Brief interventions to de-escalate disturbances in emergency departments.

This study aimed to systematically review evidence to assess the efficacy of non-pharmacological brief interventions in the emergency department to reduce the incidence, severity and impact of acute behavioural disturbances. The literature search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A total of 18 articles were identified as meeting the inclusion criteria and read in full. Following a full read and a consensus discussion, it was subsequently considered the studies chosen had not met the inclusion criteria. Research into the use of non-pharmacological brief interventions in the management of acute behavioural disturbance in the emergency department is warranted given the absence of evidence found by this systematic review.

An investigation into the cause of the inner dark areas and outer lighter areas (ghosting) seen in dynamically-created two-dimensional bare footprints.

Dynamic bare footprints differ from static bare footprints through the presence of additional, lighter markings around the rear of the heel print and apices of the toe print areas. These images can appropriately be described as inner dark and outer ghosting features. To date, the functional cause of both features has not been understood. To gain such an understanding could potentially allow the further development and use of these features in forensic identification. The aim of this project was to investigate the causes of the inner dark and outer ghosting features seen in dynamic bare footprints through an observational, practice-based action research approach within a gait laboratory. Volunteer male participants provided bare footprints on inkless paper taped to a Kistler force plate with video cameras situated either side. Ground reaction force data were collected as the footprints were formed and the event recorded using video cameras to allow these data to be correlated later. The findings suggest that the ghosting at the heel is the result of splaying of the fibro fatty pad, while that at the toes is the result of the distal ends of the toes coming into contact with the ground as the heel is lifted. Footprint, ground reaction force and video data comparisons showed that the inner dark area of the heel print corresponded with the main body of the heel contacting the ground. Outer ghosting corresponded with a backward splaying of the fat pad and the heel strike transient spike in vertical ground reaction force during increased loading. The inner dark area of the toes corresponded with a longer period of toe contact with the ground. Outer ghosting corresponded with the decreasing vertical ground reaction force and shorter contact time as the toes were leaving the ground towards the end of the contact phase of gait. Although the sample size was limited, these are new appreciations which could facilitate the use of the inner dark features in identification to provide additional points for comparison in cases involving dynamic bare footprints. Further work is now indicated to study these features in different populations and under varying conditions.

Can the F-Scan in-shoe pressure system be combined with the GAITRite® temporal and spatial parameter-recording walkway as a cost-effective alternative in clinical gait analysis? A validation study.

BACKGROUND: Clinical gait analysis is widely used to aid the assessment and diagnosis of symptomatic pathologies. Foot function pressure systems such as F-scan and analysis of the spatial-temporal parameters of gait using GAITRite® can provide clinicians with a more comprehensive assessment. There are systems however, such as Strideway™ that can measure these parameters simultaneously but can be expensive. F-Scan in-shoe pressure data is normally collected whilst the person is walking on a hard floor surface. The effects of the softer Gaitrite® mat upon the F-Scan in-shoe sensor pressure data is unknown. This study therefore aimed to assess the agreement between F-Scan pressure measurements taken from a standard walkway (normal hard floor), and those from a GAITRite® walkway to establish whether these two pieces of equipment (in-shoe F-Scan and GAITRite®) can be used simultaneously, as a cost-effective alternative. METHOD: Twenty-three participants first walked on a standard floor and then on a GAITRite® walkway wearing F-Scan pressure sensor insoles with same footwear. They repeated these walks three times on each surface. Mid gait protocols were utilised by analysing the contact pressure of the first and second metatarsophalangeal joint of the third, fifth and seventh step from each walk. For both joints, 95% Bland-Altman Limits of Agreement was used to determine a level of agreement between the two surfaces, using mean values from pressure data collected from participants who successfully completed all required walks. The intraclass correlation coefficient (ICC) and Lin's concordance correlation coefficient were calculated as indices of reliability. FINDINGS: ICC results for the hard surface and the GAITRrite® walkway at the first and second metatarsophalangeal joints were 0.806 and 0.991 respectively. Lin's concordance correlation coefficient for the first and second metatarsophalangeal joints were calculated to be 0.899 and 0.956 respectively. Both sets of statistics indicate very good reproducibility. Bland-Altman plots revealed good repeatability of data at both joints. CONCLUSION: The level of agreement in F-Scan plantar pressures observed between walking on a normal hard floor and on a GAITRite® walkway was very high, suggesting that it is feasible to use F-Scan with GAITRite® together in a clinical setting, as an alternative to other less cost-effective standalone systems. Although it is assumed combining F-Scan with GAITRite® does not affect spatiotemporal analysis, this was not validated in this study.

Pediatric Oncology and Obesity: An Introduction for General Pediatricians.

For pediatric patients with cancer, a healthy lifestyle is important for treatment outcomes and beyond. General pediatricians play a major role in the care of these patients, particularly given the improved rates of survival. Pediatric obesity has many negative consequences, but it is an area where primary care providers can make an impact and provide support to childhood cancer survivors. To provide the best quality of care for this population, there must be collaboration between primary care and oncology providers. Additionally, general practioners should feel empowered to offer standard nutrition and physical activity recommendations to all childhood cancer survivors. For pediatric patients who carry a cancer diagnosis, cure is no longer the only goal. Pediatric providers across specialties need to work as a team to improve long-term quality of life for these patients, starting with modifiable healthy habits.

A preliminary study investigating the overlay method in forensic podiatry for comparison of insole footprints.

The overlay method is used in forensic podiatry to compare the shape, position, and overall fit of features between questioned and reference footprint evidence. However, the scientific foundation underpinning its validity in the comparison of insole footprints is not fully understood because of a lack of published data defining its statistical operating parameters. A review of literature revealed its subjective nature with little scientific validation, limited only to face validity. The aim of this study investigated strength of agreement between three expert footprint examiners' overlay comparisons of ten reference insole footprints using Cohen's weighted kappa (Kw). Validity of method was explored using measures of sensitivity, specificity, false positive rate (FPR), false negative rate (FNR), receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). Results showed two examiners demonstrated high inter-rater consistency between their overlay comparisons (Kw: 0.981; 95 %CI: 0.943 to 1.020 for Rater1 v Rater2) whilst one examiner did not (Kw: 0.340; 95 %CI: 0.148 to 0.532 for Rater1 v Rater3; Kw: 0.310; 95 %CI: 0.100 to 0.519 for Rater2 v Rater3). Validity was investigated using a conclusion scale in a verbal expressions table to indicate support or rejection of compatibility of footprints between one questioned insole and ten reference insoles. Data analysis indicated validity as follows: Sensitivity: 77.8 %, Specificity: 61.9 %, FPR: 38.1 % and FNR: 22.2 %. ROC analysis corroborated this finding. AUC was calculated at 0.762 or 76.2 % indicating an 'acceptable' measure of overall accuracy of the overlay method for insole footprint comparison. Findings provide novel data supporting previous suggestions that the overlay method should not be used in isolation to compare insole footprints. Data also offers insight into the scientific foundation of this method, whilst highlighting its limitations and providing some implications and recommendations for forensic podiatry practice.

The application of TreadMatch scans to aid the process of footwear mark comparison.

Currently in the UK, if a person is arrested or charged with a recordable offence, they can have prints of their footwear taken whilst in custody. The tread pattern recorded in these prints can be searched for using the National Footwear Database to find out if the same footwear pattern has been recovered at previous crime scenes, generating forensic intelligence. TreadMatch is a digitised system for collecting footwear prints seized from detainees in custody for this purpose. Whilst its use for generating intelligence is accepted, validation experiments have not been conducted to understand its level of performance in assisting in forensic comparison purposes for identification, because in the absence of an incorporated scale, it is not known how well TreadMatch reproduces the pattern size of a tread, threatening the validity of the comparison. If it can be determined that the measurements of TreadMatch scans are consistent with the more commonly used aluminium powder test marks, this could save Police time and resources if the digital scans could be used for preliminary assessment prior to the footwear being physically submitted for evidential comparison. Therefore, this study set out to compare three different types of TreadMatch scans ('dynamic', 'zoomed' and 'rolled') for thirty different pieces of footwear, with test marks of the same footwear using the traditional method (fingerprint powder). Length and width measurements were obtained from each tread pattern using GNU Image Manipulation Program software. The resulting data were analysed to assess for agreement between TreadMatch scans and test marks using 95% Intraclass Correlation Coefficients (ICC) and 95% Bland-Altman plots of Limits of Agreement (LOA). Additionally, an intra-sample study using fifteen repeated measurements of the same piece of footwear for different TreadMatch scanning methods was carried out to support the larger validity study. 95% ICC3,1 resulted in coefficients ranging from 0.99 to 1.00 across all measurements. 95% LOA displayed close agreement. There was less agreement and more variation displayed between the test marks and the TreadMatch rolled scans for both length and width measurements. This variation for hand-rolled prints must be taken into consideration and a standard approach developed. The study suggests TreadMatch can be used for preliminary assessments in assisting forensic comparisons, particularly for dynamic and zoomed prints.

Planning and developing a method for collecting ground truth data relating to footwear mark evidence.

Ground Truth Data is data that comes from a known source, where the truth about the data is known and not inferred (FSR, 2021). The Forensic Science Regulator requires forensic units (that carry out certain forensic processes) to undertake tests against ground truth data for the purposes of quality assurance/quality control processes such as accreditation. However, the data collected must form a meaningful dataset that will enable relevant tests to be performed that inform the end-user. This technical note discusses how a forensic unit in the UK planned and developed a method for collecting ground truth data for footwear mark evidence. It discusses the materials and variables that were considered when developing the method and the evidence-based, decision-making processes that enabled its creation. Recommendations and considerations are provided to assist other forensic units collect data relevant to their jurisdiction. Whilst the method is not prescriptive, if it is used as a guide, it may facilitate the development of a large and relevant national dataset.

The role of podiatry in the early identification and prevention of lower limb venous disease: an ethnographic study.

BACKGROUND: Lower limb venous disease can cause significant pain, loss of mobility, and can be detrimental to an individual's quality of life. Manifestations of venous disease often pose a substantially negative impact on patients and place a high demand on finite healthcare resources. Whilst this problem is internationally recognised, most research and discourse has predominantly focussed on treatment of leg ulceration and prevention of recurrence. Prevention of lower limb venous disease progression to the first ulceration has received far less attention. Overall, the care of this condition appears to rest in the domain of medicine and nursing yet podiatry, a profession with responsibility for the lower limb and foot, is conspicuous by its absence from the literature.  METHODS: An ethnographic approach was used to gather data from 26 participants through observation, semi-structured interviews, and a focus group interview. Qualitative analysis was conducted using the framework approach. RESULTS: The findings revealed an identity crisis within the podiatry profession. Evidence emerged of ritual and routine practices that did not include lower limb venous disease. External control over practice limited the professional autonomy of podiatrists determining their own activities. Inter-professional relationships with nursing, and perceptions of boundaries that venous disease was a nursing role were also found to be limiting factors. CONCLUSIONS: This research revealed that podiatry does not occupy a substantive role in contributing to the early identification and prevention of lower limb venous disease. Policy, education, research and practice changes are all required to enhance the contribution of podiatry to reduce the burden of this disease.

Reliability of a two-dimensional sock-clad footprint linear measurement method.

A two-dimensional linear measurement approach for footprints, herein referred to as the "Reel Method," has been shown to be valid and reliable when used on bare footprints, however, few measurement approaches have been examined on sock-clad footprints. The present investigation examines the validity and reliability of the Reel Method as a two-dimensional linear measurement approach for use on sock-clad footprints. A walking, mid-gait footprint was collected from 30 volunteer participants using the Identicator Inkless Shoe Print Model LE 25P system. The width of the ball of the foot, calcaneal width, and distance from the most posterior aspect of the heel to the most distal aspect of the first toe were each measured and compared between and within three raters. The statistical analysis demonstrated high reliability of the Reel Method among these three raters. The data were found to be normally distributed, and measurements were consistent between and within raters. 95% Intraclass Correlation coefficients, 95% Bland-Altman Limits of Agreement and 95% Standard Error of Measurement determined high statistical agreement between and within raters, demonstrating that the Reel Method is reliable and thus valid for the linear measurement of sock-clad footprints.

Sexing white 2D footprints using convolutional neural networks.

Footprints are left, or obtained, in a variety of scenarios from crime scenes to anthropological investigations. Determining the sex of a footprint can be useful in screening such impressions and attempts have been made to do so using single or multi landmark distances, shape analyses and via the density of friction ridges. Here we explore the relative importance of different components in sexing two-dimensional foot impressions namely, size, shape and texture. We use a machine learning approach and compare this to more traditional methods of discrimination. Two datasets are used, a pilot data set collected from students at Bournemouth University (N = 196) and a larger data set collected by podiatrists at Sheffield NHS Teaching Hospital (N = 2677). Our convolutional neural network can sex a footprint with accuracy of around 90% on a test set of N = 267 footprint images using all image components, which is better than an expert can achieve. However, the quality of the impressions impacts on this success rate, but the results are promising and in time it may be possible to create an automated screening algorithm in which practitioners of whatever sort (medical or forensic) can obtain a first order sexing of a two-dimensional footprint.

Reliability of a two-dimensional footprint measurement approach.

Although footprint evidence can be taken from the scene of a crime, the science underpinning such measurement in forensic science has not been fully explored. A literature search revealed various measuring approaches, all of which demonstrated either little or no measurement rigour in terms of reliability. The aim of this study was to apply a robust measurement approach for testing the reliability of two-dimensional footprint impressions. Three dynamic and three static footprints were taken from the right foot of thirty female and thirty one male volunteers using the 'Inkless Shoeprint Kit'. The images were digitised. Lengths, widths and angles were measured using a selection of currently employed methods. An investigation of the reliability of the chosen measuring method suggested high intra-rater agreement: for example, the length measurement suggested an intraclass correlation coefficient (ICC) 0.99, 95% Confidence Interval (CI) -0.28 to 0.01, standard error of measurement (SEM) 0.07, Limits of Agreement (LOA) -0.91 to 0.65. Inter-rater reliability between three operators was also high: SEM ranged from 0.05 mm to 0.07 mm, ICC 0.99. Our study has established a reliable two-dimensional measuring technique that could be used for footprint comparison in further research.

An investigation to assess ankle mobility in healthy individuals from the application of multi-component compression bandages and compression hosiery.

BACKGROUND: An investigation was undertaken to compare the effect of multi-component compression bandages and compression hosiery kits on individuals' range of ankle motion whilst wearing typical and medical footwear, and barefoot. METHODS: A convenience sample of 30 healthy individuals recruited from the staff and student population at the University of Huddersfield, UK. Plantarflexion/dorsiflexion range of ankle motion (ROAM) was measured in participants over 6 steps in every combination of typical, medical and no footwear; and multi-component bandages, compression hosiery and no garments. RESULTS: Controlling for age, gender and garments, the use of typical footwear was associated with a mean increase in ROAM of 2.54° at best estimate compared with barefoot; the use of medical footwear was associated with a mean decrease in ROAM of 1.12° at best estimate compared with barefoot. Controlling for age, gender and footwear, the use of bandaging was associated with a mean decrease in ROAM of 2.51° at best estimate compared with no garments. Controlling for age, gender and footwear, the use of hosiery was not associated with a significant change in ROAM compared with no garments. CONCLUSIONS: Bandages appear to restrict ROAM more than hosiery when used in conjunction with a variety of footwear types.

Estimation of stature from static and dynamic footprints.

The ability to estimate accurately from known parameters is a fundamental aspect of science and is evident as an emerging approach in the area of footprints and stature estimation within the field of forensic identification. There are numerous foot dimensions that have been measured in the literature to predict stature with varying degrees of confidence but few studies have tried to link the strength of estimation to anatomical landmarks. Such an approach is utilised in this study which estimates stature from the right footprints of sixty one adult male and female UK participants. Static and dynamic footprints were taken from each volunteer using the 'inkless paper system'. The prints were digitised and twelve length, width and angle measurements were chosen for the analysis. The highest correlations with stature were shown to be the heel to fourth toe print for the static group of footprints (r=0.786, p<0.01), and the heel to fifth toe print in the dynamic footprints (r=0.858, p<0.01). Collinearity statistics suggest the heel to fifth toe print length measurement is independent and not influenced by any other variables in the estimation of stature for the dynamic prints. Linear regression equations for this measurement presented the smallest standard error of estimate (SEE) and highest shared variance (R(2)) of all included variables (SEE 4.16, R(2) 0.74). Our study discusses a potential anatomical explanation as to why the lateral border of the foot and hence the impression it makes upon a hard surface, is a more stable indicator in the estimation of stature. The investigation recommends the use of Calc_A4 and Calc_A5 length measurements when estimating stature from footprint impressions.