Audit of surgical delay in relationship to outcome after proximal femoral fracture.

To ascertain the influence of surgical delay on outcome after proximal femoral fracture in elderly females, a cohort study of patients presenting in 1987 was compared to 1989/90. Organisational changes in the intervening period were introduced to reduce delay to surgical intervention. Two hundred and eighty females aged 65 years and over presenting from the local catchment area of an acute inner-city teaching hospital were enrolled in the study. Seventy-nine patients received surgery in 1987 and 186 in 1989/90. The one year mortality was 34% and 26% respectively. The proportion receiving surgery within 24 hours rose from 34% in 1987 to 57% in 1989/90. The relative hazard of the group receiving surgery on day 2 in comparison to day 1 was 1.7 (95% CI 1.0 to 2.9) when adjusted for co-variance of age and mental score. Medically fit elderly patients presenting with proximal femoral fracture have improved survival with early surgery within 24 hours of admission. Improvements in the organisation of hospital care will result in important benefits for the increasing number of elderly females presenting with proximal femoral fracture

An optimality-based model of the dynamic feedbacks between natural vegetation and the water balance

The hypothesis that vegetation adapts optimally to its environment gives rise to a novel framework for modeling the interactions between vegetation dynamics and the catchment water balance that does not rely on prior knowledge about the vegetation at a particular site. We present a new model based on this framework that includes a multilayered physically based catchment water balance model and an ecophysiological gas exchange and photosynthesis model. The model uses optimization algorithms to find those static and dynamic vegetation properties that would maximize the net carbon profit under given environmental conditions. The model was tested at a savanna site near Howard Springs (Northern Territory, Australia) by comparing the modeled fluxes and vegetation properties with long-term observations at the site. The results suggest that optimality may be a useful way of approaching the prediction and estimation of vegetation cover, rooting depth, and fluxes such as transpiration and CO2 assimilation in ungauged basins without model calibration

An optimality-based model of the coupled soil moisture and root dynamics

The main processes determining soil moisture dynamics are infiltration, percolation, evaporation and root water uptake. Modelling soil moisture dynamics therefore requires an interdisciplinary approach that links hydrological, atmospheric and biological processes. Previous approaches treat either root water uptake rates or root distributions and transpiration rates as given, and calculate the soil moisture dynamics based on the theory of flow in unsaturated media. The present study introduces a different approach to linking soil water and vegetation dynamics, based on vegetation optimality. Assuming that plants have evolved mechanisms that minimise costs related to the maintenance of the root system while meeting their demand for water, we develop a model that dynamically adjusts the vertical root distribution in the soil profile to meet this objective. The model was used to compute the soil moisture dynamics, root water uptake and fine root respiration in a tropical savanna over 12 months, and the results were compared with observations at the site and with a model based on a fixed root distribution. The optimality-based model reproduced the main features of the observations such as a shift of roots from the shallow soil in the wet season to the deeper soil in the dry season and substantial root water uptake during the dry season. At the same time, simulated fine root respiration rates never exceeded the upper envelope determined by the observed soil respiration. The model based on a fixed root distribution, in contrast, failed to explain the magnitude of water use during parts of the dry season and largely over-estimated root respiration rates. The observed surface soil moisture dynamics were also better reproduced by the optimality-based model than the model based on a prescribed root distribution. The optimality-based approach has the potential to reduce the number of unknowns in a model (e.g. the vertical root distribution), which makes it a valuable alternative to more empirically-based approaches, especially for simulating possible responses to environmental change

Memory usage verification using Hip/Sleek.

Embedded systems often come with constrained memory footprints. It is therefore essential to ensure that software running on such platforms fulfils memory usage specifications at compile-time, to prevent memory-related software failure after deployment. Previous proposals on memory usage verification are not satisfactory as they usually can only handle restricted subsets of programs, especially when shared mutable data structures are involved. In this paper, we propose a simple but novel solution. We instrument programs with explicit memory operations so that memory usage verification can be done along with the verification of other properties, using an automated verification system Hip/Sleek developed recently by Chin et al.[10,19]. The instrumentation can be done automatically and is proven sound with respect to an underlying semantics. One immediate benefit is that we do not need to develop from scratch a specific system for memory usage verification. Another benefit is that we can verify more programs, especially those involving shared mutable data structures, which previous systems failed to handle, as evidenced by our experimental results

Coupling carbon allocation with leaf and root phenology predicts tree-grass partitioning along a savanna rainfall gradient

© Author(s) 2016. The relative complexity of the mechanisms underlying savanna ecosystem dynamics, in comparison to other biomes such as temperate and tropical forests, challenges the representation of such dynamics in ecosystem and Earth system models. A realistic representation of processes governing carbon allocation and phenology for the two defining elements of savanna vegetation (namely trees and grasses) may be a key to understanding variations in tree-grass partitioning in time and space across the savanna biome worldwide. Here we present a new approach for modelling coupled phenology and carbon allocation, applied to competing tree and grass plant functional types. The approach accounts for a temporal shift between assimilation and growth, mediated by a labile carbohydrate store. This is combined with a method to maximize long-term net primary production (NPP) by optimally partitioning plant growth between fine roots and (leaves + stem). The computational efficiency of the analytic method used here allows it to be uniquely and readily applied at regional scale, as required, for example, within the framework of a global biogeochemical model. We demonstrate the approach by encoding it in a new simple carbon-water cycle model that we call HAVANA (Hydrology and Vegetation-dynamics Algorithm for Northern Australia), coupled to the existing POP (Population Orders Physiology) model for tree demography and disturbance-mediated heterogeneity. HAVANA-POP is calibrated using monthly remotely sensed fraction of absorbed photosynthetically active radiation (fPAR) and eddy-covariance-based estimates of carbon and water fluxes at five tower sites along the North Australian Tropical Transect (NATT), which is characterized by large gradients in rainfall and wildfire disturbance. The calibrated model replicates observed gradients of fPAR, tree leaf area index, basal area, and foliage projective cover along the NATT. The model behaviour emerges from complex feedbacks between the plant physiology and vegetation dynamics, mediated by shifting above- versus below-ground resources, and not from imposed hypotheses about the controls on tree-grass co-existence. Results support the hypothesis that resource limitation is a stronger determinant of tree cover than disturbance in Australian savannas

Comparison of nursing home residents admitted from home or hospital.

A growing elderly population coupled with a reduction in hospital long term care has led to an increase in the independent nursing home sector. This is an expensive resource. Proper placement is therefore essential to ensure its efficient use. Prior to the introduction of care management there was no standard assessment procedure for admission to nursing home care from different sources. A nursing home population (n = 624) in North and West Belfast was studied and mental scores, levels of disability, and the source of admission to the nursing home recorded. Residents admitted from geriatric medical units (n = 132) were compared with those from general medical and surgical wards (n = 168) and those from home (n = 243). Residents who were admitted from a geriatric unit were the most disabled, those admitted from home were the least and those from general wards had intermediate levels of disability (p < 0.005). This is likely to be the result of different assessment procedures for prospective nursing home residents. With the introduction of care management, it is hoped that standardised assessment will follow. The roles of different medical specialists in this process is not yet clear. Further study is needed to assess the appropriateness of placement in nursing homes under care management