Transpiration by established trees could increase the efficiency of stormwater control measures.

Evapotranspiration is an important aspect of the hydrological cycle in natural landscapes. In cities, evapotranspiration is typically limited by reduced vegetation and extensive impervious surfaces. Stormwater control measures (SCMs) seek, among other objectives, to move the urban hydrological cycle towards pre-development conditions, promoting processes such as infiltration and evapotranspiration. Yet, evapotranspiration is generally assumed to play a minor role in the water balance of stormwater control measures. Since established urban trees can use large quantities of water, their inclusion with stormwater control measures could potentially substantially increase evapotranspiration. We installed infiltration trenches alongside established Lophostemon confertus trees in the grassed verges of a typical suburban street to assess 1) whether redirecting stormwater to trees could increase their transpiration and 2) the contribution of transpiration to the water balance of stormwater control measures. We measured stormwater retention and transpiration for two spring-summer periods and estimated an annual water balance for the infiltration trenches. Although redirecting stormwater to trees did not increase their transpiration, these trees did use large volumes of water (up to 96 L d-1), corresponding to 3.4 mm d-1 per projected canopy area. Annually, stormwater retention was 24% of runoff and tree transpiration was equivalent to 17% of runoff. Our results suggest that streetscapes fitted with tree-based stormwater control measures, could increase the volumetric reduction of stormwater runoff by increasing the proportion of evapotranspiration in the water balance. Since public space is highly contested in cities and increasing canopy cover is a priority for many planners, integrating trees with stormwater control measures could provide dual benefits for a single management intervention, enabling a greater number of distributed stormwater control measures with smaller impervious catchments in the streetscape.

Dorsiflexory Phalangeal Osteotomy for Grade II Hallux Rigidus: Patient-Focused Outcomes at Eleven-Year Follow-Up.

Dorsiflexory phalangeal osteotomy has been shown to be an effective treatment for mild to moderate hallux rigidus in short- to medium-term follow-up studies. It is speculated that the procedure alters the mechanical function of the joint and reduces the demand for hallux dorsiflexion by elevating the proximal phalanx into a more dorsiflexed position. However, it has been demonstrated that the first metatarsophalangeal (MTP) joint space and joint range of motion are reduced by the procedure, calling into question the long-term effectiveness of the operation. This study reviewed 27 dorsiflexory phalangeal osteotomy cases at an average of 11 years postoperatively. Twenty-one (77%) patients reported that they were completely satisfied with the results of their surgery; 4 (15%) patients reported that they were satisfied with reservations; and 2 (7%) patients reported that they were dissatisfied. The patients who were satisfied with reservations complained of interphalangeal (IP) joint pain or stiffness. One patient developed second MTP joint metatarsalgia after surgery, and in 1 patient first MTP joint pain returned at 24 months after surgery. One dissatisfied patient complained of second MTP joint metatarsalgia, and a second patient required revision excisional arthroplasty for continued joint pain. Ten patients (38%) reported stiffness of the first MTP joint, but only 2 patients reported any restriction of activity. Footwear restrictions were reported by 15 (58%) patients preoperatively and by 9 (35%) patients at final follow-up. Dorsiflexory phalangeal osteotomy maybe a reliable long-term treatment for grade II or moderate hallux rigidus and is a safe and effective alternative to first MTP joint fusion in joints where movement is still present and joint cartilage is viable.

Health and climate related ecosystem services provided by street trees in the urban environment.

Urban tree planting initiatives are being actively promoted as a planning tool to enable urban areas to adapt to and mitigate against climate change, enhance urban sustainability and improve human health and well-being. However, opportunities for creating new areas of green space within cities are often limited and tree planting initiatives may be constrained to kerbside locations. At this scale, the net impact of trees on human health and the local environment is less clear, and generalised approaches for evaluating their impact are not well developed.In this review, we use an urban ecosystems services framework to evaluate the direct, and locally-generated, ecosystems services and disservices provided by street trees. We focus our review on the services of major importance to human health and well-being which include 'climate regulation', 'air quality regulation' and 'aesthetics and cultural services'. These are themes that are commonly used to justify new street tree or street tree retention initiatives. We argue that current scientific understanding of the impact of street trees on human health and the urban environment has been limited by predominantly regional-scale reductionist approaches which consider vegetation generally and/or single out individual services or impacts without considering the wider synergistic impacts of street trees on urban ecosystems. This can lead planners and policymakers towards decision making based on single parameter optimisation strategies which may be problematic when a single intervention offers different outcomes and has multiple effects and potential trade-offs in different places.We suggest that a holistic approach is required to evaluate the services and disservices provided by street trees at different scales. We provide information to guide decision makers and planners in their attempts to evaluate the value of vegetation in their local setting. We show that by ensuring that the specific aim of the intervention, the scale of the desired biophysical effect and an awareness of a range of impacts guide the choice of i) tree species, ii) location and iii) density of tree placement, street trees can be an important tool for urban planners and designers in developing resilient and resourceful cities in an era of climatic change.

The long-term patient focused outcomes of the Keller's arthroplasty for the treatment of hallux rigidus.

BACKGROUND: The Keller arthroplasty has been used to treat painful conditions of the first MTP joint for over 100 years. More recently the procedure has fallen out of favour, due to a high incidence of transfer metatarsalgia and poor function of the first MTP joint post-operatively. OBJECTIVE: This study sought to review the place for Keller arthroplasty in the management of hallux rigidus by considering outcomes from the patient's perspective. METHODS: From 1997 to 2005, 104 patients (131 feet) underwent a Keller excisional arthroplasty for the treatment of hallux rigidus. All subjects were classed as grade III on the Hattrup and Johnson scale of joint classification and had a primary complaint of painful hallux rigidus. The American orthopaedic foot and ankle scale was applied pre-operatively and post-operatively. Thirty-two participants (42 feet) were available for a final review (6 male feet and 34 female feet). The range of follow up was 36-154 months with a mean average follow up of 92 months (7.6 years). The age range at the time of surgery was 42-78 years with a mean average age of 62 years at surgery and 69 years and eight months at review. RESULTS: Seventy-six percent of participants were completely satisfied, 21.5% satisfied with reservations and 2.5% were dissatisfied. High levels of satisfaction were recorded for pain relief, activity levels and overall patient satisfaction. Ninety-five percent of participants reported their symptoms were improved at long-term follow up compared to pre operatively; however 9.5% of the group complained of transfer metatarsalgia. Nineteen percent of participants, all female, were not happy with the cosmetic appearance of their foot. The mean pre-operative AOFAS clinical rating scale scores was 38. At final follow up the mean score was 89. CONCLUSION: The Keller excisional arthroplasty is a simple reliable procedure for the treatment of severe hallux rigidus. Furthermore, it is effective in achieving pain-free movement of the first MTP joint, but carries a risk of creating transfer metatarsalgia. For nearly 20% of participants post-operative cosmetic appearance was disappointing.