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OMFS training is perceived as a long and expensive pathway although papers have shown it compares favourably with other surgical specialties. Every OMFS clinician has a vested interest and duty continually to improve the quality of training and minimise costs, especially to trainees at junior levels. Any serious proposal to fundamentally change the format of training, must be given due consideration by all stakeholders. In 2016, a British Medical Journal article whose authors included the BAOMS President of that year and OMFS Specialty Advisory Committee (SAC) Chair, posed the question - should the future of OMFS training revert to single dental degree, change to single medical degree - or continue as a dual degree specialty? The BMJ publication was discussed at the British Association of Oral and Maxillofacial Surgeons (BAOMS) Council in March 2016 and all present unanimously supported the dual degree pathway. Later that year a formal proposal was made by the BAOMS immediate past President that training in the UK change to single medical degree ‘Maxillofacial Surgery’ similar to the training in Spain, France or Italy. Evidence around the risks and benefits of making this change to OMFS training was assembled and reviewed by BAOMS Council in March 2017. BAOMS Council once again unanimously supported continuing OMFS as a dual degree specialty with the observation that the quality of patient care which this training provided was the specialty’s Unique Selling Point or USP. The requirement for both degrees to provide care for OMFS patients had been confirmed by external scrutiny on two separate occasions by the responsible regulators. In this paper, we outline the key steps to be considered when making major changes in the OMFS training pathways using this event as an example and the suggestion that those proposing changes should assemble and present evidence to support their proposal using the template provided.

Purpose Patients presenting to emergency departments (EDs) following head injury often undergo computed tomography (CT) of the head to exclude traumatic brain injury. In many cases, this does not show the maxillofacial skeleton. A proportion of these patients also sustain facial fractures, and when fractures involve the orbits, CT imaging is useful in diagnosis and management; obtaining a second scan may cause delay, incur greater cost, and increase radiation dose. The aim of this preliminary study was to examine the value of signs and symptoms of orbital fractures in predicting a fracture on CT. Methods The clinical records of 47 patients who underwent CT of the face following facial trauma were retrospectively examined for the presence of signs and symptoms of orbital fractures. Sensitivity, specificity, negative predictive value (NPV) and positive predictive values (PPV) were then calculated for each sign and symptom for the presence of an orbital fracture on CT. We also described a clinical decision instrument and examined the predictive values of this. Results Change in the position of the globe, reduced visual acuity, subconjunctival haemorrhage and change in sensation in the maxillary division of the trigeminal nerve were the most specific signs and symptoms for orbital fracture. Our clinical decision instrument had 80.0% sensitivity, 75.0% specificity, 90.3% PPV and 56.3% NPV for predicting the presence of an orbital fracture on CT in this population. Conclusions Our results demonstrate that signs and symptoms of orbital fractures may be useful for predicting these injuries, and a decision instrument could be used in the ED to identify patients likely to benefit from extending the radiation field to include the orbits where CT of the head is already planned. This work is however exploratory; and further prospective validation is required before a robust instrument can be recommended for clinical use.

The cost of the NHS, wastage within it and how much trusts have overspent is a national obsession. Despite these widespread opinions, the costs of individual treatments and impacts of non-attendance appear to be little understood. There is a paucity of literature with regards to patients’ awareness of costs associated with services provided by the NHS. The authors aim to ascertain whether patients are aware of the costs associated with care services provided, and if these data could aid educating patients on NHS costs to reduce missed appointments. A questionnaire was randomly distributed to new and review patients in our Oral and Maxillofacial outpatient and emergency departments from November-December 2017 asking them to estimate the cost of common services they may encounter, such as an outpatient appointment, an orthopantomogram (OPT), a CT head, and a full blood count test (FBC). The results demonstrate that 81% of patients surveyed underestimated the cost of their new patient appointment, with 34% underestimating the cost of their review appointment. The cost of an overnight stay in hospital was underestimated by 65% of patients, with 89% of patients underestimating the cost of an hours’s operating. The costs of a full blood count, an OPT and a CT head have been mostly overestimated by 89%, 77%, and 54% of patients respectively. The results show there is a wide variation in patients’ estimates of costs, with over 50% of patients overestimating the costs of investigations but underestimating the cost of their appointment/A&E attendance.

Cybersecurity risk management is the foundation of business and organizational decisions involving digital technology. Various models have been proposed and are in use, but these apply to current technologies and use cases, and none are sufficient to evaluate new technologies. This paper builds upon prior work using CVSS to quantify potential security threats for which information is limited. That prior work merges CVSS data with MITRE’s Common Attack Pattern Enumeration and Classification (CAPEC™) tools to inform a new technology risk scoring system in a Bayesian Belief Network (BBN). This work extends this risk model to incorporate CWSS data to better reflect the environments’ weaknesses that may apply to new technologies. This approach enables a more accurate and trustworthy way of quantitatively estimating risk as a function of the Base Finding Subscore and Attack Surface Subscore for weaknesses most relevant to businesses, missions, and deployed technologies.

Cybersecurity risk management often uses experience-based data to quantify the potential risks of new security technologies based on their exploitability and impact. However, use of such data may be limited and is rarely reusable because it often contains confidential information. This paper proposes a new approach using the Department of Homeland Security’s public National Vulnerability Database (NVD) for information on known vulnerabilities, and MITRE’s public Common Attack Pattern Enumeration and Classification (CAPEC™) tools as the basis of a risk scoring system.

Background Health services researchers have studied how care from oncologists impacts treatment and outcomes for cancer patients. These studies frequently identify physician specialty using files from the Center for Medicare and Medicaid Services (CMS) or the American Medical Association (AMA). The completeness of the CMS data resources, individually or combined, to identify oncologists is unknown. This study assessed the sensitivity of CMS data to capture oncologists included in the AMA Physician Masterfile. Methods Oncologists were identified from three CMS data resources: physician claims, the National Plan and Provider Enumeration System Registry, and the Medicare Data on Provider Practice and Specialty file. CMS files and AMA data were linked using a unique physician identifier. Sensitivity to identify any oncologists, radiation oncologists (ROs), surgical oncologists (SOs), and medical oncologists (MOs) was calculated for individual and combined CMS files. For oncologists in the AMA data not identified as oncologists in the CMS data, their CMS specialty was assessed. Results Individual CMS files each captured approximately 83% of the 17 934 oncologists in the AMA Masterfile; combined CMS files captured 90.4%. By specialty, combined CMS data captured 98.2% of ROs, 89.3% of MOs, and 70.1% of SOs. For ROs and SOs in the AMA data not identified as oncologists in the CMS data, their CMS specialty was usually similar to the AMA subspecialty; ROs were radiologists and SOs were surgeons. Conclusion Using combined files from CMS identified most ROs and MOs found in the AMA, but not most SOs. Determining whether to use the AMA data or CMS files for a particular research project will depend on the specific research question and the type of oncologist included in the study.

Many health services researchers are interested in assessing long term, individual physician treatment patterns, particularly for cancer care. In 2007, Medicare changed the physician identifier used on billed services from the Unique Physician Identification Number (UPIN) to the National Provider Identifier (NPI), precluding the ability to use Medicare claims data to evaluate individual physician treatment patterns across this transition period.Using the 2007-2008 carrier (physician) claims from the linked Surveillance, Epidemiology and End Results (SEER) cancer registry-Medicare data and Medicare's NPI and UPIN Directories, we created a crosswalk that paired physician NPIs included in SEER-Medicare data with UPINs. We evaluated the ability to identify an NPI-UPIN match by physician sex and specialty.We identified 470,313 unique NPIs in the 2007-2008 SEER-Medicare carrier claims and found a UPIN match for 90.1% of these NPIs (n=423,842) based on 3 approaches: (1) NPI and UPIN coreported on the SEER-Medicare claims; (2) UPINs reported on the NPI Directory; or (3) a name match between the NPI and UPIN Directories. A total of 46.6% (n=219,315) of NPIs matched to the same UPIN across all 3 approaches, 34.1% (n=160,277) agreed across 2 approaches, and 9.4% (n=44,250) had a match identified by 1 approach only. NPIs were paired to UPINs less frequently for women and primary care physicians compared with other specialists.National Cancer Institute has created a crosswalk resource available to researchers that links NPIs and UPINs based on the SEER-Medicare data. In addition, the documented process could be used to create other NPI-UPIN crosswalks using data beyond SEER-Medicare.

The British Association of Oral and Maxillofacial Surgeons (BAOMS) has been at the centre of the transition of our specialty in the UK from a branch of dentistry to one of the 10 UK surgical specialties. In this role it has, at different times, pushed boundaries against resistance from other specialties, and redirected the ambitions of the deputy chair of the Postgraduate Medical Education and Training Board (PMETB) review to produce recommendations that were exactly what OMFS needed. The editorial Our specialty. The future. Is the writing on the wall? is just the most recent iteration of half a century of internal debate. Whilst there are some issues with how the authors have presented recruitment data (their figures omit ST1 run-through and do not recognise that the same single, unfilled post may be present for two or more national selection rounds) their first paragraph A debate that we feel is long overdue presents the greatest concern. In this short communication, we illustrate that in the last 20 years the specialty has not been short of debate. In the absence of new and specific evidence that any other route forward would be supported by our national training committee (OMFS SAC), our regulator (GMC), the breadth of our specialty (including our current specialists and our current and future trainees) and, most importantly, would actually address our problems, we should avoid putting energy into an empty debate. Our focus should be on delivering the PMETB recommendations and inspiring our future trainees.

Facial asymmetry secondary to unilateral condylar hyperplasia can be a diagnostic challenge to oral and maxillofacial surgeons. Single positron emission computed tomography (SPECT) scans provide a useful adjunct. We report a brief summary of the evidence describing the effectiveness of different methods of analysing SPECT scans and compare it with the results of a 10-year study at Sunderland Royal Hospital. Overall, both the evidence base and our study strongly favour use of the condyle:condyle ratio over the condyle:reference bone ratio, suggesting that no further comparisons are needed.

The process of investigating spacecraft accidents rests on the lessons of more than 60 years of aircraft crash investigation. There was little need for such skills in the early years of US spaceflight. This changed dramatically in 1986 with the loss of the Space Shuttle Challenger and was perpetuated by the loss of Space Shuttle Columbia in 2003. There have been other fatal accidents involving spacecraft and many near misses. With plans that include continued manning of the International Space Station (ISS); multiple new vehicles; exploration of the moon, asteroids, and Mars; and a vigorous civilian presence in space, it is certain that there will be a need for such investigations in the future. Medical investigators, human factors specialists, and flight surgeons will have essential roles. Their activities will concern human factors, physiology, and the assessment of human survivability – all aimed at preventing future injury and death. The necessary “forensic analysis” will be difficult, both emotionally and physically, and will not always be appreciated, supported, or understood by those uninvolved with the process. Outcome conclusions must be “evidence based” and oriented toward gaining information that will contribute to answering specific questions relevant to future practices and designs.

This paper introduces a series of papers in the form of a special edition that reports phenotypic analyses done in parallel with genotypic analyses for the Australian Sheep Industry Cooperative Research Centre (Sheep CRC) using data generated from the information nucleus flock (INF). This has allowed new knowledge to be gained of the genetic, environment and management factors that impact on the carcase and eating quality, visual appeal, odour and health attributes of Australian lamb meat. The research described involved close collaboration with commercial partners across the supply chain in the sire breeding as well as the meat processing industries. This approach has enabled timely delivery and adoption of research results to industry in an unprecedented way and provides a good model for future research.

Coursework masters degrees in Australia have experienced rapid, decentralised growth since deregulation at the end of the 1980s. The result is an extraordinarily high level of diversity and some confusion as to standards, strategic positioning, purpose and educational approaches. Throughout this period of growth, a sense that large-scale (often distance-education based) collaboration between universities and with industry would be beneficial has not always led to successful outcomes. Using a new collaborative, industry-funded postgraduate coursework program as a case study, this paper describes the issues that decision-makers need to address and evaluates the challenges and benefits of the coursework masters in higher education. The outcomes of industry surveys, student interviews and action research suggest that postgraduate coursework can facilitate technology transfer and aid capacity building, through mechanisms similar to ‘mode 2’ research. With some additional systems to ensure sustainability and standards, this could position coursework masters to be uniquely valuable nationally.

Australian seedstock cattle breeders have expressed concerns that while there has been genetic improvement in feedlot and abattoir performance of cows, it could have led to a decline in maternal productivity, especially under variable nutritional conditions. This paper describes a substantial project with two components designed to address these issues. The first sub-project was to monitor bodyweight and composition of 7760 young Angus and Hereford cows as they experience variable physiological states (pregnancy and lactation) and seasons. This was conducted on large numbers in seedstock herds. The second sub-project was to monitor more regularly bodyweight, body composition, and calf rearing performance of 500 Angus cows that are genetically divergent for either fat or residual feed intake at two research centres. This also included two levels of nutrition and recording of weekly feed intake of small groups of cows for at least three parities to allow reporting of genotype × nutrition effects on maternal productivity and efficiency. Results from the project are reported in a series of papers with each one having a defined focus.

The purpose of this study was to define the anatomical arrangement of the lumbar spine in the mid body sagittal plane of a human volunteer while in three postures: a driving posture; full flexion; and full extension. Radiographic images of the lumbar spine were made of a 33-year old 50th percentile male subject seated in a comfortable driving position. The paper discusses findings of the study.

The Internet is a powerful method of acquiring and sharing information. In marketing and business, online visibility is vital for publicity and the reputation of an organisation. To our knowledge, the importance of such visibility in medicine in general, and in Oral and Maxillofacial Surgery (OMFS) services in the UK, has not previously been investigated. We aimed to provide a better understanding of the way that patients use the Internet by asking 450 patients to complete a questionnaire when they attended outpatient OMFS departments at 2 centres. We also assessed the online visibility of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and investigated the correlation between the strength of online visibility and professional reputation. Results from the self-administered, anonymous, validated questionnaires showed that 82% of patients agreed that the Internet was a powerful source of information, and two-thirds associated online visibility with a good reputation. However, the perceived online visibility of the BAOMS was poor (2%). This study mirrors findings in business publications, and confirms the link between online visibility and professional reputation. It also shows that there is a gap between patients’ perceptions and the level of uptake of professional resources. We propose various strategies to bridge this gap and to promote the online visibility and professional reputation of the BAOMS and of OMFS services in the UK.

Current cyber defenses are reactive and cannot protect against customized malware and other zero day attacks which persist for many weeks. Using Receiver Operating Characteristic curve analysis and damage cost models, we trade-off the true positive rate and false positive rate to compare alternative architectures. This analysis provides optimal value(s) of Probability of Detection by evaluating the potential damage from a missed intrusion and costs of processing false positives. In this paper, we propose an approach which involves determining the influencing factors of each strategy and studying the impact of their variations within the context of an integrated intrusion defense strategy. Our goal is to manage the intrusion risks by proactively scheduling recovery for dependable networks.

Sheep breeders in Australia that focus on lamb production simultaneously breed sheep that have higher growth rate, improved carcass quality and are resistant to internal parasites. The objective of this study was to estimate genetic parameters for 11 traits recorded in Australian meat sheep, covering liveweight, carcass and internal parasite resistance traits. As the population of meat sheep in this database have become increasingly crossbred this study also investigates the genetic variation within and between breeds. The data comprised 1 046 298 animals from 149 Poll Dorset, 17 Suffolk, 24 Texel and 118 White Suffolk flocks. The results are averages of analyses of 10 datasets constructed by randomly sampling 25% of these flocks. There was considerable genetic variation in all traits analysed: the lowest heritabilities (0.12) were found for weaning weight and the highest heritabilities (0.31–0.32) for eye muscle depth. There were also significant differences between breeds for most traits, which breeders appear to be utilising through crossbreeding. Direct heterosis effects were small and only significant for the liveweight traits ranging from 2% to 3.4% of the phenotypic means. Maternal heterosis was not significant for any trait studied. The inclusion of heterosis effects in the model did not significantly influence the estimated genetic parameters. The results from this study have been used to review the genetic parameters used in the LAMBPLAN routine genetic evaluations conducted by Sheep Genetics.

Objective: The objective of this study was to document cancer mortality among American butchers. Methods: Death certificates collected in 24 American states were used to calculate mortality odds ratios (ORs) and their confidence intervals (CIs) for 18,639 butchers. Results: Butcher's experienced an increased mortality of cancer of the oral cavity (OR, 1.40; 95% CI = 1.09-1.81), esophagus (OR, 1.19; 95% CI = 1.01-1.40), pharynx (OR, 1.22; 95% CI = 0.91-1.64), and larynx (OR, 1.19; 95% CI = 0.92-1.54), as well as a reduced mortality from melanoma (OR, 0.70; 95% CI = 0.52-0.94), non-Hodgkin lymphoma (OR, 0.82; 95% CI = 0.69-0.97), and breast cancer (OR, 0.76; 95% CI = 0.58-0.99). Conclusions: It is likely that occupational exposures experienced by butchers have contributed to the increased risk of cancers of the oral cavity and esophagus. Copyright © by American College of Occupational and Environmental Medicine.

This paper describes the development programme for a portable non‐contact inspection system, suitable for in‐service inspection of aeronautical structures. The instrument is powered from a re‐chargeable battery pack which provides over six hours of continuous usage. The transducer front end is a lightweight, hand‐held assembly in which a pair of piezocomposite transducers are housed. Angular adjustment of the transducers enables the instrument to operate into a variety of materials, with metallic and composite materials of primary interest. Importantly, a single channel oscilloscope has been incorporated to provide visual interpretation of the processed received signal. Defect detection is demonstrated in a number of aerospace samples, with the resultant C‐scans presented where appropriate.

A model of the sheep breeding industry with nucleus flocks, multiplier flocks and commercial sheep flocks was used to examine the value of genomic selection. The model reflected a dual-purpose Merino breeding objective, with genomic information improving selection accuracy by 39% for rams at 6 months of age and by 17% at 18 months. The current level of net dollar benefit to the sheep industry from selection, but without genomic testing, can be improved by 10–14% for a closed three-tiered breeding structure with rams used at 18 months. If the rams are first used at 6–7 months then the dollar gains can be improved by 15–17%, since genomic information can provide proportionately greater gains for young animals that have limited phenotypic information. In a two-tiered breeding system, with nucleus flocks selling rams direct to commercial producers, rather than through multiplier flocks, the dollar gains to industry from genomic testing increased to ~12–13% for rams bred at 18 months, and 20–22% if nucleus rams are used at 6–7 months. The optimal structure requires two-stage selection, with an initial selection based on information available without genomic testing, to limit the cost of testing to only the superior rams. However, the optimum proportion of rams tested depends on the system and the cost of testing. In order to recover the cost of genomic testing, the nucleus flocks must recover up to 5% of the extra genetic gain as extra profit from sale of rams to commercial sheep producers.

The Australian sheep Cooperative Research Centre has initiated an information nucleus with the aim to estimate genetic parameters for new traits, to undertake a large-scale whole-genome association study and to enhance the breeding values of breeding animals in commercial studs. This paper presents the rationale behind the current design factors to meet the main objectives. It then discusses the potential design of an information nucleus if it were a sustainable part of commercial sheep-breeding programs in the long term. Advantages of such an information nucleus are summarised and quantified where possible.

This paper provides an introduction to the special edition of the Australian Journal of Agricultural Research dedicated to an integrated research program to understand the effects of genetic selection for live animal traits (growth, muscle, and fatness) that determine carcass and meat attributes. Combined with this are the effects of nutritional status of the dam and growing lamb. The reasons for, and general approach of, the research is outlined.

The study was conducted to estimate heritabilities and genetic correlations for liveweight, fat depth at the C site and eye muscle depth, width and area measured by B mode ultrasound on live young sheep. Records on 4338 animals were available for analysis, representing 161 sires and 79 managementlsex groups. The management groups were allocated to young (5-9 months), medium (10-13 months) and old (14-18 months) data sets for analysis, representing 89, 82 and 19 sires respectively. The heritabilities of liveweight, ultrasonic fat depth and ultrasonic eye muscle measurements were estimated after adjusting for managementlsex group, birth and rearing type, age class of dam and age of the animal. The heritability estimates for the three age data sets respectively were: for liveweight 0.19 � 0.06, 0.11 � 0.06 and 0.37 � 0.18; for fat depth 0.01 � 0.03, 0.18 � 0.07 and 0.28 � 0.15; and for eye muscle depth 0.15 � 0.05, 0.11 � 0.06 and 0.l6 � 0.11. After adjusting for sex/management group and liveweight within sex (the other factors listed above being no longer significant), heritability estimates were: for adjusted fat depth 0.11 � 0.05, 0.33 � 0.09 and 0.29 � 0.16 and for adjusted eye muscle depth 0.l5 � 0.06, 0.l5 � 0.06 and 0.19 � 0.12. The heritability estimates for eye muscle area, estimated as the area of an ellipse with dimensions equal to the measured depth and width, were about 10% lower than for eye muscle depth, but the genetic correlations with depth, in each case were 0.94 or higher. The heritability estimates for eye muscle width were less than 0.05 in young and medium age animals and 0.12 to 0.15 in old animals with high genetic correlations with depth which were not different from 1.00. Ultrasound measurements of fat depth at the GR site were available on 2065 lambs under 8 months of age representing 76 sires in 33 groups. The heritability estimates for fat depth adjusted for liveweight, at the GR and C sites in these lambs were both 0.10 � 0.05 with the genetic correlation between sites being 0.76 � 0.19. There is potential for including eye muscle depth in selection indices to improve leanness. Ultrasound measurement of eye muscle width and area will not improve prediction of eye muscle over that attained by measuring eye muscle depth. Predicted responses in liveweight, fat depth and eye muscle depth for five breeding objectives for terminal sires, using the appropriate LAMBPLAN selection indices, are shown and discussed.

We recorded the discharge of 66 single sympathetic preganglionic fibres isolated from the third and fourth left thoracic sympathetic rami communicantes of spinal vagotomized cats. Various mechanical and chemical stimuli were applied to different cardiovascular receptors in order to initiate reflex responses. Stimuli affecting mainly cardiac receptors always increased the discharge of the responsive fibres. Conversely, stimuli affecting simultaneously cardiac and vascular receptors or restricted to aortic receptors, either increased or decreased the discharge of the same fibres. The responses, consistent for each individual fibre, were reflex in nature. The data demonstrate that both specificity and convergence regulate cardiovascular sympathetic spinal reflexes.

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