Correction to: Tram system related cycling injuries.

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Tram system related cycling injuries.

INTRODUCTION: Understanding of tram-system related cycling injuries (TSRCI) is poor. The aim of this study was to report the spectrum of injuries, demographics and social deprivation status of patients. Secondary aims included assessment of accident circumstances, effects of TSRCI on patients' confidence cycling, together with time off work and cycling. METHODS: A retrospective review of patients presenting to emergency services across all hospitals in Edinburgh and West Lothian with tram related injuries between May 2009 and April 2016 was undertaken. Medical records and imagining were analysed and patients were contacted by telephone. RESULTS: 191 cyclists (119 males, 72 females) were identified. 63 patients sustained one or more fractures or dislocations. Upper limb fractures/dislocations occurred in 55, lower limb fractures in 8 and facial fractures in 2. Most patients demonstrated low levels of socioeconomic deprivation. In 142 cases, the wheel was caught in tram-tracks, while in 32 it slid on tracks. The latter occurred more commonly in wet conditions (p = 0.028). 151 patients answered detailed questionnaires. Ninety-eight were commuting. 112 patients intended to cross tramlines and 65 accidents occurred at a junction. Eighty patients reported traffic pressures contributed to their accident. 120 stated that their confidence was affected and 24 did not resume cycling. Female gender (p < 0.001) and presence of a fracture/dislocation (p = 0.012) were independent predictors of negative effects on confidence. Patients sustaining a fracture/dislocation spent more time off work (median 5 days vs 1, p < 0.001) and cycling (median 57 days vs 21, p < 0.001). CONCLUSIONS: TSRCI occur predominantly in young to middle-aged adults with low levels of socioeconomic deprivation, most commonly when bicycle wheels get caught in tram-tracks. They result in various injuries, frequently affecting the upper limb. Traffic pressures are commonly implicated. Most patients report negative effects on confidence and a sizeable minority do not resume cycling. TSRCI can result in significant loss of working and cycling days.

Quantifying the Contribution of On-Site Wastewater Treatment Systems to Stream Discharge Using the SWAT Model.

In the southeastern United States, on-site wastewater treatment systems (OWTSs) are widely used for domestic wastewater treatment. The degree to which OWTSs represent consumptive water use has been questioned in Georgia. The goal of this study was to estimate the effect of OWTSs on streamflow in a gauged watershed in Gwinnett County, Georgia using the Soil and Water Assessment Tool (SWAT) watershed-scale model, which includes a new OWTS algorithm. Streamflow was modeled with and without the presence of OWTSs. The model was calibrated using data from 1 Jan. 2003 to 31 Dec. 2006 and validated from 1 Jan. 2007 to 31 Dec. 2010 using the auto-calibration tool SWAT-CUP 4. The daily and monthly streamflow Nash-Sutcliffe coefficients were 0.49 and 0.71, respectively, for the calibration period and 0.37 and 0.68, respectively, for the validation period, indicating a satisfactory fit. Analysis of water balance output variables between simulations showed a 3.1% increase in total water yield at the watershed scale and a 5.9% increase at the subbasin scale for a high-density OWTS area. The percent change in water yield between simulations was the greatest in dry years, implying that the influence of OWTSs on the water yield is greatest under drought conditions. Mean OWTS water use was approximately 5.7% consumptive, contrary to common assumptions by water planning agencies in Georgia. Results from this study may be used by OWTS users and by watershed planners to understand the influence of OWTSs on water quantity within watersheds in this region.

Bionic prosthetic hands: A review of present technology and future aspirations.

BACKGROUND: Bionic prosthetic hands are rapidly evolving. An in-depth knowledge of this field of medicine is currently only required by a small number of individuals working in highly specialist units. However, with improving technology it is likely that the demand for and application of bionic hands will continue to increase and a wider understanding will be necessary. METHODS: We review the literature and summarise the important advances in medicine, computing and engineering that have led to the development of currently available bionic hand prostheses. FINDINGS: The bionic limb of today has progressed greatly since the hook prostheses that were introduced centuries ago. We discuss the ways that major functions of the human hand are being replicated artificially in modern bionic hands. Despite the impressive advances bionic prostheses remain an inferior replacement to their biological counterparts. Finally we discuss some of the key areas of research that could lead to vast improvements in bionic limb functionality that may one day be able to fully replicate the biological hand or perhaps even surpass its innate capabilities. CONCLUSION: It is important for the healthcare community to have an understanding of the development of bionic hands and the technology underpinning them as this area of medicine will expand.

Percutaneous fixation of acute scaphoid waist fractures: Long-term patient-reported functional outcomes and satisfaction at a mean of 11 years following surgery.

The aim of this study was to report the long-term functional outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. A trauma database was searched to identify all skeletally-mature patients with an undisplaced or minimally-displaced scaphoid waist fracture managed with early percutaneous retrograde screw fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based review. The Patient-Rated Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included the Quick version of the Disability of the Arm, Shoulder and Hand score (QuickDASH), the EuroQol 5-dimensions score (EQ-5D-5L), and complications. During the study period 114 patients underwent this procedure. The mean age was 28 years (range 17-62) and 97 patients (85%) were male. The median time from injury to surgery was nine days (range 1-27). Twelve patients (11%) reported a complication, all of whom required repeat surgical intervention (six revision ORIF for non-union, five elective removal of hardware, one early revision fixation due to screw impingement). Long-term outcome data was available for 77 patients (68%) at mean follow-up of 11.4 years (range 6.4-19.8). The median PRWE was 0 (IQR 0-7.5), median QuickDASH 0 (IQR 0-4.5) and median EQ-5D-5L 1.0 (IQR 0.837-1.0). There were 97% (n = 74) patients satisfied with their outcome. Early percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures results in good long-term patient reported outcomes and health-related quality of life. Although comparable with previous studies, the overall surgical reintervention rate is notable and can result in inferior outcomes. LEVEL OF EVIDENCE: Therapeutic level III (Retrospective Cohort Study).

The carpal bones: a basic test of medical students' and junior doctors' knowledge of anatomy.

With the changing emphasis of the modern medical school curriculum, many senior doctors and authors are commenting on a decline in anatomical knowledge of trainees. This study was conceived to provide a snapshot of medical students' and junior doctors' knowledge of anatomy. The carpal bones were chosen as a benchmark for anatomical knowledge as they are easily objectively examined and have clinical relevance to junior doctors in a number of disciplines. Twenty five fourth and final year medical students, fifteen pre-registration house officers (PRHOs) and ten senior house officers (SHOs) were recruited and the questionnaires were completed in the presence of one author. Of all participants recruited only fifteen could correctly name all eight carpal bones. Seven of these were SHOs in Surgery or Accident and Emergency (A&E). Seventeen medical students (68%) and nine PRHOs (60%) correctly identified less than five carpal bones. Most SHOs (90%) could name five or more bones; the proportion of PRHOs and medical students correctly naming more than five bones was similar (40% vs 32%). The scaphoid was the most frequently identified bone, with an accuracy of 92%. Only 15 candidates (30%) managed to name the triquetrum. The overall recognition scores obtained by medical students was poor, however the SHO's results were more reassuring. Anatomy teaching should be encouraged in undergraduate and postgraduate training.

Long-term patient-reported outcomes following Bennett's fractures.

We define the long-term outcomes and rates of further operative intervention following displaced Bennett's fractures treated with Kirschner (K-) wire fixation between 1996 and 2009. We retrospectively identified 143 patients (127 men and 16 women) with a mean age at the time of injury of 33.2 years (18 to 75). Electronic records were examined and patients were invited to complete the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in addition to a satisfaction questionnaire. The time since injury was a mean of 11.5 years (3.4 to 18.5). In total 11 patients had died, one had developed dementia and 12 patients were lost to follow-up. This left 119 patients available for recruitment. Of these, 57 did not respond, leaving a study group of 62 patients. Patients reported excellent functional outcomes and high levels of satisfaction at follow-up. Median satisfaction was 94% (interquartile range 91.5 to 97.5) and the mean DASH score was 3.0 (0 to 38). None of the patients had undergone salvage procedures and none of the responders had changed occupation or sporting activities. Long-term patient reported outcomes following displaced Bennett's fractures treated by closed reduction and K-wire fixation show excellent functional results and a high level of patient satisfaction. The rate of infection is low and similar to other surgical procedures with percutaneous K-wires.

Assessment of spinal musculature using surface electromyographic spectral color mapping.

STUDY DESIGN: A technique is described for analyzing electromyogram data from lumbar spinal muscles, with special reference to discrimination of people with back pain. The ability to discriminate was evaluated in 99 people (61 healthy and 38 with chronic or acute back pain), and the influence of load was assessed. OBJECTIVES: To evaluate methods of analysis of complex electromyogram data and to assess correlation of electromyogram information with clinical condition in people with and without back pain. SUMMARY OF BACKGROUND INFORMATION: In previous analyses of electromyogram data, only a small part of the data have been used. Spinal muscular decompensation has been postulated in chronic low back pain, but there has been no direct demonstration of this phenomenon. Objective measures are still elusive. METHODS: Lumbar spinal surface electromyograms were recorded during an isometric lifting task. The data were represented graphically as color-coded plots of electromyogram frequency, time, and electromyogram amplitude. Spectral width at half-peak amplitude (spectral half width) was calculated from the digitized, summed data. Ninety-nine people were tested: 48 men (29 with no recent [in the past 2 years] history of back pain, 16 with chronic back pain, 3 with acute back pain) and 51 women (32 with no recent back pain and 19 with chronic back pain). RESULTS: Spectral color maps in people with chronic back pain were markedly different from those in healthy people. Spectral half width was greater in people with chronic back pain than in healthy people (P < 0.01). Blinded analysis of spectral color maps allowed discrimination of people with back pain from healthy people with a sensitivity of 76% and a specificity of 81%. People with a history of back pain had markedly variable half widths. CONCLUSIONS: A new method of analysis of electromyogram data from lumbar spinal muscles has allowed discrimination between people with back pain and healthy people. This provides direct evidence of a correlation between muscular electrical function, measured by electromyogram, and low back pain. This technique may have potential as an objective measurement tool.

The Mailbase hand surgery electronic mailing list.

Hand - an Internet based electronic mailing list - enables surgeons with a common interest in hand surgery to share experiences and engage in worldwide electronic scholarly discussion. This paper examines the thinking behind the setting up of this list and gives examples of how the list is being used.

"Uneasy lies the hand in which rests the crown" an unusual foreign body following a punch injury.

A case of cellulitis of the hand resulting from embedding of a dental crown following a punch injury is described. This report emphasises the need for X-ray imaging in all cases of penetrating hand trauma, particularly when the history is vague, and also the difficulty in using metronidazole in alcoholic patients.

The audit of orthopaedic trainee teaching improves supervision rates.

Inefficiency in surgical training has been identified as a result of low rates of supervision, with direct teaching of operating by consultants occurring in less than 20% of cases in papers dealing with general surgery and cardiac surgery training. The introduction of an audit system in an orthopaedic training programme was associated with an improvement of teaching from an already high 30% to 40% of cases. A logbook programme was introduced which allows easy analysis of the distribution of experience on an anatomical basis.