Negotiating Value: Comparing Human and Animal Fracture Care in Industrial Societies

At the beginning of the twentieth-century, human and veterinary surgeons faced the challenge of a medical marketplace transformed by technology. The socio-economic value ascribed to their patients – people and domestic animals – was changing, reflecting the increasing mechanisation of industry and the decreasing dependence of society upon non-human animals for labour. In human medicine, concern for the economic consequences of fractures “pathologised” any significant level of post-therapeutic disability, a productivist perspective contrary to the traditional corpus of medical values. In contrast, veterinarians adapted to the mechanisation of horse-power by shifting their primary professional interest to companion animals; a type of veterinary patient generally valued for the unique emotional attachment of the owner, and not the productive capacity of the animal. The economic rationalisation of human fracture care and the “sentimental” transformation of veterinary orthopaedic expertise indicates how these specialists utilised increasingly convergent rhetorical arguments to justify the application of innovative fracture care technologies to their humans and animal patients. Keywords: Fracture care, Industrialisation, Veterinary History, Human/animal relation

Role of radiography, MRI and FDG-PET/CT in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma

Multiple myeloma is a malignant B-cell neoplasm that involves the skeleton in approximately 80% of the patients. With an average age of 60 years and a 5-years survival of nearly 45% Brenner et al. (Blood 111:2516–2520, 35) the onset is to be classified as occurring still early in life while the disease can be very aggressive and debilitating. In the last decades, several new imaging techniques were introduced. The aim of this review is to compare the different techniques such as radiographic survey, multidetector computed tomography (MDCT), whole-body magnetic resonance imaging (WB-MRI), fluorodeoxyglucose positron emission tomography- (FDG-PET) with or without computed tomography (CT), and 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy. We conclude that both FDG-PET in combination with low-dose CT and whole-body MRI are more sensitive than skeleton X-ray in screening and diagnosing multiple myeloma. WB-MRI allows assessment of bone marrow involvement but cannot detect bone destruction, which might result in overstaging. Moreover, WB-MRI is less suitable in assessing response to therapy than FDG-PET. The combination of PET with low-dose CT can replace the golden standard, conventional skeletal survey. In the clinical practise, this will result in upstaging, due to the higher sensitivity

INSTITUTIONAL ISSUES AND STRATEGIES FOR SUSTAINABLE AGRICULTURE: VIEW FROM WITHIN THE LAND-GRANT UNIVERSITY

Sustainable agricultural research and education have gained acceptability within the land-grant system in less than a decade, an impressive change. Attitudes were changed by a set of forces which include lobbying by sustainable agriculture advocates, requests from farmers as a result of the cost-price squeeze of the early 1980's, changing demands for both environmental quality and less pesticide residues from food consumers, and the availability of new funding sources. Despite its hard-won acceptability, there are tensions with respect to sustainable agriculture within the land-grant system. Sustainable agricultural issues are not yet integrated into the fabric of the land-grant institution. In order to integrate it fully, challenges remain in three key areas: knowledge generation, research and education, and funding. The challenge to generate new knowledge embraces not only biological and ecological systems, but also the socioeconomic systems of the humans who manage agriculture. We must move beyond anecdotal evidence of biological integration efficiencies to scientific understanding of the underlying processes and opportunities for human intervention. The biological research agenda covers a plethora of plant-animal-environment interactions from the microbial level on upward. Socioeconomic research must grapple with human motivations to change farming methods, as well as the likely impacts of change on farmers, consumers, other species, and the quality of the environment in which we live. One important area for such knowledge-generation is the relative merits of government policy tools, which have been and will continue to be central to environmental quality assurance. Attempts to generate new sustainable agriculture knowledge have already begun to raise new challenges for the integration of research and education. Research trials conducted off the research station pose new quandaries for scientific analysis and validation. Having farmers set the research and outreach agenda can be threatening to land-grant personnel as the old distinction between research and extension begins to dissolve. This situation is complicated by the budgetary stress on land-grant institutions and uncertainty about the dividing line between public and private responsibilities in a rapidly changing agricultural business environment. Funding is the third area where more integration into the land-grant university is needed. Earmarked funding for sustainable agriculture has helped to legitimize it in the land-grant university. But earmarked funding is a two-edged sword. If sustainable agriculture fails to become integrated into the routine land-grant agenda for research and education, it will lose its newly gained momentum if those funds disappear. It needs to gain full acceptance as legitimate science that will allow its researchers to compete for "mainline" funding sources such as the USDA National Research Initiative grants. Sustainable agriculture has made strong gains within the land-grant university system. But it can easily slip from the land-grant agenda or become co-opted if sustainable agriculture research and education are not integrated further into the system while retaining a clear focus on its original goals