Cost effectiveness of community leg ulcer clinics: randomised controlled trial

Objectives: To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compression bandaging versus usual care provided by district nurses. Design: Randomised controlled trial with 1 year of follow up. Setting: Eight community based research clinics in four trusts in Trent. Subjects: 233 patients with venous leg ulcers allocated at random to intervention (120) or control (113) group. Interventions: Weekly treatment with four layer bandaging in a leg ulcer clinic (clinic group) or usual care at home by the district nursing service (control group). Main outcome measures: Time to complete ulcer healing, patient health status, and recurrence of ulcers. Satisfaction with care, use of services, and personal costs were also monitored. Results: The ulcers of patients in the clinic group tended to heal sooner than those in the control group over the whole 12 month follow up (log rank P=0.03). At 12 weeks, 34% of patients in the clinic group were healed compared with 24% in the control. The crude initial healing rate of ulcers in intervention compared with control patients was 1.45 (95% confidence interval 1.04 to 2.03). No significant differences were found between the groups in health status. Mean total NHS costs were £878.06 per year for the clinic group and £859.34 for the control (P=0.89). Conclusions: Community based leg ulcer clinics with trained nurses using four layer bandaging is more effective than traditional home based treatment. This benefit is achieved at a small additional cost and could be delivered at reduced cost if certain service configurations were used

A new disposal strategy for the Western Scheldt, conciliating port accessibility and nature preservation

In 1999, Flanders and the Netherlands agreed to set up a common strategy for managing the Scheldt estuary. In 2002, both parties signed a memorandum of understanding in which was defined a “Long Term Vision” strategy and its objectives. One of these is the preservation in the Western Scheldt of a dynamic flood and ebb channel network, the so-called “multi-channel system”. The present trend, a continuation of past natural morphological evolutions combined with human interference (land reclamation and polder building, dredging and other river works) may jeopardise this objective.<p>An expert team appointed by the Antwerp Port Authority stated the need for morphological management, aiming at steering the estuarine morphology. In a first phase, sediment from dredging works could be used to reshape eroded sandbars where needed, in order for the flood and ebb flows to continue maintaining the multiple channels.<p>Since 2002, this new disposal strategy is being investigated as a pilot project on the Walsoorden sandbar in the Western Scheldt. An extended research was conducted in 2002 and 2003, combining several tools: desk studies with maps on the historical morphological changes, field measurements, physical scale model tests and numerical models. As a result of the research work executed at Flanders Hydraulics Research, it was concluded that none of the results contradicted the feasibility of the new disposal strategy at the Walsoorden sandbar, although final judgement would only be possible after the execution of an in situ disposal test.<p>At the end of 2004, 500.000 m³ of sand was disposed during one month with a diffuser in relatively shallow water at the seaward end of the Walsoorden sandbar. The experiment was thoroughly monitored, morphological as well as ecological. One year after the execution of the in situ disposal test, it was concluded that from morphological viewpoint the test was a success. The ecological monitoring revealed no significant negative changes in trends due to the disposal test.<p>In 2006 a new disposal test was executed, using the traditional dumping (“clapping”) technique with hopper dredgers. Due to practical limitations, the disposal (again 500.000 m³) was spread over 3 months. The new experiment was again thoroughly monitored. Due to larger currents in the disposal area, a higher percentage of the material was transported towards the Walsoorden sandbar. This morphological evolution was seen as positive within the objectives of the disposal strategy. From ecological viewpoint again no significant negative changes in trends have been identified.<p>Due to the success of both in situ tests, the strategy of morphological disposal will be included in the dredging and disposal operations for the future deepening of the navigation channel. This new disposal strategy will introduce benefits for both the economy (deepening and maintenance of the fairway) and the ecology (keeping the sediment in the estuary, creating new valuable areas without endangering the multiple channel system). Therefore further research work has been carried out in 2007-2008 on how to embed this strategy in the future dredging and disposal policy and the possible use of the strategy on other locations. During execution (planned to start in 2009) an intensive monitoring programme will monitor the morphological and ecological effects of the disposed sediments, allowing adjusting the strategy if necessary. However, this is only part of a morphological management of the estuary, which would also have to include morphological dredging and modifying the hard bordering at some locations

Complete genome sequence and taxonomic position of anguillid herpesvirus 1

Eel herpesvirus or anguillid herpesvirus 1 (AngHV1) frequently causes disease in freshwater eels. The complete genome sequence of AngHV1 and its taxonomic position within the family Alloherpesviridae were determined. Shotgun sequencing revealed a 249 kbp genome including an 11 kbp terminal direct repeat that contains 7 of the 136 predicted protein-coding open reading frames. Twelve of these genes are conserved among other members of the family Alloherpesviridae and another 28 genes have clear homologues in cyprinid herpesvirus 3. Phylogenetic analyses based on amino acid sequences of five conserved genes, including the ATPase subunit of the terminase, confirm the position of AngHV1 within the family Alloherpesviridae, where it is most closely related to the cyprinid herpesviruses. Our analyses support a recent proposal to subdivide the family Alloherpesviridae into two sister clades, one containing AngHV1 and the cyprinid herpesviruses and the other containing Ictalurid herpesvirus 1 and the ranid herpesviruses

A new disposal strategy for the Western Scheldt, conciliating port accessibility and nature preservation

In 1999, Flanders and the Netherlands agreed to set up a common strategy for managing the Scheldt estuary. In 2002, both parties signed a memorandum of understanding in which was defined a “Long Term Vision” strategy and its objectives. One of these is the preservation in the Western Scheldt of a dynamic flood and ebb channel network, the so-called “multi-channel system”. The present trend, a continuation of past natural morphological evolutions combined with human interference (land reclamation and polder building, dredging and other river works) may jeopardise this objective.An expert team appointed by the Antwerp Port Authority stated the need for morphological management, aiming at steering the estuarine morphology. In a first phase, sediment from dredging works could be used to reshape eroded sandbars where needed, in order for the flood and ebb flows to continue maintaining the multiple channels.Since 2002, this new disposal strategy is being investigated as a pilot project on the Walsoorden sandbar in the Western Scheldt. An extended research was conducted in 2002 and 2003, combining several tools: desk studies with maps on the historical morphological changes, field measurements, physical scale model tests and numerical models. As a result of the research work executed at Flanders Hydraulics Research, it was concluded that none of the results contradicted the feasibility of the new disposal strategy at the Walsoorden sandbar, although final judgement would only be possible after the execution of an in situ disposal test.At the end of 2004, 500.000 m3 of sand was disposed during one month with a diffuser in relatively shallow water at the seaward end of the Walsoorden sandbar. The experiment was thoroughly monitored, morphological as well as ecological. One year after the execution of the in situ disposal test, it was concluded that from morphological viewpoint the test was a success. The ecological monitoring revealed no significant negative changes in trends due to the disposal test.In 2006 a new disposal test was executed, using the traditional dumping (“clapping”) technique with hopper dredgers. Due to practical limitations, the disposal (again 500.000 m3) was spread over 3 months. The new experiment was again thoroughly monitored. Due to larger currents in the disposal area, a higher percentage of the material was transported towards the Walsoorden sandbar. This morphological evolution was seen as positive within the objectives of the disposal strategy. From ecological viewpoint again no significant negative changes in trends have been identified.Due to the success of both in situ tests, the strategy of morphological disposal will be included in the dredging and disposal operations for the future deepening of the navigation channel. This new disposal strategy will introduce benefits for both the economy (deepening and maintenance of the fairway) and the ecology (keeping the sediment in the estuary, creating new valuable areas without endangering the multiple channel system). Therefore further research work has been carried out in 2007-2008 on how to embed this strategy in the future dredging and disposal policy and the possible use of the strategy on other locations. During execution (planned to start in 2009) an intensive monitoring programme will monitor the morphological and ecological effects of the disposed sediments, allowing adjusting the strategy if necessary. However, this is only part of a morphological management of the estuary, which would also have to include morphological dredging and modifying the hard bordering at some locations

Parallelization, Special Hardware and Post-Newtonian Dynamics in Direct N - Body Simulations

The formation and evolution of supermassive black hole (SMBH) binaries during and after galaxy mergers is an important ingredient for our understanding of galaxy formation and evolution in a cosmological context, e.g. for predictions of cosmic star formation histories or of SMBH demographics (to predict events that emit gravitational waves). If galaxies merge in the course of their evolution, there should be either many binary or even multiple black holes, or we have to find out what happens to black hole multiples in galactic nuclei, e.g. whether they come sufficiently close to merge resulting from emission of gravitational waves, or whether they eject each other in gravitational slingshot interactions

Nanomechanics of the endothelial glycocalyx in experimental sepsis

The endothelial glycocalyx (eGC), a carbohydrate-rich layer lining the luminal side of the endothelium, regulates vascular adhesiveness and permeability. Although central to the pathophysiology of vascular barrier dysfunction in sepsis, glycocalyx damage has been generally understudied, in part because of the aberrancy of in vitro preparations and its degradation during tissue handling. The aim of this study was to analyze inflammation-induced damage of the eGC on living endothelial cells by atomic-force microscopy (AFM) nanoindentation technique. AFM revealed the existence of a mature eGC on the luminal endothelial surface of freshly isolated rodent aorta preparations ex vivo, as well as on cultured human pulmonary microvascular endothelial cells (HPMEC) in vitro. AFM detected a marked reduction in glycocalyx thickness (266 ± 12 vs. 137 ± 17 nm, P<0.0001) and stiffness (0.34 ± 0.03 vs. 0.21 ± 0.01 pN/mn, P<0.0001) in septic mice (1 mg E. coli lipopolysaccharides (LPS)/kg BW i.p.) compared to controls. Corresponding in vitro experiments revealed that sepsis-associated mediators, such as thrombin, LPS or Tumor Necrosis Factor-α alone were sufficient to rapidly decrease eGC thickness (-50%, all P<0.0001) and stiffness (-20% P<0.0001) on HPMEC. In summary, AFM nanoindentation is a promising novel approach to uncover mechanisms involved in deterioration and refurbishment of the eGC in sepsis

Dilepton Spectra from Decays of Light Unflavored Mesons

The invariant mass spectrum of the $e^{+}e^{-}$ and $\mu ^{+}\mu ^{-}$ pairs from decays of light unflavored mesons with masses below the $\phi (1020)$-meson mass to final states containing along with a dilepton pair one photon, one meson, and two mesons are calculated within the framework of the effective meson theory. The results can be used for simulations of the dilepton spectra in heavy-ion collisions and for experimental searches of dilepton meson decays.Comment: 73 pages, 19 figures, 3 tables, REVTeX, new references adde

Evaluating the function of wildcat faecal marks in relation to the defence of favourable hunting areas

This is an Accepted Manuscript of an article published by Taylor & Francis in Ethology Ecology and Evolution on 2015, available online: http://www.tandfonline.com/10.1080/03949370.2014.905499To date, there have been no studies of carnivores that have been specifically designed to examine the function of scent marks in trophic resource defence, although several chemical communication studies have discussed other functions of these marks. The aim of this study was to test the hypothesis that faecal marks deposited by wildcats (Felis silvestris) serve to defend their primary trophic resource, small mammals. Field data were collected over a 2-year period in a protected area in northwestern Spain. To determine the small mammal abundance in different habitat types, a seasonal live trapping campaign was undertaken in deciduous forests, mature pine forests and scrublands. In each habitat, we trapped in three widely separated Universal Transverse Mercator (UTM) cells. At the same time that the trapping was being performed, transects were conducted on foot along forest roads in each trapping cell and in one adjacent cell to detect fresh wildcat scats that did or did not have a scent-marking function. A scat was considered to have a presumed marking function when it was located on a conspicuous substrate, above ground level, at a crossroad or in a latrine. The number of faecal marks and the small mammal abundance varied by habitat type but not by seasons. The results of the analysis of covariance (ANCOVA) indicated that small mammal abundance and habitat type were the factors that explained the largest degrees of variation in the faecal marking index (number of faecal marks in each cell/number of kilometres surveyed in each cell). This result suggests that wildcats defended favourable hunting areas. They mark most often where their main prey lives and so where they spend the most time hunting (in areas where their main prey is more abundant). This practice would allow wildcats to protect their main trophic resource and would reduce intraspecific trophic competitio