences, and health sciences.

This book is not only about Just War Theory. Rather, it is a collection of essays by leading international historians who have analyzed how wars in the modern age have been justified in different political, economic and cultural contexts.1 It starts from the premise that wars have always been with us. Each essay is placed in historical context with the intention to question whether the Just War Tradition remains a valid theoretical framework for governing principles of how and why wars are fought. If Just War Theory (albeit with important redefinitions) has survived the test of different types of war during the nineteenth and twentieth centuries, will it remain robust in the face of the challenges of the twenty-first century? In the modern age, once wars have begun, belligerent states, in order rapidly to mobilize opinion, invariably begin publishing accounts of how the war has been caused. They do so because the issue of responsibility is one of the key elements in the propaganda battle for ‘hearts and minds’. The relationship between the need to justify war and the means of communications is the other central feature of this volume. Propaganda came of age in the twentieth century. The development of mass- and multi-media offered a fertile ground for propaganda and total war — and, later, global conflict and asymmetric warfare — provided the impetus needed for its growth. Over the past 100 years, ‘opinion management’ has become a major preoccupation of states, in times of both war and peace.

Like his younger brother Ian, Peter Fleming imagined the fantastic. The theme of his 1940 novel, The Flying Visit, was barely believable: Hitler, wanting to emphasize his status as the “Eagle Fuhrer,” embarks upon a flight over England in order to survey what he sought to conquer. An assassination attempt blows his plane from the sky, but Hitler escapes in his parachute. As a highly recognizable figure now stranded in the English countryside, he contemplates his course of action: “If he could only get hold of Mr Chamberlain, or Sir Horace Wilson [Head of the Civil Service], … he would stand (he was sure) a fair chance of persuading them that he had come to England, risking everything, on a peace mission. The English would never take advantage of an unarmed enemy of the highest possible rank who with incredible temerity, and from the noblest motives, had faced untold dangers in order to put himself at their mercy. … And he, Hitler, would return to Germany not as a superman but as a god, a god who got results.”1 Contacting an English aristocrat, Lord Scunner, who reveled in the celebrity afforded to those with connections to Nazism in the prewar years and whom Hitler briefly met at a Nuremberg rally, the Fuhrer decides to surrender himself to the authorities. After the initial euphoria of securing such an extraordinary prize, the Cabinet cannot find appropriate propaganda or diplomatic strategies for dealing with him and decides to “say nothing, do nothing. … Keep the little man on ice.”2 Eventually, in frustration at their inability to exploit the prize, they parachute the “Eagle Fuhrer” back into Germany where they would know how to deal with him. Just a matter of months after Fleming published this book, on the evening of May 10, 1941, routine patrols over the North Sea reported the approach of a Messerschmidt 110 crossing the Scottish coast. The German airman bailed out just south of Glasgow and was found by a plowman, David McLean, taken to his cottage, and offered a cup of tea. He gave his name as Captain Alfred Horn.3 The village had probably never seen such excitement: the Home Guard mobilized, and they moved the prisoner to the Girl Guides' hut at Busby. At one point, around 200 military and civilian personnel inspected the find.4 At the local hospital, where he received treatment for a broken ankle, the visitor declared that he was Rudolf Hess and willingly showed photographs of himself in an attempt to confirm his identity.5 In a bizarre turn of events that paralleled Fleming's strange tale of 1940, the Deputy Fuhrer had parachuted into Britain. The coincidence did not end there, however. As Fleming predicted, the authorities struggled in dealing with the potential propaganda coup, giving rise to prolonged speculation, rumor, and indeed diplomatic troubles until the end of the war.

As this comment made in the trade newspaper To-day’s Cinema suggests, it was noticeable that, by 1935, German film exports to the United Kingdom were not as they had been. Britain had been an important consumer of German films of the silent era, praising and appreciating the talent emanating from the ‘second Hollywood’ located at the heart of Europe, with the likes of Ernst Lubitsch, Erich Pommer and Fritz Lang producing some of the most memorable and defining films of the 1920s. Nevertheless, the rise of the Nationalsozialistische Deutsche Arbeiterpartei (NSDAP) had profound implications for the political and cultural life of the ‘new Germany’, as well as its artistic exports. This chapter traces the cinematic relationship between Britain and Germany from the Machtergreifung (seizure of power) in 1933 to the fall of the Reich in 1945. In many ways, the history of their shared filmic past mirrors wider Anglo-German relations in this period, moving from an initial attempt to understand each other’s form of government and the vague hope of reconciliation to disquiet about the Nazi regime’s racial policies and its implications to the era of appeasement and finally to the outbreak of another European conflict, concluding in 1945 with both nations standing at the poles of defeat and victory.

Rapidly developing technology has changed the environment in libraries so that some degree of computer search ability is required now in order to give standard, non-obsolete reference service. New library school graduates regularly receive a basic understanding of DIALOG, BRS and other database utilities, but some feel more inclined toward working with computers than others. At the same time, seasoned librarians are faced with new learning requirements for computer searching. How do librarians in the "transition generation" handle the change required by professional technological development? A wide range of responses - from enthusiastic to reluctant - requires flexibility and variety in training and continuing education methods. This paper will address the human factor in some issues of broad technological change. The authors will offer some observations about how we as a profession are adapting to the new environment of computer-enhanced information. A case study of one library's experience with trainin...

In 1996, Eric Rentschler claimed that ‘cinema in the Third Reich involved a division of labour between heavy hands and light touches’. Such a description is a fitting comment on both the organisational processes of the propaganda machine under the Nazis and the sometimes inconsistent messages of their feature film productions. Issues surrounding the nature of cinematic culture in the Third Reich have prompted intense debates among film scholars. This article seeks to outline the key debates and issues, concluding with an analysis of Veit Harlan's Der grose Konig, with reference to the diverse methodological approaches employed to study film under National Socialism. It argues that one needs to understand both the ‘heavy hands’ and the ‘light touches’ of NS film policy and production to enable a deeper understanding of feature films produced in the Third Reich.