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Introduction: Posterior native hip dislocations (NHD) are high-energy injuries. Thompson-Epstein Type I dislocations describe those without significant associated femoral or acetabular fracture. The aim of this study was to compare the clinical and radiological outcomes of patients with Type I NHDs. We also evaluate the association between radiological indicators of femoroacetabular impingement (FAI) and NHD. Patients and methods: A retrospective study from January 2012 to May 2021 compared skeletally mature patients (⩾16 years) with Type I posterior NHD to age and gender-matched controls with Type II–V posterior NHD. Patient demographics, mechanism of injury, complications and patient-reported outcome measures (PROMs) are presented. Post reduction radiographs and computed tomography were used to assess for FAI. Univariate analyses were performed to evaluate radiological outcomes. Results: 13 patients (77% male) with Type I posterior NHD were compared to a control group of 40 patients (80% male) with Type II–V posterior NHD. 11 patients in the study group and 14 in the control group experienced isolated injuries (p = 0.01). Post-reduction complications were similar. The study group had significantly lower post-injury osteoarthritis incidence (n = 0) compared to controls (n = 18, p = 0.0083). Patients reported a mean Oxford Hip Score of 43.5 ± 2.2 and EQ-5D-VAS score of 87.1 ± 7.4, with 6 patients indicating minimal symptoms across all EQ-5D-5L domains. Radiological femoroacetabular impingement (FAI) was prevalent in both groups, especially among males. Conclusions: Patients who underwent emergent closed reduction of Type I NHD demonstrated good short to medium term outcomes. Our radiological findings suggest a high prevalence of FAI. Future work should aim to quantify longer term outcomes following this injury. We call for further comparative studies of patients who suffer NHD with and without fractures to aid our understanding of risk factors. Given the rarity of this injury, multicentre efforts will be required to capture large numbers of patients. [ABSTRACT FROM AUTHOR]

Background: Healthcare data frequently lack the specificity level needed to achieve clinical and operational objectives such as optimising bed management. Pneumonia is a disease of importance as it accounts for more bed days than any other lung disease and has a varied aetiology. The condition has a range of SNOMED CT concepts with different levels of specificity. Objective: This study aimed to quantify the importance of the specificity of an SNOMED CT concept, against well-established predictors, for forecasting length of stay for pneumonia patients. Method: A retrospective data analysis was conducted of pneumonia admissions to a tertiary hospital between 2011 and 2021. For inclusion, the primary diagnosis was a subtype of bacterial or viral pneumonia, as identified by SNOMED CT concepts. Three linear mixed models were constructed. Model One included known predictors of length of stay. Model Two included the predictors in Model One and SNOMED CT concepts of lower specificity. Model Three included the Model Two predictors and the concepts with higher specificity. Model performances were compared. Results: Sex, ethnicity, deprivation rank and Charlson Comorbidity Index scores (age-adjusted) were meaningful predictors of length of stay in all models. Inclusion of lower specificity SNOMED CT concepts did not significantly improve performance (ΔR2 = 0.41%, p =.058). SNOMED CT concepts with higher specificity explained more variance than each of the individual predictors (ΔR2 = 4.31%, p <.001). Conclusion: SNOMED CT concepts with higher specificity explained more variance in length of stay than a range of well-studied predictors. Implications: Accurate and specific clinical documentation using SNOMED CT can improve predictive modelling and the generation of actionable insights. Resources should be dedicated to optimising and assuring clinical documentation quality at the point of recording. [ABSTRACT FROM AUTHOR]

Introduction: Parent/carers of disabled children want timely and personalized support. Research suggests that technology may address some limitations associated with traditional methods of communication with therapists (e.g. letter, telephone). This exploratory study examined United Kingdom (UK) parents and carers views on the use of digital technology (i.e. computers/phones) in supporting their child and the potential for its greater use in the care of children with complex needs. Methods: An online survey was distributed via special schools and support forums/networks. Questions explored use of and attitudes to digital technology in the care of children with complex needs. Descriptive statistical analyses and content analyses were undertaken on the data. Results: Respondents were 43 parents/carers whose children used rehabilitation services prior to the COVID-19 pandemic. The majority used digital technology frequently to support their child and saw the potential for greater use in rehabilitation services – provided this was not at the expense of in-person therapist contact. Conclusion: Parents and carers held positive views of digital technology as a tool to support their child and enhance rehabilitation services. Recommendations include regular service consultation on parental/child attitudes to digital service delivery and longitudinal studies to assess related health outcomes. [ABSTRACT FROM AUTHOR]

Objective: This retrospective review documents the experience of ipratropium bromide use among pediatric patients with sialorrhea at our multidisciplinary sialorrhea clinic at Children's Hospital at London Health Sciences Centre (LHSC). Methods: A retrospective chart review of patients diagnosed with sialorrhea at our multidisciplinary clinic between January 2015 and June 2021 was completed. Data on patient demographics, comorbidities, clinical presentation, previous interventions, quality of life, and medication adverse side effects was collected. Drooling Frequency and Severity Scale (DFSS) scores were reviewed to compare sialorrhea management pre- and post-treatment with topical 0.03% ipratropium bromide nasal solution. A descriptive analysis and Wilcoxon signed rank tests were conducted to compare pre- versus post-treatment DFSS scores. Results: A total of 12 patients presented for follow-up and were included in the final analysis. At the pre-treatment visit, the median DFSS score was 4 for frequency and 5 for severity. Post-treatment, median DFSS score was 3 for frequency and 4.5 for severity, (P =.020 and.129, respectively). Minimal adverse effects were encountered. Conclusions: Ipratropium bromide provided a statistically significant benefit for drooling frequency in the patients studied and may present an additional topical medical option for pediatric sialorrhea with limited adverse effects. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this clinical audit was to assess patient demographics, outcomes and experience with care in patients who received acupuncture in a private practice setting in the United Kingdom. Methods: Demographic and clinical data were extracted from patients' records over a 7-year period. The Measure Yourself Medical Outcomes Profile (MYMOP) questionnaire and an adapted Patient Global Impression of Change (PGIC) scale were used routinely to monitor patient outcomes over an 18-month period. Finally, a retrospective questionnaire was used to assess patient beliefs regarding treatment effectiveness, adverse events and overall experience with care. Patients not providing consent or known to be deceased were excluded. Results: Data were collected for 306 patients presenting with 376 separate health complaints, 58% of which were musculoskeletal. Follow-up outcomes (MYMOP scores (n = 51) and PGIC scale responses (n = 50)) showed a clinically significant improvement compared to baseline for the majority of health complaints (93% of PGIC scores were 'improved' and 79% MYMOP demonstrated > 1 point change). Total mean MYMOP severity scores were reduced by almost 50% (p < 0.001) after 1–4 weeks, and this was sustained in the medium-to-long term. There was a strong negative correlation (r = −0.767, p < 0.001) between the MYMOP and PGIC scores. A total of 118 health complaints were reported by 85/255 patients who responded to a retrospective questionnaire. Over 84% of patients believed that the treatments they received were 'effective' at addressing their health complaints. Seven minor adverse events were reported and four patients experienced negative treatment outcomes. Conclusions: Although musculoskeletal conditions were the most common, this audit found that patients sought treatment for a wide range of predominantly chronic health complaints, for many of which there is a currently a lack of quality evidence to support the use of acupuncture. Overall, the small sample of patients who responded to outcome questionnaires reported clinically meaningful and sustained improvements. [ABSTRACT FROM AUTHOR]

Positive effects of Positive Behavior Intervention and Supports (PBIS) frameworks have been reported in juvenile justice facilities but have not yet been extended to adult prisons. As part of initial PBIS development in a large prison in the United Kingdom, this study utilized focus groups to investigate the valued outcomes considered most important to prison officers and prisoners. We found that although prisoners and staff largely shared the same values, there were meaningful differences in their relative priorities, reflecting the disparate roles that each play in the functioning of the prison. Focus groups also revealed possible contextual barriers to PBIS implementation in this setting. We conclude that input from both parties is essential in designing values-based support strategies that are aligned across key stakeholders. We discuss how focus groups might inform PBIS intervention planning and how our findings point to specific research gaps in applying PBIS in adult prisons. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and associated public health 'stay at home' restrictions have intensified familial risk factors. Children would appear to be at increased risk of harm and abuse, yet administrative data from the early months of the pandemic showed falling cases of child maltreatment. Using weekly administrative data from Scotland, UK that span the first 17 months of the pandemic, this article found that child maltreatment activity levels fluctuated as 'stay at home' restrictions changed. During lockdown periods, the number of children subject to Inter-agency Referral Discussion fell but a higher number of children were placed on the Child Protection Register. When restrictions were eased, the number of Inter-agency Referral Discussions increased but the number of children placed on the Child Protection Register fell. To explain the fluctuations, the article asserts that the pandemic's impact on services' ability to engage directly with children and families has been critical, but the limitations of administrative data in providing an accurate measure of child maltreatment levels also need to be recognised. The article advocates that analysis of administrative data is best done in tandem with wider quantitative and qualitative sources in order to understand the impact of crisis events on children and families. [ABSTRACT FROM AUTHOR]

Background: The Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD) is an 18-item measure which provides a structured and standardized approach to rating various clinical and psychosocial outcomes and has been in use nationally since 2002. Aims: To revise and improve the HoNOS-LD's utility in contemporary intellectual disability (ID) services whilst retaining its original objectives and five-point severity ratings. Method: ID clinicians were invited to complete an online survey, rating each item on the existing measure for being fit for purpose, identifying issues and suggesting improvements based on their experience of using the HoNOS-LD in practice. Scales were then assessed and revised sequentially; survey responses were used to inform discussion and revisions to the HoNOS-LD by the Advisory Board. Results: A total of 75 individuals replied. Respondents had used HoNOS-LD for an average of 8.0 years (S.D. 5.28 years) and 88% found the scale to be useful in their practice. On average, respondents used HoNOS-LD ratings to inform care 42.4% of the time (S.D. 33.5%). For each scale there was a significant negative correlation between the percentage of positive/very positive respondent ratings and the number of changes proposed. Common changes included simplifying terms, reducing ambiguity and replacing anachronistic language. Conclusion: The changes outlined in this paper are based on the advisory group's expert consensus. These changes are intended to improve reliability and validity but now need empirical testing as well as review by service users. [ABSTRACT FROM AUTHOR]

Background: Despite the use of care bundles, ventilator associated pneumonia (VAP) remains a frequently occurring health care-associated infection, increasing costs, length of stay (LOS) and mortality. The incidence is higher amongst trauma patients, although due to variable definitions and study populations risk factors for developing VAP are disputed, with few reports from the UK. Methods: This 6-year review of intubated trauma patients admitted to the general Intensive Care Unit (ICU) of a UK major trauma centre, collected data on suspected risk factors for VAP, as well as demographic information, outcomes and microbiology. Ninety-nine patients who developed VAP within the first 7 days of admission were compared with 191 patient who did not, with multivariable logistic regression used to control for confounding variables. Results: Univariable analysis suggested that injury severity score (ISS) (34 v 29), head injury (66.7% v 50.8%), polytrauma (79.8% v 68.1%) and ventilator days (10 v 5) were associated with increased risk of VAP, but after adjustment only ventilator days remained significant (OR 1.04, 95% CI 1.01–1.06). Antibiotics within 24 h of admission were associated with reduced odds of developing VAP, whether this was for pulmonary prophylaxis (OR 0.43, 95% CI 0.22–0.83, p = 0.013) or non-pulmonary reasons (OR 0.27, 95% CI 0.15–0.51, p < 0.001). Conclusions: Only increasing ventilator days was associated with increased odds of developing VAP. The use of early antimicrobials was associated strongly with a reduction in the odds of developing VAP; this could be explained by unmeasured confounding or a prophylactic effect against aspiration. [ABSTRACT FROM AUTHOR]

For decades, researchers and providers of adult-directed early behavioral intervention services have made conceptual arguments linking the receipt of such services to improvements in family and family member quality of life. To date, there has not been a review of the literature to empirically evaluate this claim. Therefore, we conducted a systematic review and identified 15 studies contributing 40 effect sizes to evaluate the relationship between the receipt of early behavioral intervention and family quality of life. Our analyses did not detect that there was a robust and meaningful difference in the quality of life of families with a child that did and did not receive early behavioral intervention. Considerations to inform future research are presented; and implications are discussed with respect to parents, pediatricians, providers, and those involved in the public dissemination of evidence-based treatments for individuals with autism. [ABSTRACT FROM AUTHOR]

Background: Reiki is a biofield therapy which is based on the explanatory model that the fields of energy and information of living systems can be influenced to promote relaxation and stimulate a healing response. Objective: To conduct a pragmatic within-subject pilot trial of a remote Reiki program for frontline healthcare workers' health-related symptoms during the COVID-19 pandemic. Methods: Healthcare professionals in the UK (eg, physicians, nurses, and paramedics) were eligible to sign up for a distance Reiki program and were also invited to participate in the research study. Eight Reiki practitioners simultaneously gave each participant Reiki remotely for 20 minutes on 4 consecutive days. Feasibility of the research was assessed, including recruitment, data completeness, acceptability and intervention fidelity, and preliminary evaluation of changes in outcome measures. Participants' stress, anxiety, pain, wellbeing, and sleep quality were evaluated with 7-point numerical rating scales. Measures were completed when signing up to receive Reiki (pre) and following the final Reiki session (post). Pre and post data were analyzed using Wilcoxon signed ranks tests. Results: Seventy-nine healthcare professionals signed up to receive Reiki and took the baseline measures. Of those, 40 completed post-measures after the 4-day intervention and were therefore included in the pre-post analysis. Most participants were female (97.5%), and the mean age was 43.9 years old (standard deviations = 11.2). The study was feasible to conduct, with satisfactory recruitment, data completeness, acceptability, and fidelity. Wilcoxon signed ranks tests revealed statistically significant decreases in stress (M = −2.33; P <.001), anxiety (M = −2.79; P <.001) and pain (M = −.79; P <.001), and significant increases in wellbeing (M = −1.79; P <.001) and sleep quality (M = −1.33; P =.019). Conclusions: The Reiki program was feasible and was associated with decreased stress, anxiety and pain, and increased wellbeing and sleep quality in frontline healthcare workers impacted by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Using data from a cross-national survey conducted on representative samples of populations from 10 European countries (n = 10,766), the present study is the first one to empirically measure the validity of Christie's influential ideal victim model. We use a range of scenarios built around common types of anti-LGBT violence to verify the extent to which the public's empathy for victims is contingent on the victim's identity and the circumstances of the crime. The results provide strong evidence that, when applied to this group of victims, the rules of the ideal victim work, adequately moderating the public's emotional reactions. We found that all victims receive relatively high levels of empathy, but the further the victim is from the ideal, the less support they can count on. Thus, even though no victim is "rejected," a clear hierarchy of victimization emerges. As a group, LGBT people suffer from an empathy deficit, but there also are considerable variations within this group, with a lesbian attacked by extremists receiving the most, and a drunk transgender person receiving the least empathy from the public. The study contributes to the development of theory by embedding the ideal victim model in a broader sociological paradigm of dramaturgical analysis. Since our research shows that the victim's LGBT status decreases the levels of empathy (being seen as a type of stigma), we call for more attention to be paid to the actor's identity in Goffman's framework. Implications for practice and further research are offered. [ABSTRACT FROM AUTHOR]

Objective: CLEFT-Q is a condition-specific patient-reported outcome measure (PROM) for patients with cleft lip and/or palate (CL/P). The aim of this study was to examine the cross-sectional construct validity of the CLEFT-Q scales. Design: Construct validity was assessed through a prospective study that tested hypotheses regarding correlations of scores with other PROMs that measure related constructs. Setting: Seven cleft centres in Canada, the USA, and UK were involved. Patients/Participants: Patients were aged eight to 29 years with CL/P. Interventions: Before undergoing rhinoplasty, orthognathic, cleft lip scar revision, and alveolar bone graft, participants were asked to complete the following PROMs: CLEFT-Q (9 scales), Child Oral Health Impact Profile (socio-emotional subscale) and Cleft Hearing Appearance and Speech Questionnaire (features 1 subscale). Main Outcome Measure(s): The correlation coefficients examining the relationship between the scales were the main outcome measures. Correlations (Spearman) were calculated and interpreted as follows: <0.3 weak, 0.30 to 0.50 moderate, ≥0.50 strong. Results: Participants (n = 177) were mostly male (61%) and aged between eight and 11 years (42%). Overall, 38 of 52 (73%) hypotheses tested were supported. More specifically, 20 of 26 (77%) hypotheses about correlations between the appearance scales were supported, two of three (67%) hypotheses about correlations between the health-related quality of life scales were supported, and 16 of 23 (70%) hypotheses about correlations between the appearance and health-related quality of life scales were supported. Conclusions: Cross-sectional construct validity of the CLEFT-Q scales adds further evidence of the psychometric properties of this instrument. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Objectives: Abdominal aortic aneurysm ultrasound surveillance varies between hospitals in the United Kingdom. University Hospitals Bristol and Weston adopt a 6-monthly surveillance interval for 4.5–4.9 cm abdominal aortic aneurysm, which is a deviation from nationally recommended 3-monthly intervals. Assessment of abdominal aortic aneurysm growth rate, and the concurrent impact of abdominal aortic aneurysm risk factors and medications prescribed for risk factors, may inform whether this change in surveillance intervals is safe and appropriate. Methods: This analysis was conducted retrospectively. A total of 1312 abdominal aortic aneurysm ultrasound scans from 315 patients between January 2015 and March 2020 were split into 0.5 cm groups, ranging from 3.0 to 5.5 cm. Abdominal aortic aneurysm growth rate was assessed with one-way analysis of variance. The impact of risk factors and risk factor medication on abdominal aortic aneurysm growth rate was analysed using multivariate and univariate linear regression and Kruskal–Wallis tests. Patient cause of death among surveillance patients was recorded. Results: Abdominal aortic aneurysm growth rate was significantly associated with increased abdominal aortic aneurysm diameter (p < 0.001). There was a significant whole-group reduction in growth rate from 0.29 to 0.19 cm/year in diabetics compared to non-diabetics (p = 0.02), supported by univariate linear regression (p = 0.04). In addition, gliclazide patients had lower growth rate compared to patients not on the medication (p = 0.04). One abdominal aortic aneurysm rupture occurred <5.5 cm resulting in death. Conclusion: Abdominal aortic aneurysm measuring 4.5–4.9 cm had a mean growth rate of 0.3 cm/year (± 0.18 cm/year). Therefore, mean growth rate and variability suggest patients are unlikely to surpass surgical threshold of 5.5 cm between the 6-monthly surveillance scans, supported by low rupture rates. This suggests the surveillance interval for 4.5–4.9 cm abdominal aortic aneurysm is a safe and appropriate deviation from national guidance. In addition, it may be pertinent to consider diabetic status when designing surveillance intervals. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic placed additional demands and stressors on UK obstetric sonographers, who were required to balance parent safety and service quality, alongside staff safety. Increased pressure can negatively impact a healthcare worker's well-being and the provision of person-centred care. The aim of this study was to explore obstetric sonographers' experiences of performing pregnancy ultrasound scans during the pandemic and to assess the impact on burnout, role satisfaction and clinical practice. Methods: An online, anonymous cross-sectional survey was created to capture sonographers' experience alongside using the Oldenburg Burnout Inventory to evaluate burnout and Clinical Outcomes in Routine Evaluation 10 (CORE-10) to measure psychological distress. Results: Responses were received from 138 sonographers. Of those completing the Oldenburg Burnout Inventory (n = 89), 92.1% and 91.0% met the burnout thresholds for exhaustion and disengagement, respectively. Sonographers with a higher burnout score also perceived that COVID-19 had a greater, negative impact on their practice (p < 0.05). The mean CORE-10 score of 14.39 (standard deviation = 7.99) suggests mild psychological distress among respondents. A significant decrease in role satisfaction was reported from before to during the pandemic (p < 0.001), which was associated with higher scores for burnout and psychological distress (p < 0.001). Change in role satisfaction was correlated with sonographers' perception of safety while scanning during the pandemic (R 2 = 0.148, p < 0.001). Sixty-five sonographers (73.9%) reported they were considering leaving the profession, changing their area of practice or working hours within the next 5 years. Conclusion: Job and context-specific interventions are required to mitigate burnout and its consequences on the workforce and service provision beyond the pandemic. [ABSTRACT FROM AUTHOR]

We investigated whether expression of social meaning operationalized as individual gender identitity and politeness moderated pitch range in the two languages of female and male Japanese-English sequential bilinguals. The bilinguals were resident in either London (UK) or Tokyo (Japan) and read sentences to imagined addressees who varied in formality and sex. Results indicated significant differences in the pitch range of the two languages of the bilinguals, and this was confirmed for female and male bilinguals in London and Tokyo, with the language differences being more extreme in the London bilinguals than in the Tokyo bilinguals. Interestingly, self-attribution of masculine gender traits patterned with within-language variation in the English pitch level of the female bilinguals, whereas self-attribution of feminine gender traits patterned with within-language variation in the English pitch level of the male bilinguals. In addition, female and male bilinguals significantly varied their pitch range in Japanese, but not in English, as a function of the imagined addressees. Findings confirmed that bilinguals produce pitch range differently in their languages and suggest that expression of social meaning may affect pitch range of the two languages of female and male bilinguals differently. [ABSTRACT FROM AUTHOR]

Sexual harassment and other forms of gendered discrimination are social psychological phenomena, yet the psychological impact of sexual harassment has rarely been examined through a model which considers the role of diverse content of gender identity (i.e. norms). We used an experimental design to investigate how salient norms associated with the social identity of 'women' affect coping with sexual harassment. Participants who identified as women (N = 291) were randomly assigned to either a feminist, traditional feminine, or control norm condition, in which the salience of particular norms associated with womanhood was manipulated. Participants completed measures of personal growth (as a proxy for post-traumatic growth), and help-seeking intentions in response to a hypothetical sexual harassment scenario. Participants in the feminist condition reported significantly greater personal growth relative to those in the traditional feminine and control conditions. Participants in both the feminist and traditional feminine conditions reported significantly greater intentions to seek help from formal supports (e.g. primary care doctor), relative to those in the control condition. The findings suggest that the salience of social identities and their content may be valuable resources in promoting recovery following experiences of gendered discrimination and support the role of social identities in influencing post-trauma trajectories. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that anterolateral procedures can reduce the risk of rerupture in high-risk recreational athletes undergoing primary anterior cruciate ligament (ACL) reconstruction (ACLR). However, this effectiveness has never been evaluated in elite athletes. Purpose: The purpose of this study was to evaluate the effectiveness of lateral extra-articular tenodesis (LET) in reducing revision rates in primary ACLR in elite athletes. Additionally, this study evaluated whether LET had a greater effect when combined with ACLR utilizing a hamstring or patellar tendon graft. Study Design: Cohort study; Level of evidence, 3. Methods: A consecutive cohort of elite athletes with an isolated ACL tear undergoing autograft patellar or hamstring tendon reconstruction with or without Lemaire LET were analyzed between 2005 and 2018. A minimum 2-year follow-up was required. The association between the use of LET and ACL graft failure as defined by revision ACLR was evaluated with univariate and multivariate logistic regression models. Results: A total of 455 elite athletes (83% men and overall age 22.5 ± 4.7 years) underwent primary ACLR with (n = 117) or without (n = 338) a LET procedure. Overall, 36 athletes (7.9%) experienced ACL graft failure, including 32 (9.5%) reconstructions without a LET and 4 (3.4%) with a LET. Utilization of LET during primary ACLR reduced the risk of graft failure by 2.8 times, with 16.5 athletes needing LET to prevent a single ACL graft failure. Multivariate models showed that LET significantly reduced the risk of graft rupture (relative risk = 0.325; P =.029) as compared with ACLR alone after controlling for sex and age at ACLR. Including graft type in the model did not significantly change the risk profile, and although a patellar tendon graft had a slightly lower risk of failure, this was not statistically significant (P =.466). Conclusion: The addition of LET reduced the risk of undergoing revision by 2.8 times in elite athletes undergoing primary ACLR. This risk reduction did not differ significantly between the patellar tendon and hamstring tendon autografts. With these results, status as an elite athlete should be included in the indications for a LET, as they are at increased risk for ACL graft failure. [ABSTRACT FROM AUTHOR]

Introduction: The introduction of the COVID-19 lockdown and social distancing policy has the potential to restrict access to physical activity, change exercise behavior, and to increase sedentary behavior. This study was conducted with the support of British Blind Sport and evaluates the effect of the lockdown policy on adults with visual impairments in the United Kingdom (UK). Methods: An online survey based on the World Health Organization's Global Physical Activity Questionnaire was completed by 73 participants (median age 35–44 years, 59% female) to gain information on how the implementation of the lockdown policy by the UK government has affected physical activity and sedentary behavior in adults that are visually impaired. Paired sample t-tests and Wilcoxon signed rank tests were used to analyze continuous and Likert scale data, respectively. Results: The majority of participants continued to exercise during lockdown, but the nature of this activity altered with a significant change to exercising in a private indoor space (+190% (always), z = −3.871, p < 0.001), and those exercising alone (+118% (always), z = −2.595, p = 0.009). The volume of activity reduced in all cases, between −11% and −52%, with significant changes in duration of vigorous day-to-day activity, moderate day-to-day activity, travel by foot or cycle, and vigorous recreational activity. Sedentary behavior increased on average by 21% (t (59) = −2.050, p = 0.045), with a greater effect seen in females (+36%, t (35) = −2.525, p = 0.016). Discussion: Reductions in physical activity volume and increases in sedentary behavior are consequences of the UK lockdown for those with visual impairments. The health and well-being implications of these data to this specific population are of particular concern. Implications for Practitioners: Lockdown measures should be designed with consideration of the needs of people with disabilities. Innovative ways to engage these populations in physical activity are strongly encouraged. [ABSTRACT FROM AUTHOR]

Introduction: Model of Human and Occupational Screening Tool (MOHOST) is a scale used to assess occupational functioning in mental health inpatients which can inform suitable post-discharge placements. However, there is little research on the relationship between scores on Motivation for Occupation (MO) and Pattern of Occupation (PO) subscales of the MOHOST and types of discharge placement. Method: The records of all patients discharged over a 2-year period from a male psychiatric rehabilitation unit were examined. All patients had undergone MOHOST assessments; however, these scores were not a factor in their discharge placement selection. Analyses were done on types of discharge placements (transfer to another psychiatric unit or community discharge) versus predischarge scores in MO and PO of MOHOST. Results: N = 20 and average length of stay was 23 months. There was positive correlation between MO and PO scores and discharge placements (rs = 0.66, p = 0.002; rs = 0.67 and p = 0.001, respectively). Using ordinal logistic regression, for each unit increase of negative score in PO, there was 0.68 increase in the log odds of more restrictive discharge placements, p = 0.008. Conclusion: The study suggests that MOHOST is a useful tool in determining suitable placements for patients being discharged or transferred from psychiatric rehabilitation units. [ABSTRACT FROM AUTHOR]

This study examined the psychometric properties of the Ego Resiliency Scale-Revised (ER89-R). Though support exists for a multidimensional conceptualisation using classical test theory approaches (i.e., a higher-order model comprising Openness to Life Experiences and Optimal Regulation factors), this measure has not been subjected to Rasch analysis. Accordingly, this paper evaluated the higher-order model via confirmatory factor analysis (CFA) before assessing Openness to Life Experiences and Optimal Regulation components using Rasch analysis. CFA, using a general population sample (N = 2009), supported the higher-order factor structure. Openness to Life Experiences and Optimal Regulation scales met Rasch model assumptions. Specifically, good item/person fit and item/person reliability, and evidence of unidimensionality. Moreover, most items displayed gender invariance. Overall, findings supported the higher-order conceptualisation of the ER89-R, and indicated that the Openness to Life Experiences and Optimal Regulation scales are relatively useful measures of ego resiliency components in a general population sample. [ABSTRACT FROM AUTHOR]

Previous research has explored offline intimate partner violence from an evolutionary perspective, primarily focusing on the role of individual differences in perpetration and victimization. However, a current form of intimate partner violence is digital dating abuse, which involves abuse toward a romantic partner, occuring online through the use of electronic communication technology. This form of abuse differs from offline abuse, in that physical proximity is not required. Although research has focused on the effects digital dating abuse has on victims, little research has focused on the perpetration of digital dating abuse. This is important as research focused on perpetration can inform a wide range of initiatives geared toward understanding the factors which drive this behavior. Recent research has focused on evolutionary mating-relevant factors that drive the perpetration of digital dating abuse. Here, we extended and replicated previous work by reporting two studies (study 1, n = 114; study 2, n = 162) which explored the roles of mate value discrepancy, intrasexual competition, and relationship-contingent self-esteem in the perpetration of digital dating abuse. We found that mate value discrepancy (studies 1 and 2) and intrasexual competition (study 2) positively predicted the perpetration of digital dating abuse. To our knowledge, this article is the first to provide support that those who report high intrasexual competition, engage in greater levels of digital dating abuse, thus furthering theoretical advancements in this field by showing digital dating abuse is a mate retention tactic. Our findings further our understanding of online behavior in romantic relationships through an evolutionary psychological lens. [ABSTRACT FROM AUTHOR]

Introduction: The periods of lockdown during 2020 led to changes in daily occupations. As participation relies on dynamic interactions between the person, his/her occupations and his/her environment, we wondered whether people from different generations shared the same perception of occupational disruptions during the lockdown. Methods: We performed an online survey based on the Canadian Occupational Performance Measure (COPM) of adults in 27 European Union countries, the United Kingdom and Switzerland. Three groups were compared: young adults (YAs, aged 18–39), middle-aged adults (MAs, aged 40–59) and older adults (OAs, aged 60 and over). Results: 2865 participants (YAs: 47%; MAs: 33%; OAs: 20%) reported a total of 6549 disrupted occupations. The most frequently disrupted domain was leisure (83%), followed by productivity (16%) and self-care (2%); there were no significant intergroup differences (p = 0.18). In a multivariate analysis, socializing disruptions were more likely to be associated with younger age (adjusted odds ratio (OR) [95% confidence interval (CI)] = 0.62 [0.50–0.76] for YAs versus MAs and 0.46 [0.30–0.71] for YAs versus OAs. Conclusion: With the exception of socializing, the main disrupted occupations were similar from one generation to another. Our findings might enable the more accurate assessment of the risk of occupational disruption in a restrictive environment. [ABSTRACT FROM AUTHOR]

Rape is a serious concern globally. Past research has identified Ambivalent Sexism (AS), Rape Myth Acceptance (RMA), and the victim–perpetrator relationship as key constructs influencing rape blame attributions and rape proclivity. Limitations with methodologies have, however, limited the practical implications of past research, particularly in the context of underpowered samples and a lack of transparency in vignette development and implementation. In the current research, three studies aimed to validate material to be used in research into rape perceptions and to examine the impact of victim–perpetrator relationship, AS, and RMA on victim and perpetrator culpability, and rape proclivity, using an experimental design. On 563 participants, this research developed and validated six rape vignettes which accounted for methodological limitations of past research (Study One) and were found to be believable and realistic by participants; it further found that aggressively sexist attitudes were associated with increased victim culpability and decreased perpetrator culpability (Study Two), and increased rape proclivity (Study Three). Scenarios of a casual acquaintance produced the highest levels of victim culpability and the lowest levels of perpetrator culpability. Victims were ascribed more control than blame, or responsibility. Men reported the highest levels of rape proclivity in scenarios of casual acquaintance, and intimate partner relationships. Contrary to past research, Benevolent Sexism (BS) did not directly impact attributions in rape cases but may maintain and legitimize the attitudes, which do. As some of our findings contradict past research, we suggest that the need for standardized rape vignettes is evident, along with greater transparency and methodological rigor in sexual assault research, as this will improve the practical implications of findings. Reproducible research practices may be useful for this. While limited in diversity, this research has important implications for policy and research practice, particularly in producing validated material that can be reused by future researchers. [ABSTRACT FROM AUTHOR]

This study assessed physical activity (PA) and wellbeing during lockdown. UK adults reported their PA in the previous week, perception of PA importance (more, less, same) and wellbeing, depression, anxiety and stress. One-way ANOVA compared PA and wellbeing by PA importance. The 'less' importance group did less PA than the 'more' and 'same' (p < 0.05) importance group; and scored worse on all wellbeing measures than the 'same' importance group (p < 0.01). They also had worse wellbeing, depression and anxiety than the 'more' importance group (p < 0.05). Strategies to overcome the impact of the pandemic should aim to increase PA. [ABSTRACT FROM AUTHOR]

Enhancing Audio Description is a research project that explores how sound design, first-person narration, and binaural audio could be utilised to provide accessible versions of films for visually impaired audiences, presenting an alternative to current audio description (AD) practices. This article explores such techniques in the context of the redesign of the short film 'Pearl', by discussing the creative process as well as evaluating the feedback supplied by visually impaired audiences. The research presented in this article demonstrates that the methods proposed were as successful as traditional AD in terms of providing information, enjoyment, and accessibility to audiences, demonstrating that both practices can coexist and, as a result, cater for the different stylistic preferences of end users. [ABSTRACT FROM AUTHOR]

This article reports on a U.K. research study encompassing two surveys which used evidence-based scales of awareness, confidence to intervene, and intervention opportunities and action regarding sexual and domestic abuse on campus. They were sent to all first-year incoming undergraduates (> n = 7,000) at one post-1992 U.K. university and received n = 1,604 responses. The study finds that survey respondents demonstrated low awareness of sexual and domestic abuse as a problem on campus. In the analysis of Survey 2, respondents were divided into three groups, those receiving active intervention, passive intervention, and no intervention from a university social norms marketing campaign challenging abuse on campus. The study drives the field forward by considering how confidence to act mediates the relationship between awareness and positive action. It finds associations between active intervention and raised awareness that is not noted in passive or no intervention. Active intervention potentially brings together the mediating variable of confidence where awareness + confidence = positive action. This article makes recommendations for first-year incoming undergraduates to receive awareness raising information about sexual and domestic abuse, prior to coming to university. Universities may also consider working with schools to counter a lack of awareness, which may emanate from normalization discourses learnt prior to coming to university and perpetuated once there. Managing low awareness of sexual and domestic abuse should be a priority of bystander programs and some form of active intervention is potentially beneficial as early as possible in university student journeys. [ABSTRACT FROM AUTHOR]

Objective: To report speech outcomes following Orticochea pharyngoplasty in 43 patients with cleft palate and noncleft velopharyngeal dysfunction. Design: A retrospective surgical audit of patients undergoing Orticochea pharyngoplasty between 2004 and 2012, with speech as a primary outcome measure. Setting: Patients known to a regional UK cleft center. Methods: Forty-three patients underwent Orticochea pharyngoplasty by a single surgeon in a UK regional cleft center. Twenty-one patients had undergone a prior procedure for velopharyngeal dysfunction. Pre- and postoperative speech samples were assessed blindly using the Cleft Audit Protocol for Speech-Augmented by a specialist cleft speech and language therapist, external to the team. Speech samples were rated on the following parameters: hypernasality, hyponasality, audible nasal emission, nasal, turbulence, and passive cleft speech characteristics. Statistical differences in pre- and postoperative speech scores were tested using the Wilcoxon matched-pairs signed-ranks test. Inter- and intrareliability scores were calculated using weighted Cohen κ. Results: Whole group: A statistically significant difference in pre- and postoperative scores for hypernasality (P <.001), hyponasality (P <.05), nasal emission (P <.01), and passive cleft speech characteristics (P <.01) were reported. Patients with cleft diagnoses: A statistically significant difference in scores for hypernasality (P <.001), nasal emission (P <.01), and passive cleft speech characteristics (P <.01) were reported for this group of patients. Patients with noncleft diagnoses: The only parameter to demonstrate a statistically significant difference was hypernasality (P <.01) in this group. Conclusions: Orticochea pharyngoplasty is a successful surgical procedure in treating velopharyngeal dysfunction in both the cleft and noncleft populations. [ABSTRACT FROM AUTHOR]

Background: The Surprise Question ('Would I be surprised if this patient died within 12 months?') identifies patients in the last year of life. It is unclear if 'surprised' means the same for each clinician, and whether their responses are internally consistent. Aim: To determine the consistency with which the Surprise Question is used. Design: A cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries ('vignettes'). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]–100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently 'no') and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213. Setting/participants: Registered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes. Results: Participants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries (p = 0.002). There was also a difference in threshold levels depending on age of clinician, for every yearly increase, participants had a higher threshold. There was no difference in inconsistency between countries (p = 0.53). Conclusions: There is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Successful adoption of POCTs (Point-of-Care tests) for COVID-19 in care homes requires the identification of ideal use cases and a full understanding of the contextual and usability factors that affect test results and minimise biosafety risks. This paper presents a scoping-usability and test performance study of a microfluidic immunofluorescence assay for COVID-19 in care homes. Methods: A mixed-methods evaluation was conducted in four UK care homes to scope usability and to assess the agreement with qRT-PCR. A dry run with luminescent dye was conducted to explore biosafety issues. Results: The agreement analysis was conducted on 227 asymptomatic participants (159 staff and 68 residents) and 14 symptomatic participants (5 staff and 9 residents). Asymptomatic specimens showed 50% (95% CI:1.3%−98.7%) positive agreement and 96% (95% CI: 92.5%−98.1%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.911 (95% CI: 0.857−0.965). Symptomatic specimens showed 83.3% (95% CI: 35.9%−99.6%) positive agreement and 100% (95% CI: 63.1%−100%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.857 (95% CI: 0.549−1). The dry run highlighted four main sources of contamination that led to the modification of the standard operating procedures. Simulation post-modification showed no further evidence of contamination. Conclusion: Careful consideration of biosafety issues and contextual factors associated with care home are mandatory for safe use the POCT. Whilst POCT may have some utility for ruling out COVID-19, further diagnostic accuracy evaluations are needed to promote effective adoption. [ABSTRACT FROM AUTHOR]

The term "apostate" describes the term used by the religious to describe individuals raised within religious families who once identified as religious, but who have ceased to believe in the existence of God, gods or follow their religious belief, and now identify as non-religious. Given the strong feelings families can have about the rejection of their shared faith, and the difficulty that police forces may have in identifying and understanding the complexities of violence toward the apostate, this study sought to examine the possibility that apostates represent a hidden population of abuse victims within religious households. We recruited 228 persons (102 males, 119 females) from an online survey with the support of "Faith to Faithless"—a service within Humanists UK, which supports people that leave their religious faith. Individuals were screened using a modified version of the Conflict Tactics Scale to quantify their experience of assault and negotiation. It was found that persons who identified as apostates experienced more assault (i.e., harmful violence) than non-religious persons. Within this sample, Muslim apostates were significantly more likely to be victimized than Christian apostates. Disclosure of being abused for identifying as an apostate within a religious household to law enforcement was extremely uncommon, thereby preventing detection or prosecution of abusive acts committed by family members and limiting public awareness of this issue. These results are discussed in the context of the broader culture of honor-based (izzat) violence, which occurs across the Eastern Mediterranean, Middle East, and North Africa, and is also seen in some Protestant Christian subcultures, and common to all Abrahamic religions, rather than Islam alone. This study highlights that within a multicultural society, there remain hidden populations of abuse victims who are vulnerable due to religious, cultural, and traditional constraints made by abusive family members. [ABSTRACT FROM AUTHOR]

Offender profiling follows the idea that if offenders' crime scene actions can be empirically linked to their background characteristics, it will be possible to predict one from the other. There is a lack of research exploring whether homicide offenders' crime scene actions are predictive of their criminal histories, despite the potential utility of such information. The current study addresses this gap in the literature. A sample of 213 adult male-on-female homicides with sexual or unknown motive was drawn from a U.K.-wide database. Relationships between 13 preconviction variables and 29 crime scene behaviors were explored using a bivariate statistical approach. Subsequently, binary logistic regression models were used to predict the presence, or absence, of specific preconvictions based on a combination of offense behaviors. Analyses highlighted 16 statistically significant associations between key offense behaviors and previous convictions, these associations were often "less likely" to result in previous conviction. The analysis failed to find any association for various other variables, most notably sexual preconvictions. Results indicate offenders' criminal histories can be predicted from their offense behaviors, though not all preconvictions may be similarly suited. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Introduction: The clinical benefits of 24-hour postural management are widely recognised by occupational therapists, but little is known about its impact on service users and carers or whether clinical practice is consistent across regions. The aim of this research was to investigate the use of 24-hour postural management by occupational therapists and to explore its impact on service users with neurodisability and their carers. Methods: Quantitative and qualitative methods were employed in two phases: (a) online survey with 96 occupational therapists across one UK region, with data analysed by descriptive statistics and correlations; (b) focus groups with service users and/or carers (n = 9), with data analysed by thematic analysis. Results: Findings showed moderate positive correlation between frequency of use and (a) all key intervention skills and (b) knowledge of night-time positioning (p < 0.001). Moderate positive correlations were found between level of training and (a) assessment skills and (b) knowledge of night-time positioning (p < 0.001). The overarching theme from focus groups was 'reliance on individualised equipment', with overwhelming frustration from lack of support, loss of identity, equipment cost, insufficient focus on preventative strategies and accessibility issues. Conclusion: A clinical practice guideline, including training, is crucial to direct practice. Providers must engage with service users and carers to address their frustrations. [ABSTRACT FROM AUTHOR]

Much of the literature on rape, victim blaming, and rape myth acceptance is focused on the United States, and there is a general dearth of such scholarly activity in other countries. This article offers insights on university students' perspectives in two new country contexts—India and the United Kingdom. A total of 693 students contributed to the data collection for this study. Rape myth acceptance was fairly low for both countries, however, students in India were more likely to endorse rape myths. Several demographic characteristics were significant for rape myth acceptance in each country. This study makes an important contribution to the extant literature to address paucity of knowledge and promote understandings to help develop country-specific and appropriate policy, practice, and education and awareness programs. In particular, the study provides novel comparative findings on rape myth acceptance in new country contexts to help advance academic thinking in this area of work. [ABSTRACT FROM AUTHOR]

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Background: Day care services support older people living with long-term conditions (LTC's). Aims: The aims of the study were to determine outcomes in terms of loneliness and health-related quality of life for older people with LTCs attending day care services in the United Kingdom. Methods: Newly referred older people with LTCs to day care services in North West of England and Wales were invited to participate. The EQ-5D-3L and De Jong Loneliness questionnaires were completed at recruitment, 6 and 12 weeks. Results: Ninty-four older people (64% female), age range 65–99 years; mean number of LTCs 4.3 (range: 2–9) were recruited. About 52% lived alone and 36% lived in one of the 20% most deprived local authorities in England and Wales. Outcomes over 12 weeks were comparable for paid, blended, and for volunteer-led services. Conclusion: Following the Covid-19 pandemic, it is increasingly urgent to support older people with LTCs who may have lost physical and cognitive function during lockdown and to support their recovery. Our study suggests that volunteers can provide services and complement the care provided by paid staff, freeing up resources and enabling increasing numbers of older people to be supported. [ABSTRACT FROM AUTHOR]

In the late nineteenth century, British anthropometrists attempted to normalize the practice of measuring bodies as they sought to collate data about the health and racial makeup of their fellow citizens. As the country's leading anthropometrists, Francis Galton and Charles Roberts worked to overcome suspicion about their motives and tried to establish the value of recording physical dimensions from their subjects' perspective. For Galton, the father of the eugenics movement, the attainment of objective self-knowledge figured alongside the ranking of one's physique and faculties against established norms. The competitive tests at Galton's anthropometric laboratory were meant to help subjects identify their strengths and weaknesses, ultimately revealing their level of eugenic fitness. Roberts, on the other hand, saw the particular value of anthropometric data in informing economic and social policy, but capitalized on parents' interest in their children's growth rates to encourage regular monitoring of their physical development. While both Galton and Roberts hoped that individuals would ultimately furnish experts with their anthropometric data to analyze, they both understood that the public would need to have explained the practical purposes of such studies and to familiarize themselves with their methods. This article argues that while anthropometry did not become a fully domestic practice in this period, it became a more visible one, paving the way for individuals to take an interest in metrical evaluations of their bodies in the coming years. [ABSTRACT FROM AUTHOR]

Previous work suggests that written text produced by university students with dyslexia is scored lower than that produced by their peers. The present study used a digital writing tablet to examine the writing process and the quality of text written by university students with dyslexia. Revision behavior during and after writing was also investigated. Thirty-two university students with dyslexia (mean age, 20 years), were compared with 32 typically developing (TD) students matched by age. Students composed a written text in response to an expository essay prompt. In line with previous research, students with dyslexia made a higher number of spelling errors and their essays were rated as poorer than TD students. However, students with dyslexia were comparable to their peers on measures of time spent writing, amount of text produced, and the temporal analyses (handwriting execution, pause times). Students with dyslexia made significantly more revisions to spelling during and after transcription than their peers, although other revision behavior was similar across groups. Explanations for the finding of poor writing quality are explored. Importantly, the findings suggest that continued support with spelling and writing is needed for university students with dyslexia. Instruction directed toward effective revision strategies may also prove useful. Limitations and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Comparative international data on patterns of inequality in child welfare interventions, for example, the proportion of children about whom there are substantiated child protection concerns or who are in out-of-home care, are far less developed than data about inequalities in health. Few countries collect reliable, comprehensive information and definitions, methods of data collection and analysis are rarely consistent. The four UK countries (England, Northern Ireland, Scotland and Wales) provide a potential 'natural experiment' for comparing intervention patterns. This study reports on a large quantitative, descriptive study focusing on children in contact with children's services on a single date in 2015. It found that children's chances of receiving a child protection intervention were related to family socio-economic circumstances, measured by neighbourhood deprivation, within all four countries. There was a strong social gradient which was significantly steeper in some countries than others. Ethnicity was another important factor underlying inequalities. While inequalities in patterns of intervention between the four countries were considerable, they did not mirror relative levels of deprivation in the child population. Inequalities in intervention rates result from a combination of demand and supply factors. The level and extent of inequity raise profound ethical, economic and practical challenges to those involved in child protection, the wider society and the state. [ABSTRACT FROM AUTHOR]

Objectives: To assess the inter-observer agreement amongst five observers of differing levels of expertise in applying the British Thyroid Association (2014) guidelines for ultrasound scoring of thyroid nodules (BTA-U score) in the management of thyroid cancer, and to assess the U-score diagnostic performance in predicting malignancy. Method: A total of 73 consecutive patients were included over a two-year period (July 2012 to July 2014), after referral to a tertiary head and neck oncology centre for ultrasound plus fine needle aspiration and cytology. Our five observers retrospectively and independently reviewed static ultrasound images on PACS and scored the thyroid nodules according to BTA-U classification. The observers were blinded to each other's scoring, cytology and histology results. Either the Kappa-statistic or intra-class correlation was used to assess the level of inter-observer agreement, plus agreement between the radiological and cytological diagnoses. The diagnostic performance of U-scoring for predicting final histological diagnosis was assessed with sensitivity, specificity, positive and negative predictive values. Results: A Kappa-value of 0.73 (95% CI: 0.68–0.77) confirmed substantial inter-observer agreement amongst the five observers. All 17 histology confirmed malignant nodules were correctly classified as potentially malignant by all observers. The sensitivity and negative predictive value of BTA-U score in detecting and predicting malignancy were 100%, whereas the specificity and positive predictive values were 34% and 32%, respectively. Conclusions: There is good inter-observer agreement in using the BTA-U score amongst different observers at differing levels of expertise. Adhering to BTA-U scoring can potentially achieve 100% sensitivity in selecting malignant nodules for sampling. [ABSTRACT FROM AUTHOR]

The NHS routinely evaluates the quality of life of patients receiving hip or knee replacement surgery using patient-reported outcome measures (PROMs), but some hospital completion rates are only 30%, restricting data usefulness. Statistics limit insights into how and why data are missing, so qualitative methods were used to explore this issue. Observation periods preceded semistructured interviews with 34 preoperative patients attending an orthopedic outpatient clinic. Interview themes covered: completion time/timing, orientation, setting, measures, and practicalities. Triangulated against observations, pragmatic barriers, and facilitators were considered. Refined themes included completion conditions, patient support, and national delivery. Simple improvements (e.g., quiet zone) could improve completion rates and reducing missing data. Reorganizing preoperative leaflets and their systematic distribution via standardized procedures could reassure patients, enhancing PROMs acceptance, while reducing inquiries and subsequent staff burden. Findings have implications for interpreting national statistics. They indicate that further debate about mandating preoperative PROMs is due. [ABSTRACT FROM AUTHOR]

Objective: To establish the prevalence of unmet need for spasticity management in care home residents in two counties of the United Kingdom. Design: Cross-sectional observational study with a six-month follow-up arm for participants with identified unmet needs. Setting: 22 care homes in Derbyshire and Nottinghamshire. Subjects: 60 care home residents with upper motor neuron syndrome–related spasticity. Interventions: No intervention. When unmet needs around spasticity management were identified, the participant's general practitioner was advised of these in writing. Main measures: Resistance to Passive Movement Scale to assess spasticity; recording of (a) the presence of factors which may aggravate spasticity, (b) potential complications of spasticity, (c) spasticity-related needs and (d) current interventions to manage spasticity. Two assessors judged the presence or absence of needs for spasticity management and whether these needs were met by current care. Results: Out of 60 participants, 14 had no spasticity-related needs; 46 had spasticity-related needs; 11 had needs which were being met by current care and 35 participants had spasticity-related needs at baseline which were not being met by their current care. These were most frequently related to the risk of contracture development or problems with skin hygiene or integrity in the upper limb. In total, 6 participants had one or more pressure sores and 35 participants had one or more established joint contractures. A total of 31 participants were available for follow-up. Informing general practitioners of unmet needs resulted in no change to spasticity management in 23/31 cases. Conclusion: Care home residents in this study had high levels of unmet need for spasticity management. [ABSTRACT FROM AUTHOR]

Oral language skills in childhood are known to predict literacy levels and academic performance. Identification of children's low-average oral language skills in school is challenging when clear criteria for developmental language disorder are not met. There are few studies of targeted, school-based oral language interventions for the older child. This study aimed to investigate the feasibility of implementing and evaluating a manualized language intervention (Talk Boost KS2) for children aged between 7 and 9 years who were identified as having low-average oral language skills, as delivered by trained teaching assistants in mainstream schools. Twenty-one UK mainstream primary schools each selected eight Year 3 (7–8-year-olds) and Year 4 (8–9-year-olds) children with low-average oral language skills. School staff received training in a new manualized intervention, Talk Boost KS2. Schools were allocated to an Active Intervention (AI) or a Waiting Control condition (WC) condition. The final sample consisted of 162 children of which 87 were allocated to the AI condition and 75 to the WC condition. Progress in favour of the intervention was found on teacher ratings of speech, language and communication needs and on a Learning Behaviours Checklist but not on standardized language or reading comprehension tests. Parents of AI children reported improvements in communication and language skills. Teaching staff reported significant increases in confidence and knowledge in managing children with low-average oral language skills as a result of being involved in the intervention. The findings are discussed in relation to the imperative to provide practical language intervention tools as well as training and support for education staff in order to support children with low-average oral language skills in mainstream schools. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine prevalence of pre-stroke frailty in acute stroke and describe validity of a Frailty Index–based assessment. Design: Cross-sectional. Setting: Single UK urban teaching hospital. Subjects: Consecutive acute stroke unit admissions, recruited in four waves (May 2016–August 2018). We performed the assessments within first week and attempted to include all admissions. Main measures: Our primary measure was a Frailty Index, based on cumulative disorders. A proportion of participants were also assessed with the 'Frail non-disabled' questionnaire. We evaluated concurrent validity of Frailty Index against variables associated with frailty in non-stroke populations. We described predictive validity of Frailty Index for stroke severity and delirium. We described convergent validity, quantifying agreement between frailty assessments and a measure of pre-stroke disability (modified Rankin Scale) using kappa statistics and correlations. Results: We included 546 patients. A Frailty Index–defined frailty syndrome was observed in 427 of 545 patients (78%), of whom, 151 (28%) had frank frailty and 276 (51%) were pre-frail. Phenotypic frailty was observed in 72 of 258 patients (28%). We demonstrated concurrent validity via significant associations with all variables (all p < 0.01). We demonstrated predictive validity for stroke severity and delirium (p < 0.01). Agreement between the frailty measures was poor (kappa = –0.06) and convergent validity was moderate (Frail non-disabled 'Cramer's V' = 0.25; modified Rankin Scale 'Cramer's V' = 0.47). Conclusion: Frailty is present in around one in four patients with acute stroke; if pre-frailty is included, then a frailty syndrome is seen in three out of four patients. The Frailty Index is a valid measure of frailty in stroke; however, there is little agreement between this scale and other measurements of frailty. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented, in which the editor discusses plans for the Research Methods Forum scheduled for November 2, 2010, political polls and official statistics in Great Britain, and all of the articles published within the issue.

Background: Suicide prevention literature currently suffers from inconsistent measurement and incomplete theoretical development. Aims: Using a recommended suicide measurement approach for epidemiological studies (i.e. the Suicidal Behaviors Questionnaire–Revised (SBQ-R)), the present investigation assessed United Kingdom young adult suicide prevalence rates. This study also investigated the utility of a Preferences in Information Processing (PIP) model of suicide in identifying those at increased odds for elevated suicide risk, as well as lifetime ideation and attempt. Method: A cross-sectional mental health and well-being survey study (n = 414) was conducted. Results: The prevalence rates of elevated risk (49.8%), lifetime ideation only (55.3%) and lifetime attempt (13.5%) were high. Bivariate associations demonstrated that elevated depression, anxiety and Need for Affect (NFA) Avoidance were associated with worsened suicide outcomes, whereas elevated Need for Cognition (NFC) was associated with decreased suicide risk. Logistic regression results identified depression and NFA Avoidance as the strongest predictors of elevated suicide risk. Multinomial logistic regression results established several PIP-based moderation effects for depression and anxiety in which NFA Approach and NFC differentially influenced odds of suicide attempt group membership. Conclusion: The SBQ-R is an appropriate tool for UK young adult suicide research. NFA and NFC demonstrated potential for inclusion in young adult suicide prevention programming. Further research is needed to fully evaluate the PIP model of suicide and effectiveness of proposed theory-based approaches to suicide prevention. [ABSTRACT FROM AUTHOR]

Most study samples show less variability in key variables than do their source populations due most often to indirect selection into study participation associated with a wide range of personal and circumstantial characteristics. Formulas exist to correct the distortions of population-level correlations created. Formula accuracy has been tested using simulated normally distributed data, but empirical data are rarely available for testing. We did so in a rare data set in which it was possible: the 6-Day Sample, a representative subsample of 1,208 from the Scottish Mental Survey 1947 of cognitive ability in 1936-born Scottish schoolchildren (70,805). 6-Day Sample participants completed a follow-up assessment in childhood and were re-recruited for study at age 77 years. We compared full 6-Day Sample correlations of early-life variables with those of the range-restricted correlations in the later-participating subsample, before and after adjustment for direct and indirect range restriction. Results differed, especially for two highly correlated cognitive tests; neither reproduced full-sample correlations well due to small deviations from normal distribution in skew and kurtosis. Maximum likelihood estimates did little better. To assess these results’ typicality, we simulated sample selection and made similar comparisons using the 42 cognitive ability tests administered to the Minnesota Study of Twins Reared Apart, with very similar results. We discuss problems in developing further adjustments to offset range-restriction distortions and possible approaches to solutions. [ABSTRACT FROM AUTHOR]

Background: Anterolateral complex injuries are becoming more recognized. While these are known to affect tibiofemoral mechanics, it is not known how they affect patellofemoral joint behavior. Purpose: To determine the effect of (1) sectioning the anterolateral complex and (2) performing a MacIntosh tenodesis under various conditions on patellofemoral contact mechanics and kinematics. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric knees were tested in a customized rig, with the femur fixed and tibia free to move, with optical tracking to record patellar kinematics and with thin pressure sensors to record patellofemoral contact pressures at 0°, 30°, 60°, and 90° of knee flexion. The quadriceps and iliotibial tract were loaded with 205 N throughout testing. Intact and anterolateral complex–sectioned states were tested, followed by 4 randomized tenodeses applying 20- and 80-N graft tension, each with the tibia in its neutral intact alignment or left free to rotate. Statistical analyses were undertaken with repeated measures analysis of variance, Bonferroni post hoc analysis, and paired samples t tests. Results: Patellar kinematics and contact pressures were not significantly altered after sectioning of the anterolateral complex (all: P > .05). Similarly, they were not significantly different from the intact knee in tenodeses performed when fixed tibial rotation was combined with 20- or 80-N graft tension (all: P > .05). However, grafts tensioned with 20 N and 80 N while the tibia was free hanging resulted in significant increases in lateral patellar tilt (P < .05), and significantly elevated lateral peak patellofemoral pressures (P < .05) were observed for 80 N. Conclusion: This work did not find that an anterolateral injury altered patellofemoral mechanics or kinematics, but adding a lateral tenodesis can elevate lateral contact pressures and induce lateral patellar tilting if the tibia is pulled into external rotation by the tenodesis. Although these in vitro changes were small and might not be relevant in a fully loaded knee, controlling the position of the tibia at graft fixation is effective in avoiding overconstraint at time zero in a lateral tenodesis. Clinical Relevance: Small changes in lateral patellar tilt and patellofemoral contact pressures were found at time zero with a MacIntosh tenodesis. These changes were eliminated when the tibia was held in neutral rotation at the time of graft fixation. The risk of overconstraint after a lateral tenodesis therefore seems low and in accordance with recent published reports. [ABSTRACT FROM AUTHOR]