Category: Academic Analysis

Source: The Conversation – UK – By Michelle Spear, Professor of Anatomy, University of Bristol

Many women recognise the pattern. A routine procedure takes longer than expected. It’s more uncomfortable than promised. The doctor reassures them that this sometimes happens, or suggests anxiety or muscle tension might be playing a role. But often the explanation is simpler – and anatomical.

This mismatch between bodies and procedures isn’t related to rare conditions or specialist care. It reflects a recurring problem in everyday medicine. Many routine procedures were designed around male anatomy, and they don’t always work the same way on female bodies.

Take colonoscopy. It’s one of the most common investigations used to diagnose bowel disease and screen for cancer. Yet women are more likely than men to experience discomfort, require repositioning, or have an incomplete examination on the first attempt.

The reason lies in normal anatomy. On average, women have a longer and more mobile colon, particularly in the sigmoid segment that loops through the pelvis.

The female pelvis itself is broader and shallower, creating sharper angles as the bowel curves downward. These features make the scope more likely to bend and loop inside the bowel, slowing its progress and pulling on surrounding tissue – a major source of pain.

This isn’t abnormal anatomy. It’s normal anatomy that standard techniques don’t always take into account.

Urinary catheterisation is another routine procedure where anatomy matters. Although the urethra performs the same function in men and women, its length, course and anatomical context differ in ways that matter clinically.

In males, the urethra is long – around 18-22cm – and is usually described in three parts: the prostatic urethra, which is wide and fixed as it passes through the prostate; the membranous urethra, the narrowest segment as it crosses the pelvic floor; and the spongy (penile) urethra, which runs in a predictable course to a clearly identifiable external opening at the tip of the penis. Despite its length, the male urethra follows a stable path and ends at a prominent external landmark.

The female urethra is much shorter, usually about 3-4cm long, but lies within a more variable anatomical environment. From the bladder neck, it passes through the bladder wall and pelvic floor, before opening into the vulval vestibule at a meatus (the external opening of the urethra) closely related to the anterior vaginal wall.

Its position varies between individuals and across the life course, influenced by pelvic floor tone and hormonal status. In practice, this can make catheter insertion technically more difficult, increasing the likelihood of repeated attempts and discomfort – particularly in older women or those with atrophic tissue (thin, delicate tissue).

Lumbar puncture and spinal procedures show similar issues. Women tend to have a greater lumbar curve and different pelvic tilt, altering the angle at which a needle must pass between vertebrae. Mild spinal curvature is also more common in women. The procedure itself doesn’t change, but the geometry does, increasing the likelihood of multiple attempts and prolonged discomfort.

Even airway management, a cornerstone of anaesthesia and emergency medicine, reflects the same mismatch. Female airways are, on average, shorter and narrower. When equipment sizing and technique is based on a “standard” airway, women are more likely to experience sore throat and hoarseness afterward – effects often dismissed as minor, but rooted in anatomy rather than sensitivity.

Even something as commonplace as peripheral venous cannulation, the insertion of a small tube into a vein to deliver fluids, medications, or to take blood, reflects this mismatch. Women’s superficial veins are often smaller, less prominent and more mobile in soft tissue, making standard cannulation techniques more likely to result in repeated attempts, bruising and pain.

Design for variation, not exception

Doctors know bodies vary. In practice, many already adapt – choosing different patient positions, smaller instruments or altered techniques. But these adjustments are informal, inconsistently taught and rarely explained to patients.

Instead, difficulty is often bundled into vague categories: anxiety, tension, low pain tolerance or “one of those things”. The result is that women experience real, anatomy-driven discomfort without being told why, and may internalise it as a personal failing.

This matters. When discomfort is normalised or minimised, patients are less likely to return for screening, more likely to delay care, and more likely to mistrust reassurance that future procedures will be different.

None of this requires radical innovation. It requires naming the issue accurately. When procedures are taught and designed around a single reference body, predictable anatomical variation becomes an obstacle rather than a design feature.

Acknowledging that bodies differ – in length, curvature, mobility and spatial relationships – allows doctors to plan, explain and adapt more effectively.

Crucially, it also shifts the narrative. Instead of “this shouldn’t hurt”, the message becomes: “your anatomy means this procedure can be more challenging, and we’ll adjust it accordingly”.

Michelle Spear does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Routine medical procedures can feel harder for women – here’s why – https://theconversation.com/routine-medical-procedures-can-feel-harder-for-women-heres-why-274041

Source: The Conversation – UK – By Adam Taylor, Professor of Anatomy, Lancaster University

For most people, cold weather is an inconvenience, requiring an extra layer of clothing or the thermostat to be turned up. For others, exposure to cold can trigger an allergic reaction severe enough to cause them to collapse.

Cold urticaria is a rare but potentially dangerous condition in which contact with cold temperatures causes the immune system to misfire. The results can be hives, swelling, pain and in some cases, life-threatening anaphylaxis.

The condition was first described in 1792 by a German physician called Johann Peter Frank. Today, we know it is almost twice as common in women than in men, with the average age of onset in the early twenties, though it can affect people at any age.

There is some good news: between 24% and 50% of people with the condition see improvement – or even full recovery – over the years.

There are two forms of the condition. Primary cold urticaria is the most common, accounting for about 95% of cases and often has no known cause. The remaining 5% are classified as secondary urticaria, which is linked to underlying conditions or infections, such as the Epstein-Barr virus, certain types of lymphoma (blood cancer), HIV and hepatitis C.

Primary cold urticaria typically causes a rash, swelling, bumps or hives, though some people also report fatigue, fever and aching joints. Symptoms usually appear when the skin is exposed to cold, but can also occur as the skin warms up again. Triggers aren’t limited to cold weather – they can include swimming, eating frozen food, drinking cold liquids and handling cold objects.

Aside from a few very rare genetic causes, why some people develop primary cold urticaria remains unknown. What is clear is that mast cells are involved. These sentinel cells act as first responders in the body’s tissues – including the skin – alerting the immune system to danger signals or germs.

What triggers their activation in cold urticaria remains a mystery, though one theory suggests that cold exposure causes the body to produce so-called autoallergens – substances that trigger an immune response against the body’s own tissues. Much more research is needed to understand how this happens.

When mast cells are activated, they release a chemical called histamine. Think of histamine as an alarm that alerts other immune cells to rush to the area. It also makes the blood vessels in that part of your body widen and become “leakier”, which causes the telltale swelling, redness and itchiness.

Normally, this response is helpful – the extra blood flow and leaky blood vessels allow immune cells to squeeze out of the bloodstream and into the surrounding tissue to fight off a genuine threat. But in cold urticaria, it’s a false alarm. Your body is mounting a full-scale immune response when there’s nothing to fight, causing discomfort without any benefit.

Doctors test for cold urticaria by placing an ice cube on a patient’s forearm and watching what happens after they remove it. This test typically follows patients noticing they develop welts, hives or rashes on exposure to cold things. This must be done by a medical professional because in about 20% of cases, it can trigger anaphylaxis.

The condition is quite rare, affecting six in every 10,000 people. But it may be underdiagnosed as not all sufferers have severe symptoms and, in some countries, particularly tropical ones, temperatures tend not to drop below 0°C in winter.

Once diagnosed, it’s important to help people with cold urticaria avoid or recognise their trigger temperatures. There are two measures that may be assessed, depending on the availability of measuring devices. One is the cold stimulation time test, which indicates how quickly your skin reacts to cold with a lump or rash (a shorter time suggests a more active response). The other measure is the critical temperature threshold, which is the warmest temperature that can still trigger symptoms.

Antihistamines and beyond

There are treatments that can help manage the symptoms. One approach is taking antihistamines before exposure to cold environments or stimuli.

For many people, though, a standard oral antihistamine dose isn’t enough. Sometimes, up to four times the standard dose may be needed. The trade-off is that some antihistamines can have a sedating effect, so caution is needed.

About 60% of people with cold urticaria respond well to treatment with antihistamines.

During short flare-ups, other drugs, such as corticosteroids, may be beneficial, although longer-term use brings side-effects, such as weight gain, indigestion and mood changes.

Severe cases can be treated with a monoclonal antibody called Omalizumab, which targets immunoglobulin E, a molecule involved in mast cell activation.

Another option is desensitisation: gradually exposing the skin to cooler temperatures over several days (although, sometimes over a few hours) to try to overcome the response and histamine release. There have been some successes with this approach, but most of the studies have been small.

For people with the most severe cases, adrenaline is a lifesaving option in response to anaphylaxis, though it appears to be under-prescribed in patients with cold urticaria.

People with this condition also face increased risk during surgical procedures, where anaesthetic drugs reduce core body temperature and operating theatres are kept deliberately cool. While warming measures are used during surgery, for people with heightened sensitivity to cold, this can present an additional risk.

As winter continues, it’s worth remembering that for some people, the cold isn’t just uncomfortable – it can be genuinely dangerous. Understanding and recognising cold urticaria could make all the difference.

Adam Taylor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Allergic to the cold? It’s a real thing and it can even kill – https://theconversation.com/allergic-to-the-cold-its-a-real-thing-and-it-can-even-kill-273984

Source: The Conversation – UK – By Duncan Sayer, Professor in Archaeology, University of Lancashire

Four early Anglo-Saxon swords uncovered during a recent archaeological excavation I took part in each tell a story about how weapons were viewed at the time. There was also a striking discovery of a child buried with spear and shield. Was the child an underage fighter? Or were weapons more than mere tools of war to these people?

Weapons are embedded with values. Would, for example, the Jedi knights in the Star Wars franchise have as much nobility if they were armed with knives instead of light sabres? Today, modern armies fight remotely with missiles and drones, or mechanically with guns and armour. Yet in many countries, an officer still has a ceremonial sword, which worn incorrectly might even reveal an imposter.

The excavation, which I carried out with archaeologist Andrew Richardson, focused on an early medieval cemetery and our swords were found in graves. Our team from the University of Lancashire and Isle Heritage has excavated around 40 graves in total. The discovery can be seen in BBC2’s Digging for Britain.

One of the swords we uncovered has a decorated silver pommel (the rear part of the handle) and ring which is fixed to the handle. It is a beautiful, high status 6th century object sheathed in a beaver fur lined scabbard. The other sword has a small silver hilt and wide, ribbed, gilt scabbard mouth – two elements with different artistic styles, from different dates, brought together on one weapon.

This mixture was also seen in the Staffordshire Hoard (discovered in 2009) which featured 78 pommels and 100 hilt collars with a range of dates from the 5th to the 7th centuries AD.

In medieval times, swords – or their parts – were curated by their owners, and old swords were valued more highly than new ones.

The Old English poem Beowulf (probably composed between the 8th and early 11th century) describes old swords (“ealdsweord”), ancient swords (“gomelswyrd”) and heirlooms (“yrfelafe”). As well as describing “waepen wundum heard” – “weapons hardened by wounds”.

There are two sword riddles in the Exeter Book, a large codex of poetry written down in the 10th century (although the texts within it may describe earlier attitudes). In riddle 80, the sword describes itself: “I am a warrior’s shoulder-companion”. It’s an interesting turn of phrase given our 6th century discoveries. In each case the hilt was placed at the shoulder and the arm of the deceased appeared to hug the weapon.

A comparable embrace has been seen in burials at Dover Buckland, also in Kent. There were two in Blacknall Field, Wiltshire, and one in West Garth Gardens, Suffolk. It is, however, unusual to see four people buried like this in one cemetery, and interestingly they were found in close proximity.

The part of the cemetery we have excavated includes several weapon burials placed around a deep grave with a ring ditch enclosing it. A small mound of earth would have been built over the top of the grave marking it out.

This earliest grave – the one that the others weapon graves used to guide their location – contained a man without metal artefacts or weapons. Weapon graves were more popular in the generations either side of the middle 6th century, so it is likely this person was buried before the fashion to dress the dead with weapons was established. Perhaps because during the tumultuous later 5th century and earliest years of the 6th century weapons were valued too highly for the defence of the living.

Our further discovery of a 10-12 year old child’s grave with a spear and shield adds to this picture. The child’s curved spine made it unlikely he could use these weapons comfortably.

A second grave of a younger child contained a large silver belt buckle. This looks to have been far too large to be worn by the boy who was just two to three years old. Graves with objects like these usually belong to adult men, large buckles were a symbol of office in later Roman and early Medieval contexts, for example the spectacular gold examples from Sutton Hoo.

So why were these objects found in the graves? Recent DNA results point to the importance of relatedness, particularly within the Y chromosome that denotes male ancestry.

Read more:
Updown girl: DNA research shows ancient Britain was more diverse than we imagined

At West Helsterton in east Yorkshire, DNA results point to a biological relationships between men buried in close proximity. Many of these men had weapons, including one with a sword and two spears. Many of the other male graves were placed around their heavily armed ancestor.

We are not saying that ancient weapons were purely ceremonial. Dents on shields, and wear on bladed weapons speak of practice and conflict. Injury and early death seen in skeletons testifies to the use of weapons in early medieval society and early English poetry speaks of grief and loss as much as heroism.

As Beowulf shows, feelings of loss were bound up in the display of the male dead and their weapons as well as fears for the future:

The Geat people built a pyre for Beowulf, Beowulf’s funeral

stacked and decked it until it stood four-square,

hung with helmets, heavy war-shields

and shining armour, just as he had ordered.

Then his warriors laid him in the middle of it,

mourning a lord far-famed and beloved.

The weapons in our graves were as much as an expression of loss and grief, as they were a physical statement about strength or masculinity and the male family. Even battle hardened and ancient warriors cried, and they buried their dead with weapons like swords that told stories.

The spear, shield and buckles found in little graves spoke of the men these children might have become.

Duncan Sayer would like to thank Dr Andrew Richardson who is a co-director of the east Kent excavation project.

– ref. Four early medieval swords found in Kent – child graves reveal they were more than just weapons – https://theconversation.com/four-early-medieval-swords-found-in-kent-child-graves-reveal-they-were-more-than-just-weapons-274059

Source: The Conversation – UK – By Jay Silverstein, Senior Lecturer in the Department of Chemistry and Forensics, Nottingham Trent University

When Aztec emissaries arrived in 1520 to Tzintzuntzan, the capital of the Tarascan Kingdom in what is now the Mexican state of Michoacán, they carried a warning from the Aztec emperor, Cuauhtémoc.

They cautioned that strange foreigners – the Spaniards – had invaded the land and posed a grave threat. The emissaries requested an audience with the Tarascan ruler, known as the Cazonci, King Zuanga. But Zuanga had recently died, most likely from smallpox brought by the Spaniards.

Relations between the two empires had long been tense. They had clashed on the western frontier since 1476, fighting major battles and fortifying their borders. The Tarascans viewed the Aztecs as deceitful and dangerous – a threat to their very existence.

So, when the emissaries arrived to speak with a king who was already dead, they were sacrificed and granted audience with him in the afterlife. In that moment, the fate of the Aztecs was sealed in blood.

The Aztec empire did not fall because it lacked capability. It collapsed because it accumulated too many adversaries who resented its dominance. This is a historical episode the US president, Donald Trump, should take notice of as his rift with traditional US allies deepens.

Carl von Clausewitz and other philosophers of war have distinguished the concepts of force and power in relation to statecraft. In the broadest sense, power is ideological capital, predicated on military strength and influence in the global political sphere. In contrast, force is the exertion of military might to coerce other nations to your political will.

While power can be sustained through a strong economy, alliances and moral influence, force is expended. It drains resources and can erode internal political capital as well as global influence if it is used in a way that is perceived as arrogant or imperialistic.

The Aztec empire formed in 1428 as a triple alliance between the city-states of Tenochtitlan, Texcoco and Tlacopan, with Tenochtitlan eventually dominating the political structure. The empire exerted force through seasonal military campaigns and balanced this with a power dynamic of sacrificial display, threat, tribute and a culture of racial superiority.

In both its use of force and power, the Aztec empire was coercive and depended on fear to rule. Those subjugated by the empire, and those engaged in what seemed perpetual war, held great animosity and distrust of the Aztecs. The empire was thus built on conquered people and enemies waiting for the right opportunity to overthrow their overlords.

Hernán Cortés, the Spanish conquistador who ultimately brought large parts of what is now Mexico under the rule of Spain, exploited this hostility. He forged alliances with Tlaxcala and other former Aztec subjects, augmenting his small Spanish force with thousands of indigenous warriors.

Cortés led this Spanish-indigenous force against the Aztecs and besieged them in Tenochtitlan. The Aztecs had only one hope: to persuade the other great power in Mexico, the Tarascan empire to the west, to join forces with them. Their first emissaries met an ill fate. So, they tried again.

In 1521, Aztec envoys arrived once more in Tzintzuntzan and this time met with the new lord, Tangáxuan II. They brought captured steel weapons, a crossbow and armour to demonstrate the military threat they faced.

The Tarascan king paid attention. He sent an exploratory mission to the frontier to determine whether this was Aztec trickery or truth. As they arrived at the frontier, they met a group of Chichimecs – semi-nomadic warrior people who often worked for empires to patrol borders.

When told the mission was heading to Tenochtitlan to scout the situation, the Chichimecs replied that they were too late. It was only a city of death now, and they were on their way to the Tarascan king to offer their services. Tangáxuan submitted to the Spanish as a tributary kingdom the following year before being burned to death in 1530 by Spaniards trying to find where he had hidden gold.

Had the Tarascans maintained normal political relations with the Aztecs, they might have investigated the report of the first emissaries. One can imagine how history would be different if, during the siege of Tenochtitlan, 40,000 Tarascan warriors – renowned archers – had descended from the mountains to the west. It is unlikely that Cortés and his army could have prevailed.

American foreign policy

The failings of the Aztec empire were not due to a lack of courage or military prowess. During their battles with the Spanish, the Aztecs repeatedly demonstrated adaptability, learning how to fight against horses and cannon-laden ships.

The failing was a fundamental flaw in the political strategy of the empire – it was built on coercion and fear, leaving a ready force to challenge its authority when it was most vulnerable.

The foreign policy of the US since 2025, when Trump entered office for his second term, has emulated this model. Recently, the Trump administration has been projecting coercive power to support its ambitions for wealth, notoriety and to project American exceptionalism and manifest superiority.

This has manifested in threats or the exercise of limited force, such as tariffs or military attacks in Iran, Syria, Nigeria and Venezuela. Increasingly, other nations are challenging the effectiveness of this power. Colombia, Panama, Mexico and Canada, for example, have largely ignored the threat of coercive power.

As Trump uses American power to demand Greenland, his threats are becoming more feeble. Nato nations are abiding by their longstanding pact with economic and military resolve, with their leaders saying they will not give in to Trump’s pressure. The US is being pushed towards a position where it will have to switch from coercive power to coercive force.

If this course persists, military engagements, animosity from neighbours and vulnerabilities arising from the strength of other militaries, economic disruptions and environmental catastrophes may well leave the world’s most powerful nation exposed with no allies.

Jay Silverstein received funding from the US National Science Foundation (NSF), the Foundation for the Advancment of Mesoamerican Studies (FAMSI), and The Penn State Hill Foundation that supported his doctoral studies.

– ref. The Aztec empire’s collapse shows why ruling through coercion and force fails – https://theconversation.com/the-aztec-empires-collapse-shows-why-ruling-through-coercion-and-force-fails-273528

Source: The Conversation – UK – By John Coxhead, Visiting Professor in Solution Oriented Policing, De Montfort University

The government has announced a massive shake-up of policing in England and Wales, with the aim to balance providing a local police service across the country while also facing national threats. It involves the creation of a new National Police Service (touted as a “British FBI”) and reducing the number of forces across England and Wales from 43 to a possible 12 bigger, regional forces.

Elected police and crime commissioners will be replaced by regional mayors, or police and crime boards from 2028. And Whitehall will be given refreshed powers to intervene in failing forces.

The last strategic reform of policing in England and Wales was informed by a royal commission, in May 1962. This examined policing function, accountability, public relationships and staffing. It led to the current structure, cutting the number of forces down from 117.

The government claims its plans will deliver better governance and improve both national capabilities for challenging crimes and local visibility of policing. Yet, unlike in 1962, 2026 reform avoids addressing a key problem: the relationship the public wants with the police.

The idea of “policing by consent” underpins policing in the UK. Key to this is the police working with the public. But fewer than half of the public have confidence in their local policing. Data consistently shows the public do not like or want what they are getting.

The government is proposing to introduce new local policing guarantees, setting out “the minimum levels of service the public should expect to receive from their police force wherever in England and Wales they live”.

But this doesn’t need to involve a massive structural overhaul. Research tells us what the public wants is basic: they want the police to turn up, and care. Good policing relies on building relationships of trust – but you can’t achieve that by not being there.

Read more:
Police are failing to deliver a minimum standard of service, according to the UK public

Lack of response

The police inspectorate has noted in recent years that understaffing and inexperienced policing teams have left forces unable to respond effectively: “This can lead to non-emergency calls for help from the public waiting days for a response, or investigations failing because key lines of enquiry have been missed.”

As part of the overhaul, the government is proposing national response and performance targets for 999 calls and for officers attending a scene. Slow response times are one thing, but not turning up at all is the bigger issue. Reports of forces screening out calls sends a message to the public that the police don’t care, and to criminals that they can get away with it.

The government argues that its proposed approach will mean less pressure on local forces to address national issues, freeing up resources to deal with local crime. But the current largest force, the Met, struggles to solve large numbers of reported crimes. I would argue that moving local policing further away from communities will further erode any working relationship with policing’s greatest stakeholder: the public.

The Neighbourhood Policing Guarantee introduced in April 2025 promised to deliver better response times, but the public are still frustrated with the lack of police response to visible, low-level crimes.

Shoplifting alone is seen to be “spiralling out of control” with a brazen 20% increase in the year to March 2025. And yet the head of the Met police has called on shopkeepers to do more to protect themselves.

The proposals aim to “ensure that shop theft and assaults on shopworkers will no longer go unpunished by bringing in new powers and providing additional funding to policing, working with retailers, to take further action”.

When the police do turn up, they do not need new powers, they just need to use the powers they’ve already got. But to do that warranted police officers (with actual powers of arrest) need to be the boots on the ground – not an app, a bot or a drone.

Just like ambulances, the public should be able to rely on the police in an emergency. There needs to be far more proactive, preventative work done with partners on long-term solutions. We simply can’t afford a perpetual reactive problem solving model.

Rebuilding trust

The government is proposing a number of reforms to increase policing standards and trust, including (a yet-to-be costed) “Licence to Practise” that police officers will need to renew over their career. But officers already swear an oath of operational independence for their warrant card – this risks adding more administrative burden on overly stretched officers, despite a claim that administrative red tape will be cut.

Police officer numbers are already falling, with forces losing nearly 1,500 this year alone, largely driven by losses at the Met. The government has committed to 13,000 more neighbourhood officers, but has also placed an emphasis on automative technology. This could, I argue, be used to justify fewer actual police officers in the future.

Rising crime, coupled with falling public confidence, represents a crisis in policing. The argument is that there is an “urgent” need to better tackle crime and improve trust and confidence, yet reforms of this scale will take time.

The police must work with the public on solutions that pay for themselves. This would not rely on restructuring necessarily, just listening to people about what good policing looks like, then working together on making that happen.

John Coxhead receives funding from the Police for Research.

– ref. The public wants police to show up and care – will new reforms in England and Wales do this? – https://theconversation.com/the-public-wants-police-to-show-up-and-care-will-new-reforms-in-england-and-wales-do-this-274439