The Pavlik Harness in the Treatment of Congenital Dislocating Hip: Report on a Multicenter Study of the European Paediatric Orthopaedic Society

The results of functional treatment using the Pavlik harness in congenital dislocation and congenital dysplasia of the hip in children aged less than 11 months were examined by an EPOS study group. This study was conducted on 3,611 hips in 2,636 patients for a period of 1-9 years after treatment. The reduction rate was 92% in grade Tonnis 2 and 3; the healing rate was 80%. In children with dysplastic hips, the healing rate was 95.35%. Avascular necrosis of the femoral head was observed in 2.38%. The Pavlik harness is designed for outpatient treatment if the parents are complian

Total Angular Momentum Conservation During Tunnelling through Semiconductor Barriers

We have investigated the electrical transport through strained p-Si/Si_{1-x}Ge_x double-barrier resonant tunnelling diodes. The confinement shift for diodes with different well width, the shift due to a central potential spike in a well, and magnetotunnelling spectroscopy demonstrate that the first two resonances are due to tunnelling through heavy hole levels, whereas there is no sign of tunnelling through the first light hole state. This demonstrates for the first time the conservation of the total angular momentum in valence band resonant tunnelling. It is also shown that conduction through light hole states is possible in many structures due to tunnelling of carriers from bulk emitter states.Comment: 4 pages, 4 figure

Late diagnosis of medial condyle fracture of the humerus with rotational displacement in a child

For displaced medial condyle fractures in children, open reduction with internal fixation seems to be most popular treatment method. The major complication of this method is failure to make the proper early diagnosis. Corrective supracondylar humeral osteotomy has been preferred to open reduction and internal fixation for managing malunited fragments. We report a case of a child with nonunion of the medial condyle of the humerus who was subsequently treated successfully with open reduction and internal fixation

The clubfoot assessment protocol (CAP); description and reliability of a structured multi-level instrument for follow-up

BACKGROUND: In most clubfoot studies, the outcome instruments used are designed to evaluate classification or long-term cross-sectional results. Variables deal mainly with factors on body function/structure level. Wide scorings intervals and total sum scores increase the risk that important changes and information are not detected. Studies of the reliability, validity and responsiveness of these instruments are sparse. The lack of an instrument for longitudinal follow-up led the investigators to develop the Clubfoot Assessment Protocol (CAP). The aim of this article is to introduce and describe the CAP and evaluate the items inter- and intra reliability in relation to patient age. METHODS: The CAP was created from 22 items divided between body function/structure (three subgroups) and activity (one subgroup) levels according to the International Classification of Function, Disability and Health (ICF). The focus is on item and subgroup development. Two experienced examiners assessed 69 clubfeet in 48 children who had a median age of 2.1 years (range, 0 to 6.7 years). Both treated and untreated feet with different grades of severity were included. Three age groups were constructed for studying the influence of age on reliability. The intra- rater study included 32 feet in 20 children who had a median age of 2.5 years (range, 4 months to 6.8 years). The Unweighted Kappa statistics, percentage observer agreement, and amount of categories defined how reliability was to be interpreted. RESULTS: The inter-rater reliability was assessed as moderate to good for all but one item. Eighteen items had kappa values > 0.40. Three items varied from 0.35 to 0.38. The mean percentage observed agreement was 82% (range, 62 to 95%). Different age groups showed sufficient agreement. Intra- rater; all items had kappa values > 0.40 [range, 0.54 to 1.00] and a mean percentage agreement of 89.5%. Categories varied from 3 to 5. CONCLUSION: The CAP contains more detailed information than previous protocols. It is a multi-dimensional observer administered standardized measurement instrument with the focus on item and subgroup level. It can be used with sufficient reliability, independent of age, during the first seven years of childhood by examiners with good clinical experience. A few items showed low reliability, partly dependent on the child's age and /or varying professional backgrounds between the examiners. These items should be interpreted with caution, until further studies have confirmed the validity and sensitivity of the instrument

What Makes an Ex-Combatant Happy? A Micro-Analysis of Disarmament, Demobilization, and Reintegration in South Sudan

Successful management of combatants through disarmament, demobilization, and reintegration (DDR) remains one of the main challenges of post-conflict peacebuilding. While DDR is meant to contribute to a secure post-conflict environment conducive to economic and political development, the success of DDR efforts remains mixed. Unlike previous work focusing on procedural aspects or post-conflict reconstruction and development, we shift the focus to understand microlevel conditions—economic, security, and ethnic concerns—that influence ex-combatants' satisfaction with DDR. We argue that ex-combatant satisfaction with DDR should increase as individual-level economic conditions increase, as security situations improve, and as ethnic tensions decrease. We test our expectations using an original data set collected with field interviews and surveys from 122 ex-combatants in South Sudan in 2011–2012. We find that participants are more satisfied when their income-generating activity is based on DDR job training and when the UN has a large presence in their area. Concerns about political instability and an abundance of firearms make ex-combatants less satisfied with DDR

Validity and responsiveness of the Clubfoot Assessment Protocol (CAP). A methodological study

BACKGROUND: The Clubfoot Assessment Protocol (CAP) is a multi dimensional instrument designed for longitudinal follow up of the clubfoot deformity during growth. Item reliability has shown to be sufficient. In this article the CAP's validity and responsiveness is studied using the Dimeglio classification scoring as a gold standard. METHODS: Thirty-two children with 45 congenital clubfeet were assessed prospectively and consecutively at ages of new-born, one, two, four months and two years of age. For convergent/divergent construct validity the Spearman's correlation coefficients were calculated. Discriminate validity was evaluated by studying the scores in bilateral clubfeet. The floor-ceiling effects at baseline (untreated clubfeet) and at two years of age (treated clubfeet) were evaluated. Responsiveness was evaluated by using effect sizes (ES) and by calculating if significant changes (Wilcoxons signed test) had occurred between the different measurement occasions. RESULTS: High to moderate significant correlation were found between CAP mobility I and morphology and the Dimeglio scores (r(s )= 0.77 and 0.44 respectively). Low correlation was found between CAP muscle function, mobility II and motion quality and the Dimeglio scoring system (r(s )= 0.20, 0.09 and 0.06 respectively). Of 13 children with bilateral clubfeet, 11 showed different CAP mobility I scores between right and left foot at baseline (untreated) compared with 5 with the Dimeglio score. At the other assessment occasions the CAP mobility I continued to show higher discrimination ability than the Dimeglio. No floor effects and low ceiling effects were found in the untreated clubfeet for both instruments. High ceiling effects were found in the CAP for the treated children and low for the Dimeglio. Responsiveness was good. ES from untreated to treated ranged from 0.80 to 4.35 for the CAP subgroups and was 4.68 for the Dimeglio. The first four treatment months, the CAP mobility I had generally higher ES compared with the Dimeglio. CONCLUSION: The Clubfoot Assessment Protocol shows in this study good validity and responsiveness. The CAP is more responsive when severity ranges between mild – moderate to severe, while the Dimeglio focuses more on the extremes. The ability to discriminate between different mobility status of the right and left foot in bilaterally affected children in this population was higher compared with the Dimeglio score implicating a better sensitivity for the CAP

Pragmatism over principle: US intervention and burden shifting in Somalia, 1992–1993

The conventional wisdom about the 1992 US intervention in Somalia is that it was a quintessentially humanitarian mission pushed by President George H. W. Bush. This article challenges that interpretation, drawing on newly declassified documents. The Somalia intervention, I argue, was largely a pragmatic response to concerns held by the US military. In late 1992, as the small UN mission in Somalia was collapsing, senior American generals worried about being drawn into the resulting vacuum. Hence they reluctantly recommended a robust US intervention, in the expectation that this would allow the UN to assemble a larger peacekeeping force that would take over within months. The intervention ultimately failed, but the military learned useful lessons from this experience on how to achieve smoother UN handoffs in the future and thus effectively shift longer-term stabilisation burdens to the international community.Open access publication was made possible by an EC Career Integration Grant

Transatlantic intelligence and security cooperation

Despite recent advances in transatlantic intelligence and security cooperation, significant problems remain. The bombings in Madrid in March 2004 have demonstrated how terrorists and criminals can continue to exploit the limits of hesitant or partial exchange to dangerous effect. Intelligence and security cooperation remain problematic because of the fundamental tension between an increasingly networked world, which is ideal terrain for the new religious terrorism, and highly compartmentalized national intelligence gathering. If cooperation is to improve, we require a better mutual understanding about the relationship between privacy and security to help us decide what sort of intelligence should be shared. This is a higher priority than building elaborate new structures. While most practical problems of intelligence exchange are ultimately resolvable, the challenge of agreeing what the intelligence means in broad terms is even more problematic. The last section of this article argues that shared NATO intelligence estimates would be difficult to achieve and of doubtful value