Plate fixation of extra-articular fractures of the proximal phalanx: do new implants cause less problems?

BACKGROUND Limited range of finger motion is a frequent complication after plate fixation of phalangeal fractures. The purpose of this study was to evaluate the results of plate fixation of extra-articular fractures of the proximal phalanx using current low-profile mini-fragment-systems. METHODS From 2006 to 2012, 32 patients with 36 extra-articular fractures of the proximal phalanx of the triphalangeal fingers were treated with open reduction and plate fixation (ORPF) using 1.2 and 1.5 mm mini-fragment systems. Patients presenting with open fractures grade 2 and 3 or relevant laceration of adjacent structures were excluded from the study. We retrospectively evaluated the rate of mal-union or non-union after ORPF, the need for revision surgery, for plate removal, and for tenolysis. Data were analyzed for further complications with regard to infections or complex regional pain syndrome (CRPS). RESULTS No infections were noted. Five patients developed transient symptoms of CRPS. Six weeks postoperatively, total active finger motion (TAM) averaged 183°, and all 32 patients underwent formal hand therapy. At the latest follow-up or at the time of plate removal, respectively, the mean TAM improved to 213°. Extension lag of proximal interphalangeal joints was found in 67 % of all fractured fingers. Secondary surgery was necessary in 14 of 32 patients (2 corrective osteotomies, 12 plate removals including 7 procedures explicitly because of reduced mobility). CONCLUSIONS Despite of new implant designs significant problems persist. Adhesions of extensor tendons leading to limited range of finger motion are still the most frequent complications after ORPF of proximal phalangeal fractures, even in absence of significant soft-tissue damage. LEVEL OF EVIDENCE Therapeutic, Retrospective, Level IV.

The 100 Most Influential Publications in Cervical Spine Research

STUDY DESIGN Bibliometric study of current literature. OBJECTIVE To identify and analyze the 100 most cited publications in cervical spine research. SUMMARY OF BACKGROUND DATA The cervical spine is a dynamic field of research with many advances made within the last century. However, the literature has never been comprehensively analyzed to identify and compare the most influential articles as measured by the number of citations. METHODS All databases of the Thomson Reuters Web of Knowledge were utilized in a two-step approach. First, the 150 most cited cervical spine studies up to and including 2014 were identified using four keywords. Second, all keywords related to the cervical spine found in the 150 studies (n = 38) were used to conduct a second search of the database. The top 100 most cited articles were hereby selected for further analysis of current and past citations, authorship, geographic origin, article type, and level of evidence. RESULTS Total citations for the 100 studies identified ranged from 173 to 879. They were published in the time frame 1952 to 2008 in a total of 30 different journals. Most studies (n = 42) were published in the decade 1991 - 2000. Level of evidence ranged from 1 to 5 with 39 studies in the level 4 category. 13 researchers were first author more than once and 9 researchers senior author more than once. The two step approach with a secondary widening of search terms yielded an additional 27 studies, including the first ranking article. CONCLUSIONS This bibliometric study is likely to include some of the most important milestones in the field of cervical spine research of the last 100 years. LEVEL OF EVIDENCE 3.

Operative Treatment of Acute Fractures of the Tarsal Navicular Body: Midterm Results With a New Classification.

BACKGROUND Treatment of displaced tarsal navicular body fractures usually consists of open reduction and internal fixation. However, there is little literature reporting results of this treatment and correlation to fracture severity. METHODS We report the results of 24 patients treated in our institution over a 12-year period. Primary outcome measurements were Visual-Analogue-Scale Foot and Ankle score (VAS-FA), AOFAS midfoot score, and talonavicular osteoarthritis at final follow-up. According to a new classification system reflecting talonavicular joint damage, 2-part fractures were classified as type I, multifragmentary fractures as type II, and fractures with talonavicular joint dislocation and/or concomitant talar head fractures as type III. Spearman's coefficients tested this classification's correlation with the primary outcome measurements. Mean patient age was 33 (range 16-61) years and mean follow-up duration 73 (range 24-159) months. RESULTS Average VAS-FA score was 74.7 (standard deviation [SD] 16.9), and average AOFAS midfoot score was 83.8 (SD = 12.8). Final radiographs showed no talonavicular arthritis in 5 patients, grade 1 in 7, grade 2 in 3, grade 3 in 6, and grade 4 in 1 patient. Two patients had secondary or spontaneous talonavicular fusion. Spearman coefficients showed strong correlation of the classification system with VAS-FA score (r = -0.663, P < .005) and talonavicular arthritis (r = 0.600, P = .003), and moderate correlation with AOFAS score (r = -.509, P = .011). CONCLUSION At midterm follow-up, open reduction and internal fixation of navicular body fractures led to good clinical outcome but was closely related to fracture severity. A new classification based on the degree of talonavicular joint damage showed close correlation to clinical and radiologic outcome. LEVEL OF EVIDENCE Level IV, retrospective case series.

Temporary Internal Fixation for Ligamentous and Osseous Lisfranc Injuries: Outcome and Technical Tip

BACKGROUND Open rather than closed reduction and internal fixation as well as primary definitive arthrodesis are well accepted for ligamentous and osseous Lisfranc injuries. For ligamentous injuries, a better outcome after primary definitive partial arthrodesis has been published. METHODS Of 135 Lisfranc injuries that were treated from 1998 to 2012 with open reduction, temporary internal fixation by screws and plates, and restricted weight bearing in a lower leg cast for 3 months followed by an arch support for another 4 to 6 weeks, 29 ligamentous Lisfranc injuries were available for follow-up. They were compared with 29 osseous Lisfranc injuries matched in age and gender. RESULTS Between the groups, there were no significant differences in average age (39.9 vs 38 years) or in average follow-up time (8.3 vs 9.1 years). Also, no significant differences were seen in the AOFAS midfoot score (84 vs 85.3 points), the FFI pain scale (9.9 vs 14.9 points), SF 36 physical component (56.2 vs 53.9 points), SF 36 mental component (57 vs 56.4 points), or VAS for pain (1.6 vs 1.5 points). The FFI function scale was significantly lower in the ligamentous group (11.6 vs 19.5 points). Radiographically, loss of reduction was recorded 3 times in the ligamentous injuries and 4 times in the osseous injuries. Arthritis was mild/moderate/severe in 5/3/0 ligamentous injuries and in 7/2/1 osseous injuries, requiring 1 definitive secondary Lisfranc arthrodesis in each group. CONCLUSION With longer and conservative postoperative management, open reduction and temporary internal fixation in ligamentous and osseous Lisfranc injuries led to equal medium-term outcome. Inferior outcome in ligamentous injuries was not found. LEVEL OF EVIDENCE Level III, retrospective comparative cohort study.

Effect of chin-cup treatment on the temporomandibular joint: a systematic review

AIM To systematically search the literature and assess the available evidence for the influence of chin-cup therapy on the temporomandibular joint regarding morphological adaptations and appearance of temporomandibular disorders (TMD). MATERIALS AND METHODS Electronic database searches of published and unpublished literature were performed. The following electronic databases with no language and publication date restrictions were searched: MEDLINE (via Ovid and PubMed), EMBASE (via Ovid), the Cochrane Oral Health Group's Trials Register, and CENTRAL. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. The reference lists of all eligible studies were checked for additional studies. Two review authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion or the involvement of an arbiter. RESULTS From the 209 articles identified, 55 papers were considered eligible for inclusion in the review. Following the full text reading stage, 12 studies qualified for the final review analysis. No randomized clinical trial was identified. Eight of the included studies were of prospective and four of retrospective design. All studies were assessed for their quality and graded eventually from low to medium level of evidence. Based on the reported evidence, chin-cup therapy affects the condylar growth pattern, even though two studies reported no significance changes in disc position and arthrosis configuration. Concerning the incidence of TMD, it can be concluded from the available evidence that chin-cup therapy constitutes no risk factor for TMD. CONCLUSION Based on the available evidence, chin-cup therapy for Class III orthodontic anomaly seems to induce craniofacial adaptations. Nevertheless, there are insufficient or low-quality data in the orthodontic literature to allow the formulation of clear statements regarding the influence of chin-cup treatment on the temporomandibular joint.

Dynamic intraligamentary stabilization: novel technique for preserving the ruptured ACL

PURPOSE Replacement of the torn anterior cruciate ligament (ACL) with a transplant is today`s gold standard. A new technique for preserving and healing the torn ACL is presented. HYPOTHESIS a dynamic intraligamentary stabilization (DIS) that provides continuous postinjury stability of the knee and ACL in combination with biological improvement of the healing environment [leucocyte- and platelet-rich fibrin (L-PRF) and microfracturing] should enable biomechanically stable ACL self-healing. METHODS Ten sportive patients were treated by DIS employing an internal stabilizer to keep the unstable knee in a posterior translation, combined with microfracturing and platelet-rich fibrin induction at the rupture site to promote self-healing. Postoperative clinical [Tegner, Lysholm, International Knee Documentation Committee (IKDC), visual analogue scale patient satisfaction score] and radiological evaluation, as well as assessment of knee laxity was performed at 6 weeks, 3, 6, 12, and 24 months. RESULTS One patient had a re-rupture 5 months postoperative and was hence excluded from further follow-ups. The other nine patients presented the following outcomes at 24 months: median Lysholm score of 100; IKDC score of 98 (97-100); median Tegner score of 6 (range 9-5); anterior translation difference of 1.4 mm (-1 to 3 mm); median satisfaction score of 9.8 (9-10). MRI showed scarring and continuity of the ligament in all patients. CONCLUSIONS DIS combined with microfracturing and L-PRF resulted in stable clinical and radiological healing of the torn ACL in all but one patient of this first series. They attained normal knee scores, reported excellent satisfaction and could return to their previous levels of sporting activity. LEVEL OF EVIDENCE Case series with no comparison group, Level IV.

Patient-Rated Outcomes of Lumbar Fusion in Patients with Degenerative Disease of the Lumbar Spine: Does Age Matter?

STUDY DESIGN Single centre retrospective study of prospectively collected data, nested within the Eurospine Spine Tango data acquisition system. OBJECTIVE The aim of this study was to assess the patient-rated outcome and complication rates associated with lumbar fusion procedures in three different age groups. SUMMARY OF BACKGROUND DATA There is a general reluctance to consider spinal fusion procedures in elderly patients due to the increased likelihood of complications. METHODS Before and at 3, 12, and 24 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI). At the 3-, 12-, and 24-month follow-ups they also rated the Global Treatment Outcome (GTO) and their satisfaction with care. Patients were divided into three age groups: younger (≥50y < 65y; n = 317), older (≥65y < 80y; n = 350), and geriatric (≥ 80y; n = 40). RESULTS 707 consecutive patients were included. The preoperative comorbidity status differed significantly (p < 0.0001) between the age groups, with the highest scores in the geriatric group. Medical complications during surgery were lower in the younger age group (7%) than in the older (13.4%; p = 0.006) and geriatric groups (17.5%; p = 0.007); surgical complications tended to be higher in the elderly group (younger, 6.3%; older, 6.0%; geriatric, 15.0%; p = 0.09). There were no significant group differences (p > 0.05) for the scores on any of the COMI domains, GTO, or patient-rated satisfaction at either 3-, 12-, and 24-months follow-up. CONCLUSIONS Despite greater comorbidity and complication rates in geriatric patients, the patient-rated outcome was as good in the elderly as it was in younger age groups up to two years after surgery. These data indicate that geriatric age needs careful consideration of associated risks but is not per se a contraindication for fusion for lumbar degenerative disease. LEVEL OF EVIDENCE 4.

Is the sedimentation sign associated with spinal stenosis surgical treatment effect in SPORT?

STUDY DESIGN Subgroup analysis of the lumbar spinal stenosis (LSS) without degenerative spondylolisthesis diagnostic cohort of the Spine Patient Outcomes Research Trial multicenter randomized clinical trial with a concurrent observational cohort. OBJECTIVE To determine if sedimentation sign on magnetic resonance image can help with LSS treatment decisions. SUMMARY OF BACKGROUND DATA LSS is one of the most common reasons for surgery in the US elderly, but there is a dearth of reliable diagnostic tools that give a clear indication for surgery. Recent studies have suggested that positive sedimentation sign on magnetic resonance image may be a possible prognostic indicator. METHODS All patients with LSS in both the randomized and observational cohorts had imaging-confirmed stenosis, were surgical candidates, and had neurogenic claudication for at least 12 weeks prior to enrollment. Patients were categorized as "mild," "moderate," or "severe" according to stenosis severity. Of the 654 patients with LSS enrolled in Spine Patient Outcomes Research Trial, complete T2-weighted axial and sagittal digitized images of 115 patients were available for retrospective review. An independent orthopedic spine surgeon evaluated these deidentified Digital Imaging and Communications in Medicine files for the sedimentation sign. RESULTS Sixty-six percent (76/115) of patients were found to have a positive sedimentation sign. Those with a positive sedimentation sign were more likely to have stenosis at L2-L3 (33% vs. 10% P=0.016) or L3-L4 76% vs. 51%, P=0.012), and to have severe (72% vs. 33%, P<0.0001) central stenosis (93% vs. 67% P<0.001) at 2 or more concurrent levels (57% vs. 18%, P=0.01). In multivariate models, the surgical treatment effect was significantly larger in the positive sedimentation sign group for Oswestry Disability Index (-16 vs. -7; P=0.02). CONCLUSION A positive sedimentation sign was associated with a small but significantly greater surgical treatment effect for Oswestry Disability Index in patients with symptomatic LSS, after adjusting for other demographic and imaging features. These findings suggest that positive sedimentation sign may potentially be a useful adjunct to help guide an informed treatment choice regarding surgery for LSS. LEVEL OF EVIDENCE 2.

Geochemistry of vein rocks of ODP Hole 118-735B

Rock samples from Hole 735B, Southwest Indian Ridge, were examined to determine the principal vein-related types of alteration that occurred, the nature of fluids that were present, and the temperatures and pressures of these fluids. Samples studied included veined metagabbro, veined mylonitic metagabbro, felsic trondhjemite, and late-stage leucocratic diopside-bearing veins. The methods used were standard petrographic analysis, mineral chemical analysis by electron microprobe, fluid inclusion petrography and analysis by heating/freezing techniques and laser Raman microspectroscopy, and oxygen isotopic analyses of mineral separates. Alteration in lithologic Units I and II (above the level of Core 118-735B-3OR; approximately 140 meters below the seafloor) is dominated by hydration by seawater-derived fluids at high temperature, up to about 700°C, and low water/rock ratio, during and immediately after pervasive ductile deformation. Below Core 118-735B-30R, pervasive deformation is less common, and brittle veining and brecciation are the major alteration styles. Leucocratic centimeter-scale veins, often containing diopside and plagioclase, were produced by interaction of hot (about 500°C) seawater-derived fluid and gabbro. The water/rock ratio was locally high at the veins and breccia zones, but the integrated water/rock ratio for the lower part of the hole is probably low. Accessory hydrous magmatic or deuteric phases formed from magmatic volatiles in some gabbro and in trondhjemite. Most subsequent alteration was affected by fluids that were seawater-derived, based on isotopic and chemical analyses of minerals and analyses of fluid inclusions. Many early-generation fluid inclusions, associated with high-temperature veining, contain appreciable methane as well as saline water. The source of methane is unclear, but it may have formed as seawater was reduced during low water/rock interaction with ultramafic upper mantle or ultramafic and mafic layer 3. Temperatures of alteration were calculated on the basis of coexisting mineral chemistry and isotopic values. Hydrothermal metamorphism commenced at about 720°C and continued to about 550°C. Leucocratic veining took place at about 500°C. Alteration within brecciated horizons was also at about 500° to less than 400°C, and the trondhjemite was altered at about 550° to below 490°C. Pressures calculated from a diopside-bearing vein, based on a combination of fluid inclusion and isotopic analysis, were 90 to 100 MPa. This pressure places the sample, from Core 118-735B-70R in Unit V, at about 2 km below the seafloor.

La gestión de la sequía: contribuciones para su evaluación

La sequía afecta a todos los sectores de la sociedad y se espera que su frecuencia e intensidad aumente debido al cambio climático. Su gestión plantea importantes retos en el futuro. El enfoque de riesgo, que promueve una respuesta proactiva, se identifica como un marco de gestión apropiado que se está empezando a consolidar a nivel internacional. Sin embargo, es necesario contar con estudios sobre las características de la gestión de la sequía bajo este enfoque y sus implicaciones en la práctica. En esta tesis se evalúan diversos elementos que son relevantes para la gestión de la sequía, desde diferentes perspectivas, con especial énfasis en el componente social de la sequía. Para esta investigación se han desarrollado cinco estudios: (1) un análisis de las leyes de emergencia aprobadas durante la sequía 2005-2008 en España; (2) un estudio sobre la percepción de la sequía de los agricultores a nivel local; (3) una evaluación de las características y enfoque de gestión en seis casos de estudio a nivel europeo; (4) un análisis sistemático de los estudios de cuantificación de la vulnerabilidad a la sequía a nivel global; y (5) un análisis de los impactos de la sequía a partir en una base de datos europea. Los estudios muestran la importancia de la capacidad institucional como un factor que promueve y facilita la adopción del enfoque de riesgo. Al mismo tiempo, la falta de estudios de vulnerabilidad, el escaso conocimiento de los impactos y una escasa cultura de la evaluación post-sequía destacan como importantes limitantes para aprovechar el conocimiento que se genera en la gestión de un evento. A través del estudio de las leyes de sequía se evidencia la existencia de incoherencias entre cómo se define el problema de la sequía y las soluciones que se plantean, así como el uso de un discurso de securitización para perseguir objetivos más allá de la gestión de la sequía. El estudio de percepción permite identificar la existencia de diferentes problemas y percepciones de la sequía y muestra cómo los regantes utilizan principalmente los impactos para identificar y caracterizar la severidad de un evento, lo cual difiere de las definiciones predominantes a otros niveles de gestión. Esto evidencia la importancia de considerar la diversidad de definiciones y percepciones en la gestión, para realizar una gestión más ajustada a las necesidades de los diferentes sectores y colectivos. El análisis de la gestión de la sequía en seis casos de estudio a nivel europeo ha permitido identificar diferentes niveles de adopción del enfoque de riesgo en la práctica. El marco de análisis establecido, que se basa en seis dimensiones de análisis y 21 criterios, ha resultado ser una herramienta útil para diagnosticar los elementos que funcionan y los que es necesario mejorar en relación a la gestión del riesgo a la sequía. El análisis sistemático de los estudios de vulnerabilidad ha evidenciado la heterogeneidad en los marcos conceptuales utilizados así como debilidades en los factores de vulnerabilidad que se suelen incluir, en muchos casos derivada de la falta de datos. El trabajo sistemático de recolección de información sobre impactos de la sequía ha evidenciado la escasez de información sobre el tema a nivel europeo y la importancia de la gestión de la información. La base de datos de impactos desarrollada tiene un gran potencial como herramienta exploratoria y orientativa del tipo de impactos que produce la sequía en cada región, pero todavía presenta algunos retos respecto a su contenido, proceso de gestión y utilidad práctica. Existen importantes limitaciones vinculadas con el acceso y la disponibilidad de información y datos relevantes vinculados con la gestión de la sequía y todos sus componentes. La participación, los niveles de gestión, la perspectiva sectorial y las relaciones entre los componentes de gestión del riesgo considerados constituyen aspectos críticos que es necesario mejorar en el futuro. Así, los cinco artículos en su conjunto presentan ejemplos concretos que ayudan a conocer mejor la gestión de la sequía y que pueden resultar de utilidad para políticos, gestores y usuarios. ABSTRACT Drought affects all sectors and their frequency and intensity is expected to increase due to climate change. Drought management poses significant challenges in the future. Undertaking a drought risk management approach promotes a proactive response, and it is starting to consolidate internationally. However, it is still necessary to conduct studies on the characteristics of drought risk management and its practical implications. This thesis provides an evaluation of various relevant aspects of drought management from different perspectives and with special emphasis on the social component of droughts. For the purpose of this research a number of five studies have been carried out: (1) analysis of the emergency laws adopted during the 2005-2008 drought in Spain; (2) study of farmers perception of drought at a local level; (3) assessment of the characteristics and drought management issues in six case studies across Europe; (4) systematic analysis of drought vulnerability assessments; and (5) analysis of drought impacts from an European impacts text-based database. The results show the importance of institutional capacity as a factor that promotes and facilitates the adoption of a risk approach. In contrast, the following issues are identified as the main obstacles to take advantage of the lessons learnt: (1) lack of vulnerability studies, (2) limited knowledge about the impact and (3) limited availability of post-drought assessments Drought emergency laws evidence the existence of inconsistencies between drought problem definition and the measures proposed as solutions. Moreover, the securitization of the discourse pursue goals beyond management drought. The perception of drought by farmers helps to identify the existence of several definitions of drought. It also highlights the importance of impacts in defining and characterizing the severity of an event. However, this definition differs from the one used at other institutional and management level. As a conclusion, this remarks the importance of considering the diversity of definitions and perceptions to better tailor drought management to the needs of different sectors and stakeholders. The analysis of drought management in six case studies across Europe show different levels of risk adoption approach in practice. The analytical framework proposed is based on six dimensions and 21 criteria. This method has proven to be a useful tool in diagnosing the elements that work and those that need to be improved in relation to drought risk management. The systematic analysis of vulnerability assessment studies demonstrates the heterogeneity of the conceptual frameworks used. Driven by the lack of relevant data, the studies point out significant weaknesses of the vulnerabilities factors that are typically included The heterogeneity of the impact data collected at European level to build the European Drought Impact Reports Database (EDII) highlights the importance of information management. The database has great potential as exploratory tool and provides indicative useful information of the type of impacts that occurred in a particular region. However, it still presents some challenges regarding their content, the process of data collection and management and its usefulness. There are significant limitations associated with the access and availability of relevant information and data related to drought management and its components. The following improvement areas on critical aspects have been identified for the near future: participation, levels of drought management, sectorial perspective and in-depth assessment of the relationships between the components of drought risk management The five articles presented in this dissertation provides concrete examples of drought management evaluation that help to better understand drought management from a risk-based perspective which can be useful for policy makers, managers and users.

Evidencia científica y recomendaciones sobre cribado de agudeza visual: revisión bibliográfica

Fundamentos: En los ámbitos científico e institucional existe controversia sobre cuándo recomendar la práctica del cribado visual en la población. El objetivo de este trabajo es valorar el nivel de evidencia científica que existe sobre el cribado visual para determinar si las recomendaciones existentes son o no adecuadas. Métodos: Revisión sistemática de artículos científicos consultando las bases de datos MedLine y The Cochranre Library Plus, sin restricción de fecha, en los idiomas español e inglés. Se incluyó literatura gris mediante búsqueda manual. No se hicieron restricciones respecto al tipo de estudio. Se revisaron los abstracts y en los casos necesarios los artículos completos, teniéndose en cuenta finalmente todos los artículos que incluían recomendaciones sobre cribado de agudeza visual y eliminando el resto. Resultados: Se seleccionaron 6 artículos. La mayoría de las recomendaciones realizadas por las sociedades fueron a través de guías de práctica clínica o artículos de opinión. Respecto a los diseños de los artículos científicos localizados hubo 2 ensayos aleatorios controlados, 3 ensayos no controlados y 1 estudio transversal. Conclusiones: Los estudios sobre adultos no permiten determinar que las recomendaciones realizadas por las sociedades científicas tengan una base científica sólida. En el caso de los niños, los estudios y las sociedades científicas no aclaran cuál es la edad más idónea para realizar cribado visual.

Does the scientific evidence support the advertising claims made for products containing Lactobacillus casei and Bifidobacterium lactis? A systematic review

Background To analyse the scientific evidence that exists for the advertising claims made for two products containing Lactobacillus casei and Bifidobacterium lactis and to conduct a comparison between the published literature and what is presented in the corporate website. Methods Systematic review, using Medline through Pubmed and Embase. We included human clinical trials that exclusively measured the effect of Lactobacillus casei or Bifidobacterium lactis on a healthy population, and where the objective was related to the health claims made for certain products in advertising. We assessed the levels of evidence and the strength of the recommendation according to the classification criteria established by the Oxford Centre for Evidence Based Medicine (CEBM). We also assessed the outcomes of the studies published on the website that did not appear in the search. Results Of the 440 articles identified, 16 met the inclusion criteria. Only four (25%) of these presented a level of evidence of 1b and a recommendation grade of A, all corresponding to studies on product containing Bifidobacterium lactis, and only 12 of the 16 studies were published on the corporate website (47). Conclusions There is insufficient scientific evidence to support the health claims made for these products, especially in the case of product containing Lactobacillus casei.

SMEs and Level 2 BIM, the Way Forward

The UK construction industry comprises a very high proportion of SMEs that is companies employing up to 250. A Department for Business, Innovation and Skills research paper, found that SMEs had a 71.2% share of work in the construction industry. Micro and small firms (i.e. those employing up to 50) had a share of 46.7% of work (Ive and Murray 2013). The Government has high ambitions for UK construction. Having been found by successive government commissioned studies to be inefficient and highly fragmented, ambitious targets have been set for the industry to achieve 33% reduction in costs and 50% faster delivery by 2025. As a significant construction client, the Government has mandated the use of Level 2 BIM from 2016 on publicly funded projects over £5 million. The adoption of BIM plays a key role in the 2025 vision but a lack of clarity persists in the industry over BIM and significant barriers are perceived to its implementation, particularly amongst SMEs. However, industry wide transformation will be challenging without serious consideration of the capabilities of this large majority. Many larger firms, having implemented Level 2 BIM are now working towards Level 3 BIM while many of the smaller firms in the industry have not even heard of BIM. It would seem that fears of a ‘two tier’ industry are perhaps being realised. This paper builds on an earlier one (Mellon & Kouider 2014) and investigates, through field work, the level of Level 2 BIM implementation amongst SMEs compared to a large organisation. Challenges and innovative solutions identified through collected data are fully discussed and compared. It is suggested that where the SME perceives barriers towards adoption of the technologies which underpin BIM, they may consider collaborative methods of working as an interim step in order to work towards realising the efficiencies and benefits that these methods can yield. While the barriers to adoption of BIM are significant, it is suggested that they are not insurmountable for the SME and some recommendations for possible solutions are made.

Report of Her Majesty's commissioners appointed to inquire into the revenues and management of certain colleges and schools, and the studies pursued and instruction given therein : with an appendix and evidence.

Treats of the public schools of Eton, Winchester, Westminster, Charterhouse, St. Paul's Merchant taylors', Harrow, Rugby, Shrewsbury.

Do external funds yield lower returns? Recent evidence from East Asian economies

One of the central explanations of the recent Asian Crisis has been the problem of moral hazard as the source of over-investment and excessive external borrowing. There is however rather limited firm-level empirical evidence to characterise inefficient use of internal and external finances. Using a large firm-level panel data-set from four badly affected Asian countries, this paper compares the rates of return to various internal and external funds among firms with low and high debt financing (relative to equity) among financially constrained and other firms. Selectivity-corrected estimates obtained from random effects panel data model do suggest evidence of significantly lower rates of return to long-term debt, even among firms relying more on debt relative to equity in our sample. There is also evidence that average effective interest rates often significantly exceeded the average returns to long-term debt in the sample countries in the pre-crisis period. © 2006 Elsevier Inc. All rights reserved.