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Introduction Complex Regional Pain Syndrome (CRPS) is most common in the upper limb and associated with high disability. The purpose of this review was to critically appraise and synthesise literature exploring non-pharmacological treatment for upper limb CRPS, to guide upper-limb-specific management. Methods Using an integrative review methodology, 13 databases were searched to identify all published studies on non-pharmacological management of upper limb CRPS. The Crowe Critical Appraisal Tool was used to provide quality ratings for included studies, and analysis employed a qualitative descriptive approach. Results From 236 abstracts reviewed, 113 full texts were read, and 38 articles selected for data extraction. Designs included single case ( n = 14), randomised controlled trial ( n = 8), prospective cohort ( n = 8), case series ( n = 4), retrospective ( n = 3), and mixed methods ( n = 1). Interventions were categorised as sensory retraining ( n = 13), kinesiotherapy ( n = 7), manual therapies ( n = 7), physical modalities ( n = 6), and interdisciplinary treatment programmes ( n = 5). All studies measured pain intensity, and most ( n = 24) measured physical parameters such as strength, movement, or perceptual abilities. Few measured patient-rated function ( n = 13) or psychological factors ( n = 4). Quality ratings ranged from 30% to 93%, with a median of 60%. Conclusion Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. Movement, desensitisation, and graded functional activity remain the mainstays of intervention. However, despite the impact of CRPS on wellbeing and function, psychological factors and functional outcomes are infrequently addressed. Further robust research is required to determine which aspects of treatment have the greatest influence on which symptoms, and when and how these should be introduced and progressed.

Background: There are limited randomized controlled trials with long-term outcomes comparing autologous chondrocyte implantation (ACI) versus alternative forms of surgical cartilage management within the knee. Purpose: To determine at 5 years after surgery whether ACI was superior to alternative forms of cartilage management in patients after a failed previous treatment for chondral or osteochondral defects in the knee. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In total, 390 participants were randomly assigned to receive either ACI or alternative management. Patients aged 18 to 55 years with one or two symptomatic cartilage defects who had failed 1 previous therapeutic surgical procedure in excess of 6 months prior were included. Dual primary outcome measures were used: (1) patient-completed Lysholm knee score and (2) time from surgery to cessation of treatment benefit. Secondary outcome measures included International Knee Documentation Committee and Cincinnati Knee Rating System scores, as well as number of serious adverse events. Analysis was performed on an intention-to-treat basis. Results: Lysholm scores were improved by 1 year in both groups (15.4 points [95% CI, 11.9 to 18.8] and 15.2 points [95% CI, 11.6 to 18.9]) for ACI and alternative, with this improvement sustained over the duration of the trial. However, no evidence of a difference was found between the groups at 5 years (2.9 points; 95% CI, −1.8 to 7.5; P = .46). Approximately half of the participants (55%; 95% CI, 47% to 64% with ACI) were still experiencing benefit at 5 years, with time to cessation of treatment benefit similar in both groups (hazard ratio, 0.97; 95% CI, 0.72 to 1.32; P > .99). There was a differential effect on Lysholm scores in patients without previous marrow stimulation compared with those with marrow stimulation ( P = .03; 6.4 points in favor of ACI; 95% CI, −0.4 to 13.1). More participants experienced a serious adverse event with ACI ( P = .02). Conclusion: Over 5 years, there was no evidence of a difference in Lysholm scores between ACI and alternative management in patients who had previously failed treatment. Previous marrow stimulation had a detrimental effect on the outcome of ACI. Registration: International Standard Randomised Controlled Trial Number: 48911177

The article explores how the future is imagined through disability activism. It highlights how UK Disabled People’s Movement members, established and newcomers, envisage inclusive and accessible societies and what role disability activism has in realising such visions. To achieve this, conceptualisations of the future are mapped within a framework of three topias (places/worlds): utopia, retrotopia and heterotopia. These topian configurations provide a way to make sense of activist visions for progressing disabled people’s emancipation. The article argues that the UK Disabled People’s Movement currently produces two dominant conceptualisations of the future: a deterministic, radical overhaul of political and economic arrangements (utopia); and a return to ‘purer’ forms of disability activism produced by historical activists and their networks (retrotopia). Young disabled activists who do not align with such conceptualisations are denied opportunities to influence broad activist strategies and are, instead, relegated to opportunities that necessitate a youth perspective. Young disabled activist’s conceptualisations of the future can be best understood as the production of counter sites, which generate activities, politics and discourses around notions of inclusion, social justice and accessibility (heterotopia). These produce possible and preferable alternatives to the current ordering of the social world – with disability activism becoming spaces that encourage creativity of new ideas, new practices and new options against existing norms and inaccessible worlds.

The Northern Territory (NT) has the highest rates of domestic, family and sexual violence (DFSV) in Australia. Although we know that alcohol and other drug (AOD) use and trauma both contribute to DFSV in the NT, some specifics remain unknown. This paper aims to (a) describe the extent of AOD involvement in criminally serious DFSV, (b) describe the volume of trauma experienced by convicted criminally serious DFSV offenders, and (c) qualitatively explore the judicial recognition of the intersections between alcohol and trauma. To do this we reviewed Judicial Sentencing Remarks (JSRs) from the Supreme Court of the NT. A content analysis of all DFSV JSRs from July to Dec 2020 was undertaken ( n = 64). A structured coding instrument was developed to extract quantitative and qualitative variables through repeated reviews by multiple authors. Descriptive statistics regarding demographics, number of significant traumatic events experienced, and AOD involvement were generated. The qualitative data from which these statistics were generated was used to explore the interplay between trauma and AOD involvement. The majority of offenders had experienced at least one form of trauma. The social determinants of health underpinned a significant amount of this trauma, with housing, poverty, and unemployment frequently described. The use of alcohol as a maladaptive coping mechanism was explicitly recognised. There was frequent judicial recognition of the intersections between trauma, alcohol, and violence, however addressing trauma as an essential part of rehabilitation processes was rare. Trauma and AOD use were widespread among convicted DFSV offenders, with alcohol involved in the majority of incidents. Further research is required to understand the bio-psycho-social factors involved in the relationship between trauma, alcohol, and DFSV. Systematic piloting and trialling of interventions is necessary to determine what approaches are effective for preventing DFSV and reducing recidivism for people with intersecting experiences of trauma and AOD concerns.

Introduction Through routine respiratory samples surveillance among COVID-19 patients in the intensive care, three patients with aspergillus were identified in a newly opened general intensive care unit during the second wave of the pandemic. Methodology As no previous cases of aspergillus had occurred since the unit had opened. An urgent multidisciplinary outbreak meeting was held. The possible sources of aspergillus infection were explored. The multidisciplinary approach enabled stakeholders from different skills to discuss possible sources and management strategies. Environmental precipitants like air handling units were considered and the overall clinical practice was reviewed. Settle plates were placed around the unit to identify the source. Reports of recent water leaks were also investigated. Results Growth of aspergillus on a settle plate was identified the potential source above a nurse’s station. This was the site of a historic water leak from the ceiling above, that resolved promptly and was not investigated further. Subsequent investigation above the ceiling tiles found pooling of water and mould due to a slow water leak from a pipe. Conclusion Water leaks in patient areas should be promptly notified to infection prevention. Detailed investigation to ascertain the actual cause of the leak and ensure any remedial work could be carried out swiftly. Outbreak meetings that include diverse people with various expertises (clinical and non-clinical) can enable prompt identification and resolution of contaminated areas to minimise risk to patients and staff. During challenging pandemic periods hospitals must not lose focus on other clusters and outbreaks occurring simultaneously.

This article evaluates the recent Attorney General's Guidelines on disclosure in criminal cases. These Guidelines signal a further step away from adversarialism, towards an internally incoherent justice system which incorporates managerial characteristics, alongside increasing elements of inquisitorialism. Whilst still promoting the rhetoric of adversarialism, these changes have the potential to reconfigure the role of the suspect and the court in such a way as to circumvent the protections inherent in the adversarial system. This article considers two areas of the Guidelines, pre-charge engagement and the enforcement of a ‘thinking manner’ approach to the disclosure exercise. By considering these two expansive areas, a broader perspective of the Guidelines is taken in order to fully appreciate their significance. The impact of these newly minted Guidelines is not yet apparent, but this article postulates the potential longer-term ramifications of the changes and ultimately concludes that the Guidelines will result in further systemic incoherence which undermines suspect and defendant rights, and fundamentally reconstitutes courts as adjudicators of criminal investigations.

Thirty-one participants engaged in this oral history research study aimed at exploring the lived experience of intellectual disability nurses and healthcare assistants’ knowledge of the trajectory of intellectual disability nursing over the last 30 years in the Republic of Ireland and England. This paper documents some of these experiences offering perspectives on intellectual disability nursing and what is important for the future. Findings from Ireland consider the nature of intellectual disability services and the registered nurse in intellectual disability. Findings from England focus on opportunities and restrictions in intellectual disability nursing, shared visions, the changing context within which work took place and also the internal and external supports that impacted their roles. It is evident that intellectual disability nurses must be responsive to the changing landscape of service provision and also the requirements for contemporary new roles to meet the changing needs of people with intellectual disabilities.

Objectives To better understand the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers, leading to recommendations for the prioritisation of personal protective equipment, testing, training and vaccination. Design Observational, longitudinal, national cohort study. Setting Our cohort were secondary care (hospital-based) healthcare workers employed by NHS Wales (United Kingdom) organisations from 1 April 2020 to 30 November 2020. Participants We included 577,756 monthly observations among 77,587 healthcare workers. Using linked anonymised datasets, participants were grouped into 20 staff roles. Additionally, each role was deemed either patient-facing, non-patient-facing or undetermined. This was linked to individual demographic details and dates of positive SARS-CoV-2 PCR tests. Main outcome measures We used univariable and multivariable logistic regression models to determine odds ratios (ORs) for the risk of a positive SARS-CoV-2 PCR test. Results Patient-facing healthcare workers were at the highest risk of SARS-CoV-2 infection with an adjusted OR (95% confidence interval [CI]) of 2.28 (95% CI 2.10–2.47). We found that after adjustment, foundation year doctors (OR 1.83 [95% CI 1.47–2.27]), healthcare support workers [OR 1.36 [95% CI 1.20–1.54]) and hospital nurses (OR 1.27 [95% CI 1.12–1.44]) were at the highest risk of infection among all staff groups. Younger healthcare workers and those living in more deprived areas were at a higher risk of infection. We also observed that infection rates varied over time and by organisation. Conclusions These findings have important policy implications for the prioritisation of vaccination, testing, training and personal protective equipment provision for patient-facing roles and the higher risk staff groups.

Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) may be associated with relapsing disease, but clinical progression independent of relapse activity is rare. Objectives: To report progressive disease in a patient with MOGAD. Methods: A single retrospective case report. Results: At 4 years of age, the patient had a single episode of acute disseminated encephalomyelitis. She remained well until age 17 years but over the next 9 years developed progressive spastic quadriparesis, cognitive and bulbar dysfunction. Brain imaging showed a leukodystrophy-like pattern of white matter abnormality with contrast enhancement at different time points. Myelin oligodendrocyte glycoprotein (MOG)-IgG was repeatedly positive by live cell-based assay. Conclusion: Secondary progression may be a rare presentation of MOG-IgG-associated disease.

This article critically examines thanato-geographies of Palestine-Israel and Palestinians and the crucial question of the possibility of politics in the context of sovereign exception. The main argument of the article is that bare life as referent for Palestinians’ lives overstates the subject-making capacities of the sovereign and understates the possibilities of political agency. As a response, the discussion turns to two prominent examples of exception – Israeli checkpoints and the Gaza borderlands – with the aim to keep in sharp focus both the thanatopolitical and that which – whether as complement or counter – exceeds it. Two important correctives arise from such an approach: thanatopolitical formations are i) dependent on broader thanato-geographies of capitalism; and ii) countered by the political agency of those figured as bare life.

Objectives There is a lack of research informing service delivery for older forensic mental health patients. This study explored service provision in forensic mental health inpatient and community services in England, investigating what is required for progress in terms of quality of life, health, wellbeing, recovery and reduced risk, and the barriers and facilitators associated with this. Methods Semi-structured interviews were undertaken with 48 members of staff working with older forensic mental health patients in secure inpatient units or the community in England. Data were analysed using thematic analysis. Results Two global themes ‘What works’ and ‘What doesn’t work’ were identified comprising themes representing environmental, interpersonal and individual factors. ‘What works’ included: positive social support and relationships; individualised holistic patient-centred care; hub and spoke approach to patient care; and suitable environments. ‘What doesn’t work’ included: absence of/or maladaptive relationships with family and friends; gaps in service provision; and unsuitable environments. Conclusions For older patients to progress to improved quality of life, health, wellbeing and reduced risk, multilevel and comprehensive support is required, comprising a range of services, interventions, and multidisciplinary input, and individualised to each patient’s needs. The physical environment needs to be adapted for older patients and provide a social environment that seeks to include supportive families, friends and expert professional input. A clear patient progression pathway is required; this must be reflected in policy and provision.

Subtle slights refer to a wide range of ambiguous negative interactions between people that may harm individual health, wellbeing and performance at work. This literature review aims to help human resource development practitioners and researchers understand the similarities and distinguishing features of disparate bodies of subtle slight research. A systematic review yielded 338 papers, the majority of which concerned three constructs: microaggressions, everyday discrimination and workplace incivilities. Meta-synthesis revealed that all three categories related to subtle, low-intensity interactions but differed in their descriptions of the type of perceived violation. The most common demographic factors under scrutiny were race or ethnicity, gender, sexual orientation, and age. We propose a framework that involves four dimensions common to all subtle slights: type of violation, intensity, duration and intent (VIDI). This framework may help future efforts to understand, monitor and address this issue of contemporary concern in the workplace.

Inaccurate stereotypes—perceived differences among groups that do not actually differ—are prevalent and consequential. Past research explains stereotypes as emerging from a range of factors, including motivational biases, cognitive limitations, and information deficits. Considering the minimal forces required to produce inaccurate assumptions about group differences, we found that locally adaptive exploration is sufficient: An initial arbitrary interaction, if rewarding enough, may discourage people from investigating alternatives that would be equal or better. Historical accidents can snowball into globally inaccurate generalizations, and inaccurate stereotypes can emerge in the absence of real group differences. Using multiarmed-bandit models, we found that the mere act of choosing among groups with the goal of maximizing the long-term benefit of interactions is enough to produce inaccurate assessments of different groups. This phenomenon was reproduced in two large online experiments with English-speaking adults ( N = 2,404), which demonstrated a minimal process that suffices to produce biased impressions.

Association football has been viewed as an industry with considerable lucrative career prospects; however, this has not prevented the use of unpaid staff throughout football in the UK. There has been increasing academic research regarding the professionalisation and commercialisation of football, yet there has been little acknowledgement of the role of those working in football in an unpaid capacity. Therefore, this paper examines the culture of unpaid work in football scouting, by exploring the motivations of 12 unpaid scouts at professional clubs, from a figurational perspective. Our findings suggest that scouts want to work in the industry because of their ‘love of the game’, in a ‘quest for excitement’ in their career. Unpaid work was in the pursuit of experience and contacts, the latter of which was highly valued in the industry. Football clubs are enclosed figurations and the scouts placed importance on developing interdependent social relations to gain entry to the industry, demonstrating how football may be perceived nepotistic. The likelihood of gaining a paid role directly from an unpaid position was low and therefore the decisions to continually accept unpaid work represented the notion of fantasy-laden thinking.

Objectives Examine the spatial relationship between firearm dealers and shootings in Atlanta. Methods We combine data from the Atlanta Police Department (APD), the Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF), and the American Community Survey (ACS) to conduct a street network analysis from 2016 through 2018. We employ the Network Cross K Function to assess whether firearm dealers attract shootings in the city. We examine whether this spatial relationship differs by level of concentrated disadvantage in neighborhoods. Results Without consideration of concentrated neighborhood disadvantage, firearm dealers and shootings are spatially unrelated to one another. Tract-level disadvantage influences the relationship between firearm dealers and shootings wherein dealers significantly attract shootings in disadvantaged neighborhoods. Conversely, shootings are located further from gun stores in non-disadvantaged communities. Shootings related to manslaughter and assault, but not robbery, are spatially associated with firearm dealers in disadvantaged neighborhoods. Conclusions Building on prior research regarding firearm dealers and gun violence, we find support for an attraction effect in disadvantaged neighborhoods for certain types of shootings. We contextualize these findings within a broader discussion of how firearm dealers contribute to the complex ecology of local gun violence. This is important in light of federal policies and investments related to the prevention of and response to gun crime.

Background: The reward deficiency syndrome (RDS) integrates psychological, neurological, and genetic factors of addictive, impulsive, and compulsive behaviors. However, to date, no instrument has been validated to assess the RDS construct. Aims: The present study developed and tested a tool to assess RDS. Methods: Data were collected on two college and university samples. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed on Sample 1 ( N = 1726), and confirmatory analysis was conducted on an independent sample ( N = 253). Impulsivity and sensation-seeking were assessed. Results: Based on EFAs, a 29-item Reward Deficiency Syndrome Questionnaire (RDSQ-29) was developed, containing four subscales (lack of sexual satisfaction, activity, social concerns, and risk-seeking behavior). CFA indicated good fit (comparative fit index (CFI) = 0.941; Tucker–Lewis index (TLI) = 0.933; root mean square error of approximation (RMSEA) = 0.068). Construct validity analysis showed strong relationship between sensation-seeking and the RDS scale. Conclusion: The RDSQ-29 is an adequate scale assessing psychological and behavioral aspects of RDS. The RDSQ-29 assesses psychological and behavioral characteristics that may contribute to addictions generally.

Attending to connections between serious health conditions (cancers and congenital disorders) and weapons residues in Iraq, Afghanistan and Gaza, this article develops a geographical agenda for examining power in late modern war from the perspective of the ground and the life it sustains. A case is made for understanding the time-spaces of war as not compressed, vertical or remote but enduring, terranean and proximate in which violence emerges through processes (carcinogenic and teratogenic) that transcend boundaries between ‘life’ ( bios) and ‘nonlife’ ( geos). Such are the geontological time-spaces of late modern war that geographers – in both ‘physical’ and ‘human’ sub-fields – are uniquely equipped to examine.

The UK government identified ‘improving support within the criminal justice systems’ as a priority for autistic people. There is a lack of quantitative research to enable policymakers to make evidence-based decisions on how to improve access to justice for autistic people. This study used a case-comparison design to compare the experiences of 145 autistic and 116 non-autistic adults who had been arrested at some point in their life. Autistic participants were nearly five times more likely to state that they were not given an appropriate adult even though they believed they needed one and felt less able to communicate with the police. Autistic participants felt less able to cope with stress, twice as likely to have experienced meltdowns and five times more likely to have experienced shutdowns because of their criminal justice involvement. We conclude that there are inequalities that autistic people face when navigating the criminal justice system and the degree to which they can participate effectively in the justice process. This has an impact on their mental health. Policy recommendations are discussed based on this evidence. Lay Abstract Most autistic people will never experience being arrested or charged with a crime, however for those who do tend to be less satisfied with the way they were treated. The purpose of this study was to find out if autistic people are being disadvantaged by the criminal justice system if they are arrested. Previous research has shown that autistic people may have difficulties communicating with the police. This study builds on this knowledge by uncovering why autistic people may not feel able to communicate with the police and whether the police made any adjustments to help them. This study also measures the impact of being involved with the criminal justice system on autistic people’s mental health, such as stress, meltdowns and shutdowns. The results show that autistic people were not always given the support they felt they needed. For example, not all autistic people had an appropriate adult with them at the police station who could help to make sure they understood what was happening around them. Autistic people were also more likely to feel less able to cope with the stress and more likely to suffer meltdowns and shutdowns because of their involvement with the criminal justice system. We hope this study will help police officers and lawyers to better support autistic people if they become involved with the criminal justice system.