'Treatment of the Sportsman's groin': British Hernia Society's 2014 position statement based on the Manchester Consensus Conference

<b>Introduction</b> The aim was to produce a multidisciplinary consensus to determine the current position on the nomenclature, definition, diagnosis, imaging modalities and management of Sportsman's groin (SG).<p></p> <b>Methods</b> Experts in the diagnosis and management of SG were invited to participate in a consensus conference held by the British Hernia Society in Manchester, UK on 11–12 October 2012. Experts included a physiotherapist, a musculoskeletal radiologist and surgeons with a proven track record of expertise in this field. Presentations detailing scientific as well as outcome data from their own experiences were given. Records were made of the presentations with specific areas debated openly.<p></p> <b>Results</b> The term ‘inguinal disruption’ (ID) was agreed as the preferred nomenclature with the term ‘Sportsman's hernia’ or ‘groin’ rejected, as no true hernia exists. There was an overwhelming agreement of opinion that there was abnormal tension in the groin, particularly around the inguinal ligament attachment. Other common findings included the possibility of external oblique disruption with consequent small tears noted as well as some oedema of the tissues. A multidisciplinary approach with tailored physiotherapy as the initial treatment was recommended with any surgery involving releasing the tension in the inguinal canal by various techniques and reinforcing it with a mesh or suture repair. A national registry should be developed for all athletes undergoing surgery.<p></p> <b>Conclusions</b> ID is a common condition where no true hernia exists. It should be managed through a multidisciplinary approach to ensure consistent standards and outcomes are achieved

‘Hey, teach these kids to eat their own food!’: Institutional intergroup contact in immigrant mothers' talk

Although informal segregation often persists in multiethnic neighbourhoods, local institutions offering public services may act as an important setting for intergroup contact. Therefore, we studied how immigrant mothers of young children discursively construct institutional intergroup contact with workers of public playgrounds and kindergartens. We conducted longitudinal interviews with 10 immigrant mothers three times over the period of a year in 2 multi-ethnic neighbourhoods in Helsinki, Finland. Using Critical Discursive Psychology, we analysed respondents' talk about the encounters and identified three interpretative repertoires: 'contact as asserting rights', 'contact as helping', and 'contact as cultural rectification'. Our analysis showed how mothers positioned themselves and the workers differently in terms of agency and power in each repertoire. Our findings stress the importance of studying people's own sense-making of institutional contact, with different roles for participants, and that construction of agency within institutional contact is important for building equal membership in society. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement

Numerical calculations of effective elastic properties of two cellular structures

Young's moduli of regular two-dimensional truss-like and eye-shape-like structures are simulated by using the finite element method. The structures are the idealizations of soft polymeric materials used in the electret applications. In the simulations size of the representative smallest units are varied, which changes the dimensions of the cell-walls in the structures. A power-law expression with a quadratic as the exponential term is proposed for the effective Young's moduli of the systems as a function of the solid volume fraction. The data is divided into three regions with respect to the volume fraction; low, intermediate and high concentrations. The parameters of the proposed power-law expression in each region are later represented as a function of the structural parameters, unit-cell dimensions. The presented expression can be used to predict structure/property relationship in materials with similar cellular structures. It is observed that the structures with volume fractions of solid higher than 0.15 exhibit the importance of the cell-wall thickness contribution in the elastic properties. The cell-wall thickness is the most significant factor to predict the effective Young's modulus of regular cellular structures at high volume fractions of solid. At lower concentrations of solid, eye-like structure yields lower Young's modulus than the truss-like structure with the similar anisotropy. Comparison of the numerical results with those of experimental data of poly(propylene) show good aggreement regarding the influence of cell-wall thickness on elastic properties of thin cellular films.Comment: 7 figures and 2 table

Ten-year audit of Lichtenstein hernioplasty under local anaesthesia performed by surgical residents

<p>Abstract</p> <p>Background</p> <p>To analyse in a prospective trial the long-term results of Lichtenstein hernioplasty performed by surgical trainees.</p> <p>Methods</p> <p>Training of tension-free Lichtenstein hernia operation was started in our ambulatory unit as an outpatient procedure under local anaesthesia in 1996. After performing 36 teaching operations together with residents and their supervising specialist, 281 patients were operated during 1996-2000 either by one senior consultant (n = 141) or by 12 surgical trainees (n = 140). After 10 years, 247 (88%) patients were available for the long-term assessment.</p> <p>Results</p> <p>After one month postoperatively, the rate of wound infections (consultant 1.1%, residents 0.7%) and hematomas (consultant 1.1%, residents 3.0%) were low and not related to surgeon's training level (ns). Only 6 (2.1%) clinically evident recurrences were found after 10 years: two after specialist repair and four after trainee repair (ns). Although one third of the patients reported some discomfort after 3 and 10 years, 93-95% of the patients were very satisfied with the operation, with no statistical difference between the surgeons.</p> <p>Conclusion</p> <p>Ambulatory open mesh repair under local anaesthesia was a safe operation and the long-term results were acceptable among the patients operated by surgical trainees.</p

PP/PP-HI/silica nanocomposites for HVDC cable insulation: Are silica clusters beneficial for space charge accumulation?

New potential High Voltage Direct Current (HVDC) cable insulation materials based on nanocomposites are developed in this study. The nanocomposites are produced by blending of polypropylene (PP), propylene-ethylene copolymer (PP–HI) and a modified fumed silica (A-silica) in a concentration of 1 and 2 wt %. The A-silica is successfully modified with (3-aminopropyl)triethoxysilane (APTES) via a solvent-free method, as proven by infrared spectroscopy, thermogravimetry and transmission electron microscope mapping. A-silica in the polymer matrix acts as a nucleating agent resulting in an increase of the crystallization temperature of the polymers and a smaller crystal size. Moreover, the silica addition modified the crystals morphology of the unfilled PP/PP-HI blend. The composite containing A-silica with 2 wt% contains bigger-size silica clusters than the composite filled with 1 wt%. The composite with the higher A-silica concentration shows lower space charge accumulation and a lower charge current value. Besides, much deeper traps and lower trap density are observed in the composite with 2 wt% A-silica addition compared to the one with a lower concentration. Surprisingly, the presence of silica clusters with dimensions of more than 200 nm exhibit a positive effect on reducing the space charge accumulation. However, the real cause of this improvement might be due to change of the electron distribution stemming from the amine-amine hydrogen bond formation, or the change of the chain mobility due to the presence of occluded polymer macromolecules constrained inside the high structure silica clusters. Both phenomena may lead to a higher energetic barrier of charge de-trapping, thus increasing the depth of the charge traps

Optimising the antibiotic treatment of uncomplicated acute appendicitis: a protocol for a multicentre randomised clinical trial (APPAC II trial)

DiscussionTo our knowledge, APPAC II trial is the first randomised controlled trial comparing per oral antibiotic monotherapy with intravenous antibiotic therapy continued by per oral antibiotics in the treatment of uncomplicated acute appendicitis. The APPAC II trial aims to add clinical evidence on the debated role of antibiotics as the first-line treatment for a CT-confirmed uncomplicated acute appendicitis as well as to optimise the non-operative treatment for uncomplicated acute appendicitis.</p