A globally relevant change taxonomy and evidence-based change framework for land monitoring.

A globally relevant and standardized taxonomy and framework for consistently describing land cover change based on evidence is presented, which makes use of structured land cover taxonomies and is underpinned by the Driver-Pressure-State-Impact-Response (DPSIR) framework. The Global Change Taxonomy currently lists 246 classes based on the notation 'impact (pressure)', with this encompassing the consequence of observed change and associated reason(s), and uses scale-independent terms that factor in time. Evidence for different impacts is gathered through temporal comparison (e.g., days, decades apart) of land cover classes constructed and described from Environmental Descriptors (EDs; state indicators) with pre-defined measurement units (e.g., m, %) or categories (e.g., species type). Evidence for pressures, whether abiotic, biotic or human-influenced, is similarly accumulated, but EDs often differ from those used to determine impacts. Each impact and pressure term is defined separately, allowing flexible combination into 'impact (pressure)' categories, and all are listed in an openly accessible glossary to ensure consistent use and common understanding. The taxonomy and framework are globally relevant and can reference EDs quantified on the ground, retrieved/classified remotely (from ground-based, airborne or spaceborne sensors) or predicted through modelling. By providing capacity to more consistently describe change processes-including land degradation, desertification and ecosystem restoration-the overall framework addresses a wide and diverse range of local to international needs including those relevant to policy, socioeconomics and land management. Actions in response to impacts and pressures and monitoring towards targets are also supported to assist future planning, including impact mitigation actions.

An interprofessional induction to hand surgery.

BACKGROUND: Hand surgery is a multidisciplinary specialty and health care professionals require effective training. An interprofessional induction for hand trauma co-ordinators (HTCs), core trainees (CTs) and specialty trainees (STs) was designed. The primary aim of our study was to determine any improvement in participants' knowledge. Our secondary aim was to assess participants' responses to the interprofessional aspect of the induction, and to gather general feedback. METHODS: Validated multiple-choice questionnaires (MCQs) were distributed to 18 participants before and after induction. Score improvement was analysed for significance with a Student's t-test. Feedback was obtained with validated questionnaires using Likert-scale answers, Yes/No answers and qualitative free-text answers. RESULTS/FINDINGS: Overall, the MCQ scores significantly improved by 3.8/16 points (p < 0.0001). HTC, CT and ST scores improved by 4.3 points (p < 0.05), 3.8 points (p < 0.0005) and 3.6 points (p < 0.005), respectively. The educational content and presentation of the sessions were rated as 4.44/5 and 4.50/5, respectively. Participants appreciated the interdisciplinary aspect of the induction and thought it improved interprofessional teamworking (83%) and patient care (89%), but needed more time to cover topics. DISCUSSION: Our study shows that our interprofessional induction significantly improved the knowledge of participants from all levels of experience within the MDT, whilst developing interprofessional collaboration to promote safe and effective care for patients. This study is of interest to specialties working within a multidisciplinary team environment. Hand surgery is a multidisciplinary speciality and health care professionals require effective training.

Severe destructive arthritis of the carpometacarpal joint: a diagnosis of exclusion case report.

We present a case of severe destruction of the thumb carpometacarpal joint (CMCJ) and surrounding structures on a background of osteoarthritis and Seronegative Rheumatoid arthritis. Imaging studies suggested a soft tissue lesion consistent with Pigmented Villonodular Synovitis (PVNS), Synovial Osteochondromatosis or Giant Cell Tumour (GCT). Due to the possibility of malignant transformation and deteriorating symptoms the mass was excised. Histological analysis of the lesion revealed severe degenerative disease with no evidence of malignancy or infection. This represents an atypical presentation of thumb carpometacarpal joint arthritis, which should be diagnosed once more sinister pathology has been excluded.

Ultrasound findings of the locked metacarpophalangeal joint.

The radiographs and sonographic findings of two cases of locked metacarpophalangeal joint secondary to tethering of the volar plate are described. The presence of osteophytes and the dynamic ultrasound assessment of the volar plate have provided confirmation of the clinical diagnosis prior to surgery.