Barr and Stroud (United Kingdom)

The low incidence of non-iatrogenic extremity vascular injuries in children, combined with the anatomical and physiological characteristics of children, poses challenges for diagnosis, operative treatment, and recovery. No national guidelines are available to inform the care of children with vascular injuries to the extremities. The objective of this concise report is to describe the incidence and contributing mechanisms of injury resulting in pediatric extremity vascular trauma and summarize currently cited approaches for management. English-language publications in PubMed and CINAHL that focus on extremity vascular injuries in children aged 0-17years were reviewed. Publications from 2014 to the present were prioritized; however, as relevant research remains sparse, sentinel papers published before 2014 were also reviewed. Bibliographies from retrieved articles were also scanned. Retrospective studies, case studies, and single institution studies were included in the analysis. Data were manually extracted from journal publications using established inclusion and exclusion criteria. A panel of pediatric trauma experts reviewed a total of 29 papers, seeking evidence-based methodology and brief summaries of the available literature. These injuries are rare, and the anatomical and physiological characteristics of pediatric vascular injuries mandate a multidisciplinary approach. To minimize the consequences of extremity vascular injuries, successful treatment requires a high index of suspicion that allows for early diagnosis and prompt management. Clear recommendations regarding diagnosis and treatment are needed.

While critically informed approaches to medical education are increasingly advocated in literature, discussion of the potential role of disability studies in informing pedagogy and practice is largely lacking. The emergence of long Covid, alongside the strong possibility of a wave of covid-related disability, underlines an urgent need for medicine to develop more contextualised, nuanced and structurally competent understandings of chronic illness and disability. This article argues that the integration of thinking from disability studies into medical curricula offers a pathway to such understanding, informing a more equitable, holistic and patient-centred approach to practice. Further, a structurally competent, antiableist approach positions clinicians and patients as allies, working together within a structural context that constrains both parties. Such positioning may mitigate tensions within the clinical encounter, tensions that are well documented in the realm of marginalised chronic illness and disability. While the possibilities arising from a partnership between disability studies and medicine are numerous, the foci here are the social relational model of disability and the concept of psycho-emotional disablism, within a broader framework of critical disability studies. It is argued that inadequate healthcare provision and policy in the realm of long Covid can be understood as a form of structural and psycho-emotional disablism, arising from and reinforcing an ableist psychosocial imaginary permeated with neoliberal assumptions, and carrying a risk of furthering both disability and impairment. After considering long Covid through these particular lenses, the article concludes with a discussion of how a partnership between disability studies and a structurally competent approach to medical education might translate into practice.

The links between green physical activity and wellbeing are increasingly well evidenced, and in this chapter, we will look at the ways in which woodland settings can promote movement and enjoyment of movement. Children monitored for levels of physical activity using accelerometers in case study one demonstrated that more pupils got active during outdoor learning in woodland compared to outdoor learning in school grounds or in the classrooms. A second case study explores teenagers’ vigorous, physical, playful activity at Forest School. The final case study follows adults and families getting physically active in the forest through arts-based interventions. Each study finds that nature’s biophilic effects and cues to behaviour and action are important in underpinning enjoyment and motivating movement amongst trees, woods and forests.

Abstract Trees fall naturally into rivers generating flow heterogeneity, inducing geomorphological features, and creating habitats for biota. Wood is increasingly used in restoration projects and the potential of wood acting as leaky barriers to deliver natural flood management by ‘slowing the flow’ is recognised. However, wood in rivers can pose a risk to infrastructure and locally increase flood hazards. The aim of this paper is to provide an up‐to‐date summary of the benefits and risks associated with using wood to promote geomorphological processes to restore and manage rivers. This summary was developed through a workshop that brought together academics, river managers, restoration practitioners and consultants in the UK to share science and best practice on wood in rivers. A consensus was developed on four key issues: (i) hydrogeomorphological effects, (ii) current use in restoration and management, (iii) uncertainties and risks and (iv) tools and guidance required to inform process‐based restoration and management.

Aims and methodTo evaluate outcomes for service users during their first year of treatment in three English assertive outreach teams. Changes in health and social functioning, engagement with services, service use and need (rated by staff and service users) were evaluated.ResultsIn 49 service users we found a significant increase in mean staff-rated met needs up to 6 months of treatment. There were no significant changes in ratings of engagement or Health of the Nation Outcome Scales (HoNOS) scores at 6 and 12 months. Unmet needs rated by service users and staff showed a non-significant trend for improvement across a range of individual health and social domains. Duration of hospital admission reduced significantly between the 12 months before the evaluation and the 12 months of the evaluation. Formal and informal admission and levels of contact with crisis teams reduced over the study period.Clinical implicationsAlthough these results offer some support to the assertive outreach approach, further research in larger samples is needed to identify which changes in health and social functioning are associated with transfer to assertive outreach teams.

PE specialist Paul Barns explains how he has been using Nintendo Wii to improve physical activity among disaffected students

The observational data presented by Macfarlane et al on the aetiology of acute lower respiratory tract illness in the community1 confirm that the often stated assertion that these illnesses are usually caused by viral infection is incorrect. The high prevalence of bacteriological and atypical pathogens and, in particular, the high prevalence of Chlamydia pneumoniae in these patients is of interest and points to the need for further studies to clarify the clinical significance of these isolates. The lack of correlation between indirect evidence of infection (radiographic and CRP levels), GP assessment of the need for antibiotics, and pathogen isolation is also of great interest and …

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The use of subsequent MgO indiffusion to bury Ti indiffused waveguides in LiNbO 3 is shown to reduce the surface scatter contribution to waveguide propagation loss. Assessment of waveguide propagation loss foil- non-buried and buried waveguides at wavelengths 0.851μn, 1.06μm, 1.32tim and 1.52μm show a λ dependence for non-buried waveguides, indicating a surface scatter mechanism. Buried waveguide propagation loss exhibits no such dependence on wavelength, with a propagation loss of i0.25dB/cm over the wavelength range. Reduced excess loss of buried λ- junction waveguide structures, in Mach Zehnder intensity modulators, is demonstrated. This improvement is ascribed to increased light confinement and reduced scatter in the vicinity of the bifurcation region. Active performance of phase and intensity modulators, with non-buried and buried waveguides, indicate no significant change in required drive voltage. This is due to a choice of MgO conditions which lead to sufficient waveguide burial to reduce propagation loss, but to little change in Ti diffusion depth and hence optical/electrical field overlap characteristic.

Electro-Optically active Guided Wave Optical Components are only commercially available in Lithium Niobate substrate material. In this paper some examples of the applications of these components are given, along with a comparison between Lithium Niobate based components and those fabricated in other materials. The advantages of Lithium Niobate components in terms of cost and performance for both electro-optical, passive and non-linear optical waveguide devices are highlighted.