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Aims: Our main aim was to describe the trend in the comorbidities of patients undergoing elective total hip arthroplasties (THAs) and knee arthroplasties (KAs) between 1 January 2005 and 31 December 2018 in England., Methods: We combined data from the National Joint Registry (NJR) on primary elective hip and knee arthroplasties performed between 2005 and 2018 with pre-existing conditions recorded at the time of their primary operation from Hospital Episodes Statistics. We described the temporal trend in the number of comorbidities identified using the Charlson Comorbidity Index, and how this varied by age, sex, American Society of Anesthesiologists (ASA) grade, index of multiple deprivation, and type of KA., Results: We included 696,504 and 833,745 elective primary THAs and KAs respectively, performed for any indication. Between 2005 and 2018, the proportion of elective THA and KA patients with one or more comorbidity at the time of their operation increased substantially (THA: 20% to 38%, KA: 22% to 41%). This was driven by increases in four conditions: chronic obstructive pulmonary disease (COPD) (2018: ~17%), diabetes without complications (2018: THA 10%, KA 14%), myocardial infarction (2018: 4%), and renal disease (2018: ~8%). Notably, renal disease prevalence increased from < 1% in 2005 to ~8% in 2018., Conclusion: Between 2005 and 2018 there were significant changes in the number of comorbidities recorded in patients having elective primary THAs and KAs. Renal disease is now one of the most prevalent comorbidities in this patient population. Future research should explore whether this comorbidity trend has increased the burden on other medical specialities to optimize these patients before surgery and to provide additional postoperative care.Cite this article: Bone Joint J  2022;104-B(9):1052-1059.

Animals form an integral part of our planetary ecosystem but balance is critical to effective ecosystem functioning as demand for livestock products has increased, greater numbers of domesticated livestock have created an imbalance and hence had a negative impact on a number of ecosystem services which means that life as we know it will become unsustainable. Policies and technology advances have helped to manage the impact but more needs to be done. The aim of this paper is to highlight ways in which better knowledge of animal science, and other disciplines, can both harness technology and inform policy to work towards a sustainable balance between livestock and the environment. Effective policies require simple, quantifiable indicators against which to set targets and monitor progress. Indicators are clear for water pollution, but more complex for biodiversity. Hence, more progress has been made with the former. It is not yet possible to measure the impacts of changes in livestock management on greenhouse gas emissions per se at a farm level and progress has been slower, although new technologies are emerging. With respect to land use, the simple indicator of area has been used, but total area is oversimplistic. Our analysis of land suitability and use highlights a relatively overlooked role of livestock in acting as a 'buffer' to use by-products and grains which do not meet the standards for processing by industry during years of inclement weather, which in the past has provided an 'insurance policy' for farmers. Since extreme weather events are increasing in frequency with climate change, this role for livestock may be more important in future. The conclusions of the review with respect to strengthening the links between research and policy are i) to encourage animal scientists to identify the relevant environmental indicators, work with the cutting edge experts developing technologies to measure these cost-effectively and across a range of relevant livestock systems and ii) to work with the feed industry to optimize diets not just in terms of least cost financially but also least 'cost' in terms of global carbon flux and engage in dialogue with the food industry and policy makers on regulations for grain quality., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Radiographers in Oman are believed to be engaged with varying levels of role extension however the nature and extent of this currently unknown. The aim of this study was to investigate role extension for radiographers in Oman, and to evaluate radiographers and the radiologists' opinions and attitudes toward role extension., Methods: A cross sectional study of radiographers and radiologists at 13 major hospitals in Oman was used. A total of 189 radiographers and 77 radiologists were invited to complete a questionnaire seeking information on current and possible future role extension activities., Results: The overall response rate was 80.4% for radiographers and 63.6% for radiologists. Approximately half (53.3%) of the radiographer respondents reported they carry out examinations traditionally performed by radiologists (i.e. role extension); this was primarily in gastrointestinal and barium enema studies. Fewer (21%) reported being involved in image interpretation, most commonly in accident and emergency examinations. Forty percent of radiographers reported involvement in intravenous injections, most commonly for CT and intravenous urography procedures. Both radiographers and radiologists supported the involvement of radiographers in a range of examination types however responses vary within and between hospitals., Conclusion: This study concluded that radiography role extension activities are widely implemented at hospitals in Oman and that radiographers have sufficient skills and education for participating in these activities., Implications for Practice: The involvement of radiographers in role extension activities is believed to be cost and time effective, improve teamwork and has potential for significant service delivery benefits., (Copyright © 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

The unitary evolution of a quantum system preserves its coherence, but interactions between the system and its environment result in decoherence, a process in which the quantum information stored in the system becomes degraded. A spin-polarized positively charged muon implanted in a fluoride crystal realizes such a coherent quantum system, and the entanglement of muon and nearest-neighbor fluorine nuclear spins gives rise to an oscillatory time dependence of the muon polarization that can be detected and measured. Here we show that the decohering effect of more distant nuclear spins can be modelled quantitatively, allowing a very detailed description of the decoherence processes coupling the muon-fluorine "system" with its "environment," and allowing us to track the system entropy as the quantum information degrades. These results show how to precisely quantify the spin relaxation of muons implanted into quantum entangled states in fluoride crystals.

Osteoarthritis affects the morphological properties of the femoral head. The goal of this study was to develop a method to elucidate whether these changes are localised to discrete regions, or if the reported trends in microstructural changes may be identified throughout the subchondral bone of the human femoral head. Whole femoral heads extracted from osteoarthritic (n = 5) and healthy controls (n = 5) underwent microCT imaging 39 μm voxel size. The subchondral bone plate was virtually isolated to evaluate the plate thickness and plate porosity. The trabecular bone region was divided into 37 volumes of interest spatially distributed in the femoral head, and bone morphometric properties were determined in each region. The study showed how the developed approach can be used to study the heterogeneous properties of the human femoral head affected by a disease such as osteoarthritis. As example, in the superior femoral head osteoarthritic specimens exhibited a more heterogeneous micro-architecture, with trends towards thicker cortical bone plate, higher trabecular connectivity density, higher trabecular bone density and thicker structures, something that could only be observed with the newly developed approach. Bone cysts were mostly confined to the postero-lateral quadrants extending from the subchondral region into the mid trabecular region. Nevertheless, in order to generalise these findings, a larger sample size should be analysed in the future. This novel method allowed a comprehensive evaluation of the heterogeneous micro-architectural properties of the human femoral head, highlighting effects of OA in the superior subchondral cortical and trabecular bone. Further investigations on different stages of OA would be needed to identify early changes in the bone.

Competing Interests: Conflicts of interest statement: J. M. Wilkinson is a board member of National Joint Registry.

Aims: The aim of this study was to describe temporal trends and survivorship of total hip arthroplasty (THA) in very young patients, aged ≤ 20 years., Patients and Methods: A descriptive observational study was undertaken using data from the National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man between April 2003 and March 2017. All patients aged ≤ 20 years at the time of THA were included and the primary outcome was revision surgery. Descriptive statistics were used to summarize the data and Kaplan-Meier estimates calculated for the cumulative implant survival., Results: A total of 769 THAs were performed in 703 patients. The median follow-up was 5.1 years (interquartile range (IQR) 2.6 to 7.8). Eight patients died and 35 THAs were revised. The use of metal-on-metal (MoM) bearings and resurfacing procedures declined after 2008. The most frequently recorded indications for revision were loosening (20%) and infection (20%), although the absolute risk of these events occurring was low (0.9%). Factors associated with lower implant survival were MoM and metal-on-polyethylene (MoP) bearings and resurfacing arthroplasty ( vs ceramic-on-polyethylene (CoP) and ceramic-on-ceramic (CoC) bearings, p = 0.002), and operations performed by surgeons who undertook few THAs in this age group as recorded in the NJR ( vs those with five or more recorded operations, p = 0.030). Kaplan-Meier estimates showed 96% (95% confidence interval (CI) 94% to 98%) survivorship of implants at five years., Conclusion: Within the NJR, the overall survival for very young patients undergoing THA exceeded 96% during the first five postoperative years. In the absence of studies that can better account for differences in the characteristics of the patients, surgeons should consider the association between early revision and the type of implant, the number of THAs performed in these patients, and the bearing surface when performing THA in very young patients. Cite this article: Bone Joint J 2018;100-B:1320-9.

The drive to increase the output of animal product in some sectors of ruminant livestock production has led to greater use of feeds such as cereal grains and soyabean meal that are potentially human-edible. This trend has caused concern since, by so doing, ruminants compete not only with monogastric livestock but also with the human population for a limited global area of cultivatable land on which to produce grain crops. Reasons for using potentially human-edible feeds in ruminant diets include increased total daily energy intake, greater supply of essential amino acids and improved ruminal balance between fermentable energy and degradable protein. Soyabean meal, produced on land that has been in arable cultivation for many years can fulfil a useful role as a supplier of undegraded dietary protein in diets for high-yielding dairy cows. However, in the context of sustaining the production of high-quality foods from livestock to meet the demands of a growing human population, the use of potentially human-edible feed resources by livestock should be restricted to livestock with the highest daily nutrient requirements; that is, potentially human-edible feed inputs should be constrained to meeting requirements for energy and protein and to rectifying imbalances in nutrient supply from pastures and forage crops such as high concentrations of nitrogen (N). There is therefore a role for human-edible feeds in milk production because forage-only systems are associated with relatively low output per head and also low N use efficiency compared with systems with greater reliance on human-edible feeds. Profitability on farm is driven by control of input costs as well as product value and examples are given of low-cost bovine milk and meat production with little or no reliance on potentially human-edible feeds. In beef production, the forage-only systems currently under detailed real-time life-cycle analysis at the North Wyke Farm Platform, can sustain high levels of animal growth at low feed cost. The potential of all-forage diets should be demonstrated for a wide range of ruminant milk and meat production systems. The challenge for the future development of ruminant systems is to ensure that potentially human-edible feeds, or preferably human-inedible by-products if available locally, are used to complement pastures and forage crops strategically rather than replace them.

Silage may contain several agents that are potentially hazardous to animal health, the safety of milk or other animal food products, or both. This paper reviews published literature about microbial hazards, plant toxins, and chemical hazards. Microbial hazards include Clostridium botulinum, Bacillus cereus, Listeria monocytogenes, Shiga toxin-producing Escherichia coli, Mycobacterium bovis, and various mold species. High concentrations of C. botulinum in silage have been associated with cattle botulism. A high initial concentration of C. botulinum spores in forage in combination with poor silage fermentation conditions can promote the growth of C. botulinum in silage. The elevated pH level that is generally associated with aerobic deterioration of silage is a major factor influencing concentrations of L. monocytogenes, Shiga toxin-producing E. coli, and molds in silage and may also encourage survival and growth of M. bovis, the bacterium that causes bovine tuberculosis. Soil is a major source of B. cereus spores in silage; growth of this bacterium in silage appears to be limited. Hazards from plant toxins include pyrrolizidine, tropane and tropolone alkaloids, phytoestrogens, prussic acid, and mimosine, compounds that exist naturally in certain plant species that may contaminate forages at harvesting. Another group of toxins belonging to this category are ergot alkaloids, which are produced by endophytic fungal species in forages such as tall fescue grass, sorghum, and ryegrass. Varying effects of ensiling on the degradation of these plant toxins have been reported. Chemical hazards include nitrate, nitrite, and toxic oxide gases of nitrogen produced from nitrate and high levels of butyric acid, biogenic amines, and ammonia. Chemical and microbiological hazards are associated with poorly fermented silages, which can be avoided by using proper silage-making practices and creating conditions that promote a rapid and sufficient reduction of the silage pH and prevent aerobic deterioration., (Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Aims: The aim of this study was to determine whether patients with metal-on-metal (MoM) arthroplasties of the hip have an increased risk of cardiac failure compared with those with alternative types of arthroplasties (non-MoM)., Patients and Methods: A linkage study between the National Joint Registry, Hospital Episodes Statistics and records of the Office for National Statistics on deaths was undertaken. Patients who underwent elective total hip arthroplasty between January 2003 and December 2014 with no past history of cardiac failure were included and stratified as having either a MoM (n = 53 529) or a non-MoM (n = 482 247) arthroplasty. The primary outcome measure was the time to an admission to hospital for cardiac failure or death. Analysis was carried out using data from all patients and from those matched by propensity score., Results: The risk of cardiac failure was lower in the MoM cohort compared with the non-MoM cohort (adjusted hazard ratio (aHR) 0.901; 95% confidence interval (CI) 0.853 to 0.953). The risk of cardiac failure was similar following matching (aHR 0.909; 95% CI 0.838 to 0.987) and the findings were consistent in subgroup analysis., Conclusion: The risk of cardiac failure following total hip arthroplasty was not increased in those in whom MoM implants were used, compared with those in whom other types of prostheses were used, in the first seven years after surgery. Cite this article: Bone Joint J 2018;100-B:20-7., (©2018 Manisty et al.)

Aims: To investigate whether elective joint arthroplasty performed at the weekend is associated with a different 30-day mortality versus that performed between Monday and Friday., Patients and Methods: We examined the 30-day cumulative mortality rate (Kaplan-Meier) for all elective hip and knee arthroplasties performed in England and Wales between 1st April 2003 and 31st December 2014, comprising 118 096 episodes undertaken at the weekend and 1 233 882 episodes performed on a weekday. We used Cox proportional-hazards regression models to assess for time-dependent variation and adjusted for identified risk factors for mortality., Results: The cumulative 30-day mortality for hip arthroplasty was 0.15% (95% confidence interval (CI) 0.12 to 0.19) for patients operated on at the weekend versus 0.20% (95% CI 0.19 to 0.21) for patients undergoing surgery during the normal working week. For knee arthroplasty, the cumulative 30-day mortality was 0.14% (95% CI 0.11 to 0.17) for weekend-operated patients versus 0.18% (95% CI 0.17 to 0.19) for weekday-operated patients. These differences were independent of any differences in patient age, gender, American Society of Anaesthesiologists grade, surgeon seniority, surgical and anaesthetic practices, and thromboprophylaxis choice in weekend versus weekday-operated patients., Conclusion: The 30-day mortality rate after elective joint arthroplasty is low. Surgery performed at the weekend is associated with lower post-operative mortality versus operations performed on a weekday. Cite this article: Bone Joint J 2017;99-B:1618-28., (©2017 The British Editorial Society of Bone & Joint Surgery.)

Objective: Despite a health care system that is free at the point of delivery, ethnic minorities may not always get care equitable to that of White patients in England. We examined whether ethnic differences exist in joint replacement rates and surgical practice in England., Design: 373,613 hip and 428,936 knee National Joint Registry (NJR) primary replacement patients had coded ethnicity in Hospital Episode Statistics (HES). Age and gender adjusted observed/expected ratios of hip and knee replacements amongst ethnic groups were compared using indirect standardisation. Associations between ethnic group and type of procedure were explored and effects of demographic, clinical and hospital-related factors examined using multivariable logistic regression., Results: Adjusted standardised observed/expected ratios were substantially lower in Blacks and Asians than Whites for hip replacement (Blacks 0.33 [95% CI, 0.31-0.35], Asians 0.20 [CI, 0.19-0.21]) and knee replacement (Blacks 0.64 [CI, 0.61-0.67], Asians 0.86 % [CI, 0.84-0.88]). Blacks were more likely to receive uncemented hip replacements (Blacks 52%, Whites 37%, Asians 44%; P < 0.001). Black men and women aged <70 years were less likely to receive unicondylar or patellofemoral knee replacements than Whites (men 10% vs 15%, P = 0.001; women 6% vs 14%, P < 0.001). After adjustment for demographic, clinical and hospital-related factors, Blacks were more likely to receive uncemented hip replacement (OR 1.43 [CI, 1.11-1.84])., Conclusions: In England, hip and knee replacement rates and prosthesis type given differ amongst ethnic groups. Whether these reflect differences in clinical need or differential access to treatment requires urgent investigation., (Copyright © 2017. Published by Elsevier Ltd.)

Bone is established as the preferred site of breast cancer metastasis. However, the precise mechanisms responsible for this preference remain unidentified. In order to improve outcome for patients with advanced breast cancer and skeletal involvement, we need to better understand how this process is initiated and regulated. As bone metastasis cannot be easily studied in patients, researchers have to date mainly relied on in vivo xenograft models. A major limitation of these is that they do not contain a human bone microenvironment, increasingly considered to be an important component of metastases. In order to address this shortcoming, we have developed a novel humanised bone model, where 1 × 10(5) luciferase-expressing MDA-MB-231 or T47D human breast tumour cells are seeded on viable human subchaodral bone discs in vitro. These discs contain functional osteoclasts 2-weeks after in vitro culture and positive staining for calcine 1-week after culture demonstrating active bone resorption/formation. In vitro inoculation of MDA-MB-231 or T47D cells colonised human bone cores and remained viable for <4 weeks, however, use of matrigel to enhance adhesion or a moving platform to increase diffusion of nutrients provided no additional advantage. Following colonisation by the tumour cells, bone discs pre-seeded with MDA-MB-231 cells were implanted subcutaneously into NOD SCID mice, and tumour growth monitored using in vivo imaging for up to 6 weeks. Tumour growth progressed in human bone discs in 80 % of the animals mimicking the later stages of human bone metastasis. Immunohistochemical and PCR analysis revealed that growing MDA-MB-231 cells in human bone resulted in these cells acquiring a molecular phenotype previously associated with breast cancer bone metastases. MDA-MB-231 cells grown in human bone discs showed increased expression of IL-1B, HRAS and MMP9 and decreased expression of S100A4, whereas, DKK2 and FN1 were unaltered compared with the same cells grown in mammary fat pads of mice not implanted with human bone discs.

Introduction: One in eight of all total hip replacements requires revision within 10 years, 60% because of wear-related complications. The bearing surfaces may be made of cobalt/chromium, stainless steel, ceramic, or polyethylene. Friction between bearing surfaces and corrosion of non-moving parts can result in increased local and systemic metal concentrations., Objectives: To identify and systematically review published reports of systemic toxicity attributed to metal released from hip implants and to propose criteria for the assessment of these patients., Methods: Medline (from 1950) and Embase (from 1980) were searched to 28 February 2014 using the search terms (text/abstract) chrom* or cobalt* and [toxic* or intox* or poison* or adverse effect or complication] and [prosthes* or 'joint replacement' or hip or arthroplast*] and PubMed (all available years) was searched using the search term (("Chromium/adverse effects"[Mesh] OR "Chromium/poisoning"[Mesh] OR "Chromium/toxicity"[Mesh]) OR ("Cobalt/adverse effects"[Mesh] OR "Cobalt/poisoning"[Mesh] OR "Cobalt/toxicity"[Mesh])) AND ("Arthroplasty, Replacement, Hip"[Mesh] OR "Hip Prosthesis"[Mesh]). These searches identified 281 unique references, of which 23 contained original case data. Three further reports were identified from the bibliographies of these papers. As some cases were reported repeatedly the 26 papers described only 18 individual cases. Systemic toxicity. Ten of these eighteen patients had undergone revision from a ceramic-containing bearing to one containing a metal component. The other eight had metal-on-metal prostheses. Systemic toxicity was first manifest months and often several years after placement of the metal-containing joint. The reported systemic features fell into three main categories: neuro-ocular toxicity (14 patients), cardiotoxicity (11 patients) and thyroid toxicity (9 patients). Neurotoxicity was manifest as peripheral neuropathy (8 cases), sensorineural hearing loss (7) and cognitive decline (5); ocular toxicity presented as visual impairment (6). All these neurological features, except cognitive decline, have been associated with cobalt poisoning previously. Type of prosthesis and blood metal concentrations. Where blood or serum metal concentrations were reported (n = 17 for cobalt and n = 14 for chromium), the median cobalt concentration was 398 (range, 13.6-6521) μg/L and the median chromium concentration was 48 μg/L (in whole blood) (range, 4.1-221 μg/L including serum and blood values). Those patients reported to have systemic features who had received a metal-on-metal prosthesis (n = 8) had a median peak blood cobalt concentration of 34.5 (range, 13.6-398.6) μg/L; those with a metal-containing revision of a failed ceramic prosthesis (n = 10) had a median blood cobalt concentration of 506 (range, 353-6521) μg/L. Management. The most common treatment was removal of the metal-containing prosthesis, undertaken in all but 2 patients. This was usually associated with a fall in circulating cobalt concentration and improvement in some or all features. Clinical and toxicological assessment of systemic features. We propose the following criteria for assessing the likelihood that clinical features are related to cobalt toxicity: clinical effects consistent with the known neurological, cardiac, or thyroidal effects of cobalt, and for which any other explanation is less likely; increased blood cobalt concentrations (substantially higher than those in patients with well-functioning prostheses) several months after hip replacement; a fall in the blood cobalt concentration, usually accompanied by signs of improvement in features. When judged by these criteria, the systemic features in 10 of the reported cases are likely to be related to cobalt exposure from a metal-containing hip prosthesis., Conclusions: Rarely, patients exposed to high circulating concentrations of cobalt from failed hip replacements develop neurological damage, hypothyroidism and/or cardiomyopathy, which may not resolve completely even after removal of the prosthesis. The greatest risk of systemic cobalt toxicity seems to result from accelerated wear of a cobalt-containing revision of a failed ceramic prosthesis, rather than from primary failure of a metal-on-metal prosthesis.

Background and Purpose: Hip prostheses that use a metal-on-metal articulation expose the brain to elevated metal concentrations that, in acute excess due to prosthesis malfunction, is associated with neurologic damage, including visual and hearing loss and motor deficits. Here, we examined whether chronic exposure to lower elevated metal levels, typical of well-functioning prostheses, also affects brain structure and function., Materials and Methods: We compared brain volumes, metal deposition, and gray matter attenuation by MR imaging and clinical neurologic function in patients 8 years after receiving a metal-on-metal hip resurfacing versus a matched group of patients with the same duration exposure to a conventional hip prosthesis., Results: Twenty-nine patients (25 men; mean, age 59±7 years) after metal-on-metal hip resurfacing and 29 patients (25 men; 59±8 years) after total hip arthroplasty were compared. Whole blood cobalt and chromium concentrations were 5-10 times higher in the metal-on-metal hip resurfacing group (P<.0001). Occipital cortex gray matter attenuation tended to be lower (P<.005 uncorrected, P>.05 corrected), and the optic chiasm area tended to be lower (mean difference, -2.7 mm2; P=.076) in the metal-on-metal hip resurfacing group. Subgroup analyses in 34 patients (17 per group), after exclusion of primary ocular pathology, showed the same trend in gray matter attenuation in the occipital cortex and basal ganglia and a smaller optic chiasm in the metal-on-metal hip resurfacing group (mean difference, -3.9 mm2; P=.048). No other structural or functional differences were found between the groups., Conclusions: Chronic exposure to metal-on-metal hip resurfacing is associated with subtle structural change in the visual pathways and the basal ganglia in asymptomatic patients., (© 2014 by American Journal of Neuroradiology.)

Objective: Interleukin-1β (IL-1β) is involved in the up-regulation of matrix metalloproteinases (MMPs) leading to cartilage degradation. Cannabinoids are anti-inflammatory and reduce joint damage in animal models of arthritis. This study aimed to determine a mechanism whereby the synthetic cannabinoid WIN-55,212-2 mesylate (WIN-55) may inhibit cartilage degradation., Methods: Effects of WIN-55 were studied on IL-1β stimulated production of MMP-3 and -13 and their inhibitors TIMP-1 and -2 in human chondrocytes. Chondrocytes were obtained from articular cartilage of patients undergoing total knee replacement. Chondrocytes were grown in monolayer and 3D alginate bead cultures. Real-time polymerase chain reaction (PCR) was used to determine the gene expression of MMP-3, -13, TIMP-1 and -2 and Enzyme Linked Immunosorbent Assay (ELISA) to measure the amount of MMP-3 and MMP-13 protein released into media. Immunocytochemistry was used to investigate the expression of cannabinoid receptors in chondrocyte cultures., Results: Treatment with WIN-55 alone or in combination with IL-1β, decreased or abolished MMP-3, -13, TIMP-1 and -2 gene expression in human chondrocyte monolayer and alginate bead cultures in both a concentration and time dependent manner. WIN-55 treatment alone, and in combination with IL-1β, reduced MMP-3 and -13 protein production by chondrocytes cultured in alginate beads. Immunocytochemistry demonstrated the expression of cannabinoid receptors in chondrocyte cultures., Conclusion: Cannabinoid WIN-55 can reduce both basal and IL-1β stimulated gene and protein expression of MMP-3 and -13. However WIN-55 also decreased basal levels of TIMP-1 and -2 mRNA. These actions of WIN-55 suggest a mechanism by which cannabinoids may act to prevent cartilage breakdown in arthritis., (Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate the accuracy and sensitivity of a fully automatic shape model matching (FASMM) system to derive statistical shape models (SSMs) of the proximal femur from non-standardised anteroposterior (AP) pelvic radiographs., Design: AP pelvic radiographs obtained with informed consent and appropriate ethical approval were available for 1105 subjects with unilateral hip osteoarthritis (OA) who had been recruited previously for The arcOGEN Study. The FASMM system was applied to capture the shape of the unaffected (i.e., without signs of radiographic OA) proximal femur from these radiographs. The accuracy and sensitivity of the FASMM system in calculating geometric measurements of the proximal femur and in shape representation were evaluated relative to validated manual methods., Results: De novo application of the FASMM system had a mean point-to-curve error of less than 0.9 mm in 99% of images (n = 266). Geometric measurements generated by the FASMM system were as accurate as those obtained manually. The analysis of the SSMs generated by the FASMM system for male and female subject groups identified more significant differences (in five of 17 SSM modes after Bonferroni adjustment) in their global proximal femur shape than those obtained from the analysis of conventional geometric measurements. Multivariate gender-classification accuracy was higher when using SSM mode values (76.3%) than when using conventional hip geometric measurements (71.8%)., Conclusions: The FASMM system rapidly and accurately generates a global SSM of the proximal femur from radiographs of varying quality and resolution. This system will facilitate complex morphometric analysis of global shape variation across large datasets. The FASMM system could be adapted to generate SSMs from the radiographs of other skeletal structures such as the hand, knee or pelvis., (Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

We studied the relationship between osteolysis and polyethylene wear, age at surgery, body mass index and height in 463 subjects (180 osteolysis and 283 controls) after cemented Charnley total hip arthroplasty (THA), in order to develop a kernel-based Bayesian model to quantitate risk of osteolysis. Such tools may be integrated into decision-making algorithms to help personalize clinical decision-making. A predictive model was constructed, and the estimated posterior probability of the implant failure calculated. Annual wear provided the greatest discriminatory information. Age at surgery provided additional predictive information and was added to the model. Body mass index and height did not contain valuable discriminatory information over the range in which observations were densely sampled. The robustness and misclassification rate of the predictive model was evaluated by a five-times cross-validation method. This yielded a 70% correct predictive classification of subjects into osteolysis versus non-osteolysis groups at a mean of 11 years after THA. Finally, the data were divided into male and female subsets to further explore the relationship between wear rate, age at surgery and incidence of osteolysis. The correct classification rate using age and wear rate in the model was approximately 66% for males and 74% for females.

Extraction of bone contours from radiographs plays an important role in disease diagnosis, preoperative planning, and treatment analysis. We present a fully automatic method to accurately segment the proximal femur in anteroposterior pelvic radiographs. A number of candidate positions are produced by a global search with a detector. Each is then refined using a statistical shape model together with local detectors for each model point. Both global and local models use Random Forest regression to vote for the optimal positions, leading to robust and accurate results. The performance of the system is evaluated using a set of 839 images of mixed quality. We show that the local search significantly outperforms a range of alternative matching techniques, and that the fully automated system is able to achieve a mean point-to-curve error of less than 0.9 mm for 99% of all 839 images. To the best of our knowledge, this is the most accurate automatic method for segmenting the proximal femur in radiographs yet reported.

Background: The practice of naturopathy and Western herbal medicine (WHM) was built on traditional evidence but may be undergoing change with the advent of scientific evidence. The aims of this research were to provide a better understanding of practitioners' attitudes towards evidence, information sources, professional regulation and their knowledge about the evidence of commonly used complementary medicines (CMs)., Method: Naturopaths and WHM practitioners were invited to participate in an anonymous, self-administered, on-line survey. Participants were recruited using the mailing lists and websites of CM manufacturers and professional associations., Results: Four hundred and seventy nine practitioners participated; 95% currently in practice. The majority (99%) thought well documented traditional evidence was essential or important, 97% patient reports and feedback, 97% personal experience, 94% controlled randomised trials and 89% published case reports. Significantly more recent graduates (less than 5 years) rated randomised trials as essential compared to others. Most (82%) respondents want information sources containing both traditional and scientific evidence. They currently use several resources; 74% CM textbooks, 67% conferences/seminars, 57% CM journals, 48% databases and 40% manufacturers' information. The mean knowledge score was 61.5% with no significant differences between respondents with diploma or degree level education or by graduating year. Eighty-five percent of practitioners strongly agreed or agreed that practitioners should be formally registered to safeguard the public, 8% were unsure and 8% disagreed or strongly disagreed., Conclusion: Naturopaths and WHM practitioners accept the importance of scientific evidence whilst maintaining the importance and use of traditional evidence. The majority are in favour of professional registration., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: To investigate the profile and health attitudes of complementary and alternative medicine (CAM) practitioners in Singapore., Design and Setting: A descriptive survey with convenience and snowball sampling were used. An anonymous self-administered survey was sent to 130 practitioners found in publicly accessible online practitioner registers, groups, and directories practicing CAM modalities from April 2010 to October 2010., Main Outcome Measures: Participants' demographics, business structure, and attitudes towards health, CAM and orthodox medicine (OM)., Results: Response rate was 32%. The data suggest that the typical CAM practitioner in Singapore is a middle-aged female who specialises in more than one CAM modality. Almost half (45%) of the participants possessed a degree and massage is the most commonly practiced modality. Participants practiced an average of 2-3 therapies and group-practice size ranged from 2 to 15 practitioners. Most participants (69%) experienced a radical change in job type to become a CAM practitioner and their previous employment suggests a slightly middle-class profile. The cost and duration of initial consultation and treatment ranged from SG$20 to SG$345 and 30-120min, respectively. The most common source of CAM information was seminars/lectures/workshops (76%). Communication and referral between CAM and orthodox medicine practitioners are high (>70%). Participants perceived CAM to be more suitable for disease prevention than treatment of serious medical conditions., Conclusions: This study provides important base-line data that will help future researchers explore further Singaporean CAM practitioners' business aspirations, and attitudes towards regulation and integration with OM., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

It is difficult to obtain phenotypic data on disease susceptibility directly from swine in an industry setting. The magnitude of the proliferative response of peripheral blood mononuclear cells (PBMC) to the T cell mitogen concanavalin A (Con A) has long been used as an indirect measure of the responsiveness of the immune system to antigenic stimulation. This trait is known to exhibit moderate heritability in swine, but little is known about the identity of the genes that control the response. In this study, we carried out a time-course microarray experiment to measure gene expression at 3 different stages (3, 20, and 68 h) poststimulation of PBMC with Con A. A total of 46, 452, and 418 differentially expressed (DifEx) genes were identified at each time point, respectively. Expression changes for a subset of these genes were subsequently confirmed by real-time PCR. Functional annotation analyses of the microarray results successfully identified sets of genes involved in processes associated with multiple aspects of cell division, such as DNA and protein synthesis, and control of mitosis. However, the discovery of genes that controlled the response of PBMC to mitogen was limited with this approach, because the drastic changes in the transcriptional program necessitated by cells undergoing division masked changes in smaller immune response gene sets. Pathway and network analyses that focused on immune cells proved to be a more effective strategy for the identification of genes that coordinate aspects of the mitogenic response that are specific to PBMC. The cytokine gene IL15 was shown to be central to the highest scoring network at 20 h and affect the expression of 16 other DifEx genes, including some genes known to regulate T cell activation, such as IL7R, JUN, TNFRSF9, and ZAP70. The IL15 gene maps to a previously identified QTL interval for immune responsiveness to Con A on SSC 8, which also contains the related IL2 gene. At 68 h, a distinct downregulation of major histocompatibility complex class II antigen presentation genes was observed. Overall, the gene expression profile of the Con A-stimulated porcine PBMC points to a Th(1) bias in immune activation. Further work is required to determine whether polymorphisms linked to genes identified in this study affect this immune response trait in pig populations and whether the trait itself correlates with decreased susceptibility to intracellular pathogens in swine.

Extraction of bone contours from radiographs plays an important role in disease diagnosis, pre-operative planning, and treatment analysis. We present a fully automatic method to accurately segment the proximal femur in anteroposterior pelvic radiographs. A number of candidate positions are produced by a global search with a detector. Each is then refined using a statistical shape model together with local detectors for each model point. Both global and local models use Random Forest regression to vote for the optimal positions, leading to robust and accurate results. The performance of the system is evaluated using a set of 519 images. We show that the fully automated system is able to achieve a mean point-to-curve error of less than 1 mm for 98% of all 519 images. To the best of our knowledge, this is the most accurate automatic method for segmenting the proximal femur in radiographs yet reported.

Objectives: The genetic aetiology of osteoarthritis has not yet been elucidated. To enable a well-powered genome-wide association study (GWAS) for osteoarthritis, the authors have formed the arcOGEN Consortium, a UK-wide collaborative effort aiming to scan genome-wide over 7500 osteoarthritis cases in a two-stage genome-wide association scan. Here the authors report the findings of the stage 1 interim analysis., Methods: The authors have performed a genome-wide association scan for knee and hip osteoarthritis in 3177 cases and 4894 population-based controls from the UK. Replication of promising signals was carried out in silico in five further scans (44,449 individuals), and de novo in 14 534 independent samples, all of European descent., Results: None of the association signals the authors identified reach genome-wide levels of statistical significance, therefore stressing the need for corroboration in sample sets of a larger size. Application of analytical approaches to examine the allelic architecture of disease to the stage 1 genome-wide association scan data suggests that osteoarthritis is a highly polygenic disease with multiple risk variants conferring small effects., Conclusions: Identifying loci conferring susceptibility to osteoarthritis will require large-scale sample sizes and well-defined phenotypes to minimise heterogeneity.

Livestock, particularly ruminants, can eat a wider range of biomass than humans. In the drive for greater efficiency, intensive systems of livestock production have evolved to compete with humans for high-energy crops such as cereals. Feeds consumed by livestock were analysed in terms of the quantities used and efficiency of conversion of grassland, human-edible ('edible') crops and crop by-products into milk, meat and eggs, using the United Kingdom as an example of a developed livestock industry. Some 42 million tonnes of forage dry matter were consumed from 2008 to 2009 by the UK ruminant livestock population of which 0.7 was grazed pasture and 0.3 million tonnes was conserved forage. In addition, almost 13 million tonnes of raw material concentrate feeds were used in the UK animal feed industry from 2008 to 2009 of which cereal grains comprised 5.3 and soyabean meal 1.9 million tonnes. The proportion of edible feed in typical UK concentrate formulations ranged from 0.36 for milk production to 0.75 for poultry meat production. Example systems of livestock production were used to calculate feed conversion ratios (FCR - feed input per unit of fresh product). FCR for concentrate feeds was lowest for milk at 0.27 and for the meat systems ranged from 2.3 for poultry meat to 8.8 for cereal beef. Differences in FCR between systems of meat production were smaller when efficiency was calculated on an edible input/output basis, where spring-calving/grass finishing upland suckler beef and lowland lamb production were more efficient than pig and poultry meat production. With the exception of milk and upland suckler beef, FCR for edible feed protein into edible animal protein were >1.0. Edible protein/animal protein FCR of 1.0 may be possible by replacing cereal grain and soyabean meal with cereal by-products in concentrate formulations. It is concluded that by accounting for the proportions of human-edible and inedible feeds used in typical livestock production systems, a more realistic estimate of efficiency can be made for comparisons between systems.

Objective: To address the need for standardization of osteoarthritis (OA) phenotypes by examining the effect of heterogeneity among symptomatic (SOA) and radiographic osteoarthritis (ROA) phenotypes., Methods: Descriptions of OA phenotypes of the 28 studies involved in the TREAT-OA consortium were collected. We investigated whether different OA definitions result in different association results by creating various hip OA definitions in one large population based cohort (the Rotterdam Study I (RSI)) and testing those for association with gender, age and body mass index using one-way ANOVA. For ROA, we standardized the hip-, knee- and hand ROA definitions and calculated prevalence's of ROA before and after standardization in nine cohort studies. This procedure could only be performed in cohort studies and standardization of SOA definitions was not feasible at this moment., Results: In this consortium, all studies with SOA phenotypes (knee, hip and hand) used a different definition and/or assessment of OA status. For knee-, hip- and hand ROA five, four and seven different definitions were used, respectively. Different hip ROA definitions do lead to different association results. For example, we showed in the RSI that hip OA defined as "at least definite joint space narrowing (JSN) and one definite osteophyte" was not associated with gender (P =0.22), but defined as "at least one definite osteophyte" was significantly associated with gender (P=3×10(-9)). Therefore, a standardization process was undertaken for ROA definitions. Before standardization a wide range of ROA prevalence's was observed in the nine cohorts studied. After standardization the range in prevalence of knee- and hip ROA was small., Conclusion: Phenotype definitions influence the prevalence of OA and association with clinical variables. ROA phenotypes within the TREAT-OA consortium were standardized to reduce heterogeneity and improve power in future genetics studies., (Copyright © 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

A variety of assays were utilized to determine the effects of Leptospermum petersonii essential oil on both Candida albicans and Aspergillus fumigatus. Hyphal morphology, susceptibility of spheroplasts and uptake of propidium iodide following exposure to the oil suggest that the mode of action of L. petersonii essential oil is through direct disturbance of the fungal cell membrane. Data also confirms that the volatile component of the oil is highly antifungal, independent of direct contact between the liquid oil and the fungal membrane. The degree of inhibition was greater when fungi were directly exposed to oil volatiles compared to pre-inoculation exposure of oil volatiles into the agar. It is likely that the essential oil volatiles are acting both directly and indirectly on the fungi to produce growth inhibition.

Between 1988 and 1998 we implanted 318 total hip replacements (THRs) in 287 patients using the Plasmacup (B. Braun Ltd, Sheffield, United Kingdom) and a conventional metal-on-polyethylene articulation. The main indications for THR were primary or secondary osteoarthritis. At follow-up after a mean 11.6 years (7.6 to 18.4) 17 patients had died and 20 could not be traced leaving a final series of 280 THRs in 250 patients. There were 62 revisions (22.1%) in 59 patients. A total of 43 acetabular shells (15.4%) had been revised and 13 (4.6%) had undergone exchange of the liner. The most frequent indications for revision were osteolysis and aseptic loosening, followed by polyethylene wear. The mean Kaplan-Meier survival of the Plasmacup was 91% at ten years and 58% at 14 years. Osteolysis was found around 36 (17.1%) of the 211 surviving shells. The median annual rate of linear wear in the surviving shells was 0.12 mm/year and 0.25 mm/year in those which had been revised (p < 0.001). Polyethylene wear was a strong independent risk factor for osteolysis and aseptic loosening. The percentage of patients with osteolysis increased proportionately with each quintile of wear-rate. There is a high late rate of failure of the Plasmacup. Patients with the combination of this prosthesis and bearing should be closely monitored after ten years.

Livestock contribute directly (i.e. as methane and nitrous oxide (N2O)) to about 9% of global anthropogenic greenhouse gas (GHG) emissions and around 3% of UK emissions. If all parts of the livestock production lifecycle are included (fossil fuels used to produce mineral fertilizers used in feed production and N2O emissions from fertilizer use; methane release from the breakdown of fertilizers and from animal manure; land-use changes for feed production and for grazing; land degradation; fossil fuel use during feed and animal production; fossil fuel use in production and transport of processed and refrigerated animal products), livestock are estimated to account for 18% of global anthropogenic emissions, but less than 8% in the UK. In terms of GHG emissions per unit of livestock product, monogastric livestock are more efficient than ruminants; thus in the UK, while sheep and cattle accounted for 32% of meat production in 2006, they accounted for 48% of GHG emissions associated with meat production. More efficient management of grazing lands and of manure can have a direct impact in decreasing emissions. Improving efficiency of livestock production through better breeding, health interventions or improving fertility can also decrease GHG emissions through decreasing the number of livestock required per unit product. Increasing the energy density of the diet has a dual effect, decreasing both direct emissions and the numbers of livestock per unit product, but, as the demands for food increase in response to increasing human population and a better diet in some developing countries, there is increasing competition for land for food v. energy-dense feed crops. Recalculating efficiencies of energy and protein production on the basis of human-edible food produced per unit of human-edible feed consumed gave higher efficiencies for ruminants than for monogastric animals. The policy community thus have difficult decisions to make in balancing the negative contribution of livestock to the environment against the positive benefit in terms of food security. The animal science community have a responsibility to provide an evidence base which is objective and holistic with respect to these two competing challenges.

Objectives: This study investigates the volatile (vapour) component of an essential oil derived from the Australian native Leptospermum petersonii as a potential treatment for aspergillosis., Methods: The in vitro antifungal effects of the volatiles were assayed by a variety of methods. In vitro mammalian cell toxicity of the oil and the oil volatiles was also determined prior to animal testing. Efficacy of the volatiles in vivo was assessed using a murine model., Results: L. petersonii oil volatiles were found to be potent inhibitors of fungal growth in vitro, with fungicidal activity displayed following short exposure times (< or =1 h). No significant mammalian cell toxicity was found to be associated with the volatiles. In the absence of treatment, Aspergillus fumigatus infection of animals resulted in an increase in inflammatory cell counts and high fungal burden within the lung tissue. Chitin levels in treated animals were significantly reduced compared with control animals. No viable fungi could be recovered from animals that had completed the treatment regimen., Conclusions: The significant reduction in fungal burden in the lungs of infected animals by the volatiles of L. petersonii oil was larger than that reported for conventional antifungal drugs of choice.

Extracts of Clitoria ternatea (butterfly pea) flowers are used in Thailand as a component of cosmetics and the chemical composition of the flowers suggest that they may have antioxidant activity. In this study the potential antioxidant activity of C. ternatea extracts and an extract containing eye gel formulation was investigated. Aqueous extracts were shown to have stronger antioxidant activity (as measured by DPPH scavenging activity) than ethanol extracts (IC(50) values were 1 mg/mL and 4 mg/mL, respectively). Aqueous extracts incorporated in to an eye gel formulation were also shown to retain this activity, however, it was significantly less than a commercial antiwrinkle cream included for comparison. The total phenolic content was 1.9 mg/g extract as gallic acid equivalents. The data from this study support the use of C. ternatea extracts as antioxidant inclusions in cosmetic products.

There are currently less than 40 locus-specific databases (LSDBs) and one large general database that curate data on somatic mutations in human cancer genes. These databases have different scope and use different annotation standards and database systems, resulting in duplicated efforts in data curation, and making it difficult for users to find clear and consistent information. As data related to somatic mutations are generated at an increasing pace it is urgent to create a framework for improving the collecting of this information and making it more accessible to clinicians, scientists, and epidemiologists to facilitate research on biomarkers. Here we propose a data flow for improving the connectivity between existing databases and we provide practical guidelines for data reporting, database contents, and annotation standards. These proposals are based on common standards recommended by the Human Genome Variation Society (HGVS) with additions related to specific requirements of somatic mutations in cancer. Indeed, somatic mutations may be used in molecular pathology and clinical studies to characterize tumor types, help treatment choice, predict response to treatment and patient outcome, or in epidemiological studies as markers for tumor etiology or exposure assessment. Thus, specific annotations are required to cover these diverse research topics. This initiative is meant to promote collaboration and discussion on these issues and the development of adequate resources that would avoid the loss of extremely valuable information generated by years of basic and clinical research., (2008 Wiley-Liss, Inc.)

Craniospinal irradiation is technically demanding due to the complex shape of the planning target volume (PTV). Radiotherapy treatment techniques have evolved over time as imaging and radiotherapy treatment technology have improved. However, most are variations on a class solution utilizing a prone patient position with two shaped lateral cranial portals and a matched posterior spinal portal with moving junctions. Major areas of difficulty remain with the accurate definition of the PTV and achieving a homogeneous dose within it, especially at the junctions. We describe a three-dimensionally (3D) planned craniospinal radiation technique that permits rapid image acquisition with reduced localization time, simplified spinal PTV definition and standardized cranial PTV definition. Improved dose homogeneity within the PTV is achieved by use of a segmented "field-in-field" technique (forward planned intensity-modulated radiotherapy (IMRT)) in place of customized compensators. This has negated the requirement for constructing physical compensators. Autosequencing for field delivery enables the junction to be "moved" during a single fraction and reduces the overall treatment time, an important consideration when treating very young patients.

Bleeding is a major complication of revision total hip replacement. We report a case where the inflated balloon of a urinary catheter was used to temporarily control intrapelvic bleeding from the superior gluteal artery, while definitive measures for endovascular embolisation were made.

The movement of knowledge and skills from academia to industry is paramount for continuing growth and innovation. A wide cultural gap persists between the two and an effective means of partnering is required. This review looks at current solutions and recent progress.

Roadmapping can provide insight into emerging opportunities and competitive threats. The various processes to produce roadmaps are described and some examples are presented.

The aims of this study were to examine the repeatability of measurements of bone mineral density (BMD) around a cemented polyethylene Charnley acetabular component using dual-energy x-ray absorptiometry and to determine the longitudinal pattern of change in BMD during the first 24 months after surgery. The precision of measurements of BMD in 19 subjects ranged from 7.7% to 10.8% between regions, using a four-region-of-interest model. A longitudinal study of 27 patients demonstrated a transient decrease in net pelvic BMD during the first 12 months, which recovered to baseline at 24 months. The BMD in the region medial to the dome of the component reduced by between 7% and 10% during the first three months, but recovered to approximately baseline values by two years. Changes in BMD in the pelvis around cemented acetabular components may be measured using dual-energy x-ray absorptiometry. Bone loss after insertion of a cemented Charnley acetabular component is small, transient and occurs mainly at the medial wall of the acetabulum. After two years, bone mass returns to baseline values, with a pattern suggesting a uniform transmission of load to the acetabulum.

Just over two years ago, it was forecast that transdermal patches would be one of the fastest growing sectors of the drug delivery market. Has the promise of new technology been fulfilled or do pills and potions taken orally still dominate the market? This review will look at the most recent developments and update the technology roadmaps in this US dollar 40-billion market.

EBRA-Digital is an established method for measuring implant migration after total hip arthroplasty using digitized radiographs that has recently undergone a change in the software platform that may influence its precision. We assessed the precision of EBRA-Digital 2003 release and compared it to the previous 1998 release using consecutive, standardized, plain radiographic examinations made on the same day after repositioning in 29 patients. The precision of implant migration and wear measurements was similar between the two software releases, although analysis times were quicker using the 2003 release (p<0.01). Image file compression at a ratio of 30 resulted in poorer measurement precision for some variables. The EBRA 2003 software platform has similar precision to the previous release and allows faster measurement of implant migration and wear. The level of image file compression that is used affects the precision of these measurements. (Hip International 2005; 15: 226-9).

Functional genomics, including analysis of the transcriptome and proteome, provides new opportunities for understanding the molecular processes in muscle and how these influence its conversion to meat. The Quality Pork Genes project was established to identify genes associated with variation in different aspects of raw material (muscle) quality and to then develop genetic tools that could be utilized to improve this quality. DNA polymorphisms identified in the porcine PRKAG3 and CAST genes illustrate the impact that such tools can have in improving meat quality. The resources developed in Quality Pork Genes provide the basis for identifying more of these tools.

Developments in imaging offer real-time visualisation of biological processes at the cellular and molecular level. This article considers how micro- and nanotechnology may enhance the application of optical imaging for in vivo and in vitro diagnostics.

The role of pH on the antimicrobial activity of essential oils has not been well studied. The effect of four essential oils: Backhousia citriodora, Melaleuca alternifolia, Lavandula angustifolia and Santalum spicatum (0.1% to 10%) on the pH of two commonly used media, nutrient broth and Iso-sensitest broth, was therefore undertaken. Small (less than 0.5 pH units) but statistically significant differences between the pH of the two media followed the addition of M. alternifolia, L. angustifolia and S. spicatum essential oil. In general the effect on pH was greatest at higher concentrations and the fall in pH was greatest in the nutrient broth. The addition of B. citriodora essential oil to nutrient broth resulted in a fall in pH from 7.29 +/- 0.02 (no oil) to 5.2 +/- 0.03 (10% oil). This effect was not observed in the Iso-sensitest broth., (Copyright 2004 John Wiley & Sons, Ltd.)

Grassland in the United Kingdom can accept sewage sludge when, as a result of cropping restrictions, arable land cannot. However, one of the uncertainties associated with the application of sewage sludge to grassland is the potential exposure of the grazing ruminant to sewage sludge particulates adhered to the grass or deposited on the soil surface. The implications of elevated levels of sludge particulates and associated potentially toxic metals (PTMs) are the potential accumulation of PTMs into edible tissues of the grazing animal. Two experiments were performed to investigate the effect of season of application on the adhesion, retention and recontamination of herbage by sewage sludge and PTMs. In each experiment, three treatments were installed, an untreated control, application of sludge in the autumn and application of sludge in the spring. Sewage sludge particulates and PTMs were eluted sequentially 21 days after the application of sludge using water and detergent and the residual (tissue) concentrations were monitored. Total concentrations in each fraction and adhesion indices were calculated. Soil samples taken from the sward treatments after each application showed no elevated concentrations of PTMs or concentrations that approached the maximum concentrations allowed for soils amended with sewage sludge. The amounts of sludge adhered to herbage ranged from 114 to 360 g sludge DM/kg herbage DM. There was evidence of preferential retention of PTMs to herbage. However, during the 21-day no grazing period there was a general decline in concentration of all PTMs. Copper was retained on the herbage for greater periods of time compared to Zn, CD, Pb and Fe (P < 0.01). The proportion of Pb recovered from the water phase increased during the 21-day no grazing period in comparison to Cu, Zn and Fe (P < 0.001). It is concluded that the concentrations of PTMs adhered and integral to herbage as a result of surface application of sewage sludge are likely to fall to acceptable levels in well-managed permanent grassland.

Many medical products are taking advantage of the developments in micro-and nanotechnology. Fabrication processes for metal products are reviewed here. Those featured include stents, surgical blades and needles, wound dressings and fluorescent labels for diagnostic testing.

A retrospective study has been undertaken in an attempt to identify physical parameters that could confidently be used to predict an enhanced risk of bladder morbidity following intracavitary brachytherapy. 366 women received brachytherapy as all, or part, of their treatment for cervical cancer at the Christie Hospital in 1990 and 1991, and of these, 60 patients developed identifiable bladder morbidity (graded on a scale of 1-4 using the Franco-Italian glossary). These were age and stage matched with 60 asymptomatic women who were also treated for cervical cancer by brachytherapy during the same time period. The sizes of applicators used in the two groups were noted and compared. The two groups were also compared with respect to the heights of the applicator set above the symphysis pubis, the degree of anteversion or retroversion of the applicator sets and where possible, the doses at the International Commission on Radiation Units and Measurements (ICRU) bladder reference point. Where CT scans of the applications were available, these were reviewed to see if any differences in the size, shape or location of the bladder were apparent. No significant difference was found between the two groups of patients for any of the parameters investigated. The physical factors investigated in this study cannot be used to reliably predict bladder complications. There was a significant correlation between bladder morbidity and morbidity in other pelvic sites.

Table I summarises the potential medical applications for nanotechnology. It is clear that the use of nanotechnology in medical applications is still at a very early stage. However, the potential benefits are enormous and potential applications widespread.

The main factors affecting the accumulation of potentially-toxic metals (PTM) by grazing animals are the presence of the metal, its concentration in herbage and at the soil surface, and the duration of exposure to the contaminated pasture and soil. In addition, the elapsed time between the contamination of the pasture and grazing, the quantity of soil ingested together with herbage, the mechanism of absorption of the metal into blood and the presence or absence of antagonistic metals can interact to influence the rate and extent of accumulation of heavy metals in edible body tissues. Models of the accumulation of metals by grazing animals may be used to determine the statutory limits of radionuclides and PTM in soils under grazed pastures. Meta-analysis of existing data, using a random-effects model, is a useful approach to understanding the factors affecting the accumulation of some metals, e.g. Cd. The target edible body tissues for the accumulation of most PTM are the liver and kidneys, with the exception of radiocaesium, which accumulates in muscle to a greater extent than in other tissues. The livers and kidneys of mature livestock that have been grazed on areas of pasture at the legal limit of contamination by Cd for more than one grazing season should be removed from the human food chain in order to reduce the risk of intake of Cd by the human population.