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Objective: Emerging research supports the role of chronic stress in chronic disease development. This scoping review aimed to map the field of research exploring relationships between chronic stress and the development of arthritis in adult populations. Methods: Five electronic databases were systematically searched without publication limits based on three key concepts: stress, arthritis and adults. Eligible qualitative studies investigated individuals’ perceived causes of arthritis; quantitative studies investigated relationships between exposure to a chronic stressor and an arthritis presence outcome. Articles were screened by two independent reviewers and data were narratively synthesised. Results: Of 1819 unique records, 54 studies met inclusion criteria. Nine studies used qualitative methods and 45 used quantitative methods. Studies increased chronologically, with half (n = 27) published since 2010. Chronic stress exposures were heterogenous; most were categorised as adverse life events (n = 22) or adverse childhood experiences (n = 17). Self‐reported arthritis was the most frequent measure of arthritis outcome (n = 26) in quantitative studies. A majority of studies (n = 41) suggested a relationship between exposure to chronic stressors and arthritis development. Conclusion: Increasing study numbers in the past decade may reflect increasing awareness of the potential impact of chronic stress in arthritis development, consistent with a biopsychosocial approach to chronic disease aetiology and management. Further research, using precise arthritis definitions, conducted within a clearly articulated pathophysiological framework, is required to establish a causal relationship between exposure to chronic stressors and the development of specific arthritis conditions. Refereed/Peer-reviewed

The time children spend in nature has severely decreased. While nature-based learning at school is considered an important strategy in addressing this, numerous knowledge gaps continue to remain. To address these, a systematic review was undertaken. Nine commonly used health and education databases were searched from inception to January 2019. To be included, study participants were required to be children aged 4 to 12 without health or developmental conditions with a focus on nature-based learning. The methodological quality of the included studies was assessed, followed by a descriptive synthesis. Out of 4703 results, 20 quantitative studies were included. There was a lack of universal definition of nature-based learning. This resulted in heterogeneity in how interventions were delivered, and outcomes measured. Overall, nature-based learning had varying levels of positive impacts across a range of outcomes. Despite these positive findings, the evidence base is constrained by some methodological issues. Refereed/Peer-reviewed

BACKGROUND The orally administered combination trifluridine/tipiracil has been approved as third line treatment in mCRC, demonstrating survival benefit and acceptable toxicity profile in the phase III RECOURSE study. PATIENT AND METHODS We performed a multicenter retrospective real-world analysis of patients with mCRC receiving trifluridine/tipiracil between 2016 and 2019 in eight cancer centers across the United Kingdom. RESULTS A total of 236 patients were included with median age of 69 years. All patients had received at least 2 lines of fluoropyrimidine-based chemotherapy doublet with oxaliplatin or irinotecan. About 10% of patients had ECOG ≥ 2. Median duration of trifluridine/tipiracil treatment was 3 months with an ORR of 2.1% and disease control rate of 21.6%. Median OS was 7.6 and median PFS 3.3 months. A dose reduction was required in 27% of patients, while 7.6% discontinued treatment due to toxicity. The most common grade 3 toxicities were neutropenia (34%), fatigue (10%), anemia (9%) and febrile neutropenia (5%). Baseline NLR

Motor vehicle driver fatalities (≥18 years) from the files at Forensic Science South Australia were reviewed from January 2008 to December 2018 for cases in which either positive blood sample for methamphetamine (MA) or an illegal blood alcohol concentration (BAC) >0.05g/100 ml were found. Three hundred driver deaths were found with MA detected in 28 cases (age range 21-62 years; ave. 37.8 years; M:F 23:5). Hundred and fifteen cases with a BAC > 0.05 g/100 ml were identified (age range 18-67 years; ave 35.7 years; M:F 95:20). No change was found in numbers of MA cases, although alcohol cases showed a significant decline (p < 0.001). Drunk driving-related fatal crashes tended to occur in the evening (5 p.m. to 11 p.m.), while MA-related fatal crashes had a longer peak extending from late evening until late morning (11 p.m. to 8 a.m.). This study has demonstrated that while roadside breath testing, legislative changes, and increased monitoring have resulted in reduced levels of drunk driving, similar safety countermeasures have had negligible effects on MA use in drivers. Continued monitoring of MA use by drivers will, therefore, be necessary to assess the possible effects, or not, of new countermeasures.

In modern radiotherapy, imaging is an important component in the treatment process where it is used for planning the doses to be delivered and for verifying and monitoring the position of the target during treatments. Recent developments in imaging have contributed to advancing radiotherapy techniques’ such as image-guided radiotherapy (IGRT) for intrafraction motion management and adaptive radiation therapy (ART). This is has resulted in the ability to deliver highly conformal radiation doses with increased precision, which has enabled the safe increase in the dose that can be delivered to the tumour, resulting in improvements in clinical outcomes and the implementation of hypofractionated radiotherapy regimens. Although x-ray imaging has predominantly been used in radiotherapy for many years, more complex radiotherapy such as ART, demands an imaging modality with greater soft tissue contrast so radiotherapy targets can be imaged directly. A requirement that has led to the recent introduction of the MR-linac. Ultrasound also offers soft tissue contrast and may have advantages in terms of imaging rates, we therefore considered it pertinent to consider the role of ultrasound imaging in future radiotherapy treatments. In this timely debate, Emma Harris and Davide Fontanarosa discuss whether ultrasound guidance in radiotherapy will become a clinical standard in the future.

Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an emergency care and treatment planning (ECTP) process, developed to offer a patient-centred approach to deciding about and recording treatment recommendations. Conversations between clinicians and patients or their representatives are central to the ReSPECT process. This study aims to understand why, when, and how ReSPECT conversations unfold in practice.\ud \ud Methods: ReSPECT conversations were observed in hospitals within six acute National Health Service (NHS) trusts in England; the clinicians who conducted these conversations were interviewed. Following observation-based thematic analysis, five ReSPECT conversation types were identified: resuscitation and escalation; confirmation of decision; bad news; palliative care; and clinical decision. Interview-based thematic analysis examined the reasons and prompts for each conversation type, and the level of detail and patient engagement in these different conversations.\ud \ud Results: Whereas resuscitation and escalation conversations concerned possible futures, palliative care and bad news conversations responded to present-tense changes. Conversations were timed to respond to organisational, clinical, and patient/relative prompts. While bad news and palliative care conversations included detailed discussions of treatment options beyond CPR, this varied in other conversation types. ReSPECT conversations varied in doctors’ engagement with patient/relative preferences, with only palliative care conversations consistently including an open-ended approach.\ud \ud Conclusions: While ReSPECT supports holistic, person-centred, anticipatory decision-making in some situations, a gap remains between the ReSPECT’s aims and their implementation in practice. Promoting an understanding and valuing of the aims of ReSPECT among clinicians, supported by appropriate training and structural support will enhance ReSPECT conversations.

PurposeThis Impact Pathways paper aims to provide a timely and structured discussion of real-world problems at Marks and Spencer and in retail in general, evoked through the current COVID-19 pandemic.Design/methodology/approachThe article presents collaborative research based on more than five hours of interviews and several iterative paper writing steps between management scholars and Marks & Spencer’s Head of Procurement - Logistics and Supply Chain. Continuous discussions for more than ten months among the research team assure the timeliness and relevance of the findings. The exceptional position of the executive and his career biography allowed the integration of a variety of intra-organisational and inter-organisational stakeholders.FindingsThis paper highlights the impacts of the current COVID-19 pandemic on operations and supply chain management (OSCM) in the retail industry, structured in upstream, internal and operational, and downstream and customer perspectives. The paper concludes with a practice-infused research agenda, which aims to trigger relevant research about the current and potential future crises.Research limitations/implicationsAlthough the research agenda is directly related to the COVID-19 pandemic and the retail industry, the future research pathways are expected to inform business responses to potential future external shocks other than pandemics and in different industries as well.Originality/valueDespite a plethora of studies already published on COVID-19 and OSCM, little is known on how the outbreak affects specific firms and industries. This paper offers an overview of COVID-19 related change as it happens at the retailer and in the retailing industry in general. This article is among the first to provide a practice-infused call for research on urgent issues being faced by business leaders directly relevant to our domain.

Management of inflammatory bowel disease (IBD) has changed considerably over recent years, which has coincided with increased subspecialisation amongst general surgeons. This study evaluated the demographics and outcomes of patients with IBD undergoing bowel resection and assessed for the potential impact of surgical subspecialisation. Patient demographic, operative and outcome data were collected for patients undergoing a bowel resection secondary to IBD, admitted acutely to NHS trusts in the North of England between 2002 and 2016. The primary outcome of interest was 30-day post-operative mortality, with secondary outcomes: length of stay, stoma and anastomosis rates. A total of 913 patients were included in the study cohort. A reduction in the number of resections was noted over time (2002–2006: 361 vs. 2012–2016: 262). No change was observed for 30-day mortality over the study period (3.9%, p = 0.233). Length of stay was also unchanged (p = 0.949). Laparoscopic surgery was increasingly utilised (0.6% vs. 17.2%, p

The knife-edge imaging-based wavefront-sensing technique is used for wavefront error characterization of Be X-ray lenses with and without corrector plate. Different 3D printed corrector plates are proposed to achieve pseudo-perfect compensation of wavefront errors of Be X-ray lenses., A refractive phase corrector optics is proposed for the compensation of fabrication error of X-ray optical elements. Here, at-wavelength wavefront measurements of the focused X-ray beam by knife-edge imaging technique, the design of a three-dimensional corrector plate, its fabrication by 3D printing, and use of a corrector to compensate for X-ray lens figure errors are presented. A rotationally invariant corrector was manufactured in the polymer IP-STM using additive manufacturing based on the two-photon polymerization technique. The fabricated corrector was characterized at the B16 Test beamline, Diamond Light Source, UK, showing a reduction in r.m.s. wavefront error of a Be compound refractive Lens (CRL) by a factor of six. The r.m.s. wavefront error is a figure of merit for the wavefront quality but, for X-ray lenses, with significant X-ray absorption, a form of the r.m.s. error with weighting proportional to the transmitted X-ray intensity has been proposed. The knife-edge imaging wavefront-sensing technique was adapted to measure rotationally variant wavefront errors from two different sets of Be CRL consisting of 98 and 24 lenses. The optical aberrations were then quantified using a Zernike polynomial expansion of the 2D wavefront error. The compensation by a rotationally invariant corrector plate was partial as the Be CRL wavefront error distribution was found to vary with polar angle indicating the presence of non-spherical aberration terms. A wavefront correction plate with rotationally anisotropic thickness is proposed to compensate for anisotropy in order to achieve good focusing by CRLs at beamlines operating at diffraction-limited storage rings.

BackgroundAlthough carpal tunnel syndrome (CTS) is the most common form of peripheral entrapment neuropathy, its pathogenesis remains largely unknown. An estimated heritability index of 0.46 and an increased familial occurrence indicate that genetic factors must play a role in the pathogenesis.Methods and resultsWe report on a family in which CTS occurred in subsequent generations at an unusually young age. Additional clinical features included brachydactyly and short Achilles tendons resulting in toe walking in childhood. Using exome sequencing, we identified a heterozygous variant (c.5009T>G; p.Phe1670Cys) in the fibrillin-2 (FBN2) gene that co‐segregated with the phenotype in the family. Functional assays showed that the missense variant impaired integrin-mediated cell adhesion and migration. Moreover, we observed an increased transforming growth factor-β signalling and fibrosis in the carpal tissues of affected individuals. A variant burden test in a large cohort of patients with CTS revealed a significantly increased frequency of rare (6.7% vs 2.5%–3.4%, pFBN2 variants in patient alleles compared with controls.ConclusionThe identification of a novel FBN2 variant (p.Phe1670Cys) in a unique family with early onset CTS, together with the observed increased frequency of rare and high-impact FBN2 variants in patients with sporadic CTS, strongly suggest a role of FBN2 in the pathogenesis of CTS.

Little is known about the long-term skeletal impact of bariatric procedures, particularly the increasingly commonly performed gastric sleeve surgery (GS). We examined bone density (BMD) change following three types of bariatric surgery Roux-en-Y gastric bypass (RYGB), GS and laparoscopic adjustable gastric banding (LAGB), compared with diet, over 36 months. Non-randomized, prospective study of participants with severe obesity (n = 52), undergoing weight-loss interventions: RYGB (n = 7), GS (n = 21), LAGB (n = 11) and diet (n = 13). Measurements of calciotropic indices, gut hormones (fasting and post prandial) peptide YY (PYY), glucagon-like peptide 1 (GLP1) and adiponectin together with dual-X-ray absorptiometry and quantitative computed tomography scans were performed thorough the study. All groups lost weight during the first 12 months. Despite weight stability from 12 to 36 months and supplementation of calcium and vitamin D, there was progressive bone loss at the total hip (TH) over 36 months in RYGB −14% (95% CI: −12, −17) and GS −9% (95% CI: −7, −10). In RYGB forearm BMD also declined over 36 months −9% (95% CI: −6, −12) and LS BMD declined over the first 12 months −7% (95% CI: −3, −12). RYGB and GS groups experienced significantly greater bone loss until 36 months than LAGB and diet groups, which experienced no significant BMD loss. These bone losses remained significant after adjustment for weight loss and age. RYGB and GS procedures resulted in elevated postprandial PYY, adiponectin and bone turnover markers up to 36 months without such changes among LAGB and diet participants. RYGB and GS but not LAGB resulted in ongoing TH bone loss for three postoperative years. For RYGB, bone loss was also observed at LS and non-weight-bearing forearms. These BMD changes were independent of weight and age differences. We, therefore, recommend close monitoring of bone health following RYGB and GS surgeries.

Purpose This paper aims to raise awareness of the potential misuse of Transparency International’s Corruption Perception Index (CPI) within the financial services industry and outline the potential negative impact this may have on society in certain developing countries. Design/methodology/approach This piece of research adopted a mix-method approach across three strands; an online line anonymous survey, consisting of 24 questions, face to face interviews with 10 anti-bribery and corruption compliance officers and three focus group, one in Hong Kong, India and Mexico. Findings The results of the research have evidenced that there is a lack of understanding of the methodology used to compile the CPI within the financial services industry and there is a potential adverse impact if misused. Research limitations/implications A potential limitation was the fact that the survey was written in English yet was distributed to some countries where English was not the respondents’ first language. As such, it was accepted that there may have been context challenges or a misunderstanding of what the question asked. Practical implications By raising awareness of the methodology of the CPI and the advantages and disadvantages of its use, it will enable the financial service industry to better understand the implications of using such an index and the impacts of its misuse. Social implications This research highlights that through the potential misuse and lack of understanding of the CPI by the financial services industry this may have an adverse financial, growth and development impact on societies in low ranked countries. Originality/value This paper draws on a sub-set of results from a wider piece of research that was undertaken for a Professional Doctorate. This research combined academic knowledge with practitioner research skills, providing an original contribution to knowledge surrounding corruption from a more targeted focal point, particularly with input from anti-bribery and corruption compliance officers in the financial service industry.

Major advances in external beam radiation therapy in the last decade have provided technologies for planning and delivering highly conformal radiation dose distributions made available by refined beam targeting methods, including intensity-modulated radiation therapy using tomotherapy, volumetric modulated arc therapy and many other auspicious tools for 3D dose painting. The emergence of magnetic resonance imaging (MRI) systems integrated with linear accelerators (linacs), commonly known as an MR-linacs, have realized MR-image guided radiation therapy (MRgRT) systems.

Emergency laparotomy is associated with high morbidity and mortality. Current trends suggest improvements have been made in recent years, with increased survival and shorter lengths of stay in hospital. The National Emergency Laparotomy Audit (NELA) has evaluated participating hospitals in England and Wales and their individual outcomes since 2013. This study aims to establish temporal trends for patients undergoing emergency laparotomy and evaluate the influence of NELA.Data for emergency laparotomies admitted to NHS hospitals in the Northern Deanery between 2001 and 2016 were collected, including demographics, co-morbidities, diagnoses, operations undertaken and outcomes. The primary outcome of interest was in-hospital death within 30 days of admission. Cox-regression analysis was undertaken with adjustment for covariates.There were 2828 in-hospital deaths from 24,291 laparotomies within 30 days of admission (11.6%). Overall 30-day mortality significantly reduced during the 15-year period studied from 16.3% (2001-04), to 8.1% during 2013-16 (p 0.001). After multivariate adjustment, laparotomies undertaken in more recent years were associated with a lower mortality risk compared to earlier years (2013-16: HR 0.73, p 0.001). There was a significant improvement in 30-day postoperative mortality year-on-year during the NELA period (from 9.1 to 7.1%, p = 0.039). However, there was no difference in postoperative mortality for patients who underwent laparotomy during NELA (2013-16) compared with the preceding three years (both 8.1%, p = 0.526).30 day postoperative mortality for emergency laparotomy has improved over the past 15-years, with significantly reduced mortality risk in recent years. However, it is unclear if NELA has yet had a measurable effect on 30-day post-operative mortality.

In the years following the introduction of legislation in Australian states mandating the wearing of helmets, there was a decline in the number of deaths. Debate has occurred, however, as to why this occurred. The Traffic Accident Reporting System database, which records data for all police-reported crashes in South Australia, was searched for all cases of deaths occurring in the state in bicycle riders aged ≤14 years from January 1982 to December 2001. The numbers of deaths were then compared over the 10-year periods before (1982–1991) and after (1992–2001) the introduction of helmet legislation, and also on a yearly basis from 1982 to 2001. Comparing the numbers of deaths in the two periods before and after helmet legislation in 1991 showed a marked decrease in cases from 36 to 12. However, in examining the numbers of deaths per year in greater detail, it appears that these were already steadily reducing from nine cases per year in 1982 (2.9/100,000) to two cases in 1991 (0.67/100,000) to a virtual plateau after 1991 (ranging from 0 to 2 cases annually). It seems that the introduction of compulsory bicycle helmet wearing in South Australia came at a time when the numbers of child cyclist deaths had been steadily declining over the preceding decade. While helmet wearing clearly protects children who are still riding bicycles, the reasons for the reduction in numbers of deaths appears more complex than legislative change and likely involves a subtle interaction with other behavioural and societal factors and preferences.

Aim The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges to healthcare systems globally. Orthopaedic surgeons are at risk of contracting COVID-19 due to their close contact with patients in both outpatient and theatre environments. The aim of this review was to perform a literature review, including articles of other coronaviruses, to formulate guidelines for orthopaedic healthcare staff. Methods A search of Medline, EMBASE, the Cochrane Library, World Health Organization (WHO), and Centers for Disease Control and Prevention (CDC) databases was performed encompassing a variety of terms including ‘coronavirus’, ‘covid-19’, ‘orthopaedic’, ‘personal protective environment’ and ‘PPE’. Online database searches identified 354 articles. Articles were included if they studied any of the other coronaviruses or if the basic science could potentially applied to COVID-19 (i.e. use of an inactivated virus with a similar diameter to COVID-19). Two reviewers independently identified and screened articles based on the titles and abstracts. 274 were subsequently excluded, with 80 full-text articles retrieved and assessed for eligibility. Of these, 66 were excluded as they compared personal protection equipment to no personal protection equipment or referred to prevention measures in the context of bacterial infections. Results There is a paucity of high quality evidence surrounding COVID-19. This review collates evidence from previous coronavirus outbreaks to put forward recommendations for orthopaedic surgeons during the COVID-19 pandemic. The key findings have been summarized and interpreted for application to the orthopaedic operative setting. Conclusion For COVID-19 positive patients, minimum suggested PPE includes N95 respirator, goggles, face shield, gown, double gloves, and surgical balaclava. Space suits not advised. Be trained in the correct technique of donning and doffing PPE. Use negative pressure theatres if available. Minimize aerosolization and its effects (smoke evacuation and no pulse lavage). Minimize further unnecessary patient-staff contact (dissolvable sutures, clear dressings, split casts).

Motorcycle riders have a high risk of serious injury if they crash. To assist with identification of countermeasures, the present study examined records from the Royal Adelaide Hospital (RAH) in South Australia for 763 motorcyclists (including scooter riders) admitted between January 2008 and November 2010 and between April 2014 and December 2016. Records were linked with police-reported crash data and results of forensic blood tests for alcohol and drugs. When compared with 1617 car drivers admitted to the RAH over the same periods, motorcyclists were younger, were more commonly male, more likely to hold a learner permit, less likely to hold a provisional licence, less likely to be over the legal alcohol limit and less likely to be at-fault in multiple vehicle crashes. Their crashes were more likely to be single vehicle crashes (specifically roll over, left road – out of control and hit object/animal/pedestrian on road crashes) and were more common on weekends, during the afternoon, on sloping roads, on curved roads, on roads with speed limits of 50 and 80 km/h, during daylight hours, in dry weather and on dry roads. They had a higher severity of injury than car drivers, spent longer in hospital, and were more likely to sustain injuries to multiple body regions. Linear regression showed that older age, higher blood alcohol concentration and higher speed limit increased injury severity for motorcyclists. Based on present findings, motorcycling safety can be improved through countermeasures related to Graduated Licensing Systems, infrastructure, motorcycle technology and protective clothing.

Introduction In recent years, several management options have been used in the management of perforated diverticulitis, ranging from conservative treatment to laparotomy. General surgery has also become increasingly specialised over time. This retrospective cohort study investigated changes in patient outcomes following perforated diverticulitis, management approach and the influence of consultant subspecialisation over time. Materials and methods Data was collected on patients admitted with perforated diverticulitis in the North of England between 2002 and 2016. Subspecialisation was categorised as colorectal or other general subspecialties. The primary outcome of interest was overall 30-day mortality; secondary outcomes included surgical approach, stoma and anastomosis rate. Results A total of 3394 cases of perforated diverticulitis were analysed (colorectal, n = 1290 and other subspecialists, n = 2104) with a 30-day mortality of 11.6%. There was a significant reduction in mortality over time (2002–2006: 18.6% to 2012–2016: 6.8, P < 0.001). There was a significant reduction in open surgery (60% to 25.3%, P < 0.001) with increased conservative management (37.4% to 63.5%, P < 0.001), laparoscopic resection (0.1% to 4.9%, P < 0.001) and laparoscopic washout (0.1% to 5.7%, P < 0.001). Patients admitted under colorectal surgeons had lower mortality than other subspecialists (9.9% vs 12.4%, P = 0.027), which remained significant following multivariate adjustment (hazard ratio 1.44, P = 0.039). These patients had fewer stomas (13.9% vs. 21.0%, P = 0.001) and higher anastomosis rates (22.1% vs 15.8%, P = 0.004). Conclusion This study demonstrated considerable improvements in the management of perforated diverticulitis alongside the positive impact of subspecialisation on patient outcomes.

Background: Insufficient physical activity is one of four primary risk factors for non‐communicable diseases such as stroke, heart disease, type 2 diabetes, cancer and chronic lung disease. As few as one in five children aged 5 to 17 years have the physical activity recommended for health benefits. The outside‐school hours period contributes around 30% of children's daily physical activity and presents a key opportunity for children to increase their physical activity. Testing the effects of interventions in outside‐school hours childcare settings is required to assess the potential to increase physical activity and reduce disease burden. Objectives: To assess the effectiveness, cost‐effectiveness and associated adverse events of interventions designed to increase physical activity in children aged 4 to 12 years in outside‐school hours childcare settings. Search methods: We searched CENTRAL, MEDLINE, Embase, ERIC and SportsDISCUS to identify eligible trials on 18 August 2020. We searched two databases, three trial registries, reference lists of included trials and handsearched two physical activity journals in August 2020. We contacted first and senior authors on articles identified for inclusion for ongoing or unpublished potentially relevant trials in August 2020. Selection criteria: We included randomised controlled trials, including cluster‐randomised controlled trials, of any intervention primarily aimed at increasing physical activity in children aged 4 to 12 years in outside‐school hours childcare settings compared to usual care. To be eligible, the interventions must have been delivered in the context of an existing outside‐school hours childcare setting (i.e. childcare that was available consistently throughout the school week/year), and not set up in the after‐school period for the purpose of research. Two review authors independently screened titles and abstracts of identified papers with discrepancies resolved via a consensus discussion. A third review author was not required to resolve disagreements. Data collection and analysis: Two review authors independently extracted data and assessed the risk of bias of included trials with discrepancies resolved via a consensus discussion; a third review author was not required to resolve disagreements. For continuous measures of physical activity, we reported the mean difference (MD) with 95% confidence intervals (CIs) in random‐effects models using the generic inverse variance method for each outcome. For continuous measures, when studies used different scales to measure the same outcome, we used standardised mean differences (SMDs). We conducted assessments of risk of bias of all outcomes and evaluated the certainty of evidence (GRADE approach) using standard Cochrane procedures. Main results:We included nine trials with 4458 participants. Five trials examined the effectiveness of staff‐based interventions to change practice in the outside‐school hours childcare setting (e.g. change in programming, activities offered by staff, staff facilitation/training). Two trials examined the effectiveness of staff‐ and parent‐based interventions (e.g. parent newsletters/telephone calls/messages or parent tool‐kits in addition to staff‐based interventions), one trial assessed staff‐ and child‐based intervention (e.g. children had home activities to emphasise physical activity education learnt during outside‐school hours childcare sessions in addition to staff‐based interventions) and one trial assessed child‐only based intervention (i.e. only children were targeted). We judged two trials as free from high risk of bias across all domains. Of those studies at high risk of bias, it was across domains of randomisation process, missing outcome data and measurement of the outcome.There was low‐certainty evidence that physical activity interventions may have little to no effect on total daily moderate‐to‐vigorous physical activity compared to no intervention (MD 1.7 minutes, 95% CI –0.42 to 3.82; P = 0.12; 6 trials; 3042 children). We were unable to pool data on proportion of the OSHC session spent in moderate‐to‐vigorous physical activity in a meta‐analysis. Both trials showed an increase in proportion of session spent in moderate‐to‐vigorous physical activity (moderate‐certainty evidence) from 4% to 7.3% of session time; however, only one trial was statistically significant. There was low‐certainty evidence that physical activity interventions may lead to little to no reduction in body mass index (BMI) as a measure of cardiovascular health, compared to no intervention (SMD –0.17, 95% CI –0.44 to 0.10; P = 0.22; 4 trials, 1684 children). Physical activity interventions that were delivered online were more cost‐effective than in person. Combined results suggest that staff‐and‐parent and staff‐and‐child‐based interventions may lead to a small increase in overall daily physical activity and a small reduction or no difference in BMI. Process evaluation was assessed differently by four of the included studies, with two studies reporting improvements in physical activity practices, one reporting high programme satisfaction and one high programme fidelity. The certainty of the evidence for these outcomes was low to moderate. Finally, there was very low‐certainty evidence that physical activity interventions in outside‐school hours childcare settings may increase cardiovascular fitness.No trials reported on quality of life or adverse outcomes. Trials reported funding from local government health grants or charitable funds; no trials reported industry funding. Authors' conclusions: Although the review included nine trials, the evidence for how to increase children's physical activity in outside‐school hours care settings remains limited, both in terms of certainty of evidence and magnitude of the effect. Of the types of interventions identified, when assessed using GRADE there was low‐certainty evidence that multi‐component interventions, with a specific physical activity goal may have a small increase in daily moderate‐to‐vigorous physical activity and a slight reduction in BMI. There was very low‐certainty evidence that interventions increase cardiovascular fitness. By contrast there was moderate‐certainty evidence that interventions were effective for increasing proportion of time spent in moderate‐to‐vigorous physical activity, and online training is cost‐effective. Refereed/Peer-reviewed

One of the primary characteristics of community work at the present moment is that the worker is often subjected to a degree of isolation in the job. He has very little in the way of institutionalised professional support and is likely to have relatively little support within his own agency. ‘Bureaucracy’ is already a dirty word and ‘professional’ is becoming one in some circles. For many the attraction of community work is precisely its relative freedom from institutional entanglements which, they feel, allows a better response to the people with whom they are working. Nevertheless, the absence of professional and agency support is a source of strain as well as of freedom of action. It is for this reason that many community workers have sought support from colleagues through the vehicle of groups of community workers meeting on a regular basis. That such groups were felt to be needed is demonstrated by the fact that the setting up of one has usually followed close on the establishment of a number of community work posts in an area. Most of the big cities have had them since 1971.

Background Aesthetic medicine is a rapidly expanding field that is progressively becoming a normal part of society’s health and beauty regime. Hyaluronic Acid dermal filler injections are the second most widely performed aesthetic procedure, following Botulinum Toxin type A. Although serious complications are rare, they can have a detrimental impact on aesthetic outcome and general health. Infections following dermal fillers can be difficult to treat and have the potential to require hospital admission, intravenous antibiotics and surgical intervention. Case description We present a case of a 41-year-old female who suffered from facial cellulitis as a consequence of palpebro-malar groove dermal filler injections. The patient had 0.1ml of Monalisa dermal filler injected over her right malar prominence and suffered complications 6 days later, which eventually lead to the need for hospital admission on day 12 following the procedure for intravenous antibiotics. The management of this aesthetic procedure complication is outlined to highlight the risks and serious complications of these procedures. Conclusions Facial cellulitis is a rare adverse event following facial filler injection; however, it is an important risk factor to discuss during the consent process for these procedures. In addition, it is important that a highly trained and skilled professional performs these injections using a sterile non-touch technique due to the potential for serious complications and the anatomical proximity to vital structures.

Introduction Junior doctor changeover has been perceived as a period of increased risk to patients. However, there is a paucity of contemporary evidence into this ‘Changeover Effect’. The aim of this study was to evaluate the presence of an adverse patient effect during periods of junior doctor changeover. Method Data were requested on all patients aged 18 years or older admitted acutely under General Surgery in the North England between 2005-16. This included patient characteristics, diagnoses, co-morbidities, procedure codes, mortality and length of stay. Patients were included in the study if they were admitted during the ‘changeover week’; defined as the first day of the changeover followed by the six subsequent days. For junior trainees (FY1-CT2), this is the first Wednesday of August, December and April each year. For higher surgical trainees (ST3-8) the first Wednesday and October. Another week, four weeks prior, was chosen as a historical comparator. Results 61714 patients were included in this study. Patient characteristics did not vary between the cohorts. There was no difference in 30-day mortality between changeover and non-changeover groups (2.5% vs. 2.6%, p = 0.280) or length of stay (5.3 vs 5.2, p = 0.613). Changeover week was not a predictor of increased mortality (OR 1.06, p = 0.302) following multivariate adjustment. Further analysis of the first junior and higher specialty trainee periods, August and October respectively, showed no significant difference for measured outcomes. Conclusions This retrospective cohort study provides contemporary evidence that the ‘changeover effect’ does not exist in acute general surgical admissions in the UK.

Introduction Junior doctor changeover has been perceived as a period of increased risk to patients. However, there is a paucity of contemporary evidence of this ‘changeover effect’. The aim of this study was to evaluate the presence of an adverse patient effect during periods of junior doctor changeover. Methods Data were requested on all patients aged 18 years or older admitted acutely under General Surgery in the North of England between 2005 and 2016. This included patient characteristics, diagnoses, comorbidities, procedure codes, mortality and length of stay. Patients were included in the study if they were admitted during the ‘changeover week’; defined as the first day of the changeover followed by the six subsequent days. For junior trainees (FY1-CT2), this is the first Wednesday of August, December and April each year. For higher surgical trainees (ST3–ST8), it is the first Wednesday in October. Another week, four weeks prior, was chosen as a historical comparator. Results In total, 61,714 patients were included in this study. Patient characteristics did not vary between the cohorts. There was no difference in 30-day mortality between changeover and non-changeover groups (2.5% vs 2.6%, p = 0.280) or length of stay (5.3 vs 5.2, p = 0.613). Changeover week was not a predictor of increased mortality (OR 1.06, p = 0.302) following multivariable adjustment. Further analysis of the first junior and higher specialty trainee periods, August and October, respectively, showed no significant difference for measured outcomes. Conclusions This retrospective cohort study provides contemporary evidence that the ‘changeover effect’ does not exist in acute general surgical admissions in the UK.

Mosquito surveillance remains a cornerstone of pest and disease control operations globally but is strongly limited in scale by resources. The use of citizen science to upscale scientific data collection is commonplace, and mosquito surveillance programs have begun to make use of citizen scientists in several countries, particularly for exotic species detection. Here we report on a proof of concept trial in southern Australia for a citizen science mosquito surveillance program characterised by fixed point trapping with BG GAT devices and remote mosquito identification through emailed images, which we term 'e-entomology'. In a study with 126 participants, we detected mosquito seasonality with peak abundance in mid-summer (1.78 mosquitoes per trap per day), weather correlations (positive correlation with maximum temperature, r = 0.41) and a diversity of species (15 of 22 known species in the region) in a metropolitan setting. Whilst we demonstrated that the costs of a citizen science program is only about 20% of a comparable professional surveillance program, the mosquito community sampled by citizen scientists was biased towards container-inhabiting species, particularly Aedes notoscriptus. This is the first time fixed-point mosquito trapping has been combined with citizen science e-entomology to deliver comprehensive surveillance of urban mosquitoes. Refereed/Peer-reviewed

Chronic pain and restricted knee motion is a significant problem following the total knee arthroplasty (TKA). The molecular pathogenesis of pain post‐TKA is not known and no targeted therapeutic intervention is available. The aim of this study was to investigate whether pro‐inflammatory mediators are elevated in revision knee patients, indicating an active, ongoing inflammatory process that may contribute to pain. Twelve key markers (pro‐inflammatory cytokines granulocyte‐macrophage colony‐stimulating factor [GM‐CSF], interleukin 5 [IL‐5], IL‐8 and IL‐10, chemokines CCL2, CCL3, CCL4, and CCL13, mediators of angiogenesis Flt‐1, vascular endothelial growth factor, and cell migration vascular cell adhesion molecule 1 and intercellular adhesion molecule 1) were measured in knee tissue and synovial fluid (SF) from primary TKA (n = 29) and revision patients (n = 32). Indications for surgery were osteoarthritis (OA) for primary TKA, and component loosening (n = 11), stiffness (n = 11), laxity pattern (n = 8), or progression of OA in patella resurfacing (n = 3) for revision surgery. Pain levels (WOMAC score) were higher in revision than primary patients (p ≤ 0.05). Time from primary to revision ranged from 8 months to 30 years (median 10 years). All markers were elevated in revision TKA; there was no trend toward decreasing levels with greater time from primary surgery for any marker studied in SF. Similar results were seen in knee tissue. We found no differences comparing indications for revision surgery (p ≥ 0.05). The elevation of inflammatory mediators in painful post‐TKA knees requiring revision suggests active, chronic inflammation. Characterization of upregulated markers provides rationale for targeted therapy, even many years from the primary surgery. © 2019 The Authors. Journal of Orthopaedic Research ® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2316–2324, 2019

BACKGROUND: Whole-body MRI (WB-MRI) could be an alternative to multimodality staging of colorectal cancer, but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in colorectal cancer.METHODS: The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer. Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or polyp cancer. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs), and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN43958015, and is complete.FINDINGS: Between March 26, 2013, and Aug 19, 2016, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial; 68 (23%) had metastasis at baseline. Pathway sensitivity was 67% (95% CI 56 to 78) for WB-MRI and 63% (51 to 74) for standard pathways, a difference in sensitivity of 4% (-5 to 13, p=0·51). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (95% [95% CI 92-97]) and standard pathways (93% [90-96], p=0·48). Agreement with the multidisciplinary team's final treatment decision was 96% for WB-MRI and 95% for the standard pathway. Time to complete staging was shorter for WB-MRI (median, 8 days [IQR 6-9]) than for the standard pathway (13 days [11-15]); a 5-day (3-7) difference. WB-MRI required fewer tests (median, one [95% CI 1 to 1]) than did standard pathways (two [2 to 2]), a difference of one (1 to 1). Mean per-patient staging costs were £216 (95% CI 211-221) for WB-MRI and £285 (260-310) for standard pathways.INTERPRETATION: WB-MRI staging pathways have similar accuracy to standard pathways and reduce the number of tests needed, staging time, and cost.FUNDING: UK National Institute for Health Research.

Background/Aims Sport and Exercise Medicine (SEM) can play a key role to help manage the increasing demands on NHS Rheumatology and Musculoskeletal services. The ‘Complex MSK clinic’ has been developed as a combined consultant-led service staffed by Rheumatologists and Sport and Exercise Medicine (SEM) physicians at the Oxford University Hospitals. Patients referred from primary care to the rheumatology services were allocated to this clinic via an internal triage process. The aim of this project was to identify the spectrum of diagnoses and the epidemiological characteristics of patients seen in the clinic to help develop patient pathways, optimise patient care, and to showcase this collaborative approach Methods A retrospective analysis of the electronic patient record (EPR) of 194 consecutive patients attending the Complex MSK Clinic between 1 October and 30 November 2019 was performed. Patient age, reason for referral, length of time to appointment, prior investigations and treatment were all recorded, as were the primary/secondary diagnoses made, investigations requested, treatment provided and follow up arrangements. 16 patients had missing data or did not attend their appointment, leaving 178 patients that were included in the analysis. Results Mean age at appointment was 49 (range 17-90). 86.5% of all referrals were made by Oxfordshire GPs , with the main reason for referral being diagnostic uncertainty (78%). Almost 1 in 4 patients were given a primary diagnosis of osteoarthritis (23.6%), of which 64.3% involved the hands. Other prominent diagnoses included chronic pain syndrome/fibromyalgia (20.2%), mechanical pain (15.7%), and inflammatory arthritis or spondyloarthritis (14.0%). The most common further management was referral to physiotherapy services (46.1%), with 23.6% of patients offered additional medication and 11.2% a therapeutic injection. 104 (58%) patients were discharged after their first appointment, with 52 (29%) followed up in the complex MSK service and only 22 (12%) referred to another specialist clinic. Conclusion This report illustrates the spectrum of diagnoses seen within this unique service, highlighting a role for both Rheumatology and SEM within the same clinic. The low onward referral rate demonstrates appropriate triage and an efficient approach that is appropriate for this cohort of patients. It could reduce overall costs and patient journeys. Further work is required to streamline patient pathways, evaluate patient satisfaction and to determine whether the clinic is cost-effective and improves patient pathways. Disclosure J.A. Navarajasegaran: None. J. Betts: None. J. Baldock: None. A. Soni: None. R. Smith: None.

Chronic pain is highly prevalent and more common in people with chronic obstructive pulmonary disease (COPD) than people of similar age/sex in the general population. This systematic review aimed to describe how frequently and in which contexts pain is considered in the clinical practice guidelines (CPGs) for the broad management of COPD. Databases (Medline, Scopus, CiNAHL, EMbase, and clinical guideline) and websites were searched to identify current versions of COPD CPGs published in any language since 2006. Data on the frequency, context, and specific recommendations or strategies for the assessment or management of pain were extracted, collated, and reported descriptively. Of the 41 CPGs (English n = 20) reviewed, 16 (39%) did not mention pain. Within the remaining 25 CPGs, pain was mentioned 67 times (ranging from 1 to 10 mentions in a single CPG). The most frequent contexts for mentioning pain were as a potential side effect of specific pharmacotherapies (22 mentions in 13 CPGs), as part of differential diagnosis (14 mentions in 10 CPGs), and end of life or palliative care management (7 mentions in 6 CPGs). In people with COPD, chronic pain is common; adversely impacts quality of life, mood, breathlessness, and participation in activities of daily living; and warrants consideration within CPGs for COPD. Refereed/Peer-reviewed

Chronic obstructive pulmonary disease (COPD) is a progressive disease of the airways, underpinned by inflammation and worsening lung function. Omega-3 polyunsaturated fatty acids (n-3PUFA) can modulate inflammatory mechanisms and may therefore impact lung function in people with COPD. This observational, cross-sectional study of 577 adults in the Whyalla Intergenerational Study of Health (WISH), conducted during 2008–09 in regional South Australia, explored associations between fish and PUFA intakes (from food frequency questionnaires) and lung function (spirometry). It also included a nested case-control study which compared fish and PUFA intakes and plasma phospholipid PUFA levels between 40 people with COPD and 80 age-sex matched controls. In the whole population, linear regression models adjusted for age, sex, smoking status and education demonstrated a weak negative association between lung function (FEV1% predicted) and consumption of fried fish (OR -0.12, 95% CI -0.22, −0.01, P = 0.026) but not fish prepared by other cooking methods or estimated intakes of PUFA. There was no association between fish or PUFA intakes and COPD risk. Compared to age and sex matched controls, cases had poorer lung function and a higher rate of smoking prevalence but did not differ in their intakes of fish or PUFA or their PUFA levels in plasma phospholipids. In this sub-population, we found a marginally significant association between COPD risk and total long chain n-3PUFA levels in plasma phospholipids (OR 1.22 95% CI 1.00–1.49, P = 0.046). Given the relatively small number of cases in this analysis, this finding should be interpreted with caution, especially given the lack of association with other markers of n-3PUFA intake or status. Taken together, our data suggest that n-3PUFA intake and status are not determinants of improved lung function in this regional Australian population. Keywords: Lung function, Chronic obstructive pulmonary disease, COPD, Polyunsaturated fatty acid, PUFA

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In recent years, development of new technologies designed to enhance user experience have accelerated, often being used in modern media such as in films and games. Specifically, immersive experiences, such as virtual reality (VR) and augmented reality (AR), have redefined how digital media can be delivered, encouraging us to interact with and explore our environment. Reciprocally, as the power of these technologies has advanced, the associated costs to implement them have decreased, making them more cost-effective and feasible to deliver in a variety of settings. Despite the cost reduction, several issues remain with accessibility due to the knowledge base required to generate, optimise and deliver three-dimensional (3D)-digital content in both AR and VR. Here, we sought to integrate an AR-based experience into a level-4 biochemistry module in order to support the delivery of university lectures on protein structure and function. Traditionally, this topic would comprise two-dimensional still images of complex 3D structures. By combining a breadth of subject-specific and technological expertise from across the university, we developed an AR-enhanced learning experience hosted on the Zapworks AR platform. AR enabled full illustration of the complexity of these 3D structures, while promoting collaboration through a shared user experience. Assessing the impact of the AR experience via a formative test and survey revealed that despite only a modest increase in test performance, students overwhelmingly reported positively on the engaging nature and interactivity of AR. Critically, expanding our repertoire of content delivery formats will support the forward-thinking blended learning environments adopted across the higher education sector.

BackgroundPaediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common (prevalence 1%–2%). Two-thirds of children experience moderate or severe pain, which is associated with increased fatigue and poorer physical function. However, we do not know if treatment for CFS/ME improves pain.ObjectiveIdentify whether specialist treatment of paediatric CFS/ME improves pain.MethodsWe conducted a detailed search in MEDLINE, EMBASE, PsycINFO and the Cochrane Library. Two researchers independently screened texts published between 1994 and 24 January 2019 with no language restrictions. Inclusion criteria were (1) randomised controlled trials and observational studies; (2) participants aged ResultsOf 1898 papers screened, 26 studies investigated treatment for paediatric CFS/ME, 19 of which did not measure pain at any time point. Only five treatment studies measured pain at baseline and follow-up and were included in this review. None of the interventions were specifically targeted at treating pain. Of the included studies, two showed no improvement in pain scores, one suggested an improvement in one subgroup and two studies identified improvements in pain measures in ‘recovered’ patients compared with ‘non-recovered’ patients.ConclusionsDespite the prevalence and impact of pain in children with CFS/ME surprisingly few treatment studies measured pain. In those that did measure pain, the treatments used focused on overall management of CFS/ME and we identified no treatments that were targeted specifically at managing pain. There is limited evidence that treatment helps improve pain scores. However, patients who recover appear to have less pain than those who do not recover. More studies are needed to determine if pain in paediatric CFS/ME requires a specific treatment approach, with a particular focus on patients who do not recover following initial treatment.PROSPERO registration numberCRD42019117540.

This chapter discusses claims that the UK system of higher education faces a crisis of both legitimacy and adequate resources. Competing explanations for this possible ‘crisis’ are compared and placed in the context of changes to the funding and regulation of universities. At the beginning of the 2020s British higher education, and in particular its universities, have a problem of declining incomes together with rising demand from growth in numbers aged between 18 and 24. Before the impact of Covid 19 a high proportion of institutions were in financial difficulty and were reducing staff numbers. There had been growing criticism of universities, from within for becoming too managerialist, commercial and market-focussed, and from outside for failing to meet key needs of society and the economy; such as equality of access for those from minority or disadvantaged backgrounds, and the production of graduates with the skills required by employers. Some commentators have attributed these challenges to the recent strength of right-wing and populist forces, and ideas which question the role and usefulness of higher education and support for increased government control and regulation. The chapter argues instead that the current problems of universities are not new, but have a longer history, and largely be explained by incremental changes to the funding of higher education over the last seventy years.

Surf amenity can be significantly affected by coastal infrastructure and is a growing consideration for local governments. Quantitative assessment of the surf amenity of artificial reefs is also growing in interest. Surf amenity has been quantified using metrics derived from the surfable region near the breaking edge of a wave, defined as the ‘wave pocket’. Wave pocket tracking software has been developed to track potential surfing rides using computer vision. This software enabled a surf amenity assessment of the Rainbow Bay (QLD) ‘superbank’ during Cyclone Eusi and the Palm Beach artificial reef. The produced data revealed new insights into the surf amenity of natural and artificial surf locations.

The use of physics-based wave propagation predictions requires a considerable time commitment, a high level of expertise and extensive climate and reef data that are not always available when undertaking planning for management of coasts and coral reef ecosystems. Bayesian belief networks (BBNs) have at least three attributes that make them an excellent choice to communicate physics-based wave model predictions. First, BBNs subsume thousands of predictions to provide probabilistic outcomes. Second, by using prior probabilities, a practitioner can still obtain predictions of wave outcomes even when their knowledge of input parameters is incomplete. Third, BBNs can propagate evidence from outputs to inputs, which can be used to identify input conditions that are most likely to deliver a chosen outcome. These three attributes are tested and found to hold for a BBN developed for this purpose.

Research from the USA and Great Britain indicates that the number of fatal crashes (as well as the rates of crashes of all levels of injury and property damage) involving older drivers declined between approximately 1997 and 2010 despite increases in the number of older drivers on the road and in their driving exposure. Differing results have been found in Australian research with the number of older driver fatalities having been steady and even slightly increasing between 2004 and 2013. The present study further examined trends in the crash involvement of older drivers in Australia to determine whether their involvement has been increasing or decreasing, and how this compares to trends for younger aged drivers. Crash, injury, population and licensure data were examined by age group for the years 2003-2012. There were increases in the population and licensure of drivers aged 65 years and older, while the total crashes, serious injuries, and fatalities remained steady for drivers aged 65-84 and increased for the oldest group (85+) between 2003 and 2012. Increasing trends were also found for drivers 85 and older for rates of serious or fatal injuries per head of population and per licensed driver. Population and licensure among younger age groups also increased but their crash numbers and crash rates remained steady or declined. The stable or slightly increasing fatal crash involvement of older drivers in Australia contrasts with the declining trends in the USA and Great Britain. Therefore, greater attention should be given to the road safety of older drivers in Australia.

Motor-vehicle collisions are the leading cause of unintentional injury and death in children in many parts of the world, including Europe, North America and Australia. The number of fatal collisions has decreased considerably in countries where safety measures such as child restraints, seat belts and air bags have been introduced, providing protection for children within vehicles, although it is recognised that there have been concomitant improvements in emergency responses and techniques, and in hospital treatments. Helmets and changes in external vehicle designs have been implemented to protect paediatric pedestrians and cyclists. However, despite the development of safety guidelines and technologies, injuries still occur. This paper provides an overview of the role of motor-vehicle collisions in paediatric morbidity and mortality to analyse the nature and aetiology of common fatal and non-fatal injuries in children that may present for forensic assessment as passengers, pedestrians or cyclists.

Australian agriculture is dominated by rainfed cropping in environments where evaporative demand greatly exceeds annual rainfall. In this paper we review field measurements of crop transpiration and bare soil evaporation under rainfed grain crops, and crop transpiration efficiencies. Crop transpiration is typically calculated from the difference between evapotranspiration and bare soil evaporation, however, while the former is readily measured, the latter is difficult to obtain. For wheat we found only 19 studies which measured the critical water balance parameters of bare soil evaporation and crop transpiration in Australia, and very many fewer for other crops. From the studies reported for wheat, on average 38% of evapotranspiration was lost to direct soil evaporation. Data for other crops are insufficient to ascertain whether they are similar or different to wheat in terms of the relative contributions of Es and T to the water balance. Although it may have occurred in practice, we can find no field measurements of the crop water balance to demonstrate an increase in crop transpiration at the expense of bare soil evaporation as a function of improvements in agronomic practices in recent decades. Although it is thought that crop transpiration efficiencies are primarily a function of vapour pressure deficit, transpiration efficiencies reported in the literature vary considerably within crops, even after accounting for vapour pressure deficit. We conclude that more reliable estimates of crop transpiration efficiency would be highly valuable for calculating seasonal transpiration of field grown crops from shoot biomass measurement, and provide an fruitful avenue for exploring water use efficiency of grain crops.

To determine whether age and neuropeptide Y (NPY) were involved in the skeletal response to extended periods of diet-induced obesity. Male wild-type (WT) and NPY null (NPYKO) mice were fed a mild (23% fat) high-fat diet for 10 weeks from 6 or 16 weeks of age. Metabolism and bone density were assessed during feeding. Skeletal changes were assessed by microCT and histomorphometry. High-fat feeding in 6-week-old WT mice led to significantly increased body weight, adiposity and serum leptin levels, accompanied with markedly suppressed cortical bone accrual. NPYKO mice were less susceptible to fat accrual but, importantly, displayed a complete lack of suppression of bone accrual or cortical bone loss. In contrast, when skeletally mature (16 week old) mice underwent 10 weeks of fat feeding, the metabolic response to HFD was similar to younger mice, however bone mass was not affected in either WT or NPYKO. Thus, growing mice are particularly susceptible to the detrimental effects of HFD on bone mass, through suppression of bone accrual involving NPY signalling. This study provides new insights into the relationship between the opposing processes of a positive weight/bone relationship and the negative ‘metabolic’ effect of obesity on bone mass. This negative effect is particularly active in growing skeletons, which have heightened sensitivity to changes in obesity. In addition, NPY is identified as a fundamental driver of this negative ‘metabolic’ pathway to bone.

Background: Cortical bone is a significant determinant of bone strength and its deterioration contributes to bone fragility. Thin cortices and increased cortical porosity have been noted in patients with chronic kidney disease (CKD), but the “Turnover Mineralization Volume” classification of renal osteodystrophy does not emphasize cortical bone as a key parameter. We aimed to assess trabecular and cortical bone microarchitecture by histomorphometry and micro-CT in patients with CKD G5 and 5D (dialysis). Methods: Transiliac bone biopsies were performed in 14 patients undergoing kidney transplantation (n = 12) and parathyroidectomy (n = 2). Structural parameters were analysed by histomorphometry and micro-CT including trabecular bone volume, thickness (TbTh), number (TbN) and separation and cortical thickness (CtTh) and porosity (CtPo). Indices of bone remodelling and mineralisation were obtained and relationships to bone biomarkers examined. Associations were determined by Spearman’s or Pearson’s rank correlation coefficients. Results: By micro-CT, trabecular parameters were within normal ranges in most patients, but all patients showed very low CtTh (127 ± 44 µm) and high CtPo (60.3 ± 22.5%). CtPo was inversely related to TbN (r = –0.56; p = 0.03) by micro-CT and to TbTh (r = –0.60; p = 0.024) by histomorphometry and correlated to parathyroid hormone values (r = 0.62; p = 0.021). By histomorphometry, bone turnover was high in 50%, low in 21% and normal in 29%, while 36% showed abnormal patterns of mineralization. Significant positive associations were observed between osteoblast surface, osteoclast surface, mineralization surface and bone turnover markers. Conclusions: Deterioration of cortical ­microarchitecture despite predominantly normal trabecular parameters reinforces the importance of comprehensive cortical evaluation in patients with CKD.

Purpose: The main goal in treating knee osteoarthritis (OA) is providing symptom relief, with a continued focus on easing joint pain and enabling mobility, in order for patients to go about daily activity. With the COVID-19 pandemic having impacted healthcare systems and regimes globally, the aim of this study is to understand how treatment management of knee OA patients and prescribing behavior across US healthcare professionals (HCPs) was affected, and how they adapt towards a potential ‘new norm’ in treating this condition. Methods: A cross-sectional chart review survey was conducted in both Q2 2019 and Q2 2020 among US board-certified rheumatologists (rheums), orthopedic surgeons (orthos), primary care physicians with a focus in sports medicine (SM PCPs), and pain specialists, all practicing across hospital and private practices. Recruited from a large access panel, physicians were screened for duration of practice in their specialty (3-50 years) and caseload (35 or more knee OA patients personally managed, at least 10 of which must be classified as moderate-severe). Participants were asked to complete a 3-part online survey: (1) a doctor demographic questionnaire, (2) a perceptual questionnaire, assessing perception of available and upcoming OA therapies, and (3) patient record charts for the next 5 knee OA patients seen following receipt of the survey, capturing demographics and treatment history. Data were analyzed using descriptive statistics. Results: The total number of sampled physicians recruited in this survey with their reported patient totals are stated in Table 1. [Formula presented] When focusing on the current prescription medication reported patients are receiving, oral medications, particularly NSAIDs, are widely used, regardless of the physician specialty. Here we see a directional increase in the proportion of reported patients deriving from sampled primary care SM PCPs from pre-COVID (Q219) to during COVID (Q220) (not statistically significantly different), whilst the same is not true for the other three secondary care sampled specialties, namely rheums, orthos and pain specialists (not statistically significantly different) - see Fig. 1. [Formula presented] [Formula presented] [Formula presented] Conclusions: From the sample surveyed, it appears that primary care SM PCPs adopted their treatment adjustment during COVID-19 pandemic differently, by prescribing more orals while other secondary care physicians (rheums, orthos, pain specialists) focused on injection treatment for longer pain relief. Considering movement restrictions and limited elective surgeries during the pandemic, the lack of targeted treatment options for knee OA has been made more apparent. With a burgeoning pipeline, many of which are targeted therapies, it is hopeful that knee OA treaters will be less reliant on symptom remedies and can readily offer patients’ longer-acting pain relief or disease modifying options to combat joint deterioration.