Toxicity of pyrolysis gases from synthetic polymers

The screening test method was used to investigate toxicity in polyethylene, polystyrene, polymethyl methacrylate, polyaryl sulfone, polyether sulfone, polyphenyl sulfone, and polyphenylene sulfide. Changing from a rising temperature program to a fixed temperature program resulted on shorter times to animal responses. This effect was attributed in part to more rapid generation of toxicants. The toxicants from the sulfur containing polymers appeared to act more rapidly than the toxicants from the other polymers. It was not known whether this effect was due primarily to difference in concentration or in the nature of the toxicants. The carbon monoxide concentration found did not account for the results observed with the sulfur containing polymers. Polyphenyl sulfone appeared to exhibit the least toxicity among the sulfur containing polymers evaluated under these test conditions

Toxicity of Pyrolysis Gases from Elastomers

The toxicity of the pyrolysis gases from six elastomers was investigated. The elastomers were polyisoprene (natural rubber), styrene-butadiene rubber (SBR), ethylene propylene diene terpolymer (EPDM), acrylonitrile rubber, chlorosulfonated polyethylene rubber, and polychloroprene. The rising temperature and fixed temperature programs produced exactly the same rank order of materials based on time to death. Acryltonitrile rubber exhibited the greatest toxicity under these test conditions; carbon monoxide was not found in sufficient concentrations to be the primary cause of death

Blunt Abdominal Trauma in a European Trauma Setting : Need for Complex or Non-Complex Skills in Emergency Laparotomy

Background and Aims: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. Materials and Methods: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006-2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. Results: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p <0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). Conclusion: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.Peer reviewe

Comparison of official food control results in Finland between food establishments with and without a certified food safety management system

Funding Information: The authors wish to acknowledge the Finnish Food Authority, which provided the inspection data for this research. This work was supported by the Finnish Ministry of Agriculture and Forestry (grant number 1821/03.01.01/2018 ). Funding Information: The authors wish to acknowledge the Finnish Food Authority, which provided the inspection data for this research. This work was supported by the Finnish Ministry of Agriculture and Forestry (grant number 1821/03.01.01/2018). Publisher Copyright: © 2021 The Author(s)Certified food safety management systems (FSMSs), such as ISO 22000 and BRC, along with official food control, focus on food safety. European Union regulation 2017/625 requires to take FSMSs and their audits into account in official food control. To assess the possibility to decrease official food control frequency due to certified FSMSs the association of certified FSMSs on food business operators' (FBO) compliance was examined. The results of 1484 official inspections of 110 Finnish food establishments representing slaughterhouses, other meat establishments, fish and milk establishments, and bakeries with (n = 59) and without (n = 51) certified FSMS were studied over the period of 2016–2018. Altogether, 14 356 scores were given to 87 different items during the inspections. The comparison of scores between food establishments with and without certified FSMS discovered minor differences: 98.3% and 98.0% of inspected items in food establishments with and without a certified FSMS, respectively, did not impair food safety. The association between certified FSMSs and food establishments’ compliance was inconsistent in different establishment types and among inspected items. Therefore, the results do not support a decrease in the frequency of official food control inspections merely based on the existence of a certified FSMS. Instead, the results advocate for an individual assessment of the FBO's inspection frequency, based on the history of compliance.Peer reviewe

Information Systems for Disability Determination: A Multi-Stakeholder Assessment of Electronic Medical Evidence Needs and Processes

This study focuses on Health Information Technology (Health IT) in improving the decision-making process concerning disability benefits. Using a multimethod, multilevel approach that includes case analysis and semi-structured interviews, this study examines the practices, challenges, and potential solutions or methods involved in adequate and timely collection of medical evidence through information technology (IT) to support disability determination. Researchers collected qualitative data through fifty-six semi-structured thirty-minute interviews with Disability Determination Services (DDS) personnel in three states. Based on site observations, interviews, and document analysis, they developed two provider case studies. To demonstrate the adequacy and timeliness of medical evidence collection, the study also examined and reviewed twelve disability claimant cases. Findings suggest that, at the payer and provider levels, electronic solutions provide more adequate and timely responses to medical evidence requests. Based on the case studies, implemented Health IT reduces incomplete medical evidence and decreases provider turnaround time in processing a payer’s requests. Among the claims examined, 50 percent received low scores for adequacy of medical evidence and 33 percent received high or medium scores for delay of return of medical evidence of record. This examination of disability determination demonstrated that Health IT holds promise for clinical data use in this context

Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution

Publisher Copyright: © 2021 Arthroscopy Association of North AmericaPurpose: The purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants. Methods: Thirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively. Results: The mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤.05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤.05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ±.63 (P ≤.05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤.05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation. Conclusions: In this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing. Level of Evidence: Level IV, therapeutic case series.Peer reviewe

Arthroscopic Coracoclavicular Ligament Reconstruction Using Graft Augmentation and Titanium Implants

Several techniques have been introduced to treat acromioclavicular separation with coracoclavicular ligament reconstruction using graft augmentation. A modified arthroscopic technique for coracoclavicular ligament reconstruction was used based on a previous technique where the supportive device and tendon graft share the clavicular and coracoid drill holes. A notable problem with the previous technique was large protruding suture knots on the washer and clavicle, which could predispose to wound infection. In this modified technique, titanium implants were introduced. The implants hid the suture knot on the clavicle, and less foreign material was needed between the clavicular and coracoid implants.</p

Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution

PurposeThe purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants.MethodsThirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively.ResultsThe mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤ .05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤ .05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ± .63 (P ≤ .05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤ .05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation.ConclusionsIn this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing.Level of EvidenceLevel IV, therapeutic case series.</p