instruction:
In this task, you are given a passage which has a question and the context. You have to generate an answer to the question based on the information present in the context.
question:
Context: "Virtual fracture clinics" have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a "top-down" analysis of the cost effectiveness of this virtual fracture clinic pathway.', 'National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign.', 'The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs.\Question: Does fracture clinic redesign reduce the cost of outpatient orthopaedic trauma care?
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The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings.Cite this article: P. J. Jenkins. Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care. Bone Joint Res 2016;5:33-36. doi: 10.1302/2046-3758.52.2000506.


question:
Context: Our previous work demonstrated altered messenger RNA expression of integrin β-5 and -8, using an in silico analysis of publically available data from patients with biliary atresia (BA); however, we were unable to demonstrate statistically significant differences in protein expression because of sample size. In the present study, we repeated the analysis of liver fibrosis and protein expression of the integrins in a larger cohort of patients with BA and compared them with patients undergoing liver biopsy for other diagnoses, with the hypothesis that ≥ 1 of the integrins would be differentially expressed.', 'Liver specimens were obtained at 2 collaborating institutions. Samples from infants with BA (n = 23) were compared with samples from those who underwent liver biopsy for neonatal hepatitis (n = 9). All of the specimens were analyzed by 2 pathologists (C.R. and R.A.), who were blinded to the diagnoses. Standard Ishak scoring was performed to evaluate fibrosis and inflammation, and immunohistochemical (IHC) positivity was graded from 0 to 4. Comparisons between the IHC positivity and Ishak scoring for the BA and control groups were performed using the Student t test with P < 0.01 considered significant because of the multiple comparisons. Interobserver variability was assessed by intraclass correlation (ICC).', 'Pooled analysis from specimens from patients with BA showed significantly more fibrosis than controls based on Ishak scores (3.21 ± 1.82 vs 1.17 ± 1.00, P < 0.005). IHC evaluation showed increased integrin ανβ8 protein expression when compared with controls (2.67 ± 0.81 vs 1.72 ± 0.62, P < 0.005); however, there were no significant differences in integrin ανβ5 (1.93 ± 0.84 vs 1.50 ± 0.90, P = 0.23) or integrin ανβ6 (0.85 ± 1.20 vs 0.94 ± 0.85, P = 0.82) expression. These data were confirmed on individual analysis. Interobserver agreement was fair for integrin ανβ5 (ICC 0.52), good for integrin ανβ6 (ICC 0.72), and excellent for integrin ανβ8 (ICC 0.79) and fibrosis (ICC 0.89).\Question: Is integrin β-8 , but not β-5 or -6 , protein expression increased in livers of children with biliary atresia?
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Our data show that integrin ανβ8, but not integrin ανβ5 or integrin ανβ6, protein expression is increased in liver specimens of patients with BA. These data support the mounting evidence that transforming growth factor-β (TGF-β) activation is responsible for the fibrosis found in BA. Anti-integrin ανβ8 or more global integrin blocking strategies may be therapeutic options in BA, but further work is clearly needed.


question:
Context: The aim of this research was to describe nomograms of brainstem auditory evoked potentials, oscillating stimulation of the vestibular organs and ultrastructural research methodology of a spiral organ of guinea-pigs.', "For the experimental purposes 60 guinea-pigs of both sexes, weight 250-300 grams, were used as research materials. After general anesthesia with Ketalar dosed 100 milligrams per kilogram and with Fentanyl dosed 0.1 milliliter per kilogram of the body mass, brainstem auditory evoked potentials were registered and the oscillating chair test (no prior anesthesia). Was placed on an assistant's knees, who was sitting on a chair. Then the guinea-pigs were anesthetized with 35 per cent solution of chloral hydrate intraperitoneally (dosed 1 milliliter per kilogram of the body mass). For electron microscopic research membranous helix was collected bilaterally by the method of micropreparation. Qualitative observation was conducted in the Philips' electron microscope (EM 300).", 'On the basis of the obtained results it was concluded that the time of transmission between elements P1-P2 is constant and figures between 3.1 and 3.6 ms independently from a force of stimulation. Vestibular organs of a guinea-pig are more sensitive to high accelerations (17-12 degree/s2) than human vestibularl organs. However, their reaction is much weaker to lower accelerations (12-0 degree/s2).\Question: Do [ Guinea pig as often object to otoneurological experimental examinations ]?
answer:

The processed nomograms of the brainstem auditory evoked potentials, oscillating stimulation of vestibular organs and methodology of ultrastructural research in guinea-pigs' spiral organs are expected to facilitate using them in experimental research.