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The Journey-I total knee replacement was designed to improve knee kinematics but had several complications including early dislocation. The Journey-II modification was introduced to reduce these while maintaining high function. To assess whether the modified Journey-II prosthesis has succeeded in its designers aims, we undertook an observational study of prospectively recorded data to analyze and compare the two knees. A total of 217 Journey-I and 129 Journey-II knees were identified from the department's prospectively collated registry and were assessed at 1 year by a comparative statistical analysis using numerous factors including pain, functional activity, physical assessment, Short Form-12 (SF-12), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Oxford scores. The statistical tests included Chi-square, Wilcoxon's rank and Mann–Whitney U-tests with the level of significance set at p

Sydney’s Harbour is an integral part of the city providing natural, social, and economic benefits to 4.84 million residents. It has significant environmental value including a diverse range of habitats and animals. A range of anthropogenic and environmental pressures threatens these including loss and modification of habitats, oversupply of nutrients and introduction of pollutants such as metals, organics, and microplastics, introduction of non-indigenous species and the impacts of recreational fishing. Many people now recognise not only the environmental value of Sydney Harbour, but also the economic and social benefits a healthy harbour provides. Over 80% of residents recognise the importance of maintaining a pollution-free coastal environment and conserving the Harbour’s abundant and diverse marine life. A recent review gathered information to make some first estimates of economic revenues and values associated with Sydney Harbour. Port and maritime revenues ($430 million/yr), ferries ($175 million/yr), cruise ship expenditure ($1025 million/yr), major foreshore events such as New Year’s Eve and the Sydney Festival ($400 million/yr), and also income from culture, heritage, arts and science (over $33 million/yr) inject considerable funds into the Australian economy. Notably, proximity to the harbour enhances Sydney domestic real estate capital by an estimated $40 billion, equivalent to $3775 million/yr and biological ecosystem services were valued at $175 million/yr. Here we provide i) a synthesis of our current understanding of the natural, social, and economic resources of Sydney Harbour, ii) the threats and pressures these resources face, and finally iii) how a new marine management framework is being used to address these threats to the natural, social and economic wellbeing of Sydney Harbour. This review clearly shows that Sydney Harbour is a valuable and valued environment that deserves continuing scientific, social, and economic research to support management now and in the future.

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Although much work has been done to predict the effects of hypoxia (dissolved oxygen < 2 mg l−1) at regional scales, individual estuaries consist of a patchwork of micro-environments that can have different responses. We followed the effects of extended dissolved oxygen (DO) depletion on benthic fluxes of CO2, O2, NO3 −, NH4 +, N2, PO4 3− and Fe from estuarine sediments from 3 shallow sites with different macrofauna communities and levels of organic enrichment. DO depletion was achieved by a prolonged (40 d) dark incubation of sealed sediment cores. There were no discernible differences in NO3 − and N2 fluxes between sites, but the effects of hypoxia on sediment metabolism, and on bioavailable nutrient release, NH4 + and PO4 3−, were modified by the initial macrofauna communities. The DO in cores containing sediments from a site dominated by small epifauna declined significantly faster than in cores containing a greater portion of burrowing infauna; burrows may provide an oxic reservoir within the sediments. Macrofauna mortality led to a more rapid efflux of mineralization products (CO2, NH4 + and PO4 3−) in the epifaunadominated sites, as the small surface-dwelling animals decomposed more quickly. However, the cores were sealed, preventing migration of mobile epifauna away from the hypoxic conditions. The site with the lowest abundance of macrofauna also contained a large amount of refractory organic matter. Decomposition of this material was slow, with little release of nutrients. The study highlights the fact that environmental patchiness can modify the effects of hypoxia and stresses the importance of deeper burrowing fauna as a buffer against declining DO conditions.

Nutrient inputs to estuarine and coastal waters worldwide are increasing and this in turn is increasing the prevalence of eutrophication and hypoxic and anoxic episodes in these systems. Many urbanised estuaries are also subject to high levels of anthropogenic metal contamination. Environmental O(2) levels may influence whether sediments act as sinks or sources of metals. In this study we investigated the effect of an extended O(2) depletion event (40 days) on fluxes of trace metals (and the metalloid As) across the sediment-water interface in sediments from a highly metal contaminated estuary in S.E. Tasmania, Australia. We collected sediments from three sites that spanned a range of contamination and measured total metal concentration in the overlying water using sealed core incubations. Manganese and iron, which are known to regulate the release of other divalent cations from sub-oxic sediments, were released from sediments at all sites as hypoxia developed. In contrast, the release of arsenic, cadmium, copper and zinc was comparatively low, most likely due to inherent stability of these elements within the sediments, perhaps as a result of their refractory origin, their association with fine-grained sediments or their being bound in stable sulphide complexes. Metal release was not sustained due to the powerful effect of metal-sulphide precipitation of dissolved metals back into sediments. The limited mobilisation of sediment bound metals during hypoxia is encouraging, nevertheless the results highlight particular problems for management in areas where hypoxia might occur, such as the release of metals exacerbating already high loads or resulting in localised toxicity.

Biodiversity conservation is a major issue in ports and harbours as scientists, managers and the public become increasingly aware of the importance of healthy ecosystems to the wellbeing of urban populations. Sydney’s Harbour provides essential environmental, social and economic values to community, government and industry. Recent systematic reviews of the biological and physical characteristics of Sydney Harbour revealed high environmental and conservation value, especially considering the large numbers of people using its resources. However, like many coastal areas, the harbour has been subject to stressors such as habitat loss, metal, organic and nutrient pollution, the introduction of non-indigenous species, foreshore construction and commercial and recreational fishing. Here we outline the environmental assets of the harbour and the major threats, and report on current and developing conservation strategies. By learning about the progress of environmental management in Sydney Harbour, the difficulties faced and new planning strategies implemented, coastal and harbour environmental managers within the region can be better prepared when faced with similar challenges.

We investigated the effects of the burrowing cirratulid polychaete Cirriformia filigera (Delle Chiaje, 1828) on benthic respiration and nitrogen regeneration in metal-contaminated estuarine sediments using laboratory mesocosms. C. filigera is a dominant component of assemblages in the most severely contaminated sediments within the Derwent estuary, southern Australia. In the presence of C. filigera sediment O2 consumption doubled, with approximately 55% of this increase due to their respiration and the remaining 45% attributable to oxidation reactions and increased microbial respiration associated with burrow walls. Combined NO3 and NO2 fluxes were unaffected. The addition of labile organic matter did not affect benthic fluxes, in the presence or absence of C. filigera, presumably due to the short timeframe of the experiment and naturally enriched test sediments. The results suggest that a combination of tolerance and burrowing activity enables this species to provide an ecosystem service in the removal of N from contaminated sites.

Virginia Woolf wrote novels, essays, biography, diaries, and letters. She also wrote at least forty-five short narratives. Amid the brilliant richness of the other work, however, the short pieces lie neglected. They are said, even by Woolf herself, to hint at the accomplishments of the novels.

Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine.

Excerpt To the editor: Students of the humanities are indebted to Kenneth S. Warren for his attempt to spot the "mirages" of medical humanities education (1). It is especially interesting that medi...