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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.

Twenty years ago, at a public ceremony in Amsterdam, a group of European academics made a solemn declaration on the future of the European Union (EU). Eventually over 1000 scholars and policy makers signed the Amsterdam Declaration on the Social Quality of Europe and it was translated into sixteen languages. The main intention behind the declaration was to remind policy makers and citizens about the unique nature of the western European model of development, comprising aspirations for economic growth, competitiveness and social justice. The risk being warned against was that, in the process of Economic and Monetary Union, the politics of integration would neglect what was then labelled the ‘social dimension’ and, among other far-reaching consequences, this would lead to a loss of legitimacy for the whole European project. As the Comité des Sages put it, bluntly, in 1996, ‘Europe will be a Europe for everyone, for all its citizens, or it will be nothing’.

Traditional foods of indigenous people are a potential untapped source for providing nutritious dietary options in the modern world. The rising popularity of indigenous foods such as amaranth in recent years suggests that these foods can become a popular part of a healthy diet in the United States. Traditional knowledge of indigenous people can form the basis for using wild food resources. This research provides data on 50 plant species common to the central United States that are abundant sources of dietary protein and fiber, and used traditionally by Native American tribes. Many species show promise with high amounts of protein and fiber being found in lamb’s quarters, nettles, grass seeds, and buffalo gourd seeds. These results honor traditional knowledge. In addition, many of these species could be cultivated using techniques similar to those existing for commercial grains and vegetables. Seeds and/or greens of these wild plants could easily be incorporated into the diets of many more people, improving modern diets, and the nutritional quality of food products.

This article investigates the idea of ‘the social’ in Europe after the UK's EU Referendum vote, with reference to the ‘European social model’. It is argued that the key drivers of the vote outcome did not feature in the referendum campaign but are features of longer running and deeper fractures in both British and wider European society. Especially, the lack of response to societal problems, the downplaying of individual participation, and a crisis in democracy created by an increasingly neoliberal direction within an EU concerned with austerity and social control, contrary to the values of the ‘European social model’ (Walker, 2005). In the absence of action for better ‘social quality’, this overall neoliberal direction has also weakened the progressive and integrative potential of social policy. The result is the regressive nationalist populist backlash against neoliberal technocracy. Instead, we argue that answers to contemporary European challenges must focus on improving social quality and democracy.

As a result of the dominant neo-liberal approach to economic and social policy in the United Kingdom over the last three and a half decades British society is becoming increasingly fragmented with, for the first time since the 1930s, a generation of people set to experience worse living standards than their parents. With the marginalisation of the collectivist and humanitarian aims of the post-war welfare settlement and promotion of a strongly individualistic culture and politics, it is necessary to reconsider what ‘the social’ means and why it is important for societal progress. First, this chapter considers what ‘the social’ has meant for social policy in the post-war welfare state period. Second, the chapter examines how ‘the social’ aspect of policy has been downgraded over the last three and a half decades by the dominant neo-liberal approach. This has been achieved by a combination of policy change, the biased mobilisations of public discourse, and increasing individualisation and disempowerment experienced by citizens. Third, an alternative ‘social quality’ approach is proposed, which seeks to put ‘the social’ back into both social and economic policy. This alternative model, which focuses on humans as social beings and collective solutions to social problems, provides an as yet incomplete, but promising basis on which to oppose neoliberal policy and promote an alternative vision for social policy in the 21st century.

Objective To determine historical disparities in tuberculosis morbidity between Native American youth attending government boarding schools and the non-Native American population. Findings are placed within the context of documented health disparities in Native American populations, with implications for modern health. Methods Analysis performed on epidemiologic data from Haskell Institute in Kansas and corresponding statewide data for the years 1910–1940. Data on tuberculosis prevalence and enrollment for Haskell were collected via historical records. Tuberculosis morbidity rates were calculated, along with comparative tuberculosis morbidity for the state of Kansas. Results Tuberculosis rates at Haskell Institute were significantly higher than for the state of Kansas from 1910 to 1940. Conclusion Tuberculosis morbidity among Native American boarding school youth in the early 20th century was higher than among the general public. Entrenched social and historical determinants resulted in increased susceptibility to tuberculosis; these factors continue to cause increased rates of tuberculosis among Native Americans today.

We analyzed ethnobotanical data on Kansas plants to evaluate differences among families for medicinal uses by Native Americans. We compared three different statistical methods used in previous ethnobotanical studies for use in our Native Medicinal Plant Research Program, which seeks to determine which plant families are more likely to contain species with medicinal compounds. The three approaches were linear regression, binomial approach, and Bayesian analysis. All were useful for determining medicinal plant use differences among plant families, although regression analysis was most useful for our purposes. Asteraceae and Fabaceae are abundant in the open sun environments of Great Plains grasslands and contain high numbers of medicinal plants. In contrast, although grasses (Poaceae) and sedges (Cyperaceae) also are species-rich and ecologically abundant, each is underrepresented as being used by Native Americans as medicine, which can be explained at least partially by their paucity of secondary compounds.

This article examines the 2016 Referendum on the United Kingdom’s membership of the European Union and draws on initial research into the reasons that the UK voted to leave and demographics of the leave vote. This initial analysis suggests that the Brexit (British Exit) vote reveals wider and deeper societal tensions along the lines of age, class, income, and education (Goodwin and Heath 2016). By providing an account of the background and events of the referendum, this article asserts that the vote was a case study in populist right-wing Eurosceptic discourse (Leconte 2010; Taggart 2004), but it also reveals strong elements of English nationalism (including British exceptionalism and social conservatism) in parts of British society (Henderson et al. 2016; Wellings 2010). Given this, the article begins to make sense of Brexit from a social quality perspective and outlines a possible social quality approach to the UK and Europe post-Brexit.

The Ethnobotany and Ethnopharmacology of Wild Tomatillos, Physalis longifolia Nutt., and Related Physalis Species: A Review. The wild tomatillo, Physalis longifolia Nutt., and related species have been important wild-harvested foods and medicinal plants. This paper reviews their traditional use as food and medicine; it also discusses taxonomic difficulties and provides information on recent medicinal chemistry discoveries within this and related species. Subtle morphological differences recognized by taxonomists to distinguish this species from closely related taxa can be confusing to botanists and ethnobotanists, and many of these differences are not considered to be important by indigenous people. Therefore, the food and medicinal uses reported here include information for P. longifolia, as well as uses for several related taxa found north of Mexico. The importance of wild Physalis species as food is reported by many tribes, and its long history of use is evidenced by frequent discovery in archaeological sites. These plants may have been cultivated, or “tended,” by Pueblo farmers and other tribes. The importance of this plant as medicine is made evident through its historical ethnobotanical use, information in recent literature on Physalis species pharmacology, and our Native Medicinal Plant Research Program’s recent discovery of 14 new natural products, some of which have potent anti-cancer activity.

This article contributes to the steady flow of critiques of the big society idea contained in The Political Quarterly. It focuses chiefly on two sets of parallels. The first is between the big society and the policies pursued by the Thatcher government which, despite their obvious rhetorical differences, contain many striking similarities, including their neoliberal origins, application of the ‘crowding out’ thesis and uncritically idealised notions of community. The second is between the big society and a policy with the same name pursued doggedly by the Chinese Communist Party for nearly 20 years until being abandoned as a failure. Lessons for the Prime Minister's flagship policy are drawn from the Chinese experience. The article concludes with a welcome for the rediscovery of the social by public policy and some suggestions as to how a more participative and democratic state could follow from this breakthrough.

In 1928, white Indian agents became convinced that the conditions on the Potawatomi reservation in northeast Kansas were not conducive to good health. The agents commissioned the “Pottawatomie Indian Survey”, a house to house analysis of the health status of the people on the reservation. This article examines the results of that 1928 survey. Eye maladies such as trachoma were the most commonly reported health complaints of the people, and tuberculosis the most often reported cause of death. The disease pattern of the Potawatomi in 1928 was more like that of the rest of the United States in the nineteenth century, and dissimilar from that of other neighboring Kansas populations. Though the agency surveyors of the time laid the blame for health inadequacies at the feet of the Potawatomi, this analysis suggests that poor public health services and the imposition of an alien subsistence strategy were to blame.

We report a fatality due to massive gastrointestinal haemorrhage in a patient receiving prophylactic dabigatran etexilate following a total hip replacement. A 79-year-old woman was commenced on dabigatran for venous thromboembolic prophylaxis following a total hip replacement. She presented again four days after surgery with haematemesis and hypotension but her coagulopathy could not be corrected, leading to her death. This case highlights the lack of reversal agent for dabigatran etexilate that resulted in this fatal complication.

We describe a novel all-arthroscopic technique for suprascapular nerve (SSN) decompression and present our preliminary results for this procedure.A prospective series of 10 patients with preoperative electromyographic findings consistent with chronic SSN compression, posterior shoulder pain, and subjective weakness were treated with arthroscopic SSN decompression. There were 8 men and 2 women, with a mean age of 50 years. The mean follow-up was 15 months (range, 6 to 27 months). In 8 of 10 patients, we performed an electromyographic examination postoperatively to evaluate nerve recovery after decompression. The clinical outcomes measures used to assess preoperative and postoperative function were the visual analog scale for pain, the Constant score, strength testing of the supraspinatus and infraspinatus, and a subjective satisfaction questionnaire. In all patients preoperative and postoperative computed tomography arthrograms were obtained to document the absence of a rotator cuff tear.There were no complications resulting from SSN decompression. Of 10 patients, 8 had postoperative electromyography at a mean of 6 months after SSN release and 2 refused to undergo this study after surgery. Of the 8 postoperative electromyograms, 7 had complete normalization of the latency in the motor fibers of the SSN and normalization of the voluntary motor action potential for the supraspinatus and infraspinatus muscles. Two of the electromyograms showed evidence of partial recovery. The preoperative and postoperative Constant scores for these patients were 60.3 and 83.4, respectively (P.001). All patients returned to their normal work and sports activity at a mean of 3 weeks (range, 2 days to 3 months). The abduction and external rotation strength also significantly improved. At the time of last follow-up, 9 patients graded their clinical outcome as excellent and responded that they had complete relief of pain. One of the study subjects reported a satisfactory result with moderate relief of pain.Arthroscopic release of the SSN can be performed safely and effectively. All of the patients in this preliminary study had improvement in their postoperative electromyographic findings and had marked improvement in pain relief and function.Level IV, therapeutic case series.

Adoption of farming along the rivers of Turkana District in Kenya has lead to the settling of traditionally nomadic Ngisonyoka Turkana pastoralists. The impact of resulting changes in activity and energy expenditure, disease, and diet have not been investigated previously. This study examines the effects of subsistence transition on body composition of nomadic and settled Turkana. Anthropometric measurements (height, weight, skinfolds, circumferences) were taken in 1989-1990 and 1994, from a sample of 93 nomadic and 81 settled males, and 184 nomadic and 107 settled females. The two groups were compared by sex using univariate tests. Factor analysis was used to identify important components of body composition differences, and these were tested for differences between groups. The effects of age and parity on body build were removed for the analysis. Results indicate that settled males and females both have greater fat stores than nomads. No differences were found between male groups in fat-free mass. However, nomadic females develop more lean tissue and are larger than settled females. Differences in body composition between groups probably reflect differences in diet, disease, and activity. The settled diet based primarily on grains may be calorically sufficient to encourage fat tissue stores, but deficient in protein necessary for fat-free tissue development and growth. The high protein, low calorie nomadic diet may contribute to maintaining fat-free mass but not adipose tissue. Increased exposure to pathogens may contribute to differences in overall body composition by increasing the nitrogen and amino acid requirements of the settled population. Differences in physical activities may be responsible for some bodily differences by encouraging muscle hypertrophy.

Polymer thick film (PTF) technology provides the lowest cost, cleanest and most efficient manufacturing method for producing flexible circuits. Non‐contact radio frequency (RF) smart cards and related information transaction devices, such as RFID tags, appear to be a good fit for PTF‐flex. Flip chip also seems well suited for these “contactless” RF transceiver products. Flip chip and PTF adhesive technologies are highly compatible and synergistic. All PTF SMT adhesives assembly methods are viable for flip chip. However, the merging of flip chip with PTF‐flex presents major challenges in design, materials and processing. This paper will compare assembly methods and discuss obstacles and solutions for state‐of‐the‐art flip chip on flex within the RFID product environment.

Objectives To investigate a cluster of leukaemia among young people and assess the plausibility of a disease-exposure relationship. Design Descriptive analysis of population-based leukaemia incidence data, review of evidence related to the causation of leukaemia, assessment of environmental exposures to known leukaemogens, and resulting risks of leukaemia. Setting Illawarra region of New South Wales, Australia, focusing on suburbs between the Port Kembla industrial complex and Lake Illawarra (the Warrawong area). Main outcome measures Standardised incidence ratios (SIRs) for leukaemia; current measured and past estimated ambient air benzene concentrations; and expected leukaemia cases attributable to estimates of ambient air benzene concentrations. Results In 1989-1996, 12 leukaemia cases among Warrawong residents aged less than 50 years were observed, more than the 3.49 cases expected from the rate in the rest of the Illawarra region (SIR, 343.8; 99% CI, 141.6-691.7). These people lived in suburbs immediately to the south-southwest of a coke byproducts plant (a major industrial source of benzene, one of the few known leukaemogens). The greatest excess was among 15-24-year-olds (SIR, 1085.6; 99% CI, 234.1-3072.4). In 1996, ambient air concentrations of benzene averaged less than 1 part per billion (ppb). Since 1970, ambient air concentrations of benzene were estimated to have averaged up to 3 ppb, about one-thousandth of the level at which leukaemia risk has been identified in occupational epidemiological studies. Using the risk assessment model developed by the US Environmental Protection Agency, we estimate that past benzene levels in the Warrawong area could have resulted in 0.4 additional cases of leukaemia in 1989-1996. Conclusions The excess occurrence of leukaemia in the Warrawong area in 1989-1996 is highly unusual. Current environmental benzene exposure and the reconstructed past environmental benzene exposure level are too low to explain the large excess of leukaemia. The cause of the cluster is uncertain.

Background: Reviewing litigation brought against health institutions is a clinical governance issue and can help to prevent further cases. While large-scale databases are rare, the British National Health Service Litigation Authority deals with claims brought against all public health trusts in England. Methods: We reviewed all 2312 successful cases pertaining to adult orthopaedic claims between 2000 and 2006 in an effort to establish trends of litigation and highlight specific areas of concern such that orthopaedic health care could be potentially improved. A total of 1473 entries had sufficient detail to be considered in our study. Results: There were 4,847,841 elective and trauma-related orthopaedic procedures performed between 2000 and 2006 in the United Kingdom. Compared with the number of cases performed, the frequency of successful litigation is relatively low but financially costly to the National Health Service. From 2000 to 2006, a total of more than US$321,695,072 was paid in adult orthopaedic surgery-related settlements. The most common reason for successful litigation was due to the presence and sequelae of infection (123 cases). In the remaining cases, successful litigation appeared to be related to two common themes: the consent process and the mismanagement of orthopaedic conditions, particularly fractures, cauda equina syndrome, and compartment syndrome. Conclusions: These findings highlight the fact that education and vigilance remain important components of orthopaedic training as many of the cases of successful litigation had a preventable cause.