‘Getting under our skin’: Introducing banked allograft skin to burn surgery in South Africa

Deceased donor skin possesses many of the properties of the ideal biological dressing, and a well-stocked skin bank has become a critically important asset for the modern burn surgeon. Without it, managing patients with extensive burns and wounds becomes far more challenging, and outcomes are significantly worse. With the recent establishment of such a bank in South Africa, the challenge facing the medical fraternity is to facilitate tissue donation so that allograft skin supply can match the enormous demand

The hospital costs associated with acute paediatric burn injuries

Background. Ongoing rationing of healthcare threatens services that are well established, and cripples others that desperately require investment. Burn, for one, remains a neglected epidemic in South Africa (SA), despite the magnitude of the problem.Objective. To identify the prominent components contributing to the cost of hospital admission with paediatric burn injury. Determining the true costs of specialist services is important, so that resources can be allocated appropriately to achieve the greatest possible impact.Methods. A retrospective study was undertaken over 1 year to determine patient demographics and injury details of 987 patients admitted with burn injuries to Red Cross War Memorial Children’s Hospital, Cape Town, SA. The in-hospital financial records of 80 randomly selected patients were examined. This was followed by a prospective study to determine the financial implications of four cost drivers, i.e. bed cost per day, costs of medications received, costs of dressings for wound care, and costs of surgical intervention. A random selection of 37 dressing changes (in 31 paediatric patients) and 19 surgical interventions was observed, during which all costs were recorded.Results. As expected, severe flame burns are responsible for more prolonged hospital stays and usually require surgical intervention. Scald burns comprise the greatest proportion of burn injuries, and therefore account for a considerable part of the hospital’s expenditure towards burn care.Conclusion. While community programmes aiming to prevent burn injuries are important, this study motivates for the implementation of accessible ambulatory services in low-income areas. This strategy would enable the burn unit to reduce its costs by limiting unnecessary admissions, and prioritising its resources for those with more severe burn injuries

The hospital costs associated with acute paediatric burn injuries

__Background__ Ongoing rationing of healthcare threatens services that are well established, and cripples others that desperately require investment. Burn, for one, remains a neglected epidemic in South Africa (SA), despite the magnitude of the problem. __Objective__ To identify the prominent components contributing to the cost of hospital admission with paediatric burn injury. Determining the true costs of specialist services is important, so that resources can be allocated appropriately to achieve the greatest possible impact. __Methods__ A retrospective study was undertaken over 1 year to determine patient demographics and injury details of 987 patients admitted with burn injuries to Red Cross War Memorial Children’s Hospital, Cape Town, SA. The in-hospital financial records of 80 randomly selected patients were examined. This was followed by a prospective study to determine the financial implications of four cost drivers, i.e. bed cost per day, costs of medications received, costs of dressings for wound care, and costs of surgical intervention. A random selection of 37 dressing changes (in 31 p

The impact of deep-sea fisheries and implementation of the UNGA Resolutions 61/105 and 64/72. Report of an international scientific workshop

The scientific workshop to review fisheries management, held in Lisbon in May 2011, brought together 22 scientists and fisheries experts from around the world to consider the United Nations General Assembly (UNGA) resolutions on high seas bottom fisheries: what progress has been made and what the outstanding issues are. This report summarises the workshop conclusions, identifying examples of good practice and making recommendations in areas where it was agreed that the current management measures fall short of their target

Local time and the pricing of time-dependent barrier options

A time-dependent double-barrier option is a derivative security that delivers the terminal value $\phi(S_T)$ at expiry $T$ if neither of the continuous time-dependent barriers b_\pm:[0,T]\to \RR_+ have been hit during the time interval $[0,T]$. Using a probabilistic approach we obtain a decomposition of the barrier option price into the corresponding European option price minus the barrier premium for a wide class of payoff functions $\phi$, barrier functions $b_\pm$ and linear diffusions $(S_t)_{t\in[0,T]}$. We show that the barrier premium can be expressed as a sum of integrals along the barriers $b_\pm$ of the option's deltas \Delta_\pm:[0,T]\to\RR at the barriers and that the pair of functions $(\Delta_+,\Delta_-)$ solves a system of Volterra integral equations of the first kind. We find a semi-analytic solution for this system in the case of constant double barriers and briefly discus a numerical algorithm for the time-dependent case.Comment: 32 pages, to appear in Finance and Stochastic

How do cities approach policy innovation and policy learning? A study of 30 policies in Northern Europe and North America

This paper reports on a study of current practice in policy transfer, and ways in which its effectiveness can be increased. A literature review identifies important factors in examining the transfer of policies. Results of interviews in eleven cities in Northern Europe and North America investigate these factors further. The principal motivations for policy transfer were strategic need and curiosity. Local officials and politicians dominated the process of initiating policy transfer, and local officials were also the leading players in transferring experience. A range of information sources are used in the search process but human interaction was the most important source of learning for two main reasons. First, there is too much information available through the Internet and the search techniques are not seen to be wholly effective in identifying the necessary information. Secondly, the information available on websites, portals and even good practice guides is not seen to be of mixed quality with risks of focussing only on successful implementation and therefore subject to some bias. Officials therefore rely on their trusted networks of peers for lessons as here they can access the ‘real implementation’ story and the unwritten lessons. Organisations which have a culture that is supportive of learning from elsewhere had strong and broad networks of external contacts and resourced their development whilst others are more insular or inward looking and reluctant to invest in policy lessons from elsewhere. Solutions to the problems identified in the evidence base are proposed

Anthropogenic controls on overwash deposition: Evidence and consequences

Accelerated sea level rise and the potential for an increase in frequency of the most intense hurricanes due to climate change threaten the vitality and habitability of barrier islands by lowering their relative elevation and altering frequency of overwash. High-density development may further increase island vulnerability by restricting delivery of overwash to the subaerial island. We analyzed pre-Hurricane Sandy and post-Hurricane Sandy (2012) lidar surveys of the New Jersey coast to assess human influence on barrier overwash, comparing natural environments to two developed environments (commercial and residential) using shore-perpendicular topographic profiles. The volumes of overwash delivered to residential and commercial environments are reduced by 40% and 90%, respectively, of that delivered to natural environments. We use this analysis and an exploratory barrier island evolution model to assess long-term impacts of anthropogenic structures. Simulations suggest that natural barrier islands may persist under a range of likely future sea level rise scenarios (7-13 mm/yr), whereas developed barrier islands will have a long-term tendency toward drowning

Seamount seascape composition and configuration shape Southwest Indian Ridge fish assemblages

Seamounts are commercially important fishing grounds. Yet, little is known about their physical characteristics as fish habitat, important for informing conservation and ecosystem-based management. This study examines how multiscale seabed spatial heterogeneity influences commercially important fish families at three Southwest Indian Ridge seamounts (Coral Seamount, Melville Bank and Atlantis Bank). We quantified seascape heterogeneity from bathymetry and geomorphological habitat maps and identified 15 focal fish families from video data. Fish-habitat associations were examined using spatial pattern metrics that measured terrain morphology, seascape composition (variety and relative abundance of patch types) and seascape configuration (spatial arrangement of patches). Broader seascape context was characterised by geographic location and water depth. Multivariate regression trees and random forests modelled fish-habitat associations and identified the most influential explanatory variables. Assemblage characteristics and individual families were strongly influenced by geographic location and depth, and at finer scales (500 m buffers) seascape composition and configuration helped explain fish-habitat associations. Spatially continuous summit habitat and complex shaped ridge features supported high abundance and diversity of commercial fish families. Metrics of seascape composition and configuration (i.e., habitat size, shape and structural connectivity) had higher predictive power than the terrain metrics commonly used in developing proxies for deep-water fish species and biodiversity. These outcomes indicate that seascape metrics, commonly applied on land and in shallow marine environments, are also relevant environmental predictors of fish distributions in deep-sea environments. We highlight strong context dependency and depth-specific associations that hinder attempts to draw wider generalisations on fish-seascape linkages for seamounts

New consensus nomenclature for mammalian keratins

Keratins are intermediate filament–forming proteins that provide mechanical support and fulfill a variety of additional functions in epithelial cells. In 1982, a nomenclature was devised to name the keratin proteins that were known at that point. The systematic sequencing of the human genome in recent years uncovered the existence of several novel keratin genes and their encoded proteins. Their naming could not be adequately handled in the context of the original system. We propose a new consensus nomenclature for keratin genes and proteins that relies upon and extends the 1982 system and adheres to the guidelines issued by the Human and Mouse Genome Nomenclature Committees. This revised nomenclature accommodates functional genes and pseudogenes, and although designed specifically for the full complement of human keratins, it offers the flexibility needed to incorporate additional keratins from other mammalian species