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Padded clothing (shoulder padding) is worn in Rugby Union to give players an opportunity to protect themselves. A performance specification for padded clothing has been set out by World Rugby™, with the intention that padded clothing only protects against lacerations and abrasions. Test protocols in this specification provide an assessment of the impact force attenuative properties of the material, this itself will not indicate what injuries they may have the potential to prevent or lessen the severity of. The current study has used previously established biomechanical parameters to develop a mechanical test procedure to assess the ability of padded clothing to prevent or lessen the severity of stud-induced laceration and abrasion injuries. A synthetic skin and soft tissue surrogate was developed and validated to mimic human anatomy. Without the addition of padded clothing, both wearing (abrasion) and tearing (laceration) of the synthetic tissue surrogate were seen. The addition of padded clothing saw no sign of stud-induced injury, even after six repeated trials of the same product, showing padded clothing can prevent or lessen the severity of lacerations and abrasions. The developed testing protocols could be used to assess the safety of any sports stud designs in relation to skin injury as well as the effectiveness of various protective clothing products across the sports industry.

Introduction Coronavirus (COVID-19) has negatively impacted healthcare around the world. It has had a major impact on orthopaedic training. The independent sector has been proposed as a facility for future training. Our aim was to provide an overview of the current higher surgical trainees’ experience in the independent sector. Method Training orthopaedic registrars within the East of England deanery were asked to complete an electronic questionnaire of their training experience in the independent sector between 5th November to 2nd December 2020. Results 57 of 64 registrars (89%) from across all thirteen regional training hospitals responded. 44% attended the independent sector, but 7 only assisted (28%). No third year trainees went, but there was an even spread of other training years attending a mean of four sessions. Sixty-six indicative procedures were performed, all with supervisors scrubbed. Second year trainees performed the most cases with 4 on average. Completion of work based assessments was low. 20% trainees reported a negative experience. 80% enjoyed themselves. 52% felt they achieved their goals. 29% trainees felt that independent sector operating would compensate for the shortfall in training brought about by COVID-19. The main obstacles to independent sector training were lack of access and opportunity (51%) and poor induction and paperwork issues (22%) Conclusion This is the first deanery-wide assessment of access to and training within the independent sector due to COVID-19. Independent sector operating for orthopaedic trainees is feasible on scale and should be embedded to supplement training in the future. In their current state independent sector facilities are not easily and universally accessible to fulfil training needs.

Radiofrequency ablation (RFA) ± endoscopic resection (EMR) is an established treatment strategy for neoplastic Barrett's and intramucosal cancer. Most patients are managed with proton pump inhibitors. The incidence of recurrent Barrett's metaplasia, dysplasia, or cancer after complete eradication is up to 43 % using this strategy. We hypothesize the addition of fundoplication should result in a lower recurrence rates after complete eradication.Multi-institutional retrospective review of patients undergoing endotherapy followed by Nissen fundoplicationA total of 49 patients underwent RFA ± EMR followed by Nissen fundoplication. Complete remission of intestinal metaplasia (CR-IM) was achieved in 26 (53 %) patients, complete remission of dysplasia (CR-D) in 16 (33 %) patients, and 7 (14 %) had persistent neoplastic Barrett's. After fundoplication, 18/26 (70 %) remained in CR-IM. An additional 10/16 CR-D achieved CR-IM and 4/7 with persistent dysplasia achieved CR-IM. One patient progressed to LGD while no patient developed HGD or cancer.Endoscopic therapy for Barrett's dysplasia and/or intramucosal cancer followed by fundoplication results in similar durability of CR-IM to patients being managed with PPIs alone after endoscopic therapy. However, fundoplication may be superior in preventing further progression of disease and the development of cancer. Fundoplication is an important strategy to achieve and maintain CR-IM, and facilitate eradication of persistent dysplasia.

The nature of minerals in the B horizons of alpine forest soils in subtropical and tropical areas remains to be identified. The objective of this study was to investigate the distribution of Fe-oxides and hydroxy-interlayered vermiculite (HIV) in typical alpine forest soils of Taiwan. Five pedons at roughly 2000 m elevation of Taiwan were selected as example for this study. High gradient magnetic separation (HGMS), conventional X-ray diffraction (XRD), differential X-ray diffraction (DXRD), and transmission electron microscopy (TEM) were employed to characterize the clay minerals. The content of crystalline Fe-oxides increased sharply from E to B horizons. Only Al-substituted lepidocrocite and goethite were identified by differential X-ray diffraction (DXRD) analysis in magnetic clay fractions of the B (or placic) horizons; no substantial hematite peaks appeared in the XRD patterns of any pedons. These observations are quite different from those of Spodosols or Spodosol-like soils developed in the temperate and frigid zones of North America. Hydroxy-interlayered vermiculite (HIV) was characterized by collapse of the 1.42-nm peak in the XRD diagrams toward 1.0 nm when the K-saturated clay samples were heated to 350°C. In the surface horizons, only vermiculite could be identified in the coarse clay fractions. The distribution patterns of acid ammonium oxalate extractable Fe and Al in these pedons indicate that Al and Fe were leached from the A horizons and accumulated in the B horizons when forming Al-substituted lepidocrocite, goethite, and HIV. This is attributed to the combined effect of organic acids, Al, and Fe in the pedogenic environments. The present findings are of fundamental significance in understanding the formation of Spodosol-like soils in alpine forest soils in the subtropics and tropics.

L’evolution vers un financement plus consequent des acteurs locaux, et d’une meilleure appropriation par ces derniers de l’action humanitaire entreprise dans leur pays, represente un changement majeur pour celle-ci. Pourtant, il n’est pas sur qu’elle y gagne en efficacite. A partir du cas syrien, cet article explore l’action humanitaire locale et sa relation avec la communaute internationale. Il montre que les organisations locales syriennes sont un acteur primordial de l’humanitaire a l’interieur des frontieres syriennes. Celles-ci revelent un potentiel remarquable pour une action humanitaire plus adaptee, plus efficace et plus durable, ce qui va dans le sens des arguments en faveur d’une relocalisation de cette action. Toutefois, la concretisation de ce potentiel depend lourdement de la facon dont les ONG internationales envisagent leurs relations avec ces organisations locales.