Segmental clavicle fractures are uncommon injuries. When they do present, they tend to comprise a distal and mid-shaft fracture. A clavicular injury with proximal and distal fractures is a rarer presentation still which is sparsely covered in the literature. These injuries, which have been termed bipolar, are easily missed at presentation and due to their infrequency the optimal method of management for these patients is unclear. We describe the successful non-operative management of a bipolar clavicle fracture and review the existing literature.

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161 patients have been offered assessment and patient uptake is high with only 23 (14%) declining assessment. 52 (32%) patients were offered group therapy and the rest received individual therapy or declined ongoing support. Patients have been keen to access the service and feedback from those who have accessed it has been positive. Conclusions There is high demand for an IBD psychology service with high patient uptake. This has led to pressure on the service and development of a long waiting list.Within the IBD team there is improved understanding of what psychology can offer but the wide variation in referrals between individuals would suggest that further education as to the role of psychological input is required. This is supported by the observation that the greatest numbers of referrals come from sources where psychologist has most interaction.As referrals increase the service will have to adapt to manage them as a 5 month waiting list is inappropriate for certain referrals.Provision of this service has allowed the team to move closer to meeting IBD standards (IBDUK, 2019).

Despite the vast amount of research that supports investing in early childhood development and education in emergencies (ECDEiE), this area of programming continues to be underprioritized and underfunded. We applied a strategic problem-solving framework to systematically address the challenge of low access to ECDEiE in the global context. Specifically, we addressed three root causes of this problem: low prioritization of ECDEiE across sectors; the lack of a systematic characterization of the ECDEiE institutional and programmatic landscapes; and limited consensus on strategic advocacy for ECDEiE. To address these issues, we applied a mixed methods approach. We administered an online global stocktaking survey to 118 respondents, including those working in humanitarian aid, ECDEiE, government, and academia. We also reviewed the gray literature (N=218 documents). We discuss our six main findings in order to inform strategic initiatives that could be used to increase access to ECDEiE globewide.