Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care

Objectives: “Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods: National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results: The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions: The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings

Osteoclast formation from mononuclear phagocytes : role of bone forming cells

Contains fulltext : 4431.pdf (publisher's version ) (Open Access

Canopy dynamics of a tropical rain forest in French Guiana

The canopy dynamics (i.e. the formation and closure of canopy gaps) of a tropical rain forest in French Guiana are described. The formation of canopy gaps is investigated. The difficulties with gap size measurements are studied, and causes and consequences of treefalls and branchfalls are examined. It is concluded that canopy gap location is not random. Sod factors may make some areas in the forest hot spots of disturbances, whereas other areas are less frequently disturbed. Furthermore, the closure of canopy gaps and tree seedling performance in gaps are discussed. Recruitment in gaps is largely determined by the fortuitous occurrence of seedlings and sapling that were present before the gap was formed. Specialisation of species is discussed and its concluded that detailed information on micro-habitat availability (in gaps) and on micro-habitat needs of species may indicate which individuals at which location have the highest chance of survival. Finally, the potential application of these findings for application in forest practices are examined

Effects of light and soil flooding on the growth and photosynthesis of ramin (Gonystylus bancanus) seedlings in Malaysia

We studied the ecophysiology of ramin (Gonystylus bancanus) seedlings in an experimental set up at the Forest Research Centre in Kuching, Sarawak, Malaysia. Ramin seedlings were grown on flooded and drained peat soil under 100, 76, 46 and 23% sunlight, thus simulating effects of different light conditions (canopy gap size) and drainage that occur in natural ramin populations. Seedling growth was highest in partial sunlight (76%) and reduced with reducing light levels. Aboveground productivity and fine root development were significantly higher in seedlings grown on flooded soil compared with those on drained soil. In contrast, investment in coarse root biomass was significantly higher in seedlings grown on drained soil. It appeared that the aboveground growth benefits in flooded conditions were the result of more advantageous conditions for allocation of carbon to leaves, thus enhancing overall relative growth rates through higher light interception rates despite lower photosynthetic capacity. The results of this experiment suggested that drainage of peat swamp forests would seriously hamper natural regeneration of ramin by limiting the growth of seedlings. It is also suggested that selective logging operations which produce medium-size canopy gaps improve ramin regeneration in hydrologically undisturbed mixed swamp forest

Proceedings of the International Workshop on: methods and tools for water-related adaptation to climate change and climate proofing

The workshop fits in the National Water Plan of the Netherlands’ government of which the international chapter includes the strengthening of cooperation with other delta countries, including Indonesia, Vietnam and Bangladesh and is part of the work plan of the Cooperative Programme on Water and Climate, a Netherlands’ sponsored programme with the objective to improve knowledge and capacity on the relation between water and climate change especially in developing countries and countries in transition

Selective antimicrobial modulation of the intestinal flora of patients with acute nonlymphocytic leukemia : A double blind placebo-controlled study

Contains fulltext : 4423.pdf (publisher's version ) (Open Access

Limited value of acyclovir in the treatment of uncomplicated herpes zoster

Contains fulltext : 4429.pdf (publisher's version ) (Open Access

Transpleural lung biopsy by the thorascopic route in patients with diffuse interstitial pulmonary disease

Contains fulltext : 4341.pdf (publisher's version ) (Open Access

Implementation of an educational program and an antibiotic order form to optimize quality of antimicrobial drug use in a department of internal medicine

Contains fulltext : 26051___.pdf (publisher's version ) (Open Access

Septicaemia with Dysgonic Fermenter -2 (DF-2) bacterium in a compromised host

Contains fulltext : 4451.pdf (publisher's version ) (Open Access