Knee osteoarthritis is a bilateral disease

Knee osteoarthritis (OA) is a common cause of pain and disability. Patients often complain that they overload the other limb when they walk, resulting in disease in the unaffected knee. However, it is unknown whether this happens or the mechanism by which it occurs. Data was analysed from an established longitudinal cohort study to examine the development of bilateral knee OA. One hundred and forty-three subjects were examined over a 12 year period with bilateral radiographs. Bilateral knee osteoarthritis was found to be very common over time, and the majority of individuals with unilateral knee OA eventually developed bilateral disease. A gait analysis study was performed on 20 subjects with unilateral knee OA awaiting arthroplasty surgery and 20 healthy age equivalent controls. Abnormal moments and muscle co-contractions were observed in the other knee and hips when they walked due a characteristic slow, cautious, stiff-legged gait pattern. Fifteen subjects re-attended 12 months following their surgery. Whilst moments returned to normal in most of the replaced knees, they remained elevated at the contra-lateral side and co-contraction failed to recover in either knee. A novel study design is presented to examine the effect of gait-derived loading waveforms on fresh human osteochondral plugs. By applying mechano-biology techniques and Finite Element Modelling to fresh human tissue, new observations vi can be made about the relationship between in-vivo loading and cartilage mechano-biology. A characteristic gait pattern was observed in knee OA which is not simply antalgic but tends towards symmetry, with an increase in joint loading bilaterally. The observed gait behaviour does not resolve, despite arthroplasty of the affected joint. This would be expected to contribute to the development of disease in an inherently vulnerable joint. Additional training may have a role to play in restoring normal biomechanics and protecting the other knee from disease

Making too much of a weak case

LetterB E Christopher Nordin, Robin M Daly, John Horowitz, Andrew V Metcalf

Which osteoarthritic gait features recover following total knee replacement surgery?

Background Gait analysis can be used to measure variations in joint function in patients with knee osteoarthritis (OA), and is useful when observing longitudinal biomechanical changes following Total Knee Replacement (TKR) surgery. The Cardiff Classifier is an objective classification tool applied previously to examine the extent of biomechanical recovery following TKR. In this study, it is further developed to reveal the salient features that contribute to recovery towards healthy function. Methods Gait analysis was performed on 30 patients before and after TKR surgery, and 30 healthy controls. Median TKR follow-up time was 13 months. The combined application of principal component analysis (PCA) and the Cardiff Classifier defined 18 biomechanical features that discriminated OA from healthy gait. Statistical analysis tested whether these features were affected by TKR surgery and, if so, whether they recovered to values found for the controls. Results The Cardiff Classifier successfully discriminated between OA and healthy gait in all 60 cases. Of the 18 discriminatory features, only six (33%) were significantly affected by surgery, including features in all three planes of the ground reaction force (p<0.001), ankle dorsiflexion moment (p<0.001), hip adduction moment (p = 0.003), and transverse hip angle (p = 0.007). All but two (89%) of these features remained significantly different to those of the control group after surgery. Conclusions This approach was able to discriminate gait biomechanics associated with knee OA. The ground reaction force provided the strongest discriminatory features. Despite increased gait velocity and improvements in self-reported pain and function, which would normally be clinical indicators of recovery, the majority of features were not affected by TKR surgery. This TKR cohort retained pre-operative gait patterns; reduced sagittal hip and knee moments, decreased knee flexion, increased hip flexion, and reduced hip adduction. The changes that were associated with surgery were predominantly found at the ankle and hip, rather than at the knee

Cosmic cookery : making a stereoscopic 3D animated movie.

This paper describes our experience making a short stereoscopic movie visualizing the development of structure in the universe during the 13.7 billion years from the Big Bang to the present day. Aimed at a general audience for the Royal Society's 2005 Summer Science Exhibition, the movie illustrates how the latest cosmological theories based on dark matter and dark energy are capable of producing structures as complex as spiral galaxies and allows the viewer to directly compare observations from the real universe with theoretical results. 3D is an inherent feature of the cosmology data sets and stereoscopic visualization provides a natural way to present the images to the viewer, in addition to allowing researchers to visualize these vast, complex data sets. The presentation of the movie used passive, linearly polarized projection onto a 2m wide screen but it was also required to playback on a Sharp RD3D display and in anaglyph projection at venues without dedicated stereoscopic display equipment. Additionally lenticular prints were made from key images in the movie. We discuss the following technical challenges during the stereoscopic production process; 1) Controlling the depth presentation, 2) Editing the stereoscopic sequences, 3) Generating compressed movies in display speci¯c formats. We conclude that the generation of high quality stereoscopic movie content using desktop tools and equipment is feasible. This does require careful quality control and manual intervention but we believe these overheads are worthwhile when presenting inherently 3D data as the result is signi¯cantly increased impact and better understanding of complex 3D scenes

Inequity in access to transplantation in the UK

Background and objectives Despite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns. Design, setting, participants, & measurements In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study were analyzed to assess preemptive listing (n=2676) and listing within 2 years of starting dialysis (n=1970) by center. Results Seven hundred and six participants (26%) were listed preemptively, whereas 585 (30%) were listed within 2 years of commencing dialysis. The interquartile range across centers was 6%–33% for preemptive listing and 25%–40% for listing after starting dialysis. Patient factors, including increasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, were associated with a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants were both associated with reduced access to preemptive listing; however Asian participants were associated with a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) were associated with higher preemptive listing, whereas using a written protocol was associated negatively with listing within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9). Conclusions Patient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, with practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system

759–5 Use of an Interactive Electronic Whiteboard to Teach Clinical Cardiology Decision Analysis to Medical Students

We used innovative state-of-the-art computer and collaboration technologies to teach first-year medical students an analytic methodology to solve difficult clinical cardiology problems to make informed medical decisions. Clinical examples included the decision to administer thrombolytic therapy considering the risk of hemorrhagic stroke, and activity recommendations for athletes at risk for sudden death. Students received instruction on the decision-analytic approach which integrates pathophysiology, treatment efficacy, diagnostic test interpretation, health outcomes, patient preferences, and cost-effectiveness into a decision-analytic model.The traditional environment of a small group and blackboard was significantly enhanced by using an electronic whiteboard, the Xerox LiveBoard™. The LiveBoard features an 80486-based personal computer, large (3’×4’) display, and wireless pens for input. It allowed the integration of decision-analytic software, statistical software, digital slides, and additional media. We developed TIDAL (Team Interactive Decision Analysis in the Large-screen environment), a software package to interactively construct decision trees, calculate expected utilities, and perform one- and two-way sensitivity analyses using pen and gesture inputs. The Live Board also allowed the novel incorporation of Gambler, a utility assessment program obtained from the New England Medical Center. Gambler was used to obtain utilities for outcomes such as non-disabling hemorrhagic stroke. The interactive nature of the LiveBoard allowed real-time decision model development by the class, followed by instantaneous calculation of expected utilities and sensitivity analyses. The multimedia aspect and interactivity were conducive to extensive class participation.Ten out of eleven students wanted decision-analytic software available for use during their clinical years and all students would recommend the course to next year's students. We plan to experiment with the electronic collaboration features of this technology and allow groups separated by time or space to collaborate on decisions and explore the models created

Taphonomy of Biosignatures in Microbial Mats on Little Ambergris Cay, Turks and Caicos Islands

Microbial mats are taxonomically and metabolically diverse microbial ecosystems, with a characteristic layering that reflects vertical gradients in light and oxygen availability. Silicified microbial mats in Proterozoic carbonate successions are generally interpreted in terms of the surficial, mat building community. However, information about biodiversity in the once-surface-layer can be lost through decay as the mats accrete. To better understand how information about surface microbial communities is impacted by processes of decay within the mat, we studied microbial mats from Little Ambergris Cay, Turks and Caicos Islands. We used molecular techniques, microscopy and geochemistry to investigate microbial mat taphonomy – how processes of degradation affect biological signatures in sedimentary rocks, including fossils, molecular fossils and isotopic records. The top < 1 cm of these mats host cyanobacteria-rich communities overlying and admixed with diverse bacterial and eukaryotic taxa. Lower layers contain abundant, often empty, sheaths of large filamentous cyanobacteria, preserving their record as key mat-builders. Morphological remains and free lipid biomarkers of several bacterial groups, as well as diatoms, arthropods, and other eukaryotes also persist in lower mat layers, although at lower abundances than in surface layers. Carbon isotope signatures of organic matter were consistent with the majority of the biomass being sourced from CO2-limited cyanobacteria. Porewater sulfide sulfur isotope values were lower than seawater sulfate sulfur isotope values by ∼45–50‰, consistent with microbial sulfate reduction under sulfate-replete conditions. Our findings provide insight into how processes of degradation and decay bias biosignatures in the geological record of microbial mats, especially mats that formed widely during the Proterozoic (2,500–541 million years ago) Eon. Cyanobacteria were the key mat-builders, their robust and cohesive fabric retained at depth. Additionally, eukaryotic remains and eukaryotic biosignatures were preserved at depth, which suggests that microbial mats are not inherently biased against eukaryote preservation, either today or in the past

Engineering standards for trauma and orthopaedic implants worldwide : a systematic review protocol

Introduction Despite multiple scandals in the medical implant sector, premarket testing has been the attention of little published research. Complications related to new devices, such as the DePuy Articular Surface Replacement (ASR, DePuy Synthes, USA), have raised the issue of how designs are tested and whether engineering standards remain up to date with our understanding of implant biomechanics. Despite much work setting up national joint registries to improve implant monitoring, there have been few academic studies examining the premarket engineering standards new implants must meet. Emerging global economies mean that the markets have changed, and it is unknown to what degree engineering standards vary around the world. Governments, industry and independent regulatory bodies all produce engineering standards; therefore, the comparison of surgical implants across different manufacturers and jurisdictions is difficult. In this review, we will systematically collate and compare engineering standards for trauma and orthopaedic implants around the world. This will help inform patient, hospital and surgeon choice and provide an evidence base for future research in this area. Methods and analysis This protocol is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. We will conduct a systematic review of trauma and orthopaedic engineering standards from four main sources of information as identified in our preliminary scoping searches: governments, industry, independent regulatory bodies and engineering and medical publications. Any current standard relevant to trauma and orthopaedic implants will be included. We will use a predefined search strategy and follow the recommendations of the Cochrane handbook where applicable. We will undertake a narrative synthesis with qualitative evaluation of homogeneity between engineering standards. Ethics and dissemination No ethics approval is required as no primary data are being collected. The results will be made available by peer-reviewed publication and reported according to PRISMA-P guidelines

Wine Terroir and the Soil Bacteria: An Amplicon Sequencing-Based Assessment of the Barossa Valley and Its Sub-Regions

A wines’ terroir, represented as wine traits with regional distinctiveness, is a reflection of both the biophysical and human-driven conditions in which the grapes were grown and wine made. Soil is an important factor contributing to the uniqueness of a wine produced by vines grown in specific conditions. Here, we evaluated the impact of environmental variables on the soil bacteria of 22 Barossa Valley vineyard sites based on the 16S rRNA gene hypervariable region 4. In this study, we report that both dispersal isolation by geographic distance and environmental heterogeneity (soil plant-available P content, elevation, rainfall, temperature, spacing between row and spacing between vine) contribute to microbial community dissimilarity between vineyards. Vineyards located in cooler and wetter regions showed lower beta diversity and a higher ratio of dominant taxa. Differences in soil bacterial community composition were significantly associated with differences in fruit and wine composition. Our results suggest that environmental factors affecting wine terroir, may be mediated by changes in microbial structure, thus providing a basic understanding of how growing conditions affect interactions between plants and their soil bacteria