The wear behaviour of ion implanted biomaterials

The tribological performance of biomaterials used for artificial joints is of much importance, and require low coefficients of friction, resistance to wear and the ability to withstand many millions of cycles under a multitude of loading regimes. Currently used material combinations include Ti6A14V, 316L stainless steel and Co-Cr-Mo articulating against UHMWPE. Although typical wear rates are low (60 mm(^3)/10(^6) cycles), the UHMWPE wear debris produced during articulation has been linked to osteolysis, leading to loosening of prostheses and necessitating revision surgery. This study aimed to characterise the surfaces and quantitatively assess the tribological performance of such biomaterials when surface modified by N(^+) ion implantation. Beyond this, investigation of the physical effects of the N(^+) ion implantations were carried out with a view to determination of an optimum ion implantation protocol. The tribological performance of the materials, were quantitatively assessed using multidirectional pin-on-plate wear testing. Surface characterisation of the materials, were studied using a combination of optical microscopy, AFM, non-contacting interferometry, SEM, and XPS. A significant increase in the surface microhardness of the modified materials was measured post ion implantation. This was attributed to the formation of ion implantation induced lattice disorder and hard phase nitride precipitates on the metallic surfaces, and cross-linking incorporating new formed chemical bonds on the polymeric surfaces. N(^+) ion implantation with 5 x 10(^15) N(^+)ions/cm(^2) significantly enhanced the wear resistance of UHMWPE by ≈ 55 % when articulated against 2 x lO(^17) N(^+) ions/cm(^2) implanted Ti6A14V; by ≈ 48 % when articulated against 2 x lO(^17) N(^+) ions/cm(^2) implanted stainless steel; and by ≈ 48 % when articulated against 2 x 10(^17) N(^+) ions/cm^ implanted Co-Cr-Mo. The technique of ion implantation offers potential as a modification method, to improve wear resistance of these biomaterials for articulating applications such as in total joint replacement

Investigating ramp gradients for humps on railway platforms

Horizontal and vertical gaps between the train and the platform are a major safety concern for railway passengers, especially for disabled passengers. London Underground is implementing a programme to install platform humps to remove vertical differences between the train and the platform. In order to properly design platform humps, this study empirically investigated the effects of the design factors of the ramps, namely the slope and cross-fall gradients, on disabled passengers. The investigation consisted of two experiments: one where 20 participants were asked to walk on simulated slopes, and the other where 25 participants were asked to board or alight from the simulated train from or onto the slopes. The slope gradients tested were 3·0% (1:33), 5·2% (1:19) and 6·9% (1:14) with the cross-fall gradients 1·5% (1:67), 2·0% (1:50) and 2·5% (1:40). The results showed that the slope gradient does not largely affect the participants’ performance of longitudinal walking on the slopes or their subjective safety evaluation, but would cause additional difficulty for them to board/alight from the train from/onto the slope. This suggests that train doors should not stop next to the ramp. There was little evidence concerning the effects of the cross-fall gradient. The results provide useful information for designing platform humps

Navigational cue effects in Alzheimer's disease and posterior cortical atrophy.

OBJECTIVE: Deficits in spatial navigation are characteristic and disabling features of typical Alzheimer's disease (tAD) and posterior cortical atrophy (PCA). Visual cues have been proposed to mitigate such deficits; however, there is currently little empirical evidence for their use. METHODS: The effect of visual cues on visually guided navigation was assessed within a simplified real-world setting in individuals with tAD (n = 10), PCA (n = 8), and healthy controls (n = 12). In a repeated-measures design comprising 36 trials, participants walked to a visible target destination (an open door within a built environment), with or without the presence of an obstacle. Contrast and motion-based cues were evaluated; both aimed to facilitate performance by applying perceptual changes to target destinations without carrying explicit information. The primary outcome was completion time; secondary outcomes were measures of fixation position and walking path directness during consecutive task phases, determined using mobile eyetracking and motion capture methods. RESULTS: Results illustrate marked deficits in patients' navigational ability, with patient groups taking an estimated two to three times longer to reach target destinations than controls and exhibiting tortuous walking paths. There were no significant differences between tAD and PCA task performance. Overall, patients took less time to reach target destinations under cue conditions (contrast-cue: 11.8%; 95% CI: [2.5, 20.3]) and were more likely initially to fixate on targets. INTERPRETATION: The study evaluated navigation to destinations within a real-world environment. There is evidence that introducing perceptual changes to the environment may improve patients' navigational ability

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BackgroundEstimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period.Methods22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.FindingsGlobal all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.InterpretationGlobal adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic