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There has been separate testing in time and place of the model on a new rs 3 gold test set. In view of the established difficulty of transferring prognostic models,28 it is surprising that such follow up testing is seldom performed. Use of statistical techniques such as shrinkage of the regression coefficients29 to correct for overoptimism in the model (for example, MRC Antiepileptic Drug Withdrawal Study Group26) may help to make models more transferable.
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Advice is broad ranging and inconsistent.1 Current information ranges from waiting until the sutures are removed and the wound has healed1 to abstaining from swimming for six weeks postoperatively.2 Patients with external frame fixators are advised that it is permissible to swim in a chlorinated pool or clean sea water, although in practice this is difficult to ascertain and is far from an objective measure, once the pin sites have healed.3 Evidence to back up the advice is scarce.Concerns about the risks of swimming with a sutured wound primarily centre on the potential for infection,4 5 as opposed to impaired wound healing. The risk of infection depends on the type of wound (for example, an open wound might be said to be at higher risk than an epithelialised wound), comorbidities, the type and quality of water in which patients plan to swim, and the relative risks of complications should the wound become infected. Wound infections can result from exposure to aquatic microbes in treated swimming pools and fresh or marine water.4 5 6 The infective organisms vary accordingly.It is, however, difficult to quantify the risk of infection in sutured wounds and hence giving an evidence based answer when patients ask about swimming is problematic.What is the evidence of the uncertainty?To tackle our dilemma on how to advise patients on swimming with sutures, we searched PubMed, Embase, and Cochrane databases for articles on swimming related wound infections using combinations of the key words "swimming", "infection", "wound management", "water", "sutures", .

Bangalore based Kiran Gopinath's Ozone Media is an Internet advertising network. It brings together those with advertising space on the Web and those who need it. He partners online publishers to take advertising reach across the world. With a fleet of 300 dams, California is among the nation's leaders in hydropower generation. However, hydro in the state has declined from peaks in the 1950s, when it was responsible for more than half of the state's generation mix, to just 9% in 2013. Having prepared for hydro's decline by broadening its generation mix over the last several decades, the California grid remains mostly insulated from the worst effects of nearly a half decade of severe drought..
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