On the growth and form of the gut.

The developing vertebrate gut tube forms a reproducible looped pattern as it grows into the body cavity. Here we use developmental experiments to eliminate alternative models and show that gut looping morphogenesis is driven by the homogeneous and isotropic forces that arise from the relative growth between the gut tube and the anchoring dorsal mesenteric sheet, tissues that grow at different rates. A simple physical mimic, using a differentially strained composite of a pliable rubber tube and a soft latex sheet is consistent with this mechanism and produces similar patterns. We devise a mathematical theory and a computational model for the number, size and shape of intestinal loops based solely on the measurable geometry, elasticity and relative growth of the tissues. The predictions of our theory are quantitatively consistent with observations of intestinal loops at different stages of development in the chick embryo. Our model also accounts for the qualitative and quantitative variation in the distinct gut looping patterns seen in a variety of species including quail, finch and mouse, illuminating how the simple macroscopic mechanics of differential growth drives the morphology of the developing gut.

Techniques to improve the shear strength of impacted bone graft: the effect of particle size and washing of the graft.

BACKGROUND: When fresh morselized graft is compacted, as in impaction bone-grafting for revision hip surgery, fat and marrow fluid is either exuded or trapped in the voids between particles. We hypothesized that the presence of incompressible fluid damps and resists compressive forces during impaction and prevents the graft particles from moving into a closer formation, thus reducing the graft strength. In addition, viscous fluid such as fat may act as an interparticle lubricant, thus reducing the interlocking of the particles. METHODS: We performed mechanical shear testing in the laboratory with use of fresh-frozen human femoral-head allografts that had been passed through different orthopaedic bone mills to produce graft of differing particle-size distributions (grading). RESULTS: After compaction of fresh graft, fat and marrow fluid continued to escape on application of normal loads. Washed graft, however, had little lubricating fluid and better contact between the particles, increasing the shear resistance. On mechanical testing, washed graft was significantly (p < 0.001) more resistant to shearing forces than fresh graft was. This feature was consistent for different bone mills that produced graft of different particle-size distributions and shear strengths. CONCLUSIONS: Removal of fat and marrow fluid from milled human allograft by washing the graft allows the production of stronger compacted graft that is more resistant to shear, which is the usual mode of failure. Further research into the optimum grading of particle sizes from bone mills is required.

Techniques to improve the shear strength of impacted bone graft: The effect of particle size and washing of the graft

Background: When fresh morselized graft is compacted, as in impaction bone-grafting for revision hip surgery, fat and marrow fluid is either exuded or trapped in the voids between particles. We hypothesized that the presence of incompressible fluid damps and resists compressive forces during impaction and prevents the graft particles from moving into a closer formation, thus reducing the graft strength. In addition, viscous fluid such as fat may act as an interparticle lubricant, thus reducing the interlocking of the particles. Methods: We performed mechanical shear testing in the laboratory with use of fresh-frozen human femoral-head allografts that had been passed through different orthopaedic bone mills to produce graft of differing particle-size distributions (grading). Results: After compaction of fresh graft, fat and marrow fluid continued to escape on application of normal loads. Washed graft, however, had little lubricating fluid and better contact between the particles, increasing the shear resistance. On mechanical testing, washed graft was significantly (p < 0.001) more resistant to shearing forces than fresh graft was. This feature was consistent for different bone mills that produced graft of different particle-size distributions and shear strengths. Conclusions: Removal of fat and marrow fluid from milled human allograft by washing the graft allows the production of stronger compacted graft that is more resistant to shear, which is the usual mode of failure. Further research into the optimum grading of particle sizes from bone mills is required. Clinical Relevance: Understanding the mechanical properties of milled human allograft is important when impaction grafting is used for mechanical support. A simple means of improving the mechanical strength of graft produced by currently available bone mills, including an intraoperative washing technique, is described.

A global model for effective use and evaluation of e-learning in health.

Healthcare systems worldwide face a wide range of challenges, including demographic change, rising drug and medical technology costs, and persistent and widening health inequalities both within and between countries. Simultaneously, issues such as professional silos, static medical curricula, and perceptions of "information overload" have made it difficult for medical training and continued professional development (CPD) to adapt to the changing needs of healthcare professionals in increasingly patient-centered, collaborative, and/or remote delivery contexts. In response to these challenges, increasing numbers of medical education and CPD programs have adopted e-learning approaches, which have been shown to provide flexible, low-cost, user-centered, and easily updated learning. The effectiveness of e-learning varies from context to context, however, and has also been shown to make considerable demands on users' motivation and "digital literacy" and on providing institutions. Consequently, there is a need to evaluate the effectiveness of e-learning in healthcare as part of ongoing quality improvement efforts. This article outlines the key issues for developing successful models for analyzing e-health learning.

Preliminary laboratory-scale model auger installation and testing of carbonated soil-MgO columns

This paper presents details of the installation and performance of carbonated soil-MgO columns using a laboratory-scale model auger setup. MgO grout was mixed with the soil using the auger and the columns were then carbonated with gaseous CO2 introduced in two different ways: one using auger mixing and the other through a perforated plastic tube system inserted into the treated column. The performance of the columns in terms of unconfined compressive strength (UCS), stiffness, strain at failure and microstructure (using X-ray diffraction and scanning electron microscopy) showed that the soil-MgO columns were carbonated very quickly (in under 1 h) and yielded relatively high strength values, of 2.4-9.4 MPa, which on average were five times that of corresponding 28-day ambient cured uncarbonated columns. This confirmed, together with observations of dense microstructure and hydrated magnesium carbonates, that a good degree of carbonation had taken place. The results also showed that the carbonation method and period have a significant effect on the resulting performance, with the carbonation through the perforated pipe producing the best results. Copyright © 2013 by ASTM International.

Improving the safety and security of the pharmaceutical supply chain

This paper discusses various techniques that may be used to combat counterfeiting in the pharmaceutical supply chain. These include the use of electronic pedigrees (to ensure the integrity of the supply chain), together with mass-serialization (to provide for a unique lifecycle history of each individual package) and authentication of the product (to check for any discrepancies in the various attributes of the product and its packaging are as intended for that individual package). Management of the pedigree process and product authentication is discussed in some detail, together with various other learnings from the Drug Security Network, including identification of some remaining vulnerabilities and suggestions for tightening these loopholes. © 2008 Springer-Verlag Berlin Heidelberg.