The accuracy and clinical utility of spectral CT bone density measurement in the lumbar spine of unenhanced images: a narrative review

Objectives: To review and evaluate available literature on spectral computed tomography (SCT) bone mineral density (BMD) measurement in adult thoracolumbar vertebrae of unenhanced images compared to quantitative computed tomography (QCT), to understand its current clinical utility.Key findings: Keyword searches in four databases identified four cross-sectional studies which acquired an SCT BMD measurement in thoracolumbar vertebrae and compared this respectively to QCT, which were then critically appraised using the AXIS tool for cross-sectional studies. 862 vertebrae were measured between T10-S1 in 368 patients. Three studies demonstrated a statistically significant correlation between SCT and QCT for the measurement of Hydroxyapatite (HAP) and calcium (r = 0.86–0.96). One study demonstrated a diagnostic accuracy of 96% using a receiver operating curve. Conclusions: SCT measurements of HAP and calcium in the lumbar vertebrae are comparable to QCT for patients with no additional pathology present. However, further research is required to evaluate diagnostic accuracy before clinical application.Implications for practice: SCT BMD measurement has the potential to be developed as a screening tool for osteoporosis within the fracture liaison service (FLS). This could aid in the identification of patients with osteoporosis and address the current treatment gap. Nonetheless, many factors must be considered for this application including staff training, radiation protection and patient engagement with the screening programme.</p

Litigants in person in private family law cases

1. Context (p1-2 of the Report) The Legal Aid, Sentencing and Punishment of Offenders Act (LASPO) 2012 removed most private family cases from the scope of legal aid after April 2013. It was anticipated that the volume and proportion of litigants in person (hereafter LIPs) would increase as a result. The Ministry of Justice commissioned research to explore both the characteristics and support needs of LIPs in private family law cases and their impact on the courts prior to the implementation of legal aid reforms. It was designed to inform policy and practice responses to LIPs following the legal aid changes. 2. Research design (p3-10 and p136-164 of the Report) The study was designed to develop understanding of the range of litigants in person in private family law cases, their behavioural drivers and support needs, and their impact on the court system. The research was designed as a primarily qualitative study focusing on understanding the range of experiences and perspectives, rather than a quantitative study seeking to measure variables. The research included three linked studies: • Intensive Cases Study (ICS). The largest element of the research involved detailed analysis of a sample of 151 cases heard in five courts over a three to four week data collection time frame in each court between January and March 2013. The approach was multi-perspectival, involving observation of the hearing in each case, interviews with the parties and professionals associated with the observed case (subject to consent and availability) and scrutiny of the court file. • Local Contextual Study (LCS). This involved a series of focus groups in each of the five courts with local stakeholders (judges, lawyers, Cafcass and court staff), interviews and observations with local LIP support organisations and observations of public areas such as court counters and waiting rooms. • Secondary Analysis Study (SAS). This involved secondary analysis relating to LIPs of two large national datasets from two current studies led by members of the research team. 3. Main findings 3.1 Characteristics of LIPs (p11-34 of the Report) The major reason for self-representation was an inability to afford a lawyer, with only around one quarter of LIPs indicating that their appearance in person was wholly or partially a matter of choice. Over half of the LIPs observed had had legal representation at some stage during the current proceeding and/or in previous family law proceedings. Only a small minority of LIPs were able to represent themselves competently in all aspects of their family law proceedings. Even those with high levels of education or professional experience struggled with aspects of the legal process. The great majority of LIPs were procedurally (and, where relevant, legally) challenged in some way, with some having no real capacity to advocate for their own or their children’s interests. A wide range of personal vulnerabilities were identified with around half of those observed experiencing one or more vulnerabilities which often added to their difficulties in self-representation and in some cases defeated their attempts to do so. A significant number were also trying to handle quite complex cases. LIPs may create problems for the courts by reason of non-appearances, refusal to engage with proceedings, or, less often, violent and aggressive behaviour. While non-appearances may be quite common, the reasons for apparent resistance to court proceedings, as for violence and aggression, may often be related to litigants’ vulnerabilities. Unmeritorious and serial applications did not appear to be brought any more often by the LIPs in the sample than by represented parties, although having to respond to these applications was another vulnerability faced by some women LIPs. 3.2 Pre-hearing preparations (p35-51 of the Report) Much of the work in a family case is conducted before and between hearings rather than in the courtroom itself. The list of tasks to be accomplished in the pre-court and between-hearing phases is quite extensive and technically and practically demanding. The list includes determining legal merits and translating a dispute into legal form; consideration of mediation; making an application using the correct form and filing and serving correctly; possible negotiation with the other side in the waiting room and subsequent handling of the case (e.g. handling disclosure, preparing and filing statements). The successful completion of these tasks was important for the smooth running of the case and for timely and effective hearings. The extent to which LIPs were able to complete those tasks was highly variable. Understandably, many LIPs struggled with a range of technical tasks, including understanding which application form to use, how to complete it and how to file and serve correctly. Some LIPs faced practical problems such as an inability to access or print out online forms. Many LIPs also did not grasp foundational legal principles or concepts such as the importance of disclosure or the expectation of negotiation or settlement. A significant part of the problem is that the family justice system and the pre-court processes, procedures and tasks are predicated on a full representation model with two trained and experienced lawyers undertaking all these preparatory tasks. At least at the time of the fieldwork, there had been limited adaptation of processes to support LIPs and instead LIPs were largely required to comply with existing processes. There had been comparatively little adaptation of documentation (forms, guidance, letters from court etc) to meet the needs of LIPs. There was limited face-to face contact, advice and support at all stages of the pre-court process and on arrival in the court building before the hearing. The support available from court service staff varied locally but was constrained by concerns about straying into giving legal advice. The reduction in court counter hours and switch to an appointment system in some courts has reduced further the opportunities for face-to-face support. The challenging and complex nature of the pre-hearing tasks, coupled with limited support and advice, was a source of anxiety and stress for many LIPs. It also had consequences for court service staff workloads as they had to deal with correspondence from LIPs or pick up the errors or omissions in LIP paperwork. Some of the problems also had a significant impact on the conduct of the hearing itself. 3.3 In the courtroom (p52-78 of the Report) The court system is based on an adversarial, full representation model with two lawyers presenting their client’s cases to an impartial arbiter – the judge – who will make a decision. The role of the lawyers is central. Hearings where both parties were represented were generally patterned, predictable and efficient. All participants understood their roles without any need for explanation or behaviour management. LIP hearings were far less standardised. There was considerable variation in who picked up the tasks that a lawyer would normally perform in their absence – whether it was a LIP, the judge, the lawyer for the represented party or nobody. There was also variation in how effectively those tasks were done. The data suggested that semi-represented cases had longer final hearings and required more hearings than fully represented and non-represented cases. Cases with a LIP were more likely to require adjudication or be withdrawn or dismissed. Secondary analysis of a dataset of financial remedy contested hearings also suggested that LIP cases were less likely to settle and less likely to settle early than fully represented cases. There was variation in how well LIP hearings appear to work or not work in court. Four types appeared relatively fair and efficient/effective: umbrella semi – the represented party’s lawyer works on behalf of both parties; third party (quasi) lawyer – the children’s lawyer acts as broker for both LIPs; fully inquisitorial judge – the judge takes on the role of lawyer(s) and judge holding-their-own LIPs – a competent LIP manages a simple hearing with support from the judge. Four types of hearing appeared inefficient/ineffective or unfair: “hot potato” hearings - chaotic hearings with disruptive LIPs, adjourned or listed for contested hearings; over-confident LIPs - rambling hearings unable to restrict LIPs to legally relevant matters; out of their depth LIPs – LIPs unable to understand/accomplish tasks resulting in longer or extra hearings and unprotected LIPs - LIPs unable to explore concerns/present case. A combination of factors appears to influence how well courts and LIPs cope. These include matter and hearing type (directions vs. substantive hearing), the approach of the judge and any legal representative, the availability of any facilitative third party and the capacity of the LIP(s). The availability of additional professional (legal) support for the LIP was often key to success. Three of the four types of ‘working’ hearings involved either a supportive lawyer or an activist/inquisitorial judge. Causes of delay included LIPs’ lack of understanding and experience meaning sometimes critical tasks were missed out, were done inadequately or were completed by the LIP only with considerable coaching and support from others, particularly judges. Ensuring equality of arms between parties was a real challenge, notably when a LIP was unaware of their legal entitlements and/or unable to do justice to their case. Judges varied considerably in the extent to which they helped LIPs, in itself a source of potential unfairness. Judicial attempts to support LIPs could be seen as unfair to represented parties in semi-representation cases. Two key ‘legal’ tasks - the preparation of bundles and cross-examination - were beyond the capacity of most LIPs unless they had considerable help. 3.4 The support needs of litigants in person (p79-100 of the Report) The LIP experience was mixed, sometimes better than expected but often stressful and confusing. LIPs reported fear and anxiety about the process, feeling marginalised and bewilderment and confusion, regardless of educational level. Factors that made the experience more positive were judges and sometimes opposing solicitors who took time to explain things and being able to draw upon previous experience of being at court. A degree of self-assurance or confidence was helpful, although over-confidence and an over-estimation of one’s understanding of the process could cause difficulties. The main support needs identified by LIPs were for information about process and procedure, emotional support, practical support and tailored legal advice including broad questions about their entitlements and specific questions about tactics and tasks. LIPs varied enormously in terms both of willingness and ability to seek support and of the effectiveness with which support was sought. A minority of LIPs were proactive in searching for information without any prompting by the courts. The proactive LIPs could be divided into the capable/organised and those with a scattergun/shot in the dark approach, although even the capable/organised could find it difficult to find the information they needed. Reactive LIPs responded to instructions or suggestions from family justice professionals, especially where those instructions were clear and precise. Passive LIPs relied on others to provide help, did not engage with the court process or had chaotic lifestyles. Support for LIPs at the time of the study was disparate, variable and limited. The internet has potential for informing LIPs, as well as some very significant drawbacks in relation to relevance, accuracy as well as accessibility for all. Few of the LIPs interviewed reported using the HMCTS or MoJ websites and those who did reported they did not meet their needs. Further, not all LIPs have access to online resources and, even for those who do, websites cannot adequately substitute for the tailored legal advice that many LIPs require. LIPs reported frustration that organisations like CABx, the court service and Cafcass were not able to offer advice and advised them to seek legal advice that could not be afforded. There is a dearth of free or low-cost legal advice in the community. Family and friends could be very helpful acting as informal supporters, but the development of paid ‘professional’ McKenzie Friends was a source of real concern to judges, lawyers and Cafcass officers. As previous studies have found, the courts did little signposting to sources of support. Professional training in how to support LIPs is needed. The development of support services for LIPs and training for professionals should be informed by, and responsive to, the different needs and help-seeking approaches of LIPs. 4. Policy Implications and Recommendations (p101-125 of the Report) 4.1 LIPS after 1st April 2013: eligibility for legal aid and the ‘new’ LIPs Chapter 6 of the Report considers the policy and practice implications of the findings reported above. The chapter begins with consideration of how far the findings are likely to apply after 1 April 2013. The available evidence suggested that the majority of represented parties in the sample who were in receipt of legal aid would no longer be eligible for legal aid after the LASPO reforms. In comparison with the observed pre-LASPO LIPs, the researchers would expect that LIPs post-LASPO would be less likely to be partially represented and more likely to present with vulnerabilities which affect their capacity to represent themselves effectively and create challenges for the courts in terms of safety at court, testing, disclosure and safeguarding children 4.2 Recommendations The report identified that LIPs have considerable needs for support across several dimensions. It also identified what the researchers consider to be best practices for meeting those needs, based on the team’s review of the literature and the observations and interviews with LIPs and family justice system professionals. It has not been part of the research team’s brief, however, to analyse the cost-benefit of these proposals or to produce a fully worked-up blueprint for change. This section, therefore, summarises the broad recommendations arising from the team’s analysis of the literature and the research data. Further detailed policy and operational consideration will of course be required to determine how these recommendations could be implemented. Information needs • That all relevant family justice communications, including forms, leaflets, practice directions, templates and pro forma, are re-evaluated from the perspective of LIPs and (if necessary) redesigned with their various needs in mind. • That a single authoritative ‘official’ family court website is established with all the resources that a LIP needs in one place. • That the court’s communication with parties prior to the first hearing is used more effectively to convey important information to LIPs. • That judges are encouraged to give LIPs clear verbal instructions and guidance on process and procedure. • That the court service provides increased opportunity for face-to-face inquiries with relevant court staff and that guidelines and training for court staff are devised to facilitate information-giving whilst avoiding giving advice. Emotional/moral support • That there is a presumption that a single family member, friend or volunteer may accompany a LIP in court to offer emotional/moral support without the need to submit a formal CV. • That consideration is given to the development of a code of conduct, practice guidance or regulatory framework for paid/’professional’ McKenzie Friends. Practical support and legal knowledge • That initial legal advice to facilitate dispute resolution and, where necessary, for initial preparation for court proceedings is made universally available. • That providing support for LIPs in a consistent way in both semi-represented and non-represented cases is understood as a key element of the judicial role; and that judicial officers receive appropriate guidance and training to do so. • That measures are introduced to ensure greater availability of and access to exceptional case funding in private family law matters. • That a mechanism is introduced to enable judicial recommendation for the provision of publicly funded representation in the interests of justice. • That the MoJ consider which other forms of legal and procedural assistance outlined in this Chapter for LIPs engaged in court proceedings can feasibly be supported or implemented. Other issues • Follow up independent research is needed to examine the impact of the legal aid reforms on the types and experiences of LIPs, their impact on the court system and the effectiveness of innovations and services to support LIPs

Automated delineation of roof planes from LIDAR data

In this paper, we describe an algorithm for roof line delineation from LIDAR data which aims at achieving models of a high level of detail. Roof planes are initially extracted by segmentation based on the local homogeneity of surface normal vectors of a digital surface model (DSM). A case analysis then reveals which of these roof planes intersect and which of them are separated by a step edge. The positions of the step edges are determined precisely by a new algorithm taking into account domain specific information. Finally, all step edges and intersection lines are combined to form consistent polyhedral models. In all phases of this workflow, decision making is based upon statistical reasoning about geometrical relations between neighbouring entities in order to reduce the number of control parameters and to increase the robustness of the method

Old hat in a brave new world – the impact of technology ageing in managed learning environments

This paper reports on the progress of a project at the University of Glasgow to investigate the benefits of PDAs (Personal Digital Assistant) as teaching, learning and revision tools and the practicalities of deploying PDAs and measuring their use. A pilot study in 2003, funded by LTSN Engineering, highlighted additional benefits of CAA assessment methods when CAA is combined with PDAs, allowing fully ubiquitous use by students1,2. Each student was loaned a PDA which contained a logging application to record when the PDA was used along with a quiz application to deliver formative self- assessment questions. Additional applications were pre- installed on each PDA, the applications included chemical tables, a scientific calculator and document readers. The students were encouraged to install their choice of additional applications on the PDA’s. The students used the PDAs during lecture and practical laboratory sessions and were allowed to take the device home

Using PDAs for CAA: practicalities, disasters, apathy

For the last 3 years the Departments of Electronics & Electrical Engineering and the Robert Clark Centre for Technological Education at the University of Glasgow have been collaborating on projects to investigate the potential of PDAs in flexible learning and the use of highly portable mobile devices as CAA delivery platforms. During this time a number of challenges have been identified which will have implications for more widespread deployment of mobile devices. The project has now been extended and PDAs have been given to the students to use throughout their 4 years at university. This paper describes some of the technical, institutional and social factors that have been encountered during the project, various methods we have used to overcome these difficulties, and an assessment of the merit of each method, singly and in concert. Although our chosen platform has been a Palm OS based device the problems encountered are largely platform independent

Building Detection by Dempster-Shafer Fusion of LIDAR Data and Multispectral Aerial Imagery

A method for the classification of land cover in urban areas by the fusion of first and last pulse LIDAR data and multi-spectral images is presented. Apart from buildings, the classes "tree", "grass land", and "bare soil" are also distinguished by a classification method based on the theory of Dempster-Shafer for data fusion. Examples are given for a test site in Germany

Evaluation of a method for fusing LIDAR data and multispectral images for building detection

In this paper, we describe the evaluation of a method for building detection by the Dempster-Shafer fusion of LIDAR data and multispectral images. For that purpose, ground truth was digitised for two test sites with quite different characteristics. Using these data sets, the heuristic model for the probability mass assignments of the method is validated, and rules for the tuning of the parameters of this model are discussed. Further we evaluate the contributions of the individual cues used in the classification process to the quality of the classification results. Our results show the degree to which the overall correctness of the results can be improved by fusing LIDAR data with multispectral images

Special Delivery: Programming with Mailbox Types (Extended Version)

The asynchronous and unidirectional communication model supported by mailboxes is a key reason for the success of actor languages like Erlang and Elixir for implementing reliable and scalable distributed systems. While many actors may send messages to some actor, only the actor may (selectively) receive from its mailbox. Although actors eliminate many of the issues stemming from shared memory concurrency, they remain vulnerable to communication errors such as protocol violations and deadlocks. Mailbox types are a novel behavioural type system for mailboxes first introduced for a process calculus by de'Liguoro and Padovani in 2018, which capture the contents of a mailbox as a commutative regular expression. Due to aliasing and nested evaluation contexts, moving from a process calculus to a programming language is challenging. This paper presents Pat, the first programming language design incorporating mailbox types, and describes an algorithmic type system. We make essential use of quasi-linear typing to tame some of the complexity introduced by aliasing. Our algorithmic type system is necessarily co-contextual, achieved through a novel use of backwards bidirectional typing, and we prove it sound and complete with respect to our declarative type system. We implement a prototype type checker, and use it to demonstrate the expressiveness of Pat on a factory automation case study and a series of examples from the Savina actor benchmark suite.Comment: Extended version of paper accepted to ICFP'2