The construction and implementation of a clinical decision-making algorithm reduces the cost of adult fracture clinic visits by up to £104,800 per year: a quality improvement study.

INTRODUCTION Inappropriate referrals to the new patient fracture clinic unnecessarily consume hospital resources and many hospitals lack clear guidelines as to what should be referred. Many of these injuries can be definitively managed by the emergency department. Our aim was to construct and disseminate a clinical decision-making algorithm to reduce the frequency of inappropriate referrals to fracture clinics at our institution, to improve the management of patients with minor injuries and save the hospital and the patient the cost of unnecessary visits. MATERIALS AND METHODS Data were prospectively collected for all new fracture clinic referrals over two separate 1-week cycles with cohorts of 94 and 74 patients, respectively. After the first cycle, the referral algorithm was disseminated both electronically (intranet) and orally (presentations to emergency department staff). The results of this intervention were examined in the second cycle, which took place 6 months after the first cycle. RESULTS The introduction of this algorithm significantly reduced inappropriate referrals by almost 20% (P = 0.0445). DISCUSSION This simple intervention highlighted a potential annual cost saving of up to £104,000. We advocate the use of this concise algorithm in improving the efficiency of the referral system to fracture clinics.

Improving accuracy and efficiency of mutual information for multi-modal retinal image registration using adaptive probability density estimation.

Mutual information (MI) is a popular similarity measure for performing image registration between different modalities. MI makes a statistical comparison between two images by computing the entropy from the probability distribution of the data. Therefore, to obtain an accurate registration it is important to have an accurate estimation of the true underlying probability distribution. Within the statistics literature, many methods have been proposed for finding the 'optimal' probability density, with the aim of improving the estimation by means of optimal histogram bin size selection. This provokes the common question of how many bins should actually be used when constructing a histogram. There is no definitive answer to this. This question itself has received little attention in the MI literature, and yet this issue is critical to the effectiveness of the algorithm. The purpose of this paper is to highlight this fundamental element of the MI algorithm. We present a comprehensive study that introduces methods from statistics literature and incorporates these for image registration. We demonstrate this work for registration of multi-modal retinal images: colour fundus photographs and scanning laser ophthalmoscope images. The registration of these modalities offers significant enhancement to early glaucoma detection, however traditional registration techniques fail to perform sufficiently well. We find that adaptive probability density estimation heavily impacts on registration accuracy and runtime, improving over traditional binning techniques.

Turn costs change the value of animal search paths.

The tortuosity of the track taken by an animal searching for food profoundly affects search efficiency, which should be optimised to maximise net energy gain. Models examining this generally describe movement as a series of straight steps interspaced by turns, and implicitly assume no turn costs. We used both empirical- and modelling-based approaches to show that the energetic costs for turns in both terrestrial and aerial locomotion are substantial, which calls into question the value of conventional movement models such as correlated random walk or Lévy walk for assessing optimum path types. We show how, because straight-line travel is energetically most efficient, search strategies should favour constrained turn angles, with uninformed foragers continuing in straight lines unless the potential benefits of turning offset the cost.

Surgical aspects of international drug smuggling.

The internal concealment of cocaine and other drugs in packets by "body packers"--those who swallow packets of drugs or hide them in their vagina or rectum--to avoid detection by customs officials has been increasing in both the United States and Europe. The types of package and how they are concealed are changing as the traffickers become more sophisticated in their methods. The latest parcels are less likely to burst, but obstruction of the bowel may occur. Awareness of the problem is important for staff of emergency medical services near international ports of arrival.

A comparison of burley tobacco doubled-haploid lines with their source inbred cultivars.

A doubled-haploid line was randomly derived from each of seven burley tobacco, Nicotiana tabacum L., cultivars using anther culture and leaf-midvein chromosomal doubling. The doubled-haploid lines were compared to their source inbred cultivars in two experiments for several agronomic and chemical characters. A consistent relationship between anther-derived materials and reduced vigor was not observed in these doubled-haploid lines. Significant differences between the doubled-haploid mean and their source cultivar mean were observed only for days to flower and total alkaloids. The doubled-haploid means were not significantly different from their source cultivar means for yield, plant height, and leaf number. In total, 26 of the 35 individual comparisons between a doubled-haploid line and its source cultivar were nonsignificant. Reciprocal crosses between the doubled-haploid lines and their source inbred cultivars also demonstrated no significant differences. The diallel progeny of the seven doubled-haploid lines showed a similar genetic performance to that of diallel progeny from conventional materials in previous studies. The differences observed between the doubled-haploid lines and their source inbred cultivars could be explained by residual heterozygosity. The performances of the doubled-haploid progeny could also be attributed to the presence of residual heterozygosity in the original cultivars. As tested by reciprocal crosses, cytoplasmic effects were not significantly involved in the performance of the double-dhaploid lines.

Effects of the Nicotiana debneyi black root rot resistance factor on agronomic and chemical traits in burley tobacco.

Lines isogenic or near isogenic for traits other than resistance to black root rot from Nicotiana debneyi were developed in eight cultivar backgrounds of burley tobacco (N. tabacum L.). For each cultivar background, a resistant and susceptible selection from the seventh backcross generation plus the recurrent parental cultivar were evaluated for ten agronomic and chemical traits. Resistant selections were statistically different from the susceptible entries for days to flower, total nitrogen content, and total alkaloid content. Also, resistant selections were consistently lower in yield, but the differences were statistically nonsignificant. Resistant selections were also taller in three families and in two families the resistant selections had wider leaves. Linkage of genetic material from N. debneyi with the resistance factor was suggested as the possible reason for differences between resistant and susceptible selections.

Incorporation--a solution to the veterinarian's income tax miseries?

This series of three articles discusses the new income tax rules regarding the incorporation of professionals in general and veterinarians in particular. It points out that while there may be some degree of tax saving or deferral achieved by incorporating, many provincial veterinary associations may not yet permit its members to incorporate. The incorporation of the nonprofessional aspects, however, should be carefully considered.

Genetic parameters in aKy 14 xKy Ex 42 burley population ofNicotiana tabacum L.

In the F2 generation of the cross between burley varieties,Ky 14 andKy Ex 42, estimates of additive genetic variance were significant for yield, days to flower, and number of leaves. All estimates of dominance variance, additive X additive variance, and interactions between genetic variances and years were smaller than twice their standard errors. The gain expected from selecting and recombining the best 10% of theF 2 plants ranged from 4% for number of leaves to 8.6% for yield. Additive genetic correlations between pairs of agronomic characters were positive. Yield and number of leaves were negatively correlated with total alkaloids.

Peroxidase activity in rat liver microbodies after amino-triazole inhibition.

The in vivo effects of 3-amino-1,2,4-triazole (AT) on the fine structure of microbodies in hepatic cells of male rats has been studied by the peroxidase-staining technique. Within 1 hr of intraperitoneal injection AT abolishes microbody peroxidase-staining, and the return of staining coincides temporally with the known pattern of return of catalase activity following AT inhibition; this is further evidence that the peroxidase staining of microbodies is due to catalase activity. Peroxidase staining reappears in the microbody matrix without evidence of either massive degradation or rapid proliferation of the organelles. Furthermore, during the period of return of activity, ribosomal staining occurs adjacent to microbodies whose matrix shows little or no peroxidase staining. These observations are interpreted as evidence that (a) catalase is capable of entering preexisting microbodies without traversing the cisternae of the rough endoplasmic reticulum or the Golgi apparatus, and that (b) the ribosomal staining is probably not cytochemical diffusion artifact and may represent a localized site of synthesis or activation of catalase.

New observations on microbodies. A cytochemical study on CPIB-treated rat liver.

The liver of male rats has been studied after CPIB stimulation by using the peroxidase reaction for localizing catalase in hepatic cells. CPIB administration leads to an increase in the number of microbodies, and it is suggested that one mechanism by which microbody proliferation occurs is a process of fragmentation or budding from preexisting microbodies. Reaction product was observed not only within the microbody matrix, but outside the limiting membrane of the microbody and in association with ribosomes of adjacent rough endoplasmic reticulum. This localization of reaction product is interpreted as evidence that catalase after synthesis on rough endoplasmic reticulum may accumulate near microbodies and may be transferred directly into these organelles without traversing the cisternae of the endoplasmic reticulum or Golgi apparatus.