The axillary approach to raising the latissimus dorsi free flap for facial re-animation: a descriptive surgical technique

The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time

Chemical Association via Exact Thermodynamic Formulations

It can be fruitful to view two-component physical systems of attractive monomers, A and B, ``chemically'' in terms of a reaction A + B C, where C = AB is an associated pair or complex. We show how to construct free energies in the three-component or chemical picture which, under mass-action equilibration, exactly reproduce any given two-component or ``physical'' thermodynamics. Order-by-order matching conditions and closed-form chemical representations reveal the freedom available to modify the A-C, B-C, and C-C interactions and to adjust the association constant. The theory (in the simpler one-component, i.e., A = B, case) is illustrated by treating a van der Waals fluid.Comment: 15 double-spaced pages (RevTeX), including 1 eps figur

Solving the Twin’s Paradox with Special Relativity

In this paper, we examine one of the most well known of special relativity’s apparent paradoxes: the twin’s paradox. It is regularly claimed that because this paradox contains accelerating frames that it does not belong in the domain of special relativity but must be solved via general relativity. We will demonstrate that this is not the case by considering to solutions to the paradox which only involve flat Minkowski spacetime. The first is the Doppler shift analysis which considers what each observer actually sees according to the relativistic Doppler equation which finds that both observers agree the travelling twin is younger. Then we solve it analytically by considering Rindler coordinates which quantify accelerating frames in special relativity. This will give us a numeric result which shows that the Earthbound twin ages the required amount during the turnaround according to the accelerated frame. Thus, by considering the appropriate framework, we demonstrate there is no paradox involved at all

Remodelling a multi-anode ionisation chamber detector for accelerator mass spectrometry of 53Mn

Accelerator Mass Spectrometry (AMS) is a single-atom counting technique that measures the abundance of rare, long-lived radioisotopes using only milligrams of sample. The astrophysical radioisotopes 53Mn and 60Fe have been utilised for many applications including meteoritics, exposure dating, and the search for near-Earth supernovae. 53Mn measurements at the ANU have been limited to sensitivities above 10^-13 by insufficient suppression of the stable isobar, 53Cr. To expand the applications accessible to 53Mn analysis, a new detector was commissioned that will improve the available sensitivity. This thesis covers the implementation of the new Flexible Anti-Scatter Multi-Anode (FASMA) detector. Simulations were conducted to determine the optimal placement of the detector inside the gas-filled magnet, and to assist with the design of a new multi-anode configuration. The FASMA detector was successfully tested and full spectra were recorded. These preliminary results indicate an improvement in the achievable sensitivity, even without the suppression of scattered particles. With further work, the FASMA detector should reach a sensitivity at or below 10^-14, which is competitive with the best reported level in the field. Long-lived radionuclides, such as 53Mn and 60Fe, are important for extracting the exposure history of meteorites, both in space and on Earth, as well helping to identify their origin. In light of this, cosmogenic 53Mn and 60Fe ratios were measured in ten meteorite samples. Since the available data on live 53Mn and 60Fe is scarce, these measurements will improve the constraints on current production rate models for meteorites

Approaches to the management of synkinesis: a scoping review.

Post-paralysis facial synkinesis can develop in any facial palsy and is associated with significant functional and psychosocial consequences for affected patients. While the prevention of synkinesis especially after Bell's Palsy has been well examined, much less evidence exists regarding the management of patients with already established synkinesis. Therefore, the purpose of this review is to summarize the available literature and to provide an overview of the current therapeutic options for facial palsy patients with established synkinesis. A systematic literature review was undertaken, following the PRISMA 2020 guidelines. MEDLINE via PubMed and Cochrane Library were searched using the following strategy: ((facial palsy) OR (facial paralysis) OR (facial paresis)) AND (synkinesis) AND ((management) OR (guidelines) OR (treatment)). The initial search yielded 201 articles of which 36 original papers and 2 meta-analyses met the criteria for inclusion. Overall, the included articles provided original outcome data on 1408 patients. Articles were divided into the following treatment categories: chemodenervation (12 studies, 536 patients), facial therapy (5 studies, 206 patients), surgical (10 studies, 389 patients) and combination therapy (9 studies, 278 patients). Results are analyzed and discussed accordingly. Significant heterogeneity in study population and design, lack of control groups, differences in postoperative follow-up as well as the use of a variety of subjective and objective assessment tools to quantify synkinesis prevent direct comparison between treatment modalities. To date there is no consensus on how post-paralysis facial synkinesis is best treated. The lack of comparative studies and standardized outcome reporting hinder our understanding of this complex condition. Until higher-quality scientific evidence is available, it remains a challenge best approached in an interdisciplinary team. An individualized multimodal therapeutic concept consisting of facial therapy, chemodenervation and surgery should be tailored to meet the specific needs of the patient

Developing a competency framework for effective assistive technology training

This report considers the provision of digital assistive technology (AT) in special schools and specialist colleges. The definition of digital assistive technology includes software, hardware and services specifically designed to support people with a disability or learning difficulty, as well as accessibility features found in mainstream software and operating systems. Provision of AT in specialist education contexts is often dependent on localised expertise, or on individuals with an interest and enthusiasm for the topic. To date, no formal training pathways exist for the majority of learner-facing staff who support AT, and no agreed framework of skills and competencies informs the training that does exist. This has been cited as a barrier to the development of new AT training pathways for learner-facing staff.This work addresses this gap by proposing a competency framework of knowledge and skills required by different job roles across the AT implementation pathway: assessment, provisioning, ongoing support and review. This framework is the result of a comprehensive review of published literature in the field, combined with exploratory work conducted by the research team with participants from specialist schools and colleges in England. Expert sources (staff working in various roles in ‘AT mature’ special schools and specialist colleges) have been consulted to determine what current AT professionals in specialist schools and colleges see as the minimum required standards for staff working across the AT implementation pathway. This work focuses on specialist provision where staff have an understanding of both the learning environment and the skills and knowledge needed to support pupils or students with additional support needs to use assistive technology effectively.The framework highlights the benefits derived from all staff working in special schools and specialist colleges having some level of competence and skills in the AT implementation pathway. The work also identifies that, given the range of needs that are supported in special schools and specialist colleges, it is not realistic to expect all staff to have knowledge of the range of AT systems that are in use. Staff may not have the skills to undertake assessment for AT in all cases, and referral routes to specialist services should be developed where this is the case. Staff can be trained in the use of AT frameworks to support implementation, ensuring they have the core skills to identify, critique and apply new AT tools. Knowledge at the person level, understanding of specific disabilities as well as users, their preferences and relevant environmental factors is also important. Knowledge of local and national funding routes is useful. The work highlights that basic IT skills are a foundational factor in the successful support of AT by learner facing staff. At an institutional level, management buy-in and the creation and maintenance of an AT-positive environment are key, as shown in both the literature review and the focus groups.The research also identifies the value that participants place on AT specialist roles and, indicates that where these roles exist, they provide support across the AT implementation pathway. This report highlights the potential benefits of providing support for the creation of dedicated AT specialist roles, with expert levels of skills and competence developed through experience or ring-fenced time to access specialist training. Based on the literature review and focus group findings staff in schools and colleges clearly see value in access to AT specialists and their skills, as they can support local training provision through a ‘train the trainer’ model, fostering communities of practice which increase AT proficiency.Training for all learner-facing roles in special schools and specialist colleges is helpful at both pre-service and in-service career stages, and the outcomes of this work evidence the benefits of increasing the availability of the currently limited training opportunities for staff. However, resource constraints on funding and available training time remain major barriers to staff undertaking AT training, even where training needs can be identified.The report also shows the importance of interdisciplinary working, acknowledging that different professional groups bring a range of skills and background knowledge, all of which contribute to successful AT outcomes for learners. This work supports and builds on previous DfE funded research by Prof Dave Edyburn (2020), whose recommendations directly informed the project. In particular, this report highlights the benefits of increased AT training provision and also identifies that it would be helpful to develop ways of measuring training outcomes and impact.This work may serve as the basis for future enquiry around currently available AT training and resources which, once identified, may be mapped against the competency framework. This will enable staff to identify sources of training relevant to their role and future development. The process may also facilitate a gap analysis to identify where important elements are missing, under-developed or not addressed in the current training and resource offer.Other areas of future development identified in this report include exploring the benefits realised by development of specialist AT support services, which may act as a pan-sectoral body to organise and oversee training and development, dissemination of best practice and to act as a conduit between learner-facing staff and policy makers. In addition, this report may begin the conversation on the development of standards of practice across the four phases of AT implementation, in order to standardise the expected level of service provision in special schools and specialist colleges. These ideas are presented to support staff working in special schools and specialist colleges to make best possible use of AT to support learners with SEND

Developing a competency framework for effective assistive technology training

This report considers the provision of digital assistive technology (AT) in special schools and specialist colleges. The definition of digital assistive technology includes software, hardware and services specifically designed to support people with a disability or learning difficulty, as well as accessibility features found in mainstream software and operating systems. Provision of AT in specialist education contexts is often dependent on localised expertise, or on individuals with an interest and enthusiasm for the topic. To date, no formal training pathways exist for the majority of learner-facing staff who support AT, and no agreed framework of skills and competencies informs the training that does exist. This has been cited as a barrier to the development of new AT training pathways for learner-facing staff.This work addresses this gap by proposing a competency framework of knowledge and skills required by different job roles across the AT implementation pathway: assessment, provisioning, ongoing support and review. This framework is the result of a comprehensive review of published literature in the field, combined with exploratory work conducted by the research team with participants from specialist schools and colleges in England. Expert sources (staff working in various roles in ‘AT mature’ special schools and specialist colleges) have been consulted to determine what current AT professionals in specialist schools and colleges see as the minimum required standards for staff working across the AT implementation pathway. This work focuses on specialist provision where staff have an understanding of both the learning environment and the skills and knowledge needed to support pupils or students with additional support needs to use assistive technology effectively.The framework highlights the benefits derived from all staff working in special schools and specialist colleges having some level of competence and skills in the AT implementation pathway. The work also identifies that, given the range of needs that are supported in special schools and specialist colleges, it is not realistic to expect all staff to have knowledge of the range of AT systems that are in use. Staff may not have the skills to undertake assessment for AT in all cases, and referral routes to specialist services should be developed where this is the case. Staff can be trained in the use of AT frameworks to support implementation, ensuring they have the core skills to identify, critique and apply new AT tools. Knowledge at the person level, understanding of specific disabilities as well as users, their preferences and relevant environmental factors is also important. Knowledge of local and national funding routes is useful. The work highlights that basic IT skills are a foundational factor in the successful support of AT by learner facing staff. At an institutional level, management buy-in and the creation and maintenance of an AT-positive environment are key, as shown in both the literature review and the focus groups.The research also identifies the value that participants place on AT specialist roles and, indicates that where these roles exist, they provide support across the AT implementation pathway. This report highlights the potential benefits of providing support for the creation of dedicated AT specialist roles, with expert levels of skills and competence developed through experience or ring-fenced time to access specialist training. Based on the literature review and focus group findings staff in schools and colleges clearly see value in access to AT specialists and their skills, as they can support local training provision through a ‘train the trainer’ model, fostering communities of practice which increase AT proficiency.Training for all learner-facing roles in special schools and specialist colleges is helpful at both pre-service and in-service career stages, and the outcomes of this work evidence the benefits of increasing the availability of the currently limited training opportunities for staff. However, resource constraints on funding and available training time remain major barriers to staff undertaking AT training, even where training needs can be identified.The report also shows the importance of interdisciplinary working, acknowledging that different professional groups bring a range of skills and background knowledge, all of which contribute to successful AT outcomes for learners. This work supports and builds on previous DfE funded research by Prof Dave Edyburn (2020), whose recommendations directly informed the project. In particular, this report highlights the benefits of increased AT training provision and also identifies that it would be helpful to develop ways of measuring training outcomes and impact.This work may serve as the basis for future enquiry around currently available AT training and resources which, once identified, may be mapped against the competency framework. This will enable staff to identify sources of training relevant to their role and future development. The process may also facilitate a gap analysis to identify where important elements are missing, under-developed or not addressed in the current training and resource offer.Other areas of future development identified in this report include exploring the benefits realised by development of specialist AT support services, which may act as a pan-sectoral body to organise and oversee training and development, dissemination of best practice and to act as a conduit between learner-facing staff and policy makers. In addition, this report may begin the conversation on the development of standards of practice across the four phases of AT implementation, in order to standardise the expected level of service provision in special schools and specialist colleges. These ideas are presented to support staff working in special schools and specialist colleges to make best possible use of AT to support learners with SEND

Developing a competency framework for effective assistive technology training

This report considers the provision of digital assistive technology (AT) in special schools and specialist colleges. The definition of digital assistive technology includes software, hardware and services specifically designed to support people with a disability or learning difficulty, as well as accessibility features found in mainstream software and operating systems. Provision of AT in specialist education contexts is often dependent on localised expertise, or on individuals with an interest and enthusiasm for the topic. To date, no formal training pathways exist for the majority of learner-facing staff who support AT, and no agreed framework of skills and competencies informs the training that does exist. This has been cited as a barrier to the development of new AT training pathways for learner-facing staff.This work addresses this gap by proposing a competency framework of knowledge and skills required by different job roles across the AT implementation pathway: assessment, provisioning, ongoing support and review. This framework is the result of a comprehensive review of published literature in the field, combined with exploratory work conducted by the research team with participants from specialist schools and colleges in England. Expert sources (staff working in various roles in ‘AT mature’ special schools and specialist colleges) have been consulted to determine what current AT professionals in specialist schools and colleges see as the minimum required standards for staff working across the AT implementation pathway. This work focuses on specialist provision where staff have an understanding of both the learning environment and the skills and knowledge needed to support pupils or students with additional support needs to use assistive technology effectively.The framework highlights the benefits derived from all staff working in special schools and specialist colleges having some level of competence and skills in the AT implementation pathway. The work also identifies that, given the range of needs that are supported in special schools and specialist colleges, it is not realistic to expect all staff to have knowledge of the range of AT systems that are in use. Staff may not have the skills to undertake assessment for AT in all cases, and referral routes to specialist services should be developed where this is the case. Staff can be trained in the use of AT frameworks to support implementation, ensuring they have the core skills to identify, critique and apply new AT tools. Knowledge at the person level, understanding of specific disabilities as well as users, their preferences and relevant environmental factors is also important. Knowledge of local and national funding routes is useful. The work highlights that basic IT skills are a foundational factor in the successful support of AT by learner facing staff. At an institutional level, management buy-in and the creation and maintenance of an AT-positive environment are key, as shown in both the literature review and the focus groups.The research also identifies the value that participants place on AT specialist roles and, indicates that where these roles exist, they provide support across the AT implementation pathway. This report highlights the potential benefits of providing support for the creation of dedicated AT specialist roles, with expert levels of skills and competence developed through experience or ring-fenced time to access specialist training. Based on the literature review and focus group findings staff in schools and colleges clearly see value in access to AT specialists and their skills, as they can support local training provision through a ‘train the trainer’ model, fostering communities of practice which increase AT proficiency.Training for all learner-facing roles in special schools and specialist colleges is helpful at both pre-service and in-service career stages, and the outcomes of this work evidence the benefits of increasing the availability of the currently limited training opportunities for staff. However, resource constraints on funding and available training time remain major barriers to staff undertaking AT training, even where training needs can be identified.The report also shows the importance of interdisciplinary working, acknowledging that different professional groups bring a range of skills and background knowledge, all of which contribute to successful AT outcomes for learners. This work supports and builds on previous DfE funded research by Prof Dave Edyburn (2020), whose recommendations directly informed the project. In particular, this report highlights the benefits of increased AT training provision and also identifies that it would be helpful to develop ways of measuring training outcomes and impact.This work may serve as the basis for future enquiry around currently available AT training and resources which, once identified, may be mapped against the competency framework. This will enable staff to identify sources of training relevant to their role and future development. The process may also facilitate a gap analysis to identify where important elements are missing, under-developed or not addressed in the current training and resource offer.Other areas of future development identified in this report include exploring the benefits realised by development of specialist AT support services, which may act as a pan-sectoral body to organise and oversee training and development, dissemination of best practice and to act as a conduit between learner-facing staff and policy makers. In addition, this report may begin the conversation on the development of standards of practice across the four phases of AT implementation, in order to standardise the expected level of service provision in special schools and specialist colleges. These ideas are presented to support staff working in special schools and specialist colleges to make best possible use of AT to support learners with SEND