Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England

<p>Abstract</p> <p>Background</p> <p>Dupuytren's disease is a fibro-proliferative disorder affecting ~3-5% of the UK population. Current surgical treatments for Dupuytren's contracture (DC) include fasciectomy and fasciotomy. We assessed the clinical management of DC in England over a 5-year period; associated NHS costs were assessed for a 1-year period.</p> <p>Methods</p> <p>Hospital Episode Statistics were extracted from April 2003 to March 2008 for patients with Palmar Fascial Fibromatosis (ICD10 = M720) and DC-related procedures. Variables included demographics, OPCS, patient status and physician specialty. To estimate 2010-2011 costs, HRG4 codes and the National Schedule of Tariff 2010-11-NHS Trusts were applied to the 2007-2008 period.</p> <p>Results</p> <p>Over 5 years, 75,157 DC admissions were recorded; 64,506 were analyzed. Mean admissions per year were 12,901 and stable. Day cases increased from 42% (2003-2004) to 62% (2007-2008). The percent of patients having two or more admissions per year increased from 5.5% in 2003-2004 to 26.1% in 2007-2008. Between 2003 and 2007, 91% of procedures were Fasciectomy. Revision of Fasciectomy and Fasciotomy each accounted for ~4%; Amputation for 1%. In 2007, classification was extended to identify Digital Fasciectomy, its Revision and Dermofasciectomy. In 2007-2008, admissions were: 70% Palmar Fasciectomy, 16% Digital Fasciectomy, 1.3% Other Fasciectomy, 4.4% Revision of Palmar Fasciectomy, 1.3% Revision of Digital Fasciectomy, 3.8% Division of Palmar Fascia, 2.6% Dermofasciectomy and 1.1% Amputation. 79% of cases were overseen by trauma and orthopaedic surgeons, 19% by plastic surgeons. Mean (±SD) inpatient hospital length of stay was 1.5 (±1.4) days in 2003-2004 and 1.0 (±1.3) days in 2007-2008. Total estimated costs for 1 year (2010-2011) were £41,576,141. Per-patient costs were £2,885 (day case) and £3,534 (inpatient). Costs ranged from £2,736 (day-case Fasciectomy) to £9,210 (day-case Revision Digital).</p> <p>Conclusions</p> <p>Between 2003 and 2008, fasciectomy was the most common surgical procedure for DC in England. While procedure rates and physician specialties varied little, there was a reversal in surgical venue: inpatient operations decreased as day-case procedures increased. The change is likely due to economic trends and changes to the healthcare system. Estimated costs for 2010-2011 varied by procedure type and patient status. These findings can be used to understand clinical management of DC and guide healthcare policy.</p

Commissioning and Calibrating the CMS Silicon Strip Tracker

The data acquisition system for the CMS Silicon Strip Tracker (SST) is based around a custom analogue front-end ASIC, an analogue optical link system and an off-detector VME board that performs digitization, zero-suppression and data formatting. A complex procedure is required to optimally configure, calibrate and synchronize the 107 channels of the SST readout system. We present an overview of this procedure, which will be used to commission and calibrate the SST during the integration, Start-Up and operational phases of the experiment. Recent experiences from the CMS Magnet Test Cosmic Challenge and system tests at the Tracker Integration Facility are also reported

Effects of cutting length and bud removal on root yield and starch content of cassava under rainfed conditions

Bud removal of the cuttings at underground level has been claimed by cassava growers in Thailand as a method to increase cassava yield. This practise should be tested experimentally to explain the reason for yield increase. The objective of this study was to investigate the effects of bud removal and cutting length on storage root yield and starch content of three cassava varieties. Field experiment was conducted in a split–split plot design with four replications in 2010 and 2011, under rainfed conditions. Three cassava varieties (KU50, RY9 and HB60) were assigned as main plot. Two cutting lengths (15 cm and 30 cm) were assigned as sub plots, and two treatments of buds (buds cut and not cut) were assigned as sub–sub plots. The buds on the cuttings that were inserted into the soil were removed. In 2010, the plants from 15-cm long cuttings subjected to bud removal had higher fresh storage root yield (88.4 Mg ha−1) than did plants from 30-cm long cuttings subjected to bud removal (75.8 Mg ha−1). Cutting of buds also had higher fresh storage root yield (89.1 Mg ha−1) than did non bud-cutting (75.0 Mg ha−1). KU50 had the highest fresh storage root yield (91.4 Mg ha−1), dry root yield (48.4 Mg ha−1) and starch yield (20.1 Mg ha−1). Cutting length of 15 cm had higher starch concentration in storage roots (25.6%) than did cutting length of 30 cm (24.2%). HB60 had the highest starch concentration (27.0%) among cassava varieties tested. The data in 2011 were similar to the data in 2010. The responses of varieties to bud removal and cutting length are discussed

Procedure for the fine delay adjustment of the CMS tracker

One of the crucial aspects of the commissioning of the CMS silicon tracker will be the absolute timing adjustment of each module, to accommodate both delays introduced by the hardware configuration and effects due to the time of flight of particles. The objective is to be optimally synchronized with the bunch-crossing to maximize the efficiency while minimizing the number of remnant hits from the adjacent bunch-crossings. In the present note, a procedure to reach that goal is studied. Monte Carlo studies as well as the analysis of data from the commissioning of the detector are used to assess the time needed and the resolution that can be achieved. Critical aspects are discussed, and results from the first implementation are presented

A Map of the Nanoworld: Sizing up the Science, Politics, and Business of the Infinitesimal

Mapping out the eight main nodes of nanotechnology discourse that have emerged in the past decade, we explore how various scientific, social, and ethical islands of discussion have developed, been recognized, and are being continually renegotiated. We do so by (1) identifying the ways in which scientists, policy makers, entrepreneurs, educators, and environmental groups have drawn boundaries on issues relating to nanotechnology; (2) describing concisely the perspectives from which these boundaries are drawn; and (3) exploring how boundaries on nanotechnology are marked and negotiated by various nodes of nanotechnology discourse.Comment: 25 page

Caffeine and Progression of Parkinson Disease: A Deleterious Interaction With Creatine.

OBJECTIVE: Increased caffeine intake is associated with a lower risk of Parkinson disease (PD) and is neuroprotective in mouse models of PD. However, in a previous study, an exploratory analysis suggested that, in patients taking creatine, caffeine intake was associated with a faster rate of progression. In the current study, we investigated the association of caffeine with the rate of progression of PD and the interaction of this association with creatine intake. METHODS: Data were analyzed from a large phase 3 placebo-controlled clinical study of creatine as a potentially disease-modifying agent in PD. Subjects were recruited for this study from 45 movement disorders centers across the United States and Canada. A total of 1741 subjects with PD participated in the primary clinical study, and caffeine intake data were available for 1549 of these subjects. The association of caffeine intake with rate of progression of PD as measured by the change in the total Unified Parkinson Disease Rating Scale score and the interaction of this association with creatine intake were assessed. RESULTS: Caffeine intake was not associated with the rate of progression of PD in the main analysis, but higher caffeine intake was associated with significantly faster progression among subjects taking creatine. CONCLUSIONS: This is the largest and longest study conducted to date that addresses the association of caffeine with the rate of progression of PD. These data indicate a potentially deleterious interaction between caffeine and creatine with respect to the rate of progression of PD

Differential Modulation of Retinal Degeneration by Ccl2 and Cx3cr1 Chemokine Signalling

Microglia and macrophages are recruited to sites of retinal degeneration where local cytokines and chemokines determine protective or neurotoxic microglia responses. Defining the role of Ccl2-Ccr2 and Cx3cl1-Cx3cr1 signalling for retinal pathology is of particular interest because of its potential role in age-related macular degeneration (AMD). Ccl2, Ccr2, and Cx3cr1 signalling defects impair macrophage trafficking, but have, in several conflicting studies, been reported to show different degrees of age-related retinal degeneration. Ccl2/Cx3cr1 double knockout (CCDKO) mice show an early onset retinal degeneration and have been suggested as a model for AMD. In order to understand phenotypic discrepancies in different chemokine knockout lines and to study how defects in Ccl2 and/or Cx3cr1 signalling contribute to the described early onset retinal degeneration, we defined primary and secondary pathological events in CCDKO mice. To control for genetic background variability, we compared the original phenotype with that of single Ccl2, Cx3cr1 and Ccl2/Cx3cr1 double knockout mice obtained from backcrosses of CCDKO with C57Bl/6 mice. We found that the primary pathological event in CCDKO mice develops in the inferior outer nuclear layer independently of light around postnatal day P14. RPE and vascular lesions develop secondarily with increasing penetrance with age and are clinically similar to retinal telangiectasia not to choroidal neovascularisation. Furthermore, we provide evidence that a third autosomal recessive gene causes the degeneration in CCDKO mice and in all affected re-derived lines and subsequently demonstrated co-segregation of the naturally occurring RD8 mutation in the Crb1 gene. By comparing CCDKO mice with re-derived CCl2−/−/Crb1Rd8/RD8, Cx3cr1−/−/Crb1Rd8/RD8 and CCl2−/−/Cx3cr1−/−/Crb1Rd8/RD8 mice, we observed a differential modulation of the retinal phenotype by genetic background and both chemokine signalling pathways. These findings indicate that CCDKO mice are not a model of AMD, but a model for an inherited retinal degeneration that is differentially modulated by Ccl2-Ccr2 and Cx3cl1-Cx3cr1 chemokine signalling