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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.

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.

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.

Evidence has accumulated that visual rehabilitation for patients with neurological visual impairment can be effective. Unfortunately, the existing therapy tools are repetitive, uninteresting, and unsuitable for use with children. This project aims to improve the engaging qualities of visual rehabilitation for children, through the design of therapy tools based on game design principles. Development is ongoing in a participatory, user-centred manner in conjunction with a specialist centre for childhood visual impairment. This paper outlines design requirements and briefly reports early findings of the development process.

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.

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.

The combined effects of age and genetics and Poll Dorset sire and growth path were studied in two separate experiments (n = 595 and 627, respectively). In the first experiment, containing genotype crosses typically used in Australia (Merino, Poll Dorset, Border Leicester) and sires selected for growth or muscling, sheep were slaughtered at 4, 8, 14 and 22 months. The second experiment used Poll Dorset sires selected for high muscling, fat or growth with progeny having two levels of nutrition postweaning. Border Leicesters expressed higher levels of carcass fat percentage and intramuscular fat and produced the heaviest carcass. Merinos had the lowest subcutaneous fat depth and highest carcass lean percentage when compared at the same age. The progeny of Poll Dorset sires selected for high muscling (PDm) expressed a shift toward glycolytic fibres relative to those from Merino sires, and PDm sires produced progeny with reduced spine and limb length and higher carcass muscle : mineral ratios, suggesting skeletal stunting. Genotype meat quality differences were minimal except that PDm sire topsides were tougher and Merinos produced higher pH meat. With age (4–22 months), lambs became heavier and fatter, fibres shifted towards oxidative and away from glycolytic, muscle myoglobin increased, the meat became darker and redder and tenderness declined. Early weaning had no effect on the time to reach slaughter weight, provided nutrition was not restricted. The sire genetics influence on the carcass composition far outweighed the effect of nutrition postweaning. Lambs on a restricted diet tended to have less acceptable meat quality but this was not evident in lambs from sires selected for high fatness. Sensory tenderness was improved and intramuscular fat was higher in lamb progeny from sires selected for high fatness.

An experiment was conducted to test 3 hypotheses regarding the variation in plasma parameters and their association with lamb growth and composition. The experiment tested whether sire genetics and available nutrition affected specific plasma traits, whether these traits were associated with growth and compositional characteristics, and whether data on plasma traits could improve the prediction of growth and carcass composition. Lambs (n = 103) produced by sires differing in estimated breeding values for growth, muscling, and fat were reared on LOW or HIGH planes of lifetime nutrition. Blood samples were collected immediately prior to weaning and before slaughter at 8 months of age. Concentrations of plasma creatinine (CRE), urea (PUN), insulin like growth factor I (IGF-I) were measured in all samples. Leptin was measured in samples from male lambs only (n = 56). HIGH nutrition increased preweaning and preslaughter IGF-I and leptin concentrations; nutritional effects on PUN and CRE were inconsistent. Lambs of the high muscle sire-type exhibited increased plasma IGF-I, reduced PUN, and an increased PUN : CRE ratio preweaning. Increased genetic potential of the sire for growth reduced PUN and increased PUN : CRE ratio. Plasma IGF-I correlated strongly with lamb growth rate (r2 = 0.49). Interaction of nutrition and sire-type for preslaughter leptin mimicked the interaction occurring for carcass fat, providing an example of selection on genotype inducing a physiological (hormonal) change and resulting in a modified phenotype. Stepwise regressions developed to predict carcass protein and fat mass from information available at weaning or at slaughter indicated that inclusion of plasma parameters in these models caused only small increases in the proportion of variance accounted for. The most significant benefit was an increase in the proportion of variance in carcass weight accounted for (from 65 to 73%) by including IGF-I and CRE as predictors compared with prediction from weaning weight alone. If slaughter data were available, then >90% of the variance in carcass fat and protein masses was explained by carcass weight alone and this was not increased by inclusion of any preslaughter plasma parameter in the model. It was concluded that while nutrition and the genetic capacity of the sire (especially for muscling) affect plasma constituents as well as lamb growth and carcass composition, the inclusion of the measured plasma traits in models to predict final carcass composition from weaning data or slaughter data is unlikely to improve the prediction sufficient to justify the additional measurement cost.

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.

Experimentation was carried out to test for a relationship between subjective time perception and ability to make temporal judgements. The performance of 20 depersonalized and derealized patients and 20 controls, was compared on a variety of tests of time judgement administered under normal laboratory conditions and under conditions which have been shown to induce or amplify distortions in subjective temporal experience. The results failed to indicate any reliable relationship between subjective temporal experience and ability to make time judgements. The performance of patients did not differ reliably from that of controls under any of the testing conditions; exposure to distorting conditions did not have a reliable effect on temporal performance and Ss who reported temporal distortions either in their past life or while actually performing the tests of time judgement, failed to perform differently from Ss who did not report distortions.

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