To increase public satisfaction in the NHS, we need a new conversation about how to improve it As satisfaction with the NHS reaches a new low, we should embrace the power of citizens and society to restore public confidence, argue these authors

Easter Saturdaywill see the fourth anniversary of the introduction of the Ultra Low Emission Zone (ULEZ) to central London, and in August 2023 the Mayor of Londonplans to extend it to theboundaries ofGreater London.With the schemehigh-polluting vehicles are charged when entering the zone. Not everybody is pleased about this, and four outer London boroughs and Surrey County Council have funded a judicial review,hoping toblock the expansion. Theexpansion will improve health through reducing air pollution and emissions of greenhouse gases and by encouraging walking, cycling, and use of public transport. Doctors and other health professionals need to speak up in its favour. This matters most not only for London, but for the other cities in the UK and across theworld introducingor planning to introduce similar ultra low emission zones.

Some 30 years ago I heard Sam Thier, then chief executive of the Massachusetts General Hospital, say something like "If you want to understand an organisation don't look at their strategy, look at their budgets."It's even more true of governments, where the rhetoric is grossly inflated and the budgeting brutal.

This study is concerned with the changes of the floor surface topography in the early stage of repetitive wear rubbings and the relationships between slip resistance properties and operationally defined geometric characteristics of the floor surfaces. It was assumed that: (1) alterations in surface topography will be associated with changes in the DFC; and (2) wear process will be accompanied by changes in surface topography. For the analysis of initial characterization on the surface topography, specially prepared, dry and clean metal and perspex specimens were chosen. The surface profiles of the fresh and rubbed flooring specimens were recorded using a laser scanning confocal microscope. From the profile ordinate data read at 1 mum intervals, a number of surface roughness parameters - centre line average, root-mean-square roughness, maximum height, maximum mean peak height, maximum mean depth, and absolute average asperity slope were calculated using a computer program. The skew and the kurtosis of the statistical distribution of each surface profile were also computed. The results indicate that the asperity height and the maximum mean depth were significantly reduced after the friction tests. The average slope of asperities was the parameter that most highly correlated with the dynamic friction coefficient. The analyses also showed that the surface parameters underwent large Variations initially, but subsequently these changes were less marked, which was explained by the transition from unsteady-state friction to steady-state friction. These results found that slip resistance properties between the shoes and the Boor counterfaces were greatly influenced by the manner in which the geometry of the Boor surface was modified. It was suggested that measurement of changes in the surface geometry provides additional information on the analysis of slip resistance and could usefully be reported with friction measurements.

The "acting White" accusation (AWA) is a type of cultural invalidation that undermines the racial authenticity of Black youths. This study examines how the AWA and racial identity (RI) influence one another longitudinally during the transition to college for Black students. Findings were moderated by gender. For Black males, a negative feedback loop emerged for RI centrality where AWA experiences predicted lower centrality, which then predicted more AWA experiences over a 2-year period. Additionally, AWA experiences in high school predicted lower RI private regard for Black males and lower RI public regard for Black females during the first year of college. Implications and policy recommendations to address forms of cultural oppression such as the AWA are further discussed.

1 Today there was a launch webinar, which you will be able to watch even if you are reading this months later.

Black people engage in a variety of behaviors to avoid stereotyping and promote a professional image in the workplace. Racial codeswitching is one impression management strategy where Black people adjust their self-presentation to receive desirable outcomes (e.g., perceived professionalism) through mirroring the norms, behaviors, and attributes of the dominant group (i.e., White people) in specific contexts. In this study, we examine whether racial codeswitching enhances perceived professionalism for Black employees. We investigate Black and White participants' perceptions of racial codeswitching and subsequent evaluations of professionalism through manipulating three behaviors (e.g., adjusting style of speech, name selection, hairstyle) of a fictitious Black coworker in two, between-subjects experimental studies using audio and written stimuli. Results indicate that employees who engage in racial codeswitching are consistently perceived as more professional by both Black and White participants compared to employees who do not codeswitch (Studies 1 & 2). We also found that Black participants perceive the non-codeswitching employee as more professional than White participants (Studies 2a & 2b). Black and White participants' evaluation of specific codeswitching behaviors varied with both groups supporting adjustment of speech, opposing adjusting one's name, and diverging on wearing natural hairstyles (Studies 1 & 2). Although racial codeswitching is presented as an impression management strategy, it may reinforce White professional standards and generate social and psychological costs for Black employees. Implications of our work for impression management and impression formation are further discussed.

The study aimed to translate the foot function index (FFI) questionnaire to Thai and to determine psychometric properties of the questionnaire among individuals with plantar foot complaints. The Thai version of the FFI (FFI-Th) was adapted according to a forward and backward translation protocol by two independent translators and analyzed by a linguist and a committee. The FFI-Th was administered among 49 individuals with plantar foot complaints to determine internal consistency, reliability, and validity. Cronbach’s alpha and the Intraclass Correlation Coefficient (ICC3,1) were used to test the internal consistency and test-retest reliability. The Principal Component Analysis with varimax rotation method was used to test the factor structure and construct validity. Furthermore, the criterion validity was tested using Pearson’s correlation coefficient (rp) between the FFI-Th and the visual analogue pain scale (pain-VAS) as well as the EuroQol five-dimensional questionnaire (EQ-5D-5L). The FFI-Th showed good to excellent internal consistency and test-retest reliability in the total score, pain, disability, and activity limitation subscales. The Principal Component Analysis produced 4 principal factors from the FFI-Th items. Criterion validity of the FFI-Th total score showed moderate to strong correlations with pain-VAS and EQ-5D-5L, and EQ-VAS scores. The FFI-Th was a reliable and valid questionnaire to assess the foot function in a Thai population. NCT03161314 (08/05/2017).

The anterior cruciate ligament (ACL) plays an important role in controlling knee joint stability. The literature provides conflicting information on whether patients with ACL deficiency exhibits gait adaptations. The aim of this study is to investigate if the use of neural networks with a new pattern recognition-based method can differentiate gait patterns between ACL deficient (ACL-D) knee and contralateral ACL-intact (ACL-I) knee in patients with unilateral ACL deficiency. The proposed method is divided into two stages. In the training stage, kinematic and kinetic gait variables are measured and compared between the two lower extremities. Gait dynamics underlying gait patterns of ACL-D and ACL-I knees are locally accurately modeled and approximated by radial basis function (RBF) neural networks via deterministic learning theory. The derived knowledge of approximated gait dynamics is preserved in constant RBF networks. In the classification stage, a bank of dynamical estimators is constructed using the preserved constant RBF networks to represent the learned training gait patterns. By comparing the set of estimators with a test gait pattern, the generated average L_1 norms of errors are taken as the difference and classification measure between the training and test gait patterns. Finally, experiments are carried out on forty-three patients to assess the effectiveness of the proposed method. By using the leave-one-out cross-validation style under normal and fast walking speed conditions, the correct classification rates for discriminating between ACL-D and ACL-I knees are reported to be 95.9 % and 94.0 % , respectively. Compared with other state-of-the-art methods, the results demonstrate that gait alterations in the presence of chronic ACL deficiency can be detected with superior performance and support the validity of the proposed method.

Objectives: The present research examined if Blacks differ in how they categorize Blacks. Whites, and Black-White Biracials (Biracials. hereafter) as ingroup members and whether those categorizations predict the degree to which they attribute rejection feedback to discrimination. Methods: In Study 1 (N = 115). Black participants received rejection feedback from a Black. White. or Biracial online partner and then indicated the extent to which they perceived their partner as part of their racial ingroup and the extent to which they attributed the rejection feedback to discrimination. In Study 2a (N = 92), Black participants viewed the profile of a Biracial who self-identified as Black, White, or Biracial and then indicated the extent to which they perceived them as an ingroup member. Study 2b (N = 183) followed a similar design as Study 1 except that Black participants received rejection feedback from a Biracial online partner who self-identified as Black. White. or Biracial. Results: In Study 1, participants considered Black and Biracial partners to be more of an ingroup member than White partners and, in turn, were less likely to attribute rejection feedback to discrimination. In Study 2. participants perceived Biracials who self-identified as White, versus Black or Biracial, to be less of an ingroup member (Study 2a. 2b) and, in turn, were more likely to attribute rejection feedback to discrimination (Study 2b). Conclusions: Findings suggest that Blacks' perception of a Biracial's ingroup membership affects their attributions to discrimination following social rejection.

Purpose: The objective of this study was to compare the ground reaction forces (GRFs) and the multi-segment foot motion between individuals with plantar fasciitis (PF) and healthy controls.Methods: Twenty-one individuals with PF and 21 matched-case healthy controls who passed the criteria participated in the study.Gait data were assessed during their self-selected comfortable speeds by the 3D motion analysis system.The multi-segment foot motions were determined by the Oxford Foot Model.Outcome measures included the vertical and antero-posterior ground reaction forces (GRFs) and the multi-segment foot motions [the dorsiflexion (DF), plantarflexion (PF), inversion (Inv), eversion (Eve), adduction (Add), and abduction (Abd) peak angles for the forefoot with respect to hindfoot (FFHF) and the DF, PF, Inv, Eve, internal rotation (IR), and external rotation (ER) peak angles for the hindfoot with respect to tibia (HFTB) as well as their ranges (R)].Results: Comparisons between individuals with PF and healthy controls showed no significant differences in any of the GRFs.Significant reductions were found in the FFHF-DF, FFHF-DF-R, FFHF-Inv, and HFTB-Inv/Eve-R in individuals with PF.In addition, there were tendencies of the increased angles of the FFHF-PF, HFTB-DF, HFTB-Inv, and HFTB-ER, but not significantly for individuals with PF, compared to healthy controls.Conclusions: Adaptations of the intra-foot motion showed the reduction of some angles but no change for the GRFs in individuals with PF compared to the healthy controls when both groups walked at a similar gait speed.

Purpose Our clinical understanding of the relationship between 3D bone morphology and knee osteoarthritis, as well as our ability to investigate potential causative factors of osteoarthritis, has been hampered by the time-intensive nature of manually segmenting bone from MR images. Thus, we aim to develop and validate a fully automated deep learning framework for segmenting the patella and distal femur cortex, in both adults and actively growing adolescents. Methods Data from 93 subjects, obtained from on institutional review board-approved protocol, formed the study database. 3D sagittal gradient recalled echo and gradient recalled echo with fat saturation images and manual models of the outer cortex were available for 86 femurs and 90 patellae. A deep-learning-based 2D holistically nested network (HNN) architecture was developed to automatically segment the patella and distal femur using both single (sagittal, uniplanar) and 3 cardinal plane (triplanar) methodologies. Errors in the surface-to-surface distances and the Dice coefficient were the primary measures used to quantitatively evaluate segmentation accuracy using a 9-fold cross-validation. Results Average absolute errors for segmenting both the patella and femur were 0.33 mm. The Dice coefficients were 97% and 94% for the femur and patella. The uniplanar, relative to the triplanar, methodology produced slightly superior segmentation. Neither the presence of active growth plates nor pathology influenced segmentation accuracy. Conclusion The proposed HNN with multi-feature architecture provides a fully automatic technique capable of delineating the often indistinct interfaces between the bone and other joint structures with an accuracy better than nearly all other techniques presented previously, even when active growth plates are present.

Objective To investigate the effects of physical therapy interventions using strengthening and stretching exercise programs on pain and temporospatial gait parameters in patients with plantar fasciitis (PF). Methods Eighty-four patients with PF participated in the study and were randomly assigned to the strengthening or stretching exercise groups. All patients received 8 physical therapy interventions two times per week in the first 4 weeks and performed daily strengthening or stretching exercises three times per day. After 4 weeks, they continued the assigned exercise programs every day for 8 weeks. Pain visual analogue scale (VAS) scores at the worst and in the morning and temporospatial gait parameters were evaluated at the baseline, intermediate of the intervention, end of the intervention, and the first and second month follow-up. Results There were significant effects of the time on the worst pain, morning pain, cadence, stride time, stride length, total double support, and gait speed, but there was no effect on step width. In addition, the main effect of the group and the interaction effects of the time and the group were not found in any parameters. For intra-group comparisons, there were significant differences in worst pain, morning pain, cadence, and stride time among the assessment times in both groups. For inter-group comparisons, there were no significant differences in all parameters. Conclusion Both strengthening and stretching exercise programs significantly reduced pain and improved gait in patients with PF.

Purpose: Kleine-Levin syndrome (KLS) is a rare, relapsing-remitting, debilitating sleep disorder. Examining KLS characteristics in different ethnic populations may help elucidate the genetic basis of the disorder. No studies have examined KLS in Arabs. Therefore, we compared the clinical characteristics of Saudi Arabian KLS patients to those in other published cohorts to determine whether Arab patients have a distinct phenotype.Methods: This study included all patients who were diagnosed with KLS at our center between June 2003 and July 2016 (P = 12; Six familial cases). All participants completed the Stanford KLS questionnaire. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale; eating attitudes were assessed with the Eating Attitudes Test-26. We compared the clinical characteristics of our patients to those in other published cohorts.Results: Saudi Arabian patients with KLS had similar features to those in patients from different countries and ethnic backgrounds, with only minor differences in sleep duration during disease episodes (2-3h shorter). However, between episodes, Saudi Arabian KLS patients reported worse sleep, greater daytime sleepiness and higher levels of baseline depression, which may be related to KLS or to local cultural practices. Ankylosing spondylitis was present in five of the six familial patients.Conclusion: Saudi Arabian patients with KLS exhibited similar clinical characteristics during episodes compared to patients with KLS of different ethnicities. However, a new and interesting finding is that KLS patients may have inter-episode behavioral and pathophysiological changes, which may suggest that KLS is not necessarily a static disorder.

A positive attitude to organ donation among doctors is key to increasing organ donation. Education of medical students is suggested to be central to achieving this. This study examined whether knowledge of organ donation and transplantation (ODT) correlates with attitudes and beliefs relevant to ODT among medical students in Saudi Arabia. Two hundred and thirty-three students completed a self-administered questionnaire. A knowledge score was calculated for each student and correlated with answers on attitudes and beliefs with regard to ODT. This study revealed a complex interaction between knowledge, attitudes, and beliefs to ODT. The majority of students support ODT in general, but a significant proportion have negative beliefs when asked about specific details of the process and concern for family members with regard to both deceased and live donation is evident. Despite almost all students believing that Islamic beliefs do not preclude ODT, 27.1% believe transplantation to be unacceptable in the Society in which they live. Education is an important strategy to improve donation rates. These findings can guide development of medical student education programs suggesting inclusion of open debate about views in society and the importance of discussion with family members to be essential.

OBJECTIVES:To examine whether the Functional Data Analysis (FDA), Statistical Parametric Mapping (SPM) and Statistical non-Parametric Mapping (SnPM) hypothesis testing techniques differ in their ability to draw inferences in the context of a single, simple experimental design.DESIGN:The sample data used is cross-sectional (two-sample gender comparison) and evaluation of differences between statistical techniques used a combination of descriptive and qualitative assessments.METHODS:FDA, SPM and SnPM t-tests were applied to sample data of twenty highly skilled male and female rowers, rowing at 32 strokes per minute in a single scull boat. Statistical differences for gender were assessed by applying two t-tests (one for each side of the boat).RESULTS:The t-statistic values were identical for all three methods (with the FDA t-statistic presented as an absolute measure). The critical t-statistics (tcrit) were very similar between the techniques, with SPM tcrit providing a marginally higher tcrit than the FDA and SnPM tcrit values (which were identical). All techniques were successful in identifying consistent sections of the force waveform, where male and female rowers were shown to differ significantly (p<0.05).CONCLUSIONS:This is the first study to show that FDA, SPM and SnPM t-tests provide consistent results when applied to sports biomechanics data. Though the results were similar, selection of one technique over another by applied researchers and practitioners should be based on the underlying parametric assumption of SPM, as well as contextual factors related to the type of waveform data to be analysed and the experimental research question of interest.