Are virtual planning and guided surgery for head and neck reconstruction economically viable?

PURPOSE: Virtual planning and guided surgery with or without prebent or milled plates are becoming more and more common for mandibular reconstruction with fibular free flaps (FFFs). Although this excellent surgical option is being used more widely, the question of the additional cost of planning and cutting-guide production has to be discussed. In capped payment systems such additional costs have to be offset by other savings if there are no special provisions for extra funding. Our study was designed to determine whether using virtual planning and guided surgery resulted in time saved during surgery and whether this time gain resulted in self-funding of such planning through the time saved. MATERIALS AND METHODS: All consecutive cases of FFF surgery were evaluated during a 2-year period. Institutional data were used to determine the price of 1 minute of operative time. The time for fibula molding, plate adaptation, and insetting was recorded. RESULTS: During the defined period, we performed 20 mandibular reconstructions using FFFs, 9 with virtual planning and guided surgery and 11 freehand cases. One minute of operative time was calculated to cost US $47.50. Multiplying this number by the time saved, we found that the additional cost of virtual planning was reduced from US $5,098 to US $1,231.50 with a prebent plate and from US $6,980 to US $3,113.50 for a milled plate. CONCLUSIONS: Even in capped health care systems, virtual planning and guided surgery including prebent or milled plates are financially viable.

How central and connected am I in my family? Bridging and bonding social capital in family configurations of young adults with psychiatric disorders

AIMS: This article explores the structures of relational resources that individuals with psychiatric disorders get from their family configurations using the concept of social capital. METHODS: The research is based on a sample of 54 individuals with psychiatric disorders and behavioural problems, and a comparison sample of 54 individuals without a clinical record matched to the clinical respondents for age and sex. Standard measures of social capital from social network methods are applied on family configurations of individuals from both samples. Differences are tested by variance analysis. RESULTS: Structures of family resources available to individuals with psychiatric disorders are distinct. Individuals with psychiatric disorders perceive themselves as less central in their family configurations and less connected to their family members. Their significant family members are perceived as less connected with each other. As a whole, their family configurations are smaller and do not include spouses or partners. Therefore bridging and bonding social capitals are not readily available for them. CONCLUSION: As family configurations of individuals with psychiatric disorders provide fewer relational resources than other families, they are not able to deal with social integration of individuals with psychiatric disorders on their own.

. Phenotype/genotype correlation associated with a novel nonsense Glu20stop mutation in the Rp2 gene in a three-generation family with x-linked retinitis pigmentosa

Purpose: To assess the phenotype of patients in a large 3 generation Swiss family with X-linked retinitis pigmentosa (XLRP) due to a novel nonsense mutation Glu20stop in RP2 gene and to correlate with the genotype. Methods: 6 affected patients (1 male, 5 females, age range: 23 - 73 years) were assessed with a complete ophthalmologic examination. All had fundus autofluorescence images, standardised electroretinography, Goldmann visual fields and Optical Coherence Tomography. In addition, medical records of 2 affected male patients were reviewed. Blood sample was taken for molecular analysis. Results: The male patients were severely affected at a young age with early macular involvement. The youngest 23 y old male had also high myopia and vision of less than 0.05 according to Snellen EDTRS chart bilaterally. All 5 female carriers had some degree of rod-cone dystrophy, but no macular involvement. The visual acuity was 1.0 in the younger carriers, while the 73 years old had VA of 0.5. Two females had mild myopia (range -0.75 to -2) and one had anisometropia of 3.5D, with the more severely affected eye being myopic. Three out of 5 female carriers had optic nerve drusen. Conclusions: We report a novel Glu20stop mutation in RP2 gene, which is a rare cause of XLRP. Our description of severe phenotype in male patients with high myopia and early macular atrophy confirms previous reports. Unlike previous reports, all our female carriers had RP, but not macular involvement or high myopia. The identifiable phenotype for RP2-XLRP aids in clinical diagnosis and targeted genetic screening.

Polar gradients of the DYRK-family kinase Pom1 couple cell length with the cell cycle.

Cells normally grow to a certain size before they enter mitosis and divide. Entry into mitosis depends on the activity of Cdk1, which is inhibited by the Wee1 kinase and activated by the Cdc25 phosphatase. However, how cells sense their size for mitotic commitment remains unknown. Here we show that an intracellular gradient of the dual-specificity tyrosine-phosphorylation regulated kinase (DYRK) Pom1, which emanates from the ends of rod-shaped Schizosaccharomyces pombe cells, serves to measure cell length and control mitotic entry. Pom1 provides positional information both for polarized growth and to inhibit cell division at cell ends. We discovered that Pom1 is also a dose-dependent G2-M inhibitor. Genetic analyses indicate that Pom1 negatively regulates Cdr1 and Cdr2, two previously described Wee1 inhibitors of the SAD kinase family. This inhibition may be direct, because in vivo and in vitro evidence suggest that Pom1 phosphorylates Cdr2. Whereas Cdr1 and Cdr2 localize to a medial cortical region, Pom1 forms concentration gradients from cell tips that overlap with Cdr1 and Cdr2 in short cells, but not in long cells. Disturbing these Pom1 gradients leads to Cdr2 phosphorylation and imposes a G2 delay. In short cells, Pom1 prevents precocious M-phase entry, suggesting that the higher medial Pom1 levels inhibit Cdr2 and promote a G2 delay. Thus, gradients of Pom1 from cell ends provide a measure of cell length to regulate M-phase entry.

Screening for health impacts in Local Area Planning in Donegal County Council (2004)

In 2004 an interagency team consisting of members the North Western Health Board and Donegal County Council commissioned the IPH to conduct a HIA screening exercise on planning policy in Donegal. This involved an overview of literature, analysis of policy documents, contact with Planning Officers and observation of public consultation meetings. Following completion of the final report, the intention is to produce a user-friendly template to enable planners to incorporate a health dimension into their decision making.

IPH response to Draft Regional Planning Guidelines for the Greater Dublin Area 2010-2022

The Regional Planning Guidelines (RPG) for the Greater Dublin Area 2010-2022 (draft) is a policy document which aims to direct the future growth of the Greater Dublin Area over the medium to long term and works to implement the strategic planning framework set out in the National Spatial Strategy (NSS) published in 2002.  A series of recommendations have been made to Local Authorities clearly linked to and supporting the national investment in transport, particularly public transport, under Transport 21.  The draft was prepared and agreed for public consultation. The IPH response  to the consultation reports on how the RPG may impact on health and makes recommendations to maximise opportunities for health gain and minimise health loss.

IPH response to Department of Environment (NI) Planning Policy Statement 7

The Institute of Public Health in Ireland (IPH) aims to improve health on the island of Ireland by working to combat health inequalities and influence public policies in favour of health.  The Institute promotes cooperation between Northern Ireland and the Republic of Ireland in public health research, training and policy advice. IPH acknowledge that health is influenced by a wide range of social determinants, including economic, environmental, social and biological factors.  Housing and residential areas are identified as key determinants of health and IPH welcomes the opportunity to comment on the Department of the Environment (DoE), Draft Addendum to Planning Policy Statement 7.

IPH response to Department of the Environment (NI) Planning Policy Statement 21 (PPS21)

In responding, IPH identify a number of potential health impacts including providing employment opportunities through farm diversification.  Other issues include access to open space and housing located close to traditional focal points.   The Institute of Public Health in Ireland (IPH) is an all-island body which aims to improve health in Ireland, by working to combat health inequalities and influence public policies in favour of health. IPH promotes co-operation in research, training, information and policy in order to contribute to policies which tackle inequalities in health. IPH is particularly interested in the Draft Planning Policy Statement 21 due to the impact on the countryside and potential implications on health for the population of Northern Ireland. IPH conducted a Health Impact Assessment on the proposed West Tyrone Area Plan 2019 and through this work has developed extensive knowledge when looking at health and rural issues.

IPH Response to Draft planning policy statement 18 Renewable energy - March 2008

IPH welcomes the Planning Policy Statement 18 Renewable Energy (PPS18) and the opportunity to comment on the publication.  IPH applies a holistic model of health which emphasises a wide range of social determinants, including economic, environmental, social and biological factors. IPH considers that the health impacts of renewable energy should be considered as part of PPS18. We wish to make the following general observations in relation to the Proposed Plan:  IPH welcomes the sustainable approach by the Department of the Environment to encourage and facilitate the provision of renewal energy in Northern Ireland. PPS18 can support the move to reduce pollutants entering the environment. However there is a need to consider wider public health concerns in the adoption of PPS18. Encouraging renewable energy (while balancing this with environmental and conservation concerns) will benefit health locally, and on a global scale. Climate change has been identified as one of the most important public health challenges of the 21st Century and therefore any policy which seeks to address this major issue is welcomed.

Residential Family Centres Standards

This document sets out the minimum standards which providers of Residential Family Centre services are expected to meet.