Introduction: Ankle fractures are amongst the most common open fracture injuries presenting to major trauma centres (MTC) and their management remains a topic of debate. Incidence is increasing particularly in the elderly population however the optimal surgical approach and risk factors for unplanned reoperation remain scarce. We therefore conducted a retrospective case study to analyse our institution's outcomes as well as identify risk factors for early unplanned reoperation. Materials and methods: Sixty-five consecutive open ankle fractures were identified using our institutional database between July 2016 and July 2020. Medical records and operation notes were reviewed to identify patient age at injury, Sex, co-morbidities and other co-morbidities, fracture configuration, extent of soft tissue injury, fixation type and post-operative complications. The data was categorised into four groups for analysis, 1) age, 2) AO-OTA classification 3) Sex 4) Gustilo-Anderson grade. Statistical analysis was undertaken to identify predictors of unplanned reoperation. Results: The mean age of patients at the time of injury was 60.8. Unplanned reoperation rate was 17.5%. Age and Gustilo-Anderson classification grade were both statistically significant predictors of unplanned reoperation. AO-OTA classification, Sex and Diabetes were not statistically significant factors associated with unplanned reoperation. Conclusion: Age and quality of soft tissue envelope are significant risk factors for unplanned reoperation. Patients with these risk factors may benefit from an alternative surgical approach. (c) 2022 Elsevier Ltd. All rights reserved.

System architects are accustomed to developing systems hosted in federated environments that allow for developmental independence. However the system boundaries are different when systems are hosted in an Integrated Modular Avionics (IMA) platform. The boundaries lie within shared resources, and thus lead to greater dependencies between systems. This drives new design considerations for system architects. The natural tendency is to leverage traditional federated design concepts when building systems for IMA environments, but this can lead to inefficient use of system resources, and a lack of preparedness for the inevitable change that will occur within the integrated set of systems. IMA has become a standard in the civil and military aviation industries, so it is important to understand these new design considerations.The question addressed by this paper is "What unique design considerations are there for systems hosted on an IMA platform?" All of the considerations can be attributed to three main drivers present in the IMA environment: (1) optimization of system resources across the integrated set of hosted systems, (2) change containment when hosted systems change and (3) change containment when the IMA platform elements change (technology insertion).These three factors impact the traditional developmental independence between systems since it requires the architect to consider their system's role within the integrated set of systems. They must now consider how they will tolerate changes that are out of their control, such as changes to other hosted systems or the IMA platform that affect the shared resource performance. They must now consider how they contribute to the efficient use of system resources as part of the greater system-wide optimization strategy. If these factors are not addressed, then it can lead to wasted system resources, increased development costs, and high costs-of-change. Therefore the incentive to ensure that these new design considerations are addressed lies with both the system integrator who owns the integrated set of systems and the architect of each hosted system.This paper is based upon the authors' experience in developing IMA systems at GE Aviation. GE Aviation has developed open system IMA architectures for commercial aircraft (Boeing 787 Dreamliner), as well as military aircraft (Boeing C-130 combat aircraft, and Boeing KC-767 Tanker).

This article explores an educational experiment mounted at a public school for girls in Bristol in the 1920s and 1930s. In examining the aims and methods of the Badminton School for girls in this period it aims to do two things. The first is to analyse the relationship between the gendered, class‐based and nationalist values of the public school system and the aspirations of progressive internationalism that Badminton sought to introduce. The second is to assess how that relationship influenced the citizenship‐building role that Badminton (as with all public schools) charged itself with in this period. In answering these questions it is useful to consider the work of Gary McCulloch and Colin McCaig who have reflected on the history of education in the light of Eric Hobsbawm's The Invention of Tradition. 1 1 Hobsbawm, E. "Introduction: inventing traditions." In The Invention of Tradition, edited by E. Hobsbawm and T. Ranger. Cambridge: Cambridge University Press, 1983. McCulloch and McCaig argued that the headmaster of Harrow and leading defender of the public schools, Cyril Norwood, summoned the public school tradition in this period 'as a direct response to threats, from rapid sociological and ideological change'. 2 2 McCulloch, G. and C. McCaig. "Reinventing the Past: The Case of the English Tradition of Education." British Journal of Educational Studies, 50, no. 2 (2002): 241. Did the progressive public schools also 'invent' tradition in this way? How did the gender of the students and the ideology of the staff influence this process? The interwar period saw the rise of a number of schools that positioned themselves in opposition to the structures and ethos of the public schools but retained their class exclusivity and their confidence in education for leadership. The term 'progressive' was applied to schools that opposed the structures and ethos of the public school tradition root and branch, decrying their repressive moral codes, autocratic value systems and veneration of classical and athletic prowess. 'Progressive' has also been used to refer to schools that accepted the role of elite schooling in shaping models of citizenship and national leadership but aimed to subvert the value‐system of the public school tradition in order to mould new kinds of citizens and leaders. 3 3 A 1934 publication titled The Modern Schools Handbook purported to be the 'first book in which the heads of a representative selection of modern schools have described their aims and practice'. The editor used the foreword to the Handbook, in which Badminton featured, to distinguish between the two progressive streams, stressing that whilst 'some rank as public schools, others are experimental'. Blewitt, T., ed. The Modern Schools Handbook. London: Gollancz, 1934: 1. As we shall see, Badminton was progressive in the latter sense.

Data are summarised relating resting heart/pulse rate to teachers' ratings of disruptive behaviour in a sample of 206 non-referred children, aged 7-9 years, attending mainstream schools and not subject to specialist attention. Low base heart rate (BHR) was found to be associated with teachers' ratings of disruptive behaviour, confirming similar earlier research based on children aged 11-16 years. The findings are discussed in relation to psychophysiology and child development and with reference to several theoretical frameworks, identifying the need for further research.

OBJECTIVE:To determine if streptococcicidal levels of penicillin G benzathine can be detected in maternal serum 4 weeks after treatment with 4.8 million units. METHODS:Thirty-seven pregnant women with positive group B streptococcus vaginal or urine cultures were each given 4.8 million units of penicillin G benzathine. Maternal blood samples were collected after injection and at delivery. Serum penicillin levels were measured by high-pressure liquid chromatography. Follow-up cultures were done when possible. RESULTS:None of the patients had serum penicillin levels below 0.20 microgram/mL 30 days after treatment. Cord blood levels were approximately 50% lower than maternal levels. In all but three subjects, cord blood levels exceeded 0.06 microgram/mL, the minimal inhibitory concentration for group B streptococcus. The three exceptions were patients who delivered more than 100 days after treatment. Group B streptococcus cultures were negative at the time of delivery in 72% of cases. None of the patients with positive cultures were moderately or heavily colonized. CONCLUSION:In pregnant women, penicillin G benzathine levels are high enough to inhibit the growth of group B streptococcus for more than 4 weeks after injection with 4.8 million units. Further studies are needed to evaluate whether this regimen can prevent neonatal colonization and invasive group B streptococcus disease.