London Fire Brigade

Abstract Background Endometriosis affects ~ 10% of women, yet diagnosis is delayed 7–10 years, exposing patients to prolonged pain, clinician dismissal, and worsening mental health. Comparative data across diagnostic stages are limited. Methods A cross-sectional, anonymous online survey (Feb–Apr 2025) recruited adults assigned female at birth who currently identify as female (≥ 18 y) via targeted social-media posts. Respondents self-classified as (i) surgically/clinically diagnosed with endometriosis, (ii) symptomatic but undiagnosed, or (iii) asymptomatic controls. Instruments comprised a 0–10 pelvic-pain scale, two-item Perceived Dismissal Scale, and PHQ-9 (α = 0.88). Group differences were tested with one-way ANOVA (Bonferroni) and χ²; Hedges g and Cramér V quantified effect sizes. Results Among 473 participants (diagnosed = 332; symptomatic-undiagnosed = 94; controls = 47), pain was highest in the symptomatic-undiagnosed group (7.8 ± 1.8) versus diagnosed (7.7 ± 1.9) and controls (4.5 ± 2.3); F(2,470) = 158, p < 0.001, g = 1.71. Depressive burden mirrored this pattern (PHQ-9 = 8.4 ± 5.0 vs 7.6 ± 4.9 and 5.3 ± 4.1); F(2,470) = 12.4, p < 0.001, g = 0.69. Perceived dismissal was reported by 92% of symptomatic-undiagnosed, 86.5% of diagnosed, and 10% of controls (χ²=255, p < 0.001, V = 0.74). Conclusions Individuals trapped in diagnostic limbo shoulder the heaviest pain and depressive load, underscoring the mental-health cost of delayed recognition. Integrating routine pelvic-pain and depression screening with trauma-informed communication in primary care may hasten diagnosis and reduce burden.

This study assesses the health symptoms and longer-term health outcomes of firefighters who attended the Grenfell Tower fire. All available data sources were analyzed, including databases published by the Public Inquiry, the Firefighter Cancer and Disease Registry, incident logs, and sickness reports up to 3 years postfire. More than three times as many firefighters who reported exposure to smoke during the fire also reported digestive and respiratory diseases following the fire, compared with those not reporting exposure to smoke. Other more complex relationships are reported among smoke exposure, immediate health symptoms, and longer-term health outcomes. The incident's urgency led professional firefighters to operate without respiratory protection equipment, resulting in debilitating health effects.

### What you need to know A 23 year old man with no medical history presents to the emergency department with a three day history of headache, transient visual disturbance, dizziness, and hypertension. On clinical examination the patient is flushed and drowsy with redness in the sclera, with no further visual or systemic symptoms. A venous blood gas on air shows a carboxyhaemoglobin level (COHb) grossly elevated at 26.0 (0-3), which leads to the diagnosis of carbon monoxide poisoning. Carbon monoxide (CO) is a poisonous gas produced through burning fuel. Sources of CO in the home include boilers and central heating systems, cookers and barbecues, and fireplaces and chimneys (figure).1 Owners of such appliances are required to have them serviced by registered technicians as per recommended individual guidance (usually once per year).1 If outlets from these appliances (such as flues and chimneys) become blocked or if they are operated as normal in a closed environment with no ventilation, dangerous levels of CO can build up in living spaces.1 When inhaled in high quantities, CO enters the bloodstream and binds to haemoglobin molecules with a much greater affinity (230 times higher) than oxygen, creating carboxyhaemoglobin.2 The binding of CO results in reduced delivery of oxygen to tissues, which leads to tissue ischaemia.2 Figure Common domestic sources of CO Presentation of CO poisoning is not frequent enough for the condition to prioritised in medical training, diagnostic decision making, initial patient testing, and publicity and public …

The dynamic testing of stress wave reflection method is an easy, economical, rapid and reliable nondestructive testing technology and has been perfected used in the pile foundation dynamic testing. Anchor rod is more in line with the wave theory of one-dimensional elastic rod than pile foundation whether to theory or the geometric solid, material, stress state and other factors. The quality of anchor rod is determined by using small strain method (hammering method) of pile foundation dynamic measurement. Four testing anchor rods with different length and integrity were made in project of "China Marine Sport School", stress wave time domain curve of anchor rod was obtained by ZK-7E portable intelligent testing of piles instrument, defect location, length of anchor rod and integrity reflected by measured waveform are consistent with the actual situation, the method using pile foundation dynamic testing technology for anchor rod nondestructive testing is proved feasible and reliable.

Resident's case problem. Cauda equina syndrome (CES) is a rare, potentially devastating, disorder and is considered a true neurologic emergency. CES often has a rapid clinical progression, making timely recognition and immediate surgical referral essential. A 32-year-old male presented to a medical aid station in Iraq with a history of 4 weeks of insidious onset and recent worsening of low back, left buttock, and posterior left thigh pain. He denied symptoms distal to the knee, paresthesias, saddle anesthesia, or bowel and bladder function changes. At the initial examination, the patient was neurologically intact throughout all lumbosacral levels with negative straight-leg raises. He also presented with severely limited lumbar flexion active range of motion, and reduction of symptoms occurred with repeated lumbar extension. At the follow-up visit, 10 days later, he reported a new, sudden onset of saddle anesthesia, constipation, and urinary hesitancy, with physical exam findings of right plantar flexion weakness, absent right ankle reflex, and decreased anal sphincter tone. No advanced medical imaging capabilities were available locally. Due to suspected CES, the patient was medically evacuated to a neurosurgeon and within 48 hours underwent an emergent L4-5 laminectomy/decompression. He returned to full military duty 18 weeks after surgery without back or lower extremity symptoms or neurological deficit. This case demonstrates the importance of continual medical screening for physical therapists throughout the patient management cycle. It further demonstrates the importance of immediate referral to surgical specialists when CES is suspected, as rapid intervention offers the best prognosis for recovery. Differential diagnosis, level 4. J Orthop Sports Phys Ther 2009;39(7):541-549, Epub 24 February 2009. doi: 10.2519/jospt.2009.2999.

The purpose of this paper is to provide a brief summary of developments in NATO nations in order to bring these developments to a wider audience. The basis of the survey provided is the information collated by NATO Research Study Group 15 Computer‐Based Assessment of Military Personnel as given in its report to NATO Headquarters in 1993.