Does physical activity change following hip and knee replacement? Matched case-control study evaluating Physical Activity Scale for the Elderly data from the Osteoarthritis Initiative.

OBJECTIVES: To determine whether physical activity measured using the Physical Activity Scale for the Elderly (PASE), changes during the initial 24 months post-total hip (THR) or knee replacement (TKR), and how this compares to a matched non-arthroplasty cohort. DESIGN: Case-controlled study analysis of a prospectively collected dataset. SETTING: USA community-based. PARTICIPANTS: 116 people post-THR, 105 people post-TKR compared to 663 people who had not undergone THR or TKR, or had hip or knee osteoarthritis. Cohorts were age-, gender- and BMI-matched. MAIN OUTCOME MEASURES: Physical activity assessed using the 12-item PASE at 12 and 24 months post operatively. RESULTS: There was no significant difference in total PASE score between pre-operative to 12 months (mean: 136 vs 135 points; p=0.860) or 24 months following THR (mean: 136 vs 132 points; p=0.950). Whilst there was no significant difference in total PASE score from pre-operative to 12 months post-TKR (126 vs 121 points; p=0.930), by 24 months people following TKR reported significantly greater physical activity (126 vs 142 points; p=0.040). There was no statistically significant difference in physical activity between the normative matched and THR (p≥0.140) or TKR (p≥0.060) cohorts at 12 or 24 months post joint replacement. CONCLUSIONS: Physical activity is not appreciably different to pre-operative levels at 12 or 24 months post-THR, but was greater at 24 months following TKR. Health promotion strategies are needed to encourage greater physical activity participation following joint replacement, and particularly targeting those who undergo THR.

Changes in social isolation and loneliness following total hip and knee arthroplasty: longitudinal analysis of the English Longitudinal Study of Ageing (ELSA) cohort.

OBJECTIVE: To determine the prevalence and change in social isolation and loneliness in people before and after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in England. DESIGN: The English Longitudinal Study of Ageing (ELSA) dataset, a prospective study of community-dwelling older adults, was used to identify people who had undergone primary THA or TKA because of osteoarthritis. Social isolation was assessed using the ELSA Social Isolation Index. Loneliness was evaluated using the Revised University of California, Los Angeles (UCLA) Loneliness Scale. The prevalence of social isolation and loneliness were calculated and multilevel modelling was performed to assess the potential change of these measures before arthroplasty, within a two-year operative-recovery phase and a following two-year follow-up. RESULTS: The sample consisted of 393 people following THA and TKA. The prevalence of social isolation and loneliness changed from 16.9% to 18.8% pre-operative to 21.8% and 18.9% at the final post-operative follow-up respectively. This was not a statistically significant change for either measure (P = 0.15; P = 0.74). There was a significant difference in social isolation at the recovery phase compared to the pre-operative phase (P = 0.01), where people following arthroplasty reported an increase in social isolation (16.9-21.4%). There was no significant difference between the assessment phases in respect to UCLA Loneliness Scale score (P ≥ 0.74). CONCLUSIONS: Given the negative physical and psychological consequences which social isolation and loneliness can have on individuals following THA or TKA, clinicians should be mindful of this health challenge for this population. The reported prevalence of social isolation and loneliness suggests this is an important issue.

Zinc absorption in Brazilian subjects fed a healthy meal.

BACKGROUND: The high amounts of phytic acid present in diets from developing countries are considered as important inhibitors of zinc (Zn) absorption. The present study aimed to assess the fractional absorption of Zn from a meal containing common Brazilian foods using the stable isotope technique. METHODS: Twelve men, aged 19-42 years, were fed a healthy experimental diet comprising lettuce, tomato, French fries, steak with onions, rice, beans, papaya, orange, pineapple, and passion fruit juice. Each subject received one intravenous dose of enriched (70) Zn, and the lunch was extrinsically labelled with enriched (67) Zn. Urinary (67) Zn and (70) Zn enrichments were assessed by inductively coupled plasma mass spectrometry. RESULTS: The labelled meal phytate : Zn molar ratio was very divergent with respect to chemically determined and calculated data. Subjects presented a normal Zn nutritional status before and after the study. The mean Zn absorption from the labelled meal was 30% (range 11-47%). CONCLUSIONS: According to the World Health Organization parameters, the results denote a moderate/high Zn bioavailability in the evaluated meal, with a variability in the absorption percentage that is similar to other studies. The data show that a typical Brazilian meal, with an adequate energy amount and a balanced macronutrient distribution, presents a Zn bioavailability in accordance with the worldwide recommended standard.

High precision isotope measurements reveal poor control of copper metabolism in parkinsonism.

Disordered copper metabolism may be important in the aetiology of Parkinsonism, as caeruloplasmin is a key enzyme in handling oxidative stress and is involved in the synthesis pathway of dopamine. The human Cu metabolism of ten Parkinsonism patients was compared to ten healthy controls with the aid of a stable (65)Cu isotope tracer. The analyses of blood serum (65)Cu/(63)Cu ratios yielded individual isotopic profiles, which indicate that the Cu metabolism is less controlled in patients with Parkinsonism. Modelling based on both isotope tracer and total Cu concentrations suggests that 30% of the subjects affected by Parkinsonism have abnormally large Cu stores in tissues. To detect the small differences in Cu metabolism between Parkinsonism and controls, the analysis of stable isotope composition must be performed using multiple-collector inductively coupled plasma mass spectrometry and the associated sample preparation techniques. This pilot investigation supports full-scale medical studies into the Cu metabolism of those with Parkinsonism.

Fast vectorial calculation of the volumetric focused field distribution by using a three-dimensional Fourier transform.

We show that the volumetric field distribution in the focal region of a high numerical aperture focusing system can be efficiently calculated with a three-dimensional Fourier transform. In addition to focusing in a single medium, the method is able to calculate the more complex case of focusing through a planar interface between two media of mismatched refractive indices. The use of the chirp z-transform in our numerical implementation of the method allows us to perform fast calculations of the three-dimensional focused field distribution with good accuracy.

Ambiguity of optical coherence tomography measurements due to rough surface scattering.

Optical coherence tomography (OCT) images are frequently interpreted in terms of layers (for example, of tissue) with the boundary defined by a change in refractive index. Real boundaries are rough compared with the wavelength of light, and in this paper we show that this roughness has to be taken into account in interpreting the images. We give an example of the same OCT image obtained from two quite different objects, one smooth compared to the optical wavelength, and the other rough.

Direct calculation of a three-dimensional diffracted field.

We present an approach to calculating the complex amplitude of a three-dimensional (3D) diffracted light field in the paraxial approximation based on a 3D Fourier transform. Starting from the Huygens-Fresnel principle, the method is first developed for the computation of the light distribution around the focus of an apertured spherical wave. The method, with modification, is then extended to treat the 3D diffraction of an aperture with an arbitrary transmittance function.

Pupil matching of Zernike aberrations.

The measurement of the wavefront at the exit pupil of an optical system is a reliable method to investigate its imaging performance. It is sometimes necessary to compare the measurement obtained with a wavefront sensor to some known aberration function, which is for example given by a simulation or a gold standard measurement technique such as interferometry. For accurate measurement systems, the residual after direct subtraction of the two wavefronts is often partly due to a mismatch between coordinate systems. We present in this paper a method that uses the Zernike expansion of wavefronts to numerically cancel such small alignment errors. We use this algorithm to quantify the accuracy of a custom-built Shack-Hartmann wavefront sensor in the measurement of known aberration functions.

Application of orbital angular momentum to simultaneous determination of tilt and lateral displacement of a misaligned laser beam.

We present an analysis of the combined effects of tilt and lateral displacement on the orbital angular momentum spectrum of a laser beam. Our theory explains the symmetries and properties of the spectrum under the influence of misalignments. We apply the theory to establish a reliable and efficient method for determining and subsequently eliminating tilt and lateral displacement. An improved technique for obtaining the orbital angular momentum spectrum employing Laguerre-Gaussian modes is proposed. Finally, a numerical experiment is carried out to verify the method.

Profiling CpG island field methylation in both morphologically normal and neoplastic human colonic mucosa.

Aberrant CpG island (CGI) methylation occurs early in colorectal neoplasia. Quantitative methylation-specific PCR profiling applied to biopsies was used to quantify low levels of CGI methylation of 18 genes in the morphologically normal colonic mucosa of neoplasia-free subjects, adenomatous polyp patients, cancer patients and their tumours. Multivariate statistical analyses distinguished tumour from mucosa with a sensitivity of 78.9% and a specificity of 100% (P=3 x 10(-7)). In morphologically normal mucosa, age-dependent CGI methylation was observed for APC, AXIN2, DKK1, HPP1, N33, p16, SFRP1, SFRP2 and SFRP4 genes, and significant differences in CGI methylation levels were detected between groups. Multinomial logistic regression models based on the CGI methylation profiles from normal mucosa correctly identified 78.9% of cancer patients and 87.9% of non-cancer (neoplasia-free+polyp) patients (P=4.93 x 10(-7)) using APC, HPP1, p16, SFRP4, WIF1 and ESR1 methylation as the most informative variables. Similarly, CGI methylation of SFRP4, SFRP5 and WIF1 correctly identified 61.5% of polyp patients and 78.9% of neoplasia-free subjects (P=0.0167). The apparently normal mucosal field of patients presenting with neoplasia has evidently undergone significant epigenetic modification. Methylation of the genes selected by the models may play a role in the earliest stages of the development of colorectal neoplasia.

Chromatic effects of the atmosphere on astronomical adaptive optics.

The atmosphere introduces chromatic errors that may limit the performance of adaptive optics (AO) systems on large telescopes. Various aspects of this problem have been considered in the literature over the past two decades. It is necessary to revisit this problem in order to examine the effect on currently planned systems, including very high-order AO on current 8-10 m class telescopes and on future 30-42 m extremely large telescopes. We review the literature on chromatic effects and combine an analysis of all effects in one place. We examine implications for AO and point out some effects that should be taken into account in the design of future systems. In particular we show that attention should be paid to chromatic pupil shifts, which may arise in components such as atmospheric dispersion compensators.

Task Performance in Astronomical Adaptive Optics.

In objective or task-based assessment of image quality, figures of merit are defined by the performance of some specific observer on some task of scientific interest. This methodology is well established in medical imaging but is just beginning to be applied in astronomy. In this paper we survey the theory needed to understand the performance of ideal or ideal-linear (Hotelling) observers on detection tasks with adaptive-optical data. The theory is illustrated by discussing its application to detection of exoplanets from a sequence of short-exposure images.

Compact multireference wavefront sensor design.

We present a compact optical design for a multireference Shack-Hartmann-based wavefront sensor (WFS) for multiconjugate adaptive optical systems. The key component of this WFS design is a field lenslet array that separates the exit pupil images in the sensing plane for all reference sources. An analytical method for WFS optical design is presented, and the optimal strategy for selecting optical components from a discrete set is outlined. The feasibility of the WFS design has been demonstrated for a prototype WFS system in a laboratory setup with five reference sources and two deformable mirrors representing a wavefront-distorting medium.

[6S]5-methyltetrahydrofolate or folic acid supplementation and absorption and initial elimination of folate in young and middle-aged adults.

OBJECTIVES: To assess the effects of supplementation with the diastereoisomer of 5-methyltetrahydrofolate ([6S]5-methylTHF), as an alternative supplement for folic acid, on folate absorption and elimination, in two age groups. DESIGN: A randomized, double-blind intervention study. SUBJECTS: A total of 12 young (<30 y) and 12 middle-aged (> or =50 y) healthy volunteers were recruited. METHODS: Volunteers were randomized to receive daily supplementation with 400 mug folic acid or equimolar amounts of [6S]5-methylTHF during 5 weeks. Before and after supplementation, absorption and initial elimination were calculated following oral [(2)H(2)]folic acid test doses using isotope kinetics in plasma. RESULTS: Folic acid absorption was lower in the middle-aged as compared to the young adults, both before (P = 0.03) and after (P = 0.05) supplementation. In the young adults, absorption decreased by 22% after [6S]5-methylTHF and increased by 21% after folic acid (P = 0.02). In the other age group, no such changes were found. The folate rate constant of elimination increased after folic acid supplementation in the young (+50%; P = 0.05) but not in the middle-aged (+18%; P = 0.5) adults. CONCLUSIONS: Young adults show increased folate turnover after folic acid supplementation relative to the effect of [6S]5-methylTHF supplementation. Similar differences are not observed in middle-aged adults, in whom folic acid absorption was found to be lower as compared to the young adults. SPONSORSHIP: Financial support was received from the European Union 5th Framework Programme (Grant QLRT-1999-00576).

Laboratory MCAO Test-Bed for Developing Wavefront Sensing Concepts.

An experimental optical bench test-bed for developing new wavefront sensing concepts for Multi-Conjugate Adaptive Optics (MCAO) systems is described. The main objective is to resolve imaging problems associated with wavefront sensing of the atmospheric turbulence for future MCAO systems on Extremely Large Telescopes (ELTs). The test-bed incorporates five reference sources, two deformable mirrors (DMs) and atmospheric phase screens to simulate a scaled version of a 10-m adaptive telescope operating at the K band. A recently proposed compact tomographic wavefront sensor is employed for star-oriented DMs control in the MCAO system. The MCAO test-bed is used to verify the feasibility of the wavefront sensing concept utilizing a field lenslet array for multi-pupil imaging on a single detector. First experimental results of MCAO correction with the proposed tomographic wavefront sensor are presented and compared to the theoretical prediction based on the characteristics of the phase screens, actuator density of the DMs and the guide star configuration.

Estimation of iron absorption in humans using compartmental modelling.

OBJECTIVE: To evaluate whether a compartmental model could estimate iron absorption as accurately as the well-validated technique of plasma area under the curve using labelled test meals. DESIGN: The study is a randomised cross-sectional intervention. SETTING: The study was carried out at the Human Nutrition Unit at the Institute of Food Research, Norwich, UK. SUBJECTS: A total of nine female volunteers, aged 33+/-8 y. INTERVENTIONS: Volunteers were given an oral dose (approximately 5 mg) of Fe-57 as iron sulphate in an orange juice test drink and simultaneously infused Fe-58 (approximately 200 microg) as iron citrate over 90 min. Multiple blood samples were taken for the following 6 h. The samples were analysed by mass spectrometry and iron absorption was estimated using a mathematical model based on the appearance of Fe isotopes in plasma and the area under the curve technique. RESULTS: The geometric mean (-1 s.d., +1 s.d.) absorption of the model estimate is 16% (9, 31) and the area under curve estimate is 18% (8, 29). CONCLUSIONS: Results indicate that a compartmental model can be used to estimate labelled iron absorption although it is unlikely that this new method will be used in favour of an existing one. Further studies are now needed with unlabelled iron to assess whether the technique could have application in the assessment of total (haem+nonhaem) iron absorption from food.

Copper absorption from foods labelled intrinsically and extrinsically with Cu-65 stable isotope.

OBJECTIVE: To determine copper absorption from copper containing foods labelled either intrinsically or extrinsically with a highly enriched Cu-65 stable isotope label. DESIGN: A longitudinal cross-over study. SETTING: The study was conducted at the Institute of Food Research, Human Nutrition Unit, Norwich, UK. SUBJECTS: Subjects were recruited locally via advertisements placed around the Norwich Research Park. A total of 10 volunteers (nine female, one male) took part in the study, but not all volunteers completed each of the test meals. INTERVENTIONS: A highly enriched Cu-65 stable isotope label was administered to volunteers in the form of a reference dose or in breakfast test meals consisting of red wine, soya beans, mushrooms or sunflower seeds. Faecal monitoring and mass spectrometry techniques were used to estimate the relative quantities of copper absorbed from the different test meals. RESULTS: True copper absorption from the reference dose (54%) was similar to extrinsically labelled red wine (49%) and intrinsically labelled sunflower seeds (52%), but significantly higher than extrinsically labelled mushrooms (35%), intrinsically (29%) and extrinsically (15%) labelled soya beans and extrinsically labelled sunflower seed (32%) test meals. CONCLUSIONS: The use of Cu-65 extrinsic labels in copper absorption studies requires validation according to the food being examined; intrinsic and extrinsic labelling produced significantly different results for sunflower seeds.

5-Methyltetrahydrofolic acid and folic acid measured in plasma with liquid chromatography tandem mass spectrometry: applications to folate absorption and metabolism.

We describe a liquid chromatography (LC) tandem mass spectrometry (MS-MS) method for the determination of 5-methyltetrahydrofolic acid (5-methylTHF) and folic acid concentrations and enrichments in human plasma. It was used to study absorption and initial metabolism in five volunteers with two simultaneously administered oral test doses ([(13)C(6)]folic acid in capsules and [(2)H(2)]folic acid in a drink). [(13)C(5)]5-methylTHF and [(2)H(4)]folic acid were used as internal standards. Plasma samples (2 ml) were purified using folate binding protein affinity columns, followed by a concentration step. After LC separation, folates were detected using positive electrospray ionization MS-MS under multiple reaction monitoring conditions. Calibrations were linear for 5-methylTHF over the range 1.2 x 10(-11) (=limit of detection) to 3.2 x 10(-7)mol/L and for folic acid over the range 5 x 10(-10) (=limit of detection) to 4.5 x 10(-8)mol/L. For 5-methylTHF concentration in plasma, intraassay coefficient of variation was within 8.6% (and for unlabeled 5-methylTHF it was within 2.8%) and interassay coefficient of variation was within 9.0%. For folic acid concentrations these coefficient of variations were within 7.5% and within 6.5%, respectively. The [(13)C(6)] and [(2)H(2)] isotopomers of folic acid and 5-methylTHF were measured in the plasma of each volunteer for 8h. After accounting for the time delay due to capsule opening, the modeling results showed no significant differences in absorption time, first pass effect, and elimination rate in the folic acid test doses in capsule or drink. We conclude that LC-MS-MS offers increased sensitivity for quantification of plasma concentrations and enrichments of 5-methylTHF and folic acid and is applicable to stable-isotope studies in humans.

Wave-induced hydraulic forces on submerged aquatic plants in shallow lakes.

BACKGROUND AND AIMS: Hydraulic pulling forces arising from wave action are likely to limit the presence of freshwater macrophytes in shallow lakes, particularly those with soft sediments. The aim of this study was to develop and test experimentally simple models, based on linear wave theory for deep water, to predict such forces on individual shoots. METHODS: Models were derived theoretically from the action of the vertical component of the orbital velocity of the waves on shoot size. Alternative shoot-size descriptors (plan-form area or dry mass) and alternative distributions of the shoot material along its length (cylinder or inverted cone) were examined. Models were tested experimentally in a flume that generated sinusoidal waves which lasted 1 s and were up to 0.2 m high. Hydraulic pulling forces were measured on plastic replicas of Elodea sp. and on six species of real plants with varying morphology (Ceratophyllum demersum, Chara intermedia, Elodea canadensis, Myriophyllum spicatum, Potamogeton natans and Potamogeton obtusifolius). KEY RESULTS: Measurements on the plastic replicas confirmed predicted relationships between force and wave phase, wave height and plant submergence depth. Predicted and measured forces were linearly related over all combinations of wave height and submergence depth. Measured forces on real plants were linearly related to theoretically derived predictors of the hydraulic forces (integrals of the products of the vertical orbital velocity raised to the power 1.5 and shoot size). CONCLUSIONS: The general applicability of the simplified wave equations used was confirmed. Overall, dry mass and plan-form area performed similarly well as shoot-size descriptors, as did the conical or cylindrical models of shoot distribution. The utility of the modelling approach in predicting hydraulic pulling forces from relatively simple plant and environmental measurements was validated over a wide range of forces, plant sizes and species.

Bioavailability of selenium from fish, yeast and selenate: a comparative study in humans using stable isotopes.

OBJECTIVE: To measure the bioavailability of selenium from cooked and raw fish in humans by estimating and comparing apparent absorption and retention of selenium in biosynthetically labelled fish with labelled selenate and biosynthetically labelled selenium in brewers yeast. DESIGN: The intervention study was a parallel, randomised, reference substance controlled design carried out at two different centres in Europe. SETTING: The human study was carried out at the Institute of Food Research, Norwich, UK and at TNO Nutrition and Food Research, Zeist, The Netherlands. SUBJECTS: In all, 35 male volunteers aged 18-50 y were recruited; 17 subjects were studied in Norwich (UK) and 18 in Zeist (Netherlands). All of the recruited subjects completed the study. INTERVENTIONS: Biosynthetically labelled trout fish (processed by two different methods), biosynthetically labelled brewers yeast and isotopically labelled selenate were used to estimate selenium apparent absorption and retention by quantitative analysis of stable isotope labels recovered in faeces and urine. Subjects consumed the labelled foods in four meals over two consecutive days and absorption was measured by the luminal disappearance method over 10 days. Urinary clearance of isotopic labels was measured over 7 days to enable retention to be calculated. RESULTS: Apparent absorption of selenium from fish was similar to selenate and there was no difference between the two processing methods used. However, retention of fish selenium was significantly higher than selenate (P<0.001). Apparent absorption and retention of yeast selenium was significantly different (P<0.001) from both fish selenium and selenate. CONCLUSION: Fish selenium is a highly bioavailable source of dietary selenium. Cooking did not affect selenium apparent absorption or retention from fish. Selenium from yeast is less bioavailable.