Management of Gustilo-Anderson IIIB open tibial fractures in adults-a systematic review.

INTRODUCTION: Open tibial fractures are the most common open long bone fracture, despite this, the management of these complex injuries still remains a topic of discussion amongst orthopaedic surgeons. SOURCES OF DATA: We searched the EMBASE, MEDLINE and Google Scholar and a systematic review of 7500 articles, leaving 23 after exclusion criteria were applied, in order to analyse the management of open tibial fractures. AREAS OF AGREEMENT AND CONTROVERSY: Infection was noted to be the most significant concern amongst authors, with definitive external fixation having a high rate of superficial pin-site infection and internal fixation having a high deep infection rate. GROWING POINTS: It is essential to have a combined ortho-plastic approach to the management of these fractures as muscle flaps were the most common form of soft tissue coverage. AREAS TIMELY FOR DEVELOPING RESEARCH: A national pragmatic trial into the management of open tibial fractures is required looking at fixation methods and soft tissue coverage, with at least a 2-year follow-up in order to ascertain the most appropriate management of these fractures and patient-related outcomes.

Real time control of water distribution networks: A state-of-the-art review.

This paper presents a review of the current state of the art of real time control (RTC) of water distribution networks (WDNs). After proving the basic concept and terms of RTC and presenting sensors, regulation devices and controllers typically used in WDNs, the paper goes on by describing the most frequent control objectives, which mainly include service pressure regulation, control of tank filling and energy production in each WDN district. Various control methodologies recently proposed in the scientific literature are presented and discussed, along with experimental and numerical results achieved. Also, aspects related to the cost-effectiveness of RTC are critically analyzed. The paper ends by giving an outlook into potential future developments in the area of RTC for WDNs.

Factors affecting planned return to work after trauma: A prospective descriptive qualitative and quantitative study.

The use of patient reported outcome measures (PROMs) in trauma is limited. The aim of this pilot study is to evaluate qualitative responses and factors affecting planned return to work following significant trauma, for which there is currently a poor evidence base. National ethical approval was obtained for routine prospective PROMs data collection, including EQ-5D, between Sept 2013 and March 2015 for trauma patients admitted to the Sussex Major Trauma Centre (n=92). 84 trauma patients disclosed their intended return to work at discharge. Additional open questions asked 'things done well' and 'things to be improved'. EQ-5D responses were valued using the time trade-off method. Statistical analysis between multiple variables was completed by ANOVA, and with categorical categories by Chi squared analysis. Only 18/68 of patients working at admission anticipated returning to work within 14days post-discharge. The injury severity scores (ISS) of those predicting return to work within two weeks and those predicting return to work longer than two weeks were 14.17 and 13.59, respectively. Increased physicality of work showed a trend towards poorer return to work outcomes, although non-significant in Chi-squared test in groups predicting return in less than or greater than two weeks (4.621, p=0.2017ns). No significant difference was demonstrated in the comparative incomes of patients with different estimated return to work outcomes (ANOVA r2=0.001, P=0.9590ns). EQ-5D scores were higher in those predicting return to work within two weeks when compared to greater than two weeks. Qualitative thematic content analysis of open responses was possible for 66/92 of respondents. Prominent positive themes were: care, staff, professionalism, and communication. Prominent negative themes were: food, ward response time, and communication. This pilot study highlights the importance of qualitative PROMs analysis in leading patient-driven improvements in trauma care. We provide standard deviations for ISS scores and EQ-5D scores in our general trauma cohort, for use in sample size calculations for further studies analysing factors affecting return to work after trauma.

The impact of genital trauma on wounded servicemen: qualitative study.

BACKGROUND: Recent military operations in Afghanistan have resulted in considerable lower limb trauma. Associated with this trauma have been serious injuries to the genitalia. No previous study has looked at the effect of traumatic genital injury on the individual. This study expresses the impact of these injuries. METHODS: A qualitative evaluation, interviewing 13 male patients with extensive genital injuries, including 11 patients with orchidectomies. RESULTS: Patients attach a very high importance to their genital injury, rating this injury as having more impact than lower limb amputations. They also have a high expectation for the recovery of sexual function. Psychological outcomes are better when an individual's future fertility is known at an early stage. CONCLUSION: Better outcomes are achieved for the patient when psychological and surgical support if provided throughout the long treatment and recovery process It is important that every effort is made to preserve fertility right from the point of injury.

Relativistic symmetry suppresses quark spin-orbit splitting.

Experimental data indicate small spin-orbit splittings in hadrons. For heavy-light mesons we identify a relativistic symmetry that suppresses these splittings. We suggest an experimental test in electron-positron annihilation. Furthermore, we argue that the dynamics necessary for this symmetry are possible in QCD.