Evaluation of minimal fracture liaison service resource : costs and survival in secondary fracture prevention-a prospective one-year study in South-Finland

Background Fracture liaison service (FLS) is a secondary prevention model for identification of patients at risk for fragility fractures. Aims This study was conducted to evaluate the number and costs of secondary prevention of low-energy fractures in the city of Kouvola in Finland. Methods Women aged >= 45 years and men >= 60 years treated in the emergency department with a low-energy fracture were identified. Laboratory testing, BMI, and DXA scans were performed. Fracture Risk Assessment Tool was used. The direct FLS costs were calculated. Survival was analyzed using univariate and multivariate analysis and the life-table method. Results 525 patients with 570 fractures were identified. The mean age of women was 73.8 years and of men 75.9 years. Most patients sustained wrist (31%), hip (21%) or proximal humerus (12%) fractures. 41.5% of the patients had osteoporosis according to DXA scans. 62% of patients used calcium and vitamin D daily and 38% started anti-osteoporotic medication. Protective factors for survival were: age <80 years, female sex, and S-25OHD concentration of 50-119 nmol/L. Excess mortality was highest among patients with a fracture of the femur. The total annual direct costs of FLS were 1.3% of the costs of all fractures. Discussion Many low-energy fracture types were associated with excess mortality. The use of anti-osteoporotic medication was not optimal. Conclusions FLS increased the catchment of low-energy fracture patients and was inexpensive. However, identification, evaluation and post-fracture assessment of patients should be expedited. Rehabilitation of hip fracture patients needs to be improved.Peer reviewe

A 10-Year Retrospective Study of 490 Hip Fracture Patients: Reoperations, Direct Medical Costs, and Survival

Background and Aims: Reoperations after operative treatment of hip fracture patients may be associated with higher costs and inferior survival. We examined the acute hospital costs, long-term reoperation rates, and survival of patients with a new hip fracture. Materials and Methods: A total of 490 consecutive new hip fracture patients treated at a single center between 31 December 2004 and 6 December 2006 were analyzed retrospectively. Fractures were classified according to Garden and AO. All medical records were checked manually. The costs of reoperations were calculated using the diagnosis-related groups (DRG)-based prices. Survival analysis was performed using the life-table method. The follow-up time was 10 years. Results: In all, 70/490 patients (14.3%) needed reoperations. Of all reoperations, 34.2% were performed during the first month and 72.9% within 1 year after the primary operation. The hemiarthroplasty dislocation rate was 8.5%, and mechanical failures of osteosynthesis occurred in 6.2%. Alcohol abuse was associated with a heightened risk of reoperation. The mean direct costs of primary fracture care were lower than the mean costs of reoperations (euro7500 vs euro9800). The mortality rate at 10 years was 79.8% among non-reoperated patients and 62.9% among reoperated patients. Conclusions: According to our hypothesis, the cost per patient of reoperation in acute care was 31% higher than the corresponding cost of a primary operation. Reoperations increased the overall immediate costs of index fractures by nearly 20%. One-third of all reoperations were performed during the first month and almost 75% within 1 year after the primary operation.Peer reviewe

Cycling injuries and alcohol

Background: Most of the cycling accidents that occur in Finland do not end up in the official traffic accident statistics. Thus, there is minimal information on these accidents and their consequences, particularly in cases in which alcohol was involved. The focus of the present study is on cycling accidents and injuries involving alcohol in particular. Methods: Data on patients visiting the emergency department at North Kymi Hospital because of a cycling accident was prospectively collected for two years, from June 1, 2004 to May 31, 2006. Blood alcohol concentration (BAC) was measured on admission with a breath analyser. The severity of the cycling injuries was classified according to the Abbreviated Injury Scale (AIS). Results: A total of 217 cycling accidents occurred. One third of the injured cyclists were involved with alcohol at the time of visiting the hospital. Of these, 85% were males. A blood alcohol concentration of Conclusions: Cyclists involved with alcohol were, in most cases, heavily intoxicated and were not wearing a bicycle helmet. Head injuries were more common among these cyclists than among sober cyclists. As cycling continues to increase, it is important to monitor cycling accidents, improve the accident statistics and heighten awareness of the risks of head injuries when cycling under the influence of alcohol. (c) 2018 Elsevier Ltd. All rights reserved.Peer reviewe

Time--delay autosynchronization of the spatio-temporal dynamics in resonant tunneling diodes

The double barrier resonant tunneling diode exhibits complex spatio-temporal patterns including low-dimensional chaos when operated in an active external circuit. We demonstrate how autosynchronization by time--delayed feedback control can be used to select and stabilize specific current density patterns in a noninvasive way. We compare the efficiency of different control schemes involving feedback in either local spatial or global degrees of freedom. The numerically obtained Floquet exponents are explained by analytical results from linear stability analysis.Comment: 10 pages, 16 figure

Regional High-Resolution Benthic Habitat Data From Planet Dove Imagery For Conservation Decision-Making and Marine Planning

High-resolution benthic habitat data fill an important knowledge gap for many areas of the world and are essential for strategic marine conservation planning and implementing effective resource management. Many countries lack the resources and capacity to create these products, which has hindered the development of accurate ecological baselines for assessing protection needs for coastal and marine habitats and monitoring change to guide adaptive management actions. The PlanetScope (PS) Dove Classic SmallSat constellation delivers high-resolution imagery (4 m) and near-daily global coverage that facilitates the compilation of a cloud-free and optimal water column image composite of the Caribbean’s nearshore environment. These data were used to develop a first-of-its-kind regional thirteen-class benthic habitat map to 30 m water depth using an object-based image analysis (OBIA) approach. A total of 203,676 km2 of shallow benthic habitat across the Insular Caribbean was mapped, representing 5% coral reef, 43% seagrass, 15% hardbottom, and 37% other habitats. Results from a combined major class accuracy assessment yielded an overall accuracy of 80% with a standard error of less than 1% yielding a confidence interval of 78–82%. Of the total area mapped, 15% of these habitats (31,311.7 km2) are within a marine protected or managed area. This information provides a baseline of ecological data for developing and executing more strategic conservation actions, including implementing more effective marine spatial plans, prioritizing and improving marine protected area design, monitoring condition and change for post-storm damage assessments, and providing more accurate habitat data for ecosystem service models

Modeling the summertime evolution of sea-ice melt ponds

1] We present a mathematical model describing the summer melting of sea ice. We simulate the evolution of melt ponds and determine area coverage and total surface ablation. The model predictions are tested for sensitivity to the melt rate of unponded ice, enhanced melt rate beneath the melt ponds, vertical seepage, and horizontal permeability. The model is initialized with surface topographies derived from laser altimetry corresponding to first-year sea ice and multiyear sea ice. We predict that there are large differences in the depth of melt ponds and the area of coverage between the two types of ice. We also find that the vertical seepage rate and the melt rate of unponded ice are important in determining the total surface ablation and area covered by melt ponds

Osteoporosis in the community. Sensitivity of self-reported estimates and medication use of those diagnosed with the condition

Objectives: To assess the sensitivity and specificity of self-reported osteoporosis compared with dual energy X-ray absorptiometry (DXA) defined osteoporosis, and to describe medication use among participants with the condition. Methods: Data were obtained from a population-based longitudinal study and assessed for the prevalence of osteoporosis, falls, fractures and medication use. DXA scans were also undertaken. Results: Overall 3.8% (95% confidence interval (CI) 3.2 to 4.5) of respondents and 8.8% (95% CI 7.5 to 10.3) of those aged ≥ 50 years reported that they had been diagnosed with osteoporosis by a doctor. The sensitivity (those self-reporting osteoporosis and having low bone mineral density (BMD) on DXA) was low (22.7%), although the specificity was high (94.4%). Only 16.1% of those aged ≥ 50 years and with DXA-defined osteoporosis were taking bisphosphonates. Conclusions: The sensitivity of self-reporting to identify osteoporosis is low. Anti-osteoporotic medications are an important part of osteoporosis treatment but opportunities to use appropriate medications were missed and inappropriate medications were used.T. K. Gill, A. W. Taylor, C. L. Hill, P. J. Phillip

An Evaluation Model For Web-based 3D Mass Customization Toolkit Design

The development of geometric modelling technologies and web technologies provides the ability to present a virtual 3D product in a mass customization (MC) toolkit. Compared with 2D graphic toolkits, 3D toolkit design requires better consideration of individual customer needs, consumer and toolkit interaction, and also a means of integrating with the underlying technical infrastructure. However, there is currently no widely accepted model or criteria to regulate and evaluate 3D MC toolkit design. Given these considerations, in this paper we provide an evaluation model for web-based 3D toolkits and a heuristic evaluation of two representative commercial web-based 3D toolkits. The evaluation results indicate the usefulness and effectiveness of the model as a scale for evaluating 3D toolkits. It also reveals that despite a fair amount of effort that has been devoted to theoretical research, current 3D toolkits are still at an early development stage. We therefore conclude this paper by identifying and encouraging further topics and questions as directions for future research