‘It is successful, and if it is successful, it reduces crime, and it can make the victims happier’: volunteers’ perceptions of working in restorative justice

Purpose: The purpose of the study was to explore the experiences of those volunteering within a Restorative Justice service thus enabling an insight into their perceptions of the different methods used, their beliefs about Restorative Justice effectiveness and its place within the Criminal Justice System (CJS). The study also sought to identify any challenges and positive experiences the participants encountered during their role as a volunteer, with volunteering during the COVID-19 pandemic explored specifically. Methodology: Data was collected from the participants (n=5) via semi-structured interviews and analysed using thematic analysis, thus enabling patterns within the experience of the volunteers to be identified. Findings: A prior understanding and interest in Restorative Justice was evident within the data, with participants demonstrating a preference for direct, face to face mediations. The perceived lack of support from external agencies was discussed along with the role of education in their volunteering experience. Finally, it was acknowledged that although face-to-face practice was deemed the most effective overall, certain practices adopted during Covid-19 enabled aspects of the role to be carried out more efficiently, and equally as effective. Practical implications: The findings from this study draw out real-world implications, producing tangible action points for Restorative Justice services. Some tentative suggestions for future practice are outlined. Originality: The volunteers’ role within Restorative Justice is often over-looked within the literature (Paul and Borton, 2013) and time constraints can add additional barriers to a hard-to-reach population. However, volunteers play a vital role in Restorative Justice. By exploring and listening to the volunteers’ experience, this study expands an additional strand within the literature in terms of what makes Restorative Justice effective and the challenges that are faced from a volunteer perspective

An In Vitro Study Comparing Limited to Full Cementation of Polyethylene Glenoid Components

BACKGROUND: Glenoid component survival is critical to good long-term outcomes in total shoulder arthroplasty. Optimizing the fixation environment is paramount. The purpose of this study was to compare two glenoid cementing techniques for fixation in total shoulder arthroplasty. METHODS: Sixteen cadaveric specimens were randomized to receive peg-only cementation (CPEG) or full back-side cementation (CBACK). Physiological cyclic loading was performed and implant displacement was recorded using an optical tracking system. The cement mantle was examined with micro-computed tomography before and after cyclic loading. RESULTS: Significantly greater implant displacement away from the inferior portion of the glenoid was observed in the peg cementation group when compared to the fully cemented group during the physiological loading. The displacement was greatest at the beginning of the loading protocol and persisted at a diminished rate during the remainder of the loading protocol. Micro-CT scanning demonstrated that the cement mantle remained intact in both groups and that three specimens in the CBACK group demonstrated microfracturing in one area only. DISCUSSION: Displacement of the CPEG implants away from the inferior subchondral bone may represent a suboptimal condition for long-term implant survival. Cement around the back of the implant is suggested to improve initial stability of all polyethylene glenoid implants. CLINICAL RELEVANCE: Full cementation provides greater implant stability when compared to limited cementation techniques for insertion of glenoid implants. Loading characteristics are more favorable when cement is placed along the entire back of the implant contacting the subchondral bone

Five-year publication rate of clinical presentations at the open and closed American shoulder and elbow surgeons annual meeting from 2005–2010

© 2016, The Author(s). Background: The purpose of this study was to evaluate the five-year publication rate of papers presented at both the open and closed American Shoulder and Elbow Surgeons’ (ASES) annual meetings from 2005 to 2010. Methods: Online abstracts of the presentations at the open and closed ASES annual meetings were independently screened for clinical studies and graded for quality using level of evidence. The databases PubMed (MEDLINE), Ovid (MEDLINE), and EMBASE were comprehensively searched for full-text publications corresponding to these presentations and any paper published within five years of the presentation date was counted. Results: Overall, 131/266 papers corresponding to the meeting presentations were identified for a five-year publication rate of 49.2 %. Sixty two (48 %) of the papers were published in The Journal of Shoulder and Elbow Surgeons, 23 (18 %) were published in The American Journal of Sports Medicine, and 20 (16 %) were published in The Journal of Bone and Joint Surgery. The mean patient sample size included in presentations with a subsequent full-text publication was higher (154; standard error =27) than the presentations not published (93; standard error = 13) (p = 0.039). There was no correlation (p = 0.248) between the publication rate and the level of evidence of the presentations. Conclusions: The publication rate of presentations at ASES meetings from 2005 to 2010 is similar to that reported from other orthopaedic meetings. Studies with large sample sizes should continue to be encouraged, and high quality presentations must consistently be followed up with full-text manuscript preparation in order to maximize the future clinical impact

Level of clinical evidence presented at the open and closed American Shoulder and Elbow Surgeons annual meeting over 10 years (2005-2014)

© 2016 The Author(s). Background: The American Shoulder and Elbow Surgeons (ASES) annual scientific meetings are premier forums whereby orthopaedic surgeons are informed of the latest research advances in shoulder and elbow surgery. The purpose of the present study was to assess the Level of evidence (LOE) in the clinical papers presented at both the open and closed ASES annual scientific meetings from 2005 to 2014. Secondarily, the study evaluated whether there were any changes in the distribution of LOE over this period of time. Methods: Two reviewers independently evaluated the abstracts of 532 paper presentations at either the open or closed ASES annual meetings. The independent reviewers first screened the abstracts for clinical evidence and excluded cadaveric, biomechanical, technique, and review studies. The included abstracts were then independently graded for methodological quality using LOE from Level I (highest quality) to IV (lowest quality) based on the classification system created by The American Academy of Orthopaedic Surgeons (AAOS). Results: Overall, 421 presentations were included and graded for LOE. In general, 17% of the presentations were graded level I; 15% level II; 25% level III; and 43% assigned a LOE of IV. Chi-square analysis demonstrated a statistically significant improvement in the LOE of presentations at the open and closed ASES meetings combined (p = 0.028) between the years 2005 and 2014. In particular, the proportion of presentations graded as level IV significantly decreased over this period (p = \u3c0.001). Conclusions: While most presentations at the ASES annual scientific meetings were of lower LOEs the percentage of level I evidence is greater than that reported at other Orthopaedic meetings. There has been a significant improvement in the LOE of clinical research at open and closed ASES meetings from 2005 to 2014. Specifically, the proportion of level IV studies have dramatically decreased over time

Britain: racial violence and the politics of hate

Drawing on empirical research into racist attacks in three cities in England, this article reveals a changing geography of racial violence (in terms of new areas and targets), and sets this in the context of the socially destructive impact of neoliberalism as well as government policies to manage the UK’s changing demographic make-up. With racial violence officially defined as a form of ‘hate crime’, it is divorced from any wider political context or racialised climate and reduced to a matter of individual pathology. The changing parameters of racism and the state’s responses present a challenge which the Left and anti-racists have been slow to meet

Randomised controlled trial comparing intraoperative cell salvage and autotransfusion with standard care in the treatment of hip fractures : a protocol for the WHITE 9 study

Introduction: People who sustain a hip fracture are typically elderly, frail and require urgent surgery. Hip fracture and the urgent surgery is associated with acute blood loss, compounding patients’ pre-existing comorbidities including anaemia. Approximately 30% of patients require a donor blood transfusion in the perioperative period. Donor blood transfusions are associated with increased rates of infections, allergic reactions and longer lengths of stay. Furthermore, there is a substantial cost associated with the use of donor blood. Cell salvage and autotransfusion is a technique that recovers, washes and transfuses blood lost during surgery back to the patient. The objective of this study is to determine the clinical and cost effectiveness of intraoperative cell salvage, compared with standard care, in improving health related quality-of-life of patients undergoing hip fracture surgery. Methods and analysis: Multicentre, parallel group, two-arm, randomised controlled trial. Patients aged 60 years and older with a hip fracture treated with surgery are eligible. Participants will be randomly allocated on a 1:1 basis to either undergo cell salvage and autotransfusion or they will follow the standard care pathway. Otherwise, all care will be in accordance with the National Institute for Health and Care Excellence guidance. A minimum of 1128 patients will be recruited to obtain 90% power to detect a 0.075-point difference in the primary endpoint: EuroQol-5D-5L HRQoL at 4 months post injury. Secondary outcomes will include complications, postoperative delirium, residential status, mobility, allogenic blood use, mortality and resource use. Ethics and dissemination: NHS ethical approval was provided on 14 August 2019 (19/WA/0197) and the trial registered (ISRCTN15945622). After the conclusion of this trial, a manuscript will be prepared for peer-review publication. Results will be disseminated in lay form to participants and the public. Trial registration number: ISRCTN15945622

A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: The RAMBO trial

Background: The choice between operative or nonoperative treatment is questioned for partial articular fractures of the radial head that have at least 2 millimeters of articular step-off on at least one radiograph (defined as displaced), but less than 2 millimeter of gap between the fragments (defined as stable) and that are not associated with an elbow dislocation, interosseous ligament injury, or other fractures. These kinds of fractures are often classified as Mason type-2 fractures. Retrospective comparative studies suggest that operative treatment might be better than nonoperative treatment, but the long-term results of nonoperative treatment are very good. Most experts agree that problems like reduced range of motion, painful crepitation, nonunion or bony ankylosis are infrequent with both nonoperative and operative treatment of an isolated displaced partial articular fracture of the radial head, but determining which patients will have problems is difficult. A prospective, randomized comparison would help minimize bias and determine the balance between operative and nonoperative risks and benefits. Methods/Design. The RAMBO trial (Radial Head - Amsterdam - Amphia - Boston - Others) is an international prospective, randomized, multicenter trial. The primary objective of this study is to compare patient related outcome defined by the 'Disabilities of Arm, Shoulder and Hand (DASH) score' twelve months after injury between operative and nonoperative treated patients. Adult patients with partial articular fractures of the radial head that comprise at least 1/3rd of the articular surface, have ≥ 2 millimeters of articular step-off but less than 2 millimeter of gap between the fragments will be enrolled. Secondary outcome measures will be the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score (OES), pain intensity through the 'Numeric Rating Scale', range of motion (flexion arc and rotational arc), radiographic appearance of the fracture (heterotopic ossification, radiocapitellar and ulnohumeral arthrosis, fracture healing, and signs of implant loosening or breakage) and adverse events (infection, nerve injury, secondary interventions) after one year. Discussion. The successful completion of this trial will provide evidence on the best treatment for stable, displaced, partial articular fractures of the radial head. Trial registration. The trial is registered at the Dutch Trial Register: NTR3413

Intraosseous foreign body granuloma in rotator cuff repair with bioabsorbable suture anchor

Biodegradable implants lead to problems such as cyst formation, soft-tissue inflammation, loose implant fragments or local osteolysis. This report represents the first published case of an intraosseous foreign body granuloma in the humeral head after arthroscopic rotator cuff tear fixation with a poly-l-lactide (PLLA) suture anchor. A 48-year-old female patient presented with pain in her right shoulder. A refixation of her right supraspinatus tendon with a biodegradable suture anchor was performed 11 months ago at an external hospital. Laboratory tests showed normal values for C-reactive protein, leukocytes and the erythrocyte sedimentation rate. No signs of infection or instability were noted. The visual analogue scale (VAS) was 8, the simple shoulder test (SST) was 4 and the American shoulder and elbow surgeons score (ASES) was 44. Plain radiographs showed high lucency in the area of the tuberculum majus. MRI showed an intra- and extraosseous mass surrounded by fluid in this area. Surgical care involved arthroscopic debridement and removal of the suture anchor. Histological examination revealed a foreign body granuloma. At the 18-month follow-up the patient was nearly pain-free. The VAS was 2, SST was 10 and ASES was 88. Foreign body granulomas are a well known but rarely described complication that arises after the use of biodegradable suture anchors in shoulder surgery. Every patient presenting with shoulder pain after usage of a biodegradable fixation material should be evaluated closely. Orthopaedic surgeons should be aware of the possibility of delayed foreign body reactions, especially after using PLLA anchors

Using a machine learning model to risk stratify for the presence of significant liver disease in a primary care population

Background: Current strategies for detecting significant chronic liver disease (CLD) in the community are based on the extrapolation of diagnostic tests used in secondary care settings. Whilst this approach provides clinical utility, it has limitations related to diagnostic accuracy being predicated on disease prevalence and spectrum bias, which will differ in the community. Machine learning (ML) techniques provide a novel way of identifying significant variables without preconceived bias. As a proof-of-concept study, we wanted to examine the performance of nine different ML models based on both risk factors and abnormal liver enzyme tests in a large community cohort.Methods: Routine demographic and laboratory data was collected on 1,453 patients with risk factors for CLD, including high alcohol consumption, diabetes and obesity, in a community setting in Nottingham (UK) as part of the Scarred Liver project. A total of 87 variables were extracted. Transient elastography (TE) was used to define clinically significant liver fibrosis. The data was split into a training and hold out set. The median age of the cohort was 59, mean body mass index (BMI) 29.7 kg/m2, median TE 5.5 kPa, 49.2% had type 2 diabetes and 20.3% had a TE >8 kPa.Results: The nine different ML models, which included Random Forrest classifier, Support Vector classification and Gradient Boosting classifier, had a range of area under the curve (AUC) statistics of 0.5 to 0.75. Ensemble Stacker model showed the best performance, and this was replicated in the testing dataset (AUC 0.72). Recursive feature elimination found eight variables had a significant impact on model output. The model had superior sensitivity (74%) compared to specificity (60%).Conclusions: ML shows encouraging performance and highlights variables that may have bespoke value for diagnosing community liver disease. Optimising how ML algorithms are integrated into clinical pathways of care and exploring new biomarkers will further enhance diagnostic utility