Towards a consensus for classification of mandibular condyle fractures.

The merits of surgical treatment of fractures of the mandibular condyle versus non-surgical management remains highly controversial, despite a large volume of literature dedicated to this topic. One reason the controversy remains, is because most of the outcomes in the literature are not directly comparable. The disparate range of condylar fracture classifications used is one of the reasons that studies are not comparable. We sought to review classification systems for condylar fractures used in the recent scientific literature. Review of the literature from 2016 to 2019, looking for papers relating to fractures of the mandibular condyle. Papers identified were assessed for type of study, focus of study, classification system used. 88 studies were identified, including prospective and retrospective cohort studies, randomised and non-randomised prospective studies, randomised controlled trials and case series. More studies focussed on epidemiological factors than surgical access, fixation or outcomes. 31 used no classification system, whilst 17 used unique classification systems and 40 used previously referenced classification systems. Classification systems are used to help separate clinical problems into distinguishable groups, where there is a difference in management or outcome depending on the distinguishing features. There is currently a wide diversity of classification systems used for condyle fractures, and as a result, comparisons of surgical access, fixation and outcomes are difficult to make. Having a single classification system across the published literature would allow easier comparison and the classification proposed by the AO group is recommended for future use.

Improving out-of-hours surgical patient care.

PURPOSE: The Royal College of Surgeons recognises patient handover as the point at which patients are collectively at their most vulnerable. Concerns were raised in a London teaching hospital surgical department regarding an unstructured handover system, poor access to relevant clinical information, and inadequate weekend staffing. A quality improvement programme was designed and implemented to respond to these concerns and improve patient safety. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: A structured questionnaire was distributed to staff and results used to construct a diagram outlining the main factors influencing weekend patient safety. This framework was used to design changes, including a new electronic handover tool, regular handover meetings and additional weekend staff. Regular staff training was provided, and success was assessed in a continuous audit cycle with the results fed back to team leaders. FINDINGS: Over a three-month period, the handover meeting recorded an attendance rate consistently above 80 per cent. The electronic handover entries were scored according to seven criteria (correct layout; key information, i.e.: patient location, clinical priority, active issues, resuscitation status, test results and weekend plan), averaging between 42.2 and 92.9 per cent, with progressive improvement seen over the assessment period. Weekend staffing was increased by 50 per cent, allowing a dedicated team to care for stable inpatients and to oversee discharges. ORIGINALITY/VALUE: This improvement programme delivered lasting and significant change in response to staff concerns. It resulted in a more structured and reliable weekend system and established key mechanisms for dynamic performance feedback.

Engineered Sulfur-Resistant Catalyst System with an Assisted Regeneration Strategy for Lean-Burn Methane Combustion.

Catalytic combustion of methane, the main component of natural gas, is a challenge under lean-burn conditions and at low temperatures owing to sulfur poisoning of the Pd-rich catalyst. This paper introduces a more sulfur-resistant catalyst system that can be regenerated during operation. The developed catalyst system lowers the barrier that has restrained the use of liquefied natural gas as a fuel in energy production.

Have vehicle emissions of primary NO2 peaked?

Reducing ambient concentrations of nitrogen dioxide (NO2) remains a key challenge across many European urban areas, particularly close to roads. This challenge mostly relates to the lack of reduction in emissions of oxides of nitrogen (NOx) from diesel road vehicles relative to the reductions expected through increasingly stringent vehicle emissions legislation. However, a key component of near-road concentrations of NO2 derives from directly emitted (primary) NO2 from diesel vehicles. It is well-established that the proportion of NO2 (i.e. the NO2/NOx ratio) in vehicle exhaust has increased over the past decade as a result of vehicle after-treatment technologies that oxidise carbon monoxide and hydrocarbons and generate NO2 to aid the emissions control of diesel particulate. In this work we bring together an analysis of ambient NOx and NO2 measurements with comprehensive vehicle emission remote sensing data obtained in London to better understand recent trends in the NO2/NOx ratio from road vehicles. We show that there is evidence that NO2 concentrations have decreased since around 2010 despite less evidence of a reduction in total NOx. The decrease is shown to be driven by relatively large reductions in the amount of NO2 directly emitted by vehicles; from around 25 vol% in 2010 to 15 vol% in 2014 in inner London, for example. The analysis of NOx and NO2 vehicle emission remote sensing data shows that these reductions have been mostly driven by reduced NO2/NOx emission ratios from heavy duty vehicles and buses rather than light duty vehicles. However, there is also evidence from the analysis of Euro 4 and 5 diesel passenger cars that as vehicles age the NO2/NOx ratio decreases. For example the NO2/NOx ratio decreased from 29.5 ± 2.0% in Euro 5 diesel cars up to one year old to 22.7 ± 2.5% for four-year old vehicles. At some roadside locations the reductions in primary NO2 have had a large effect on reducing both the annual mean and number of hourly exceedances of the European Limit Values of NO2.

Effect of different types of conditioning contraction on upper body postactivation potentiation.

Muscle contractions preceding an activity can result in increased force generation (postactivation potentiation [PAP]). Although the type of muscular contractions could affect subsequent strength and power performance, little information exists on their effects. The purpose of this study was to examine PAP effects produced by isometric (ISO), concentric (CON), eccentric (ECC), or concentric-eccentric (DYN) conditioning contractions on upper body force and power performance. Ten male, competitive rugby players (mean ± SD: age 20.4 ± 0.8 years, height 177.0 ± 8.1 cm, body mass 90.2 ± 13.8 kg) performed a ballistic bench press throw (BBPT) followed by a 10-minute rest and one of the conditioning contractions. After a 12-minute rest, the subjects performed another BBPT (post-BBPT). The conditioning contractions, applied on separate days and in counterbalanced randomized order, were a 7-second isometric barbell bench press for ISO and 1 set of 3 bench press repetitions at 3 repetition maximum for CON, ECC, and DYN (each repetition lasting 2 seconds for CON and ECC, overall execution time <7 seconds for DYN). Peak power (Ppeak), peak force (Fpeak), maximum distance (Dmax) and rate of force development (RFD) were measured using a linear position transducer. Electromyography (EMG) of the pectoralis major and triceps brachii was also recorded. The ISO produced significantly higher Ppeak (587 ± 116 and 605 ± 126 W for pre- and post-BBPT, respectively; p < 0.05). No significant differences in Ppeak were revealed for CON, ECC, and DYN (p > 0.05), and no significant differences existed in Fpeak, Dmax, and RFD for ISO, CON, ECC, and DYN (p > 0.05). Finally, EMG was not significantly different between pre- and post-BBPT for any of the conditioning contractions (p > 0.05). Isometric contractions appear to be the only conditioning contractions increasing upper body power output after long resting periods.