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• Drivers chose whether to go through gaps in traffic in fire-appliance driving clips. • Novice fire-appliance drivers were worse at this task than more experienced drivers. • All drivers looked more at the right edge of the gap than the left... • ...though our safest drivers had the shortest fixations on this location. • This test may provide a future training and assessment tool. Low-speed collisions are a common occurrence for UK Fire and Rescue Services, with frequent bumps and scrapes adding up to create a significant drain on emergency service budgets, and damaging public faith in the service. We hypothesised that the decision to drive through a gap, or aperture, created by other vehicles and/or road furniture, may be related to driver experience and risk-level. To create a test to assess this skill, video clips were recorded from a fire appliance on blue-light training runs. Eighteen clips were selected on the basis that they culminated in a narrow aperture that the film-driver either navigated through, or stopped and waited for other vehicles to move and the gap to widen. Drivers were required to watch these clips, which paused at the point that the film-driver made the decision to either go though, or to wait. The participants rated their belief that the appliance would fit through the gap, and how confident they would be to drive through that aperture themselves (on a 1–8 scale). Novice fire-appliance drivers were less accurate in deciding whether to proceed or not, though their criterion threshold did not differ to that of more experienced drivers. All drivers favoured looking at the right edge of the aperture (either a vehicle or road furniture), but low-risk, experienced fire appliance drivers had the shortest fixations on this area. The results suggest that a video-based test of aperture judgement can differentiate between fire-appliance driver groups based on experience, opening the way for future testing and training tools using this methodology. [ABSTRACT FROM AUTHOR]

Large-scale compressed air energy storage facilities offer one solution to the UK's energy demands, using solutionmined caverns in salt lithologies. For optimum gas storage efficiency, cavern geometry should ideally be smooth: spherical to cylindrical with a circular cross-section. However, such caverns are often irregular with marked asymmetry or ellipticity, and although the reasons for non-circular cross-sections developing during solution mining in some caverns can be related to, for example, the presence of interbedded lithologies, in other instances they are not fully understood. Cavities from dissolution experiments using five main end-member salt facies fabrics from the Triassic Preesall and Northwich Halite formations have been assessed to determine factors affecting cavity geometry, formation and variability in dissolution behaviour. Identical sets of experiments were performed on each fabric type, using two solution concentration strengths: brine and synthetic seawater. Comparison of experimental results using a combination of analytical and imaging techniques shows the extent to which the salt fabric and enhancement of features within the salt influence the resulting dissolution cavity. Observations show a visible increase in micropores within the adjacent halite matrix following dissolution. Smaller-scale features provide further insights into the dissolution processes, and salt fabric behaviour under different dissolution conditions. [ABSTRACT FROM AUTHOR]

Background: Idiopathic macular holes are an important cause of blindness. They have an annual incidence of 8 per 100,000 individuals, and prevalence of 0.2 to 3.3 per 1000 individuals with visual impairment. The condition occurs more frequently in adults aged 75 years or older. Macular holes can be repaired by surgery in which the causative tractional forces in the eye are released and a temporary bubble of gas is injected. To promote successful hole closure individuals may be advised to maintain a face-down position for up to 10 days following surgery. The aim of this study is to determine whether advice to position face-down improves the surgical success rate of closure of large (>400 μm) macular holes, and thereby reduces the need for further surgery.Methods/design: This will be a multicentre interventional, comparative randomised controlled clinical trial comparing face-down positioning with face-forward positioning. At the conclusion of standardised surgery across all sites, participants still eligible for inclusion will be allocated randomly 1:1 to 1 of the 2 treatment arms stratified by site, using random permuted blocks of size 4 or 6 in equal proportions. We will recruit 192 participants having surgery for large macular holes (>400 μm); 96 in each of the 2 arms of the study. The primary objective is to determine the impact of face-down positioning on the likelihood of closure of large (≥400 μm) full-thickness macular holes following surgery.Discussion: This will be the first multicentre randomised control trial to investigate the value of face-down positioning following macular hole standardised surgery.Trial Registration: UK CRN: 17966 (date of registration 26 November 2014). [ABSTRACT FROM AUTHOR]

In contrast to Britain, no fundamental research has been carried out in German-speaking countries into the effectiveness of loopholes. In view of the early adaptation of French and British slit-type loopholes in Alsace and Southwest Germany from about the mid-13th century, the author carried out practical experiments at selected castles - Ortenberg, Spesburg, Hoh-Andlau, Landsberg-West, Birkenfels (all in Alsace), Gräifenstein and Neu-Leiningen (Palatinate) and Pfalzgrafenstein and Schönburg (Middle Rhine) - using, firstly, a traditional longbow and, secondly, a crossbow to examine the effectiveness and usefulness of loopholes at those castles. The aim of the experiment was to test the extent to which a person using either bow from the loopholes could effectively counter a potential attack. In particular, the author wanted to find out whether a target outside the loophole could be hit with accuracy and what area could be covered with the bow (angle of fire). This led to further questions: were the loopholes designed with a clear plan in mind; was the archer behind the loophole safe from enemy fire and, indeed, what properties should a loophole possess to enable it to be used to best purpose? The results were somewhat surprising, although not unexpected. The very narrow loopholes at Gräfenstein und Neu-Leiningen could not be used effectively with either type of bow. A longbow could be used with great difficulty at Birkenfels, Hoh-Andlau and Landsberg-West, although this was not true of the crossbow. However, the crossbow could only fire in a straight line out of the loophole; i.e. there was only a very limited angle of fire. Only at Spesburg were the loopholes really suitable for the bow. Given the clearly successful design of the castle, the results at Ortenberg were positive. The view expressed by various authors that loopholes were often of only symbolic importance, as a means of expressing the aspirations of the nobility, is supported by the experiments (and confirmed by similar experiments in Great Britain). Another interesting finding is the fact that cross-shaped loopholes were not specifically designed for crossbows, but merely served to widen what would otherwise be a seriously restricted angle of fire. In the medium and long term the author will be establishing a database of loopholes to enable conclusions to be drawn about the way in which they developed. This study is the first step in this direction. The results, together with an interpretation, additional illustrations and scale drawings can be found on the author's webpage under http://www.binsy.org. [ABSTRACT FROM AUTHOR]

Background We present an updated case series of patients treated with a novel Transgastric (TG) drainage technique, previously published by the senior author in 2008 [Ref], which has now been used in 6 hospitals across United Kingdom and Ireland. The technique establishes vacuum drainage of the lumen of the injured oesophagus whilst maintaining its patency, effectively exteriorizing complex oesophageal perforations to allow healing. Methods Patients presenting with Boerhaave or iatrogenic rupture, undergo an initial decontamination of the chest with drainage as required. A 32–36 Fr Chest drain is inserted in a PEG guided technique, where the proximal end of the drain is positioned 5 cm above the perforation site within the oesophagus, whilst the distal end is pulled out through the stomach and abdominal wall. Continuous low-pressure suction at -10 cm water is applied. Patients continue to drink water. Further intervention is not required until the leak has healed and the drain removed. Results We have used this technique in 20 patients in our institution (3 iatrogenic perforations, 17 Boerhaave), with a median age of 72 (range; 55–85). Perforation length ranged from 1–15 cms. Three cases were performed after stenting failed to control the leak. Pleural decontamination required thoracotomy (n = 12), VATS (n = 2); in 6 cases, no pleural decontamination was required. There were four in-hospital deaths. Median duration from surgery to removal of TG drain was 31 days (range; 10 - 71). Two patients required post discharge dilatation for stricture and are currently asymptomatic. Conclusion TG drainage in effect exteriorizes the oesophageal lumen at the site of oesophageal perforation, encouraging the perforated edges to appose and allow healing by secondary intention. Mediastinal sepsis drains through the transgastric drain (on suction) and intercostal drains placed at decontamination (off suction). Patients tolerate it well, drinking while their perforation heals, avoiding nasogastric intubation. [Ref] Berrisford RG, Krishnadas R, Froeschle P, Wajed S. European Journal of Cardiothoracic Surgery 33(2008):742–744. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Esophageal perforation is an uncommon and challenging surgical emergency associated with high rates of morbidity and mortality. At present, no consensus exists on optimal management of the condition. The Pittsburgh Severity Score (PSS) is a tool intended to stratify perforation severity and guide treatment. However, there is a paucity of literature examining the validity of the score or its application in a UK population. This study aims to validate the PSS and explore its use in stratifying patients with esophageal perforation into distinct subgroups with differential outcomes in an independent UK study population. All patients treated for esophageal perforation at Queen Elizabeth Hospital, Birmingham between September 2003 and October 2017 were included in this study. Cases were identified using a combination of ICD-10 and OPCS informatics search codes and prospective case collection. Data relating to the clinical presentation, diagnosis, management, and outcome of cases were recorded using a preformed data collection form. PSS predictive performance was assessed against five outcomes: rates of post-perforation and post-operative complications, in-hospital mortality, length of intensive care (ICU/HDU) stay, and total length of hospital stay. A total of 87 cases were identified, consisting of 48 (55%) iatrogenic perforations, 24 (28%) cases of spontaneous (Boerhaave's) perforation, and 15 perforations due to other etiologies (17%). Operative management was favored in this series, with 47% of all perforations being treated surgically. Overall in-hospital mortality was 13%, coupled with a median length of hospital stay of 24 days (interquartile range [IQR]: 12–49), of which a median of 2 days was spent in intensive care facilities (IQR: 0–14). A total of 46% of patients developed post-perforation complications, with 59% of the operatively managed cohort developing complications post-operatively. The PSS was not found to be significantly predictive of post-perforation complications (area under the ROC curve [AUROC]: 0.62, p  = 0.053) or in-hospital mortality (AUROC: 0.69, p  = 0.057) for the cohort as a whole. However, a subgroup analysis found the accuracy of the PSS to vary considerably by etiology, being significantly predictive of post-perforation complications within the subgroup of Boerhaave's perforations (AUROC: 0.86, p  = 0.004). In conclusion, we found that the PSS has some utility in stratifying esophageal perforation severity and predicting specific patient outcomes. However, it appears to be of more value when applied to the subgroup of patients with Boerhaave's perforations. [ABSTRACT FROM AUTHOR]