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Illustrates 5 key exercises to improve posture, awareness, flexibility, and mobility. These exercises will teach you how to move more easily and freely, and avoid such consequences of poor posture as overuse injuries to hands, arms, and shoulders.

Objectives(1) To develop a mixed course of individual and group lessons in the Alexander Technique (AT) for low back pain, and (2) to explore its: (a) effectiveness and (b) acceptability to both participant AT teachers and patients.DesignSingle-centre study, mixed methods.SettingMembers of the public in the Brighton area (community recruitment), and patients from six Hampshire General Practices (GP) (National Health Service (NHS) recruitment).ParticipantsPeople with chronic or recurrent low back pain; AT teachers.InterventionsIterative development and implementation of a 10-lesson (6 group, 4 individual) AT course.Outcome measuresPerceptions from semistructured interviews analysed using inductive thematic analysis. Descriptive analysis of RMDQ (Roland-Morris Disability Questionnaire) over 12 weeks.ResultsThirty-nine participants with low back pain were included and 32 AT teachers were interviewed, 7 of whom taught on the course. Some participants had reservations, preferring only individual lessons, but the majority found the sharing of experience and learning in groups helpful. There was also concern regarding group teaching among some AT teachers, but most also found it acceptable. By 12 weeks, RMDQ score among participants fell from 10.38 to 4.39, a change of −5.99. 29 of 39 (74%) participants had a clinically important reduction in RMDQ score of 2.5 or more.ConclusionSome patients and practitioners had reservations about group AT lessons, but most found groups helpful. Further development is needed, but the course of individual and group lessons has the potential to cost-effectively deliver clinically important benefits to patients with back pain, who are known to improve little and slowly.

Carolyn Nicholls reflects on the impact of full coeducation

In a randomized trial, 5988 patients with heart failure with preserved ejection fraction were assigned to receive either empagliflozin or placebo in addition to usual therapy. At a median of 26 months, the empagliflozin group had a lower incidence of cardiovascular death or hospitalization for heart failure than the placebo group.

This paper argues that when the technological basis of an industry is changing, the firm's approach to technology sourcing plays a critical role in building the capabilities needed to generate new technical outputs. Using survey and archival data from the U.S. pharmaceutical industry during the period 1981-91, we find that different approaches to technology sourcing (internal R&D and external R&D) are related to different types of biotechnology-based output at the end of the period. Internal R&D was positively associated with patent output. Acquisition activity was positively related to number of biotechnology-based products. Greater use of R&D contracts and licenses was associated with stronger reputation for possessing expertise in biotechnology. These findings underscore the importance of taking a multifaceted approach to technology sourcing in order to build the absorptive capacity needed to generate new technical output. Surprisingly, we also found that involvement in joint ventures was negatively related to patent output. This raises interesting questions about the strategic use of joint ventures in a regime of encompassing technological change.

[...]the Commission's structure and specific areas of focus will evolve organically through a dynamic, bottom-up process driven by the collective insights, lived experiences, and diverse expertise of all Commissioners. CSPL has received research support from Novo Nordisk and Roche Diagnostics; consulting fees from Alnylam Pharma, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Biopeutics, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Corteria, CPC Clinical Research, Cytokinetics, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Janssen Research & Development LLC, Medscape/WebMD Global LLC, Merck, Novartis, Novo Nordisk, Quidel Corporation, Radcliffe Group, Roche, and Us2.ai; is the co-founder and non-executive director of Us2.ai; and is an owner of patents (US patent no 10,631,828 B1; US 10,702,247 B2; US 11,301,996 B2; US 11,446,009 B2; US 11,931,207 B2; US 12,001,939) and has a patent pending (PCT/SG2016/050217). KCBT has received advisory board fees from Daiichi Sankyo and Eli Lilly; speaker fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Novo Nordisk, and Sanofi; and is a Council Member of the Hong Kong Society of Endocrinology, Metabolism and Reproduction and an Executive Board Member of the Asian Association for the Study of Diabetes.

Background Self‐harm is associated with factors that are relevant to and exacerbated by rurality. Living in rural areas may intensify existing socio‐economic disadvantages linked to service access, employment opportunities, transport conditions and risks from hazardous environments. Geographical isolation and fragmented social networks, particularly those related to family, are also common among rural residents. Rurality is therefore likely to shape experiences of mental health problems, including self‐harm. However, this literature has not been synthesised. Aim To synthesise current qualitative evidence on the experiences and perceptions of self‐harm among rural‐dwelling adults and care providers' perspectives and to identify knowledge gaps. Approach Rapid review of qualitative evidence identified via relevant electronic literature databases. Thematic synthesis was used to compare findings on perceptions and experiences of self‐harm in rural areas. Confidence in synthesis findings was assessed using GRADE‐CERQual. Findings Searches identified 1673 unique references, of which 14 were included in the final synthesis. Two themes were generated with high to moderate confidence: ‘experiences of rural self‐harm’ with two subthemes ‘reasons for self‐harm’ and ‘perceptions of self‐harm’, and ‘access to healthcare’ with two subthemes: ‘healthcare practitioners' perceptions of rural self‐harm’ and ‘lack of support and resources’. Various reasons and motivations for self‐harm were identified; stigma was commonly reported. Services for rural residents who self‐harmed were difficult to access. Healthcare practitioners in these areas may lack adequate training, which may maintain stigmatised views. Conclusion The review identified shared experiences and motivations for self‐harm across different rural contexts globally. Perceptions of self‐harm by people with lived experience, family and healthcare professionals reflected stigmatised views, which impacted access to and provision of care. Experiences and perceptions of self‐harm reported in the literature are somewhat overshadowed by data on suicide and suicide behaviours. Methodological implications are noted in terms of the complexity of extracting data about self‐harm. Future research would help inform intervention development for people who are at risk of self‐harm, to support healthcare practitioners to improve awareness and identify best practices to support those who self‐harm. Patient or Public Contribution Patient and public involvement was integrated at various points throughout the study, including reviewing themes, supporting the writing up of findings and a review draft and final manuscripts.

Introduction The components of integrated care for children, young people and families (CYPF) listed across existing authoritative guidance is generally consistent; the guidance suggests a list of components that should ideally be considered for implementation. Local system managers report specific challenges around integrating system-wide funding, trusted workforce relationships, and CYPF engagement. We aimed to systematically generate a list of components of integrated care from existing systems and models for CYPF, assess their commonality, intended target(s) of impact, and compare these findings with guidance and local system managers’ concerns. Methods PubMed, CINHAL and Cochrane CENTRAL were systematically searched (01/01/2016 to 31/12/2023) for studies of any design, conducted in high-income countries, describing components of an integrated care system or model for CYPF. Following data extraction, individual components within studies were coded a) using the framework method to generate Component Themes b) for their intended target(s) of impact; system (S), users (U) and/or workforce (W). Simple analytic methods were used to rank and map the commonality of Component Themes and their intended target(s) of impact. Subgroup analysis was conducted for four public health priorities: mental health, learning disabilities and autism, obesity, and early years. Results From 170 studies, 1057 components nested in one or more 25 Component Themes of integration were identified. None of the studies identified all Component Themes (median 5, range 1–16). Most commonly identified were ‘shared professional responsibility and practices’ (in 58% of studies; intended targets of impact S and W), ‘stronger connections and partnerships’ (52%;SUW), ‘empowerment of service users’ (36%;U), ‘early detection and prevention’ (32%;SUW) and ‘training of parents’ (32%;SUW). Those not commonly identified were ‘finance/budgeting’ (8%;S), ‘family engagement’ (12%;U), 'leadership’ (11%;W), ‘empowering staff’ (8%;SUW), and ‘role of language and culture’ (5%;SW). The commonality of Component Themes for all studies combined and for each of the four subgroups was very similar and is described in visual representations. Alignment with guidance and local system managers’ concerns is discussed. Conclusion We suggest this list of Component Themes and their intended target(s) of impact be considered when updating guidance on integrated care for CYPF. Existing guidance may benefit from additional implementation support around the integration of finance across the system; leadership, empowerment, language and culture across the workforce; and embedding meaningful CYPF engagement.

Background Integrated care has become a central feature of health system reform worldwide. In England, Integrated Care Systems (ICS) are intended to improve integration across public health, the National Health Service (NHS), education and social care. By April 2021, England had been divided into 42 geographical areas, each tasked with developing local ICS provision . However, it was not clear how ICSs would address the specific needs of children and young people (CYP). This study elicited the views of senior professional stakeholders in the first year of the ICS national roll out, to learn how integrated care for CYP was being implemented within the ICSs and future plans for service provision. Methods A qualitative analysis of in-depth interviews with stakeholders, including healthcare professionals, NHS managers and local authority leaders ( n  = 25) selected from a diverse sample of ICSs ( n  = 7) across England, conducted during winter 2021/22. Reflexive thematic analysis involving a collaborative coding approach was used to analyse interview transcripts. Results Four themes were identified, indicating challenges and opportunities for ICSs in relation to the health of CYP: 1) Best start in life (a more holistic approach to health afforded by integrated care); 2) Local and national contexts (tensions between local and national settings and priorities); 3) Funding and planning (instituting innovative, long-term plans using limited existing CYP funding streams); 4) Organisational complexities (integrating the work of diverse organisations). Conclusions The views of stakeholders, provided at the beginning of the journey towards developing local ICS CYP provision, revealed a common aspiration to change focus from provision of acute, largely adult-orientated services towards one with a broader, population health remit, including prevention and early intervention. This would be delivered by integration of a range of local services, including health, education, housing and social care, to set CYP on a life-long path towards improved health and wellbeing. Yet there was an awareness that change would take place over time within existing national policy and funding frameworks, and would require overcoming organisational barriers through further developing local collaborations and partnerships. As ICSs mature, the experiences of stakeholders should continue to be canvassed to identify practical lessons for successful CYP integrated care.