The Libyan civil conflict : selected case series of orthopaedic trauma managed in Malta in 2014

Aim: The purpose of this series of cases was to analyse our management of orthopaedic trauma casualties in the Libyan civil war crisis in the European summer of 2014. We looked at both damage control orthopaedics and for case variety of war trauma at a civilian hospital. Due to our geographical proximity to Libya, Malta was the closest European tertiary referral centre. Having only one Level 1 trauma care hospital in our country, our Trauma and Orthopaedics department played a pivotal role in the management of Libyan battlefield injuries. Our aims were to assess acute outcomes and short term mortality of surgery within the perspective of a damage control orthopaedic strategy whereby aggressive wound management, early fixation using relative stability principles, antibiotic cover with adequate soft tissue cover are paramount. We also aim to describe the variety of war injuries we came across, with a goal for future improvement in regards to service providing.Methods: Prospective collection of six interesting cases with severe limb and spinal injuries sustained in Libya during the Libyan civil war between June and November 2014.Conclusions: We applied current trends in the treatment of war injuries, specifically in damage control orthopaedic strategy and converting to definitive treatment where permissible. The majority of our cases were classified as most severe (Type IIIB/C) according to the Gustilo-Anderson classification of open fractures. The injuries treated reflected the type of standard and improved weaponry available in modern warfare affecting both militants and civilians alike with increasing severity and extent of damage. Due to this fact, multidisciplinary team approach to patient centred care was utilised with an ultimate aim of swift recovery and early mobilisation. It also highlighted the difficulties and complex issues required on a hospital management level as a neighbouring country to war zone countries in transforming care of civil trauma to military trauma.peer-reviewe

Can perceptual indices estimate physiological strain across a range of environments and metabolic workloads when wearing explosive ordnance disposal and chemical protective clothing?

Objective Explosive ordnance disposal (EOD) often requires technicians to wear multiple protective garments in challenging environmental conditions. The accumulative effect of increased metabolic cost coupled with decreased heat dissipation associated with these garments predisposes technicians to high levels of physiological strain. It has been proposed that a perceptual strain index (PeSI) using subjective ratings of thermal sensation and perceived exertion as surrogate measures of core body temperature and heart rate, may provide an accurate estimation of physiological strain. Therefore, this study aimed to determine if the PeSI could estimate the physiological strain index (PSI) across a range of metabolic workloads and environments while wearing heavy EOD and chemical protective clothing. Methods Eleven healthy males wore an EOD and chemical protective ensemble while walking on a treadmill at 2.5, 4 and 5.5 km·h− 1 at 1% grade in environmental conditions equivalent to wet bulb globe temperature (WBGT) 21, 30 and 37 °C. WBGT conditions were randomly presented and a maximum of three randomised treadmill walking trials were completed in a single testing day. Trials were ceased at a maximum of 60-min or until the attainment of termination criteria. A Pearson's correlation coefficient, mixed linear model, absolute agreement and receiver operating characteristic (ROC) curves were used to determine the relationship between the PeSI and PSI. Results A significant moderate relationship between the PeSI and the PSI was observed [r = 0.77; p < 0.001; mean difference = 0.8 ± 1.1 a.u. (modified 95% limits of agreement − 1.3 to 3.0)]. The ROC curves indicated that the PeSI had a good predictive power when used with two, single-threshold cut-offs to differentiate between low and high levels of physiological strain (area under curve: PSI three cut-off = 0.936 and seven cut-off = 0.841). Conclusions These findings support the use of the PeSI for monitoring physiological strain while wearing EOD and chemical protective clothing. However, future research is needed to confirm the validity of the PeSI for active EOD technicians operating in the field

Perceived exertion is as effective as the perceptual strain index in predicting physiological strain when wearing personal protective clothing

Objective The perceptual strain index (PeSI) has been shown to overcome the limitations associated with the assessment of the physiological strain index (PSI), primarily the need to obtain a core body temperature measurement. The PeSI uses the subjective scales of thermal sensation and perceived exertion (RPE) to provide surrogate measures of core temperature and heart rate, respectively. Unfortunately, thermal sensation has shown large variability in providing an estimation of core body temperature. Therefore, the primary aim of this study was to determine if thermal comfort improved the ability of the PeSI to predict the PSI during exertional-heat stress. Methods Eighteen healthy males (age: 23.5 years; body mass: 79.4 kg; maximal aerobic capacity: 57.2 ml·kg− 1·min− 1) wore four different chemical/biological protective garments while walking on treadmill at a low (< 325 W) or moderate (326–499 W) metabolic workload in environmental conditions equivalent to wet bulb globe temperatures 21, 30 or 37 °C. Trials were terminated when heart rate exceeded 90% of maximum, when core body temperature reached 39 °C, at 120 min or due to volitional fatigue. Core body temperature, heart rate, thermal sensation, thermal comfort and RPE were recorded at 15 min intervals and at termination. Multiple statistical methods were used to determine the most accurate perceptual predictor. Results Significant moderate relationships were observed between the PeSI (r = 0.74; p < 0.001), the modified PeSI (r = 0.73; p < 0.001) and unexpectedly RPE (r = 0.71; p < 0.001) with the PSI, respectively. The PeSI (mean bias: − 0.8 ± 1.5 based on a 0–10 scale; area under the curve: 0.887), modified PeSI (mean bias: − 0.5 ± 1.4 based on 0–10 scale; area under the curve: 0.886) and RPE (mean bias: − 0.7 ± 1.4 based on a 0–10 scale; area under the curve: 0.883) displayed similar predictive performance when participants experienced high-to-very high levels of physiological strain. Conclusions Modifying the PeSI did not improve the subjective prediction of physiological strain. However, RPE provided an equally accurate prediction of physiological strain, particularly when high-to-very high levels of strain were observed. Therefore, given its predictive performance and user-friendliness, the evidence suggests that RPE in isolation is a practical and cost-effective tool able to estimate physiological strain during exertional-heat stress under these work conditions

A novel method of personnel cooling in an operating theatre environment

Funding obtained from University of Malta.An optimized theatre environment, including personal temperature regulation, can help maintain concentration, extend work times and may improve surgical outcomes. However, devices, such as cooling vests, are bulky and may impair the surgeon's mobility. We describe the use of a low-cost, low-energy 'bladeless fan' as a personal cooling device. The safety profile of this device was investigated by testing air quality using 0.5- and 5-µm particle counts as well as airborne bacterial counts on an operating table simulating a wound in a thoracic operation in a busy theatre environment. Particle and bacterial counts were obtained with both an empty and full theatre, with and without the 'bladeless fan'. The use of the 'bladeless fan' within the operating theatre during the simulated operation led to a minor, not statistically significant, lowering of both the particle and bacterial counts. In conclusion, the 'bladeless fan' is a safe, effective, low-cost and low-energy consumption solution for personnel cooling in a theatre environment that maintains the clean room conditions of the operating theatre.peer-reviewe

E-heritage : the future for integrated applications in cultural heritage

A number of factors are combining to change the structure and contents of documentation of cultural heritage: 1) the exponential growth in data generated by imaging techniques makes it possible for a site or an artifact to be recorded at a resolution of over 16 megapixels and at a density of several hundred million cloud points; 2) high-resolution imaging is becoming more affordable and/or available; 3) the economics and legal constraints of conservation practice are gradually pushing towards more stringent documentation standards; 4) improved communications infrastructure and mobile computing facilities are changing the way that data is recorded, processed, stored and – inevitably - used; 5) increasingly available computerized expert systems will be integrated into the very systems that conservators and documentation specialists carry around with them or access on a daily basis; 6) the advent of web-based systems will afford super-computer processing power and large-system database handling to the documentation specialist and the conservator in the field and permit greater flexibility for teleworking; 7) Computerised Project-based Management techniques will gradually spread from the realm of large institutions to SME’s and individual practitioners making digital image processing in architecture and archaeology more akin to the exchange of engineering drawings in automobile design industry. 8) The availability of cheap local or distributed processing power means that most of the above advantages will be present in both developed and developing countries. This paper explores. e-heritage as an integrated project which aims at providing a seamless yet structurally and inherently up-gradeable technological platform for all activities within cultural heritage conservation and management.peer-reviewe

The effects of daily cold-water recovery and postexercise hot-water immersion on training-load tolerance during 5 days of heat-based training

PURPOSE: To examine the effects of daily cold- and hot-water recovery on training load (TL) during 5 days of heat-based training. METHODS: Eight men completed 5 days of cycle training for 60 minutes (50% peak power output) in 4 different conditions in a block counter-balanced-order design. Three conditions were completed in the heat (35°C) and 1 in a thermoneutral environment (24°C; CON). Each day after cycling, participants completed 20 minutes of seated rest (CON and heat training [HT]) or cold- (14°C; HTCWI) or hot-water (39°C; HTHWI) immersion. Heart rate, rectal temperature, and rating of perceived exertion (RPE) were collected during cycling. Session-RPE was collected 10 minutes after recovery for the determination of session-RPE TL. Data were analyzed using hierarchical regression in a Bayesian framework; Cohen d was calculated, and for session-RPE TL, the probability that d > 0.5 was also computed. RESULTS: There was evidence that session-RPE TL was increased in HTCWI (d = 2.90) and HTHWI (d = 2.38) compared with HT. The probabilities that d > 0.5 were .99 and .96, respectively. The higher session-RPE TL observed in HTCWI coincided with a greater cardiovascular (d = 2.29) and thermoregulatory (d = 2.68) response during cycling than in HT. This result was not observed for HTHWI. CONCLUSION: These findings suggest that cold-water recovery may negatively affect TL during 5 days of heat-based training, hot-water recovery could increase session-RPE TL, and the session-RPE method can detect environmental temperature-mediated increases in TL in the context of this study.</p

The reproducibility of 10 and 20km time trial cycling performance in recreational cyclists, runners and team sport athletes

Objectives: This study aimed to determine the reliability of 10 and 20 km cycling time trial (TT) performance on the Velotron Pro in recreational cyclists, runners and intermittent-sprint based team sport athletes, with and without a familiarisation. Design: Thirty-one male, recreationally active athletes completed four 10 or 20 km cycling TTs on different days. Methods: During cycling, power output, speed and cadence were recorded at 23 Hz, and heart rate and rating of perceived exertion (RPE) were recorded every km. Multiple statistical methods were used to ensure a comprehensive assessment of reliability. Intraclass correlations, standard error of the measurement, minimum difference required for a worthwhile change and coefficient of variation were determined for completion time and mean trial variables (power output, speed, cadence, heart rate, RPE, session RPE). Results: A meaningful change in performance for cyclists, runners, team sport athletes would be represented by 7.5, 3.6 and 12.9% improvement for 10 km and a 4.9, 4.0 and 5.6% for 20 km completion time. After a familiarisation, a 4.0, 3.7 and 6.4% improvement for 10 km and a 4.1, 3.0 and 4.4% would be required for 20 km. Conclusions: Data from this study suggest not all athletic subgroups require a familiarisation to produce substantially reliable 10 and 20 km cycling performance. However, a familiarisation considerably improves the reliability of pacing strategy adopted by recreational runners and team sport athletes across these distances

Regulatory evaluation of Glybera in Europe-two committees, one mission

publishersversionPeer reviewe

Attitudes and Performance: An Analysis of Russian Workers

This paper investigates the relationship between locus of control and performance among Russian employees, using survey data collected at 28 workplaces in 2002 in Taganrog and at 47 workplaces in 2003 in Ekaterinburg. We develop a measure that allows us to categorize the Russian employees participating in our survey as exhibiting an internal or external locus of control. We then assess the extent to which there are significant differences between “internals” and “externals” in work-related attitudes that may affect performance. In particular, we focus on (1) attitudes about outcomes associated with hard work, (2) level of job satisfaction, (3) expectation of receiving a desired reward, and (4) loyalty to and involvement with one’s organization. In each case we identify where gender and generational differences emerge. Our main objective is to determine whether Russian employees who exhibit an internal locus of control perform better than employees with an external locus of control. Our performance measures include earnings, expected promotions, and assessments of the quantity and quality of work in comparison to others at the same organization doing a similar job. Controlling for a variety of worker characteristics, we find that (1) individuals who exhibit an internal locus of control perform better, but this result is not always statistically significant; (2) even among “internals,” women earn significantly less than men and have a much lower expectation of promotion; (3) even among “internals,” experience with unemployment has a negative influence on performance.http://deepblue.lib.umich.edu/bitstream/2027.42/40144/3/wp758.pd

Evaluation of polygenic risk scores for breast and ovarian cancer risk prediction in BRCA1 and BRCA2 mutation carriers

Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2 x 10(53)). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2 x 10(-20)). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management