The Economic Impact of a Pilot Digital Day-Case Pathway for Knee Arthroplasty in a U.K. Setting.

Knee replacements are an increasingly common procedure in the U.K. National Health Service (NHS). Importantly, the pathway for such procedures represents a prime opportunity to leverage digital technology, modernize and streamline the approach to care, and free up resources. Methods: In this 21-patient pilot study, we assessed the impact of implementing a digital day-case pathway for knee replacement surgery at the Calderdale and Huddersfield NHS Foundation trust. Results: Fourteen (67%) of the 21 eligible patients were treated as day cases, with an average length of stay of 8.8 hours. The pilot data were utilized to model the potential impact of implementing a digital day-case program more widely across the trust. This model showed increased efficiency over the entire episode of care, with reductions in physiotherapy appointments, preoperative visits, hospital days, and face-to-face consultations. Not only would these improvements free up capacity, but they would also result in an estimated saving of £240,540 to the trust while reducing the CO2 footprint of knee replacements by 119,381 kg CO2 emitted. A sensitivity analysis revealed that, even with substantial variation of several key variables within the pathway, a trust-wide digital day-case program would still be a cost-saving measure. Conclusions: Overall, the present study supports the growing notion that digital technology can facilitate the transformation of care pathways, resulting in greater efficiency and financial savings for health-care providers while reducing the time patients spend in the hospital. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cardiopulmonary and cerebrovascular acclimatization in children and adults at 3800 m.

Maturational differences exist in cardiopulmonary and cerebrovascular function at sea-level, but the impact of maturation on acclimatization responses to high altitude is unknown. Ten children (9.8 ± 2.5 years) and 10 adults (34.7 ± 7.1 years) were assessed at sea-level (BL), 3000 m and twice over 4 days at 3800 m (B1, B4). Measurements included minute ventilation ( V ̇ E ${\dot{V}}_{\rm{E}}$ ), end-tidal partial pressures of oxygen ( P ETO 2 ${P}_{{\rm{ETO}}_{\rm{2}}}$ ) and carbon dioxide, echocardiographic assessment of pulmonary artery systolic pressure (PASP) and stroke volume (SV) and ultrasound assessment of blood flow through the internal carotid and vertebral arteries was performed to calculate global cerebral blood flow (gCBF). At 3000 m, V ̇ E ${\dot{V}}_{\rm{E}}$ was increased from BL by 19.6 ± 19.1% (P = 0.031) in children, but not in adults (P = 0.835); SV was reduced in children (-11 ± 13%, P = 0.020) but not adults (P = 0.827), which was compensated for by a larger increase in heart rate in children (+26 beats min-1 vs. +13 beats min-1 , P = 0.019). Between B1 and B4, adults increased V ̇ E ${\dot{V}}_{\rm{E}}$ by 38.5 ± 34.7% (P = 0.006), while V ̇ E ${\dot{V}}_{\rm{E}}$ did not increase further in children. The rise in PASP was not different between groups; however, ∆PASP from BL was related to ∆ P ETO 2 ${P}_{{\rm{ETO}}_{\rm{2}}}$ in adults (R2  = 0.288, P = 0.022), but not children. At BL, gCBF was 43% higher in children than adults (P = 0.017), and this difference was maintained at high altitude, with a similar pattern and magnitude of change in gCBF between groups (P = 0.845). Despite V ̇ E ${\dot{V}}_{\rm{E}}$ increasing in children but not adults at a lower altitude, the pulmonary vascular and cerebrovascular responses to prolonged hypoxia are similar between children and adults. KEY POINTS: Children have different ventilatory and metabolic requirements from adults, which may present differently in the pulmonary and cerebral vasculature upon ascent to high altitude. Children (ages 7-14) and adults (ages 23-44) were brought from sea level to high altitude (3000 to 3800 m) and changes in ventilation, pulmonary artery systolic pressure (PASP) and cerebral blood flow (CBF) were assessed over 1 week. Significant increases in ventilation and decreases in left ventricle stroke volume were observed at a lower altitude in children than adults. PASP and CBF increased by a similar relative amount between children and adults at 3800 m. These results help us better understand age-related differences in compensatory responses to prolonged hypoxia in children, despite similar changes in pulmonary artery pressure and CBF between children and adults.

Towards novel measurements of remodeling activity in cortical bone: implications for osteoporosis and related pharmaceutical treatments.

Bone remodelling is performed by basic multicellular units (BMUs) that resorb and subsequently form discrete packets of bone tissue. Normally, the resorption and formation phases of BMU activity are tightly coupled spatially and temporally to promote relatively stable bone mass and bone quality. However, dysfunctional remodelling can lead to bone loss and is the underlying cause of osteoporosis. This review surveys how BMU activity is altered in postmenopausal, disuse and glucocorticoid-induced osteoporosis as well as the impact of anabolic and anti-resorptive pharmaceutical treatments. The dysfunctional remodelling observed during disease and following medical intervention bares many testable hypotheses regarding the regulation of BMU activity and may provide novel insights that challenge existing paradigms of remodelling dynamics, particularly the poorly understood BMU coupling mechanisms. Most bone remodelling research has focused on trabecular bone and 2D analyses, as technical challenges limit the direct assessment of BMU activity in cortical bone. Recent advances in imaging technology present an opportunity to investigate cortical bone remodelling in vivo. This review discusses innovative experimental methods, such as 3D and 4D (i.e. time- lapsed) evaluation of BMU morphology and trajectory, that may be leveraged to improve the understanding of the spatio-temporal coordination of BMUs in cortical bone.

Exploring the Impact and Acceptance of Wearable Sensor Technology for Pre- and Postoperative Rehabilitation in Knee Replacement Patients: A U.K.-Based Pilot Study.

Knee replacement operations are common, highly successful procedures that are increasing in frequency. The COVID-19 pandemic has emphasized the need for innovative care pathways that reduce face-to-face appointments. We report on the impact of introducing a wearable sensor for pre- and postoperative rehabilitation of 21 knee replacement patients at 2 hospitals in the U.K. Methods: The sensor (BPMpathway; 270 Vision) was provided during joint school prior to knee replacement and stayed with the patient until a maximum of 9 weeks post-surgery. Participant progress and exercise were monitored remotely, with exercise regimens altered as required. Participants and clinicians could communicate remotely via the device. Results: The median range of motion during the first week post-surgery was 63° (interquartile range [IQR] = 21°) and increased to 136° (IQR = 16°) by week 7. The rate of participant compliance with exercises using the device was 32.3% for thrice-daily compliance and 52.4% for once-daily compliance. The 2-way communication channel was well utilized by both participants and clinicians. We report a 35.7% reduction in face-to-face physiotherapy appointments compared with standard practice. Finally, >80% of users who completed the feedback questionnaire reported a positive experience using the device, finding it easy to understand and reporting that it motivated them to perform their exercises. Conclusions: The use of BPMpathway was well received, effective, and reduced face-to-face physiotherapy appointments. Clinical Relevance: Remote monitoring can reduce the burden to the outpatient physiotherapy service by supporting the post-COVID-19 surgical service recovery plans of the National Health Service and allowing patients to recuperate at home.

Quantifying Subresolution 3D Morphology of Bone with Clinical Computed Tomography.

The aim of this study was to quantify sub-resolution trabecular bone morphometrics, which are also related to osteoarthritis (OA), from clinical resolution cone beam computed tomography (CBCT). Samples (n = 53) were harvested from human tibiae (N = 4) and femora (N = 7). Grey-level co-occurrence matrix (GLCM) texture and histogram-based parameters were calculated from CBCT imaged trabecular bone data, and compared with the morphometric parameters quantified from micro-computed tomography. As a reference for OA severity, histological sections were subjected to OARSI histopathological grading. GLCM and histogram parameters were correlated to bone morphometrics and OARSI individually. Furthermore, a statistical model of combined GLCM/histogram parameters was generated to estimate the bone morphometrics. Several individual histogram and GLCM parameters had strong associations with various bone morphometrics (|r| > 0.7). The most prominent correlation was observed between the histogram mean and bone volume fraction (r = 0.907). The statistical model combining GLCM and histogram-parameters resulted in even better association with bone volume fraction determined from CBCT data (adjusted R2 change = 0.047). Histopathology showed mainly moderate associations with bone morphometrics (|r| > 0.4). In conclusion, we demonstrated that GLCM- and histogram-based parameters from CBCT imaged trabecular bone (ex vivo) are associated with sub-resolution morphometrics. Our results suggest that sub-resolution morphometrics can be estimated from clinical CBCT images, associations becoming even stronger when combining histogram and GLCM-based parameters.

Homogeneous hydroxyapatite/alginate composite hydrogel promotes calcified cartilage matrix deposition with potential for three-dimensional bioprinting.

Calcified cartilage regeneration plays an important role in successful osteochondral repair, since it provides a biological and mechanical transition from the unmineralized cartilage at the articulating surface to the underlying mineralized bone. To biomimic native calcified cartilage in engineered constructs, here we test the hypothesis that hydroxyapatite (HAP) stimulates chondrocytes to secrete the characteristic matrix of calcified cartilage. Sodium citrate (SC) was added as a dispersant of HAP within alginate (ALG), and homogeneous dispersal of HAP within ALG hydrogel was confirmed using sedimentation tests, electron microscopy, and energy dispersive spectroscopy. To examine the biological performance of ALG/HAP composites, chondrocyte survival and proliferation, extracellular matrix production, and mineralization potential were evaluated in the presence or absence of the HAP phase. Chondrocytes in ALG/HAP constructs survived well and proliferated, but also expressed higher levels of calcified cartilage markers compared to controls, including Collagen type X secretion, alkaline phosphatase (ALP) activity, and mineral deposition. Compared to controls, ALG/HAP constructs also showed an elevated level of mineralized matrix in vivo when implanted subcutaneously in mice. The printability of ALG/HAP composite hydrogel precursors was verified by 3D printing of ALG/HAP hydrogel scaffolds with a porous structure. In summary, these results confirm the hypothesis that HAP in ALG hydrogel stimulates chondrocytes to secrete calcified matrix in vitro and in vivo and reveal that ALG/HAP composites have the potential for 3D bioprinting and osteochondral regeneration.

Pilot feasibility study to detect mesenchymal stem cell biomarkers of bronchopulmonary dysplasia in the tracheal aspirate fluid of preterm infants.

OBJECTIVE: This study aimed to detect novel mesenchymal stem cell peptides/biomarkers of bronchopulmonary dysplasia (BPD) in the tracheal aspirate fluid (TAF) of preterm infants. STUDY DESIGN: Participants included infants less than 32 weeks' gestational age or birth weight under 1500 grams who required endotracheal intubation and mechanical ventilation within first 24 hours of life. TAF sample collection was performed at the time of the first clinically indicated routine suctioning. Standardization curves for human levels of osteopontin (Opn), macrophage colony stimulating factor 1 (Csf1), transforming growth factor beta 1 (TGF-ß1), and secretory immunoglobulin A (sIgA) were generated for 15 enrolled participants. RESULTS: We demonstrated that stem cell biomarkers are secreted into the TAF of preterm infants and their concentrations can be easily measured during the first week of life. CONCLUSIONS: Further studies are warranted to determine a causal relationship between these biomarkers and BPD development and severity.

Skeletal Lead Burden of the British Royal Navy in Colonial Antigua.

Lead (Pb) has been known to be a cause of human poisoning since ancient times, but despite this, it was a widely used metal in the European colonial period. In this study, the relationship between Pb exposure and the demographic variables ancestry and age was explored by comparing the bone Pb levels of individuals that were of either African or European ancestry, excavated from a British Royal Navy hospital cemetery (1793-1822 CE) at English Harbour in Antigua, West Indies. More direct comparisons of Pb levels between the two ancestral groups were possible in this study because of the unsegregated nature of this cemetery. Inductively coupled plasma mass spectrometry was used to determine bulk Pb levels in cortical bone samples from the fibular diaphyses of 23 male individuals. No significant difference was found between the distributions of the Pb levels of the ancestral groups (p = 0.94). Further, no positive correlations or significant differences were found in relation to the individuals' ages and their Pb levels (p = 0.24). Levels of Ba, Ca and rare earth elements support a largely biogenic origin of lead. This is bolstered by Pb deposition patterns, generated by synchrotron X-ray fluorescence imaging for another study. The data suggest that naval personnel, regardless of ancestry at English Harbour, had very similar experiences with regard to Pb exposure. Their exposure to the toxic metal was likely not consistent over time as steady exposure would have resulted in accumulation of Pb with age. This study contributes to addressing historical questions regarding the prevalence of Pb poisoning within the British Royal Navy during the colonial period.

Lacunar-canalicular network in femoral cortical bone is reduced in aged women and is predominantly due to a loss of canalicular porosity.

The lacunar-canalicular network (LCN) of bone contains osteocytes and their dendritic extensions, which allow for intercellular communication, and are believed to serve as the mechanosensors that coordinate the processes of bone modeling and remodeling. Imbalances in remodeling, for example, are linked to bone disease, including fragility associated with aging. We have reported that there is a reduction in scale for one component of the LCN, osteocyte lacunar volume, across the human lifespan in females. In the present study, we explore the hypothesis that canalicular porosity also declines with age. To visualize the LCN and to determine how its components are altered with aging, we examined samples from young (age: 20-23 y; n = 5) and aged (age: 70-86 y; n = 6) healthy women donors utilizing a fluorescent labelling technique in combination with confocal laser scanning microscopy. A large cross-sectional area of cortical bone spanning the endosteal to periosteal surfaces from the anterior proximal femoral shaft was examined in order to account for potential trans-cortical variation in the LCN. Overall, we found that LCN areal fraction was reduced by 40.6% in the samples from aged women. This reduction was due, in part, to a reduction in lacunar density (21.4% decline in lacunae number per given area of bone), but much more so due to a 44.6% decline in canalicular areal fraction. While the areal fraction of larger vascular canals was higher in endosteal vs. periosteal regions for both age groups, no regional differences were observed in the areal fractions of the LCN and its components for either age group. Our data indicate that the LCN is diminished in aged women, and is largely due to a decline in the canalicular areal fraction, and that, unlike vascular canal porosity, this diminished LCN is uniform across the cortex.

Newborn insula gray matter volume is prospectively associated with early life adiposity gain.

BACKGROUND: The importance of energy homeostasis brain circuitry in the context of obesity is well established, however, the developmental ontogeny of this circuitry in humans is currently unknown. Here, we investigate the prospective association between newborn gray matter (GM) volume in the insula, a key brain region underlying energy homeostasis, and change in percent body fat accrual over the first six months of postnatal life, an outcome that represents among the most reliable infant predictors of childhood obesity risk. METHODS: A total of 52 infants (29 male, 23 female, gestational age at birth=39(1.5) weeks) were assessed using structural MRI shortly after birth (postnatal age at MRI scan=25.9(12.2) days), and serial Dual X-Ray Absorptiometry shortly after birth (postnatal age at DXA scan 1=24.6(11.4) days) and at six months of age (postnatal age at DXA scan 2=26.7(3.3) weeks). RESULTS: Insula GM volume was inversely associated with change in percent body fat from birth to six-months postnatal age and accounted for 19% of its variance (ß=-3.6%/S.D., P=0.001). This association was driven by the central-posterior portion of the insula, a region of particular importance for gustation and interoception. The direction of this effect is in concordance with observations in adults, and the results remained statistically significant after adjusting for relevant covariates and potential confounding variables. CONCLUSIONS: Altogether, these findings suggest an underlying neural basis of childhood obesity that precedes the influence of the postnatal environment. The identification of plausible brain-related biomarkers of childhood obesity risk that predate the influence of the postnatal obesogenic environment may contribute to an improved understanding of propensity for obesity, early identification of at-risk individuals, and intervention targets for primary prevention.

Cortical Bone Porosity: What Is It, Why Is It Important, and How Can We Detect It?

There is growing recognition of the role of micro-architecture in osteoporotic bone loss and fragility. This trend has been driven by advances in imaging technology, which have enabled a transition from measures of mass to micro-architecture. Imaging trabecular bone has been a key research focus, but advances in resolution have also enabled the detection of cortical bone micro-architecture, particularly the network of vascular canals, commonly referred to as 'cortical porosity.' This review aims to provide an overview of what this level of porosity is, why it is important, and how it can be characterized by imaging. Moving beyond a 'trabeculocentric' view of bone loss holds the potential to improve diagnosis and monitoring of interventions. Furthermore, cortical porosity is intimately linked to the remodeling process, which underpins bone loss, and thus a larger potential exists to improve our fundamental understanding of bone health through imaging of both humans and animal models.

Role of endocortical contouring methods on precision of HR-pQCT-derived cortical micro-architecture in postmenopausal women and young adults.

UNLABELLED: Precision errors of cortical bone micro-architecture from high-resolution peripheral quantitative computed tomography (pQCT) ranged from 1 to 16 % and did not differ between automatic or manually modified endocortical contour methods in postmenopausal women or young adults. In postmenopausal women, manually modified contours led to generally higher cortical bone properties when compared to the automated method. INTRODUCTION: First, the objective of the study was to define in vivo precision errors (coefficient of variation root mean square (CV%RMS)) and least significant change (LSC) for cortical bone micro-architecture using two endocortical contouring methods: automatic (AUTO) and manually modified (MOD) in two groups (postmenopausal women and young adults) from high-resolution pQCT (HR-pQCT) scans. Second, it was to compare precision errors and bone outcomes obtained with both methods within and between groups. METHODS: Using HR-pQCT, we scanned twice the distal radius and tibia of 34 postmenopausal women (mean age ± SD 74 ± 7 years) and 30 young adults (27 ± 9 years). Cortical micro-architecture was determined using AUTO and MOD contour methods. CV%RMS and LSC were calculated. Repeated measures and multivariate ANOVA were used to compare mean CV% and bone outcomes between the methods within and between the groups. Significance was accepted at P < 0.05. RESULTS: CV%RMS ranged from 0.9 to 16.3 %. Within-group precision did not differ between evaluation methods. Compared to young adults, postmenopausal women had better precision for radial cortical porosity (precision difference 9.3 %) and pore volume (7.5 %) with MOD. Young adults had better precision for cortical thickness (0.8 %, MOD) and tibial cortical density (0.2 %, AUTO). In postmenopausal women, MOD resulted in 0.2-54 % higher values for most cortical outcomes, as well as 6-8 % lower radial and tibial cortical BMD and 2 % lower tibial cortical thickness. CONCLUSIONS: Results suggest that AUTO and MOD endocortical contour methods provide comparable repeatability. In postmenopausal women, manual modification of endocortical contours led to generally higher cortical bone properties when compared to the automated method, while no between-method differences were observed in young adults.

Structural Characterization of Sm(III)(EDTMP).

Samarium-153 ethylenediamine-N,N,N',N'-tetrakis(methylenephosphonic acid) ((153)Sm-EDTMP, or samarium lexidronam), also known by its registered trademark name Quadramet, is an approved therapeutic radiopharmaceutical used in the palliative treatment of painful bone metastases. Typically, patients with prostate, breast, or lung cancer are most likely to go on to require bone pain palliation treatment due to bone metastases. Sm(EDTMP) is a bone-seeking drug which accumulates on rapidly growing bone, thereby delivering a highly region-specific dose of radiation, chiefly through ß particle emission. Even with its widespread clinical use, the structure of Sm(EDTMP) has not yet been characterized at atomic resolution, despite attempts to crystallize the complex. Herein, we prepared a 1:1 complex of the cold (stable isotope) of Sm(EDTMP) under alkaline conditions and then isolated and characterized the complex using conventional spectroscopic techniques, as well as with extended X-ray absorption fine structure (EXAFS) spectroscopy and density functional structure calculations, using natural abundance Sm. We present the atomic resolution structure of [Sm(III)(EDTMP)-8H](5-) for the first time, supported by the EXAFS data and complementary spectroscopic techniques, which demonstrate that the samarium coordination environment in solution is in agreement with the structure that has long been conjectured.

In vivo imaging of rat cortical bone porosity by synchrotron phase contrast micro computed tomography.

Cortical bone is a dynamic tissue which undergoes adaptive and pathological changes throughout life. Direct longitudinal tracking of this remodeling process holds great promise for improving our understanding of bone development, maintenance and senescence. The application of in vivo micro-computed tomography (micro-CT) has enabled longitudinal tracking of trabecular bone microarchitecture with commercially available scanners generally operating in the 10-20 µm voxel range with absorbed doses reported between 0.5 and 1 Gy. Imaging of cortical bone microarchitecture (porosity) requires higher resolution and thus in vivo imaging of these structures has not been achieved due to excessive radiation dose. In this study we tested the hypothesis that synchrotron propagation phase contrast micro-CT can enable in vivo imaging of cortical porosity in rats at doses comparable to those currently employed for trabecular bone imaging. Synchrotron imaging experiments were conducted at the Canadian Light Source using the bending magnet beamline of the BioMedical Imaging and Therapy (BMIT) facility. Protocol optimization (propagation distance, projection number) was conducted ex vivo on rat (Sprague-Dawley) forelimbs with dose determined by ion chamber and lithium fluoride crystal thermoluminescent dosimeters. Comparative ex vivo imaging was performed using laboratory in vivo scanning systems, identifying a range of doses between 1.2-3.6 Gy for common protocols. A final in vivo synchrotron protocol involving a 2.5 Gy dose was implemented with live rats. The resulting images demonstrated improved delineation of cortical porosity through the improved edge enhancement effect of phase contrast, opening the door to novel experimental studies involving the longitudinal tracking of remodeling.

Molybdenum distributions and variability in drinking water from England and Wales.

An investigation has been carried out of molybdenum in drinking water from a selection of public supply sources and domestic taps across England and Wales. This was to assess concentrations in relation to the World Health Organization (WHO) health-based value for Mo in drinking water of 70 µg/l and the decision to remove the element from the list of formal guideline values. Samples of treated drinking water from 12 water supply works were monitored up to four times over an 18-month period, and 24 domestic taps were sampled from three of their supply areas. Significant (p < 0.05) differences were apparent in Mo concentration between sources. Highest concentrations were derived from groundwater from a sulphide-mineralised catchment, although concentrations were only 1.5 µg/l. Temporal variability within sites was small, and no seasonal effects (p > 0.05) were detected. Tap water samples collected from three towns (North Wales, the English Midlands, and South East England) supplied uniquely by upland reservoir water, river water, and Chalk groundwater, respectively, also showed a remarkable uniformity in Mo concentrations at each location. Within each, the variability was very small between houses (old and new), between pre-flush and post-flush samples, and between the tap water and respective source water samples. The results indicate that water distribution pipework has a negligible effect on supplied tap water Mo concentrations. The findings contrast with those for Cu, Zn, Ni, Pb, and Cd, which showed significant differences (p < 0.05) in concentrations between pre-flush and post-flush tap water samples. In two pre-flush samples, concentrations of Ni or Pb were above drinking water limits, although in all cases, post-flush waters were compliant. The high concentrations, most likely derived from metal pipework in the domestic distribution system, accumulated during overnight stagnation. The concentrations of Mo observed in British drinking water, in all cases less than 2 µg/l, were more than an order of magnitude below the WHO health-based value and suggest that Mo is unlikely to pose a significant health or water supply problem in England and Wales.

Application of a simple multiplicative spatio-temporal stream water quality model to the river Conwy, North Wales.

We use a simple multiplicative spatio-temporal model to describe variability in a sequence of water quality monitoring data from headwater streams in the Conwy catchment, North Wales. The spatial component of the model treats concentrations as due to simple mixing of a small number of distinct source types, each associated with particular upstream catchment characteristics. The temporal component allows concentration variability due to seasonal or hydrological change. We apply the model using three candidate catchment characteristic classifications to generate mixing concentrations, and a seasonal component to describe temporal variability, and test a range of sub-models. We identify a cross-classification of soil and land cover as providing the best spatial indicator of water quality of the classifications considered. The spatial model based on a selected grouped cross-classification was shown to account for between 35% and 90% of the spatial variability and the seasonal model accounted for between 45% and 100% of the temporal variability in the data. Analysis of residuals showed an inverse relationship between DOC and sulphate and between hydrogen ion concentration and calcium and magnesium. We also found residual correlations between sites which are strongly related to landscape class. These are attributed to landscape class by time interactions which are not accounted for in the simple multiplicative model.

Predicting nitrogen and acidity effects on long-term dynamics of dissolved organic matter.

Increases in dissolved organic carbon (DOC) fluxes may relate to changes in sulphur and nitrogen pollution. We integrated existing models of vegetation growth and soil organic matter turnover, acid-base dynamics, and organic matter mobility, to form the 'MADOC' model. After calibrating parameters governing interactions between pH and DOC dissolution using control treatments on two field experiments, MADOC reproduced responses of pH and DOC to additions of acidifying and alkalising solutions. Long-term trends in a range of acid waters were also reproduced. The model suggests that the sustained nature of observed DOC increases can best be explained by a continuously replenishing potentially-dissolved carbon pool, rather than dissolution of a large accumulated store. The simulations informed the development of hypotheses that: DOC increase is related to plant productivity increase as well as to pH change; DOC increases due to nitrogen pollution will become evident, and be sustained, after soil pH has stabilised.

Point taken: An unusual case of incisor agenesis and mandibular trauma in Early Bronze Age Siberia.

This paper focuses on the mandible of an adult male individual (radiocarbon dated to 4420-3995cal BP) from the Early Bronze Age Cis-Baikal cemetery of Ust'-Ida I (Siberia, Russian Federation). The mandible contains two features of interest: (1) bilaterally missing central incisors, and (2) the tip of a lithic projectile point embedded in the symphyseal region. Despite the absent teeth, the mandible presents a dental arcade without diastemata, appearing normal and complete on first glance. Three different levels of CT (computed tomography) imaging-ranging from clinical to synchrotron-based-were employed in order to establish the aetiology behind the missing dentition, whether subsequent to the projectile trauma or entirely unrelated to it. Results indicate that the mandible exhibits two highly unusual but unrelated features: probable bilateral agenesis of the central incisors and perimortem trauma to the mental symphysis. In addition, the embedded tip was successfully matched via digital imaging to photographs of a broken projectile point, an artefact recovered from the facial region of the skeleton.

Does frequency of resistance training affect tibial cortical bone density in older women? A randomized controlled trial.

SUMMARY: This randomized controlled trial evaluated the effect of resistance training frequency (0, 1, and 2 times/week) on cortical volumetric bone mineral density (vBMD) at the tibia in older women. There was no mean difference in change in tibial cortical vBMD in older women who engaged in resistance training (RT) one or two times/week compared with the control group over 12 months after adjusting for baseline values. INTRODUCTION: National guidelines recommend RT two to three times/week to optimize bone health. Our objective was to determine the effect of a 12-month intervention of three different RT frequencies on tibial volumetric cortical density (CovBMD) in healthy older women. METHODS: We randomized participants to the following groups: (1) 2×/week balance and tone group (i.e., no resistance beyond body weight, BT), (2) 1×/week RT (RT1), and (3) 2×/week RT (RT2). Treatment allocation was concealed, and measurement team and the bone data analyst were blinded to group allocation. We used peripheral quantitative computed tomography to acquire one 2.3-mm scan at the 50 % tibia, and the primary outcome was CovBMD. Data were collected at baseline, 6 and 12 months, and we used linear mixed modeling to assess the effect at 12 months. RESULTS: We assessed 147 participants; 100 women provided data at all three points. Baseline unadjusted mean (SD) tibial CovBMD (in milligrams per cubic centimeter) at the 50 % site was 1,077.4 (43.0) (BT), 1,087.8 (42.0) (RT1), and 1,058.7 (60.4) (RT2). At 12 months, there were no statistically significant differences (-0.45 to -0.17 %) between BT and RT groups for mean difference in change in tibial CovBMD for exercise interventions (BT, RT1, RT2) after adjusting for baseline tibial CovBMD. CONCLUSION: We note no mean difference in change in tibial CovBMD in older women who engaged in RT one or two times/week compared with the control group over 12 months. It is unknown if RT of 3× or 4×/week would be enough to promote a statistically significant difference in change of bone density.

Three dimensional mapping of strontium in bone by dual energy K-edge subtraction imaging.

The bones of many terrestrial vertebrates, including humans, are continually altered through an internal process of turnover known as remodeling. This process plays a central role in bone adaptation and disease. The uptake of fluorescent tetracyclines within bone mineral is widely exploited as a means of tracking new tissue formation. While investigation of bone microarchitecture has undergone a dimensional shift from 2D to 3D in recent years, we lack a 3D equivalent to fluorescent labeling. In the current study we demonstrate the ability of synchrotron radiation dual energy K-edge subtraction (KES) imaging to map the 3D distribution of elemental strontium within rat vertebral samples. This approach has great potential for ex vivo analysis of preclinical models and human tissue samples. KES also represents a powerful tool for investigating the pharmokinetics of strontium-based drugs recently approved in many countries around the globe for the treatment of osteoporosis.