Guideline for the non-surgical management of hip and knee osteoarthritis

Introduction: Chronic disease is a major public health burden on Australian society. An increasing proportion of the population has risk factors for, or at least one, chronic disease, leading to increasing public health costs. Health service policy and delivery must not only address acute conditions, it must also effectively respond to the wide range of health and public service requirements of people with chronic illness.^1,2 Strong primary health care policy is an important foundation for a successful national health delivery system and long term management of public health, and is linked to practical outcomes including lower mortality, decreased hospitalisation and improved health outcomes.¹ National strategic health policy has recently given increased recognition to the importance of chronic disease management, with the Australian Federal Government endorsement of a number of initiatives for the prevention (or delay in onset), early detection and evidence based management of chronic disease, including osteoarthritis.^1,3
Chronic musculoskeletal conditions, including arthritis, account for over 4% of the national disease burden in terms of disability adjusted life years. Over 6 million Australians (almost one-third of the population) are estimated to have a chronic musculoskeletal disease; chronic musculoskeletal disease represents the main cause of long term pain and physical disability. In Australia, osteoarthritis is self reported by more than 1.4 million people (7.3% of the population4) and is the tenth most commonly managed problem in general practice.5 This number is set to rise as the elderly population grows. Osteoarthritis exerts a significant burden on the individual and the community through reduction in quality of life, diminished employment capacity and an increase in health care costs. For further details, refer to the Evidence to support the National Action Plan for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis: Opportunities to improve health-related quality of life and reduce the burden of disease and disability (2004).⁶
As such, federal government health policy has identified arthritis as a National Health Priority Area and adopted a number of initiatives aimed at decreasing the burden of chronic disease and disability; raising awareness of preventive disease factors; providing access to evidence based knowledge; and improving the overall management of arthritis within the community.4 In 2002, all Australian health ministers designated arthritis and musculoskeletal conditions as Australia’s seventh National Health Priority Area. In response, a National Action Plan was developed in 2004 by the National Arthritis and Musculoskeletal Conditions Advisory Group (NAMSCAG).6 The aim of this document was to provide a blueprint for national initiatives to improve the health related quality of life of people living with osteoarthritis, rheumatoid arthritis and osteoporosis; reduce the cost and prevalence of these conditions; and reduce the impact on individuals, their carers and their communities within Australia. The National Action Plan was developed to complement both the National Chronic Disease Strategy – which is broader – and the National Service Improvement Framework for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis, in addition to other national and state/ territory structures.

Effects of long-term tennis playing on the muscle-bone relationship in the dominant and non-dominant forearms

The relationship between muscle strength and bone mineral density illustrates the positive effect of mechanical loading on bone. But local and systemic factors may affect both muscle and bone tissues. This study investigated the effects of long-term tennis playing on the relationship between lean tissue mass and bone mineral content in the forearms, taking the body dimensions into account. Fifty-two tennis players (age 24.2 +/- 5.8 yrs, 16.2 +/- 6.1 yrs of practice) were recruited. Lean tissue mass (LTM), bone area, bone mineral content (BMC), and bone mineral density were measured at the forearms from a DXA whole-body scan. Grip strength was assessed with a dynamometer. A marked side-to-side difference (p < 0.0001) was found in favor of the dominant forearm in all parameters. Bone area and BMC correlated with grip strength on both sides (r = 0.81 - 0.84, p < 0.0001). The correlations were still significant after adjusting for whole-body BMC body height, or forearm length. This result reinforced the putative role of the muscles in the mechanical loading on bones. In addition, forearm BMC adjusted to LTM or grip strength was higher on the dominant side, suggesting that tennis playing exerts a direct effect on bone.

Endemic freshwater finfish of Asia : distribution and conservation status

Freshwater finfish species richness and level of endemism in East, and South and South-East Asia that included 17 nations were studied using available databases, and included nation-wise distribution, habitat types, and conservation status. The number of endemic finfish species in the region was 559, belonging to 47 families. Families Cyprinidae and Balitoridae accounted for 43.5% and 16.2% of the total number of endemic species in the region, respectively, followed by Sisoridae (25), Gobiidae (20), Melanotaeniidae (19), and Bagridae (16), and the other 41 families had at least one endemic species. Nation-wise the most number of endemic freshwater finfish species occur in India (191), followed by China (88), Indonesia (84), and Myanmar (60). In India, the endemic species accounted for 26.4% of the native freshwater fish fauna, followed by South Korea (16.9%), the Philippines, (16.3%) and Myanmar (15.7%).

Statistically significant relationships discerned between the number of indigenous and endemic species richness to land area (X_la in 10³ km²) of the nations in the region were, Y_in = 218.961 Ln(X_la) – 843.1 (R² = 0.735; P < 0.001) and Y_e = 28.445 Ln X_la−134.47 (R² = 0.534; P < 0.01), respectively, and between indigenous and endemic species richness was Y_e = 0.079X_n− 1.558 (R² = 0.235; P < 0.05).

The overall conservation status of endemic finfish in Asia was satisfactory in that only 92 species were in some state of vulnerability, of which 37 species (6.6%) are endangered or critically endangered. However, the bulk of these species (83.7%) were cave- and or lake-dwelling fish. However, nation-wise, the endemic freshwater finfish fauna of the Philippines and Sri Lanka, based on the imperilment index, were found to be in a highly vulnerable state. Among river basins, the Mekong Basin had the highest number of endemic species (31.3%). The discrepancies between databases are highlighted and the need to consolidate information among databases is discussed. It is suggested that the Mekong Basin be considered as a biodiversity hotspot, and appropriate management strategies be introduced in this regard.

Tensile behaviour of non-uniform fibres and fibrous composites

This work investigates the tensile behaviour of non-uniform fibres and fibrous composites. Wool fibres are used as an example of non-uniform fibres because they're physical, morphological and geometrical properties vary greatly not only between fibres but also within a fibre. The focus of this work is on the effect of both between-fibre and within-fibre diameter variations on fibre tensile behaviour. In addition, fit to the Weibull distribution by the non-brittle and non-uniform visco-elastic wool fibres is examined, and the Weibull model is developed further for non-uniform fibres with diameter variation along the fibre length. A novel model fibre composite is introduced to facilitate the investigation into the tensile behaviour of fibre-reinforced composites. This work first confirms that for processed wool, its coefficient of variation in break force can be predicted from that of minimum fibre diameters, and the prediction is better for longer fibres. This implies that even for processed wool, fibre breakage is closely associated with the occurrence of thin sections along a fibre, and damage to fibres during processing is not the main cause of fibre breakage. The effect of along-fibre diameter variation on fibre tensile behaviour of scoured wool and mohair is examined next. Only wet wool samples were examined in the past. The extensions of individual segments of single non-uniform fibres are measured at different strain levels. An important finding is the maximum extension (%) (Normally at the thinnest section) equals the average fibre extension (%) plus the diameter variation (CV %) among the fibre segments. This relationship has not been reported before. During a tensile test, it is only the average fibre extension that is measured. The third part of this work is on the applicability of Weibull distribution to the strength of non-uniform visco-elastic wool fibres. Little work has been done for wool fibres in this area, even though the Weibull model has been widely applied to many brittle fibres. An improved Weibull model incorporating within-fibre diameter variations has been developed for non-uniform fibres. This model predicts the gauge length effect more accurately than the conventional Weibull model. In studies of fibre-reinforced composites, ideal composite specimens are usually prepared and used in the experiments. Sample preparation has been a tedious process. A novel fibre reinforced composite is developed and used in this work to investigate the tensile behaviour of fibre-reinforced composites. The results obtained from the novel composite specimen are consistent with that obtained from the normal specimens.

Assessment of spatiotemporal varying relationships between rainfall, land cover and surface water area using geographically weighted regression

Traditional regression techniques such as ordinary least squares (OLS) are often unable to accurately model spatially varying data and may ignore or hide local variations in model coefficients. A relatively new technique, geographically weighted regression (GWR) has been shown to greatly improve model performance compared to OLS in terms of higher R 2 and lower corrected Akaike information criterion (AICC). GWR models have the potential to improve reliabilities of the identified relationships by reducing spatial autocorrelations and by accounting for local variations and spatial non-stationarity between dependent and independent variables. In this study, GWR was used to examine the relationship between land cover, rainfall and surface water habitat in 149 sub-catchments in a predominately agricultural region covering 2.6 million ha in southeast Australia. The application of the GWR models revealed that the relationships between land cover, rainfall and surface water habitat display significant spatial non-stationarity. GWR showed improvements over analogous OLS models in terms of higher R 2 and lower AICC. The increased explanatory power of GWR was confirmed by the results of an approximate likelihood ratio test, which showed statistically significant improvements over analogous OLS models. The models suggest that the amount of surface water area in the landscape is related to anthropogenic drainage practices enhancing runoff to facilitate intensive agriculture and increased plantation forestry. However, with some key variables not present in our analysis, the strength of this relationship could not be qualified. GWR techniques have the potential to serve as a useful tool for environmental research and management across a broad range of scales for the investigation of spatially varying relationships.

Enhanced cell growth using non-woven scaffolds of multilobal fibres

Multilobal fibres contain several grooves and have higher surface area than round fibres. Cell density can be enhanced when cultured on scaffolds manufactured with multilobal fibres. This study compared the cell growth of dermal fibroblasts and osteoblast-like SaOS2 cells on polymeric scaffolds produced from multilobal fibres to the conventional round-fibred scaffolds. Cells were cultured on round nylon 6,6, trilobal nylon 6,6, round polyethylene terephthalate (PET) and multilobal PET scaffolds for 14 days. There were more cells cultured on trilobal nylon 6,6 and PET multilobal scaffolds than their round counterparts. Preference to the type of multilobal scaffolds was cell dependent. Fibroblasts increased by 21.8 ± 1.9 fold to 6.3 × 105 cells (p < 0.001) when cultured on trilobal nylon 6,6 scaffolds while SaOS2 cells exhibited a 16.7 ± 2.8 fold increase (2.9 × 105 cells, p < 0.001) on the multilobal PET scaffolds after 14 days of culture. The ability of multilobal fibres to accommodate large quantities of cells presents an excellent alternative to round fibres as scaffolds for tissue engineering.

Non-face to face consultations and communications in primary care : the role and perspective of general practice managers in Scotland

Background Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers’ attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients.

Objectives To investigate practice managers’ attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies.

Methods We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews.

Results Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand.

Conclusion Practice managers are likely to play a central role in the introduction of new consultation/communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics.Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/ communication technologies.

Non-invasive collection and examination of human corneal epithelial cells

Purpose. To report the development of a new apparatus for non-invasive collection of human corneal epithelial cells.

Methods. Previous methods of non-invasive, irrigative corneal cell collection resulted in low cell yields limiting potential analysis. A new ocular surface cell collection apparatus (OSCCA) was designed to collect more epithelial cells from direct irrigation of the corneal surface to allow for clinical comparisons. Forty-five samples were obtained (unilateral or bilateral over seven visits) from five human participants. Cell yield, size, phenotype, and corneal staining (prior and post eye wash) were examined.

Results. On average 364 ± 230 epithelial cells were collected from the cornea per eye. Epithelial cell sizes ranged from 8.21 to 51.69 μm in diameter, and 67.30 to 2098.85 μm2 area. The proportion of corneal specific cells collected per sample was 75 ± 14% as determined by positive K3 expression with AE5. On average, 77 ± 0.2% of epithelial cells harvested were nucleated, the remainder were non-nucleated ghost cells. Corneal staining was reduced in the OSCCA-washed vs. contralateral non-washed eyes (p = 0.02).

Conclusions. The OSCCA allows collection of human corneal epithelial cells with significantly higher yields, and greater specificity than previously reported. Reduced corneal staining observed post eye-wash demonstrated the safety of the technique, and its ability to remove cells directly from the corneal surface. The OSCCA could provide an objective non-invasive method of investigating pathological changes, effects of topical therapeutics, and impact of contact lenses and care-solutions of the cells of the ocular surface.

A proposed approach to monitor private-sector policies and practices related to food environments, obesity and non-communicable disease prevention

Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first (‘minimal’) step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second (‘expanded’) step assesses the nutritional composition of each organization's products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third (‘optimal’) step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private-sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention.

Offering fragile X syndrome carrier screening: a prospective mixed-methods observational study comparing carrier screening of pregnant and non-pregnant women in the general population

Article focus
▪ This article is a protocol of a study that involves offering fragile X syndrome carrier screening to pregnant and non-pregnant women in the general population. We are undertaking a programme evaluation approach using mixed methods to collect data about informed decisionmaking and predictors of test uptake, with a focus on psychosocial measures. We are also undertaking an economic appraisal.

Increased mortality of naive varanid lizards after the invasion of non-native can toads (bufo marinus)

Exotic animal and plant species introduced into the Australian continent often imparted catastrophic effects on the indigenous fauna and flora. Proponents of biological control introduced the South American Cane Toad (Bufo marinus) into the sugar cane fields of Queensland in 1935. The Cane Toad is one of the most toxic bufonids and when seized by naive Australian predators, the toxin usually kills the attacker. One group of Australian squamate reptiles that are very susceptible to Cane Toad toxins is varanid lizards. Prior to Cane Toad invasion of our study area, the Adelaide River floodplain of the Northern Territory of Australia, annual mortality of adult male radio-tagged yellow-spotted Goannas (Varanus panoptes) was very low. After the arrival of toads in October 2005, all radio-tracked goannas were found dead in August 2006, most likely attempting to feed on the toads. Our results suggest that invasive Cane Toads place naive adult male Yellow-spotted Goannas at risk of possibly >90% mortality. This increase in mortality could reduce the genetic diversity and hamper long-term survival of these large carnivorous lizards.

Towards global benchmarking of food environments and policies to reduce obesity and diet-related non-communicable diseases : design and methods for nation-wide surveys

Introduction: 

Estimating cumulative exposure of wildlife to non-lethal disturbance using spatially explicit capture-recapture models

Impact assessments often focus on short-term behavioral responses of animals to human disturbance. However, the cumulative effects caused by repeated behavioral disruptions are of management concern because these effects have the potential to influence individuals' survival and reproduction. We need to estimate individual exposure rates to disturbance to determine cumulative effects. We present a new approach to estimate the spatial exposure of minke whales to whalewatching boats in Faxaflõi Bay, Iceland. We used recent advances in spatially explicit capture-recapture modeling to estimate the probability that whales would encounter a disturbance (i.e., whalewatching boat). We obtained spatially explicit individual encounter histories of individually identifiable animals using photo-identification. We divided the study area into 1-km2 grid cells and considered each cell a spatially distinct sampling unit. We used capture history of individuals to model and estimate spatial encounter probabilities of individual minke whales across the study area, accounting for heterogeneity in sampling effort. We inferred the exposure of individual minke whales to whalewatching vessels throughout the feeding season by estimating individual whale encounters with vessels using the whale encounter probabilities and spatially explicit whalewatching intensity in the same area, obtained from recorded whalewatching vessel tracks. We then estimated the cumulative time whales spent with whalewatching boats to assess the biological significance of whalewatching disturbances. The estimated exposure levels to boats varied considerably between individuals because of both temporal and spatial variations in the activity centers of whales and the whalewatching intensity in the area. However, although some whales were repeatedly exposed to whalewatching boats throughout the feeding season, the estimated cumulative time they spent with boats was very low. Although whalewatching boat interactions caused feeding disruptions for the whales, the estimated low cumulative exposure indicated that the whalewatching industry in its current state likely is not having any long-term negative effects on vital rates.

Oral versus parenteral antimicrobials for the treatment of cellulitis : a randomized non-inferiority trial

Objectives To determine whether outcomes for patients with cellulitis treated with oral antimicrobials are as good as for those who are treated with parenteral antimicrobials.Methods A prospective randomized non-inferiority trial was conducted at a tertiary teaching hospital in Melbourne, Australia. Participants were patients referred by the emergency department for treatment of uncomplicated cellulitis with parenteral antimicrobials. Patients were randomized to receive either oral cefalexin or parenteral cefazolin. Parenteral antimicrobials were changed to oral after the area of cellulitis ceased progressing. The primary outcome was days until no advancement of the area of cellulitis. A non-inferiority margin of 15% was set for the oral arm compared with the parenteral arm. Secondary outcomes were failure of treatment, pain, complications and satisfaction with care. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000685910).Results Twenty-four patients were randomized to oral antimicrobials and 23 to parenteral antimicrobials. Mean days to no advancement of cellulitis was 1.29 (SD 0.62) for the oral arm and 1.78 (SD 1.13) for the parenteral arm, with a mean difference of −0.49 (95% CI: −1.02 to +0.04). The upper limit of the 95% CI of the difference in means of +0.04 was below the 15% non-inferiority margin of +0.27 days, indicating non-inferiority. More patients failed treatment in the parenteral arm (5 of 23, 22%) compared with the oral arm (1 of 24, 4%), although this difference was not statistically significant (P = 0.10). Pain, complications and satisfaction with care were similar for both groups.Conclusions Oral antimicrobials are as effective as parenteral antimicrobials for the treatment of uncomplicated cellulitis.

Energy consumption and output: time series evidence from non-OECD developing countries

Statistically significant association between energy consumption and economic growth is now well established in the literature. However, it still remains an unsettled issue whether economic growth is the cause or effect of energy consumption. The importance of identifying the direction of causality emanates from its relevance in national policy-making issues regarding energy conservation. Energy conservationissue is more important when energy acts as a contributing factor in economic growth than when it is used as a result of higher economic growth. In this backdrop, it is justified to search causal relationship between energy consumption and national output (GDP) of those countries that are expected to have higher energy consumption in future. Evidence shows that countries classified as non-OECD Asia will have the highest growth in energy consumption (3.7 percent) over the period 2003-2030. This forecasted energy consumption in these countries will have significant policy implication in the area of energy conservation. Hence, the present paper attempts to identify the direction of causality between energy consumption and output in the context of six major energy dependent non-OECD Asian countries.However, since the traditional bivariate approach suffers from omitted variable problems (Stern 1993, Masih and Masih, 1996 and Asafu-Adjaye, 2000), this paper employs a trivariate demand side approach consisting of energy consumption, income and prices. The countries selected for this purpose are Bangladesh, China, India, Malaysia, Pakistan and Thailand. Moreover, according to the Energy Information Administration (EIA) data of 2005, these six countries contribute 81.35% of the energyconsumption by all non-OECD Asian countries (aggregate energy consumption of 2005 by all non-OECD Asian countries is 113.60 quadrillion BTU while for these six countries alone the consumption is 92.42 quadrillion BTU).