Clinical- and cost-effectiveness of the STAR care pathway compared to usual care for patients with chronic pain after total knee replacement: study protocol for a UK randomised controlled trial.

Approximately 20% of patients experience chronic pain after total knee replacement. There is little evidence for effective interventions for the management of this pain, and current healthcare provision is patchy and inconsistent. Given the complexity of this condition, multimodal and individualised interventions matched to pain characteristics are needed. We have undertaken a comprehensive programme of work to develop a care pathway for patients with chronic pain after total knee replacement. This protocol describes the design of a randomised controlled trial to evaluate the clinical- and cost-effectiveness of a complex intervention care pathway compared with usual care.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site

LundbladEmilyRuth.pdf

Coral reef ecosystems are the most diverse on earth, and their subsistence is being threatened by natural and adverse anthropogenic patterns and processes. In an effort to understand and protect these marine environments, several programs have outlined strategies and initiatives. For example, the United States Coral Reef Task Force’s Mapping and Information Working Group has outlined a specific goal to map all coral reefs below 30 m depth by 2009. This study contributes to achieving that goal for three sites around the island of Tutuila, American Samoa, lying in the heart of the South Pacific. American Samoa, a U.S. territory, is home to the Fagatele Bay National Marine Sanctuary, the smallest and most remote in the United States, and to the National Park of American Samoa. Extensive modern scientific surveys were implemented around the territory in 2001 and have since continued and increased. The presence of protected areas and the existence of scientific data collected with state of the art technology have made the site a priority for the Coral Reef Task Force. In this study, methods for classifying surficial seafloor characteristics as bathymetric position index (BPI) zones and structures were developed and applied to the study sites. BPI zones and structures were classified by using algorithms that combine high-resolution (1 m) multibeam bathymetry and its derivatives: bathymetric position index at multiple scales and slope. The development of algorithms and the classification scheme involved the use of historical and current classification studies and three-dimensional visualization. In addition, the BPI zones and structures were compared to limited biological, geological, and physical attributes recorded during accuracy assessment surveys (photos) and towed diver surveys (video). A rugosity (surface ratio) analysis was added to the study to give a picture of the seafloor roughness. The BPI zone and structure classifications overlap and extend existing classifications from Ikonos satellite imagery for water depths shallower than 30 m. Methods, data and classifications developed and applied in this study will be available to the public as a benthic habitat mapping tool (ArcGIS extension), in an online GIS data archive, and on a compact disc attached to this thesis. They contribute to a broader understanding of the marine and coastal environment and will serve as a baseline of information for benthic habitat mapping and future biological, ecological, and geological surveys. The baseline gives a good indication of characteristics that may indicate areas of high biodiversity. The final maps presented here are especially useful to managers, researchers and scientists that seek to establish and monitor a wider and more effective network of marine and coastal protection.Coral reef ecosystems are the most diverse on eart

A Benthic Terrain Classification Scheme for American Samoa

Coral reef ecosystems, the most varied on earth, continually face destruction from anthropogenic and natural threats. The U.S. Coral Reef Task Force seeks to characterize and map priority coral reef ecosystems in the U.S./Trust Territories by 2009. Building upon NOAA Biogeography shallow-water classifications based on Ikonos imagery, presented here are new methods, based on acoustic data, for classifying benthic terrain below 30 m, around Tutuila, American Samoa. The result is a new classification scheme for American Samoa that extends and improves the NOAA Biogeography scheme, which, although developed for Pacific island nations and territories, is only applicable to a maximum depth of 30 m, due to the limitations of satellite imagery. The scheme may be suitable for developing habitat maps pinpointing high biodiversity around coral reefs throughout the western Pacific

Status of coral reef resources in Micronesia and American Samoa: 2008

Coral reefs in Micronesia and American Samoa appear to be amongst the most resilient in the world, despite numerous on-going threats;\ud \ud There has been considerable recovery of reefs in western Micronesia (especially Palau) that were devastated during the massive coral bleaching in 1998;\ud \ud The more remote islands support thriving communities of large reef fishes due to limited fishing pressures and habitat degradation;\ud \ud Fish populations around major population centres show clear signs of over-fishing with few large fish observed because of fishing pressure, particularly spear-fishers using scuba;\ud \ud Management and monitoring efforts are on-going throughout the region and numerous effective initiatives are promoting recovery of damaged coral reefs as well as the conservation of healthy ones;\ud \ud Lack of enforcement continues to be one of the major hindrances to effective resource management outcomes and more support is necessary