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Purpose Properly planned road illumination systems are collectively a public wealth and the commissioning of such systems may require extensive planning, simulation and testing. The purpose of this simulative work is to offer a simple approach to facilitate luminance-based road lighting calculations that can be easier to comprehend and apply to practical designing problems when compared to complex multi-objective algorithms and other convoluted simulative techniques. Design/methodology/approach Road illumination systems were photometrically simulated with a created model in a validated software platform for specified system design configurations involving high-pressure sodium (HPS) and light-emitting diode (LED) luminaires. Multiple regression analyses were conducted with the simulatively obtained data set to propound a linear model of estimating average luminance, overall uniformity of luminance and energy efficiency of lighting installations, and the simulatively obtained data set was used to explore luminaire power–road surface average luminance characteristics for common geometric design configurations involving HPS and LED luminaires, and four categories of road surfaces. Findings The six linear equations of the propounded linear model were found to be well-fitted with their corresponding observation sets. Moreover, it was found that the luminaire power–road surface average luminance characteristics were well-fitted with linear trendlines and the increment in road surface average luminance level per watt increment of luminaire power was marginally higher for LEDs. Originality/value This neoteric approach of estimating road surface luminance parameters and energy efficiency of lighting installations, and the compendia of luminaire power–road surface average luminance characteristics offer new insights that can prove to be very useful for practical purposes.

The extensor tendon system of the hand includes the forearm-based extrinsic extensors that power wrist and finger extension as well as the hand-based intrinsic extensors that stabilize the digits in extension. The anatomy and interaction of these tendons are described with reference to the topographic classification system of Verdan’s zones. The injuries of the extensors can be either closed or open and the treatment is injury and site specific. The approaches to the individual injuries and treatment are described.

Background. Essential Skills in the Management of Surgical Cases (ESMSC) is an international, animal model-based course. It combines interactive lectures with basic ex vivo stations and more advanced wet lab modules, that is, in vivo dissections and Heart Transplant Surgery on a swine model.Materials and Methods. Forty-nine medical students (male,N=27, femaleN=22, and mean age = 23.7 years) from King’s College London (KCL) and Greek Medical Schools attended the course. Participants were assessed with Direct Observation of Procedural Skills (DOPS), as well as Multiple Choice Questions (MCQs). Pairedt-test associations were used to evaluate whether there was statistically significant improvement in their performance.Aim. To evaluate the effectiveness of a combined applied surgical science and wet lab simulation course as a teaching model for surgical skills at the undergraduate level.Results. The mean MCQ score was improved by 2.33/32 (P<0.005). Surgical skills competences, as defined by DOPS scores, were improved in a statically significant manner (P<0.005for all pairedt-test correlations).Conclusions. ESMSC seems to be an effective teaching model, which improves the understanding of the surgical approach and the basic surgical skills. In vivo models could be used potentially as a step further in the Undergraduate Surgical Education.

It has been estimated that approximately 15000 to 20000 hours are required to train a surgeon.1 However, several time-constrains imposed globally2 have significantly reduced training time in the Operating Room (OR) posing a significant challenge for surgical educators and creating an impetus for the development of new educational methods.3 Since August 2005, all medical graduates in the United Kingdom must enter a 2 year postgraduate programme prior to commencing training in their chosen medical or surgical specialty.4 What is the problem? Despite this two-year programme being a good introduction to duties as a doctor there have been some concerns that the trainees do not gain significant experience in surgical procedures leading to reduced confidence.5 Which can make transition from a second year postgraduate (Foundation) doctor (PGY2) to a surgical resident particular difficult. To gain more experience a large number of doctors undertaking additional posts, which are not part of the recognised training scheme, in the UK and abroad, or roles such as anatomy demonstrators, in order to broaden their skills and relevant knowledge prior to progressing to surgical training.6

Background: After the devastating earthquake in Haiti on January 12, 2010, a British orthoplastic limb salvage team was mobilized. The team operated in a suburb of Port-au-Prince from January 20, 2010. This analysis gives an overview of the caseload and early outcomes. Methods: A retrospective analysis of operative data from the log book was performed from the opening of the facility on January 20, 2010, until March 12, 2010. Results: In total, 348 operations were carried out on 158 patients, at an average of 47 cases per week. Seventy-three percent of the cases were soft-tissue cases and 25 percent were bony or combined soft-tissue and bony cases. The majority of bony procedures (n = 26; 16 percent) and flap procedures (n = 16; 10 percent) took place in the early weeks (weeks 1 through 4). Combined orthoplastic cases accounted for 37 percent of cases (16 of 44) in week 2 but only 7 percent (three of 43) in week 7. General anesthetic cases accounted for 89 percent of cases (39 of 44) in week 2 but only 40 percent (17 of 43) in week 7. Only six patients (4 percent) underwent amputation, but 36 operations (10 percent) dealt with the sequelae of amputation. Sixteen patients (10 percent) suffered complications, including two amputations for failed limb salvage. Conclusions: This article reports the outcomes of a limb salvage team in the acute response after an earthquake disaster with a favorable amputation rate and highlights the potential benefit of mobilizing this type of team. Detailing the changing caseload over time will allow for more efficient planning in case of a similar future disaster.

The National Burn Care Review prompted us to review trends in adult acute admissions to our unit with the intention to implement the guidelines of referral set down in the report. We had recently also adopted a more open admissions policy in keeping with these recommendations. This was achieved by a retrospective casenote analysis with the years 1981, 1991, and 2001 used as reference snapshot years to outline trends. The results showed an increase in the number of patients, a decrease in the depth and extent of burns, a decrease in the number of inpatient days and crude mortality rate. There was also a slight decrease in the age of patients.

We describe the largest reported epineural ganglion of the ulnar nerve arising in the cubital tunnel. A 54-year-old male, driver presented with progressive symptoms of left sided cubital tunnel syndrome. Surgery demonstrated a 11 × 3 cm ganglion which was successfully removed. Post-operatively the patient demonstrated partial recovery with no recurrence of the ganglion.

Background Due to increasing requirements of service provision and the introduction of the European Working Time Directive, Foundation trainees have limited exposure to surgical procedures.1 Confidence of novice trainees to perform procedures is improved by undergoing simulation training.2 We have therefore designed a novel, multidisciplinary course aiming to familiarise foundation doctors to surgical procedures. The aim of this study is to evaluate the impact of such a course on their confidence. Methodology 23 Foundation Year 2 doctors due to start Core Surgical Training from August 2014 attended the Essential Surgical Skills Course over 2 days. Trainees rotated around a circuit of sub-speciality skills workshops undertaking simulated procedures in General Surgery, Urology, Trauma and Orthopaedics and Plastic surgery, all led by Consultant faculty. Pre and post-course questionnaires were distributed, assessing confidence to perform each skill on a Likert scale (1–5). Results Median values were calculated across each speciality’s skills. General Surgery and Urology demonstrated an increase in median value for all 23 participants pre- and post-course. Median differences pre- and post-course ranged from 1–3.5 in both General Surgery and Urology. 22 out of 23 demonstrated an increase in median value for Trauma and Orthopaedics, (median difference range 1–4), one participant had equal median values. 20 out of 23 demonstrated an increase in median value for Plastic Surgery, (median difference range of 1–4), three participants had equal median values. Conclusions and recommendations Participants were overall increasingly confident in performing these core surgical skills having undertaken the course. Simulation is a critical part of surgical training in an era where surgical exposure in the operating theatre is more time-restricted. Trainees feel that a course simulating surgical skills, taught by Consultant surgeons, is important in enhancing confidence and skill acquisition; aiding in bridging the gap between completing foundation training and entering a surgical career. References Varley et al. Changes in caseload and the potential impact on surgical training: a retrospective review of one hospital’s experience. BMC Medical Education 2006;6:6 Green-Carlsen et alet al. Is Current Surgical Training Efficient? J Surg Educ 2014;71(3):367–74

We present a modification to the widely used lead hand retraction system that allows for improved surgical access to a digit with a severe flexor contracture. A simple construct using surgical adhesive tape and a silk suture can be made and applied to the digit and lead hand. Our technique is simple and inexpensive to use, and we recommend its use to improve surgical access without causing unnecessary trauma to the digit.

At present there is a fashion for ‘tunnel and plug’ ear piercings (Figure 1). The initial piercing is performed as with any normal ear piercing, creating a hole approximately 1 mm in diameter in the lobe of the ear. Clients are advised to allow the ear to heal for a period of 6 weeks with a stud in place. Gradually increasing sizes of ear plugs are then placed into the lobe, increasing by 0.2e0.6 mm every 2e3 weeks as tolerated. It is advised that once a 10 mm piercing is in place that the dilated hole will remain stretched despite the piercing being removed. Prior to this point being reached any stretch can recover and will constrict with removal of the piercing. This advice is obviously a generalisation which will vary between individuals.

Keeping in mind the historical importance of the associations among smoking, substance abuse, psychiatric history, and burns, we collected the relevant data as part of a larger research project. A retrospective casenote review was conducted using 1981, 1991, and 2001 as reference years to identify the trends in acute adult admissions. In keeping with the increase in the total number of patients, burns victims who were smokers increased in numbers. The percentage increased in 2001 from other reference years, but it was not statistically significant. The results of our study also show no significant increase in trends as far as burns causation and alcohol/psychiatric history/drug dependence is concerned, but the prevalence of these conditions in burns patients has remained persistently high compared with the general population in the past 20 years.

We propose that the simple method of passing an extra suture through the Mitek anchor eyelet before bony insertion provides a safety net against failure of the preloaded suture and gives extra strength to the core repair.