Opening closed doors: a micro analytic investigation of dispute resolution in child contact cases

Full Research Report ESRC End of Award Report, RES-000-22-2646. Swindon: ESRCThe family courts face intense criticism about decisions made about child contact (or access) following parental separation or divorce. Both father's rights groups and Women's Aid have raised concerns about institutional bias, ineffectiveness and a lack of transparency. However, the inherently closed nature of decision-making in the family courts has prevented greater understanding of how decisions are reached. This study addresses this gap by undertaking a detailed analysis of in-court conciliation meetings where parents negotiate over contact with the assistance of a judge or court social worker. The research uses conversation analysis to explore precisely how the actual, real-time work of family courts is undertaken in and through the communicative processes of spoken interaction. The study will explore, for example, the interactional processes by which agreements are achieved, negotiated and/or impeded, and how the rights and needs of children and parents are discursively framed by conciliators and disputants.Research supported by ESRC grant RES-000-22-264

Valgus stress radiography following superficial medial collateral ligament reconstruction using a modified LaPrade technique with adjustable loop femoral fixation

Purpose of this study was to assess postoperative laxity of MCL reconstructions utilizing a modified LaPrade superficial MCL reconstruction. We retrospectively reviewed post-operative valgus stress radiographs in 23 multiligament injured patients who underwent concurrent sMCL and cruciate ligament reconstruction by a single surgeon. Post- operatively, 23 patients underwent valgus stress radiographs that were assessed at a mean of 8.7 months (range: 4-13 months), and mean SSD was 0.64mm ± 0.42mm. Eight patients underwent both pre- and post-operative valgus stress radiographs. Post-operative (0.09mm ± 0.63mm) SSD was found to be significantly reduced compared to pre-operative (2.07mm ± 0.44mm) SSD (mean diff. = 1.98mm, 95% CI = 0.72-3.24, P=0.007). Inter-observer reliability value for medial compartment gap measurement was 0.91 with a 95% confidence interval of 0.34- 0.97. In conclusion, presented technique results in excellent static stability of the knee as measured by valgus stress radiography at a minimum of 6 months postoperative. Level of Evidence: IV

Patients' views on the use of an Option Grid for knee osteoarthritis in physiotherapy clinical encounters: an interview study

Background: Patient decision support tools have been developed as a means of providing accurate and accessible information in order for patients to make informed decisions about their care. Option GridsTM are a type of decision support tool specifically designed to be used during clinical encounters. Objective: To explore patients’ views of the Option Grid encounter tool used in clinical consultations with physiotherapists, in comparison to usual care, within a patient population who are likely to be disadvantaged by age and low health literacy. Methods: Semi-structured interviews with 72 patients (36 who had been given an Option Grid in their consultation and 36 who had not). Thematic analysis explored patients’ understanding of treatment options, perceptions of involvement, and readability and utility of the Option Grid. Results: Interviews suggested that the Option Grids facilitated more detailed discussion about the risks and benefits of a wider range of treatment options for osteoarthritis of the knee. Participants indicated that the Option Grid was clear and aided their understanding of a structured progression of the options as their condition advanced, although it was not clear whether the option grid facilitated greater engagement in shared decision making. Discussion and Conclusion: The Option Grid for osteoarthritis of the knee was well received by patient participants who reported that it helped them to understand their options, and made the notion of choice explicit. Use of Option Grids should be considered within routine consultations

Frequency selection by soliton excitation in nondegenerate intracavity downconversion

We show that soliton excitation in intracavity downconversion naturally selects a strictly defined frequency difference between the signal and idler fields. In particular, this phenomenon implies that if the signal has smaller losses than the idler then its frequency is pulled away from the cavity resonance and the idler frequency is pulled towards the resonance and {\em vice versa}. The frequency selection is shown to be closely linked with the relative energy balance between the idler and signal fields.Comment: 5 pages, 3 figures. To appear in Phys Rev Let

Pharmacologic Atrial Natriuretic Peptide Reduces Human Leg Capillary Filtration

Atrial natriuretic peptide (ANP) is produced and secreted by atrial cells. We measured calf capillary filtration rate with prolonged venous-occlusion plethys-mography of supine health male subjects during pharmacologic infusion of ANP (48 pmol/kg/min for 15 min; n equals 6) and during placebo infusion (n equals 7). Results during infusions were compared to prior control measurements. ANP infusion increased plasma (ANP) from 30 plus or minus 4 to 2,568 plus or minus 595 pmol/L. Systemic hemoconcentration occurred during ANP infusion; mean hematocrit and plasma colloid osmotic pressure increased 4.6 and 11.3 percent respectively, relative to pre-infusion baseline values (p is less than 0.05). Mean calf filtration, however was significantly reduced from 0.15 to 0.08 ml/100 ml/min with ANP. Heart rate increased 20 percent with ANP infusion, wheras blood pressure was unchanged. Calf conductance (blood flow/arterial pressure) and venous compliance were unaffected by ANP infusion. Placebo infusion had no effect relative to prior baseline control measurements. Although ANP induced systemic capillary filtration, in the calf, filtration was reduced with ANP. Therefore, phamacologic ANP infusion enhances capillary filtration from the systemic circulation, perhaps at upper body or splanchic sites or both, while having the opposite effect in the leg

Closing-Wedge Posterior Tibial Slope-Reducing Osteotomy in Complex Revision ACL Reconstruction

Background: A posterior tibial slope (PTS) >12° has been shown to correlate with failure of anterior cruciate ligament (ACL) reconstruction (ACLR). PTS-reducing osteotomy has been described to correct the PTS in patients with a deficient ACL, mostly after failure of primary ACLR. Purpose: To report radiologic indices, clinical outcomes, and postoperative complications after PTS-reducing osteotomy performed concurrently with revision ACLR (R-ACLR). Study design: Case series; Level of evidence, 4. Methods: A review of medical records at 3 institutions was performed of patients who had undergone PTS-reducing osteotomy concurrently with R-ACLR between August 2010 and October 2020. Radiologic parameters recorded included the PTS, patellar height according to the Caton-Deschamps Index (CDI), and anterior tibial translation (ATT). Patient-reported outcomes (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]), reoperations, and complications were evaluated. Results: Included were 23 patients with a mean follow-up of 26.7 months (range, 6-84 months; median, 22.5 months). Statistically significant differences from preoperative to postoperative values were found in PTS (median [range], 14.0° [12°-18°] vs 4.0° [0°-15°], respectively; P < .001), CDI (median, 1.00 vs 1.10, respectively; P = .04) and ATT (median, 8.5 vs 3.6 mm, respectively; P = .001). At the final follow-up, the IKDC score was 52.4 ± 19.2 and the KOOS subscale scores were 81.5 ± 9.5 (Pain), 74 ± 21.6 (Symptoms), 88.5 ± 8 (Activities of Daily Living); 52.5 ± 21.6 (Sport and Recreation), and 48.8 ± 15.8 (Quality of Life). A traumatic ACL graft failure occurred in 2 patients (8.7%). Reoperations were necessary for 6 patients (26.1%) because of symptomatic hardware, and atraumatic recurrent knee instability was diagnosed in 1 patient (4.3%). Conclusion: Tibial slope-reducing osteotomy resulted in a significant decrease of ATT and can be considered in patients with a preoperative PTS ≥12° and ≥1 ACLR failure. In highly complex patients with multiple prior surgeries, the authors found a reasonably low graft failure rate (8.7%) when utilizing PTS-reducing osteotomy. Surgeons must be aware of potential complications in patients with multiple previous failed ACLRs

Ballistic protective properties of material representative of English civil war buff-coats and clothing

One type of clothing system used in the English Civil War, more common amongst cavalrymen than infantrymen, was the linen shirt, wool waistcoat and buff-coat. Ballistic testing was conducted to estimate the velocity at which 50% of 12-bore lead spherical projectiles (V50) would be expected to perforate this clothing system when mounted on gelatine (a tissue simulant used in wound ballistic studies). An estimated six-shot V50 for the clothing system was calculated as 102 m/s. The distance at which the projectile would have decelerated from the muzzle of the weapon to this velocity in free flight was triple the recognised effective range of weapons of the era suggesting that the clothing system would provide limited protection for the wearer. The estimated V50 was also compared with recorded bounce-and-roll data; this suggested that the clothing system could provide some protection to the wearer from ricochets. Finally, potential wounding behind the clothing system was investigated; the results compared favourably with seventeenth century medical writings

Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations.

BACKGROUND: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death. Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance. CONCLUSIONS: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems

Minimum information and guidelines for reporting a Multiplexed Assay of Variant Effect

Multiplexed Assays of Variant Effect (MAVEs) have emerged as a powerful approach for interrogating thousands of genetic variants in a single experiment. The flexibility and widespread adoption of these techniques across diverse disciplines has led to a heterogeneous mix of data formats and descriptions, which complicates the downstream use of the resulting datasets. To address these issues and promote reproducibility and reuse of MAVE data, we define a set of minimum information standards for MAVE data and metadata and outline a controlled vocabulary aligned with established biomedical ontologies for describing these experimental designs